Disease Specific Program

In this paper, we would be discussing the application of self-management concepts involved in improving the health and quality of life for people with chronic Diabetes Mellitus. Diabetes Mellitus is a complex disorder of carbohydrate, protein, and fat metabolism in which a relative or absolute insulin deficiency is the essential feature, Drury (1986). Diabetes is recognized as a model of broader based communicable disease control programs, WHO (1991 – 1998).The metabolic derangement is frequently associated with permanent and irreversible functional and structural changes in the cells of the body, those of the vascular system being particularly susceptible. The changes lead in turn to the development of well-defined clinical entities, the so-called ‘complications’ of Diabetes which most characteristically affect the eye, the kidney and the nervous system. Introduction It is not too distant past one of the critical tests of the skill of a nurse was the ability to m eet the needs of a patient with an acute infectious disease such as Typhoid fever or pneumonia.When the patient recovered, the nurse could rightly take credit for having made an important contribution. As infectious diseases have been brought under control, the incidence of chronic illness has risen so that they now account for a significant portion of morbidity and morality. Chronically ill patients often have a wider range of problems and need a greater variety of services than are needed to meet the needs of the acutely ill.Res ¬toration of the patient to optimum status and preven ¬tion of progress of the illness often demands the con ¬tinued efforts of the patient, family, nurse, physician, and other health and welfare personnel as well as the members of the community. With patients in whom progress toward recovery is slow and in whom control or prevention of the progression of disease is the goal rather than complete recovery, the nurse may not be able to see immediate re sults of her or his efforts. Instead of a relatively brief and intense relationship in which the patient is dependent on the nurse, the nurse often has a more or less pro ¬longed relationship.This relationship with the pa ¬tient changes from time to time, from dependence to independence to interdependence. To meet the needs of the patient, the nurse should be able to identify clues indicating the type of relationship best suited to the needs of the patient at a given time and to adapt her or his behavior accordingly. A Clinical Nurse Specialist (CNS) is described as an administrator, leader, manager, collaborator, practitioner, advanced clinician, consultant, educator and researcher (Wilson-Barnett, 1994; Dunne, 1997; McCarthy, 1996).Literature Review Today the test of the skill of the nurse is the ability to meet the needs of the chronically ill patient. If a single disease was to be selected as the modern day test of nursing knowledge and skill, diabetes mel ¬litus would und oubtedly receive many votes. There are many reasons that this is true. Diabetes mellitus has a relatively high incidence. It affects all age groups. Its complications are many and serious. There are, however, effective means for its detec ¬tion, diagnosis, and treatment.With modern methods of therapy, persons with diabetes mellitus can live almost as long as those who do not have diabetes. Even more important, they can have full and useful lives with few restrictions on their activi ¬ties. Persons with diabetes mellitus have been Rhodes scholars, mountain climbers, hockey players, television stars and statesmen. They marry, bear and rear children, and can lead successful, vigorous, productive, lives-a far cry from the predictable fate of the diabetic before the era of insulin therapy. The nurse is always concerned about the epide ¬miology of disease.Understanding the distribution and dynamics (epidemiology) of a disease serves as a basis for meeting objectives of disease detec tion and for education of patient, family, and community. Because diabetes and other chronic diseases are not reportable, they are not subjected to the type of surveillance used for communicable diseases. As sur ¬veys and techniques of detection and diagnosis im ¬prove, reporting will increase and it may be possible to identify and to improve preventive measures.According to the 1975 National Health Interview Survey, a rate of 20.4 per 1,000 population or an estimated 4. 8 million persons in the United States reported diagnosed dia ¬betes. Between 1965 and 1975, the prevalence of diabetes increased by 50 per cent in the United States (Guthrie & Guthrie, 2002; Flarey & Blancett, 1996). There is some question if there is a true in ¬crease in the frequency. The data may represent an increase in recognition due to increased use of automated blood chemistry laboratory techniques.Diabetes mellitus occurs in all age groups and in both sexes. The prevalence rate increases with age, from 1.3/1,000 (1 in 77) for persons under 17 years of age to 78. 5/1,000 (1 in 12) in persons over the age of 65. Diabetes is reported more frequently in females (2. 4 per cent) than in males (1. 6 per cent). Females have a prevalence rate of 24. 1/ 1,000. This is a 50 per cent increase from 1965 data when it was 16. 1 /l, 000. The prevalence rate for males is 16. 3/1,000. The most dramatic changes in preva ¬lence of reported diabetes is the increase of diabetes in nonwhites under the age of 45. This group has a percentage change of 150 per cent.Non ¬whites are 20 per cent more likely than whites to have diabetes (Dunning, 2003). Incidence is the frequency of new cases of a disease developed during a specified time period. In 1963, 17 years after the first Oxford study, 65. 