xt7pvm42ss18 https://exploreuk.uky.edu/dips/xt7pvm42ss18/data/mets.xml The Frontier Nursing Service, Inc. 1992 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. 67, No. 3, Winter 1992 text Frontier Nursing Service Quarterly Bulletin, Vol. 67, No. 3, Winter 1992 1992 2014 true xt7pvm42ss18 section xt7pvm42ss18 T
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 US ISSN 0016-2116
Table of Contents
Notes from the School - Judith Treistrnan 1 {I
Graduation of the first CNEP Class - Judith Treistman 5
My Experience as a Courier - Kristin Erickson & S ky Blackiston 7
Meet the Board of Governors - Barb Gibson 10 I
Beyond the Mountains - Deanna Severance 12 i
Employees of our Organization - Barb Gibson 19  
Local Spotlight — Barb Gibson 20 I
Courier News - Susie H udgins 18  
Field Notes - Susie H udgins 19 i
Appalachian Health Care - Deanna Severance 24 i
In Memoriam — Barb Gibson 30  
Memorial Gifts - Barb Gibson 30  
Urgent Needs - Barb Gibson inside back cover i
COVER: Reclaimed Strip Mining Site at Wendover, KY {
Photo: Amy Behrens I
US ISSN 0016-2116
Published at the end of each quarter by the Frontier Nursing Service, Inc. I
Wendover, Kentucky 41775 I  
Subscription Price $5.00 a Year I I
Editor's Office, Wendover, Kentucky 41775 ` I
VOLUME 67 NUMBER 3 Winter 1992  
Second—class postage paid at Wendover, KY 41775 and at additional mailing offices. I
POSTMASTER: Send address changes to Frontier Nursing Service, Wendover, KY 41775. I
Copyright 1986, Frontier Nursing Service, Inc. I

Xl   I ln January 1992, we received notice that the Division
of Accreditation of the American College of Nurse Mid-
wifery had granted the Community—Based Nurse—Midwifery
Educational Program (CNEP) five years of continuing ac-
y creditation. I thought it might be a good idea to review the
 I process of accreditation, how it works and just what this
  means for the Frontier School of Midwifery & Family
il Nursing.
_  Receiving five-years of accreditation means that the
l" CNEP is recognized by our own professional organization
E} (the American College of Nurse—Midwives, known as
 l ACNM) as meeting the highest possible standards of excel-
 ~ lence! Further, CNEP has successfully met the ACNM‘s
 9 criterion of creative innovation in nurse—midwifery educa-
i l tion. Accreditation of the CNEP demonstrates that alterna-
 V tive pathways in professional education can, and do work.
  Accreditation acknowledges that it is possible to train well
  qualified nurse-midwives in greater numbers than ever
  thought possible!
  The education of nurse-midwives in the United
  States can be traced back to the "School of the Association
  for the Promotion and Standardization of Midwifery",
1 * founded in 1932 by the Maternity Center Association in New
i ‘ York City. Mary Breckinridge, who just seven years later
E created the Frontier Graduate School of Midwifery, served
  on the Board of the Maternity Center Association. Rose
  McNaught, a public health nurse who had received nurse-
ii midwifery training in England was "loaned" to the new
'L School by Frontier Nursing Service. FNS started its own

program of nurse-midwifery education in 1939, continuing  
to expand upon the idea of combining education and clini— if
cal service. From the very beginning, both schools recog- j
nized the need to establish standards for the education of  
practitioners. Adhering to these standards assured the A
highest quality of care for mothers and babies, and won the 2
I confidence of other health care professionals and the gen- F
j eral public.
{ In 1955 the American College of Nurse—Midwifery  
l was formed and later joined forces with the American  
j Association of Midwives (formerly the Kentucky As socia- {
K tion of Midwives). One of the first tasks the new American
j College of Nurse Midwives achieved was to raise nurse- ;
  midwifery to the status of a "profession" by setting educa-  
  tional goals and defining criteria of excellence in perform-  
§ ance. The process of evaluating educational programs  
j according to these goals and criteria is known as  
  accreditation. The American College of Nurse—Midwives e
t (ACNM) is now our national professional organization.
The ACNM serves as our accrediting body, identifies the j
core of knowledge and skills necessary for safe practice and {
evaluates how well educational programs prepare future V
nurse-midwives. There are two standards against which all  
nurse-midwifery schools are judged.  
First, the ACNM Division of Accreditaion looks at  
each educational program. The goal of the Division of i
Accreditation is to assure "...that the highest possible stan-  
dards of scholarship and professional competence are  
maintained"r The ACNM recognizes that "...within the  
boundaries of sound educational principles and quality  
clinical experience, innovation and creativity to facilitate j.
excellence in nurse-midwifery education are encouaged".z  

