xt7jq23qwn6r https://exploreuk.uky.edu/dips/xt7jq23qwn6r/data/mets.xml The Frontier Nursing Service, Inc. 1983 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. 58, No. 4, Spring 1983 text Frontier Nursing Service Quarterly Bulletin, Vol. 58, No. 4, Spring 1983 1983 2014 true xt7jq23qwn6r section xt7jq23qwn6r _ FRONTIER NURSING SERVICE :2: Q ° VoIume58 Number4 Spring,I983 E Q ; TA »I_ vc? QUARTERLY BULLETIN °·IL,,M I . ’ *»`» Ia I ij ,“= · SI~S * u S S. s · ·EiE~ES¥ = I ‘°":I”°¤.¤u¤‘% ELI, " .¤¤¤LT NYS S I Reachmg mt0 — I S R I I I 'T , I I I.;, E L_ *- ``'`· IS A I -\. ~L~\$; I In E ;L;— I ·~ *1-·~ I, N 1 A . 'Q; _? : A >· . .. `\ H I ' iv I J" ·,*’.. · ~· - ~ v»·` ¤ N IT C E~R¢RLL I in I II., ·»» . ’ I`»I ` * v s I., S·NS \ * I L, I = I E ISSS S 5, I N . —the Commumty E _ N `F I,I, _ ,I.II\ \ Ms WI __\I ` ’ ·· x _ .I E v_ , I :._:\;A_ . _ __;& ` · H I I ·~*» ~ ·I»‘ S ‘’· 1 i I 2 I I g. I; li US ISSN 0016-2116 li { _1 `l i I coNTENTs ?° ii Reaching into the Community - CHC 1 FNS School Graduates 93rd Class 8 ‘\ FNS Student Nurses Bring Health Care to Public Schools 12 Photo Pages 17 and 24 Beyond the Mountains 18 Joint Practice -— Care, Caring, and Trust 22 Memorial Gifts 25 In Memoriam 26 "Short-Time Couriers" Enjoy Working Vacations at Wendover 28 Field Notes 30 Alumni News 32 ` In Brief 33 Courier and Volunteer News 34 I FNS Announces ‘NEED’ Campaign 37 Staff Opportunities 37 ; Urgent Needs 37 ‘ E ·r FRONTIER NURSING SERVICE QUARTERLY BULLETIN I US ISSN 0016-2116 > Published at the end of each quarter by the Frontier Nursing Service, Inc. Wendover, Kentucky 41775 y Subscription Price $5.00 zi Year Editor’s Office, Wendover, Kentucky 41775 V VOLUME sa SPRING, 1983 NUMBER 4 —_ Second-class postage paid at Wendover, Ky. 41775 and at additional mailing offices I Send Form 3579 tu Frontier Nursing Service, Wendover, Ky. 41775 . Copyright 1982, Frontier Nursing Service, Inc. ‘i : 1 1 1 r . 1 QUARTERLY Bu1.1.mu~z 1 l R { REACHING . i THE COMMUNITY V _COMMUNg§NIcr 1, — CHC ,,;A\»;HN S ,` »Q(‘ i P ·». ’T RR r l This is the first in a series of articles il, I,,'’ A ’·. · on the FNS district clinics. It is expect- Fg , Q_ V ed that the articles will appear in _» , _ _ every other issue. ‘ A R V - l Z Passing through the small community of Big Creek, in Q Kentucky’s Clay County, one may or may not notice a white frame building set back a hundred yards from the main road, with the mountains ofthe Daniel Boone National Forest rising behind it. It looks like many another white frame house in this part of { southeastern Kentucky — but it is much more than that. Where l the driveway turns off the main road, there is a sign that reads E "Community Health Clinic, FNS." And that is only the begin- l ning of the story. l b The Community Health Center at Big Creek is, in a strictly § . technical sense, one of four district clinics through which the g Frontier Nursing Service provides health care throughout the area it serves. In that sense, CHC is orthodox enough. It sees P é, about 24 patients a day. Sometimes there are as many as 35 or 40, , · and the peak load has been as high as 48. Like the other clinics, ; , CHC provides primary health care, including counseling on V xl health maintenance, and referrals to Mary Breckinridge Hospital j for more specialized medical treatment or for nursing care at home. 'j But there is a special emphasis at CHC — an emphasis indi- Q cated by the first word in its name — "community." To a degree E unusual even for the community-oriented clinics of FNS, there a, has grown up around CHC a network of close and cooperative I community relationships that make it possible, on the one hand, g - V L FRoN·m:R Nunsmo Smnvics i` for the community to take over health-related projects CHC could I not manage on its own and, on the other, for CHC to reach into the community to discover its needs and to initiate programs to meet them. CHC Project Director Susan Hull and her staff are dedicated to , the FNS belief that good health is a natural outgrowth of " general ? well—being" in the community as a whole, and they feel that that , sense of well-being needs to be nourished by providing help beyond those services covered by medical directives. The approach is at once a reaffirmation of the beliefs of Mary {_ Breckinridge, who created the FNS concepts of rural health care, * and a reinterpretation of those principles for contemporary rural A society. In essence, it is a