International Perspectives on Rural Nursing: Australia, Canada, Usa

Aust. J. Rural Health (2002) 10, 104–111 OriginalBlackwellOxford,1038-5282200210457australianINTERNATIONAL10.1046[sol Australian Blackwell UKAJRThe journalScience, ]j.1038-5282.2002.00457.x Journal Science of Ltd PERSPECTIVESrural of Asia healthRural Pty Health Ltd ON RURAL NURSING: A. BUSHY Article BEES SGML INTERNATIONAL PERSPECTIVES ON RURAL NURSING: AUSTRALIA, CANADA, USA Angeline Bushy University of Central Florida School of Nursing, Daytona Beach, Florida, USA ABSTRACT: This article compares and contrasts nursing practice in rural areas based on selected publications by nurse scholars from Australia, Canada and the USA. By no means is the analysis complete; rather this pre- liminary effort is designed to provoke interest about rural nursing in the global village. The information can be used to examine the rural phenomenon in greater depth from an international perspective and challenges nurses to collaborate, study, develop and refine the foundations of rural practice across nations and cultures. KEY WORDS: international nursing, rural healthcare, rural nursing. INTRODUCTION than urban residents. However, they also tend to seek medical care less often than urban residents. Publications from three countries reveal that nurses Rural communities have fewer people living in larger who practice in rural environments provide services to and more remote geographical regions, which affects individuals and their families (client systems) in a similar economic, political and healthcare delivery systems. The context. Summary articles prepared by nurse scholars more remote the community, the lower the population describe more similarities than differences among rural density tends to be. In other words, rural regions often nurses in Australia,1–3 Canada4,5 and the USA.6–8 Based do not have the critical mass to support public infra- on analysis of select publications, several international structures that are fiscally sound. Small communities trends were also noted with respect to rural nursing. may have limited, sometimes inadequate and antiquated For example, definitions for urban, suburban, rural and public infrastructures (i.e. utilities, transportation, health, remote vary and are imprecise thus posing challenges communication, educational systems). Subsequently, such when rural practice and policy issues are discussed. systems may indirectly (and sometimes directly) affect Similar demographic trends emerge related to population the health status of residents who live there and influ- mix and increasing diversity; in turn, these are affecting ence healthcare delivery systems and services in those the manner in which healthcare and nursing services regions. Managed care has been the model for health- are delivered in the three countries. There are incom- care delivery for some years in Canada and Australia, plete and conflicting data related to the health status of and dominates the USA market. While there are adminis- rural populations, making comparisons between groups trative variations, the three nations experience similar problematic. In general, morbidity and mortality reports challenges in delivering services to residents in rural suggest rural residents are older, describe themselves and remote areas. Challenges are defined within the con- as ‘less healthy’ and have more chronic health problems text of sparse resources (facilities, services, providers) coupled with the need for cost containment and provision of equitable access to services. Correspondence: Professor Angeline Bushy, University of There are regional variations but the recruitment, Central Florida School of Nursing, 1200 Speedway Blvd, Daytona retention, and education of health professionals in Beach, FL 32114, USA. Email: [email protected] general and nurses in particular, is a common concern Accepted for publication January 2002. across rural settings at an international level. Nurses INTERNATIONAL PERSPECTIVES ON RURAL NURSING: A. BUSHY 105 are expanding their scope of practice and increasingly given region. The nursing care needs of rural residents function in advanced practice roles to help meet the vary according to the predominant industry and popula- needs of medically under-served regions – often without tion mix within a given community. For example, in the legal endorsement to do so.1–11 Equitable access to, communities having an economy driven by agriculture and use of, technology (biomedical, telecommunication, one can expect to see a greater number of machinery- information systems) is of concern to rural providers at related accidents, animal-induced injuries, and agricul- an international level. Likewise, designing appropriate tural chemical exposures. While communities having an and meaningful quality assessment and health outcome economy driven by mining may have higher incidents of measures for rural populations is of concern to rural respiratory conditions and perhaps skeletal trauma. In providers in Australia, Canada and the USA. Inclusion turn the local healthcare system and nurses therein of the rural perspective in policy making, health planning must be prepared to meet those kinds of health-related along with ethical and legal discussion are other per- needs.5–8 vasive themes. The remainder of this article will discuss the aforementioned international themes in greater depth RURAL LIFESTYLE with respect to nursing in rural environments (Table 1).5 The rural lifestyle is reported to be similar regardless CHANGING DEMOGRAPHIC PATTERNS of where a small community is located.1–6 Since there are fewer people, they tend to be acquainted and social The three countries are experiencing similar demographic dynamics differ from those in more populated urban changes, particularly in rural areas, but there are regional areas. Informal social structures predominate, the pace variations. Improved healthcare and healthier lifestyles of life seems to be less hectic, and there tends to be a in these industrialised nations have led to people living ‘connectedness’ among the people who live in rural longer, hence, the elderly population is increasing. There towns. Such dynamics can have both advantages, and is increasing diversity, perhaps more so in the USA6–8 disadvantages, depending on individual perspectives and in certain regions of Canada4,5 and Australia.1–3 and preferences. On the one hand, accessible pervasive There are growing numbers of people who are described kinship networks are there to assist and support a member as vulnerable and/or with special needs in both rural and in need. On the other hand, everyone who lives there urban areas. Rural communities, however, often are not knows what is going on with most of the other locals, in able to provide the span of services needed by individuals turn, creating another set of stressors for some residents. who are physically, emotionally and/or mentally chal- Along with informal social structures, health profes- lenged. About one-quarter of the population in each of the sionals in general, and nurses in particular, usually have three nations is classified as ‘rural’. The rural population high public visibility and are highly esteemed in small as a whole and the number of acres of agricultural land communities. Often public visibility extends to the are declining, as production methods are becoming family members of the health professional. For example, more efficient. In other words, fewer people are involved consider the case of a mental health professional. in food production. In rural communities younger people Community locals often will evaluate a professional’s are migrating to urban areas to find work. The elderly and competence by the behaviour of his or her children. In vulnerable are more likely to remain behind, thus creating other words, when children are well behaved and success- an even greater burden on already strained healthcare ful, the professional is deemed to be a ‘good and effective’ systems in small towns. In response to declining agricul- healthcare provider.8 If they are not, the individual’s tural production and out migration, efforts are underway professional competence also may be in question. to increase economic diversity to help small rural towns Essentially, in rural areas the boundaries between pro- survive in a global economy. fessionals’ work-related roles and personal life are nebu- In rural areas the healthcare delivery system often is lous and diffuse. Consequently, high public visibility can one of the larger, if not largest, employers in the commu- affect retention of health professionals in rural practice nity. The existence and adequacy of the local healthcare settings. Conversely, for those accustomed to frequent system plays a major role in the degree of success experi- informal face-to-face exchanges, its absence can lead to a enced by the community in its economic development and sense of social isolation. Overall, pervasive informal net- diversification initiatives. Correspondingly, the health works can present challenges in maintaining individual status of people living in rural communities is influenced anonymity and confidentiality within a small community. by the predominant industries, or the lack thereof, in a Kinship networks, along with other cultural factors, need 106 TABLE 1: Comparison of rural and urban nursing practice on select characteristics* Feature Rural Urban Clients Of all ages and across the life span More likely to focus on one or two age groups Personally acquainted with many of them Usually not personally acquainted

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