Forces Initiating or Inhibiting Change in Organizations Essay

Forces Initiating or Inhibiting Change in Organizations - Essay Example The coming of new technology, Robins said, affects the jobs and the organization. There was a time when pagers were in vogue. It was a necessary communication tool for sales and field personnel, but cellular phones took them out of the picture. Computer knowledge is an added requirement for new employees, a necessity in almost all business outfits. Technology, likewise, affects a company or industry, especially the music industry with online downloads and sharing. He commented that genetic technology allows pharmaceutical corporations to produce drugs for particular individuals, which in turn produces a dilemma for insurance companies on who would be insured or not. With competition no longer confined within a geographic territory but globally, new products and services should be introduced for survival. With business deals being transacted and concluded online, technical and support units became part of the structure.

Alcohol as an acceptable adjunct for occasions in our society Essay Example for Free

Alcohol as an acceptable adjunct for occasions in our society Essay There are approximately 50% or 126 million of Americans whom are past month alcohol drinkers, or also known as current drinkers. Also, approximately 23% or 55 million of Americans binge drink, and 6.6% or 16 million Americans reported heavy drinking. The estimated spending for healthcare services to treat alcohol problems, and its medical consequences of alcohol is 18.8 billion dollars a year. Alcohol is also officially linked to at least over half of all highway fatalities. To date, alcohol has been tried by 41% of 8th graders, 63% of 10th graders, 75% of 12th graders, and 87% of college students. Also there was an estimated 82 billion dollars lost in potential productivity due to alcohol and other drug use. We all know that alcohol is offered almost everywhere we go. At parties, in bars, in clubs, in stores, and restaurants. People consume alcohol for every occasion they can think of, or just to make their problems go away and to make them feel better, even though it is just for a limited amount of time. We all know what alcohol does, and can do. Why do we always chose alcohol at a party, in a bar, at a restaurant, or in a store? People can have fun without it. Alcohol is used to socialize better, but why cant people socialize without it? Why is alcohol used as an acceptable, unnecessary addition to celebrations such as parties, weddings, birthdays, and anniversaries, and as a way of relaxing and relieving stress and anxiety? People know what alcohol is about but yet continue drinking massively into more disasters. Reference: Drugs and Society Tenth Edition Chapter 8 p.182-191, U.S. National Library of Medicine and the National Institutes of Health http://www.nlm.nih.gov/medlineplus/alcoholconsumption.html#cat1 People use alcoholic beverages to enjoy while chatting with friends. Thinking about the effects of alcohol on the health of a person using it is never apparent. The holidays are the time when alcoholic beverages are mostly abused of which includes parties and small gatherings of friends and families. In this case, the people responsible in that activity such as hosts and party organizers must think of the safety of every drinking pattern. Any risky of harmful pattern must be regulated and prevented. I am not saying that it is acceptable to use alcohol during parties. What I am trying to say is that when drinking alcoholic beverages cannot be prevented during holidays, proper caution must be used in doing so to prevent untoward incidents.

J.B.Priestley’s play, An Inspector Calls Essay -- English Literature

By what means, and how successfully is suspense created and sustained in An Inspector Calls? An Inspector Calls Essay By what means, and how successfully is suspense created and sustained in ‘An Inspector Calls?’  · Show analytical and interpretative skills  · The effects of dramatic devices and structure  · Layers of meaning in language, ideas and themes  · The social and historical setting/context JB Priestley wrote ‘An Inspector Calls’ towards the end of World War 2. The play however, is set in 1912 at a wealthy, middle-class family home. The play is about a family celebrating an engagement, when an Inspector calls, and tells them of a young girl’s suicide. The play is always set in the family’s dining room, but it has precise stage directions, so each character must be sitting in a certain place. Suspense is used right through the play, usually at its peak at the end of an act. I think JB Priestley was trying to get a message across to us that we need to abolish the social class differences, and all be equal. The play is very good because you are always trying to find out who was responsible for the suicide, and you know that everybody fits in, but you don’t know when or how. As you find, or think you’ve found something out, the play takes a new dramatic turn, which definitely makes suspense the key factor. What makes the play even better is that the audience always knows a lot more than the characters do, and you are always wondering: â€Å"why haven’t they worked that out?† Suspense is very successfully created and sustained in ‘An Inspector Calls.’ When Act one begins, the mood is merry, and civilised in the dining room, at The Birlings’ house. The family are happy, excited and ... ...er this phone call means that yes everything was true, or no, it was a hoax. Then, it is used as a dramatic device again when it rings, and the local Inspector says he is coming round to question the Birlings about a young girl’s death. The play ends here. Now, we have found out the suspense is created and sustained very successfully in ‘An Inspector Calls’. With you always wondering whether the Inspector is real, and all the cliffhangers that are used, you are constantly left in suspense, even after the very unusual ending. You are wondering at the end whether this time it really is real, or is it another hoax? We will never know. Dramatic devices are a key element in this play, for example in Act 3; a telephone is the focal point. It can be little things like that. I hope this brings a good conclusion to a very good, interesting, even if strange play.

Shark Attacks

On 11 July, 1916 Rensselaer Cartan Jr. saw a looming dark figure and noticed a large fin protruding from the water. A shark, the newest fear of many after the several attacks that occurred just days before. Yet he was 17 miles inland, he knew what he saw and set out to warn the town of the â€Å"sea monster† looming in the creek. â€Å"No way† were the thoughts of many as they heard Caratan Jr. tell his tale, and they continued on with their normal lives, despite his desperate cries of fear and warning. The attacks of Lester Stilwell and Stanley Fisher show that the technology of this era was very un-advanced, this was also the first recorded shark attack in fresh water, and the amount of time it took for a doctor to reach the place of the attack was lengthy and costly. The technology in this era was very weak in comparison to today’s modern medicine and was not efficient in life if death situations. In this time there was no ambulances and the way to be rushed to the hospital was by train and by automobile. If theses attacks had occurred in modern times, the death of Fisher may have been stopped. The death of Stilwell was definite, due to the fact that the shark mangled Stilwell’s body beneath the water, where he drowned. He also would have died from sheer amounts of blood loss and the fact that no one would have reached the eleven year old boy on time. Though modern technology has changed the amount of help that doctors can provide patients the patient, must be first saved from the cause of death. In this case the shark did not let young Stilwell have the opportunity of medical treatment that he so desperately needed. These attacks were a shock to the world because they occurred in a creek seventeen miles inland. Bull sharks have been found in various fresh water sources, sometimes far upriver or upstream in some cases, their high tolerance for fresh water nearly unique among shark species. (Davidson) The bull shark is a shark that is known to be found in modern times to swim into the mouths of rivers to find better prey. This was unknown to the people of 1916 as was many facts of the entire species of sharks. Nobody thought a shark would travel so far inland and in a creek no larger than 45 feet across. (capuzzo 89) The shark had been allowed to travel so far up due to the fact the the tide was at its highest point due to the lunar cycle. (capuzzo 91) The shark was easily able to maneuver and find its prey in the murky water. The amount of time that it took for a doctor to reach the scene, where Stilwell and Fisher were attacked was far too long. According to Julius Kish, no doctor lived or worked in the town of Matawan in 1916. This may have contributed to the fact that Fisher died and did not receive medical attention right away as was needed. The only immediate he received was that of his friends, who were in shock. His friends made a makeshift tourniquet using rope to stop the excessive blood flow. (Capuzzo 101) This was not enough to save the mans life, he needed immediate medical attention. Stanley fisher slowly began to die as he waited for the doctors to arrive to treat his wound, a large chunk of flesh missing from his pelvis. Fisher’s wounds were dire, yet he willed to live. â€Å"That afternoon in 1916, however, the treatment Stanley Fisher required was two hours and thirty-nine minutes away. † (Capuzzo 101) At this time hospitals lay far apart and the travel to a hospital may be too far and by the time patients reach the hospital, death has already set in. When Fisher pulled his body out of the water he lied there in a pool of his own blood. (capuzzo 100) As the blood would continue to flow he was at risk for blood loss and also diseases of having an uncared for open gash. With such a limited supply of medical attention in this era caused casualties that would be routine in todays modern age. The attacks of 1916 started an epidemic of natural fear against man eating sharks. Lester Stilwell’s body took two days to resurface. In those two days rumors flowed through America on what had happened to the boy. The curiosity on what caused this â€Å"rouge† shark to go on such vicious attacks initiated people to begin researching these mysterious predators. presently we now no much more about sharks and continue to research to better understand how these suspicious animals tick.

