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Workforce Demands of Rural Nurse Practitioners: A Descriptive Study 农村执业护士的劳动力需求:一项描述性研究
Pub Date : 2021-05-03 DOI: 10.14574/OJRNHC.V21I1.656
Jody Toerber-Clark, Marion M. Jamison, M. Scheibmeir
Purpose: Nurse practitioners (NPs) are rendering health care services in rural areas in increasing numbers, yet little is known about clinical skills and patient care management activities performed by these advanced practice nurses in the rural environment. The purpose of this descriptive study of rural NPs was to identify skills and patient care management activities that they have performed and considered critical to Kansas rural practice. Sample: A convenience sample of 208 nurse practitioners (NP) in rural and frontier Kansas were emailed a survey that asked about skills and activities they perform in their rural practice. Sixtythree responded for a response rate of 30%. Findings: The analysis produced a list of 26 skills and 37 patient care management activities critical to Kansas rural NP practice. Most of the skills/procedures were learned after graduation. Almost all the respondents reported additional training/certifications in advanced life support and trauma. The majority of respondents were family nurse practitioners who practiced in a variety of rural settings. “I grew up in a rural setting” and “Autonomy of practice” were the two top factors that influenced their decision to practice in a rural setting.
目的:越来越多的执业护士在农村地区提供医疗保健服务,但对这些高级执业护士在乡村环境中的临床技能和患者护理管理活动知之甚少。这项针对农村NPs的描述性研究的目的是确定他们所执行的技能和患者护理管理活动,并认为这些活动对堪萨斯州的农村实践至关重要。样本:堪萨斯州农村和边境地区208名执业护士(NP)通过电子邮件接受了一项调查,询问他们在农村执业中的技能和活动。Sixthree的回复率为30%。研究结果:该分析列出了对堪萨斯州农村NP实践至关重要的26项技能和37项患者护理管理活动。大部分技能/程序是在毕业后学习的。几乎所有受访者都报告了在高级生命支持和创伤方面的额外培训/认证。大多数受访者是在各种农村环境中执业的家庭护士。“我在农村长大”和“实践的自主性”是影响他们在农村实践决定的两个主要因素。
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引用次数: 0
The International Rural Nursing Conference is Coming to You in 2021 2021年国际乡村护理大会向您走来
Pub Date : 2021-05-03 DOI: 10.14574/OJRNHC.V21I1.684
P. Fahs
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引用次数: 0
Where Have They Gone? Recruiting and Retaining Older Rural Research Participants. 他们去哪儿了?招募和留住老年农村研究参与者。
Pub Date : 2021-01-01 Epub Date: 2021-05-04
Elizabeth Grace Nichols, Jean Shreffler-Grant, Clarann Weinert

Issue: Rural-dwelling elderly have been shown to suffer from health disparities when compared to the general population. Research involving these individuals is important, and to have meaningful results, sample sizes must be adequate. Recruiting and retaining these individuals pose significant challenges.

Context: Nurse researchers in the rural northwestern United States conducted a 4-part educational intervention aimed at increasing general and complementary and alternative health care literacy of older rural dwellers. Significant challenges were faced in both recruiting and retaining participants over the 6-month study period. Despite careful planning and community selection, the team had to double the number of communities in which they carried out the project to meet recruitment goals. Retention was also a challenge. Of 127 participants initially enrolled in the study, only 52 remained to the end.

Lessons learned: Challenges of recruiting and retaining are complex and compounded when the target population is rural, older and the study is longitudinal. Recruitment challenges included reaching older adults, offering a compelling program, and offering it in an acceptable format at a convenient time and place. A variety of outreach activities were conducted including in-person presentations, advertising or public interest stories in local newspapers or radio stations, and flyers on bulletin boards in restaurants, clinics, churches, community centers, and libraries. A project champion, an individual well known and connected within the community and committed to the success of the proposed study, is a major asset. Retention strategies included developing relationships with the participants and maintaining contact with them over the course of the study through such mechanisms as appointment cards, e-mail or regular mail, telephone reminders, and thank you cards. Oversampling was important as factors beyond the control of the researcher occurred; for example, illness, death, family crises, unexpected relocations, and weather events that prevented travel to scheduled research events.

