Summary of Rizal

Republic Act No. 1425, known as the  Rizal Law, mandates all educational institutions in the  Philippines  to offer courses about  Jose Rizal. The full name of the law is  An Act to Include in the Curricula of All Public and Private Schools, Colleges and Universities Courses On the Life, Works and Writings of  Jose Rizal, Particularly His Novels  Noli Me Tangere  and  El Filibusterismo, Authorizing the Printing and Distribution Thereof, and for Other Purposes.The measure was strongly opposed by the Roman Catholic Church in the Philippines due to the anti-clerical themes in  Noli Me Tangere  andEl Filibusterismo. Senator  Claro M. Recto  was the main proponent of the then Rizal Bill. He sought to sponsor the bill at Congress. However, this was met with stiff opposition from the Catholic Church. During the  1955 Senate election, the church charged Recto with being a communist and an anti-Catholic.After Recto's election, the Church continued to oppose the bil l mandating the reading of Rizal's novels  Noli Me Tangere  and  El Filibusterismo, claiming it would violate  freedom of conscience  and  religion. [1] In the campaign to oppose the Rizal bill, the Catholic Church urged its adherents to write to their congressmen and senators showing their opposition to the bill; later, it organized symposiums. In one of these symposiums, Fr. Jesus Cavanna argued that the novels belonged to the past and that teaching them would misrepresent current conditions.Radio commentator Jesus Paredes also said that Catholics had the right to refuse to read them as it would â€Å"endanger their salvation†. [1] Groups such as Catholic Action of the Philippines, the  Congregation of the Mission, the  Knights of Columbus, and the Catholic Teachers Guild organized opposition to the bill; they were countered by Veteranos de la Revolucion (Spirit of 1896), Alagad in Rizal, the Freemasons, and the  Knights of Rizal. The Senate Committee on E ducation sponsored a bill co-written by both  Jose P.Laurel  and Recto, with the only opposition coming from  Francisco Soc Rodrigo,  Mariano Jesus Cuenco, and  Decoroso Rosales. [2] The  Archbishop of Manila,  Rufino Santos, protested in a  pastoral letter  that Catholic students would be affected if compulsory reading of the unexpurgated version were pushed through. [3]  Arsenio Lacson, Manila's mayor, who supported the bill, walked out of Mass when the priest read a circular from the archbishop denouncing the bill. [4] Rizal, according to  Cuenco, â€Å"attack[ed] dogmas, beliefs and practices of the Church.The assertion that Rizal limited himself to castigating undeserving priests and refrained from criticizing, ridiculing or putting in doubt dogmas of the Catholic Church, is absolutely gratuitous and misleading. † Cuenco touched on Rizal's denial of the existence of  purgatory, as it was not found in the Bible, and that Moses and Jesus Christ did not mention its existence; Cuenco concluded that a â€Å"majority of the Members of this Chamber, if not all [including] our good friend, the gentleman from Sulu† believed in purgatory. 5]  The senator from Sulu, Domocao Alonto, attacked Filipinos who proclaimed Rizal as â€Å"their national hero but seemed to despise what he had written†, saying that theIndonesians  used Rizal's books as their Bible on their independence movement;  Pedro Lopez, who hails from Cebu, Cuenco's province, in his support for the bill, reasoned out that it was in their province the independence movement started, when  Lapu-Lapu  fought  Ferdinand Magellan. [3] Outside the Senate, the Catholic schools threatened to close down if the bill was passed; Recto countered that if that happened, the schools would be nationalized.Recto did not believe the threat, stating that the schools were too profitable to be closed. [1]  The schools gave up the threat, but threatened to â€Å"punis h† legislators in favor of the law in future elections. A compromise was suggested, to use the expurgated version; Recto, who had supported the required reading of the unexpurgated version, declared: â€Å"The people who would eliminate the books of Rizal from the schools would blot out from our minds the memory of the national hero. This is not a fight against Recto but a fight against Rizal,† adding that since Rizal is dead, they are attempting to suppress his memory. 6] On May 12, 1956, a compromise inserted by Committee on Education chairman Laurel that accommodated the objections of the Catholic Church was approved unanimously. The bill specified that only college (university) students would have the option of reading unexpurgated versions of clerically-contested reading material, such as  Noli Me Tangere  and  El Filibusterismo. [1][3][6]  The bill was enacted on June 12, 1956,[3]  Flag Day. ——————— Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€- [edit]Content | | | The  Noli  and  Fili  were required readings for college students. Section 1 mandated that the students were to read the novels as they were written in  Spanish, although a provision ordered that the Board of National Education create rules on how these should be applied. [5]  The last two sections were focused on making Rizal's works accessible to the general public: the second section mandated the schools to have â€Å"an adequate number† of copies in their libraries, while the third ordered the board to publish the works in major  Philippine languages. [5] ————————————————- edit]Aftermath After the bill was enacted into law, there were no recorded instances of students applying for exemption from reading the novels, and no known procedure for such exemptions. [6]à ‚  In 1994, President  Fidel V. Ramos  ordered the  Department of Education, Culture and Sports  to fully implement the law as there had been reports that it has still not been fully implemented. [7] The debate during the enactment of the Rizal Law has been compared to the  Reproductive Health bill  (RH bill) debate of 2011. 8]  Akbayan  representativeKaka Bag-ao, one of the proponents of the RH bill, said, quoting the Catholic hierarchy, that â€Å"More than 50 years ago, they said the Rizal Law violates the Catholic's right to conscience and religion, interestingly, the same line of reasoning they use to oppose the RH bill. â€Å"[9] ————————————————- [edit]References 1. ^  a  b  c  d  Abinales, Patricio N. ; Amoroso, Donna J. (2005). State and society in the Philippines. Lanham, Maryland:  Rowman & Littlefield. p. 187. ISBN  978-0-742 5-1024-1. 2.   Cruz-Araneta, Gemma  (2010-12-29). â€Å"Legislating Rizal, 1†. Manila Bulletin. Retrieved 2011-05-24. 3. ^  a  b  c  d  Cruz-Araneta, Gemma  (2010-12-29). â€Å"Legislating Rizal, 2†. Manila Bulletin. Retrieved 2011-05-24. 4. ^  Rodis, Rodel (2010-01-07). â€Å"Global Networking  : The Rizal bill†. Philippine Daily Inquirer. Retrieved 2011-06-12. 5. ^  a  b  c  Pangalangan, Raul (2010-12-31). â€Å"The intense debate on the Rizal Law†. Philippine Daily Inquirer. Retrieved 2011-05-24. 6. ^  a  b  c  Ocampo, Ambeth  (2007-05-04). â€Å"The fight over the Rizal Law†. Philippine Daily Inquirer.Retrieved 2011-05-24. 7. ^  Ã¢â‚¬Å"Mr. Ramos leads Rizal Day rites†. Manila Standard. 1994-12-29. Retrieved 2011-06-19. 8. ^  Mendez, Christina (2011-05-23). â€Å"JPE, Joker confident of compromise on RH bill†. Philippine Star. Retrieved 2011-05-24. 9. ^  Ã¢â‚¬Å"Jose Rizal: new symbol of re productive health rights? â€Å". ABS-CBNnews. com. 2011-06-01. Retrieved 2011-06-01. Jose Rizal: A Biographical Sketch BY TEOFILO H. MONTEMAYOR| | JOSE RIZAL, the national hero of the Philippines and pride of the Malayan race, was born on June 19, 1861, in the town of Calamba, Laguna.He was the seventh child in a family of 11 children (2 boys and 9 girls). Both his parents were educated and belonged to distinguished families. His father, Francisco Mercado Rizal, an industrious farmer whom Rizal called â€Å"a model of fathers,† came from Binan, Laguna; while his mother, Teodora Alonzo y Quintos, a highly cultured and accomplished woman whom Rizal called â€Å"loving and prudent mother,† was born in Meisic, Sta. Cruz, Manila. At the age of 3, he learned the alphabet from his mother; at 5, while learning to read and write, he already showed inclinations to be an artist.He astounded his family and relatives by his pencil drawings and sketches and by his moldings of clay . At the age 8, he wrote a Tagalog poem, â€Å"Sa Aking Mga Kabata,† the theme of which revolves on the love of one’s language. In 1877, at the age of 16, he obtained his Bachelor of Arts degree with an average of â€Å"excellent† from the Ateneo Municipal de Manila. In the same year, he enrolled in Philosophy and Letters at the University of Santo Tomas, while at the same time took courses leading to the degree of surveyor and expert assessor at the Ateneo.He finished the latter course on March 21, 1877 and passed the Surveyor’s examination on May 21, 1878; but because of his age, 17, he was not granted license to practice the profession until December 30, 1881. In 1878, he enrolled in medicine at the University of Santo Tomas but had to stop in his studies when he felt that the Filipino students were being discriminated upon by their Dominican tutors. On May 3, 1882, he sailed for Spain where he continued his studies at the Universidad Central de Madrid .On June 21, 1884, at the age of 23, he was conferred the degree of Licentiate in Medicine and on June 19,1885, at the age of 24, he finished his course in Philosophy and Letters with a grade of â€Å"excellent. †Ã‚  Having traveled extensively in Europe, America and Asia, he mastered 22 languages. These include Arabic, Catalan, Chinese, English, French, German, Greek, Hebrew, Italian, Japanese, Latin, Malayan, Portuguese, Russian, Sanskrit, Spanish, Tagalog, and other native dialects.A versatile genius, he was an architect, artists, businessman, cartoonist, educator, economist, ethnologist, scientific farmer, historian, inventor, journalist, linguist, musician, mythologist, nationalist, naturalist, novelist, opthalmic surgeon, poet, propagandist, psychologist, scientist, sculptor, sociologist, and theologian. He was an expert swordsman and a good shot. In the hope of securing political and social reforms for his country and at the same time educate his countrymen, Rizal, the greatest apostle of Filipino nationalism, published, while in Europe, several works with highly nationalistic and revolutionary tendencies.In March 1887, his daring book, NOLI ME TANGERE, a satirical novel exposing the arrogance and despotism of the Spanish clergy, was published in Berlin; in 1890 he reprinted in Paris, Morga’s SUCCESSOS DE LAS ISLAS FILIPINAS with his annotations to prove that the Filipinos had a civilization worthy to be proud of even long before the Spaniards set foot on Philippine soil; on September 18, 1891, EL FILIBUSTERISMO, his second novel and a sequel to the NOLI and more revolutionary and tragic than the latter, was printed in Ghent.Because of his fearless exposures of the injustices committed by the civil and clerical officials, Rizal provoked the animosity of those in power. This led himself, his relatives and countrymen into trouble with the Spanish officials of the country. As a consequence, he and those who had contacts with him, were shadowe d; the authorities were not only finding faults but even fabricating charges to pin him down. Thus, he was imprisoned in Fort Santiago from July 6, 1892 to July 15, 1892 on a charge that anti-friar pamphlets were found in the luggage of his sister Lucia who arrive with him from Hong Kong.While a political exile in Dapitan, he engaged in agriculture, fishing and business; he maintained and operated a hospital; he conducted classes- taught his pupils the English and Spanish languages, the arts. The sciences, vocational courses including agriculture, surveying, sculpturing, and painting, as well as the art of self defense; he did some researches and collected specimens; he entered into correspondence with renowned men of letters and sciences abroad; and with the help of his pupils, he constructed water dam and a relief map of Mindanao – both considered remarkable engineering feats.His sincerity and friendliness won for him the trust and confidence of even those assigned to guard him; his good manners and warm personality were found irresistible by women of all races with whom he had personal contacts; his intelligence and humility gained for him the respect and admiration of prominent men of other nations; while his undaunted courage and determination to uplift the welfare of his people were feared by his enemies.When the Philippine Revolution started on August 26, 1896, his enemies lost no time in pressing him down. They were able to enlist witnesses that linked him with the revolt and these were never allowed to be confronted by him. Thus, from November 3, 1986, to the date of his execution, he was again committed to Fort Santiago. In his prison cell, he wrote an untitled poem, now known as â€Å"Ultimo Adios† which is considered a masterpiece and a living document expressing not only the hero’s great love of country but also that of all Filipinos.After a mock trial, he was convicted of rebellion, sedition and of forming illegal association . In the cold morning of December 30, 1896, Rizal, a man whose 35 years of life had been packed with varied activities which proved that the Filipino has capacity to equal if not excel even those who treat him as a slave, was shot at Bagumbayan Field. |

