xt7p2n4zj19f https://exploreuk.uky.edu/dips/xt7p2n4zj19f/data/mets.xml The Frontier Nursing Service, Inc. 1979 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. 3, Winter 1979 text Frontier Nursing Service Quarterly Bulletin, Vol. 54, No. 3, Winter 1979 1979 2014 true xt7p2n4zj19f section xt7p2n4zj19f FRONTIER NURSING SERVICE
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joint Practice

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Published at the end of Gfichdquarteigiyy tl? Frontier Nursing Service, Inc. ; `
0 , tu 41775
Subsdlriptligtn Psirde 5:2.560 a Year  
Editor’s Office, Wendover, Kentucky 41775  Y‘
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Send Form 3579 to Frontier Nursing Service, Wendover, Ky. 41775  
Copyright 1979, Frontier Nursing Service, Inc.  {
A !

  A Moment of Heroism 37
I At Wendover it Blooms 32
E, _ in the Spring, Tra-La . . .
I Charlie is My Big Brother Marcia McDonald 27
I I Field Notes 40
l   Hippocrates Revisited Sandford A. Franzblau, M D. 20
Ii Joint Practice at Holly Powell 3
Frontier Nursing Service and Jan Tobey
` KHA Supervisory I)evelopment Course 10
  Liberian Investigation 33
  Mary Breckinridge Hospital Auxiliary 28
  Meadow Lady Amy H. Stewart 19
  Old Courier News 15
  Old Staff News 23
  Once Over Lightly W. B. R. Beasley, M. D. 2
I Our Mail Bag 30
Q;. Overseas Internship Karen Slabaugh 11
I `i_i I The Big House at Wendover Inside
I ~  Back Cover
  The FNS Tour Mrs. C. Wayne Elsea 13
Im  The Ghost of Joy House Joy Lee Peterle 22
* , White Elephant 39

We regrettably have delayed the publication date ofthe Winter  
Quarterly Bulletin and for this reason the two issues, Winter and _;_
Spring, are included in one mailing. The special issue with *
vignettes of various county activities have made up the Spring _
issue. , ,
Once a month our staff has Grand Rounds at which a
significant medical or nursing activity or problem is presented for _
discussion. The article on Joint Practice at Frontier Nursing
Service was the basis of one of these sessions. There are two
articles relating to African activities: one on the Overseas
Internship of some of our midwives in Africa, and a second ”
describing the response to a request from the Minister of Health in Y
Liberia. il
The activities of two groups of special friends are reported: The T
National Council of the Daughters of Colonial Wars who honored  
us with a three-day visit, and the Mary Breckinridge Hospital  
Auxiliary which has been especially busy in its assistance  
program. E s
This, the Winter issue, includes our regular columns of Old M
Staff News, Courier News and Field Notes. . ·
'icgus B5 as (Ul
W. B. R. Beasley, M. D.  
l- ‘
r i

  By Holly Powell, FNP and Jan 'Tobey, PNA
ly On April 20, 1979, the monthly Grand Rounds of the Mary
  Breckinridge Hospital was presented by Jan Tobey and Holly
Q Powell on "Joint Practice". The objectives of the Grand Rounds
E were: 1) to define Joint Practice according to the National Joint
`i ` Practice Commission: 2) to provoke some serious thought regar-
ding this concept by the staff of FNS as they strive to deliver
é ‘ quality health care; and 3) to stimulate the development of a
clearer definition of the roles of the health care providers at FNS.
~ The following is the context of the Grand Rounds on Joint
i Practice.
We feel that there is much talk about Joint Practice and the
‘ _ collegial role of the nurse and the physician. However, underlying
  ° all the talk, we feel that there is not a good understanding of what
  actually constitutes joint practice. There is a level of frustration in
A the practice of family nursing which is caused, in part, by the ill
g I defined roles of the physicians and nurses. Subsequently,
  sometimes the care given is not always of the highest quality
  attainable. Since we are educating Family Nurse Practitioners at
¥ ¥ this institution it is important that both the staff family nurse
  j practitioners and the staff physicians understand their roles and
é , their overlapping areas. Therefore, we would like to present to you,
  i through this Grand Rounds, what we feel constitutes Joint
  J Practice. We will discuss, the role of the physician, the role of the
l nurse, and how these roles relate to each other in a joint practice
setting, be it a primary or acute care setting. Following this we will
_ give you our recommendations for implementing joint practice at
Q It is imperative to understand the role of the physician and the
` role of the nurse in order to understand joint practice. The role of
, I the physician has been from time immemorial that of diagnosing
_ , and treating of illnesses} This role has never been questioned and
  physicians have traditionally been disease oriented.
_ ° However, the role ofthe nurse has been evolving over the years.
» The following is an exaggerated and oversimplified version ofthe
  historical sequence of that role evolution. (The exaggeration and
  oversimplification is intentional and is only used to stress the

