Amber,

Online Journal of Rural Nursing and Health Care, vol. 8, no. 2, Fall 2008

A RURAL NURSING CENTER WITHOUT WALLS

Clarann Weinert, SC, PhD, RN, FAAN
1

Amber Spring, BS
2

Shirley Cudney, MA, RN, GNP
3

1
Professor, College of Nursing, Montana State University, cweinert@montana.edu

2
Project Manager, College of Nursing, Montana State University, aspring@montana.edu

3
Associate Professor (Retired), College of Nursing, Montana State University, scudney@montana.edu

Key Words: Research Center, Rural Nursing Research, Chronic Illness

ABSTRACT

Background. Conducting nursing research with rural populations is complicated by multidimensional

characteristics of rural dwellers; rural environment; paucity of nurse scientists prepared and supported to

conduct rural research; and institutional constraints of academic entities serving rural communities.

Unique research strategies are required to meet these challenges.

Purposes. To review the history of the Center for Research on Chronic Health Conditions in Rural

Dwellers (CRCHC), report the degree to which its objectives were met, summarize its accomplishments

over five years, and explicate the strategies used to overcome the challenges of conducting rural nursing

research in the western United States.

Findings. The CRCHC was successful in building human research capacity, supporting the development

of rural nursing science, and increasing research productivity.

Conclusions. A Center model is one mechanism that has been demonstrated to effectively meet the

challenges of conducting rural nursing research in the rural mountain west.

INTRODUCTION

A sense of charm and nostalgia is associated with rural living—at least as it is

characterized in literature and lore--which tends to perpetrate the myth that ―rural‖ is one-

dimensional and associated with open spaces, fresh air, bucolic life style, and healthy people.

While it is true that the rural lifestyle has many positive characteristics, it is no longer, if it ever

was, unidimensional or homogeneous. It is a vast and varied tapestry, populated with

communities rich in historic, cultural, economic, geographic, occupational, and demographic

diversity. It is often presumed that rural dwellers are healthy and robust. In reality, they are

burdened with a vast array of health needs associated with chronic health conditions, limited

access to health care services, poverty, social issues such as drug abuse, suicide, domestic

violence, alcoholism, smoking, and the likelihood of employment in hazardous occupations that

expose workers to chemicals and dangerous machinery.

The increasingly fluid socio-cultural and demographic profile, geographic contrasts, and

health status challenges of many rural dwellers present barriers to an adequate rural definition

and to conducting rural health-related research (Weinert & Burman, 1994). Nursing research

with rural populations is influenced by the multidimensional characteristics of the population, the

rural environment, and rural sub-cultural values. Likewise, rural nursing research differs widely

in its levels of sophistication (Weinert & Burman, 1996; Weinert, 2006), and there exist only a

few nurses prepared to conduct research in the rural context—factors which impact the state of

rural nursing research. Ideally, rural nursing research is best done by nurse scientists working in

academic settings located in rural areas who understand the rural subculture, rural health needs,

and rural health care delivery systems. In reality, these rural academic environments are often

http://www.montana.edu/wwwnu/
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mailto:aspring@montana.edu
http://www.montana.edu/wwwnu/
mailto:scudney@montana.edu

Online Journal of Rural Nursing and Health Care, vol. 8, no. 2, Fall 2008

isolated geographically from other higher education units, have an underdeveloped research

infrastructure, and, because there are few faculty members prepared at the doctoral level, have

limited resources and expertise for developing programs of nursing research or seeking support

from extramural grant funding.

With baccalaureate nursing education as the most common primary program focus,

faculty members shoulder heavy dyadic and clinical teaching responsibilities, as well as

obligations related to governance of the academic unit. Their small numbers result in added

assignments that include multiple committee memberships, curriculum development and

implementation, and advisement of large numbers of students. In the face of these constraints, it

is difficult to develop and support the critical mass of nurse investigators required to conduct

research that addresses the health issues of rural dwellers. Thus, in the face of these challenges,

developing a strategy to nurture investigators and foster collaboration among nurse researchers

across rural academic settings was imperative to the success of rural nursing science.

An organizational entity that was created to overcome some of the barriers to conducting

rural nursing research was the Center for Research on Chronic Health Conditions in Rural

Dwellers (CRCHC), located in the College of Nursing at Montana State University (MSU).

Collaborating Center investigators and their research teams were located in Iowa, Montana,

Nebraska, Nevada, North Dakota, and Wyoming--all rural areas characterized by an agricultural

economic base, wide open spaces, sparse populations, limited access to health care, few

academic settings, and notable geographic distance between nurse investigators.

