xt7dnc5s8r3s https://exploreuk.uky.edu/dips/xt7dnc5s8r3s/data/mets.xml The Frontier Nursing Service, Inc. 1977 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. 53, No. 2, Autumn 1977 text Frontier Nursing Service Quarterly Bulletin, Vol. 53, No. 2, Autumn 1977 1977 2014 true xt7dnc5s8r3s section xt7dnc5s8r3s   VOLUME 53 AUTUMN, 1977 NUMBER 2
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Published at the end of each quarter by the Frontier Nursing: Service, lnc.
Wendover, Kentucky 41775
Subscription Price $2.00 a Year
Editor’s ()f`f`iee. Wendover, Kentucky 41775 `
V<)1.U1V11·] ma /\U'1‘1IMN,1E177 NuMm·;i< 2
Se<·ond—class postage paid at Wenalover, Ky. ·11777> and at additional mailin;;o1`1i¢·es '
Send Form I15'i$1t¢» Frontier Nursing Service, Wendover, Ky. 41775
Copyright 1978, Frontier Nursing Service, lm:.

  `  coNTBNTs
    Beyond The Mountains 46
  Calling All Couriers 29
»  Field Notes 52
ii  For Those Who Minister
_ V And Heal MusicByRichardDirksen, 1977
l Words by John Oxenham, 1914 :36
{ - In Memoriam 30
_ Old Courier News 37
  Old Staff News 43
  Once Over Lightly W.B.R. Beasley, M.D. 3
  The Dedication of the Mary
  Breckinridge Banners (Illus.) Betty Lester 33
~ The Frontier Nursing Service
. A Home Health Agency (Illus.) Gabrielle Beasley
F Peggy G. Elmore
. Marianna M. Fuchs
$ James Johnson
` § Verna M. Potter
` A Karen Slabaugh
 · _ Kathy Smith
  Anne A. Wasson, M.D.
 h I Excerpts from The
 : Call Of The Nurse
 _` E Urgent Needs 32
  Why Joseph? Mary Alice Murray 2
 n  A Patient Suffering . . . Modern Maturity 51
— ·i
 `   Radio Spots Jim Fulmer 39
  White Elephant 45

Why would God choose a carpenter ;.
to raise God’s only Son? °
A man in David’s line?  I
Surely there were others in that line . . . " I
With power and influence? {
Surely some more able to provide advantages . .  
education . . . travel . . . culture. . . , ~
A man of wisdom? l
Surely some more learned in scriptures. ..
greater teachers . . .
Why a carpenter, in Nazareth?
carefully rounding sharp corners, .
patiently sanding to smoothness rough edges,
lovingly rubbing dull surfaces of wood till they glowed,
joseph, master craftsman,
shaper of wood,
builder of lovely things,
creator of beauty,
was chosen.
joseph would possess the skill
and patience and love
to shape
and round
and smooth
and polish
the life of a young child.
So jesus, j
growing up with such a man, ?
in such a place, _
seeing beauty brought forth from rough hewn timber, ,l _,
could see beneath the rough and unpolished life  t'
of Peter,  
of Matthew, ,•.·
or james, or john, »·`
or you or me,  }
and He would know, %
and call forth the beauty within _
until the full worth of that life
became visible,
the work of a Master Craftsman,
and a glory to God.
—Mary Alice Murray
Wooton, Kentucky
Christmas, 1976

 QUAR'l`ERl,Y BUl,|.}·1'l‘IN ;i
· The Home Health Agency embodies much of what FNS has
 , always represented; it epitomizes bedside nursing care in the
li home. This Bulletin is both a description of and a tribute to that
~ group of Frontier Nurses who are providing this type of personal
  service twenty-four hours a day, seven days a week. The ad-
  ministrative procedures involved have been described by Verna
Potter who coordinated the unification of these services over a
- year ago. The medical support is described and specific factual
examples have been presented by the nurses themselves, an aide
and other staff.
Q The gift and dedication of a pair of splendid banners to the
National Cathedral in Washington in honor of Mrs. Breckinridge
is well recorded through the eyes of Betty Lester, together with the
official photograph from the Cathedral and the reproduction of
music especially written for the occasion.
Passage of the Rural Health Clinics bill by Congress and its
signing into law by President Carter on December 8, is a true
‘ landmark to which most of you as Trustees and City Committee
members contributed when you wrote your Congressmen early in
V the year urging support of this legislation. This long-awaited law
will authorize payment to nurse practitioners, certified nurse-
midwives and physician assistants for the services they render to
Medicare and Medicaid patients; our nurses will be reimbursed for
their professional services. In order for this to begin in April,
much work is being done on the regulations, both in Washington
NI and in Frankfort.
E Needed support for modification of the Nurse Practice Act in
gl _ Kentucky is being developed; to this end FNS family nurse-
  midwife Chris Schenk led a group from the Kentucky Nurses
_ Association in a presentation to the Kentucky Medical Associa-
`  tion Board of Trustees.
  GUI   who (vb;
Regus Bs as lvl

