The health care delivery system remains in a state of flux, placing increased demands on nurses. The plight of individuals, poverty, hopelessness, and an aging population all have implications for the delivery of health care. These societal and health care trends demand the establishment of new conventions. Unconventional modes of nursing practice merit exploration; the mavericks of current practice are likely to become normative conventions of tomorrow. This issue of Holistic Nursing Practice introduces the reader to new conventions for nursing practice. The scholarship of practice is demonstrated through inquiry, seeking different and better ways to practice nursing. It involves taking risks, testing clinical competence, and questioning conventional modes of operation. 1 Initially the readers are introduced to a paradoxical presentation of service as an innovative form of scholarship of application. Here Capers and Wessman examine service from academic and practice perspectives of professional nurses. Emphasis is placed on the evolution of service with data and case studies provided to illustrate various ways in which nurses are expertly providing service to the profession and community. The need to further explore the innovative contributions nurses make through scholarly service is stressed.

Then in juxtaposition with the service adage, contemporary events associated with the development of a nurse-managed clinic in an urban community are explored. Kinion offers descriptive information about the development of primary care services to urban American Indians who were without health care insurance. Perceived barriers to care are discussed, cultural sensitivity is addressed, and patient situations are presented.

Next, a collection of cutting edge practice scenarios addressing innovative care in the community with vulnerable populations is provided. Gerberich describes a service learning approach combining academic learning objectives of community nursing students and the health care needs of homeless men. DiMarco, who plays dual roles as an instructor and a nurse practitioner, explains the complexity of the role and experiences of a pediatric nurse practitioner at a clinic in a homeless shelter. Sadler, Huff, and Harrigan note that the advantages of providing health promotional services to persons in a correctional facility are felt by the client and the practitioner. Through their practice client needs are met while professional goals of faculty practice and service are achieved. Mitzel-Wilkinson extends the focus on innovation through her article on massage therapy as a nursing practice; holistic and faculty practice models are addressed. Together these four articles provide key insights about meeting needs of vulnerable populations along with promoting faculty practice and facilitating student learning.

The next group of articles addresses clinical approaches, theoretical interventions and nursing studies that spur unique nursing practice. Glanville highlights the importance of health-oriented patient education (HOPE) to better meet the education needs of individuals and groups. She notes that nurse practitioners are well suited to provide care that facilitates behavioral change through the HOPE approach. Kolanowski and Whall use the Need-driven Dementia-compromised Behavior Model to demonstrate holistic interventions. This model provides a view of dementia behaviors through understanding client situations. Schwarz and Roberts draw on the theoretical tenets of social support in their work about the role of social support in moderating the effects of strain and depressive symptomatology of family caregivers for functionally impaired older adults. The findings suggest that nursing must continue to examine the myriad factors influencing caregivers. Dowd, Kolcaba, and Steiner bring attention to compromised urinary bladder syndrome, a common clinical problem, and report their findings related to how a holistic cognitive strategy facilitates client comfort and improved bladder functioning. This last collection of articles directs attention to relevant clinical situations with suggestions for nursing practice.

The need for holistic care emerged when society was streamlining health care services. Fragmentation and splintering of needed services emerged with compromised quality and client dissatisfaction resulting. Clearly, action is required for appropriate client focused care to be available to persons in need. This issue of Holistic Nursing Practice provides a selected overview of nursing practice in action. Theoretical linkages, case presentations, practice models, and research studies illustrate sensitivity to clients and innovative practice. This edition of Holistic Nursing Practice, Nursing Practice in Action, positions service and practice, clinical challenges with clinical success, service with scholarship, teaching with practice, theory with innovation and research with individualized care. It is believed that the information contained herein will be helpful to those who strive for relevant and innovative nursing practice.

REFERENCE