问题:事实证明,与一般人口相比,居住在农村的老年人存在健康差距。涉及这些个体的研究很重要,为了获得有意义的结果,样本量必须足够。招聘和留住这些人才是一项重大挑战。背景:美国西北部农村的护士研究人员进行了一项由四部分组成的教育干预,旨在提高农村老年居民的一般、补充和替代卫生保健素养。在为期6个月的研究期间,招募和留住参与者都面临着重大挑战。尽管经过仔细的规划和社区选择,该团队不得不将开展项目的社区数量增加一倍,以达到招聘目标。留存率也是一个挑战。在最初参加研究的127名参与者中,只有52人坚持到了最后。经验教训:如果目标人群是农村、老年人,而且研究是纵向的,那么招聘和留住人才的挑战就会变得复杂和复杂。招聘方面的挑战包括接触到老年人,提供一个引人注目的项目,并在方便的时间和地点以一种可接受的形式提供。各种各样的外展活动进行了,包括亲自演讲,广告或在当地报纸或广播电台的公益故事,并在餐馆,诊所,教堂,社区中心和图书馆的公告栏上张贴传单。项目倡导者是一项重要资产,即在社区内知名度高、人脉广,并致力于拟议研究的成功。保留策略包括发展与参与者的关系,并在研究过程中通过预约卡、电子邮件或常规邮件、电话提醒和感谢卡等机制与他们保持联系。当研究人员无法控制的因素发生时,过采样很重要;例如,疾病、死亡、家庭危机、意外搬迁和天气事件阻碍了前往预定的研究活动。
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引用次数: 0
Rural Status of Equine Assisted Activities and Therapies and Cancer Survivors 马辅助活动和治疗与癌症幸存者的农村状况
Pub Date : 2020-12-11 DOI: 10.14574/ojrnhc.v20i2.601
Khalid Bandar Almasloukh, P. Fahs
Background: Although equine assisted activities and therapies (EAAT) are rapidly increasing, as are cancer survival rates, little is known about the engagement of cancer survivors in EAAT. One may conceptualize equine or horse related activities as occurring in rural areas; however, the rural status of EAAT centers are not fully reported.Purpose: To explore the rural status of EAAT centers, and whether EAAT is provided for cancer survivors and the more common service for post-traumatic stress disorder at those centers.Method: A quantitative descriptive analysis was conducted of publicly available data after an exempt status decision of an Institutional Review Board. Services using EAAT for those with terminal illnesses, post-traumatic stress disorder and cancer survivors were examined. Rural status was evaluated for all organizational members (N = 784) of Professional Association of Therapeutic Horsemanship International (PATH Intl.). Roy adaptation model was used as a theoretical framework in this project.Findings: All types of the organizational members, cluster in urban areas more than rural areas. Significant relationship (p = 0.039) was found between rural status and type of membership, where more urban than rural centers were premier accredited center members. Most of the contacted and responding centers stated that they do provided EAAT for cancer survivors (n = 204); however, only (n = 26) centers have programs specifically designed for cancer survivors.Conclusion: There are not only less EAAT rural than urban centers, but rural centers also tend to have lower quality level membership based on PATH Intl. standards. Although EAAT is provided for cancer survivors, identifying effective ways to provide EAAT and standardization of programs for cancer survivors is recommended. DOI:  http://doi.org/10.14574/ojrnhc.v20i2.601 
背景:尽管马辅助活动和治疗(EAAT)正在迅速增加,癌症存活率也在迅速增加,但人们对癌症幸存者参与EAAT的情况知之甚少。人们可以将马或与马有关的活动概念化为发生在农村地区;然而,EAAT中心的农村状况并没有得到充分的报道。目的:探讨EAAT中心的农村状况,以及EAAT是否为癌症幸存者提供,以及这些中心为创伤后应激障碍提供更常见的服务。方法:在机构审查委员会做出豁免状态决定后,对公开可用的数据进行定量描述性分析。对那些患有绝症、创伤后应激障碍和癌症幸存者使用EAAT的服务进行了检查。对国际马术治疗专业协会(PATH国际)所有组织成员(N=784)的农村状况进行了评估。罗伊适应模型被用作该项目的理论框架。研究结果:所有类型的组织成员,城市地区的集群多于农村地区。农村地位和会员类型之间存在显著关系(p=0.039),其中更多的城市中心比农村中心是首要认证中心成员。大多数联系和响应中心表示,他们确实为癌症幸存者提供EAAT(n=204);然而,只有(n=26)个中心有专门为癌症幸存者设计的项目。结论:农村EAAT不仅比城市中心少,而且根据PATH国际标准,农村中心的会员质量水平也往往较低。尽管EAAT是为癌症幸存者提供的,但建议确定为癌症幸存者提供EAAT和标准化程序的有效方法。DOI:http://doi.org/10.14574/ojrnhc.v20i2.601