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l. to r.: Mrs. Willa Hood, Betty Huff, R.N., Mrs. Verna Potter, Mr. Bill Pollard, Anne ~
A. Wasson, M.D. Members not present when the photograph was taken: Mrs.
Lottie Roberts, Mrs. Lois Valentine, Mr. james Mosle , Mr. Howard Na ier, Karl
Gorwoda, R.N. EV
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Home Health Nurse janice Noren discusses foot care with a Home Health atient.

 ouAm·i;m.Y BULLETIN  
.,g By H.R.H. The Princess Louise, Duchess of Argyll
L President of the Scottish Branch
 · I have been asked to write a few words for this little book], and
 _ perhaps it would be of most interest if I recall the origin of the
I Queen Victoria’s Jubilee Institute for Nurses from its beginning.
` In 1887, Jubilee year, a Committee was formed by Her
- Majesty’s desire. The Queen nominated the then Duke of West-
minster, Sir James Paget and Sir Rutherford Alcock to consider,
· and report to her, on the best means of carrying out a project
, which she had much at heart—namely, the best means of
? promoting home nursing for the benefit of the sick who were
J  unable to obtain this advantage for themselves.
  The Queen wished to devote to this purpose £70,000 ofthe fund
  which had been collected by the women of Great Britain and
* Ireland, as a Women’s Jubilee offering to her.
  The Committee reported that this object could best be achieved
_ by the foundation of an Institute for promoting the education and
i maintenance of nurses, rendering them thoroughly efficient in
I- every way, to enable them to attend the sick poor in their own
  homes—the chief centre to be in London, with similar centres in
 T Edinburgh and Dublin. This proposal meeting with the Queen’s
.  approval, she desired that a Provisional Committee should be at
i, once formed, and the Duke of Westminster, Sir James Paget and
Sir Rutherford Alcock were appointed as Trustees, and a system
 { for district nursing, capable of expansion over the whole of the
. Q kingdom, was outlined.
, By Sir Leslie MacKenzie, M.A., M.D., LL.D.*’,
‘ Member of the Scottish Board of Health
_ The Queen’s Nurses.—The largest organisation for the provi-
L sion of trained nurses is the Queen Victoria’s Jubilee Institute for
"l`HE CALL OF 'l`HE NURSE, Edinburgh, June 1926
A ·‘Sir Leslie and Lady MacKenzie came to Kentucky in 1928 for the dedication of
Frontier Nursing Service`s Hyden Hospital and Health Center.

 4; 1~·RoN·m:R NURSING smvicrs
Nurses (Scottish Branch). The Institute has sent trained nurses to
every locality of Scotland. It is difficult to over-estimate the value
of those nursing associations to the localities and of the Institute j
as the central organising agency. The Institute has not only I ·
succeeded in placing large numbers of trained nurses; it has had
indirect effects that are quite as important. It has stimulated the
whole social interest in nursing and led to the creating of nursing ‘
associations everywhere, although not all have fallen in with the
formality of affiliation. Like the Red Cross in the military world, S
the Q.V.J. Institute must be regarded as an organisation of the
highest beneficience in the civil world. A generation of active
work has prepared the way for further adjustments between the »
medical profession and the nursing profession. A statutory lead
has been given in the Act constituting the Highlands and Islands
Medical Service Board. In this Act medical service expressly
includes nursing. Under the new powers of the Local Authorities
for the framing of child welfare schemes the same principle
appears. This alone is a very important step in the integration of
health services.
By The Rev. Lauchlan Maclean Watt, D. D.,
Glasgow Cathedral
The local nurse, with the training and prestige of Queen i
Victoria’s name upon her, is an unspeakable comfort to a district _
in city or country, and invaluable aid to an overworked physician. é
When I think of the districts I have known——the long winding ‘ '°
roads across the hills, the steep tracks over the moors, the .
mountain streams with stepping-stones in the uncertain dark, or °l
the wave-beaten headlands, and far-seeking arms of the sea  i `
lapping the gloomy cliffs—which the grey-haired doctor had to -
face, it makes me wonder at human fidelities. When the sudden Q
summons came, it mattered not what weather was in the night- 5.
wind, rain, snow or frost. With never a qualm or hesitation, he Y
would go . . . .
Think what a difference the trained woman has made there, ;
both for doctor and for people. No longer the anguish of the _

