Online Journal of Rural Nursing and Health Care, 1(2) 10 

Editorial 

Rural Practice Forum:  Hospitalizing Older Adults 

Bette Ide, PhD, RN, Editorial Board Member 

 

Jeanie Niemoller, MS, RNc, Director of Extended Care at Ivinson Memorial Hospital in 

Laramie, WY, is a rural nurse who speaks from many years in community health and hospital 

nursing.  She sends the following practice "tip." It encompasses useful advice for anyone, 

particularly an older adult from a rural area, who is planning on hospitalization or currently 

hospitalized:  When a person spends time in the hospital, and has surgery or serious illness, it is 

not unlikely that they will need help at home after the hospitalization.  Whenever possible, they 

or the nurse should find out about home care providers, the services offered by the local senior 

citizen center or area association for aging prior to the hospital admission.  They can also talk to 

friends and neighbors about services they have used and what is available.  A good question to 

ask home health agencies is "How often can you visit since I live 10, 30, or 50 miles from 

town?"  If services are not available, the individual may need to plan to stay temporarily at a 

nursing home or assisted living center to get the aftercare they need.  Asking questions 

beforehand will save lots of stress and possible longer stays in the hospital.  Stephanie Christian 

RN, MS, CCRN, concurs with the above.  She works and teaches nursing students in the acute 

care setting in Altru Hospital, Grand Forks, ND, a small city within a large rural area.  She states 

that preplanning is great but not always possible, and it is essential to begin discharge planning 

on admission to the hospital.  Prior living situations, support systems and availability of possible 

resources are important factors to assess.  Family involvement is particularly important because, 

due to the acuity of care required on admission, discharge planning is not usually a priority for 



Online Journal of Rural Nursing and Health Care, 1(2) 11 

the patient.  As the patient recovers their involvement significantly increases, and family 

involvement is reinforcement for the patient.  Education and plans upon discharge seem to be 

more successful when support systems are involved.  Post discharge follow-up with a nurse, 

hopefully through a home visit, helps to ensure that the patient is doing well and the support 

following discharge is adequate.  Ms. Christian collaborated with Ellen J. O’Conner, MS, RN, 

CS, a community health nurse in rural North Dakota and northwestern Minnesota for many 

years, in conducting a pilot Hospital-to-Home program at Altru Hospital during the summer of 

2000.  Most of the patients involved had multiple diagnoses such as COPD and a variety of 

cardiovascular problems, or had had a cardiac procedure such as CABG.  The students 

functioned in leadership and primary care roles while their patient was hospitalized.  They were 

able to observe what the patient and family were going through during and after a short but 

intense hospital stay.  Patients loved the support and wanted it to continue.  Thus, these rural 

nurses describe some ways to smooth the transition from hospital to home for rural residents. 

Comments and questions should be directed to Bette_Ide@mail.und.nodak.edu.