Managerial Leadership role for Nurses’ Use of Research Evidence Essay

The rapid noticeable change in healthcare delivery coupled with professional responsibilities of nurses to incorporate research evidence into their decision making underscores the need to understand the factors involved in implementing evidence-based practice. Linking current research findings with patients’ conditions, values, and circumstances is the defining feature of evidence-based practice. Significant and rational for using evidence in practice in nursing care Evidence-based practice (EBP) is an approach to health care where the best evidence possible is used in health professionals to make clinical decisions for individual. It involves complex and conscientious decision-making based on the available evidence, patient characteristics, situations, and preferences( McKibbon, 1998). Evidence-based practice in nursing is defined as â€Å"integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities who are served† (â€Å"Sigma Theta Tau International position statement on evidence-based practice February 2007 summary,† 2008). The gist of evidence based health care is the integration of individual clinical expertise with the best available external clinical evidence and the values and expectations of the patient. There are different recourses of evidence which includes the following: †¢Research Evidence: which refers to methodologically sound, clinically relevant research about the effectiveness and safety of interventions, the accuracy of assessment measures, the strength of causal relationships and the cost-effectiveness of nursing interventions. †¢Patients Experiences and Preferences: identification and consideration of patient’s experiences and preferences are central to evidence-based decision making. Patients may have varying views about their health care options, depending on factors such as their condition personal values and experiences, degree of aversion to risk, resources, availability of information, cultural beliefs, and family influences. †¢ Clinical Expertise. AS the mixing of these different types of evidence may be influenced by factors in the practice context such as available resources, practice cultures and norms leadership styles, and data management, we must consider the level of evidence while using the research evidence to take the proper decision, look to appendix A which is represent the level of evidence. (Haynes, Devereaux, & Guyatt, 2002; Sigma Theta Tau International position statement on evidence-based practice February 2007 summary,† 2008). Evidence-based practice is a prominent issue in international health care which is intended to develop and promote an explicit and rational process for clinical decision making that emphasizing the importance of incorporating the best research findings into clinical care to ensure the best possible treatment and care derived from the best available evidence (E. Fineout-Overholt, Levin, & Melnyk, 2004) Once a new research is completed new evidence comes into play every day, technology advances, and patients present with unique challenges and personal experiences(Krainovich-Miller, Haber, Yost, & Jacobs, 2009). The nurse who bases practice on what was learned in basic nursing education soon becomes outdated, then becomes dangerous. Patients are not safe if they do not receive care that is based on the best evidence available to assist them at the time their needs arise, so all aspects of nursing, from education to management to direct patient care, should be based on the best evidence available at the time (Reavy & Tavernier, 2008). Through reviewing the literature there is a dramatically changing and advancing in the technology, available body information and quality of care provided, the rapid pace of change in healthcare delivery coupled with professional responsibilities of nurses to incorporate research evidence into their provided care and decision making underscores the need to understand the factors involved in implementing evidence-based practice (Bostrà ¶m, Ehrenberg, Gustavsson, & Wallin, 2009; Ellen Fineout-Overholt, Williamson, Kent, & Hutchinson, 2010; Gerrish, et al., 2011; Gifford, Davies, Edwards, Griffin, & Lybanon, 2007). Before that nurses must first believe that basing their practice on the best evidence will lead to the highest quality of care and outcomes for patients and their families(Ellen Fineout-Overholt, et al., 2010; Melnyk, et al., 2004). To let change occuring, â€Å"there must be a clear vision, written goals, and a well-developed strategic plan, including strategies for overcoming anticipated barriers along the course of the change†(Melnyk, et al., 2004). Emerging evidence indicates that the  leadership behaviors’ of nurse managers and administrators play an important role in successfully utlizing research evidence into clinical nursing(Amabile, Schatzel, Moneta, & Kramer, 2004; Antrobus & Kitson, 1999; Gifford, et al., 2007). There is a consistency between many researches that clamethe importance role of the leadership and leadership factors such as support and commitment of managers on the staff at the implication of EBP(Aitken, et al., 2011; Antrobus & Kitson, 1999; Melnyk, et al., 2004; Winch, Creedy, & Chaboyer, 2002). Nurse managers and administrators are responsible for the professional practice environments where nurses provide care, and are strategically positioned to enable nurses to use research. As being a role model, administrators must be committed to provide the necessary resources such as EBP mentors, computers, and EBP education. Some administrators have tried to encourage a change to EBP by integrating EBP competencies into clinical promotions. However, Miller (2010) argue that this extrinsic motivational strategy is unlikely to be as effective as when people are intrinsically motivated to change. Also there is a claimed that if people are involved in the strategic planning process, they are more likely to change to EBP. Intervention protocol for promoting nurses compliance to EBP As the Decision making in health care has changed dramatically, with nurses expected to make choices which based on the best available evidence and continually review them as new evidence comes to light (Pearson et al, 2007). Evidence-based practice involves the use of reliable, explicit and judicious evidence to make decisions about the care of individual patients. As an important role in providing safe and high quality care the nurses must take into account the quality of evidence, assessing the degree to which it meets the four principles of feasibility, appropriateness, meaningfulness and (Doody & Doody, 2011; Johnson, Gardner, Kelly, Maas, & McCloskey, 1991). What nurses need to operate in an evidence-based manner, is to be aware of how to introduce, develop and evaluate evidence-based practice. There more than one model for introducing the EBP in health care one of them that I chose is the Iowa model. The Iowa model focuses on organization and collaboration incorporating conduct use of research, along with other types of evidence(Doody & Doody, 2011; Johnson, et al., 1991). Since its origin in 1994, it has been continually referenced in nursing journal articles and extensively used in clinical research programmes. This model uses key triggers that can be either problem focused or knowledge focused, leading staff to question current nursing practices and whether care can be improved through the use of current research findings(Bauer, 2010; Doody & Doody, 2011; Johnson, et al., 1991; Titler, et al., 2001). By using Iowa Model; a question is generated either from a problem or as a result of becoming aware of new knowledge. Then a determination is made about the question relevance to organizational priorities. If the question posed is relevant, then the next step is to determine if there is any evidence to answer the question. Once the evidence has been examined, if there is sufficient evidence, then a pilot of the practice change is performed. If there is insufficient evidence, then the model supports that new evidence should be generated through research (Bauer, 2010). Step one of the Iowa model is to formulate a question. The question if asked in a PICO format is easier to use to search the literature. A PICO format uses the following method to frame the question: Frame question in PICO format †¢ P= Population of interest †¢ I= Intervention †¢ C= Comparison of what you will do †¢ O= Outcome(Hoogendam, de Vries Robbà ©, & Overbeke, 2012). The final step to the process is to share the outcomes of the practice change with other in the form of an article or poster. In using the Iowa model, there are seven steps to follow in detail as it is outlined in the figure shown in appendix B. Step 1: Selection of a topic In selecting a topic for evidence-based practice, several factors need to be considered. These include the priority and magnitude of the problem, its application to all areas of practice, its contribution to improving care, the availability of data and evidence in the problem area, the multidisciplinary nature of the problem, and the commitment of staff. Step 2: Forming a team The team is responsible for development, implementation, and evaluation. The composition of the team should be directed by the chosen topic and include all interested stakeholders. The process of changing a specific area of practice will be assisted by specialist staff team members, who can provide input and support, and discuss the practicality of guideline. A bottom-up approach to implementing evidence-based practice is essential as change is more successful when initiated by frontline practitioners, rather than imposed by management. Staff support is also important. Without the necessary resources and managerial involvement, the team will not feel they have the authority to change care or the support from their organization to implement the change in practice. To develop evidence-based practice at unit level, the team should draw up written policies, procedures and guidelines that are evidence based. Interaction should take place between the organization’s direct care providers and management such as nurse managers, to support these changes(Antrobus & Kitson, 1999; Cookson, 2005; Doody & Doody, 2011; Hughes, Duke, Bamford, & Moss, 2006). Step 3: Evidence retrieval Evidence should be retrieved through electronic databases such as Cinahl, Medline, Cochrane and up-to-date web site. Step 4: Grading the evidence To grade the evidence, the team will address quality areas of the individual research and the strength of the body of evidence overall (see appendix A for level of evidence). Step 5: Developing an Evidence-Based Practice (EBP) standard After a critique of the literature, team members come together to set recommendations for practice. The type and strength of evidence used in practice needs to be and based in the consistency of replicated studies. The design of the studies and recommendations made should be based on identifiable benefits and risks to the patient. This sets the standard of practice guidelines, assessments, actions, and treatment as required. These will be based on the group decision, considering the relevance for practice, its feasibility, appropriateness, meaningfulness, and effectiveness for practice. To support evidence-based practice, guidelines should be devised for the patient group, health screening issues addressed, and policy and procedural guidelines devised highlighting frequency and areas of screening. Evidence-based practice is ideally a patient centered approach, which when implemented is highly individualized. Step 6: Implementing EPB For implementation to occur, aspects such as written policy, procedures and guidelines that are evidence based need to be considered. There needs to be a direct interaction between the direct care providers, the organization, and its leadership roles (e.g. nurse managers) to support these changes. The evidence also needs to be diffused and should focus on its strengths and perceived benefits, including the manner in which it is communicated. This can be achieved through in-service education, audit and feedback provided by team members. Social and organizational factors can affect implementation and there needs to be support and value placed on the integration of evidence into practice and the application of research findings(Aitken, et al., 2011; Doody & Doody, 2011; Gerrish, et al., 2011; Reavy & Tavernier, 2008) Step 7: Evaluation Evaluation is essential to seeing the value and contribution of the evidence into practice. A baseline of the data before implementation would benefit, as it would show how the evidence has contributed to patient care. Audit and feedback through the process of implementation should be conducted and support from leaders and the organization is needed for success. Evaluation will highlight the programme’s impact. Barriers also need to be identified. Information and skill deficit are common barriers to evidence-based practice. A lack of knowledge regarding the indications and contraindications, current recommendations, and guidelines or results of research, has the potential to cause nurses to feel they do not have sufficient training, skill or expertise to implement the change. Awareness of evidence must be increased to promote the translation of evidence into practice . A useful method for identifying perceived barriers is the use of a force field analysis conducted by the team leader. Impact evaluation, which relates to the immediate effect of the intervention, should be carried out. However, some benefits may only become apparent after a considerable period of time. This is known as the sleep effect. On the contrary, the back-sliding effect could also occur where the intervention has a more or less immediate effect, which decreases over time. We must not to evaluate  too late, to avoid missing the measures of the immediate impact. Even if we do observe the early effect, we cannot assume it will last. Therefore, evaluation should be carried out at different periods during and following the intervention (Doody & Doody, 2011). Nursing leadership is an essential role for promoting evidence-based practice while the nurse managers and administrators are responsible for the professional practice environments where nurses provide care, are strategically positioned to enable nurses to use research. AS the leadership is essential for creating change for effective patient care the leadership behaviors are critical in successfully influencing the stimulation, acceptance, and utilization of innovations in organizations (Antrobus & Kitson, 1999; Gifford, et al., 2007). From my perspective I consider that the leaders and managers are the corner stone for utilizing researches and make practices based on evidence. By playing a role model for staff and handling the authority they have a magic force to urges the staff to use evidence based in there practice. Leaders can encourage the staff to use EBP in their practice in several ways such as increase the staff awareness, stimulating the intrinsic motivation of people, implying an effort to increase the will and internal desire to change through support encouragement, education, and appealing to a common purpose, monitoring performance, strengthen the body of knowledge that the staff have by forcing them to attend and participate in conferences, workshops & Journal clups, giving rewards to staff who collaborate in finding, utilizing and applying the EBP and make promotion and appraisal according to adherence to application of EBP. Implication of EBP For implementation to occur, aspects such as written policy, procedures and guidelines that are evidence based need to be considered. There needs to be a direct interaction between the direct care providers, the organization, and its leadership roles (e.g. nurse managers) to support these changes. The evidence also needs to be diffused and should focus on its strengths and perceived benefits, including the manner in which it is communicated. This can be achieved through in-service education, audit and feedback provided by team members. Social and organizational factors can affect implementation and there needs to be support and value placed on the integration of evidence into practice and the application of research findings. There are many ways that can be used to create an environment to implement and sustain an area of EBP such as : -Development of EBP champions; – Use of EBP mentors; – Provision of resources such as time and money; – Creation of a culture and expectation related to EBP; – Use of practical strategies including EBP workgroups, journal club and nursing rounds (Aitken, et al., 2011). EBP is being used in every aspect of the life, especially in the health care. The most common application of EBP is not only in intervention or treatment plane, but also the EBP process has been applied to making choices about diagnostic tests and protocols to insure thorough and accurate diagnosis, selecting preventive or harm-reduction interventions or programs, determining the etiology of a disorder or illness, determining the course or progression of a disorder or illness, determining the prevalence of symptoms as part of establishing or refining diagnostic criteria, completing economic decision-making about medical and social service programs. Nursing research proves pivotal to achieving Magnet recognition, yet the term research often evokes an hunch of mystery. Most of the policy, guidelines. And protocols that guide the work in the organization are based on evidance (Weeks & Satusky, 2005). Also, it is also useful to think of EBP as a much larger social movement. Drisko and Grady (2012) argue that at a macro-level, EBP is actively used by policy makers to shape service delivery and funding. EBP is impacting the kinds of interventions that agencies offer, and even shaping how supervision is done. EBP is establishing a hierarchy of research evidence that is privileging experimental research over other ways of knowing. There are other aspects of EBP beyond the core practice decision-making process that are re-shaping social work practice, social work education, and our clients’ lives. As such, it may be viewed as a public idea or a social movement at a macro level (â€Å"Evidence-Based Practice: Why Does It Matter?,† 2012). Cost effectiveness of using EBP in health care  Beneficial outcomes of the implementation and use of evidence-based practice by staff nurses include increased ability to offer safe, cost-effective,  and patient-specific interventions. Critical thinking skills and leadership abilities can also grow because of the use of evidence based practice; it is a way for staff nurses to become involved in change and regain ownership of their practice (Reavy & Tavernier, 2008). EBP used in clinical practice lead to make improvement in quality of provided care, which lead to improve the patients outcome, patient satisfaction and employee satisfaction. All these aspect are directly and indirectly lead to increase the cost effectiveness of the organization. When the patient satisfaction increased the patient acceptance to the organization increased, the employee satisfaction also increases and turnover will decrease all these things will increase the financial revenue to the organization. Also when using EBP in health care this will lead to decrease errors, complications and losses (e.g. compliance of evidence based infection control guidelines will lead to decrease incidence of infection, decrease length of stay an d decrease the cost of patient treatment), another example is using EBP to treat diabetic foot will result in decreasing the loses and increases the satisfaction so adherence to EBP will be costly effective when it result in better outcome, quality of care and satisfaction. Sometimes using EBP in certain area is costly; in such cases we must weighing the benefits ( immediately and after considered period of time) and mak e our decision based on the collected data and information. References: Aitken, L. M., Hackwood, B., Crouch, S., Clayton, S., West, N., Carney, D., et al. (2011). Creating an environment to implement and sustain evidence based practice: A developmental process. Australian Critical Care, 24(4), 244-254. Amabile, T. M., Schatzel, E. A., Moneta, G. B., & Kramer, S. J. (2004). Leader behaviors and the work environment for creativity: Perceived leader support. The Leadership Quarterly, 15(1), 5-32. Antrobus, S., & Kitson, A. (1999). Nursing leadership: influencing and shaping health policy and nursing practice. Journal of Advanced Nursing, 29(3), 746-753. Bauer, C. (2010). Evidence Based Practice:Demystifying the Iowa Model Providing optimal care through promotion of professional standard, networking and development, 25(2). Bostrà ¶m, A.-M., Ehrenberg, A., Gustavsson, J. P., & Wallin, L. (2009). Registered nurses’ application of evidence-based practice: a national survey. Journal Of Evaluation In Clinical Practice, 15(6), 1159-1163. Cookson, R. (2005). Evidence-based policy making in health care: what it is and what it isn’t. Journal Of Health Services Research & Policy, 10(2), 118-121. Doody, C. M., & Doody, O. (2011). Introducing evidence into nursing practice: using the IOWA model. British Journal of Nursing, 20(11), 661-664. Evidence-Based Practice: Why Does It Matter? (2012). ISNA Bulletin, 39(1), 6-10. Fineout-Overholt, E., Levin, R. F., & Melnyk, B. M. (2004). Strategies for advancing evidence-based practice in clinical settings. Journal of the New York State Nurses Association, 35(2), 28-32. Fineout-Overholt, E., Williamson, K. M., Kent, B., & Hutchinson, A. M. (2010). Teaching EBP: strategies for achieving sustainable organizational change toward evidence-based practice. Worldviews On Evidence-Based Nursing / Sigma Theta Tau International, Honor Society Of Nursing, 7(1), 51-53. Gerrish, K., Guillaume, L., Kirshbaum, M., McDonnell, A., Tod, A., & Nolan, M. (2011). Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey. Journal of Advanced Nursing, 67(5), 1079-1090. Gifford, W., Davies, B., Edwards, N., Griffin, P., & Lybanon, V. (2007). Managerial leadership for nurses’ use of research evidence: an integrative review of the literature. Worldviews on Evidence-Based Nursing, 4(3), 126-145. Haynes, R. B., Devereaux, P. J., & Guyatt, G. H. (2002). Clinical expertise in the era of evidence-based medicine and patient choice. ACP Journal Club, 136(2), A11-A14. Hoogendam, A., de Vries Robbà ©, P. F., & Overbeke, A. J. P. M. (2012). Comparing patient characteristics, type of intervention, control, and outcome (PICO) queries with unguided searching: a randomized controlled crossover trial. Journal Of The Medical Library Association: JMLA, 100(2), 121-126. Hughes, F., Duke, J., Bamford, A., & Moss, C. (2006). Enhancing nursing leadership: Through policy, politics, and strategic alliances. Nurse Leader, 4(2), 24-27. Johnson, M., Gardner, D., Kelly, K., Maas, M., & McCloskey, J. C. (1991). The Iowa Model: a proposed model for nursing administration. Nursing Economic$, 9(4), 255-262. Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. K. (2009). Evidence-based practice challenge: teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journa l of Nursing Education, 48(4), 186-195. Melnyk, B. M., Fineout-Overholt, E., Feinstein, N. F., Li, H., Small, L., Wilcox, L., et al. (2004). Nurses’ perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: implications for accelerating the paradigm shift. Worldviews on Evidence-Based Nursing, 1(3), 185-193. Reavy, K., & Tavernier, S. (2008). Nurses reclaiming ownership of their practice: implementation of an evidence-based practice model and process. Journal of Continuing Education in Nursing, 39(4), 166-172. Sigma Theta Tau International position statement on evidence-based practice February 2007 summary. (2008). Worldviews on Evidence-Based Nursing, 5(2), 57-59. Titler, M. G., Kleiber, C., Steelman, V. J., Rakel, B. A., Budreau, G., Everett, C. L. Q., et al. (2001). The Iowa Model of Evidence-Based Practice to Promote Quality Care. Critical Care Nursing Clinics of North America, 13(4), 497-509. Weeks, S. K., & Satusky, M. J. (2005). Demystifying nursing research: to encourage compliance with Magnet accreditation standards, f urther your facility’s research initiatives. Nursing Management, 36(2), 42. Winch, S., Creedy, D., & Chaboyer, W. (2002). Governing nursing conduct: the rise of evidence-based practice. Nursing Inquiry, 9(3), 156-161.

