Corus Departments Essay

The marketing department do everything, from putting the brochures together for market research, to understanding precisely what the competitors are doing e. g. understanding how big the demand for steel is, or how big the threat from competitive material. Communication is also extremely important: if the other departments don’t work efficiently, then the marketing department won’t get the right information needed to make formal decisions that would benefit the company. The marketing department constantly needs to be in contact with the other departments, such as; the technical department and production department. They also need to produce a newsletter covering all the departments, which is then sent out to these departments meaning that they are all up to date. Sales The sales department is responsible for obtaining the most common business aim and objective, which is to increase sales levels Finance The finance department is responsible for producing financial information with the use of graphs and tables: as figures are mainly being used this is the easiest way to communicate between departments. By using a graph it is then easier and a lot faster to track the trends throughout the year. The graphs and tables are usually sent by e-mail, to enable other people within the business to print copies when appropriate. The finance department also need to be in contact with the other departments, especially the production, sales and purchasing teams. Communication is vital for the finance department, to enable them to confirm that all the figures they have produced are correct. If the figures they have given coming in and going out of the business are incorrect this could result in the performance of the business, as the decisions being made would be wrong, overall affecting the future of the business. Human Resources Human resources are responsible for employing staff into the business and training them. They also have to make sure their employees get their wages and are responsible for managing and disciplining individuals within the business. When they’re dealing with individuals, trade unions and management they must organise face to face meetings, as this is the most effective way because it allows them to build strong relationships and also allows trust to be developed. They are also put in place to make an open and honest forum which other methods of communication don’t offer e. g. e-mail and telephone. Within the Corus business the HR advisor is responsible employee relations and looking after the logistics team and central functions within the company.

Drama Analysis Essay

In preparing to write my drama-analysis research paper, I encountered a wealth of information regarding my topic: The Pursuit of Happyness, a film which I believe demonstrates a return to â€Å"classic† movie-making and also a return to film as inspiration rather than lamentation. In my essay, I argued that, despite certain flaws and tendencies to revision historical relaity, The Pursuit of Happyness is a great film , and potentially one of the most important American films. Arriving at this conclusion was a long and interesting road, which was partially established by the research and writing of the paper itself. However, I felt determining my opinions and reinforcing them with information from my research materials was much easier than organizing the paper and expressing my opinions in solid, correctly constructed writing. One approach that I thought would be workable, but which proved to be merely frustrating, was to draw primarily from my own experience and opinions about movies. In my original intention for the paper, I had imagined that I would contrast The Pursuit of Happyness with other films I had seen and contrast, also, the way these various movies made me feel and also what I may have thought about their technical aspects. When I tried to use these kinds of comparisons in the actual research paper, I felt like what had been so obvious to me, as a subjective movie viewer, would be very hard for others to identify with, unless I expended a tremendous amount of space and energy to explain my personal tastes and opinions. What seemed to work better than the inclusion of my extended opinions was the citation of otehrs’ opinions. There seemed to be two advantages in citing material which supported my opinions rather than merely offering my opinions themselves. the first advantage was that i found certain writers expressed my thoughts and ideas just as I would have liked to express them myself. However, because the writers of the articles and essays I cited were professionals, their words were much more succinct and precise than some of my own attempts at saying the same thing. The second benefit of using cited materials was that some of the opinions I cited were, in fact, slightly different â€Å"takes† on opinions of mine, and I don’t think i would have necessarily come to understand these slight variations without having done the research. So, rather than merely supporting my opinions, the research materials actually modified my opinions and sometimes reinforced them very nicely. I felt more confident and determined in my own thesis because I knew authoritative writers from The Wall Street Journal and other professional publications supported some of my views. The only real obstacle I faced with research was whittling down the enormous amount of available information. I think the Internet has made it easier to conduct wide-ranging research quickly, but that in itself makes it much more difficult to sift through all of the available information and pinpoint what will be useful in support of the research paper in question and its thesis. Defining my thesis itself was also challenging. The more I thought about stating my argument simply and directly in a single sentence or a couple of sentences, the less the whole idea seemed meaningful at all. I learned as I continued to work at defining my thesis that it is important to get everything set in a single direction. I’m not sure if I was actually successful in presenting a sharp, simple thesis, but I tried very hard, Essentially, I wanted to show that The Pursuit of Happyness is a good film and one which also returns film-making to a role which it has steadily abandoned over the years in America: that of inspiring people. I believed that the thesis statement is true and feel it is true,. but I found that making my points in writing and spelling them out logically, as well as addressing counter-arguments forced me to reconsider my solidly constructed beliefs. Even though my overall opinions did not change very much, my respect for the logical formation of written arguments grew steadily as I worked on my own paper. Just as it is important to think simply in many way to secure a good thesis for a research paper, it seems important tow rite simply, as well. That is, I think it is important to stay on topic and make your argument point by point rather than digressing or getting too far off of track, no matter how tempting it is to launch into extra thoughts and associations. Even paragraph by paragraph, I think, all of the sentences should be necessary and feed into one another. I wasn’t as aware of this fact before spending time on the drama-analysis research paper. In addition to learning valuable steps and techniques for writing and thinking, the process of writing the paper caused me to re-examine the methods or logic by which I arrive at my opinions in the first place. I think that;s the most important thing I leaned in composing my research paper: that the logic and â€Å"formal† thought that goes into writing a good research paper differs widely from the â€Å"looser† thoughts and associations which typically help define at least my own subjective opinions. I’m not sure IO was aware of just how different my â€Å"everyday† thoughts and logic were from those which are necessary to present a clear, convincing argument which is backed up by solid evidence. In the long run, I feel certain that I could now make, as a consequence of my experience in writing the research paper, a much stronger argument on behalf of my original opinions.

Castle in Air Essay

Are messages like these popping up more and more in your workplace? Faced with complex, open-ended, ever-changing challenges, organizations realize that constant, ongoing innovation is critical to stay ahead of the competition. This is why we need to be on the lookout for new ideas that can drive innovation, and it’s why the ability to think differently, generate new ideas, and spark creativity within a team becomes an important skill. You need to work actively on building and cultivating this skill, and it can be done! Often, though, we make the mistake of assuming that good ideas just happen. Or worse still, we get caught in the mind trap that creativity is an aptitude; some people have it, others don’t. Then there is the other self-defeating belief – â€Å"I am not intelligent enough to come up with good ideas. † These assumptions are rarely true. Everyone can come up with fresh, radical ideas – you just need to learn to open your mind and think differently. This article shows you how to do so. How to Generate New Ideas Standard idea-generation techniques concentrate on combining or adapting existing ideas. This can certainly generate results. But here, our focus is on equipping you with tools that help you leap onto a totally different plane. These approaches push your mind to forge new connections, think differently and consider new perspectives. A word of caution – while these techniques are extremely effective, they will only succeed if they are backed by rich knowledge of the area you’re working on. This means that if you are not prepared with adequate information about the issue, you are unlikely to come up with a great idea even by using the techniques listed here. Incidentally, these techniques can be applied to spark creativity in group settings and brainstorming sessions as well. Breaking Thought Patterns All of us can tend to get stuck in certain thinking patterns. Breaking these thought patterns can help you get your mind unstuck and generate new ideas. There are several techniques you can use to break established thought patterns: * Challenge assumptions: For every situation, you have a set of key assumptions. Challenging these assumptions gives you a whole new spin on possibilities. * You want to buy a house but can’t since you assume you don’t have the money to make a down payment on the loan. Challenge the assumption. Sure, you don’t have cash in the bank but couldn’t you sell some of your other assets to raise the money? Could you dip into your retirement fund? Could you work overtime and build up the kitty in six months? Suddenly the picture starts looking brighter. * Reword the problem: Stating the problem differently often leads to different ideas. To reword the problem look at the issue from different angles. â€Å"Why do we need to solve the problem? â€Å", â€Å"What’s the roadblock here? â€Å", â€Å"What will happen if we don’t solve the problem? † These questions will give you new insights. You might come up with new ideas to solve your new problem. * In the mid 1950s, shipping companies were losing money on freighters. They decided they needed to focus on building faster and more efficient ships. However, the problem persisted. Then one consultant defined the problem differently. He said the problem the industry should consider was â€Å"how can we reduce cost? † The new problem statement generated new ideas. All aspects of shipping, including storage of cargo and loading time, were considered. The outcome of this shift in focus resulted in the container ship and the roll-on/roll-off freighter. Think in reverse: If you feel you cannot think of anything new, try turning things upside-down. Instead of focusing on how you could solve a problem/improve operations/enhance a product, consider how could you create the problem/worsen operations/downgrade the product. The reverse ideas will come flowing in. Consider these ideas – once you’ve reversed them again – as possible solutions for the original challenge. * Express yourself through different media: We have multiple intelligences but somehow, when faced with workplace challenges we just tend to use our verbal reasoning ability. How about expressing the challenge through different media? Clay, music, word association games, paint, there are several ways you can express the challenge. Don’t bother about solving the challenge at this point. Just express it. Different expression might spark off different thought patterns. And these new thought patterns may yield new ideas. Connect the Unconnected Some of the best ideas seem to occur just by chance. You see something or you hear someone, often totally unconnected to the situation you are trying to resolve, and the penny drops in place. Newton and the apple, Archimedes in the bath tub; examples abound. Why does this happen? The random element provides a new stimulus and gets our brain cells ticking. You can capitalize on this knowledge by consciously trying to connect the unconnected. Actively seek stimuli from unexpected places and then see if you can use these stimuli to build a connection with your situation. Some techniques you could use are: * Use random input: Choose a word from the dictionary and look for novel connections between the word and your problem. * Mind map possible ideas: Put a key word or phrase in the middle of the page. Write whatever else comes in your mind on the same page. See if you can make any connections. Pick up a picture. Consider how you can relate it to your situation. * Take an item. Ask yourself questions such as â€Å"How could this item help in addressing the challenge? â€Å", or â€Å"What attributes of this item could help us solve our challenge? † Shift Perspective Over the years we all build a certain type of perspective and this perspective yields a certain type of idea. If you want different ideas, you will have to shift your perspective. To do so: * Get someone else’s perspective: Ask different people what they would do if faced with your challenge. You could approach friends engaged in different kind of work, our spouse, a nine-year old child, customers, suppliers, senior citizens, someone from a different culture; in essence anyone who might see things differently. * Play the â€Å"If I were† game: Ask yourself â€Å"If I were †¦ † how would I address this challenge? You could be anyone: a millionaire, Tiger Woods, anyone. * The idea is the person you decide to be has certain identifiable traits. And you have to use these traits to address the challenge. For instance, if you decide to play the millionaire, you might want to bring traits such as flamboyance, big thinking and risk-taking when formulating an idea. If you are Tiger Woods you would focus on things such as perfection, persistence and execution detail. Employ Enablers Enablers are activities and actions that assist with, rather than directly provoke, idea generation. They create a positive atmosphere. Some of the enablers that can help you get your creative juices flowing are: * Belief in yourself: Believe that you are creative, believe that ideas will come to you; positive reinforcement helps you perform better. * Creative loafing time: Nap, go for a walk, listen to music, play with your child, take a break from formal idea-generating. Your mind needs the rest, and will often come up with connections precisely when it isn’t trying to make them. * Change of environment: Sometimes changing the setting changes your thought process. Go to a nearby coffee shop instead of the conference room in your office, or hold your discussion while walking together round a local park. * Shutting out distractions: Keep your thinking space both literally and mentally clutter-free. Shut off the Blackberry, close the door, divert your phone calls and then think. * Fun and humor: These are essential ingredients, especially in team settings.

