Lees-McRae Assistant Dean of Nursing seeks to improve nursing field in rural Appalachia with doctoral research

Even before becoming the Assistant Dean of Nursing and an Assistant Professor at Lees-McRae, most of Evelyn Brewer’s life has been dedicated to nursing in Appalachia. From growing up on a farm in the North Carolina mountains of Ashe County to earning her PhD from East Tennessee State University, Brewer’s dedication to caring for her community and those who live in it has never waned.

Brewer began researching the unique benefits and challenges of rural nursing in her master’s program and carried that interest and research through her PhD program, where the subject eventually became her dissertation. Having been a practicing Appalachian nurse for 12 years, Brewer was acutely aware of the differences between urban and rural nursing and was able to apply that first-hand experience to her research.

“My goal when I started the research, and when I started the doctoral program, was to figure out how to educate people to become the nurses that I would like to take care of my grandmother,” Brewer said. “Not only was my grandmother an inspiration to me, but from a nursing perspective she was the ideal of the kind of patient I would be caring for. Sometimes she would say ‘they just don’t understand,’ and while the nurses who cared for her were skilled, there was a disconnect between her and some of her nurses.”

Brewer said that when her grandmother, a born and raised Appalachian, was receiving care near the end of her life, there were several misunderstandings between her and her caregivers. These were usually a result of a cultural or language difference between Brewer’s grandmother and her nurses who weren’t from Appalachia.

Through personal experience, Brewer learned how to navigate some of the challenges that come with working in healthcare in a rural setting, as well as the benefits. She came to understand the importance and effectiveness of a nurse who has a greater understanding of her patients’ backgrounds.

Brewer became  fascinated by this disconnect between Appalachian patients and non-Appalachian nurses. Why did these patients feel like they were not being heard? What was it that the nurses did not understand?

Her research was driven by these questions, and the desire to help nurses become better care providers for their rural patients. According to Brewer, age, education level, culture, and countless other life factors play a role in being able to provide effective care to any patient, so it was vital for nurses to understand the cultural gap they were trying to bridge.

“One of the things that is fairly prominent for native Appalachians is the reliance on family, friends, and the church first before seeking healthcare,” Brewer said. “They go to family and friends for advice and for home remedies, and they go to the church for faith-based healing before they ever go to a hospital. This is very common, and it contributes to the degree that they’re sick. They often get sicker before medical care can get in, and nurses need to understand that so they can be an advocate for earlier care.”

Brewer said that nurses who are not from the area often find it difficult to understand their Appalachian patients and vice versa, but she believes that her research can help fill that gap.

“One of the ways to help is to bring knowledge of the area, or any rural area, into the classroom as a piece of experiential learning,” Brewer said. “Herbals and folk remedies are not specific to the region, but they’re very popular. They are a part of a lot of cultures, and it is helpful to understand that and help promote cultural awareness and cultural confidence, and help the students understand that we are all different. People feel slighted when they’re critiqued for things that are inherently part of their culture.”

While this cultural gap is not necessarily a challenge for nurses who themselves live, learn, and work in the Appalachian region, these nurses have other challenges to face. Brewer was also interested in addressing the fewer resources, level of isolation, and lack of support for continued education which she says can be prevalent in rural settings.

“There’s a lack of support in the local region for continued education,” Brewer said. “Many people don’t even think about going to get a graduate degree or even a BSN, but research shows that clients who are cared for by a baccalaureate prepared nurse have better outcomes because they have a wider world view and a more holistic approach to client care.”

Because of this lack of support, Brewer said many students enter the nursing program here at Lees-McRae with some level of educational disparity. However, she highlights economic disparities as another challenging factor that many aspiring rural nurses must overcome.

“There is a degree of educational disparity inherent in parts of Appalachia,” Brewer said. “The educational preparation may not be quite as strong, which applies not only to pre-nursing education, but also to the educational programs for current nurses in Appalachia. There is also an economic disparity. There are pockets of poverty everywhere.”

Through her research Brewer has identified some solutions to these issues that challenge nurses in rural Appalachia whether they are native to the region or not. One of the most important and effective steps to be taken is creating a support network which provides resources, and access to continued educational opportunities.

For Brewer, this comes in the form of the Rural Nursing Organization (RNO), a national organization for rural nurses. Brewer is a member of the local chapter, Appalachian Regional Tristate Chapter (ARTS). Through this organization Brewer hopes to help provide resources to nurses from Appalachia and other rural communities who would not be able to access them otherwise.

“By having a local chapter, we hope to be able to help in our little corner of the world,” Brewer said. “It’s a tri-state chapter, so Virginia, North Carolina, and Tennessee are all a part of it. We’re hoping to be able to offer professional development, and networking opportunities.”

Brewer hopes that her research and her work with ARTS will produce nurses who are more effective and confident, and who can therefore provide a higher level of care to their patients, ensuring quality medical care for people, like her grandmother, who call the Appalachian region home.

“Each individual has value, and each individual deserves an opportunity to be the very best they can be,” Brewer said. “That is regardless of any kind of culture, whether that be Appalachian or anything else.”

By Maya JarrellMarch 08, 2022