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Health & Wellness in Rural and Medically Underserved Areas
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Mona M. Counts, PhD, CRNP,FANP, FAANP
EmeritusPenn State University
Past PresidentAmerican Academy of Nurse
Practitioners
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RURALFolk Culture
Folk culture refers to the localized lifestyle of a subsistence or otherwise inward looking culture. It is usually handed down through oral tradition and a strong sense of community, and values the "old ways" over novelty. Finally, folk culture is quite often imbued with a sense of place. If its elements are copied by, or removed to, a foreign locale, they will still carry strong connotations of their original place of creation.
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Rural
Rural areas (also referred to as "the country", countryside) are sparsely settled places away from the influence of large cities. Such areas are distinct from more intensively settled urban and suburban areas, and also from unsettled lands such as outback, American Old West or wilderness. Inhabitants live in villages, hamlets, on farms and in other isolated houses
Wikipedia
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Healthy Partneringfor
Rural Health Care Culturally Competent Care Community Empowerment Partners and Coalitions Technology Future “best practices”
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Rural Areas
Agricultural character Characterized by an economy
based on– Logging– Mining– Petroleum– Natural gas– Tourism
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Lifestyles in Rural Areas Lifestyles in rural areas are different Limited services, especially public services,
are available. Governmental services:
– Police– Schools– Fire stations– Libraries
Utilities:– Water– Sewerage– Street lighting– Waste managment.
Public Transport.
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Rural Health
Rural health is the interdisciplinary study of health and health care delivery in the context of a rural environment or location
Population Density Geographic Location HPSA MUA
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Rural Sterotype
Redneck, in modern usage, predominantly refers to a particular stereotype of people who may be found in many regions of the United States or Canada. Originally limited to the Appalachians and the American South, and later the Ozarks and Rocky Mountains, this stereotype is now widespread in other states and the Canadian provinces. The word can be used either as a pejorative or as a matter of pride.
Wikipedia
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Cultural CompetentCare
APPALACHIANPATTERNS
GENESIS III
General Ethnographic Nursing Evaluation Studies in
the StateTarget Population Research
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Findings for
Practice
Perceived needs “POWER” Resources Community Organizations Barriers
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Appalachian Characteristics
• Hardiness
• Family
• Continuity
• Acceptance
• Spiritual
• Age
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Appalachian Characteristics
• Self (We’ness)
• Time• Commitment• View of Health
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ECONOMICS
Industry
Strengths, Barriers & Needs
Employment
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Strengths --- Barriers&
Needs
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Rural Family Health Patterns
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Community-Based Research
Barriers– Small populations– Isolated settings– History of past experience with
researchers– Education (no middle)
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Community-Based Research
Strategies for Success– Work within the context of the culture– Integrate “insiders” into all phases of
project (Planning, Implementation, Evaluation)
– Keep open to improving the model based on outcomes (quality improvement goals vs. end-point evaluation)
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APPALACHIANOUTCOMES
Neighboring Dichotomies Health Empowerment Resolution Hope
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NPs
Your Partnersfor
HEALTH
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Community Empowerment
Findings for practice
• Value of Family and roots
• No insurance or underinsured
• Lack of confidence in large centers
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Community Empowerment
Findings for practice
• Limited economic resources
• Significance of culturally specific care
• Consistency and continuity of care desired
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IMPLICATIONSfor
Practice
How to achieve in rural Communities
• Integral part of community (providers and board)
• Life long resident (family ties or proven commitment)
• Female (in Appalachia)
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IMPLICATIONSfor
Practice
How to achieve in rural Communities
Low key (accessing power)
• Caring (Professional Involvement)
• Perceived as knowledgeable (University)
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Potential Coalitions
Technology Integration Access Development Quality Best Practice Improved Living
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Primary Care Center of Mt Morris
6000 Patients Community Owned 4 Nurse Practitioners 7 Personnel Student Rotations Partnerships
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Target Population Focus
Prevention of Diabetes in High Risk Rural Families– Translation of research evidence -
application in rural primary care– Design- Based on context of setting– Method- Culturally congruent– Outcomes Selection- measure health
lifestyle improvements
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Outcomes
Teen Pregnancy Hgb A1c Hypertension Goal Lipid Control Weight Loss Tobacco Use Asthma and Lead Reduction Health Screenings (Health Promotion)
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Outcomes
Increased Community Competence Skill Building (two edge sword) Awareness of opportunity Economic Additions Improved quality of life Adherence Facilitation of prescription
acquisition
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Source of Revenue
Insurance Medicaid Medicare No Insurance Grants Other
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FUTURE
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IMAGES of Appalachia
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APPALACHIA
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APPALACHIA
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ENVIRONMENT
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Climate
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HOME
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APPALACHIA