Christina Esperat, R.N., Ph.D., FAAN

Texas Tech University Health Sciences Center

Kathryn Fiandt, R.N., D.N.S., M.S.N., F.N.P.

University of Texas Medical Branch

Gloria McNeal, R.N., Ph.D., A.C.N.S.-B.C., FAAN

Charles Drew University of Medicine and Science

Loretta Heuer, R.N., Ph.D., FAAN

North Dakota State University

Erin Denholm, R.N., M.S.N.

Centura Health


Nurse-led initiatives are at the forefront of the management of chronic diseases—a significant health care focus of the 21st century. The Centers for Disease Control and Prevention report that the leading causes of death and disability in the United States are chronic diseases such as heart disease, cancer, and diabetes. In absolute terms, more than 1.7 million people die of a chronic disease annually in this country. For 25 million people, chronic, disabling conditions cause major limitations in activity; the prolonged course of illness and disability result in extended pain and suffering and decreased quality of life for millions of Americans. The costs in human and economic terms of these diseases are incalculable; paradoxically, these diseases are also the most preventable. This Brief presents five nurse-led innovations in which chronic disease management is approached in cost-effective and practical ways, using prevention and health promotion orientations.


The Transformacion Para Salud Program is a HRSA-funded demonstration project at the Larry Combest Community Health and Wellness Center, a nurse-managed primary care center. Advance Practice Nurses oversee four Promotores, who are certified community health workers (CHWs). The CHWs apply the Transformation for Health conceptual framework based on Paulo Freire’s educational philosophy and developed in the School of Nursing at the Texas Tech University Health Sciences Center (Esperat et al., 2005, 2008), to provide intensive care coordination involving home visitation and telephonic contacts. Clients and families served, who belong to health disparate groups residing in

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