Meeting the Need: A Primary Health Care Model for a Community-Based/nurse-Managed Health Center

By Hatcher, Penny A.; Scarinzi, Gina D. et al. | Nursing and Health Care Perspectives, January-February 1998 | Go to article overview

Meeting the Need: A Primary Health Care Model for a Community-Based/nurse-Managed Health Center


Hatcher, Penny A., Scarinzi, Gina D., Kreider, Mildred S., Nursing and Health Care Perspectives


LONG BEFORE the World Health Conference at Alma-Ata, when 113 nations agreed to incorporate the concepts and principles of primary health care in their health care systems (World Health Organization [WHO], 1978), nurses were practicing primary health care. Indeed, such care has been practiced since the time of Florence Nightingale. Here, in the United States, the records show that public health nurses were involved in numerous primary health care activities in the early and mid-1900s (Fitzpatrick, 1975).

Primary health care has been discussed frequently in the nursing literature but is often confused with the medically oriented concept of primary care (Barnes et al., 1995; Hatcher, Shoultz, & Hurrell, 1993; Institute of Medicine, 1994; Pullen, Edwards, Lenz, & Alley, 1994; Shoultz & Hatcher, in press; Shoultz, Hatcher, & Hurrell, 1992). In addition, there are few community-based sites in which the concepts and principles of primary health care can be taught, practiced, and researched (Bless, Murphy, & Vinson, 1995; Bray & Edwards; 1994; Farley, 1993; Swider & McElmurry, 1990).

Open Gates Health Center is one of the few. It is a nurse-managed, community-based health center that offers a unique setting for diverse faculty, including nurse practitioners and student groups, to practice within a primary health care model.

Open Gates Health Center Open Gates Health Center, located in Baltimore's inner city, is managed and primarily staffed by University of Maryland Baltimore (UMB) School of Nursing faculty and students. The need for a nurse-managed health center in the economically disadvantaged section of Baltimore known as "Pigtown" was evident from the large numbers of area residents who were seeking care from a small public health nursing clinic for the homeless situated at Paul's Place, a neighborhood soup kitchen. The UMB School of Nursing dean, a board member of Paul's Place, collaborated with community leaders and Open Gates, Inc., a nonprofit board of Episcopal clergy and lay members, to develop Open Gates Health Center. A grant from the U.S. Department of Health and Human Services, Division of Nursing, provided funding for the first three years of operation.

The mission statement reflects the needs of the community, for "quality health care for those individuals and families who are uninsured, underinsured and those who are having difficulty in accessing the traditional health care system." The goal was to offer primary health care, health promotion, and disease prevention services. Two vacant and decaying row houses in the community were renovated with funding from the Middendorf Foundation, a local private charity, to serve as the focal site for Center activities. The Center opened in 1993.

Community Characteristics The name "Pigtown" is spoken with pride by the longtime residents of the area; it is not considered a pejorative term. The epithet dates from Baltimore's history as a meat-processing center (Rehbein & Peterson, eds., 1979). Every month several hundred pigs were shipped by rail to the Union Stockyards at one end of the community and herded down the streets to a slaughterhouse at the other end.

The Pigtown community is located in southwest Baltimore, which, at the latest census, had a population of 142,158. Sixty-eight percent of the population is white, 7 percent are under the age of five years, and 14 percent are over age 65. Thirty-five percent of residents have had less than 12 years of schooling, and 12 percent are considered low-income uninsured (U.S. Bureau of the Census, 1990).

Community history and pride run deep. Many families have lived in Pigtown for three or four generations and would not consider leaving, even now that the neighborhood has deteriorated and serious crime has become routine. Historically, the community is home to the working poor, but only 57 to 67 percent of persons aged 16 to 64 are in the labor force (U. …

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