Copyright © 2008 Delmar. All rights reserved. Chapter 24 Rural and Migrant Populations.

Copyright © 2008 Delmar. All rights reserved.

Chapter 24

Rural and Migrant Populations


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Rural Defined

• Rural – Distribution of people across space

• Metropolitan area• Nonmetropolitan area


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Rural Defined

• Fewer than 2,500 residents

• Demographics– 28 percent under age 18– 30 percent over age 65


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Rural Defined

• Health professional shortage areas

• Medically underserved areas– Established under U.S. Public Health

Services Act


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History of Public Health Nursing in Rural Areas

• First rural nursing service (1896)

• Rural Nursing Service (1912)– Lillian Wald and American Red Cross

• Frontier Nursing Service (FNS) (1925)– Mary Breckinridge


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History of Public Health Nursing in Rural Areas

• Frontier School of Midwifery (1939)– Started by Frontier Nursing Service

• FNS started FNP program (1999)


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Federal Initiatives in Rural Health

• National Health Service Corp (1972)

• National Center for Farm Work Health (1974)

• Rural Health Clinic Service Act (1977)

• Office of Rural Health Policy (1987)


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Federal Initiatives in Rural Health

• Rural Information Center Health Service (1987)

• National Advisory Committee on Rural Health and Human Service (1987)


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Demographics and Health Status Indicators

• High poverty and unemployment rates

• High percentage employers not providing health insurance– Working poor


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• Disproportionate number of elderly and young

• Injury

• Pesticide poisoning


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• Potential for abuse, family violence, neglect

• Weather hazards, social isolation

• Lack of public transportation


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• Lack of specialty care

• Higher rates of chronicity

• Economic stress

• Increased tobacco use


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• High risk injuries– Forestry, mining, fishing, agriculture

• Accidents• Trauma• Selected cancers • Respiratory diseases


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Cultural Characteristics of Rural Populations

• Rural communities are unique– Commonalities do exist:

• Self reliance, independence, individualism• Time and crisis orientation in relation to health • Distrust of outsiders• Religious influence• Use of alternative healing remedies


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Migrant Rural Farm Workers

• Individuals who move from one area to another in search of seasonal or temporary work

• Among the poorest in the nation

• Chronic poverty, frequent mobility, low literacy, language, cultural and logistic barriers


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Migrant Rural Farm Workers

• Often not aware of benefits available

• Migrant farm worker health issues– Suffer from poverty-related health problems

• TB• Dental disease• Workplace injury or illness


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Undocumented Migrant Farm Workers

• Live in fear of being reported and deported– Delay seeking medical attention

• Live in poor, overcrowded housing

• Limited resources and language skills


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Public Health Nursing Practice in Rural Communities

• Requires independence

• Develop trust

• Social and professional roles may overlap

• Positive community visibility


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Healthy People 2010 and Primary Health Care Concepts

• Health care specific to rural health care needs: – Affordable – Accessible – Acceptable– Available


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Theory Developmentfor Rural Public Health Nursing

• Long and Weinert

• Three conceptual statements:– Rural dwellers define health primarily as

ability to work– Rural dwellers are self-reliant and resist

accepting help from outsiders– Help is usually sought through an informal

system


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• Denham Family Health Model– Family health influenced by interactions of

household members– Involvement of family members in:

• Assessment• Decision making• Planning• Effective communication


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Theory Development for Rural Public Health Nursing

• Opportunities for service learning– Work with the community in a partnership

• Health policy in rural settings– Balanced Budget Act 1997– Nurses should assume leadership positions,

build networks, grant write, communicate with state and local officials


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• Research in rural settings– Evidence-based research needed

• Efficacy and cost effectiveness of nurse managed models of care in rural settings

• Long-term use of pesticide


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• Alternative research methods– Ethnographic studies– Qualitative methods

Copyright © 2008 Delmar. All rights reserved. Chapter 24 Rural and Migrant Populations.

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