Introduction
Ethical dilemmas are integral to nursing practice, which is why it is essential to study them. Every day, nurses make critical decisions that impact patient health and life. Having such a significant responsibility makes it important for nurses to choose options that are in the patient’s best interests. Sometimes the choice is simple; nevertheless, there are also barriers to ethical practice that can be structural or personal. For instance, some nurses experience ethical dilemmas due to impaired communication or inadequacy of treatment prescribed. Others, however, face ethical challenges that involve patients and their beliefs. Patient’s involvement in medical decision-making often creates ethical problems, especially if his or her culture or religion opposes certain methods of treatment.
This essay aims to describe and analyze a clinical situation that involved an ethical dilemma. The chosen clinical situation is the patient’s refusal to proceed with medical treatment due to his religious beliefs. The case exemplifies some essential topics, such as culturally-sensitive care, patient autonomy in decision-making, and the application of ethical theory to practice. The main ethical theory will be applied to the chosen clinical situation in narrative ethics. Reviewing the clinical situation from a theoretical perspective can help in gaining valuable insight into ethical decision-making in nursing.
Clinical Situation
The patient is a 69-year-old white male who was admitted to primary care due to repeated vomiting. Upon examination, it was found that the patient has high blood pressure, fatigue, and increased swelling of the feet, which indicated that he might have kidney disease. Right from the beginning, the patient refused medication for vomiting; however, he accepted hospitalization and further diagnostic tests. The doctors also suspected that the patient is dehydrated due to vomiting, and treated him for dehydration after receiving approval. Blood tests, urine tests, and kidney ultrasound were prescribed by the doctor to evaluate kidney damage and determine the presence of kidney disease. The blood test indicated that the patient had a low content of red blood cells, showing signs of anemia, while the ultrasound and urine tests confirmed chronic kidney disease.
Upon hearing about the diagnosis, the patient appeared to be sad. The doctor explained that, although the disease was not curable, it was possible to control the symptoms, including high blood pressure, fatigue, and nausea. In particular, the doctor noted that a red blood cell transfusion was in order due to the patient’s anemia. However, the patient revealed that he was a Jehovah’s Witness and that his religious beliefs prevented him from receiving a blood transfusion of any sort. Even after the doctor explained the benefits of the procedure and the consequences of leaving anemia untreated, the patient did not agree to the procedure. He explained that his faith was more important to him than his quality of life. I chose not to interfere with the patient’s decision, as I did not have enough knowledge and experience with ethical decision-making at the time. Therefore, the patient only accepted the prescribed medications for high blood pressure and nausea. After the initial symptoms subsided, the patient was released from the hospital.
Ethical Characteristics of the Dilemma
Hamric, Hanson, Tracy, and O’Grady (2014) state that certain characteristics distinguish ethical dilemmas in nursing from other work situations. According to Hamric et al. (2014), “an ethical or moral dilemma occurs when obligations require or appear to require that a person adopt two (or more) alternative actions, but the person cannot carry out all the required alternatives” (p. 328). Thus, ethical dilemmas are defined by the conflict that puts pressure on the moral agent and complicates the decision-making. In the present case, the two conflicting actions were to persuade the patient to accept the blood transfusion and to respect the patient’s beliefs. The moral distress, which is also characteristic of moral dilemmas, resulted from the understanding that the patient’s quality of life could be improved after the treatment. The influence of religion on medical decision-making can often threaten patients’ life and health, which is why it poses significant concerns for nurses and other medical professionals (Coyne, 2015).
Apart from defining the key characteristics of moral dilemmas, Hamric et al. (2014) also list three main types of sources of ethical dilemmas: communication problems, interdisciplinary conflict, or multiple commitments. Communication problems arise when one or more of the parties involved fail to provide a clear and succinct explanation of his or her viewpoint (Hamric et al., 2014). For example, a dispute between the patient and his family regarding treatment options is an example of a communication problem. Interdisciplinary conflict, on the other hand, occurs between different professionals (Hamric et al., 2014). For instance, if two different medical professionals, such as a physician and a surgeon, disagree on the preferred treatment option, it might cause an interdisciplinary conflict leading to an ethical dilemma.
