Page 487 - Encyclopedia of Nursing Research

454 n RURAl HEAlTH

by the Roy adaptation model. This prompted 2007). No matter the definition, the num-
them to translate Roy’s concept of adapta- ber of rural dwellers varies greatly by state,
R tion into a congruent middle range theory for example, using the U.S. census defini-
concept of adjustment (De Santo-Madeya & tion, Maine, Mississippi, Vermont, and West
Fawcett, 2006). In addition, they developed Virginia have more than 50% of their resi-
a single-item scale to measure this new con- dents in rural areas, and states like California
cept (De Santo-Madeya & Fawcett, 2006). and Nevada have less than 10% (U.S. Census
Using the Roy adaptation model to guide Bureau, 2000). looking beyond the numbers,
nursing research has contributed to both the the term rural brings to mind landmasses
basic and clinical sciences of nursing. Studies between urban areas with farmland, moun-
have provided some confirmation for the tains, forests, and open ranges with sparsely
model, demonstrated its ability to generate populated remote areas and small towns. For
new information, and contributed to clinical some rural residents, it is the place where, for
practice. generations, they have engaged in farming,
The Roy adaptation model is being used ranching, mining, or logging; and for others,
by nurses throughout the world. Researchers it is an escape from urban tensions—a place
and scholars as far afield as Japan, Columbia, to recreate and to relax. For those providing
Mexico, and Puerto Rico are testing and health care, there are unique challenges and
applying the model in a variety of settings opportunities in the rural setting.
(Roy, Whetsell, & Frederickson, 2009). Many One of the greatest challenges is the
of these countries have set up chapters of the high rates of poverty in rural areas. The last
Roy adaptation association, and held confer- decade’s bouts of recessions have hit rural
ences and workshops related to the model areas harder than the surrounding urban
(Roy et al., 2009). This global expansion pro- areas (Economic Research Services, 2009).
vides new horizons and different cultural The national poverty rate was 12.5% in 2007,
perspectives for the application and testing but in rural areas, it was 15.4%. Concurrently,
of the Roy adaptation model. Overall, the rural areas also saw a sharper increase in
Roy adaptation model is a very useful model unemployment rates and, subsequently, the
in practice and as a guide to research. The uninsured. Although rural areas in gen-
Roy adaptation model continues to make a eral have higher rates of unemployment,
significant contribution to nursing science as decreases in employment were seen in both
it continues to evolve. traditional rural jobs, for example, the tim-
ber industry, and jobs in employment sec-
Updated by Mary T. Quinn Griffin tors that cover both rural and urban areas,
such as manufacturing, construction, trans-
portation and utilities, wholesale and retail
trade, and professional business services.
RuRal health The higher unemployment rate is partly
because rural residents are less likely to have
completed high school and even fewer have
It is estimated that about 20% of the U.S. pop- a college degree (IOM, 2006). The problem is
ulation lives in the 75% of the U.S. land mass not necessarily the lack of educational oppor-
considered rural (Institute of Medicine [IOM], tunities but rather that young people often
2005, 2006c). However, there is no single def- move to metropolitan areas after graduation.
inition for what constitutes rural. There are Rural America is still the site of our food
more than 15 definitions of rural used in fed- production, but only 1.1% of the U.S. popu-
eral programs in the United States (Coburn, lation lives on farms (IOM, 2006). Even fewer
MacKinney, McBride, Slifkin, & Wakefield people live off the farm. About 70% of either