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Historically, public health nurses have been the cornerstone of keeping communities healthy. Ideally, primary care is the point of access for health care and nurse practitioners provide cost-effective, high quality primary care. It is a natural progression to build a nurse-managed health center on the foundation of public health nursing with primary care provided by nurse practitioners. Such collaboration produced the 11th Street Family Health Services of Drexel University serving the most vulnerable census tracts in Pennsylvania.

The person who is undergoing surgery for the creation of an ileostomy may have had extensive and unsuccessful medical management but should have a successful surgical outcome. A well-constructed and sited stoma accompanied by diligent, competent, and compassionate nursing management and education will insure this outcome. Information is vital in all stages of the process. Preoperative information needs to center around the nature of the surgery and the expected post-operative course. Once the information needs are met, the nurse can concentrate on the emotional support required. Preoperatively, the patient becomes dependent on health care providers to meet all of his needs. He requires patience, understanding, and repeated explanations to allay his apprehension and anxiety. Postoperatively, the patient needs information on self-care techniques and emotional support to adjust to his new method of toileting. He needs assistance to "accept" the new arrangement and incorporate it into his self-image and lifestyle. Long-term, the patient needs information about possible complications, the need for lifelong medical monitoring, and the availability of support services in his community. By physically preparing the patient for self-care and discharge, the nurse can gently ease him onto the road to independence and a new lease on life.