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引用次数: 0
Collaborating with Rural Practice Patners to Address the Need for RNs in Primary Care 与农村执业Patners合作,解决初级保健中对RN的需求
Pub Date : 2020-12-11 DOI: 10.14574/ojrnhc.v20i2.618
Robin J. Brown, H. Mennenga, Alham A. Abuatiq, L. Burdette, L. Horsley, Christina Plemmons
Abstract Purpose: Primary care in rural areas of the U.S. urgently need competent healthcare providers, especially registered nurses (RNs). Registered nurses are ideal team members to help meet the primary care needs in rural communities, yet RNs are underutilized in primary care settings and rarely practice to the full scope of their license in these settings. The purpose of the project was to conduct a needs assessment with rural primary care practice partners to address the need for RNs in primary care. Sample: A needs assessment was sent to nurse leaders at 13 rural primary care facilities via an online survey in December 2018. Methods: This descriptive exploratory study utilized an online needs assessment survey to gather information from 13 rural clinical practice partners regarding their knowledge, interest, and use of RNs in primary care. Results: Twelve of the 13 rural clinical practice partners completed the needs assessment survey. A majority of the clinical partners indicated they felt knowledgeable about the RN full scope of license and expressed a high interest in the expanded role of the RN in primary care. The clinical practice partners reported interest in providing independent RN chronic and acute care visits, care management, medication management, and collaborative provider and RN visits. Conclusion: Conducting a needs assessment and collaborating with rural primary care practice partners to address the need for RNs in primary care is the first step in developing policies and utilizing RNs to the full scope of their license.             Keywords: primary care, rural, registered nurses    
摘要目的:美国农村地区的初级保健迫切需要有能力的医疗保健提供者,尤其是注册护士。注册护士是帮助满足农村社区初级保健需求的理想团队成员,但注册护士在初级保健环境中利用不足,很少在这些环境中充分执业。该项目的目的是与农村初级保健实践合作伙伴进行需求评估,以解决初级保健中对RN的需求。样本:2018年12月,通过一项在线调查,向13家农村初级保健机构的护士领导发送了一份需求评估。方法:这项描述性探索性研究利用在线需求评估调查,从13名农村临床实践伙伴那里收集关于他们在初级保健中对RN的知识、兴趣和使用的信息。结果:13名农村临床实践合作伙伴中有12人完成了需求评估调查。大多数临床合作伙伴表示,他们对注册护士的全部许可范围感到了解,并对注册护士在初级保健中的扩大作用表示高度兴趣。临床实践合作伙伴报告称,他们有兴趣提供独立的注册护士慢性和急性护理就诊、护理管理、药物管理以及合作提供者和注册护士就诊。结论:进行需求评估并与农村初级保健实践合作伙伴合作,以解决初级保健中对RN的需求,是制定政策并在许可证的范围内充分利用RN的第一步。关键词:初级保健,农村,注册护士
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引用次数: 0
Assessment of Readmission in a Rural Medical Center 农村医疗中心再住院的评估
Pub Date : 2020-12-11 DOI: 10.14574/ojrnhc.v20i2.615
J. Mallow, Andrea Bailey, Karen Clark, Laurie A. Theeke