In an earlier publication, Weinert, Lotts, & Winters (2004) discussed structure,

objectives, and some of the proposed strategies for attaining them. The purposes of this current

article are to: a) review the history of the CRCHC; b) report on the degree to which its objectives

were attained; c) summarize the accomplishments of the Center over its five years of operation;

and d) further explicate the strategies used to overcome the challenges of conducting rural

nursing research in the greater intermountain region of the western United States. While some of

the techniques used to build research skills, link researchers, maximize resources, and develop a

true community of scholars over geographic distance can be adapted, there is no intent to

generalize this discussion to other rural settings.

HISTORY OF THE CRCHC

The CRCHC was funded as a P20 Center by the National Institutes of Health/National

Institute for Nursing Research (1P20NR07790-01) and later supplemented by the SC Ministry

Foundation. The Center was in operation from August of 2001 until August of 2006 and was

designed to enhance the quality, quantity, and potential impact of rural nursing research. The

CRCHC was under the leadership of Director Clarann Weinert, SC, PhD, RN, FAAN, and

Associate Director, Charlene Winters, DNSc, APRN, BC, with the assistance of a Center

Manager.

OBJECTIVES OF THE CRCHC

The CRCHC was established on five foundational objectives which were to:

1. Increase the human capacity for conducting sound rural nursing research;
2. Develop the infrastructure to facilitate the development of programs of research to

generate new knowledge;

3. Provide small grant funding and technical support for pilot projects;

Online Journal of Rural Nursing and Health Care, vol. 8, no. 2, Fall 2008

4. Provide a focal point for synergistic linkages of scholars across Montana and the region;
and

5. Develop a knowledge base for addressing the multiple complex issues associated with
chronic illness management for persons living in sparsely populated areas.

The overarching goal of the CRCHC was to reduce health disparities and improve the health of

rural residents.

ACHIEVING THE OBJECTIVES: STRATEGIES AND OUTCOMES

Research Capacity Building

The first, and foundational objective, was to enhance the prerequisite research skills

needed to increase the human capacity for conducting sound rural research. To do so, a basic

toolbox of resources was made available to aspiring rural researchers that included on-call

writing assistance and consultation about all aspects of the research process from the Director,

who served as the lead mentor, and two external consultants who were knowledgeable about

grant writing and statistical methods. In addition, a variety of strategies were used to enhance

the research skills of investigators in Montana and the region that included linking with resources

at other universities, research brown bag sessions, visiting scholars, a writing support group, and

Principal Investigator meetings.

University linkages. The CRCHC linkages were with the Universities of Washington,

Iowa, and Wyoming. The University of Washington (UW) School of Nursing multi-talented

faculty shared their bi-monthly research seminars on a wide variety of research topics with the

CRCHC investigators and other interested professionals via telephone connection. For those

unable to attend, a video of each session was provided, supplemented with an accompanying

handout--all of which have been catalogued and are available on request.

Collaboration with the Gerontological Nursing Interventions Research Center at the

University of Iowa, College of Nursing provided a variety of resources. As a seasoned

researcher and Center Director, Dr. Toni Tripp-Reimer provided invaluable research insights, the

staff at the Iowa Center were generous in providing us with technical information on the running

of a Center, and one project was jointly funded through the Iowa Center and the CRCHC.

The other key linkage was with the Nightingale Center for Nursing Scholarship (NCNS)

located at the University of Wyoming. The CRCHC and NCNS collaboratively supported a

writers’ group, promoted one another’s research activities on a joint website, and explored the

development of joint databases and a mechanism to conduct mock reviews of grant proposals.

Research Brown Bag Sessions. Monthly, the CRCHC hosted an hour-long Research

Brown Bag Session, featuring eminent nurse scholars from around the country who addressed

multiple and varied research topics. These sessions, using the College of Nursing teleconference

system, were a low-cost method of providing exposure to some of the foremost scholars from

North America. Handouts were disseminated to the participating sites prior to the sessions. In all,

23 speakers representing 20 institutions reached over 500 participants (faculty, staff, students,

clinical colleagues) at 15 sites across Montana and 14 sites in 11 other states. See Table 1 for the

list of speakers and topics. The Research Brown Bag Sessions were enthusiastically embraced

and were a highly successful research capacity-building strategy.

Online Journal of Rural Nursing and Health Care, vol. 8, no. 2, Fall 2008

Table 1

Research Brownbag Session Speakers and Topics

Date Speaker Topic

9/16/2002 Mary Ann Curry

Oregon Health & Sciences University

Research with High Risk Populations: Persons with

Disabilities

10/21/2002 Lauren Aaronson

University of Kansas

Unfolding Human Subjects Regulations

11/18/2002 Toni Tripp-Reimer

University of Iowa

Certificate of Confidentiality and Memorandum of

Understanding

3/17/2003 Leslie Schmidt

Montana State University

How Grants and Contracts Can Help You!!

