xt7np55dd567 https://exploreuk.uky.edu/dips/xt7np55dd567/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. 3, Winter 1983 text Frontier Nursing Service Quarterly Bulletin, Vol. 58, No. 3, Winter 1983 1983 2014 true xt7np55dd567 section xt7np55dd567 ‘}NUEl~c
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 US ISSN 0016-2116 ;
4 lll
coNTEN·rs ¤°
"Dr. Anne" Retires 2 ; Q,
Ruth Beeman is New Dean of FNS School 5
Beyond the Mountains 7 l
Alumna Awarded Honorary Doctorate 7 }
New Class Enters FNS Nursing School 9 l
The "Baby Blues" — A Cultural Phenomenon? _
by Laurence Kruckman, Ph.D. 10 2
News of Former FNS Staff 16
Photo Pages 17 and 2() ,
Miss Margaret Gage, 1895-1982 18 i
Faye Farmer to Lead Community Group 21
In Brief 21
In Memoriam 22
An FNS Homecoming: Bernadette Hart 23
Courier News 24
Memorial Gifts 26
Field Notes 26
Alumni News 28
Urgent Needs Inside Back Cover
Staff Opportunities Inside Back Cover
FRONT COVER Upper Left: Dr. Anne Wasson, who is retiring from
FNS, and David Hatfield, Director of FNS. Upper Right: Ruth Coates
Beeman, new Dean of FSMFN. Lower Left: Dr. Laurence Kruckman,
author of The Baby Blues- A Cultural Phenomenon? Lower Right:
Bernadette Hart, formerly of FNS, with Robert Beeman, Managing
Editor of the Quarterly Bulletin.
US ISSN 0016-2116
Published at the end of each quarter by the Frontier Nursing Service, Inc. ,
Wendover, Kentucky 41775   L
Subscription Price $5.00 a Year S` l`
Editor’s Office, Wendover, Kentucky 41775
Secondclass postage paid at Wendover, Ky. 41775 and at additional mailing offices
Send Form 3579 to Frontier Nursing Service, Wendover, Ky. 41775
Copyright 1983, Frontier Nursing Service, Inc. {
2. l

, a wss,
e¤=C?r/ .
[ .4 A Word ‘   R
R of Introduction     JR   
9 ;         Lj 5;;;,
I ‘ ;€“'-·            
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    The proper place for a managing editor is at the editorial desk, not on
{ the pages of his magazine. However, custom requires exceptions at
{ certain times. One such time is the occasion of his arrival on the scene,
» and that is why I venture to make a brief appearance on this page.
E Readers may or may not be interested in my credentials, but they at least
  have the right to know who should be yelled at or (one might hope)
i granted an occasional smile of approval as they turn the pages of future
The credentials may be disposed of simply. I have a B.A. in English
Literature from Yale. I have spent much of my career in and around
publishing. A few years back I took early retirement from IBM after 17
years of writing and management in the area of programming documen-
T My decision to come out of retirement and take on the managing
editorship of the Quarterly Bulletin was a response to two unexpected
i events. The first was the offer to my wife to become the dean of the
Frontier School of Midwifery and Family Nursing. The second was a visit
to Hyden last September, which revived in me an old conviction that
there remain in this world a few good causes that deserve one’s best
efforts and most ardent concern.
It is this concern that I wish to speak about here. The Frontier Nursing
~ Service has from its first days had a splendid record of dedication and
creative leadership in the field of health care. In a world now much
E different from that into which it was born, FNS is actively concerned with
its commitments, and with discovering how, in this last part of the
i s twentieth century, it should respond to the changing needs of the
  community and, in fact, of the nation and the world.
é The Bulletin, as the voice of FNS, needs in its turn to respond to,
I " support, and communicate what FNS is doing in these changing times.
  Like FNS itself, it must reflect change and participate in it.
{ If I can make a constructive contribution to that cause, I will be
  , grateful for having been given the opportunity, for I believe it is an
' important cause.
f -—R0bert Beeman
I .
l i

