Nursing in rural, remote and isolated settings: a literature review

Introduction: Public Health and Community Nurses provide the foundation of Ireland’s community, school and home delivered nursing care in rural, remote and isolated settings in Ireland, yet there is limited research evidence on the roles, responsibilities and models of care provided by these nurses.

Methods: Research literature was searched using CINAHL, PubMED, Medline. Fifteen articles were subject to quality appraisal and included for review. Findings were analysed, thematised and compared.

Results: Emergent themes – (1) models of nursing care provision in rural, remote and isolated settings; (2) barriers and facilitating factors impacting the roles and responsibilities; (3) expanded scope of practice shaping responsibilities; and (4) providing an integrated approach to care.

Discussion: Nurses working in rural, remote and isolated settings including off-shore islands are frequently lone workers who act as liaison for care recipients and their families with other healthcare providers. They triage care, engage in home visits, provide emergency first response, engage in illness prevention and health maintenance support. Models of care delivery using a hub and spoke model, orbiting staff, or longer-term shared positions must be based on principles for assigning nurses in rural settings and off-shore islands. New technologies allow specialist care to be delivered remotely and acute professionals will integrate with nurses in maximising care in the community. Better health outcomes are driven by the use of: validated evidence-based decision-making tools; medicine protocols; and accessible, integrated and role-specific education. Planned and focused mentorship programmes support nurses who are lone workers and impact on retention challenges.