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Community Health - Chapter 22 Rural/Migrant
Stanhope Chapter 22
33
Nursing
Undergraduate 4
07/08/2013

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Term
central
Definition
counties in large metro areas (1 million+) that contain all or part of the largest central city
Term
farm residency
Definition
outside the area zoned as city limits
Term
fringe
Definition
  • remaining counties in large metro area
  • best health & health practices
Term
frontier
Definition
regions with <6 people/square mile
Term
Health Professional Shortage Areas (HPSAs)
Definition
  • usually rural, usually on provider for seveal counties
  • usually higher proprotion of racial minorities
Term
medium
Definition
counties in metro area with <1 million
Term
migrant farm worker
Definition

seasonal; worked within past 2 years; has a temporary abode

  • 3-5 million in US
  • life expectancy 49
  • many return to country of origin after growing season ends
  • 85% minority, many are American citizens
  • typically: 6 months farm work, 8 wks nonfarm work, 8 wks travelling, 10 weeks unemployed (often go home) per year
Term
Migrant Health Act
Definition
  • 1962
  • provides support for clinics
  • grants to community-based & state orgs
  • 670,000 received services in 2002
    • reaches only 20% of migrant population
Term
nonfarm residency
Definition
within an area zoned as city limits
Term
pesticide exposure
Definition
  • also enters home & food
  • risk of mild psychological & behavior deficits
  • severe poisoning can cause death
Term
rural
Definition

<20,000 resident communities, or <99 per square mile

  • 50% diagnosed with 1+ chronic conditions
  • average one less physician visit per year than urban
  • health status varies greatly
  • 26% rural families below poverty line
  • 40% rural children live in poverty
  • 25% of Americans live in rural area
  • larger proportion of whites
  • more young & old
Term
small
Definition
counties in metro areas with <250,000
Term
urban
Definition
between 20,000 & 50,000; >99 per square mile
Term
rural residents
Definition
  • poorer health
  • highest death rates for children & young adults
  • highest death rates from accidents
  • highest suicide rates
  • fewest dental visits
  • highest teenager smoking rates
  • AIDS increasing more quickly here (heterosexual sex, most cases)
  • gay men not open & more likely to engage in unprotected sex
Term
suburban residents
Definition
  • signficantly better health
  • suburban women least likely to be obese
  • most likely to have insurance
Term
signs & symptoms of pesticide exposure
Definition
  • acute: headache, dizziness, confusion, irritability, twitching, weakness, respiratory problems, NVD, stomach cramps
  • chronic: cancer, Parkinson's like symptoms, infertility, liver namage, neuro problems
  • nurse should develop a pesticide history
Term
nursing practice in rural environments
Definition
  • more diverse clinical experiences, exposures
  • broader scope of practice
  • sparse resources
  • slower pace
  • lack of anonymity
  • prestigious status in community
Term
COPHC
Definition

Community Health Primary Health Care

  • partnership model to address some of the deficits/disparities between rural  & other
  • steps
    • Define & characterize community
    • ID health problems
    • Develop/modify HC services
    • Monitor & eval program process & client outcomes
Term
working poor
Definition
higher incidence in rural
Term
formal rural nursing
Definition
began 1912, Red Cross Rural Nursing Service
Term
population shift
Definition
from urban to less-populated, suburbs; west & south fastest growing
Term
working poor
Definition
cannot afford health insurance; make too much for public insurance
Term
worst pregnancy outcomes
Definition
Native American, migrant workers, rural African-American women in the deep south
Term
rural school nursing
Definition
one nurse may cover more than one county as a "district" health nurse; maybe only visit each school once or twice a term; usually for immunizations & sex ed
Term
rural mental health
Definition
  • usually wait for crisis to seek help
  • epidemic of young male suicides in some communities
Term
seasonal farm workers
Definition
work cyclically but do not migrate
Term
farmworker compensation
Definition
for 75%, usually <$10,000/year
Term
Availability of services for migrant workers
Definition
  • 1996 Welfare Reform legislation changed availability of federal services; immigrants treated differently depending if they came before or after this
  • many legal & illegal immigrants are ineligible for food stamps, social security income, etc
Term
specific health problems for migrant workers
Definition
  • dental
  • TB (often drug resistant; little continuity of care)
  • HIV
  • depression, anxiety, phobias
Term
OSHA regulations
Definition
  • employers with 11 or more farm workers must provide drinking water, hand washing facilities, & toilets
  • compliance is poor
  • farming/ranching often do not fall under OSHA guidelines because they are small enterprises (usually no worker's comp, either)
Term
children of migrant workers
Definition
  • often appear normal & healthy
  • but often have malnutrition (vit A, iron), dental caries, inadequate immunizations, colds & stomach bugs
  • 2.5 times more likely to repeat a grade than child that does not move
  • Migrant Head Start helps (6 mo - 5 yrs)
  • 55% graduate high school
Term
laws about child workers
Definition
  • 14 years is minimum for farm work
  • 16 years for other industries
  • 12-13 if parents consent or parent works on same farm
  • <12 can work on a farm with fewer than 7 full-time workers
  • federal law does not protect children from overwork; may work very early or very late
Term
Mexican cultural norms
Definition
  • prefer polite nonconfrontational relationships
  • may nod to indicate understanding but really don't
  • expect chit-chat for first few minutes
  • expect nurse to not be rushed and to be a good listener
  • humor & touching appreciated
  • health decisions often by females
  • health may be seen as gift from God; illness a punishment
  • consider themselves healthy if they can work
  • most common folk remedies: chamomile, peppermint, cactus, epazote
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