Qualitative study among rural nurses of Armenia

Abstract

The rural health care system in the world has improved during the last years but there is a still need for further improvements. Generally, rural communities have fewer hospital beds, physicians, nurses and specialists per capita as compared to urban residents. The lack of health resources in rural areas and limited access to them continues to affect the health of rural communities (1). When comparing rural residents’ measures of health to urban residents, rural people rank lower (5). There are some diseases or conditions that are more prevalent in the rural communities than in urban communities. Examples of such conditions are injuries and accidents, chronic diseases and health damaging behaviors associated with them, high infant mortality (1). The health of people in rural areas of Armenia is similar to health of rural people around the world. Mortality rates in infancy and early childhood are higher in rural communities of Armenia than in the cities. The rural health care system in Armenia is mainly provided by nurses working in 500 health care facilities called ambulatories, medical posts or feldsher’s stations. Typically each village has one medical post, which offers a nurse-led service that includes: basic care of children and adults, antenatal care, developmental checks for infants, prescription of drugs, first aid, 24-hour emergency coverage, home visits and preventive services such as immunization and health education (16). In most villages of Armenia health care facilities are in poor physical condition. In some villages, the nurses do not use the facilities because of their inadequate condition. Some have no health facilities (14). This exploratory qualitative research was conducted among rural nurses of three regions of Armenia. The purpose of the study was to describe rural nursing practice in Armenia and its strengths and weaknesses. The results of the study are used for making recommendations for improving rural health care in Armenia. Twenty-one in-depth interviews were conducted from June to September of 2003. The participants of the interviews were nurses working in ambulatories without physicians. Ten of those nurses worked in villages assisted by UMCOR (United Methodists Committee on Relief). UMCOR has a MMT (Mobile Medical Team), which travels to remote villages and provides free medical treatment to village people. Nurses assisted the physicians from MMT during patient examinations. The numbers of the participants from each region are the following: six nurses from Gegharkunik, eight from Lori, and seven from Tavush. All participants were females; the median age of experience is ten years in the rural ambulatory. The study found that the nurses are not satisfied with their working conditions and availability of equipment and supply. They are concerned about the health of rural people and their ability of getting care on time. The nurses recognize the importance of continuing education of rural nurses. The results of this study show that the available resources in rural health care in Armenia are not adequate to provide appropriate health care to village people. The following recommendations are needed for improving rural health care: furnish and equip the ambulatories, organize continuing education for nurses, and provide health education programs for rural people.