 QUARTERLY Burrrrm 7
unknown; no longer the terrible waiting while the messenger
y covers the night-hid trail and returns with the strength and hope
.» of the doctor’s presence; but the ready, swift comforting of skilled
`  . hands, from the first, and the strengthening, rallying sympathy
of a woman’s heart.
So, also, in the sickness and sorrows of cities and towns . . .
» Is it wonder that the sick poor thank God for these blessed
· women, whose sympathetic advent to their hour of suffering is as
_ the coming of a new day of hope, and whose skilled help is to the
 · physician as the gift of another hand? Their work should never be
W allowed to falter for need of the little money that they cost; and all
p who love their fellows must see to it for the sake of kindly
 I humanity, dedicated to a nobler service.
l In 1860, Florence Nightingale used the money given her by the
Y grateful British people following the Crimean War to found a
  training school for nurses at St. Thomas’ Hospital in London,
Q thus creating modern nursing.
.1 "It was one of ‘Miss Nightingale’s Young Ladies’ (as nurses
 , were then called), Miss Rosalind Paget, later Dame Rosalind, who
 Y took up and followed through Miss Nightingale’s schemes for the
  modern education of midwives. Like Miss Nightingale, she was a
 ` handsome girl of ample private means when she decided on
 _ nursing as a career and received in 1879 a certificate from the
  London Hospital. She was not long in learning that a Nightingale
·'° nurse needed to be a midwife as well. In cooperation with other
_ gentlewomen of like interest, Miss Paget founded the Midwives
, “‘ Institute in 1881—the year in which I was born. In 1882, she took a
. ' course at the British Lying-In Hospital in order to get such
V  training in midwifery as was possible then. Although ladies of
it  birth and fashion did not often become nurses it was permissible
{ to do so following Miss Nightingale’s example, but that ladies
j could become midwives was not acceptable in English—speaking
countries. One of Miss Paget’s friends said to her, ‘My dear, I wish
L  there were another word for you, it would be so awkward if we used
. it just when the footman came in to put on coals} "5
·‘ Wide Neighborhoods by Mary Breckimidge, Harper & Row, Publishers, 1952.

 8 raoxmea Nunsmo senvice i
When the Queen Victoria’s Jubilee Institute for Nurses in ¥
England and Wales was founded in 1887, Miss Paget was selected C
as the first Queen’s Nurse. Although the Institute had been
founded to give nursing care to the sick poor in their homes, Z 
midwifery was soon included in the preparation of the Queen’s
Nurses and, with the advent of preventive medicine, the Institute .»
added the training of public health nurses, the "health visitors" of W 
the British system. Care became available to all segments of the .
British population, not just "the poor".  J
After Mrs. Mary Breckinridge had completed her midwifery ;
training at the British Hospital for Mothers and Babies in 1924,  —
she spent some months in Scotland, under the auspices of Sir  ._
Leslie MacKenzie, to study the work ofthe Highlands and Islands  
Medical and Nursing Service. (By this time nurses were officially A
recognized as colleagues of the physicians in the organization —
which became the model for Frontier Nursing Service.) After her
Scottish tour, Mrs. Breckinridge returned to England for a post  
certificate course in midwifery and to renew her acquaintance
with the leaders of nursing in England, among them Miss Paget ,
and Miss Peterkin who was then Superintendent of the Queen’s ,
Institute of District Nursing, the successor to the Queen Victoria’s F
Jubilee Institute for Nurses. Miss Peterkin arranged for Mrs. F} 
Breckinridge to observe the work of the Queen’s Nurses both in  .
London and in the county of Hertfordshire—an invaluable  I
experience for her when the time came to begin the Frontier if
Nursing Service in 1925. For years, many of the British nurse- A
midwives who joined the staff of Frontier Nursing Service were A
also "Queen’s Nurses", including Molly Lee who is still with FNS.   #
The Queen’s Institute survived the advent of the National Health E
Service in 1949 but succumbed to further reorganization of health ·
services in Great Britain in the latter half of the 20th Century. V ·
The model which was adapted for use by the Frontier Nursing gg
Service has also changed over the years but the principles i
remain—care of the sick in the home has not only been of help to  ;
the patient and his family but has also provided the district nurse i
with an entree into the home, into the totality of family-centered ‘
health care, and has reduced the cost of health care in general by  
keeping the patient out of the expensive hospital care situation.  
For forty years bedside care in the home was provided by the `
district nurses and nurse-midwives ofthe FNS. In 1966 the advent {