Finally, as nurses often have commitments to multiple parties, including the patient, family, and other medical professionals, they might experience ethical dilemmas resulting from multiple commitments (Hamric et al., 2014). The clinical situation described as a result of impaired communication between the patient and the medical professionals attending to him. Having different cultural or religious backgrounds is among the key barriers to communication reported by patients and medical professionals (Norouzinia, Aghabarari, Shiri, Karimi, & Samami, 2016). Initially, the patient did not mention his religious beliefs upon being admitted to the hospital, which is why the doctor offered an inappropriate treatment method to him. Moreover, the doctor did not provide comprehensive information about the treatment when the patient first started his views, which is why I tried to influence the patient by providing more information.
Ethical Principles
Ethical principles or rules are the aspects of the decision that are taken into account in an ethical dilemma. Hamric et al. (2014) identify several key ethical principles, including autonomy, beneficence, nonmaleficence, justice, and respect for persons. In the present situation, the principles of autonomy, respect for persons, beneficence, and nonmaleficence were the main aspects of the conflict. The decision to release the patient without red blood cell transfusion promoted the ethical principles of autonomy and respect for persons by allowing the patient to make decisions about his treatment and accepting his views. However, it also violated the principles of beneficence and nonmaleficence. The principle of beneficence stresses the importance of promoting positive health outcomes and advocating for the patient’s best interests. Nonmaleficence, on the other hand, includes avoiding harm and actions that could hurt the patient. As the treatment did not target the patient’s anemia, which could be a threat to his further life and health, both of these ethical principles were violated.
Barriers to Ethical Practice
There are four types of barriers to ethical practice, including barriers internal to the nurse, interprofessional barriers, patient-provider barriers, and organizational or environmental barriers (Hamric et al., 2014). In the present situation, three types of barriers were evident. First of all, barriers internal to the nurse, including the lack of ethical knowledge and confidence, affected my decision-making in the clinical situation. I was unsure how to address the patient whose religious beliefs prevented him from obtaining the treatment he needed, which affected my decision to step away instead of persuading the patient to proceed with the treatment.
Another barrier to ethical practice that was evident in the scenario was the difference in cultural and religious backgrounds, which is one of the key patient-provider barriers (Hamric et al., 2014). I had little knowledge and understanding of the patient’s religion and thus was unable to emphasize his views and show compassion. As demonstrated by Hordern (2016) religious and cultural beliefs are often the source of ethical issues as they often contradict the obligations of medical professionals and normal diagnostic or treatment practices. Also, differences in religion and culture prompt for a higher risk of miscommunication, which is a barrier to ethical decision-making (Norouzinia et al., 2016).
Finally, the absence of a clear guideline for culturally-sensitive care in the primary care unit of the hospital was an organizational barrier to ethical practice. As shown by Douglas et al. (2014), creating a distinctive code of conduct or set guidelines for nurses and other medical professionals is a vital factor influencing the implementation of culturally competent care.
Ethical Theory
The present clinical case is rather complex, with a variety of perspectives and viewpoints affecting the outcome. However, the patient’s religious beliefs are the key aspect of the ethical dilemma. Faith is important to many people. Hordern (2016) explains that religion and spirituality often give patients moral strength to overcome the disease or live a fulfilling life with their diagnosis. The importance of faith for the patient has to be taken into account when doctors or nurses make critical treatment decisions. Therefore, narrative ethics would be useful for resolving the case. Narrative ethics emphasizes the importance of the patient’s story in making a difficult decision (Hamric et al., 2014). By applying narrative ethics to the clinical situation, the doctors and nurses would have been able to learn more about the importance of faith for the patient, which could have helped them in making an informed decision.
Reflection
The clinical situation described in the essay is an important example of an ethical dilemma in nursing care. The dilemma was focused on whether or not to insist on red blood cell transfusion when the patient refuses it due to religious reasons. On the one hand, the ANA Code of Ethics requires nurses to act in the patient’s best interests and perform actions necessary for promoting better health outcomes (ANA, 2015). On the other hand, however, the ANA (2015) also stresses the importance of patient advocacy and protecting patient’s rights. The ethical dilemma in the present clinical situation was the result of a conflict between the required treatment actions and the patient’s right to make decisions regarding his health and wellbeing.
Although I decided not to try to persuade the patient to proceed with treatment, the clinical situation made me anxious and sad, and I remember it every time I treat patients from different cultural or religious backgrounds. It is not often that patients refuse treatment due to their cultural or religious beliefs; however, it usually prompts me to think about how to handle the situation correctly to balance patient health outcomes and the patient’s right to autonomy.
