The purpose of this study was to describe how the rural place influences the social processes of rural grandmother-mothering. An integrated conceptual framework, coupling social ecology theory with cultural geography theory, was used to investigate how rurality influences social processes and how this place influence affects the health of rural grandmothers raising grandchildren. This conceptual framework was chosen because it reflects a trend within contemporary community health research to investigate health phenomenon by examining the impact of the built environment and health-enhancing landscapes. Social ecological theory provides the explanatory theoretical foundation describing the interactions of persons with their most immediate environment of family and community, to the more distant systems of region, state and country. The concept of place refers to how people construct meaning from interaction with situated space; a concept that incorporates the physical environment into the social and symbolic environments of social systems.

The research question was “how do experiences of the rural place influence women’s health in grandmother-mothering?” A literature review of health and social sciences studies examining the effects of place on social behavior, grandparents raising grandchildren and grandmothers raising grandchildren, revealed that the body of knowledge about rural grandmother-mothering is very limited. This study explored grandmother-mothering set within the context of rurality and examined how rural living influences the antecedents, dynamics, interaction patterns and health outcomes of rural grandmother-mothering and identified some of the problems that may be most amenable to community focused nursing interventions. This modified Glaserian grounded theory study investigated the phenomenon of rural grandmother-mothering. The study was conducted in four rural counties in West Texas during a nine month time frame. Two groups of participants were included in this study; rural living grandmothers raising grandchildren and rural living community contacts. Data consisted of transcripts of audio-taped interviews with the grandmothers, written notes from community contact interviews, field notes and participant observations. Constant comparative analysis was used to analyze the data. Substantive coding, consisting of line-by-line open coding and selective coding determined coding categories. Trustworthiness was achieved and rigor was maintained by intense engagement with the data, member checks, thick theoretical description of the basic social process, sampling until saturation was achieved and an inquiry audit conducted by a qualitative researcher unconnected with the study. The results of this study were the generation of a middle range theory and the development of the Rural Grandmother-Mothering as Cushioning Model. The Rural Grandmother-Mothering model explains how the rural place influences the social dynamics of rural grandmother-mothering. Rural grandmother-mothering, functioning as successful Cushioning, and characterized by a sense of Blessed Burdening and Health as a Way of Living, was associated with positive rural place experiences of Community Mothering. The model provides a visual representation of the connections between community mothering and positive rural place experiences and serves as guide for future rural grandmother-mothering studies. This study builds place-based theory in nursing, expands rural nursing theory and encourages women’s health nurses to embrace a place focus to better understand how social processes influence women’s health.