conviction that "everything is con- . nected to everything else" — that those who wish to guide, to help, or to heal must deal with the whole organism, not just the indi- vidual parts. It is a view that underlies the teachings of ecologists, j and of those who practice a "holistic" approach to medical care. This is a very modern point of view, and yet it derives from long—established principles. Actually, the concept is embodied in the much—quoted "object" of the Frontier Nursing Service: "to ¥ provide expert social service," as well as "to ameliorate economic f conditions inimical to health and growth," and, to that end, "to do any and all other things in any way incident to, or connected with ¥ these objects." . The FNS "object" also speaks of fulfilling its aims in the rural i_ districts "with the help of their own leading citizens." CHC has made a special point of doing just that, and it has done it with A; great success. A "prime mover" at Big Creek has been the CHC . Advisory Committee, a group of dedicated and hard-working members of the community. Its chairman is Al Marcum, who retired some years ago from a career in trucking and a tour of duty 4 as traffic foreman for the State Highway Department in his ; district. . Mr. Marcum’s devotion to the FNS cause, like that of many of A his fellow committee members, precedes the establishment of isi CHC itself. In the years before CHC came into being, FNS oper- ated clinics at Flat Creek, Bob Fork, Red Bird, and Brutus. Mr. Marcum had been on the committee at Red Bird. But in the course { of time, FNS came to realize that it could better meet its commit- 1 ments by consolidating these clinics into a new one. When word of Y QUARTERLY BULLETIN 3 this decision reached the community, a number of its key people decided to form a committee to assist FNS in its plans. Dr. W.B. Rogers Beasley, then director of FNS, asked Mr. Marcum to start looking for a property suitable for a new clinic. Eventually, Mr. Marcum and his stafflocated the house that would be turned into , the Community Health Center. . From the first, the CHC Advisory Committee has supported , the clinic in many ways, varying with need and the creativity of the committee members. Much of its support has been financial. The committee holds box dinner auctions and conducts group f "singings" to raise money. It has given its support for keeping up { the property, and it has bought equipment for the center. Among its contributions have been a new examining table and a new , copying machine. The committee bought a metal storage shed for * tools, and it plans to blacktop the driveway. Committee members also seek out businesses and individuals in the community who _ are able to contribute. Mr. Marcum expressed his appreciation of i the generous and continuing support that has come from local industry. gi Al Marcum feels that the committee owes its success to its spirit of cooperation. "The main things that hold the committee = together," he said, "are getting together and studying each ‘ ‘ Y s T is * »i# E ?`"?V°? · . ii``’ C. · ...— ; E? o»»» i ‘’‘i .. S C ’ ....... -1*M ~—~»~$ · `S ` ` l — §f°"> ‘~ ’ ? £i?Z so · > `i . .~.. ‘·o' ~ e T ==g » ?’!‘ ?‘ §§" l { # lE*f' ye!} ``_— I f ‘ _ . . » ‘i‘’ tt· T · ·es b l if o · ’ l`: · l ` ls}! l i The CHC staff, left to right: lunior Roberts, Alta Couch (a volunteer), lean Hoskins, FSMFN student julie Rice (behind), Susie Farmer, Sr. joan Gripshover, and Project Director Susan Hall. Rose Rokis was unable to be present for the picture. 4 FRONTIER Nonsmo SERVICE l` A . .E»· ·=··· ’`‘°= Wt `/E· .w '»“E`° ‘ `` l » ;. ,. · · »+,` s i` =·ri -·»~ it?. if . e· 5 ’‘`‘ A‘‘,*A· ‘-*»§ L .°.EQ?·‘;“?#’*?i°`T ; s¤ ·* °` f _E_, , _` 4. fg: . y »»_. i g . ,r if . , . ..»_» _ , i .~ '~ Q ig 7 · n ,~¤ ,< ` . ·"r . . ._’i—;»;;§·,} —;· i K I A - Y ig ;» » . ‘_-‘ gel; Wu gi ` :_ H , .;. 2 %. r * —E··· 4* " ? » ·· ·· .a.t»·»»·»¤» i » 1 . ¤|E` Wl . Q· .· kr "» ..,_ I ` ft _. · e § ·$»»l= r ~~;»,», _I;. . ; . g . ? — ga ` . " » "“""‘“ fi? ~¤— · ,·T; ;» *2 E! tir...»»» *‘ E»E· ~ as “ TT`. \`> " E _. EEEE E ..1 * . A . »A · _ ;¢ E.E f»E ·*—. #·‘?~ t` . . 