xt70rx938p2v https://exploreuk.uky.edu/dips/xt70rx938p2v/data/mets.xml The Frontier Nursing Service, Inc. 1970 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. 46, No. 2, Autumn 1970 text Frontier Nursing Service Quarterly Bulletin, Vol. 46, No. 2, Autumn 1970 1970 2014 true xt70rx938p2v section xt70rx938p2v frontier 3EurzIi— r V ·
V___4 . . U wv 3% V; I V V U. nl
, i ` _ r i, »·—‘ “ »— ‘— 2 r»-rEr we , / ’
;. V fi i V , ~ —- , `r {X r
ir r , r , r rrrr ; » ‘ ,, r , .rr
"'*`i"f’$§i i'`“* i w, V. Q " if
,; ,.r;€*3»i_T% ;i‘ `V ,~ ' f“"·- , i n ’+‘ ww ` ¥é?2·ii
fry, ,§»_ · _ Q ' » , ' J
~‘ i i 4 r r, ` ·,` " ‘ ..$..i;}$,’;;·; ·
iiffgr " i AQ, ` F`;. ¤ { ` Q 1 Vi x A , é k —~ »
r ’ ·.,-‘ 2 RE l' A , ` ·*” <,·*r—‘* "!
· , J ·* W u- W < ‘ - pug i§"`»¤ ¤`·7¤
*v gy: * ~ =f. = · V ~ _ " * ‘__ g *~.;
¤ ’ ` · T7" A r _l .—v, -:~; Q ""· 2£§*?Y1 -2, r .‘r
`·· ' .`_‘·, a " rr iff . ; " § · »,`—'*·:'§;;·,'i.’$§ _
i _ _ " , j }
~ · ,2 - . ji?) 1 i _ ‘ ,'i < *§“"·"*l","‘ “.e
lr ; {zi., . Nil ‘ “‘ i :¥ ,¢··
, '·»~ » ` · = \ »·= ‘ *i€i;i`i i'ii`;;i€
Ti I,
E»s.·L.;, r?ir€ *1 .,,*.. Y ‘ . ' ‘ ` ~ . 2 .;. ’,E>ew$£ ‘ Wi?
_ "All glory be +0 God on high
w
{ And on +he ear+h be peace;
"ii Good will hence+or+h +rom heaven +0 men
Begin and never cease."
——While Shepherds Wa+ch'd
Nahum Ta+e. I'/OO

dr
We are deeply grateful to Mr. and Mrs. Charles l
S. Cheston, Jr. of Millis, Massachusetts, for allow-
ing us to use the photograph of their children, Chip
and Ginny, on the cover of this Bulletin and as our A
Christmas card to our friends around the world.
l
l
l
I
—;——-———i——; —-————————————-—-—-—.......__. j
FRONTIER NURSING SERVICE QUARTERLY BULLETIN g
Published at the end of each Quarter by the Frontier Nursing Service, Inc,
Lexington, Ky. {
Subscription Price $1.00 zi Year 1
]€¢lit01·’s Office: \v0Ild0V01', Kentucky ASK?
VOLUME 46 AUTUMN, 1970 NUMBER 2 V;
[ (
Second class postage paid at Lexington, Ky. 40507
Send Form 3579 to Frontier Nursing Service, Wendover, Ky. 41775
Copyright, 1970, Frontier Nursing Service, Inc. z I
L
1 L
. {4
S
i

' CONTENTS
; ARTICLE AUTHOR PAGE
A Letter We Appreciate 21
L ‘ Aunt Hattie’s Barn Sharon Koser 27
Beyond the Mountains 39
Field Notes (illus.) 44
i ( In Memoriam 29
· ` Mary Breckinridge Day (illus.) 15
Mary Breckinridge Hospital and
. ‘ Development Fund: Over the Goal 14
i Old Courier News 25
Old Staff News 32
Some Factors Involved in the
Acceptance and Rejection of the
; Family Nurse Maria Borsay 3
1 Ten Commandments in Verse M cGu ffey’s Second
1 Eclectic Reader 2
n This Little Angel . . . A Photograph, Inside Back
Z Cover
1 Women in Washington M rs. John Sherman Cooper 23
I
i g BRIEF Brrs
E Black Spell Brook The Countryman 22
= Candour The Countryman 50
{ Discussing Family Problems, . . . Modern Maturity 20
It Could Have Been "Guiseppiland" The Colonial Crier 43
{ ` Memories of the Kentucky Hills Della Int-Hout 28
O · The Bones of an Organization Contributed 26
The Scythe Tree Harold H elfer 31
{ Some Things . . . Modern Maturity 38
·I White Elephant 42

