Post on 11-Nov-2018
Negotiating the Terrain:
The Challenges and Rewards of
Rural Nursing
Judith C. Kulig, RN, DNSc
Associate Professor
School of Health Sciences
University of Lethbridge
Thanks to:
The Conference Organizers
Wendy Herbers, School of Health Sciences, U of L
Drs. Ray Bollman,
Valerie du Plessis,
Roland Beshiri - Statistics Canada
Ernie Dal Grande - Health Canada
Increased Interest in “Rural”
What Is Rural?
Geographic Building Blocks
* Census Subdivision (CSD) 5,984 CSD
* Census Division (CD) 288 CD
Predominantly Rural Region -
More than 50% of the population
living in rural communities and
population density <150 person/km2
Beshiri & Bollman (2001)
Rural and Small Town Canada: An Overview
Demography: Population Structure
• 31.4 percent of Canada’s population lives in predominantly rural regions (in 1996)
• “predominantly rural regions” have over 50 percent of their population living in rural communities (A rural community is a census consolidated subdivision with less than 150 persons per square kilometer. Census divisions are used to delineate “regions”, to facilitate comparisons with other OECD countries.)
In 1996, 31.4 percent of Canada's population
lived in predominantly rural regions
0
5
10
15
20
25
30
35
40
45
50
1981 1986 1991 1996
Perc
en
t o
f to
tal p
op
ula
tio
n
Predominantly rural regions
Source: Statistics Canada. Census of Population, 1981 - 1996. A predominantly rural region has over 50 percent of its population living in rural communities. An intermediate region has 15 to
49 percent living rural communities and a predominantly urban region has less than 15 percent of its population living in rural communtieis.
Percent distribution of Canada's predominantly
rural population among the provinces
0 2 4 6 8 10 12 14 16 18 20 22 24
Yukon
Northwest Territories
Prince Edward Island
Newfoundland
Manitoba
Saskatchewan
Nova Scotia
New Brunswick
Alberta
British Columbia
Québec
Ontario
Percent of Canada's predominantly rural population in each province in 1996Source: Statistics Canada. Census of Population, 1996. A predominantly rural region has 50 percent of more of its populatoin living in rural communities.
490 thousand Manitobans
live in predominantly rural regions
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
1981 1986 1991 1996
Po
pu
lati
on
Predominantly rural regions
Predominantly urban
Source: Statistics Canada. Census of Population, 1981 - 1996. A predominantly rural region has over 50 percent of its population living in rural communities. An intermediate region has 15 to
49 percent living rural communities and a predominantly urban region has less than 15 percent of its population living in rural communtieis.
Population growth is smaller
in predominantly rural regions
0
2
4
6
8
10
12
1981 to 1986 1986 to 1991 1991 to 1996
Pe
rce
nt
ch
an
ge
in
po
pu
lati
on
(o
ve
r fi
ve
ye
ars
)
Predominantly urban regions Intermediate regions Predominantly rural regions
Source: Statistics Canada. Census of Population, 1981 - 1996. A predominantly rural region has over 50 percent of its population living in rural communities. An intermediate region has 15 to
49 percent living rural communities and a predominantly urban region has less than 15 percent of its population living in rural communtieis.
Population growth is larger in rural regions
adjacent to metro centres
-2
-1
0
1
2
3
4
5
6
7
8
1981 to 1986 1986 to 1991 1991 to 1996
Pe
rce
nt
ch
an
ge
in
po
pu
lati
on
(o
ve
r fi
ve
ye
ars
)
Rural Metro-Adjacent Regions Rural Non-Metro-Adjacent Regions
Rural North Regions
Source: Statistics Canada. Census of Population, 1981 - 1996.
Rural and Small Town
Outside the commuting zones of
larger urban centres (with
10,000 or more)
duPlessis, Beshiri, & Bollman (2000)
Rural and Small Town Canada: An Overview
Demography: Population Growth
• At the Canada level, the rural and small town population is increasing.
• In Newfoundland and Saskatchewan, the rural and small town population has been decreasing for decades.
• In the other provinces, the rural and small town population is increasing only in areas where individuals can commute to cities or where individuals wish to retire.
Rural and Small Town Population, Canada, 1966 to 1996
0
1
2
3
4
5
6
7
8
9
1966 1971 1976 1981 1986 1991 1996
Population (millions)
Source: Statistics Canada. Census of Population, 1966 to 1996.
Rural and small town refers to the population outside Census Metropolitan Areas (CMAs) and outside Census Agglomerations (Cas).
Rural and Small Town Population,
Manitoba, 1966 to 1996
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40
0.45
0.50
1966 1971 1976 1981 1986 1991 1996
Population (millions)
Source: Statistics Canada. Census of Population, 1966 to 1996.
Rural and small town refers to the population outside Census Metropolitan Areas (CMAs) and outside Census Agglomerations (CAs).
Population trends:
Rural minority in Manitoba in 1951
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1871 1881 1891 1901 1911 1921 1931 1941 1951 1961 1971 1981 1991
Rural (centres under 1,000)
Urban (centres 1,000+)
Source: Statistics Canada. Census of Population, 1851 - 1996.
