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. https://doi.org/10.1007/s10900-021-01052-6

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. https://doi.org/10.1037/fsh0000742

Rural Health Information Hub (RHIhub). (2023). Community health workers in rural settings. https://www.ruralhealthinfo.org/topics/community-health-workers

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. https://www.cdc.gov/nchs/fastats/disability-and-risk-factors.htm

CDC. (2023). Working together, we can help children in rural communities thrive. https://www.cdc.gov/childrensmentalhealth/features/rural-health.html

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. https://doi.org/10.1542/peds.2020-041723

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. https://doi.org/10.1001/jamanetworkopen.2023.31807

RNO will consider requests to share research studies with RNO members. Requests should be sent to membership@ruralnurseorg.org.

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.  

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.): https://www.ruralminds.org/mental-health-resources-by-topic

B. Mental Health Resource Names (organizations, associations, networks, etc.): https://www.ruralminds.org/mental-health-resources

C. Crisis Resources: https://www.ruralminds.org/crisis-resources

D. Programs and Resources to Build Mental Health Resilience: https://www.ruralminds.org/resilience

E. Mental Health Webinar: https://www.ruralminds.org/rural-mental-health-connections-webinar

F. Farm State of Mind Resources: https://www.fb.org/initiative/farm-state-of-mind

G. Other Key Mental Health Stakeholders (webinars, podcasts, presentations, toolkits, etc.): https://www.ruralhealthinfo.org/topics/farmer-mental-health

H. Agriculture Stress Help Line: https://www.agrisafe.org/agristress-helpline/

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. https://doi.org/10.1016/j.amepre.2018.01.004

Capriotti T, Pearson T, & Dufour L. (2020). Health disparities in rural America: Current challenges and future solutions. Clinical Advisor. https://www.clinicaladvisor.com/home/topics/practice-management-information-center/health-disparities-in-rural-america-current-challenges-and-future-solutions/

Centers for Disease Control and Prevention. (2022). Disparities in suicide. https://www.cdc.gov/suicide/facts/disparities-in-suicide.html

National Institute of Mental Health. (2018). Mental health and rural America: Challenges and opportunities. https://www.nimh.nih.gov/news/media/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. https://www.pewresearch.org/fact-tank/2021/08/19/some-digital-divides-persist-between-rural-urban-and-suburban-america/1

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. https://doi.org/10.1016/j.pmedr.2023.102176

• 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: https://www.fcc.gov/document/fcc-invites-public-comment-broadband-connectivity-maternal-health

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

• Over three million individuals who live in rural areas use the Veterans Affairs for their medical care (AARP, 2016). These older individuals are more likely to take multiple medications to manage chronic health conditions. In one study, almost 77% of veteran geriatric patients seen in the Emergency Department had five or more prescription medications, with over 80% taking at least one high-risk medication (Morizio et al., 2021). Unfortunately, taking this number increases the risk for medication errors and can lead to other deleterious side effects, such as falls. In examining useful interventions to improve medication adherence and management, the IMPROVE program used face-to face consultation, with recommendations, education, and other strategies. The IMPROVE program showed a 75% or greater improvement in the timing and dosages of prescribed medications, with a 14% decrease in potentially inappropriate medications. This pharmacist-led program is now available in local and rural Community-based Outpatient Clinics (CBOCs). More information about implementing a Rural Promising Practice is available at www.ruralhealth.va.gov or by email at rural.health.inquiry@va.gov. (Source: https://www.ruralhealth.va.gov/docs/promise/IMPROVE_OnePager_51117.pdf)

American Association of Retired Persons ([AARP], 2016). Chronic conditions among Americans. https://assets.aarp.org/rgcenter/health/beyond_50_hcr_conditions.pdf

Morizio, P. L., Mistry, V., McKnight, A., Pepin, M. J., Bryan, W. E., Owenby, R. K., Previll, L., & Ragsdale, L. C. (2021). Polypharmacy and high-risk medications in older veterans presenting for emergency care. Journal of Geriatric Emergency Medicine, 2(12), Article 3. https://institutionalrepository.aah.org/cgi/viewcontent.cgi?article=1007&context=jgem