 4 Fnomim NURSING smzviom I;
point.) Until World War II the nurses major role was to assist the  ;
physician in his diagnosis and treatment.? Nurses were generally  l
graduates of three year schools of nursing that were associated  i
with hospitals. They were competent in carrying out medical j
techniques and medical orders such as giving injections and ‘
changing dressings. They were viewed as "good nurses" by °
physicians if they carried their bandage scissors with them at all f
times and stood when the physician approached the desk. In
essence their role was that of the physician’s handmaiden. It was if
characterized by the three "S’s; subservience, submission, and Q.
self sacrifice.3  
After World War II the role continued to emphasize assisting "
the physician in his diagnoses and treatment but there was a .
murmur of change going on within the profession. Nurses were i
encouraged to be prepared at the baccalaureate level. The role
shifted to managing and coordinating patient care through the L,
use of non nursing personnel. Unfortunately, personal contact  
with the patient was abdicated and delegated to non professional i= 
staff. The nurses’ time became consumed with paperwork and red f
tape.4 Nurses were viewed as "good nurses" if they managed to  ~,
keep all hospital departments happy by properly completing the  
necessary and appropriate forms. In a sense, nurses now nursed  
the desk.5 Eventually, nurses became very frustrated with this  
role and rightfully so.  
Today the nursing role has dramatically shifted from assisting  
the physician to assisting the patient. Their role involves  ,
preventive health care screening, planning, counseling and  
education, the management of minor illnesses and the monitoring  g
of chronic disease states.6 Nurses have now become an extension ‘
of the patient, not an extension of the physician.  
The goal of nursing is to maintain and to improve the patient’s  
health state and is achieved through comprehensive and con-  
tinuous care whereas the physician’s goal is achieved through Q"
intermittent, episodic care. Nurses and physicians may have a V
similar knowledge base but that knowledge is used toward their _ I j
. specific goals; the goal of the physicial being more disease- iv  
oriented, the goal of the nurse being more health-oriented.  
Now that we have a clearer understanding of physician and  I
nurse roles we will discuss how they relate to each other in joint  ,
practice in a primary and acute care setting.  

; Joint Practice is generally defined by the National Joint
j Practice Commission as "nurses and physicians collaborating as
 " colleagues to provide patient care".7 Joint Practice in Primary
 . Care has the following characteristics:
 V 1) An initial and continuing relationship between patients in
A need of care and the providers of the care.
i 2) Continuity of care for patient populations of all ages and in
W all states of health and illness.
~ 3) Responsibility by the providers for a continuum of com-
1 prehensive care which includes maintenance and promo-
  tion of health, evaluation and management of disease,
{ restoration of health and coordination of all necessary
services and agencies.
Z 4) Accessibility, which is defined as attainable services that
are continuously available.
E 5) Acceptability to patients.
  The guidelines for Joint Practice in Primary Care are:
 . 1) The scope of practice ofthe nurse and the physician should
f be jointly determined to their mutual satisfaction. Their
 g practice should remain flexible and should be reviewed and
{ changed as necessary.
  2) The performance of tasks by nurses that are not commonly
  accepted nursing practice should be mutually agreed upon
  by the nurse and the physician.
  3) The delineation of tasks should be determined on the basis
 i of the practice situation, the capabilities of the nurse and
  the physician, and the needs of the patient.
 ¥ 4) The medical and nursing services of the joint practice must
i be available to all patients.
  5) The joint practice relationship should be explained to all
  6) The business relationship of the nurses and physicians
lv should be negotiated between them and stated in writing.
The goal of joint practice in an acute care setting as in any
._ _, setting is to improve the quality of health care provided to the
  patient. Joint practice in an acute care setting involves five
 i factors: 1) primary nursing; 2) nursing involvement in the
 ~ decision-making process of the hospital; 3) adequate communica-
 , tion on a formal and informal basis with physicians; 4) joint nurse
 ‘ and physician evaluation of patient care; and 5) a joint practice