2 Faomumn NURSING swnvxcm __ Y I
TEN COMMANDMENTS IN VERSE i
I. Thou no gods shalT have buT me.
2. BeTore no idol bend The knee.
3. Take noT The name oT God in vain. I
4. Dare noT The sabbaTh—day proTane.
5. Give To Thy parenTs honor due.
6. Take heed ThaT Thou no murder do.
7. /\bsTain Trom words and deeds unclean.
8. STeal noT, Tor Thou by God arT seen.
9. Tell noT a willTul lie. nor love iT.
IO. \/\/haT is Thy neighbor`s do noT <:oveT.
WiTh all Thy soul love God above;
And as ThyselT Thy neighbor love.
MeeuHey‘e Second EclecTic Reader
Y
gg
I {

_ QUARTERLY BULLETIN s
SOME FACTORS INVOLVED IN THE
ACCEPTANCE AND REJECTION
_ OF THE FAMILY NURSE
Jl A report of a study conducted for the FNS
ln by
MARIA BORSAY, R.N., M.S.
= Doctoral Student in Anthropology
2 University of Kentucky
Lexington, Ky.
1970
,’ The Frontier Nursing Service (FNS), established more than
forty years ago, has as its chief goal the improvement of health
3 care delivery to a mountain population in southeastern Kentucky.
ir Health services in this area are otherwise quite limited, and
socioeconomic conditions are poor. The FNS maintains a small
hospital in Hyden, the county seat of Leslie county, and, in addi-
¥ tion, has six nursing outposts, some in a neighboring county,
_‘ manned by one or two nurses. There is easy communication
between the headquarters in Hyden and the nurses at the out-
posts. The service also operates a training program for nurse-
Q midwives-one of the few in the United States.
. The FNS now desires to enlarge its scope and is in the
process of setting up an educational program to train Family
Nurses. This Family Nurse will function in an extended role,
I making diagnoses and prescribing treatments within certain
limits which have not yet been fully specihed.
Since the FNS is concerned with the use of its Family Nurse
' graduates in other areas and by other agencies, it was deemed
‘ desirable to identify some of the factors that might contribute
@3* to the acceptance and/ or rejection of the Family Nurse, especially
.g among professional personnel. With that in mind, a study was
p made in the summer of 1970 at Hospital A in eastern Kentucky.
Q For purposes of comparision, a brief study was also carried out
j at Health Agency B, also in eastern Kentucky.

E
4 FRoN·r1ER NURSING smavxcn
Some Theoretical Considerations
Change, as a rule, does not come easily or without cost. Indi- ,
viduals or groups accept or reject innovations for a variety of —
interlocking reasons which are not always those which the inno-
vator or change agent intended. These factors that can con-
tribute to the acceptance or rejection of an innovation have been
studied by behavioral scientists, and some of them are relevant j
for the project at hand. They can be divided into "barriers" v
(factors that contribute to rejection) and "stimulants" (factors
that contribute to acceptance). E
One of the cultural barriers to change is the orientation of §
people to their past traditions. In non-industrial parts of the _E
world, change or novelty is rarely sought after; and when j
changes come, they are viewed with scepticism. If conservatism
is the rule, acceptance of a new idea may be delayed. Related to
this may be an attitude of fatalism, especially in areas where
medical and social services are lacking, with a consequent low
_ degree of mastery over nature. Fulfillment of the will of God is,
under the circumstances, the best adjustment a person can make {lj
to a rather hopeless situation. lj,
Since no change occurs in isolation, consideration must be
given to the secondary and tertiary changes that may result from ,
‘ the introduction of any given innovation. The example of a pebble
thrown into a pond is often used to illustrate this point. Thus, (
the reception an innovation gets often depends on the resultant K
changes it brings about or that people think it will bring about.
If these consequences (or expected consequences), are seen as
undesirable by the potential recipients, they become barriers.
Structural patterns of an institution (e.g. interpersonal rela-
tionships, degree of rigidity or openness, lines of authority) have I
important bearings on the ease with which change can be accom-
plished, as will be noted in this study. Similarly, identification l
with small groups provides satisfaction and security for most j,
people whether this is within the family or in a work situation. ‘_ "
An innovation which upsets such a familiar and established small W
group may meet with strong resistance; and economic rationality , 4
may be put aside for psychological security. On the other hand, _
although on the surface the small group or institution may pre- `_
sent an ideal image of solidarity, confiict and factionalism may