 2 Faoimsn Nuizsmc. smzvics A
Dr. Anne Wasson, who has done many fine things for FNS in  
the course of her career, has now done the one thing her many
friends hoped fervently, if unrealistically, that she would never i
do — she has announced her retirement. It is as if we were losing {_
not one, but several, dear colleagues and friends, for Dr. Anne has K
been carrying more jobs and more resposibilities, and meant V
more things to more people, than it is reasonable to ask of any one
person. ,
From 1970 until mid-1977, "Dr. Anne" was Chief of Clinical A
Services for FNS and also Medical Education Coordinator and i
Instructor for the Frontier School of Midwifery and Family
Nursing, as well as a practicing physician. In 1977, she was i
named Chief of Special Services, a position that expanded her i
responsibilities. In- 1981, she was called on to help FNS through a _
critical period of transition. In the absence of an FNS Director, she
took on the duties of Interim Director of FNS and Administrator of
the Mary Breckinridge Hospital. In August of 1981, when the '
Frontier School of Midwifery and Family Nursing found itself
without a dean, Dr. Anne took on the additional duties of acting
dean. In spite of this heavy load, Dr. Anne was always available `
to all who needed her to give guidance and help. L-
Fortunately for Dr. Anne, this load eventually was lightened. . »
David Hatfield was appointed Director last year, and Ruth
Beeman came to Hyden this January as Dean of FSMFN. With t
these two key positions filled, Dr. Anne felt she could take the rest ,
she had earned. Typically, although her retirement became I
official as Dean Beeman arrived, Dr. Anne volunteered her .
services through April to help in the period of transition. I.
Few persons in the history of FNS have been as widely loved  
and as deeply admired as Dr. Anne. (This accounts for the impos-   ,
sibility of writing a dispassionate, matter-of-fact announcement ,
of her retirement.) This regard has been expressed repeatedly in
many ways by both professional colleagues and personal friends. t
The American Medical Association last year gave Dr. Anne its ‘ y
"Physician ofthe Year" award for the third time. At the end of the i 
year she was made a Kentucky Colonel — an honor not easily  
come by. Numerous friends of FNS have written to express the f
hope that she could be persuaded not to retire. 2

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Photo courtesy uf Thuusandsticks News  

, A new class of ten nurses entered the Frontier School of
i‘ Midwifery and Family Nursing on January 3. All ten are
· registered nurses with at least three years of experience. One has
; worked on an Indian reservation, another in Lesotho, and a third
l in Sierra Leone. Most have said they wish to work in rural
_ communities after completing their studies at FNS.
‘ The first three trimesters, which end next December, prepare
students for work as family nurse practitioners. Most of the class
will remain for the fourth trimester, which will qualify them as
' family nurse-midwives. That program will end in April of next
year. Staff members have said that the new students appear
R exceptionally well prepared and highly motivated to do the
demanding work that FSMFN requires in this program.
The new class is pictured on Standing from top to bottom:
the opposite page together
with its mstructors. DEIRDRE POE RN MSN
CFNP, CNM, ’ ’ ’
_ . Family Nurse Education
Seated, from top to bottom. Coordinator, FSMFN,
BSN, CFNP, CNM, Catlettsburg, Ky., ADN, Morehead
A Family Nurse Instructor, FSMFN State University, 1978,
Q Wynona (Nonie) Grover, RN,
_ Lamar, Colo., BS (Nursing),
D€b1’8 Pl¤}m, RN, _ _ Evangel College, 1977.
Waupum W1Sc" Diploma m NurSmg’ Marlaine (Lainie) Epstein, RN,
" Mercy M€d1cal.C€m€r’ Charlottesville, Va., ADN, Santa Fe
School of N¤m¤g· 1977 Community College, 1976.
Debra Buchanan, RN,
~ Elizabeth (Beth) Newton, RN, grew A$g¤¤;·g’I¤¤*-» @3%
Huntington, W.Va., BSN, Case Bglliriily 0 1 regom ’
{ Western Reserve University, 1974,BS P rg, nd gp? ogy): .t 1975
‘ (Biology), Wheaton College, 1972. 0 an 3 B mversl y’ '
‘ Andrea (Taffy) Aldrovandi, RN,
Cataumet, Mass., MSN, Boston
_ Judy Hoath, RN, College, 1982, BSN, Boston College,
Z ‘ Zillah, Wash., ADN, Kellogg 1975.
· Cemmumtv C¤¤<¤g¢» 1975- wimem (Bill) Auaeeee, RN,
» Originally from Louisville, now from
[ San Francisco; BA, Golden Gate Un-
 ` Linda Jacobsen. RN, iversity, 1971; MBA, San Jose State
i Olympia, Wash-. BSN, U¤iV€1`Sity of University, 1974; ADN, Santa Rosa
  Washington, School of Nursing, 1977. Junior College, 1977,

