Online Journal of Rural Nursing and Health Care, 2(2) 5 

Editorial 

Rural Practice Forum: Communicating with Rural People 

Bette Ide, PhD, RN, Editorial Board Member 

 

Helene Kahlstorf, M.S., RN is a graduate of the University of North Dakota rural health 

nursing graduate option.  She is a parish nurse and the Regional Coordinator for Colleagues in 

Caring in western Minnesota.  She speaks from having lived in a rural culture for over 40 years 

and from vast experience with rural people.  She states that rural people tend to be rugged 

individuals, very independent.  Early in her career, as the only public health nurse in a large 

county where there had not been a nursing service for two years, she found advice from the 

District Nursing Consultant from the Minnesota Department of Health to be invaluable.  During 

the same period, she met a farmer who showed her his healing varicose ulcer.  The medication he 

used was “Bag Balm,” a treatment for his cows’ udders.  He also used terminology that was new 

to her at the time – “bound up” meant constipated.  Some of the deterrents to seeking health care 

she notes are high insurance costs (resulting in many rural persons without insurance or 

underinsured), escalating health care costs combined with lower incomes, distance to travel for 

health care plus the time it takes away from work, and values related to health.  Because health 

care professionals speak in a “code” known only to them, she says that they need to listen 

carefully to what is being said, listen respectfully, and learn to speak the language of the people 

and identify their values.  For example, a rural mother brought her child in regularly for 

immunizations but was noted to have significant body odor.  The mother described their water 

supply as being from a source some distance from their farm.  They valued car racing, and their 

money was used for building a car rather than for more easily accessible pure water.  Another 



Online Journal of Rural Nursing and Health Care, 2(2) 6 

example was an 85+ woman who described her endoscopy as “looking for a splinter (rather than 

sphincter) in my throat.”  In addition, she misinterpreted the instructions for the cholestyramine 

as six times a day because the label said you may take up to six doses a day.  The doctor’s 

instructions said “take one scoop a day.”  She strongly recommends that nurses in rural areas use 

community health workers for follow-up care.  This practice has been very successful in many 

places for many years.  Indian reservations have successful programs using Tribal Diabetes 

Educators, the Mississippi Delta Luke Society has had almost zero unplanned pregnancies 

because of community health workers, and oncology nurses have discovered their patients did 

better when trained lay persons assisted the patients.  

For questions or comments, e-mail me at Bette_ide@mail.und.nodak.edu.