xt7qft8dh30d https://exploreuk.uky.edu/dips/xt7qft8dh30d/data/mets.xml The Frontier Nursing Service, Inc. 1985 bulletins  English The Frontier Nursing Service, Inc. Contact the Special Collections Research Center for information regarding rights and use of this collection. Frontier Nursing Service Quarterly Bulletins Frontier Nursing Service Quarterly Bulletin, Vol. 61, No. 2, Autumn 1985 text Frontier Nursing Service Quarterly Bulletin, Vol. 61, No. 2, Autumn 1985 1985 2014 true xt7qft8dh30d section xt7qft8dh30d 43 ‘¤
FRONTIER NURSING SERVICE   · E
Volume 61 Number 2 Autumn, 1985     E
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QUARTERLY BULLETIN    
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‘ FNS Remembers Sixty Years
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CONTENTS I
FNS Archives Presented to University of Kentucky
in Ceremonies Full of Memories and Meaning 1
A Christmas "Least One" on Hell-fer—Sartin
by Frances Fell
(Reprinted from The Public Health Nurse, December 1930) 6
Ruth Lubic Receives Honorary Doctor of Laws Degree ,
from University of Pennsylvania 10
THE NURSE PRACTITIONER — A NURSE WHOIS 4
MORE THAN A NURSE 11-29 L
The Role of the Nurse Practitioner
— with the Accent on “Nurse”  
by Nancy Fishwick 12
Nurse Practitioner and the Law
by Deirdre Poe 18  
The Education of a Nurse Practitioner I
by Sr. Kathryn O'l\/leara 23
Beyond the Mountains I
by Kate Ireland and judy Lewis 30
In Memoriam and Memorial Gifts 32-33
Notes from the School 34
Field Notes 35
Courier News 37
Alumni News Inside Back Cover
Urgent News Back Cover
Cover: For sixty years, the Frontier Nursing Service has dedicated itself to bringing care to
whole families, well and sick, from birth through the whole life span. Mary Breckinridge
trained nurse practitioners long before they were ever given that name and the Quarterly
Bulletin feels that this sixtieth anniversary year is a particularly appropriate time to I
celebrate these "nurses who are more than nurses/’ Our cover photograph is one of many
in the archives that record the outreach that FNS began in the 1920’s and that has been 4
symbolic of its work over six decades.
Comments and questions regarding the editorial content of the FNS Quarterly Bulletin
may be addressed to its Managing Editor, Robert Beeman, at the Frontier Nursing Service, l‘
Hyden, Kentucky 41749. ~
I·`I{(>N'I`II·1I{ Nt¥ii.uM1c 01 NUMI%I·ZI< z Ati’ruMt~2. ism 1
Second-eluss postage pnitl ni. Wentlnver, Ky. 11775 ztntl nt utltlitinnzii mailing tiffittes  
I‘()S'I`MAS'I`I€I{: Send address ehtinges t0 I·`rr»nti1-r Nursing St·rv1t·t·, \‘Vi-t1tI<»vt~1·. Ky. 111775  
(`0pyrigI1t MHS, I·`rnntit-r Nursing: Service. Inc. I
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Mrs.]efferson Patterson,FNS' Honor-     _v·. , `-’»        
· ary National Chairman, with some of  [ _ _;`*·""`l " I iiiie V   ,,1,  t   -    
B her historic photographs that were ” _ ` A   ‘'—·
displayedatthe UniversityofKentucky I ".€°l¥·:° ` il?  
as FNS presented its archives to the _  
University.
Photo by courtesy of University of Kentucky
FNS ARCHIVES PRESENTED TO UNIVERSITY
OF KENTUCKY IN CEREMONIES
FULL OF MEMORIES AND MEANING
The printed program carried the words "Frontier Nursing Service"
in white on its dark blue cover, and inside, the list of scheduled
events centered on "Formal Acceptance of the Collection/’ But to
the several hundred friends of FNS who gathered in the University
of Kentucky’s Memorial Hall last November 7th, the occasion was
much more than a formal presentation of historical records. It was
a revitalizing experience in retrospection, re—evaluation, and rededi-
cation.
