Abstract
The Native Women Enjoying the Benefit (WEB) program trains nurses to perform breast and cervical cancer screening examinations for Native American women. Several evaluations have shown that the program improves nurses' knowledge and skills, and nurses value its positive impact on clinic, nurse, and patient behaviors. Beyond effectiveness, program longevity often rests upon equilibrium that results from alignment between a program's values and principles with those of its sponsoring organization and pertinent surrounding environments. We examined how Native WEB values align with those of its 2 most relevant environments-the medical institution (immediate environment) that sponsors it and the broader health care context (distal environment). We found that social justice views articulated in Catholic social teaching served as a convenient synthesis of the 2 environments' values and principles. We used this conception of social justice to determine whether the Native WEB program reflected the perspectives of its immediate and distal environments.
Since 1995 the Native Women Enjoying the Benefit (WEB) program has been training nurses at tribal, urban Indian, and Indian Health Service (IHS)-operated clinics to conduct breast and cervical screening examinations, and to teach community women of the importance of early detection and followup. Such training prepares nurses to assume a role that traditionally has belonged to physicians.
Funded by the Cancer Center of its sponsoring institution, the Native WEB is unique among the sponsor's programs. It provides training and services at little or no charge to nurses who have no formal affiliation with the institution (or its hospitals) and conducts most of its work off-site (often in remote settings) in the service of populations who generally do not become its sponsor's patients. Lacking a predictable revenue stream to cover the cost of its service, Native WEB would seem vulnerable to health care cost-containment efforts.
We wanted to determine how well Native WEB aligned with its sponsoring organization's stated values and principles 1 (Table 1), and learn how well the program aligned with the important values within the broader health care environment. We did not find a universal set of health care values and principles, but we did find an approximation in the health care principles proposed by the Tavistock Group 2,3 (Table 1). To reduce the complexity of comparing Native WEB's alignment with its organizational and external environments, we identified a synthesizing set of values and principles to serve as a common metric. We selected a social justice perspective derived from Catholic social teaching 4 (Table 1) to be our benchmark. This expression of social justice provided the best fit with the perspectives articulated by Native WEB's immediate and distal environments. By this measure, Native WEB aligns well with its sponsor's principles and with those proposed by the Tavistock Group for health care in general.