xt7ghx15nw1t https://nyx.uky.edu/dips/xt7ghx15nw1t/data/mets.xml The Frontier Nursing Service, Inc. 1978 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. 54, No. 2, Autumn 1978 text Frontier Nursing Service Quarterly Bulletin, Vol. 54, No. 2, Autumn 1978 1978 2014 true xt7ghx15nw1t section xt7ghx15nw1t FRONTIER NURSING SERVICE
The Frontier School of Midwifery and Family Nursing
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“Family Group"

us ISSN 0016-2116 1
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An original bronze sculpture by Bertalan
Marine Gardens, Hastings, Barbados, West Indies. _
Courtesy of Dr. Anne Wasson  
Photo by Gabrielle Beasley  
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FR()N'I`I1·IR NUHSINGS1~]1{VI(j1~l ooAici·i·;i 6:16.740 uy
Published at the end of each quarter by the Frontier Nursing Service, Inc.  
Wendover, Kentucky 41775 ` {Qi
Subscription Price $2.00 a Year yi A
Edit0r’s Office, Wendover, Kentucky 4 I775 ( QL
voi,uM1·: 54 AU'l`UMN_ 1076 Vivi H   BGGB N[1MillKg J
Second-class postage paid at Wendover, Ky. 411775 and at additional mailing oiiices »l
Send Form 51579 to Frontier Nursing Service, Wendover, Ky. #11775  
Copyright 1979, Frontier Nursing Service, lne.  
i 3

*  Al('I`l(‘I.}·I AU'I‘HO1{ PAGE
5 Beyond the Mountains 59
I  Elsie Maier 47
  Field Notes 51
l Frontier School of Midwifery and
Family Nursing 3
  A Family Physician Speaks Anne A. Wasson, M.D. 32
  A Student’s Viewpoint Sr. Ellen Hartung 13
  An Interview with Dr. Gilbert 3()
  Charlie’s Story Charlie and Paul Kelly 39
  Diplomas Granted 31
,5% Education for Tomorrow Phyllis J. Long 22
  Family Nursing 20
  Financing of Programs 11
Y FNS Graduates: Where Are You? Karen A. Gordon 44
U Into Wider Neighborhoods Molly Lee 26
  Midwifery 3
il Off-Campus Experience Sr. Dorothy Dalton 45
I Reflections on a Rural
    Health Experience Gail A. Wolf 19
1 1 School Questionnaire Report 38
  Students are Teachers for a Day Tony Horwitz 16
  The l)eans 43
  The Husbands, Bless ”Em! Susie Palmer 36
  The Program Today Elsie Maier 7
g The School: In Summary . . . 41
I Fund-Raising Dinner for
` Midwifery School 45
. In Memoriam 52
[ Memorial Gifts 52
Qi   Miss Samantha`s Christmas Party 59
  Navajo Nation 46
I A Once ()ver Lightly W. B. R. Beasley. M.D. 2
 VT  Staff Opportunities Inside Back Cover
U 5 'l`he Right To Die Tony Horwitz 56
1 _ A Public Relations Volunteer 48
  Volunteers for the
?j'° ()ral History Project 51