Old Age Dependency Ratio:
> is highest in rural non-metro-adjacent regions
> is increasing everywhere
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
Predominantly
rural regions
Intermediate
regions
Rural metro-
adjacent regions
Rural non-metro-
adjacent regions
Rural northern
regions
Old
ag
e d
ep
en
den
cy r
ati
o(p
op
ula
tio
n 6
5 y
ea
rs a
nd
ov
er
as
pe
rce
nt
of
po
pu
lati
on
15
to
64
)
1981
1986
1991
1996
Source: Statistics Canada. Census of Population, 1981 to 1996. A predominantly rural region has over 50 percent of its population living in rural communities. An
intermediate region has 15 to 49 percent and a predominantly urban region has less than 15 percent.
Child Dependency Ratio:
> is highest in rural northern regions
> is declining everywhere
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Predominantly
rural regions
Intermediate
regions
Rural metro-
adjacent regions
Rural non-metro-
adjacent regions
Rural northern
regions
Ch
ild
de
pe
nd
en
cy r
ati
o
(po
pu
lati
on
un
de
r 1
5 y
ea
rs o
f a
ge
as
pe
rce
nt
of
po
pu
lati
on
15
to
64
)
1981 1986 1991 1996
Source: Statistics Canada. Census of Population, 1981 to 1996. A predominantly rural region has over 50 percent of its population living in rural communities. An
intermediate region has 15 to 49 percent and a predominantly urban region has less than 15 percent.
Health Status of Rural
Canadians
largely ignored
Geographic Setting
- Deterioration of health status
- Impact of place
Employment Patterns
• Lung cancer rates higher in mining areas (Pong, et al., 1999)
• Emphysema & asthma among farmers (Fair, 1992)
• Decline in lung function among swine workers & grain farmers (Kirychuk, S.P., Senthilson, A.,
Dosman, J.A., et al., 1998)
Unique Populations
• First Nations
• Ethnic Groups
• Women
Health Services & Health
Professionals
• Fewer physicians in rural areas
• Rural and remote nursing practice – poorly
studied
The Nature of Nursing Practice in
Rural and Remote Canada
PIs: Dr. M. Macleod, UNBC
Dr. J. Kulig, U of L
Dr. N. Stewart, U of S
Dr. R. Pitblado, Laurentian
http://ruralnursing.unbc.ca
Co-Investigators
* Ruth Martin-Misener Dalhousie University * Ginette Lazure Université Laval
* Jenny Medves Queen's University
* Michel Morton Lakehead University
* Carolyn Vogt U. Manitoba
* Gail Remus U. Saskatchewan
* Debra Morgan U. Saskatchewan
* Dorothy Forbes U. Saskatchewan
* Barbara Smith U. Saskatchewan
* Carl D'Arcy U. Saskatchewan
* Elizabeth Thomlinson U. Calgary
* Kathy Banks UNBC
* Sandra Kioke UNBC
* Lela Zimmer UNBC
Advisory Team Members
•Marian Knock, B.C. MOH, Principal Decision-Maker
•Denise Alcock, U. Ottawa
•Madge Applin, Centre for Nursing Studies, Nfld.
•Donna Brunskill, SRNA
•Elizabeth Cook, Aurora College, Yellowknife, NWT
•Marta Crawford, MARN
•Fran Curran, Yukon Health & Social Services
•Joyce England, ANPEI
•Fjola Hart Wasekeesikaw, Aboriginal Nurses Ass’n
•Adele Vukic, Dalhousie U.
•Cecile Hunt, North Central Health District, SK
•Kathleen MacMillan, Ontario Health and Long-Term Care
•Maria MacNaughton, MSB - Health Canada
•Suzanne Michaud, QHA
•Rachel Munday, Health and Social Services, Nunavut
•Debbie Phillipchuk, AARN
•Francine Anne Roy, CIHI
•Marlene Smadu, Saskatchewan Health
•Roxanne A. Tarjan, NANB
•Cathy Ulrich, Northern Interior Health Region, BC
Funding Partners
• Canadian Health Services Research Foundation
• Canadian Institutes of Health Research
• Nursing Research Fund
• Ontario Ministry of Health and Long-Term Care
• Alberta Heritage Foundation for Medical Research
• Michael Smith Foundation for Health Research
• Nova Scotia Health Research Foundation
• British Columbia Rural and Remote Health Research Institute
• Saskatchewan Economic and Cooperative Development
• Provincial and Territorial Nurses Associations
• Government of Nunavut
• Canadian Institute for Health Information
Rewards of Rural Nursing
Practice
• Provide care to unique populations
• Contribute to rural sustainability
• Pursuit of a specific lifestyle
Challenges of Rural
Nursing Practice
Broader but unclear scope
Misunderstandings and lack of
understanding
Lack of Resources
Recruitment and Retention
* Satisfaction with job and community
Rural Health Research & Training
Lack of Education
n = 14
UNBC University of Manitoba
Athabasca University of Saskatchewan
University of Lethbridge Sask. Indian Federated College
University of Alberta University of Ottawa
University of Calgary University of Toronto
Dalhousie University Univ. of Western Ontario
Univ. of New Brunswick Memorial University
(Minore, Kulig, Stewart, & Mack, 2001)
Less than half offered courses
in rural health
• 64% of the students chose a rural health
focus
• 7 of the programs indicated that their
faculty conducted rural health research
(Minore, Kulig, Stewart, & Mack, 2001)
Inappropriate Policies
The Future of
Rural Nursing Practice
Evidence Based Practice
• Rural nurse researchers
• Use of knowledge
• Preparing future rural nurses
New Models for Health
Care Delivery
Nurse Responder
RN First Call Program
“Nurse Practitioners”
Using Technology
Telecommunications infrastructure
FNIHB Pilot Project
Telehealth
Source: Gary Larson