Introduction: Rural emergency nurses face unique obstacles to providing quality end-of-life (EOL) care. Stories provided by emergency nurses embody their most difficult EOL care obstacles. Methods: A questionnaire was sent to 53 rural hospitals. Respondents were asked to share stories that epitomized the obstacles faced while providing EOL care in the rural emergency setting. Results: The lack of an ideal death (nurse personally knows the patient, issues with family members, and unknown patient wishes) was the top obstacle. Other reported obstacles were insufficient ED staff and power struggles between nurses and physicians. Discussion: Rural emergency nurses often provide EOL care to friends and family members, while their urban counterparts are likely to transfer care to nurses with no relation to the dying patient. Not only does caring for patients, that the nurse knows or is related to, cause great distress to rural emergency nurses, this unfortunately common situation may also prevent patients from receiving the highest quality of EOL care. Conclusion: Emergency nurses often face obstacles that hinder their ability to provide high quality EOL care to patients. These obstacles are compounded by a unique set of challenges faced by nurses working in rural emergency departments. Stories from rural emergency nurses revealed that being unable to provide optimal care at the EOL, having difficulties with family members, or not knowing the patient's wishes for EOL care were the most common obstacles. Additional obstacles included stories about the impact of low or unavailable staff and feeling powerless in some EOL situations.

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.

Thesis (M.A. (Nursing Science)) --University of Limpopo, 2018 / Introduction and background The shortage of human resources in rural areas remains a crisis, especially in subSaharan Africa, affecting rural primary health centres. The purpose of this study was to identify and describe factors influencing the retention of health care workers in rural clinics, in order to develop strategies to improve retention in rural clinics. Methodology A quantitative research method and descriptive design was used in this study. The population was professional nurses and operational managers in rural clinics. Simple random sampling was used to select the clinics, the professional nurses and operational managers. The sample size were 210 professional nurses and operational managers. Only 170 professional nurses and operational managers participated in the study. Data were collected using a questionnaire, and all ethical principles were adhered to. The data was analysed using SPSS version 22.0. Results The study revealed that there are complex interconnecting factors that affect retention. It was further revealed that age is the core factor affecting retention (P= 0.001) with 19 (100%) of those aged < 30 years intending to leave rural practice. Furthermore, more than half of the respondents 118 (87.06%) were dissatisfied with the salary they earned. Only 1 (0.6%) of the respondents had a masters’ degree. Conclusion It is therefore concluded that both financial and non-financial incentives such as education, improving working conditions and relationship with colleagues needs to be incorporated in order to improve nurse retention. Key words: Retention, migration, rural health care workers, job satisfaction

Purpose/Aims: The aim of this study was to understand the health issues of a rural Southeastern Arizona border community. More specifically, this study used community assessment with ethnographic principles to: 1) Conduct a community assessment centered on definitions of health, access to care, quality of care, and health needs in a rural Southeastern Arizona border community; and 2) Compared the findings of this study to previous studies, models, and theories of rural nursing and rural health.Background: It is important to understand that each community has a unique set of health priorities that are dictated by these factors; making every rural community different. Much of the work that has been done in rural America has been performed in the Midwest, Southeast, or Northern states. There is limited information regarding Arizona or even Southern US border communities and whether previous work can be generalized to areas that have not been studied.Sample and Methodology: This study utilized community assessment with ethnographic underpinnings through the use of focus groups, key informant interviews, participant observation, and secondary data analysis of existing community data. Sampling for the focus groups and key informants was purposive. Focus groups included: 1) participants who use local health services and 2) participants who do not.Analysis: Lincoln and Guba's (1985) guidelines for rigor in qualitative studies was utilized. Thematic analysis and thick description were used to analyze data. Theoretical triangulation was performed between individual, group, and community level data with theoretical linkages made to community capacity theory and rural nursing key concepts.Implications and Conclusions: The location of this project, rural Arizona community, near the US-Mexico border, posed an interesting contrast to the proposed concepts widely being used today. From this study, healthcare leaders in this community are better equipped to provide relevant, high-quality, and safe services; but an informed community emerged that has an interest in promoting the health and well-being of the community as a whole.

Thesis (Ph. D.)--State University of New York at Binghamton, Decker School of Nursing, Rural Nursing, 2009. / Includes bibliographical references.

Thesis (Ph. D.)--State University of New York at Binghamton, Decker School of Nursing, Rural Nursing, 2009. / Includes bibliographical references.