Literature review discussing the advantages and disadvantages of Essay

Literature review discussing the advantages and disadvantages of having children nursed in both mixed A&Es and seperate childrens A&Es - Essay Example Aharonson et al (1996) provided information on patterns of services, arrival and factors influencing queuing in A&E departments and suggested that there are potential benefits for management and applying operations research methods in clinical environments. A&E departments are in considerable demand and proper utilization of these services can lead to improvement in the quality and promptness of clinical services offered. However contrary to Chow’s arguments, several hospital emergency departments may be directly related to primary care in providing rapid access and an emergency care network could be established in primary care as well. Integrating the strengths and weaknesses of emergency care with objective data model could help in describing multiple levels of operation and in highlighting process efficiency and clinical effectiveness. The support systems within NHS Direct have shown how people do things within A&E departments especially and how deliberate and thoughtful care could be provided by improving network operations. Accident and emergency departments and networking can help measure and control effective networking and promote interactions. The recent strategic policy shift towards a primary care-led National Health Service in the UK (Department of Health, 1994) has led to renewed interest in redefining the boundaries between primary and secondary care with the aim of shifting selected services traditionally provided in the acute hospital to less resource-intensive primary and community based alternatives. This systematic literature review looks at the potential for effective service provision for young A & E patients at mixed A & Es in UK. The UK has experienced a rapid increase in general practitioner out of hour’s co-operatives over the last 5 years. More generally, a government review of emergency pre-hospital care in England and Wales recently resulted in a series of pilot schemes to test interventions

Small-Cale Chinese Restaurant in Hatfield Dissertation

Small-Cale Chinese Restaurant in Hatfield - Dissertation Example They compare the perceived benefits received against the perceived costs in terms of sacrifices they make. If they are not treated fairly, the perceived customer value is not derived. The study also finds that the two restaurants under study have their own restaurant management methods. One has an authoritative structure with formal procedures and policies while the other nurtures a culture of service, with its roots in the Chinese culture, characterized by guanxi and harmony. Both have created their own points of differentiation. One thrives on food quality and the other on service quality. The study concluded by recommending that restaurants should adopt experiential marketing which would enable evaluating and understanding customers’ point of view, their expectations and perceptions. Customer feedback should be adopted as a strategic imperative which is being ignored by one of the restaurants under study. Employee empowerment is another human resources strategy that should be adopted. While a customer-focused approach is essential the finer details of the strategy would depend on the size of the restaurant, the level of the restaurant, the clientele it serves, the cuisine it has on offer and on the objectives and goals of the company. Acknowledgement The presentation of this dissertation has been a challenging and one of the most satisfying experiences in my academic life. It has been possible to complete this study only with the support, guidance and patience of the following people: Ms Bunce Sally, my tutor, whose patience and guidance has been a motivating factor. She undertook to be my supervisor despite her academic and professional commitments. Her persistence in corrections helped me achieve this level of work. The owners of two... The hospitality sector, being a service sector, maintaining service quality is a major challenge. Competitive advantage and consequent success relies heavily on the service delivered. Globalization and internationalization have made the business environment even more challenging. The delivery of service depends upon several factors, the human resources being the most important factor. Every interaction in the service sector is a service encounter and such encounters take place at various levels. With services being intangible, heterogeneous, perishable and inseparable, how these elements are perceived by the customer would lead to customer satisfaction. Besides, elements of human â€Å"chemistry† may affect service delivery as some might be more committed to successful service encounters (Lashley, 1998). However, assessing customer expectations of satisfactory service becomes difficult. With the globalization of the food industry, the British appetite for global food transform ed national eating habits. Asian cuisine became palatable along with the traditional English fish and chips or burger chips. As per a survey conducted by, Valued Opinions, a company that conducts paid surveys, Chinese food is Britain’s favorite takeaway. A market research report by Mintel also shows that Chinese cuisine has come out on the top for the first time as the nation’s most popular takeaway meal. By now, more and more western people enjoy Chinese cuisine in the UK as they find Chinese food is not just delicious, but green and healthy as well.

China's Aging Population Research Paper Example | Topics and Well Written Essays - 1750 words

China's Aging Population - Research Paper Example The advances in health care that has raised the life expectancy to about 78 years have caused the china to change into an aging population. The high nutritional values in conjunction with the one child policy assumed by the modern day families in the country are also catalyst to aging population in China. The shift of China’s population to old age oriented might have a profound effect on her economy for the adults to be. The Chinese government will have to alter its budgetary policy in favor of the current situation and allow for heightened expenses. According to the international standards of population and demographic distribution, if more than ten percent of the county’s population is above sixty years of age, then this population is described as an ageing population. The Chinese government announced in 2000 that those beyond sixty-five years make about seven per cent of the national population. However, the expectation was that this trend would continue and expected that by 2050 more than thirty per cent of the country’s population would be more than sixty years. The basis of china’s aging population are just as those found anywhere in any other country (Robinson 231). The country has low infertility rate, the life expectancy has risen, and there has been cumulative effect in changes of birth and death rates. The country is and will continue to experience a decline in fertility rate due to the one-child policy. The government has been advocating for the adoption of this policy, thus it has been the main contributor to the changing structure of the Chinese population. The future of the Chinese economy is likely to be very prudent if measures to counteract the negative economic effects that may come along with the aging population are not set. The country may have to change the legal retirement age in order to facilitate work for a continuous production round the year. The Chinese economy is likely to have a great effect in the fut ure. Take for instance the education system that receives a lot of emphasis in the Chinese families. The education system currently has great effect from the large swaths of population where even the secondary education has no guarantee and the technical training as well (Uhlenberg 157). However, improving the education system and the skills of the workers may have a positive effect in improving the economy and compensate the impending decline in the share of the working age. Improving the skills of labor that is absorbed in to the production sector improves the productivity of the country. China has been on the long run to lay strategies that would mobilize the portion of the potential workforce, which is dormant or poorly utilized. The reserve labor force of china lays the concerns that china may not have enough workers in the future (England 5). As the population ages, the country will have to devote most of the resources to the care of the elderly people. The government will hav e to increase the pension rates in order to benefit the elderly. The increasing ration of the old people in the Chinese population has diverse economic implication for its society and thus impromptu policies and measures to counteract the future effect have to be laid. As the proportion of the elderly people, grow higher in relation to the overall population, the proportion of the young workers drops (Robinson 238). For example in china the active labor force aged

Investment proposal report Essay Example | Topics and Well Written Essays - 2000 words

Investment proposal report - Essay Example Contextually, the mission of this particular business will be to operate with the deliverance of high quality products and services to the customers so that it can ensure maximum productivity that further shall ascertain the growth of the business. The business will also take into consideration the interests of the stakeholders while framing its strategies. The business idea, which will be focused in this context, will be multi-cuisine restaurant. A multi-cuisine restaurant is a particular sort of restaurant, which uses cooking methods of different nations of the world. This kind of restaurants often serves customers with diverse sorts of foods that have resemblance of any specific nation or region. However, establishing such business requires a considerable amount of investments. This particular business will require funds for various purposes including equipment and vehicles, marketing, land purchase, purchase of machinery, setting up of infrastructure and startup capital among others. These aspects are mandatorily required to set up multi-cuisine restaurant in any part of the UK. Hence, the need for investors is quite apparent in this particular business. It is known that investors are the people who invest their money in any business and earn profit for the same in return. For this particular business, funds will mainly be acquired from sources preferably the financial institutions of the UK. Funds will be acquired from these institutions against the payment of interest at a particular rate. It can be affirmed that acquiring funds is not only the sole step in setting up investment plans for the business rather financial planning is also considered to be important. Observably, financial planning is a set of financial goals and objectives of any business on which the profitability or the stability of the entire business is dependent.

