Ethical imperative to health and epistemological distance : rural patients and advanced practice registered nurses
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Rural populations have increased mortality, lower life expectancy, and less access to specialty care. Rural health disparities result from geographic, social, and epistemological barriers. In the wake of rural hospital closures, rural patients necessarily seek care from non-rural hospitals. These barriers facilitate comorbidities and untreated illnesses, requiring complex care that advanced practice registered nurses (APRNs) can provide. APRNs offer unique insights into the context of rural care. To explore these dynamics, this study uses a systematic literature review and analyses of semi-structured in-depth interviews. The literature review uses the Preferred Reporting Items for Systematic reviews and Meta-Analyses Scoping Review extension (PRISMA-ScR) methodology. This review explores the role and scope of APRNs in rural health. This study used semi-structured in-depth interviews to discuss rural health barriers with twenty APRNs, including nurse practitioners (NPs), certified nurse midwives (CNMs), and clinical nurse specialists (CNSs). These APRNs practice within a large, Midwestern, university-affiliated, non-rural, hospital system with a level one trauma center. APRNs provide insights into rural barriers to health, including their role in addressing rural health challenges. Addressing rural patients' limited cultural health capital and infrequent exposure to healthcare systems, APRNs engage in culturally competent care. Culture, as well as the ways in which rural populations understand health, are consequential factors in care outcomes. Building trust and rapport with rural patients is essential to rural patient care, especially for those who are wary or distrustful of clinical approaches to health. APRNs confront the ways in which rural culture intersects with epistemology, meeting challenging dynamics within the context of providing care.
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Ph. D.