How to Kill a Tree Without Chemicals

How to Kill a Tree Without Chemicals Killing a tree is hard work, particularly if you avoid using chemical assistance. You have to cut off a trees water, food and/or sunlight at a critical time in its life cycle to do the job. Herbicides work by gumming up or shutting down a trees working parts to deprive the plant of one or more of the above.   Using the Bark Trees can be killed without herbicides or chemicals but extra time, patience, and understanding of tree anatomy are necessary. You most especially need to know about the function of a trees inner bark- cambium, xylem, and phloem- and how they combine forces to affect a trees life.   The bark is a trees most vulnerable body part above ground and the easiest target for an effective kill. Damaging enough roots to kill the tree quickly is complicated and hard to do without using chemicals. The bark is made up of cork and phloem which protects the cambium and xylem. Dead xylem cells carry water and minerals from the roots to the leaves and are considered the trees wood. Phloem, a living tissue, carries manufactured food (sugars) from the leaves to the roots. The cambium, which is a moist layer only a few cells thick, is the regenerative layer that gives birth to xylem on its inside and phloem to its outside. Destroying the Bark If the food-transporting phloem is severed all the way around the tree (a process called girdling), food cannot be carried to the roots and they will eventually die. As the roots die, so does the tree. Periods of rapid growth, usually from March until June in North America, are the best times to girdle a tree. These spring growth spurts are when tree bark slips. The phloem and cork layer easily peels free, leaving the cambium and xylem exposed. Remove as wide a section of bark as you have time to make an adequate girdle ring. Then scrape (or chop) into the surface of the xylem to remove the cambium. If any cambial material remains, the tree will heal by overgrowing the girdle. The best time to girdle is before the trees leaf out. The process of leafing out will deplete energy stores from the roots, which stores cannot be renewed if the phloem conduit has been interrupted. Avoid the Sprout Some trees are prolific sprouters and produce adventitious twigs near an injury. If you dont remove or kill the entire root, you just may have to control these sprouts. Sprouts coming out below the girdle must be removed as they will continue the process of feeding the roots if left to grow. When you are removing these sprouts, it is a good idea to check the girdled strip and remove any bark and cambium that may be trying to bridge the wound. Even cutting a tree down cant guarantee it will be killed. Many tree species, particularly some deciduous broad-leaf species, will sprout back from the original stump and root system.

Inspirational Quotes About Teacher

Inspirational Quotes About Teacher Do you remember a teacher who inspired you? Do you want to thank that teacher for her or his selfless service? Here is your chance. Pick an inspirational quote for your teacher from this page and send it as a special message for your teacher. Each inspirational quote lauds the efforts of good teachers. Martin HeideggerTeaching is more difficult than learning because what teaching calls for is this: to let learn. The real teacher, in fact, lets nothing else be learned than learning. His conduct, therefore, often produces the impression that we properly learn nothing from him, if by learning we now suddenly understand merely the procurement of useful information.AnonymousIf you can read this, thank a teacher.Albert EinsteinIt is the supreme art of the teacher to awaken joy in creative expression and knowledge.John GarrettThe job of a teacher is to excite in the young a boundless sense of curiosity about life, so that the growing child shall come to apprehend it with an excitement tempered by awe and wonder.Edmond H. FischerIt is commonly said that a teacher fails if he has not been surpassed by his students.David E. PriceThe impending teacher shortage is the most critical education issue we will face in the next decade.Malcolm S. ForbesEducations purpose is to replace an empty mind w ith an open one. Morihei UeshibaStudy how water flows in a valley stream, smoothly and freely between the rocks. Also learn from holy books and wise people. Everything even mountains, rivers, plants and trees should be your teacher.Richard BachLearning is finding out what we already know. Doing is demonstrating that you know it. Teaching is reminding others that they know just as well as you. You are all learners, doers and teachers.Thomas H. HuxleySit down before fact as a little child, be prepared to give up every preconceived notion, follow humbly wherever or whatever abysses nature leads, or you will learn nothing.