 6 momrsn Nunsmo smzvrom
committee composed of physicians and nurses.8 V
The concept of primary nursing was developed in the late  `
l960’s and was initially instituted in a 23 bed medical unit at the ‘
University of Minnesota Hospital. Primary nursing is defined as
the performance of clinical nursing functions by the professional t
nurse, (not only the family nurse practitioner) with minimal or no  ·
delegation of nursing tasks to others.9 In primary nursing, the ¥
nurse has direct responsibility to the patient and family. The ,,,
nurse has a 24 hour accountability for a patient’s care throughout
his hospitalization. This is accomplished by consultation, coor— gh
dination, evaluation and direction of the patient’s care through a  
written plan of care. When a primary nurse is not there to ?
administer her written plan of care due to scheduling *
arrangements, an "associate nurse" carries out the initial plan of  
care. It is in this way that the primary nurse achieves 24 hour I
responsibility and accountability for a patient’s care.  
In hospitals where primary nursing has been instituted · 
patients are more satisfied because they feel they are receiving I
more personalized care. They have one nurse whom they can say  °
is my nurse. The nurse’s satisfaction also increases when  —
primary nursing is instituted. She feels that she is able to use her T
clinical judgment in providing quality care. Generally, °
physicians are more satisfied with the care their patients receive j
through primary care nursing. Adrninistratively, primary nur- it
sing has been proven to be cost effective.1° All parties involved P 
know, with primary nursing, who is responsible for the care the  —
patient receives. _ 
The second requirement for joint practice in an acute care  
setting is nursing involvement in the decision-making process of  
the hospital. Until recently, nurses have had very little input into  
the organizational management of hospitals. Physicians have * 
traditionally had input into decisions and it is nurses who have  
had to bear the burden of these decisions on a day-to-day basis. I
For example, if administration decides to build a new hospital, I
physicians will be consulted regarding the floor plan, whereas ~» z
nurses will not be consulted and yet they will be the ones who will i _—'i
utilize that floor plan 24 hours a day, seven days a week. Since V: 
nurses now have a responsibility to the patients to provide quality Y
care, they must have a voice in hospital management in so far as it  
concerns the patient. Physicians and nurses now should have an {· 

equal status in the organizational stratum of a hospital.
A Thirdly, there needs to be adequate communication for joint
T practice in an acute care setting. Adequate communication
V consists of the Problem-Oriented Medical Record and a joint
process of consultation and patient care conferences. An informal
( communication system is necessary for nurses and physicians
s continuously to integrate a patient’s care and is based on trust
0, and acceptance of each others specific clinical competence and
L. Fourthly, for joint practice in an acute care setting, evaluation
  of care provided to the patient must be done jointly between nurses
and physicians. This is accomplished through joint care con-
f ferences, joint peer review and joint continuing education.
  Fifthly, a Joint Practice Committee which equally represents
  nurses and physicians must be established. The Joint Practice
 ¥ Committee’s function is continuously to define the scope of
  medical and nursing practice within the hospital.
.[ How is joint practice in a primary care setting achieved? Dr.
 ” Ingeborg Mauksch, a well known figure in nursing today and a
  member of the Governing Council of the American Academy of
  Nursing, sees a role for all nurses in the future that is similar to the
‘ role of nurse practitioners today. This role will make it possible for
~ nurses to participate professionally in joint practice.
  In order for nurses to be able to define their role and
 Y competence for practice in that role, they will have to demonstrate
  the following five behaviors.11
.  Autonomy, which comes from confidence in one’s action, is
  based on competence, research, experience and reasoning.
  Accountability must be second to autonomy. It is different
 · from responsibility where one is answerable to someone else, in
 il that nurses will initiate actions because of their decision and
l ‘ will be principally answerable to themselves and their
__ ( The third behavior, Risk Taking, is not one traditionally
» ~ demonstrated by nurses. Nurses must learn to demonstrate
 f this in wise and calculated ways which are directed toward
 ` patient advocacy.
  Nurses must learn to practice Self Direction in continual self
 ii growth, striving for competence, assertiveness and participa-