4/21/2003 Carole Hudgings

NIH/NINR

Techniques and Tips for Developing a Competitive

Research Application

10/20/2003 Angela McBride

University of Indiana

Mentors, Mentoring, and Career Development

9/15/2003 Joan Shaver

University of Illinois

Thoughts on Creating and Sustaining Programs of

Research

12/15/2003 Lillian Nail

Oregon Health & Sciences University

Sustaining a Career, Help Along the Way

11/17/2003 Linda Cronenwett

University of North Carolina

Becoming a Successful Nurse Scientist

3/22/2004 Margaret Heitkemper

University of Washington

Building Teams: It Takes a Village, Part One

4/19/2004 Nancy Woods

University of Washington

Building Teams: It Takes a Village, Part Two

9/20/2004 Martha Lenz

University of Washington

Writing a WINning Abstract

10/18/2004 Adeline Nyamathi

University of California San Francisco

Recruiting Participants from Vulnerable Populations

11/15/2004 Terry Badger

University of Arizona

Scholarly Dilemmas: Recruitment and

Dissemination

1/21/2005 Peggy Chinn

Yale

Scholarship: The Paradoxes of the 14 C’s

3/21/2005 Rosemary Donley,SC

Catholic University

The Relationship Between Research and Policy

4/18/2005 Marie Lobo

University of New Mexico

When the Blinded Data Collector Knows About the

Intervention

9/19/2005 Alyce Schultz

Arizona State University

Clinical Nurse Scholars: Building a Community of

Evidence-Based Practice Mentors

10/17/2005 Linda Everett

University of Iowa

Setting the Stage for Evidence-Based Practice in an

Acute Care Setting

11/21/2005 Suzanne Prevost

Middle Tennessee State University

Finding the Resources to Support Evidence-Based

Practice

1/30/2006 Carole Estabrooks

University of Alberta

Knowledge Translation: State of the Science

3/20/06 Russ McGuire

Appalachian Regional Healthcare, Inc.

Evidence-based Nursing

Practice Implementation and

Utilization in Central Appalachia

4/17/2006 Maureen Dobbins

McMaster University

Around the World in Sixty Minutes: Lessons

Learned in Evidence-Based Nursing

Online Journal of Rural Nursing and Health Care, vol. 8, no. 2, Fall 2008

Visiting scholars. The more conventional workshop model was also used as a strategy to

enhance research skills. The one-to-two day workshops were usually held on the MSU Bozeman

campus, and faculty and students drove from across the state and region to participate.

Distinguished presenters and their topics were: Carole Hudgings,PhD, RN, FAAN, from

NIH/NINR--grant writing; Toni Tripp-Reimer,PhD, RN, FAAN, University of Iowa--qualitative

research; Shirley Moore,PhD, RN, FAAN, Case Western Reserve--Electronic Interventions in

Nursing; and Ruth Kleinpell,PhD, RN, ACNP, Rush University--scientific writing (telephone

workshop). The opportunity to be in the physical presence of these distinguished scholars and be

able to personally exchange ideas with them added a new dimension to the experience of

building the novice researcher’s personal research capacity.

Western Writers’ Coercion Group. Ongoing support for the improvement of writing skills

and for increasing scholarly productivity was encouraged through the Western Writers’ Coercion

Group (WWCG). The overall goal of the group was to facilitate scholarship productivity through

multi-disciplinary and inter-institutional ongoing support, critique, mentoring, and scholarly

exchange. The WWCG first began the summer of 2001 in the University of Wyoming

Nightingale Center for Nursing Scholarship (NCNS) as a local innovation. By the summer of

2002, the group expanded to include faculty from other disciplines such as social work and

mathematics. The composition of the group was eclectic (faculty members – nursing, social

work, mathematics, doctoral student, clinical nurse researcher) who were located in a variety of

settings in Montana, Nebraska, North Dakota, New Mexico, and Wyoming.

