title: An ecological view of the rural environment: levels of influence on access to health care.
abstract: Access to health care has diminished for rural Americans due in part to a record number of rural hospital closures. Hospitals have served as the infrastructure of rural health care. When hospitals close, other health services and providers are frequently lost. Adequate access to health care is one determinant of health. An ecological perspective on environment reveals multiple levels of influence that support or do not support access to rural health care. Implications for nursing science and practice involving all levels of environment are suggested by an ecological view.
authors.affiliation: School of Nursing, University of Washington, Seattle, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Shreffler
mesh_terms: D004463:Ecology; D004777:Environment; D006297:Health Services Accessibility / Q000191:economics / Q000639:trends; D006780:Hospitals, Rural / Q000191:economics; D006801:Humans; D019035:Rural Health Services / Q000191:economics / Q000639:trends*