The Changing Spirit of Rural Community Nursing: Documentation Burden

Abstract

Rural community and public health nursing are characterized by an impressive commitment of nurses to their communities and a connectedness of people to one another. Home care as an integral part of long-term and acute care for the older adult population has emerged as a vital practice area in community health nursing. The purpose of this ethnographic field study was to describe rural home care for frail older adults from the perspective of those providing and receiving care. More than 250 interviews were conducted with home care providers, recipients and their families, and other community members. The setting included eight culturally and geographically diverse counties in rural Colorado. One major theme is presented: the perceived change in the spirit of rural community nursing due to the overwhelming documentation required for home care reimbursement. Oppressive paperwork requirements impeded practice and resulted in fewer home visits per day, low job satisfaction, increased nursing staff turnover, decreased quality of care, and changed the spirit of community nursing from an emphasis on caring and community service to a focus on reimbursement. The study results have timely implications for health policy formulation as the United States undergoes major health care reform.

Nursing staff's actions during older residents’ transition into long-term care facility in a nursing home in rural Norway

“…Local affinity influenced the staff's actions. Staff involvement in rural contexts has been observed in other studies (Congdon & Magilvy, 1995 /2007, Ryan & McKenna, 2013 ). Ryan and McKenna ( 2013 ) found that when the older residents and staff knew each other and friends and neighbors visited, this facilitated a more positive transition for older people and their families.…”

Rural Health Care Providers in the United States

“…Planning for nursing recruitment must be intertwined with examination of retention factors. Improvement of the job environment (Pan, Dunkin, Muus, Harris, & Geller, 1995), minimizing paperwork requirements (Congdon & Magilvy, 1995), addressing inequality of salaries (Pan & Straub, 1997), and continued professional education development (Farmer & Richardson, 1997) are workforce policy areas to be addressed. In many cases, restraints on the scope of local rural clinical care are limited as much by the availability of experienced local clinic and hospital nursing staff configurations as by the physician mix.…”

Beyond 50. challenges at work for older nurses and allied health workers in rural Australia: a thematic analysis of focus group discussions

“…This is related to an interplay of personal, environmental and wider work-related factors. Professional isolation, lack of recognition limited access to professional education, high workloads and stress related to lack of replacement staff, long work hours, limited resources and sometimes unsupportive management practices are commonly described workplace challenges [3,19-22]. …”