Education Law Essay Example | Topics and Well Written Essays - 500 words

Education Law - Essay Example The significance of the case is to show that school authorities should ensure that the off-campus rules they implement need clear wording, applied and interpreted for students who do not understand them. The case is an excellent example for school authority officials and for students showing what happens in instances when school rules get breached. The student was not suspended from carrying out other school activities and functions, but got suspended from the baseball team as punishment for being in possession of alcohol. The violation of school rules warrants different punishments. However, certain factors have to be considered before enforcing such punishments. The first factor is the seriousness of the offense. Other factors such as the student’s age, the student’s code adopted by the board, the attitude and how often the student commits the offense are also important to assess. Lastly, the other two factors include requirements of chapter 37 of the education code and the potential effect that the student’s misconduct has on the school environment. The first concept is that the state has to take action (Lesson 3). For example, a teacher from a private school who gets fired without getting a notice from the school’s board of team members has the right to complain for contractual breach. In such an instance the school becomes liable for a lawsuit because it violates its own policies. The second concept is that the person must have been dispossessed of his or her property or liberty by the state for the court to accept that there has been a violation of due process. In this case, the state is liable for violation of due process because of breaching the contract formed between it and the person. The third concept is that the nature of due process is dependent on how severe the problem is in a case. In a case where a person has killed another person and gets sentenced to life imprisonment or death penalty, the state is liable for

Women, Religion and Politics Essay Example | Topics and Well Written Essays - 1250 words

Women, Religion and Politics - Essay Example But the religious doctrines often hinder the women from actively participating in politics. A notable example is the women in Arab countries who particularly remain under-represented in parliaments. When the percentage of women constitutes 16.3% across all the parliaments, it is very low in Arab countries. In Iraq women population constitutes 50% while their representation in parliament is only 31%.It may be because of the strict influence of religion on women folk. But there is a remarkable change in Africa and in Latin America where there has been an increase of more than 5 points during the past 10 years. In these countries religious rules are more liberal that enable women to participate actively in politics. The reservations allotted to women in all the parliaments are controversial even now. This is made clear by Gila Stopler when the author states: â€Å"Though modern liberal theory is commonly understood as guaranteeing similar rights to both men and women, I will argue that there exists a tremendous gap between this understanding of liberal theory and the reality of both liberal theory and liberal practice in relation to discrimination against women. A similar gap exists between the liberal attitude toward sex discrimination and the liberal attitude toward racial, ethnic, and religious discrimination.† ... In USA, the Republicans could keep clear view about women, religion and politics. Their female candidate Hillary Clinton launches a contemptuous attack against the current insurance industry in USA .She accuses that the covetous reforms deliberately lying in all reform plans are based on defending their profits. She may be the first lady who publicly attacked any Americans or American industries. In USA we can't find a clear cut margin between US women's religion and politics even though the female candidates of Republican party including Hillary were the followers of Roman Catholic Religion. Structured religion in the world always has been and remains the enemy of women's rights .Roman catholic churches fought with tooth and nail against the developments of woman .Today the most dreadful enemy of women - socially, politically, and economically - is the religious constraints. Even the sexuality of women is under religious scrutiny. Religion overpowered the equal right debate. The Bible establishes women's inferior status, her unseemliness, and the god practiced a master/servant relationship. Even the Bible itself produces the evidence for gender discrimination. Ferrara and Wilson make it clear when they state: "Jesus Christ took the flesh of human nature and made it wholly his own. In the unity of the Church, a Gentile is as much an image of the Jewish Christ as a Jew; a slave is as much the image of the freeborn Christ as a citizen; a woman is as much the image of the male Christ as a man. It is arbitrary to slice up the unities in one way and not in the other. It is a b izarre fixation on gender that requires male body parts to represent Christ. In fact, it is a denial of Jesus' incarnation and resurrection alike to say that women cannot stand in persona

Examining switching costs as a moderator in the relationship between Essay - 1

Examining switching costs as a moderator in the relationship between service personalization, customer satisfaction and customer - Essay Example The customers may get time saving in searching, locating and evaluating the alternatives services providers. They do not need to waste their time on learning. They do not need to spend their efforts, while switching to other vendors. In commercial view, customer loyalty is the key precondition for achieving success in e-business (Reichheld and Schefter 2000). Loyal customers benefit firm, since they bring additional revenues but require little attention from organizations. Loyal customers are more likely to forgive services handicaps and decreased price sensitivity. Committed customers generate positive work-of-mouth to others, enhance firms’ resistance to competition, and decrease the costs of selling. As a result, customer loyalty can be treated as a valuable asset. It is also a major source of sustaining continued profitability and organizational growth (Dick and Basu 1994; Anderson and Mittal 2000). The current state of research provides numerous definitions of custome r loyalty. In general level, customer loyalty defines the features and attitudes that consumers exhibit towards products, services, brands, and advertising messages. Customer loyalty signifies customer's willingness to re-buy, repeat patronage behavior over a period of time and a desire to continue and keep a continued relationship with the service providers (Dick and Basu 1994; Oliver 1999). (Anderson and Srinivasan 2003) described customer loyalty as a customer’s favored or chosen provider that leads them to behave positively toward a service provider with repeat patronage behavior. In general, customer loyalty in literature is conceptualized as a form of attitudinal behaviors in marketing and business (Jacoby and Chestnut 1978; Dick and Basu 1994; Oliver 1999; Casalo, Flavian et al. 2008). From an attitudinal perspective, it includes cognitive loyalty and affective loyalty. The customers want sustained relationships with their service providers. From the viewpoint of behavior, cognitive loyalty is a form of repeated patronage that sets the pattern for repeated purchases. Theoretically, whenever customers identify and choose the product or service they like, which meets their quality and price expectations, they are willing to use this product on a long-term basis; as a result, they are no longer concerned with searching for alternatives and become disinterested in competitive and advertising messages and threats. (Oliver 1999). (Oliver 1999) introduced four stage loyalty model; cognitive loyalty is the first stage, which is essentially about the quality of buying behaviors that are affected by customer’s individual characteristics and the circumstances, in which purchase takes place. Customers cannot be loyal to the brand, unless they have information about it. Loyalty develops when customers have sufficient information to decide that the brand is a preferable choice relative to other alternatives. Brand attitudes can be based on pri or knowledge of the brand or brand experiences. Affective loyalty is the second stage, when customers link their knowledge and experiences about the brand to this very brand. Conative loyalty is the third step. This is a very deep commitment by a customer that would like to

Training and Development in Tesco Assignment Example | Topics and Well Written Essays - 1000 words

Training and Development in Tesco - Assignment Example This is aimed at the analysis of instilling a sense of inclusiveness in the workers as well as their commitment. Since Leahy’s resignation announcement, drastic changes were witnessed in its stock market, which witnessed a sharp drop in the value of Tesco’s shares. From the above, it was evident that Tesco needed to instill confidence in its customers and the public hence there was a re-engineered customer service mechanism in operation for sustenance of Leahy’s transformational leadership style that saw Tesco’s unprecedented rise in the last one and a half decade (Bass,1990) . Tesco has further undertaken transformational change in its organization so as to become the carbon-zero company. This change has been through reducing energy usage and then getting the rest of the energy it uses from renewable sources. In the last few years, a Tesco has developed a supermarket that is zero carbon in its operation, but not its build. Tesco has extended its effort to both its supply chain and its customers’ carbon footprint. Tesco also wants to make it easy for staff to understand how they can change the way they work to promote carbon reduction. More so over the last three years Tesco has committed huge resource in its training and development programme. It has made progress toward achieving this by being the first supermarket to have its apprenticeship training programme accredited. This has been eating achievement for the company. This is in line with its strategy of improving its workforce and getting the best out of it. Tesco further introduced Tesco club card which is a kind of customer loyalty card.  

Life as a Buddhist Essay Example for Free

Life as a Buddhist Essay Many people all around this planet have knowingly or unknowingly met people of the Buddhist community or even seen a Buddhist Temple. In whatever circumstances, hearing of, meeting with the real Buddhists or visiting their temple is not an issue. The fundamental question is, ‘what is Buddhism? ’ An article, The Buddhist Way appearing in the Buddha Net (2008) defines Buddhism as, â€Å"†¦a religion, a series of practices and a way of life based on the teachings of Buddha who, after achieving enlightenment, taught that the nature of the world is constant change. † According to the teaching of Buddha, all things in this world are temporary and the inability to understand life’s nature is the source of people’s unhappiness, trouble and their suffering. Buddhism is therefore a means to correct people’s views, expectations along with their conduct and bring happiness, peace, wisdom, Nirvana and end suffering. Buddha’s teachings are a source of inspiration to people whose religion is Buddhism. Their lives have perhaps been influenced by these teachings (Buddha Net 2008). This essay seeks to explore through the day to day life of Buddhist men, women and children The males were the dominant figures in the Buddhist community. Their responsibility was to take care of the females in their community. They were the voice in their families and no woman could dare go against their wishes. The woman could only manage the affairs of the house in the way that the husband dictated. The males could marry as many wives as their strength allowed (Buddha Net 2008). They could become monks to serve in the Buddhism religion where they were supposed to live a celibate life (Andrew, nd). To understand the situation currently facing the Buddhist woman, it is important to look at the early life of the Buddhist woman. The Buddhist woman seems to have gone through so much than any other living creature. Her life was that of submissiveness and servitude; as a child and youth, a wife and an elderly woman, she had to obey and serve her parents, husband and grown children respectively. They had no right to chose whom to marry and would marry anyone chosen to them by parents. On very rare occasions, they were given an opportunity to choose from a few suitors. Some of the women therefore were forced to elope. Once they were in marriage they were to obey their husbands together with his parents without question. Like objects, they could seldom make decisions; they were ordered on what was to be done by men (Andrew, nd). Women’s role in the Buddhist society was to manage household affairs such as cooking, cleaning the house, bearing and looking after the children. They only ate leftovers after the men had had their fill. Women were treated more or less like objects. Their husbands could beat them up if they were displeased to, an extent of being thrown out from the family house. A woman could not file for a divorce but a man could (Andrew, nd). Their role as said earlier was to bring forth children for their dear husbands and if the woman was barren, another wife was the better option for the husband. As opposed to men, women who committed adultery were put to death. Men could also give away their wives to their men friends. The woman was the most degraded creature in the early Buddhist community whose activates and decisions were under the remote control of men. Many women served as slaves and had to follow whatever their masters said even if it meant the sexual act. They were also beaten up by their master and even murdered without anyone’s alarm. Due to these merciless and regular beatings they occasionally committed suicide. The life of a traditional Buddhist woman was made of a dark cloud of suffering. Andrews in her article Women in Theravada Buddhism joins Janice Willis in saying that women â€Å"†¦were helpmates at best and burdens at worst, but always they were viewed as being inferior, second class citizens† (Andrew, nd). The birth of Buddha also marked the birth of the women’s freedom. At one time Buddha was asked about women by one of his disciples, Ananda and he replied that just like men, they could also become enlightened. Buddha in an effort of lifting the woman figure founded orders for both Bhikkhus (monks) and Bhikkhunis (nuns). The practices and rules that governed the two orders were similar. Buddha also taught anyone; male and females alike (Andrew, nd). However it had not been easy for Buddha to establish the order of nuns. Had it not been for his disciple Ananda’s pleading, the women could not have been ordained. Despite their ordination, Buddha dictated eight rules that placed the nuns as monks’ subordinates. To Buddha still, a woman was a lesser being. It was because of nuns’ ordination that his teachings would last for only 500 years instead of the expected 1000 years. Ordination of women was like a crime that he had committed (Andrew, nd). After the death of Buddha, the one time patriarch society wore back its earlier face. They could not deal with women nuns who were their equal and rules to lower the standards of women in the society were made. No one was against Buddha’s teachings that women could in the same way as men attain enlightment but there were certain limitations made for Bhikkhunis to perhaps increase acceptance of monastic rules in the society. Despite these limitations, many women joined the Bhikkhunis as there was more freedom, no servitude; no doing of household chores and above all they had independence. Once liberated, they taught the same to other women. Bhikkhunism therefore was a way of escaping from the harsh realities of life. All women could not be Bhikkhunis; some established other movements such as the Lay Women (Andrew, nd). The life expectations of a Buddhist child can be drawn from the teaching of Buddha to his own son Rahula. Parents and teachers were supposed to pass these teachings on to their children. A Buddhist child is expected to be truthful. If the Buddhist child wanted to find truth the child must be truthful in the first place. Children are also supposed grow up with their actions as mirrors. They were advised not to perform any action that seemed harmful. Children were supposed to learn from their mistakes and be responsible for their actions. They were also supposed to be compassionate. Buddhist children are also trained to become monks from an early age (Talbot, 2010) Conclusion Just like in any other institution, the Buddhist community has had their own way of life. Each and every group had a place it held in the society. However, it had been a patriarch society that infringed on the rights of women. Men were superior figures but women were expected to be in total submission of their husbands. With the coming of Buddha the status of women was lifted but was not equal to that of men. Women are still below men in communities that practice Buddhism such as in India and Thailand. References Andrew, K. (nd). Women in Theravada Buddhism. Retrieved form http://www. enabling. org/ia/vipassana/Archive/A/Andrews/womenTheraBudAndrews. html Buddha Net. (2008). The Buddhist way. Retrieved from http://www. buddhanet. net/e-learning/buddhism/bs-s01. htm Talbot, M. (2010). Introduction: teaching your children Buddhist values. Retrieved from http://www. tricycle. com/special-section/introduction-teaching-your-children-buddhist-values