Purpose: The purpose of this project was to conduct an educational workshop among ICU nurses working in rural areas, to reduce risk of compassion fatigue. Background: Compassion fatigue is a job-related hazard unique to professionals in caring professions such as nursing. Rural ICU nurses represent a population that may encounter unique triggers for the risk of compassion fatigue due to professional isolation, less resources and more risk of knowing the patient as a community member. A review of literature reveals limited research related to compassion fatigue development in rural ICU nurses. Method: Two educational workshops were conducted among rural ICU nurses (N=3). Workshop content included discussion about symptoms, triggers, and outcomes of compassion fatigue, as well as positive coping strategies. Participants journaled physical and emotional responses to situations such as ethical or moral dilemmas, boundary issues, and aspects of self-care. Each workshop included time to discuss the educational content and participant experiences; the resulting narratives were analyzed for commonalities. Findings: Universally, burnout was viewed as inherent to the profession. All participants recounted past traumatic patient encounters that preoccupies their thinking when in similar situations. Symptoms identified as compassion fatigue included chronic, constant, generalized pain, symptoms of depression, isolation, withdrawal and lack of interest in enjoyable activities. Triggers were prolonged patient hospitalizations due to lack of resources, lack of supporting services, lack of leadership support, unexpected patient loss, witnessing patient trauma and grief, caring for patients who did not seem to really need ICU, social situations surrounding patients 10 and floating to different departments. Increased alcohol intake, sarcasm, and venting were the most reported mitigation strategies among participants. Implications: Compassion fatigue negatively impacts the lives of rural ICU nurses on many dimensions, although it is perceived as inherent to the profession. These participants desired support from nursing leadership and a supportive work environment. Participants expressed they continued to feel compassion, despite experiencing the phenomenon described as compassion fatigue. A less stigmatizing term might better capture the phenomenon now labeled as compassion fatigue.

Background: Twenty percent of Americans live in rural areas where most of their healthcare is provided in Critical Access Hospitals (CAHs). It is unknown how frequently obstacle and helpful behavior items occur in End-of-Life (EOL) care in CAHs. Objectives: To determine the frequency of occurrence scores of obstacle and helpful behavior items in providing EOL care in CAHs. To also determine which obstacles and helpful behaviors have the greatest or least impact on EOL care based on the magnitude scores. Methods: A questionnaire was sent to nurses working in 39 CAHs in the United States. Nurse participants were asked to rate obstacle and helpful behavior items by size and frequency of occurrence. Data were analyzed to quantify the impact of obstacle and helpful behavior items on EOL care in CAHs by multiplying the mean size by the mean frequency of items to determine mean magnitude scores. Results: Items with the highest and lowest frequency were determined. Additionally, obstacle and helpful behavior item magnitude scores were calculated. Seven of the top ten obstacles were related to patients' families. Seven of the top ten helpful behaviors involved nurses ensuring families had positive experiences. Discussion: CAH nurses perceived issues around patient family members as significant obstacles to EOL care. Nurses work to ensure that families have positive experiences. Visiting hour issues seemed to be irrelevant. The use of technology, such as telehealth, seemed to provide little benefit in EOL care in CAHs.

Background: The Critical Access Hospitals (CAHs) system was developed to bring health care to rural populations. Although CAHs lack equipment and resources, CAH nurses still provide end-of-life (EOL) care to critically-ill and dying patients. Objectives: To determine the largest and smallest ranked obstacles and helpful behaviors to providing EOL care to rural patients as perceived by CAH nurses. Also, to determine how CAH nurses' perceptions of obstacles and helpful behaviors to providing EOL care compare to that of their urban counterparts. Methods: A cross-sectional, nationally representative sample of nurses working in 39 CAHs were sent a questionnaire. Nurse participants were asked to rate obstacle and helpful behavior item sizes to providing EOL care to critically-ill patients. Current data were analyzed and compared with previously collected data obtained from urban-working critical care nurses. Results: Seven of the top 10 largest obstacle items were related directly to family behaviors and attitudes such as families not understanding what lifesaving measures entail and intra-family disagreements about life support. Largest helpful behavior items ranked in the top 10 included interventions which the nurse controls and items that impacted nurses having adequate time to deliver EOL care. The majority of the top 10 largest obstacle and helpful behavior items from the 2015 study, as ranked by urban critical care nurses, remained in the top 10 for the current study. Obstacle and helpful behavior items unique to CAHs such as a lack of resources and the nurse knowing the patient or patient's family fell below the top 10 largest items in ranking. Conclusion: As perceived by nurse participants, obstacles and helpful behaviors to providing EOL care remain similar despite location (rural versus urban). CAH nurses are accustomed to working without typical resources found in urban hospitals and therefore did not perceive resource deficits to be among the largest-ranked obstacles to providing EOL care. Family behaviors and attitudes remain the most dominant obstacle noted by nurses.

Thesis (M.S.)--University of Wyoming, 2008. / Title from PDF title page (viewed on Nov. 12, 2009). Includes bibliographical references (p. 55-58).