Influential Factors in the Recovery Process of Burn Survivors in a Predominately Rural State: A Qualitative Study

Navigating the recovery journey following a burn injury can be challenging. Survivor stories can help define recovery constructs that can be incorporated into support programs. We undertook this study to determine themes of recovery in a predominately rural state. Eleven purposefully selected burn survivors were interviewed using a semi-structured format. Consensus coding of verbatim transcriptions was used to determine themes of successful recovery. Four support-specific themes were identified. These included: using active coping strategies, expressing altruism through helping others, finding meaning and acceptance, and the active seeking and use of support. These themes could be incorporated into support programming and would help guide future survivors through the recovery period.

Early Collaboration Measures Among a Cross-Sector Stakeholder Group in a Statewide GWEP

The AgingME Geriatrics Workforce Enhancement Program (GWEP) uses collaboration across institutions of higher education, community-based organizations, and healthcare entities to imbed transformational healthcare practice change across Maine, a primarily rural state. To explore the factors that influence cross-sector collaboration among a diverse array of partners, a baseline anonymous electronic survey was distributed to the newly formed project steering committee. The survey consisted of the Wilder Collaborative Factors Inventory, an established measure of 22 research-based collaboration factors along with four open response questions on process-level challenges and opportunities for improvement. A total of eleven responses (N = 11) were received out of 20 Steering Committee members (55% response). Collaboration strengths noted in the assessment include unique purpose of statewide GWEP efforts (M = 4.41 out of 5 points), mutual trust among members (M = 4.32), favorable social and political environment (M = 4.27), and a history of collaboration among partners (M = 4.27). Lower scores were received on the multiple layers of participation (M = 3.45 out of 5 points), and ability to compromise factors (M = 3.45). Qualitative responses reinforced the need for a common understanding of the project’s goals and outcomes early on in the collaboration. Barriers to collaboration included scheduling considerations and limited time and energy among partners due to heightened COVID-19 response efforts. Results elucidate: 1) Early collaboration strengths and needs of a newly formed statewide education collaborative; and 2) Strategic action steps and focal points informing early partnershipping among organizations engaged in interprofessional health education efforts.

The Evolution of Telepractice Use during the COVID-19 Pandemic: Perspectives of Pediatric Speech–Language Pathologists

The study investigated how pediatric speech-language pathologists (SLPs) applied telepractice to compensate for the loss of in-person services and the dynamics of telepractice use during the COVID-19 pandemic in a rural state. We conducted interviews with 10 SLPs and then a statewide survey in which 51 SLPs participated. The qualitative interviews revealed themes including changes in service environment due to the pandemic (e.g., transition to telepractice, losing clients), challenges in the transition to telepractice (e.g., limited training, difficulty engaging clients), worsening wellbeing of clinicians and clients, and SLPs’ perspectives and suggestions towards telepractice in the future. Survey results showed service disruptions and transition dynamics during the pandemic. SLPs’ weekly caseloads reduced from an average of 42.3 clients prior to the pandemic to 25.9 and 23.4 from March to May and from June to September 2020, respectively, and then recovered to 37.2 clients from October to December 2020. In contrast, the number of telepractice caseloads sharply increased from 0.2 clients per week prior to the pandemic to 14.8 from March to May 2020. The weekly telepractice caseloads then declined to 5.5 clients from June to September and 7.9 clients from October to December 2020. In the months right after the pandemic outbreak (i.e., March to May), client children struggled with treatment gains and behavioral wellbeing. However, their outcomes gradually improved by October to December and approached pre-pandemic levels. About one-third of the SLPs reported that they would be more likely or much more likely to use telepractice in the future regardless of the pandemic. However, only about a quarter perceived telepractice as comparable to in-person services. We concluded that the transition from in-person services to telepractice substantially mitigated service disruptions right after the pandemic outbreak and that telepractice’s substitute role evolved over time.

“If I Ever Leave, I Have a List of People That Are Going With Me:” Principals’ Understandings of and Responses to Place Influences on Teacher Staffing in West Virginia

Purpose: Schools across the predominately rural state of West Virginia are experiencing widespread teacher shortages, though recruitment and retention difficulties are unevenly distributed across place. Using spatial in/justice as our framework, we explore how principals define place, how place influences principal perceptions of teacher recruitment and retention, and how principals respond to these staffing challenges given their leadership experiences, relationship to school community, and understandings of place affordances and disadvantages. Research Methods/Approach This research utilized interviews with eight principals across six school districts in West Virginia over a four-month time frame. We inductively coded interview transcripts in iterative cycles using our research framework as a guide for emic and etic codes. Findings: We find principals’ understanding of place influences on staffing to be specific to the unique attributes of each community and the placement of their leadership experiences – as community returners, seasoned though not originally from the community, and new-to-place. Their understandings of spatial in/justice as it relates to teacher staffing shape ideas of place affordances and disadvantages and recruitment and retention practices. These findings complexify the teacher staffing picture across geographically diverse rural places and the responses available to leaders given their leadership experience and relationship to place. Implications for Research and Practice The place-specific influences on teacher staffing problematize statewide policy mechanisms for ameliorating teacher shortages. The findings also suggest the need for further in-depth qualitative research within districts and across states, with an emphasis on racially diverse rural places.