The primary intent of the program was to transfer the FNS
archives formally to the University of Kentucky, and in the process,
4 the ceremonies also honored FNS’s sixtieth anniversary, which
occurred earlier this year. The archives were presented officially by
FNS National Chairman Kate Ireland and graciously received for
2 the University by Dr. Art Gallaher, Jr., Chancellor ofthe Lexington
Campus.
The FNS Collection, which is now housed in the University’s
Margaret I. King Library, was described in the last issue of the
Quarterly Bulletin in an article by Anne G. Campbell, Curator of
the Appalachian Collection. It contains personal letters, official
records and files, books, published articles, photographs, films, and
personal memorabilia. The spoken memories of many persons
J

 2 FRONTIER NURSING SERVICE
involved in the birth and growth of FNS are recorded in a I
significant oral history. The collection is available for the enlighten-
ment of the public and for research and inquiry by scholars and
others interested in Appalachian history and in the Frontier ,
Nursing Service. It is an ongoing record of how FNS came into Y
being and how it has pursued its objectives and developed its  
resources so that, sixty years later, it remains a major force in the  
world of health care, vigorous, inspired, and fully prepared to face a U
future of new challenges. The ceremonies of the day grew out of this   i
history and reflected it from many points of view.  
The program began with a musical presentation by the Graduate E ;
String Quartet, from the University’s School of Music, which 5
established a reflective mood. There followed a multi-image presen- Q
tation that evoked the first years of FNS by means of an artful  
combination of projected photographs and the spoken words of ·
people who told of "the old days" with the authority and fervor that .
grow out of personal experience.  
Then Mrs. Jefferson Patterson, that remarkable lady who came  I
to FNS in the late twenties as the first young woman to serve as a  
courier, and who has devoted much of her life to guiding and  
supporting the Service, reminisced about those first years and  
about her personal impressions of FNS founder Mary Breckinridge,  `
her second cousin. Yet, though the memories were warm and  
cheerful, it was an almost casual reference to an early Kentucky Q
mother that pictured most convincingly the kind of world that  »
Mary Breckinridge came to serve. The mother, asked how many ,
children she had, had said, "Twelve children — eight here, and four  ,
better off."  
It was indeed a world in desperate need of health care in 1925, lil
when Mrs. Breckinridge founded the Kentucky Committee for ?
Mothers and Babies — a name that was changed to Frontier
Nursing Service three years later. Mary Breckinridge’s response to 1
that need was more than the founding of a health agency in the  
mountains. It was also the definition of values and principles. It  {
was not enough that FNS should serve the people of Leslie County.  
It must also become — as she emphasized many times — a ·
"demonstration" of ways to bring health care to rural areas. i
What actually resulted was "a nursing model" (as it was
described later in the program by Jo Eleanor Elliott, Director of the
X

 l
i
§ QUARTERLY BULLETIN Ji
Q Division of Nursing, U.S. Public Health Service) "in providing
  formal health—oriented care, decentralized to permit easy access by
  clients." She spoke of it as client—centered, cost efficient, accessible,
  and acceptable. It was concerned with health promotion and
f disease prevention, and was offered as "out—of-institution" care in
i clinics and at home. The speaker said it was "exciting" to recall that
* FNS was "the first nurse-initiated, nurse—run, innovative health
promotion, disease prevention, care delivery system, ever."
i As has often been said, FNS has from the first been dedicated to
that special combination of care and caring that encompasses both
L wellness and illness. It is devoted to providing continuous care
V throughout the life span, with as much concern for preventing
g illness as for curing it. It believes that technology should be the
{ servant of health providers, not their master.
l Speaker "Kitty" Ernst (Director of the National Association of
{ Childbearing Centers, alumna of the Frontier Graduate School of
i Midwifery, and former FNS Board member) echoed this principle in
  discussing modern trends in childbearing practice. She deplored
g the tendency of some to see pregnancy as an illness, birth as a
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V‘ Several of the participants in the presentation ceremonies: Dr.