7 per cent of the residents aged 34 to 55 years who lived in Oxford during the first study were re ¬studied. The percentage of diabetics was found to be the same in the second as in the first study (O†™Sulli ¬van, 1969). In the 1930s and 1940s there was marked improve ¬ment in the life expectancy of diabetics. Since that time, there has been little improvement.This may be due to the fact that Diabetes patients are living long enough to develop the more dangerous concomitants (Kessler, 1971). Reasons for failure to prevent the concomitants of Diabetes are one of the problems being studied intensively today. The Management of Diabetes Mellitus The ideal treatment for diabetes would allow the patient lead a completely normal life to remain not only symptom-free but in positive good health, to achieve a normal metabolic state, and to escape the complications associated with long-term diabetes.Nowadays diabetic patients rarely die in ketoacidosis in any number, but the major problem which has emerged is the chronic invalidism, due to disease of both large and small blood vessels, of many of those whose duration of life has been extended. It is well known that diabetics show an i ncreased propensity to fall due to visual impairment and neuropathy, as well as foot problems (Wallace et al, 2002; Keegan et al, 2002) and presumably accelerated cognitive decline (Gregg et al, 2000).Data from clinical studies strongly suggest that although genetic factors affect the susceptibility to develop complications, the incidence of serious retinopathy is related to the degree of diabetic control achieved (Clark & Cefalu, 2000). It is therefore incumbent on all those who are involved in looking after diabetic patients to strive in every way to achieve as good control as is practicable in terms of blood glucose concentration. The management of diabetes demands a broad range of professional skills, which include communication, counseling, leadership, teaching and research to name but a few.The Diabetes Nurse Specialist has the expertise and specialist knowledge to incorporate these skills into practice and so develop standards of care that benefits the patient (Daly, 1997). T he Diabetes Nurse Specialist (DNS) plays a pivotal role within a multidisciplinary team. The recognition of the contribution of the Diabetes Nurse Specialist in helping patients achieve good diabetes control highlights his/her essential role in diabetes care, (DCCT,1995; UKPDS, 1998). Metcalfe (1998) states that a Diabetes Nurse Specialist works in collaboration with a team to ensure continuity of care, lends towards more successful management.Types of Treatment There are three methods of treatment, namely diet alone, diet and oral hypoglycemic drugs and diet and insulin. Each obliges the patient to adhere to a life long dietary regimen. Approximately 60% of new cases of diabetes can be controlled adequately by diet alone, about 20% will need an oral hypoglycemic drug and another 20%, mainly younger patients, will require insulin (Long, et al, 1995). A patient may pass from one group to another – temporarily or permanently. Role of the Nurse in Prevention and DiagnosisNurses have numerous opportunities to assist the identification of persons who either have diabetes or are potential diabetics. The CNS is prepared beyond the level of a generalist (The Report of The Commission on Nursing, 1998). Review of the etiologic factors gives the nurse clues as to the target populations. In addition she or he, regardless of the field of practice, must always be alert to the signs and symptoms of diabetes. Any individual with symptoms suggesting diabetes mellitus should be encouraged to seek medical attention. The Suspicion of the school nurse should be aroused when a child develops polyuria and polydipsia.The public health nurse who visits in the home should be alert to the possibility of diabetes in family members. Some patients are discovered to have diabetes after they are admitted to the hospital. Most hospitals have a rule that before a patient can undergo any type of surgical procedure, the urine must be checked for glucose. The nurse can also assist in commu nity screening programs. In addition to opportunities for the nurse to participate in programs for the identification of persons who have diabetes mellitus, nurses have a role in the prevention of the disease.Because of the frequency with which diabetes in the middle-aged person is associated with obesity, individuals are encouraged to avoid overweight by diet and exercise. The preventive aspects related to genetic counseling are less clear. Persons with diabetes or persons with families in which there is a known history of diabetes should be acquainted with the risks involved when planning marriage. Psychological Aspects Fink (1967) has proposed a model of the processes of adaptation to stressful situations. He proposes that psychological phases follow a sequential pattern as follows:Stage 1: Shock; in this phase the person's cognitive structure is characterized by disorganiza ¬tion. There is inability to plan or to reason. Stage 2: Defensive retreat characterized by denial. Stag e 3: Acknowledgment, giving up the past, and starting to face reality. Stage 4: Adaptation, acceptance. of the modification in health. Planning to care for self and to prevent complications. When a person learns that he or she has diabetes mellitus, even when its presence was suspected, he or she experiences disbelief and then grief. The degree of shock will depend on the individual and what the diagnosis and treatment mean to him or her.Any preexisting problem can be expected to be intensified. The pa ¬tient and family can be expected to react to knowl ¬edge of the diagnosis as they do to other crisis situa ¬tions in life. The patient compares dia ¬betes with health and prefers health. The nurse can usually be of more