A scoping review of rural mental health and substance use nursing

Introduction: Globally, nearly 50% of the population live in rural areas, while just 36% of nurses serve in these locations. Rural nurses face distinct challenges such as limited resources and geographical isolation, and often work with an expanded scope of practice that includes mental health and substance use (MHSU) care. The extent to which rural nurses engage in MHSU care, care barriers, and facilitators has not been previously well-described. Thus, this scoping review explored the international research on rural MHSU nursing. The aim was to synthesize the rural MHSU nursing evidence and consider it in relation to 'Knowing the Rural Community: A Framework for Nursing Practice in Rural and Remote Canada' [herein referred to as the Framework]. The research question for this review was, what is known about rural nursing related to mental health and/or substance use considerations?
Methods: A scoping review approach was used to guide a systematic exploration of the literature. CINAHL, Medline, and PsycINFO databases were searched for international qualitative, quantitative, and mixed-method scholarly articles with rural MHSU nursing considerations, with no date limiters. Extracted data were mapped to the Framework’s categories: rural people, community, rural context, and larger society.
Results: Forty-seven articles were selected for this critical review of the literature, with most of the articles from Australia (n=15), the United States (n=8), Canada (n=7), and South Africa (n=5), and representing rural nurses who worked in hospital (n=16), primary care (n=11), community mental health (n=7), and emergency department (n=6) practice settings. Rural MHSU nursing was described as a  generalist and multifaceted role, with challenges such as workplace violence, practice setting and community isolation, and resource inadequacies. Results also indicated that rural MHSU nursing is influenced by a nurse’s preparedness for their role, with a lack of preparedness  complicated by multilayered resource deficits. Social determinants of health, mental health stigma, and health inequities also affected rural MHSU nursing practice. Despite facing significant barriers, rural nurses demonstrated resilience and commitment to providing quality MHSU care for their communities.
Discussion: Overall, there was congruence between the included studies and the Framework. The Framework provided a comprehensive foundation for this scoping review. However, based on the findings of this scoping review, minor amendments to the Framework are recommended, such as including the rural nurse as an explicit part of the Framework. Further, a rural-centric approach that is local, context-sensitive, and developed in collaboration with rural people, was identified as crucial for addressing the unique challenges faced by rural MHSU nurses and their communities. Future rural research should address nursing shortages, practice support, and under-researched areas such as child and youth MHSU nursing and Indigenous health.
Conclusion: This scoping review highlighted some of the challenges rural MHSU nurses encounter and provided valuable insights into the complexities of rural MHSU nursing internationally. By using the Framework to organize and synthesize the literature, this study contributed to a deeper understanding of the role of rural nurses in addressing MHSU challenges and the context in which rural MHSU nursing care may be situated.
Keywords: Mental health, substance use, nurses, rural nursing, scoping review