Dr. Jean Watson’s theory of human caring science applies to the clinical situation as it emphasizes the need for nurses to respect the patient’s rituals, wishes, and beliefs. The theory also shows that there are multiple paths to knowledge, thus arguing that using evidence-based practices is not the only option available to nurses. The theory promotes the importance of building a patient-provider relationship that is based on mutual trust and understanding, which is essential to provide culturally-sensitive care.
I believe that, if a similar situation arises in my work as a Family Nurse Practitioner, I will be able to approach it as a more insightful and make an informed decision. I would use narrative ethics to make a decision based on the patient’s story. I would also approach the decision-making based on Dr. Jean Watson’s theory of human caring science, thus building a supportive and caring relationship with the patient.
Conclusion
Overall, I think that the purpose of the assignment was to obtain insight into the clinical situation and to re-evaluate it using ethical principles and theories, as well as to develop knowledge of the barriers to ethical practice. Improving my knowledge of ethical dilemmas in nursing care allowed me to see the weaknesses of my approach to the issue and to develop a thorough understanding of what else could be done to resolve the dilemma. This experience can be used to resolve ethical dilemmas and conflicts in my future work, thus improving the quality of care provided to patients.
References
American Nurses Association (ANA). (2015). Code of Ethics with interpretative statements. Silver Spring, MD: ANA.
Coyne, J. A. (2015). Faith healing kills children. Slate Medical Examiner. Web.
Douglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M., Lauderdale, J.,… Purnell, L. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing, 25(2), 109-121.
Hamric, A. B., Hanson, C. M., Tracy, M. F., O’Grady, E. T. (2014). Advanced Practice Nursing: An integrative approach. Amsterdam, Netherlands: Elsevier Health Sciences.
Hordern, J. (2016). Religion and culture. Medicine, 44(10), 589-592.
Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M., & Samami, E. (2016). Communication barriers perceived by nurses and patients. Global Journal of Health Science, 8(6), 65-74.
Motivational Theories In Healthcare
What are the major motivation issues at play in the health care industry according to the major needs-based theories of motivation (Maslow’s need hierarchy theory, McClelland’s acquired needs and Deci & Ryan’s self-determination)? What motivation theory is more popular expectancy theory or Herzberg’s two-factor theory? Keep reading to find out!
Introduction: Role of Motivational Theories in Healthcare
Lack of a motivated workforce is one of the impediments to the achievement of the millennium development goals in the context of healthcare. This is due to a lack of motivation among health care workers and especially in low and middle-income generating countries leading to poor provision of healthcare. There is a loss of clinical staff and this further cripples the health care system, which is already fragile due to insufficient workforce (Dieleman & Harnmeijer, 2006).
The lack of motivation among the health workers is as a result of inability by the health service managers to meet the needs of these health workers. It is, therefore, necessary that health service managers develop the appropriate mechanisms to retain and motivate health care workers. Health service managers need to understand the various theories that govern the motivation of health workers to work to ensure their motivation and retention in the workplace (MHEN & VSO, 2011). This paper will discuss why it is essential that health service managers understand what motivates health worker by looking at their needs with the help of various motivational theories.
Motivational Theories in Healthcare: Discussion
According to Deci and Ryan (2000), motivation is the impetus drive to do something. There is sufficient evidence to support the fact that workers’ performance is highly dependent on the level of motivation by the workers (Garcia-Prado, 2005; Rowe, 2005; Marsden, French & Kubo, 2000; Vroom, 1970). Different theories have been put forth to argue out the fact that the motivation to work is governed by various needs, which if not satisfied de-motivate workers to indulge in productive work and efforts.
Motivational Theories: Maslow’s-Hierarchy of Needs Theory
Abraham Maslow proposed the Maslow’s-Hierarchy of needs theory that outlines five universal needs as the main motivating factors for people (Dolea & Adams, 2005; Zurn et al., 2005). One thing to note with Maslow’s hierarchy of needs is that a lower must be significantly fulfilled before moving on to the next higher need on the hierarchy. His hierarchy of needs theory ranks the needs based on their level of influence on human behaviour as indicated in the figure below (Maslow, 1954):
To start with, there are physiological needs, which are considered to be the lowest-level needs and include needs such as food and water. When these needs are not satisfied in a person’s life, a driving/motivating force is created and it seeks to achieve these needs. When a person is hungry, this person develops a felt need that gives rise to psychological and physical tensions, which can be realized by the person’s overt behaviour aiming to reduce such tensions that result from the need to eat. After the person gets something to eat, the hunger and the resulting tensions are reduced. This is applicable in the case of a health worker who has various physiological needs, which motivates the health worker to continuously provide health care to patients. This way, he/she would get paid after his/her services hence can meet his/her physiological needs (Benson & Dundis, 2003).