 8 Fnomim Nunsmo sraviciz
tion in public issues. ;
The fifth demonstrable behavior is that of the Patient’s  ¤
Interest which one would think would always be the heart of
health care, but which in actuality, sometimes becomes
shadowed in the fragmentation of care offered.  
Dachelet and Sullivan maintain that there is a certain
percentage of nurses who have been independent and  
autonomous in their practice in fields such as public health and *§·
midwifery.12 They have traditionally maintained a low profile in  
the health system, not overtly challenging medicine’s assumed  
dominance. The late l960’s brought the development of the nurse if
practitioner with the education of Pediatric Nurse Practitioners A
by Ford and Silver in Colorado. i
The nurse practitioner is educated to the ideal of professional
autonomy, yet leaves school to face the fact that this role is
fraught with ambiguity and misconceptions. As in most ._
situations, where traditional methods are threatened, strain  
develops between the two parties, in this case the physician and ‘
the nurse. The need for the defining of the basis for autonomy is A
paramount. The nurse practitioner’s quest for increased
autonomy is for the provision of another dimension of care to the I
patient. The nurse practitioners nursing functions will comple—  
ment the physician’s medical function in a collaborative effort. _
This "collaborative eff`ort" for the benefit of the patient is joint
practice. Following are some suggestions to assist nurses and “
physicians as they work toward this collaborative effort.
1) Individual states, through their licensure responsibility, .·
must determine the legal boundaries of professions. `
2) Physicians will need to recognize the functional autonomy .
of the nurse practitioner. The physician should maintain ?
responsibility for the patient’s medical care and the nurse
practitioner should assume responsibility for the patient’s l
health and nursing care, which is her unique area of i
expertise. This will require a collaborative effort of nurses A _,
and physicians sitting down together to define the respon- l
sibilities of these two roles in their own unique joint ¤
practice. ` ,
3) Administrators who control the social organization of work  
in the health care system must see to it that the , {
t I
· 2

 , organizational structure is flexible enough to accommodate
  experimentation with the more autonomous nurse prac-
_ titioner.
I 4) The public must become familiar with this new role so it, too,
  can determine its value.
5) Lastly, but probably most important, is the practice of
Q professional courtesy. Collaboration begins with the
ki premise of teamwork; therefore, the pitcher must unders-
, tand the catcher’s signals if they expect to win the game.
·g In order to establish a joint practice at Mary Breckinridge
LF Hospital, an acute care setting, 1) all staff members must be
, firmly committed to the concept of joint practice; 2) primary
i nursing must be initiated; and 3) nursing involvement in the
I decision-making process must be instituted. Joint communica-
tion, joint evaluation of care provided and a Joint Practice
I Committee have already been instituted at Mary Breckinridge
I Hospital. However, these need to be continually assessed and
" evaluated to insure that they function properly and not in name
I only.
V In summary, "Joint Practice can be achieved only by the
  practitioners involved. External events and statutes can facilitate
Y joint practice but do not guarantee it."13
` References:
J 1. Kenlein, M. Lucille. Independent Nursing Practice with Clients, J. B.
I Lippincott Co., 1977.
2. Ibid.
3. Ibid.
i 4. ibid.
' 5. Ibid.
`V 6. Thomas, Betty J. "Primary Care Delivery — Incorporating Joint Practice",
I Pediatric Nursing, May—June 1978, pg. 35.
7. National Joint Practice Commission Publication, 1977. NJPC statement on
' The Definition of Joint or Collaborative Practice in Primary Care.
_ 8. National Joint Practice Commission Publication, 1977. NJPC statement on
. The Definition of Joint or Collaborative Practice in Hospitals.
4* 9. Hospitals, Vol. 52, No. 14, July 16, 1978.
10. Ibid.
 I 11. Mauksch, Ingeborg. Context from presentation of “Cont&emporary Issues in
” Nursing Practice", University of Kentucky, March , 1979.
  12. Dachelet and Sullivan. "Autonomy In Practice", The Nurse Practitioner, 4:2,
: March-April 1979, pp. 15-22.
  i 13. Hospitals, Vol. 52, No. 14, July 16, 1978.
» I
. I