Quotes Attributed to Epictetus

Quotes Attributed to Epictetus Epictetus (A.D. c. 55 - c.135) To a reasonable creature, that alone is insupportable which is unreasonable; but everything reasonable may be supported.Epictetus - Discourses Chap. ii. The rational and the irrational are naturally different for different persons as are good and evil and profitable and unprofitable. For this reason we need to learn how to adjust our conceptions of rational and irrational and keep them in harmony with nature. When we determine the rational and the irrational we use both our estimates of external things and the criterion of our own character. This makes it most important that we understand ourselves. You must know how highly you value yourself and at what price you will sell yourself; different men sell themselves at different prices.Epictetus - Discourses 1.2Courtesy of translator Giles Laurà ©n, author of The Stoics Bible. When Vespasian sent word to Helvidius Priscus not to attend the Senate, he answered: It is in your power to forbid me to be a member of the Senate, but so long as I am one I must attend its meetings.Epictetus - Discourses 1.2.Courtesy of translator Giles Laurà ©n, author of The Stoics Bible. If every man could be convinced heart and soul in the belief that we are all begotten by Zeus, father to both men and gods, I think he could no longer have any ignoble or mean thought about himself. If Caesar adopts you no one will be able to endure your conceit, but if you know you are a son of Zeus shouldnt you be elated? Two elements are commingled in us: the body which we have in common with the brutes and intelligence which we have in common with the gods. Many of us incline towards the former which is unblessed and mortal and only a few incline towards the latter which is divine and blessed. Clearly, every man is free to deal with things according to his opinions of them, and those few who think that their birth is a call to fidelity, self-respect and unerring judgement cherish no mean or ignoble thoughts about themselves, whereas the multitude do quite the opposite and cleave to their animal part and become rascally and degraded.Epictetus - Discourses 1.3.Courtesy of translat or Giles Laurà ©n, author of The Stoics Bible. He who is making progress has learned that desire is for things good and that aversion is for things evil, and further, that peace and calm are only achieved as a man gets the things he wants and avoids the things he doesnt want. Since virtue is rewarded with happiness, calm and serenity, progress towards virtue is progress towards its benefits and this progress is always a step towards perfection.Epictetus - Discourses 1.4.Courtesy of translator Giles Laurà ©n, author of The Stoics Bible. In a word, neither death, nor exile, nor pain, nor anything of this kind is the real cause of our doing or not doing any action, but our inward opinions and principles.Epictetus - Discourses Chap xi. Reason is not measured by size or height, but by principle.Epictetus - Discourses Chap. xii. O slavish man! will you not bear with your own brother, who has God for his Father, as being a son from the same stock, and of the same high descent? But if you chance to be placed in some superior station, w ill you presently set yourself up for a tyrant?Epictetus - Discourses Chap. xiii. When you have shut your doors, and darkened your room, remember never to say that you are alone, for you are not alone; but God is within, and your genius is within, and what need have they of light to see what you are doing?Epictetus - Discourses Chap. xiv. No great thing is created suddenly, any more than a bunch of grapes or a fig. If you tell me that you desire a fig, I answer you that there must be time. Let it first blossom, then bear fruit, then ripen.Epictetus - Discourses Chap. xv. Any one thing in the creation is sufficient to demonstrate a Providence to an humble and grateful mind.Epictetus - Discourses Chap. xvi. Were I a nightingale, I would act the part of a nightingale; were I a swan, the part of a swan.Epictetus - Discourses Chap. xvi. Since it is Reason which shapes and regulates all other things, it ought not itself to be left in disorder.Epictetus - Discourses Chap. xvii. If what the philosophers say be true,that all mens actions proceed from one source; that as they assent from a persuasion that a thing is so, and dissent from a persuasion that it is not, and suspend their judgment from a persuasion that it is uncertain, so likewise they seek a thing from a persuasion that it is for their advantage.Epictetus - Discourses Chap. xviii. Practise yourself, for heavens sake, in little things; and thence proceed to greater.Epictetus - Discourses Chap xviii. Every art and every faculty contemplates certain things as its principal objects.Epictetus - Discourses Chap. xx. Why, then, do you walk as if you had swallowed a ramrod?Epictetus - Discourses Chap. xxi. When one maintains his proper attitude in life, he does not long after externals. What would you have, O man?Epictetus - Discourses Chap. xxi. Difficulties are things that show what men are.Epictetus - Discourses Chap. xxiv. If we are not stupid or insincere when we say that the good or ill of man lies within his own will, and that all beside is nothing to us, why are we still troubled?Epictetus - Discourses Chap. xxv. In theory there is nothing to hinder our following what we are taught; but in life there are many things to draw us aside.Epictetus - Discourses Chap. xxvi. Appearances to the mind are of four kinds. Things either are what they appear to be; or they neither are, nor appear to be; or they are, and do not appear to be; or they are not, and yet appear to be. Rightly to aim in all these cases is the wise mans task.Epictetus - Discourses. Chap. xxvii. Everything has two handles, one by which it may be borne; another by which it cannot.Epictetus - Enchiridion. xliii. When a man prides himself on being able to understand and interpret a difficult book, say to yourself: If the book had been well written this man would have nothing on which to pride himself.Epictetus - Encheiridon 49.Courtesy of translator Giles Laurà ©n, author of The Stoics Bible. My object is to understand and follow Nature, so I look for someone who understands her and I read his book. When I have found a man of understanding, it is not for me to praise his book but rather to act on his precepts.Epictetus - Encheiridon 49.Courtesy of translator Giles Laurà ©n, author of The Stoics Bible. Once you have fixed on you governing principles, you must hold them as laws that you cannot transgress. Pay no heed to what is said of you for it is beyond your control.Epictetus - Encheiridon 50.Courtesy of translator Giles Laurà ©n, author of The Stoics Bible. The appearanc e of things to the mind is the standard of every action to man.Epictetus - That we ought not to be angry with Mankind. Chap. xxviii. The essence of good and evil is a certain disposition of the will.Epictetus - Of Courage. Chap. xxix. It is not reasonings that are wanted now; for there are books stuffed full of stoical reasonings.Epictetus - Of Courage. Chap. xxix. For what constitutes a child? Ignorance. What constitutes a child? Want of instruction; for they are our equals so far as their degree of knowledge permits.Epictetus - That Courage is not inconsistent with Caution. Book ii. Chap. i. Appear to know only this, never to fail nor fall.Epictetus - That Courage is not inconsistent with Caution. Book ii. Chap. i. The materials of action are variable, but the use we make of them should be constant.Epictetus - How Nobleness of Mind may be consistent with Prudence. Chap. v. Shall I show you the muscular training of a philosopher? What muscles are those? A will undisappointed; evils avoided; powers daily exercised; careful resolutions; unerring decisions.Epictetus - Wherein consists the Essence of Good. Chap. viii. Dare to look up to God and say, Make use of me for the future as Thou wilt. I am of the same mind; I am one with Thee. I refuse nothing which seems good to Thee. Lead me whither Thou wilt. Clothe me in whatever dress Thou wilt.Epictetus - That we do not study to make Use of the established Principles concerning Good and Evil. Chap. xvi. What is the first business of one who studies philosophy? To part with self-conceit. For it is impossible for any one to begin to learn what he thinks that he already knows.Epictetus - How to apply general Principles to particular Cases. Chap. xvii. Every habit and faculty is preserved and increased by correspondent actions,as the habit of walking, by walking; of running, by running.Epictetus - How the Semblances of Things Are to Be Combated. Chap. xviii. Whatever you would make habitual, practise it; and if you would not make a thing habitual, do not practise it, but habituate yourself to something else.Epictetus - How the Semblances of Things Are t o Be Combated. Chap. xviii. Reckon the days in which you have not been angry. I used to be angry every day; now every other day; then every third and fourth day; and if you miss it so long as thirty days, offer a sacrifice of thanksgiving to God.Epictetus - How the Semblances of Things Are to Be Combated. Chap. xviii. What saith Antisthenes? Hast thou never heard? It is a kingly thing, O Cyrus, to do well and to be evil spoken of.Epictetus - Golden Sayings - VII Whereas if Caesar were to adopt you, your haughty looks would be intolerable; will you not be elated at knowing that you are the son of God?Epictetus - Golden Sayings - IX There is petrifaction of the understanding; and also of the sense of shame. This happens when a man obstinately refuses to acknowledge plain truths, and persists in maintaining what is self-contradictory.Epictetus - Golden Sayings - XXIII If what philosophers say of the kinship of God and Man be true, what remains for men to do but as Socrates did; never, when asked ones country, to answer, I am an Athenian or a Corinthian, but I am a citizen of the world.Epictetus - Golden Sayings - XV But there is a great difference between other mens occupations and ours. . . . A glance at theirs will make it clear to you. All day long they do nothing but calculate, contrive, consult how to wring their profit out of food-stuffs, farm-plots and the like. . . . Whereas, I entreat you to learn what the administration of the World is, and what place a Being endowed with reason holds therein: to consider what you are yourself, and wherein your Good and Evil consists.Epictetus - Golden Sayings - XXIV True instruction is this: to learn to wish that each thing should come to pass as it does. And how does it come to pass? As the Disposer has disposed it. Now He has disposed that there should be summer and winter, and plenty and dearth, and vice and virtue, and all such opposites, for the harmony of the whole.Epictetus - Golden Sayings - XXVI Concerning the Gods, there are who deny the very existence of the Godhead; others say that it exists, but neither bestirs nor concerns itself nor ha s forethought for anything. A third party attribute to it existence and forethought, but only for great and heavenly matters, not for anything that is on earth. A fourth party admit things on earth as well as in heaven, but only in general, and not with respect to each individual. A fifth, of whom were Ulysses and Socrates are those that cry: I move not without Thy knowledge!Epictetus - Golden Sayings - XXVIII You must know that it is no easy thing for a principle to become a mans own, unless each day he maintain it and hear it maintained, as well as work it out in life.Epictetus - Golden Sayings - XXX What you shun enduring yourself, attempt not to impose on others. You shun slavery beware of enslaving others! If you can endure to do that, one would thing you had been once upon a time a slave yourself. For Vice has nothing in common with virtue, nor Freedom with slavery.Epictetus - Golden Sayings - XLI Above all, remember that the door stands open. Be not more fearful than children; but as they, when they weary of the game, cry, I will play no more, even so, when thou art in the like case, cry, I will play no more and depart. But if thou stayest, make no lamentation.Epictetus - Golden Sayings - XLIV Death has no terror; only a Death of shame!Epictetus - Golden Sayings - LV That was a good reply which Diogenes made to a man who asked him for letters of recommendation. That you are a man , he will know when he sees you; whether a good or bad one, he will know if he has any skill in discerning the good or bad. But if he has none, he will never know, though I write him a thousand times.Epictetus - Golden Sayings - LVII God is beneficent. But the Good also is beneficent. It should seem then that where the real nature of God is, there too is to be found the real nature of the Good. What then is the real nature of God?Intelligence, Knowledge, Right Reason. Here then without more ado seek the real nature of the Good. For surely thou dost not seek it in a plant or in an animal that reasoneth not.Epictetus - Golden Sayings - LIX Why, wert thou a statue of Phidias, an Athena or a Zeus, thou wouldst bethink thee both of thyself and thine artificer; and hadst thou any sense, thou wouldst strive to do no dishonour to thyself or him that fashioned thee, nor appear to beholders in unbefitting guise. But now, because God is thy Maker, is that why thou carest not of what sort thou shalt show thyself to be?Epictetus - Golden Sayings - LXI Since then every one must deal with each thing according to the view which he forms about it, those few who hold that they are born for fidelity, modesty, and unerring sureness in dealing with the things of sense, never conceive aught base or ignoble of themselves: but the multitude the contrary.Epictetus - Golden Sayings - IX You also must show the unlearned man the truth, and you will see that he will follow. But so long as you do not show it him, you should not mock, but rather feel your own incapacity.Epictetus - Golden Sayings - LXIII It was the first and most striking characteristic of Socrates never to become heated in discourse, never to utter an injurious or insulting word on the contrary, he persistently bore insult from others and thus put an end to the fray.Epictetus - Golden Sayings - LXIV When we are invited to a banquet, we take what is set before us; and were one to call upon his host to set fish upon the table or sweet things, he would be deemed absurd. Yet in a word, we ask the Gods for what they do not give; and that, although they have given us so many things!Epictetus - Golden Sayings - XXXV Knowest thou what a speck thou art in comparison with the Universe? That is, with respect to the body; since with respect to Reason, thou art not inferior to the Gods, nor less than they. For th e greatness of Reason is not measured by length or height, but by the resolves of the mind. Place then thy happiness in that wherein thou art equal to the Gods.Epictetus - Golden Sayings - XXIII Who would Hercules have been had he loitered at home? no Hercules, but Eurystheus. And in his wanderings through the world how many friends and comrades did he find? but nothing dearer to him than God. Wherefore he was believed to be Gods son, as indeed he was. So then in obedience to Him, he went about delivering the earth from injustice and lawlessness.Epictetus - Golden Sayings - LXXI The reason why I lost my lamp was that the thief was superior to me in vigilance. He paid however this price for the lamp, that in exchange for it he consented to become a thief: in exchange for it, to become faithless.Epictetus - Golden Sayings - XII No labour, according to Diogenes, is good but that which aims at producing courage and strength of soul rather than of body.Epictetus - Golden Sayings - LXII But thou art not Hercules, thou sayest, and canst not deliver others from their iniquitynot even Theseus, to deliver the soil of Attica from its monsters? Purge away thine own, cast forth thencefr om thine own mind, not robbers and monsters, but Fear, Desire, Envy, Malignity, Avarice, Effeminacy, Intemperance.Epictetus - Golden Sayings - LXXI If a man would pursue Philosophy, his first task is to throw away conceit. For it is impossible for a man to begin to learn what he has a conceit that he already knows.Epictetus - Golden Sayings - LXXII The question at stake, said Epictetus, is no common one; it is this: Are we in our senses, or are we not?Epictetus - Golden Sayings - LXXIV One who has had fever, even when it has left him, is not in the same condition of health as before, unless indeed his cure is complete. Something of the same sort is true also of diseases of the mind. Behind, there remains a legacy of traces and blisters: and unless these are effectually erased, subsequent blows on the same spot will produce no longer mere blisters, but sores. If you do not wish to be prone to anger, do not feed the habit; give it nothing which may tend its increase.Epictetus - Golden Sayings - LXXV No man can rob us of our Willno man can lord it over that!Epictetus - Golden Sayings - LXXXIII Wouldst thou have men speak good of thee? speak good of them. And when thou hast learned to speak good of them, try to do good unto them, and thus thou wilt reap in return their speaking good of thee.Epictetus - Golden Sayings - L The beginning of philosophy is to know the condition of ones own mind. If a man recognises that this is in a weakly state, he will not then want to apply it to questions of the greatest moment. As it is, men who are not fit to swallow even a morsel, buy whole treatises and try to devour them. Accordingly they either vomit them up again, or suffer from indigestion, whence come gripings, fluxions, and fevers. Whereas they should have stopped to consider their capacity.Epictetus - Golden Sayings - XLVI In theory it is easy to convince an ignorant person: in actual life, men not only object to offer themselves to be convinced, but hate the man who has convinced them. Whereas Socrates used to say that we should never lead a life not subjected to examination.Epictetus - Golden Sayings - XLVII