• Over the last several years, rural physicians have progressively decreased in number while nurse practitioners (NPs) have increased, leaving a pathway for many NPs to meet the healthcare needs of individuals who live in rural areas. About 90% of NPs are certified in primary care, 70% deliver that care, and represent about one out of four rural providers (AANP, 2020, 2022). These statistics indicate NPs provide comprehensive care to rural patients through health promotion and prevention and management of chronic illnesses. Measuring this valuable care that results in positive health outcomes in rural patients is essential to share among ourselves but also with others who have an active voice in advancing our discipline.

AANP (2020, November 19). AANP highlights NP Role in providing accessible rural health care during pandemic. https://www.aanp.org/news-feed/aanp-highlights-np-role-in-providing-accessible-rural-health-care-during-pandemic

AANP (2022). 2022 AANP National Nurse Practitioner Workforce Survey — Preliminary analysis. https://storage.aanp.org/www/documents/NPFacts__111022.pdf?_gl=1*1j7cjqc*_gcl_au*MTYwNzE1MDI4NC4xNjk1MDg1MjY4

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

Below are three programs that will potentially provide essential services, safer living areas, job opportunities, and valuable resources for individuals who live in rural areas.

• The USDA is contributing more than 800 million dollars toward improving rural electric services to connect thousands of individuals in rural areas. Another key service is to provide clean drinking water (e.g., removing steel, lead, and cast-iron service lines), and wastewater systems. These efforts will offer rural employment opportunities for close to 500,000 individuals in 36 states and two U.S. territories. Loans or grants also are available to provide these improvements in low-income communities. (Source: https://www.usda.gov/media/press-releases/2023/08/28/biden-harris-administration-announces-more-800-million-strengthen)

• Starting in 2025, the Medicare Prescription Payment Plan will offer Medicare recipients the ability to make regulated monthly payments for out-of-pocket medications over 12 months (Source: https://www.cms.gov/files/document/medicare-prescription-payment-plan-fact-sheet.pdf).

• The 2026 Medicare Drug Price Negotiation Program will allow Medicare to negotiate prescription prices with drug companies for expensive patented drugs, without substituting generic equivalents. Initially, Medicare has released 10 drugs used to treat kidney and heart disease, diabetes, coronary and peripheral artery disease, rheumatoid arthritis, and others illnesses (Source: https://www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf).

Just as orthopedic nurses are skilled at caring for the musculoskeletal system, and cardiac nurses specialize in caring for the heart, rural nurses are skilled at knowing a little bit about everything and balancing the needs of their patients with the often limited resources in small and sometimes isolated parts of the country.

With this realization, NRHA is excited to launch its Rural Health Nursing Certification Program! Join us for a webinar about this brand new, multifaceted course designed to equip rural nurses with the information they need and a network of colleagues to help them provide quality care in rural settings while recognizing and celebrating their vast skill sets.

For more information, see below:

Nursing Certification Program Webinar on February 21st at 1 pm EST – register here

Enrollment is open for all Certification Programs for 2023 Cohorts - visit our website for details and application information at www.crhleadership.com

The 2023 election is now closed. Please check back in early 2024 for the next election cycle.

The Call for Nominations is open for the 2023 RNO Election. Please consider nominating a member colleague or yourself. A nominee must be a current RNO member. 

Offices to be filled in 2023:

• President Elect: 1-year, then 2 as President, then 1 year as Past President
• Treasurer: 2-year term
• Member at Large: 3-year term

Please send the nominee’s name, the office, the nominee’s qualifications, and contact information to Adrianne Lane at lanea6@nku.edu by February 28, 2023. If you have questions, please email Adrianne and set up a time to discuss any questions you may have. Do consider this leadership opportunity.  Thank you.