All aspects of physical, psychological and social needs

All aspects of physical, psychological and social needs Nursing care for ill patient as a holistic and encompasses all aspects of physical, psychological and social needs. Therefore, patients and their families are the center on nursing care by more respect, dignity. Nurses and the other care providers must provide patients needs when dealing with chronic ill patients. The benefits of palliative care cancer/chronic ill patients are significant that enhancing patient quality of life (Lewis et al., 2007). Advanced cancer often causes a pain and other symptoms that need professional team to manage and control it. Pain, nausea, shortness of breath, vomiting and constipation are the most common symptoms appearance with these patients. In addition, each one of them has different experience of pain and the meaning of quality of life. Expert can deal and manage with these symptoms very well. (Backer, 2010). World health organization has defined palliative care as the full care that approach to improve quality of life for patient and their families whom are facing life threatening disease through prevent and relief their suffering and problems. This care concern in pain and other problems treatment, physical, psychological, social and spiritual support (Lugton Mcintyre, 2005). Many patients need palliative care specially the cancer patients those suffering too much at the end stage, regarding the metastatic. Cancer is known as a rapid creation of abnormal cells that grow beyond their usual boundaries which can break into the adjacent part of the body and spared to other organs. Refer this process as malignant tumor can be metastases to other part and organ in the body, which leading to death (WHO, 2011). Quality of life is the maximize comfort to the patient and family through four main areas the quality of physical, psychological, spiritual and existential (Batiste, Caja, Espinosa, Bullich, Porta-Sales, Sala, Lim ´n, Trellis, PascualPuente, 2010). Lung cancer for which surgery is not considered the most appropriate treatment option that called (inoperable lung cancer) due to one of several reasons, including the size of the tumor distant spread (metastasis) of tumor, location of the tumor and other health conditions that could rise the risk associated with surgery. In operable lung cancer does not mean that a tumor is untreatable. Other treatment, such as chemotherapy or radiation therapy may be better options than surgery (Llewellyn, Aun Ang, Lewis, Al-Abdulla, 2006). Lennart has been diagnosed with lung cancer and he has several problems that make him more weakness and affect his quality of life. These symptoms such as elevated blood pressure, diabetes type2, and inoperable lung cancer, cancer spread to his abdomen, pain and draining tube irritate his body tumor growth and constipation; he cannot eat anything and drinks only small sips of water.ØÙ„ØØ ³ÃƒËœÃ‚ ªÃƒâ„¢Ã¢â‚¬ ¦ÃƒËœÃƒËœÃ‚ ¹Ãƒâ„¢Ã¢â‚¬Å¡ÃƒËœÃ‚ ±ÃƒËœÃƒËœÃ‚ ¡ÃƒËœÃ‚ © Ø µÃƒâ„¢Ã‹â€ ÃƒËœÃ‚ ªÃƒâ„¢Ã…  ÃƒËœÃ‚ © للكلÙ†¦ÃƒËœÃƒËœÃ‚ ª   The team should start to control his symptoms 1. Pain 2. Nausea. 3. Constipation diarrhea 4. Lost appetite. 5. No energy. 6. Elevated blood pressure. 7. Diabetes type2. Nursing assessment; Objective data; He has an elevated blood pressure and diabetes type 2. Diagnosed with an inoperable lung cancer. Subjective data; Pain and the draining tubes irritate his body, nausea and diarrhea, fatigue cancer has speared to his abdomen. 1. The problem is pain; pain can be appear due to the direct effects of the cancer (late stage) or caused by some treatment like surgery, drugs and chemotherapy. The patient may also have chronic underlying disease that directly causes or contributes to pain. (Lewis et al., 2007). A- Nursing care plan- pain control. Use analgesics appropriately. Use non analgesic relief measures. Report pain control. B Nursing intervention and rational; Observe for nonverbal cause of discomfort to plan appropriate intervention. Perform a comprehensive assessment of pain to include location, characteristic, onset, duration, frequency, quality, intensity of pain and precipitating factor. Teach Lennart and family the use of non pharmacological techniques e.g. (relaxation, massage). Provide the person optimal pain relief with prescribed analgesics to determine if is effective. Use pain control measures before pain become severe (Lewis et al., 2007). 2. The problem is nausea and vomiting. Lennatr has these symptoms due to 1. Release of intracellular breakdown products stimulates vomiting center in brain. 2. Drugs stimulate vomiting center in brain (Lewis et al., 2007). Nursing care plan nausea and vomiting control. Recognizes precipitating stimuli. Use preventive measures Use antiemetic medications. Report nausea, retching and vomiting controlled. B- Nursing intervention and rational. Perform complete assessment of nausea, including frequency, duration, and severity and precipitating factors to plan appropriate interventions. Reduce or eliminate personal factors that precipitate or increase the nausea (anxiety, fear, fatigue and lack of knowledge to avoid precipitating factors of nausea and vomiting. Use frequent oral hygiene, unless it stimulates nausea to promote comfort. Ensure effective antiemetic drugs are given when possible to prevent nausea and vomiting. Teach the family to use of the non pharmacologic e.g. (relaxation) to manage nausea and vomiting. Promote adequate rest and sleep to facilitate nausea relief (Backer, 2010). 3. The problem is Diarrhea; the patient has it due to 1. Denuding of epithelial lining of intestinal .2. The side effects of if the patient on chemotherapy.3. Radiation to the abdomen, pelvis and lumbosacral areas if he receives it .4. Laxatives, tube-feeding (Lewis et al., 2007). A. Nursing care plan-stop diarrhea. Bowel elimination. Diarrhea. . Pain with passage of stool. (Lewis et al., 2007). B .Nursing intervention and rational; Obtain stool for culture and sensitivity if diarrhea continues to provide appropriate treatment. Perform action to rest bowel (e.g. NPO, liquid diet). Instruct Lennart, and family members to record color, volume, frequency and consistency of stool to monitor treatment. Teach Lennart and his family appropriate use of anti-diarrheal medication to prevent patients use of anti peristaltic agents that prolong exposure to infection organisms. 4. The problem is diabetic. Insulin resistance decreased insulin production and alteration in production of adipokines.Disease is result of complex genetic interactions, which are modified by environmental factors such as body weight and exercise (Lewis et al., 2007). A .Nursing care plan- diabetic control. Description of insulin function. Description the role of diet in controlling blood glucose level. Explanation of the role of exercise in controlling blood glucose level Description of hyperglycemia, hypoglycemia, related symptoms and the procedure to be followed in the treatment. Explanation the impact of acute illness on blood glucose level. Description of when seek help from health care professional team. (Lewis et al., 2007). B. Nursing intervention and rationales Describe the disease process. Appraise Lennart current level of knowledge related to disease to determine the scope and extent of required teaching. Discuss the rationale behind management, therapy and treatment. Instruct Lennart on measures to prevent, minimize symptoms to promote management of disease. Discuss life style change that maybe required preventing complication and encouraging patient in determining change that will be acceptable. Instruct Lennart the signs and symptoms and reported to ensure prompt treatment. Refer the patient to support group to provide continuing support and education (Lewis et al., 2007). 5. The problem is loss of energy. Anabolic processes resulting in accumulation of metabolites from cell breakdown (Lewis et al., 2007). A. Nursing care plan- energy conservation. Recognize energy limitations. Uses energy conservation techniques. Balance activity and rest. Organize activities to conserve energy. Adapts life style to energy level, B. Nursing intervention and rationales. Determine patient physical limitations to plan daily activities. Assist Lennart to schedule rest periods to temporarily reverse effect of fatigue. Teach him and the family activity organization and time management teaching to prevent fatigue. Instruct patient significant other to recognize signs and symptoms of fatigue. Instruct patient significant other to notify health care provider if signs and symptoms of fatigue persist to increase patient support and family understanding of disease and related problem (Lewis et al., 2007). The problem is elevated blood pressure.. Potential complication adverse effect from antihypertensive therapy. 2. Potential complication hypertensive crisis.3. Potential complication of stroke. 4. Potential complication of myocardial infarction (Lewis et al., 2007). A. Nursing care plan blood pressure control. Improve myocardial contractility and systematic perfusion. Reduce fluid volume overload. Prevent complication. Provide information regarding disease, prognosis, therapy needs and prevention of recurrent. B. Nursing interventions and rationales; Assess cardiovascular status including vital signs to detect cardiac out compromise. Measurement blood pressure to ovoid complication. Assess neurologic static and observe for any change that can indicate an alteration in cerebral perfusion. Administer medication to lower the blood presser. Make sure that Lennart maintain a low sodium diet. Record and monitor the intake and output. Encourage Lennart and support them to express the feeling of stress to ease the anxiety. Promote quiet environment to reduce stress (Lewis et al., 2007). 7. The problem is constipation. The factors of constipation are many from the mass in anorectic region or neurologic and may be from the mechanical changes from surgery or decrease oral intake and mobility. Medications can affect like opioids and tricycle antidepressants (Lewis et al., 2007). A. Nursing care plan promote bowel movement. Stool soft and formed. Comfort of stool passage. Passage of stool without aids. (Lewis et al., 2007). B. Nursing intervention and rationales; Encouraging Lennart to movement and ambulation Maintaining bowel awareness. Ensuring adequate hydration and bulk-forming diet. Use of laxatives. Encourage fluid and fiber intake (Lewis et al., 2007). All these care it will provide by multidisciplinary team care of the cancer pain patient must be active by continuous care and communication to the patients and their families. It should attend physical, psychological, social and spiritual needs. Moreover, this type of team members need diverse training share the main goal of improving the quality of life with the patient and interact as a group of individuals with the common purpose of working together. Each member has own expertises and training and makes decisions within that area of responsibility. Nevertheless team work does not mean joining health care workers together in one room, nor is it the same as collaboration .information must be the issue for interaction of members and must be shared by the vehicle recorded, such as (physician, psychologist, and nurse, volunteer. social worker, chaplain, physical therapist and occupational therapist). In addition the family is important member of palliative team because they are the on e living with patient at the same home or attend them .the family need more care from the team and teach them the intervention to take care of their patients. (Euro, who, 2010). Effective communication is an important part of the therapy. In treating patients with advanced stages of incurable disease it is mandatory to provide intelligible and coherent information to the patient and relatives, focusing on the development of basic listening skills in the health care professionals all this from patient right and consideration from the ethics of communication (Batiste et al., 2010). ØلقØÙ†¦Ãƒâ„¢Ã‹â€ ÃƒËœÃ‚ ³ Ø ¹ÃƒËœÃ‚ ±ÃƒËœÃ‚ ¶ ØلقØÙ†¦Ãƒâ„¢Ã‹â€ ÃƒËœÃ‚ ³ Øلن¦Ãƒâ„¢Ã‚ ÃƒËœÃ‚ µÃƒâ„¢Ã¢â‚¬Å¾ Conclusion; Palliative care is not cure disease or prolongs life it is control the pain and symptoms and improves the quality of life for patients and family. More than 90% of cancer patients can be achieved relief from pain and symptoms through palliative care. There are effective strategies for the provision of palliative care for cancer patients and their families in places where resources are setting. (Who, 2011).Therefore palliative care is effective out come with professionals team. In addition the teams are requiring a high level of professional ethical skills to cooperate the primary goal. The primary goals of the team are to offers the best possible quality of life for the patient and family as well as to provide support.

