Sometime ago, Dr. John Brownsberger, medical superintendent of the Mountain Sanitarium and Hospital at Fletcher, North Carolina, was asked to prepare a paper on "Nursing Education and Nursing Service in Rural Areas." This paper was presented at a meeting of the Southern Institute of Hospital Administrators, held at Duke University, August 4.
Many local papers of the Southland printed large sections of this report, and one New York daily presented a front-page half-column abstract. The paper reemphasizes the ideals of community service and education held by our institutions, and has so much of value, that we herewith present a rather extensive abstract for the readers of the Ministry.
"In presenting this problem I have not attempted to consider the basic curriculum of schools of nursing, taking it for granted that the curriculum advocated by the National League of Nursing Education is and should be the basis of study in schools of nursing, not only in urban areas, but in rural areas as well. However, in making a study of the rural situation, especially in the Southern States, and profiting by our own experience in operating a school of nursing in a rural district, we find different problems and conditions which require some additions and adjustments in the nurses' education which we feel will aid in better preparing nurses to work in rural districts."
After discussing the need of better medical and nursing service, with special emphasis on the need of "well-trained superior nurse midwives," Doctor Brownsberger continues:
"There are other rural needs for which our nurses should be prepared. There is the field of health preservation, or preventive activities; health education in the school and home; and the ever-present need of nursing the sick in the rural home. If we are to graduate nurses who are willing to go into rural areas, who are willing to endure the isolation, the inconveniences, and the poor pay, the education of the rural nurse should begin early in the course with a well-planned scheme for the integration of rural needs throughout the entire basic course. Schools of nursing located in small towns or rural areas would do well to incorporate in their objectives the preparation of the nurse for community service in rural areas, the training of the rural-minded professional nurse. In order to do this, no radical changes are necessary, but rather a careful integration of the rural idea in all class instruction and clinical experience. We recognize that the integration of the public health and social aspects are important throughout the basic course. . . .
"In attempting to integrate the rural-nursing idea in the basic course, there should be a well-planned scheme for the continuity of rural public health teaching beginning in the preliminary period and continuing through the entire three-year course.
"In the first year, the student should be orientated to the rural community in which the school is located. Observation visits may be made in homes of the rural people, and contacts made with the county health department and its nursing staff, with the Red Cross nursing service if it operates in that community, and with all other health-promotion agencies at work in that area. Case studies may be selected from patients who live in the local rural vicinity, and arrangements made for student nurses to follow up such patients after their dismissal from the hospital.
"Formal class instruction may well include a course in rural sociology. In one school we noted that such a course was incorporated in the curriculum. This school utilized county farm agents and health officers to present the local economic and health conditions of the county. The course was climaxed by a trip of the entire class to the well-known John C. Campbell Folk School in Brasstown, North Carolina, where country living is made unusually attractive and successful. Reference reading of inspirational and educational books dealing with country life and its problems was required as a part of this course. One student nurse, a city girl from one of our larger Southern cities, was heard to remark at the termination of the class, 'I always thought that I could never stand to live in the country, but now I not only want to work there, but I want to make my home there as well.'
"In the second year the integration of rural health should continue, with observation and independent visits in the home, follow-up visits to clinic cases and hospital dismissals, and contacts and observation of the school nurse at work. Continued efforts should be made to acquaint the student with tuberculosis and venereal disease control, and other social problems of the community.
"During the third year, a month's field experience with the public health nurse of the county or with the school's community nurse, would give the student one of the best opportunities for acquaintance with rural needs. A rotating service of one month in such work would contribute largely to the education of the potential rural nurse. Many schools and hospitals find this difficult to arrange, because of financial problems and various complications. When schools of nursing can arrange such an affiliation with county health departments for monthly services in field work, this would be ideal.
"The outpatient department also has unlimited resources for educating the student for rural work, especially when opportunity is given for follow-up work in the homes. The course in obstetrics offers excellent opportunities for integration of rural public health. Rural home deliveries, by resident or staff physicians, assisted by graduate and student nurses, aid in preparing the student for rural nursing. Prenatal and postnatal care and preparations for home deliveries may be stressed in the classroom and practiced in the community.
"In the course known as Community Health, home-hygiene classes or health-preservation courses should be organized by the instructor for the women in the community, student nurses assisting in instruction and demonstration. Just last week it was my privilege to attend the closing exercises of such a class, held in a rural Negro church for a group of Negro women. The course was twenty-four hours in length, two hours a week for twelve weeks, and was taught by a graduate nurse on the school of nursing faculty. Not only did the student nurses participate in the practical instruction on the proper care of the body and simple ways of caring for the family's health, but they went beyond that and helped to organize garden, corn, and poultry contests in order that these Negro mothers and their families might be encouraged to raise foods essential for the health of their families. This helped the student nurse to understand the relationship between good health and the economic status of the family.
"Even the extracurricular activities may serve to inculcate the rural idea in the student. Rural, health-giving types of recreation, such as camping in the open, mountain climbing, hiking, trips to nature's beauty spots in the county, will all contribute to fit the student nurse for rural life. In one school the Christmas season offered opportunity for the student nurse to further contact the needs of the rural people. A list of former patients from impoverished rural homes was secured; visits were made to some of these homes in order to ascertain the needs of the families ; student nurses organized a campaign to raise funds to meet these needs in order to bring cheer and comfort to these destitute families. These nurses called on department-store managers of near-by towns, soliciting gifts of broken toys or shelf-worn clothes. These were gathered together, mended, repaired, and then, with funds collected on a dime-board placed in the hospital lobby, fruit, candy, and nuts were purchased. Heavily laden with 'boxes for each family, the student nurses, at an early morning hour, drove by truck from home to home, distributing gifts and singing carols. Small incidents these are in the education of the nurse, but they all contribute to the development of the rural-minded nurse.
"I have cited but a few of the opportunities in the basic course for the integration of the rural public health problem in formal class instruction, in clinical experience, and in extracurricular activities of the school. There are many others, but time forbids further discussion.
"We recognize that a nurse graduating from a school in which the rural health needs are stressed is not ready for active rural public health responsibilities. Special study in the postgraduate field is necessary. Such nurses should further qualify themselves by enrolling in some of the splendid public health courses offered by our universities. But the integration of the rural health idea in the basic course does promote an interest in, and fosters an ambition for, this type of service, and the possibilities are greater that the nurse so trained will more willingly serve in rural areas."
K. L. J.
