course materials

1. Assignment: Population Affected by Disabilities
Assignment: Population Affected by Disabilities ON Assignment: Population Affected by
DisabilitiesRead chapter 21 and 23 of the class textbook and review the attached
PowerPoint presentations. Once done, answer the following questions.Mention and discuss
the differentiation between the medical model and social construct definitions of
disability.Identify and discuss selected health care and social issues that influence the
ability of people with disabilities to live and thrive in the community.Mention and discuss
the characteristics of rural community health nursing practice.Mention and describe the
features of the health care system and population characteristics common to rural
aggregates.As stated in the syllabus present your assignment in an APA format word
document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled
“Week 8 discussion questions” and the SafeAssign exercise in the assignment tab of the
blackboard which is a mandatory requirement. A minimum of 2 evidence-based references
(besides the class textbook) no older than 5 years must be used. You must post two replies
to any of your peers sustained with the proper references no older than 5 years as well and
make sure the references are properly quoted in your assignment. The replies must be
posted on different dates (to verify attendance), I must see different dates in the replies. A
minimum of 700 words is required (excluding the first and reference page).Please make
sure to follow the instructions as given and use either spell-check or Grammarly before you
post your assignment.Please check your assignment every time you log in because I can ask
questions requesting clarification or giving feedback to your
assignment.chn_chapter_023.pptxrubric_2_4_.docxchn_chapter_021.pptxUnformatted
Attachment PreviewChapter 23 Rural and Migrant Health Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Rural Populations ? ? ? The largest
rural population in history of United States is now. 75% of counties are classified as rural;
they contain only 20% of the U.S. population Number/size of rural counties are highest … ? ?
? ? in the South (35%) in the Midwest and West (23%) in the Northeast (19%) Census data ?
? ? 20% of nation’s children under 18 15% of nation’s elderly More than 50% of nation’s
poor Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier
Inc. 2 Rural Populations (Cont.) ? Economic base is shifting ? ? ? Agriculture is the “food and
fiber system” All aspects of agriculture (core materials to wholesale and retail and food
service sectors) are included Poverty in rural areas greater than in urban areas Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Rural
Populations (Cont.) ? ? ? ? Poverty continues to be greater in rural America than in urban

2. areas. Aging-in-place, out-migration of young adults, and immigration of older persons from
metro areas. Greater diversity among residents: a country of immigrants historically and
today. Health disparities exist—rural population more likely to be older, less educated, live
in poverty, lack health insurance, and experience a lack of available health care providers
and access to health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
imprint of Elsevier Inc. 4 Health Disparities Among Rural Americans ? ? ? ? ? ? Only 10% of
U.S. physicians practice in rural areas Ratio of physicians in rural population is 36:100,000
(nearly double in urban settings) More often assess their health as fair or poor More
disability days resulting from acute conditions More negative health behaviors (untreated
mental illness, obesity, alcohol, tobacco, and drug use) that contribute to excess deaths and
chronic disease and disability rates Higher number of unintentional injuries Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Assignment:
Population Affected by DisabilitiesDefining Rural Populations ? Population size ? ? Rural =
towns with population of less than 2500 or in open country [farm/nonfarm] Density ? ?
Rural = fewer than 45 persons per square mile Frontier = less than 6 people per square mile
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6
Defining Rural Populations (Cont.) ? The Rural-Urban Continuum uses population and
adjacency to metropolitan areas ? Core Based Statistical Areas (CBSAs) • Metropolitan areas
= county with at least one urbanized area of 50,000 or more people • Micropolitan area =
area contains a cluster of 10,000 to 50,000 persons • Outside CBSAs = noncare areas
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7
Describing Rural Health and Populations ? ? Differ in complex geographical, social, and
economic areas Disparities include key indicators of health: ? Employment ? Income ?
Education ? Health insurance ? Mortality ? Morbidity ? Access to care Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Rural Health
Disparities: Context and Composition ? Context: characteristics of places of residence ? ?