Understanding and predicting hospital readmission has been of interest for more than three decades. To strategically place readmission reduction resources where most beneficial, organizations use readmission risk-stratification tools. However, common tools used to assess 30day risk do not incorporate health disparity and it is unknown how modifying currently validated tools affects their predictive value. The aims of this retrospective study were to describe the population of people who are admitted and re-admitted for hospital care in a rural population and examine the effectiveness of a common risk stratification tool to predict 30-day readmission in a rural population experiencing health disparities. This retrospective cohort study examined data
三十多年来,了解和预测医院再次入院一直是人们感兴趣的问题。为了战略性地将减少再次入院的资源放在最有利的地方,组织使用再次入院风险分层工具。然而,用于评估30天风险的常用工具没有纳入健康差异,目前尚不清楚修改当前验证的工具如何影响其预测价值。这项回顾性研究的目的是描述农村人口中入院和再次入院接受医院护理的人群,并检查常见风险分层工具在经历健康差异的农村人口中预测30天再次入院的有效性。这项回顾性队列研究检查了数据
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引用次数: 1
Hepatitis C Treatment at a Rural Navajo Health Clinic Using Project ECHO 使用ECHO项目在纳瓦霍农村卫生诊所治疗丙型肝炎
Pub Date : 2020-12-11 DOI: 10.14574/ojrnhc.v20i2.634
A. Nance, L. Saiki, Elizabeth G. Kuchler, Conni J DeBlieck, S. Forster-Cox
Purpose: Hepatitis C incidence is higher among American Indian/Alaskan Native populations than any other racial or ethnic group in the United States. Chronic Hepatitis C complications include cirrhosis of the liver, end stage liver disease, and hepatocellular cancer. Direct acting antiviral treatment taken orally results in > 90% cure, yet rural primary care providers lack the training and confidence to treat and monitor patients with chronic Hepatitis C. Rural patients are reluctant to travel to urban areas for Hepatitis C treatment. Project ECHO is an innovative telementoring program where specialists mentor primary care providers via videoconferencing to treat
目的:丙型肝炎在美国印第安人/阿拉斯加原住民中的发病率高于美国任何其他种族或民族。慢性丙型肝炎并发症包括肝硬化、终末期肝病和肝细胞癌症。口服直接作用抗病毒治疗可治愈90%以上,但农村初级保健提供者缺乏治疗和监测慢性丙型肝炎患者的培训和信心。农村患者不愿意前往城市地区接受丙型肝炎治疗。ECHO项目是一个创新的远程指导计划,专家通过视频会议指导初级保健提供者进行治疗
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引用次数: 2
Lived Experience of Nursing Appalachia 阿巴拉契亚护理的生活体验
Pub Date : 2020-12-11 DOI: 10.14574/ojrnhc.v20i2.619
Evelyn P Brewer, F. Weierbach, R. Fletcher, Katherine Hall, W. Nehring
Purpose: Research in rural areas presents special challenges for sampling and recruitment. Examples of considerations include smaller sampling population, privacy concerns, and the rural context. The purpose of this article is to discuss the results of sampling and recruitment strategies within this study. Sample: Nurses form a central hub of health care in rural communities. However, little is known about the lived experience of nurses serving in this capacity. This study explored stories of nurses in a six-county area of three adjoining states in rural South Central Appalachia. Method: Recruitment for the study was completed using state boards of nursing social marketing strategies and snowball sampling. Findings: Sampling and recruitment efforts enlisted 15 participants. The sample was