help to the patient if she or he can help in identifying and expressing feelings rather than telling the patient how lucky he or she is. During the period immediately following diagnosis, the patient and family require psychological support. This should start with the patient’s admission to the office of the physician, to the clinic, or to the hospital.The type and amount of support will vary with each individual. Both the patient and family have a right to expect professional personnel to try to understand their feelings and to accept their behavior as having meaning (Otong, 2003). The nurse should try to convey to the patient that, while understanding or trying to understand his or her feelings, the patient will be able to learn to do what must be done and will be provided with the necessary assistance. Control of Diabetes Mellitus Successful management of diabetes mellitus depends on the intelligent co-operation of the patient and the family.Unlike recovery from an acute infectious disease, recovery from Diabetes does not follow a period of acute illness. Diabetes Mellitus is permanent. Remissions can and do occur, but even these patients should not think of themselves as cured. The fundamental methods used in the treatment are diet, insulin or hypoglycemic agents, exercise, and education. The continued management and con ¬trol of diabetes mellitus depend on the patient. Edu ¬cation as to the nature and behavior of the disease is required so that the patient understands the rea ¬sons for what he or she must do and develops the skills required for it.Diet The keystone for management of the diabetic is dietary control. In most respects the goals of the diet for the diabetic patient are similar to those for the non-diabetic. They are to provide sufficient calories to establish and maintain body weight. The number will vary with the age, sex, body size, activity, and growth and development requirements along with an adequate intake of all nutrients, including minerals and vitamins. Modifications in amounts and types of foods as required in the control of complications of diabetes and other diseases.Meal spacing so that absorption coincides with peak levels of insulin in the blood and protects from hypog lycemia during the night. For patients on intermediate-acting insulin, food is usually dis ¬tributed in five meals-three main meals with a small meal about 4 P. M. and another at bedtime. For the patient who is taking insulin, it is essential that a regular meal schedule be observed. Integration of exercise and diet with medications is essential. Most diabetic diets contain 50 to 60 per cent carbohydrates with 10 to 15 per cent in the form of Disaccharides and monosaccharide.Fats should comprise no more than 35 per cent of the total calories. The remaining calories are protein (Arky, 1978). Patients are encouraged to select unsatu ¬rated fats as recommended by the American Heart Association. Concentrated sweets and refined sugars should be avoided. Insulin Treatment with exogenous insulin is indicated in the following situations: diabetic ketoacidosis, juvenile diabetes, diabetes developing before the age of 40, unstable diabetes, oral hypoglycemic failure, diet therapy failures , and during stress of pregnancy, infections, major surgery.For the ketosis-prone individual and the unstable adult an exogenous insulin supply is always required. For the others it may be an intermittent requirement (Bonar, 1977) that is required during periods of stress. In the non-diabetic, insulin is released in response to food intake. The beta cells have the ability to release approximately 40 units daily, and there are another 200 units stored for emergency (Ellenburg et al, 2002). The diabetic does not have an endogenous supply, and an exogenous form is provided. Various types of insulin preparations have been developed.They fall into three general categories: fast-acting (regular and semilente), intermediate (NPH and lente), and long-acting (PZI and ultra lente). The actions of each preparation vary as to time of onset, duration of action, and peak activity time. Hypogly ¬cemic reactions are most likely to occur at time of peak action. Regular insulin is the only form giv en intravenously, and it has a clear appearance. The other insu ¬lin preparations have a turbid appearance. Each type of insulin comes in three concentrations; U-40, U-80, and U-I00. This refers to the concentration of insulin per milliliter.U-40 has 40 units per ml, U-80 has 80 units per ml, and U-100 has 100 units per ml. Syringes are specially calibrated for each concentration. Eventually, the only concentration available will be the U-100 strength (Joshu, 1996). This will decrease confusion and cut down on errors. The objective of insulin therapy is to enable the individual to utilize sufficient food to meet nutri ¬tional needs and, within limits, the desire for food. For many patients this objective can be achieved by a single injection of protamine zinc insulin or one of the intermediate-acting insulin, either alone or in combination with crystalline insulin.The ideal preparation of insulin would be one in which the insulin is released in response to hyperglycemia. At this time there is no such preparation. Persons who require less than 40 units of insulin per day often do very well on a single injection of Protamine Zinc Insulin. Insulin-Equipment and Administration The patient must know the type of insulin, concen ¬tration (U-80, U-100), and the prescribed dosage. It is essential that the appropriate syringe be used for the insulin concentration prescribed.Diabetic pa ¬tients on insulin may use either disposable or reusa ¬ble syringes. The former are used one time only and then discarded. Patients find them highly desirable because they do not require