Meetings (weekly during the summer and bi-weekly during the academic year) were

conducted from Wyoming’s NCNS with support from Montana’s CRCHC for the teleconference

connection and website. At each meeting, individual goal attainment was assessed, manuscripts

were discussed, and support/encouragement was given. All participants paid a $5.00 filing fee to

join the group, and those who, by self-report at the meetings, had not met their goals were

―fined‖ $5.00. Over time, the accumulated fees/fines were used to buy a Sigma Theta Tau

International Brick Paver and to make an additional contribution to the Honor Society's Research

Fund. A total of 22 faculty participated, with an average of 10 participating at each meeting. The

WWCG was disbanded in December, 2006, with a notable record of productivity. There were 74

manuscripts prepared (53 published, 9 in press, and 5 in review). WWCG members presented

symposia about the writing support group at the Western Institute of Nursing Conference (2004)

and at the State of the Science Congress (2006). The impact of such a group as a research

capacity-building strategy was reflected in observations from the group members that included:

an appreciation for the collegial support and encouragement received; a sense of group loyalty; a

feeling of gratitude for the ―gentle coercion‖ to stay on track with individual goals; and the value

of the regular accountability to the group. A more detailed description of the Western Writers’

Coercion Group is provided in a publication by Cumbie, Weinert, Luparell, Conley, and Smith,

(2005).

Principal Investigator meetings. Principal Investigators of current and prior pilot projects

met periodically by teleconference with the Associate Director for the purposes of mutual

support, problem solving, and generation of ideas. The group ranged from very senior and

seasoned researchers to more novice investigators. This rich mixture provided additional

opportunities to learn the research process and to develop skills in problem-solving issues related

to conducting rural research.

Online Journal of Rural Nursing and Health Care, vol. 8, no. 2, Fall 2008

Infrastructure Development

The second objective--the development of the infrastructure to facilitate the development

of programs of research to generate new knowledge—added the physical, technical, and resource

support needed to complement the gains in human research capacity building. As well as

providing a physical environment to house Center activities (office space and equipment, access

to the teleconferencing system, etc.), the CRCHC provided investigators with a wide range of

resources to aid them in their research efforts. The Center staff assembled a clearinghouse of

information useful to researchers in an easily-accessible format on the CRCHC’s well-developed

website where they could connect to a ―research toolbox‖ with useful research links, seminar

information, writing tools, the CRCHC library, audio and video tapes, and consultation services.

The CRCHC staff provided assistance with budget preparation, grant writing, editing,

proofreading, and dissemination efforts. These resources were open to all interested investigators

from across the region and beyond, as well as to MSU students and faculty. This strong

infrastructure made it possible to build upon prior research efforts, strengthen ongoing research,

stimulate initiatives, increase funding, attract investigators, and enrich student research

opportunities (Weinert, Lotts, & Winters , 2004).

Support for Pilot Projects

To enhance human capacity building, forge regional linkages, and promote rural nursing

science, the CRCHC provided grant funding and technical support for pilot projects related to

chronic illness in adults and children living in rural areas—its third objective. Through the Pilot

Project Program, three studies were funded each year. Awards were a maximum of $10,000 and

one year in length. Collaborative endeavors were encouraged among faculty investigators and

master’s prepared faculty, clinical nurses, and inter-disciplinary and inter-institutional projects.

The research questions evolved from a wide range of issues related to management of chronic

health conditions within the context of the rural environment. Study topics addressed the

promotion of healthy behaviors, prevention of complications, encouragement of self-

management, and support of the family in managing chronic health conditions.

The Pilot Project Program funding process was a mentored endeavor from the initial

conceptualization of the idea, through the development of the research team, preparation of a

PHS398 format proposal, conduct of the research, dissemination of findings, and finally,

assistance with follow-up funding acquisition. The day-to-day grant management and interface

with the MSU entities, e.g., Office of Sponsored Projects, Personnel, Institutional Review Board,

was handled by the Center Manager. Grant management was complicated by the fact that none of

the Principal Investigators and few of the research team members were located on the Bozeman

campus. To enable the investigators to focus on the science, all necessary paperwork (payroll,

personnel, contracts, travel forms, reimbursement, budget tracking, etc.) was handled by the

Center staff. Although it was more efficient for the CRCHC to assume these duties, the

investigators were consistently informed about these processes and engaged in discussions of

evolving issues as strategies for enhancing their understanding of grant management.

Pilot Project Program proposals were prepared in an iterative process with the Center

Director. A system of formal review for each proposal included review by the Pilot Core which

consisted of one MSU non-nurse faculty, one external nurse reviewer, and three College of

Nursing reviewers. In addition, each proposal was reviewed by two content experts who were

external to Montana State University and the universities with which the Principal Investigator

and research team were affiliated.

Online Journal of Rural Nursing and Health Care, vol. 8, no. 2, Fall 2008

Investigators were encouraged to submit a poster abstract during their year of funding

and a podium abstract the year following funding to be presented at the Western Institute of

Nursing’s annual conference. The Principal Investigators provided a written progress report and

a final grant report and were required to submit a manuscript for publication, present at a

regional, national, or international scientific conference, and submit a research proposal for

extramural funding within one year after completing the study. All of these activities were

supported and facilitated by the CRCHC staff. In addition, the pilot project investigators were

expected to participate in and support CRCHC events such as the research workshops, Research

Brown Bag Sessions, and Principal Investigator meetings.