Q;. The first step in the process of accreditation occurs
i when the ACNM Board of Review asks the Program under
scrutiny to submit a self-evaluation report detailing all
'{`I aspects of the curriculum, student and faculty selection,
clinical training opportunities, etc. Then "site—visitors"
  from the Board of Review spend a few days at the School,
A validating the information included in the report. The site-
Q visitors were able to interview students and faculty, admini-
  stration and the Chairman of the FSMFN Board of Direc-
  tors. The visitors worked almost around the clock, review-
- ing the documents and exhibits we had prepared, and
making sure that all was in order. The visitors report their
e findings to the Division of Accreditation, which in tum
  makes the final recommendations. The Division of
  Accreditation awarded the CNEP its vote of approval.
, The second measure of achievement for an educa-
  tional program is the degree to which its graduates qualify
l for certification by the ACNM. To date, 20 CNEP gradu-
. ates have sat for the National Certifying Examination and
. all have passed with flying colors! Our students are all
’ pioneers, courageous and dedicated to the mission of the
~ FNS. We believe that they are just the first wave of a new
  generation of nurse—midwives, one that will sweep forward
  to meet the goal of 10,000 by the year 2000!
  Judith Treistman
EI In the Summer ' 91 Quarterly Bulletin, Catherine Croft wrote an article on
ai, Teresa "Tia" Casertano and her work in Guatemala opening and operating a
,' Children's Home. We recently leamed that'l`ia was among this years recipient
i of the "Iaycee's 10 Outstanding Young American Awards". The awards
  recognize people ages 21to 39 who exemplify the best attributes of the nation's
- Barb Gibson

Frontier School of MidwUery and Family Nursing
I Dr. Ed Hughes and students from Hazard Community College visiting the ,
CNEP Program _
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i., Family and friends gathered on October l9th to join
E   in the festivities as the first f 22 t d
group o s u ents was
 I l graduated from the Comrnunity-Based N urse-Midwifery
  Education Program.
  The weather, unpredictable at this time of year,
  turned out to be a little on the cool side with the wind tossing
· leaves around throughout the entire ceremony. The sun did
 p shine on us as the presentations were made. We were
 P I indeed happy to have ALL the faculty present along with
  several clinical preceptors, and two new Regional
  Coordinators. Kate Ernst ventured forth from
Perkiomenville to see the friends she had made during the
ai chicken-coop days of CNEP. As students and guests
Z (infants, toddlers, parents and grandparents) arrived, we
  . realized that it is probably a mistake to call our program
. ' ° "Community-Based." The CNEP is tmly "Family—Based"
t   education!
3 In lieu of a keynote speaker, representatives of the
Y four founding institutions sent messages. We were espe-
  cially pleased to welcome Rosemary Hogan, Associate
I Dean at the Frances Payne Bolton School of Nursing
’ (CWRU), who brought greetings from Dean Joyce Fitzpa-
  trick. The Burslems (Vicki, who announced that she is
  pregnant, and husband Rick) led us in an invocation.
  Deanna Severance, Director of FNS, invested (seated?)
gi Kitty Ernst in the endowed Mary Breckinridge Chair of
  N urse-Midwifery amid some off-key but enthusiastic sing-
ji ing. Faculty took turns presenting diplomas to the graduates
  as flashbulbs popped. Ruth Beeman delivered an inspiring
 . closing address, recalling the dream that has now become
  reality. — Judith Treiszman