Complications Of Skeletal Traction Health And Social Care Essay

Complications Of Skeletal Traction Health And Social Care Essay In the last two decades, there have been major changes in the management of lower limb long bone fractures, surgical management has become the norm. Skeletal traction is now rarely used as the definitive form of management. Most of the patients admitted to our hospitals have skeletal injuries, and these patients have prolonged length of stay as they are initially managed non- operatively. Complications of traction have been looked at since 1947 and have been published but literature from the developing countries is lacking. This study is being conducted to evaluate the prevalence of complications associated with skeletal traction with lower extremity fractures. Objective : To determine the proportion of patients with Lower Extremity fractures who develop complications associated with skeletal traction. Study Design:- This is a Hospital based Prospective Descriptive study, that will be carried out from December 2010 to March 2011. Study Setting :- The study will be carried out at the KNH orthopaedic wards. Materials and Methods :- Patients who are put on lower limb skeletal traction will be recruited into the study, They will be reviewed weekly for complications namely pin tract infection, pressure sores, venous thrombo-embolism, orthostatic pneumonia and knee stiffness, until upto the point they are taken off traction. The data will be collected using pre-designed questionnaires. INTRODUCTION Fractures of the femur are almost always the result of great violence and are sometime a threat to the patients life, not only because of the immediate complications such as bleeding or associated injuries but also because of subsequent complications related either to the treatment of the fracture or to the complications of the associated injuries. Immobilization of the fracture was recognised as essential for union. The development of splints, such as the Thomas splint and the subsequent combinations of the splints with traction methods either fixed or balanced, allowed for better control of the fracture, patients never the less had to remain in traction for three months or longer before the fracture was sufficiently stable to allow ambulation. Skeletal traction is seldom used in modern practice, usually it is only a temporary mode of treatment. Internal Fixation is still the treatment of choice for most closed injuries, this is because of higher union rates, lower rates of complications, earlier weight bearing, shorter hospital stays and early return to daily activites. In KNH majority of the patients admitted with femoral fractures are managed initially on skeletal traction. Patients with proximal femoral fractures are on Russel Hamiltons traction while patients with femoral shaft fractures are on Perkins traction. When the patient is managed on skeletal traction the patient is on prolonged bed rest and hospital stay increases also nursing care is difficult and the patient is at risk of developing morbidities due to the skeletal traction and prolonged immobilisation. The cost of care is increased and as seen in our setting most of the patients we manage come from a low socio-economic background who have difficulties in financing their healthcare. The prolonged confinements of the patients on traction is associated with certain complications, such as pin tract infections, decubitus ulcers, which can be overcome by better nursing care, but the complications of prolonged bed rest such as bladder and bowel derangements, deep venous thrombosis, osteoporosis, muscle wasting, to mention only a few cannot be prevented hence the need for early internal fixation. Literature Review Motor vehicle crashes are the leading cause of death in adolescents and young adults (1,2,3,4) and of the estimated 856 000 road deaths occurring annually worldwide, 74% are in developing countries (5). In both Nigeria (6,7) and Kenya (8), for example, a fivefold increase in traffic-related fatalities was observed over the last 30 years. Injuries cause profound morbidity and are one of top 10 causes of death and disability in both developing and developed economies (9). Kenya, like other developing countries, lacks organised efforts to reduce the burden of injuries. Although there is debate as to whether trauma systems in high-income countries are transferable to developing economies, baseline studies providing accounts of injury and injury trends in least developed countries are scanty.(10) Media reports have raised concern over rising road accident injuries in Kenya. Most of these occur in the capital city, Nairobi (11). Those injured mainly receive treatment at the Kenyatta National Hospital (KNH) the citys main hospital. The city lacks a systematic pre-hospital care and the patients arrive at the institution at any time and unannounced. As demonstrated in Saidis study, the injured are transported to hospital by private vehicles in the majority of cases. Ninety two per cent of the casualties arrive at KNH without any pre-hospital optimisation. (10) Saidi et al (12)found 31.0% of all admissions at KNH are due to injury indicating that a large volume of trauma admissions is handled at this public hospital. The average length of hospital stay of 14 days is from Saidis study is much longer than in reports from established trauma facilities. At the Vancouver General and Teaching Hospital, Canada, the length in 1997 was 9.14 days despite caring for patients with severer injuries (24% with ISS > 16) than in Saidis (12) cohort of patients (13.4% with ISS > 15) [12,13]. The excess length of hospital stay at KNH is caused by the predominance of skeletal injuries. Long bone fracture fixation is usually performed late, a practice occasioned by the local economic environment and a limiting factor for external validity of this outcome measure. An initial period of nonoperative care, which may last up to 4 weeks, is inevitable. The delay is caused by time spent to raise funds for desired implants. Many patients (90%) pay for the services out of their pockets [14]. If a policy of early fracture treatment incorporating a care reimbursement system that does not delay the operative intervention is introduced, the average length of stay may improve. This early fixation would additionally prevent pulmonary failure state, alleviate pain, ease nursing care, reduce complications [15], and allow early rehabilitation and return to work. The principles of traction are a pulling force that is applied to part of the body i.e. the limbs, the pelvis or spine and another force applied in the opposite direction called counter traction. The forces involved in traction are based on Newtons third law of motion, which states for every action there has to be an equal and opposite reaction. Malgaigne characterized as the greatest surgical historian, and author of the 1st comprehensive work on the diagnosis and the treatment of fractures (18), credits Guy de Chauliac with the introduction of continuous, isotonic traction in the treatment of fractures of the femur. This was accomplished by suspending a weight, attached to the leg by a cord over a pulley at the foot of the bed. The use of traction dates as far back as 3000 yrs. The Aztecs and the ancient Egyptians used manual traction and made splints out of tree branches and bark. (19) In 1847, Malgaigne introduced the first effective device which grasped the bone itself, these hooks were designed for the Rx of displaced patella fractures, the hooks were pressed through the skin and subcutaneous tissue to engage the proximal and distal fragment of the patella.(18) During World War One there was a rapid spread of the use of skeletal traction by application of tongs to the femoral condyles. After the war the tongs were extensively used in the United States but their popularity gradually decreased because of the complications, particularly infection associated with their use, tongs are now mainly reserved for skull traction.(21,22,23,24,25) Skeletal traction by means of the Steinman pin was popularized by Bohler and his students. Isotonic traction still remains an essential element in the closed treatment of many fractures. In many places worldwide it is standard practice to apply skeletal or skin traction to the injured limb following acute fractures prior to surgery Billsten 1996; Brink, 2005 (41). Traction may be either skin or skeletal. The main theoretical advantages of traction are that it will reduce pain at the fracture site and assist the reduction of the fracture thereby making the subsequent operation easier to perform. For intracapsular fractures reduction in circulatory complications has been proposed as traction may reduce any tamponade effect (Pressure caused by build up of excess fluid) which will compress blood vessels and block blood flow within the joint. Traction however has potential disadvantages, it makes nursing of the patients more difficult for e.g. use of a bed pan by the patient, pressure area care prior to surgery. Other adverse effects especially of skeletal traction include complications of sepsis at the pin site, pulmonary complications and knee stiffness because of the prolonged immobilization. In the last two decades there have been major changes in the management of lower limb long bone fractures, where resources permit, surgical management of open closed femoral tibial fractures has become routine.(26) Traction should now be rarely used as the definitive form of management. Orthopaedic surgeons have come to appreciate that there are 4 main treatment goals for fracture management (27). These goals were created by the ASIF (association for the study of internal fixation) and are: Anatomic reduction of the number fragments, ensuring alignment, length, and angulation and rotation are corrected as required. Stable internal fixation to fulfil bio-mechanical demands Preservation of blood supply to the injured area of the extremity. Active pain free mobilization of adjacent muscles and joints to prevent the development of fracture disease There are several studies done to determine the usefulness of pre-op traction, (32,33,34,,35,36,37,38,39), though these studies are mainly looking at proximal femoral fractures. Traction prior to surgery is standard practise in some hospitals, a survey of 78 hospitals in Sweden (40) showed that a quarter of those, routinely applied skin traction to all patients with hip fractures, while another survey done by Brink et al in 2005(41) found that pre-op traction was standard practise in 20% of trauma departments in the Netherlands. These studies have shortfalls in that the type of traction used is mainly skin fraction, and the maximum duration patients are on traction is 2.3 days Brink 2005(41), while in our setting patients are on traction for minimum one week prior to internal fixation . In this study only 4 patients were put on skeletal traction of the total patients put on traction, reasons for the difference are not given. From the Cochrane review article on the pre-op benefits of traction, not many studies have looked at the complications of patients put on skeletal traction. The main outcome measures in these studies (32,33,34,35,36,37,38,39,40,41) were degree of pain, analgesia use, length of surgery, ease of fracture reduction, and it seems like incidence of pressure sores and other complications were secondary objectives. One of the earliest accounts of complications of skeletal traction is from 1946, by Kirby Fills (42) they mainly looked at complications associated with trans-fixation pins and wires in skeletal traction, from a series of 305 fractures of long bones, complications occurred in 12, of these only 3 were related with Steinman pin use one of the patients had pin tract infection (PTI), and 2 had peroneal nerve palsy, however the author clearly states many patients who had a little drainage from the pin but no signs of inflammation were not regarded as pin tract infection . Pin tract infection is defined as an abnormal condition associated with skeletal traction or external fixation devices and is characterized by infection of superficial, deeper or soft tissues or by osteomyelitis. These infections may develop at skeletal traction pin sites. Some of the signs of pin tract infection are erythema at the pin sites, drainage, pin loosening, elevated temperature, and pain. The bone pin construct is not a sterile interface, but it is a pathway between the surface of the skin, which is normally colonized by bacteria, and the medullary cavity which is sterile (43). Factors which predispose to pin tract infection are thermal necrosis (44) and accumulation of fluid around the pin (45). Regular pin care prevents crusting around the pins, thus minimizing fluid accumulation and hence transmission of bacteria, within the underlying tissues (45). Pin insertion using a hammer leads to splintering of the cortex (46). Insertion of the pin using power tools has been indicated as the main cause of thermal necrosis (44) hence hand drills are preferable for insertion. Necrosis of osteophytes and tissues due to the temperature elevation provide a fertile bed for any pathogenic bacteria. Patients who are put on skeletal traction suffer from morbidities associated with prolonged bed rest. A feature peculiar to these patients is morbidities associated with pin tract infections, which results in pain, pin loosening and subsequently need for removal of the pin. Neglect in these cases can lead to abscess formation and osteomyelitis (43). Similar morbidity of pin tract infection is associated with pins used in external fixators. Reported incidence in the world literature on pin tract infection is 5-10% (47,48,49,50). This incidence increases in cases of transfixation pins upto about 80% (51). The prevalence of pin tract infection varies dramatically in the literature from a 1% prevalence of major infections to an 80% prevalence of minor infections (52). Even in the study identified by the Cochrane review (53) the prevalence of pin tract infection varied, based on the treatment of pin sites, from 8-25% (54). A common factor in most studies of pin site complication is the lack of a standard definition of what constitutes a PTI is it inflammation around the pin site as reported in upto 41.6% in one series (55), or is it cellulitis around the pins or pin sites with draining sero-purulent discharge or is it pin loosening. Therefore this study is being done to establish what the rates of pin tract infection are when all the signs of inflammation will be used to diagnose pin tract infection. Looking at studies done closer to home in 1962 procter reported his series of 41 patients in SA (56), he was looking at use of perkins traction in femoral fracture management. PTI was found in 15% of the patients, while all the patients had full knee ROM at a period of 10 weeks. A few years later Usdin reported his own series of 58 patients, managed by perkins traction, and 5 of these patients 8.6% developed pin tract infections, and 2 cases had residual knee stiffness (57). More recently Gosselin in his series of 53 patients from Sierra Leone in 2005 reported that 23 patients (42.6%) of his patients had a pin tract infection and at an average 29 days after being put on traction.