Harley-Davidson Marketing Strategies Essay

In 1903, 21-year old William S. Harley and 20-year old Arthur Davidson the first production Harley-Davidson motorcycle that was hand-built in a small garage in Milwaukee. Today, Harley-Davidson, Inc. employs more than 8,200 people and has 1,110 dealership worldwide. Its corporate headquarters are still located in Milwaukee, Wisconsin. The domestic production facilities are in the Milwaukee area, East Troy and Tomahawk, Wisconsin; York, Pennsylvania; and Kansas City, Missouri. Design, customer focus and sales have placed this company is in a very unique and desirable marketing situation. Design is critical to the continued success of this company. For some companies, the word design may bring thoughts of sweeping changes and new model lines. However, for the design team at Harley-Davidson, it inspires thoughts of being faithful to the classic lines and sounds of a Harley-Davidson motorcycle. This is not to say that the designers are not allowed and encouraged to improve on the hugely successful line of motorcycles, just the opposite is true. Ken Schmidt, director of communications for Harley-Davidson, stated that: â€Å"We are constantly improving and modernizing the machine, yet not every component. That is what our customers want, and that’s also, I believe, what sparks the strong emotional attachments that Harleys generate.† In the early 1980’s, the company was plagued with quality control and reliability issues that nearly caused the company to go out of business. At this point, it was up to the design and quality control engineers to revamp the mechanical and electrical portions while staying true to the classic line of the motorcycle. They succeeded in resolving the problems and saved the company. William G. Davidson, who heads up a team of five product designers, is quick to add, â€Å"It’s important to understand that we’re not in the business of making antiques. Every year we make further improvements to our engines and chassis. But from a styling standpoint, we have to incorporate improvements without compromising `the look.’ If we move a bolt or re-route one hose, our customers take note and call us on it. A Harley isn’t shrouded in fiberglass like so many other bikes. Everything we do is right out in the open.† This mindset prevents lifelong riders from feeling  alienated and accusing the company of â€Å"selling out† in the pursuit of increased revenue and profits. Harley-Davidson understands that it is as important to maintain their current enthusiasts as it is to develop new ones. No where is this more evident than in their mission statement: â€Å"We fulfill dreams through the experience of motorcycling, by providing to motorcyclists and to the general public an expanding line of motorcycles and branded products and services in selected market segments.† Customer focus is another area of marketing where this company excels. Factory sponsored rallies and test drives are just two ways that Harley stays in touch with their customers. The largest sponsored rally occurs each year at Sturgis in the Black Hills of South Dakota. This event draws 400,000 riders from around the world. There are hundreds of company employees there as well, not only to enjoy the rally, but also to gather information from the enthusiasts. There is no better or more efficient way to survey your customers than to speak with them directly after they just traveled to an event on your product. This â€Å"close-to-the-customer† philosophy allows the company to use these rallies as product development centers. It allows the company leadership to get instant responses on both current products as well as new products that may soon go into production. Customers respond positively to this type of product survey, because they feel like their opinion matters and will influence the next year’s product line. Another marketing tool that has been quite successful for this company has been the factory-sponsored test-drives. The factory sends a tractor-trailer filled with demo bikes to each dealership that is willing to participate. All of the new models are available and anyone with a helmet and a valid license to operate a motorcycle can try them out. For many of the dealerships, it is the busiest day of the year. Harley-Davidson headquarters employs eight merchandising specialists that develop â€Å"designer stores†. These stores are much different from the standard â€Å"garage-type† store of the past. These stores are designed to draw customers in, surround them with motorcycles, and provide an inviting retail environment. Dealerships that have converted their shops to the Designer Store concept have seen soaring revenues and rapid return on investments.  Inventive marketing strategies have kept Harley-Davidson as the leader of America’s big-bike market. It is not just the motorcycles that are in high demand. Harley has developed a very profitable retail merchandising line. This line includes clothing, tattoo patches, coffee mugs, belt buckles, infant wear and memorabilia. Most would think that this company must spend a significant portion of their revenue on advertising. The opposite is true, in 1995 the company generated $1.3 billion in revenue while spending less than $2 million on advertising costs. â€Å"Word of mouth† is their main form of advertising. Company executives feel that their customers are their sales force, after all, satisfied customers are the better than advertising. Harley-Davidson is in a unique marketing situation because they are not selling transportation; they are selling a lifestyle. Customers routinely wait between six and eighteen months for delivery of a new model. That type of product loyalty is hard to find and not easily developed. The waiting list for a new Harley-Davidson is now more than a year, and used bikes are more expensive today than when they were new. How can this possibly be true when new cars depreciate quicker than you can make the payment? The reason is the supply-to-demand ratio and Harley-Davidson has mastered this ratio. Although they produced more than 300,000 bikes last year, demand is still on their side. Many new customers look at purchasing a Harley as an investment that you can enjoy on a daily basis. The first turning point for the company was when they changed the engines back in 1984. The second was when the â€Å"baby boomers† hit their mid-life crisis. Since then, dealers have struggled to keep display models on the floor. Scarcity allows the company to achieve higher profitability, and it also helps protect the investment for previous buyers. Women are the last great frontier for this company and they are beginning to focus more on that segment of the market. They have begun to place advertisements in women’s magazines in an attempt to change the company’s image to a more family-oriented one. They have also begun to make engineering changes to some of the models. Some of the new bikes will have  smaller handlebar grips, an easier pulling clutch, and lower seats. â€Å"Riders Edge† is a program at Harley dealerships providing riders’ education classes to help novices learn to ride and get licensed. Technology upgrades such as liquid-cooled, high-powered, engines and lightweight materials will make bikes more powerful, but also less difficult to handle. All of these changes are being implemented to encourage women to purchase their own bikes as opposed to simply being passengers. Customers can sense that the Harley-Davidson employees care about them and their concerns. The company takes this responsibility so seriously that they developed a list of â€Å"core values†. These are their values. They are the heart of how we run their business. They guide their actions and serve as the framework for the decisions and contributions their employees make at every level of the company. Tell the truth, be fair, keep your promises, respect the individual, and encourage intellectual curiosity. Because of their supply-and-demand ratio, it would be very easy for this company to develop a â€Å"take it or leave it† attitude with their customers. A large part of the success has to be attributed to the high-value they place on the opinion of their customers.

How can we explain the international expansion of Chinese business Essay - 1

How can we explain the international expansion of Chinese business Discuss using a big business group example(s) to illustrate your argument - Essay Example Both push and pull factors have contributed to the international expansion of Chinese business. China opened up its economy in the 1970s and gained accession to World Trading Organization (WTO) in 1990. Because of the locational advantages that China offered, it received huge inward FDI (foreign direct investment) flows since the mid-1990s which has been one of the reasons for outward FDI (OFDI). Inward FDI resulted in massive foreign currency reserves (Andersson and Wang 2011) while the MNCs in China also provided the much-needed technical know-how, competence and confidence to the domestic companies to venture overseas (Bhuiyan 2011). China no longer remained a magnet for inward FDI but now has become a major source of OFDI (Liu and Buck 2009). Most OFDI was directed towards developing nations with geographical or institutional proximity requiring limited resources. The newly industrialized economies (NICs) of East Asia and Japan engaged in OFDI due to push factors (labour shortages, high operating costs) while China initially engaged in OFDI due to pull factors (natural resource endowments and market potential) (Biggeri and Sanfilippo 2009). The motives to internationalize included enhancing the corporate brand values of Chinese enterprises (OECD 2009). However, as the Chinese government tried to integrate China into the world economy (1979-1985) only the state-owned enterprises (SEOs) were granted approval for internationalization. In the next stage the non-SOEs were allowed to expand abroad through a foreign affiliate. OFDI from China remained highly regulated during the first two decades of the economic reform (Liou 2009). As part of the Go Global Policy outlined in China’s 10th five-year plan in 2001, certain industries like textiles, machinery and electrical equipment, were provided with foreign exchange support and export tax rebates to boost internationalization.