 10 FRoN*1·1sR NURSING ssnvics
A Preliminary Report ,
by Laurence Kruckman, Ph.D. l
This interesting study suggests that "baby blues" (i.e., "postpartum I
blues") is a phenomenon unique to western culture, and that it may be ,°
related to cultural factors peculiar to the "civilized" world. The study __
reports that postpartum depression seems to occur much less frequently _
in "traditional" societies.
This article, which was written especially for the Quarterly Bulletin,  ,
reflects the findings of a study part of which was conducted in the FNS
area. The study was funded in part by an Appalachian Studies
Fellowship, the Appalachia Research Center, and Berea College, Berea, _
Kentucky. Dr. Kruckman has asked that the Bulletin give his special
thanks to the Frontier Nursing Service and the staff at Mary ‘
Breckinridge Hospital and the district clinics, in particular, Dr. Anne
Wasson, Dr. Peter Morris, David and Sharon Hatfield, Susan Baker,
J oEl1en Hagger, Danna Larson, Margaret Duggan, Susan Hull, Laura A
Pilotto, Laurel Evans, Abby Porter, Carol Sparer, and the mothers who °
participated in the study.
One difficulty encountered by many mothers after childbirth is i
the occurrence of postpartum depression. However, the nature of
this problem — as a disease and as an illness - remains unclear.  i
Even the term “p0stpartum depression" has been applied rather  
imprecisely to include both mild, transient forms of depression  l
which are quite common in the first postpartum days, as well as `
the more severe psychotic reactions which are quite rare. ,
By reading women’s magazines and listening to "folk talk" of I  
new mothers concerning childbirth, it is clear that there is great Q
interest in the "baby blues," or "postpartum blues." Still, the  
medical and psychiatric literature reflects a preoccupation with A
more severe postpartum psychosis. Psychological research has  `
looked at psychosocial factors such as the number and spacing of I
children, age, marital relationship, and psychiatric history for .
causes. These studies have tended to focus on personality ·
problems as measured through tests identifying "depression,"
"anxiety," "tender-mindedness," etc. Few studies have actually I ¤
observed behavior, or interpreted the results of psychological T
tests, in the context of the wider social system of the family or  
community. Much of the data has been_ gathered in the hospital  .
prior to release, and as a result we know very little about . 
postpartum reactions outside institutions. .

i   " ···
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g The author, Dr. Laurence Kruckmannat his desk
  Although hormonal research has identified potential links
with depression, especially estrogen, progesterone, cor-
ticosteroids, and cyclic AMP, much of this research has been
problematic. For example, various daily hormonal changes and
rhythms occur in late pregnancy, and there are individual
i differences in hormonal levels, making research difficult. Finally,
l normal levels have not been established, nor do we know much
about the ability of individuals to adapt to hormonal changes.
Again, the primary focus of much physiological research has been
on women with psychotic reactions; the women studied tend to be
institutionalized and the numbers of those studied small. While
most researchers agree that hormonal studies have not produced
a direct link to postpartum depression, treatment has generally
F involved pharmacological intervention based on hormonal
i therapy and psychotrophic drugs.
I · The perinatal period — conception through childbirth and the
g postpartum period — is structured differently in various societies
E in terms of social content. Perinatal events are not merely
k · physiological sequences, but a "biosocial" phenomenon in which
both the behavior and feelings of the woman, as well as those
l around her, are differently patterned, emphasized, and marked
» with ritual. Since psychological stimuli affect the neuroendocrine
` systems, hormonal research should be carried out in connection
with psychosocial research. It usually isn’t.

