Creating a healing environment.

To regain some of the principles of personalized care that were part of the foundation of nursing, Carondelet St. Mary's Health Center in Tucson, AZ, instituted a nurse case manager program in 1985. The program assigns a nurse case manager to coordinate patient and family care from an array of nursing services. Its special characteristic is a focus on home care after discharge. The basis for the program is a belief in holistic care, beginning during the hospital stay and continuing after discharge. Because the psychosocial and spiritual impact of the illness might not be felt until the client returns home, the nurse case manager concentrates on preventing or alleviating distress through a program of care, education, and service. In 1988 the center was asked to apply its program to a high-risk adolescent obstetrical group enrolled in a local health maintenance organization. The challenges for the nurses included poor nutritional status, substance abuse, unemployment, low self-esteem, and other factors precipitated by the group's socioeconomic status. By direct intervention the nurses were able to set patterns for positive adult behavior, and by the end of the program most of the clients had made considerable changes toward more successful life-styles.