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Rural News for Nurses Blog

Dear RNO Members: We value your expertise! We invite you to contribute to our monthly Rural News for Nurses Blog. If you would like to contribute content, please email your submission to RNORNO may edit your submission slightly, so it flows with other content we add to these monthly posts. Of course, we will give you recognition for your contribution.  Again, thank you for contributing your expertise to the Rural News for Nurses Blog. 

Please view the RNO Rural News for Nurses Blog Categories for a list of content that has been or will soon be published.

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  • June 13, 2024 6:45 PM | Anonymous

    This blog post was prepared by RNO Website Committee Chair Joan Grant Keltner.

    Life is on a continuum from birth to death, but aging is a natural process. As we age, we encounter a variety of significant changes in our daily lives--career transitions, children growing up and leaving home, loss of loved ones, physical and psychosocial illnesses, and sometimes, changes in our ability to perform many activities of daily living. While many of us know of older individuals who can outperform us in many activities, as we age, we often experience more chronic illnesses. Individuals who live in rural locations have a higher risk for high cholesterol and blood pressure, obesity, arthritis, depressive disorder, diabetes mellitus, COPD, and heart disease (Research Triangle Institute, 2023).

    As health professionals, how we meet the needs of older individuals as they face these challenges is key and a high priority in developing effective interventions. A review of 40 empirical studies confirmed older individuals face physical and psychosocial challenges and require supportive interventions directed toward their social activities and relationships, psychological well-being, mobility, self-care, and domestic life. While these individuals desire independence in managing their illness, they lack strategies health professionals can provide regarding self-care, communication, coordination of services, and knowledge about various care pathways and support servicesto enhance quality-of-life (Abdi et al., 2019). The Rural Health Information Hub (2022) and others also offer many resources for health providers.

    A few strategies for these individuals include:

    • ·       suggesting purposeful activities that facilitate active functional roles, such as mentoring activities (teaching preschool and school-age reading; volunteer activities; Owen et al., 2022);
    • ·       providing information about developing heart healthy nutritional eating habits, quality rest and sleep habits, and mobility (e.g., with adapted exercises);
    • ·       encouraging using mental stimulation activities (e.g., reading, learning new skills and hobbies), social connections (e.g., family, friends, etc., community volunteer and work groups), and emotional support (refer for counseling, telephone or face-to-face support groups, developing new hobbies) to enhance mental and emotional well-being;
    • ·       teaching strength training, fall prevention and safety strategies for those who have difficulty in performing daily activities;
    • ·       encourage interactions with family and friends and participating in community activities to facilitate enjoyable activities;
    • ·       offer classes that focus on strength training, aerobic exercise, dietary skill building, and/or civic engagement (RIH Hub, 2022);
    • ·       use trained community health workers and coaches to offer information about various illnesses such as hypertension, diabetes, mellitus, heart disease etc. (RIH Hub, 2022);
    • ·       offer mobile screening clinics for chronic conditions (e.g., high blood pressure and cholesterol, obesity, diabetes mellitus, arthritis, COPD, etc. RIH Hub, 2022); and
    • ·       engage rural community-based organizations, leaders, health-care systems, and providers to offer programs to enhance the well-being of older adults;


    Abdi, S., Spann, A., Borilovic, J., de Witte, L., & Hawley, M. (2019). Understanding the care and support needs of older people: A scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatrics, 19(1), 195.

    Owen, R., Berry, K., & Brown, L. J. E. (2022). Enhancing older adults' well-being and quality of life through purposeful activity: A systematic review of intervention studies. The Gerontologist, 62(6), e317–e327.

    Research Triangle Institute (2023). Overlooked Americans: The toll of chronic disease in rural America.,non%2Dmetropolitan%20than%20metropolitan%20areas

    Rural Health Information Hub ([RHI Hub] 2022). Chronic disease in rural America – Models and innovations.

  • May 15, 2024 7:46 PM | Anonymous
    This blog post was prepared by RNO Website Committee Chair Joan Grant Keltner.