,  Art Gallaher, jr., Mrs. E.K.M. ("Kitty") Ernst, and lo Eleanor Elliott.

 4 FRONTIER NURSING SERVICE  
surgical event. She argued that modern systems are designed for
acute care but that most women do not need that kind of care. She V
said that birthing centers were beginning "to turn this upside down l
system right side up." "Doesn’t it make sense," she asked, "to treat
pregnant women as healthy women until proven otherwise? Espe- ‘
cially if we can provide that care at half the cost?" At another point,
she spoke of the need "to assist women who are giving birth, rather ITT
than being delivered." n'
During this 60th anniversary year, a number of people at FNS Y
have spoken of "looking backward into the future." And that is *
what happened at this presentation ceremony. That past, into Q
which so many looked with warmth and pride, sent back its own  
message of guidance for our own time. Kitty Ernst foresaw that
"birth centers are on the verge of major growth," that they will  
overcome the present crisis in liability insurance, and that, with the
caring and professional skills of nurse-midwives, they will restore
naturalness and joy to childbearing.
Jo Eleanor Elliott stressed the importance of education, noting  
that the preparation of nurses is undergoing important changes, l
with increasing emphasis on clinical practice as well as class work, I
and on the value of research, especially in client outcomes, care
delivery, and training methodologies. She pointed out that the ‘
Nursing Education Amendments of 1985 undertake to demonstrate
"methods to improve access to nursing services in non-institutional  
settings through support of nursing practice arrangements in
communities" and "methods to encourage nursing graduates to ‘
practice in health manpower shortage areas. . .in order to improve ri
the specialty and geographical distribution of nurses in the United l
States." She warned that nurses must counter the efforts of some   .
physicians to restrict the practice of nurse practitioners and nurse- I
midwives, and, she urged, "All of us — in nursing and our Q
colleagues not in nursing — must strengthen our networks, mobilize 2
our resources both financial and human, and use our power bases to V
ensure the optimum use of the skills of family nurse practi- Y
tioners/ midwives that we know from the FNS history are effective
and efficient."  §
These points, and many others that were voiced during the  ,
afternoon, reflect the basic principles that Mary Breckinridge set  ,
forth in establishing the Frontier Nursing Service. Unfortunately,  1

 QUARTERLY BULLETIN 5
i  
l Miss Kate IreIand,FNS National
Chairmamformall resentsthe ’ ·
‘ archives. yp   ,: · KV.
the Quarterly Bulletin does not have space in this issue to report on
all that was said and done on this memorable afternoon. However,
5 a portion of the remarks made at a luncheon earlier that day by
T Carolyn Williams, dean of the College of Nursing at the University
? of Kentucky, are reproduced as part of the introduction to this
  issue’s special section on family nurse practitioners, which begins
{ on page 11.
  At a luncheon preceding the formal program, Mrs. Jefferson
  Patterson was given an honorary Kentucky Colonel Commission
1 by Mrs. Steven Beshear, wife of Kentucky’s lieutenant governor.
i And in still another way she both honored the occasion and was
· honored by it. A number of the celebrated photographs she took
during the early days of FNS were placed on display in the library
· for a period of several weeks — the second time in recent months
J that her camera work has been given special attention, three of her
l photographs having been published in the September issue of
* Washington Dossier.
V Altogether, this was an occasion that grew out of the printed
E schedule of events into an experience full of memories, inspiration,
and commitment. The central event, the presentation of the FNS
archives, was not obscured by it, but rather brought into meaningful
, focus. FNS is grateful to those at the University of Kentucky who so
generously directed and supported the very considerable effort
, required to bring it all about.