Following a central portion of the Object of Frontier Nursing
Service, a large part of our activities is in "providing and
preparing trained nursemidwives for rural areas in Kentucky
and elsewhere, where there is inadequate medical service". This ,
special Bulletin issue presents the Frontier School of Midwifery  
and Family Nursing; we have chosen a cover picture to emphasize   _
the focus of our training as family-centered and contemporary.
The history of the School as a midwifery training institution since é
1939 begins on page 3 and is carried through to its present day Q,
inclusion of family nursing. This report is followed by reflections  
and thoughts of students, interns, staff and faculty. Itis our belief gl
and commitment that health care through family nurses and 3
nurse-midwives—with medical support—is superior and less
expensive than traditional medical treatment. The contribution of J;
FNS, through this School, to international health is indicated in I
the interview with Dr. Gilbert on page 30 and more fully  
illustrated in the account of a visit of a faculty member to a former  
student in Pakistan on page 26. A preliminary study of graduates ‘
since 1970 is presented on page 44, together with a table of the  
numbers and types of graduates on page 31. These are wide  
neighborhoods indeed.  
Support of our training program is increasingly expensive. § ‘
_ The table on page 11 compares our cost with others. A current  
sampling of our subscribers, exploring their concern with service   <’
and training, is reported on page 38 and we are heartened by the  
broad support of our educational activities. Yi
Should this service institution be involved in training? "By all  
means. The strength and competence of FNS in training is well Y {
established," so we were recently assured in Washington by an _  
HEW Nurse Training Officer. In addition to a Federal grant in JY  
partial support of the School, a special endowment is being Y "
established for the School. f i
Focus E$ as lol  ¥
W.B.R. Beasley, M.D.  p

* Midwifery
» If one were asked to list the consequences of global conflict, it is
unlikely that the birth of a school of midwifery in the Kentucky
,.9 mountains would ever appear. Nevertheless, the beginning of
  World War II in Europe on September 3, 1939, was probably the
if · single most important factor which led to the opening of the
Frontier Graduate School of Midwifery by Frontier Nursing
  Service later that same fall.
*g· Mrs. Breckinridge, herself a British-trained midwife, with
  personal as well as professional ties to the British nursing world,
 i~ had no difficulty, in the early days of FNS, in recruiting British
{  nurse—midwives to come to Kentucky, or in arranging for
 _ American nurses to go to England or Scotland to take the
  midwifery training. However, the need for nursemidwifery
  training in the United States, the desire to have a school in this
  country, was in the back of Mrs. Breckinridge’s mind from the
  beginning of FNS in 1925. The first opportunity offered FNS to
  participate in nurse—midwifery education in the United States
  came in 1931 when FNS loaned Miss Rose McNaught to the
  Association for the Promotion and Standardization of Midwifery
 A in New York as the Midwifery Supervisor of student nurse
  In 1939 Mrs. Breckinridge wrote: "When we began our work
  more than fourteen years ago, we started with a three point
gi program . . . We also intended to train American graduate nurses
  in midwifery and in frontier techniques . . . I wanted the school to
  start on an established basis, in Lexington, affiliated with the
  3 University.of Kentucky. The President of the University [the late
g.  Dr. Frank McVey] endorsed the idea. The physicians on our
  Medical Advisory Committee wanted it so much they were willing
' , to work for the indispensable hospital connections. Our plan
I called for graduate nurse students to get most of their field work
{ ,4· with the FNS in the mountains. A university school in Lexington
 *P* did not come about because I failed, after several attempts, to get it
. The idea of having a school of midwifery in Kentucky was no
  new idea in 1939 — it didn’t burst full blown into the heads of Mrs.

