The changing spirit of rural community nursing: documentation burden.

Rural community and public health nursing are characterized by an impressive commitment of nurses to their communities and a connectedness of people to one another. Home care as an integral part of long-term and acute care for the older adult population has emerged as a vital practice area in community health nursing. The purpose of this ethnographic field study was to describe rural home care for frail older adults from the perspective of those providing and receiving care. More than 250 interviews were conducted with home care providers, recipients and their families, and other community members. The setting included eight culturally and geographically diverse counties in rural Colorado. One major theme is presented: the perceived change in the spirit of rural community nursing due to the overwhelming documentation required for home care reimbursement. Oppressive paperwork requirements impeded practice and resulted in fewer home visits per day, low job satisfaction, increased nursing staff turnover, decreased quality of care, and changed the spirit of community nursing from an emphasis on caring and community service to a focus on reimbursement. The study results have timely implications for health policy formulation as the United States undergoes major health care reform.