sterilization. Although minimal, cost may be considered a disadvantage. If reusable syringes and needles are used they should be sterilized by boiling before each injection. Boiling is simplified by placing the separated barrel and plunger of the syringe and the needle in a metal strainer. The strainer is placed in a saucepan of cold water and boiled for 5 minutes.When the syringe is removed fro m the water, care should be taken not to contaminate any part of the needle or syringe that comes in contact with the insulin or is intro ¬duced into the patient. When the syringe and needle are kept in alcohol, the alcohol container should be emptied, washed, and boiled at the time the syringe is sterilized. Before the syringe is filled with insulin, alcohol should be removed from the barrel by mov ¬ing the plunger in and out of the barrel a number of times. The skin over the site of injection should be clean, and just before the injection is made, it should be cleansed with alcohol.The hour at which the patient takes the insulin will depend on the type of insulin, the severity of the diabetes, when blood sugar is highest, and the practices of the physician. The most common time is 20 to 30 minutes before breakfast for patients re ¬ceiving one injection a day. Modified insulin con ¬taining a precipitate should be gently rotated until the sediment is thoroughly mixed with th e clear solu ¬tion. Vigorous shaking should be avoided to prevent bubble formation. Insulin, though usually called a protein, is a poly ¬peptide and is digested in the alimentary canal. It must therefore be administered parenterally.The usual method is by subcutaneous injection into loose subcutaneous tissues. Because daily, or more fre ¬quent, injections are required over the lifetime of the individual, care should be taken to rotate the sites, so that one area is not used more often than once each month. Conclusion The nurse has major responsibilities in the care of the diabetic patient. She or he must provide instruction, guidance and understanding for the control and management of the condition. The nurse must be prepared to provide nursing care for the patient if acute or chronic complications should occur.Last but not least, the nurse must recognize that the diabetic is not exempt from other diseases. She or he must be prepared to evaluate the impact of a concurrent illn ess on the diabetes and the impact of the diabetes on the concurrent illness. The sick diabetic has all the problems of any person who is ill and they are compounded by the diabetic state. The special needs of the diabetic must be recognized and met. The nurse who assists in the care of the diabetic patient has the satisfaction of knowing that the quality of life of the diabetic can be improved by intelligent nursing care. References Arky, R.A. 1978. â€Å"Current Principles of Dietary therapy of Diabetes Mellitus,† Med. Clin. North Am., 62, 655-62. Bonar, J. 1977. Diabetes: A Clinical Guide, Flushing, N.Y.: Medical Exam Publishing Co, pp.20-22. Clark, Nathanial Goodwin & Cefalu, William T. 2000. â€Å"Medical Management of Diabetes Mellitus,† CRC Press. Daly F. 1997. â€Å"The Role of the Diabetes Nurse specialist,† Irish Medical times, 14(17), 18. Diabetes Control and Complications Trial (DCCT). 1995. â€Å"Annals of Internal Medicine,† 122: 561-568. Drury. 1986. â€Å"Diabetes Mellitus,† 2nd Ed, Blackwell & Scientific Publications. Dunne L.1997. â€Å"A literature review of advanced clinical nursing practice in the United States of America,† Journal of Advanced Nursing, 25: 814-819. Dunning. 2003. â€Å"Care of People with Diabetes: A Manual of Nursing Practice, p.65-69.† Ellenberg et al. 2002. â€Å"Ellenberg and Rifkin's Diabetes Mellitus,† McGraw-Hill Professional, p.82. Fink, SL. 1967. â€Å"Crisis and Motivation: A Theoretical Model,† Arch. Phys. Med. Rehab., 592–97. Flarey, Dominick L & Blancett, Suzanne Smith. 1996. â€Å"Case Studies in Nursing Case Management: Health Care Delivery in a World of Managed Care,† Jones and Bartlett Publishers. Gregg et al. 2000. â€Å"Is diabetes associated with cognitive impairment and cognitive decline among older women?† Study of Osteoporotic Fractures Research Group, Arch Intern Med, 160:174–180. Guthrie, Richard A & Guthrie, Diana W. 2002. â€Å"Nursing Management of Diabetes Mellitus: A Guide to the Pattern Approach,† Springer Publishing. Joshu, Debra Haire. 1996. â€Å"Management of Diabetes Mellitus: Perspectives of Care across the Life Span,† Mosby, 2nd ed. Keegan et al. 2002. â€Å"Foot problems as risk factors of fractures,† Am J Epidemiology, 155:926–931. Kessler, IJ. 1971. â€Å"Mortality experience of diabetic patients,† Am.J.Med., 51, p.724. Long, Barbara C et al. 1995. â€Å"Adult Nursing: A Nursing Process Approach,† Elsevier Health Sciences. McCarthy. 1996. â€Å"Advantages and Disadvantages of Specialism in nursing,† Paper presented to An Bord altranais Conference, Continuing Education for Nurses. Metcalf L. 1998. â€Å"Ensuring continuity of care for diabetic patients attending hospital,† Journal of Diabetes Nursing, 2(5):135-138. O’Sullivan, JB. 1969. â€Å"Population re-tested for diabetes after 17 years: New Prevalence Study,† Diabetologia, 5:4, 211-14. Otong, Deoborah Antai. 2003. â€Å"Psychiatric Nursing: Biological and Behavioral Concepts,† Thomson Delmar Learning. Report of the Commission on Nursing. 1998. â€Å"Government Publications,† Section 6.33, page 105. United Kingdom Prospective Diabetes Study (UKPDS). 1998. British Medical Journal 317(7160): 703-713. Wallace et al. 2002. â€Å"Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer,† Diabetes Care, 25:1983–1986. Wilson-Barnett J & Beech S. 1994. â€Å"Evaluating the Clinical Nurse Specialist: A review,† International Journal of Nursing Studies, 13 (6): 561-571. World Health Organization Publications.1991-1998.