Foreign Currancy Essay Example | Topics and Well Written Essays - 1000 words

Foreign Currancy - Essay Example It is even predicted by the IMF that it will overtake the US economy by 2016(Economy Watch, June 2, 2010) In November 2011, U.S. debt to China amounts to $1.13 trillion. This is 25% of the total $4.6 trillion of US debts. In 2011, China exported $1.58 trillion worth of production, 18% of which is exported to the US, while it has imported $333.9 billion from US, creating a trade deficit of $295.5 billion.(Kimberly, Amadeo). This massive surplus is the effect of China’s monetary policy of keeping their Remnibi lower than the equilibrium rate. This monetary policy is the subject of debate of IMF, the World bank, the government ,and other financing bodies. However, despite its robust economy, its GDP per capita income has remained relatively low as compared to United States. China’s GDP per capita is $4,428 while US has $47,153.(The World Bank) In effect, China is not subsidizing US economy because both countries benefit from the deal. The proceeds of the US debts are spent on federal programs while payments of interests of loan is spent by China to propel its economic growth. US debts also kept interest rates low. It is threatening because by holding too much ownership of U.S debts, China can use it as an economic weapon and shift the economic balance in its favor. Being second greatest in the world’s economy, China can use this power as leverage for imposing demands. For instance, in 2009, China proposed for a new global currency to replace the dollar because it was alarmed of the drop of dollar rate, and was afraid that its investments would deteriorate (Macdonald, Joe. 24, Mar. 2009). China has been reported to feel uneasy about relying on the dollar to store its reserves. It has also pressed for changes to give developing countries more influence on the IMF, the World Bank and other financing institutions. To reduce its complete reliance to dollars, China now swaps currency with G-20 trading partners like Hong Kong and Argentina. G-20 is a group of finance ministers and central bank governors from 20 economies and was formed to discuss the international financial system. To date, there is no report on the success of this proposition. What is its impact to the U.S. economy? The reduction of China’s demand for dollars leads to a domino effect – increase of interest rates that would hamper revival of the economy. Threatening to pull out all of its holding from the US will create havoc because if China calls its debts all at once; demand for dollars would be increasingly high, causing a dollar collapse that would disrupt international markets. This would trigger another financial crisis wherein everybody suffers including China (Kimberly). This is more unlikely to happen because it will reflect of China’s competitiveness. When China raises its export prices, US consumers will think twice and buy US products instead. As a policy, China keeps its currency Remnibi, lower than the dollar, a strategy that works for its advantage because it makes product imported from China lower than the U.S. products, and in the final analysis, be able to create more jobs for the Chinese, and be able to fund the growth of its economy. The US is trying to persuade China to revise its policy of having an undervalued Remnibi. The Remnibi is said to be 40 percent below it real value thus making its products excessively low and the US exports comparatively high, but whether this will be heeded by the Chinese government remains to be seen in the light of recent

Compare and contrast Essay Example | Topics and Well Written Essays - 1500 words

Compare and contrast - Essay Example In Sonny’s Blues, the narrator laments about the darkness and hopelessness in his community, which were traits that existed in his ancestor’s communities and still continue to trouble youth in his generation. Sonny’s brother weeps for the boys of his community because they use heroin and other drugs, yet it seems that they are pushed into drug-taking and selling simply because other prospects for success do not exist. As he rides through the streets of Harlem, he finds history repeating itself through the youth of his time; it is almost as if black people have no hope but to resign to their fate. Likewise, Barton Fink also lives in a world where he can do little to change his circumstances; initially he seemed like a successful playwright, in charge of his world. However, when his agent informs him of an opportunity to transition into film by working in Hollywood, Fink jumps at the opportunity. Little does he know that once he signs the contract, he will be entra pped in the highly demanding, yet unforgiving world of filmmaking. Barton is frustrated when he dances and celebrates about completing his script, only to realize that his boss Lipnick thinks it is too rosy to be any good. The Capital Pictures owner then decides that he will punish Barton by keeping him in the studio even though none of Barton’s films will be produced there. Therefore, the budding writer must honor terms of his contract without necessarily gaining from them materially or professionally, so he is entrapped by the employment system. Writing films is a flaky affair, where writers surrender themselves to the whims of their eccentric employers; most of them may hold a lot of promise but may never realize it when they get into the wrong deal (Dunne 308). If something minor occurs, it is likely that those same individuals will get blamed for it, and everything else that

Homework Assignment Example | Topics and Well Written Essays - 250 words - 10

Homework - Assignment Example This means that there should be a balance between the cost and benefit of pollution control. If the business is asked to pay more than the benefits it has obtained, this request will become ineffecient for the business and the business will close. 2. Adverse selection is a term used to refer to the outcomes of the decisions that are based on varying information. This outcome is caused because the information available to the purchasers and sellers is not same. Moral hazard is term used to describe a situation when an individual takes an action knowing that it will not negatively impact him but will negatively impact others and the individual himself experiences profitability out of this decision. Moral hazards are experienced by the insurance sector of the health industry, although difference in information exists in different parts of the health industry, but it impacts the insurance sector in the worst possible manner (Taylor 484). Due to asymmetry of information, insurance fail to realize the real risk they are taking in insuring an individual. Adverse selection effects health insurance companies because the best plans offered by the companies are usually purchased by those whoa re terminally ill and such plans cost more m oney to insurance

How Do Groups React to Unexpected Threats Crisis Management in Research Paper

How Do Groups React to Unexpected Threats Crisis Management in Organizational Teams - Research Paper Example Contextually, when assessing the current scenario of the global business world, particularly due to the continuous globalization effects and the consequent alterations taking place in the socio-economic conditions, managing such obstacle have emerged as one of the most significant concerns of contemporary business organizations. A crisis management is thus essentially required to be devised with the intention of minimizing the impacts of unpredictable occurrences which may seriously hamper the performances of an organization either in its short-run or in its long-run performances2. In this regard, various literature studies have been conducted which emphasized on addressing the various dimensions of crisis management. However, in the article titled as ‘How do Groups React to Unexpected Threats? Crisis Management in Organizational Teams’, the authors Jin Nam Choi, Sun Young Sung, and Myung Un Kim proclaimed that comprehensive researches are available in limited numbers wh ich were focused on learning the behavior of organizational teams when responding to crisis situations and crisis management strategies. Correspondingly, in this article, qualitative as well as quantitative methods have been used with the intention to satisfy the literature gap existing in relation to the study of organizational team responses to crisis management3. The paper will intend to discuss the concepts which can be acquired from the article further describing the applicability of such findings in the organizational level crisis management practices. Moreover, references will also be considered from the book named ‘Organization Theory & Design’ written by Richard L. Daft when assessing the article. The Concepts Acquired from the Article The article depicts that organizational teams are commonly observed to behave as dependent on the persisting ‘interdependent relationships’ within the work culture being subjected to their external activities when im plementing crisis management strategies. The findings of this article also reveal that environment of an organization is complex as well as uncertain which results in many crises situations. It has been fundamentally due to these reasons that crises within organizational teams are observed to be rising immensely since the past few years. In this regard, management of an organization is required to effectively forecast the time as well as the procedure through which the crisis event is most likely to occur. In most instances, organizational teams focus on determining the reasons and likewise sort out the type of crises being witnessed or probable to be witnessed in order to initiate better effective crisis management strategies. The article also stated that irrespective of such practices apparent in the organizational teams of the corporate sector, only insignificant number of studies were conducted in order to sort the various types of crises witnessed by contemporary businesses and the strategies which are devised as well as implemented accordingly3. Furthermore, the article also aims at demonstrating the importance of organizational teams’ performances at times of uncertain situations. In this respect, organizational teams performing in groups are observed to

Today's Crisis - 2009 vs. 2007 Crisis Essay Example | Topics and Well Written Essays - 2000 words

Today's Crisis - 2009 vs. 2007 Crisis - Essay Example Some of the biggest financial companies of the world, including Lehman Brothers and Merrill Lynch, have collapsed completely during this time (Savona et al., 2011, p.295). The crisis situation involves large number of aspects from restructuring of financial markets to that of economic policies across the globe (Kent et al., 2011, p.128). This decline has caused the decline in the financial as well as monetary system of countries across the globe. The financial crisis of 2009 has been a continuation of the financial crisis of 2007. This crisis has occurred because of the failure of world financial system to cope up with the growing level of demand for different goods and services and capital accumulation. This fact has been accelerated by the fact that during this time the rate of unemployment across the globe has reached a very high level (Poole, n.d., p.442). This paper is aimed at providing an analytical perspective of the crises situations. Global effects: The world economy has be en facing a 30% risk of entering into the depression. This figure has been coined according to the â€Å"Economist Intelligence Unit†. The London consultancy has defined the fact that an economic or a financial depression as growth or development process in the developed as well as developing world averaging lower than 1% per year between the time period of 2009 and 2013. There has been a 60% chance that the fiscal as well as monetary policies now being implemented will stabilise the world economy by the next year that it said. "Deflation would be characterised as mass bankruptcies and job losses," the London consultancy argued. A third situation in which lessening assurance in the US directs to the dollar getting dumped contains a 10% probability, it argued. The â€Å"International Monetary Fund† observes the global economy contracting 2012 for the very first time since times of â€Å"Second World War†. The â€Å"Economist Intelligence Unit† has estimate d 95 nations are at "high" or at "very high" risk of economic or financial unrest (World 'faces 30% risk of depression', 2009). Several banks across the country have failed or collapsed due to the prevalence of the financial crisis situation. These banks have been acquired by other banks or financial corporations. Hence, the negative effects have been exposed to the level of customer confidence on the banking and financial system of the country (Failed Bank List, 2012). The profundity of the financial and economic recession as well as widespread deflation has suggested the fact that nominal monetary policy rates are required to fall into negative region in order to supply sufficient incentive, which is impossible. Theoretically, in the equilibrium, the cost of acquired capital in respect to the aggregate economy must roughly be comparable to the rate of growth of nominal GDP. This is used as the substitute for the rate of capital return in respect to the aggregate economy). Both the se policy rates as well as the rates of growth of GDP values have been reduced during this time of deep financial recession across the globe (A World Of Credit Easing, 2009). Also the creation of large number of tent cities across the US has revealed the severity of the crises situations which have been outcomes of greater level of job losses and loss of houses. These tent cities have been found in New York and in New Jersey to a great extent (USA tent 'cities' on rise as US economy crumbles (23Dec11).flv, 2012). Effects on UAE: The emerging market (EM) nations in the â€Å"Middle East and North Africa† (MENA) region (which also incorporates UAE and all other GCC nations) have been comparatively insulated from the effect of the crisis

