xt7qft8dh310 https://exploreuk.uky.edu/dips/xt7qft8dh310/data/mets.xml The Frontier Nursing Service, Inc. 2003 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, Vol. 78, No. 4, Spring/June 2003 text Frontier Nursing Service, Vol. 78, No. 4, Spring/June 2003 2003 2014 true xt7qft8dh310 section xt7qft8dh310 FRONTIER NURSING SERVICE  
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 US ISSN 0016-2116
Introduction to FNS I
Courier Program News - Barb Gibson 2
Wendover News - Barb Gibson 3
Board of Govemors - New Members 6
Mary Breckinridge Healthcare News - Mallie Noble 8
Rural Healthcare Clinics update - Heidi Froemke 14
Frontier School of Midwifery & Family Nursing News -
- Dr Julie Marfell 12
Website Information 14
Nurse without Borders 15
Urgent Need - Renovation of old Beech Fork Nursing Center 18
ln Memoriam 22
Urgent Needs 29
Cover: Original Beech Fork Nursing Center - 1926
Frontier Nursing Service Quarterly Bulletin
Published at the end of each quarter by the Frontier Nursing Service
Subscription Price $5.00 a year for Donors/$15.00 for Institutions
Volume 78 Number 4 Spring/June 2003
Periodicals postage paid at Wendover, Kentucky 41775 and at addi- '
tional mailing oilices. POSTMASTER: Send address changes to FNS,
Inc. 132 FNS Drive, Wendover, Kentucky. Copyright FNS/Inc. 2000
All Rights Reserved.

Frontier Nursing Service
U you have never been introduced to the Frontier Nurs-
ing Service we would like to take this opportunity to brief you on
the history and the on-going work of the Service. Please share
this information with a friend
Bom in 1881 into a prominent American family, Mary
Breckinridge spent her early years in many parts of the world —
Russia, France, Switzerland and the British Isles. After the death
of her two children, she abandoned the homebound life expected
of women of her class to devote herself to the service of others,
particularly children.
Mrs. Breckinridge established the Frontier Nursing Ser-
vice (FNS) in Leslie County, Kentucky in 1925, then one of the
poorest and most inaccessible areas in the United States. Mrs.
Breckinridge introduced the first nurse—midwives in this country.
Riding their horses up mountains and across streams in blizzard,
fog or flood, the FNS nurses brought modern healthcare to fami-
_ lies throughout an area of 700 square miles.
l Until her death in 1965, Mary Breckinridge was the driv-
ing force behind the work of the Service whose influence today
extends far beyond eastern Kentucky. Through the Frontier School
of Midwifery and Family Nursing, hundreds of nurses have been
trained and this important concept of family healthcare has been
carried throughout the world.
Today, FNS, Inc., is organized as a parent holding com-
pany for Mary Breckinridge Healthcare, Inc., Frontier Nursing
Healthcare, Inc., which includes four rural healthcare clinics (Com-
munity Health Center, Beech Fork Clinic, Kate Ireland Healthcare
Center and Dr. Anne Wasson Healthcare Center) and for the Fron-
tier School of Midwifery and Family Nursing - the largest mid-
wifery program in the United States. The Frontier School of Mid-
· wifery & Family Nursing also trains family nurse practitioners.
Remarkably, the purpose and philosophy of the FNS has
remained constant since 1925.

Courier Program News
by Barb Gibson, Assistant to CEO
We haven’t had any couriers since Kate Fox and Keith '
Hendershot left at the end of February. Approximately a year ago,
the Courier Program was restructured to focus on community/pa-
tient assistance rather than observing providers in healthcare. The
restructuring phase decreased our applicants. We have recently
changed the Program to again provide observing or "shadowing"
opportunities. These opportunities include FNPs, internists, RNs
and other providers in Leslie County. We are looking forward to ~
more applicants when the word gets out that we are allowing cou-
riers to "shadow”.
Deanna Severance Leaves Service
Deanna wrote the following:
“Great success was built during my thirteen years with
the FNS. Many committed people invested time, effort and energy
into the growth. The care shows. Now the time has come to move I
on. I am looking forward to new challenges and pursuits. I will
always fondly remember Mary Breckinridge`s good work to im-
prove the lives of mothers, babies, families." A

