bluuebunny/crossref_metadata_2025_split huggingface dataset:
The 1990s and Beyond: Determining the Need for Community Health and Primary Care Nurses for Rural Populations*
Authors: Hanson Charlene M. 
Published: April 2008

ABSTRACTIncreased numbers of primary care and advanced practice nurses with unique generalist skills will be required to meet the accelerating physiologic and sociocultural health care needs of rural populations. Several factors have been identified that will influence the demands and position of community‐based nurses in rural practice settings during the next decade. A back‐to‐basics type of health care offered out of a growing elderly population; technological breakthroughs that make it possible for more chronically ill patients to live at home; serious substance abuse and other adolescent problems; AIDS; and high infant morbidity and mortality statistics are only some of the concerns that will demand nursing intervention. These changes speak to the need for improved nursing coordination, stronger collegial relationships, and better communication between physicians and nurses. Health care is moving in new directions to offer more efficient and technologically sophisticated care. These changes enhance the need for clinically expert educators who teach and jointly practice in programs with a rural focus. Telecommunications, and heightened computer literacy, will play a major role both in nursing education and clinical practice. The goals of kindergarten through 12th grade health promotion and disease prevention strategies in school health will be the norm and will require better prepared, and positions for, school nurses. More midwives and public health nurses will be needed to care for the growing population of sexually active adolescents who are in need of family planning and prenatal care. Underinsured and indigent populations will continue to fall within the purview of midlevel practitioners, as will providing anesthesia services in small rural hospitals. The transition of some rural hospitals into expanded primary care units (e.g., EACHs and RPCHs), and new models of case management will greatly influence nursing demands. This paper will further identify critical areas of advanced practice nursing within community settings, including new relationships with other health care providers, and will introduce strategies upon which rural health policy recommendations for the 1990s can be addressed.
Current Approaches to Shortage Area Designation*
Authors: Lee Richard C. 
Published: April 2008

ABSTRACTThis paper reviews the various indicators and criteria that are in use to identify rural and urban areas with shortages of primary care physicians, dentists, psychiatrists, or nurses; areas with medically under served populations; high migrant impact areas; and areas of greatest need/shortage, leading to lists of designated shortage or underserved areas eligible for various federal and state programs; and to lists of areas with priority for resource placement. Presenting these shortage and under service criteria at a workshop dealing with adequacy was not meant to suggest an equivalency between the concepts of “shortage,”“underservice,” and “adequacy,” but the shortage and underservice criteria can be thought of as a floor on the definition of adequacy, and may contain elements of that definition. Refinements or revisions to the various criteria could probably better identify the needs in rural areas, or the kind of staffing mix needed in various types of areas, or improve priority setting among designated areas; but the existing criteria remain a good first screen to identify those areas with health services‐related needs that require further attention.
Drinking, Farm, and Camp Life: A Study of Drinking Behavior in Migrant Camps in New York State
Authors: Chi Peter S.K. , McClain Janet 
Published: April 2008

ABSTRACT:This research focuses on issues of alcohol consumption among migrant farmworkers in Orange County, NY. Because drinking is a common behavioral response to erratic hard work and camp life, variation in alcohol consumption was analyzed within the context of a holistic perspective on migrant life. Although migrant farmworkers tend to drink more in the camp than in the home community, the multivariate analysis indicates that such variation is primarily affected by socialization and social support factors, not by work‐related variables. Potential strategies for modifying migrant farmworkers’drinking behavior are discussed based on the results of this study.
Farm Product Prices and Agricultural Safety: Connections and Consequences
Authors: Kelsey Timothy W. 
Published: April 2008

ABSTRACT:Economic conditions in farming have been a common thread in explanations of agriculture's high rate of occupational injuries and death. If prices were higher or the farm economy were stronger, it is said, farmers could afford to be safer. However, could afford to be safer does not mean that farmers would be safer. This study examines the question of whether higher farm product prices could be expected to reduce agricultural injury rates. The critique includes a statistical model relating prices and acres per worker to non‐rollover fatal farm injuries, using national data from 1969 to 1987. Contrary to current arguments, the model shows that higher prices historically are associated with higher fatality rates, suggesting that increased prices serve as an incentive for working harder and that the state of the agricultural economy is not a good explanation for high injury rates.
Job Retention of Medical Clerical
Authors: Troutt‐Ervin Eileen D. , Morgan Frederic L. 
Published: April 2008

