Infection control Essay

In this research essay the essayist will discuss the principles of evidence- based nursing research and its importance in healthcare. Therefore a brief introduction in infection and infection prevention and control will also be made followed by the main focus of this research essay which will be hand hygiene by making use of five research terms, which are qualitative, quantitative, ethical consolidation, data collection and sample. In addition to this, the issue of the most common Healthcare – Associated Infections (HAIs) acquired in hospitals will also be explored and by referring to relevant research the essayist will investigate why then HAI still a major problem in the UK healthcare settings, as a number of studies and reports suggests that adequate hand hygiene practice is the key to reduce infection across the field of care (British Medical Journal, 2005; Lancet, 2007). The method used to collect the primary source of information was gathered through the use of the University library digital search, Cinahl Plus (a comprehensive source of evidence-based full-text for nursing & allied health journals, which provide concise overviews of diseases and conditions and outline the most effective treatment options based on peer-reviewed medical research. Cinahl plus is available via EBSCO host), medical journal articles, books, publications and Department of Health (DH) database, and clinical guidelines if they indicate hand hygiene as a key to control and prevent HAI. A number of keywords were used, including quantitative, qualitative and research within the title ‘infection control’, ‘hand hygiene’ and ‘HAI’ so only records containing all the keywords were saved. The resulting list of articles was then reduced to English language, adult population, and systematic reviews published between 2000 to present. Of the 26 randomized controlled trials (RCT), twelve were discarded, as some were not relevant and some were unavailable. Furthermore the remaining ten literature review was divided into subtopics: hand washing technique and decontamination, alcohol-based hand rub, MRSA, and patient infection prevention information. Evidence- based nursing practice is the term used to describe the process the nurses use to make clinical decisions and answer clinical questions based on scientifically proved evidence rather than on  assumption, intuition or tradition (Bishop and Freshwater, 2003) In order for nurses to make the correct decision, they have to be based in four approaches which include; reviewing the best available evidence from peer-reviewed researches; using their clinical expertise; determining the values and cultural needs of the individual, and determining the preferences of the individual, family and community. Therefore such could only be achieved if the nurse’s know how to access the latest research and correctly interpret and apply the findings to their clinical practice (STTI, 2005). Fact that is also supported by the Nursing & Midwifery Council (NMC), 2008, which states ‘nurses must deliver care based on the best available evidence or best practice’. The fear of infection has been and will always be present in the human minds, rightly so as infections are the most common causes of death worldwide. From time to time we hear of methicillin- resistant Staphylococcus aureus (MRSA), C- Difficile, Norovirus, and any other organisms causing infection and threatening the health of the population (Ryan et al. 2001). Although in the developed countries the cardiovascular diseases and cancer are now the major causes, it is always an infection that tips morbidity into mortality (Meers, McPerson & Sedgwick, 2007). Infection prevention and control policies are a contentious issue in the healthcare settings. According to NICE (2012) new clinical guideline, everyone in involved in providing care must comply with the standard principles and regulations in infection control. Standard precautions should be applied at all times by the healthcare workers when caring for patients. Such can be accomplished by practising simple skills including; good hygiene in clinical environment, appropriate decontamination of hands and equipment, correct use of personal protective equipment, correct use and disposal of sharps, aseptic technique and waste disposal (DH, 2007, Pratt et al. 2007). The purpose of this is to reduce the risk of infectious diseases to staff, patients and others where care is delivered. Additionally, is the healthcare professional duty and responsibility to provide and deliver safe care to patients (NMC, 2008). According to World Health Organization (WHO) 2005, there are around 5000 death in healthcare setting due to HAI though the actual number of infections developed in the community is unknown (NHS QIS, 2005). Moreover,  with many HAIs manifesting post-hospital discharge (National Audit Office (NAO), 2000), the prevalence of HAI in the UK is likely to be greater than that reported in current official statistics, although 15-30% of these can be prevented with good infection control practices such as adequate hand hygiene practice (Damani 2003). Wilson (2006) states that hand washing are a simple procedure and the rates of procedure should be high. However the evidence points to the contrary as it written in the Centers for Disease Control and Prevention (CDC) report, suggesting that healthcare professional’s compliance to hand hygiene standards averages at 40% (CDC, 2002). Furthermore, Rumbau et al (2001) suggests that poor hand hygiene practice is the major area in contention in healthcare settings and healthcare professionals fail to comply with appropriate hand hygiene technique due to workload, understaff, and skin conditions, i.e. dermatitis (WHO,2009). Subsequently, the heavy workload may have a negative impact on compliance (O’Boyle et al, 2001, Pittet et al 1999), resulting in infecting patients with avoidable HAIs such as staphylococcus aureus bacteraemia (MRSA) and Clostridium difficile infection (C-difficile), among others types of infection (DH, 2003). Eventually, the distress and suffering it causes to the patient who acquires the above mentioned infection whilst in hospital, leads to loss of confidence and credibility and reputation of healthcare professionals and the NHS Trusts. As a result, it brings an increase to the costs of the already under funded hospitals from increased stays, increased medical expenses and damage to the patients and their relatives who may decide taking lawsuit demands (WHO report, 2006). NAO (2000) states that the cost of HAIs is approximately  £ 1 billion per year, also around 9% of patients in hospitals in England at one time have an HAI. The Journal of Hospital Infection (JHI), (2008) own researchers A. Mears et al, carried out a quantitative and qualitative research study following the death of 180 patients infected with stomach infection in one of the worst outbreaks ever seen in the NHS Trust. The outbreak was blamed on poor measures, to manage, control and prevent infection, despite the Trust having high rates of HAI over several years (JHI, 2009). The study was aimed to investigate the potential factors linked to HAIs rates in acute NHS hospitals and which interventions may be effective to tackle this issue. The mixed methodological research terms used in the research was purposely  chosen as it has been proved that integrate both research terms (qualitative and quantitative) in a study are essential to answer different sort of questions, collect different types of data and produce different