title: The influence of geographical and social distance on nursing practice and continuity of care in a remote First Nations community.
abstract: The purpose of this article, which draws on the findings of a larger ethnographic study, is to explore the influences of geographical and social distancing on nursing practice and continuity of care in a remote First Nations community in Canada. Employing an ethnographic design, the authors use multiple data sources to ground the analysis in the unique context of health services in the selected community. The findings suggest that remote geographical location, the inequitable social conditions that shape the health and well-being of First Nations people, and nurses' level of preparedness to practise in this complex environment fostered patterns of social distancing in nurse-patient relationships. These patterns constrained nurses' ability to engage in practice that promotes continuity of care. In some cases, social distancing took the form of Othering practices and relational disengagement from patients. Changing the social determinants of Aboriginal people's health in remote communities is an important first step in supporting the changes in nurses' practice that are key to improving continuity of care and to effecting long-term, sustainable health improvements.
authors.affiliation: School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada. dtarlier@tru.ca
authors.forename: Denise S
authors.initials: DS
authors.lastname: Tarlier
authors.forename: Annette J
authors.initials: AJ
authors.lastname: Browne
authors.forename: Joy
authors.initials: J
authors.lastname: Johnson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel / Q000208:ethnology*; D001294:Attitude to Health / Q000208:ethnology; D001955:British Columbia; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D005843:Geography; D006801:Humans; D007198:Indians, North American / Q000208:ethnology*; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D016294:Models, Nursing; D024802:Nurse's Role / Q000523:psychology; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration; D012929:Psychological Distance; D012111:Residence Characteristics; D019035:Rural Health Services / Q000458:organization & administration*; D011795:Surveys and Questionnaires