1 . * 4 The new firehouse at Big Creek stands on FNS property close to the Community Health Center. Urgently needed in this wooded region where residential fires have repeatedly { caused total destruction, it came into being a unique demonstration of community [ effort and cooperation. lt went into service early this year. V other." And, he added, "they are all one big family, working for the community." Although television and modern roads came to Big Creek some years ago, the community preserves a natural spirit of C independence and self—sufficiency. A community that must sus- · tain itself without outside help tends to develop internal "net— A works" of support. The result is very different from the "tree—like" structure of most formal organizations, where lines of communi- cation branch out from a main stem and each branch may branch again, in order to reach the remotest elements of the organization. ln a community like Big Creek, these networks seem to appear i spontaneously, and they touch each other and interact like a kind A of community nervous system through which all elements keep in touch with each other and stimulate them to action for the com- mon good. · Sue Hull and her fellow family nurse practitioner, Rose Rokis, ` have enough to do in providing CHC’s basic service. In fact, they L also need the support of a staff of five, which includes a secretary, . a nurse’s aide, a part-time housekeeper, and a part-time volunteer _ secretary. Yet, through the networks, Sue and Rose can reach into parts of the community they otherwise could not touch, and they . can, in a real sense, bring the community in to CHC. j i QUARTERLY BULLETIN 5 V One of these networks centers around Joy Center, which is run by the Red Bird Missionary Conference; it is directed by a young couple, Tom and Chris Denman. Like the other network systems, I Joy Center is not a part of the FNS organization, but it provides T CHC with opportunities for reaching the community. A year and 1 a half ago, for example, Susan Hull started a series of aerobic LI dance classes at CHC. The program was popular and soon out- 'Q grew the space available at the clinic. Sue then asked the Den- mans if the classes could be held at Joy Center, and classes are \_ now given there three times a week. Joy Center has also become , "home" to a series of CPR classes that Sue Hull started at CHC. v_ At present, these classes are given once a year, using certified instructors from the larger center of Manchester, about fifteen it miles away. _ Susan Hull commented that one value of using Joy Center for _ activities such as these was that area residents felt free to partici- Y pate even ·if they were not clients of CHC. Also, she said, these T activities seem to promote the good name of FNS and make the community more aware of, and more appreciative of, its work. Sue i also has plans to use Joy Center for a series of classes on preven- tive health subjects. 1 A second "network" is a group called the Community Aware- A ness Proj ect. This is made up of concerned citizens from Big Creek ” and from nearby Bob Fork, Elk Creek, and Flat Creek. The over- seeing authority for this group is the United Methodist Church. I The CAP was formed in 1981. Its membership includes, according to its own statement, "ministers, teachers, health care providers, community developers and local citizenry who feel x` that needs and resources are best assessed through joint coopera- l tion." Soon after its formation, the CAP focused on one of the gw serious problems confronting small mountain-based communi- 1 i ties — the threat of fire. Big Creek lacked a fire department, and ‘ everyone felt it urgent to form one. _` Fire is a particularly serious threat in a mountainous wooded area like Big Creek. Where no fire fighting resources are available, Q a fire that once gets started tends to be totally consuming. Local f records showed that some twelve residential fires had occurred in ji the preceding year, and that each of them had resulted in total j destruction. Unfortunately, most of these homes belonged to individuals who could not afford the high cost of insurance 6 FRONTIER NURSING SERVICE premiums. Thus, the occurrence of a residential fire became a major disaster for those involved. The CAP appointed a special committee, which concluded after due study that the best site for a new firehouse would be on , land adjacent to CHC and owned by FNS. FNS was glad to cooperate, making the land available without charge as long as it was used by the Volunteer Fire Department as originally intended. = Construction began last year, and the new firehouse went into service early in 1983. Sue Hull herself is a member of the fire department. Interestingly, the members of the