Management of Critically Ill Pregnant Patients with COVID-19 Infection in a Rural State

Objective There is limited data on the treatment of coronavirus disease 2019 (COVID-19) in pregnancy. Arkansas saw an increase in COVID-19 cases in June 2020. The first critically ill pregnant patient was admitted to our institution on May 21st, 2020. The objective of this study was to evaluate outcomes in critically ill pregnant women with COVID-19 at a single tertiary care center who received remdesivir and convalescent plasma (CCP). Study Design This is a retrospective observational review of critically ill pregnant women with COVID-19 who received remdesivir and CCP. This study was approved by the institutional review board (#261354). Results Seven pregnant patients with COVID-19 were admitted to the intensive care unit (ICU). All received remdesivir and CCP. Six received dexamethasone. The median ICU length of stay (LOS) was 8 days (range 3–17). Patient 1 had multi-organ failure requiring vasopressors, renal dialysis, and had an intrauterine fetal demise. Patients 4 and 6 required mechanical ventilation, were delivered for respiratory distress and were extubated at 2 and 1 days postpartum, respectively. The only common risk factor was obesity. There were no adverse events noted with remdesivir or CCP. Conclusion There is little data regarding the use of remdesivir or CCP for the treatment of COVID-19 in pregnant women. In our cohort, these were well tolerated with no adverse events. Previously reported median ICU LOS in critically ill pregnant women with COVID-19 was 8 days (range 4–15).1 Our study found a similar ICU LOS (8 days; range 3–17). Patient 1 did not receive remdesivir or CCP until transport to our facility on hospital day 3. Excluding patient 1, median ICU LOS was 6.5 days (range 3–9). Our institution's treatment of pregnant women with critical illness with remdesivir, CCP and dexamethasone combined with delivery in select cases has thus far had good outcomes. Key Points

Exploring the needs of urban producers in a rural state: A qualitative needs assessment

Urban farming is a phenomenon rising in popular­ity across the United States. Investigating the needs of urban farmers in a predominately rural state is important in informing future programming and technical assistance for these clients. This qualita­tive study used semi-structured, in-depth interviews that investigated the perceptions, needs, and expe­riences of Arkansas urban farmers and their inter­actions with the University of Arkansas Division of Agriculture Cooperative Extension Service. Inter­views were conducted with 16 urban farmers in Northwest and Central Arkansas. The interview data revealed highly individualized needs based on the operation size, years in operation, and mission of each urban farmer interviewed. While needs var­ied, some were consistent, such as market pricing, co-ops, and access to appropriate equipment. Par­ticipants also revealed a positive perception of Extension, though they cited that the organization did not always have resources specific to small-scale, sustainable farming. Building from the Com­munity Food System Development Framework for Change and informed by the AgroEcological-Educator theory, this study provides urban farm­ers’ insights and contextualizes urban farming in a predominately rural, southern state. Potential remains for increased collaboration and communi­cation between Arkansas urban farmers and Exten­sion. This article demonstrates the diverse needs of Arkansas urban farmers, which can be used by Extension and sustainable agriculture experts to inform research about urban and sustainable farmers in their respective states.

Parental Involvement or Interference? Rural Teachers’ Perceptions

This research explored rural state school teachers’ perceptions concerning parental involvement in children’s education in a developing country context. The data were collected through thematic interviews with teachers of public schools situated in the rural areas of Khyber Pakhtunkhwa (KPK), Pakistan. The study findings revealed teachers’ frustration and disappointment regarding parental involvement. Teachers believed that susceptible socioeconomic circumstances and adherence to local customs hindered many parents from participating in their children’s education. In line with this, teachers frequently held negative perceptions regarding children’s parents, and these perceptions have the potential to adversely affect parent–teacher communion and children’s learning. We offered several policy implications for enhancing parents’ roles and teachers’ competency in supporting parental involvement, which could also be practical in other developing countries sharing similar impediments, such as widespread illiteracy, poverty, and a lack of qualified teachers.

Return to the Past

Chapter 15 analyzes ethnographic data that suggests many people in postsocialist countries, particularly those who lived in rural areas, felt that their lives were moving backward following transition. It shows that many were forced to return to subsistence agriculture and pastoral herding as rural state enterprises collapsed through privatization and as state job guarantees disappeared. The chapter explores how the flaws of privatization led to the substantial growth of informal economies and examines the new phenomenon of homelessness in societies where all had previously been guaranteed a home. In analyzing homelessness, it shows how the dissolution of state-support networks caused those without individual support networks to be “thrown away,” many of whom would end up living on the street in the clutches of alcoholism. The chapter considers nostalgia for past systems by those who cannot compete in a market economy, generally the elderly or members of marginalized groups.