l
QUARTERLY BULLETIN 5
exist within the group; and these, too, may serve as a barrier
. to change. Vested interests also play a part in small group
Y dynamics in that certain changes may be interpreted as threaten-
ing to the group or to individuals within the group. Introducing
» a new type of health worker into a system, for example, may be
seen as potentially threatening competition.
The loci of authority (whether structural or charismatic)
Ji in a group or institution, and the related decision-making mecha-
nisms are also key factors in the acceptance of change. That is,
__ an individual in authority can do much to further acceptance or
~ rejection of an innovation, especially if he has decision-making
powers in regard to that particular innovation. He can use per-
suasion and the power of his position either to reject the new
¤ idea or to become an initial acceptor. In either case, he is usually
imitated by others since, in a bureaucratic organization, lines of
, authority are clearly defined and people expect to take orders
{ from those in superior positions.
In addition to the sorts of social and cultural factors men-
tioned above, psychological barriers can also affect a change
situation. What the innovator perceives as an advantage may
fj not appear so to the recipients. Communication, therefore, plays
a major role in change. It can facilitate equal perception of the
. innovation and its purpose by the recipient and the innovator.
iv Differential perception and differential expectations of role be- ·
{ havior constitute barriers.
3.; An understanding of the psychological factors that motivate
individuals or groups to change is also necessary for success.
? Desire for prestige is one such factor, and being the first to
try something new or emulate someone in a higher position may
offer such prestige: economic gain is another important motivat-
i ing factor in acceptance. Conversely, cost may be a serious deter-
_ rent. Many people may be ready to accept an innovation psycho-
logically but may be unable to afford it. The practical realization
*` of a new idea is often costly.
IY Although motivation is important, an innovation, to be suc-
ngq. cessful, must fit into the social structure of the institution or
I, 4 society. This simply means that a new role is accepted more
` easily if it can be integrated into an already existing and recog-
nized role.
Besides the above mentioned factors, the timing of the intro-
<

6 Fnoiwinn Nunsmc smnvxcm l
duction of the novelty can be a determining factor in acceptance _
or rejection. The people involved must not only recognize the l
need for the innovation, but the supporting circumstances. (e.g.,
economic conditions) must also be right. In this and in the case _
of other factors (social and psychological), barriers must be
neutralized as much as possible; and factors that might stimulate Fi
change must be identified. i

The Method of Study Y .
Data bearing on the questions posed in the previous section
were collected during June and July of 1970, using an unstruc- g
tured interview technique. ¥
At Hospital A interviews were conducted with all three phy-
sicians, nine of the eleven Registered Nurses (the other two were I;
unavailable at the time), one Licensed Practical Nurse, and the
pharmacist. Interviews with non-medical people included the »
business manager, two members of the hospital’s Board of Direc- I
tors, and several patients. In the comparative study of Agency B, F
the entire professional staff, with the exception of two nurses on
vacation, was interviewed.
Most of the nurses and some of the physicians were unfa- gi
miliar with the work of FNS nurses. The same was true of the ‘
meaning of "extended role" or "Family Nurse." Since neither Y
the "extended role" nor the exact concept of "Family Nurse"
has been deiined as yet by the FNS, it was necessary to devise ¥
an operational definition for the purposes of this study. The
explanation of these roles given by the investigator before each {
interview was the same as the one given to her by one of the Q
co—directors of the educational program; it consisted of the fol- _i
lowing statement: j
The FNS is in the process of setting up a new edu- Q
cational program for the Family Nurse. The purpose of i
the program is to give a formalized educational back-
ground for the work that the FNS district nurses are d
presently doing. They are and have been functioning in
a role that includes making some diagnoses and giving In
some treatments not traditionally a nursing role. I l,
Examples of conditions that such a Family Nurse might {
diagnose and treat were given from actual observations of FNS {
nurses; they included such things as anemia, worms, sinusitis,