Toward what was, ultimately, to be the end of operations of the CRCHC because of lack

of monetary support, two Pilot Program Project proposals were prepared, submitted, reviewed,

and recommended for funding. However, despite their high quality, they could not be funded

because of the demise of the CRCHC.

One of the proposals, ―A Descriptive Analysis of the Health Status of a National

Asbestos-related Disease Cohort,” was prepared by five MSU nursing faculty members under

the leadership of the CRCHC Associate Director. The purpose of the study was to establish a

comprehensive understanding of the health status and impact of chronic illness on persons

exposed to asbestos in Libby, Montana. The research team, with the assistance of the CRCHC,

revised the proposal, and, though rejected by one foundation, it was ultimately funded by the

HRSA Office of Rural Health Policy (R04RH07544-01-01).

The second unfunded CRCHC-approved proposal was ―Sustained Breastfeeding:

Preventing Chronic Illness in Rural, Hispanic Infants,‖ headed by a nurse investigator from the

University of Nebraska. Her research team included three nurse scientists from the Universities

of Nebraska, Wyoming, and Montana. This study was a direct outcome of a CRCHC-funded

project by the same research team whose overall interest is promoting infant respiratory health in

rural settings through sustained breastfeeding and interventions targeted at decreasing

environment triggers. The research team re-conceptualized its approach and is currently funded

for two projects. The first, ―Motivational Interviewing to Promote Sustained Breastfeeding,‖

funded by the Minority Health Research Seed Projects at the University of Nebraska, is in

progress on a Native American reservation in South Dakota. The second, ―Screening Native

American Children for Asthma,‖ is also funded and is being implemented on a second South

Dakota reservation.

Overall, the CRCHC Pilot Project Program funded 13 projects, under the umbrella of

chronic illness management, which involved a total of 29 investigators from nine employment

affiliations. These researchers were Montana State University nursing faculty (n=12); nursing

faculty from other universities/organizations (n=12), and non-nursing investigators (n=5). On

Table 2 are displayed the name, discipline, affiliation, and project(s) for each investigator. The

Pilot Project Program was a major strategy of the CRCHC that was used to successfully advance

the state of the science in areas of chronic illness and rural health.

Online Journal of Rural Nursing and Health Care, vol. 8, no. 2, Fall 2008

Table 2

Pilot Program Investigators: Discipline, Affiliation, Research Project

Investigator Discipline Affiliation Team

1. Brandt Nursing St. Vincent

Hospital - Billings

Pain Management/Telehealth Crow

Indians

2. Zulkowski (PI) Nursing MSU Pain Management/Telehealth for Crow

Indians

3. Cumbie (PI) Nursing U of Wyoming Nursing Care Model

4. Burman Nursing U of Wyoming Nursing Care Model

5. Conley Nursing U of Wyoming Nursing Care Model

6. Weinert Nursing MSU Nursing Care Model; Spirituality &

Chronic Illness; Rural Data Collection;

Isolated Rural Women; Native

American Elders; Health Care Choices

7. Sullivan Nursing MSU Cancer Management; Health Care

Choices; Isolated Rural Women

8. Craig (PI) Nursing OHSU Spirituality & Chronic Illness

9. Walton Nursing Carroll College Spirituality & Chronic Illness

10. Derwinski-robinson Nursing MSU Spirituality & Chronic Illness

11. Holkup (PI) Nursing MSU Native American Elders

12. Tripp-Reimer (PI) Nursing U Iowa Native American Elders

13. Salois Social Work Independent Native American Elders

14. Ide Nursing U North Dakota Health Care Choices

15. Nichols Nursing MSU Health Care Choices

16. Shreffler-Grant (PI) Nursing MSU Health Care Choices; Medical

Assistance Facilities; Hospice use of

CAM

17. Mayer Nursing MSU Men's Heart Network

18. Winters (PI) Nursing MSU Men's Heart Network; Isolated Rural

Women

19. Parker (PI) Nursing MSU Cancer Management

20. Rodehorst Nursing U of Nebraska Rural Data Collection

21. Wilhelm Nursing U of Nebraska Rural Data Collection

22. Stepans (PI) Nursing U of Wyoming Rural Data Collection

23. Smith Physiology U of Wyoming Rural Data Collection

24. Kuntz (PI) Nursing MSU Methylmercury Risk

25. Hill Nursing MSU Methylmercury Risk; Men’s Heart

Network

26. King Engineering MSU Methylmercury Risk

27. Lande Health & Human Dev MSU Methylmercury Risk

28. Linkenbach Health & Human Dev MSU Methylmercury Risk

29. Running (PI) Nursing U of Nevada Hospice use of CAM

Creating Scholarly Linkages

To achieve the fourth objective—provide a focal point for synergistic linkages of scholars

across Montana and the region—several mechanisms that were available locally, throughout the

state, and across the region were utilized to link investigators with the resources of the CRCHC.