 4 raozmsu NURSING smzvicr
Breckinridge and her associates with the first blast of Panzers
crossing the Polish frontier. The war did, however, preclude the .
possibility of recruiting British nurse-midwives, of sending
Americans to Great Britain for training, and it depleted the A
Service’s nurse-midwifery staff by about two-thirds as many of
the British midwives went home during the fall of ‘39 and the
winter of ‘40. If FNS were to continue its nurse-midwifery service .
program, then it had to get on the stick and train its own
midwives. In an increditably short time, Mrs. Breckinridge  e,
presented the plan for a Frontier School to the district committees
in the mountains, to the Medical Advisory Committee in Lex-
ington, to Dr. Arthur T. McCormack and Dr. Charles B.  
Crittenden of the Kentucky State Board of Health, to the "
Governing Board of FNS, all of whom gave their approval; she J
discussed the curriculum and obtained support from Miss Lillian
Hudson and Miss Isabel Stewart of the Department of Nursing
and Health at Teachers’ College, Columbia University, with Miss  A
Hazel Corbin and Miss Hattie Hemschemeyer, Director and
Associate Director of the Maternity Center Association; and with
individual members ofthe National Medical Council of FNS, such
as Dr. John Rock of the Boston Lying—In Hospital and Dr. Robert
M. Lewis of the Yale University School of Obstetrics.  
By late November of 1939 the School was ready to open—with
two students and two of the most experienced British nurse- .
midwives who delayed their departure to get the program under
way. Two new midwives were not going to fill the Service’s need, ‘
and neither were the two more admitted six months later, but it .
was a start — and Mrs. Breckinridge always believed in starting A
small so that growth, when it came, would be lasting. There were
many difficulties over the years, mirroring the problems of FNS
itself, but the School endured, and grew, and broadened its
mission to include the education of family nurses as well as nurse-  .,
It is the oldest school in continuous operation in the United ,l 
States. It is the only school combining education in midwifery and   p
family nursing. It is the only school outside of a university setting,  *_
although it has recently achieved university affiliation. Next it 
fall—in 1979-the Frontier School of Midwifery and Family T
Nursing will celebrate its fortieth birthday, and we all know "life
begins at forty"!

 QUARTERLY Burwrrw .s
Family Nursing
In Wide Neighborhoods and in conversations, Mrs.
Breckinridge spoke ofthe need for a "school of instructive district
` nursing", a companion school to the nurse—midwifery education,
to prepare nurses to provide services other than midwifery. The
_ precipitating factors leading to the beginning of family nursing at
FNS were not as dramatic as World War II but rather reflected the
 ;._ changing times, such as the movement of deliveries almost
' entirely to the hospital as a result of insurance after the war and
third party payments. This trend was reinforced by Medicaid
  requirements for hospital deliveries in the mid—60’s. As a conse-
` quence, the district nurse no longer spent hours attending labor
J and deliveries in the home and had free time which could be
devoted to the rest of the family.
A second factor was the concentration on family planning
 I when Dr. John Rock included FNS in his family planning
activities in 1957; the growth of this much-desired service
decreased the over-all amount of prenatal care and deliveries. The
third factor was technological; during this same twenty-five years
the advance in medical technology was enormous. The common
  use of antibiotics, cortisone, blood transfusions, laboratory ser-
vices, all accelerated phenomenally. To state it very simply, the
, management of pneumonia depended no longer on successful
nursing in turning the patient and providing cough syrup and
‘ oxygen, but on early diagnosis and prompt provision of an
_ appropriate antibiotic. So, as district nurses were required to
’ devote less time to prenatals and newborns, as they acquired more
technological skill in contraceptive services, it became necessary
to provide them training in the use of selected medical technology,
to expand their nursing skills in primary care.
 ., It was in the mid—60’s that Helen E. Browne gave permission
  for this concept to be explored and reemphasized FNS’s training
El  mission.Meetings were held, first with former staff members who
il  were involved in nursing education elsewhere, secondly with
 *_ nursing educators with no previous FNS experience, to obtain
’  their support and recommendations on training and on expan-
I ding the nursing role. Subsequently, Dr. Gertrude Isaacs and Dr.
I Rogers Beasley came back to FNS as co-directors to establish a
family nursing training program which would preceed and