‘ QUARTERLY BULLETIN 7
- and follicular tonsillitis. It was explained that midwifery was
? also part of the program and that on completion of her training,
the practitioner would be able to handle normal maternity cases
·, independently. The interviews were open-ended; and after the
brief explanation, the respondent was encouraged to express his
iq or her views on the "Family Nurse," the "extended role," and
lj the way such a person might function.
3 Findings at Hospital A
This hospital is a modern, thirty-bed facility in eastern Ken-
tucky, located on a good black top road. It is supported by and
is part of a voluntary organization. Living quarters for physi-
cians and staff surround the hospital. Hospital A is located near
one of the FNS outposts. The people living in the area know and
, can use both facilities for health care, and there is a collaborative
Z relationship between the two agencies. The area itself is rural
and poor, similar to the Hyden area. The nearest town is about
fifteen miles away.
Interviews with the staff revealed that the need for a well
fi prepared Family Nurse who could relieve the over-worked phy-
sicians was recognized by all professionals. One of the nurses
g who disapproved of nurses making diagnoses still wanted to see
a Family Nurse in her hospital because "there are not enough
Q doctors." Several suggested that such a nurse be used for screen-
. ing patients in the clinic "so that the doctor would not have to see
all the patients." As one physician said, "Doctors need more pro-
fessional help; they can’t do all the work themselves."
? Nurses and doctors, however, differed in their concepts and
j opinions concerning the role of the Family Nurse, the extent of
I her functioning, and the chances for her acceptance by profes-
{ sionals and laymen. In general, the physicians showed more
` acceptance for the Family Nurse than the nurses gave them
* credit for. They expressed caution, however, in discussing the
_• extent of her functioning. As one pointed out, "I would like to
* see how they function first." The limitation put on the nurse, he
I"? Said, would depend on her training and individual judgment, One
< of the physicians at Hospital A also expressed concern about
, the legal aspects of Family Nurse practice. He said he would
A not let this nurse function without close supervision since the
physician cannot relinquish his responsibility for patients.

s Faonrinp. mmsme smnvicn i
All of the physicians expressed concern about the acceptance V
of the Family Nurse by patients who, in this area, are used to
seeing a physician rather than a nurse. "The patients want to
see the doctor," one stated. This resistance, the doctors felt,
could be overcome slowly by building up the confidence of the
patients in the Family Nurse. One of the physicians who was 5;
worried about the patients accepting the nurse midwife thought J
it would be all right if the patient knew from the beginning that V
the nurse was going to do the delivery. With the Family Nurse,
this would be set up from the beginning, he said; and she could '
then go ahead on her own. ;
As already stated, the nursing staff showed little familiarity .
with the work of the FNS nurses or with the home background i
of their patients. Most said they had never seen a patient’s home. §
Although they all agreed that there is a need for a well prepared
Family Nurse, there was no homogeneous opinion as to the role
she could play. Some saw her only visiting homes, while others ,
saw her primarily within the hospital setting, especially in the
emergency room, prenatal clinic, and general clinic. j
Almost all the nurses expressed concern about the physicians
not accepting the Family Nurse in her extended role. She could ‘
not, they felt, function to her full capacity and would have to '
work her way up gradually. As one nurse said, "The work of F
the district nurse is necessary, otherwise many people would not é
get help. I don’t think the Family Nurse would be too well {
accepted by the doctors at iirst; they would need to be shown ,
that this person could be useful to them." Another expressed ·
similar feelings when she said, "Doctors would need time to get _‘
used to the idea of the Family Nurse."
Some nurses did not think they would themselves feel com- l
fortable in an extended role. Most emphasized the desire to have i
close supervision from doctors for themselves as well as the ‘
Family Nurse. "I would always like to have a doctor around for ._
security," one nurse stated. Another said, "The Family Nurse {
should work under the supervision of the doctor in giving treat- Y
ments and making home calls." 5
The nurses were fearful about the acceptance of the Family · T
Nurse by the people. They made the point that local girls familiar T
with the area would be better accepted, or else the Family Nurse `