type of answer (Burnang and Hannigan, 2000, Bourgeois, 2002). In addition, multiple data sources are useful in researches or studies as they are part of within method triangulation to make the study more trustworthy and credible, also to enhance its depth by meeting different needs at different stages of a project, as well as compensates for shortcomings in any one method (Bourgeois, 2002; Kelly and Long, 2005), as it has been proved by the findings. Qualitative method is an organized, descriptive, systematic, and intensive process to collect data by using computer software programs i.e.ATLAS.ti, to efficiently examine, analyse, and organise data, also to synthesize large volumes of data (Rebar et al, 2011). This method focuses on individual perceptions and how these are described, as well as recognise that the way people behave is determined by many factors including; what is expected of them, how they interpret the behaviour of other people, and how they feel about what is happening (Rebar, Gersch, Macnee & McCabe, 2011). It is essential that the research is carried out with an open mind, as preconceptions could distort the interpretation of what is going on (Rapport, 2008). . Quantitative The method used for data collection in the study was semi-structure interview and a self- completion questionnaire with textual analysis of response to open questions, sent to 900 NHS Trust nurses. Interviews and questionnaires are the most common methods used for data collection. A questionnaire is an instrument used to collect specific written data in order to specifically target objective factors or interest (Rebar et al, 2011). Whereas interviews are better for collecting sensitive personal information as the interviewer can establish a rapport with the subject (Crombie and Davies, 2002). Out of 900 nurses interviewed 700 acknowledged that inadequate hand washing by healthcare staff was the major cause of HAI. When questioned why healthcare professionals fail to comply with appropriate hand hygiene technique, more than 70% answered that lack of time, workload and high activity levels was  the reason, and 66% answered low staff level and insufficient and inconveniently located s inks makes it difficult to comply. These findings are supported by evidence from infection control literature. However, it is clearly specified in the literature that the consequences of high activity levels experience among healthcare workers can have a negative impact on compliance (DH 2003, McCall & Tankersley, 2007). Besides The self- completion questionnaires were returned with 100% response rate. The results demonstrated that more than 95% of nurses assume that the inclusion of infection prevention and control in the staff (including medical students) training programmes may address the causes of the outbreak, therefore help to promote good infection prevention and control in the NHS Trusts hospital. Wilson (2006) argues in his literature that effective interventions in the management of HAIs, would involve a behaviour change on its own, feedback on behaviour, ownership of the problem and personal growth from healthcare staff. As such training alone would not be enough. The research terms and choice of methods used by the researcher were appropriate as it provided the reader with a detailed understanding of the issues discussed in the study also can be used as a basis for future work. The Health Protection Agency (2006) reports that MRSA tops the list of HAI acquired in the NHS hospitals by 40% and in average 4000 patients develop this condition every year. The situation is so serious that the credibility and subsistence of NHS as an institution may be in jeopardy (Cooper et al, 2004, Marshall et al, 2004& Voss, 2004). In the UK the levels of MRSA in hospital has staggering arisen from 2% in 1990 to 42% in 2000, generating a major public health problem and a source of public and political concern (Hawker, et al., 2005). Such rise has been attributed to the appearance of new strains with epidemic potential, hospital patients who are vulnerable to infections and failure to sustain good hospital hygiene, including hand hygiene. Several studies of health professionals in hospitals fault the spread of antibiotic resistant infections to poor hand hygiene and decontamination among healthcare professionals (Sharek et al.2002, Ariello et al 2004). In the document ‘Wining Ways’ released by the DH (2003), it is clearly stated that hand hygiene is essential to reducing the exposure of patients to HAIs, therefore the responsibility remains with staff to  demonstrate high levels of compliance in hand disinfection protocols. However, improving compliance with hand hygiene remains a pressing patient safety concern (Lautenbach, 2001). The WHO (2009), developed a strategy known as â€Å"Five Moments for Hand Hygiene† to improve hand hygiene compliance among healthcare workers and to add value to any hand hygiene improvement strategy, also to educate healthcare workers about the benefits of effective hand washing correlated with the correct techniques and timing of hand hygiene. The strategy indicates that cleaning hands at the right time and in the correct way should be an indispensable element of care, and form an integral part of the culture of all health service, and any failure to address this issue in a satisfactory manner could be seen as a breach of the Code of Professional Conduct. As a result it may put in question the healthcare professional fitness to practice and endanger his/ hers registration (CDC, 2002; NMC, 2006). The CDC first released formal written guidelines on handwashing in hospitals in 1975, aiming to reducing the risk of infection in hospitals, though it is believed that the idea has been around long before that (JHI, 2006). The NICE (2004) and HPA(2004) guidelines proposes that effective hand washing techniques should involve preparation, washing, rinsing, drying and the sequence should take roughly 40 to 60 seconds. The preparation, involves wetting the hands under tepid water (hot water should be avoided as it increases skin irritation) before applying liquid soap to all surfaces of the hand. Then the hands must be rubbed together, paying particular attention to the tips of the fingers, the thumbs and areas between the fingers for at least 15 seconds. Finally, the hands should be rinsed thoroughly and the taps turned off by using the elbows to avoid recontamination. The hands should be pat dry with good quality paper towels which are therefore disposed of in a foot-operated bin (NICE, 2003). The above mentioned technique should be performed immediately, before direct patient contact or care (including aseptic procedures), after direct patient contact or care, after exposure to body fluid, after any contact with patient’s surrounding i.e. bed making, after touching wound dressings, handling medication, etc. Hand rubs or alcohol gel is part of the modern hand wash procedure. They are frequently used in between hand washing, as an alternative agent to water and soap or when hands are physically clean (i.e. not contaminated with organic matter or soil),  (Endacott, Jevon and Cooper, 2009). Alcohol gel/ rub should be applied in sufficient quantity to cover hands and wrists, as any surface that is not covered may leave contamination on the hands. The hands should be rubbed together briskly for approximately 10-15 seconds, until the hands feel dry. Hands should be washed with water and soap after every five applications of alcohol hand gel. Many campaigns’ and studies in hand hygiene clearly