29.10.2020 | Kommentarer

Micro- and Macro- perspective in Healthcare

 

Abstract

The preception of the effectiveness and competence in healthcare are reflected in the measured outcome of the service delivery as it strives to provide necessary care and services to help patients who need preventive, curative, rehabilitative and palliative care. In some cases, the health and economic sector work together to reach this goal while in other cases, it is the government and the municipalities that cooperate. To achieve success, healthcare is considered from a holistic approach whereby the micro or basic factors such as the interrelat-ionship among healthcare givers within the healthcare environment as well as the macro factors have to be considered and are given priority. The macro picture includes how care delivery operates, the decisions, cost and change facilitators. Caregivers, especially nurses face challenges in adapting to new roles and approaches in healthcare as it is required. Both perspectives enhance cooperation, communication, inspire motivation and well-being amongst patients and caregivers.

Introduction

The WHO (2020) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Healthcare therefore means improving or maintaining health by preventing, diagnosing, treating and curing the ailments whether they are physical or mental. Healthcare is an institution, a service system and intervention (Chang et al., 2018). However, people can have access to healthcare depending on certain factors such as the economic and social settings of the countries or communities they belong to, the health policies as well as the individuals concerned. Closely attached to healthcare is well-being and quality of life. Worldwide, healthcare is paramount because it has an effect on the general well-being, mental and physical health of humans at large (Roots & MacDonald, 2014). On this basis, it is important to consider the micro and macro perspectives in health-care.

Micro perspective

A micro perspective considers every detail that regulates day to day activities and processes. Such details about how things are carried out are essential especially in healthcare where the process and performances in daily practice are usually measured.

Among work personnel

The relationship among health professionals. It is vital that there is clarification of roles, defi-nition of task descriptions, expectations and hierarchies that often exist because these may affect the cooperation between nurses, sometimes facing some form of resistance from fellow colleagues. A degree of coordination and interdisciplinary team work is required in nursing. There is usually a mixture of different expert skills available which would require that re-sponsibilities are allocated efficiently since the situations, settings, medical treatments and nursing encounters would vary. It is certain that a team of this nature will include individuals with varying educational, professional experiences, core preferences and character differ-ences. Also, when there is no universal language among the group, differences and conflicts may occur (Greiner & Knebel, 2003). Undue emphasis on these factors will interfere with the nursing care system (Roots & MacDonald, 2014), diverting more attention to designated roles and hierarchy instead of satisfying the desires of patients (Gribnau et al., 2011).

Within the team, doctors are seen to dominate the hierarchy on the ground that they are personally responsible for making health decisions, therefore the reluctance to request for the relevant input of other health givers (Fairman et al., 2011) irrespective of their educational qualifications and certifications (Timbs & Tully, 2020). However, when leadership and gov-ernance is shared, it encourages independence, creates opportunities for nurses to gain author-ity and excellence over their work (Nasr, 2018). This strategy gives them a measure of free-dom, professional autonomy, accountability and bonds them to the healthcare organization. An organization’s culture of care, communication and conflict resolutions (Nasr, 2018) are closely associated. Interdisciplinary teams would need to redesign if necessary, the system of operation such that nurses would not only work in a well-organized pattern, but would also collaborate, function and coordinate themselves within the team (Roots & MacDonald, 2014).

Relationship with patients

Encounters and interactions between patients and physicians are vital details in healthcare. There may seldom be opportunities for personal contact between them but whenever it hap-pens, it should influence better care, be caring and supportive (Kilpatrick, 2009). Therefore, at every opportunity, nurses engage in positive interactions with patients, giving them the feeling that their needs and desires are their priorities. Nurses also participate in developing short and long-term strategic priorities on their behalf. Their care plan, needs and preferences are well communicated to the necessary stations. This has an effect on patients as well (Roots & MacDonald, 2014). Infact, poor communication can be detrimental to the health of patients (Hirschman et al., 2015). Furthermore, good communication allows for social and stable envi-ronment where patients can freely relate their fears and desires, which in turn are channeled to the macro- level healthcare personnel who make necessary readjustments and changes in the allocation (Bohmer, 2016). The social roles and networks created by physicians with patients are forces which encourage or restrict healthcare actions and decisions. This implies that nur-ses render a service that is intangible, measured qualitatively via interactions and communicat-ions (Roots & MacDonald, 2014).

Quality healthcare is “consistently delighting the patient by providing efficacious, ef-fective and efficient healthcare services according to the latest clinical guidelines and stan-dards, which meet the patient's needs and satisfies providers” (Mosadeghrad, 2012, p. 251). In addition, nurses strive to make available and offer quality care while they incessantly stay abreast with medical information and altering medical measures. In the past, nursing care pro-cedures would be carried out based on previous academic training and nowadays, such knowledge is almost invalid because it cannot keep pace with the growing expanding knowledge base concerning efficient care methods and settings (Millenson, 2018). Healthcare organizations endeavor to make quality care a priority and ensure avoidance of medical errors. Situations such as the increasing rate of nurses losing their skills needed to provide quality care, unwillingness to report medical errors and unsafe work environments interfere with qual-ity of delivery.

Patients’ cultural background

Placing consideration on accommodating the diversified cultural demands and different choices of racial and national groups will solve issues of inequalities. This is an important fac-tor in healthcare because humans are inclined to migrate for reasons such as seeking better life (Nagurney & Daniele, 2020). Therefore, those with differing cultural background with differ-ences in age, earnings, insurance coverage and severity of situations should not in any way perceive or receive lower-quality care compared to others. The recommendation is that nurses be ready and completely equipped at providing care that is culturally receptive (Betancourt et al., 2016) and employing the potentials available to manage information and acquire the latest medical evidence.