CNEP students in H yden
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{li 9 As I left New York City A I i` Q
  · E driving South, I thought of where I   ,. _
_;’ was going and why I was going ’ '_   Y- » -·f- _
in   there. The mountains of Southeast   . " V L A,
Q · I Kentucky. A Courier for the FNS.   "~ I V-as-.  .  
°   Vague impressions ran around my ¤  I I I     g 4   if
‘· , head of dirt roads, babies, and de- Af   ‘i‘=  I   ’·i· AA if  
i, I livering mail. I really didn`t know `·       ‘        
  ’ what to expect. My knowledge of  .;- I ‘ ·   `XA     ‘ A
Kentucky ran no deeper than good   l A    =  I A
A ‘ A 'ole Kentucky Fried Chicken and     I    
- the roadmap I had with me. As for   · 1; `Z, I`;  _;—‘
· the mountains, I knew that they Kristin Erickson
A would smell better than New York,
but that's about all I knew. I was ready for anything. Having deferred
_ A my college admittance until September 1992, I found myself in
* September 1991 with the seasonal hankering to learn, and I couldn't
I  wait to explore the limits of what I knew, to get to know people with
  , backgrounds completely different from my own, to live in another part
:-e   ‘ of our country, and to learn all that I could outside of a classroom.
 QA Well, after a beautiful drive I arrived at Wendover where I
  spent the following three months. As Susie Hudgins (Courier
  S Coordinator) explained the different possible areas of involvement for
J3;  a Courier I soon realized that the problem was not going to be what to
  'V do,but whatnot to do. All Couxiers must serve tea on Monday evenings,
_ A ` I go on rounds delivering mail between the hospital and the clinics and
  ‘ be on call to pick up someone from the airport or transport lab to some
  other hospital. But, beyond that, we can with Susie's help, set our own
. During the fall I tutored a woman who lives up the road from
  Wendover. She is leaming how to read and write. ( She has a leaming
i disability which hindered her in school and finally she is pursuing
l something she has wanted for a long time). She is sharp as a nail and her
sense of humor always spiced up our lessons. At the end of November
I began tutoring a65 year old woman of great determination who is also
` leaming to read and write. Being literate was something I had taken for
granted my whole life, and it was exciting to share that tool with
someone else. I've also leamed that literacy and intelligence have little
e to do with each other; These two women that I tutored are two of the
sharpest people I have ever met and has taught me more about life than
A I could possibly teach them about phonics or spelling.

1 I spent one day a week going on Home Health rounds with a Y1
nurse's aide, driving through the hills, visiting and bathing homebound ji
1 patients. I have met wonderful people through Home Health, and heard  
some crazy stories coupled with nuggets of wisdom. After a while I , =
even got a handle on Leslie County geography, as the names "Cutshin"  
and "Big Rock" became real places which I had visited. On the opposite 1
end ofthe age spectrum, Sky Blackiston andl taught art to the first grade I
at the Hyden Elementary School and in December we started with the  
fifth and sixth grades. Those kids are full of excitement, and in every  
project we did they would surprise us with their ideas. And then, of  
course, there are assorted random jobs that are all part of the Courier 1
1 experience; working in the food booths at the Mary Breckinridge  
1 Festival, judging an inter-school talent show, setting up a haunted house 1
1 for the Halloween fair at Beech Fork Elementary School, selling candy 1
1 bars at the hospital and organizing the Wendover Christmas Pagaent.  
1 Wendoverisabig partofCourier1ife. Itis where we eat, sleep,  
1 bathe and come home to at the end of the day; where we read, play cards, 1
1 and dance in the kitchen; where we stuff envelopes and help out with 1
1 general work in the Development Office; where we bake breads and 1
1 cook chili and sit around and talk, getting to know thc Courier hodge- 1
1 podge of individuals from all over the country.
1 Originally I had planned to leave for good at Christmas time,
1 but, like many others before me, I find myself back at Wendover to
pursue more thoroughly what I started in the fall, I know that I will
1 never be "finished" here. I am not taking classes which end with the last
1 paper or exam, and everywhere I tum there is something new to learn.
1 I hope to do, give, and absorb as much as I can while I am here, and spend
1 time with the people I have met, who have already taught me so much.
1 — Kristin Erickson
1 1 _
1 1

