WINIBSC1.docx

Module 3: Rural Health Disparities

This module introduces some of the health disparities that are a reality for many rural dwellers. Approaches nurses can utilize to mitigate the impact of some disparities will be addressed.

Module Objectives:

1) Appraise barriers to optimal health care that exist in rural areas.

2) Analyze factors that impact access to care in rural areas.

3) Explore consequences of limited access to healthcare.

4) Explore ways nurses can promote health in areas of limited health care access.

Assigned readings:

Bushy, A. (2013). Health Disparities in Rural Populations Across the Lifespan. In C.A. Winters (Ed.), Rural nursing: Concepts, theory, and practice (pp.225 – 239). Springer.

American Nurses Association (2015) . Code of ethics for nurses: With interpretive statements. Silver Spring, MD: ANA. (choose portions that will be valuable in your synthesis and application post)

COVID – 19 and Rural Health Care. (2020). Online Journal of Rural Nursing & Health Care, 20(1),

1–5. https://doi.org/10.14574/ojrnhc.v20i1.626. Available at

Erwin, C., Aultman, J., Harter, T., Illes, J., & Kogan, R. C. J. (2020). Rural and Remote Communities: Unique Ethical Issues in the COVID-19 Pandemic. American Journal of Bioethics, 20(7), 117–120. https://doi.org/10.1080/15265161.2020.1764139.

Shreffler-Grant, J.M., Nicols, E., Weinert, C, & Ide, B. (2013). Complementary Therapy and Health Literacy in Rural Dwellers. In C.A. Winters (Ed.), Rural nursing: Concepts, theory, and practice (pp.205- 214). Springer.

Be sure to take adequate time to peruse Rural Health Information (RHI) Hub and Center for Disease

Control (CDC) sites as well as other information linked into this module

Key points

· Communities in rural areas are impacted by policies developed at the national level.

· Competition between rural and urban areas in the domain of healthcare occurs increasingly as resources become scarcer.

· Healthcare policies impact rural and urban areas in unique ways.

· A variety of social determinants may impact the health of individuals and families.

· Although health disparities occur in all settings, there are a number that are particularly noteworthy in rural areas.

· Poverty often compounds other risks and vulnerabilities.

· A high proportion rural residents are among the ‘working poor’ and uninsured. Low income correlates with lower educational levels, poorer nutrition, fewer preventative health care practices, increased risk of trauma, developmental delays, inadequate immunization, and increased chronic illness.

· Rural people are often older. Many elderly adults have a low fixed income, relying primarily on social security benefits. They may have difficulty accessing additional benefits

Graded Assignment:  

You will complete your next synthesis and application assignment. Synthesis and Application assignments have two separate components. Please see the information in the Synthesis and Application Assignment folder for a video and more detailed direction. Refer to the grading rubric (Appendix B in your syllabus or at the end of this document) for how points can be earned.  Carefully note the criteria for a professional nursing journal as found in the course syllabus (p. 9). 

Part 1: Choose one of the situations /topics below. You may need to refer back to information from prior assigned readings in addition to the readings assigned for this module. Respond to the situation you choose in the discussion forum adhering to the grading rubric in Appendix B. Note that  all parts of the discussion question/topic must be addressed to earn full points.  You can earn up to 15 points for your initial post.

Part 2: There is an opportunity to review what your peers have posted and build on their knowledge and insights by the date included on the course schedule.  You will post a substantive addition to one of your peers' post. Yoursubstantive addition must address the topic/situation  other than the topic/ situation addressed in your original synthesis and application post . You can earn up to 10 points a substantive addition that meets rubric criteria.

As you search for articles the first weeks of this course, two journals that may be especially helpful are the Online Journal of Rural Nursing and Health Care and the Journal of Rural Health.  Both are readily accessible via the SMSU library.  There are many other articles and journals that will be helpful as well.

Topic One

1. Examine three barriers that may impact access to health care (not including lack of services) that may be especially prevalent in rural areas in the United States. Note: A professional examination regarding this question should include at least three well thought out and professionally written sentences examining each of the three barriers you choose.