My Scary Experience

Seven months ago, in Pan Rang, Vietnam I took a scary experience for a herd of mice at my house. Those happened with my mother, my sister and me. First, my mother, young sister and I heard noises above the ceiling and the kitchen. Then, we were finding them, and I discovered the black chits on the corners, floors and in the pans in kitchen. Moreover, my little sister found a pink baby mouse lying on the toilet, and she said that:† It's so cute†. That which I couldn't stand and I felt them really terrible. We told our mother and cleaned all of them.Next, in the morning, my little sister and I set the mouse traps and glue- boards in the corners around inside house, at holes in front of the door and on the cooking- stove. However, we thought the difficulty things to catch all of them that mice living on the ceiling, and they moved down on the pipes. Also, they went on the walls and went down many different ways. On the other hand, mice were the smart animals so we were hard to deal with them. In addition, my mother saw a lot of mice In the traps and some struggling on the glue- boards.Then, she told my young sister and me put them under sunshine, which made them die, and brought them to the garbage. I wore rubber gloves and I must hold their stomach to take them away glue. If some were alive, I could feel them move and breathe. In fact, I was so scary and seemingly, I could cry right away. That herd of mice was decreased. However, we moved to another house. My mother, my young sister and I absolutely had a scary experience about finding and catching mice but we calmed down and found the good ways to work around. No matter what happens to another, I will be ready to face and derive valuable experience.

Policy Analysis on Dementia Care

Abstract The policy ‘Improving Care for People with Dementia’ aims to increase diagnosis of dementia, improve health and care services in hospitals, care homes and communities, create dementia-friendly communities and widen research on dementia care. This brief aims to analyse only the aspect of improving health and care services in communities and the patients’ homes and relate this to the district nurse’s role of bringing care to the patient’s home and community. With an ageing population, the London Borough of Hackney, and the rest of the UK, is experiencing increased incidence of dementia. The costs associated with dementia care are approximately ?23bn annually in the UK. As a district nurse, this policy is important since it seeks to improve the care received by patients in community settings or their own homes. My caseload demonstrates a disproportionate number of patients suffering from dementia and the resources channelled to their care. Dementia is a chronic and complex condition and requires interventions from different health and social care professionals. However, informal carers bear most of the burden of caring. As a district nurse, I have to address the patients and the carers’ needs. Patients need to receive interventions to improve their nutrition, health and wellbeing. Carers need to receive training on how to feed their patients, ease their anxiety, regulate their sleeping habits or improve their mobility and independence. Meeting all these needs require additional training and collaboration between the district nurses and other health and social care professionals. The Department of Health and the Royal College of Nursing have a cknowledged the district nurses’ role in meeting the needs of patients with dementia in hospital settings. These nurses are tasked to prevent admission of patients and promote positive experiences for families during end of life care. However, the politics and economic context of this policy could all influence the care received by the patients. Ethics also play a role in delivery of care. The state’s apparent withdrawal of minimum service and delegating most of the task to home care could have ethical implications. Safeguards to quality care most commonly seen in wards or hospitals are missing in home care. This might do more harm for the patient than good. However, district nurses still have to weigh if choosing to provide care at home would be more beneficial for the patient or otherwise. Finally, this brief shows that community care for patients with dementia is possible if district nurse teams are dedicated and the workforce increased to respond to the increasing workload. Introduction The Department of Health Public Health Nursing (2013) has recognised that care for patients with long-term conditions often continue in their own communities and in the people’s homes. This type of care would require sustained relationships with district nurses (DN), who are responsible for managing the patient’s healthcare conditions. This brief aims to critically analyse the policy Improving Care for People with Dementia (Department of Health, 2013) and will relate this with the Department of Health Public Health Nursing’s (2013) Care in Local communities- District Nurse Vision and Model. The Department of Health Public Health Nursing (2013) has acknowledged that this new vision is a response to the growing needs of the ageing population in the UK. Specifically, it has recognised the growing incidence of dementia amongst the elderly population and this vision sets out the contribution of DNs and other healthcare teams in meeting the challenge of dementia. The first part of this brief justifies the choice of this policy and the focus on dementia care. A community in Hackney is chosen in this brief to represent my nursing caseloads of dementia. The second part discusses political, economic and philosophical context of the policy. The third part critically appraises the ethical and moral implications of this policy for practice. Policy on