When a person’s physiological needs are satisfied, they move on to the next needs, which according to Maslow’s hierarchy of needs are the safety. Safety needs include needs for shelter and security. Safety and security needs entail the desire for “security, stability, dependency, protection, freedom from fear and anxiety, and a need for structure, order, and law” (Hughes et al., 2002). Safety and security needs by health workers translate into a need for employment security and as such will stop at nothing until they are assured for continued employment.
Health workers will, therefore, engage in high levels of effort and productivity so that they do not lose their jobs. Subsequently, social needs are next and entail the need for belongingness and love. In the workplace, health workers aim at satisfying their social needs through interacting with colleagues, superiors and subordinates. The ability to work with others in peace and establish good working relations motivates the workers to put all their efforts to work because peace and good working relations with other workers define good working conditions (Benson & Dundis, 2003).
Once social needs have been met, there is the need to satisfy workers’ ego and esteem. The workers seek to achieve “self-respect, self-esteem and esteem of others” as intrinsic components of the esteem need (Dieleman & Harnmeijer, 2006). Also, there is an external element of the esteem need and it entails the need for “reputation, prestige, status, fame, glory, dominance, recognition, attention, importance, and appreciation” (Zurn et al., 2005).
In this context, health service managers need to understand that how a health service manager manages and/or supervises the health workers greatly determines the health workers’ motivation about their ego and esteem needs. If managerial and/or supervisory roles are given to adept and qualified individuals then it is not difficult to motivate the health care workers. Highly qualified leaders and managers know how to lobby for resources to ensure that the health workers’ needs are addressed and met hence giving them the motivation they require (King & McInerney, 2006).
Good communications with a caring leader/manager is a great motivating factor for the health workers as they appreciate a leader or manager, who is ready to listen to their voices thus, the health workers feel obliged to work as per the desired expectations. As a health service manager, therefore, it is important to understand that health workers’ needs are paramount if quality health care outputs are to be obtained. A health service manager should always ensure that he/she is committed to the welfare of the health workers; this will motivate them to give their best since they are aware that their efforts are valued (Gray, 1991). Health service managers should understand the need to motivate health workers based by creating good relations with them to satisfy their social needs.
Self-actualization is the highest need according to Maslow’s hierarchy. Self-actualization entails the need for self-realization and continuous development. This is the point in time when a health worker seeks to become the best person they can be. It is facilitated by career opportunities that enable health workers to grow and develop professionally. Career opportunities are very vital to an employee since, one aims at climbing up the ladder of job promotion (Benson & Dundis, 2003). Therefore, health managers must develop strategies to ensure that health workers can reach their fullest potential as a way of ensuring effective and efficient performance from the workers.
According to a study by Willis-Shattuck and others (2008), findings showed that motivation concerning career development and training in the context of self-actualization according to Maslow’s hierarchy of needs is a very critical factor in as far as the performance of health-care workers is concerned. Health workers guided by intrinsic motivation factors have the desire to gain personal growth and more skills to enable them to perform better. If such training and educative opportunities that ensure professional growth are lacking, this is very demoralizing for the health workers and especially the young professionals. Professional development through training or education is very important because it allows health workers to handle job requirements in a more proficient manner.
Alderfer’s Hierarchy of motivational needs is a revised version of Maslow’s hierarchy of needs where Clayton Alderfer linked Maslow’s hierarchy of needs with empirical research. After revising Maslow’s theory based on the hierarchy of needs, Alderfer came up with the ERG theory (Existence, Relatedness and Growth). Existence is in line with Maslow’s physiological and safety needs where an individual’s existence is concerned with the existence of basic materials. Relatedness is compared to Maslow’s social/love needs the external element of the esteem need. Relatedness is an individual’s desire to relate well with other people. Growth is synonymous with Maslow’s intrinsic component of the esteem need, as well as self- actualization (Murphy, 2009; WHO, 2006).
