Themes of rural health and aging from a program of research.

The culture and diversity of rural life and limitations of rural health systems to meet the changing health needs of an aging population lead to problems of obtaining appropriate care in rural America. In a program of nursing research involving three ethnographic studies in rural Colorado, transitions of older adults across differing levels of heath care were explored. The sample totaled 425 participants, of whom 25% were Hispanic. Five major themes emerged: circles of formal and informal care; integration of faith, spirituality, and family with health status; crisis nature of health care transitions; nursing homes as a housing option; and changing spirit of traditional rural nursing. Recommendations for providers included making their practices congruent with rural culture, being fully informed of available resources, facilitating acceptable health care decisions, and integrating physical, mental, and spiritual health care for elders and their families.

The crisis nature of health care transitions for rural older adults.

The complex health, socioeconomic, and environmental problems experienced by many American elders often place them at high risk for disease and disability. Over time, acutely or chronically ill older persons experience numerous transitions across various health care settings. Although availability of health services is improving in rural areas, barriers such as distance, geography, and poor distribution often limit access to health care. In a longitudinal rural ethnography, the health care transition experiences of older adults, families, and health care providers were examined. A major ethnographic theme emerged from analysis data from interviews, participant observations, and photographs: the crisis nature of health care transitions experienced by rural older adults and their families and observed by rural nurses and other health care providers. Several patterns were observed including the crisis was compounded by surprise; limited knowledge of local resources exacerbated the crisis; inconsistent discharge planning disrupted transitions; changing family support necessitated admission to nursing homes; continuity of care in nursing home discharge lessened transition crisis; and rural home health care was identified as a strength. Recommendations were made for community-based interventions to improve the transition experience. Comprehensive care management services provided by public health nurses (PHNs) in the local rural community were recommended.

Rural nursing homes: a housing option for older adults.

Rural conditions and circumstances contribute to different perspectives on institutional long-term care. A rural ethnographic study revealed issues of transition into and out of nursing homes as identified and illustrated by older adults, their families, and care providers. Findings included the use of rural nursing homes as an alternate housing option because of limited assisted-living options, appropriate and inappropriate referrals to nursing homes, and strained family caregivers. Helping olders adults and families evaluate and access appropriate community resources, including housing, is essential to providing continuity of care.

The changing spirit of rural community nursing: documentation burden.

Rural community and public health nursing are characterized by an impressive commitment of nurses to their communities and a connectedness of people to one another. Home care as an integral part of long-term and acute care for the older adult population has emerged as a vital practice area in community health nursing. The purpose of this ethnographic field study was to describe rural home care for frail older adults from the perspective of those providing and receiving care. More than 250 interviews were conducted with home care providers, recipients and their families, and other community members. The setting included eight culturally and geographically diverse counties in rural Colorado. One major theme is presented: the perceived change in the spirit of rural community nursing due to the overwhelming documentation required for home care reimbursement. Oppressive paperwork requirements impeded practice and resulted in fewer home visits per day, low job satisfaction, increased nursing staff turnover, decreased quality of care, and changed the spirit of community nursing from an emphasis on caring and community service to a focus on reimbursement. The study results have timely implications for health policy formulation as the United States undergoes major health care reform.

Managing the incongruities: the hospital discharge experience for elderly patients, their families, and nurses.

The purpose of this study was to describe the elderly person's hospital discharge experience. Using a grounded theory design, data were generated from patients, families, and nurses. Four major categories emerged: (a) diversity of discharge readiness--patients were ready for discharge, families were not, and nurses were uncertain; (b) family support for patients--families supported the patients, but no support was offered to families; (c) decision making--patients and families were not involved; and (d) multidisciplinary approach--patients and families experienced confusion and distress with lack of team coordination. Managing the incongruities of the discharge process was a struggle for patients and families.

Circles of care: home care and community support for rural older adults.

Rural dwelling, frail older adults are a vulnerable population owing to the complexity of health problems superimposed upon limited health care resources. Home care facilitates managing complex health needs and is congruent with rural valued independence. An ethnography was conducted to describe rural home care for frail older adults from the perspective of those delivering and receiving services. A major theme identified was "Circles of Care." Grounded in rural culture, the circles assisted the system of formal care to work in harmony with informal care, maintaining independence for vulnerable rural elderly and their families.

Visions of rural aging: use of photographic method in gerontological research.

The use of photography is described as a method embedded within an ethnographic investigation of rural home care for older adults. Photography fostered data generation, elicited participants' stories, and illustrated patterns of rural aging. Analysis of photographic data pooled with interview and observational data facilitated an in-depth understanding of rural aging and home health care.