Dementia Care and the Community of Hackney With an ageing population, the London Borough of Hackney, like the rest of the UK, is faced with a rising incidence of the long-term conditions associated with old age (Office for National Statistics, 2013). According to the Alzheimer’s Research UK (2013), more than 820,000 elderly individuals are affected by dementia. The rate of dementia in Hackney is four times higher than that of the general population’s rate (Public Health England, 2013). In 2010, approximately 1,350 elderly people were living with dementia in Hackney (NHS, 2012). This policy aims to increase diagnosis rate, improve health and care services in hospitals, care homes, communities and homes, create dementia-friendly communities and widen research on dementia care. This brief will only focus on improving health and care services in communities and homes and relate these to the DNs role in providing care to patients in their own communities and homes. Implications of the Policy on Current Practice The policy on dementia care has an important implication in my practice as a district nurse. Providing holistic interventions to improve the quality of care in community settings require collaborative efforts of health and social care professionals (National Collaborating Centre for Mental Health, 2007). As a district nurse, I take the lead in provision of healthcare in community settings. On reflection, patients with dementia have complex needs that require collaborative care from nurses, physical and occupational therapists, dieticians, social care workers and other healthcare professionals. My role extends from planning care to coordinating care with other professionals. The King’s Fund (2012) explains that multidisciplinary teams are needed to provide quality care to patients. However, the quality of care could be affected if there are fewer nurses caring for patients. I observed that the number of registered nurses in my practice is declining. This observation is similar in a survey conducted by the Royal College of Nursing (2011), which reported that almost 70% of district nurse respondents claimed that registered nurses in their staff have dropped out. In my current caseload, a third of my patients in our team suffer from dementia. The incidence of dementia in Hackney is four times higher compared to the UK’s average (Public Health England, 2013). However, due to the nature of the condition, the care of this group of patients requires a disproportionate amount of time and resources. One of the duties of DNs in addressing the policy on dementia care is to ensure that carers also receive appropriate support. Carers have the right to h ave their needs assessed under the Carers and Disabled Children Act 2000 (UK Legislation, 2000). In my experience, CBT has been show to be effective not only in reducing anxiety in my patients but also depression in the carers. It has been shown that joining support groups has been associated with reduced incidence of depression (NICE, 2006). Implications of the Policy on Future Practice With the increasing focus on community care, there is a need to strengthen the district nurse workforce. Based on my experiences and observation, the quality of care could be compromised due to the decreasing number of DNs (Queen’s Nursing Institute, 2010). There is increased pressure to provide quality care at the least cost and with reduced number of nurses (Queen’s Nursing Institute, 2010). Establishing a therapeutic relationship is difficult when the continuous decline of healthcare workforce in the community is not addressed. Sheehan et al. (2009) argue that a positive relationship between healthcare professionals and the patient is needed in order to make healthcare decisions that would dictate the future of the patient. Based on these observations, the policy on dementia care would require additional workforce of registered nurses who would be willing to work in community settings. At present, the issue of sustainability of the DN workforce in meeting the present and future demands of elderly patients has been raised (Royal College of Nursing, 2013, 2011). Unless the issue of reduced workforce is not addressed, meeting the demands of the dementia policy would continue to be difficult. The policy would also require additional education and training for nurses. The Royal College of Nursing (2013) has acknowledged that the present DN workforce is highly qualified. Many have met the qualifications of nurse prescriber or district nurse while the rest of the staff either have completed qualifications for nursing first or second level registration or at least hold a nursing degree. However, the Royal College of Nursing (2013) also notes that the workforce number is still low. A small workforce could not adequately meet these needs. Further, the ageing population in the UK would mean that the NHS would continue to see a rise in the incidence of dementia in the succeeding years. The issue of recording performance data is also raised with the recent policy on dementia care. This would be a challenge since a community or a home does not present any safeguards commonly found in a controlled environment such as wards in hospital settings (Royal College of Nursing, 2013). There is also a need for DNs to be trained on how to give education and training to caregivers. In a systematic review conducted by Zabalegui et al. (2014), suggest that the quality of care of patients with dementia living at home could be improved if caregivers receive sufficient education and training from healthcare providers. Political, Economic and Philosophical Context The Alzheimer’s society (2014) states that in the UK, approximately ?23 billion is spent annually to manage patients with dementia. However, the same organisation