These mechanisms included: Center Affiliates, Center Collaborators, Center Investigators, and

Pilot Program Investigators.

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Center Affiliates. Center Affiliates were an integral part of the overall CRCHC and

contributed to its mission through their support of Center goals and participation in Center

activities. These were non-university related investigators/organizations that promoted the

CRCHC efforts by: a) participating in research that addressed issues related to chronic illness in

rural dwellers; b) being involved with the training efforts of the Center; and c) engaging in the

dissemination of information through workshops, conferences, and media. Center Affiliates had

full access to all CRCHC resources. Likewise, Center Affiliate investigators could identify with

a larger entity when submitting grant proposals and receive assistance from the CRCHC for

preparation of grant applications, help with dissemination efforts, and consultation about

conducting research.

Center affiliation for institutions/organizations provided a research connection for

individuals within their institution/organization and the opportunity to identify with research

efforts across the state and region. They received advance notice of guest speakers, other

educational opportunities, and the Center newsletter. The six Center Affiliates were seen as

valued friends and collaborators, a win-win situation for Center Affiliates and for the CRCHC.

Center Collaborators. Center Collaborators included partner universities, industry, and

private community researchers who shared common interests with the CRCHC. They joined with

the CRCHC to write grants, contracted with the staff for consultation or assistance, or teamed

with CRCHC investigators to conduct ongoing research.

One Center Collaborator project, titled ―Spirituality and Suicide,‖ was headed by a

chaplain from a local hospital. His research team consisted of a retired minister, a nursing

colleague from Oregon Health & Sciences University, and the CRCHC Director. The goal of this

study, funded by a private family foundation, was to better understand the role of spirituality in

dealing with suicide and the attendant dynamics of spiritual support and personal faith beliefs of

family members coping with this type of loss (Craig, Weinert, & Vandecreek, 2007). To pursue

this understanding, the theological difficulties or conflicts experienced by suicide loss survivors

in integrating their faith with the tragedy of suicide, the personal trauma of suicide loss, and the

appropriate intervention to provide spiritual support for survivors that help lead to healthy

resolution of grief were explored.

The "cross pollination" of the Center Collaborators with the other Center Investigators

added to the synergistic health and/or rural nursing research efforts. Through this strategy,

lasting research relationships evolved, and contributions were made to the overall state of

nursing science and health in the USA.

Pilot Project Program Investigators. The Pilot Project Program strategy, as previously

described, was a key player in the forging of inter-institutional and interstate (Iowa and

Wyoming) linkages between nine institutions as well as the non-nursing disciplines of social

work and applied physiology. A secondary gain from the interstate linkages was the sharing of

the expertise of the more experienced researchers from Iowa with the less experienced CRCHC

staff.

The strategy of creating scholarly linkages among nurse researchers of the west has been

highly productive. Weinert and colleagues (2004) emphasized that ―Through these linkages, the

CRCHC works to develop both nursing science and nurse scientists which, over time, helps to

generate the critical mass necessary to conduct quality rural nursing research that will enhance

nursing practice and improve the health of rural dwellers‖ (p. 70).

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Table 3

Pilot Project Titles, Teams and Descriptions

Project title Team Project description

Pain Management and Telehealth

for Crow Indians

Zulkowski (PI)

Brandt

Determine the feasibility of nursing management of

chronic pain using telehealth Native American

Crow

Exploring Chronic Illness in

Isolated Rural Women

Winters (PI)\

Sullivan, Weinert

Secondary analysis of Women to Women data to

identify themes related to illness uncertainty and

illness management.

Care for Chronic Conditions in

Medical Assistance Facilities

Shreffler-Grant (PI) Develop method to assess quality of care for acute

exacerbations of chronic health problems in low-

acuity low volume facilities

Spirituality: Rural Dwellers and

Chronic Illness

Craig (PI)

Derwinski-robinson,

Walton, Weinert

Examine spirituality and health behaviors, quality

of life, and illness management and nature of

spirituality among rural dwellers with chronic

illness.

Caring for Native American

Elders

Tripp-Reimer (PI)

Holkup ,Salois, Weinert

Develop, pilot, and assess the feasibility of an

intervention - the Family Care Conference (FCC).