 12 FRONTIER Nuizsmc- smwrcs H
Interestingly, a review of the anthropological or cross-cultural
literature reveals surprisingly little evidence of postpartum
depression in traditional or non-western settings. Even in third-  
generation Chicanos in urban centers such as Chicago, ap- °
proximately 60% of new mothers still practice "La Cuarantena," a ·
structured postpartum ritual involving dietary constraints, man- M
dated rest, and ceremonies honoring primarily the mother. By H .
comparison, we have no formal structure of the postpartum period .
in the United States once the mother has returned home. There is a
popular, informal, "folk" notion in the U.S. that this period is
emotionally draining, stressful, and fatiguing. Between 60% and
80% of U.S. mothers express this experience in terms of the "baby
blues"; and 3% to 20% experience "moderate depressive dis-
Descriptions of postpartum activities in traditional societies
suggest that there may be activities that provide the necessary ,
support and which cushion or prevent the experience of depres-
sion, whether its cause is biological, psychological, or social. A ‘
careful reading of ethnographic studies has identified six
somewhat universal patterns in non-western societies: T
1. There is a cultural patterning of a distinct postpartum time .
period. For example, a 40-day postpartum is common in Spain,
Latin America, and the Caribbean, as well as among Moslems. _
2. There are measures designed to reflect the vulnerability of the i
new mother. Among the Subanum in the Philippines, the `
seven-day period after birth is referred to as the "tandeg," ‘
where the mother is spiritually and physically at risk and
follows a special, proctective routine. j
3. Social seclusion is required. In rural Jamaica, women are
"ritually secluded" for nine days. `
4. There is mandated rest. I
5. There is assistance in child-rearing and everyday tasks from ,
relatives or midwives.
6. There is social recognition of new status through rituals, gifts, 4
or other means. However, in the United States, changes in our »
"management" of childbirth have resulted in a definition of the ’
perinatal period which, compared to traditional settings, often V
excludes any notion of a postpartum period after hospitaliza-
tion. Hospitals formerly required a week’s stay — this is A

currently shortened to about three days. We do not talk in terms
of "La Cuarantena" (roughly translated as "the quarantine"),
  or the 30-day postpartum period of Asia (translated as "doing
° the month"). In the west, we at times fail to provide necessary
· social support and assistance and, for many, we provide no
{ \ - social recognition of the change in a woman’s status.
A . Our hypothesis is that most depression and "baby blues" in the
U.S. result from the relative lack of :
1. Social structuring of the postpartum events.
2. Social recognition of a role change for the new mother, and
3. Meaningful emotional or physical assistance.
Conversely, cultural activities and events that are focused on
. the mother, explicit recognition of new social status, assistance in
coming to grips with former role expectations, and caring for the
newborn may serve to mask or prevent the experience of negative
` emotional reactions to childbirth (Note 1).
Despite the national concern with events occurring in the
postpartum period, such as child abuse and neglect, failure-to-
( thrive, and sudden·infant-death syndrome, there is little research
4 on how people organize and experience their lives in this critical
i period. We know very little about what occurs after new mothers
return from giving birth in the hospital.
L In an attempt to learn more about the postpartum period, 30
1 women were interviewed between June and October 1982 in Leslie
County, Kentucky. This sample represents 12% of the total births
by county residents (Note 2). Eastern Kentucky was selected as a
study site for a variety of reasons:
1. The family support networks are unique in their structure and
provide a contrast to other urban and rural U.S. locations (Note
, 2. The county is served by a primary health care system and has a
long history of midwifery service (approximately 70% of all
births are attended by a midwife (Note 4)).
‘ 3. The population is relatively stable, thus removing many of the
2 variables linked to mobility.
Both qualitative and quantitative methodology were utilized.
V A 54-item questionnaire was constructed and used as a basis for
g an open-ended interview that ranged from 40 minutes to 1-1%
hours. New mothers were asked to participate in the study when

they returned to the clinics for well-baby checks. Less than 2% Q
refused the invitation. Arrangements were made for interviews
which took place both at the clinic and in the home during the ._