is quick to observe that a large portion of this cost is borne by carers of the patient rather than social care services or the NHS. To date, there is only one study (Alzheimer’s UK, 2007) that investigated the cost of managing patients with dementia in community settings. The report shows that in 2007, the cost of managing one patient with mild dementia within one year in a community setting amounts to ?14, 540. For an individual with moderate dementia, the annual cost is ?20,355. This increases to ?28,527 for a patient with severe dementia. If a patient is sent to a care home, the annual cost of managing the condition amounts to ?31,263. It should be noted that all these costs were calculated almost 7 years ago. The individual cost of treatment is now higher. The same survey also shows that majority of the costs of dementia care is channelled to the carers. However, these costs do not account for the informal carers. Alzheimer’s UK (2007) estimates that the number of hours informal carers devote to caring run up to 1.5bn hours each year. This translates to ?12bn in cost, which is higher than the combined health and social care cost for dementia. Patients with severe dementia living in their homes or communities need at least 46 hours of paid carer support within a week (Alzheimer’s UK, 2007). However, the changing dynamics of families, with children living far from their parents or loss of spouse due to divorce or death could limit the pool of family carers. This issue could all influence the impact of the service provided by informal carers of dementia. The ageing population of the UK (Office for National Statistics, 2013) could further drive up the cost of caring for patients with dementia. The policy on dementia care increasingly depends on homes and communities to support the care of patients with dementia. Since many informal carers manage patients with dementia, the burden of caring is now channelled to the patient’s family. The main stakeholders then for this policy include informal carers, patients, DN staff and multidisciplinary team. This increasing reliance on home care and management could even be viewed as a strategy of the NHS to reduce the cost of caring for patients with dementia. There is also a concern on whether the quality of care is maintained at home, especially with fewer DNs supervising the care at home. Apart from the economic cost, politics could also influence DN practice. As with other policies, the policy on dementia (Department of Health, 2013) bring care close to home and care at home. These gradual changes are projected to empower patients, lower costs of healthcare while empowering communities to take care of their own health (Department of Health, 2013). The withdrawal of the state in providing minimum services for patients with dementia in favour of care at home should be evaluated on whether this would cause harm to the patient. If care at home would be possible with supportive carers, my role as a DN would focus on coordinating care with other healthcare professionals. However, if the patient does not receive sufficient support, the Mental Health Act 2007 (UK Legislation, 2007) mandates the appointment of a carer for the patient. The consequences of the political context of moving care closer to home for patients with dementia would be felt in the succeeding years. On re flection, making this policy work would require DNs to provide adequate support to the informal carers. The philosophical underpinning of this policy focuses on tackling health inequalities. Social determinants of health (NHS, 2012) have long known to influence the health outcomes of many individuals. In the London Borough of Hackney, incidence of dementia is higher amongst the older black elderly compared to the general white population (Office for National Statistics, 2013; Public Health England, 2013). Yaffe et al. (2013) argue that genetics do not account entirely on the disparity of incidence between black and white older populations in the UK. Instead, Yaffe et al. (2013) maintain that socioeconomic differences appear to have a greater influence on the higher incidence of dementia amongst black older people. Related risk factors for dementia such as poorer health, less education and literacy are higher in the black elderly and might account for the variation in dementia incidence. A number of earlier studies (Haas et al., 2012; Thorpe et al., 2011) have pointed out the relationsh ip between socioeconomic status and cognitive outcomes. The dementia policy not only brings care closer to home but also addresses socio-economic disparities of patients with dementia by allowing DNs to provide care in home settings. However, this is still challenging since carers and family members would provide care on a daily basis. The limited financial capacities of families with lower socio-economic status could have an effect on the nutritional status and physical health of the patients (Adelman et al., 2009). It has been stressed that poor nutrition and health could increase the risk of cognitive decline (Adelman et al., 2011). Ethical and Moral Implications of the Dementia Policy for Practice Approaches to ethics include the Deontological approach, Justice, Virtue and Consequentialism. Fry (2010) explain that in deontology, individuals should perform an action because it is their duty to do so regardless of the consequences of the action. The Dementia Policy in the UK is underpinned by ethical approaches. Using deontology, it is moral for nurses and carers to provide care for patients with dementia. In rule-deontology, decisions regarding the care of patients become moral when these follow the rules. Fry (2010) emphasise that the actions of individuals following deontology is usually predictable since it follows set of