” I am from Greenwich, CT
st and have been a Courier at the FNS   ‘
,, since last September. I have three  
I distant cousins who were Couriers T   { if 
back in the '50s and '70s. I didn't find  — ~j ¤   i t 
this out until after I had gotten here. {     _ ,   *   el
I came here to have the opportunity Q       ;=·=t  Fg  W
to work with children. I wanted to be  i  , ;   
i in a rural area so that I might exper-  ‘·  *  -. ~    e ‘ _~
[ ience a different culture from what I
_ know. ‘
i For the past three months
i that I have been here, I‘ve been help- Sky Blackiston
Q ing out in three different schools in
_ Leslie County. I‘ve been assisting the teacher with the first, second and
third grades combined. I‘ve also helped with the music classes and
tutoring one-on-one with special education. I‘ve taught Art to various
age levels along with my regular Courier "duties" which include
Courier rounds, and delivering mail and supplies to the four district
° I think one of my most meaningful experiences has been
teaching Art. I had never taught Artbefore, so at first I didn'tknow what
I was in for. I took out a couple of books on Art Education at the local
library and got some ideas. I also got some ideas from working with the
Art teacher at one of the other schools. Now, after having taught a few
Art classes, I‘ve realized that it is not that hard and is quite exciting and
i rewarding.
Tutoring has been meaningful to me because I find that the
l kids I tutor have the same problems that I had in school. I think the kids
`—$ can do their work, they're just fearful of it. They don't feel confident
enough to do it on their own and they feel much better to have someone
A sit beside them and encourage them. I think the tutoring experience has
{V been helpful to me as well as to the children becausel have gained a new
V perspective in the learning process and about my own difficulties I had
in school.
I plan on staying at FNS for two more months, then on to
England or Scotland, and then to college. - Sky Blackiston

Meet the Board of Governors
The FNS Board 0f Governors is re- ·w
sponsible for establishing the policies by
which FNS is governed, as well as approving _
the annual budget and overseeing expendi- I ·
tures. Each member of the board brings Q
unique g#`ts and personal history in involve-  
ment with FNS to his or her position of lead-  
I ership;and each has a key role to play in the ‘
I governance of the Service.This is another in  
I our series of projiles on the members of the I
I Board of Governors. I
I James Klotter grew up   f ,  . _ I I   .
and graduated from high school in S t`II  I ;.  I`.   .
I Booneville, Owsley County, Ky.   ,      
I where his grandfather was a phy-     I it, »- I-     9   I
I sician. He attended the Unversity  I  M ”          I  
I of Kentucky, served in the U.S.   I  ` · ii 9.   `   I
I Army from 1970-71, and returned   .   "" I I --‘" _ ;* “’ I
I to UK to complete his Ph.D in his-   .     I  ' ,   
tory. James Klotter I
I Mr. Klotter first leamed of FNS while growing up in Owsley  
‘ County, and then did research of FNS when he was in graduate school.
I He became a FNS Board Member in April, 1991. He also serves on the
board of Hyden Citizens Bankcoip, Inc., and is chairman of the board
I of Farmers State Bank in Booneville, Ky.
Mr. Klotter had focused his research on Kentucky and
I Appalachia and has written or edited eight books, including The
I Breckinridges of Kentucky (1986), which devotes much space to Mary
Breckinridge and the Frontier Nursing Service. Cmrently, he is writing _I
a history of Kentucky in the 20th century. _
I Mr. Klotter lives in Lexington, where his wife teaches school. _
I They are the parents of three children. He is the State Historian and I,
I director of the Kentucky Historical Society. ·
I Mr. Klotter has devoted much of his time to FNS and says that _
"all good organizations are usually in some stage of transition. As the  I
FNS moves forward - as it must - into new frontiers, I want to make ·
certain that the organization remembers its past and the spirit of the  [
founders."  I
- Barb Gibson I

