Academic journal article Scholarly Inquiry for Nursing Practice

Rural Nursing: Developing the Theory Base

Academic journal article Scholarly Inquiry for Nursing Practice

Rural Nursing: Developing the Theory Base

Article excerpt

Many health care needs of rural dwellers cannot be adequately met through the use of existing nursing models alone but require unique approaches emphasizing the special needs of this population. The development of an integrated theory base for rural nursing is necessary. A retroductive approach, building upon both qualitative and quantitative research data, is being used to develop a theory of rural nursing. Key concepts identified are: work beliefs and health beliefs; isolation and distance; self-reliance; lack of anonymity; outsider/insider; and old-timer/newcomer. Implications for practice include the importance of relating health care to work practices and the need to intervene indirectly through established informal systems.

A logger suffering from "heart lock" does not have a cardiovascular abnormality. He is suffering from a work-related anxiety disorder and can be assisted by an emergency room nurse who accurately assesses his needs and responds with effective communication and a supportive interpersonal relationship. A farmer who has lost his finger in a grain thresher several hours earlier does not have time during the harvesting season for a discussion of occupational safety. He will cope with his injury assisted by a clinic nurse who can adjust the timing of his antibiotic doses to fit with his work schedule in the fields.

Many health care needs of rural dwellers cannot be adequately addressed by the application of nursing models developed in urban or suburban areas but require unique approaches emphasizing the special needs of this population. While nurses are significant, and frequently the sole, health care providers for people living in rural areas, little has been written to guide the practice of rural nursing. The literature provides vignettes and individual descriptions, but there is a need for an integrated, theoretical approach to rural nursing.

Rural nursing is defined as the provision of health care by professional nurses to persons living in sparsely populated areas. Over the past 8 years, graduate students and faculty members at the Montana State University College of Nursing, have worked toward developing a theory base for rural nursing. Theory development has used primarily a retroductive approach, and data have been collected and refined using a combination of qualitative and quantitative methods. The experiences of rural residents and rural nurses have guided the identification of key concepts relevant to rural nursing. The goal of the theory building process has been to identify commonalities and differences in nursing practice across all rural areas and the common and unique elements of rural nursing in relation to nursing overall. The implications of developing a theory of rural nursing for practice have been examined as a part of the ongoing process.

The theory building process was initiated in the late 1970s. At that time, literature and research related to rural health care were limited and focused primarily on the problem of retaining physicians in rural areas and providing assessments of rural health care needs and prescriptions for rural health care services based on models and experiences from urban and suburban areas (Coward, 1977; Flax, Wagenfield, Ivans, & Weiss, 1979). The unique health problems and health care needs of extremely sparsely populated states, such as Montana, had not been addressed from the perspective of the rural consumer. No organized theoretical base for guiding rural health care practice in general, or rural nursing in particular, existed.

QUALITATIVE DATA

The target population for qualitative data collection was the people of Montana. Montana, the fourth largest state in the United States, is an extremely sparsely populated state, with nearly 800,000 people and an average population density of approximately five persons per square mile. One half of the counties in Montana have three or fewer persons per square mile, with six of those counties having less than one person per square mile. …

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