QUARTERLY BULLETIN s
would have to familiarize herself with the area before the people
would trust her. As one nurse summarized it, "People here have
trouble trusting new people. The Family Nurse should make
home visits, and this would make her familiar with the area and
_ the people."
The local people’s attitude toward the Family Nurse was
Y. generally favorable and most were familiar with FNS services.
, Several said, however, that they would consult a doctor iirst if he
were available. "I would use a Family Nurse if I could not get
I to the hospital or would have to wait too long . . . I think every-
i one would use the nurse if they knew she would ask the doctor
A if in doubt," one informant said. The sample of laymen inter-
viewed, however, was small; and no homogeneous opinions were
obtained.
Findings at Agency B
Agency B operates a clinic, a home health agency, and pro-
vides services for prenatal care, delivery, and post-partum follow
S up. The setting is again a socioeconomically depressed area al-
[ though perhaps not quite as isolated as Hospital A. It is acces-
—_ sible to an Appalachian Regional Hospital in a larger town.
Q This area is not covered by FNS outposts, but maternity
._ services are provided by FNS nurses through the Agency clinic
by contractural arrangement. Here the Family Nurse in her
i extended role is well accepted by the physicians, mainly through
§ the influence of a British trained physician who said, "The mid-
v_ wives in England functioned in extended roles and saved me a
lot of work." He emphasized, however, that he would not extend
the role of the nurse quite to the extent now practiced by the
` FNS. He would not allow nurses to prescribe injectable medica-
, tions to which reactions could develop. "There is no need for
V- this. If the patient is sick enough for a penicillin injection, he
ld should see a doctor." A Family Nurse working at this Agency
E would have to function within the framework of the Agency.
( i Nurses at Agency B showed similar attitudes to the ones at
5 Hospital A. They expressed a need for a Family Nurse, especially
I in the area of home visiting. The director of the clinic thought
Q that Family Nurses could be used for screening patients in the
clinic and "there is a great need for home visiting. Doctors are

io Fnonnrmn NURSING smnvicn `
scarce and can’t do all the work." Nurses here also emphasized ”
the necessity for close supervision by the physicians and were
concerned about acceptance by the people. They felt that break-
ing down the people’s resistance to the Family Nurse might be
difficult. One nurse related that in the last two or three years
the clinic nurses took over some functions previously carried out
by physicians, and they met with a lot of resistance and made l
many enemies in the process. Another thought that "people pre- I,
fer old ways and are resistant to change." She felt that if nurses Q
could be local girls or familiar with the area they would be better
accepted. Several nurses also suggested calling the Family Nurse
something other than "nurse." She saw their role as one between in
nurse and physician. °
Local people were not interviewed concerning their attitude 'I
about the Family Nurse, with the exception of two health aides ,
on the home health agency staff whose attitudes may or may not
be representative of local feelings. They both stated that they ;
would not think of going to a nurse with any health problems
unless they could not find a physician. In this case, they would E
expect the nurse to contact a physician for them. As one of them
stated, "My iirst thought if I became ill would be to call the .
doctor and do what he said." ’
Conclusion and Recommendations ·
Before discussing any conclusions or recommendations, a ’
few words should be said about the limitations of this study. The ‘
data, collected as they were through interviews, reflect only the
attitudes expressed by the subjects and do not necessarily reflect ;
their actual behavior. Such information is usually a reflection c
of how a respondent thinks he ought to behave in a given situa- _
tion, and it usually incorporates the ideals accepted in his culture. r
Social scientists have often found discrepancies between the ideal ’
and actual behavior patterns. It is the difference between rules .
and practices. Behavioral patterns, or the actual modes of con- I
duct, cannot be obtained by the interview technique, although
it is reasonable to assume that most people try to behave in ways
they believe are approved by their society. The data are further
limited by the smallness of the samples. For these reasons, I `
generalizations derived from the study must be viewed with Q
caution.

