UNIVERSITY OF CENTRAL MISSOURI
School of Nursing
Nursing 5015
Theories of Nursing
Fall 2021 Semester
Chapter 9 Case Study
Case Study, Chapter 9, Grand Nursing Theories Based on Unitary Process
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 adornment
and only some faded and outdated educational posters.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.*
References
Barrington, R. (1995). Repatterning of an urban Indian clinic through Rogerian nursing science
and caring framework. Paper presented at the regional meeting of the Society of
Rogerian Scholars, San Diego, CA.
Schubert, P., Hitchcock, J., & Thomas, S. A. (1999). Visions for the future. In J. Hitchcock, P.
Schubert, & S. A. Thomas (Eds.), Community health nursing: Caring in action (pp. 765–
785). New York, NY: Delmar.
*This scenario is based on an actual occurrence, with just the names changed to
demonstrate that using nursing models and theories is not only possible but also practical,
beneficial, and healing for clients and nurses. Thanks to Rosze Barrington, RN, DNP, for
her contributions to the creation of this scenario
Address all of the following related to the case study presented: Be sure that responses are in the
form of a discussion and that you provide through rationale for all conclusions and choices.
1. Select one of the nursing models/theories from this chapter that guided Ms. Barton to
assess the clinic and community and plan care. Why did you select that model?
I selected Newman’s Health as Expanding Consciousness as the theory that guided Ms.
Barton to assess the clinic and community and plan care. In the introductory paragraph of
the case study it was stated that the clients felt a disconnect with their culture and
heritage. They also felt they did not have ownership in their care or the clinic. By
facilitating the development of the women’s circle to help with planning the climate of
the clinic, she was able to create a community that focused on building an atmosphere
centered around the cultural beliefs and practices of the people (nursing). She became
knowledgeable of their patterns to create an environment that allowed for positive
interactions and showed that she recognized and respected each person as a whole not
just their medical issues (consciousness). As clients entered the clinic, they were met with
their culture’s music and art and they were able to learn about their conditions with
educational material printed their own language (integration via movement). (McEwen
& Wills, 2019)
2. Do you think that Heather would have approached this clinic differently if she was
utilizing the biomedical model? Why or why not?
Yes, I believe Heather would have approached this clinic differently if she was utilizing
the biomedical model. The biomedical model focuses on the systems and disease
processes not the individual person. The biomedical model does not take culture and
religious beliefs into account when treating a person. This approach focuses on the
symptoms and how they relate to the systems inside the body. Medication is given to
alleviate the symptoms and then another pill is given to alleviate the symptoms that arise
because of the initial medication. A person is deemed healthy or unhealthy depending on
whether there is some disease process taking place within their body. Heather would have
looked at statistics about the people to determine most common disease among them,
then designed a sterile clinic that specialized in the treatments for the most common
diseases among the cultural group, not taking into account the needs of the community as
a whole.
3. Select a unit, clinic, or other setting where nurses work and discuss how you might begin
to make changes if you utilized the Rogerian model, as Ms. Barton did in her setting.
The long-term care setting is an area I would make changes. I would start by talking to
those who are currently in the long-term care setting. I would ask them how they feel
about being there and what are the positive and negative attributes of their current living
situation. I would also talk to those who are not in that setting and ask them what their
current perception is and what would need to change to make it a place they would want
to go if they were in a situation that warranted placement. I would then determine what
changes need to be made to make the environment meet the needs of the residents both
personally and physically. Everything from the art work on the walls to the nurses’
station would be taken into consideration. The goal is to create a setting that allows the
individual to take care of themselves as much as possible but provides individuals
assistance when needed. The residents would have a say in the changes and how they will
best accommodate their needs. Ideally, changes would be done each time a new resident
moved into the space. The common spaces would remain relatively static but the
individual rooms could be updated with each resident that occupies them with their wants
and needs taken into consideration. The more the environment can invoke the feelings of
home, the better the resident will do at acclimating to their new setting.