[Developing expertise in the rural milieu]

Although rural nursing gets little attention, the health of the farming family is increasingly threatened. Isolation, stress, psychological distress, violence, drug and alcohol abuse, suicide and the health risks of farming itself make daily life difficult. In terms of accident-prone occupations, farming is rated tenth and is considered one of the most stressful. These problems have resulted in a drop in the number of farming enterprises in Quebec, from 80,000 in the 1930s to less than 11,400 in the mid-1990s. The farming family is largely misunderstood and presents a sizeable challenge to researchers and health care providers. This population has no desire to disclose its problems or share confidences in others. A summary of American papers, plus information from a recent study by Santé-Québec, reveals the determining factors in the health of the faming family. In the rural environment, health is first defined by work and is influenced by rural values. Nurses must be able to offer health care that relies on these values and use their knowledge to be innovative and personalize interventions. It is important that nursing programs reflect current knowledge of rural nursing. Research is also needed to help nurses further define the problems and determine the factors that influence the health of the farming family.