Page 488 - Encyclopedia of Nursing Research

RURAl HEAlTH n 455

the farmer or the spouse works off the farm (IOM, 2005). There are 53 primary care phy-
for their income. A major employer in many sicians per 100,000 rural residents compared
rural communities is the hospital, which thus with 78 per 100,000 urban residents. The gap R
plays an essential part in the economic and between rural and urban is even wider for
social identity of a community (Moscovice & specialists, with 54 and 134 specialists per
Stensland, 2002). 100,000 residents, respectively (Reschovsky
Rural areas have a high percentage of & Staiti, 2005). For nurses, the issues are a
older adults and people with chronic diseases bit different. From 1980 to 2004, the propor-
(IOM, 2006). Rural residents have higher rates tion of registered nurses who lived in rural
of chronic conditions caused by unhealthy areas grew from 14.9% to 18%, but so did
lifestyles such as smoking, lack of exercise, the number of nurses who resided in rural
and obesity (IOM, 2005). Depression and areas but commuted to work to an urban area
substance abuse are more common among (Skillman, Palazzo, Hart, & Butterfield, 2007).
rural residents compared with urban resi- In 1980, 86.1% of registered nurses lived and
dents (Kessler, Chiu, Demler, Merikangas, worked in rural areas, and by 2004, the num-
& Walters, 2005). With 41% of rural women ber was 62.9%; leaving rural areas with fewer
reporting symptoms of depression com- nurses and vacancies that are hard to fill.
pared with 13% to 20% of urban women, sui- With the burden of chronic diseases and
cide rates are as much as three times higher disability for rural populations, the resource-
for rural women (American Psychological poor rural care system is experiencing great
Association, 2005). The aging of rural resi- demands. For these reasons, rural residents
dents, along with the higher likelihood of are considered an underserved popula-
having chronic health problems and poorer tion that needs special attention. In recent
health status, are factors when planning and years, many approaches have been devel-
providing health care in rural areas. oped to close the health care gap between
Other health care concerns include rural and urban areas. One example is the
the high rates of farm injuries, especially approximately 1400 critical access hospitals
among the youth. According to the National (CAHs) in rural areas. Recognizing the vital
Institute of Occupational Safety and Health role of (especially the small) rural hospitals
(2008), it was estimated that 23,100 children prompted Congress in 1997 to create the
and adolescents were injured on farms in Medicare Rural Hospital Flexibility program
2006. Rural health care providers also need (Flex Program). This initiative allows small
to be prepared to care for recreational visi- hospitals to be licensed as CAHs and offers
tors in areas with a high influx of tourists grants to states to help implement initiatives
during certain times of the year. Both gen- to strengthen the rural health care infrastruc-
eral services and specialized services, such ture. To be a CAH requires certification as
as those needed to treat people involved in such before January 1, 2006 or rural location,
accidents, are higher demands during these and to be more than 35 miles (or 15 miles in
seasonal peaks (IOM, 2006). areas with mountainous terrain or only sec-
It is not only the characteristics of rural ondary roads available) from another hospi-
populations that challenge the delivery of tal (Gale, Coburn, Gregg, Slifkin, & Freeman,
rural health care, but also whether health 2007). In return for CAH status, hospitals
care services are available. The major barri- provide 24-hour emergency care services
ers for rural residents to have access to health availability, have a maximum of 25 acute care
care are shortages of clinicians, facilities, and and swing beds (a bed used for either acute
specialized services as well as geographical or skilled nursing facility care), and maintain
and climatic conditions that affect travel con- an annual average length of stay of 96 hours
ditions to health care providers and facilities or less for their acute care patients.