 6 FRONTIER NURSING SERVICE
A CHRISTMAS "LEAST ONE" ON HELL-FER-SARTIN E ‘
by Frances Fell, RN e
Frontier Nursing Service i {
This account of an early FNS Christmas has become available to the FNS `
Quarterly Bulletin through the courtesy of the University of Kentucky ¤
Library, Frontier Nursing Service Collection. The article has been reprinted
from The Public Health Nurse of December, 1930. `
Friends ofFNS and readers ofthe Quarterly Bulletin will find the story I
familiar in its celebration of challenges met, duty done, and — perhaps ‘
most important of all — care given lovingly, in the isolated mountains of
FNS’ early days. Yet, even ifthis story reminds us ofmany others, there is
something about the fact that there are so very many of them that is
especially inspiring. They remind us where FNS started and where its .
greatest concerns have always been rooted.
Much of this issue of the Bulletin deals with the very different
challenges of the modern world. Yet we need to see that these challenges
differ mainly in that they must focus on changes in the "externals" of our
society — in our laws, our culture, and our medical technology. Underneath
all of that there still remain the concerns and values to which FNS has
always devoted itself. The guiding force in FNS is still a deep desire to help
human beings in need. .
We feel that these occasional retrospectives are not really an indulgence ‘
in nostalgia. They help us preserve our perspective, reminding us again of A
what we set out to do and must continue trying to do in this later time when
the mountains and the weather are much less a challenge than issues of
malpractice insurance, government regulation, financial stress, and that _
peculiar phenomenon of our age: technological advance that has given i
medical practice the sophistication to transfer hearts from body to body, ,
and at the same time seems to have cost it its own heart.
\

 QUARTERLY BULLETIN 7
~ At six o’clock on Christmas Eve the mountain darkness that T
 . descends so quickly in the Kentucky hills had completely surrounded T
Q the two small white buildings composing Possum Bend Center. The _
; air was chilly and the nearby hillsides were being leisurely .
 S powdered by a gentle snowfall. Suddenly there gleamed in the
T darkness a light from a lantern, while the figure of a man astride a
x small, lean mule appeared at the wire fence enclosing the center
* grounds, and a man’s voice shouted — "Hello, Hello, Hello
I ‘ ——Nurses."
  Before the last hello had found its echo, the door to the little
E.; white cottage was opened and one of the nurse—midwives, clad in
`  riding clothes, appeared on the porch, holding aloft a kerosene
I lamp. She recognized the man as Sam Napier, and asked him to
¥ come inside and get warm. He refused, explaining that "Sally his
Q  wife was punishing turrible, and wanted the nurses." t
i Fifteen minutes later the two nurses mounted on their faithful
equine friends, rode out of the white barn after the anxious young
  father. Both were acutely aware ofthe distance to be traveled before
 T Sam’s house could be reached. The Napier cabin was perched on the
 . top of Devil’s-Jump-Branch on the famous "Hell-fer-Sartin" creek.
= This is the roughest creek bed to travel either afoot or on horseback
in Leslie County.
T Patiently the two horses, Penny and Darky, followed the mule
g through the chilly waters of the creek. The snow continued,
  changing from gentle, fine powdery flakes to stinging icy granules
  that clung tenaciously to the sleek coats of the horses as well as to
? the heavy outer garments of the nurses.
 _ Gloves or mittens are luxuries for a poor mountaineer. On this
 T cold, snowy Christmas Eve, Sam’s hands were bare. He frequently
` changed the lantern from one hand to the other in order to thrust his
numbed fingers into the pocket of his shabby black overcoat. He
\ often remarked "Hit’s a powerful bad night, and a heap of trouble
  for ye to come thus fur, but Sally she allowed hit were time fur you
 . all to come. She always knowed with the boys, so I reckon she needs
The nurses took turns in assuring him that this night journey
. was just part of the day’s rounds. They quoted the motto of the
’ Frontier Nursing Service adopted since its earliest pioneer days:
"No matter what the weather, if a father comes for the nurse she
. will return with him."