2. What are some interventions nurses can implement to mitigate the impact of these barriers?

3. Compare and contrast potential barriers to access to care in rural versus urban areas.

Topic Two

1. How might limited access to health care impact the use of complementary and alternative therapies?

2. Discuss the long-term consequences of limited access to health care services. Include how limited access impacts individuals, families, and the health care system.

3. Briefly discuss two provisions from the Code of Ethics with Interpretive Statements that are relevant when considering health care disparities.

Appendix B: Synthesis and Application Assignment rubric

Remember that integrating your own thoughts with evidence from the literature is an effective to demonstrate synthesis and critical analysis. Sometimes a few short direct quotes add value to your work. But remember that long quotes generally serve to share someone else's thoughts, rather than your analysis.

Please refer to the Synthesis and Application folder for a more detail and guidance.

	Primary post
Criterion	Excellent	Competent	Not satisfactory
Complete	All questions from one chosenscenario/topic addressed in a clear, focused manner. All responses demonstrate critical analysis (3 points)	Not all questions addressed OR responses not clear and focused (2 points)	Not all required questions addressed. (0 points)
Demonstrates synthesis of assigned readings	Post demonstrates that the assigned content was appropriately reviewed, understood, and synthesized. Minimal direct quotations. (points) (6 points)	Demonstrates limited familiarity and synthesis of assigned content. (3 points)	Not all questions addressed. Responses do not demonstrate synthesis of assigned readings (0 points)
Evidence based	At least two professional resources support post. Resources must be integrated, cited, and referenced per APA style. See criteria for professional references on p. 9 of syllabus. Rare APA style errors. (3 pts)	Supported by fewer than two citation/reference pairs. Or provides evidence-based, scholarly references using incorrect APA format. Or provides non-scholarly references with correct APA format in-text. (1.5 points)	Provides no scholarly reference to support position/ideas in postings/discussion and /or uses no APA format (0 points)
Writing quality	Punctuation, spelling, spacing, capitalization, and writing mechanics errors are rare.	Fewer than six total writing mechanics	Six or more writing mechanics errors; run-on sentences.
	Writing is clear, succinct, focused, organized, Easy to understand main ideas. (2 points)	Writing is focused and organized. (1 point)	Writing lacks organization or focus (0 points)
Posted	Posted in both the discussion forum and the assignment box. (1 point)	Not posted in both the discussion forum and the assignment box (0 points)	Not posted as directed. (0 points)
Substantive addition – addition must address the topic/situation  other than the topic/ situation addressed in your original synthesis and application post to earn any points.
Criterion	Excellent	Competent	Not satisfactory
Addition relevant and valuable to nursing practice	Substantive addition demonstrates thorough review of post. Adds at least one new perspective that would be relevant and valuable in nursing practice situations. (3 points)	Addition accurate, but application to nursing practice limited. (1.5 points)	Relevance to nursing practice not included. (0 points)
Demonstrates critical analysis	Offered a critical analysis of an existing posted. Demonstrates that the assigned content was appropriately reviewed, understood, and synthesized. (3 points)	Addition demonstrates limited synthesis of assigned content related to the situation/topic. Agreed or disagreed, but did not provide justification. (1.5 points)	Response not applicable to the situation/topic. (0 points)
Supported by evidence	At least one professional resource supports post. Resources must be integrated, cited, and referenced per APA style. See criteria for professional references on p. 9 of syllabus. Rare APA style errors. (3 pts)	Supported by at least one citation/reference pair. Provides evidence-based, scholarly reference using incorrect APA format Orprovides non-scholarly references with fewer than four APA format errors. (1.5 points)	Provides no scholarly reference to support position/ideas in postings/discussion and /or uses no APA format (0 points)
writing quality	Punctuation, spelling, spacing, capitalization and writing mechanics errors are rare. Writing is clear, succinct, focused, organized, Easy to understand main ideas. (1 point)	Fewer than 6 total writing mechanics Writing is focused and organized. (0.5 points)	Six or more writing mechanics errors; run-on sentences. Writing lacks organization or focus (0 points)