state the responsibility of healthcare professionals in the fight of infection prevention in hospitals, however sparse studies mention the involvement of patients in the combat of same. A study revealed that 70% of patients did not receive any information in hand hygiene or other information regarding infection control and prevention when admitted to hospital (British Journal of Nursing, 2007). Several literature highlight the fact that infection may be caused by the patient’s own microbial flora or acquired from other infected patient via the contaminated hands of those delivering care (A. Mears et al, 2008). A government document originally initiated in the NHS Plan (DH, 2002) to encourage the empowerment of patients through patient information, are correlated with the clinical governance strategy of engaging patients in partnership to improve care. This new concept will empower patients by allowing them to be involved in the management of their care (Duncason and Pearson, 2005), also in decision making powers between the patient and the healthcare professional (Henderson, 2003). Moreover, this newly acquired power by the patients will also empower them to be involved in monitoring and reporting on standard of cleanliness in hospital wards (DH, 2004). Additionally, Christopher Paul Duncan and Carol Dealey (2006) did a qualitative piece of research with the purpose to explore patient opinions about asking healthcare workers to wash their hands before a clinical procedure and assess if patients knowledge and awareness about infection risks they are exposed while in hospital would influence the patients’ anxiety about asking. The method used in the study to collect data was a semi-structure questionnaire designed to be used in a descriptive survey. Data collection involves the gathering of information for qualitative and quantitative research through a variety of data sources, for instance, questionnaires, observations, interviews, conversations telephone interviews, books, past researches or studies, books and documents including, public and private documents i.e. official reports or historical  documents to specifically target objective factors or interest (Mason, 2002; Rebar et al, 2011). There are two ways of collecting data: primary or/ and secondary sources. Primary sources are collected directly by the researchers themselves, whereas secondary sources are gathered through researches or studies published by others researchers. In this particularly study the initial semi-structured questions allows the researcher to gain an insight of the participant’s feelings about asking healthcare workers to wash their hands. Asking patients to ask staff to wash their hands might be challenging as there are ethical issues attached to it. Ethical issues are mainly concerned with a balance between protecting the right of participant’s privacy, safety, confidentiality and protection from deceit, whilst at same time pursuing scientific endeavour (I. Holloway, 2008). As it is outlined in the Nuremberg Code, some basic principles are to be reviewed for ethical appropriateness (Burnard, 2006). These principles include autonomy, beneficence and non-maleficence. Autonomy re fers to recognition that participants have the right to decide on a course of action or follow it. Meaning, the participant must have reasonable awareness of the nature of the research and its possible consequences, based on that they whether give or withhold consent. The patients must feel free from coercion. In the context of research, the researcher must maximise the benefit of the patients whilst minimizing harm (Gillon, 2003), in the sense of , it may cause distress to the patients to ask staff to wash their hands as this may affect the care they get, reason why the chance of benefit should always outweigh the chance of harm (beneficence). Gillon (2003) defines non- maleficence as the avoidance of doing harm or the risk of doing harm. However in the Nuremberg Code, is outlined that a minor harm may sometimes offset a greater good, i.e. patients ask staff to wash their hands might affect the relationship with staff, but staff will be aware that patients have a voice in their care and therefore wash hands prior to start caring for them, then benefit all others patients. Researchers are required to ensure that all participants have an equal chance of be included from a study or benefit from it results. It is unfair and unjust to excluded participants from the study because their race, colour, gender, age or so on (National Research Ethics Service (NRES), 2006). The questionnaire was dispersed to a randomized convenience sample of 224 inpatients to all department of an acute NHS Trust hospital.  Sample in qualitative research seek to identify participants who have experience with the phenomenon of the interest to the researcher and who will bring as much depth, detail and complexity to the study (Rebar et al, 2011). In this study the researchers chose to use a convenience sampling. Conveniences sampling the participants are readily available; though members of the sample may not be best respondents in the illumination of the research question (Newell and Burnard, 2011). The returned sample was 185 since some patients were too sick to answer and further 34 patients refused to participate. The study showed that 73 (71.6%) patients felt less anxious to ask staff to wash their hands before a clinical procedure if they were using a badge saying ‘It’s OK to ask’. Patients well-informed about infection risks to themselves while in hospital were more anxious to ask, although an explanation could not be found. Out of 184 patients involved in the study only 25 (25.2%) were given information about hand hygiene and infection prevention when admitted in hospital, as opposed to 74 (74.7%) of patients who were given no information. The findings go against the DH (2003), plan to involve patients in their care management, also inform the patients about health issues they may face while in hospital (NPSA, 2004; Duncanson and Person, 2005). Whilst the kind of sampling and data collection strategies used by the researchers were detailed and descriptions of personal accounts were given, a purposive sampling would have been more appropriated as participants would have been intentionally selected as they would have more characteristics related to the purpose of the research, hence would have more relevant things to say (Newell and Burnard, 2011) Additionally, interviews would have been better choice for collecting data and would fill the existing gap in the study. In conclusion, several studies links poor hand hygiene to the high rates of hospital acquired infections in NHS hospitals, yet insufficient evidence was supplied to enable a view to be taken on its potential contribution to reducing infection (A. Mears et al, 2009). More work needs to be done on hand hygiene, standards monitoring and education of healthcare professionals in the management and improvement of infection prevention and control in primary care practice (Wilson, 2006). Undoubtedly, adequate hand hygiene is the foundation for infection control activities, however there are still  several actions which NHS Trust hospitals can put in place to prevent and reduce the risks of infection, including the environment, infecting microbes and antimicrobial stewardship, patterns of healthcare and the patient treatment and diagnostic interventions (Patient Environment Action Team, 2005). Thus, the literature appraisal has highlighted the lack of the research in these areas.