QUARTERLY BULLETIN 11
I Keeping these limitations in mind, the investigator found no
homogeneous attitude at Hospital A that was resistant to the
Family Nurse. The staff did not express any severe obstacles
that would make for rejection, but they did caution that much
· will depend on the competence of the individual nurse. Neverthe-
W less, some barriers could be identified which, if not overcome,
il may hinder or delay acceptance. For one thing, cost seemed to
H be somewhat of a limiting factor to acceptance. Although most
— nurses cited cost as a definite obstacle, the business manager
» and some of the physicians did not think it prohibitive. They felt
i that if the need is proven, the money for at least one nurse could
be made available. Confusion over the legal status of the Family
, Nurse also caused some concern and might hinder immediate
acceptance. This concern was expressed mainly by the phar-
macist, the physicians and one or two nurses.
Although not particularly evident at Hospital A, the vested
` interests of physicians and nurses may prove to be a barrier to
acceptance of the Family Nurse in other geographic areas,
, especially where health care is delivered by physicians in private
. practice or where there is a higher ratio of physicians to patients.
·‘ This would be expected on the basis of some studies which have
Q shown that threatened loss of prestige or iinancial loss are often
A grounds for rejecting an innovation.
Several other factors were identified at Hospital A that
might contribute to the acceptance of the Family Nurse. One of
the major positive factors was the direct exposure of the physi-
. cians with decision-making powers in their institutions to the
; work of FNS nurses. A number of research studies have found
», that if a person in authority accepts an innovation, it usually
~ iilters down through the lines of the social structure and gains
` wider acceptance. Once a person with authority or great prestige
~ accepts an innovation, he can become both an advocate of it and
{ a model to be emulated by others. There would seem to be several
_ j avenues for increasing the exposure of physicians to the FNS
‘ nurse’s work-e.g., having the FNS nurse send more patient
Q referrals to the physician, personal contacts between nurse and
, physician, inviting the physician to participate in FNS activities,
? policy making, etc. All these approaches have been tried by FNS
‘. nurses and are thought to be successful by them.

2.
5
12 FRONTIER Nunsmo snnvicm __
The same may be true of the population in the area. That is,
increased exposure to the Family Nurse, especially involving U
community leaders, may begin to change the attitude of the ·
people from dependence on the doctor to dependence on the nurse 2
for health care. Increased availability of the nurse is not only
a convenience to the people but would also help to increase
exposure to her and contribute to easier acceptance. Another Q,
important factor is the inade-quate number of physicians in the Tl
area. This creates a need for a competent person such as the
Family Nurse who can relieve at least some of the load and at
the same time improve health care delivery to the general j
population. it
The role of the Family Nurse will have to be clearly defined I
in order to avoid duplication in health services. Since there are fl
many factors involved in defining this "extended role," it will -
require further study and careful deliberation. It may be that ;
a precise definition cannot be used in all situations and the final
role will be a product of negotiation between nurse and physician it
or nurse and the appropriate institution in each specific case. This °
approach could probably be used at Hospital A. Calling the
Family Nurse by a different name might facilitate her acceptance ·
by the nursing profession. Several nurses suggested that this be `
done. People generally tend to react to labels, and a new title ’
might alert people to the new and altered role. l
Clarification of the legal aspects of Family Nurse practice »
in Kentucky and nationally is also essential if this type of practi-
tioner is to gain acceptance. Several respondents mentioned this .
as an obstacle. Legal clarification might also facilitate role `
definition for the Family Nurse, enable the physician to share 1
his responsibilities with her, and establish a basis for a colleague .
relationship between them.
The above mentioned factors have implications for the edu-
cational program of the Family Nurse. For example, selection
and evaluation of candidates must be such that only those who
are competent, exercise good judgment, and display good inter- ;=
personal relationships are accepted into and graduated from the
program. These particular qualifications were emphasized by *
several respondents. Once the extended role of the Family Nurse q
has been defined, it should be possible to identify more precisely ,
l