Fieldtrip - King Arthur's Cave and Wye Valley Catchment Assignment

Fieldtrip - King Arthur's Cave and Wye Valley Catchment (Herefordshire) - Assignment Example It is important to highlight that the cave is located at the bottom of the low lying cliff that is at the mouth of the Lord Woods in the north eastern end in Doward, this is next to the Symonds Yat with a distance approximated to be 4 miles. It is known that the cave is said to have been inhabited by the early man in the upper Paleolithic era. The evidences that vindicate this are the archaeological exhibit that is the flint tools and the bones of the wooly mammoth. (Arthur, 2007). It is important to highlight that King Arthur’s cave is made of two chambers that intersect at the point of entrance. This is estimated to lie 300 feet above river Wye. It is important o note that one of the chambers is 25 feet in diameter and is circular in shape. The entrance also has a hearth that the archaeologists say was in existence for the past 12000 years. The Mesolithic artifacts have also been found in the cave. The chambers were called Bear’s den and Lion’s cave. This was because of the archaeological evidences that were confiscated in there. (John 2000). It is important to note that among the items that were found in the cave, the following were the ones that gave the evidence of the Mesolithic inhabitance as well the upper Paleolithic inhabitance. The bones were; wooly rhinoceros, cave bear and the hyena. The foreman of the elephant too was found in the cave. The people therefore spend much in the various areas that they spend their time in the name of visiting the place and this therefore earns foreign exchange to the country in question. The money that is earned from this is therefore use in the developments of the various infrastructural facilities that help in the boosting of the various economic sectors (John 2001). It is as well important to note the point that the Herefordshire is at the point of interconnection and at a point that it joins the Wye River. The place therefore has an added advantage of the valley is the nearby forest also acts

Oliver Ellsworth Essay Example for Free

Oliver Ellsworth Essay I, Oliver Ellsworth representative of Connecticut, propose that the basis of representation in the legislative branch remain by state as under the Articles of Confederation. I support the system of government that maintains the principle of local rule and I understand central government as the body that will strengthen the rights of property and the harmony of the republic, therefore I claim â€Å"we† are partly national and partly federal. Under this I shall introduce the resolution with my ally Roger Sherman along with William S. Johnson, The Great Compromise, breaking the deadlock between the large and small states over representative, allowing United States senators to be elected by state legislature. I do agree with Randolph’s notion of a three-fold division, but move to strike the phrase, â€Å"national government† into â€Å"government of the United States. I also advise that the House of Representatives be chosen or elected every year as Roger Sherman will also come to agree with. Favoring the three-fifths compromise on the enumeration of slaves, I do although; oppose the abolition of the foreign slave trade. Slaveholders from Maryland and Virginia can afford to oppose the slave trade, because slaves multiply accordingly fast in Virginia and Maryland, it is cheaper to raise then import them, whilst in the sickly rice swamps [of South Carolina and Georgia] foreign supplies are necessary. Ending the slave trade can also benefit slave-owners in the Chesapeake region, since the demand for slaves in other parts of the South will increase the price of slaves once the external supply is cut off. Then, shall I concur that in order for individual rights to be protected â€Å"we† must help shape America with an independent judiciary and as system of federalism. -Oliver Ellsworth, Connecticut Representative.