The Kentucky Hospital Association sponsored a cor- .
respondence course in Supervisory Development for department ,
heads in Kentucky hospitals to train them in different areas of
management and help them become more effective managers.  
The course lasted for a year and dealt with a different topic each Jn.
month, covering such areas as supervision, human relations, i§
communications, personnel management, managerial i
relationships, work simplification and management of change. 4
Fifteen Frontier Nursing Service department heads completed if
the course and will receive a Certificate of Achievement from the
Kentucky Hospital Association. They are:  
Ann Browning Peggy Hacker  
B11Si¤€SS Office S\1P€1`ViS01‘ Unit Manager, Primary Care Center I
Lillie M. Campbell Joe R. Lewis
Executive Housekeeper Chief Pharmacist
Mae Campbell Darrell M. Moore
Food Service Supervisor Personnel Director ·
Patricia Campbell Ruby Fay Moore  
Hospital Nursing Care Coordinato Medica] Records Assistant j
James L. Click Glenda S. Swartz
Physical Therapist X-Ray Technologist ~
Betty Helen Couch William C. Weaver _
Chief, Medical Records Manager, FNS Print Shop
Brenda L. Davidson Fred D. Wilson
Front Desk Supervisor Chief, Security ~
Gary A. Worley
Chief Laboratory Technologist
{ E
{ .
We are proud of these people for studying hard and completing
the course. We feel that these department heads will have a better , ’
understanding of management and can more effectively deal with L
the day to day challenges of their jobs.   l
Congratulations to everyone! ·

 Q QUARTERLY autumn 11
it By Karen Slabaugh
i The thrill of successfully completing an educational program
l is surpassed only by the realization that the education is useful to
Y one’s lifestyle. And that was the thrill of our five week midwifery
i internship in Lesotho, South Africa. We were working in a third
‘ i world environment, involved in maternal~child care; and we knew
1 what we were doing. We were competent professionals. I am
A thankful for my FNS education.
I have just completed the Family Nursing and Nurse-
A Midwifery program of study. I am preparing to leave the United
g i States by the end of April, 1979, for medical work in Nicaragua. I
! go with confidence in my professional skills because of the people
] Or FNS.
A This confidence was enhanced by the experience in a mission
hospital in Lesotho—by knowing what to do with 75 babies under
six months of age, accompanied to Well Child Clinic by their
mothers who wanted to know if their child were all right. I knew
that the weight of the child was a proven indicator of wellness. I
knew that I could examine the child and assure the mother of good
I health. I knew what vaccinations to give at what age. And most
thrillingly, I discovered that I could assess the infant’s age in
I months by his development even before the mother had the
V chance to tell me his age! (We had a very good course in Growth
E and Development!)
_ Prenatal clinics were always full and mostly they were routine
checks of healthy pregnant women. But we did discover twins at
eight and a half months gestation; we diagnosed a raging urinary
  tract infection and, upon referral to the physician, discovered that
i the treatment we had discussed was exactly what the doctor gave;
we taught the knee-chest exercise in an attempt to turn a breech
* presentation to a vertex; and improved our skills with clinical
, pelvimetry. We knew the priorities of ante—partal care because of
‘ A the instruction given us by Carolyn lVIiller and Susan Worley.
_ Delivering babies was the primary goal of this African
! internship. And because Lesotho is different from Hyden, Ken-
1 tucky, we had to adapt our practices. But the principles of care
. remained the same. And Cindy Kaufman, Molly Lee and Dr.

