The Buccaneer (1962), a yearbook published by the students of East Tennessee State University, known then as East Tennessee State College. / https://dc.etsu.edu/yearbooks/1044/thumbnail.jpg

The Buccaneer (1963), a yearbook published by the students of East Tennessee State University, known then as East Tennessee State College. / https://dc.etsu.edu/yearbooks/1045/thumbnail.jpg

The Buccaneer (1964), a yearbook published by the students of East Tennessee State University. / https://dc.etsu.edu/yearbooks/1046/thumbnail.jpg

Nurses make up a significant source of direct care for individuals, families, and communities. The problematic distribution of nurses and the potential to lose practicing nurses emphasizes the importance of retention and support of nursing professionals, especially in rural locations. One of the best ways to discover what is important to nurses is to ask and listen to the replies. The focus for this dissertation is the lived experience of registered nurses in a six-county area in three adjoining states in rural South Central Appalachia. The purpose of this study is to interpret and understand the lived experience of contemporary RN practice in rural Appalachia. The two aims of the study are to 1) understand the lived experience of contemporary nurses in rural Appalachia, and 2) understand the lived experience of nurses as they relate to the place of residence and the place of employment. The chapters include the research proposal and three manuscripts. Chapter 1 contains the background and significance. Chapter 2 is the literature review. Chapter 3 includes sampling and recruitment in rural areas. The findings are discussed in Chapter 4. Chapter 5 contains an integration of all manuscripts, discussion of the contribution to nursing science, direction for future research, and implications for nursing practice. Manuscripts are ready for submission and will be formatted per author guidelines prior to submitting. The first manuscript, “Perceptions of Nursing in Appalachia: A State of the Science Paper,” is a literature review. The manuscript reviews the literature surrounding nurses in Appalachia. It was published in the Journal of Transcultural Nursing in January, 2018 (Brewer, 2018). The second manuscript, “The Lived Experience of Nursing in Appalachia: Sampling and Recruitment,” examines the researcher’s experience with sampling and recruitment. The second manuscript will be submitted to the Online Journal of Rural Nursing and Health Care. The third manuscript, “Living and Working as a Nurse in Appalachia: A Phenomenological Study,” provides findings, implications, and future research. This paper describes findings and identifies themes of the data. The third manuscript is ready for publication to the Journal of Transcultural Nursing. The conclusion presents dissertation summary comments.

The National Nurse-led Care Consortium hosts this webinar highlighting the recently formed medical-legal partnership in East Tennessee. This session will focus on developing a Medical Legal Partnership (MLP) practice in a rural setting, where the distance between legal and health partners is up to five hours, and the availability of services for low-income patients is scarce. Using tele-technology to communicate between partners, and elevating the combined health and legal priority of children’s healthcare insurance access and optimization, the East Tennessee MLP has tackled some of the common challenges of rural MLPs, and brought new solutions to rural MLP practice. This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number and title for grant amount (under grant number U30CS09736, a National Training and Technical Assistance Cooperative Agreement (NCA) for $1,350,000, and is 100% financed by this grant). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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Sharp rises in overdose deaths nationally coincided with the arrival of the COVID-19 pandemic. Rural Appalachia, known for high rates of substance use and barriers to health care in general, was suspected to be disproportionately impacted in terms of recovery supports such as 12-step recovery meetings. This study investigated the availability of recovery meetings in South Central Appalachia before and after COVID-19 lockdowns. The number of confirmed recovery meetings was compared before and after COVID-19 lockdowns by geographic location (i.e., rural/nonrural and medium metro/small metro/micropolitan/noncore). Recovery meeting data were systematically collected through interviews with community contacts, reviewing social media and websites, making phone calls, and sending emails and surveys and updated longitudinally. There was no significant change in the number of meetings from pre- (n = 189) to post-COVID-19 (n = 178). There was no significant shift in meeting location when dichotomizing by rural/nonrural classification, χ²(1) = 2.76, p = .097, π = −0.087. Chi-square test of independence did reveal a significant change in number of recovery meetings by location when using four location classifications, χ²(3) = 7.97, p = .047, Cramer’s V = 0.147. There was a noteworthy rise in the meetings in small metro (36.5%–51.1%), with all other locations declining. The establishment and reestablishment of recovery meetings in rural communities should be prioritized to address the longstanding scarcity of recovery resources in rural locations, recent decline in such support, and the rise in overdose deaths.