INNOVATIONS IN HEALTH CARE

There could be no more timely occasion for the appearance of this issue of Advances in Nursing Science. The United States is finally implementing a landmark health care law that moves in the direction of providing affordable and accessible health care for more citizens than ever before. Many other countries in the world already provide access to basic health care and community-based wellness services, and now the United States embarks on a historical initiative to shift in this direction as well. The US law calls for a more prominent emphasis on health-promotion and disease-prevention and community-based services, and nurses are called upon to be key providers in making these services available.

The fact is that nurses have created innovative approaches to care for decades. In the early 1900s, Lillian Wald and her colleagues founded the "House on Henry Street" to provide a wide range of community-based services to immigrant families in need. In the middle of the last century, Lydia Hall established the Loeb Center for Nursing and Rehabilitation, where she implemented her theory of nursing care with nursing at the center. In my own career, several schools of nursing where I taught established mobile and community nursing care clinics, staffed by faculty and students, to provide community-based wellness care and chronic illness management. Each of these attempts provided a demonstration of the possible and evidence that clearly supported the approach. But far too often, these initiatives fell by the wayside, lacking sustainable systems of support, politically and financially.

Now, the time has come for nurses to come together as never before to revive some of the innovative models that existed in the past and to creatively forge ahead into uncharted territory. Many obstacles still exist, but there is a window of opportunity that exists in the context of massive changes happening in health care around the world. An excellent example is the Rutgers nursing schools in New Jersey, where faculty have created a model program that is designed to meet the needs of underserved urban communities in the Newark, New Jersey, area. (See video "Revolutionizaing Urban Health Care" at http://www.youtube.com/watch?v=5jusxmtdqto.)

Most of the projects of the past, and those of today, are projects focused on community care. This is timely in that there is wide recognition that community-based care is a key component of effective models of care. Years ago, Jo Ann Ashley often admonished nurses that we would need to leave hospitals in order to practice nursing. But hospitals remain, and nurses do remain in hospitals. Today, I believe that nurses can and must address the imperatives for change in every context where nurses practice. But unless nurses take drastic action to create innovative change in hospitals, Jo Ann's words remain all too relevant.

We need strong models of care that are grounded in fundamental nursing values at the bedside, at the curbside, at the chairside-wherever people are who can benefit from the kind of care that nurses can and do provide. The time for innovation is here. The articles in this issue challenge all readers to consider possibilities and to take action to build on the work of these authors and the shoulders of the brilliant nurses of the past who have paved the way for innovation.

-Peggy L. Chinn, PhD, RN, FAAN

Editor