Cancer Management: Rural

Dwellers and Their Spouses

Parker (PI),

Sullivan

Determine how older rural individuals living with

cancer and their spouses manage the symptoms

following cancer-related treatments.

Nursing Care Model for the

Chronically Ill

Cumbie (PI), Conley,

Burman, Weinert

Test a client-centered nursing intervention with

selected chronically ill rural persons in a clinic

setting,

Men's Heart Network Winters (PI)

Mayer, Hill

Adapt the Women to Women2 protocols and

materials for use with isolated rural men with CVD

Health Care Choices Shreffler-Grant (PI), Ide,

Nichols, Sullivan,

Weinert

Explore the extent of use, perceived efficacy, and

availability of complementary therapies for chronic

conditions.

Testing Protocols for Rural

Sample Data Collection

Stepans (PI), Smith,

Rodehorst, Wilhelm,

Weinert

Develop protocols for monitoring biomarkers and

aeroallergens reflective of inflammatory response

of the respiratory system of babies (12 - 18

months).

Caring for Native American

Elders: Prairie Addition

Holkup (PI), Tripp-

Reimer, Salois, Weinert

Gather background and contextual data from one

additional Tribal community in Montana to expand

the testing of the Family Care Conference.

Easing Chronic Suffering: A

Survey of Hospices Use of

Complementary Therapy

Running (PI)

Shreffler-Grant

Explore use of complementary therapies by hospice

in managing chronic conditions for rural elders at

the end of life.

Methylmercury Risk and

Awareness in American Indian

Women of Childbearing Age

Kuntz (PI)

Hill, King,

Lande, Linkenbach

Construct and adapt culturally appropriate

instrumentation and methods to assess risk for

methylmercury exposure in American Indian

women of childbearing age living on rural

reservations.

Online Journal of Rural Nursing and Health Care, vol. 8, no. 2, Fall 2008

Developing a Knowledge Base for Chronic Illness Management

The final objective of the CRCHC was to develop a knowledge base for addressing the

multiple complex issues associated with chronic illness management for persons living in

sparsely populated areas. The pilot project titles listed in Table 3 represent the contribution the

CRCHC has made to the knowledge base related to chronic illness management of rural dwellers

across the life span. Information obtained about chronic pain management through telehealth,

eldercare, and methylmercury risk in Native American populations should benefit a traditionally

underserved rural population. The knowledge gained about the impact of chronic illness on the

emotional and spiritual health of rural dwellers will guide the design of interventions intended to

enhance adaptation to chronic illness. Delivery of care by rural health care facilities that is

appropriate to the needs of those with chronic illness will be informed by the results of the

medical facilities study and complemented by the testing of a nursing intervention that can be

translated into a client-centered nursing care model for the rural chronically ill. The role of

cancer symptom management, health care choices, and complementary therapy in the chronic

illness/end of life experiences of elders and others will be illuminated. Two protocols have

addressed chronic illness issues at opposite ends of the life continuum:

1. The Women to Women protocols for assisting rural dwellers to adapt to chronic
illness have been applied to men with heart disease;

2. Protocols for monitoring biomarkers and aeroallergens in babies are being tested.

CRCHC contributions such as these have added to the knowledge base related to the multiple

complex issues associated with chronic illness management of rural dwellers and have

strengthened rural nursing science.

Accomplishments of the CRCHC

The productivity of the Center Investigators and Center Collaborators is noteworthy

especially when measured from the point where most of these investigators began in terms of

research engagement, skills, and scholarly productivity. To date, 50 manuscripts have been

prepared with 40 published, 2 in press, and 8 in review. There have been 73 published abstracts,

74 papers presented, and 37 poster sessions. Seventeen of the 38 follow-up grant proposals have

been funded.

CONCLUSIONS

The CRCHC came about through the serendipitous combination of the factors of

location, leadership, and a focus on rural nursing research at Montana State University College

of Nursing. The College in which the CRCHC was located was geographically situated in a

prime western location. With the encouragement and support of a nationally acknowledged nurse

scientist, Dr. Clarann Weinert, the faculty had begun to focus on forging and fostering bonds

among rural nurse researchers scattered across the west in geographically isolated, less research-

intensive institutions. At the same time, the College of Nursing was becoming nationally

recognized in the area of rural nursing research. The CRCHC was ideally positioned to facilitate

the creation of linkages between western nurse scientists, provide research consultation, and

promote collaboration among nurse investigators through inter-institutional research projects,

seminars, and the Western Writers’ Coercion Group.