ABSTRACT:According to the Bureau of Labor Statistics (cf. Crispell, 1990), the medical clerical field is one of the faster growing areas of employment. This paper reports on long‐term employment of trainees involved in nontraditional medical clerical programs. These programs were funded by the Job Training Partnership Act (JTPA) and filled both the needs of the local rural health care facilities and the employment needs of unskilled youths and adults. These nontraditional students of low socioeconomic background and poor work history were successfully mainstreamed into university courses and consequently obtained productive employment.A follow‐up study was conducted of 64 individuals who completed three different, one‐year JTPA programs. The study investigated the following questions: Was the trainee currently employed? If so, was employment related to the training program, and were the quarterly salaries higher than minimum wage and previous salaries? How many different jobs were reported since training? Did the individual retain employment in a rural setting?The JTPA programs at Southern Illinois University included some innovative yet practical components that resulted in very high program completion rates, high initial placement, and a continuing pattern of long‐term employment. These components included: emphasis on training for the most needed positions/jobs that matched university capabilities; the pursuit of higher starting salaries; informing participants of support services; training in job hunting and work readiness; using some individualized, competency‐based instruction; establishing internship arrangements with prospective employers; and careful matching of the trainee to initial placement site with consideration of personality as well as skills.
Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System
Authors: Halpern Michael T. , Alexander Jeffrey A. , Fennell Mary L. 
Published: April 2008

ABSTRACT:The introduction of Medicare's Prospective Payment System (PPS) has disproportionately increased financial pressures on rural hospitals and posed challenges to the survival of these institutions. Increasingly, rural hospitals are seeking strategies that can enhance their chances for survival in a turbulent and hostile environment. This study examined the survival effects of one such strategy, multihospital system affiliation. Specifically, we assessed: (1) whether and how different types of system affiliation in the post‐PPS era affect the likelihood of rural hospital survival; (2) whether particular structural, environmental and hospital performance characteristics moderate the effects of system affiliation on rural hospital survival; and (3) whether systematic selection by rural hospitals into multihospital systems potentially accounts for observed relationships between system affiliation and survival.Proportional hazards analyses indicate that system affiliation with investor‐owned systems significantly reduces survival probabilities of rural hospitals. Affiliation with not‐for‐profit systems or system affiliation under contract management arrangements does not affect survival probabilities of rural hospitals.These general findings are moderated by the effects of hospital ownership and size at the time of affiliation. Finally, study findings indicated that systematic selection by poor performing rural hospitals into investor‐owned systems has occurred in the post‐PPS era. No evidence of selection into not‐for‐profit systems was discovered.
Small Rural Hospitals with Long‐Term Care: 1983 to 1987
Authors: Beaulieu Joyce E. 
Published: April 2008

ABSTRACT:Rural hospitals were under tremendous stress in the 1980s, as evidenced by decreasing use and closures. Rural populations increased in the two proportions of people older than 65 years relative to urban areas. Rural communities had more chronically ill residents than urban areas. Population aging and hospital stress have opened an option for small rural hospitals to develop long‐term care units. Analysis of a national cohort of 750 small rural hospitals was undertaken in 1983,1985, and 1987 to identify the characteristics of these hospitals, their communities, and the relative contribution of the small rural hospital to long‐term care bed supply. Hospitals more likely to have long‐term care during this period of time had lower occupancy rates and higher expenses per admission both prior to and after developing long‐term care. While only 14 percent of the 750 hospitals studied had long‐term care, they contributed nearly 30 percent of the total long‐term care bed supply in their counties. Population‐based need and bed supply measures were not significantly different in counties having a small rural hospital with long‐term care. Areas of further analysis of the small rural hospital as a resource for long‐term care are suggested. The implications for the health care system of small rural hospitals with long‐term care are discussed.
Cancer in Rural Versus Urban Populations: A Review
Authors: Monroe Adele C. , Ricketts Thomas C. , Savitz Lucy A. 
Published: April 2008

ABSTRACTRural‐urban comparisons have identified higher age‐, race‐, and sex‐adjusted cancer incidence and mortality rates in urban populations for most anatomic sites, suggesting that rural populations are at lower risk from cancer. Conversely, findings that rural cancer patients are diagnosed at later stages of disease, that higher proportions of rural cancer cases are unstaged at diagnosis, and that rural cancer patients are at a more advanced stage of illness when referred to home health care agencies, suggest that rural cancer patients are disadvantaged when compared to their urban counterparts.This paper summarizes rural‐urban patterns of cancer mortality, incidence, and survivorship since 1950; outlines rural‐urban differences in utilization of health care services; questions the appropriateness of using rural‐urban comparisons of cancer mortality and incidence to evaluate access to cancer care; and suggests potential approaches to the question of whether rural residents have access to cancer care comparable to that available to urban residents.
Job Satisfaction Among Hospital Nurses: Facility Size and Location Comparisons
Authors: Coward Raymond T. , Horne Claydell , Duncan R. Paul , Dwyer Jeffrey W. 
Published: April 2008

