Quality challenges in rural communities

Online Journal of Rural Nursing & Health Care, Spring, 2009 by Marietta Stanton

In a few short weeks the Rural Nursing Organization will sponsor their annual conference on quality health care in the rural environment. What do we really by the term quality? The U.S. Institute of Medicine (IOM) defines "quality" as: the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. IOM released the report, "Crossing the Quality Chasm: A New Health System for the 21st Century" (IOM, 2001) calling for fundamental reform of the U.S. health care system. This report identified six aims for health care quality improvement: safe, effective, patient-centered, timely, efficient, and equitable. These six aims are just as appropriate in a rural environment as they are in an urban setting. They are also appropriate across all levels of prevention and across a variety of health care settings. To accomplish these aims in the rural environment The IOM in their report, "Quality Through Collaboration: The Future of Rural Health Care" (IOM, 2004) identified a five point strategy for rural communities:

* Adopt an integrated, prioritized approach to addressing both personal and population health needs at the community level;

* Establish a stronger quality improvement support structure to assist rural health systems and professionals in acquiring knowledge and tools to improve quality;

* Enhance the human resource capacity of rural communities, including the education, training, and deployment of health care professionals, and the preparedness of rural residents to engage actively in improving their health and health care;

* Monitor rural health care systems to ensure that they are financially stable and provide assistance in securing the necessary capital for system redesign; and

* Invest in building an information and communications technology (ICT) infrastructure, which has enormous potential to enhance health and health care over the coming decades

Nursing in the rural community is in a integral position to promote interventions that will advance these strategies through research, education, practice and nursing administration. No professional provider is in a better position to effect change in the rural environment than the rural based professional nurses. They may be employed in a variety of roles in a variety of settings but in general they can implement ways to improve the quality of rural care. As nursing administrators, rural nurses do not just coordinate services within a health care institution. They can serve as community health advocates, leaders, policy makers and political leaders in their communities. As educators, they can mentor and teach all levels of health care providers to provide safe effective care. They can support student experiences and encourage ongoing continuing education as well as encouraging career development through academic program completion for other local health care providers. They can provide health care teaching in health promotion, disease prevention and chronic disease management. They can seek training on technologies to increase the efficiency and effectiveness of health care provision.

In clinical practice rural nurses can implement evidence based care, address high volume conditions, and monitor outcomes. As researchers, they can test and monitor innovative practice and disseminate findings to encourage excellence. They can focus on performance improvement to enhance quality, increase efficiency and decrease costs. Perhaps the most important point is that nurses in the rural setting can provide leadership.

As rural nurses, our organization and it constituents can produce change and ensure that rural residents have the best care while providing a responsible stewardship of clinical resources. The challenge is apparent and nurses are the primary element for success.

REFERENCES

Institute of Medicine (IOM) (2004). Quality through collaboration: The future of rural health. Washington, DC: National Academy Press. Retrieved on May 12, 2009, from http://www.iom.edu/?id=29734

Institute of Medicine (IOM) (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. Retrieved on May 13, 2009, from http://www.iom.edu/?id=12736

Marietta Stanton, PhD, RN, CNAA, BC, CCM, CMAC

Editorial Board Member