Wendover News
by Barb Gibson, Assistant t0 CEO
· Projects this spring included repairs  vv ri
to the Upper Shelf to make it presentable y , V  
for guests as part of our guest housing. The ·~   yy
general upkeep and maintenance of all of the   l j
. . .    , y ~— .
buildings and grounds require a lot of work.   i" ¤;
During February, March and April,  ” A  iiit   E
A Wendover entertained/hosted about 80 over- t T  
T night guests and served lunch and performed tours to 88 visitors.
t Our new Tour Guide, Patricia “‘Tot1y" Lawson, does a wonderful
job and she thoroughly enjoys it. Totty particulary enjoys giving
T tours to nursing students because she sees the spirit of Mary Breck-
inridge living on in those students and sees their great love for
nursing and a desire to forge new frontiers as Mary Breckinridge
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¥ Wendover is Upper Sheyvverlaaks the Middle F ark River

We would like to recognize a very special group of medi- i
cal students from the University of Maryland, called “Medical ,
Breakaway", who stayed at Wendover for a week during the last °
of March. *
In exchange for observing or "shadowing" providers, the
students did a lot of work for Wendover including painting in the
Upper Shelf and staining all of the wood fencing. Thanks for the ‘
work you did!  
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. . . . I
LM t0 rtght: J0hn Schreiben Suzanne Smith, Daniela M0rat0,  
Jordan White, Vanessa W0y’eman (an rack), Jamie Jahnsan,  
Dina Habib, Kate Deanehan, Natalie Branagan and David  
Lundy 1
April 25 & 26, the FNS Board of Govemors held their .
annual April meeting at Wendover. The Board welcomed new Board ,
members Dr. Charles Mahan and Dr. Michael Carter to the FNS
family. I ·

Q On May 30, we held our annual employee picnic at Wen-
{ dover with employees and their families attending. Games were
i played and the food was great!
l /"
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}· Wendaver Picnic scene
  The Wendover Bed & Breakfast Inn continues to stay busy
  as more people learn about the overnight accommodations and
  touring opportunites that we have to offer. We have begun to en-
  courage community members to have their family reunions and
  other "gatherings" at Wendover. There is not a more beautiful place
  in Leslie County! We invite you to visit. For information, call Tour
f Guide/Reservations at 606-672-2317 or visit us on our website:
l www.frontiernursing.org.

Board of Governors - New Members l
Charles S. Mahan, MD.
Charles S. Mahan, M.D. is pro- _   A Q e¤»x»  
fessor of Community and Family Health     i,iv.·z·
an the College or Public Hearth at the     ·;vv·—  . I '
University of South Florida and Pro-   ..   A    . g
gram Director of the Maternal and Child     = _
Health Policy for The Lawton and Rhea   — ~’   ‘~··· i    
Chiles Center for Healthy Mothers and   W y ; 1
Babies. He holds ajoint appointment as   xllll   I
Professor, Department of Obstetrics and Gynecology, in the Uni- `
versity of South Florida College of Medicine. l
A West Virginian, Dr. Mahan received his M.D. degree A
from Northwestern University and did his residency training at the
University of Minnesota where he returned to join the faculty. He
moved to Florida in 1974 to be Professor of Obstetrics and Gyne-
cology and Director of Ambulatory Services for Women at the
University of Florida and Director of the North Central Florida
Maternal and Infant Care Program.  
Dr. Mahan directed the State Health Department in Florida A
from 1988 to 1995 and was former Dean of the College of Public p
Health at the University of South Florida from 1995 to 2002. He I
was elected to the Academy of Distinguished Alumni of West Vir-
ginia University and presented The Byford Outstanding Alumnus
Award by Northwestern University Medical School. I
Dr. Mahan is Past President of the Association of State p
and territorial Health Otticials and currently serves as Chairman i
ofthe Advisory Committee to the Director for the Centers for Dis-  
ease Control and Prevention and the HHS Secretary’s Advisory ·
Committee on Infant Mortality. He is on the Board of Directors of
the National Association of Childbearing Centers and HHS Bright
Futures for Women’s Health and Wellness Center. I "
Dr. Mahan lives in Temple Terrace, Florida. Hejoined the  
FNS Board of Govemors during October 2002.  