Hip Fracture Treatment in Older Patients

Hip Fracture Treatment in Older Patients 1.1 Background Hip (neck of femur) fractures are a common, serious and well-defined injury affecting mainly older people. As global populations age, projections for hip fracture numbers over the coming decades will rise. Delays to surgery are associated with increased post-operative complications, prolonged recovery and length of stay (LOS), and with increased morbidity and mortality (Trpeski, Kaftandziev, and Kjaev, 2013). In addition, the cost burden of hip fractures is substantial. The process of caring for people with hip fractures is complex, long, and involves several diagnostic, therapeutic and administrative activities. These activities occur in AE and orthopaedic departments, operating theatres, and in the community. They involve a range of health professionals and support staff. When this coordination fails, patients may suffer from avoidable delays and suffering. In the United Kingdom (UK), the bed occupancy rate for hip fractures was more than 1.5 million days, which represent 20% of th e total orthopaedic beds (Compston et al., 2009). The lifetime risk of sustaining a hip fracture in the UK from age 50 is around 11% for women and 3% for men (Van Staa et al., 2001). Many of those who recover suffer a loss in mobility and independence: approximately half of those previously independent become partly dependent, while one-third become totally dependent (Myers et al., 1996). 1.2 Current Process Watford General Hospital (WAT) treat 450 patients for hip fractures every year. Hip fractures are one of the most common complex trauma problems orthopaedic surgeons face. Patients are often seriously ill, elderly and frail, which can result in poor outcomes. Hip fractures generally result from a fall, patients present at AE where imaging tests are used to make a diagnosis and pain medication is administered (Appendix A). When possible, patients are moved from the emergency department to a ward. Ideally, patients will have surgery within 72 hours of arrival at hospital, provided they are in a stable condition. A pre-operative assessment is carried out to establish the patients overall health to make sure they are ready for surgery. They also have an anaesthetic assessment. Two main types of anaesthesia are used: general anaesthetic and spinal or epidural anaesthesia. A team of healthcare professionals will perform the surgery, including an orthopaedic surgeon. The National Hip Fracture Database (NHFD) produce an annual report that includes an analysis of 30-day mortality rates for hip fracture patients who are over 60 years old within the UK. WAT were alerted by the NHFD that they were an outlier, with 12% mortality over 3 years. In the UK the overall mortality rate within 30 days of hip fracture in 2014 was 7.5%   (Johansen, 2016). High mortality rates are a signal to hospitals that they should investigate to identify and resolve quality issues. Figure 1Funnel Plot of Crude and Adjusted Mortality Rates 2014 (Source: Johansen, 2016) Effective strategies are needed to reduce the burden on healthcare providers and to improve patient quality of life and outcomes after a hip fracture. Staff at WAT want to develop an action plan to analyse performance and instigate improvement programmes. This included questioning what elements of care could have been delivered better to ensure that high-quality care is delivered throughout the patients treatment, to improve 30-day mortality rates and functional outcomes for patients. 1.3 Perceived Issues with the Current Process In the present study, the incidence and mortality and functional outcomes in hip fracture patients was studied. The relationships between admission and treatment times, pain management drugs and anaesthesia, and their effect on the patients length of stay (LOS) in hospital were assessed and the following issues were found: Admission time from AE to treatment is high High level of opiate usage to manage pain Routine use of general anaesthesia 1.4 Value Adding Activities Admission to surgery times Pain management Days spent in hospital 1.5 Scope Older people with hip fractures aged 60 or over are in scope for this project.       1.6 Problem Statement 30-day mortality rates for older hip fracture patients at Watford General Hospital have been 12% for 3 consecutive years, 4.5% higher than the national average (NHFD). 1.7 Goal Statement Reduce 30-day mortality rates in older hip fracture patients to 8.5% by the end of June 2017. 2.1 Process Map Figure 2 Process Map 2.2 Process Narrative      Ã‚   The person arrives at the AE department by ambulance or car. The triage nurse assesses the patients condition. Patients are classified by severity of injury (red, yellow, or green). Patients presenting with suspected hip fractures are commonly assigned a yellow classification, which indicates an emergency but not of a life-threatening nature. An AE doctor or nurse checks the patients vital signs, records their pre-fall health condition, and administers pain medication (generally opiates). Subsequently, in consultation with an AE doctor (if available), several basic tests (blood tests) and X-rays (hip and often chest) are ordered and performed. The patient is transferred to the radiology department for x-ray. The AE doctor or nurse then reviews the test results. If a hip fracture is diagnosed, the patient is deemed admissible and an intravenous (IV) drip is started. The patient is transferred to the orthopaedic ward for admission when a bed becomes available. Admission times are curre ntly 13.4 hours. On admittance to the orthopaedic ward an orthopaedic surgeon will review the test results. If the patient is deemed suitable for treatment the medical assessment team will assess if the patient has any existing medical issues that may affect treatment. If pre-existing medical conditions with the potential to affect treatment are found patients are referred to palliative care and discharged. If no pre-existing conditions are found patients are assessed by the anaesthesia team. Patients deemed suitable for surgery are placed on the trauma list, surgery generally takes place within 72 hours. Patients deemed unsuitable are referred to palliative care and discharged. Patients go to theatre, they are anesthetised using general anaesthetic and receive surgery. They are subsequently transferred back to the orthopaedic ward for ward-based management. Patients are discharged once they are mobile. 2.3 Identification of Problems, Weaknesses, and Change Areas High level of opiate use by AE staff for pain management Admission times of 13.4 hours Surgery wait times of up to 58.6 hours Routine use of general anaesthetic in surgery 3.1 Key Strategic Elements for Improvement Patients with hip fractures often require complex and challenging care, this is provided by a number of professionals in several departments, crossing a number of service boundaries. These patients are often frail, and their outcomes depend on how effectively their care pathway is managed. Pain management medications, avoidable delays, anaesthesia choices and post-operative care affect functional outcomes and mortality. The key strategic elements towards improving outcomes for older hip fracture patients are: Reducing morbidity and mortality rates Achieving better functional outcomes for patients Increasing discharge rates to original place of residence Increased value from the healthcare budget They can be achieved by: Altering pain management practices Altering anaesthetic management Reducing admission and treatment times 3.1.1 Pain Management Despite recent advances in the care of hip fracture patients, significant morbidity and mortality persists. Some of this is attributable to the pain medication administered in hospital. Opiates are the preferred pain management drug at WAT currently (Appendix A). Opiate use can cause nausea, constipation, and confusion (delirium) in the older patients (Coruhlu and Pehlivan, 2016). Effective pain management is a primary goal in hip fracture treatment. Research suggests fascia iliaca compartment blocks (FIB) is an alternative for pain management in hip fractures. Intravenous opioid therapy is used frequently (Appendix A). However, opioid side effects, such as nausea, vomiting and delirium, are common. Regional analgesic techniques have been shown to provide similar analgesia to opioids. FIB is reported to effectively block cutaneous lateral femoral and femoral nerves in adults (Nie et al., 2015). Studies have suggested superior analgesic effect with pre-operative FIB. They provided superior analgesia to intramuscular morphine in a randomised controlled trial of hip fracture patients (Callear et al., 2016). FIB is a safe and simple technique that can be administered by junior doctors and specialist nurses with training (Hanna et al., 2014). FIB administered in AE provided significant decreases in pain when compared to opiates. Post block analgesic requirements for patients in the FIB group were minimal. A study conducted by Callear and Shah (2016) concluded that a single dose of FIB given in the pre-operative period significantly reduced the post-operative and total analgesic requirements in the hip fracture patient. Patients also experience lower rates of delirium and were discharged faster. This reduces the cost of providing inpatient hospital beds and improves quality of life for older patients. 3.1.2 Anaesthetic Management Anaesthetists have an essential role in the preoperative, operative and postoperative management of hip fracture patients. Complications arising from anaesthesia in hip fracture surgery is influenced not only by the type of anaesthetic used, but also by patient comorbidities and the delays between admission and surgery. Approximately 25% of hip fracture patients display at least one episode of cognitive dysfunction during hospitalisation (Heyburn et al., 2012). A systematic review published by SIGN (2009), suggests that the use of spinal anaesthesia may reduce the incidence of postoperative confusion. 3.1.3 Time to Surgery At present admission times are 13.4 hours (NHFD statistics show the national average is 9.3 hours) and surgery wait times are 58.6 hours. Current guidelines recommend surgery to be carried out within 24 hours of injury (BOA, 2014). Observational studies suggest better functional outcomes, shorter hospital stays, duration of pain, and lower rates of complications and mortality are achieved by performing surgery earlier. Pre-operative delays increase mortality and, in those who survive, prolongs post-operative stay. For every additional 8 h delay to surgery after the initial 48 h, an extra day in hospital results (Colais et al., 2015). Currently WAT fall far short of the ideal to provide optimal care for hip fracture patients. 3.1.4 Multidisciplinary Approach The management of hip fractures requires complex, connected care from presentation at AE, through all departments. A study of 116 patients found that dedicated nurse specialists are effective at fast-tracking hip fracture patients to surgery by securing hospital beds, organising care, operating theatre lists and acting as a liaison with all other relevant departments (Larsson and Holgers, 2011). Many published guidelines recommend a multidisciplinary approach to the treatment of hip fractures, in addition to, a good care environment to promote best outcomes. The Scottish Intercollegiate Guidelines Network (SIGN, 2009), the National Institute for Clinical Excellence (NICE, 2013), and the British Orthopaedic Association in cooperation with the British Geriatric Society (BOA, 2014), have all produced guidelines supporting a multidisciplinary team approach to deal with hip fractures in older people. Figure 3 Multidisciplinary Team (Source: Orthopaedics and Trauma) Rieman and Hutichson, (2016) It is recognised that a team approach with excellent communication between all the members is essential. The multidisciplinary team looking after hip fracture patients is large (Figure 2), and each role is important in the jigsaw of care. 3.1.5 Clinical Pathway Clinical pathways should be used to aid the multidisciplinary team. They provide a description of the expected interventions and outcomes throughout the patient journey following a hip fracture. The use of clinical pathways ensures everyone knows the next step in the process and this minimises unnecessary variations in practice (Chudyk et al., 2009). A study of 1193 older hip fracture patients conducted at 6 hospitals in the Limburg trauma region of the Netherlands concluded that the use of a multidisciplinary clinical pathways (MCP) for patients with hip fractures tends to be more effective than usual care (UC). Time to surgery was significantly shorter in the MCP group when compared to the UC group. The mean length of stay was 10 versus 12 days. In addition, the MCP group had significantly lower rates of postoperative complications (Kalmet et al., 2016). 3.2 Proposed Strategy Establish a designated Hip Fracture Unit within the main orthopaedic unit. Appoint a multi-disciplinary team to be based on the ward comprised of: Physio /Occupational Therapist Orthopaedic /Orthogeriatric Doctor Specialist Hip Fracture Nurse Nursing staff Establish a Hip Fracture Pathway. Establish a protocol-driven, fast-track admission of patients with hip fractures through AE AE bleep specialist hip fracture nurse FIB administered by nurse for pain management and patient centred care Patients are admitted to the hip fracture ward within 6 hours Appropriate, medically fit patients receive surgery within 24 hours Use of spinal anaesthesia when appropriate Continuous tracking/live data systems that regularly update patient and logistical data may improve management by identifying patients location, delays in treatment and relevant clinical information. 3.3 Potential Process Improvement Tools 3.3.1 Continuous Quality Improvement Continuous Quality Improvement (CQI) is a quality management tool that encourages all members of the health care team to continuously ask, How are we doing? and Can we do it better? (Edwards et al., 2008). It focuses on improvement for the patient and the practice by asking questions like, can we do things more efficiently? Can we be more effective? Can we do it faster? CQI uses a structured planning approach to evaluate the current processes and improve those processes to achieve the desired outcomes. Tools commonly used in CQI help team members identify the desired clinical or administrative outcome and the evaluation strategies that enable the team to determine if they are achieving that outcome. The team can adjust the CQI plan based on continuous monitoring of progress through an adaptive, real-time feedback loop (NLC, 2013). A CQI approach can help improve patient care. There is a strong link between organisations with explicit CQI strategies and high performance (Levin, 2016). Figure 4 CQI Framework Model (Adapted from NLC) Structure examines the characteristics of resources, staff and consultants, physical space, and financial resources. Process -   the activities, workflows, or tasks carried out to achieve an output/outcome. Output the immediate predecessor to a change in the patients status. Not all outputs are clinical e.g. business or efficiency goals. Outcome the end result of care. Can be change in the patients current and future health status. Feedback Loop represents its cyclical, iterative nature. 3.3.2 Lean Management Lean is a process improvement method developed by Toyota in the 1950s. Lean management principles have been used in manufacturing for many years, however, these principles can be used in healthcare too. According to Womack and Jones, there are five key lean principles: value, value stream, flow, pull, and perfection. Lean drives out waste so that all work adds value from a customer perspective. Lean thinking focuses on how efficiently resources are being used, it looks at each step in the process and asks what value is being produced? Value from a patients perspective can be defined as timeliness of treatment, reduced stress, or better functional outcomes. The NHS defines value as anything that helps treat the patient. Everything else is waste (Jones and Mitchell,2006). Figure 5 Lean Principles Identify customer value in healthcare value is any activity that improves the patients health. Manage the value stream the value stream is the patients journey. Identify process that deliver value to patients. Create Flow align processes to facilitate the smooth flow of patients and information Establish Pull provide care on demand and utilising resources effectively. Seek Perfection optimise the process through continued development and adjustment to meet patients needs. Optimal delivery of high-quality care to reduce mortality in hip fracture patients is an achievable goal. There are numerous opportunities to enhance the quality of care: reduced length of stay, reduced institutionalisation, reduced mortality and better functional outcomes for patients. Better quality care minimises treatment delay, promotes recovery and facilitates a speedier discharge. Cost and quality are not in conflict providing high quality hip fracture treatment is a lot cheaper than poor quality treatment. Lean inspired and clinical pathway related process improvement efforts make inconsistent and inefficient practices in health care more visible. The implementation and adherence to evidence based standards will considerably improve the care and management of older patients with hip fractures, this will result in significantly improved outcomes for patients and the healthcare system. 5.1 Appendix A References       BOA (2014) BOA standards for trauma (bOASTs). Available at: http://www.boa.ac.uk/publications/boa-standards-trauma-boasts/ (Accessed: 5 December 2016). Callear, J., Shah, K., Hospital, J.R. and Oxford (2016) Analgesia in hip fractures. Do fascia-iliac blocks make any difference?, BMJ Quality Improvement Reports, 5(1), pp. 210130-4147. doi: 10.1136/bmjquality.u210130.w4147. Chudyk, A., Jutai, J., Petrella, R. and Speechley, M. (2009) Systematic review of hip fracture rehabilitation practices in the elderly, Archives of physical medicine and rehabilitation., 90(2), pp. 246-62. Colais, P., Di Martino, M., Fusco, D., Perucci, C.A. and Davoli, M. (2015) The effect of early surgery after hip fracture on 1-year mortality, BMC Geriatrics, 15(1). doi: 10.1186/s12877-015-0140-y. Compston, J. (2009) Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK, Maturitas., 62(2), pp. 105-8. Coruhlu, O. and Pehlivan, S. (2016) Worst pills. Available at: http://www.worstpills.org/includes/page.cfm?op_id=459 (Accessed: 5 December 2016). Edwards, P., Huang, D., Metcalfe, L. and Sainfort, F. (2008) Maximizing your investment in EHR. Utilizing EHRs to inform continuous quality improvement., JHIM, 22(1), pp. 7-12. Hanna, L., Gulati, A., Graham, A. and Corporation, H.P. (2014) The role of Fascia Iliaca blocks in hip fractures: A prospective case-control study and feasibility assessment of a junior-doctor-delivered service, International Scholarly Research Notices, 2014. doi: 10.1155/2014/191306. Heyburn, J., Holloway, G., Leaper, E., Parker, M., Ridegway, S., White, S., Wiese, M. and Wilson, i (2012) Management of proximal femoral fractures 2011, Association of Anaesthetists of Great Britain and Ireland, 67(1), pp. 85-98. Jones, D. and Mitchell, A. (2006) Lean thinking for the NHS. Available at: http://www.nhsconfed.org/~/media/Confederation/Files/Publications/Documents/Lean%20thinking%20for%20the%20NHS.pdf (Accessed: 11 December 2016). Kalmet, P.S.H., Koc, B.B., Hemmes, B. and ten Broeke, R.H.M. (2016) Effectiveness of a Multidisciplinary Clinical Pathway for Elderly Patients With Hip Fracture: A Multicenter Comparative Cohort Study, Geriatric Orthopaedic Surgery Rehabilitation, 7(2), pp. 81-85. Levin, D. (2016) Using continuous quality improvement to improve patient experience. Available at: http://bivarus.com/using-continuous-quality-improvement-improve-patient-experience/ (Accessed: 7 December 2016). Myers, A.H., Palmer, M.H., Engel, B.T., Warrenfeltz, D.J. and Parker, J.A. (1996) Mobility in older patients with hip fractures: Examining Pre: Journal of Orthopaedic trauma, Journal of Orthopaedic Trauma, 10(2), pp. 99-107. NICE (2013) Falls in older people: Assessing risk and prevention. Available at: https://www.nice.org.uk/guidance/cg161 (Accessed: 5 December 2016). Nie, H., Yang, Y.-X., Wang, Y., Liu, Y., Zhao, B. and Luan, B. (2015) Effects of continuous fascia iliaca compartment blocks for postoperative analgesia in patients with hip fracture, 20(4). NLC (2013) Continuous quality improvement (CQI) strategies to optimize your practice Primer provided by. Available at: https://www.healthit.gov/sites/default/files/nlc_continuousqualityimprovementprimer.pdf (Accessed: 7 December 2016). Rieman, A.H.K. and Hutichson, J.D. (2016) The multidisciplinary management of hip fractures in older patients. Available at: http://www.orthopaedicsandtraumajournal.co.uk/article/S1877-1327(16)30025-2/fulltext (Accessed: 5 December 2016). Scottish intercollegiate guidelines network part of NHS quality improvement Scotland SIGN management of hip fracture in older people (2009) Available at: http://www.sign.ac.uk/pdf/sign111.pdf (Accessed: 5 December 2016). Simunovic, N., Devereaux, P. and Bhandari, M. (2011) Surgery for hip fractures: Does surgical delay affect outcomes?, 45(1). Trpeski, S., Kaftandziev, I. and Kjaev, A. (2013a) Fast-track care for patients with suspected hip fracture. Available at: http://www.injuryjournal.com/article/S0020-1383(11)00002-7/fulltext (Accessed: 10 December 2016). Trpeski, S., Kaftandziev, I. and Kjaev, A. (2013b) The effects of time-to-surgery on mortality in elderly patients following hip fractures, Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki)., 34(2), pp. 115-21. Van Staa, T.P., Dennison, E.M., Leufkens, H. and Cooper, C. (2001) Epidemiology of fractures in England and Wales. Available at: http://www.thebonejournal.com/article/S8756-3282(01)00614-7/fulltext (Accessed: 5 December 2016). Verhelst, J., Dawson, I., Paul T. P. W. Burgers, Esther M. M. Van Lieshout and Piet A. R. de Rijcke (2013) Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients, 38(5).

