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Discusses development, governing principles, community-based nursing of Frontier School of Midwifery & Family Nursing. Health care delivery in rural areas.... More...
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Paper Abstract:
Discusses development, governing principles, community-based nursing of Frontier School of Midwifery & Family Nursing. Health care delivery in rural areas.

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This research examines the origins, development, and practice of the Frontier School of Midwifery & Family Nursing. The research will set forth the background and context in which the Frontier School came about and then discuss its governing principles as well as its institutional position in the larger scheme of nursing training and practice in the US. The evolution of public health care in the US is inextricably tied to what turned out to be the establishment of institutional-based medical-care delivery on one hand, and medical-care delivery controlled and administered by professionals licensed for the purpose and under the state-sanctioned authority of physicians and institutions. This has historically made the position of nurses and the function of nursing problematic from both theoretical and practical persp

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What that implied was a commitment to formaltraining in the craft, especially in view of the fact that during the 192 sthe medical specialty of obstetrics was gaining in prominence and began tosee midwifery in competitive terms. Public Health Reports, 112, 386-94. (1999, October). The CNEP concept ofproviding distance-learning opportunities to beginning and advanced nurse-midwives and of fostering a structure of nursing practice that reflects acertain degree of autonomy and authority for practitioners (Frontier,2 ). Hyden, Ky.: Frontier School of Midwifery & Family Nursing.Retrieved from the World Wide Web 15 April 2 , athttp://www.midwives.org. (1996, July). 3). Health promotion and client learning needs.Interpersonal Relationships: Professional Communication Skills for Nurses.3d ed. (1997, September-October). Nursing, 29, 62. 39 ). The relationship between client and nurse, backedup by the nurse's understanding of the client's real-world experience, thusbecomes an element of care: The goals of health promotion and prevention include understanding health-related threats to vulnerable populations, ensuring equity in health care, and preserving ad enhancing quality of life for all health care consumers (Arnold, 1999, "Promotion," pp. In 1984, in the wake of theestablishment of a free-standing birth center, the American Academy ofPediatrics and the American College of Obstetricians and Gynecologistscautioned: "Until scientific studies are available to evaluate safety infreestanding [birth] centers, the use of such centers cannot be encouraged"(O'Mara, 1999, p. Elizabeth Arnold & Kathleen Undermann Boggs (Eds.). Only in 1971 did the American Collegeof Obstetricians and Gynecologists officially recognize the value of nursemidwifery, by way of a joint statement with the American College of Nurse-Midwives. . We've come a long way, babies. Saunders Company/Harcourt Brace. Cullen, A. Throughout the literature ofnursing is reflected a presumption that nurses should perform withfriendliness, expertise, and compassion according to the expectations ofpatients and family (Grossman, 1996)--even when those expectations fly inthe face of institutional hierarchical arrangements and even though nursesas a group bear much responsibility and little authority (Shindul-Rothschild, Berry, & Long-Middleton, 1996; Cullen, 1995). Wasson, A. New stamp honors Mary Breckinridge. As of the late 199 s, the so-called medical model and the nurse-midwife model of obstetrical care have been differentiated, with statisticspointing to the fact that low-risk births under the latter model were nomore likely to result in maternal or infant mortality than those of theformer (Gabay & Wolfe, 1997). The FGSM, established in 1939, was partly a response to theoutbreak of World War II, which sent British nurse-midwives back home andmade it impossible for American nurse-midwife recruits to use scholarshipsto Britain (Frontier, 2 , p. Frontier Nursing Service. References Arnold, E. 347-8).Embedded in this idea is also the notion of cultural sensitivity, itself afeature of the tradition of compassionate caring long associated withnursing. Still more were they in the background of the emergence ofthe Frontier Nursing Service (FNS), which began in 1925 and which was andremains based in the state of Kentucky (Frontier, 2 ). American Journal of Nursing, 96,25-39. History of the FNP Program at Frontier NursingService. 63). Her original vision was that a Family Nurse, supervised by an areaphysician, would be the primary care provider for the people there.Midwifery appears to have come to the fore, more or less the practicalproduct of the evolution of medical need: [Midwives] were the only care providers to have contact with many families [and] began to offer care to families beyond the intrapartum period. Saunders Company/Harcourt Brace. The evolution of public health care in the US is inextricably tied towhat turned out to be the establishment of institutional-based medical-caredelivery on one hand, and medical-care delivery controlled and administeredby professionals licensed for the purpose and under the state-sanctionedauthority of physicians and institutions. 368-92. Where have all the nurses gone? Thus in the background of theseemingly straightforward statement that Breckinridge's service "begantraining midwives and stimulated the establishment of other midwiferyschools" (Breckinridge, 1998, p. Indeed, FNS inmore recent years seems to have been well positioned to respond to thegrowth of the concept of community-based nursing in general, and whatbecame in particular the Community-Based Nurse-Midwifery Education Program(CNEP) after its pilot-program experiment at the FNS. CNEP concepts are connected, too, with the more general notions ofcommunity-based health care promulgated by the US Department of Health andHuman Services, beginning in the 199 s, that deal with the notion of client-nurse/caregiver partnerships aimed at preventive and maintenance care andhealth-care instruction quite as much as heroic intervention (Arnold, 1999,"Teaching," pp. Breckinridge always "viewed nurse-midwifery as central to health care"(Frontier, 2 , p. (2 ). 