Geographic Isolation

• In rural areas, it is difficult to provide care to patients living in areas that are remote or distant from the location of the healthcare facility. Transportation is not as easy or as accessible as in urban areas. This is of great significance in rural areas that face inclement weather conditions. Surviving in isolation tends to make rural populations use self-care practices, such as resting, consuming alcohol, using prayer or local healers and self-medication with over-the-counter products. As a result, patients often postpone seeking care until it is unavoidable. The poor health condition of the patient at the time of admission means that nurses have to work harder and longer to ensure recovery.
  
  

Professional Isolation

• Nurses who practice in a rural setting often manage multiple patients across a wide range of age and disease profiles. They do not have easy access to specialists or other healthcare professionals like their urban peers. As a result, rural nurses need to be "expert generalists" and hone their skills to provide quality care for all patients. This can cause physical, as well as emotional strain for nurses who face the responsibility of prioritizing the needs of a large patient population. All this is often overwhelming for nurses with less experience or low confidence as well as those who are not familiar with practicing healthcare in rural settings.
  
  

Confidentiality Issues

• In rural areas, people are more familiar with others in the community. It is therefore difficult to maintain confidentiality especially if the healthcare facility is located in a public area. Patients suffering from conditions, such as emotional disorders, sexually transmitted diseases, HIV infection or substance abuse, therefore tend to avoid seeking care because they know the nurse as a friend, neighbor or friend of a relative. They worry about information of their health condition slipping out and becoming common knowledge in the community. From the nurse's point of view, being a well-known person in the community means having to live by a particular code of conduct even outside of work times.
  
  

Patient Attitudes

• Providing healthcare in a rural setting is more challenging because of patient attitudes towards health. People living in these areas do not pay as much attention to regular health checks for blood pressure and blood sugar levels or pap smears and breast examinations. A greater proportion of rural adults have habits, such as smoking or not exercising that put them at high risk for lifestyles diseases. In some cultures, it is believed that elderly female relatives should care for pregnant women until the actual time of delivery. Such beliefs and attitudes make it difficult for nurses to ensure that patients comply with treatment regimens.