Selecting, Developing, Managing and Retaining Knowledge Workers

Do HR departments have the right strategies to select, develop, manage and retain knowledge workers? As Peter Drucker recently quoted, the new knowledge economy will rely heavily on knowledge workers who are not, as a rule, much better paid than traditional skilled workers but also see themselves as professionals. Knowledge technologists are likely to become the dominant social and perhaps, political force over the next decades. Thus, it is very important to have the right strategies in place to select, develop, manage and retain knowledge workers. But before we proceed to analyze if HR departments do have these strategies, we need to understand what the term ‘knowledge workers’ means. A knowledge worker is one who works primarily with information or one who develops and uses knowledge in the workplace. In a knowledge-driven economy, a knowledge worker is oriented more towards research, analysis and manipulation of the symbols, as in information, rather than the mechanical tools. These individuals have domain knowledge expertise and may include broadly: architects, finance experts, graphic designers, fashion designers, pharmaceutical scientists, researchers, teachers, and policy analysts, to name but a few. In order to focus on strategically critical knowledge workers, it is necessary to move beyond merely creating a supportive culture or a best place to work. Top innovators understand their worth. These workers are independent and entrepreneurial, for instance like the originators of eBay, Google and Facebook. To keep such people, it is necessary to make them feel like they are building their own businesses within the larger organization. This can be achieved partly by recognizing their status as thought leaders but it is also important to give them a stake in the new lines of business they develop. The bottom line is that organizations need to view key talent as partners, rather than as employees or â€Å"resources†. The balance of power has shifted such that highly skilled innovators need to be seen as partners or they are gone. In the past, human resources, training, and labor relations managers and specialists performed the administrative function of an organization, such as handling employee benefits questions or recruiting, interviewing, and hiring new staff in accordance with policies established by top management. Their task was to attract, motivate, and retain the most qualified employees and match them to jobs for which they are best suited. Today the role of human resources workers is more than just managing these tasks, but, increasingly, that of strategic planning in consultation with top executives. They have moved from behind-the-scenes staff work to leading the company in suggesting and changing policies. Many organizations claim to have a commitment to developing their employees and phrases such as â€Å"our people are our most valuable assets† are often spotted on motivational posters in companies. In my opinion, however, very few companies embrace a structured approach to training and retention programmes. HR departments may claim to have several strategies to select, develop, manage and retain employees, but what is important is that the psychological contract, which is vital to building and sustaining a win-win relationship, needs to be reinforced. Research shows that several well-intended training and development initiatives fail to deliver the desired results. In fact, during economic slowdowns the budget which is often the first to be cut back on is the training budget. Adopting a structured approach to employee training and retention requires a change in mindset at the very top-level of the organization. The entire issue of staff retention needs to be treated in a strategic way and this is where most organizations lack. The first step in the development of an employee retention strategy is identifying the pinch points for the organization, the areas where the company regularly suffers from a high staff turnover and the particular concerns and problems of the targeted staff groups. It is also important to have a clear understanding of the expectations and aspirations of your employees; only then can you develop the strategies needed to meet some of these aspirations and begin to develop a workplace that is a great place to work and employees who see the company as a good company to work for. A good retention strategy should address issues such as:   support in the workplace, progression, opportunities for development, remuneration, working time, and flexible working. The focus should be on retaining existing talent and keeping the available organizational knowledge intact rather than searching for new talents. The key to success will be the integration of training and development within the retention strategy. Training and development provides the means of supporting staff to operate effectively and enabling staff to access the opportunities provided by the retention strategy. Levels of remuneration and flexible working will signal the right environment but it is through using training and development as a mechanism to demonstrate investment in employees on an on-going basis that will turn an organizational commitment into a reality. The techniques and processes that help new hires learn quickly are also the techniques and processes that help retain organizational knowledge. Knowledge sharing techniques such as communities of practice, mentoring, lunch and learn sessions, business process maps, expertise directories of staff are just as useful for retaining organizational knowledge as they are for fast learning by new employees. A good knowledge sharing technique should address questions such as ‘What does it offer me? ’ ‘What does it offer us? ’ ‘What does it offer to the organization? Once these techniques fill the personal and group learning needs of staff, they will also evolve to sharing strategic information. Techniques such as communities of practice can be HR's role in strategic information management for the organization. The success of an organization in its strategy will be judged ultimately by its success in engaging individuals in development activities, not in simply having them available. The key to success will be how relevant and appropriate the development activity is and how accessible it is to employees. It requires talent to retain talent. The successful employer of the future will be a keen competitor in the skills market. They will compete for the best recruits but not in terms of purely financial rewards but by offering them the best working experience, one that offers security as well as progression and personal growth. They will focus on retaining the available organizational knowledge and harnessing it to the maximum rather than on hunting for new talents.