ABSTRACTDespite recent declines in turnover and vacancy rates, maintaining a stable nursing staff continues to be critical to the effective operation of American hospitals, fob satisfaction is a pivotal element in nurse retention, and organizational theory suggests that some of the factors that influence job satisfaction vary by facility size. This is a study of job satisfaction among a sample of 731 nurses providing direct patient care in 22 hospitals. The sample includes approximately equal numbers of nurses employed in very small rural hospitals (1‐49 beds), medium sized facilities located in small towns (50‐99 beds), and larger metropolitan institutions (>100 beds). Differences by hospital size were observed in overall job satisfaction and in five sub‐dimensions of that concept (i.e., professional status, task requirements, pay, organizational policies, and autonomy). With the exception of pay, the results indicated that nurses employed in the very small rural hospitals were more satisfied with their jobs. Differences by hospital size were also observed in the personal characteristics of the nurses, several specific aspects of their job, and in their perceptions of job mobility. A set of four hierarchically nested ordinary least squares regression models indicated that job‐specific characteristics were the most powerful predictors of job satisfaction.
The Role of Nursing Education in Preparing Students for Rural Practice
Authors: Straub LaVonne A. , Frels Lois 
Published: April 2008

ABSTRACTThis paper discusses research on the role of nursing education in preparing students for rural practice. The purpose of the research was to learn how education programs respond to unique features of rural nursing. Results from a two‐phase nationwide survey of 275 baccalaureate nursing programs are presented. The first phase identified programs offering a rural track, the second phase was a follow‐up survey to the deans and faculty of rural‐oriented programs. These findings indicate educators recognize that rural nursing differs from urban nursing because of cultural and demographic features, as well as technical and economic characteristics. Most educators believe their role should include developing student interest in rural practice. Recommendations from the findings are presented.
Stress and Coping Among Missouri Rural and Urban Children
Authors: Atkins Frances D. , Krantz Steven 
Published: April 2008

Abstract: A cross‐sectional survey using a convenience sample of 157 Missouri rural and urban children (ages 8–13 years) yielded no significant differences in perceptions of stressors or use of coping strategies for dealing with those stressors between rural and urban children. The Feel Bad Scale and the Schoolagers' Coping Strategies Inventory measured the children's perceptions of stressors and use of coping strategies.Rural children experienced stressor levels equivalent to urban children, yet they were underserved in mental and physical health needs. The children studied reported self‐care through coping strategies for management of their stressors. Longitudinal research is needed to identify the impact of stress and interventions on the health and behavior of children in rural settings.
Adequate Access to Posthospital Home Health Services: Differences Between Urban and Rural Areas
Authors: Chen Valerie , Phillips Bardara 
Published: April 2008

Abstract: The health care environment in rural areas changed dramatically in the 1980s. Policy‐makers are concerned that these changes have reduced access to care among residents of rural areas. This study measures adequate access to Medicare home health services and determines whether it differs for urban and rural beneficiaries.Adequate access to care is measured by whether a patient with a specific health condition received a level of skilled services predetermined as appropriate for that condition. The predetermined levels of care were developed in an earlier study and were found to correlate with adverse outcomes. This study focused on patients with diabetes mellitus and surgical hip procedures to concentrate on access to skilled nursing services and physical therapy services.To conduct the analysis, a data base was constructed that included both patient utilization and health status data, drawing on three different data sources: Medicare hospital claims data, Medicare home health bill record data, and home health plan of treatment data from patients' utilization review forms (forms 485 and 486). The analysis samples consisted of 404 patients with diabetes and 876 patients who had surgical hip procedures.Significant differences were found between urban and rural areas in access to home health services. The largest differences were found in access to physical therapy services, but differences in access to skilled nursing services also exist. The data suggest that the availability of skilled care services may cause these differences.
The Emerging Epidemiology of Rural AIDS
Authors: Berry David E. 
Published: April 2008

