Community health case study - Rural healthcare: Nursing

Nurse Mathias 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 5,000 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 health care services and providers. He understands that because of the geographical isolation and population sparseness, rural areas tend to have fewer healthcare settings, services, and professionals available; and in cases when adequate healthcare 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, and 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 healthcare services to those without sufficient access to care.

Now, using the information he’s gathered, Nurse Mathias chooses a priority hypothesis of ineffective access to healthcare.

Then, he generates solutions to address the community’s ineffective access to healthcare; 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 at 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.