As described in Chapter 2, Mary Breckinridge founded the Frontier Nursing Service in 1925, with nurse midwives providing care to clients in their own homes. Nurses traveled by horseback and on foot...

As described in Chapter 2, Mary Breckinridge founded the Frontier Nursing Service in 1925, with nurse midwives providing care to clients in their own homes. Nurses traveled by horseback and on foot into the sparsely populated hollows of Kentucky (Stone, 2011). Today, nurse practitioners working in nursemanaged clinics in rural Appalachian communities in Virginia were interviewed about their practices (Caldwell, 2007) and spoke about their connections to the people and communities they serve. One said, “Here you get to know the whole family and that is rewarding…you know what is important to them… what their worries and concerns are….so you probably get closer to your patient in this area than you might outside here. It becomes an extended family, which is very rewarding” (p. 76). Another NP described a man with severe COPD who visited her clinic. He was also a patient of another area provider, but when the NP examined the man, she noticed the gauze 4×4 he had on the back of his neck and inquired about it. The man said he “cut himself shaving.” The NP pressed the man to see the wound and found that he had “cancer with the bone exposed,” describing it as “the most awful thing that I had ever seen in my life. I could put my fist in there. And you could see his carotids pulsating.” She told the patient how serious this was and arranged for a plastic surgeon to see him right away. He had a total neck resection and recovered completely. She reflected, “What if I had accepted his story about the sore and it being all right? It was not what he was coming to see me for……I look at more than just the chief complaint” (p. 77). For these nurses, isolation was considered a positive aspect of their professional practice. It encouraged connection and caring relationships with their patients. (Caldwell, 2007; Stone, 2011).