Postmodern Aerobics :: Exploratory Essays Research Papers

Postmodern Aerobics These days, I'm living life flat-out, literally and figuratively. I say literally since I'm lying face up in a back float right now, and figuratively since I'm in the final stretch of my coursework for a degree in literature. I come to the pool, though, even with exam deadlines looming over my head, or perhaps be-cause of them, since I need to feel all the gravity fall away, experience even for just a moment the feeling of weightlessness. From my vantage point in the pool, I can see the aerobics class hard at work in the plate-glass exercise room on the balcony above. The other side of that room is lined with mirrors, and many of the members watch themselves step, extend, and jiggle. I can hear the bass line of the retro disco music pounding down through the foundation, overpowering the strain of classical music wavering from the radio on the pool deck. I lay my head back in the water and think about how unhappy they look, their faces wrought in sweat, determination, and desperate amusement. It occurs to me that they are engaged in a kind of postmodern aerobics. No excesses enter that stripped-down room with them; they bring to it only a sharp perception of their bodies, fragmenting themselves into pecs, abs, and buns of steel. Constantly assessing themselves in terms of the minimal, they self-consciously measure the body fat on their upper arms and thighs with a small device that pinches their flesh between two levers. Even more painful to watch is the process that follows as they evaluate the units with stern faces, consulting each other in an almost robotic fashion. It seems they'll let nothing get in the way of sculpting the exterior, perfecting the outer package. "The stomach needs work," I will hear one of them say later in the locker room; she will not say "my stomach" or "my torso." Each one proceeds to talk about an element of her body as if it were something she has managed to separate from herself. And I've never once heard them mention the soul. While members of the "Masters" competitive team may possess some or all of these qualities, "Sunset" swimmers do not think this way. We come to the pool in search of our souls, that part of ourselves that loves to be submerged and buoyed and enveloped by water.

How Entrepreneurs Differ from Other Business Owners Essay -- business

There has been a large amount of attention paid to the subject of entrepreneurship in the last few years; mainly because most people have chosen to go from working for somebody else to be their own bosses and work for their dreams. Yet, many still wonder what is entrepreneurship and what is that sets entrepreneurs apart from other regular business owners? Free-lance writer and expert in economic issues Jeanne Holden suggest: â€Å"There is no one definitive profile of an entrepreneur. Successful entrepreneurs come in various ages, income levels, gender, and race. They differ in education and experience. But research indicates that most successful entrepreneurs share certain personal attributes, including: creativity, dedication, determination, flexibility, leadership, passion, self-confidence, and smarts." (Principles of Entrepreneurship) These attributes are what characterize entrepreneurs and set them apart from other business owners. The first one is creativity, which refers to the way entrepreneurs can come up with different and innovative business ideas; they create, develop and ...

Winesburg Ohio Critical Analysis Essay -- Critical Analysis

  Ã‚  Ã‚  Ã‚  Ã‚  Written by Sherwood Anderson in 1919, Winesburg, Ohio, a collection of short stories, allows us to enter the alternately complex, lonely, joyful, and strange lives of the inhabitants of the small town of Winesburg, Ohio. While each character finds definition through their role in the community, we are witness to the individual struggle each faces in trying to reconcile their secret life within. A perfect example of two characters are Alice Hindman and Enoch Robinson. The loneliness and illusion that encompass the lives of Alice Hindman and Enoch Robinson are the result of the discrepancy between their own capacity for intimacy and affection and the inability of others to truly understand them.   Ã‚  Ã‚  Ã‚  Ã‚  In the short story, â€Å"Adventure†, Alice Hindman lives a life full of illusions and loneliness. Alice is a very quiet person on the exterior while a passion boils underneath. Alice Hindman is limited by life denying truths and guilty of allowing them to run her life. She believes in love and tradition absolutely. Alice’s blindness to the changing social mores limits her capacity to progress forward in life. She become consumed instead by the idea of herself and her memories. â€Å"It is not going to come to me. I will never find happiness. Why do I tell myself lies?† (Anderson 117). If she cannot have Ned, she will have no other.   Ã‚  Ã‚  Ã‚  Ã‚  This extremity of emotion brings her to downfall. Her tendency to limit her own abilities by her nature of fixed habits or unmovable convictions isolates Alice from her community and distorts her features. She had once been a beautiful girl but grows into a woman with a head too large for her body. This is symbolic of her self-consumption, loneliness, and illusions. â€Å"I am becoming old and queer. If Ned comes he will not want me.† (Anderson 117). She grows to support the theme of life in death, living within her own imagination and memory to the point that her head is nearly expanding under the stress. She denies herself the reality of life by narrowing the experience to a dream world. By making absolute convictions and believing her own lies, Alice refuses to meld her worlds of dream and reality together. For example, Will Hurley, the man who walks her home from Church meetings, is an impostor into her narrowly constructed universe and thus she does no t want to... ...asy life. When a woman invades this life, he cannot compromise the two worlds once again and one must be destroyed. â€Å"Enoch Robinson is so open to the power of the feminine that he feels his own identity would be â€Å"submerged, drowned out† by any intimate relationship with a real woman.â€Å" (Rigsbee 435). Of course, Enoch’s attempts at happiness would be destroyed but the story lies in the story of Enoch’s absolute hold on his particular truths which cannot be maintained. Enoch continued to live a lonely life, full of illusions. â€Å"I’m alone, all alone here. It was warm and friendly in my room but now I’m all alone.† (Anderson 178).   Ã‚  Ã‚  Ã‚  Ã‚  Alice Hindman and Enoch Robinson were two perfect examples of how a person can live a life full of illusions and loneliness. The main cause of their distorted lives was due to the inability of others to truly understand them. For example, Ned and Alice’s friends didn’t understand Alice and Enoch’s wife and art friends didn’t understand them. This caused them to make their own lives interesting, which they did by creating illusions, which also encompassed unwanted loneliness from Alice and Enoch both.   Ã‚  Ã‚  Ã‚  Ã‚  

Laptops, Hard Drives, The Ephemera Of Data, The Risk Of Theft And Consequence Of Law: Responsibilities And Liabilities