l
lz QUARTERLY BULLETIN 13
E
iX the personal and professional qualifications necessary for candi-
i dates and select them accordingly.
The program for developing Family Nurses should include
theoretical as well as experimental content which would thor-
l oughly familiarize the candidate with the local culture. Several
1 respondents mentioned the necessity for this. Local nurses should
1 be encouraged to enter the program since they could do much
it to bridge the gap between professional health personnel and the
` local population. This would certainly contribute to a more
1 accepting attitude by the people.
Finally, it should be mentioned that a great many people in
nursing as well as medicine have been writing recently about the
need for a Family Nurse or a similarly qualified individual. A
j few of these articles are included in the bibliography at the end
l of this report. It is hoped that this report also reflects the need
A for this new role; and that, by identifying some of the factors
. that will influence acceptance or rejection of the Family Nurse
in a specific area, it will contribute to the wider acceptance of
‘ this practitioner.
_1 BIBLIOGRAPHY
· Beasley, W. B. Rogers, M.D. "Extension of Medical Services Through Nurse
_‘ Assistants? Journal of the Kentucky Medical Association, Feb. 1969.
* Mereness, Dorothy, "Recent Trends in Expanding Roles of the Nurse." Nurs-
· ing Outlook, May 1970.
Michaelson, Mike, "Will Your Next Doctor Be A Doctor'?" Today’s Health,
_ March 1970.
r Moxley, John H., "The Predicament in Man Healthpower." AJN., July 1968.
Q National Commission for the Study of Nursing and Nursing Education,
"Summary Report and Recommendationsf AJN., Feb. 1970.
I Olson, Edith V., "Needed: A Shake-Up in the Status Quo." AJN., July 1968.
` Reiter, Francis, "The Nurse C1inician." AJN., Feb. 1966.
Schlotfeld, Rozella M., "The Nurse’s View of the Changing Nurse-Physician
* Relationship? Journal of Medical Education., Aug. 1965.
` \

MARY BRECKINRIDGE HOSPITAL
AND DEVELOPMENT FUND
Over The Goal
On Monday, September 21, the Frontier Nursing Service I
received a letter from The Andrew W. Mellon Foundation making P
a grant of $80,000.00 "to assist in the construction of the new
hospital." This grant put us over our goal in pledges which total
$2,803,633.00. As the fund is called the Mary Breckinridge Hos-
pital and Development Fund, we must not consider our efforts `Q
finished. We have reached our goal for construction of the Mary `
Breckinridge Hospital but as development is an on-going process, ~
we hope our friends will continue to support us at this exciting
time in the Service’s growth. We will build a new hospital-
ground was broken on Mary Breckinridge Day, October 3-but W
we will need more staff-, equipment and many unforeseen things. ,0
Recognition for their rewarding efforts is given to several ,
groups on which the FNS has depended since its beginning. First, Q
to the people with whom we work in eastern Kentucky. Under ?
the guidance of the chairmen of our eight local committees, they
met their initial goal of $25,000.00 in the summer of 1967. They
promptly doubled their goal and lack less than ten thousand
dollars of reaching it. We are certain they will achieve their _
goal before construction of the hospital is completed. ,
Our Board of Governors and our staff and all those men and ;
women of the mountains who work to keep the FNS going con-
tributed one hundred percent to the Fund. The fund raising ,`
chairmen in our city committees and all the volunteers who
helped them have won the FNS many new friends. We shall hope
to keep their interest and support as we march into the future. ,
Our friends may be interested in reading the following statistical i
breakdown of donations: _,
Gifts of: Number of Donors `
Less than $50.00 785 ‘
$50.00 - $99.00 257 _
$100.00 - $499.00 501 pg
$500.00 - $999.00 105 .
$1,000.00 - $9,999.00 215
$10,000.00 and over 59 A
Our deep appreciation goes to each and every one whose
generosity contributed to the success of the fund drive.

QUARTERLY BULLETIN 15
, MARY BRECKINRIDGE DAY
f On Saturday, October 1, 1927, Mrs. S. C. Henning of Louis-
I ville, a Vice Chairman of the Kentucky Committee for Mothers
and Babies, and Judge L. D. Lewis, the chairman of the Hyden
i District Committee, laid the cornerstones for the two wings of
ig the Hyden Health Center and Cottage Hospital.
Forty-three years later, almost to the day, Mrs. Jefferson
‘ Patterson, National Chairman of the Frontier Nursing Service,
broke ground for the Mary Breckinridge Hospital and the Fron-
tier Nursing Clinical Training Center in Hyden. Saturday, Octo-
ber 3