Transcript GENESIS - Center of Excellence for Remote and Medically

Health & Wellness in
Rural and Medically
Underserved Areas
Mona M. Counts, PhD, CRNP,FANP, FAANP
Emeritus
Penn State University
Past President
American Academy of Nurse
Practitioners
RURAL
Folk Culture
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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.
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 Partnering
for
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
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– Logging
– Mining
– Petroleum
– Natural gas
– Tourism
Lifestyles in Rural Areas
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Lifestyles in rural areas are different
Limited services, especially public services, are
available.
Governmental services:
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Utilities:
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Police
Schools
Fire stations
Libraries
Water
Sewerage
Street lighting
Waste managment.
Public Transport.
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 Competent
Care
APPALACHIAN
PATTERNS
GENESIS III
General Ethnographic Nursing
Evaluation Studies in the State
Target Population Research
Findings
for
Practice
Perceived needs
 “POWER”
 Resources
 Community Organizations
 Barriers
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Appalachian Characteristics
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Hardiness
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Family
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Continuity
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Acceptance
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Spiritual
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Age
Appalachian Characteristics
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Self (We’ness)
Time
Commitment
View of Health
Strengths, Barriers & Needs
ECONOMICS
Employment
Industry
Strengths --- Barriers
&
Needs
Rural Family Health Patterns
Community-Based Research
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Barriers
– Small populations
– Isolated settings
– History of past experience with researchers
– Education (no middle)
Community-Based Research
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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)
APPALACHIAN
OUTCOMES
Neighboring
 Dichotomies
 Health
 Empowerment
 Resolution
 Hope
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NPs
Your Partners
for
HEALTH
Community
Empowerment
Findings for practice
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Value of Family and roots
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No insurance or underinsured
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Lack of confidence in large centers
Community
Empowerment
Findings for practice
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Limited economic resources
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Significance of culturally specific care
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Consistency and continuity of care
desired
IMPLICATIONS
for
Practice
How to achieve in rural Communities
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Integral part of community (providers and
board)
Life long resident (family ties or proven
commitment)
Female (in Appalachia)
IMPLICATIONS
for
Practice
How to achieve in rural Communities
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Low key (accessing power)
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Caring (Professional Involvement)
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Perceived as knowledgeable (University)
Potential Coalitions
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Technology
Integration
Access
Development
Quality
Best Practice
Improved Living
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
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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
Outcomes
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Teen Pregnancy
Hgb A1c
Hypertension Goal
Lipid Control
Weight Loss
Tobacco Use
Asthma and Lead Reduction
Health Screenings (Health Promotion)
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
IMAGES of Appalachia
APPALACHIA
APPALACHIA
ENVIRONMENT
Climate
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APPALACHIA