    Empirical data support an imbalance in accessing quality health care and the need to test innovative solutions to deliver quality healthcare to farmers and their families. These individuals are receptive to solutions that provide reasonable, dependable, and cost-effective health care, including virtual health care platforms. As expected, some major issues farmers’ report includes not being able to access quality medical care in view of a shortage of rural health providers. The time it takes to travel long distances to medical appointments and limited access to telemedicine are other significant barriers. These individuals desire quality health care that is affordable, accessible, consistent, sufficient, and flexible care around their busy daily lives.

    Desired interventions are those which provide formal, affordable, and cost-effective health care, physical and psychosocial well-being and health programs, and affordable costs in accessing health insurance. While farmers are willing to use virtual health care for many of their medical needs, a significant constraint is smart phone costs and a lack of high-speed internet, although virtual visits commonly are cheaper when comparing to traveling long-distances to health providers. These individuals report other issues regarding isolation, time, and inadequate peer and co-worker support for integrating healthy daily lifestyle interventions. Farmers desire accessible and flexible support programs that address strategies to improve their overall health and well-being, as well as safety training (e.g., injury prevention, first aid training; Wright et al., 2021).

    So, how do policymakers and health system leaders support farmers? The NRHA (2024) and other agencies (Farm Foundation, 2022; University of Minnesota Rural Health Research Center and NORC Walsh Center for Rural Health Analysis, 2022, 2024; Wright et al., 2021; Yazd et al., 2019) suggest we support legislation and offer agendas to improve the quality and well-being of these rural individuals, through:

    • 1.     additional rural support programs that offer fiscal support to healthcare facilities to improve community health and well-being;
    • 2.     enhanced rural broadband access for access to distance learning and telemedicine programs;
    • 3.     more assistance for emergency medical services and equipment to enable health personnel to respond during urgent situations;
    • 4.     programs, hotlines, and resources focused on farmers who have physical and behavioral health issues and mental health crises;
    • 5.     food security plans to address rural health disparities and healthy lifestyles;
    • 6.     support programs to provide physical and psychosocial support for healthy lifestyles, as well as safety training; and
    • 7.     more opportunities for accessing peer and co-worker support.


    Farm Foundation. (2022). Perspective: Farmer mental and physical health as components of sustainability.,cope%20with%20farm%20related%20stress%20%28Farm%20Credit%2C%202020%29

    National Rural Health Association (NRHA). (2024). Farm bill priorities.

    University of Minnesota Rural Health Research Center and NORC Walsh Center for Rural Health Analysis. (2022). Rural Suicide Prevention Toolkit [online] Rural Health Information Hub.

    University of Minnesota Rural Health Research Center and NORC Walsh Center for Rural Health Analysis (2024). Mental Health in Rural Communities Toolkit [online] Rural Health Information Hub.

    Wright, N., Scherdt, M., Aebersold, M. L., McCullagh, M. C., Medvec, B. R., Ellimoottil, C., Patel, M. R., Shapiro, S., & Friese, C. R. (2021). Rural Michigan farmers' health concerns and experiences: A focus group study. Journal of Primary Care & Community Health, 12, 21501327211053519.

    Yazd, S. D., Wheeler, S. A., & Zuo, A. (2019). Key risk factors affecting farmers’ mental health: A systematic review. International Journal of Environmental Research and Public Health, 16(23), 4849.

  • April 16, 2024 7:31 PM | Anonymous

    This blog post was prepared by RNO Website Committee Chair Joan Grant Keltner.

