Rural perinatal nursing in Canada: A hermeneutic literature review.

Background: Nurses working in rural and remote settings are central to the delivery of perinatal services, often as the initial providers to assess and manage patients. Although policies and guidelines dictate nurses' responsibilities, little research focuses on rural perinatal nursing practice. Articulation of nurses' actual and significant involvement in rural perinatal care is needed as increasingly sustaining rural perinatal services is in jeopardy. Objective: The study aimed to answer the question, "How are nurses understood to be involved in the delivery of rural perinatal care?" Design: A hermeneutic literature review. Setting: Rural and remote Canada. Methods: A hermeneutic literature review was conducted through a two-phase, interpretive process of evaluation and deliberation for relevance and meaning carried out through dialogue and questioning with the selected texts and among members of the research team. This process provided deepened understanding of rural perinatal nursing practice and the contexts in which it takes place, highlighting not only what was evident in the texts, but also what was missing regarding nurses' involvement in the provision of perinatal care. Results: Seven of 38 grey literature documents, and 25 research articles out of 800 were selected as relevant to the research question. Rural nurses' perinatal practice was found to be largely invisible in the literature. Only a few studies focused on nurses, demonstrating their autonomy and agency to benefit patients, other providers, and system functioning, despite many contextual and health system constraints. Rural nurses' experiences and insights were found rarely to be represented in perinatal policy and guidelines. Conclusions: Rural nurses voices and practices are rarely represented in the research and grey literature relevant to rural perinatal services. Nurses' insights and experiences are essential to ensure that policies and practices in healthcare organizations foster the sustainability of rural perinatal care for rural/remote childbearing families and the retention of nurses in rural practice. Tweetable abstract: Canadian rural perinatal nurses' practices are largely invisible in research and grey literature. Their voices and recognition of their contributions to care are needed to sustain rural maternity services.