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. 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-methods 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 US (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.

None Thomas

None Oelke

None Jasper

None Pavloff

None Keys

Rural and Remote Health

RURAL AND REMOTE HEALTH 是一份非盈利、仅限在线、同行评议的学术出版物。它旨在促进农村和偏远地区的健康教育、研究和实践。该杂志的主要目的是出版并提供来自农村卫生从业者（医疗、护理和专职卫生专业人员和卫生工作者）、教育工作者、研究人员和政策制定者的同行评审材料的国际知识库。

Rural and Remote Health is a non-profit, online-only, peer-reviewed academic journal. It aims to promote health education, research, and practice in rural and remote areas. The primary objective of the journal is to publish and provide a peer-reviewed repository of international knowledge contributed by rural health practitioners (including medical, nursing, and allied health professionals), educators, researchers, and policymakers.

《Rural and Remote Health》是一本非盈利、仅限在线、经过同行评审的学术期刊。它旨在促进农村和偏远地区的健康教育、研究和实践。该期刊的主要目标是出版并提供来自农村卫生从业者（包括医疗、护理、专职卫生专业人员和卫生工作者）、教育工作者、研究人员和政策制定者的同行评审材料，形成一个国际知识库。

Category	Quartile
医学	4
医学, 公共卫生、环境卫生与职业卫生	4

A scoping review of rural mental health and substance use nursing

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Journal Info

Category	Quartile
PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH	3