Ethical Considerations in Nursing: From Micro to Macro Perspectives
Micro Ethics: Focuses on the individual patient. It involves the network of human relations and clinical decisions between family and professional users. This focus is on the relational and specific clinical decisions with immediate impact on the patient’s health or life, with a highly contextual and case-oriented approach. Meso Ethics: The ethics of healthcare organizations involves discerning values to guide management decisions that affect patient care. It considers the structure and functioning of organizations and their influence on ethical conflicts. It emphasizes placing the patient, professionals, and their families within the human structure, physical and functional, where this interaction or health organization takes place. It also considers the influence of organizational values. This focus is on the corporate and structural aspects, including procedures, protocols, and processes. Its orientation is more normative and preventive, using casuistry. It represents a step towards a collective view of ethics. Macro Ethics: This level guides and coordinates ways of providing healthcare to all of society, a nation, or a state. It addresses the right to health and/or healthcare, taking into account issues of equity related to finance, access, and the scope of healthcare provision.
Nurse Primary: This method of providing nursing services is characterized by a strong and continuous relationship between the patient and a designated nurse. This nurse is responsible for planning, managing, and coordinating the patient’s nursing care throughout the duration of their illness. As it is organized: This is a specific unit responsible for 5 or 6 patients. It has a team of nurses associated with it. What it does: It is responsible for the entire process of admitting and discharging patients. It manages patient care, including needs assessment, care planning, monitoring, and evaluation. The patient and their family know who the responsible nurse is.
Company Culture: The concept of corporate culture emerged to describe everything happening within a company that could not be explained by other formal elements of planning. This includes, for example, practices that are not established procedures but are still followed by tradition or custom. It was eventually discovered that all the aspects that accumulate in what is called corporate culture were as voluminous and momentous as the rest. The concept came to include aspects that had originally belonged to the realm of explicit planning. Phenomena such as spontaneous coordination between departments or specific delegation of powers, which were not explicitly set, came to be part of this body called company culture.
Frederick Taylor’s model is a movement to rationalize production by separating the organizers and performers. His goal is to accelerate production efficiency by reducing time and maximizing movement. Work must be done mechanically, not reflexively: the worker is a piece of perfectly geared mechanism, where each has a specific function. This model speaks of mechanization and assumes that the human factor disappears. This model should not be applied in nursing, except in specific situations where it might be useful, for example, in emergency situations such as cardiac arrests. Taylor posits the need for selecting the most skilled in a technique, thus avoiding errors and wasted time. If applied to an emergency situation, this gives us order, as it is a mechanical response where emotional levels are left behind and where it is essential to think who is more skilled, because the patient’s life depends on it. Taylor does not give importance to the autonomy of the worker, believing they must do their work mechanically, without thinking or considering what they are doing. Taylor differentiates between the thinkers and the performers. In unity, we find that although there are certain guidelines, professionals have some autonomy, possess a body of knowledge, and perform actions based on that knowledge. The conclusion is that, except in very specific cases, the unit does not operate according to the Taylorist system, providing comprehensive care based on quality.
Max Weber also believes that the perfect model of operation is the machine: rules and regulations are the mainstay of basic organization, and everything must be planned. Weber believes that workers must perform their function based on the procedure, not the rules: a certain action is right if it is based on the rules, regardless of whether it is moral or not. In nursing, this is not applicable, as ethics and morals are intrinsic and fundamental parts of our profession. We cannot perform a particular technique if the practitioner does not consider the moral rules that tell us what is right. However, this model is often found in situations where many professionals perform certain techniques with the excuse that”we’ve always done it this way” Weber defends the idea of assessing the organization to identify its faults. We believe that nurses should know the protocols and why these techniques are performed in a particular way and not another.
way and not another.