(59) Therefore it is noted incidence of PTI varies from centre to centre and is dependent on several factors , it is the purpose of this study to establish what proportion of patients on skeletal traction develop a PTI. Other complications associated with skeletal traction are decubitus ulcers, venous thromboembolism, Knee stiffness and pneumonia. There is sparse literature which reports on the occurrence of these complications in association with skeletal traction. Butt et al in his RCT of operative versus non-operative treatment of distal femoral fractures found that in the non-operative arm, a total of 26 patients developed complications. 3 of these patients had DVT, 4 had chest infections, 4 had pressure sores, 4 had UTIs (58) and 5 out of 26 patients developed pin tract infection. When critically ill patients are under our care it is important to protect them from further deterioration or delays in recovery, especially due to complications that are not related to the underlying pathophysiology that brought the patient to hospital. Immobility is associated with increased risk of VTE, decubitus ulcers and pulmonary insufficiency. Bed rest is a highly un-physiologic form of therapy and can lead to a number of complications (table1). Immobility-Associated Complications System Complications Respiratory Atelectasis Pneumonia Pulmonary embolus Cardiovascular Hypovolemia Dampened carotid baroreceptor response Orthostatic hypotension Deep venous thrombosis Gastrointestinal Constipation Ileus Renal Renal calculi Urinary stasis Endocrine Hyperglycemia Insulin resistance Musculoskeletal Muscular atrophy and deconditioning Bone demineralization Joint contractures Skin Decubitus ulcers Psychosocial Depression Decreased functional capacity Decreased respiratory excursion and stasis of secretions leads to atelectasis and pneumonia, lesser muscle contractions of the lower limbs results in reduced venous return, venous stasis and VTE. Reconditioning, loss of skeletal muscle mass and strength, is often seen because of immobilization. Bone demineralization due to absence of weight bearing stress on the skeleton, joint contraction occurs because of muscle atrophy. Pressure sores develop because of prolonged pressure on bony prominences. DVT and PE have long been recognized as major causes of morbidity and mortality in patients undergoing both elective and emergency orthopedic surgery. Numerous studies have investigated the incidence of DVT PE associated with hip and total knee arthroplasty, also the role of prophylactic anti-coagulation has been extremely investigated. When considering orthopedic trauma patients extrapolation from the arthroplasty literature is not appropriate. The incidence of DVT PE in association with hip and pelvic fracture has been looked at extensively, however there is insufficient information on patients with femoral fractures managed with skeletal traction, so as to allow the orthopedic surgeon to determine the risk or benefit rational of anti coagulation. In a prospective study done in Canada a co-host of 349 following major trauma was studied, and DVT cross found in 126 of the 182 with lower extremity orthopedic injuries, 61% of patients with pelvic fractures, 80% of patients with femoral fractures, 77% of patients with tibia fractures had confirmed DVT using venographic studies. Patients with fracture of tibia, femur are known to be at almost a 5 times more risk to have DVT as compared to patients without fractures. Geerts et al also found that only 3 of the 201 patients with confirmed DVT (ODS 1.5%) had clinical characteristics suggestive of DVT, therefore it is questionable whether clinical characteristics are adequate to make a diagnosis of DVT. Although it is well known that elderly patients have an increased risk of thrombosis. Geerts et al also found that younger patients with trauma those that are under 30years had a 46% incidence of DVT. The incidence of DVT in patients with femoral fractures on skeletal traction is unknown. The purpose of this study is to determine the incidence of DVT with positive clinical characteristics and confirmed by Doppler U/S in patients on skeletal traction for femoral fractures. Respiratory problems are common after long bone fractures, The main common complication of long bone fracture is fat embolism syndrome (FES),(60) followed by respiratory dysfunction and insufficiency.(61,62) Despite the development of medical and anesthetic management, evidence indicates that early treatment of the fractures in a multiply injured patient has a profound effect in reducing the risk of subsequent respiratory complications. (61,63,64,65,66) There are numerous studies showing that early fixation of femoral fractures can decrease the incidence of ARDS and multiple organ failure (MOF).(67,68,69,70,71,65) Over the last decade the beneficial effects of early stabilization of femoral shaft fractures by intramedullary nailing have been challenged. The association between early femoral fixation with reamed nailing and a higher risk of ARDS/MOF has been suggested.(56,64,60,61,65,66,) The first prospective study on this subject showed that among 178 patients, the incidence of pulmonary complications was significantly higher in those with late stabilized fracture.(71) In patients with single fracture, the complication rate after late fixation was 22% in comparison with 4% after early stabilization. In multiple fractures, these rates the traction were100% and 32%, respectively.(69,70) Early fixation can lead to the prevention of thrombosis, subsequent bed ulcers, and decreases the needs for analgesics.(65,74) Furthermore, early stabilization eliminates the need for supine position for skeletal traction, it improves pulmonary function and prevents atelectasis.(63,65,67,74,75) This study is aimed to determine the incidence of respiratory problems in patients who have single femoral or multiple fractures, and are awaiting operative stabilization. Severely restricted knee motion is a recognized complication of operative procedures or trauma around the knee. This is a significant problem in underdeveloped countries where the initial management of many of these injuries is suboptimal. The reported rate (76,77,78,79) of significant knee stiffness after various injuries and procedures around the knee is as high as 11% in the western literature, but may be much higher in underdeveloped countries, where ideal management of trauma is not readily available (80). A large percentage of these cases present with adhesions inside as well as outside the knee, and the management of these cases then becomes complex. Loss of extension is labelled more debilitating in western cultures, with small extension deficits impeding normal walking ; restricted flexion however is a serious problem in the Asian countries, where social and religious mores make sitting on the ground a normal requirement of everyday life. Flexion loss is mostly due to intra-articular fibrosis and scarring in the quadriceps-femoral mechanism. Anterior adhesions involve the quadriceps expansion in the lateral and medial recesses, the suprapatellar bursa, muscle adhesions to the femur, patella , or even shortening of the rectus femoris (77). A number of studies have described the complications of traction however no study from the region where patients are primarily managed on skeletal traction have looked at the complications due to skeletal traction and those associated with prolonged immobilization. STUDY JUSTIFICATION:- American College of Surgeons Committee on Trauma has recommended that femoral shaft fractures in polytrauma patients be treated within 2-12 hours after injury, provided they are hemodynamically stable.(81,82) Studies have also shown the significant benefit of intervention within the first 24 hours. Immediate fixation has been shown to decrease fatalities, respiratory complications, multisystem organ failure, and the length of ICU stays in most patients. The type of early fixation used can be debated, but the timing appears to be what makes the difference (83,84). World over fracture fixation has evolved whereby early fixation is advocated for. In the resource-poor local setting with large volumes of patients occasioned by persistently high RTA, the primary management modality is skeletal traction. There is lack of skilled personnel (surgeons/traumatologists) in most peripheral hospitals and hence most patients who have sustained fractures of the lower limb are put on skeletal traction as ORIF cannot be done therefore it is important to establish what are the common complications suffered by these patients. There is a large volume of patients who are seen at KNH, this is mainly because of the poor infrastructure at peripheral hospitals in managing major orthopaedic injuries hence most patients are referred to KNH causing a strain on its resources and ultimately leading to substandard orthopaedic care. The complications associated with skeletal traction and prolonged immobilization have been reported by several authors however most of the numbers of patients who are managed on skeletal traction in these studies are few. In our setup most of the patients with femoral fractures are put on skeletal traction while awaiting operative management therefore it is important to know what the incidence of these complications in our setting are. The incidence of pin tract infection in most studies is not adequately reported as there is no standardized definition of pin tract infection therefore this study will look at pin tract infection broadly . In KNH patients with femoral fractures are put on skeletal traction while awaiting fixation, this is mostly done on an elective operating list and it is not known what duration these patients are on traction, from this study we will establish what the mean waiting time is for a patient with femoral fracture to be internally fixed. It is not known what number of patients with femoral fractures who are put on traction in our setting develop complications hence this study is being done to establish the proportion of patients who get pin tract infections, and other complications associated with skeletal traction. BROAD OBJECTIVE:- To determine the proportion of patients with Lower Extremity fractures who develop complications associated with skeletal traction. SPECIFIC OBJECTIVE:- To determine the proportion of patients on skeletal traction for LE fracture who develop pin tract infections venous thrombo-embolism knee stiffness pressure sores orthostatic pneumonia 2. Determine the proportion of those who recover from the complications 3. To determine the duration patients are on traction 4. Proportion of those with adverse outcomes following complications PATIENTS AND METHODS STUDY DESIGN This is a Hospital based Prospective Descriptive study. STUDY SETTING:- The study will be carried out at the KNH orthopaedic wards. STUDY PERIOD:- The study will be carried out over a period of four months or?until the sample size is achieved SELECTION CRITERIA :- All patients eligible to the study will be enrolled until the sample size is obtained. INCLUSION CRITERIA:- All skeletally-mature pts with lower extremity fractures put on skeletal traction as a definitive or temporary treatment option Those consenting to be recruited in to the study. EXCLUSION CRITERIA:- Skeletal immaturity determined radiologically. Pre existing disease: pneumonia, VTE, pressure sores SAMPLE SIZE CALCULATION:- The sample size will be determined by the use of the following formulae to achieve an adequate sample to accurately estimate the prevalence of complications in pin tract infection in the study population. n = Z2ÃŽÂ ±/2 X P (1-P) D2 Where n = required sample size P = prevalence of pin tract infection (42.6%, 24%  [1]  , 26%  [2]  ), based on the estimated prevalence from a similar study in Sierra Leon by Gosselin. This is the only study in the developing country performed in a similar setting. D = Precision with which to measure prevalence, set at plus or minus 1%. The ZÃŽÂ ±/2 is the cut off points along the x-axis of the standard normal probability distribution that represents probability matching the 95% confidence interval (1.96). Substituting the above in the formulae we get; n à ¢Ã¢â‚¬ °Ã‹â€  93.9 = 94 patients DEFINITIONS OF COMPLICATIONS AS WILL BE USED IN DATA COLLECTION :- Pin Tract Infection :- will be defined by signs of hyperemia,pain,crusts,seropurulent discharge around the pin site or pin loosening. Venous Thrombo-embolism :- Patients with unilateral leg swelling, calf pain, will be subjected to doppler u/s to confirm presence of a thrombus. Pressure sores : Trochanteric,sacral,calcaneal regions of the body will be examined and the use of the pressure sore grading system will be used to record presence of pressure sores :- Grade 1 :- non blanchable erythema of intact skin Grade 2:- Partial thickness skin loss involving epidermis,dermis or both Grade 3:- Full thickness skin loss involving damage o or necrosis of subcuataneous tissues that may extend down to but not through underlying fascia Grade 4 :- Full thickness skin losswith extensive destruction, tissue necrosis or damage to muscle or bone. Knee Stiffness :- Patients have a reduced range of motion of the knee of the injured limb and will determined by range of motion of less than 30 degrees, less than or equal to 90 degrees or more than 90 degrees. Pneumonia :- Patients who have recorded high temperatures, respiratory distress, cough, chest pain will be used to make a diagnosis of pneumonia. DATA COLLECTION:- Patients will be recruited into the study Consecutively Use of a questionnaire to gather data, including demographics, cause of fracture, traction system and its duration, incidence of complications and their outcome. Data will be collected as pertains to the date of commencement of traction up to the date patient undergoes operative management or is taken off traction. Patients will be recruited into the study as they are put on traction, and will be followed upto the time they are taken off traction. DATA ANALYSIS:- The data will be collected using a structured questionnaire. The questionnaires will be coded to make the data entry easy. The filled questionnaires will be kept in a safe place ready for the data entry and for the confidentiality of the patients details. After cross checking the questionnaires for any missing entries a data base will be designed in MS Access which will allow the researcher to set controls and validation of the variables. On completion of the data entry exercise the data will be exported in a Statistical Package (SPSS Version 15.0 Chicago , Illinois) for analysis. The data will be presented in tables and figures where applicable. Non- Parametric tests (Mann Whitney U test) will be used to examine whether there is any significant association between the continuous variables e.g. age and duration count, while chi-square will be used to establish the significant associations between the categorical variables. Odds Ratios (OR) and associated 95%C