 8 FRONTIER NURSING SERVICE
On a sunny day the six mile horseback journey would have .
taken an hour and a half. The blackness of the night, together with °
the heavy snowfall kept the horses going at a slow walk. Three
hours passed before the first cabin on Devil’s-Jump-Branch was 2
reached. The last half mile was up the particularly steep, rocky ?
incline long ago christened by the early settlers "Devil’s-Jump."
When this point was reached, the nurses dismounted in order to T
lead their weary horses up the slippery path ending at the door of _
Sam’s tiny weather-beaten log cabin. l
The kindly neighbor women who had come to sit with Sally  
during her confinement had heard the horses coming and had ;
opened the door to call out a warm welcome to the tired travelers. V
Sam took immediate charge of the horses and assured the nurses
that the barn was warm and dry.
One of the women seized the saddle bags and carried them into
the cabin. Friendly hands peeled off the nurses’ wet wraps and
spread them out to dry before the brightly blazing log fire which,
together with the light from one "coal oil lamp" illuminated the  .
combined bed and living room. The whiteness of the pine board  
floor, as well as the orderly arrangement of the hand-made rustic I-
furniture would have made a lasting impression on even a casual
visitor. The walls had been freshly papered with pages from the
American Journal of Nursing and The Public Health Nurse. How ·
vividly the nurses remembered the bleak, wet autumn afternoon .
that Sally had knocked at the clinic door with five pennies saved  .
from her egg money for the purpose of purchasing enough magazines  
to repaper the interior of her home! The only periodicals on hand in .
the Center were the previous year’s nursing publications. Sally had  _
greatly admired the smoothness of the paper and the size of the ` _
pages.
The sooty black iron tea kettle used in every mountain home was
waiting on the hearth filled with boiled water. Several small tin lard a ¤
pails had been assembled on the table for the use ofthe nurses. One  i
of the beds had been made with clean sheets. Blankets were  _
unknown in this humble mountain home. There was, however, a I
plentiful supply of clean, hand-pieced quilts of various weights,  ;
patchwork patterns and brilliant colors, turkey red predominating.  
The nurses opened the midwifery saddle bags and laid out the
necessary equipment for the delivery.  

 QUARTERLY BULLETIN 9
~ Sally had since her marriage at sixteen always been known as
A the "sewinest and workinest woman on the creek." She had taken
V great pride in making the baby clothes from modern patterns l
,2 furnished from the Center. l
` Silently and patiently this young twenty-six year old mountain
. mother labored. The women folk encouraged her by relating the
story of the first Christmas baby. When she became restless they
{· admonished her to "do what these women tell ye, because they
L know what’s best for ye."
i , Shortly after midnight the first Christmas baby on "Hell-Fer-
` Sartin" made her appearance crying lustily. How her parents
I rejoiced at the birth of a daughter because the other four were sons.
The nurses were given the privilege of choosing the name for this
. tiny black-haired daughter. They consulted together and suggested
Noel Mary as a name for Sally’s "least one." The name pleased the
parents. After Sally had given her daughter a keen look and learned
her weight was eight pounds, she reckoned she was "a right pert
 . young un."
  Meanwhile Sam had raised the door in the ceiling leading to the
l loft above where the four boys were snuggled together in one bed
and informed them that they had a little sister. The nurses were
urged to "take a night" and share the other bed. However, the snow
i had ceased and the moon had come up flooding the snow clad slopes
‘ with magic light, so the hospitable invitation was refused. Sally
I  was assured that a nurse would return to care for her that
* afternoon. One of the elderly neighbors had offered to remain for a
{ week to look after the little household, so instructions regarding the
it  care of the mother and baby were given her.