Abstract: The incidence of AIDS in rural areas is increasing rapidly. However, historically it has been overshadowed by AIDS in the epicenters. From 1991–1992 the increased percentage of cases was higher in nonmetropolitan areas than in any other areas of residence. The rate per 100,000 also increased at almost the same rate in rural areas as in the largest metropolitan areas, defined by the Centers for Disease Control (CDC) as having a population of more than 500,000, and in other metropolitan areas of 50,000 to 500,000 population, as designated by CDC.To date, the epidemiology of AIDS in rural areas has not been defined. This information is necessary to developing effective policies and programs. The research presented here reviews the literature on AIDS in specific areas and populations at risk as a basis for generating hypotheses for further study. The first wave of the epidemic, primarily affecting homosexual or bisexual men, is strongly evident in many rural locations. The second wave of the epidemic is strongly evident in the South and can be seen among high‐risk groups such as black women, adolescents, migrant and seasonal farm workers, people who abuse alcohol, intravenous drug users, and users of crack cocaine, including those who trade sex for drugs. Poverty is a common characteristic of the second‐wave population. Proximity to interstate highways as well as metropolitan areas may also be associated. A national study of the epidemiology of AIDS in rural America is imperative.
Smoking Cessation Experiences of Chronic Lung Disease Patients Living in Rural and Urban Areas of Virginia
Authors: Labuhn Karen , Lewis Carolyn , Koon Kathleen , Mullooly John P. 
Published: April 2008

AbstractRural residents differ from individuals living in urban areas in their views about health and health behavior, their socioeconomic status, and their access to health care services. Such differences may have implications for health policy and the focus and design of health care services, including educational interventions. This paper reports findings from a comparative analysis of rural and urban chronic obstructive pulmonary disease (COPD) patients' smoking cessation experiences. The study's aims were to determine whether rural COPD patients differed from their urban counterparts in smoking patterns, smoking cessation attempts (i.e., number of quitting attempts, methods used, withdrawal symptoms, professional and personal supports for quitting smoking), and smoking cessation outcomes. Forty‐eight rural and 86 urban COPD patients were interviewed by telephone using a pretested questionnaire.The rural and urban samples did not significantly differ in demographic characteristics, disease severity, functional status, smoking patterns, reasons for smoking, perceived benefits of smoking cessation, or withdrawal symptoms. However, the rural COPD patients used fewer smoking cessation methods and had fewer persons supporting their smoking cessation attempts. Rural patients' support networks for smoking cessation primarily consisted of family members, whereas those of urban patients were more varied. Similar percentages of rural and urban patients had been abstinent from smoking for at least six months at the time of the interview, controlling for age and disease severity. Logistic regressions were used to identify predictors of current smoking for the rural and urban samples. For the rural sample, less educated individuals were more likely to be current smokers. Spouse smoking predicted current smoking in the rural sample but was only marginally significant (P=0.054). In the urban sample, use of daily medication for breathing (a proxy measure of disease severity) had a significant negative effect on current smoking. Smoking due to stress was a significant positive predictor of current smoking. Findings from this exploratory study suggest the existence of rural/urban differences in COPD patients' smoking cessation patterns that warrant further investigation.
Determinants of Physician Vacancy Rates in Rural Hospitals
Authors: Hyde John C. , Fottler Myron D. 
Published: April 2008

ABSTRACTThis study examines the determinants of physician vacancy rates in rural hospitals from the perspective of the rural hospital administrator. Data on community characteristics, hospital characteristics, and hospital recruitment strategies are examined for 50 rural hospitals in Kentucky using questionnaire and archival data. Physician vacancy rates in this sample were quite high (mean of 37 percent). Results indicate lower physician vacancy rates in hospitals with a chain affiliation. In addition, the “job shopping” model for physicians decisions on where to practice (Johnson, 1978) is supported. Hospitals that target physician candidates with more work experience display lower physician vacancy rates. Generally, hospital characteristics ivere more significant predictors of physician vacancy rates than were community characteristics. Implications for rural hospital physician recruitment/retention strategies are discussed.
Urban and Rural Differences in Health Insurance and Access to Care
Authors: Hartley David , Quam Lois , Lurie Nicole 
Published: April 2008

ABSTRACT:This study considers differences in access to health care and insurance characteristics between residents of urban and rural areas. Data were collected from a telephone survey of 10,310 randomly selected households in Minnesota. Sub‐samples of 400 group‐insured, individually insured, intermittently insured, and uninsured people, were asked about access to health care. Those with group or individual insurance were also asked about the costs and characteristics of their insurance policies.Rural areas had a higher proportion of uninsured and individually insured respondents than urban areas. Among those who purchased insurance through an employer, rural residents had fewer covered benefits than urban residents (5.1 vs 5.7, P < 0.01) and were more likely to have a deductible (80% versus 40%, P < 0.01). In spite of this, rural uninsured residents were more likely to have a regular source of care than urban residents (69% versus 51%, P < 0.01), and were less likely to have delayed care when they thought it was necessary (21% versus 32%, P<0.01). These differences were confirmed by multivariate analysis.Rural residents with group insurance have higher out‐of‐pocket costs and fewer benefits. Uninsured rural residents may have better access to health care than their urban counterparts. Attempts to expand access to health care need to consider how the current structure of employment‐based insurance creates inequities for individuals in rural areas as well as the burdens this structure may place on rural providers.