Dr. Gwyneth Holderby, DNP, APRN, FNP-C, has dedicated her career to addressing the unique rural health challenges. As the Director of the Wisdom Family Foundation Doctoral Program for Rural Nursing Practice at Northwestern Oklahoma State University, Dr. Holderby merges her extensive clinical experience with a passion for education, preparing the next generation of nurse practitioners to thrive in underserved communities.
With nearly a decade of service as a family nurse practitioner in rural Oklahoma, Dr. Holderby brings invaluable insights into overcoming barriers to wellness in areas with limited resources. Her research and practice focus on addressing critical issues like obesity, chronic illness, and access to care.
In this compelling Q&A, Dr. Holderby discusses the impact of her work, sharing real-world challenges and innovative solutions for nurse practitioners in rural health. From leveraging telehealth to navigating sensitive patient conversations, her experiences offer a roadmap for tackling some of the most pressing issues in rural healthcare today.
Whether you’re a healthcare provider, educator, or advocate, Dr. Holderby’s perspective sheds light on the resilience, adaptability, and ingenuity required to deliver quality care in underserved areas. Read on for her stories and strategies for rural healthcare.
This interview has been transcribed and edited for clarity.
In your research on overcoming barriers to wellness in rural communities, what specific cultural or socioeconomic factors did you identify as most significant, and how do you address these in your practice?
The most common theme is just a lack of access to resources. In a lot of these small towns, there is a lack of access to healthcare. There is no primary care provider, much less nutritionists or registered dieticians within hours of a drive. That puts a huge burden on them. A lot of rural community members are self-employed farmers, so they don’t have insurance, which further inhibits access to healthcare.
For healthy eating in small towns, there are no restaurants or even grocery stores. And so, since they are limited on how often they can go to the grocery store, a lot of the stuff they buy has a lot of preservatives in it, so they’ll last longer. You don’t see a lot of fresh fruits or vegetables because they go bad so quickly.
The town I live in has 34 people, and the closest gas stations are probably a 20-minute drive. Then you’re looking at fried food or whatever packaged stuff you can get at a gas station.
The other thing is exercise. There are definitely no health clubs anywhere near to join. Even for exercising outside, well they’re on dirt roads. There are no lampposts out here, so if the sun’s not up, then you can’t see. Then in the Oklahoma summers when it’s so hot, there aren’t a lot of beautiful days to be outside walking or exercising.
When you think about what helps obesity—access to health care, healthy diet, and exercise—all three of those in rural communities are essentially limited.
Can you describe a particularly challenging case you’ve encountered in your work with rural Oklahomans, and how you navigated the complexities of providing care in that situation?
It’s not like one particular case as what we see is repetitive with the lack of access like the registered dieticians or nutritionists. Say we have an obese patient, typically they don’t schedule because they’re obese. They schedule because they have high blood pressure or diabetes. So, we’re seeing them for a chronic illness or something along those lines.
In most clinics, you get 15 minutes per patient. In those 15 minutes, we’re trying to adjust other conditions. Then you end up with 5 minutes to talk about obesity. There’s not a lot of educating that you can do in 5 minutes.
What I like to do in the time that I do have is educate patients on the resources that are available to them online. I can spend those 5 minutes giving them information from the CDC, the World Health Organization, or the American Heart Association to give them resources for healthy diets and healthy recipes. Then they can use those tools to do some of the research on their own.
If you try to tell someone a lot of information at one time, it’s really hard for them to remember it. By printing information off or giving them resources, then when they get settled in their own environment, they have time to look into everything and can do it in a more relaxed way where they can retain more of the information.
In your role as an educator, how do you incorporate real-world experiences and challenges from rural healthcare into your curriculum to better prepare your students for their future roles?
Our DNP program at Northwestern is special because it’s a family nurse practitioner with a doctoral program focused on rural nursing practice.
We have Zoom meetings throughout the semester, and I’ll try to translate what the students are reading about the body system into what I see with that in practice since I’m a nurse practitioner out here in rural Oklahoma.
One of the things that we talk about a lot is that since we are so rural and patients have to travel to get access to specialists, rural health care is kind of unique because if you’re in a more metro area and you see something, you might be able to refer that patient on. But in rural America, when they’re going to have to travel so far, you might just treat it yourself—as long as you feel safe, and it’s within your scope. We probably see and treat more that might be referred out to specialists in other areas just because of limited resources.
Tackling Sensitive Topics Together
Back to the obesity topic, it’s such a sensitive area. One of the things that we do in one of our courses is discussion boards where we ask a question and then all the students answer. Then they also read each other’s posts and respond.
One of the questions we have in there is, “You have a patient coming in to see you for high blood pressure, and they also are considered obese. How do you approach this topic?”
Then they can start thinking about how to talk to the patient in a sensitive way. By also having their classmates put their ideas out there too, it might bring up different points of view or different ways to approach it,
Even when talking about things like STDs and teenagers, there are a lot of topics that are sensitive like that. It’s just about brainstorming ways to have those difficult conversations, and it helps prepare students because it’s inevitable that these situations are going to happen.
What innovations or emerging practices in rural healthcare are you most excited about, and how do you see these impacting the future of healthcare delivery in rural Oklahoma?
Telehealth is amazing. Before COVID, I don’t think we accessed it as much. Then during COVID, we really started doing a lot of telehealth visits. I think patients got a lot more comfortable with it. Even though we might be past that, we’re still able to use telehealth, and it’s great because it cuts down on travel and the time and money spent on travel.
A lot of specialists, registered dieticians, and nutritionists are doing telehealth as so much of what they do consists of counseling and talking. You would never have to see them in person. It can all be done through telehealth.
As we see more services go to telehealth and people get comfortable with it, that’s really going to help these small rural communities.
Have you encountered any limitations with telehealth, such as state-specific restrictions on its use or challenges in assessing patients’ conditions effectively during virtual consultations?
I think it definitely has a place with nutritionists, registered dietitians, and some specialists like if you’re meeting with an endocrinologist to discuss your Type 2 diabetes, for example. A lot of where they get their data is from blood work.
If someone thinks their child has an ear infection and they can’t look in your ear, then how do you know? There are a lot of things that can cause ear pain besides an ear infection. It’s the same with a urinary tract infection. If you’re not testing someone’s urine, then it’s all done through a phone call.
You need to be hands-on for some things, but then for other areas where you know it would mostly be consulting, telehealth is awesome for that.
At the hospital where I work, the hospitalist for those who are inpatient is through telehealth.
The nurses have a big computer that they wheel into the rooms, but it is set up with a stethoscope, so they can listen to the patient’s heart, lungs, and abdomen. They can also adjust the volume so they can hear it almost as well or louder than you would through a stethoscope in your ears.
Since it is a rural community, patients were a little leery of it at first. But now that it’s been in place for a couple of years now, the patients are all fine with it. They have good experiences. It’s hard to have a hospitalist in these rural communities, so this is great.
Championing Rural Health Solutions
Dr. Gwyneth Holderby’s insights underscore the complexities and resilience required to deliver healthcare in underserved rural communities. From addressing barriers to wellness to leveraging telehealth innovations, her approach exemplifies a commitment to providing equitable care, even in the most resource-limited settings. As both a practitioner and an educator, Dr. Holderby bridges the gap between theory and practice, preparing future nurse practitioners to tackle the unique challenges of rural health with confidence and compassion.