According to Alderfer’s hierarchy of needs, one focuses on increasing the satisfaction of a lower-order need when achievement of a higher-order need is frustrated. For example, when a health worker fails to satisfy his/her need for social interaction which is a higher-order need compared with catering for one’s material needs, the health worker results in regression to the lower-order material needs. Unlike Maslow’s theory, Alderfer’s theory shows that various needs can act as motivators simultaneously. The figure below gives a summary of Alderfer’s theory of needs (Dieleman & Harnmeijer, 2006):
Motivational Theories: Herzberg’s Two-Factor Theory
Another theory is Herzberg’s two-factor theory, otherwise known as motivation-hygiene theory. This theory was developed from a study that aimed to test the notion that people have two sets of needs:
- The need to eliminate pain as animals
- The need to grow psychologically as human beings
According to Herzberg’s study, there are two kinds of themes where each theme depicts a certain meaning concerning things that make people happy and those that do not make them happy. The first theme comprises of things that create motivation or job satisfaction and these are achievement, the work itself, responsibility, advancement and recognition. Work itself, advancement and responsibility are deemed to be of most concern concerning bringing about permanent changes concerning attitude. On the other hand, the second theme comprises on determinants of job dissatisfaction, which are working conditions, salary, company policy, supervision, administrative policies and interpersonal relations (Dolea & Adams, 2005).
Factors related to job satisfaction are separate and distinct from those that bring about job dissatisfaction. When health service managers remove dissatisfaction factors, this enhances peace but does not bring about motivation because the managers will be placating the workers instead of motivating them. It is because of this reason that Herzberg refers to the dissatisfaction factors as hygiene factors because when they are adequately present, health workers are neither satisfied nor dissatisfied thereby creating a hygienic and peaceful working atmosphere. Herzberg emphasizes that factors related to the work itself like “promotional opportunities, opportunities for personal growth, recognition, responsibility and achievement” as they are deemed to be intrinsically rewarding to the health workers (Dieleman & Harnmeijer, 2006).
In India, health workers regard motivating factors such as availability and accessibility to working tools, opportunities to train, suitable physical conditions and good working relationships with colleagues to be much more important than financial incentives thereby confirming Herzberg’s theory if the intrinsically rewarding factors (Peters, et al., 2010). This is in contrast to other regions like Ghana and as seen earlier in Malawi where financial incentives are the main reason why health workers are de-motivated thus according to Maslow’s hierarchy theory of needs, they have not yet satisfied their physiological needs (Agyepong, et al., 2004). There have been other findings to support this thereby; it is difficult to rule out non-financial motivating factors since better financial incentives alone cannot significantly enhance health worker motivation.
The working conditions are another factor that determines health worker motivation. The working conditions determine a health worker’s contentment concerning the working environment. The issue of working conditions does not merely include having adequate equipment and supplies; rather it also encompasses systems issues like information-exchange processes, decision-making processes and capacity issues like infrastructure, workload and support services (Potter & Brough, 2004).
Working conditions also entail protection against infectious diseases such as HIV and AIDs. Logically, poor protective mechanisms and facilities lead to escalated fears of infection and as a result, there is limited towards the provision of quality services and tasks are delegated to non-qualified staff (KIT/CHAZ, 2005; Dovlo, 2005). This eventually affects health service delivery and is associated with reduced health outcomes.
Availability and accessibility to hospital infrastructure and resources is a very important motivating factor for health workers. When health workers are not provided with adequate and essential equipment to work with like microscopes, then it becomes difficult for them to appropriately and adequately utilize their resources and as such, this acts as a great de-motivating factor. When a hospital lacks the necessary equipment, the health workers, alongside the patients, lack confidence and as a result, the health workers lose confidence in themselves and the patients, on the other hand, lose confidence in the health workers and the hospital at large. This can all be avoided if the health service managers understand that the intrinsic component of job fulfilment and satisfaction is very important concerning the provision of the required equipment and drugs by the health workers (Manongi, Marchant & Bygbjerg, 2006; Sararaks & Jamaluddin, 1999).
It always feels good when one’s efforts are recognized by their managers and/or supervisors, and he/she is motivated to work even harder. This case also applies to the health workers, who get motivated when they are recognized and appreciated by other people including the mangers, their employers and the outside community. This recognition and appreciation give the health workers the motivation and determination required to enhance their performance and deliver efficient and effective health services (Dieleman et al., 2006; Franco et al., 2004).