The Meaning of Life Essay Example | Topics and Well Written Essays - 750 words - 1

The Meaning of Life - Essay Example This paper will analyze the views which were articulated by Richard Taylor and Susan Wolf. To begin with, it may be particularly important to examine the ideas of each of the above mentioned scholars. Thus, the former is known for developing the concept of meaning of life that is based on the principle of fulfillment (Taylor 24). In order to illustrate it, the author used the ancient myth of Sisyphus, pointing out that while the majority thinks that life of the latter is pointless, certain alterations of the point of view might actually make it quite full of meaning. According to this kind of thinking, a person is able to live a meaningful life as long as it fulfills one’s desires, expectations as well as idea of what live should look life. Returning to the articulated example, if Sisyphus had a strong desire to roll up large stone, then his life would be rather meaningful and enjoyable. Contrary to that, Susan Wolf developed a different understanding of what people should take into account while considering the meaning of one’s life. According to her, the principle of fulfillment is an essential one; however, the objective reality should be taken into account as well which results in the fitting-fulfillment principle (Wolf 25). The author argues that life of a person can be found to be full of meaning as long as it fulfills one’s desires, expectations as well as ideas, but also fits into a general context of the social environment. For example, life of Sisyphus can hardly be called a meaningful since despite the fact that it fulfilled his possible desire to roll up stone, it did not help the society in any way. A brief examination of the above mentioned views was able to highlight one fundamental difference in the approaches that were developed by the thinkers. Thus, on the one hand, the position of Taylor is purely subjective. In other words, he argues

America Needs A National Health Care System or Insurance Program Research Paper

America Needs A National Health Care System or Insurance Program - Research Paper Example Almost fifty million people lack health insurance, another one more million have problems in their payments, and they are deducted .Almost 45000 die each year for lack of treatment. The infant mortality rates and general death rates rise dangerously each year. This the main reason for the need for a national health care service. Americas lower life expectancy America has thus achieved lower life expectancy, it is evident because of unstable security because of use of lax gun and poor healthcare planning, the ranking of the American men is the lowest with 75.6years and their women 80.7 years, and many reports come from the National Research Council and Institute of Medicine. The major contributor to the lower lifespan in America is the lax gun rules (Lewis 83). The shooting at Sandy Hook Elementary school made the lax guns to cater for the blame. The many violent deaths that America experiences have led to the shorter life span in America. Another reason for the lowering of the lifesp an of Americans is the violent deaths that they experience. In every 100000 residents, the United States of America has six violent deaths. The report from the National Research Council and Institute of Medicine says that the united state should not ignore the deaths because they own a lot of money. According to researchers, America is the leading state in violent deaths. This may be because of ownership of guns by citizens. So many citizens own guns illegally. Despite the short lifespan caused by the violent deaths and lax guns security, the consumption of large amounts of calories by the Americans that causes diabetes and involvement in alcohol and many accidents also cause deaths. Consumption of many calories results to diabetes hence early deaths in the United States (Uradnik, Lori, and Sara 109). With the invention ARV’s, AIDS still shorten the lifespan of people, because ARV’S do not eliminate the disease, it just reduces. There are three major causes summed toge ther. This includes the health care system, bad behavior and social and economic factors. Results of American fragmented health care The keeping busy of the emergency rooms is a challenge that has taken long. A report has said that Americans that are un-insured, visit the hospital many times compared to the patients who are insured (Lewis 54). Out of the 354 million, only 42% doctors are there to attend to them, this concludes the fact that there is shortage of the doctors. Another study was in spite of having an increase in the use of MRI in the ER and CT. There is no any increase in the diagnosis of the life-threatening conditions. Doctors have reduced the use of hospitals by eliminating surgery, reducing high-priced diagnostic tests with no improving of the results, removing admissions for episodes that are a cute in chronic diseases and stopping the routine of using emergency rooms for primary care. Field argues that in the time when the admissions of patients will stabilize and the hospitals financed, the hospital must attain value of importance (Simmons 76). That will be time that the medical department will take its role to ensure the practice of provision of quality services, they will also locate niches where the hospital can also make savings and to work out ways in which virtual care is delivered. They would also invent organizations accountable for care and many more organizations that will help connect patients, payers, and the sponsors. It calls for