 6 raomuau NURSING smwicm
strengthen the content of midwifery education. Grant money was
sought and obtained, both for the broadening of the School itself  
and for the construction ofthe Frontier Nursing Clinical Training
Center of which the Mary Breckinridge Hospital was an integral
part. The first class of four family nursing students, all of whom
went on to become nurse-midwives, was admitted in June, 1970.
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 oumrmarr Butrmm 7
The Program Today
` By Elsie Maier,M.S.N.,C.N.M.,C.F.N.C.
The nurse-midvvives of the Frontier Nursing Service were the
first primary care providers in this country actually to take care of
all the needs of the family, because their practice in an isolated
rural area, with an acute shortage of physicians demanded this of
, them. Formal training in family nursing was built onto the
  ‘ midwifery education offered by FNS at a time when the rest ofthe
country was just awakening to the need and practicality of
utilizing the registered nurse, with additional education, in the
*` ` provision of primary health care.
The program as it exists in the Frontier School of Midwifery
and Family Nursing today is a sixteen month program in family
nurse-midwifery, with the option of taking either family nursing
or nurse-midwifery in twelve months. A student finishing any one
_ of the three options offered in this program receives a certificate in
` the specialty which he/ she has completed. The twelve month
family nursing portion is approved by the American N urses’
Association as a short-term continuing education course. The
nurse-midwifery segment is approved by the American College of
Nurse-Midwives as a basic nurse-midwifery program. The faculty
is well—prepared and experienced, with approximately fifteen full-
time faculty members and an additional twenty clinical instruc-
. tors. The program is divided into four trimesters (a trimester is
equal to four months) and classes are admitted twice a year. The
` first trimester, Family Nursing 1A, encompasses health assess-
ment and management of the individual and family. This
trimester is required of all students and gives them a basis in
F normal physiology and assessment of the normal individual with
Q recognition of the abnormal. There is a focus on counseling and
  health teaching and an opportunity for students to get out in the
ji  community and practice the skills which have been learned.
  The second trimester, Family Nursing 1B, teaches the iden-
pr tification and management of common health problems in the
 ,‘ family. It is here that pathophysiology is reviewed and the
, management of problems is discussed. Students learn the scope
, and limitation of their practice. They learn how to consult other
A health professionals, and how to refer patients to other members
. of the health team.

The third trimester, Family Nursing II, focuses on prenatal,  
postpartum and neonatal care, family planning and gynecology, V
and the fourth trimester, Family Nursing III, concentrates on
intrapartal care. Students that take all four trimesters are given a
certificate as a family nurse-midwife. Students who choose to take
family nursing only must take the first three trimesters (Family
Nursing IA, IB and II), and those who choose to take nurse-  ·
midwifery only must take Family Nursing IA, II and III. Upon {
completion of Family Nursing III, students may take the national A '
certifying examination for accreditation as a nursemidwife by I
the American College of Nurse-Midvvifery. One year of experience ,_
as a family nurse is required before a student may sit for the  rl
certification examination in family nursing given by the ‘
American Nurses’ Association.
The family nurse-midvvife is a unique health professional.
The Frontier School of Midwifery and Family Nursing is the only
school in the country to prepare nurses to provide both kinds of
care—family nursing and nurse-midwifery. Located in a rural r
setting it also emphasizes care for rural areas. This, also, is .
unique. Other programs may offer some experience in rural areas,  
or have both family nursing and nurse—midwifery in the same {
school; however, other programs are not built one upon the other Z
and do not allow the student to focus on both specialties. =
The faculty of the Frontier School of Midwifery and Family f
Nursing believe that it is important for health providers in rural
areas to have the background of both these areas. It provides the  _
nurse with the knowledge and skills to meet the needs ofthe entire ‘
family, including maternity care. The faculty feel that it is
important for family nurses to have the same background and f
training, the same background and education in the provision of
prenatal and postpartal and neonatal care as a nurse-midwife.  .
Neither family nursing nor nurse-midwifery are to be con-  I
sidered second-rate medical care but rather an enhancement of  ’
the provision of health care in the joint practice with physicians.  
Physicians are a vital part of the success of either practitioner. Q 
Without medical back-up it would be impossible for the family  .
nurse or the nurse-midwife to practice effectively. It is in the Z
demonstration of joint practice that each profession brings its 3
expertize so the best health care can be provided for the patient E
and his family. Nurses bring with them the caring role which they .