As technology develops at the speed of light, as digital phones computers grow more powerful than twelve acres of 1967 IBM mainframes, as information is set down in liquid pixels and stored in virtual warehouses the size of a postage stamps, as hackers and those of ill-will seek out ever-new clever ways to â€Å"break and enter† virtual â€Å"banks of data†. the law must respond, reflect, assess and codify those principles which will serve the business community, management and labor, employers and employees, as it enters the unknown territory of a virtual future.In a more gentile time of scriveners, Bartleby and Scrooge, an employee as day’s end would lift the top of his writer’s desk, store the hand written documents for that day and wait for his superior to stop by with a key to lock the desk for the night. Theft of such documents would have required the breaking and entering into a physical place to obtain physical objects.Cause and effect would be cle ar, as would an assessment of responsibility and liability. However, with today’s technology and the wide-open vistas of the world wide web, theft can occur from an transnational distance over invisible lines by processes barely comprehensible to those responsible for security. The 19th century scrivener under contract to his employer performed certain services and incurred certain duties and responsibilities.Doubtless, to a certain degree (perhaps depending upon who held the key) he was responsible for the safeguard of his newly copied documents. Likewise the modern employee owes similar duties and responsibilities; however, in the cyber age of information, the protection of data and information, securing it from being lost in the ocean of the web, is a more complicated issue, a more difficult task and raises questions that have yet to be resolved in this protean and ever-burgeoning area of business law.First, a word concerning definition and semantics: The terms â€Å"resp onsibility† and â€Å"liability† tend to get laced in the TV screenwriter’s daisy-chain of legalese in much the same way as Hamilton Burger couldn’t help himself from objecting in every episode of â€Å"Perry Mason† with the contradictory charge of â€Å"irrelevant, incompetent and immaterial. † What one gains in the impressive sound of â€Å"lawyer-words† is lost to meaning and precision.The distinction is important to present issues insofar as responsibility means the capacity, so far as this is a matter of a man’s mind or will, which normal people have to control their actions and conform to law. It describes the duties a person takes on which are general for any party to an agreement, a contract for consideration. Liability, on the other hand, is the quality or state of being legally obligated or accountable.It is a legal responsibility owed to another or society enforceable by civil remedy or punishment. Liability is a more serious matter in that it is ultimately an assessment by some given authority (judge, jury, and arbitrator) that one’s failure of responsibility is of such a nature as to incur the greater duty to make amends or remedy as determined by the specific facts of the matter.In short, liabilities denote some failure of responsibility; however, all failures of responsibility do not necessarily result in the imposition of liability. At its most basic level the law is about the management of relationships, the identification, assessment and balancing of the rights, interest, duties and responsibilities of the parties to the relationship. The law assesses the relative merits of argument when these respective interests come into conflict.In the arena of cyber space, cyber theft, cyber torts, the many relationships between and among several parties raise a plethora of issues, a multitude of arguments. The primary relationship exists between the employer and the employee. The relationship rests in the employment contract; however, depending upon the conduct of the parties other areas of law may come into play: harassment, negligence, cyber tort, trespass, theft, etc.The focus on the employment contract as setting forth certain responsibilities for either party in the age of cyber-data, the portability of laptops, and the ephemeral nature of recorded data, the questions, among others, raised are to what extent an employer can direct and restrict the conduct of an employee when those directives and restrictions bounce up against the employee’s competing interests in the ownership of personal property (his or her laptop) or the employee’s right to come and go as he/she pleases in a free society without having to exercise extraordinary care concerning the contents of his/her laptop, outside the office, beyond office hours. Just how far can the four corners of the employment contract stretch to govern employee conduct, responsibilities and the imposition of potential liabilities during the employee’s personal time? (The issues concerning the use and the restrictions on use of the employee’s personal laptop in the workplace during work hours is the easier analysis with the weight of authority siding with the employer’s right to impose restrictions deemed necessary for security and employee performance. )Analogies to the this predicament which in general asks to what degree an employer, as a condition of the employment contract, can direct the employee’s â€Å"after-hours† life, can be found in similar issues raised by those employment contracts which include a 24/hour non-smoking clause (in the interest of health costs, insurance premiums) or the ban on any office romance, inside or outside the office. What responsibilities does an employee incur with the pervasive use of laptop computers, which in a physical sense are portable items of personal property, but also carry a volume of information that on ce would have been stored in several warehouses or file rooms? Simply stated, employees are probably more of a security risk than an asset.By virtue of technology’s advance, employees have been placed in a precarious position of being guardians at the gate of treasure when the gate and the treasure are often invisible and invaded by invisible means. Perimeter security doesn’t work anymore. The airwaves are filled with rogue access points, and people are bringing infected laptops in and out of the enterprise. â€Å"A number of companies †¦ are revising their policies about how employees should handle confidential data stored on computers. Many employees are facing new restrictions on who can take confidential records out of the office and are receiving special training on how to keep data secure.Workers found violating security policies are being disciplined or even dismissed. † The next relationship is a sub-set of the first. It looks at the situation in wh ich an employee, having agreed to whatever conditions, duties, responsibilities, set forth in the employment contract and the statement of company policies, exhibits negligence, even gross negligence in the care and handling of his laptop, resulting in its physical theft. Assume the laptop’s hard drive contains something equivalent to the recipe for Coca-Cola, and the implications of loss to the company are self-evident. In this hypothetical the employee has failed in his responsibilities to the company. And yet what are the company’s remedies?As referenced above, they can discipline or dismiss the employee, and then sit back and watch as Company Z manufactures a soda as good as their own. The issue as to whether they can hold the employee liable is dwarfed by the issue of remedies. One fired employee will not return the secret formula. Assume the employee’s conduct was criminal. He gets ten years, community service, and a lien on his property (a double-wide out side of Macon) in the amount of ten million dollars. Company Z is still making a fortune manufacturing a cola as good as the original. The failure of remedy only serves to point the aggrieved party downstream to search out other remedies (i. e. , deep pockets), civil and criminal, for their loss.And yet, even then, assuming the best case scenario for Company Z (meaning the likely imposition of civil remedies and criminal fines/punishment) any litigator knows that at that advanced stage of litigation with large companies and big firms on the clock, the process is exceedingly slow and absent injunctions against the offending party – the secret’s now likely to be in the hands of Companies A, B, C and D. These hypothetical only points up the extreme seriousness of the necessity for a company’s defense against attacks from outside, and the disturbing acknowledgment that said defense is not wholly within the company’s control. Companies have instituted policies to stress, express and maximize an employee’s responsibility, even imposing certain liabilities on the failure of such duties; all to minimize and the limit the risk of hacking and theft.But the 20th century world of â€Å"hard copy† (and what that implies) is about to pass by commerce as businesses enter a new age of information-gathering and information-conveyance. The substance of current information is as rock-solid, as valuable as ever, however the â€Å"thing itself† – what used to be the paper and the ink scribbles on the paper, i. e. , the thing that carried the information are now words on screens that can all too easily disappear onto invisible hard drives that move by means of invisible wires cast about the world in an invisible matrix – rendering the whole chain of custody as ephemeral as vapor, vulnerable to the peculiar talents of a new kind of thief, who’s comfortable with the notion of theft as an intellectual rather than a physical activity. So, who’s vulnerable? â€Å"Anybody who has data. †Another issue that arises out of the various relationships involved is this: Given the current state of affairs regarding the risk and threat of data theft, cyber theft, laptop theft, floppy disk theft, companies, for some time, have been on constructive (if not express) notice that there are individuals among us, peculiar perhaps in their pursuits, talented and brilliant in ways often unknown to current Baby-Boom age management, who derive pleasure and more likely profit from infecting the web and its offshoots with viruses. The following hypothetical presents itself: Hacker X in a basement in Queens has been hired by Rogue Company Z, competitor of large and established Company A, to infect Company A’s computers with a virus that will disable Company A, thereby enhancing competitor Rogue Company Z’s position in the shared market.Hacker X is to be a paid a good deal of money and not bec ause he’s stupid. He knows from experience that a direct assault on Company A is more likely to lead a trail back to himself and Rogue Company Z. Therefore Hacker X studies the interlocking systems of Company A with client companies and determines he can attack Company A through out of state Company Client. On a given Monday Company Client’s workers go to work and discover that their system has crashed with a virus that will spread through a given network, affecting several companies down line, including Company A, the prime target. The issues are what duties did Company Client have to notify entities down line?As a practical matter, is there time for Company Client to notify other companies down line? What duty does any company, such as Company Client have, not only towards itself, but to companies down the line who will suffer impairment from the traveling virus? And most importantly do the companies down line have a cause of action against Company Client for breach of some duty in failing to protect itself (and therefore others) from virus infestation. The questions are not rhetorical. They are real and fact sensitive. One can envision a circumstance in which a company is so lax in its security that it all but screams for hackers to have their way.Such a security failure might very well be deemed a breach of duty to other companies in the zone of danger (its length and breadth however defined). And yet all we are left with are the questions: What laws or what standards govern? Are they state laws? And if so do they give rise to conflict of laws problems? Are they Federal laws? Who sets the standards codified by the legislation? Does the current state of common law (tort and contract) anticipate the advantageous application of old principles in new clothes? On analysis, it appears that when all is said and done, the essential â€Å"bottom line† issue will devolve about the areas of remedies and insurance.Analysis of responsibilities, the ir breach and consequent liabilities can fill courtrooms with boxes of pleadings; however, when the issues are finally resolved and liability is determined, who, in this day of multi-billion dollar cyber secrets will have the funds, the deep pockets, to make the aggrieved party whole. The resort to insurance opens another area of analysis which for now remains without the boundaries of discussion proscribed herein; however, one can only imagine the super-layer of responsibilities to be imposed on companies and their employees by insurance contract, drafted water-tight, so as to minimize risk of theft in a high risk environment.

Chester Barnard’s Management Theory Essay

Management has been in our business culture many years. Ideas of management from the past are applicable to management practices today. In today’s society, managers are seen as a ruling authority that get their jobs done through other people; their employees. Most of the time there is a lack of communication between the managers and their employees resulting in conflicts that may place their company at high risk of failure. Leading and motivating should be the top priorities of a manager. Motivating includes communicating with your employees, dealing and solving problems and encouraging them to do their job to be successful in today’s management business. This all leads us to Chester Barnard’s management theory and his belief of the role of effectiveness within management. Chester Barnard was born in 1886 and died in 1961. He attended Mount Hermon Prep School and later enrolled at Harvard University. While at his position as a telecommunications executive, Bernard was influenced by Walter Gifford, Harvard President A. Lawrence Lowell, Donham. At that time, Chester was president of the New Jersey Bell Telephone Company. In his time he was known for publishing an article on ‘The Functions of the Executive in 1938’ which was an influential 20th century management book. In this article he helped advance thinking about organizations that later on contributed to the management theory. He created two theories which are Theory of Organization and Concept of Authority. â€Å"Authority is the character of a communication in a formal organization by virtue of which it is accepted by a contributor to or ‘member’ of the organization as governing the action he contributes; that is as governing or determining what he does or is not to do so far as the organization is concerned. †

