Rural Health in Virginia: Disparities, Dilemmas, and Overview of a JMU School of Nursing Solution

Background: There is no unified definition of rurality; this makes studying rurality, rural health, and associated health disparities and health outcomes difficult. Rural Americans constitute approximately 15% of the U.S. population, and they experience multiple barriers to healthcare and numerous health disparities as a result, particularly related to chronic disease, mental health, and increased lifestyle-linked health risks. Rural Americans should be viewed as a unique and vulnerable population, one with specific health promotion and disease prevention needs. Local problem: Although Virginia as a whole is a wealthy state, much inequity exists between the “Golden Crescent” and the “Rural Horseshoe” regions of Virginia, which includes the western portion of the State. Rural Virginians face higher unemployment, a higher poverty rate, and decreased access to care. One such area is Page County, Virginia, a local underserved health professional shortage area. Methods: In 2018, JMU obtained a HRSA grant focusing on Nursing Education, Practice, Quality, and Retention called, “The Undergraduate Primary Care and Rural Education (UPCARE) Project: a Community-based Nursing Education Collaboration. Intervention: The UPCARE Project allows JMU School of Nursing to respond to the needs for 1) BSN student education focusing on community health and primary care in a rural area, and 2) the creation two RN preceptor positions which incorporate a enhanced primary care RN role within 4 Rural Health Clinics (RHCs), all of whom are facilitated by a faculty-led grant team, including a Nurse Liaison. This two-pronged approach enables nurses to work to meet the health needs of the residents of Page County, Virginia. It is an innovative approach in keeping with Virginia’s State Rural Health Plan. Results: The JMU UPCARE Project is a collaborative, community-focused solution to the rural health disparities facing Page County. To date, nine students have started their clinical experiences in Page County, and two RN preceptors are starting their enhanced primary care RN role in the Rural Health Clinics. Conclusions/ Implications: This presentation will focus on rural health nursing in general, rural health disparities in Virginia, the creation of the UPCARE Project as part of the solution to meet the health care needs of rural Virginians. In keeping with the theme of the conference, the presentation will focus on the development of an enhanced primary care RN role, which is designed for RNs to work at the top of their practice scope

Structural barriers to health care access and IPV disclosure in first-generation Latina immigrants

Background: This study aimed to describe the unique structural barriers faced by Latina women in rural areas of Virginia as they attempt to access the health care system, and, once they have gained access, to identify barriers to intimate partner violence (IPV) disclosure. Methods: Semi-structured in-depth individual interviews with first-generation Latina immigrants were conducted after initial purposeful convenience sampling and concomitant snowball recruiting. A thematic content analysis using a phenomenological approach was employed to interpret participants\u27 experiences. Initial findings were validated through additional interviews. Results: The overarching theme expressed by these women was their search for dignity. Emergent sub-themes related to health care barriers and reluctance to disclose IPV included: no confianza, having a voice, being marginalized, and navigating a dysfunctional system. Discussion: Initial encounters with the health care system that led participants to feel disrespected interfered with care access and a sense of safety in answering intimate questions, especially concerning safety. The dysfunctional and disjointed health care system also creates unintended barriers to access and continuity of care. Conclusion and Recommendations: The experiences of barriers encountered by the women in our study suggests that reported discrepancies in IPV disclosure rates may be related to their level of perceived safety when being screened. In an effort to provide more accessible, safe and relevant care, an equity-informed approach such as trauma and violence informed care should be implemented within health care organizations to help provide more satisfying, safe and comprehensive care to immigrant populations

Ethical Reasoning Development through Disaster Simulation: SoTL in a Simulation Laboratory.

This SoTL study measured the effect of a disaster nursing simulation and debriefing session on nursing students’ perceived ethical reasoning confidence and beliefs in the importance of ethical reasoning. The simulation was placed within a community health undergraduate nursing course to teach disaster education, including triage/ prioritization, and ethical reasoning concepts. Using a quasi-experimental design, this study compared participants’ responses before and after the simulation using the Survey of Ethical Reasoning. Post-test results demonstrated an increase in students’ perceived ethical reasoning confidence, perceived importance of ethical reasoning, and utilization of our University’s Eight Key Questions Ethical Reasoning Framework