    About 1 million infants and toddlers live in rural areas in the U. S., with many parents facing challenges, such as an inadequate number of healthcare providers and a need to travel long distances to access them, transportation issues, and lower income levels. In fact, rural mothers are less likely to receive adequate prenatal care than those who live in urban areas, with mothers living in Arizona (13.7%), Alabama (9.9%), North Dakota (8.2%), South Dakota (7.4%), and Wyoming (5.9%) with the highest percentage point difference when comparing rural and urban states (Keating et al., 2020; Centers for Medicare & Medicaid Services, 2019). Women who live in the Southeastern and Southwestern U.S. also have higher rates of inadequate prenatal care (Laurore et al., 2022). Unplanned home births in rural areas are primarily assisted by “other” individuals (68.1% in rural areas; 24.3% in urban areas) rather than certified healthcare providers US DHHS; 2019). These data suggest an increased risk for complications because “other” individuals may be less well-prepared in managing maternal and infant complications. Preventive health and dental visits also are fewer in rural areas, perhaps due to a lack of health insurance (Keating et al., 2020).

    Negative health outcomes in rural areas are many. Unfortunately, infant mortality and preterm birth rates are higher in rural communities than in urban areas (CDC, 2019b; Ely & Hover, 2018). Three of the five leading deaths, congenital malformation, sudden death syndrome, and unintentional injuries are higher in rural areas compared to urban ones. Although rural infants are less likely to die from birthweight and maternal complications when compared to their urban counterparts, some rural states such as Mississippi have higher rates of lower birthweight rates (12.5%) (Ely & Hover, 2018). Breastfeeding rates also are lower in rural areas than in urban ones (CDC, 2019a), perhaps due to limited access to breastfeeding programs (Keating et al., 2020).

    So, how do we support infants, toddlers, mothers, fathers, and significant others, as rural healthcare providers? Laurore and colleagues (2020) suggested several strategies including:

    • 1)    assisting families to enroll their infants in their state’s Children Health Insurance Program (CHIP) that is designed to provide insurance to families not eligible for Medicaid;
    • 2)    investigating other methods to provide health services, such as mobile health clinics and telemedicine for well-child and ill-focused visits, including video conferencing and telephone and email contacts;
    • 3)    encouraging appropriate vaccinations for all rural families, utilizing resources such as the Vaccine for Children (VFC) program that provides vaccinations to children under 19 years old who are without insurance, those eligible for Medicaid, and those of either an American Indian or Alaska Native race/ethnicity (CDC, n.d.);
    • 4)    utilizing state public health departments through task forces or directives to identify strategies for meeting gaps in home visiting programs; and
    • 5)    developing relationships with community resources (e.g., hospitals, birthing centers, and mobile health clinics, etc.) to provide group prenatal visits, etc.

    These statistics indicate potential gaps which rural healthcare providers can fill by being creative in providing care. State and federal funding and other community resources enable health professionals to provide more comprehensive care to these individuals prior to, during, and after birth.

    Centers for Disease Control and Prevention (CDC; n.d.). Vaccines for Children Program (VFC).

    Centers for Disease Control and Prevention. (CDC; 2019a). Breastfeeding facts.

    Centers for Disease Control and Prevention (CDC; 2019b). Infant mortality.

    Centers for Medicare & Medicaid Services. (2019). Improving access to maternal health care in rural communities.

    Ely, D. M. & Hoyert, D. L. (2018). Differences between rural and urban areas in mortality rates for the leading causes of infant death: United States, 2013-2015.

    Keating, K., Cole, P., & Schaffner, M. (2020). State of babies yearbook: 2020. Washington, DC: ZERO TO THREE.

    Laurore, J., Baziyants, G., & Daily, S. (2020). Health care access for infants and toddlers in rural areas.

    United States Department of Health and Human Services (US DHHS; 2019), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Division of Vital Statistics, Natality public-use data 2018, on CDC WONDER Online Database, September 2019.

  • March 11, 2024 3:51 PM | Anonymous

    This blog post was prepared by RNO Website Committee Chair Joan Grant Keltner.