deemed representative of the population as participants represented diverse employment contexts, education preparation levels, licensure duration, and multiple generations. Conclusions: Understanding implications of rural setting and cultural context are critical to successful recruitment and sampling. Privacy considerations may still be concerning, however, multiple de-identification strategies serve to help lessen this risk. Social marketing strategies failed to recruit the needed number of participants secondary to the fact that participants from only one state were recruited in this manner. Smaller population pool limitations were eased by snowball sampling, an approved recruitment method in qualitative research. Future researchers should be cognizant of the influence of rurality norms and cultural context on recruitment and sampling efforts. Social marketing proved less successful than snowball sampling strategies. Further research is needed to develop best practice for rural recruitment and sampling via social marketing. Finally, time and resource commitment for participation can be a barrier. Flexibility in scheduling interviews, location of interview sites, and the availability of audio/phone interviews served to facilitate agreement to participate. Key words: rural, nursing, Appalachia, research, sampling, recruitment  
目的:农村地区的研究对抽样和招聘提出了特殊挑战。考虑因素的例子包括较小的抽样人口、隐私问题和农村环境。本文的目的是讨论本研究中的抽样结果和招聘策略。样本:护士构成了农村社区医疗保健的中心枢纽。然而,人们对以这种身份服务的护士的生活经历知之甚少。这项研究探讨了阿巴拉契亚中南部农村三个相邻州的六个县地区护士的故事。方法:采用州护理委员会社会营销策略和滚雪球抽样法完成研究招募。调查结果:抽样和招募工作招募了15名参与者。该样本被认为是人口的代表,因为参与者代表了不同的就业背景、教育准备水平、许可证有效期和多代人。结论:了解农村环境和文化背景的影响对于成功招募和抽样至关重要。隐私考虑可能仍然令人担忧,然而,多种去身份策略有助于降低这种风险。社交营销策略未能招募到所需数量的参与者,因为只有一个州的参与者是以这种方式招募的。滚雪球抽样是定性研究中一种被认可的招募方法,缓解了较小的人口库限制。未来的研究人员应该认识到农村规范和文化背景对招聘和抽样工作的影响。事实证明,社交营销不如滚雪球式的抽样策略成功。需要进一步研究,以制定通过社会营销进行农村招聘和抽样的最佳做法。最后,参与的时间和资源承诺可能是一个障碍。安排面试的灵活性、面试地点的位置以及音频/电话面试的可用性有助于达成参与协议。关键词:乡村,护理,阿巴拉契亚,研究,抽样,招聘
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引用次数: 1
Characteristics of Neonatal Abstinence Syndrome (NAS) in a rural clinic population: Tracking with Electronic Medical Health Records (EHR) 农村门诊人群新生儿禁欲综合征(NAS)特征的电子病历追踪
Pub Date : 2020-12-11 DOI: 10.14574/ojrnhc.v20i2.625
J. Cochran, Traci D. Jarrett, A. Baus
PurposeThe impact of intrauterine exposure of opioids and other addictive substances on pediatric patients is concerning for health care providers in rural WV.  NAS patients must be identified, screened, and treated during the pediatric years to facilitate improved outcomes. The purpose of this research was to evaluate the ability of rural providers to use EHRs to identify, describe, and monitor aspects of NAS across the pediatric health span.  MethodsThe research team used de-identified data of patients that had the NAS diagnosis from a rural clinic. One hundred fifty-five charts were evaluated.  Demographics, clinical characteristics, and developmental milestone status were extracted from charts. ResultsThere were differences in characteristics across age groups. Reported secondhand smoke was higher among the 0-3 year olds. Normal BMI percentile was highest among 4-5 year olds.  