Motivational Theories: Expectancy Theory
The expectancy theory has been the most popular motivational theory in contemporary times. This theory has its origins in Victor Vroom’s work on motivation in 964 when he comes up with Vroom’s theory that is based on the presumption that behaviour is a product of conscious choices among alternatives aiming towards minimizing pain and maximizing on pleasure (Vroom, 1970).
Expectancy, instrumentality and valence are the main components of this theory, where each component is associated with a particular belief. Expectancy is associated with the belief that particular job performance can be attained. In this case, health workers will be motivated to work if they believe that they are confident enough about the task at hand. The various factors influencing a worker’s expectation are: level of confidence in skills possessed concerning the task, support from superiors and subordinates, availability of critical information and quality of materials and equipment in place (Baumeister & Vohs, 2004; Fishbein & Ajzen, 1975).
Instrumentality is all to do with the outcomes of a task. In this case, an employee believes that high performance is important if certain outcomes are to be gotten. As a result, the health workers are motivated to work because they believe that performance is instrumental in as far as achieving a certain desired outcome is concerned (Lindner, 1998). Valence is based on the satisfaction that is expected from an outcome (Paul, 2009.). A worker is not motivated to work if the task is believed to yield into negative valence as opposed to a positive one. When none of the three conditions under expectancy theory prevails, then there is no motivational force for work. In summary, motivational force is equivalent to expectancy, instrumentality and valence as shown below (Cervone et al., 2006):
Other Motivational Theories
Yet still is another theory by David McClelland which states that workers are driven to work irrespective of their gender and culture by achievement, influence and affiliation. These drives are considered to be very crucial if the motivation is to prevail. Health workers are motivated to work effectively and efficiently if they can get results for their work, for example, achieving set goals and finding solutions to the problem.
Achievement of the desired result gives health workers the motivation they need to deliver effective and efficient healthcare services. In addition to achieving desired results and outcome, health workers are motivated by the need to belong to and interact properly with other health workers, their superiors as well as their subordinates. Influencing potential is another motivating element based on McClelland theory that is based on the need for power. Health service managers need to know which need is dominant for different individuals because the domineering need influences how an individual is to be motivated (Jones, 2008; MHEN & VSO, 2011).
The theory of X and Y by Douglas McGregor talks about two diametrically opposing viewpoints of managers concerning their workers. The theory of X is based on negative presumptions of the employees by the managers, for instance, an assumption that employees do not like to work and therefore must be forced, threatened and controlled so that they can do the work. On the other hand, the theory of Y is based on positive presumptions about employees like employees love to work and require no supervision for them to perform and work (Carver & Scheier, 2001). A health service manager should use the X and Y theories to positively influence the health workers and enhance their performance.
The goal-setting theory by Edwin Locke dictates that health workers are motivated by setting specific goals to direct their work. Goal commitment and self-efficiency are deemed to be the main influential factors in as far as the goal-setting theory is concerned (Gollwitzer, 1999). Other theories are reinforcement and equity theories. The reinforcement theory places attention on the factors that influence behaviour and these are the needs that have been discussed in the content of this paper in details (Cofer & Appley, 1967). Health workers will be motivated to work because of the need to achieve external factors such as reward other than internal elements as is the case with the goal-setting theory.
The equity theory revolves around balance/equity concerning motivation. In this regard, the equity theory is based on the perception of fairness as exercised by the management within an organization. The greater the fairness/equity perceived within an organization, the higher the motivation of the workers and vice-versa (Lu et al., 2005). Health service managers need to understand that they should give equal kind of treatment to all health workers of an equivalent cadre without favour. Health workers need to know that their inputs are equally appreciated and none is subjectively considered to be better than that of another worker.
Conclusion
The fact that health workers are an integral part of any health institution is irrefutable. Unfortunately, most health service managers fail to develop appropriate strategies to motivate different health workers. It is worth noting that health workers have different needs that trigger their motivation to work thus it is necessary as a health service manager to ensure that most of them are met to avoid issues of emigration that further aggravate the situation (Benson & Dundis, 2003). Developing countries are mainly faced with this huge challenge of retaining their health workers since most of these workers immigrate to developed countries where they are assured of better incentives alongside other improved non-financial incentives (MHEN & VSO, 2011).
Although developing/low and middle-income countries have constrained resources, strategies that facilitate personal growth and motivation within a local context is imperative. Health service managers need to understand that the needs of the health workers vary because different health workers may be interested in different kinds of needs based on their ability to satisfy them. When a health service manager understands what the health workers require based on their needs, then he/she can put in place the appropriate strategies that will act as motivating factors for the workers while applying the motivation theories discussed above (Dieleman, M., & Harnmeijer, J. W., 2006).