Geography, environment, political, social, and economic institutions Composition: collective
health effects that result from a concentration of persons with certain characteristics ? Age,
education, income, ethnicity, and health behaviors – Braveman (2010) Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Context: Health
Disparities Related to Place ? A downward spiral may exist: ? people leave ? services are lost
? tax base becomes insufficient ? fewer services are provided ? long distances to get health
care ? jobs become scarce and more people leave ? the cycle continues Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Context: Health
Disparities Related to Place (Cont.) ? ? ? ? Access to health care (#1 priority) Fewer primary
care physicians General health services lacking Health insurance coverage … ? Varies
according to race and ethnicity; age and residence (rural or urban) ? Influences health
patterns ? Assignment: Population Affected by DisabilitiesMay create financial barriers to
health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
Elsevier Inc. 11 Composition: Health Disparities Related to Persons ? Income and Poverty ? ?
? ? ? One of the most important indicators of the health and wellbeing of all Americans,
regardless of where they live. Regional differences—highest in the South Racial and ethnic
minorities—rates among rural racial minorities two to three times higher than for rural

3. whites Family composition—female-headed families have highest rates Children—among
the poorest citizens in rural America Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
Saunders, an imprint of Elsevier Inc. 12 Composition: Health Disparities Related to Persons
(Cont.) ? Health risk, injury, and death ? ? Risk factors ? ? ? ? Higher rates of obesity,
smoking, sedentary lifestyles, alcohol use, firearms usage, suicide, vehicular accidents;
lower rates of seat belt use Age, education, gender, race, ethnicity, language, and culture
Education and employment Occupational health risks Perceptions of health (gender, race,
ethnicity) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
Elsevier Inc. 13 Agricultural Workers ? Accidents and injuries caused by: ? Environmental
conditions ? Geographic isolation and working alone ? Use of agricultural machinery ?
Delayed access to emergency or trauma care ? Acute and chronic illnesses: ?
Musculoskeletal discomfort, acute and chronic respiratory conditions, hearing loss,
hypertension ? Chemical exposure (pesticides, herbicides, etc.) ? Secondary conditions
related to demanding farm work Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
Saunders, an imprint of Elsevier Inc. 14 Migrant and Seasonal Farm Workers (MSFW) ?
Health Disparities ? ? ? Poorest health and the least access Low income and migratory status
Cultural, linguistic, economic, and mobility barriers ? ? Assignment: Population Affected by
DisabilitiesMinimal or no preventive care • Mobile clinic sites form a central link to health
services Migrant Health Program (MHP) bases services on enumeration of MSFW • Migrant
and Seasonal Farm Worker Enumeration Profile Study (MSFWEPS) (2000) Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 “Thinking
Upstream” Concepts applied to Rural Health ? ? ? Attack community-based problems at their
roots Emphasize the “doing” aspects of health Maximize the use of informal networks
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16
Rural Health Care Delivery System ? Health care provider shortages ? ? ? Rural shortages
likely to become worse Need to “grow their own” Telemedicine • Cost-effective alternative
to face-to-face care • Telehealth includes telephones, fax machines, email, and remote
monitoring • Telemedicine permits two-way, real-time, interactive communication between
patient and provider Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
imprint of Elsevier Inc. 17 Rural Health Care Delivery System (Cont.) ? Managed care in the
rural environment ? ? Possible benefits: • Potential to lower primary care costs • Improve
the quality of care • Help stabilize the local rural health care system Risks • Probable high
start-up and administrative costs • Volatile effect of large, urban-based, for-profit managed
care companies Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint
of Elsevier Inc. 18 Community-Based Care ? A myriad of services provided outside the walls
of an institution ? ? ? ? Home health and hospice care, occupation health programs,
community mental health programs, ambulatory care services, school health programs,
faith-based care, elder services (adult day care) Community participation in decisions about
health care services Focus on all three levels of prevention An understanding that the
hospital is no longer the exclusive health care provider Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Home Care and Hospice
?Nurse case management and development of local resources ? ? ? ? Often hospital based in
rural areas Use county extension services as a bridge for outreach services Improve home

4. care for these patients and provide support for their families A partnership between the
public health nurse and county extension service could provide support, as well as
information groups and caregiving classes, for the important informal provider network.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20
Faith Communities and Parish Nursing ? ? ? ? A strong sense of community, family life, and
