OBJECTIVES:To explore the values, practices, and behaviours that support nursing students' professional development in practice-based learning environments in Rwanda.METHODS:A focused ethnographic approach was used. Nursing students (n=12), nurses (n=11), clinical instructors (n=7) and nurse leaders (n=8) from three teaching hospitals and an educational program participated in the study. Data was collected trough individual interviews and participant observation.RESULTS:Participants embraced a culture of preparing nursing students for their professional roles as a professional responsibility, and a means of securing the nursing profession. Modeling the appropriate behaviours to students and respecting them as learners and humans constituted the caring attributes that sustain a positive learning environment for their professional growth.CONCLUSIONS:Nurturing and caring environments offer students opportunities to integrate caring attitudes into their interactions with patients and to develop professionally.IMPLICATIONS FOR INTERNATIONAL AUDIENCE:Findings underscore the need to enhance caring values within nursing curricula.

AIM:The future of the nursing profession in Rwanda in large part depends on the students who join the workforce and the education they have received. Preparing students with the necessary knowledge, values and judgement requires practice settings to be learner-centered. This study aimed at exploring strategies that might improve the current practice-based learning environment.DESIGN:A focused ethnographic approach was used.METHODS:Nursing students, staff nurses, clinical instructors and nurse leaders from three hospitals and an educational program participated in individual interviews.RESULTS:Five key areas of improvement emanated from study data: 1) strengthening institutional support; 2) improving school-hospital collaboration; 3) building the capacity of nurses and clinical instructors; 4) restructuring clinical placement; and 5) reviewing the current supervision model. Based on these findings a "Co-CREATES" framework grounded in the actions of collaboration, care, recognizing, empowering, actively engaging, transforming, enhancement and support was developed. The framework offers a collaborative approach that engages every stakeholder in "cocreating" conditions that build positive practice environments which are conducive to preparing students as professional nurses.CONCLUSION:The positive outcomes stemming from such a collaborative approach can further enhance a positive culture of collaboration in nursing education and practice.

• Rural women use sport as a way to shape their health and wellbeing. • Motivations for sport participation can be seen as response to access to health services in rural areas. • Sport clubs in rural areas can be vital resources for community health and wellbeing. • Participants' membership in rural sport (curling) clubs are influenced by broader material conditions.

Background Health and well-being are multifaceted, with several lifestyle factors contributing (positively or negatively) to one's health status. Purpose The purpose of this qualitative study was to explore the health of rural women in the context of the sport of curling and curling clubs. As part of a national study, this study highlights findings from 17 female participants from two rural communities in Manitoba. Methods Qualitative data were collected using photovoice. Participants were asked to photograph images they felt represented health in the context of the curling rink. Researchers then conducted focus groups in which each participant was asked to choose and discuss two photographs. Results The participants photographed a total of 333 images, which were analyzed using thematic analysis. A total of six main themes emerged from the photographs and transcripts: facilitating social connections, enhancing physical health, promoting mental health, pride in the sport of curling, contributing to personal growth, and promoting gender equality. Conclusion Similar to the national study results, the findings in this study indicate that nurses, particularly community health nurses, as well as policy-makers, local communities, and others need to recognize the value of curling clubs to the health and well-being of rural populations.

Rural male farmers (RMFs) are an understudied population with high mortality, morbidity and co-morbidities due to preventable injury, most of which occur on-farm. This study examines how RMFs and their health needs are discussed in Ontario rural health policy documents. A retrospective analysis of policy was conducted to analyze the content of Ontario rural healthcare policy documents published since 2006. Discussions of RMFs were categorized by two themes: tokenism and mending fences. Tokenism refers to RMFs' invisibility, except when farming stereotypes were used to describe rural areas. Mending fences captures the desire of rural communities to be included in healthcare decisions, and to position RMFs as key stakeholders for healthcare organizations to engage with to improve how they are perceived by rural communities. This study asserts that including RMFs in health policy formation can improve rural healthcare delivery and relationships between rural healthcare organizations and the communities they serve.