Reflection on Assessment of Asthmatic Patient

In this essay, I need to reflect on the situation that taken place during my clinical assignment to develop and utilize my experiences on the assessment and intervention of asthmatic patient in my work place. In this reflection, I am going to use Gibbs (1988) Reflective Cycle. This model is a recognised framework for my reflection. Gibbs (1988) consists of six stages to complete one cycle which is able to improve my healthcare practices continuously and learning from the experience for better practice in the future. The cycle starts with a description of the situation, next is the analysis of the feelings, third is an evaluation of the experience, fourth stage is an analysis to make sense of the experience, fifth stage is a conclusion of what else could I have done and final stage is an action plan to prepare if the situation arose again (NHS, 2006). Baird and winter (2005, p. 156) gave some reasons why reflection is required in the reflective practice. They state that a reflection is to generate the practice knowledge, assist an ability to adapt new situations, develop self-esteem and satisfaction as well as to value, develop and professionalizing practice. However, Siviter (2004, p. 165) explain that reflection is about gaining self-confidence, identify when to improve, learning from own mistakes and behaviour, looking at other people perspectives, being self-aware and improving the future by learning the past. In my contact with the patient, it was important for me to establish a very good rapport which is the healthcare professional – patient relationship. There was a good mutual understanding exists between me and Mrs. A established from a sense of trust (Harkreader and Hogan, 2004, p. 243). Ruesch (1961) mentioned the purpose of the good communication is to improve the patient’s ability to function. According to Kathol (2003) healthcare provider must show up caring, sincerity, empathy and trustworthiness in order to build a warm relationship with patient. Those attitudes could be expressed by promoting the effective communication and relationships by the implementation of interpersonal skills. Thus, My reflection is about one patient whom I code her as Mrs. A, not a real name to protect the confidentiality of patient’s information (NMC, 2004). Description of the situation In this paragraph I would describe on the event that took place in assessing and provision of intervention to asthmatic patient in my work place. I was on a ward when Mrs. A was brought to the Accident & Emergency unit. She was a 76 years old been diagnosed of asthma. Mrs. A complainted of shortness of breath with audible wheezing. She could not walk herself and need to be assisted if she wanted to stand or walk. Her past medical history revealed diabetic and high blood pressure. Patient has taken her prescribed medication of ventolin at home without relief of symptom before coming to the Accident & Emergency. She was accessed and physical examination show the following: Respiratory rate 30, Heart rate 110, blood pressure 140/90, temperature 36. 2, and saturation 87. Auscultation reveals decreased breath sounds. Peak flow done before and after treatment was 125/250. Mrs. A was also coughing up small amount of sputum. Feelings In this paragraph, I would discuss on my feelings or thinking that took place in the event that happened. Before I started the assessment, I introduced myself and approached Mrs. A. So I tried to build a good rapport with her as I do not want her to feel strange as I was not her family members or her relatives. My first approach to her was to ask whether she wanted to take her lunch. She was on soft diet as she was having a difficulty in swallowing. Then I asked her permission to feed her. She looked at me and the pain was there. In this situation, I showed up my empathy as I put myself in her shoes and assuming I was having a breathing problem. According to Wold (2004, p73) empathy is about the willingness to understand the other person not just judging the person’s fact. Then, I touched her shoulder, kept saying, and raise my tone a bit because I was afraid if she had a hearing trouble. I was reassuring her she will be fine. In the meantime, I was thinking whether the English language was not her mother tongue but I kept myself communicate verbally with her including using my body gesturers and facial expression. Body gesturers and facial expressions are referred as a non-verbal communication (Funnell et al, 2005, p. 443). I thought of the language barrier that breaks our verbal communication. Castledine (2002, p. 923) mention that the language barrier arises when there are individuals comes from a different social background use their own slang or phrases in the conversations. Luckily, those particular body gesturers could make her understand that I was going to assess her. During the assessment I maintained the eye contact as I do not want her to feel shy. This is supported by Caris-Verhallen et al (1999) which mentioned that the direct of eye contact could express a sense of interest in the person to the other person involves in that communication. As a result, she gave a good cooperation and was very happy for the assessment until finished. Evaluation Developing my skills on assessment and intervention of asthmatic patient particularly an adult has been very challenging but rewarding. My learning style was kinaesthetic where I actually carried out physical activity in my work place. I was eager to try and explore the theory into practice by assessing Mrs. A under the supervision of a registered nurse. As a busy department it was difficult to get a nurse to supervise me, but the nurses were doing everything possible to make their selves available whenever I needed their help. The registered nurse asked me to assess Mrs A, at first I wasn’t confident because that was my first patient to assess. However, the more time I spent with Mrs A, the better I become. I was anxious to put theory into action by carrying out the assessment and taken part in the intervention. I took the challenge to revise the anatomy and physiology of the respiratory system. This was very helpful in understanding the changes in anatomy and physiology of a patient with asthma. The study deepened my confidence in demonstrating competences in carrying out assessment and dvising patients with asthma on the use of nebuliser. These skills have enabled me to know how to reassure patient when they come in with asthma attack. I have also developed the new skills to understand more about the trigger of asthma, symptoms, causes and intervention. It was also as my duty to feed Mrs A so that I could make sure the patient get the best care in the ward. Burnard (1990) and Stein-Parbury (1993) define attending to patient as a patient-centred process as wells as to fulfil the basic conditions as a healthcare professional to provide the genuineness, warmth and empathy towards the patient. I was able to improve my verbal and non-verbal communication skills in my conversation with her during the assessment as she was having a hearing problem and could not communicate in English language properly, so the non-verbal communication plays a role. Caris-Verhallen et al (1999, p. 809) state that the non-verbal communication becomes important when communicating with the elderly people who develop a hearing problem. Hollman et al (2005, p31) suggests some effective ways to maximize the communication with hearing impairment people such as always to gains the person’s attention before speaking, make yourself visible to prevent them feel frighten and try to use some sensitive touch. I feel this is a good experience to me because I learn to develop my verbal and non-verbal communication particularly. Furthermore, I also used my facial expressions to advise her when I finish. During meal time, she withdraws the meal after few seconds but I smiled and assured Mrs. A that it was good for her health to finish her meal. Therefore my facial expression worked out to encourage her to finish the meal. Although I could not explain detail to her about the important nutrition diet that she should take, but I could advocate her to finish the meal served because the meal was prepared according to her condition. I am also particularly impressed because I am now more experienced and confident in reassuring my patient and hence achieving my goal. Analysis In order to analyse the situation, I would add that my communication skills were very important to provide the best care to Mrs. A. My communication with Mrs. A was the interpersonal communication. This is because the interpersonal communication is a communication which involved of two persons (Funnell et al 2005, p. 438). I realized that my nonverbal communication did also help me a lot in my duty to provide the care to Mrs. A. Even though she could understand few simple English words when I was asking her some questions but I noticed that one of the problems occurs within the communication was the language barrier. Another was I could not get consent to assess and recommend treatment from Mrs A at first because she was on pain and did not want to speak. White (2005, p. 12) recommended that a healthcare professional should learn a few words or phrases in the predominant second language to put a patient at ease for better understanding. Moreover, though the registered nurses were able to help but due to the high demand of the nurses, it was not very easy to get nurse to supervise me initially because the department was very busy. Although, it was quite difficult because I am not allowed to assess patient without supervision but this really encouraged me to work very hard. She nodded her head to assign that she agreed with me or she was given me consent. In addition, Mrs. A also gave me a feedback that she understood my message by transmitting the message via her body gestures and eye behaviour. Delaune and Ladner (2002, p. 191) state a feedback is that the sender receives the information after the receiver react to the message. In a nutshell, my reflection explores my experiences in asthmatic patient intervention and assessment especially the adult. I was concern about my feeling and thoughts during the assessment so that I could improve more skills in my communication and confident. I successfully communicated with her effectively as she cooperated till the end of the assessment. So it was vital to build good rapport with her to encourage her ability to speak up verbally and non-verbal. Moreover, this ability could help her to communicate effectively with other staff nurses. She would not be neglected because of her age or her disability to understand the information given about her treatment. Hyland and Donaldson (1989), mention that communication expresses what the patients think and feel. In order to communicate with Mrs A, it was important to assess her common communication language and her ability to interact in the other languages. In my opinion, I evaluated that it does not matter whether it was a patient-centred communication or task-centred communication because both communication mentioned by McCabe (2004) actually does involves communication to the patients. So it was not a problem to argue which type of communication involves in my conversation with my patient. After I analysed the situation, I could conclude that I was able to know the skills for effective communication with the patient such as Mrs A, for example, active listening, concentration, empathy and support the patient emotions (Walsh, 2005, p. 34). Action Plan My action plan for the clinical practice in the future, if there were asthmatic patients that I need to help to assess and provide any medical intervention, I would prepare myself better to handle with the patients who would have some difficulty in communication. This is because, as one of the health care worker, I want the best care for my patients. So in related to deliver the best care to my patients, I need to understand them very well. I have to communicate effectively as this is important to know what they need most under my supervision as a Clinical assistant practitioner. According to my experience, I knew that communication was the fundamental part to develop a good relationship. Wood (2006, p. 13) express that a communication is the key foundation of relationship. Therefore a good communication is essential to get know the patient’s individual health status (Walsh, 2005, p. 30). Active listening could distinguish the existence of barrier communication when interacting with the patients. This is because, active listening means listening without making judgement to listen to the patients’ opinions or complaints which give me chances to be in the patients’ perspective (Arnold, 2007, p. 01). On the other hand, it is also crucial to avoid the barriers occurred in the communication with Mrs A. However, I would remind myself to be confident when dealing with the patient. I would make sure I remind myself not to assume or guess what my patient may have in mind. Walsh (2005) argued that making stereotyping and making assumptions about pa tients, perceptions and having first impression of patients and lack of awareness of communication skills are the main barriers in providing better care to patient. I must not judge the patients by making my first impression and assumption about the patients but I have to make patients feel valued as an individual. I should be capable to respect their fundamental values, beliefs, culture (Heath, 2000). I would be able to know on how to build rapport with the patients. There are eleven ways suggest by Crellin (1998, p. 49) which are becomes visible, anticipate needs, be reliable, listening, stay in control, self-disclosure, care for each patient as an individual, use humour when appropriate, educate the patient, give the patient some control, and use gestures to show some supports. This ways could help and give me some guidelines to improve my medical practice with patients. Another important thing to add on my action plan list is to know which the disabilities of the patients have such as hearing disability, visual impairment and mental disability. Once I could know the disability that a patient has, I could well-prepared my method of providing health care more effectively. To summarize for my action plan, I would start a communication with a good rapport to know what affects the patients’ ability to communicate well and to avoid barriers in effective communication in future. Conclusion In conclusion of my reflective essay, I mentioned the model that I chose, Gibbs (1988) Reflective Cycle as my framework of my reflective. The reason for choosing the model as well as some discussion on the important of doing reflection in medical practice. I am able to discuss every stage in the Gibbs (1988) Reflective Cycle about my ability to develop my experience in the assessment and intervention of asthmatic patient.