V Meet the Board of Governors - continued
{Z, Dr.George Edward Hughes       V, ’
Q is the President of the Hazard Com-   _
{ munity College at Hazard, KY. Dr.   ,. ,    
Hughes first learned of FNS through    _
{ Fred Brashear and Kate Ireland. He   g ''/   q    ·’·¢ )
l became a FNS board member in     I ’
f December 1989; Chairman of the . `    . . ""
  Frontier School of Midwifery and ‘ A    "I ~
5 Family Nursing in 1990; and a board  A   . ·
i member of the Mary Breckinridge jk Y  
; Healthcare, Inc. during Jan. 1992. Dr. Hughes
  Dr. Hughes also serves on numerous other boards including
[ the Executive Committee of Leadership Kentucky, Chair-President of
} the Hazard-Perry County Industrial Commission, the Region 12
  Vocational Education Advisory Board, the Area Health Education
2 Board, and is Chairman of the Election of Community College of
4 Applachia.
Dr. Hughes received his A.B. in Psychology from Catawba
College, Salisbury, NC in 1972, his M.A. from Middle Tennessee State
University, Murfreesboro, TN in 1973, and his Ph.D from Southem
Illinois University at Carbondale in 1977. He also received an Award
for Special Doctoral Assistantship in 1976-77.
Dr. Hughes is married and has three children; Laune 15, Jenny
, 13 , and Lauren 10. His wife, Sarah, was the first Coordinator ofthe Kate
i Ireland Women‘s HealthCare Center.
· Dr. Hughes says "the Frontier School of Midwifery and
Family Nursing is on the cutting edge of delivering education to
0] midwives through CNEP and this one area has impacted thousands of
 ‘ people throughout the world. We hope that by the year 2000 we will
 .\ have educated and trained 10,000 midwives. The role of Frontier
A i Nursing Service in this is as a 'model and a leader'. This is a very
 I exciting time for the school. As a member of the local MBH board, I
__  am committed to help keep quality providers and service to the people
E of Leslie and surrounding counties."
 , -Barb Gibson

 . 2
I Beyond the Mountains  
This February 28, 1992, I addressed the Missouri Perinatal {
Association at the Lake of the Ozarks. The issues of providing ._,
coverage to not only mothers and babies, but to all Americans, looms  
l on the horizon during this presidential election year.  
Q Frontier Nursing Service has been demonstrating since 1925  
I that the combination of well qualified family nurse practitioners caring  
i for people in a holistic comprehensive way, backed up by competent 5
l physicians with links to secondary and tertiary care reduces the infant  
mortality rate and improves other health indicators.  
Yet, the challenges continue. We face barriers established by g
{ ourselves, insurers, the Congress, the legislatures, professional asso-  
! ciations, credentialling bodies, universities, other agencies and the  
l like. These barriers are not unique to FNS. All providers face some  
4 or all of these barriers.  
I l
I Health Care and Taxes {
i Every individual has his or her own interest, their own  
personal belief. Often, legislators are elected on platforms reflecting  
Q their personal belief about education and taxes. The issue of health _
1 care delivery is a tax issue for the United States. How are we going to `
l finance a health care delivery system which during the past decade P
` experienced an inflationary factor which outranked that of the Gross 5f'
i National Product? I propose Americans will best be served through
Q programs where employers enroll employees and dependents in pri- in
I vate insurance plans or pay a tax which would cover their premiums 3
in federal-state public plans. There must be incentives for small _.
employers. The unemployed would be covered through a federal -
insurance program. ‘