Online Journal of Rural Nursing and Health Care, vol. 8, no. 2, Fall 2008

From its inception, the CRCHC facilitated the creation of linkages among investigators

across Montana and the region. Often investigators from the less research intense settings had no

senior researchers to serve as mentors, and the CRCHC was an optimal venue for providing that

research mentorship. The multi-site, multi-institutional linkages have: a) further strengthened the

rural nursing research efforts in Montana; b) enriched both nursing science and nurse scientists;

and c) helped to generate the critical mass necessary to conduct quality rural nursing research to

enhance nursing practice and improve the health of rural dwellers. With its regional, inter-

institutional impact, the CRCHC evolved into a "scholarly community without walls." It is

noteworthy that six of the research teams (which include investigators from across Montana and

from Nebraska, Wyoming, Iowa, Oregon, North Dakota), that were forged through the Center,

continue to actively conduct research to date. These teams have been able to continue to expand

and develop their programs of research, have been successful in obtaining intra or extra-mural

funding and have been productive in the dissemination of their findings.

The challenges to conducting rural nursing research such as distance, research resource-

poor environment, and lack of nurse investigators were addressed through the CRCHC using a

variety of techniques. Distance was often bridged by low tech methods such as the telephone

conference system. This system provided a low cost means for:

1. Research teams to meet;
2. Consultation sessions with the CRCHC Director;
3. The principal investigators meetings;
4. Western Writers Coercion Group meetings; and
5. The Brown Bag sessions.

A CRCHC website provided a mechanism for user-friendly access to critical research

information. A toll-free telephone number allowed investigators to call the CRCHC without

charge to themselves. At times the Center Director traveled to distance sites across Montana and

the region to meet face-to-face with research teams and some teams traveled to Bozeman for

consultation. Common meeting sites such as the WIN Communicating Nursing Research

Conference and the State of the Science Conference were used as times for sharing among

CRCHC investigators. The pilot program funding provided monetary support to launch projects,

as well as, the full array of grant management support from the CRCHC Program Director. The

ongoing mentoring, along with the linkages forged among investigators across Montana and the

region helped to offset the limitations of research resource-poor environments. To provide

research expertise to each project, in addition to ongoing mentoring, the Center Director served

as a co-investigator to every project that was headed by a non-MSU nursing faculty. Likewise,

she served as a co-investigator to a significant number of the projects for whom a faculty

colleague was the principal investigator. This along with the contributions of Dr. Toni Tripp-

Reimer provided research teams with assistance from seasoned and well funded nurse scientists.

The Center mechanism, as means of addressing issues associated with the management of

chronic illness within the rural context, has been very successful. Indicators that the objectives of

the CRCHC to increase research skills, improve the research infrastructure, support pilot

projects, and increase the knowledge base related to the management of chronic illness in the

rural setting are most apparent. It is clear from indicators such as the number of individuals and

institutions involved, the breadth of the pilot projects, the successful funding of follow-up

studies, the impressive dissemination statistics, and the feedback from those involved, that the

CRCHC was a success. Unfortunately, despite the successes of the CRCHC, the university and

College of Nursing were not financial positioned to support the center. A very serious pursuit

Online Journal of Rural Nursing and Health Care, vol. 8, no. 2, Fall 2008

for funds to sustain the CRCHC was undertaken and numerous proposals to various agencies,

organizations, and foundations were submitted. Interest in funding a Center was found to be

very low, as most funding bodies were interested in specific discrete projects. However, one

foundation grant allowed the CRCHC to continue functioning after the end date of the P20

funding.

The bonds of colleagueship and friendship among investigators are treasures gained well

beyond the nursing science impacted by the CRCHC. These bonds are the foundation for

continued collaboration across geographic distance and other rural barriers which are

establishing a lasting culture of rural nursing scientists that will make a difference in the health

and well-being of rural dwellers. What started as a long-standing dream of one nurse scientist

grew into the realization of a rural nursing research center that has developed, motivated, and

energized rural nurse investigators and their colleagues. During its relatively short tenure, the

CRCHC succeeded in positioning rural investigators to conduct the research necessary to reduce

some of the health disparities faced by rural residents and contribute to the improvement of the

health status of chronically ill Native Americans and rural dwellers across the lifespan. Although

it no longer exists, the influence of the CRCHC endures, and will continue to do so into the

foreseeable future.

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Cumbie, S., Weinert, C., Luparell, S., Conley, V., & Smith, J. (2005). Developing a scholarship

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Weinert, C. (2006). Rural health revisited. In J. Fitzpatrick & M. Wallace (eds.), Encyclopedia of

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Weinert, C., & Burman, M. (1996). Nursing of rural elders: Myths and reality. Advances in

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Weinert, C., & Burman, M. (1994). Rural health and health seeking behaviors. Annual Review

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Weinert, C., Lotts, K., & Winters, C. (2004). The CRCHC: A strategy for enhancing rural

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