Chauser's Wife of Bath is a Female Misgoynist Term Paper

Chauser's Wife of Bath is a Female Misgoynist - Term Paper Example But Chaucer portrays the Wife of Bath as a female misogynist that shows how a woman could react to those male expectations. Thesis-Supporting Passages The Wife of Bath is the most unusual female character who has been interpreted differently by different critics from different points of views. While some critics claim that the Wife of Bath is a typical and also stereotypical embodiment of womanly impiety, sinfulness, immorality and transgression, others claim that Chaucer’s portrayal of the Wife of Bath is asexual and convincingly feministic. Indeed the Wife of Bath’s notoriety and debauchery can be perceived as her individual tendency to follow her own pursuits and her practice of using sexual attributes for personal is essentially her only plausible alternative to economic empowerment in the strictly patriarchic Chaucerian society. Also the reasoning capability of the Wife of Bath to support her cause presents her as a female misogynist’s challenge to the patri archal notion about a woman. ... is no biblical proof against remarriage of woman, As she says, Eke well I wot he said that my husband Should let father and mother, and take to me; But of no number mention made he, Of bigamy or of octogamy; Why should men then speak of it villainy? She throws a challenge to everyone to prove her wrong on the fact that the Holy Scripture has not set a limit to the number of successive marriages that a woman can have throughout her life. Again she argues against the traditional notion of patriarchy that a man’s polygamy is acceptable because men are capable of performing sexual intercourse vigorously with many women. She says that though a man who is capable of performing intercourse with many women is rare, King Solomon had many wives. She believes in King Solomon’s virility since it is in the Scripture. Yet she wonders, Which gift of God had he for all his wives, No man hath such that in this world alive is (40-41). Conclusion In the beginning, the readers become appal led to view a sexually degraded woman who can carefully argue for her sexual role that is perceptibly problematic in the eye of Chaucerian society. But the way in which the Wife of Bath argues against the beliefs of medieval patriarchy about woman seems to be irrefutable. Nonetheless an judicious reader will perceive that Chaucer upholds the Wife of Bath as a female misogynist who is overtly feminine and very independent in nature. Works Cited Chaucer, Jeffrey, The Canterbury Tales, New York: Hacket Publishers,

IT case study Outline Example | Topics and Well Written Essays - 2000 words

IT case study - Outline Example t business metrics, beneficial service assets to the cafà ©, service utility, outcomes obtained from practicing demand management, importance of early life support and whether the cafà © should have the service desk (Lytras, Ziderman & Manolova, 2010. pp.156). IT infrastructure library is the process of supplying paramount practices for the IT services. The application of this method is rising because various business premises depend on IT to satisfy and attain the company’s’ strategies. Therefore, Bill Melmac, the owner of Melmac cafà © should consider implementing the IT infrastructure Library in its business. This will be of benefit because the library has dissimilar theories and procedures that direct any business to decide on the best and efficient idea pertaining the operation and management of the business. ITIL will offer Bill Melmac with advices and different IT courses on the management of his business services (Lytras, Ziderman & Manolova, 2010. pp.157). ITIL will equip Bill Melmac with general knowledge regarding the cafà © service strategies, the designs that he should apply in delivering the ordered foods to the clients, the best service transition applicable in his business, advisable service operations and how he can continuously improve his cafà © services. Subsequently, after applying the ITIL in his cafà ©, Bill will convey the perfect ITIL package management solutions to his cafà ©. He will also identify the specific requirements for his business and implement them consequently. He will ascertain the suitable ITIL service management solutions that are important in solving his business problems and ensure that the service is very cost effective (Lytras, Ziderman & Manolova, 2010. pp.156). Business outcome refers to the target or the benefits that a given business premise works hard to achieve after it experiences interventions or makes changes. Business outcomes are the main reasons why many companies engage dissimilar activities, initiatives,

Facebook Essay Example | Topics and Well Written Essays - 1250 words - 2

Facebook - Essay Example This entails posting or getting the discussion started, and then coordinating the protest march. Getting the discussion started regulates the extremity of the responses, where people share information and knowledge regarding certain issues. Online regulation of information enhances closeness between various groups of people. Users give their comments and ideas regarding an issue if only guided at the beginning; otherwise, the effectiveness may be distorted since different people possess diverse views and objectives in their use of social networking sites (Lee & Ingraffea, 2007). The regular plug is effective in promoting the effective communication for Facebook users. The regular signing in enhances build-up of one community. This also promotes interaction since a person can confirm availability through saying something. Facebook hosts over 800 million users out of which only 50% log on daily. It is critical that people take advantage to interact daily with their community as well as engage their community so as to announce their presence. Authenticity enhances effective communication where a person writes and comments anything without any fear, regardless of the location. The person’s values clearly show up from the posts, and this is critical when posting a link, communicating with a certain group, or when responding to a topic (Lee & Ingraffea, 2007). Brevity is critical in order to keep ones words concise and to the point. Brevity forms a vital component of the social media literacy. Research by Buddy Media indicates that Facebook posts with over 80 characters possess 27% change of engagement. Research indicates that people often get tired after the first minute of reading. Consideration of Facebook as a public space is critical where a person should not comment on anything he or she cannot say in public, and people should be positive when using the social networking site. Every person may have unpleasant experiences; however, this should not

The Application of Marketing - PARTA -The tools of Marketing Essay

The Application of Marketing - PARTA -The tools of Marketing - Essay Example For example, advertising is a powerful means to reach out to customers, but it is expensive and needs to use the right media and the right message for effective results on the vast resources expended on it. Public relations is a more subtle approach useful in managing issues of public concern and top level messages, but suffers from the deficiencies of requiring professional support and difficulty in evaluating its impact. Sales promotion is an effective means of addressing a particular target market, whose impact on the objective of increased sales can be measured, and enhances sales channel commitment to the product. However, it suffers from the deficiencies of forecasting problems, with the effect being only as long as the sales promotion lasts and the possibility of brand devaluation, particularly if price is a part of the sales promotion strategy. Yet, when used in conjunction these tools of marketing can be an effective to achieving the marketing objectives for a product (Cheve rton, 2006). In 2003, Coca-Cola along with its competitor Pepsi ran into trouble on India, when the environmental NGO, Centre for Science and Environment (CSE report) released a report that the presence of pesticides in the soft drinks exceeded the European standards (Vedwan, 2007). Coca-Cola attempted to negate the effect of this accusation by running advertisements using film stars to indicate that their production infrastructure and methods provided soft drinks that were pure for consumption. In addition they ran a sales promotion campaigning giving 50 ml more of soft drink at no extra cost. These efforts failed, though Coca-Cola was not at fault for the CSE report on the presence of pesticides in the soft drinks and their market share dropped. There was more faith in the non-profit making report than in the claims of the profit making multi-national giant and went to show the inept

Religion Essay Example | Topics and Well Written Essays - 250 words - 11

Religion - Essay Example In numerous occurrences, Jesus usually started his sermons by giving statements that equated the kingdom of God to various aspects. This use of metaphors enabled Jesus to link unknown things to those that were known and thus increased the understanding the people had of the known. Jesus employed the aspect of reversal in several parables that involved the characters, which were considered as most desirable behaving in a manner that was in contradiction to what the God’s kingdom required. For instance, when Jesus was recounting the story of the Pharisees, Jesus created a reversal of how his disciples understood the Kingdom of God through demonstrating that it did not value splendor, instead, it valued sincerity. The main attributes of the Christianity are dependent on the four ancient biographies of the life of Jesus and if they provide an accurate account of His life, then the faith they have in Jesus is completely ratified and all the opposing perceptions become illogical. If Jesus taught the aspects that were the gospels stated, then believing in Him is the only means of attaining unending salvation while any other ways would result in an everlasting parting from

Compare and contrast absorption costing Assignment

Compare and contrast absorption costing - Assignment Example Absorption costing and Marginal costing are two such costing methods. They differ to quite an extent, however whether one method is better than the other depends largely on the situations in which they are applied and the underlying objectives of the businesses in which they are applied. Before looking at these two concepts in detail, it is appropriate to discuss the components that make up the ultimate cost of a good or service. The cost of something can be broadly broken up into fixed costs and variable costs.   Fixed costs are those costs that are incurred irrespective of the level of production. So for example, in a garment factory business, fixed costs would include the rent on the factory. This rent would largely be the same, irrespective of the volume of garments produced in that factory. On the other hand, the variable costs would include the costs of the materials used (‘direct material’), the daily wages of the staff producing the garments (‘direct labour’) and even perhaps the electricity charges on the machines used (‘direct variable overheads’). These costs increase directly with the volume of production. More garments being produced would mean more fabric being used, more people being employed or the same people being employed for longer and machines using more electricity by being worked for longer or at higher capacities. This method is also called the full costing method. As the terminology implies, under this method, the full cost of the good or service is used in arriving at the cost per unit. ‘Full costs’ mean that both the variable costs and the fixed costs are included in the calculation of cost per unit. That is, this method does not differentiate between them-all the manufacturing costs are included. In the garment factory example mentioned above, this would mean that in addition to

Religion Essay Example | Topics and Well Written Essays - 250 words - 11

Religion - Essay Example In numerous occurrences, Jesus usually started his sermons by giving statements that equated the kingdom of God to various aspects. This use of metaphors enabled Jesus to link unknown things to those that were known and thus increased the understanding the people had of the known. Jesus employed the aspect of reversal in several parables that involved the characters, which were considered as most desirable behaving in a manner that was in contradiction to what the God’s kingdom required. For instance, when Jesus was recounting the story of the Pharisees, Jesus created a reversal of how his disciples understood the Kingdom of God through demonstrating that it did not value splendor, instead, it valued sincerity. The main attributes of the Christianity are dependent on the four ancient biographies of the life of Jesus and if they provide an accurate account of His life, then the faith they have in Jesus is completely ratified and all the opposing perceptions become illogical. If Jesus taught the aspects that were the gospels stated, then believing in Him is the only means of attaining unending salvation while any other ways would result in an everlasting parting from

The True Cost of Employment-at-will to American Employers Essay

The True Cost of Employment-at-will to American Employers - Essay Example In legal terms, employment-at-will refers to the employment contract that can be terminated for any reason (except for a few spelt out illegal reasons) and at any time either by the employee or the employer (Sentell and Robbins, 2008). The doctrine of employment-at-will avows that, in cases where the employee does not have an express or written employment contract and the employment term is of indefinite period, the employer can terminate the employee for no cause at all, bad cause, or good cause (ABA Section of Labor and Employment Law, 2011). In the United States, at- will employee can be terminated for no reason at all, or for any reason, and at any time, and the courts cannot intervene to protect such an employee from employer’s alleged unfair treatment. Over the years, there has been raging debate among employers, employees, and policy- makers as to whether the doctrine of employment-at-will is really good for the United States or not. More specifically, employers have be en trying to evaluate the â€Å"goodness† of the doctrine to them, both in short and long run. This paper will evaluate the true cost of employment-at-will to American employers. Among the major industrial powers, the United States is the only bone that still maintains a general rule of employment-at-will. ... Some of the court rulings coupled with the scholarly writing on the scrapping of employment-at-will prompted most employers to think on the cost of the doctrine as well as its effectiveness. For example a law review article by Professor Lawrence Blades called for scrapping of the doctrine as it threatened the freedom of individual workers just like authoritarian government would do. As a result of this review article, courts recognized some kinds of exceptions to the doctrine; the exception of public policy being the most often- used. This exception allowed the judges to consider a dismissal as â€Å"unjust† if it was as a result of an employee exercising or upholding some public policy right (Blades, 1967). Muhl (2001) notes that recent years there has been revolutionary departure from the doctrine of employment-at-will especially based on the exception of the covenant-of-good-faith. This exception emphasizes on fair dealing and good faith as being very important in employmen t relationship. Courts that are using this exception usually rule that dismissal of employees should meet the standard of â€Å"just cause† and that such dismissals can be invalidated if they were done in bad faith or were inspired by malice (Roehling, 2003). In the light of evolution of employment-at-will doctrine, it is important to evaluate its true cost to the American employers in order to determine whether it is good for them or not. Willey (2009) explains that the proponents of the doctrine point to the essence of employer’s discretion in all the employment issues impacting his or her â€Å"business†. On the other hand, the opponents of the doctrine point out to the essence of defending the freedom of individuals and