r of the third party reimbursement for home care through Titles
 · XVIII and XIX of the Social Security Act—Medicare and
l Medicaid—and the certification of Frontier Nursing Service as a
. _ "Home Health Agency", began to muddy the waters of district
A nursing. These two payment systems for the care of the elderly
; and the indigent provided reimbursement only for the eligible
s _ patient who was "hornebound"—the patient who was confined to
  his home and needed skilled care from a registered nurse or the
I care of a nurse’s aide under professional nursing supervision.
 A Such patients were eligible only if so certified by a physician and
 1 the care given by the nurse had to be under specific orders of the
 i physician—under a physician’s "plan of care". There was no
 ` provision for reimbursement for health education or preventive
E care, no reimbursement for care of the elderly patient (for
 I example) who might be physically able, in the narrow sense, to go
` to the doctor’s office but who lived ten miles up a hollow with no
1. transportation.
i For the next ten years FNS struggled to combine care of the
A official Home Health patients with the generalized family care
I provided by the district nursing staff. And a struggle it was, too,
  because neither our system of family care or our system of record
 , keeping with "family folders" was ever understood or entirely
 : accepted by Medicare and Medicaid. We might have been able to
J live with the confusion had it not been for the financial aspect of
  an awkward situation. As long as the Home Health Agency was
5 operated within the confines of the district nursing system, there
, was no way FNS could demonstrate the actual cost of home
li v health, and the reimbursement we were receiving was prohibitive
E ly low. Therefore, in the summer of 1976, the Home Health Agency
’ · was completely separated from the district nursing care system,
- with its own staff of registered nurses, aides, office personnel, its
 . own office space and vehicles. It continued to receive medical
  back-up from FNS physicians and shared the services ofthe social
  worker, the pharmacist, the physical therapist, with other
  segments of Frontier Nursing Service. In this way the actual cost
 A of home care could be demonstrated satisfactorily and our
  reimbursement rate was increased accordingly. There are some
 . frustrations. In a sense, care is fragmented because the home
2 health nurse can only care for the patient in the family who has
I the doctor’s "plan of care", and has to refer other members of the

10 Faonnm Nuasmc smviciz ._ 
family to other health professionals. The district nurses, on the Z
other hand, miss the warm personal relations they had developed  
with many of the elderly patients. Nevertheless, the separation of
Home Health from the FNS district program has meant financial  ,..
survival of a home care program in the Frontier Nursing Service.
—Peggy G. Elmore »
Early in 1976, Administration decided to take Home Health A
Agency services out of the District Centers and create a cen- ·
tralized service, not only for fiscal reasons but also to meet the
requirements of the "Conditions of Participation" in the Social
Security Act. -
The Social Security Act sets the criteria for admission to Home
Health Agency care. The patient must be essentially homebound, ,
require the skilled services of a registered nurse, physical  
therapist, and/ or speech therapist. A plan of treatment must be  
written by a physician, and his/ her advice sought for any change `
in care. Use of the FNS Medical Directivesor protocols, therefore, “
is not permitted.  
If the patient meets the criteria, he/ she is then eligible for the  `
services of a home health aide, if appropriate. The patient can be  
supplied with medical supplies and rent or purchase durable *
medical equipment. Care, supplies, and/ or medical equipment
must be recertified by the physician every two months. The
secretary, Claudette Grubb, is responsible for the proper prepara- `·
tion for review and approval by the physician. 1
Home Health is staffed by a nurse-coordinator, five registered °
nurses, four home health aides, a transcriptionist, and a medical
secretary. An agreement with Mary Breckinridge Hospital »
provides a part-time physical therapist, a part-time social worker, ,
and laboratory, X-ray, dental, emergency room and pharmacy l
services. Dr. Anne Wasson serves as medical consultant to the  _
Agency, and all billing is done in the Mary Breckinridge Hospital  
business office. .

