Purpose: This review explores the important role that Family Nurse Practitioners (FNPs) play in addressing mild to moderate anxiety and depression in rural primary care settings. With limited to no access to psychiatric providers, rural communities often rely on FNPs to bridge critical gaps. This paper highlights practical, evidence-based approaches tailored to the unique challenges of rural healthcare, including provider shortages, stigma, and geographic location. Methods: A review of clinical guidelines and peer-reviewed literature published between 2020 and 2025 was conducted. The focus was on tools and strategies that support FNPs in assessing and managing anxiety and depression rural settings. Findings: In many rural areas FNPs often serve as the primary, and sometimes only, mental health providers. Their role includes early screening, diagnosis, treatment planning, and ongoing management. Validated tools such as the PHQ-9 andGAD-7 help guide clinical decision-making and track progress over time. First-line treatments typically include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). When access to medication is limited, nonpharmacologic interventions such as cognitive behavioral therapy (CBT), behavioral activation, lifestyle changes, and community-based support become even more valuable. Telehealth and collaborative care models are increasingly used to improve access, reduce barriers and support continuity of care in rural areas. Discussion: FNPs are well positioned to respond to mental health needs in rural communities. By combining practical tools, evidence-based treatments, and flexible care delivery models-including telehealth., FNPs can expand access to care and help reduce mental health disparities. Their unique position in primary care allows them to build trust, deliver holistic care, and make a meaningful impact on the mental well-being of underserved rural populations.
Purpose: To explore the emerging role of artificial intelligence (AI) in improving pharmacologic decision-making for nurse practitioners (NPs) in rural primary care, highlighting clinical support, workflow integration, and ethical and legal responsibilities. Methods: This narrative review examines recent literature, case studies, and AI-enhanced tools to evaluate AI’s impact on prescribing safety and efficiency in rural health settings. Findings: AI-driven tools, such as clinical decision support systems and predictive analytics, are increasingly available to assist nurse practitioners (NPs) in prescribing practices. In rural settings, where providers face unique challenges such as workforce shortages, patient complexity, and limited specialist access, AI offers promising solutions. Case studies demonstrate AI’s ability to support pharmacologic decisions for chronic conditions such as diabetes and atrial fibrillation. However, ethical concerns—including bias, transparency, and informed consent—must be proactively addressed. Conclusions: NPs practicing in rural environments are well-positioned to lead the ethical and effective integration of AI into pharmacologic practice. By maintaining clinical accountability, ensuring patient understanding, and evaluating tools for rural relevance, NPs can use AI to improve medication safety and access while protecting patient trust.
Background: Rural communities face persistent challenges pertaining to healthcare access, workforce shortages, and geographic isolation. To address these issues, the Rural Ready Nurse Practitioner (RRNP) Program was established through Health Resources and Services Administration (HRSA) Advanced Nursing Education and Workforce (ANEW) funding (Award # T94HP32889) to prepare nurse practitioners (NPs) for practice in rural and underserved areas. Purpose: The paper describes the development, implementation, and outcomes of our RRNP Program, emphasizing theoretical grounding in Rural Nursing Theory and integration of the Three R’s of Rural Readiness: Relationships, Resources, and Reinforcement. Methods: Program design involved multi-level strategies, including partnerships with rural clinical sites, integration of telehealth-based interprofessional education, and expansion of the Caring for Our Own Program (COOP) to support Indigenous graduate students. Data were drawn from HRSA tracking metrics and graduate self-reports. Results: From 2021 to 2025, 31 RRNP Scholars completed the program, with 89% of graduates employed in rural and 93% employed in underserved areas. Key educational elements included annual in person Clinical Skills Days, customized medical kits, and Area Health Education Center (AHEC) Scholars Program. Implications: The RRNP model demonstrates an evidence-based framework for preparing rural-ready nurse practitioners capable of meeting healthcare needs in (State)’s frontier and tribal communities.
