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Little is known about the impact of oral health on self-esteem. The purpose of this descriptive study was to identify the frequency of low self-esteem in vulnerable persons who received oral health care at an academic nursing center. Participants (N = 86) completed the Index of Self-Esteem (Hudson, 1982b), answered open-ended questions concerning oral health care practices, and participated in an oral health examination. We found that 53% demonstrated low self-esteem, 67% (n = 58) had minor dental problems, and 33% (n = 28) had major dental problems. Oral health problems were ranked in importance along with cancer, diabetes, high blood pressure, and asthma. Oral hygiene included no tooth brushing, infrequent tooth brushing, flossing, chewing gum, and using mouth wash. This study emphasizes the roles of the community health nurse in assessing oral health (particularly among a vulnerable population), advocating for policy change, and providing education.

Appropriate self-management support is needed to help individuals and their families meet the challenges of living with chronic health conditions. Such support is characterized by productive interactions between informed, active individuals and their health care providers. The purposes of this paper are to describe the challenges to achieving self-management support and a tool, My Health Companion© (MHC), which was developed to meet that challenge. The MHC is a paper personal health record designed to help rural women with chronic health conditions to better manage and understand their health information. The selection of content for the MHC was based on the literature, input from health care experts, and chronically ill individuals, and its development incorporated principles of personal health records and clear communication. The MHC was anecdotally shown to be useful to rural women with chronic health conditions in preparing for and enhancing their visits with health care providers. As a source of information, the MHC had potential for: being beneficial to providers in recommending appropriate treatment; contributing to more informed health decision making by ill individuals; and serving as a vehicle for the establishment of more productive interactions that contributed to the achievement of true client-provider partnerships in health care.

Successful adaptation to chronic illness is enhanced by active client-health care provider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health care providers can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client-provider partnerships.

Although nurse-managed centers have been instrumental in serving the underserved since the 1800s, little is known about their capacity to serve as effective primary health care providers. Nurse-managed centers also provide unique clinical opportunities for nursing students to learn about serving vulnerable populations, with an emphasis on attaining cultural competency. As more Americans seek their services, it is imperative that nurse-managed centers become more visible and pragmatic in their approaches to document their successes in improving health care access to those in most need. This article describes a meeting with representatives from nurse-managed centers throughout the United States, in an effort to recommend a uniform set of aggregate outcome data. This outcome data will provide policy makers and the general public with information that clearly supports nurse-managed centers as key safety net providers of accessible and effective primary health care.