King James I :: Papers

King James I born June 19, 1566, Edinburgh Castle, Edinburgh, Scotland died March 27, 1625, Theobalds, Hertfordshire, England King of Scotland (as James VI) from 1567 to 1625 and first Stuart king of England from 1603 to 1625, who styled himself â€Å"king of Great Britain.† James was a strong advocate of royal absolutism, and his conflicts with an increasingly self-assertive Parliament set the stage for the rebellion against his successor, Charles I. James was the only son of Mary, Queen of Scots, and her second husband, Henry Stewart, Lord Darnley. Eight months after James's birth his father died when his house was destroyed by an explosion. After her third marriage, to James Hepburn, Earl of Bothwell, Mary was defeated by rebel Scottish lords and abdicated the throne. James, one year old, became king of Scotland on July 24, 1567; Mary left the kingdom on May 16, 1568, and never saw her son again. During his minority James was surrounded by a small band of the great Scottish lords, from whom emerged the four successive regents, the earls of Moray, Lennox, Mar, and Morton. There did not exist in Scotland the great gulf between rulers and ruled that separated the Tudors and their subjects in England. For nine generations the Stuarts had in fact been merely the ruling family among many equals, and James all his life retained a feeling for those of the great Scottish lords who gained his confidence. The young king was kept fairly isolated but was given a good education until the age of 14. He studied Greek, French, and Latin and made good use of a library of classical and religious writings that his tutors, George Buchanan and Peter Young, assembled for him. James's education aroused in him literary ambitions rarely found in princes but which also tended to make him a pedant. Before James was 12 he had taken the government nominally into his own hands when the Earl of Morton was driven from the regency in 1578. For several years more, however, James remained the puppet of contending intriguers and faction leaders. After falling under the influence of the Duke of Lennox, a Roman Catholic who schemed to win back Scotland for the imprisoned Queen Mary, James was kidnapped by William Ruthven, 1st Earl of Gowrie, in 1582 and was forced to denounce Lennox. The following year James escaped from his Protestant captors and began to pursue his own policies as king.

