1. Donnelly, Gloria Ferraro PhD, RN, FAAN

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The young Haitian woman cradled her beautiful baby boy in the waiting room of the Nursing Center. A trusted neighbor recommended that she bring the baby for a check up and immunizations. Martina lived on the street and by her wits for at least two years until the birth of her son when she moved temporarily into one room in a cousin's cramped, crumbling apartment. Both mother and son were in need of care. Urban living had worsened Martina's asthma. The baby cried constantly and had a persistent rash on his arms and legs. Martina and her son were typical patients in the daily clinic flow.


Martina lives in a neighborhood that had changed dramatically over the past two decades. Trees no longer line the streets. Crack houses are interspersed among rows of houses. Unruly weeds crowd out the once neatly trimmed privet hedge. No one sits out on the stoops in the summertime. Children are rarely seen playing on the sidewalks. Their moms keep them indoors to protect them from street violence. The elderly are often prey to those who need money for drugs. Violence, a major urban health problem, is common in the homes and on the street.


Where health is concerned, major urban areas in the United States are bimodal, the affluent gentry focused on high-level wellness and the underserved poor focused on survival. The Nursing Center had fast become a safe haven for those with no medical insurance and minimal resources: the unemployed, persons with HIV, women, and children with no place to turn. Nurse practitioners, public health nurses, and outreach workers who staff these centers are nurturing and nonjudgmental. They have a keen appreciation of all of the social and environmental factors impinging on the health of the urban poor. They work the system in whatever ways possible to ensure that patients get needed medicine, food, and even heat for their homes in the winter.


This issue of Holistic Nursing Practice describes routine encounters of nurses practicing in the urban trenches of health care. The authors of this issue work each day with pregnant women going it alone, with senior citizens who rarely access routine care, with parents grieving for their children murdered on the street, with the rise of asthma, lead poisoning, HIV, and tuberculosis. They work through community organizations, churches, and school groups to gain the trust of residents and to tap into the community's strengths and resilience. This issue of Holistic Nursing Practice is about hope. It is a testament to nurses and urban residents who struggle together to improve the health status of communities.