  l ouAm·i:1<1.r 1su1.1.r:T1N H
{ "Conditions of Participation" require quarterly meetings with
7 a Professional Advisory Committee. It must have some members
» not directly connected with FNS and is a consultant committee of
  the FNS Advisory Committee. Dr. Anne Wasson is the appointed
Chairperson along with Verna Potter, Vice—Chairperson, and
, Karl Gorwoda, Secretary, who were elected by the Committee
  itself. Reports of activities during the preceding quarter are made
  at each meeting and advice in problem areas is sought from
~ committee members. The Policies of the Agency must be reviewed
 , and revised annually.
it The purpose of the Home Health Agency is quality health care
for the people in Leslie and part of Clay counties, so
_ Documentation is the name of the game in the office. "Conditions
of Participation" require that an effective Utilization Review
Committee meet quarterly to review and assess at least 10% ofthe
case load records. Each record is examined from cover to cover for
proper utilization of service, reimbursement source judgements,
( plans of care and recertifications by physicians, adequate
documentation of progress notes by nurses and aides, attention to
Z verbal medical orders given to the nurse by the physician and
4 carried out by the registered nurse and/ or the physical therapist.
? Surveys following the same criteria are carried out by teams from
A the intermediary for Medicare (Blue Cross and Blue Shield of
‘ Kentucky), by the Division for Licensing and Regulation of the
Q  State of Kentucky, and by the Joint Commission for Accreditation
  of Hospitals.
.'__ Nurses, aides, the physical therapist, and social worker are
required to have encounter forms and progress notes entered in
patients’ charts within twenty—four hours of visits. The nurses
__ dictate reports on tape (Panasonic tape recorders donated a few
, months ago by member of the FNS.staff). Other personnel write
_ their reports and attach them to the charts. All these visits are
~ transcribed in chronological order by the transcriptionist, Brenda
. Gross.
. Members of each discipline fill out the FNS encounter form
L (PRIMEX) for each patient contact. The statistics and charges are
key—punched by Juanita Gray and sent to computers for the
` information required by government agencies, the administra-
tion, the Board of Governors, and professional organizations such

 iz 1=RoNr11aR Noasmo smzvics  
as the National League for Nursing and the National Association Q
of Home Health Agencies. ;
Frontier Nursing Service Home Health Agency is approved by I
Medicare, Medicaid, the Joint Commission for Accreditation of i 
Hospitals, and is licensed to operate in the State of Kentucky. The  
last two surveys by the licensing agency showed no deficiencies  
and a few minor recommendations. _ ·`
—Verna M. Potter  
It would be interesting, I thought, to talk with someone who
had had experience with both Home Health and district nurses, so
I went to see a friend who had grown up in an area which had been
served by the more traditional FNS district nurses but whose
mother, later, had been a Home Health patient.
"Mama was never cared for under the district system but I
have always liked the idea of district nurses. The district nurse j
took care of the entire family and her word was gospel. She always
knew all that was happening in the family, and in the area. And
everyone in the district knew, and still remembers, the district
nurse’s name, even if she was only there for a year. You can still `
hear people say ‘Miss So-and-So was our district nurse’. The FNS
district nurse was always there and did whatever had to be done ,
for the family. She used her head, and did things—there was none Q
of this having to call the doctor all the time."  
This last sentence is grounds for a fight with any Home Health Q 
nurse, and, therefore, needs some clarification! This lady grew up »
with the district system and shows her great admiration for the I
nurses who staffed the districts. Her mother was cared for by the l
Home Health Agency in her final illness and she admits that she ·.
could never have kept her mother at home without the Home  ° 
Health nurses. But the obvious frustration which arises from the * 
Home Health nurse always having to act under the doctor’s plan I
of care is apparent, and I think understandable. My friend had _
nothing but praise for the care the Home Health nurses gave her
mother but felt that more could have been done for the whole
family if the Home Health nurse had not had her hands tied with »
government rules and regulations for home care.
—Gabrielle Beasley