Sherlock Holmes Essay Example for Free

Sherlock Holmes Essay In Lamb to the slaughter we find that the story has an unconventional setting and atmosphere, which Roal Dahl creates through the narrator who describes the setting at the start of the story. The narrator describes the atmosphere of the house as a nice lovely warm home where anyone could feel safe, The room was warm and clean this creates an environment which is a warm and welcoming place and unconventional for a murder to take place in. The narrator also says that Mary Maloney is six months pregnant. Her skin- for this was her sixth month with child-had required a wonderful translucent quality this makes the readers think that there is a sort of innocent atmosphere of the house. Roal Dahl tries to create an unconventional setting when the narrator says Punctually as always, she heard the tyres on the gravel outside. This shows how it is routine for Mary Maloney to wait silently for her husband and gives a perception to the reader that there is nothing unusual about what goes on everyday. However when the murder takes place the readers realise that the settings and atmosphere are unconventional. In the The Speckled band Sir Arthur Conan Doyle uses Watson (the narrator) to reveal aspects of the story, like the characteristics of Sherlock Holmes. Holmes was for the moment as startled as I. His hand closed like a vice upon my wrist in his agitation. Then he broke in to a low laugh and put his lips to my ear  Its a nice household, he murmured. That is the baboon, This shows Watsons narration describing Holmes actions which reveals to the reader that Holmes has a sarcastic and playfully personality. Again in the story Sir Arthur Conan Doyle uses Watson to expose Holmes characteristics. My companion sat in the front of the trap, His arms folded, His hat pulled down over his eyes, and his chin sunk upon his breast, buried in the deepest thought. This shows the reader that Holmes has a very thoughtful personality and is also a very serious man. Sir Arthur Conan Doyle also uses Watson to reveal aspects of other characters characteristics such as DR Grimsby Roylott. So tall was he that his hat actually brushed the cross bar of the doorway Sir Arthur Conan Doyle uses this portrayal, as being tall always seems like being a suspicious character; perfect for describing a potential suspect in a murder case. Watson describes Roylott further saying A large face, seared with a thousand wrinkles, burned yellow with the sun, and marked with every evil passion Sir Arthur Conan Doyles use of long and complicated sentences allow Watson to describe Roylott in a lots of detail. Sir Arthur Conan Doyle also uses Watsons narration to reveal details about the settings of the manor house w here the murder took place. Panelling of the walls were of brown, worm eaten-oak, so old and discoloured Again you can still see Doyles use of long and complicated sentences through Watsons narration to describe in detail the manor houses settings to create the right atmosphere of the house in the minds of the readers. Watson also describes the grounds of the manor house of Stoke Moran as having an Ill trimmed lawn Doyle uses dialogue (speech) to reveal characteristics of Sherlock Holmes No but I observe the second half of a return ticket in the palm of your left glove This shows us how observant he is and notices small things. Doyles use in dialogue to reveal Holmes observational skills also reveals the plot when Holmes says Ah! That is suggestive. Now, on the other side of this narrow wing runs the corridor from which these three rooms open. There are windows in it, of course Sir Arthur Conan Doyle also uses dialogue as a structural device to unfold the mystery. No she was in her night dress, in her right hand was found the charred stump of the match, and in her left a match box. And what conclusions did the corner come to? As the reader reads this dialogue it becomes apparent in detail how Holmes mind works in an investigation deducing clues and moving the plot forward. This use of dialogue not only shows the reader how Holmes mind works but also motivates the readers to work out the mystery. Another example of this use of dialogue is when Holmes is in the manor house investigating the clues Pending the alterations, as I understand. By the way, there does not seem to be any very pressing need for repairs at the end wall. Sir Arthur Conan Doyle also uses Watsons narration to portray characters vividly We could see that she was indeed in a pitiable state of agitation, her face all drawn and grey. Here Sir Arthur Conan Doyle uses sentences which are complex and packed with clauses to build up layers of description and detail. With restless, frightened eyes, like those of a haunted animal. Some of the language Doyle uses in Watsons narration is often old and archaic. Here Watson is on the train with Holmes where they meet DR Grimsby Roylott, Watson describes in detail the appearance of Roylott, A large face seared with a thousand wrinkles Sir Arthur Conan Doyle use of the word seared is quite old fashioned but is a effective as it gives the reader a good description of Roylotts face. Sir Arthur Conan Doyle also uses names as a very important part of creating an impression of someone characteristics, like the name s DR Grimsby Roylott who is the villain in The speckled band. The name DR Grimsby Roylott sounds evil as DRs are often considered as the mad villains in stories such as Franklinstaine where the DR is insane and creates havoc by his invention of Franklinstaine. The name Grimsby is also an unusual name for a person so it sounds much more like the name of a villain. Doyle also uses names such as Mrs. Helen Stoner for the innocent characters which sound much more usual for a persons name and therefore make the person sound much nicer. In the story Lamb to the slaughter Roal Dahl uses black comedy to expose the ironical situation, which is that the murder took place but the detectives eat the evidence and the crime doesnt get solved which results in an unconventional villain getting away with murder. Roal Dahl also uses simple text and simple languages in the story which is easier to understand The room was warm and clean, the curtains drawn, this sentence shows Roal Dahls use of simple text and languages which are easier to understand unlike what Sir Arthur Conan Doyle uses in The speckled band. Roal Dahl uses a simple plot to go with the story as well which is basically an unconventional murder which an unconventional woman commits against a detective however during the story she turns the situation around by using her unconventional status and avoids being caught by the detectives so in this story evil triumphs over good, whilst in The speckled band its the other way round. Roal Dahl uses very little detail in the story Their was a slow smiling air about her, and about everything she did. You can clearly see Roal Dahls use of detail isnt as much as in The speckled band where Sir Arthur Conan Doyle uses very long sentences to add layers of detail. The narrator in Lamb to the slaughter moves forward lots of pace which sees the murder taking place in the middle of the story and then investigation continues to the end, this is not like in the The speckled band in which the narrator moves pace slowly but in detail seeing the murder at the beginning and the investigation to the end of the story. These two authors make their stories different by each using different characteristics of their murders and detectives, however the structures of both stories are the same as both authors establish their mortality and they both want their characters to get away with it. In The speckled band Sir Arthur Conan Doyle uses stereotyping to portray his characters; this is a technique which Roal Dahl doesnt use. Doyles use of stereotyping proves to play be a very important role in Doyles portrayal of characteristics of the characters in The speckled band as it is a good tool to use when describing to the reader characteristics of a person. This use of stereotyping is clearly visible in Doyles story The speckled band. All of Doyles characters are stereotyped such as DR Grimsby Roylott, who is described by Watson as having Bile-shot eyes and A large face. Seared with a thousand wrinkles These descriptions are related to an average villain who has distinguishing looks and features, which people would consider are common for a villain, such as when Watson mentions when describing Rowletts appearance And his high, Thin, fleshless nose. This is an aspect of a character which people would automatically presume is a villain. Roal Dahls text lacks stereotyping of the characters which results in less descriptive text from which the reader can work out the characters characteristics which is something Sir Arthur Conan Doyle has achieved. In conclusion both stories are unconventional as in the The speckled band the story seems conventional as the murderer, motive, settings and atmosphere are conventional but at the end Sherlock Holmes murders DR Grimsby Roylott accidentally which is unconventional for a mystery fiction story, especially because Sherlock Holmes doesnt feel guilty after the incident. The story Lamb to the slaughter is also an unconventional story as the murderer Mary Maloney is unconventional and so is the victim who is a detective. The case goes unsolved as the senseless detectives eat the evidence which is ironical and unconventional.

Sane Versus Insane Essay -- Health Care, Mental Hospital

Whether it is called a mental hospital, insane asylum or sanatorium, there are negative connotations connected to these titles. Your head is immediately filled with images of people off their rockers, some drooling and others moaning or crying out while others are being strapped down to gurneys being transported behind dark doors. When one thinks of the patients at these hospitals, one’s mind may wander to inquire about those behind the scenes, running it all. In One Flew Over the Cuckoo’s Nest, Ken Kesey hints that Nurse Ratched is herself insane. It provides irony throughout the novel and social commentary about the corrupt system of mental institutions for the audience. By taking Ratched’s behavior and reactions throughout the novel into consideration, it becomes more apparent that she may fit in with the patients more than with her colleagues. Also, Kesey worked as a janitor at a mental hospital and began to think that the patients â€Å"were not really cra zy after all, just more individualized than society was willing to accept† (Whitley). Through first hand experience, Kesey was able to write this satire on both the patients and staff. Nurse Ratched displays paranoiac tendencies throughout, which push her closer and closer to the edge as her limits are tested by the patients. Her desire and need for the strict routine is the first sign. She â€Å"tends to get real put out if something keeps her outfit from running smooth† (28). When something goes wrong she is infuriated, but only on the inside, for she has an odd ability to constantly keep her temper in check. The routine is what keeps everything predictable for her and she is in a constant fear of something getting off its track. Her paranoia is the reason that she detests McMur... ... social commentary for the audience. He is putting the corrupt system of mental institutions on display in a crafty way. Because Kesey has worked in mental hospitals in the past, he is a liable source to give a first hand look into that world that few citizens are aware of. The fact that these hospitals have someone employed that is potentially mentally incapable or unstable is not a comforting thought to anyone, let alone the families of the patients. In the 1960’s, mental hospitals were notorious for having unorthodox methods and sadistic caretakers, which provides a nice little category for One Flew Over the Cuckoo’s Nest to fit into. Kesey is using this medium to make his option that mental institutions are run under a corrupt system and staff known. Since then, more investigations were done and regulations put in place so that the patients treatment improved.

Violence in Schools Essay examples -- Education School Teen Violence

As teachers, parents, and students prepare and begin this new school year, hopefully fears of school violence such as the bullying, slapping, punching, weapon use, and rape will not be their major concern. To top it all, what is School Violence? As defined in the Oxford Dictionary, School Violence is a subset of students or teachers violence, physical force exerted for the purpose of violating, damaging, or abusing, the act or an instance of violent action or behavior at school, abuse or injury to meaning, content, or intent, vehemence of feeling or expression. What is sad is that school violence needs to be a concern at all. The fact is; violence of one sort or another is part of many schools today. Fortunately, this usually involves a small group of people fighting amongst themselves. School Violence is becoming more and more prevalent in today’s society. People are talking about what needs to be done to help prevent this from becoming an everyday occurrence, looking to meta l detectors for schools, profiling of who would be the most likely to commit such crimes, and changing the way violence is looked at by society as a whole. There needs to be a change within society itself, but also in suburban homes and most of all is at school. Parents have never really been encouraged to teach their children ways of non violent confrontation. A push needs to be created towards parents getting involved in their child’s lives and knowing what is going on with their son or daughter. This is not only a way to help prevent the violence that plagues the schools of today but to help stop violence from occurring. Parents are the front line defense to helping put an end to school violence. This writing will be paste on the harmful effects of v... ...lves that should be considered tackling matters that are important instead of slipping through so easily into issues that are not worth it and undemanding for not only their lives but also the lives of others in the community that affected. Thus from what we see in arguments and damages caused in most communities are the cruelty of those students coming from school violences, so therefore to make this place a better one, teach students to control their pride and have more concern with what our life is taking us through, aiming for the best and the highest accomplishments not having violence affect our schools and our society. http://law.jrank.org/pages/12101/School-Violence-Effects-school-violence.html http://en.wikipedia.org/wiki/School_shooting http://whyfiles.org/065school_violence/ http://712educators.about.com/od/schoolviolence/School_Violence.htm