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Cultural Revolution: Soviet Union And Kosovo
Introduction
The following paper is a transcript of two interviews. The first one was made with a 40-year old female Russian resident. The other interview featured a 28-year old male Kosovo resident. The transcript presents the views of the two interviewed on the cultural revolutions, the dissolution of the Soviet Union and the War in Kosovo consequently, examines the impact of the revolutions on the people’s lives, and draws conclusions on the basis of the similarities and dissimilarities of these two cultural revolutions.
The dissolution of the Soviet Union
The view on the revolution
It was the year of 1991 when the world observed in shock the Soviet Union collapsing into fifteen detached states. Its breakdown was addressed by the West as a triumph of liberty and equality over despotism, and an indication of the dominance of capitalism over communism (Czechowska, & Olszewski, 2012). In the interviewed person’s opinion, the breakup of the Soviet Union altered the entire world’s political state of affairs, leading to a wide-ranging reconstruction of party-political, commercial, and armed alliances all over the world. She also points out that the collapse of the Soviet Union began on the margins, in the parts that were not Russia.
The impact of the revolution
The dissolution of the Soviet Union made life much more challenging. Even though Russia is an enormous country that possesses numerous resources, life became unbalanced. Everything has been changed – starting with the governmental design and policies to the people’s common opinion about the country and its residents. The family life did not change a lot in its general sense, but the so-called “deficit” imposed various restrictions on people’s everyday life and their perception of the Russian government.
At first, the quiet and peaceful dissolution of the Soviet Union seemed to be seen as something natural, something that should have had eventually happened way before, but it caught most of the people by surprise. Instead of joining the efforts in an attempt to save the previously visible equality, the community split into layers.
The War in Kosovo
The view on the revolution
Continuing cultural tautness between Kosovo’s Albanian and Serb inhabitants left the area ethnologically separated, resultant in intercultural viciousness, ending in the Kosovo War, part of the broader local Yugoslav Wars. The war was over when the armed interference of NATO enforced the Federal Republic of Yugoslavia to extract its armed forces from Kosovo (Allin, 2014). An important note was made by the interviewed when he mentioned that the tension between Kosovo and Serbia still exists even though the conflict is currently usually being seen as resolved by the majority of the European populace.
The impact of the revolution
Just like any other revolution, this one was unconsciously designed to improve people’s life in Kosovo, but the War did not do any good for the country. The area was distressed by the hostilities, and the people were scared. In the respondent’s opinion, the country is now poor by European ideals with high joblessness rates, still not having completely recuperated from the historical war (O’Neil, 2014). As an example, the interviewed cites his father, who lost his official job because of the war and not yet found another to this day. He makes his living by growing and selling vegetables in the village.
His siblings are not able to get higher education and believe that they have no future in Kosovo at all. The respondent also believes that the conflict produced only issues, both major and minor, for the neighboring countries as well. For instance, he mentioned the environmental and political issues in Macedonia and the major crime and corruption issues that can be observed in Bosnia and Herzegovina. This once again confirms the tragic consequences of the War that found their reflection not only in the participating countries but the nearby countries as well.
Conclusion
If one compares the two cultural and political revolutions, the similarities between the dissolution of the Soviet Union and the War in Kosovo are obvious and appealing. The changes that should have been brought by the revolutions should have been strictly positive, but the divergence of the political and cultural views of both the governments and the residents has caused total confusion and led to a series of successive crises.
Generally speaking, the current situation once again proves the importance of the revolution as a whole, but we must pay attention to how forthright and intransigent are both of them. The political, economic, and, most importantly, cultural issues caused by these two events are explicitly graphic. Both Russia and Kosovo must soberly assess the risk of recurrence of such situations, and make every effort so that dire consequences would not repeat themselves.
References
Allin, D. H. (2014). NATO’s Balkan Interventions. New York, NY: Routledge.
Czechowska, L., & Olszewski, K. (2012). Central Europe on the Threshold of the 21st Century: Interdisciplinary Perspectives on Challenges in Politics and Society. Newcastle upon Tyne: Cambridge Scholars Pub.
O’Neil, P. H. (2014). Post-communism and the Media in Eastern Europe. New York, NY: Routledge.