fire department `q_ are completing CPR training set up through Joy Center —— a practical demonstration ofthe value of these interacting networks. · The Community Awareness Project was initially the creation of Susan Hull. It now has its own organization and meets once a month. One of its recent projects has been the compilation and publication of a special directory of emergency telephone numbers. This listing includes hospitals, poison control centers, social services, churches, county extension offices, and childbirth services. In addition, it provides numbers to call in cases of child abuse or spouse abuse. Talking to local leaders about the activities in which CHC has become involved, one hears many words like "fellowship," "well- being," and "community spirit." Hearing such words, one finds it increasingly difficult to keep track of who is involved in what. There is a pervading sense that "everyone’s in it together." It seems to become increasingly irrelevant, for exam- ple, whether a new project was started by, or is being carried on by, CHC, or the Advisory Committee, or Joy Center, or the CAP, or some other group. It seems to be the community as a whole that identifies a need, and the result is that all the networks trigger = each other to do something about it. There is, of course no end of »_ needs. One local spokesman has recently pointed out significant i health problems in the schools, ranging from poor health habits to lack of adequate food. Sue Hull is now working to get commun- ,, ity backing for a program of health education in the schools. lf some of these many activities are not explicitly noted in the i FNS statement of objectives, the general intent to provide them Z most certainly is. What CHC has done is to reexamine the pur- 1 poses for which FNS was formed and to interpret them for appli- cation in the world of the 1980’s. In so doing, it has not lost its QUARTERLY BULLETIN 7 touch in its basic work. It serves the health needs of its commun- ity. In a time when home visits tend to be replaced by visits to a clinic or a hospital, CHC still strives to visit each prenatal home . at least once. There still are home visits for reasons other than pregnancy. Some visits end up dealing with problems above and beyond the purely "medical" — Sue Hull spoke, for example, of a { pregnant girl who was having "coping pr0blems," and how she benefited from the friendly counseling of a visiting nurse. With the decline in home visits has come an increase in the §·_ number of visits to the center by doctors from FNS. Yet, although i Sue Hull said that "You don’t get people to pay for wellness," CHC believes firmly in the FNS tradition that an essential part of health care is the teaching of preventive health measures. Sue thinks that it is easier to do this in the course of home visits, and that the decline in the number of such visits places a new burden on CHC. This, of course, is one of the instincts behind CHC’s community outreach. If it can promote a sense of well-being in the community, and particularly if it can reach out through Joy Center, or the Community Awareness Project, or the Advisory Committee, or some other group, it can fulfill, more completely and in a contemporary way, the objectives that Mary Breckin- ridge defined more than half a century ago. In fact, says Susan Hull, "I really believe that this is what Mary Breckinridge had in mind in the first place." P iii ’ * `iif·» —t.—“ ~ ii`:i`i`‘` i Q » .. Té ·»i` I A I I .s ¥ ` ·°f" ti? . ... · . _,»_ , , I . ' l ‘*’ ` Tk?} ini,. }_s{;, >>`>_>_ i . U Q Q`, g . __}.:.,_.f , ` l, A Z t L §>. — v=».i ` · ·;·`i A Y ` T .·i. I . · . f R I A I . ; . L i·ti T ` CHC Advisory Committee members pause for a brief chat after a meeting. Left to right: Georgia Ledford, Glenna Davis, joe Davis, Al Marcum and Carter Couch. FNS SCHOOL GRADUATES 93rd CLASS The Frontier School of Midwifery and Family Nursing, which for 43 years has held a unique and prestigious position of leader- ship in nursing education, graduated its most recent class — its 93rd — in ceremonies held at Wendover on April 30th. Eleven nurses received diplomas, bringing to 608 the number of nurses ,. who have graduated from the Frontier School since its estab- K lishment in 1939. One graduate was awarded the school’s diploma in family _ ,_ nursing; ten received diplomas in family nurse-midwifery. At the time of enrollment, all eleven were already qualified as