Nvq 3 Assignment 307 Avi

307 AIV Explain TWO ways of helping other practitioners to understand the different systems used to record information in adult social care settings. Answer: Explain them, let them shadow you, monitor them as they use them. 206 AI Explain THREE differences between a WORKING relationship and a PERSONAL relationship. Answer: A personal relationship is one where your personal life and extra curricular activities and social life are involved. A work relationship is another way of describing a relationship with your coworker. You spend time together at work, you work well together, but you have little or no contact outside of work.It's strictly professional. 206 AII Give TWO examples of different working relationship in an adult social care setting Answer: The relationship between manager and care worker, the relationship between care worker and care worker, the relationship between nursing staff and care staff†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. and so on. 206 AIII Explain why it is important that so cial care workers to work in partnership with individuals using the service and their family Answer: It is very important that you work in partnership with your colleagues and all other people.This will include carers, families, advocates, doctors, nurses, occupational therapists, other health professionals, social workers, voluntary organisations and other people. Others people may be able to provide useful information to support you in your work and you may be able to provide useful information to support them in being part of the individual’s lives. This is good partnership working. If there are communication difficulties with service users. A carer or family member can share information with you about how you can best communicate with an individual. 206 AIVIdentify THREE ways of working that can help improve partnership working Answer: 1) it is important to work with others as we have a common goal to protect from harm such as illness abuse or injury to ensure we are all involved in decision making to contribute to the growth and development of the whole team 2) using your skills to the best of your ability, train new staff, attend training,know your own role and responsibilitys 3) seek advice from your manager if you had issues in your working relationships. seek advice from your manager if you were unable to resolve the conflict yourselfTask D Presentation or report Prepare a presentation or report on an issue or area of public concern related to the care profession. Your presentation or report should include: †¢ A description of the issue or area of public concern raised †¢ An outline of the different points of view regarding the issue or area of public concern raised †¢ A description of how the issue or area of public concern has affected service provision and methods of working †¢ A description of how public opinion is affected by issues and areas of concern in either the health, social care or children’s and young pe ople's sectorsThe fallout from Panorama's programme on 31 May, Undercover Care, is being felt across social care. The BBC screened undercover footage of people with learning disabilities being choked, pushed and taunted by members of staff at Winterbourne View hospital, run by Castlebeck. Arrests made/hospital closed Police have arrested and bailed 11 people in relation to the case, on suspicion of ill-treatment under the Mental Capacity Act 2005, while Castlebeck has suspended two managers and 11 front line members of staff. The 24-bed hospital has now closed.The provider has apologised unreservedly for the abuse and commissioned PricewaterhouseCoopers to carry out an investigation into its services. However, in a damning report on Winterbourne View, the Care Quality Commission accused Castlebeck of â€Å"misleading† it by failing in its duty to report serious incidents to the regulator. This was followed by a damning report on Castlebeck as a whole by the CQC, which found t hat half of its services were not meeting essential standards. Since then, two other Castlebeck services for people with learning disabilities, Rose Villa and Arden Vale, have closed after the CQC threatened legal action.Whistleblowing concerns Concerns at Winterbourne View came to light after a charge nurse raised the issue with the hospital in October 2010 and his allegations were passed on to the local authority, South Gloucester shire Council, in its capacity as lead safeguarding agency, and then relayed to the CQC in December. However, Castlebeck admits that its own whistleblowing procedures were not followed, and a multi-disciplinary safeguarding meeting into the issue was not held until February 2011.The CQC also failed to contact the whistleblower, which it admitted prevented it from taking swift action. It has subsequently disciplined a member of staff over the case, while it has also emerged that the CQC did not conduct any inspections of learning disability hospitalsbetwe en October 2010, when concerns were raised at Winterbourne, and January 2011 The CQC is also conducting an internal review into its role, while South Gloucester shire Safeguarding Adult Board has launched a serious case review, which will be chaired by adult protection expert Margaret Flynn.Care services minister Paul Burstow is considering an independent review into the case, to examine failings by the CQC and safeguarding agencies, and will decide whether to call a probe on the basis of the SCR's findings. In addition, Burstow has called on the CQC to carry out a series of unannounced inspections of learning disability hospitals such as Winterbourne View. This comes with use of private hospitals on the increase and in the wake of two national audits of specialist health provision for learning disabled people in recent years, both of which identified poor standards.Commissioners are also subjecting learning disability hospitals to extra scrutiny in the wake of the scandal, while th e number of inspections by the CQC has rocketed. Experts demand reform However, 86 learning disability experts and organisations have written to government to say this is not enough, and that learning disability services need wholesale reform, including an end to placements in hospitals and investment in alternatives in the community.Though these placements are designed for short-term assessment and treatment, aCommunity Care investigation found that patients had been resident in them for an average of almost two years, with one in five in hospitals for at least five years. However, a government-commissioned report has warned that there are few incentives for providers or commissioners to overhaul private hospital services. Good practiseCommunity Care has published a number of good practise pieces responding to the case: Why institutional services such as Winterbourne are still being commissioneddespite years of expert guidance calling for community-based alternatives to be used ins tead. How staff training and good recruitment practises can ensure good-quality residential care for people with learning disabilities. Training tips for providers working with adults with challenging behaviour, from the British Institute of Learning Disabilities.Community Care has also published a number of opinion pieces responding to the case: Social worker Phil Collins says the profession must stand up and be counted in hospital and secure settings. The manager of a private mental health hospital examines the barriers to good safeguarding facing the sector. The British Institute of Learning Disabilities' Sharon Paley sets out her blueprint for avoiding another Winterbourne View.A council contract monitoring officer argues that it is becoming harder to tackle poor quality care because of cuts. A therapist questions the claims of some learning disability services to offer ‘therapeutic environments'. Castlebeck was urged to put values at the heart of its services by Andy Lusk , director of autism services at the charity Ambitious about Autism. Debate is raging online on what the case means for care services for vulnerable people. Have your say on Community Care’s Care Space forum.