` After everyone had partaken of a steaming cup of black coffee
and Christmas greetings had been exchanged, two weary but elated
g _ nurses mounted their horses and rode away. It was then two o’clock
_` in the morning and brilliant moonlight was glistening on the
  snowy hillsides. In the peaceful beauty of the snow-powdered hills
 — and with the memory of the happy family in the tiny isolated
_ mountain cabin, the fatigue and cold were forgotten. The nurses
 ‘ lifted their faces to the star sprinkled sky and their silent thoughts
, were —— "Noel Mary Napier — a Christmas baby on Devil’s-Jump-
Branch, Hell-Fer-Sartin Creek — He came, that first Christmas
, Babe, that you too might have life and have it more abundantly."

 10 FRONTIER NURSING SERVICE
   fi  RUTH LUBIC RECEIVES i
 *5;.  "   H ONORA RY `
    DOCTOR OF LAWS DEGREE  
      FROM UNIVERSITY ]
, » .` "   _   OF PENNSYLVANIA [*
n
Ruth Watson Lubic, who counts among her many distinctions her   ,
membership on the FNS Board of Governors, received an honorary Doctor  
of Laws degree from the University of Pennsylvania at ceremonies held
this fall to mark the fiftieth anniversary of the University’s School of I
Nursing. The citation read as follows:
A professional nurse—midwife, anthropologist, and public health ,
scientist, and a pioneer in developing model projects for maternity
care that respond to the needs ofthe family, you have been called "one
of the eighty women to watch in the ’80s” and been numbered among .
"the 100 most important women in America."
With the goal of giving families the self-confidence to bear and rear
their offspring with, but not dependent on, professional guidance, you .
have championed the nurse/ midwife as a full partner on the maternity
care team. Serving as General Director of the Maternity Center  .
Association in New York City for the past fifteen years, in 1975 you
introduced the first out-of-hospital childbearing facility of the modern
era, a model of safe, low-cost maternity care in a homelike setting,
which became the inspiration for some fifty subsequent centers. Y
A fellow of both the American Association for the Advancement of
Science and the American Academy of Nursing, you were among the _
first members ofthe Institute of Medicine ofthe National Academy of
Sciences. Your talents were recognized early on at the Hospital of the  ,
University of Pennsylvania, where you received your basic training in l *
the diploma program and graduated with the highest academic award
as well as the Florence Nightingale medal for excellence in nursing
practice. Among your subsequent honors you have received the Q
distinguished Rockefeller Service Award presented by Princeton’s
Woodrow Wilson School of Public and International Affairs. V
Keeping their eye on you "in the ’80s” and beyond, your admiring
colleagues at the University of Pennsylvania commend you, Ruth `
Watson Lubic, for your signal ability to listen and respond to the needs
of families, and your innovative contributions in word and action to
the nursing profession, and join the Trustees in reaffirming your ~
membership in the University family with the award of the honorary
degree, Doctor of Laws. .

 The Nurse Practitioner :5. ,;            
4 A Nurse Who Is More            
p Than a Nurse     {V   .:r_ ;   M T    
 I The term "nurse practitioner" is relatively new in the long history
{ of nursing. Yet the concept — which encompasses the care of both
[ the well and the infirm — has always been an essential element in
E   the work ofthe Frontier Nursing Service. Last November 7th, at the
3 L luncheon that preceded the formal presentation of the FNS archives
 i to the University of Kentucky, Dean Carolyn Williams of that
I university’s College of Nursing had this to say:
In my view, and I think in the view of many nurses, the
contributions of FNS in blazing trails ranks with some of Florence
I N ightingale’s innovations in England and those of Lillian Wald
at the Henry Street Settlement House in New York City. This
seems reasonable when you stop and consider that the Frontier
‘ Nursing Service was providing culturally sensitive family—oriented
primary care, much of it in the home, before such concepts gained
. their present popularity. Further, Frontier Nursing Service was
developing a model delivery system long before foundations and
federal monies were available to those interested in such endeavors.