registered nurses. They came to FSMFN for the intensive special program that, as the school describes it, "is designed to prepare registered nurses to function as family nurse practitioners or family nurse- midwives in primary care agencies, with emphasis on rural health." The family nurse program requires 12 months of study and clinical work; the family nurse-midwifery program requires an additional four months. The ceremonies began with an invocation by Sister Joan Gripshover, one of the graduates, after which Mildred Minix, of the graduating class, introduced the faculty and students. Sister Valerie Chaplain, District Coordinator for FNS, and Nina Sowiski, FSMFN instructor, followed with remarks of greeting and con- gratulations. Dean Ruth Coates Beeman then presented the diplomas. A Diploma in Family Nursing was awarded to: Sr. Joan Gripshover, of Erlanger, Kentucky, who came to FSMFN with a Diploma in Nursing from Good Samaritan »_ Hospital, Cincinnati, and a Bachelor’s Degree in Elected V Studies from Thomas Moore College, Covington, Ken- j tucky. Sister Joan plans to practice family nursing in a Q rural area. _ Diplomas in Family Nurse-Midwifery were awarded to: Ann M. Davis - Garvin, who was born in Denver, Colorado but is most recently from Albion, Michigan. Ann received QUARTERLY BULLETIN 9 5·;*i»*.;%§7 <é~L p "`V F el, I : ’ c' els ·· il l. f?i··=·‘** . ·- kr l . —. `i L . , ~ I ,v ,·»j = _] .;* 1 g ,; {I YY? T één gv q V. . _ v Y fi `”€>¤ Dean Ruth Beeman presents diploma to Michele Heymann as other class members await their turns. her BSN from the University of Colorado in 1970 and her MS in Parent—Child Nursing from the University of Michi- gan in 1980. Ann is considering looking for an internship and then returning to Michigan, where she hopes either to work in a midwifery service or to practice with a physician. Anita Goldman, of New York City, who attended Misericor- dia School of Nursing and received her BS in Health Admi- nistration from the State University of New York in 1976. Anita says, "In July after boards I plan to join my hus- band, an OB/ GYN, in a joint practice in Georgetown, Ken- tucky." Jo Ellen Hager, of Spokane, Washington, who received her BSN from Southeastern Louisiana University in 1972 and her MS in Perinatal Nursing from Houston Baptist Univer- * sity in 1982. Jo Ellen says she is looking forward to teach- l ing maternity care to undergraduate nursing students, and · next year she would like to begin a midwifery practice. Michele Heymann, from Stillwater, Oklahoma, who re- ceived an AA in Nursing from Riverside City College in t January 1976 and a diploma in family nursing from FSMFN in 1982 (she returned this year for the trimester in family nurse-midwifery). Asked about her plans for the future, Michele said "I am currently investigating several pos- 10 FR0N·r1ER NURSING Smzvics sibilities in family nurse—midwifery, including an intern- ship." She will also continue to work for her BSN through the New York State Regents External Degree Program. Susan Howie, of Salmon, Idaho, who obtained her ADN from the College of Southern Idaho in 1974 and has done further work toward a BSN in the New York State Regents » External Degree Program. Susan’s plans include, "return- ing to my rural town and setting up a combined nurse-mid- wifery/ family nursing practitioner practice, specializing in i the ‘entire’ family and home deliveries, working in col- laboration with the one hospital and 5 MD’s in town." Roberta Spaller Kline, of Safford, Arizona, who received an p AS from Miami Dade Junior College in 1970 and an AAS from Eastern Arizona College in 1978. Roberta plans to return to a night supervisory position. She is looking for- I ward to an internship or possibly to opening an alternative birth center with a local physician. Mildred P. Minix, from Salyersville, Kentucky, who grad- uated from Prestonsburg Community College in 1975 and has an AD. Mildred says, "I am returning to Big Sandy Health Care, Magofiin Clinic, Salyersville, Ky. to practice as a family nurse midwife." Leonette Orr, of Redlands, California, who received her AA , in Nursing from San Bernadino Valley College in 1963. P Leonette plans to return to California and is hoping to stay in the San Bernadino/ Riverside/ Redlands area because p she is getting married in July. { Naomi Page, from Nashville, Tennessee, who obtained her ‘ diploma in nursing from Mid State Baptist Hospital (Nash- , ville) in 1964 and her BS from Belmont College in 1968. Naomi said, "l plan to return to Nashville after graduation. I will be working at Baptist Hospital in Nashville." _ Stephanie Schultz, of Moline, Illinois, who received her diploma from Lutheran Hospital School for Nurses, Moline, » QUARTERLY Bux.1.1mN 11 in 1969 and from 1976 to 1981 was instructor and instructor coordinator for the Childbirth Education Association of Northwestern Illinois. Stephanie said of her goals, "I plan to return to Moline and hope to find a physician in the area to work with, doing antepartal, intrapartal and postpar- tal care and well woman gynecology. Because my children _ are still young, I may not work full time for a few years. I ,» also hope to begin working on my BSN on a part-time basis." ., After presenting the diplomas, Dean Beeman announced that scholarship awards were to be given to the graduating class. Two of the scholarships were for the highest combined clinical and academic grades. The first-place grant in this category was awarded to Stephanie Schultz, while the second-place award was given to Anita Goldman. A second category honored graduates who had shown the greatest improvement in combined clinical and academic grades in the final trimester of the course. The first-and second-place awards in this category went to Ann Davis-Garvin and Susan Howie, respectively. The presentations were attended by about 100 guests, who came from all parts of the country to be with the graduates. Before the presentations, brunch was served at the Big House. The Frontier School was founded in 1939 by Mary Breckin- ridge, when World War II made it impossible to continue to recruit trained nurse-midwives from Great Britain or to send American nurses to England for training. The family nursing program was - added in 1970. The combination of these two programs consti- A tuted a new and important development in nursing education. In _ the words of FSMFN, "The joining of the long-established nurse- midwifery program with the new family nurse practitioner pro- * gram created a unique health care professional — the family · nurse-midwife .... Although other programs may have both _ family nursing and nurse-midwifery in the same school, they are Y not built one upon the other and do not allow nurses to focus on both specialties. The School is also unique in that it is located in a rural area and most of the clinical experiences are in primary care facilities. Other programs may offer some experience in rural areas and/ or primary care centers; but few, if any, are perman- . ently based in both." 12 Faowmzn NURSING Smnviciz · ‘AA· =‘» ‘ A A.%_,‘L g. v; » A T2 _ V Y BRING HEALTH CARE _ _ gal; j TO PUBLIC soHooLs H ” ’ ` L v' . (K L \ ` V Y , * A H, · HVH’ ` ig H,H,H “ H r r... ;, ’° ‘V Y At left, FNS student nurse Debra Buchanan examines an eighth - grade public school . __ student A thirteen-year old girl, holding a book in front of her right eye, struggles to read the letters on an eye chart. Gently, the nurse stops her and tells her that her vision is 20/40 — and then she goes on to explain what that means. The nurse adds that in a few years the girl will surely want to apply for a driver’s license. She will need to pass the eye exam, so why not see an eye doctor now? The youngster, reassured by the nurse’s friendly manner, readily agrees to take the nurse’s written recommendation to her parents. The exchange is familiar enough, but the way it has come about is a bit out ofthe ordinary. The scene is the gymnasium ofa public school, but it is not a public school nurse who is conducting the examination. Instead, it is one of the students from the Front- T ier School of Midwifery and Family Nursing, who is getting clini- ` cal training in the schools of Leslie County. The fact that they are "students," of course, does not mean that they are inexperienced. V _ They are all registered nurses with several years of practical V L experience. They are, however, learning from these contacts with ' adolescents some of the practical aspects of dealing with health L problems in a rural community. A This screening program ended its third year this April, and for L the third year in succession, it has been applauded by students, QUARTERLY Burnmm is school officials, and the FNS students and instructors. Because of its success, it is expected to continue into the future. The program was started to meet a combination