Mergers and Acquisitions as a Strategic Mean of Creating Value and Essay

Mergers and Acquisitions as a Strategic Mean of Creating Value and Maximizing Shareholder Wealth - Essay Example An Overview of Mergers and Acquisitions DePamphilis (2008 pp-04-06) defined mergers and acquisitions as a part of corporate and management strategies dealing with the buying, selling and combining of different organsiations having similar business activities or activities that can support the present and future growth and development in a systematic manner. Over the years, the distinction between mergers and acquisitions has become quite blurred in respect to economic outcomes but continues to attract organisations (Cartwright, Schoenberg, (2006 pp. 11-14). Studies have shown that 50% of acquisitions have been unsuccessful considering the complex process and different dimensions associated with the actual outcomes (Straub, 2007). Lazonick, O'Sullivan, (2008 pp-24-27) stated that the rationale behind mergers and acquisitions is based on the thought that two companies together can be more valuable and robust compared to two different companies. Moreover, mergers and acquisitions help i n attaining cost efficiency by sharing operational and functional costs along with thriving to achieve greater market share and efficiency in a planned way (Harwood, 2006 pp- 24-35) Relevant Theories Mergers and acquisitions can be linked with various relevant theories. ... behave and operate in a manner that leads to the creation of an identity that helps in the growth and development (Postmes, Branscombe, 2010 pp- 11-23). Mergers and acquisitions help in creating new identity for smaller organisations while helping in revamping the identity of large organsiations (Akerlof, Kranton.2010 pp- 04-11) Role Conflict Theory is based on the perception that individuals and organsiations experience role conflict by finding themselves pulled in various directions as per the status held by them (Tang, Chang, 2010 pp-13-21). Hitt, et al, (2009 pp-12-23) stated that mergers and acquisitions help in creating synergies between organisations that in turn help in enhancing the worth and value of organsiations. However, Straub (2007 pp-03-11) stated that value creation and wealth maximisation is dependent on the nature and relationships of organsiations. It can be said that both views are directed towards a positive relationship creating synergy and wealth maximisation but dependent on internal and external factors. Value destroying theory states that mergers and acquisitions fail because firms fail to address informational constraints and focus too much on private utility function that affects the overall value creation process of organsiations (Malmendier, Tate, 2005 pp- 24-32). Straub (2007 pp -23-45) also agreed to this statement and stated that mergers and acquisitions require proper assessment of internal and external factors to create value in the business environment. All these theories can be associated with other relevant theories such as SWOT, PESTEL, and Game Theory. Armstrong (2006 pp-24-34) stated that SWOT analysis is based on analysing the strengths, weaknesses, opportunities and threats of individuals and organsiations. Strengths and

Meuse-Argonne Offensive Research Paper Example | Topics and Well Written Essays - 1250 words

Meuse-Argonne Offensive - Research Paper Example The battle led to the stronghold of Allies with a loss of German’s on the Western front.   The European states vied together for power and military alliance. Britain, France and Russia from Asia formed a strong block. It was now a must for Germany to find a suitable alliance that could eliminate the danger of its extermination. Austria and Turkey were there for her. Then an incident, in the city of Sarajevo, made the European nations face a situation that the western philosophers feared for years. The assassination of Archduke Ferdinand and his wife Sophie led to hostilities between Serbia and Austria. The involvement of Russia and Germany on the side of Serbia and Austria, respectively, made the situation worse. Things became uncontrollable, as more and more countries began to get involved in the matter. On August 4, 1914, the German army marched into Belgium. As the war got fierce, more and more war fronts opened for Germany. With the beginning of revolution in Russia in 1 918, Germany deployed its freed troops on the western front. Using remarkable tactics of long wars, Germany gained many achievements and the French armies were then in retreat. The Germans had to face mines and military of the American Expeditionary Force at Belleau Wood, which slowed down its advancement. Meanwhile, the French army reformed its front, together with the British army. The whole area from the Meuse River to the top of the Mountains of Argonne was under a stronghold of the Germans. The presence of mines, camouflaged trenches, heavy artillery and a large number of German troops made this area a difficult battlefield for the Allies. The Argonne forest provided a good shelter to the Germans, where they could rest without the risk of being attacked. It was so because the area was lined by guns, mines and trenches and supported by artillery fire. There was no place, on the western front where the German army could think itself more safe and sound than the Argonne forest. Th is was probably the reason, for the Allies, to think the battle at this field as a decisive one. With a fresh American army on the southern flank of the western front, the Allies could now think of an offensive on the German troops in the Argonne forests. At 5:30 on the afternoon of September 26th, the American 1st Army jumped off with the French holding their flanks. The U.S. Army and the French 4th Army shared the Meuse-Argonne offensive which proved to be the biggest and the deadliest one for the American Expeditionary Force in the World War I. The French General Mariano Goybet, commanding the 157 Red Hand Division, indulged in the Meuse-Argonne offensive on 28th September. (â€Å"Meuse-Argonne Offensive†) 371 and 372 were two of his African American regiments. During the first nine days, the 372 regiment progressed through 4.8 miles of enemy defense. They captured 600 prisoners, 15 heavy guns, 20 Minenwerfers and about 150 machine guns. (â€Å"Meuse-Argonne Offensiveâ₠¬ ) The 372 regiment’s part was very important in the Meuse-Argonne Offensive. The regiment suffered total casualties of 500 men.