  I guess I can’t tell you about all Kentucky people, but perhaps I
, could tell about Bige and Mary.
  They live at a bend in the Middle Fork of the Kentucky River
 - and from their front porch the view looks up mountain sides of
i. rocks and trees, one of the prettiest spots around. To reach their
li»` ` home one must either drive through the river bed (when the water
V is low enough), or walk across a swinging bridge.
.. Years ago Mary used to do her laundry on the banks ofthe river
in a big galvanized tub: she built a fire to boil the water, then the
clothes, and scrubbed them on a washboard. Bige promised he
would buy her a washing machine if electricity was hooked up.
— Some years later, Mary remembered the promise and went to
Hyden and bought a wringer washer. Bige was taken aback. He
never imagined electricity would actually come to his part of the
 _ world!
 , Bige has had lung disease for years, and "smothering", and
L the fear of "smothering", have restricted his activity and he now
becomes quite short of breath while walking from one room to the
‘ But a few years back, before he was quite so ill, Mary was
I down, sick with pneumonia. So Bige had "to get up and do. Now,
W Mary claims Bige would burn water, but come to find out he could
, scramble eggs and make cornbread. So he did: three times a day, ·
  Mary had scrambled eggs and cornbread. Finally, about three
  days later, Mary looked at the plate, then at Bige, and asked if he
V , had washed the plate. Well, now, he hadn’t exactly washed it. . .
Mary’s recovery was instant, and Bige was banished from the
` kitchen. No wonder Bige still avoids cooking!
~. Things aren’t quite the same now. Mary has cancer and a
  troublesome abcess; Bige smothers and has pain in his legs. But
l*  Mary still fixes the meals (and washes the dishes). They take
` turns tending the fire, answering the phone, unlocking the door
; for visitors, and napping. They will continue so until they no
longer can care for each other’s needs; then they plan to go live
with their respective families.
 V A Home Health nurse visits two or three times a week, and the
· aide visits three times a week, cares for the abcess, delivers
medicine, and checks on other health matters. Their families

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4 “°%.L_
Home Health Nurse Kathy Smith enjoys a game of checkers with her patient. _
deliver groceries, carry in coal, do laundry and just visit with
them. ;
But how can I help you see the quick, dry wit of Mary, as she
gently teases Bi ge, or the naughty look in Bige’s eyes when he’s
trying to trick me into his trap during a game of checkers?
Or the tears of desperation and helplessness over a ruthless _
disease that eats away at a weary body, slowly stealing its t
vitality? {
Or the triumph of us all when, for the first time in years, Bige  
walked to the bridge after weeks of going a little further each day. "
Or the gossip shared, about folks we all know——the right and  
wrong discussed and mulled—the lessons of life distilled——advice
on gardening, baking, fire building, when to gather, how to '
The lessons taught without words—lessons of the respect due
hard work, the acceptance of illness, the humor that softens the »
blows of life, sharing what you have, regardless of how much or
how little—lessons of caring about people.
So now maybe you see a little of Bi ge and Mary, how and where
they live.
—Kathy Smith, R.N.  

 QUARTERLY autumn is
 Y "Hello! How are you today? Is there anything speciall can do
 R for you?"
E So I begin another of about one hundred home visits made each
month for the FNS’ Home Health Agency.
  *_ My visits are usually made at the same time each week so my
 ’ patients know when to expect me. There are always one or two
f primary needs that a patient wants met soon after I arrive. After
g being in bed for three days or more, it’s a great relief to take a bath,
f get up and exercise, or just sit up in a wheelchair or go outside on
the porch in the fresh air and warm sunshine.
Bringing medical supplies or medicine when they are needed is
also a welcome service. Since most of the homes I visit have no
transportation, they depend on my regular visits for these
necessities or maybe a special request for me to "pick up
something in town" for them.
; As I have worked with the patients and their families two or
it three days a week, friendships have developed that often make
, these visits go beyond just performing the personal care and
{ medical orders required. Preparing a meal, fixing a wheelchair or
Q taking time to interest someone in a meaningful occupation or
 . home craft all become part of the "service" that blends into the
i routine.
 A One of my patients is a young man who has been paralyzed
Q from the chest down for four years. Since beginning to work with
K him we have tried to find something he could do, using the ability
 I he has in his arms and hands, that would prove to be interesting
j and rewarding. At first we thought getting his car fixed with hand
I controls would give him mobility and open opportunities for
employment. But after months of working to this end, and finally
Q" getting his car ready, he found the problems involved in traveling
 ; in his condition to be too many to overcome at this time. Although
{ this was disappointing, we didn’t give up. Recently I suggested he
I try his hand at leather crafts. I began to ask around to see if
 i anyone had had some experience in working with leather and
i would like to help my patient get started. Janet Kacsmarc