Tracy Fasolino is a professor and Distinguished Palliative Care Leader at the Clemson University School of Nursing in Clemson, SC, where Kathleen Valentine is a professor. Megan E. Mayfield is a doctoral student at Emory University in Atlanta. William E. Rosa is assistant attending behavioral scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City. Anne Koci is professor emerita of nursing at Texas Woman's University in Denton. Contact author: Tracy Fasolino,
Am J Nurs. 2024 Aug 1;124(8):50-55. doi: 10.1097/01.NAJ.0001027716.70431.35. Epub 2024 Jul 25.
Rural communities in the United States are frequently marginalized and misrepresented. These communities face unique challenges, such as limited access to health care, nutritious food, and clean water, that contribute to persistent health disparities. This article presents the CARE (Complex, Access, Resourceful, Extraordinary) framework, which illustrates the dichotomy of rurality-its negative and positive aspects-in order to inform the development of palliative care delivery in rural settings. Various palliative care models are described that address access gaps, bolster provider capacity, and increase the provision of specialty palliative care. However, workforce shortages and reimbursement structures restrict the expansion of these services. Nurses, the largest segment of the health care workforce and the most trusted professionals, must partner with interdisciplinary colleagues and rural communities to advocate for equitable and inclusive care.
美国的农村社区经常被边缘化和误解。这些社区面临着独特的挑战,如医疗保健、营养食品和清洁水的获取有限,这些因素导致了持续存在的健康差距。本文提出了 CARE(复杂、可及、资源丰富、非凡)框架,该框架说明了农村地区的两面性——其消极和积极方面——以告知农村地区提供姑息治疗服务的发展。本文还描述了各种姑息治疗模式,这些模式解决了可及性差距、增强了提供者的能力,并增加了专业姑息治疗的提供。然而,劳动力短缺和报销结构限制了这些服务的扩展。护士是医疗保健劳动力中最大的群体,也是最受信任的专业人员,他们必须与跨学科的同事和农村社区合作,倡导公平和包容的护理。