Operation and supply chain management Article Example | Topics and Well Written Essays - 1000 words

Operation and supply chain management - Article Example Operation management represents the advanced designs, operations and latest improvement in the organisation dealing with delivering of products and services. This article mainly focuses the authors’ view on the area of logistic that relates with the supply chain management theories. Efficiency of any operation frames the basic problem pertaining to the aspects of economics along with management (Lichocik and Sadowski 119-125). As far as the supply chain theories are concerned, issues associated with efficiencies basically reflects process being involved in logistic field. Lichocik (2013) has further focused on the logistic rules, which claims that activities being involved in the logistic area must be carried out in an effective manner. System structure, human resource and incentive systems are certain factors, which plays a significant role pertaining to efficiency. Furthermore, it has been observed that appropriate model which has been analysed, frames the basis for consider ing the logistic operations as effectual (Lichocik and Sadowski 119-125). ... Moreover, the authors have researched upon the numerous activities being undertaken by various industries. The outcome of the research reveals that an effective Supply chain incorporates certain vital factors. The supply chain being involved in delivering process must be cost–effective. In this context, it must ensure economic efficiency of a supply chain. Correspondingly, the supply chain process is being advocated to be functional, which can be achieved by reducing the processes being involved. In relation to the aforesaid scenario, it can be further analysed that effective lean management must frame an important part of the process (Lichocik and Sadowski 119-125). The authors have radically focused upon the importance of logistic outsourcing in recent scenario. It has been observed that maintaining a logistic potential ensures generation of fixed cost within the company irrespective of any prevailing market demand. The objective of the article basically relates with the eff iciency of the SCM. The authors have taken into consideration secondary resources for conducting the research study. They have considered various literatures related to SCM for conducting the research study. The results reveals about the various determinants of SCM. Furthermore, the findings also reveals about the cost-effectiveness and lean management as an important part of the SCM in the field of logistic (Lichocik and Sadowski 119-125). ARTICLE 2 The second article, â€Å"Use Of Sales And Operations Planning In Small And Medium-Sized Enterprises† written by Michal Adamczak, Roman Domanski and Piotr Cyplik focuses on the integration of planning process as an effective way for reducing prices of

In your opinion, and according to your own personal definition of Essay

In your opinion, and according to your own personal definition of feminism, how has feminism helped or hurt our society over the past thirty years - Essay Example last thirty years it has helped society by creating greater equality for women in the workplace, normalized their position in politics, and shifted general stereotypes. One of the most impactful areas in which feminism has benefited society is in the workplace. While by 1980 women had greatly left behind the entirely male dominated culture of the 1950s, one recognizes that there was still great disparity between men and women; much of which still exists today in lesser forms. Today, however, individuals such as Sheryl Sandberg, the Chief Executive Officer of Facebook, have made staggering contributions to the employment world. Additionally, salaries for women have increased progressively. Ultimately these changes benefit society in that more of our best and brightest minds can find equal access to employment and thus make contributions to the greater good. Another prominent area where feminism has contributed to society is in the political arena. Since 1980 there has been also an increase in the amount of women running and holding political office. While a woman still hasn’t been elected President or become Vice President of the United States it seems that feminism has greatly paved the way for this in the near future. One considers that the last Presidential election featured Sarah Palin as a Vice Presidential candidate. Additionally, for a period during the primaries Hillary Clinton was a front-runner for the Democratic nomination. Although it’s clear the country still has a ways to go before females gain complete equality in this arena, it seems that feminism has made significant contributions over the last thirty years. In addition to employment and politics, feminism has also been successful in changing stereotypes surrounding women. Women have received a large amount of criticism for being overly emotional and not implementing logic or rationality to the same extent as men. Such stereotypes have been used to oppress them in the workplace and political

Mohammed Daoud Khan Essay Example for Free

Mohammed Daoud Khan Essay The chapter begins where the last left off, Amir was left speechless after Hassan’s criticism. Before Amir could respond to Hassans criticism of his story, gunfire erupted outside. The boys huddled together with Ali until Baba came home. For the first time, Amir saw fear on his fathers face. He was even glad for the violence for a moment, because Baba held him and Hassan close. The events of that night, July 17, 1973, were a precursor to the end of life as Afghanis knew it. What would follow was the Communist coup detat of 1978, followed by the Russian occupation beginning in December of 1979. On that July night, the kings brother, Daoud Khan, had seized Zahir Shahs kingdom while he was away. Afghanistan had gone overnight from a monarchy to a republic. Tired of listening to the radio news, Amir and Hassan went to climb their favourite tree. On the way, a young sociopath named Assef and his friends confronted them. He taunted Hassan for being a Hazara; Assef also had a habit of taunting Ali, whom he called Babalu. He praised Hitler and then said that he wanted to finish what Hitler started and rid Afghanistan of Hazaras. He called Amir and Baba a disgrace to Afghanistan for taking in Hazaras. Just as Assef threatened to punch Amir with his brass knuckles, Hassan pointed his slingshot at the bully and threatened to take out his eye. Assef and his friends retreated, but promised to come back for Amir and Hassan later. On Hassans birthday, Baba summoned him to the house as usual to collect his present. To Hassan, Amir, and Alis shock, Baba had hired a plastic surgeon to correct Hassans harelip. Amir was jealous that Baba was giving Hassan such special attention. The surgery went well and Hassan could finally smile an unbroken smile. Ironically, Amir explains, it was soon after that Hassan stopped smiling for good.