Macro perspective

This considers the bigger picture in healthcare. It gives attention to healthcare delivery, which is the provision of healthcare usually in a system constituting of an organization of people, institutions and healthcare givers with the primary aim of rendering healthcare services to sat-isfy the health needs of the society. Since nurses are involved, they have to be knowledgeable and experienced so that they can deliver such care effectively to patients. To facilitate effici-ent service delivery without errors as well as gain patients’ confidence, clinical transactions are automated. Information technology infrastructure accelerates delivery (Grain & Schaper, 2013) thereby boosting communication and making all health information accessible and dep-endable.

Nowadays, with the use of the internet to acquire facts and fiction, patients have become better informed and are capable of requesting that their specific desires be satisfied. It is im-perative that nurses be ready to adjust to different roles to such as adviser, teacher and com-panion in order to deliver the best care treatment. They should be well trained and better pre-pared to promote healthcare standards and it may require a re-modification of their behavioral pattern (Merkel, 2020). Thus, to better healthcare delivery, the initiatives taken should make room for accountability and management capabilities that would mark out operations that can be measured and quantified (Barasa et al., 2015). Nurses give patients individual care because focus is placed on making the best out of the care and the delivery (Huot et al., 2019). The telemedicine healthcare delivery system allows patients to meet and interact with their physi-cians virtually and not necessarily in person. This is essentially useful when proximity between patients and physicians is a hindrance to care accessibility (Perrin et al., 2020).

Healthcare decisions and cost in healthcare includes how and where the resources are being allocated to. As history asserts, nurses contend with several barriers that interfere with patient care delivery including reduced funds. Since they are fully committed to patient care, they uphold patients’ interest and serve as intermediaries between them and the healthcare administrators (Nasr, 2018). In some cases, factors such as regulatory and legislative constraint (Scanlon et al., 2016), economic forces, low- cost, demographics, advancement in healthcare reforms affect how decisions are made (Fairman et al., 2011). Of great importance is the effect the decision would have, whether favourable or damaging or both at the same time or of the greater good (Roots & MacDonald, 2014). Furthermore, making decisions on optimal nurse staffing, delivering good quality of care and allocating cost to these different areas can be challenging. The relationship between them should be considered because it has great impact on patients, care delivery and the nursing profession (Park, 2017).

The common idea is that when there are more nurses, the patient outcomes are usually better. However, employing more nurses will involve cost, therefore the gap between cost and quali-ty of care or nursing efficiency are of utmost importance (Park, 2018). Everyone is affected by any healthcare decision, in many cases it may be advantageous for some and unfavourable for others. This makes it necessary therefore that such decisions concerning resource allocat-ions are made for the benefit of the greater number of people according to the care that is healthier, superior and exact (Bauer, 2010). At the same time, patients, nurses and the health-care system are all satisfied with the decision made (Park, 2018). The nurse-patient relations-hip and interactions which should be known and considered prior to making policies, are par-tially ignored and as such, there is no arrangement for patients’ desires and wishes to be heard and met. Additionally, salient factors such as healthcare cost, allocation of resources and uses, legislative policies (Fairman et al., 2011), economic constraints and facilitators influence the process in which healthcare decisions are made (Roots & MacDonald, 2014).

Another macro perspective in healthcare is workplace advocacy. Workplace advocacy empowers and enable nurses to voice out their views and ensure that they contribute to mat-ters concerning nursing care and workplace resolutions. This strategy can be implemented between individual nurses and healthcare organizations whether at the local, state or federal levels so that care policies are quickly executed in the nursing practice. Each nurse is encour-aged to participate or join in a professional nursing organization in order to have a say in mat-ters concerning how to improve care delivery systems, how to enforce nurses’ employment rights and duties and the nursing practice as a whole. It endorses leadership support and co-ordination This concept ensures accountability for all nurses within the local, state or national sphere (Nasr, 2018).

Conclusion

Humans need healthcare and many factors affects its availability. The micro and macro per-spectives can be discussed in matters concerning the nursing profession. Indeed, both per-spectives influence healthcare (Madon et al., 2007). Although nurses have a primary responsi-bility to show compassion and respect to patients, such attitude should extend to their col-leagues or other healthcare professionals. A cooperative and clear definition of tasks would help to reduce conflicts and resistance from fellow work mates. Working in a team can have its challenges because people have varying views and skills. Over emphasizing on such differ-ences and hierarchy would distract the goals of nursing care. Therefore, understanding the concept of shared governance can be beneficial because it encourages nursing autonomy. In addition, nurse and patient interactions is a micro factor that influences the health of patients because communication plays a vital role in creating a stable environment for patients. Also, when nurses endeavor to give quality care, it includes being updated with the growing health knowledge in conjunction with relevant education and experience. On the other hand, the macro picture includes delivery and overall performance in healthcare devoid of errors with the help of information technology. Nurses strive to adjust to the use of technology to im-prove healthcare. Financial cost and resource allocation can be demanding in healthcare deliv-ery as they affect nurse staffing, patients and their care. Also, workplace advocacy give nurs-es the leadership support and professional autonomy they need to make independent deci-sions that will improve care delivery. This encourages value driven and efficient nursing skills.

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Faith Ezerie BSc Zoology, BBA International Business, BSc Nursing student, Novia UAS.
Anita Wikberg Supervisor, RN, RM, PhD, Senior lecturer, Novia UAS

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