Montana State University

Mountains and Minds

Photo by Kelly Gorham

Return of the native October 12, 2012 by Phillip Luebke • Published 10/12/12

Helen Lee's return to Montana State helped establish the College of Nursing as a leader in rural nursing research and rural nursing theory development
Because Helen Lee came home again, the quality and understanding of health care in Montana and other rural areas has benefitted.

Lee, a Montana State University professor emeritus in nursing, was 24 when she first left the state. It was 1960 and she had just earned her master's degree in nursing from Montana State College. Up to that point, she had spent her entire life in her hometown of Carter, as well as Great Falls and Bozeman. Much of her education, and even her first job, were in the very same hospital in which she had been born.

"(I) leaped at the opportunity to go other places," Lee recalled.

And over the next 16 years, go other places she did. Lee held 12 different nursing and teaching jobs in hospitals and colleges in Washington, Texas, South Dakota, California and even Denmark.

But she returned to take a job as an assistant professor on MSC's Great Falls campus in 1976, at a turning point in the history of the nursing program.

Anna Shannon, who had become director of the Montana State School of Nursing the year before, had plans for the future of the school that were rooted in Montana's rural make-up. Shannon noted that little emphasis had been placed on the environment in the early work on nursing theories, and there was a huge void in the available literature. None of the scholarly journals at the time contained any research on rural nursing. Shannon wanted Montana State to become a leader in rural nursing research, and Lee possessed the wide and varied experience, as well as a rural Montana upbringing, that would help the school fill that absence.

"I knew (Montana State was) going to be studying rural nursing and it was a prime opportunity for me to zero in on what's different about it," Lee said.

Lee became part of a working group that helped develop a theoretical model of the practice of rural nursing. Shannon, along with fellow MSU professors Jacqueline Taylor and Ruth Ludeman, won a U.S. Public Health Service training grant, which funded the creation of MSU's master's degree program in rural nursing in the late 1970s. Graduate students, faculty, administrators and consultants developed the theory, and hundreds of interviews with rural Montanans were conducted to test it. Their work led to the seminal 1989 article on rural nursing theory written by two of Lee's colleagues, Kathleen Long and Clarann Weinert.

According to the article, "subcultural values, norms, and beliefs play key roles in how rural people define health and from whom they seek advice and care. These values and beliefs, combined with the realities of rural living--such as weather, distance, and isolation--markedly affect the practice of nursing in rural settings."

Rural area nurses have to be Jacks-of-all-trades, often providing services that would be provided by multiple specialists in other health care disciplines in urban areas.
"One of the challenges in a rural area is having people with adequate education to treat people where they are," Lee said of the article. "Look at the distances between spaces (in Montana). You want to know that when you're in a rural area, that you can at least get the initial care that you need to be treated and gain function."

Lee points out that many people, particularly in eastern Montana, are many miles away from their medical and nursing caregivers. And, she said, working as a nurse in a rural area has its own unique challenges. Nurses have to be jacks-of-all-trades, often providing services that would be provided by multiple specialists in other health care disciplines in urban areas.

After the publication of the 1989 article by Long and Weinert, MSU's work in rural nursing began attracting a lot of interest from nurses, educators and researchers working in rural environments in other parts of the world, so Long suggested that they write a book to share what they had learned. Lee turned Long's idea into a reality, compiling the works of College of Nursing faculty and students into Conceptual Basis for Rural Nursing, which was published in 1998. Facilitating the publication was a grant from the Montana Consortium for Excellence in Health Care obtained through the efforts of Jane Scharff, MSU nursing professor and a book chapter contributor.

For a niche publication with a limited audience (the topic largely has relevancy for nurse educators, researchers, policy makers and clinicians interested in providing effective health care to the 16-21 percent of the U.S. population that lives in rural areas), the book has been a resounding success, with second and third editions published under the revised title Rural Nursing: Concepts, Theory, and Practice in 2005 and 2009.

The fourth edition of Rural Nursing: Concepts, Theory, and Practice is expected to be released next February. Lee has stepped aside as editor, but she did contribute to the foreword and updated one of the chapters.

"I think it's pretty great that the book is continuing on," Lee said about the fourth edition. "Having the book still viable and the publishing company wanting to continue to publish it means that there are a lot of people who are interested."

Lee credits the success of the books and the development of the rural nursing program at MSU to many people. However, according to Charlene Winters, associate professor at MSU, co-editor with Lee on the second and third editions and editor of the fourth edition, "Helen Lee's role has been critical to the development of MSU's reputation as a leader in rural nursing research and rural nursing theory development."

Serving as the editor of the leading texts on rural nursing qualifies one as an expert, and Lee has spoken about rural nursing and rural nursing theory around the globe. She has used her publishing success to pour money back into the topics for which she's so passionate. Royalties from her books go to an endowment fund she established at the MSU Alumni Foundation in 1999 to encourage students and faculty to pursue rural nursing research. Lee said she established the endowment because it's hard to find funding for rural nursing research, and she wanted to make sure that money was available for students who came through their program with an interest in rural nursing research.

In 2009 she also made a planned gift that will support graduate nursing when she's gone.

"We're only here for a little while," Lee said of the reason behind the gift. "I think I'm just one step along the way for some people. I grew up with a bias about the importance of education. I received that bias from my father who had a sixth grade education and emigrated from Denmark at the age of 19."

Passing on the legacy

Since the Helen Jacobsen Lee Endowment was established, it has funded up to three $500 awards annually to MSU nursing students to conduct rural nursing research. One of the beneficiaries of Lee's endowment is Laura Larsson, now an assistant professor in the College of Nursing at MSU.

In 2004, Larsson received an award to help her conduct research on rural community leaders' perceptions of environmental health risks.

Although Larsson has never met Lee, she says that at the time, she knew her name as a prominent researcher, author of the rural nursing theory textbook and a well-respected member of their faculty.

"I remember being amazed that she had set aside money and had created this endowment so that students and others could have money to work on rural research and advance nursing science," Larsson said. "I thought that was a pretty impressive legacy to leave.

"The work that I did when I was supported by her endowment really did lead to that decision (to become a research nurse and educator)."

Larsson has also established herself as an expert in rural nursing research. She has won a $350,000 grant from the Robert Wood Johnson Foundation to study how to reduce radon exposure among low-income people in rural areas. She was also one of 12 nurse educators in the U.S. who was named a Robert Wood Johnson Faculty Scholar. This April, Larsson received the Sigma Theta Tau International, Zeta Upsilon chapter's recognition award for scholarship, outstanding leadership qualities, high professional standards, creative work and commitment to the ideal and purpose of nursing. She has also gone on to mentor other scholars from underserved backgrounds through the McNair Scholars program.

Beyond the legacy of Lee's endowment, Larsson points out that Lee has given MSU some pretty amazing intellectual gifts as well.

"I think that Dr. Lee was very pioneering in the sense that she wanted rural nurses and rural nurse scientists to understand what was unique about doing this work in this area, and that has guided the discovery that has gone on in nursing during her time and since then," Larsson said. "Like every other discipline, the work we do advances the science and informs the folks who are out doing home visitations, or at the bedside." ■