Objective: To answer the following questions: (1) What is the existing evidence on rural maternity care and shared decision making, and (2) what are the knowledge gaps and directions for future research? Methods: The review was guided by Whittemore and Knafl. Included studies were appraised using the Mixed Methods Appraisal tool. Data Sources: With librarian support, searches were conducted in PubMed, CINAHL, PsycINFO, and ProQuest. Filters limited results to English-language, full-text publications from January 2019 to January 2026. Study Selection: The search identified 1,186 research studies. After removing duplicates, the citation mining of six articles and screening, 54 full texts were reviewed; 29 were excluded, leaving 25 studies included in the review. Data Extraction: Of the 25 studies, 20 (75%) used quantitative, 2 (8%) qualitative, and 3 (12%) mixed methods. Major themes included maternity care deserts, hospital closures, distance to maternity care, insurance, telehealth, social determinants of health, severe maternal morbidity and mortality (SMMM), and shared decision making (SDM) or relational care. Data Synthesis: Barriers such as hospital closures, maternity care deserts, and travel distances worsened maternal outcomes. Insurance instability, under-reimbursement, and workforce shortages further limited access. Telehealth showed promise but was constrained by broadband gaps. Social drivers compounded risks, with rural Black, Indigenous, and People of Color (BIPOC) experiencing the poorest outcomes. Studies addressed SDM, though continuity of care, relationships, and communication were emphasized. Conclusions: Improving rural maternal patients’ access to high-quality care is necessary to decrease the risk of SMMM. Nurses promote patient-centered communication, evidence-based interventions, and address social drivers of health through education and advocacy. Expanding the SDM evidence base in rural maternity care will strengthen nursing’s role in engagement, empowerment, and health equity.
urpose: To examine the outcomes of a mindfulness-based intervention for the prevention of mental health disorders among rural dwelling Native American youth ages 10-12. Sample: Native American student participant sample (N=20) was recruited from schools from one rural Native American tribe in the Midwestern United States. The county where the study was conducted is officially designated as a nonmetropolitan county, and it is classified as rural according to the county-level system. Methods: This cross-sectional descriptive study measured mental health outcomes that included stress, anxiety, depression, substance use (alcohol and drugs) and commercial tobacco use. All participants were Native American who resided in rural tribal communities. Findings: Study sample was both female (N-10) and male (N-10), with a mean age of 11.37. Participants self-reported significant decreases in mental health disorders of stress, anxiety, depression, substance use (alcohol and drugs) and commercial tobacco use from baseline pre-intervention to 3-months post intervention. Native Reliance (cultural identity) significantly increased from baseline pre-intervention to 3-months post-intervention. Conclusion: Findings from this pilot study support the use of a mindfulness approach delivered in a cultural based Talking Circle intervention for the prevention of mental health disorders among rural dwelling Native American youth
Purpose: Continuous glucose monitoring (CGM) provides a more reliable and convenient way for patients to check blood glucose levels than fingerstick monitoring. Patients in rural areas may have less access to CGMs than those in urban areas. The purpose of this project was to provide focused education about CGMs and a two-week user-wear experience to undergraduate nursing and family nurse practitioner (FNP) students in a rural liberal arts university through an intraprofessional workshop and user-wear experience. Sample: Students eligible for participation in the study included those in the graduate FNP (n=16) and undergraduate pre-licensure Bachelor of Science in nursing (BSN) (n=35) programs. Methods: All eligible FNP and BSN students (n=51) participated in the in-person educational session on CGMs. At the beginning of the CGM workshop, students were asked to complete the pre-implementation survey. During the workshop, students and faculty were educated about CGMs and given the opportunity to self-apply a CGM for a two-week user-wear experience. At the end of the user-wear experience, students were encouraged to complete the post-implementation survey. Findings: All 10 scored survey items measuring student familiarity and perception of skill with CGM devices had statistically significant differences in pre- and post-survey ranked scores. Review of the qualitative responses revealed four themes: understanding, confidence, personal experience, and clinical preparation. Conclusions: The intraprofessional CGM workshop and user wear experience allowed undergraduate BSN and graduate FNP students to engage with each other in a clinical and experiential learning activity to improve their understanding, confidence, and skills in diabetes management with CGM devices. All students reported improved self-perception of confidence and skills in using CGMs after the workshop. It is crucial for undergraduate and nurse practitioner students to become more familiar with CGMs through workshops and hands-on activities, especially in rural areas where CGM use is not optimized.