  Quality and Efficiency
I Why do certificates of need so often fail to limit the duplica-
M tion of services? One reason is because we as communities petition for
  these services. There appears to be conflict between the absolute
i knowledge that health care spending must be curbed and our desire as
I Americans for unlimited freedom of choice. I, too, do not want to give
i up choice in my personal health care, however, all providers and all
i services are not created and implemented under equally high standards
  of care. As a consumer I am left floundering when itcomes to informed
  I sense an almost moral panic to find a neat and tidy, "us"
  versus "them" explanation for what is wrong with the American health
  care system. All health care ills cannot be blamed on the pharmaceu-
I tical companies, physician salaries, insurance companies, malpractice
i costs, and the like. It seems to me that we Americans must point a
F retorical finger inward. How many communities of less than 30,000
I people have multiple CAT scanners? Do you want to have an intensive
ir care unit within 30 minutes of your front door? Is more than one air
Q ambulance system needed in most cities? Should all trauma units be
V. created equal?
A I wholeheartedly support the development of access and
i quality standards at the national level. Research should be funded to
gt develop national practice guidelines. For professional, health care
~. Fr providers - physicians, nurse practitioners, physician assistants - I
_ support national board examinations. Providers should be able to
  move freely across state lines. Technology assessment should be
I funded. Where advanced technology can be used more efficiently and
cost-effectively, incentives should be created to encourage the im-
  plementation. For example, many diagnostic tests can now be per-
, formed miles away from the site of the physician through electronic
» imagery. It is not cost effective to have an obsteuician travel around
i rural American administering and reading ultrasounds and non-stress

 l V
` tests when the technology exists to have a technician perform the test,  
transmitting the infomation to the physician. However, training for  
the technician and for the administration must be reimbursed at a rate {
I which allows this implementation. The technician should also be U
certified. {
l Comprehensive Benefits  
Q Benefits should be comprehensive: health education, home  
! health, occupational, medical, dental and mental health services in-  
cluding drugs and equipment. The hodgepodge of funding which now  
i exists would end. Rates would be set and all services would be  
reimbursable under the system.  
I i
i . . . {
I Equitable Financing E
{ Fee schedules should be negotiated. Deductions would be set  
Q with families below the federal poverty level exempted. As unemploy— {
1 ment increases in this country and because certain whole areas of this l
l country experience pockets where unemployment remains above the ‘
l national average, the idea of cost shifting becomes ludicrous. Health _
l care facilities whose revenues are 60% or greater Medicare or Medi- ¥
l caid (M&M) cannot afford to pay equitable salaries, benefits, purchase
{ equipment and/or supplies. Operating on M&M rates, when the people A
y you serve are M&M beneficiaries, means operating in the red. lt means  
1 closure. The cost of health care must be established and that rate must  {
K be applied whether the insurer is private or public. This may mean  ._.
r reducing profit margins in the health care system. Americans need to -
i come to grips with that issue. Research for pharmaceutical advances Y
and technological advances should be funded, but not from the health ~  V
care insurers. . 

  Elimination of Financial Barriers
{ Employers would contract for private insurance for employ-
gt ees. The unemployed would contract for public insurance. Incentives
{ for managed care would apply focusing on appropriate levels of care.
{ Is managed care the answer? The national trend certainly
Q seems to be moving in that direction. The assumption being that
  managed care is more cost effective. I believe there is truth in that
  assumption. But what happens when a managed care system closes the
  gate on the best, most appropriate care. Let me give you a personal
  example. My father is retired from Bell Telephone. After retirement
  he and my mother chose a local managed care system due to the cost
  savings. Since my mother was in her early twenties, she has suffered
E from rheumatoid arthritis. After 40 years of cortizone and other
[ treatments she has bone degeneration. During the lasttwenty years she
E has had replacement of the bones in her feet by a renowned surgeon in
i Houston, and she has had hand surgery by a community surgeon who
t advertised specialization in hand surgery. Today, my mother can wear
normal shoes and walk. The story of her hand surgery does not end as
A well. After the community surgery my mother had her hands re-
. evaluated by a surgeon in Dallas who was discreet but obviously
i horrified. He would not attempt to repair the damage done by the
I community surgeon and referred her to a surgeon in Louisville,
I Kentucky. The managed care system declar