of needs. For several years, the Leslie County school system and the Frontier Nursing Service had discussed ways of using FNS family nurse practitioner students in the school health program, but it was not until January of 1981 that a satisfactory program was worked . out. The present program was formally adopted at a meeting on -2 January 13th of that year, which was attended by faculty of the Frontier School of Midwifery and Family Nursing and several i members of the Leslie County Board of Education. Chief spokes- _ man for Leslie County was Coach Floyd Hines, who took on the . main burden of getting the program implemented in the schools, and has carried it on effectively ever since. Kentucky state law requires that every student who enters the school system get a physical examination. However, when stu- dents come in at an early age, there may be a long interval `- between the first and subsequent check—ups. School authorities wanted FNS to give screening examinations to detect problems that could have arisen in those long intervals. At the same time, FNS felt that it needed a new way to give practical clinical expe- rience to the students in the family nursing program. Thus, the proposed plan seemed a logical solution to two significant prob- lems. Much, however, depended on just how the program was carried out. One of the first considerations was to select the right age group. Eventually, it was agreed that the students in the eighth grade would make ideal subjects. In the first place, these students had gone a rather long time without check-ups. Moreover, this is an age group that is undergoing many changes, both physical {_ and psychosocial. It is a time of onsetting puberty, of rapid physi- cal growth, and of many questions that agonize teen-agers as they begin to realize that they are going to be adults. , ,2 Another consideration was social and psychological. The , eighth grade is the top grade in the Leslie County elementary , school system. Arlene Day, the FNS family nurse instructor who L coordinated the program this year, gave some of the reasons she { felt it was "the perfect group" for screening: As the senior grade in * their schools, eighth graders have a certain social status. If there V were a higher grade in the same school, they might have to take 14 Fnourisa Nuasmo Srzavics some kidding from upperclassmen — for young minds can easily imagine there is a stigma in being picked out for screening. But _ not only did they escape that problem, they ended up setting an 7 example to the lower grades that made the younger students readier to be screened when their time came. Arlene, who as a native of Leslie County is intimately familiar with its customs and points of view, is quite certain that if the examinations were . deferred until the following year, when all the students would be A high school freshman, they would be much less successful. l. The examination procedure itself sets no earth-shaking prece- ° dents. It consists of standard checks of eyes, ears, nose, throat, teeth, blood pressure and pulse, thyroid, spinal development, A heart, and lungs, and standard measurements of height and weight. However, the examination leads naturally, in most cases, to counseling sessions that the eighth-graders seem particularly to appreciate. When they come in for their exams, they bring a questionnaire on their health that they have completed before- hand. (No examination is given, incidentally, without parental . approval.) The first step in the examination is a shorter question- naire, in which the students are asked such questions as, "Are you satisfied with they way you are growing?" or "Are you satisfied _ with your weight?" or "Are you trying to lose weight?" (These are T in addition to more specific questions about allergies, diet, dental care, and so on.) As it turns out, the eighth-graders are very much concerned with some of these questions. Also, they are concerned with the last item on the questionnaire, which asks if they wish to discuss such matters as emotions, getting along with friends, smoking, - work, school, and how to cope with worries. Their answers to these questions often lead to friendly and relaxed discussions with the nurse. Arlene Day says that the students keep asking if they are "OK" —— if their health, their height and weight, their V. rate of growth are normal. The nurses soon realized that these ; teen-agers are unexpectedly well-info