The concept of social capital shows great promise for its potential to influence individual and population health. Yet challenges persist in defining and measuring social capital, and little is known about the mechanisms that link social capital and health. This paper reports on the quantitative phase of a sequential explanatory mixed methods study using data from Canada's 2013 General Social Survey (data collected 2013-14). An exploratory factor analysis revealed six underlying dimensions of social capital for 7,187 adults living in Ontario, Canada. These factors included trust in people, neighbourhood social capital, trust in institutions, sense of belonging, civic engagement, and social network size. A logistic regression indicated that having high Trust in People and Trust in Institutions were associated with better mental health while high Trust in Institutions, Sense of Belonging, and Civic Engagement were associated with better physical health. When comparing rural and urban residents, there were no differences in their self-reported health, nor did social capital influence their health any differently, despite rural residents having higher social capital scores. The study findings are important for understanding the nature of social capital and how it influences health, and provide direction for targeted health promotion strategies.

Beginning as early as 2009, recent shifts in Canadian health care delivery indicate that access to health information is essential to promote and maintain a healthy population. It is important to understand how and where various populations, such as underresourced rural populations, access health information so that public health agencies can develop and deliver appropriate information with, for, and in these contexts. There is a paucity of research that specifically examines how rural Canadian men seek health information; therefore, this review aimed to conceptualize this process based on three dynamic key constructs: health patterns of rural Canadians, health information–seeking behaviors, and rural gender identities. This conceptual theoretical literature review included 91 articles at the intersection of these three constructs. Discussion focuses on how residing in a rural region influences men’s health and health care access. Health information–seeking behaviors are discussed in terms of social networks and framed with a rural context. Connell’s theory of masculinity provides a useful approach to dissecting how rural men’s gender identities influence their health attitudes, and how such attitudes are embedded in rural social and cultural norms. Each major construct—health in rural Canada, health information seeking, and rural gender identities—is discussed to highlight how specific embodiments of masculinity may promote and inhibit men’s health information–seeking and positive health behaviors.

Purpose: The influence of place on health is beginning to be addressed in health research. Current understanding of rural places, however, remains in a state of disequilibrium, balancing between geo-graphic and sociocultural positions. This article illuminates the significance of place for rural women's experiences of health promotion in the rural church. Design: This study used a novel approach to interpretive phenomenological methodology by including the photovoice method to elicit both individual and shared experiential meanings. Method: Twenty-two participants took pictures, wrote in logbooks, and participated in individual and group interviews to share their experiences of health promotion in the rural church. Findings: The church as a place was realized through three broad discourses: (a) an intersection of physical and geographic environments, (b) a gateway to experiential attachment and personal meaning, and (c) a connection to shared culture and beliefs. It is also suggested that place may best be interpreted with an experiential lens as it exhibits lived and felt spaces. Conclusions: Data analysis suggests that place consists of both physical and experiential realities, in addition to being a resource of culture and meaning. Implications for rural women's health promotion include fostering a deeper recognition of place-shaped experiences of health.

In rural communities, religious places can significantly shape health for individuals, families, and communities. Rural churches are prominent community centers in rural communities and are deeply woven into rural culture. Thus, health influences arising from the rural church likely have health implications for the greater community. This article explores health influences emerging from rural churches using social determinants of health, social capital, and health expertise. Although nurses are important health resources for all populations, their value in rural areas may be exceedingly significant. The contribution of nurses to church-based health capital in rural communities may be quite significant and underestimated, although it remains poorly understood.

Purpose: To discuss findings from research in Ontario, Canada, that addresses the following objectives: 1) identify organizational attributes and local and provincial health policies that enable or impede the work of Ontario public health nurses to improve rural women's health, and 2) critically examine roles, job descriptions, and practices of Ontario PHNs that will improve rural women's health. Sample: 20 frontline PHNs and 14 supervisors and managers in three Ontario public health units that serve people who live in rural locations. Method: Six focus group interviews were conducted with PHNs and PHN managers in three rural Ontario public health units. Study participants were asked to describe policies and practices that guided their practice regarding rural women's health, identify organizational attributes that enable or impede public health nursing practice regarding rural women's health, and indicate roles and practices for PHNs to improve rural women's health. Findings: 1) Policies address rural women's health and rural public health minimally or not at all, 2) PHN practice is primarily focused on child bearing women and children to the exclusion of other populations of rural women such as seniors, 3) PHNs work through and around policies to address rural women' s health more effectively, and 4) institutional, government, community, professional, and personal factors play significant roles in shaping public health nursing practice and policy regarding rural women's health. Conclusions: This research facilitates understanding regarding policies, contexts, and values that shape rural PHN practice, and provides evidence for policies and practices that enhance and support public health nursing for more effective promotion of rural women's health. Clearly, more investigation is needed; this research forms the basis for ongoing inquiry in this area. Keywords: rural public health nursing, rural women's health, policy, practice, Canada DOI: http://dx.doi.org/10.14574/ojrnhc.v15i1.342

