Community health case study - Rural healthcare: Nursing

Nurse. Matthias is a community health nurse who's working on development of a mobile clinic in a rural community for residents to receive preventative and primary care.

He goes through the steps of the clinical judgment measurement model to make decisions about the population's needs by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse mathias recognizes important cues including documentation from the regional community health office that indicates many area residents don't have a primary health care provider.

He also notes that two small rural hospitals in the surrounding area have closed in the last year leaving residents to seek care at the nearest emergency department that's over an hour drive away.

Next nurse Mathias analyzes these cues. He reviews the most recent census data for the area and finds the population is approximately 5000 people which includes single older adults and families with small Children and adolescents.

He also notes that most of the employed residents work as farmers or at the power plant just outside of town. Nurse Mathias knows that barriers to healthcare in rural areas can include limited availability, accessibility, affordability, and acceptability of healthcare services and providers he understands that because of the geographical isolation and population sparseness, rural areas tend to have fewer health care settings, services and professionals available.

And in cases when adequate health care is available, residents may find it inaccessible due to lack of transportation and cost.

He also understands that acceptability of care can be impacted by cultural differences, stigma language barriers and low health literacy in that these barriers can limit use of preventative services and lead to inadequate management of chronic conditions.

In addition, nurse Mathias knows that rural residents are at higher risk for chronic conditions like hypertension and diabetes and are more likely to engage in risky health behaviors like alcohol and tobacco use than urban residents.

And since most residents in the community are farmers or plant workers, they have an increased risk of suffering from occupational injuries and hazards.

Nurse Mathias recognizes that having affordable access to a health care provider can promote health and wellness among rural residents and that residents of this rural community could benefit from the creation of a mobile clinic where health care providers travel to certain areas to deliver direct health care services to those without sufficient access to care.

Now, using the information he's gathered nurse matthias chooses a priority hypothesis of ineffective access to health care.

Then he generates solutions to address the community's ineffective access to health care. And he establishes the expected outcome that within 18 months of intervening at least 15% of the residents in the community will have been served by the mobile clinic.

Then nurse Mathias takes action to implement these solutions. First, he holds several informational sessions of the public library to gain the perspective of residents understand their needs and elicit feedback.

He also invites interested and engaged community members to join the mobile clinic planning team. Then nurse Mathias and representatives from the planning team bring information to community leaders like the mayor, school administrators and local clergy to obtain support and inform them of the goals of the mobile clinic.

Nurse Mathias secures funding through several resources including government grants and donations from community leaders and partners.

The planning team then suggests that the mobile clinic will be housed in a van parked at the elementary school two days per week with bimonthly drives into the more isolated areas to visit hard to reach residents.

Over the next few months, nurse Mathias begins organizing the health care staff and equipment needed to run the mobile clinic to build trust with residents and provide continuity of care.

Nurse Mathias encourages the same health care providers and clinical staff to work at the mobile clinic during the weekly and monthly shifts.

Whenever possible, the mobile clinic will offer preventative services such as BP, blood glucose and cholesterol measurements, mental health screenings and immunization administration for residents with existing or newly identified chronic conditions.

Nurse Mathias arranges for follow up care to be available via telehealth as well as monthly checkins at the mobile clinic to further promote health in the community.

Nurse Mathias arranges a monthly presentation inside the elementary school that's free and open to the public. Each presentation will focus on a particular health promotion or illness prevention topic such as exercise and meal planning or avoiding common occupational hazards for farmers and plant workers.

Then nurse mathias works with the nurse researcher to create surveys to develop a plan to gather information from residents about their experiences with the mobile clinic.

They also plan to ask residents about new services. They would like to see enacted as well as relevant health promotion and illness prevention presentation topics.

Once planning is complete, nurse Mathias asks residents and community leaders to encourage attendance by posting information about the mobile clinic around town and online nurse Mathias and his mobile clinic team then prepared to host their first visit with the community at the end of the mobile clinics.

First year running nurse Mathias evaluates the outcomes of his actions. He calculates that 762 residents or 15.2% of the community utilized resources offered by nurse Mathias and the mobile health team.

This included Children and adolescents receiving recommended immunizations. Residents who underwent health screenings, attendees at the public health presentations and residents with chronic conditions who checked in with healthcare providers at the mobile clinic and via telehealth.

All right. As a quick recap, nurse Mathias recognized and analyzed cues related to the rural community's ineffective access to health care and prioritized hypotheses and generated solutions to address this problem.

Nurse Mathias then implemented interventions to improve access to health care for the rural community residents and evaluated the outcomes compared with the expected outcomes.

Since over 15% of the community's residents accessed care available at the mobile clinic. Within its first year, nurse Mathias determined the plan of care was successful.