Background: Pregnant girls/young women and new mothers living in situations of social and economic disadvantage\nare at increased risk for poor health. Rural living may compound marginalization and create additional challenges for\nyoung mothers. Public health nurses (PHNs) delivering the Nurse-Family Partnership (NFP) to mothers living in rural\ncommunities may help to improve maternal and child health outcomes. The purpose of this analysis, grounded in data\ncollected as part of a broader process evaluation, was to explore and understand the influence of rural geography on\nthe delivery of NFP in British Columbia, Canada.\nMethods: For the analysis of this qualitative data, principles of inductive reasoning based on the methodology of\ninterpretive description were applied. A total of 10 PHNs and 11 supervisors providing the NFP program in rural\ncommunities were interviewed.\nResults: The results of this analysis reflect the factors and challenges of providing the NFP program in rural\ncommunities. PHNs noted the importance of NFP in the lives of their rural clients, especially in the face of\nextreme financial and social disparity. Remaining flexible in their approach to rural nursing and protecting\ntime to complete NFP work supported nurses practicing in rural environments. Rural PHNs were often the\nsole NFP nurse in their office and struggled to remain connected to their supervisors and other NFP colleagues.\nChallenges were compounded by the realities of rural geography, such as poor weather, reduced accessibility, and\nlong travel distances; however, these were considered normal occurrences of rural practice by nurses.\nConclusions: PHNs and NFP supervisors are well-positioned to identify the modifications that are required to support\nthe delivery of NFP in rural geography. NFP nurses need to articulate what classifies as rural in order to effectively\ndetermine how to best provide services to these populations. Environmental conditions must be considered when\noffering NFP in rural communities, particularly if they impact the time required to deliver the program and additional\nservices offered to young mothers. Regular NFP meetings and education opportunities address common problems\nassociated with rural nursing but could be enhanced by better use of technology.
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