The Ages and Stages Developmental screening was abnormal more in those aged 6-19 years. Foster care was highest among the ages 0-3 years. The 4-12 age groups highest amount of no show visits.  Respiratory illness was the most frequent diagnosis and was highest in the 4-5 age group.  Eye and ear diagnosis were noted as a recurrent diagnosis in the 4-5 year old group. Diagnosis related to mental health were highest in the 6-18 age group.  DiscussionThe EHR can be used to describe and track special populations such as NAS in rural areas. Tagging and tacking patients with NAS can help primary care providers manage care and anticipate age related health care needs. Tracking high risk populations assures that the patient care is maintained. Tracking no show rates assists providers in assuring that patient’s caregivers are compliant in necessary treatments and referrals. Child Protection can also be involved if medical neglect is noted. EHRs are useful in identifying high risk populations such as NAS to facilitate treatments and continuity of care.  DOI:  http://doi.org/10.14574/ojrnhc.v20i2.625 
目的子宫内接触阿片类药物和其他成瘾物质对儿科患者的影响是西弗吉尼亚州农村卫生保健提供者关注的问题。NAS患者必须在儿科期间进行识别、筛查和治疗,以促进改善预后。本研究的目的是评估农村提供者使用EHR来识别、描述和监测整个儿科健康范围内NAS各方面的能力。方法研究小组使用了一家农村诊所诊断为NAS的患者的未识别数据。对一百五十五张图表进行了评估。从图表中提取人口统计学、临床特征和发育里程碑状态。结果不同年龄组的特征存在差异。报告的二手烟在0-3岁的人群中更高。正常BMI百分位数在4-5岁人群中最高。年龄和阶段发育筛查在6-19岁人群中异常较多。寄养在0-3岁人群中最高。4-12岁年龄组的无访人数最多。呼吸道疾病是最常见的诊断,4-5岁年龄组的诊断率最高。眼睛和耳朵的诊断被认为是4-5岁组的复发诊断。与心理健康相关的诊断在6-18岁年龄组中最高。讨论EHR可用于描述和跟踪农村地区的特殊人群,如NAS。用NAS标记和固定患者可以帮助初级保健提供者管理护理并预测与年龄相关的医疗保健需求。跟踪高风险人群可确保患者护理得到维持。跟踪未就诊率有助于医疗机构确保患者的护理人员在必要的治疗和转诊中遵守规定。如果注意到医疗疏忽,也可能涉及儿童保护。EHR有助于识别NAS等高危人群,以促进治疗和护理的连续性。DOI:http://doi.org/10.14574/ojrnhc.v20i2.625
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引用次数: 0
Use of Tweet-Format Narrative Reflections During a Service-Learning Trip to Appalachia 阿巴拉契亚服务学习之旅中推特形式叙事反思的使用
Pub Date : 2020-12-11 DOI: 10.14574/ojrnhc.v20i2.633
Tracy P. George, Allison C. Munn, Tiffany A. Phillips, J. Hucks
Background: Tweet-format narratives have been used in medical education to capture student experiences. However, there is a lack of research on tweet-format narratives during experiential learning in nursing education. Purpose: The purpose of this project was to explore the usefulness of tweet-format narratives to capture nursing student experiences and to elicit reflection during a service-learning trip. Methods: Eight bachelor of science in nursing (BSN) students participated in a service-learning experience to Appalachia. A grounded theory approach with three data collection methods was
背景:推特格式的叙述已被用于医学教育,以捕捉学生的经验。然而,在护理教育体验式学习中,tweetformat narratives的研究还很缺乏。目的:这个项目的目的是探索推特格式叙述的有用性,以捕捉护理学生的经历,并在服务学习之旅中引发反思。方法:8名护理学理学士(BSN)学生参加了赴阿巴拉契亚的服务学习体验。一个接地理论的方法与三种数据收集方法
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引用次数: 1
期刊
Online Journal of Rural Nursing and Health Care
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