. have developed as a nurse and the skills of health education and
counseling which help the patient to understand himself better. In
this way the indivuduals may learn to take responsibility for their
own health care. Physicians provide the medical input, the
medical expertize, particularly in the complicated health
problems. And the joining of the two professions in the provision
of care gives the patient the best both have to offer.
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it rnoivriux Nunsmc smwicr  
In 1977, a formal academic affiliation was forged with the 3
University of Kentucky College of Nursing. This was an exciting %
step in the progress of the School. It affords the student the E
opportunity to apply to the University for admission as a f
graduate student. Students who qualify for admission may then  i
take the courses offered at the Frontier School for university 5
graduate credit, and with one or two additional semesters on the  `
UK campus, they may complete the requirements for a master of  
science degree in nursing. This program was available, at first, Q ,
only in family nursing but as of December 1978, it has been made  
available in nurse-midvvifery. The affiliation is a result of several  p
years of negotiation and planning and reflects the respect each _ ;
institution has for the other. It is felt that this affiliation greatly  
enhances both schools and it is with great joy that the announce- i
ment can be made that the nurse-midwifery portion of the  
program is now available for graduate credit.  
In 1964 the nurse-midwifery training at FNS was approved by ‘
the Central Midwives Board (CMB) of England and Wales for *
Part I of British midwifery training. This approval was confirmed  
when Helen Browne visited the CMB in 1977. In 1978, when Dr.  .
Gertrude Isaacs was in England, she visited the CMB and I
reviewed with them the change in curriculum since family  
nursing had become an integral part of our training. Subsequent-
ly, the CMB wrote of their interest in our expanded training and ‘
said they would be willing to come and reevaluate our School with »
a view to an expansion of the approval of the level of training. We
have written the CMB to try to finalize the dates for the visit in the
late spring. It is FNS’s responsibility to pay the expenses of the »
trip and some staff members are so enthusiastic about this  
development that they have contributed $100 toward the ap-  
proximately $1,000 need.  
In addition to the basic program which the Frontier School  ja.
offers, students and interns from other programs have come for  
clinical experience with the FNS. Students have elected to come J
from Vanderbilt University, the Medical College of Georgia, Pace  
University and the University of Kentucky. They have found the  
experience at FNS invaluable in their professional development.  `
Five Robert Wood Johnson Faculty Fellows chose to come to FNS {
for clinical experience this past summer and several are planning  
on coming during the summer of 1979. These Fellows are  

   QUARTERLY su1,1.1;1111~1 ll
  university faculty members who have been given a fellowship in a
1 primary care setting. It is stimulating and challenging to have
  these well-prepared individuals on the staff of Frontier Nursing
Q Service.
V The School is partly supported by a grant from the Division of
Nursing of the Department of Health, Education, and Welfare,
 ' which supplies funds vital for the maintenance of the program. It
  was through the Division of Nursing that monies were available
· , to develop the academic affiliation with the University of
f Kentucky as well. The School is indebted to the Government for its
{V support and encouragement.
V  t The future of the School is exciting and challenging as
  graduates go all over the nation and the world, providing quality
  health care to individuals and families.
  Cost Per Student
 ” Family Nurse $10,000-12,000
  Nurse-Midwife $12,0%-14,000
nj  Family Nurse, Nurse-
  Midwife, Family Nurse-
 1 Midwife $15,303-Direct
 '1 $ 3,411-Indirect
  I *This is an average of 9 and 12 month federally financed
E programs reflecting only direct cost (not possible to get indirect
  **This reflects 12 months with direct and indirect costs separated
  Cost per Medical Student (AAMC):
 1 Direct Cost (1978) Including Indirect Cost (1978)
  $17,000 $31,000

