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The structure and enactment of agency in the context of rural nursing practice

University of British Columbia

There is a growing awareness of inequities in rural healthcare in Canada and internationally. Rural nurses are embedded within complex healthcare structures, yet little attention has been paid to their experiences. These complex structures can function to both constrain and enable nurses to provide equitable, safe, and quality healthcare services to rural populations. This ethnographic study was conducted with rural nurses to explore the relationship between healthcare structures and rural nurses’ enactment of their agency. Informed by Structuration Theory (Giddens, 1984), Sewell’s (1992) notion of reciprocity, and a relational ethics lens, this research illuminates the relationship between the structures and rural nurses’ enactment of their agency in providing healthcare to rural based populations. Carspecken’s Critical Qualitative Research method (1996) was used to guide data collection during 528 hours of fieldwork and participant observations with primary nurse and allied healthcare provider participants (n=14). Additional data collected included: in-depth interviews (n=18); participant demographics; documents; and cultural commodities. Findings showed that the rural structure-nurse agent relationship was strained by urban-based policy-making. In particular, the rural practice context lacked sufficient physical and human resources to enact urban-policy directives (e.g. being unable to provide consistent primary and palliative care services). Nursing’s lack of active participation in policy decision-making has further impacted lack of policy directives toward fostering development of rural practice expertise. Key themes of: “we’re it”; “unseen complexity”; “pulling the nurse’s card”; “how many hands do you see?” and “beg forgiveness Monday morning” exemplified the disjuncture between rural and urban healthcare policy and practice. Inequities in access to healthcare services ultimately expanded rural nurses’ perceived moral obligations to include providing ad hoc care to the community outside of the formal system. Findings underscore that it is vital that rural nurses have an active voice in rural healthcare policy and decision-making in order to strengthen reciprocal relations and to provide equitable, safe, and ethical healthcare services for rural communities. Recommendations also include support for a nursing role in policy-making, increasing education opportunities, and expanding the scope of rural nursing practice to meet the demands of the rural practice context.

Text

2015-04-09

Attribution-NonCommercial-NoDerivs 2.5 Canada

http://hdl.handle.net/2429/52673

Nursing

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/2.5/ca/