V While many know about the impact which the Frontier Nursing
Service has had on nurse—midwifery, there has been relatively
little attention given to the contributions FNS has made to
- development of the family nurse practitioner role. Yet, the Frontier
Nursing Service pioneered in this activity and shared much of
% their experience in family nursing with others who sought to
develop a similar provider role. In fact, the Frontier Nursing
Service created one of the first family nurse practitioner educa-
»  tional programs in the country. And, in 1972, the Frontier Nursing
° ` Service and five other institutions were funded for the first
federally supported group of family nurse practitioner programs
in the United States.
 l A year ago, the FNS Quarterly Bulletin devoted most of its
A Autumn issue to nurse-midwifery. This year, we wish to examine
_ the new—yet-old function of the family nurse practitioner — the
concept, the role, the legal implications, and the educational
preparation. To encompass this many-sided subject, we present
. (with warm thanks to the authors) three articles by faculty of the
` Frontier School of Midwifery and Family Nursing on various
, aspects of this important branch of health care.

 I
12 FRONTIER NURSING SERVICE Q
THE ROLE OF THE NURSE PRACTITIONER .
— WITH THE ACCENT ON "NURSE” {
by Nancy J. Fishwick, RN, MSN, CFNP  
Family Nurse Instructor Q
Frontier School of Midwifery and Family Nursing  
Frontier Nursing Service I
Mary Breckinridge was forty years ahead of her time when she
envisioned nurses meeting the need for readily accessible, high ’
quality nursing care for families in Leslie County, Kentucky.
Family nursing was officially included in the curriculum of the ,
Frontier School of Midwifery and Family Nursing in 1970, FSMFN ,*
being one of several schools of nursing awarded federal monies to
prepare registered nurses for an "expanded role" in health care. The
first nurse practitioner program was at the University of Colorado,
and started in 1965.
The nurse practitioner role was originally conceived as the
tapping of underutilized talent for meeting the health needs of
medically underserved areas of this nation. Many nursing leaders
were fearful that nurse practitioners would abdicate their nursing
heritage; would, in other words, become "junior doctors." The .
evolution of the role over the past twenty years is beginning to lay I
that fear to rest. The nurse practitioner brings together the best that
nursing has to offer society: the nursing skills of teaching and I
counseling for the promotion of good health and the prevention of _
illness for people of all ages. This traditional nursing focus is
enhanced by health assessment skills through the taking of health 2
histories and the performance of physical examinations, the ability
to diagnose and manage minor illnesses, and the ability to monitor
the condition of those people with chronic illnesses. , .
In this age of specialization and high technology, the nurse  
practitioner retains the nursing art of viewing the individual as I
more than the sum of his body parts. The client is seen within the I °
context of his or her family, community, and spiritual and cultural ‘
values.
To address the nature of the health problems of modern F
America, the nurse practitioner emphasizes the need for sound i
self-care practices to achieve and maintain good health now and in ·
the future. In 1900, the average lifespan was 47 years, and only four Q
percent of the population lived beyond the age of 65. Infectious and  

 I
  QUARTERLY BULLETIN 1:;
communicable diseases were the leading causes of death and
  disability. Improvements in sanitation, water purification, the
  advent of antibiotics and insulin, and scientific technology have
Q contributed to longevity and the elimination of communicable
I disease as the leading cause of death. Today, life expectancy is
· estimated at 72 years. Eleven percent of the population is living
l beyond age 65, and in another 45 years, that age group is expected
to make up 21% of our population. The four leading causes of death
* and disability in this country are now heart disease, cancer, strokes,
and accidents. These health problems are related, to some extent, to
V life style and unsound living habits: poor diets, lack of exercise,
,i tobacco use, alcohol and drug abuse, and high stress. They are all
preventable, to some degree, through health education and modifi-
` cation of "unhealthy" behaviors. Virginia Henderson, a noted
. nursing educator, theorist, and author (Textbook of the Principles
and Practices of Nursing), has defined nursing’s unique function as
- "assisting the individual, sick or well, in performance of those
activities contributing to health or its recovery (or a peaceful death)
that he/ she would perform unaided if he/ she