    Vaccinations are a cost-effective intervention to prevent unnecessary morbidity and mortality associated with infectious diseases in children and adolescents. The National Immunization Survey–Child reported no decrease in routine vaccinations, even children born during the COVID-19 pandemic, except for those children living below the federal poverty level and in rural areas (CDC, 2022; Hill, 2023). Yet, a significant percentage of adolescents in rural communities are not getting recommended vaccines, especially HPV (15%) and meningococcal conjugate (20%) vaccines to protect against serious diseases, when compared to those who live in urban areas (CDC, 2023). In a recent review of 120 studies, and a statistical meta-analysis of 95 of them, investigators sought to examine the effectiveness of various interventions for providing vaccination coverage to children and adolescents, ages 5 to 19 yrs. Among the various interventions, education about vaccines increased adherence by 19%, reminders and recalls (e.g., telephone and autodialed calls, mailed letters, postcards, text messages, e-mails, and a combination of these methods) by 15%, health providers’ interventions by 13%, monetary incentives (i.e., cash and gift vouchers) by 67%, and concurrent multi-level interventions (i.e., to schools, health providers, and health clinics) by 25%. The influence of using school-based clinics and policies and legislation for vaccinations is unclear and no significant impact was found from providing a combination of interventions together. Other statistical information (i.e., risk ratios and confidence intervals; types of interventions and specific vaccinations) are reported in the article (Siddiqui et al., 2022). These findings highlight the importance of using various methods to improve vaccination coverage in children and adolescents, with a need for further research in families living in rural areas and experiencing financial hardships.

    CDC. (2022). Childhood vaccination coverage before and during the COVID-19 pandemic among children born January 2017–May 2020, National Immunization Survey-Child (NIS-Child), 2018–2021. Atlanta, GA: US Department of Health and Human Services.

    CDC. (2023). Vaccination in rural communities.

    Hill, H. A., Chen, M., Elam-Evans, L. D., Yankey, D., & Singleton, J. A. (2023). Vaccination coverage by age 24 months among children born during 2018–2019 — National Immunization Survey–Child, United States, 2019–2021. Morbidity and Mortality Weekly Report, 72, 33–38.

    Siddiqui, F. A., Padhani, Z. A., Salam, R. A., Aliani, R., Lassi, Z. S., Das, J. K., & Bhutta, Z. A. (2022). Interventions to improve immunization coverage among children and adolescents: A meta-analysis. Pediatrics. 149(s6), e2021053852D

  • February 26, 2024 10:22 AM | Anonymous

    RNO members, we are trying to provide news on our RNO Blog about high priorities in caring for both infants and children.  Please provide your expertise to share with RNO members!  You may send your summaries to RNO Website Committee Chair Joan Grant Keltner, at Thanks for your participation!

  • February 16, 2024 9:59 AM | Anonymous

    This blog post was prepared by RNO Website Committee Chair Joan Grant Keltner.

    Community health workers (CHWs) are trained public employees or volunteers who provide specialized services, often providing care to poor, rural, and underserved individuals within racial and ethnic minority communities. They live in communities they serve and better understand factors important in gaining acceptance and helping patients and families understand important medical facts and issues. In essence, these CHWs act as liaisons between health providers and patients/family members (RHIhub, 2023).

    These health care providers also improve quality of life and show positive outcomes for patients and their families by facilitating healthcare access and information and enhancing the healthcare team (RHIhub, 2023). Evidence from 26 studies supported the value of these health workers in providing important health information (46%) and community resources (27%), or both (27%). The most common topics related to chronic illnesses (38.5%) and women’s health (Berini et al., 2022). These services include:

    • health and prevention education;
    • referrals to health providers for physical and psychosocial services;
    • assistance in navigating and coordinating care within the health care and social services system;
    • monitoring and supporting realistic goals in managing chronic illnesses; and
    • basic screening tests for chronic conditions (e.g., glucoses, B/Ps, etc.; RHIhub, 2023).

    Another study is extending the role of CHWs to offer pediatric telebehavioral health care in rural communities. This new program hopes to expand the behavioral health workforce by integrating trained school-based community health workers (CHWs) in rural communities. They will do basic screenings, coordinate behavioral health appointments, alleviate logistical and technology issues, and provide access to social services (Nelson et al., 2022).

