Rural nursing education: a photovoice perspective.
BACKGROUND
For many rural Canadians nursing care is the primary and often the sole access point to health care. As such, rural nurses are an invaluable resource to the health and wellbeing of rural populations. However, due to a nursing workforce that is aging and retiring, limited resources and support, healthcare reform issues, and other factors, these rural professionals are in short supply. Because of limited opportunities to learn about rural practice settings, nursing students may be reluctant to select rural practice locations. Relevant and effective educational initiatives are needed to attract nursing students to underserved rural and remote communities so that rural people receive the health care they require. The purpose of this study was to explore the use of the innovative research approach called photovoice as an educational strategy to foster learning about and interest in rural locations and rural nursing as future practice settings. Fostering of interest in rural may help to address nursing workforce shortages in rural settings.


METHODS
Thirty-eight third and fourth year nursing and health sciences students enrolled in an elective 'Rural Nursing' course used the qualitative research method photovoice to take photographs that represented challenges and facilitators of rural nursing practice. They then engaged in written reflection about their photos. Photos were to be taken in rural settings of their choice, thus fostering both urban and rural student exposure to diverse rural communities.


RESULTS
One hundred forty-four photos and reflections were submitted, representing students' appreciation of diverse facilitators and challenges to rural nursing practice. Facilitators included technology, a generalist role, strong sense of community, and slower pace of life. Challenges included inadequate rural education in undergraduate nursing programs, professional isolation, safety issues, few opportunities for professional development, lack of anonymity, and insider/outsider status. Exemplar photos and reflections are provided.


CONCLUSIONS
The photovoice research approach used in this rural education endeavour proved to be very useful in fostering students' exposure to, interest in, and understanding of rural settings and their influence on rural nursing practice. Photovoice is also recommended for use in rural courses other than nursing. Suggested strategies include group photovoice experience and the expansion of reflection to enhance rural health research.
Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada. bleipert@uwo.ca
Beverly
B
Leipert
Emma
E
Anderson
D000328:Adult; D002755:Choice Behavior; D002983:Clinical Competence; D003152:Community Health Nursing / Q000193:education*; D018864:Cultural Diversity; D003479:Curriculum; D004506:Education, Nursing / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007400:Interprofessional Relations; D008875:Middle Aged; D009864:Ontario; D010781:Photography; D018794:Problem-Based Learning / Q000379:methods; D017009:Professional Autonomy; D036301:Qualitative Research; D019035:Rural Health Services; D012424:Rural Population; D012449:Safety; D012934:Social Isolation / Q000523:psychology; D013338:Students, Nursing / Q000523:psychology*; D000078329:Workforce