religious faith Integrating nursing expertise and faith-based knowledge to provide holistic
care to members of congregations Involved in case management and coordination of
services Collaboration with other organizations to extend limited rural community health
resources Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
Elsevier Inc. 21 Informal Care Systems ? ? ? ? Evolve from self-reliance and self-help traits of
rural residents Include people who have assumed the role of caregiver based on their
individual qualities, life situations, or social roles Provide direct help, advice, or information
Need to identify and combine informal services with formal systems Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Rural Public
Health Departments Public health nurses are often the core providers of public health
services in rural areas. ? ? Collaboration of services is key—need to develop partnerships
with other heath provider agencies. Environmental health, maternal and child health, and
communicable disease control are the three highestpriority programs. Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Rural Mental
Health Care ? ? ? Lack of specialized mental health providers in rural areas. Assignment:
Population Affected by DisabilitiesMost services provided by primary care providers
without adequate preparation or support. Perceived stigma prevents individuals from
seeking mental health services. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
Saunders, an imprint of Elsevier Inc. 24 Emergency Services Getting patients from the place
of injury to the trauma center within the “golden hour” is frequently not possible because of
distance, terrain, climatic conditions, and communication methods. Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Emergency
Services (Cont.) ? Challenges faced by rural EMS systems ? ? ? ? ? Shortage of volunteers and
lower levels of training Training curricula that often do not reflect rural hazards (e.g., farm
equipment trauma) Lack of guidance from physicians Lack of physician training and
orientation to EMS Also contributing to difficult public access for emergency care: • Low
population density • Large, isolated, or inaccessible areas • Sever weather • Poor roads •
Lower density of telephone/communication methods Copyright © 2015, 2011, 2007, 2001,
1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Emergency Preparedness in Rural
Communities ? Challenges in rural areas: ? ? ? ? Resource limitation • Human, financial, and
social capital Separation and remoteness • Longer response times Low population density •
Impacts funding Communication • Warning systems often absent or neglected in remote
areas; burden on individuals Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc. 27 Legislation and Programs Affecting Rural Public Health ?
Programs that augment health care facilities and services ? ? ? ? Community Health Centers
(CHC) program Migrant Health Clinic (MHC) program and the Migrant Health Program
(MHP) Medicare’s Rural Hospital Flexibility (RHF) grant program Primary care cooperative
agreements Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of

5. Elsevier Inc. 28 Rural Community Health Nursing “CH nursing along the rural continuum”
Nonmetropolitan Areas Metropolitan Areas Copyright © 2015, 2011, 2007, 2001, 1997,
1993 by Saunders, an imprint of Elsevier Inc. 29 Rural Nursing … … is the practice of
professional nursing within the physical and sociocultural context of sparsely populated
communities. Assignment: Population Affected by Disabilitiest involves the continual
interaction of the rural environment, the nurse, and his or her practice. Rural nursing is the
diagnosis and treatment of a diversified population of people of all ages and a variety of
human responses to actual (or potential) occupational hazards or actual or potential health
problems existent in maternity, pediatric, medical/surgical and emergency nursing in a
given rural area. –– Bigbee (1993), Lee & Winters (2004), Rosentahl (2005), Williams et al.
(2012) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
Elsevier Inc. 30 Characteristics of Rural Nursing Should rural nursing practice be designated
as a specialty or subspecialty area because of factors such as isolation, scarce resources, and
the need for a wide range of practice skills that must be adapted to social and economic
structures? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
Elsevier Inc. 31 Characteristics of Rural Nursing (Cont.) ? Positive aspects ? ? ? ? ? ? ? Ability
to provide holistic care Know everyone well Develop close relationships with the
community and with coworkers Enjoy rural lifestyle Autonomy and professional status
Being valued by the agency and community Negative aspects ? Professional isolation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32
The newcomer practices nursing in a rural setting, unlike the more experienced nurse, who
practices rural nursing. Somewhere between these extremes lies the transitional period of
events and conditions through which each nurse passes at her or his own pace. It is within
this time zone that nurses experience rural reality and move toward becoming
professionals who understand that having gone rural, they are not less than they were, but
rather, they are more than they expected to be. Some may be conscious of the transition,
and others may not, but in the end, a few will say, “I am a rural nurse.” – Scharff (1998, p.
38) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier
Inc. 33 Rural Health Research ? Research agendas must address: ? The capacity of rural
public health to manage improvements in health ? Assignment: Population Affected by
DisabilitiesInformation technology capacity in rural communities ? Developing and
monitoring performance standards in rural public health ? Developing leadership and
public health workforce capacity within rural public health ? Interaction and integration of
community health systems, managed care, and public health in rural America – Berkowitz,
Ivory, & Morris (2002) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
imprint of Elsevier Inc. 34 Capacity of Rural Public Health to Manage Improvements in
Health ? ? Healthy People 2020 objectives and intervention strategies Information
Technology in Rural Communities ? ? ? ? EHR and reimbursement Preparedness strengthens
infrastructure Continuing education and advanced education Telehealth impact on public
health • Skills via distance learning? • Costs and infrastructure of IT? • Gaps in epidemiology
and surveillance capacity? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc. 35 Performance Standards in Rural Public Health ? ? National
Public Health Performance Standards Program (NPHPSP) describe an optimal level of

6. performance by public health systems regardless of location. Used to improve
collaborations among key public health partners, educate participants about public health,
strengthen the network of public health partners, identify strengths and weaknesses, and
provide benchmarks for public health practice improvements Copyright © 2015, 2011,
2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36 Leadership and
Workforce Capacity for Rural Public Health ? ? ? ? IOM report (2003)—preparing public
health workforce for 21st century CDC Public Health Improvement Initiative (2012)—
accreditation support Medicaid impact on interaction and integration of community health
systems, managed care, and public health New models of health care delivery for rural and
frontier areas being tested Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc. 37 • Name DQ Rubric 2019 • • Assignment: Population Affected
by DisabilitiesDescription Rubric Detail Levels of Achievement Criteria Proficient
Competent Novice Introduction and quality of discussion’s Argument Weight 60.00%
100.00 % It is consistent with application in research related to its context. Clarity of ideas.
Comprehensive, indepth and wide ranging. 70.00 % The topic has a partially weak
association to clarity of ideas and related topic. Relevant but not comprehensive. 15.00 %
Unable to address any part of the question and/or topic. Little relevance/some accuracy.
Objectivity of Tone, overall quality & Review of Literature in APA 6th format within past 7
years Weight 10.00% 100.00 % Tone is consistent, addressed professionally and
objectively. Evidence in literature supports arguments. 70.00 % The tone is not consistently
objective. Some observations, some supportive evidence used. 15.00 % No objectivity in
tone. No evidence of literature review provided. Lacks evidence of critical analysis, poor to
no use of supportive evidence. Grammar / Writing Skills Weight 7.50% 100.00 % Excellent
mechanics, sentence structure and organization with no grammatical mistakes. 70.00 %
Some grammatical lapses , uses emotional responses in lieu of relevant points. 0.00 % Poor
grammar, weak communication, lack of clarity. Peer Reply #1 Weight 7.50% 100.00
%Assignment: Population Affected by DisabilitiesDemonstrates an exceptional ability to
analyze and synthesize student work, asks meaningful extending questions. 70.00 % Some
ability to meaningfully comment on other students work and ask meaningful questions. 0.00
% No peer response Peer Reply #2 Weight 7.50% 100.00 % 70.00 % 0.00 % No Peer
response Levels of Achievement Criteria Overall APA Use Weight 7.50% Proficient
Competent Demonstrates an exceptional ability to analyze and synthesize student work,
asks meaningful extending questions. Some ability to meaningfully comment on other
students work and ask meaningful questions. 100.00 % Demonstrates an exceptional ability
to apply 6th edition APA standards. 70.00 % Some ability to to apply 6th edition APA
standards. i.e. use of in-text citation, reference structure, quoting,etc. Novice 0.00 % No
adherence to 6th edition APA standards. Chapter 21 Populations Affected by Disabilities
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Most people whose lives do not end abrup