 rz Fnomiizn Nunsmo smwics
Gilbert had taught us well those principles. In our experiences y
with the normal vertex delivery, with repair of episiotomies, with  
problems of hemorrhage, twins, breeches and prematures, those i
principles proved successful. To be able to instruct the Lesotho
midwives how and when to use the Vacuum Extractor proved that
I had learned that skill. I
A one month old infant with cardiac failure caused me to long V 
for Dr. Gascoigne. Premature rupture of membranes with no labor  ; p
contractions made me wish for Dr. Imbleau to be present. And il
management of pre-eclampsia had us all trying to guess what Dr.  
Gilbert would do. Because in Lesotho, as in most developing  
countries today, medical doctors are in short supply, nurses are  
forced to work without their presence and expertise. It is not the  
ideal situation to be in, but because it exists, and because the Great .
Physician is present, we are committed to go and work to the best i
of our knowledge and capabilities. That knowledge has expanded ;
because of our studies at FNS. Because of the people who taught l
us, we could say at the conclusion of a day’s work in Lesotho: "We ,_
did it. We did it successfully, even though Dr. Gilbert was not I
here!" y
Kidney Disease  
NARRATOR: Every normal human being has two kidneys . . .  
These organs are bean-shaped . . . weigh about a r
quarter of a pound . . . and are located in the small
of the back along both sides ofthe spine. More than
18 gallons of blood pass through the human i_
kidneys each hour . . . performing necessary life g
sustaining functions. Unfortunately, an estimated ,
55,000 Americans of both sexes and of all ages die =
each year of kidney disease. Warning signs of {
kidney disease are puffiness around the eyes . . . ~ <
particularly in children; gradual swelling of parts  ll
of the body . . . usually ankles; lower back pains  
just below the ribs . . . and changes in the pattern _ 
of urination. If any of these signs or symptoms  
occur, see your doctor immediately.  .,

{ [Reprinted, with permission, from The Tudor Rose Council/or of the
i National Society,—l)aughters of Colonial Wars, Volume 11, Number 4,
March 1979]
, On October 5, 1978, the members of the Daughters of Colonial
Wars who had driven or flown into Lexington, Kentucky, for the
V  third DCW Tour of the Frontier Nursing Service at Hyden and
,,,, Wendover, met at the Campbell House Inn in Lexington for lunch.
{ We left at 1:00 p.m. on a chartered Greyhound bus for Hyden,
  arriving about 4:00.
  Soon after arriving at the Appalachia Motel in Hyden, we were
  taken by car to Wendover to the "Big House", Mrs. Breckinridge’s
° home, for a lovely tea and sherry party. Mrs. Verna Potter and
; members of her staff served us tea and sherry from a beautifully
‘ appointed tea table. It was a joy for former FNS Tour members to
; return to the home of Mrs. Breckinridge and I am sure it was a
, delightful experience for new Tour members to visit there for the
,_ first time.
pi On Thursday evening the members of the Kentucky State
, Society were hostesses at a delicious dinner in the motel dining
. room with Miss Josephine H. Ewalt, Kentucky State President,
2 presiding and welcoming the members and guests. After the
_ dinner, the National Officers retired to the suite of the National
i President, Mrs. Grant A. Ackerman, for the executive meeting.
  On Friday morning the group was divided into three sections,
{ one going to the Mary Breckinridge Hospital and Health Center,
Q and the other two going to outpost clinics first, and the hospital
* later.
The first clinic we visited was the Betty Lester Clinic at Bob
Fork, where we found a bake sale in progress for the benefit of
i_ their clinic. We were pleased to see one of our microscopes in use
g there.
l { Next we went to the Red Bird Clinic, where Miss Susan Hull is
= one of the resident staff. Susan has recently returned from
,‘ Nicaragua, where she has been on nursing service with CARE. I
.. i first met Susan at the Annual Meeting of the Trustees, members
  and friends of Frontier Nursing Service in May, 1974. She had just
 J finished her training in family nursing at FNS and was leaving
 , for Nicaragua. At the time I met her she had just learned that she
`  was the recipient of one of the Scholarships given by the
  Daughters of Colonial Wars, and she was overflowing with joy