3). In 1932, when Twilight Sleep was still theprincipal feature of hospital childbirth, that figure had risen.) Even though urbanizing and ever-more-industrializing America began tomake greater and greater use of physician-attended childbirths in hospitalsin the 192 s, as a practical matter the women in rural areas of the US werea population markedly underserved by professional medical care.Institutional health care was not merely unaffordable for women in remoteareas but was inaccessible as well. It is therefore perhaps not too much to suggest that without thehighly specialized caregiving efforts of Breckinridge to serve aspecifically vulnerable population in situ in the 192 s, the whole conceptof community-based nursing--still less the conceptualization of a nursepractitioner possessing and acting autonomously rather than being tied toinstitutional protocols--might not have emerged as a forceful and effective2 th-century concept before the century ended. . Additionally, many states "werebeginning to establish minimum requirements with respect to the educationand training of midwives and for the supervision and regulation of theirpractices" (Gabay & Wolfe, 1997, p. But old habits appear to die hard. Now all of these considerations are or have been at issue in themodern period. But thedevelopment of the FNS must be viewed in an even wider historicalperspective. This has historically made theposition of nurses and the function of nursing problematic from boththeoretical and practical perspectives. Burnout: why do we blame the nurse?American Journal of Nursing, 95, 22-7. (1999). 369ff). Thus the role of Breckinridge in structuringnurse-midwife training is difficult to overstate, especially since the FNSwas so vital in the project of reaching populations that might otherwisehave gone altogether unserved by competent medical care. Cultural dimensions in home health nursing.American Journal of Nursing, 96, 33-6. What is noteworthy about these general goals, however, is how muchthey appear to depend on the pioneering work of nurse-midwives. But the growth in importance and recognition of the value ofnurse practitioners such as certified nurse midwifes demonstrates that thenurses' most important work is by no means remaining invisible to thehealth-care-delivery process while also filling the role of institutionalfactotum. Indeed, until 1914, when so-calledTwilight Sleep for the mother was introduced into the childbirth process,midwives attended most American childbirths in private homes, even in urbanareas. (In 1915, by the way, the US led the industrial world in the numberof childbirth deaths per 1, . Health teaching in the nurse-client relationship.Interpersonal Relationships: Professional Communication Skills for Nurses.3d ed. Embedded in that was an ethos of care, as indicated in the text of anotice of a commemorative stamp honoring Breckinridge, which cites hercredo: "If the father would come for the nurse, the nurse would get to themother, even if she had to make her way on foot" (New stamp, 1999, p. 347-67. O'Mara, P. Together, FNS and FGSM appear to have functioned as a model for whatover the years has come to be characterized as the expanded role of nursesin the wider scheme of health-care delivery. [T]he nurse midwives treated minor medical problems of the family and instructed family members in such matters as personal hygiene, nutrition, sanitation, and disease prevention (Wasson, 2 ). The research will set forththe background and context in which the Frontier School came about and thendiscuss its governing principles as well as its institutional position inthe larger scheme of nursing training and practice in the US. Nurse-midwifery: thebeneficial alternative. Grossman, D. Mothering,56. (1999, January). 145). To be sure, as Gabay and Wolfe(1997) point out, the profession of midwifery grew very slowly over thedecades, despite the fact that US obstetrical-specialty care was increasingin cost, in its use of high technology, and in its infant mortality ratesvis-à-vis other industrialized countries, in the face of the rathersuperior track record (for low-risk births), on all fronts, of certifiednurse-midwives over the same period. One of these schools was in Kentucky, under theauspices of Mary Breckinridge and the FNS: the Frontier Graduate School ofMidwifery. Undoubtedly, nurses in general are uniquely positioned to enable andfacilitate optimal practice of the physician's art, not least becausenurses have the closest and most frequent contact with the patient and canreadily function as liaison between patient and the rest of a health-caredelivery team. (1999). 62).Indeed, nurses in the FNS were more than likely to reach patients onhorseback or on foot, often exposing themselves to physical dangers(Breckinridge, 1998, p. In 1931, childbirth statistics revealed that countries withmidwife-based obstetrics had lower infant mortality rates than those withphysician/hospital-based practice (O'Mara, 1999). Philadelphia:W.B. Shindul-Rothschild, J., Berry, D., & Long-Middleton, E. The effect of this positioning of Family Nurses in the scheme of ruralmedicine was to create "a new model for rural maternity care" (O'Mara,1999). According to Wasson (2 ), Breckinridge was respondingto found conditions: the shortage of physicians in rural Kentucky at thetime. Gabay, M., & Wolfe, S.M. The facts of American medical history were kinder to Breckinridge andmidwifery than to institutional maternity praxis and the emerging specialtyof obstetrics. This research examines the origins, development, and practice of theFrontier School of Midwifery & Family Nursing. Hyden, Ky.: Frontier School of Midwifery & Family Nursing. That same year, the firstformal training school for nurse-midwives was established in New York City(O'Mara, 1999; Gabay & Wolfe, 1997), and many more were created over thecourse of the decade. Arnold, E. Indeed, if nurses do not have reasonable input, authority, andautonomy within a caregiving system, they may be unduly burdened by it,disregarded as lacking credibility if they seek to address inequitablepower or duty arrangements within it, or de facto forced (or "burned") outof it, lacking motivation to stay in it, to many patients' great cost(Cullen, 1995). (2 ). . 145), was a rather more complex reality.Breckinridge was obliged to either send American Family Nurse recruits (onscholarship) to England for training as nurse-midwives or to recruitBritish nurse-midwives for service in rural Kentucky. (1995, November). Elizabeth Arnold & Kathleen Undermann Boggs (Eds.). (1996,November). Into this situation in 1925 came oneMary Breckinridge, a nurse-midwife trained in England, who established whatwas called the Frontier Nursing Service in the Appalachian Mountains ofsouthern Kentucky. As O'Mara points out (1999), it was not until the 192 s thatthe majority of middle class women were routinely giving birth inhospitals, attended by physicians. Frontier school of midwifery & familynursing. Philadelphia:W.B.

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