Purpose: To assess the impact of a one-hour educational presentation on rural health disparities on knowledge and attitudes of pre-health professional students. Sample: 104 undergraduate and graduate students from a mid-sized Midwestern university participated between March–April 2025. Students represented multiple health career pathways, with occupational therapy (n=36), nursing (n=19), and medicine (n=15) most common. Method: A pre-test/post-test quasi-experimental design was used. Students completed a pre-survey, attended a one-hour presentation on national and Iowa-specific rural health disparities, and then completed a post-survey. Surveys included demographic questions, Likert-scale measures of attitudes and understanding, and multiple-choice knowledge questions. Data were analyzed using descriptive statistics and independent t-tests. Findings: Knowledge of rural health disparities increased by 23.8% from pre- to post-test (p < .001). Statistically significant improvements were also observed in attitudes toward rural health (p < .05) and self-reported understanding of rural disparities (p < .001). Participants’ interest in working in rural health and belief that they could make a difference also increased significantly. The mean rating for presentation effectiveness was 4.75/5. Conclusions: A brief, one-hour educational session significantly improved knowledge and attitudes regarding rural health disparities among pre-health students. This suggests that brief, low-resource interventions can raise awareness of rural health issues and may serve as an entry point for integrating rural content into undergraduate and graduate health curricula. Future research should examine longitudinal impacts and application to professional practice.
Purpose: The purpose of this qualitative research study was to understand the phenomenon of hope among registered nurses (RNs) working at critical access hospitals (CAH) in South Dakota (SD), North Dakota (ND), and Minnesota (MN), and what facilitated hope during the COVID-19 pandemic. Past research has shown that hope can be a valuable mechanism for sustaining psychological well-being, developing personal goals, achieving goals, and promoting coping However, little research has explored what might facilitate hope for RNs during times of healthcare crises. Sample: Ten participants met the inclusion criteria, which included RN licensure in MN, SD, or ND, English-speaking, 20+ hours per week direct patient care during COVID-19, and ability to use Zoom. It was a homogenous sample of 10 Caucasian, female RNs, between the ages of 22 and 67, whose years of nursing experience ranged from 1 to 47 years. Four participants were from SD, two were from ND, and four were from MN. Method: The study used an interpretive, hermeneutic phenomenological method. Semi-structured interviews were completed virtually, lasted between 20 and 60 minutes, and were recorded. van Manen’s hermeneutic analysis method was used to construct components and themes. Findings: The phenomenon of hope for these RNs can only be understood within the context of hopelessness, which emerged prominently in the study. An unexpected finding of the study was that some components/themes sparked agency, which helped foster hope, while others stifled agency, contributing to hopelessness. Conclusions: CAH RNs experienced hopelessness and hope on the frontlines. The role of agency in relation to hope necessitates further inquiry. It is anticipated that the knowledge gained from this study will explain how hope may be fostered (and hopelessness navigated) to support and retain rural frontline nurses in future healthcare crises.
Purpose: Indigenous Peoples in rural Canadian communities experience numerous health inequities related to accessing and receiving culturally safe, trauma-informed health care. Colonialism has caused systemic racism within the health care system leading to insurmountable traumas. The Truth and Reconciliation Commission Calls to Action and the In Plain Sight Report clearly articulate health care system changes required to ensure Indigenous people experience safe and culturally appropriate experiences at points of care. Nurse Practitioners (NPs) have dual roles of being allies that can provide culturally safe care while advocating systemic changes. Additionally, NPs can improve health care access in rural communities with the use of Point of Care Ultrasound (POCUS). Aim: The aim of this scoping review was to examine the question: How is trauma-informed care being integrated into POCUS care delivery by NPs in rural and Indigenous communities in British Columbia? Methods: Arksey and O’Malley’s scoping review approach was used to guide this review. The five stages of this approach were: problem identification; identifying relevant studies; study selection; extracting and charting data; and finally, collating, summarizing, and reporting the results. Findings: Twenty studies were included in this scoping review. Results found no studies between POCUS and trauma-informed care but found that ultrasound can be re-traumatizing for some patients. Trauma-informed approaches were not found to be integrated into POCUS education or guidelines. Many providers do not have trauma-informed care training, and those that have the training do not have confidence in their knowledge. Conclusions: To improve culturally safe approaches to POCUS implementation, this paper recommends increased funding to support rural NP certification for POCUS, completion of mandatory cultural safety and trauma-informed care training, and that institutions offering POCUS training embed trauma informed approaches to POCUS application within their curricula.