Public Education Essay Example for Free

Public Education Essay Public education has been an important part of our country throughout history. After the Declaration of Independence, fourteen states had their own constitutions by 1791. Seven of those states had specific provisions regarding education. Thomas Jefferson was one of the first American leaders to suggest a public school system. He believed that education should be under the control of the government, available to all people regardless of their status in society, and free from religious biases. Before the 1840s, the education system was only available to the wealthy. However, many reformers wanted all children in the United States to receive the benefits of education. Two reformers, Horace Mann and Henry Barnard created the Common School Journal, which was a newspaper that brought the issue of education out into the public. Because of their efforts, free public education at the elementary level was available for children by the end of the 19th century. Throughout the 1900s, many schools were created due to increased demand for skilled workers. As the 20th century progressed, many states began to enact legislation requiring people to go to school, and enrollment soared. That is how our public education system got to where it is today. There are still many issues regarding our public education system, such as some areas teaching better than others, and some classrooms having better materials than others. Local and Federal governments have always been involved in schools, making sure that they teach to their full potential. There are many congressional bills that have been passed, and many that are fighting to be passed. A very important bill that is out there today is the Student Bill of Rights, or H. R. 1295. The Student Bill of Rights is a congressional bill regarding education. It was introduced on March 31st, 2011. It is sponsored by congressman Chaka Fattah. The Student Bill of Rights basically makes sure that schools are providing their students with a proper education. It especially helps the disadvantaged students. Disadvantaged means the students who are falling behind in academics, as well as the handicapped. It allows the secretary of education to annually determine whether each states public school system provides all its students with the educational resources they need to succeed academically and in life. The main idea of this bill is that it requires all education to enable students to acquire knowledge and skills necessary for responsible citizenship, meet challenging academic achievement standards, and compete and succeed in a global economy. It does this by requiring each educational system to satisfy certain criteria. One of the criteria is that the schools must satisfy certain Opportunity To Learn (OTL) indicators for all its schools, including effective teachers and resources. Opportunity To Learn indicators are strategies introduced several decades ago, and they are defined by a narrow set of instructions. Many educators and policy makers use the Opportunity to Learn concept, ensuring that all students receive an equal education, especially or disadvantaged and minority students. It helps schools, especially poor ones, educate all their students, and it makes the schools that are worse off a priority. Another criteria is that it provides educational services in local educational agencies (LEAs) that receive funds for disadvantaged students. There are local educational agencies that receive funds from the government and some that do not. Generally speaking, the ones that do not receive funds usually have a better educational program, because that educational agency has more money. This criteria makes sure that the educational services given to funded local educational agencies are equivalent to the educational services given to local educational agencies that do not receive funds from the government. This means that the schools that are better off will not get as much help as the schools that actually need help. This will make sure that the education that both these local educational agencies provide is similar. The final criteria is that it requires each educational system to comply with any final state or federal court order in any matter concerning the effectiveness or adequacy of the system. That means that the government will have the final say. So if a school feels that it is providing adequate education and the state feels that it does not, then the school will have to submit to the state and comply. This will make sure that all schools live up to the state and federal standards, ensuring that all students receive similar education. The Student Bill of Rights also allows students or  parents who are aggrieved by violations of this Act to bring civil actions for enforcement in federal district courts. That means that if students or parents feel that the educational system under the Student Bill of Rights does not meet those criteria and are violating the bill, then they are allowed to take this to court to ensure that the bill is not violated. The Student Bill of Rights also allows the federal government to withhold portions of an educational systems funding for administrative expenses. The criteria for this to happen is if the school fails to meet a yearly goal. Another criteria is if the school does not remedy a failure to provide educational services that are comparable to the services that other schools offer for disadvantaged students, after two years. This means that if there are violations and those violations are not fixed within two years, then the school will have funds withheld from them. The last criteria is if the school does comply with a court order. There are many pros and cons of this bill, but the pros will definitely outweigh the cons. There are two goals of every school, and that is to produce workers and create citizens. A pro of this bill is that it will make sure that schools are able to do this. It will make sure that schools are able to create a pool of workers with at least minimum competence and attitudes from which businesses can select employees from. This bill will help the disadvantaged learn many skills that are necessary to succeed in the working world. Those basic skills should be achieved by all students, as they are needed in most jobs. This will also increase the number of students meeting competence in basic skills, thereby increasing the pool of workers from which employers can select from. More students will have the opportunity to enter the work force, and the better ones will be selected, providing businesses with better workers. Keep in mind that opportunity doesnt mean that the students will get a job, it just means that they will have a chance to get it. That leads to another pro, which is competition for jobs. The competition for jobs allows businesses to get better workers and keep their wages lower, decreasing costs and increasing profits. However, this means that it may be harder for others to find jobs due to the competition. With more available workers in the workforce, there will be fewer available openings for jobs. So this bill actually helps the employers more than the workers, but it is still beneficial for all students. This bill will help schools create citizens because it will educate and teach many students the skills necessary to become productive citizens in our society. It helps students achieve personal excellence. It will nurture students to become adults who have the skills, attitudes, and knowledge to become productive community members, leaders, parents, and workers. It can help students identify their interests and abilities, help set goals for them, teach them responsibility and decision making, teach them how to work as a group, and make sure that every student reaches his or her full potential. This bill is fairly new. It was referred to the House Committee on Education and the Workforce, and it has yet to pass. There hasnt been much action on this bill. This bill would be very effective if passed because it will help many students, mainly disadvantaged ones, achieve their full potential. Congress, the White House, and the U.S Supreme Court hasnt done much for this bill, nor have non-profit or non-governmental organizations. However, if this bill is passed, the potential outcomes will be great. There will be many students that succeed as citizens and workers. The standard for learning will go up, and students will be more knowledgeable overall. Eventually, our society will become much more smarter in the future, raising the standard of living for all Americans. Our brains should be considered the most important part of our bodies, because if we all train our brains, the possibilities are endless!