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CASE STUDY Ms. Heather Barton is a new nurse practitioner who takes on her first NP role as director of a Native American health clinic in the Northwestern United States. When Heather took over the clinic, she noticed that the environment was institutional, dingy, and impersonal in appearance and function. The paint on the walls was dull. There were few pictures or adornments and only some faded and outdated educational posters. The clinic had inflexible hours, long waits for appointments, and an overemphasis on urgent care, not preventative care. Front office staff seemed uncaring and officious. Heather imagined that the Native American clients would be angry with the existing situation. Instead, she thought they seemed passive and hopeless, viewing the clinic as “a place of last resort” (Schubert, Hitchcock, & Thomas, 1999, p. 782). They were not involved in their care or the health center. In addition, many of them did not feel connected with their culture nor their heritage. Drug and alcohol abuse were major health problems. Heather noted that before she was hired, the clinic had previously been a medically oriented, disease-focused center (Schubert et al., 1999, p. 782). After increasing her understanding of the people and the culture, Heather began to work with the clients to initiate change. Her first steps were to interview a number of the clients to better understand their viewpoint, concerns, as well as traditional Native American religious beliefs and health care practices. Next, she worked on transforming the organizational structure from top-down (with the clients at the “bottom”) to a leadership circle that was consistent with Native American beliefs. Members of the community were invited onto the leadership committee. She facilitated the initiation of women’s circles, which were consistent with the native cultures. The committee and women’s circle helped to plan changes to the environment that were more consistent with their culture, utilizing Native American music, art, and love of nature. The clinic was painted in colors reflective of nature; some of the women donated their rugs to decorate the walls, and newer educational materials in the local native languages were posted. For every change, the women’s circle carefully considered the effect of any action on seven generations in both directions (preceding and succeeding), as this was a tenet of the culture. That helped the clients and the clinic focus on health and preventative services. Although all the changes took a while, over time, the health center became a place in which the clients felt empowered rather than powerless. Staff and clients saw themselves as working together to produce change, and the health center was able to increase its outreach and improve the health of the community. QUESTION Based on Martha Rogers’ Science of Unitary Human Beings that guided Ms. Barton to assess the clinic and community and plan care, demonstrate how components of the theory (human/environment, unitary human beings, pattern and organization, pandimensionality) were used to plan and provide care.

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