Purpose: Home- and community-based services (HCBS) have the potential to address the health needs of the rapidly growing population of people with ADRD in Appalachia and their informal caregivers. Little is known about the nature of HCBS and potential barriers to their use in Appalachia. The purpose of this qualitative study was to describe ADRD service providers’ perceptions of the barriers and facilitators to providing high-quality HCBS for people with ADRD and their caregivers in the historically underserved region of Appalachia. Sample: A qualitative descriptive study was conducted 13 HCBS settings in Tennessee, West Virginia, Virginia, and North Carolina. A standardized, semi-structured guide was used to conduct telephone-based interviews with 13 leaders of HCBS programs. Methods: Using qualitative content analysis, two investigators coded interview transcripts, and the full study team used the coded data to identify themes related to HCBS barriers to providing ADRD services and strategies HCBS leaders used to address service delivery challenges. Findings: Participants held leadership positions in governmental (n=8), non-profit (n=3), and private (n=2) HCBS programs that provided education, service referrals, respite vouchers, support groups, and other services for people with ADRD and their families. Participants described service, cultural, geographic, and funding barriers to community-based ADRD care and strategies to address barriers, including community immersion, mobile HCBS vans, transportation services, and service advocacy. Conclusions: The findings describe barriers to HCBS in Appalachia extending earlier research with evidence to frame future larger-scaled studies focused on increasing the reach of community-based ADRD care. Future studies are needed to describe larger cohorts of people with ADRD, access to HCBS services, and the relationship between service access and outcomes, such as hospital admission, control of comorbid health conditions, and caregiver self-efficacy. Implementation studies are necessary to examine adaptations of proven ADRD care models for future intervention research.
Purpose: Adverse childhood experiences (ACEs) and low utilization of mental health services due to distrust of the healthcare system and stigma contribute to poor mental health outcomes, especially for individuals living in rural areas. Evidence mounts that ACEs and mental health conditions contribute to poor sleep, yet ACEs remain understudied in rural southern communities where Black Americans face disproportionate racial and socioeconomic disparities. This study examined whether ACEs and depressive symptoms predict sleep quality in rural Black Americans, identified the types and frequency of ACEs reported among those with depressive symptoms, and explored correlations between sleep quality and ACEs overall and by specific type. Method: Participants (N = 75), Black/African American adults who completed a series of questionnaires, including a demographic survey, Patient Health Questionnaire (PHQ-9), modified ACEs, and answered two questions assessing components of sleep quality, including sleep duration and satisfaction. Findings: Of the 75 participants, 56% (n = 42) reported depressive symptoms. Among those with depressive symptoms, 40.5% (n = 17) reported having parents that had separated or divorced, and 23.8% (n = 10) reported not feeling loved by anyone in the family, and that family did not look out for each other. Sleep duration was shorter for participants who reported living with someone experiencing substance use or mental illness, p < .05. Adverse childhood experiences and depressive symptoms were not associated with sleep quality, all p >.05. Conclusion: Community-focused interventions, specifically trauma-informed care models, are needed to address the potential impact of specific ACEs on mental health outcomes within rural Black Americans.