HEALTH INSURANCE SECTOR IN INDIA: CURRENT SCENARIO Essay

1.1 Introduction: Health and health care need to be distinguished from each other for no better reason than that the former is often incorrectly seen as a direct function of the latter. Heath is clearly not the mere absence of disease. Good Health confers on a person or groups freedom from illness – and the ability to realize one’s potential. Health is therefore best understood as the indispensable basis for defining a person’s sense of well being. The health of populations is a distinct key issue in public policy discourse in every mature society often determining the deployment of huge society. They include its cultural understanding of ill health and well-being, extent of socio-economic disparities, reach of health services and quality and costs of care. and current bio-mcdical understanding about health and illness. Health care covers not merely medical care but also all aspects pro preventive care too. Nor can it be limited to care rendered by or financed out of public expenditure- within the government sector alone but must  include incentives and disincentives for self care and care paid for by private citizens to get over ill health. Where, as in India, private out-of-pocket expenditure dominates the cost financing health care, the effects are bound t be regressive. Heath care at its essential core is widely recognized to be a public good. Its demand and supply cannot therefore, be left to be regulated solely by the invisible had of the market. Nor can it be established on considerations of utility maximizing conduct alone.1 Health insurance in a narrow sense would be ‘an individual or group purchasing health care coverage in advance by paying a fee called premium.’ In its broader sense, it would be any arrangement that helps to defer, delay, reduce or altogether avoid payment for health care incurred by individuals and households. Given the appropriateness of this definition in the Indian context, this is the definition, we would adopt. The health insurance market in India is very limited covering about 10% of the total population. 1.2 Hypothesis: The Researcher assumes that all projections of health care in India must in the end rest on the overall changes in its political economy – on progress made in poverty mitigation (health care to the poor) in reduction of inequalities (health inequalities affecting access/quality’), in generation of employment /income streams (to facilitate capacity to pay and to accept individual responsibility for one’s health ) in public information and development communication (to promote preventive self care and risk reduction by conducive life styles ) and in personal life style changes. 1.3 Research Methodology: In this endeavour, both primary and secondary sources of data have been used to prepare the present paper. Further, it must be noted that the present paper discusses in detail the Indian position in this regard. 1.4 Object : The purpose of this paper is to study the Situation exists in a scenario where health care is financed through general tax revenue, community financing, out of pocket payment and social and private health insurance schemes. 1.5 Scope : The Scope this Research is limited to the extent of Indian position in this regard, while ignoring the foreign Scope. Chapter-2 Health Insurance: Health insurance in a narrow sense would be ‘an individual or group purchasing health care coverage in advance by paying a fee called premium.’ In its broader sense, it would be any arrangement that helps to defer, delay, reduce or altogether avoid payment for health care incurred by individuals and households. Given the appropriateness of this definition in the Indian context, this is the definition, we would adopt. The health insurance market in India is very limited covering about 10% of the total population2. The existing schemes can be categorized as: (1) Voluntary health insurance schemes or private-for-profit schemes; (2) Employer-based schemes; (3) Insurance offered by NGOs / community based health insurance, and (4) Mandatory health insurance schemes or government run schemes(namely ESIS, CGHS).3 2.1 Voluntary health insurance schemes or private-for-profit schemes: In private insurance, buyers are willing to pay premium to an insurance company that pools people with similar risks and insures them for health expenses. The key distinction is that the premiums are set at a level, which provides a profit to third party and provider institutions. Premiums are based on an assessment of the risk status of the consumer (or of the group of employees) and the level of benefits provided, rather than as a proportion of the consumer’s income. 4 In the public sector, the General Insurance Corporation (GIC) and its four subsidiary companies (National Insurance Corporation, New India Assurance Company, Oriental Insurance Company and United Insurance Company) and the Life Insurance Corporation (LIC) of India provide voluntary insurance  schemes. The Life Insurance Corporation offers Ashadeep Plan II and Jeevan Asha Plan II. The General Insurance Corporation offers Personal Accident policy, Jan Arogya policy, Raj Rajeshwari policy, Mediclaim policy, Overseas Mediclaim policy, Cancer Insurance policy, Bhavishya Arogya policy and Dreaded Disease policy (Srivastava 1999 as quoted in Bhat R & Malvankar D, 2000) Of the various schemes offered, Mediclaim is the main product of the GIC. The Medical Insurance Scheme or Mediclaim was introduced in November 1986 and it covers individuals and groups with persons aged 5 – 80 yrs. Children (3 months – 5 yrs) are covered with their parents. This scheme provides for reimbursement of medical expenses (now offers cashless scheme) by an individual towards hospitalization and domiciliary hospitalization as per the sum insured. There are exclusions and pre-existing disease clauses. Premiums are calculated based on age and the sum insured, which in turn varies from Rs 15 000 to Rs 5 00 000. In 1995/96 about half a million Mediclaim policies were issued with about 1.8 million beneficiaries (Krause Patrick 2000). The coverage for the year 2000-01 was around 7.2 million. Another scheme, namely the Jan Arogya Bima policy specifically targets the poor population groups. It also covers reimbursement of hospitalization costs up to Rs 5 000 annually for an individual premium of Rs 100 a year. The same exclusion mechanisms apply for this scheme as those under the Mediclaim policy. A family discount of 30% is granted, but there is no group discount or agent commission. However, like the Mediclaim, this policy too has had only limited success. The Jan Arogya Bima Scheme had only covered 400 000 individuals by 1997. The year 1999 marked the beginning of a new era for health insurance in the Indian context. With the passing of the Insurance Regulatory Development Authority Bill (IRDA) the insurance sector was opened to private and foreign participation, thereby paving the way for the entry of private health insurance companies. The Bill also facilitated the establishment of an authority to protect the interests of the insurance holders by regulating, promoting and ensuring orderly growth of the insurance industry. The bill allows foreign promoters to hold paid up capital of up to 26 percent in an Indian company and requires them to have a capital of Rs 100 crore along with a business plan to begin its operations.Currently, a few companies such as Bajaj Alliance, ICICI, Royal Sundaram, and Cholamandalam among others are offering health insurance schemes. The nature of schemes offered by these companies is described briefly.5 Bajaj Allianz: Bajaj Allianz offers three health insurance schemes namely, Health Guard, Critical Illness Policy and Hospital Cash Daily Allowance Policy. – The Health Guard scheme is available to those aged 5 to 75 years (not allowing entry for those over 55 years of age), with the sum assured ranging from Rs 100 0000 to 500 000. It offers cashless benefit and medical reimbursement for hospitalization expenses (preand post-hospitalization) at various hospitals across India (subject to exclusions and conditions). In case the member opts for hospitals besides the empanelled ones, the expenses incurred by him are reimbursed within 14 working days from submission of all the documents. While pre-existing diseases are excluded at the time of taking the policy, they are covered from the 5th year onwards if the policy is continuously renewed for four years and the same has been declared while taking the policy for the first time. Other discounts and benefits like tax exemption, health check-up at end of four claims free year, etc. can be availed of by the insured. – The Critical Illness policy pays benefits in case the insured is diagnosed as suffering from any of the listed critical events and survives for minimum of 30 days from the date of diagnosis. The illnesses covered include: first heart attack; Coronary artery disease requiring surgery: stroke; cancer; kidney failure; major organ transplantation; multiple sclerosis; surgery on aorta; primary pulmonary arterial hypertension, and paralysis. While exclusion clauses apply, premium rates are competitive and high-sum insurance can be opted for by the insured. – The Hospital Cash Daily Allowance Policy provides cash benefit for each and every completed day of hospitalization, due to sickness or accident. The amount payable per day is dependant on the selected scheme. Dependant spouse  and children (aged 3 months – 21years) can also be covered under the Policy. The benefits payable to the dependants are linked to that of insured. The Policy pays for a maximum single hospitalization period of 30 days and an overall hospitalization period of 30/60 completed days per policy period per person regardless of the number of confinements to hospital/nursing home per policy period. ICICI Lombard: ICICI Lombard offers Group Health Insurance Policy. This policy is available to those aged 5 – 80 years, (with children being covered with their parents) and is given to corporate bodies, institutions, and associations. The sum insured is minimum Rs 15 000/- and a maximum of Rs 500 000/-. The premium chargeable depends upon the age of the person and the sum insured selected. A slab wise group discount is admissible if the group size exceeds 100. The policy covers reimbursement of hospitalization expenses incurred for diseases contracted or injuries sustained in India. Medical expenses up to 30 days for Pre-hospitalization and up to 60 days for post-hospitalization are also admissible. Exclusion clauses apply. Moreover, favourable claims experience is recognized by discount and conversely, unfavourableclaims experience attracts loading on renewal premium. On payment of additional premium, the policy can be extended to cover maternity benefits, pre-existing diseases, and reimbursement of cost of health check-up after four consecutive claims-free years. Royal Sundaram Group: The Shakthi Health Shield policy offered by the Royal Sundaram group can be availed by members of the women’s group, their spouses and dependent children. No age limits apply. The premium for adults aged up to 45 years is Rs 125 per year, for those aged more than 45 years is Rs 175 per year. Children are covered at Rs 65 per year. Under this policy, hospital benefits up to Rs 7 000 per annum can be availed, with a limit per claim of Rs 5 000. Other benefits include maternity benefit of Rs 3 000 subject to waiting period of nine months after first enrolment and for first two children only. Exclusion clauses apply (Ranson K & Jowett M, 2003) Cholamandalam General Insurance: The benefits offered (in association with the Paramount Health Care, a re-insurer) in case of an illness or accident resulting in hospitalization, are cash-free hospitalization in more than 1  400 hospitals across India, reimbursement of the expenses during pre- hospitalization (60 days prior to hospitalization) and post- hospitalization (90 days after discharge) stages of treatment. Over 130 minor surgeries that require less than 24 hours hospitalization under day care procedure are also covered. Extra health covers like general health and eye examination, local ambulance service, hospital daily allowance, and 24 hours assistance can be availed of. Exclusion clauses apply. Employer-based schemes. Employers in both the public and private sector offers employer-based insurance schemes through their own employer-managed facilities by way of lump sum payments, reimbursement of employee’s health expenditure for outpatient care and hospitalization, fixed medical allowance, monthly or annual irrespective of actual expenses, or covering them under the group health insurance policy. The railways, defence and security forces, plantations sector and mining sector provide medical services and / or benefits to its own employees. The population coverage under these schemes is minimal, about 30-50 million people. 2.2 Insurance offered by NGOs / community-based health insurance: Community-based funds refer to schemes where members prepay a set amount each year for specified services. The premia are usually flat rate (not income-related) and therefore not progressive. Making profit is not the purpose of these funds, but rather improving access to services. Often there is a problem with adverse selection because of a large number of high-risk members, since premiums are not based on assessment of individual risk status. Exemptions may be adopted as a means of assisting the poor, but this will also have adverse effect on the ability of the insurance fund to meet the cost of benefits.6 Community-based schemes are typically targeted at poorer populations living in communities, in which they are involved in defining contribution level and collecting mechanisms, defining the content of the benefit package, and / or allocating the schemes, financial resources (International Labour Office Universities Programme 2002 as quoted in Ranson K & Acharya A, 2003). Such schemes are generally run by trust hospitals or nongovernmental organizations (NGOs). The benefits offered are mainly in terms of preventive care, though ambulatory and in-patient care is also covered. Such schemes tend to be financed through patient collection, government grants and donations. Increasingly in India, CBHI schemes are negotiating with the forprofit insurers for the purchase of custom designed group insurance policies. However, the coverage of such schemes is low, covering about 30-50 million (Bhat, 1999). A review by Bennett, Cresse et al. (as quoted in Ranson K & Acharya A, 2003) indicates that many community-based insurance schemes suffer from poor design and management, fail to include the poorest-of-thepoor, have low membership and require extensive financial support. Other issues relate to sustainability and replication of such schemes. Some examples of community-based health insurance schemes are discussed herein: Self-Employed Women’s Association (SEWA), Gujarat: This scheme established in 1992, provides health, life and assets insurance to women working in the informal sector and their families. The enrolment in the year 2002 was 93 000. This scheme operates in collaboration with the National Insurance Company (NIC). Under SEWA’s most popular policy, a premium of Rs 85 per individual is paid by the woman for life, health and assets insurance. At an additional payment of Rs 55, her husband too can be covered. Rs 20 per member is then paid to the National Insurance Company (NIC) which provides coverage to a maximum of Rs 2 000 per person per year for hospitalization. After being hospitalized at a hospital of one’s choice (public or private), the insurance claim is submitted to SEWA. The responsibility for enrolment of members, for processing and approving of claims rests with SEWA. NIC in turn receives premiums from SEWA annually and pays them a lumpsum on a monthly basis for all claims reimbursed. The Action for Community Organization, Rehabilitation and Development (ACCORD): Nilgiris, Tamil Nadu was established in 1991. Around 13 000 Adivasis (tribals) are covered under a group policy purchased from New India Assurance. Another scheme located in Tamil Nadu is Kadamalai Kalanjia Vattara Sangam (KKVS): Madurai. This was established in 2000 and covers members of women’s self-help groups and their families. Its enrolment in 2002 was around 5 710, with the KKVS functioning as a third party insurer. The Voluntary Health Services (VHS): Chennai, Tamil Nadu was established in 1963. It offers sliding premium with free care to the poorest. The benefits include discounted rates on both outpatient and inpatient care, with the VHS functioning as both insurer and health care provider. In 1995, its membership was 124 715. However, this scheme suffers from low levels of cost recovery due to problems of adverse selection. 2.3 Social Insurance or mandatory health insurance schemes or government run schemes (namely the ESIS, CGHS): Social insurance is an earmarked fund set up by government with explicit benefits in return for payment. It is usually compulsory for certain groups in the population and the premiums are determined by income (and hence ability to pay) rather than related to health risk. The benefit packages are standardized and contributions are earmarked for spending on health services The government-run schemes include the Central Government Health Scheme (CGHS) and the Employees State Insurance Scheme (ESIS). Central Government Health Scheme (CGHS): Since 1954, all employees of the Central Government (present and retired); some autonomous and semi-government organizations, MPs, judges, freedom fighters and journalists are covered under the Central Government Health Scheme (CGHS). This scheme was designed to replace the cumbersome and expensive system of reimbursements (GOI, 1994). It aims at providing comprehensive medical care to the Central Government employees and the benefits offered include all outpatient facilities, and preventive and promotive care in dispensaries. Inpatient facilities in government hospitals and approved private hospitals are also covered. This scheme is mainly funded through Central Government funds, with premiums ranging from Rs 15 to Rs 150 per month based on salary scales. The coverage of this scheme has grown substantially with provision  for the non-allopathic systems of medicine as well as for allopathy. Beneficiaries at this moment are around 432 000, spread across 22 cities. The CGHS has been criticized from the point of view of quality and accessibility. Subscribers have complained of high out-of-pocket expenses due to slow reimbursement and incomplete coverage for private health care (as only 80% of cost is reimbursed if referral is made to private facility when such facilities are not available with the CGHS).7 Employee and State Insurance Scheme (ESIS): The enactment of the Employees State Insurance Act in 1948 led to formulation of the Employees State Insurance Scheme. This scheme provides protection to employees against loss of wages due to inability to work due to sickness, maternity, disability and death due to employment injury. It offers medical and cash benefits, preventive and promotive care and health education. Medical care is also provided to employees and their family members without fee for service. Originally, the ESIS scheme covered all power-using non-seasonal factories employing 10 or more people. Later, it was extended to cover employees working in all non-power using factories with 20 or more persons. While persons working in mines and plantations, or an organization offering health benefits as good as or better than ESIS, are specifically excluded. Service establishments like shops, hotels, restaurants, cinema houses, road transport and news papers printing are now covered. The monthly wage limit for enrolment in the ESIS is Rs. 6 500, with a prepayment contribution in the form of a payroll tax of 1.75% by employees, 4.75% of employees’ wages to be paid by the employers, and 12.5% of the total expenses are borne by the state governments. The number of beneficiaries is over 33 million spread over 620 ESI centres across states. Under the ESIS, there were 125 hospitals, 42 annexes and 1 450 dispensaries with over 23 000 beds facilities. The scheme is managed and financed by the Employees State Insurance Corporation (a public undertaking) through the state governments, with total expenditure of Rs 3 300 million or Rs 400/- per capita insured person. The ESIS programme has attracted considerable criticism. A report based on patient surveys conducted in Gujarat (Shariff, 1994 as quoted in Ellis R et a, 2000) found that over half of those covered did not seek care from ESIS facilities. Unsatisfactory nature of ESIS services, low quality drugs, long waiting periods, impudent behaviour of personnel, lack of interest or low interest  on part of employees and low awareness of ESI procedures, were some of the reasons cited.8 Chapter-3 Conclusion: The challenge for the Indian policy-makers is to find ways to improve upon the existing situation in the health sector and to make equitable, affordable and quality health care accessible to the population, especially the poor and the vulnerable sections of the society. It is in a way inevitable that the state reforms its public health delivery system and explores other social security options like health insurance. Implementing regulations would be one, but by no means the best mechanism to contain provider behaviour and costs. This can only be done by developing mechanisms where government and households can together pool their funds. This could be one way of controlling provider behaviour. There is an urgent need to document global and Indian experiences in social health insurance. Different financing options would need to be developed for different target groups. The wide differentials in the demographic, epidemiological status and the delivery capacity of health systems are a serious constraint to a nationally mandated health insurance system. Given the heterogeneity of different regions in India and the regional specifications, one would need to undertake pilot projects to gather more information about the population to be targeted under an insurance scheme and develop options for different population groups. Health policy-makers and health systems research institutions, in collaboration with economic policy study institutes, need to gather information about the prevailing disease burden at various geographical regions; to develop standard treatment guidelines, to undertake costing of health services for evolving benefit packages to determine the premium to be levied and subsidies to be given; and to map health care facilities available and the institutional mechanisms which need to be in place, for implementing health insurance schemes. Skillbuilding for the personnel involved, and capacity-building of  all the stakeholders involved, would be a critical component for ensuring the success of any health insurance programme. The success of any social insurance scheme would depend on its design, the implementation and monitoring mechanisms which would be set in place and it would also call for restructuring and reforming the health system, and developing the necessary prerequisites to ensure its success.