  Dr. Michael Carter, B.S.]\L, M.NSc., D.NSc.
l Dr. Michael A. Carter is a Univer-
. sity Distinguished Professor at the Univer-
sity of Tennessee Health Science Center in T _
Memphis, Tennessee, and practices as an , 2
· Advanced Nurse Practitioner and Family t`  
Nurse Practitioner at the University Health A A  
l Service University of Tennessee Health (AY;. if  
  Science Center; Christian Health Center in  
, Heber Springs, Arkansas, and at the South r
  Ridge Village Nursing and Rehab Center "
l in Heber Springs, Arkansas. ·
{ Dr. Carter received his B.S.N. and M.N.Sc from the Uni-
§ versity ofArkansas College ofNursing and a D.N.Sc from Boston
‘ University School ofNursing. He received his Primary Care Health
Policy Fellowship from the US Public Health Service. Dr. Carter
A received certification as a Nurse Practitioner from the University
of Arkansas and Family Nurse Practitioner certification from the
T American Nurses Credentialing Center.
{ Dr. Carter has served on numerous boards and advisory
l groups including the Memphis Visiting Nurses Association, Rob-
p ert Wood Johnson Foundation, Christian Health Center, Baptist
§ College of Health Sciences, and Rapides Foundation.
  Dr. Carter has written articles and chapters in a large num-
  ber of nursing journals and nursing books - the number being too
i great to list. He has also performed many presentations at nursing
  conferences across the United States.
  Dr. Carter lives in Tumbling Shoals, Arkansas. Hejoined
  the FNS Board of Governors during October 2002.

, Mary Breckinridge Healthcare, Inc. News
by Mollie Noble, Administrator
Small rural hospitals as well as large ·
urban hospitals are faced with challenges, . °
- - - .j., Fl ._,·
as are all providers in the healthcare industry.     il ‘
We are currently in the process of converting     T · _   ‘
to a Critical Access Hospital which will re-   1
imburse us at cost. The Balanced Budget Act A
of l997 had a severe financial impact on hos-
pitals around the country. To help alleviate the impact on small,
rural hospitals, the BBA created the Medicare Rural Hospital
Flexibility Program. The Flex Program allows small rural hospitals
to receive a higher reimbursement rate based on cost.
Critical Access Hospitals must provide the basic services
necessary to their community, maintain a low average length of
stay, and network with other healthcare providers to ensure that
the healthcare needs of the community are met.
The focus at Frontier Nursing Service and Mary
Breckinridge Healthcare, Inc. has always been to meet the needs
ofthe community and this endeavor only reinforces our desire and "
mission to serve the citizens of Eastern Kentucky.
l wish to personally thank Mr. Woody Dunn and Mr. Larry
J. Allen, Program Coordinator ll with the University of Kentucky
Center of Excellence for Rural Health for their presentation to the
Management Staff at Mary Breckinridge Hospital on conversion
to Critical Access Hospitals.Their presentation was very
informative and l really appreciate the information.
The Management Team at MBHC, Inc. has done an
excellent job completing all the steps necessary to become licensed
as a Critical Access Hospital. This has been a long process, .
however, all the hard work will soon have its pay off as we have
requested our State Inspection for licensure and are patiently
awaiting the dates for completion.