 14 1=aoN·m:R Nunsmc smvics  
and appreciation of this gift, which made it possible for her to  
leave FNS without outstanding financial obligations.  .
We returned to the motel for lunch, after which we took a tour of i
the Hospital. Those who had not visited the hospital saw for the Q
iirst time our Pediatric Ward and visited with the children who j
were patients there. Dr. Joseph Levine, the FNS dentist, was  
pleased to show the members of DCW the much needed second  
dental operatory which has been equipped by DCW at a cost of _—
$3,159.00, our National President’s project for this administra- ”l’
tion. {
We were next taken to the cafeteria, where we were shown a  
film, Cherish the Children, and where Miss Betty Lester talked to n "
us about some of her experiences during her many years of service  
at FNS. We then gathered at the beautiful little St. Christopher’s ig
Chapel on Hospital Hill for Evensong Service, with lovely organ P
We returned to the motel feeling inspired by this day of ‘
witnessing the wonderful activities being carried on in every nook
and corner of the FNS in its ministry to the health and welfare of
the people of the mountain area.
The Tennessee State Society was hostess for the dinner on i
Friday evening. Mrs. William A. Starritt, State President, presid- ,
ed at the beautifully decorated tables. After dinner Mrs. Starritt I
presented the National President and she in turn introduced the
honored guests . . . Mrs. Ackerman presented Dr. Beasley, who V
gave a lively and entertaining talk on happenings at FNS. After `.
Dr. Beasley’s address, Mrs. Ackerman make a formal presenta- Q
tion to Dr. Beasley for the Frontier Nursing Service, of the second ,
dental operatory from the Daughters of Colonial Wars. Dr. T
Beasley responded with expressions of appreciation from the
entire staff.  
Each tour member left Frontier Nursing Service with the P
feeling that we are privileged to be a part of such a worthwhile g
project. We wish to express warm thanks to Miss Kate Ireland, Dr. "‘
Beasley, and all the FNS staff who made our visit most enjoyable i
and rewarding. We are also greatly indebted to the vice-chairmen  
of the National Projects Committee, Mrs. Dewey Daniels, Miss g'
Elizabeth Storer, and Mrs. Kenneth Wickett, for their valuable  V
assistance in working out details of the tour.
—Mrs. C. Wayne Elsea
National Projects Chairman, NSDCW i

   QUARTERLY Burrmrm is
g From Jeanne Black Pate (‘69), Edgartown, Massachusetts
E The boys are getting big—Willie is four and a half now and
  Peter is just past two years. Brian is still a parts manager for a
  Chevy and Jeep dealership. We’ll get down your way some day—I
V? miss the mountains and you all.
  From Alison Bray (’30’s), London, England
  What an eventful year you have had! I wish I could have been
Q at the Courier reunion. Cindy [her niece, Cynthia Bray (’75)] was
X married in July and is very happy. Love to all my friends.
From Lymi McFarlan (’74), Ashland, Oregon
I hope to get back to Kentucky sometime soon and visit. I’ve
thought about it so many times. Right now I’m an English teacher
; and love it. It’s a lot of work but worth the time. Ashland is a
beautiful town to live in. It’s in a valley surrounded by lakes and
A mountains.
i From Polly Beckwith Hawkes (’72), Charlottesville,
I Virginia
, I want to send something to commemorate my very warm
I feelings for you and the FNS. Dave is in medical school now-
almost finished his first year. I’m working threeor four days a
4· week at the Children’s Rehabilitation Center here. What a neat
  job it is, too! So much can be done for these kids—it is really quite
rewardingfl still have an eventual hope of working in public
I health as a nurse practitioner. That’s one good thing about
 ; nursing—there are so many opportunities tha