Determinants of health such as physical activity and social inclusion are key to the health of rural women, the basis of effective health promotion endeavors, and essential for rural community life. This study reports on a national curling and health study conducted with 48 rural women and girls ages 12 to 75 years in three provinces in Canada using the innovative photovoice method. Photovoice, with its inclusion of photos taken by study participants, provides a unique opportunity for pertinent data provision and comprehensive analysis by people living the experience. The purpose of the study was to examine the influence of curling on the health and community life of rural women. Study participants took pictures, recorded in log books, and participated in two group sessions to discuss the influence of curling on their health and community. Narrative and pictorial findings reveal important implications for rural women's sport participation; physical, mental, and social health; and the sustainability and development of curling and rural community life. Further research is needed to reveal the significance and address the sustainability of curling and its important contributions to rural health and rural communities. Keywords: curling, rural women, health, rural community, photovoice, Canada

Many rural health resources are linked to community churches, which are often well attended, especially by rural women. We used interpretive phenomenology and the photovoice method to understand how the church influenced health promotion for rural women, whose health is often significantly compromised compared with the health of urban women. Our analysis of the data from individual interviews, group sessions, photographs, and logbooks suggested that the rural church significantly facilitated rural women’s health promotion. The church supported the physical, intellectual, emotional, and spiritual health of rural women, facilitated social connectedness, and provided healthful opportunities to give and to receive. Implications included reframing religious places as health-promoting and socially inclusive places for rural women.

The rural church may be an effective health resource for rural Canadian women who have compromised access to health resources. The purpose of this paper is to explore the relevance of the Christian church and faith community nurses in promoting the health of rural Canadian women in the evolving rural context. The findings from an extensive literature search reveal that religion and spirituality often influence the health beliefs, behaviors, and decisions of rural Canadian women. The church and faith community nurses may therefore be a significant health resource for rural Canadian women, although this phenomenon has been significantly understudied.

Photovoice is a powerful method that is gaining momentum in nursing research. As a relatively new method in nursing science, the situatedness of photovoice within or alongside various research methodologies in a single study remains in a stage of early development. The purpose of this paper is to discuss the photovoice method as a means to elicit phenomenological data when researching the lived experience. While the foundational bases of phenomenology and photovoice differ substantially, the argument presented in this paper suggests that the photovoice method can be successfully used in phenomenological inquiry provided that significant rigour checks are pursued. This includes reflecting upon the origins and understandings of both methodology and method to promote methodological congruency. Data collection and analysis approaches that contribute to phenomenological inquiry using the photovoice method in addition to rigour and ethical considerations are discussed. The use of data generated from photovoice in phenomenological inquiry may fill a void of understanding furnished by limitations of traditional phenomenological inquiry and of spoken language and can enhance understanding of the lived experience, which may not always be best understood by words alone.

INTRODUCTION There is inadequate knowledge regarding the prevalence, nature, and severity of mental health issues for rural senior women in Canada. Limited research has explored rural mental health, tending to focus on identifying mental illnesses that rural senior women (aged 65 years or older) experience and overlooking factors that contribute to mental health problems. Therefore, the focus of this research was to examine mental health issues of rural senior women and factors that negatively and/or positively affect their mental health. METHODS For this study, a secondary analysis technique was employed to re-analyze focus group, logbook, and pictorial data from a primary photovoice study. This secondary analysis study more specifically identified findings related to the mental health of rural senior women, such as mental health issues and factors that positively/negatively affected their mental health. The primary study explored general health promotion needs and resources of senior rural women. RESULTS Two main mental health issues were identified: loneliness and negative self-concept. Two factors were found to positively affect these women's mental health: social and community resources, and personal characteristics and resources. The two factors that negatively affected these women's mental health were found to be: inadequate resources and loss in community; and devaluing of rurality, ethnicity, and gender. CONCLUSIONS Study findings substantially contribute to the knowledge base regarding rural mental health by focusing on senior women and key factors in the rural context. Implications of this research are important for rural communities, practice and service delivery, and future research.