Endocrinology Clinic
I would like to welcome Nisha Varghese, M.D. who travels
down from Louisville, Kentucky, twice a month on Saturdays for
· an Endocrinology Clinic. Nisha is the daughter of Roy Varghese,
Intemist at MBHC. We are very fortunate to offer this type of
service to our patients who have diabetes.
Chamber of Commerce Recognition
Years ago, the Chamber of Commerce gave awards of
merit to deserving businesses and individuals. It was agreed that
this tradition would continue. This year, among other individuals,
three employees of Mary Breckinridge Healthcare (MBHC) were
recoginzed: Dr. Roy Varghese, Intemist; Covy Feltner, Assistant
Dietary Manager; and Lawrence Bowling, Maintenance.
Congratulations Dr. Varghese, Covy, and Lawrence!
County Baby Shower
On April 4, 2003, a county wide Baby Shower took place
at the Leslie County Extension Oiiice. The purpose of this event
was to educate expecting parents, or parents who have newborn
" children, on appropriate ways to cook and care for their young.
Exhibits showed parents how to safely restrain their children in
vehicles, etc. Mary Breckinrige Healthcare participated in this event
with an exhibit. See photo on next page.
Relay for Ly“e
On May 16, 2003, Mary Breckinridge Healthcare
employees raised $1,010.00 for Relay for Life which contributed
to Leslie County raising more money than any surrounding county!
Part of the money raised at Mary Breckinridge Healthcare was
. from a yard sale where employees brought clothing and items from
home. A special thank you to all employees who participated!

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Mary Breckinridge Healthcare "Yard Sale " I

I Rural Healthcare Centers Update
by Heidi Froemke, Dupont Chair
Director of Rural Health Clinic Operations
if On April 27, 2003, the move   X
from Kate Ireland Womens Clinic in the H ,  
. Mary Breckinridge Hospital, to the Dr.   i ` if  
Anne Wasson Healthcare Center, began, A '   _;;;,§ ig`,  
Exam tables, desks, chairs, equipment,       _` ` 1 . 5 
and pictures all made the move across   —_ ""' q   
the parking lot to the small white house -.‘-  ·—`.·»  
with the now fire-engine red door. On  
March 4, 2003, we successfully opened it’s doors to the public.
There are four exam rooms to accommodate a Family Nurse-Prac-
titioner and a certified Nurse-Midwife. Patient numbers have been
growing respectfully, but we still have to do some quick talking to
convince the gentlemen that it is notjust a clinic for women!
The Kate Ireland Healthcare Center in Manchester (opened
in January 2003) continues to provide family-centered care and,
while the number of patients seen is not large, they too grow steadily.
,. Important and lasting relationships are formed between the staff
the clinic, and the community during this time. Family Nurse Prac-
. titioners and midwives work hand in hand to develop the practice.
Newspaper and radio advertising have been central to their mar-
keting campaign.
Beech Fork Clinic and Community Health Center, having
officially moved under Frontier Nursing Healthcare, Inc., on Feb-
ruary 25, 2003, remain our rocks. Though the winds of change
l blow around us, these two clinics remain steady. They continue, as
they have for many years, to faithfully serve the community around
{ them.
l We await inspection for rural health clinic status. In the
meantime, we remain vigilant and prepared.

Frontier School of Midwifery and Family Nursing News
by Dr Julie Marfell, Chair of Family Nursing
The Community-based Family Nurse Practitioner (C FNP) 9 ”
Education Program at the Frontier School of Midwifery and F am- l
ily Nursing (FSMFN) will be four years old this fall. As we have l
reorganized records for our accreditation visit, I have had the op- i' “
portunity to read some of the historical reports from the time when
the first Family Nurse Education Program was started. Upon re-
viewing the information l realize again how true it is that the more
things change the more things stay the same.
On May 9, 1969, a seminar was held in Lexington to dis-
cuss a proposal to educate a family nurse practitioner (FN P) at the
Frontier Nursing Service (FNS). A report was published in the
FNS Quarterly Bulletin regarding that meeting. To the question,
is a family nurse practitioner needed in this country, the answer
was the same as it is today. Yes, the delivery of health services in
this country must be changed and changed radically because the
present system does not work.
The educational philosophy ofthe program was then as it
is now to include a primary focus on health rather than sick care, "
though both are provided in a complementary manner. The im-
provement of health practices and conditions was considered ba-
sic to the overall improvement of health. This focus on health for
the family nurse program was considered necessary in 1969 be-
cause of the shortage of providers in rural areas and the high cost
of health care. Unfortunately, 34 years later there is still a short-
age of providers in rural areas and the cost of health care contin-
ues to soar.
The original program consisted of four trimesters that in-
cluded both family and midwifery care and could be completed in  
a sequence that would lead to a certificate in midwifery, family
nursing or as a family nurse-midwife. A fifth trimester was planned
that focused on the broader aspects of health care services includ- il
ing research. This was not implemented.