Andrew Jackson :: essays research papers

Andrew Jackson became the nation’s seventh president in 1829. He made significant changes in American politics at that time. He was very popular with the people because of the fact that he was a hero of the War of 1812. He had also served in the senate and was a tough man who had manifested the spirit of the frontier. One change Jackson brought about was the steadily increasing power of the west. He happened to be the first president to come from the west of the Appalachians. Jackson was also the start of a new era of democracy in American politics. He didn’t belong to a party but rather had much popular support.   Ã‚  Ã‚  Ã‚  Ã‚  Jackson supporters were poor and relatively new voters. Unlike other races (besides that of 1824) all white men were allowed to vote rather than just white male property owners. The election of Jackson in 1828 tripled the votes cast from 356,000 in 1824 to 1.1 million in 1828. Most of those new voters gave their votes to the man of the people, Jackson. The power of the voters was evident. Jackson had won 178 electoral votes to Adam’s 83. The election also stirred another change; the revival of the two-party system. This race gave voters a choice between two candidates with sharply differing views. An opposition party had arisen and with it came many conflicts but the new party would also strengthen the democratic process by stirring debates on key issues and giving two different views on matters.   Ã‚  Ã‚  Ã‚  Ã‚  Many newly elected officials elected to office used a practice called patronage. Jackson made the practice official by dismissing more than 200 presidential employees and about 2,000 other officeholders. They were replaced with 2,000 Jacksonian Democrats. The term spoils system was soon derived for the patronage system under Jackson. The spoils or pillage (jobs of previous appointees and officeholders) were taken from a defeated enemy. Jackson stated, in defense of the spoils system that any intelligent man could hold a public office. His support for the system made him popular with the common man.   Ã‚  Ã‚  Ã‚  Ã‚  Jackson did not approve of a overpowering or controlling federal government. He felt the national government should be the least involved as possible. He vetoed many acts of congress in his term as president, one being a road from Maysville, Kentucky to Lexington, Kentucky. He felt the state should build the road and not the national government.

Hitler: in His Mind

Adolf Hitler was known to be a somewhat of monster, and a villian, which is true in the opinions of quite a few throughout history. What Hitler accomplished is astonishing, he was a brilliant man who knew how manipulate people and their way of thinking. But, what is most intriguing about Hitler is his personality and disturbed mind. Robert G. L. Wiate and his book titled The Psychopathis God: Adolf Hitler discusses Hitler and his personality triats that led to his outrageous ideas and actions.Waite as a author is able to not create a judgement of Hitler and his and write more about Hitler as a person and why he was the way he was. Hitler had many issues that disturbed his mind, such as, his past and childhood experiences, his enourmous amount of phobias and obsessions that consumed his mind, his sexual experiences and his behavior toward sex, and of course the most well known personal hatred toward Jews. Skipping around a little bit in Waite’s book, in Chapter 3, Waite discuss ed Hitler’s childhood and family history.Hitler’s childhood experiences led to his later on in life obsessions and phobias that were to consume his thinking. Waite is able to find the facts about his childhood to help explain how Hitler’s mind became warped into his way of thinking. Hitler’s childhood was full of death and, abandonment and bad habits. These experiences help explain why he became a vegetarian, his fascination with death and suicide as well as his phobia of being alone. All of these personality triats he became known for were due to his childhood experiences and lifestyle. In my opinion, Hitler’s psychological traits were due to his past.While a boy in Vienna, he was mocked and riduculed. As a child he was strickened with the death of his mother. These types of experiences can create major personality malfunctions later in life. In the first chapter, Waite discusses Hitler’s personality traits and his odd obsessions and daily way of living. One issue that would amaze any reader of Waite’s book is learning about Hitler and his actual ways of thinking rather than just what his factual actions as one of the greatest leaders and manipulator of all time. What is so astonishing is how someone ith such odd obsessions, such as the exact measurements of a body and proportion and positioning of the body, or his obsession with blood and his childish behavior as an adult. Wait’s evidence on Hitler’s manipulating skills is impressive. Waite decribes Hitler as being a man who would use â€Å"brotherhood† and shared experiences to convince people that what they were doing to the Jewish population was alright. In my opinion, Hitler’s psychological explanations for his behavoir is simple. He was a man who was set in his ways and when his way of how life should be ran and lived, he created another obsession in his mind to conquer that obstacle.Unfortunately for Hitler, his past experienc es led to his thinking to be irrational and almost manic like. He would use his hatred for his fathers death caused by use of tabacco, as a way to lead a clean life, which in reality is a habit to form, but unfortunately for Hitler, this â€Å"clean† way of living, lead to a more toxic and harmful environment for himself. Waite describes Hitler as using his bad memories as a child to fix what he felt was wrong with society, unfortunately for Hitler, his mind went out of control to be controlling, and â€Å"perfect†.As far as Hitler and women, he looked at them as their primary purpose to be looked at like a pet. He is quoted to have said â€Å"A woman must be a cute, cuddly, naive little thing—tender, sweet and stupid†, if you read into this statement Hitler made, he expected women to be like trained animals. His sexual experiences were very limited. He was intimate with six different women in his life five of which committed suicide. Hitler had a way of making the women feel inferior and if Adolf was not in their lives then they should not be living their lives at all.Waite describes his sexual and intimate life in contrast with his lack of a motherly figure throughout his entire life. Hitler felt that women were irrational and not capable of being a leader because of women having more of emotional personalities. Hitler’s sexual behavior toward women and sex in general does indicate that this side of his personality wa disturbed. Since reading Waite’s book about Adolf Hitler and his personality and psychological state, a perspective has been put into place for myself concerning Hitler and his terrible actions later in life. This book, puts into perspective just how disturbed and unstable Hitler really was.The question that comes to mind is how can such a manic, unstable, psychologically disturbed man, create such a following of people. The only conclusion that comes to my mind is sheer ignornace of Hitler’s cap abilities as leader. The people who supported and followed Hitler were people who benefitted from his actions and power. Waite is able to write a book about Hitler that is interesting and informative about Hitler’s psychological standpoint, which helps make you as the reader understand Hitler’s thinking and exactly how much of his decision making was based on his insanity and obsessions that consumed him.

The Joint Commission

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is a non-profit organization based in the United States that offers accreditation to health care facilities as well as various health programs. The goal of the organization is to â€Å"continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. † (http://www. jointcommission.org)As a non-profit organization, the Joint Commission continues to set forth standards by which the quality of patient care is measured. In addition to providing official accreditation, after thoroughly evaluating a health care facility or program, the Joint Commission also sets safety goals for the health care industry in order to improve overall quality of care. The Joint Commission has put forth safety goals purposed to decrease the frequency of human error and p romote a more secure environment for patients.Safety goals include ensuring proper patient identification, appropriate use of medicine, enhanced communication, infection prevention and risk identification. The Joint Commission hopes to encourage the prevention of surgical mistakes and patient falls. With concern to the geriatric population, most, if not all of the safety goals may need to be integrated into health care routine. The Joint Commission’s safety goal regarding fall prevention is especially pertinent to the geriatric population.The geriatric patient is susceptible to falls in general due to decreased vision, coordination, strength, flexibility, increase in cardiovascular disease, vertigo or cognitive impairment. Injury to a geriatric patient resulting from a fall often causes greater complications than would typically occur in a younger patient. Elderly patients are more prone to fracture due to bone density loss and extensive bruising from certain medications or l oss of protective adipose tissue. Geriatric patients are also likely to obtain serious skin injuries resulting from falls because of thinning skin.Fractures could result in a patient losing mobility which could potentially lead to more serious complications such as pressure sores, urinary tract infections, thrombi or loss of joint function due to lack of movement. Injuries to the skin obtained from a fall could become infected. A simple fall to an elderly patient could result in a dramatic turn for the worse regarding overall health. â€Å"Among people 65 years and older, falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma. † (http://www. CDC.org)The Joint Commission addresses this concern with its goal to reduce the risk of falls. This particular goal is broken down into five elements of performance intended to predict risk for fall, intervene to reduce risk, educate and evaluate. The first of the ele ments of performance is an assessment of the patient’s risk for fall. This includes assessing patient’s mental status, sleep patterns, medications, blood pressure, voiding frequency, vision, gait, strength, balance and history of falls. After evaluation of a patient’s risk of falling, an interventional plan should be formulated to prevent such an incident.The Morse Fall Scale, or MSF, is a tool that is used to assess the likelihood of a patient falling. It takes into consideration a specific patient’s history of falling, secondary diagnosis, ambulatory aid, IV/Heparin lock, gait and mental status. â€Å"The MFS requires systematic, reliable assessment of a patient's fall risk factors upon admission, fall, change in status, and discharge or transfer to a new setting. † (http://www. patientsafety. gov) Equipment can be utilized to prevent falls and environmental hazards can be cleared. Referrals could be made, as needed, to ophthalmology, cardiology or physical rehabilitation.Medications can be considered and altered if they cause orthostatic hypotension, a condition in which a patient becomes dizzy upon standing due to quick drop in blood pressure. Bowel and bladder assistance programs can be implemented to reduce frequency and incontinence issues that may lead the patient to leave the bed unassisted. Educating the patient, as well as their families is critical in fall prevention. Involvement of all who care for the geriatric patient can lessen the likelihood of a fall occurring in the absence of a health care provider.Falls can occur while attempting to help a geriatric patient bathe, while assisting in transportation, or maneuvering through their home. This is especially important to the geriatric patient who has returned home resume acts of daily living without constant supervision. There may be environmental hazards within the home that pose risk to the patient. It is also possible that the patient may not administer medic ations properly, or cannot safely perform hygiene, feeding, cooking or cleaning. Such acts of daily living are essential remain or become healthy.A vast array of variables exists with regards to fall prevention. Hence, the Joint Commission recommends that the overall success of the interventional measures be evaluated and altered as needed. Follow up evaluation allows for further adjustments, if needed. The Joint Commission is a non-profit organization serving to promote health care organizations to be their best in all aspects of patient care. Their mark of accreditation has become a respected seal of approval, indicating that a particular facility or program meets a particular set of high standards.They have put forth safety goals intended to encourage nurses and other health care providers to approach potential dangers with a multifaceted plan for intervention and prevention of errors, accidents and injury. Preventing falls will be an ongoing, evolving and improving process with regard to future nursing practice. Nurses will always need to think critically and utilize the knowledge, tools and equipment available to keep patients from falling and injuring themselves. Futuristic equipment may provide a more convenient, safer, faster way to assist patient mobility.Computer health care networking may make complete health history more readily available for review and consideration. Nothing, however, can replace the critically thinking nurse. â€Å"Nurses are leading practice innovations to systematically assess patients’ risk for falls and implement population based prevention interventions. † (http://www. nursingworld. org) For this reason, The Joint Commission sets standards and safety goals to encourage those within the field of nursing to actively assess, prevent, educate and evaluate. With due diligence, such standards and safety regulations can greatly increase overall patient care.