The Roles of Registered Nursing in Shaping and Providing Care in Rural and Remote Locations: A Literature Review
The roles and perspectives of nursing have undergone major changes in the past several decades, continuing the rapid and profound development that this area of medical science and art has experienced in its relatively brief history. For quite some time, nursing existed either as a highly denigrated and unskilled profession looked down upon my others in the medical establishment and society at large, or as the semi-sacred and highly secret practice of healing through natural remedies and purely experiential knowledge transmitted orally and though demonstration from generation to generation. An appreciation and codification of nursing as a science -- albeit a science with certain subjective and aesthetic principles, making the designation of nursing as an art somewhat appropriate as well -- did not really occur until the nineteenth century, marking a rather slow beginning to this area of knowledge.
Since its inception and recognition as a valuable science, however, nursing has risen rapidly in the degree of prestige and respect that is conferred upon it as well as the degree of influence that it has on the practice of medicine as a whole. More and more, nurses are relied on to provide primary care to patients both under the direction of a physician and as autonomous decision makers. Nursing research also informs actual medical practice at a variety of institutions on an ever-increasing basis, and though many nurses still feel that they do not receive the level of respect and recognition they deserve, there is much evidence that this situation is changing.
One area in which the importance and autonomous nature of nurses can be clearly seen is in the ongoing development of care practices and models for patients in rural and geographically isolated areas. While much of the world is becoming increasingly more interconnected, the geographic removal of certain areas of the world and regions of even the most developed countries has highlighted certain issues in the medical industry that must be addressed. When it comes to actually examining these situations and developing plans of care, nurses have been central both as researchers and as recommended practitioners. This paper will provide a brief preliminary literature review of the role that registered nurses play in the provision of medical services to patients in rural areas, both in terms of direct practices and techniques that have been recommended and the roles that registered nurses have played in the research, development, and design of these practice models.
Registered nurses and nurse practitioners have been on the forefront of providing primary medical care for some time, and have been instrumental in designing best care practices while demonstrating highly favorable performance outcomes (Naylor & Kutzman 2010). This has put nurses in a unique and far more effective position in terms of assisting patient in rural communities, as nurses are more plentiful in number and more effectively networked than physicians (Banner et al. 2010; Coyle et al. 2010). Through ongoing research directly embedded in care giving scenarios, rural nursing continues to be refined (Banner et al. 2010).
There is actually a lack of codification of nursing standards, expectations, and licensing requirements as well as licensable capabilities on an international basis as well as intra-nationally in many countries (Naylor & Kutzman 2010). This can make it somewhat difficult to achieve consistent practice guidelines and widely valid and applicable research results, as the legal and often intrinsic (due to differences in education and training) capabilities of nurses can different greatly from country to country and from region to region (Naylor & Kutzman 2010). This has not stopped nurses in geographically disparate areas from forming networks of support and information sharing as a means of developing best practices, but it has certainly not made this process as truly efficient as possible or officially facilitated through any professional organization or government entity (Banner et al. 2010).
There has been some success in the development of care practices for rural and isolated patients, which is evidenced in research in at least two countries with highly dissimilar situations, though bound by a relatively close cultural and nursing association (Banner et al. 2010; Coyle et al. 2010). In both Canada and Australia, nurses have already begun to design and implement care practices for rural individuals and communities, which face generally higher rates of disease and have significantly less access to medical care and resources (Banner et al. 2010; Coyle et al. 2010). Improvements in care based on these practices cannot yet be measured, as the practices have only just begun to be designed and implemented, but it appears that by taking the lead in this area nurses have already contributed a great deal of positive change.
This does not mean that there are not significant barriers for these nurses to surmount. The Australian study noted that despite the clear importance and necessity of nurses' positions and geographic distribution in providing primary care to rural and isolated patients, and although there has already been some evidence of success in providing care to these patients through extended networks of nurses, the lack of national codification, standardization, and networking is a definite detriment to such efforts (Coyle et al. 2010). If there were a better information sharing and standardization system in place, expectations and nursing needs could be more easily communicated, leading to quicker improvement in care and a great efficiency of care for rural patients (Coyle et al. 2010). This is similar to general findings in other countries regarding the need for a greater standardization of training, knowledge and licensing requirements, and practice expectations (Naylor & Kutzman 2010).
A separate though related barrier that has been identified to developing the most efficient and effective care practices for rural patients is the lack of sufficient authority and official responsibility for nurses as recognized by governments, medical organizations, and other medical practitioners (Banner et al. 2010). Greater levels of support and empowerment for nurses both through official channels and from within the nursing community itself would increase the effectiveness of rural care programs and also provide more effective avenues for researching and designing more efficient care networks and practices (Banner et al. 2010). Such support does not appear to be immediately forthcoming, however.
This leaves the profession and industry of nursing in a somewhat difficult position, as a clear need and role for nurses in the provision of primary medical care to rural and isolated patients has been identified, yet the means of fulfilling this role and taking care of the identified needs have not really been afforded to nurses in even highly developed countries with strong degrees of infrastructure (Naylor & Kutzman 2010; Banner et al. 2010; Coyle et al. 2010). Nurses are thus left with a clear understanding of what needs to be done, yet with little in the way of real resources or networks available to accomplish what appears to be a relatively clear plan of action. There is a great deal of consensus about what works for nurses providing primary care in rural and isolated situations, which is a highly encouraging fact for the situation (Banner et al. 2010; Coyle et al. 2010). At the same time, it would be far more encouraging if proper avenues for growth and the improvement of this knowledge and its application were put into place and standardized across regions and nations.
The issues that are faced in this instance are in many ways the same issues that have faced nurses and the profession of nursing since it truly became a profession: despite a rising level of respect, nursing is still perceived by many as a secondary field in the provision of medical services, and thus it does not receive the level of official…