    Berini, C. R., Bonilha, H. S. & Simpson, A. N. (2022). Impact of community health workers on access to care for rural populations in the United States: A systematic review. Journal of Community Health, 47, 539–553.

    Nelson, E. L., Zhang, E., Punt, S. E., Engel, I. J., Giovanetti, A. K., & Stiles, R. (2022). Leveraging community health workers in extending pediatric telebehavioral health care in rural communities: Evaluation design and methods. Families, Systems & Health, 40(4), 566–571.

    Rural Health Information Hub (RHIhub). (2023). Community health workers in rural settings.

  • January 24, 2024 9:59 AM | Anonymous

    This blog post was prepared by RNO Website Committee Chair Joan Grant Keltner.

    Unsurprisingly, in a national study comparing pediatric hospitalizations in urban and rural areas over the last 10 years, researchers reported hospitalizations decreased overall, including those hospitals serving only pediatric populations (Leyenaar et al., 2023). However, inpatient beds in rural areas declined at a steeper rate than their urban counterparts, 26.1% vs 10.0%, respectively (Cushing, 2021). Births in rural hospitals also decreased by about 25%, with an almost 4-fold decrease in non-birth pediatric hospitalizations, with more admissions for children with disabilities, mental health diagnoses, and multi-faceted chronic illnesses (Leyenaar et al., 2023). Unfortunately, these statistics regarding declining inpatient units and diagnoses/illnesses demand rural parents drive much longer distances to receive medical care for their children.

    These dramatic rural statistics/facts suggest the urgent need to:

    • Develop state and healthcare system clinical and policy changes to provide primary and specialized medical care to children in rural communities.
    • Offer integrated services through telehealth and telemedicine in primary care and schools.
    • Provide early learning programs to address affordable physical and psychological, and behavioral health care resources to children and their families.
    • Develop policies and programs to alleviate fiscal difficulties in obtaining these resources.
    • Provide support for neighborhoods that provide community, social, and recreational resources to allow these children to play, read, and socialize.
    • Design school, home, and community environments that integrate child and family quality nutrition and physical activity as a part of daily life (CDC, 2023).
    • Offer services in rural schools, primary care, and communities, teaching about injury prevention, routine vaccinations, stressful life events, obesity/healthy weights and living activities, accident prevention, and disability and risk factors, such as smoking, illicit drug use, etc. (Centers for Disease Control and Prevention [CDC], 2016; 2023).

    CDC. (2016). Disability and risk factors.

    CDC. (2023). Working together, we can help children in rural communities thrive.

    Cushing, A. M., Bucholz, E. M., Chien, A. T., Rauch D. A., & Michelson, K. A. (2021). Availability of pediatric inpatient services in the United States. Pediatrics, 148(1), e2020041723.

    Leyenaar, J. K., Freyleue, S. D., Arakelyan, M., Goodman, D. C., & O’Malley, A. J. (2023). Pediatric hospitalizations at rural and urban teaching and nonteaching hospitals in the US, 2009-2019. JAMA Network Open. 2023;6(9), e2331807.

  • December 01, 2023 8:57 AM | Anonymous

    RNO will consider requests to share research studies with RNO members. Requests should be sent to

    Flyers/information regarding research studies will be posted one time after:

    • Approval by the RNO Board;
    • Documentation of either an Institutional Review Board (IRB), an Independent Ethics Committee (IEC), an Ethical Review Board (ERB) or Research Ethics Board (REB) approval;
    • Confirmation the flyer/information has final Chair approval before posting (i.e., if graduate research); and
    • Verification of RNO membership.
    • RNO has no responsibility. Individuals interested in taking part in the research need to contact the PI. Individuals who have concerns about their rights as a research participant should contact the specific IRB identified in the study.

    Note: Any postings other than the first one will be negotiated with the investigator and charged at current per diem rates for this service.  