Our program today consists of four levels that include
primary care for families and midwifery care. Programs of study
‘ are available for those pursuing an education as a nurse—midwife,
l V a family nurse practitioner or both. The current students have the
i   opportunity to complete their MSN, which includes a course in
I research.
, p From 1970-1977 the total number of graduates was 179.
fi The average age was 30 years old. Eighty-two percent ofthe gradu-
1 ates were employed in rural areas. The total number of students
from 1978-1989 was 89. The age range was from 31-40 years and
39% worked in rural areas.
Today the total number of students enrolled in the CFNP
Education Program is 40. The average age of the current student
is 39 years. Most ofthe students live in towns with a population of
less than 50,000 and plan on staying in their communities after
graduation. The majority of the CFNP graduates report working
with vulnerable populations.
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"   4     ·r    ~ P     $7 `   `
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1 Frontier Bound - Spring 2003 - CFNP Class 11 students, fac-
ulty and Dr: Julie Marfell, Chairperson of CFNR holding her
baby, Rose Marfell Konopka
1 ,

The CFNP Education Program at FSMFN continues to
promote the rich history of Family Nursing at FNS. Many of the
issues in health care in 1969 are still, unfortunately, present today.
We continue to surpass ourselves at F SMFN by preparing FNP’s ¤
to address these issues. These individuals continue a tradition of ·
providing quality health care to individuals in need all over the
globe. Again I am reminded, and proud to say, the more things —
change the more they stay the same.
Frontier Nursing Service - www.frontiernursing.org
FSMFN Community Based Nurse Midwifery Education Program
(CNEP) - www.midwives.org
FSMFN Community Based Nurse Practitioner Program (CFNP)
- www.frontierfnp.org
Special Need
FSMFN is in the process of updating our clinical labora-
tory at Mardi Cottage. One ofthe items on the wish list is SIM
MAN. SIM MAN is a life—like adult mannequin that breathes,
vocalizes and responds to treatment. Faculty can program SIM
MAN to provide different clinical situations for students. For ex-
ample, the student would be presented with a clinical situation;
SIM MAN would have the correct physical findings and respond \
to the treatment plan decided on by the student. This laboratory
experience provides a safe place for students to test their diagnos-
tic and treatment skills. SIM MAN costs $30,000. lf you would I
like to contribute to this need, please specify that your gilt is re-
stricted for SIM MAN. Thank you!

Nurse Without Borders
Carol Etherington came to the Frontier Nursing Service in l97l
I as a nurse and workedjbr two years beftre going on to Wznderhilt
University in Nashville, Tennessee ]?)r_ further ea'ucation. The fol-
i lowing are excerpts written by Heather Hall, _/rom the Reporter: a
weekly publication from Vanderbilt University Medical Center:
i Some ofthe text has been cut due to limited space.
Carol Etherington is drawn to places — Bosnia, Cambodia,
Angola, Kosovo, Sierra Leone, Tajilistan, sites of wars and natu-
ral disasters that others are fleeing.
Nurses have always courageously stridden into sickrooms
to care for the afflicted; what Etherington, as Assistant Professor
of Nursing, does is apply that professional credo on a global scale.
This mission in life became clear to the Kentucky native
very early on. “As a child, I could never understand how or why
the Holocaust occurred and l wanted to believe that, however small
my effort, l would try to respond if such a horrendous event oc-
curred in my lifetime," says Etherington. _
__ Her mission, however, was not always clear. As a young
adult Etherington found herself at the University of Kentucky (UK)
majoring in political science and journalism, but not happy with
the choice.
After taking ajob working in the Medical Center at UK,
Etherington realized what she had been ignoring all along. “l knew
that l really wanted to have close proximity to people through my
job, and there is certainly nothing that gives that more than being
a nurse. So l started over again and spent four more years in col-
Etherington graduated from Catherine Spalding College,
~ in Louisville in l97l with a B.S. degree in nursing. Etherington
packed up and headed out on the first of her life-spanning mis-
p sions to aid underserved populations.
Etherington joined the Frontier Nursing Service in l97l
and knew after two years she had chosen the right path for her
profession, but was struck by the helpless and hopeless feelings