Purpose: Long emergency department (ED) length of stay (LOS) is associated with increased mortality, delay in care, longer inpatient (IP) stays, readmission risk, poor patient satisfaction, and opportunity for error. Within the ED LOS is a quality indicator measuring the time a provider determines a patient will be admitted to the time the patient leaves the ED for an IP unit, called ED-2. Prolonged ED-2 indicates impaired ED output. Despite previous interventions, the ED-2 at a rural Midwest hospital was about 63.5 minutes; the goal set forth by the Centers for Medicare and Medicaid is 35 minutes or less. Sample: All patients over the age of 18 years presenting to the ED over a 3-month period were eligible. Method: A literature review identified admission prediction and proactive IP bed allocation as evidence-supported interventions to reduce ED-2. The Sydney Triage to Admission Risk Tool (START) was selected to aid nurses in predicting patient admissions at the time of triage. Staff were educated on START and proactive bed allocation. When a patient scored 17 or greater using START, ED staff contacted the IP bed manager to begin the bed assignment process. The ED-2 was compared 3 months pre-post implementation. Additionally, staff perceptions and experiences surrounding the change were evaluated. Findings: A 1-minute reduction in ED-2 postintervention was observed, however, the difference was not statistically significant. Survey results indicated perceived value in the intervention, but there were notable barriers impacting its success. Conclusions: The lack of postintervention ED-2 reduction, accuracy of START, and staff perceptions differed from the findings of previous studies, however, staff indicated a desire to continue the process change with modifications.
Introduction: Clinical cancer screening rates are low among patients who identify as LGBTQ+, especially in rural areas. It is important for rural nurse practitioner (NP) students to be aware of health disparities in cancer screenings among LGBTQ+ and be able to effectively promote cancer screenings in this population. Purpose: The purpose of this project was to determine rural NP students’ knowledge, attitudes, and perceptions of barriers to cancer screenings among LGBTQ+ and to educate NP students on inclusivity related to cancer screenings in this marginalized group. Sample: Nurse practitioner students at a public, rural, liberal arts university Method: Rural NP students participated in an interactive, in-person workshop to which the community was also invited. Didactic information was provided regarding barriers to/awareness of the need for cancer screenings among LGBTQ+ individuals. Students also created educational materials for use in community prevention programming. An anonymized online post-survey assessed NP students’ knowledge, attitudes, perceptions, and awareness of cancer screenings among LGBTQ+. Findings: Over 90% of participants (n=62) reported increased knowledge about the healthcare needs of LGBTQ+ populations. The largest mean level of agreement was observed with the statements, “how knowledgeable are you about the healthcare needs of LGBTQ+ populations?” and “how knowledgeable are you about current terms that should be used to increase inclusivity of LGBTQ+ populations in a healthcare setting?”, both resulting in a mean score of 3.52 corresponding with “very knowledgeable”. Three qualitative themes included recognizing the significance of culturally appropriate communication, having increased awareness of recommendations for cancer screening in the LGBTQ+ population, and the importance of reflecting on internal personal biases. Conclusion: Curricular strategies that promote awareness and increase knowledge of LGBTQ+ patient needs are essential to develop a rural NP workforce that can promote health equity and competently care for all patients.
Purpose: The purpose of this project was to implement the American Diabetes Association (ADA) Diabetes Risk screening tool and measure adherence to the Diabetic Plate patient education protocol in a rural, primary care clinic in North Carolina (NC). Sample: The setting of the project was a small, outpatient, rural primary care clinic in Western NC that serves a town population of 7,492 persons. Those of any age with a BMI > 25 were eligible for screening. During implementation, 334 patients were seen, and 157 met eligibility criteria. Method: The participating healthcare provider and medical assistants administered the ADA screening tool to eligible patients during their visits. If the patient scored a five or higher, indicating high risk for diabetes, the provider would then provide ADA Diabetes Plate education to inform patients of early T2DM prevention techniques. Completed screening tools were collected bi-weekly and charts reviewed to assess provider and staff adherence with screening. Findings: Out of the 157 eligible patients, 89 patients were screened utilizing the diabetes risk assessment tool. Of the patients screened, 41 were deemed “high risk” and 32 of them received diabetes plate education from the provider. The participating provider and clinic were able to screen eligible patients utilizing the diabetes risk screening tool with a 56.69% success rate and 78.04% of high-risk patients received diabetes plate education. Conclusions: Limitations of the project included inconsistent screening and discrepancies between paper screening forms and EHR documentation. Despite limitations, final data suggests that implementation of the ADA diabetes risk assessment tool could be beneficial in rural regions where ease of access and affordability is paramount. Additionally, implementation of this easy-to-use tool within an existing EHR would likely improve staff screening compliance and improve patient follow-up.