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 QUARTERLY Rurrrrin 1;;
By Sister Ellen Hartung, R.N.,
Graduate Family Nurse-Midwife
Being a student at FNS has to be one of the most unique
experiences of life, coupled with the weariness of a totally
challenging job. I think most students feel that if you can get
through this program, you’ve got to be a fine practitioner — be it
I · family nurse or midwife or both. And it’s worth every minute of
time and every ounce of energy, as far as I’m concerned.
I came to FNS two years ago as a practicing anesthetist for
 F eight months prior to being accepted as a student. After fifteen
years of dreaming about the nurse on horseback and the wild
country she traversed, I finally got the opportunity to complete my
life’s dream of becoming a midwife. (Being a member of a
‘ Religious Community sometimes delays a dream when
I educational opportunites have to be parcelled out according to
available finances. However, my opportunity did come and here I
am — now a fully-graduated family nurse midwife. But the dream
of the nurse on horseback in the wild country is slightly altered
from reality).
The educational experience in a nutshell — WOW! What first
attracted me to this program was the rural setting and the
emphasis on clinical practice. Having been away from formal
education for sixteen years I was more comfortable having my
fingers in the pie, so to speak, and putting into practice what
theory taught was very valuable for me. Supervision was always
available to us so patient care was never second best. The family
nurses and midwives were excellent role models. There was
always an acceptance of individual talents and abilities and a
chance to make decisions when each student felt ready. The
Medical Directives were our second best friend and the physicians
- were as close as the telephone when we needed help for more
comprehensive patient care.
During my concentrated midwifery months, I had a chance to
,_ work with a young couple preparing for their first child. We
’ worked as a team and captured our preparation process, and the
finished product, on film through the efforts of Gabrielle Beasley,
which we are using as a teaching tool for future expectant parents
and new midwifery students. Portions of the film are also being

 ii momisn Nunsmo srnvics
used in a documentary of FNS to be aired through Louisville
Educational TV in J anuary-February 1979. The opportunity as a
student is as broad as one wants to make it and as a graduate the
field is wide open. I am convinced that the health care ofthe world
will be better because of what we have to offer in preventive care —
and I am glad to be a part of that.
Since our class was the first group accepted with a one year
post—graduate work committment, we are pleased to be able to use
our new expertize toward the care of those wonderful people who  j.
have helped in our learning growth. We indeed owe a lot to our
instructors but we owe as much, or more, to the people of this
community who have entrusted their health care to us. Personal-  I
ly, I look forward to being a district family nurse-midwife at the
Beech Fork Clinic (the Jessie Preston Draper Center) to begin
January 29, 1979.
P.S. As a beginning student over a year ago we were asked to
write our idea of a family nurse. The following I share with you —
because I still believe it:
What is A Family Nurse?
Family nurses come in assorted sizes, shapes and
personalities. Their abilities vary with training, in-
genuity and committment. Basically, they all have the
desire for service to the general public, and, in par-
ticular, to the individual members that make up that
marvelous unit, the family. Here she shares with, is
concerned about, participates in and sometimes treats
for — in a process called family health maintenance
and prevention.
The family nurse is a marvelous character. People
expect her to have the stamina of a steam engine, the
patience of Job and the knowledge of God Himself. She I
knows her limitations, however, and easily succumbs  P
to the demands of her supervisor, the physician on call,
the Medical Directives, and her patients’ specific re-
quests. She does her best in whatever happens —-
always ready to ask for another opinion, a clarification  ,
of terms and an occasional day off. The family nurse is
a gentle, generous person — she wants to serve you and
your family. She cares.
Do you have a Family Nurse?

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 16 Fuowrim Nurzsmo smvics
By Tony Horwitz
A Health Fair at the Leslie County High School was one ofthe
highlights of the fall trimester at the Frontier School of Midwifery
and Family Nursing. The Fair was organized by Family Nurse
students as a community health education proj ect—a requirement  
of the FNIA curriculum. These projects help prepare the students H
for the kinds of community health problems they are likely to Q
encounter in their future practice. Equally important is the chance
these projects provide for the students to meet the local communi- i
ty outside the hospital setting. With the heavy workload required  
of Family Nurse students, it is easy for them to become insulated .
from the non-FNS world. Community health education is,
therefore, a welcome respite from their work and study in the
institutional environment.
Each student involved in the Health Fair was responsible for a
booth on one of many health-related topics. The subjects for these
exhibits were chosen after a survey of the Leslie County High »
School students to determine which health m