  • November 30, 2023 12:00 PM | Anonymous

    This blog post was prepared by RNO Website Committee Chair Joan Grant Keltner.

    • More than 60% of rural counties do not have access to a psychiatrist and greater than 80% do not employ psychiatrist nurse practitioners (Andrilla, et al., 2018). About 95% of children who live in rural counties also do not have mental health providers whose practice is within a feasible driving distance by parents (U.S. Government Printing Office, 1998). Compounding this issue, almost 30% of these individuals still do not have access to broadband internet services (Vogels, 2021). Yet, rural individuals have a higher prevalence of both depression (Capriotti et al., 2020) and suicide (Centers for Disease Control and Prevention, 2022) rates when compared to their urban counterparts. Unfortunately, a strong self-reliance, a lack of trust, long distances to medical care, few mental health providers, a lack of health insurance, and little time to travel because of the daily responsibilities of farm life are a few of the barriers that exist (National Institute of Mental Health , 2018). Yet there are resources available to these individuals caring health professionals should offer. 
    Mental Health Resources (e.g., programs, list of key stakeholders, webinars, podcasts, etc.) to assist rural individuals and their families with mental health issues:

    A. Organizational Mental Health Resources by Topics (anxiety, depression, eating disorders, etc.):

    B. Mental Health Resource Names (organizations, associations, networks, etc.):

    C. Crisis Resources:

    D. Programs and Resources to Build Mental Health Resilience:

    E. Mental Health Webinar:

    F. Farm State of Mind Resources:

    G. Other Key Mental Health Stakeholders (webinars, podcasts, presentations, toolkits, etc.):

    H. Agriculture Stress Help Line:

    Andrilla, C. H. A., Patterson, D.G., Garberson, L.A., Coulthard, C., & Larson, E. H. (2018). Geographic variation in the supply of selected behavioral health providers. American Journal of Preventive Medicine, 54(6; Suppl 3), S199-S207.

    Capriotti T, Pearson T, & Dufour L. (2020). Health disparities in rural America: Current challenges and future solutions. Clinical Advisor.

    Centers for Disease Control and Prevention. (2022). Disparities in suicide.

    National Institute of Mental Health. (2018). Mental health and rural America: Challenges and opportunities.

    U.S. Government Printing Office. (1998). Mental health, United States. DHHS Pub. No. (SMA) 99-3285. Washington, DC: Superintendent of Documents, 204-213.

    Vogels, E. (August 19, 2021). Some digital divides persist between rural, urban and suburban America. Pew Research Center.

  • November 03, 2023 11:16 AM | Anonymous

    This blog post was prepared by RNO Website Committee Chair Joan Grant Keltner.

    • A report, Rural Healthy People 2030, recently identified major rural health priorities over the next 10 years. These priorities are essential for rural health providers, researchers, and key policy leaders in working together to address these top concerns. Health Care Access and Quality was identified as the single, most paramount issue for those living in rural areas, with several top-ranking categories, including Mental Health and Mental Disorders, 2) Addiction, 3) Overweight and Obesity, and 4) Drug and Alcohol Use. Health promotion, drug and alcohol use, preventive care, and nutrition/healthy eating were important health behaviors, with a special focus on older adults, children, and adolescents (Callahan et al., 2023).

    Callaghan, T., Kassabian, M., Johnson, N., Shrestha, A., Helduser, J., Horel, S., Bolin, J. N., & Ferdinand, A. O. (2023). Rural healthy people 2030: New decade, new challenges. Preventive Medicine Reports, 33, 102176.

    • The Federal Communications Commission (FCC) is seeking information until November 23 from rural health professionals regarding strategies to enhance general maternal healthcare outcomes. The FCC posed several questions and desires information regarding the efficacy of broadband-enabled technologies, solutions, and services used for maternal care and barriers that prevent virtual care visits and remote patient monitoring services to pregnant and postpartum women. As healthcare professionals, we are a key element in providing answers to these questions about broadband connectivity and maternal health at:

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