Contributor – Karen J. Foli
June 3, 2021

Authors – Charlene A. Winters, PhD, RN, FAAN and
Helen J. Lee, PhD, RN

First published – 1989

Major Concepts

• Health beliefs and work beliefs
• Health-seeking behavior and choices
• Isolation and distance
• Self-reliance and independence
• Lack of anonymity
• Old-timer/newcomer
• Insider/outsider.

Typology

Middle range theory

Brief Description

Rural nursing theory is an evolving middle-range theory that emphasizes the environment. Health is defined as a way of life/state of of mind. Older residents are more likely to define health in a functional manner; and rural residents are self-reliant and make decisions to seek care based on self-assessment and the resources needed and available. The role of the nurse is characterized by lack of anonymity and role diffusion.

Theoretical Statements:
1. Rural residents define health as being able to do what they want to do; it is a way of life and a state of mind; there is a goal of maintaining balance in all aspects of their lives (descriptive statement)

2. Rural residents are self-reliant and make decisions to seek care for illness, sickness, or injury depending on their self-assessment of the severity of their present health condition and of the resources needed and available
(Self-reliance is a characteristic rural persons and influences responses to illness or injury and care-seeking behaviors; Informal system frequently used as a resource; Rural cultural barrier to accessing care through formal resources is changing) (relational statement)

3. Health care providers in rural areas must deal with a lack of anonymity and a much greater role diffusion than providers in urban or suburban settings (Familiarity can be a facilitator or a barrier to seeking health and illness care from local healthcare practitioners; Lack of anonymity that healthcare providers experience in rural communities is a paradox) (relational statement)

Concept Relationships:
Definition of Health: Ability to work and to be productive
Self-reliance: Resist help from outsiders or strangers
Rural nursing: Lack of anonymity
Role diffusion
Generalizability: Need for more study

Concepts to be explored: distance, resources, health-seeking behaviors, choice, environmental context, social capital.

See: Winters, C. & Lee, H. J. (Eds.). (2018). Rural nursing: Concepts, theory and practice. (5th ed.). Springer Publishing Company.

Primary Sources

Winters, C. & Lee, H. J. (Eds.). (2018). Rural nursing: Concepts, theory and practice. (5th ed.). Springer Publishing Company.

Also see:
Lee, H. J. (1998). Lack of anonymity. In H. J. Lee (Ed.), Conceptual basis for rural nursing (pp. 76–88). New York, NY: Springer Publishing.

Long, K. A., & Weinert, C. (1989). Rural nursing: Developing the theory base. Scholarly Inquiry for Nursing Practice, 3(2), 113-127.

Application Sources

Lauder, William, Reel, Sally, Farmer, Jane, & Griggs, Harvey. (2006). Social capital, rural nursing and rural nursing theory. Nursing Inquiry, 13(1), 73-79.

Lee, Helen, & Winters, Charlene. (2004). Testing Rural Nursing Theory: Perceptions and Needs of Service Providers. Online Journal of Rural Nursing and Health Care, 4(1), 51-63.

Swan, M. A., & Hobbs, B. B. (2017). Concept analysis: Lack of anonymity. Journal of Advanced Nursing, 73(5), 1075–1084. doi:10.1111/jan.13236

About the authors

Charlene A. Winters    

Charlene A. Winters is a professor emerita, College of Nursing at Montana State University, Missoula Campus. Dr. Winters research and scholarship has focused on rural health issues, rural nursing theory development, adaptation and response to illness, and chronic illness self-management; her research has also investigated exposure to environmental toxins. Dr. Winters has received research funding from the HRSA Office of Rural Health Policy and NIH/National Institute of Nursing Research, and others; and she has served as the project director for HRSA funded advanced nursing education grants (CNL & CNS options).

Helen J. Lee

Dr. Lee is a professor Emerita in the College of Nursing, Montana State University, Missoula Campus. She continues her interest in rural nursing theory and end-of-life issues.