of her patients. Etherington wanted to further her education to ad-
dress those concems and came to Vanderbilt University School of
Nursing, which at that time, offered three specialties: nurse practi-
tioner, psyco-mental health, and acute care. _
In the summer of 1975, her graduate year at VUSN,
Etherington was given special permission to do a placement with
the Nashville Metro Police Department and spent her summer re-
sponding to victims of personal crime.
Etherington was appalled to find there were no resources
to help victims of violence at that time. That’s when Etherington
made the decision to stay and work to make a diff`erence for vic-
tims of violence in Nashville. In August of 1975, she graduated
from Vanderbilt with a master’s degree in psycho-mental health
and continued working with the police department, a place she
would call home for 19 years.
In 1980, news of the tragedy in Cambodia and the geno-
cide that had taken place under four years of rule by Pol Pot and
the Khmer Rouge spread across the world and soon left haunting
impressions in Etherington’s mind. She was reluctant to leave be-
hind her work with victims of crime in Nashville, but felt a com-
pelling need to respond to the global crisis. Etherington served on ._
the U.S. medical team with the International Red Cross, or ICRC,
aiding refugees fleeing the Pol Pot regime. There, she and her col-
leagues treated more than 100,000 victims of war. After four
months, she returned to her commitment with the police depart-
ment in Nashville.
In 1993, Etherington left for Bosnia where rape was being
used as a tactic of war. lt was the first of four trips to Bosnia in a
year and a half, during which time she transitioned to consultant
status with the police department.
Etherington made the decision to leave the police depart-
ment altogether, and became the Assistant Professor of Nursing at A
Vanderbilt University Nursing School (VUSN). Etherington is now
one of four Community Health instructors at VUSN. She pairs I
students with immigrants and refugee families in Nashville to learn
what problems they face in America and to identify their health

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Carol Etherington wi h her Irish Setter; Belle, and Lhasa apso,
Wesley Qrhoto by Dana Johnson)
·- p In the fall when she is not teaching, Etherington works
J with Medicins Sans Frontieres (MSF) or Doctors Without Bordors,
l an international medical relief organization that provides acute care
i to vulnerable populations in 84 countries.
, Etherington’s position on the U.S. board marks the first
time a nurse has been elected to the prestigious post. She also
j volunteers on missions with MSF to assess and establish mental
  health programs as part of the medical response.
p Etherington aided the victims of September ll in New
York City, assisted with the Va1u.let Flight 592 plane crash in
_ Florida, the Los Angeles earthquake of 1994, Hurricane Andrew
in 1992, and countless tornadoes, fires, shootings, and explosions
in Nashville.
‘ Etherington believes that nursing should know no borders
or ethnicity and should be the model profession for care - locally,
Q nationally, and internationally.

Urgent Need - Renovation of Original
Beech Fork Nursing Center
In 1926 Mrs. Breckinridge told nurses Gladys Peacock _
and Mary B. Willeford to "go up to Beech Fork to open up the  
district there and build the nursing center". When Miss Peacock I
and Miss Willeford replied to Mrs. Breckinridge that they knew J
nothing about building, she replied that she did not know anything
about building when she built Wendover and if she could learn, so
could they.
With the permission of a donor, Mrs. Draper Ayer of Bos-
ton, Mrs. Breckinrid e ordered a read made house to be shi ed
g Y PP
to Pineville and hauled across to Beech Fork. lt took the mule
teams four and sometimes five days to go to the railroad and re-
turn with supplies.
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