rules. A second approach to ethics called the Results of Actions (Fry, 2010) is opposite to deontology. In this ethics approach, an action becomes moral when its consequences produce more advantages for the patient than disadvantages. The third approach to ethics or the virtue approach states that there is an ideal that should be pursued by individuals in order to develop their full potential (Jackson, 2013). This approach is more encompassing than the deontological approach since it seeks to make a person moral by acquiring virtues. A review of the policy reveals that the virtue approach is followed since it seeks to provide holistic care to the patients. The policy emphasises providing psychological, social and emotional support not only to patients but also to their carers. Meanwhile, Beauchamp and Childress (2001) have set out four principles of ethics. These are autonomy, non-maleficence, beneficence and justice. The Nursing and Midwifery Council’s (NMC, 2008) code of conduct has stressed that patient autonomy should always be observed in all healthcare settings. A review of the dementia policy reveals that allowing patient’s to be cared in their home settings would likely increase patient autonomy. Patients in the early stages of dementia or those with moderate forms of the condition could experience cognitive impairments but still have the capacity to decide for themselves (Department of Health, 2009). The Mental Capacity Act 2005 (UK Legislation, 2005) states that only when patients suffer significant cognitive impairments should representatives of the patients be allowed to make decisions in behalf of the patient. Since the policy focuses on patient-centred care even in home settings, patients or their family members are allowed to decide on the best treatment or management for the patients. District nurses are encouraged in the policy to always seek for the patient’s interest. The emphasis of the policy on allowing patients to decide about their care is consistent with the ethical principle of autonomy. It is also important that nurses should first do no harm to the patients as embodied in the ethics principle of non-maleficence (Beauchamp and Childress, 2001). The policy supports this principle since DNs are available to provide support and lead the care of patients in home settings. However, there are several barriers in implementing the full policy. Although the policy specifies that DNs should rally the support of patients in home settings, there is the growing concern that the standards of care seen in hospital settings might not be transferred in home settings (King’s Fund, 2012). For instance, DNs could not regularly supervise carers on a daily basis on how they provide care to individuals with dementia. These patients need to receive sufficient nutrition, engage in exercises that increase their mobility or regularly receive pharmacologic medications for their conditions (Casartelli et al., 2013; Hopper et al., 2013; Cole, 2012; Bryon et al., 2012). It would be difficu lt to determine on a regular basis if all these tasks are carried out according to standards if patients are cared in their own homes. In a recent King’s Fund (2013) report, the quality of care received by patients from their nurses is highlighted. This report observes that not all nurses are compassionate to their patients and often, basic care such as feeding or giving water to the patients are often neglected. While this report was based on a study in only one hospital setting, the results are important since it showed that basic care might not be observed. In contrast, DNs would only visit the patients in their homes and would not be around to provide long hours of care. If patients receive poor quality care, this could result to poorer health outcomes and faster deterioration of the patient. The ethics principle of non-maleficence might not be observed if the volume of DN staff in the community remains low. There has been an association of high volume of work and low staffing amongst nurses with poor quality care (King’s Fund, 2013, 2012). The policy also observes the principle of beneficence since its primary outcome is to improve the quality of care received by older patients with dementia in their own homes. Although providing care in home settings would drastically reduce healthcare costs for dementia care, it is still unclear if this would benefit the family more. The cost of informal carers remains to be high, and yet is often discounted when approximating the cost of care for dementia (Alzheimer’s Society, 2014). This policy might put undue burden on families who lack the capacity to provide care for patients in advanced stages of dementia on a 24 hours basis (Alzheimer’s Society, 2014). Despite this observation, the policy is beneficial to patients with moderate dementia. A home setting might provide them with the stability and familiarity that is absent in hospital settings (Sheehan et al., 2009). It has been shown that when patients are admitted in hospital settings, they often manifest aggressi ve behaviour that is suggested to be a response to the changes in environment (Sheehan et al., 2009). The ethics principle of justice is also observed since the policy requires all patients, regardless of race or gender and socio-economic status, to receive equitable healthcare (Department of Health, 2013). On reflection, the moral implications of the policy might come into conflict with the state’s increasing reliance on informal carers or family members to provide care for patients with dementia. The issue lies on whether it is moral to delegate most of the care to informal carers who might also need additional support when caring for patients with progressive chronic conditions. The National Collaborating Centre for Mental Health (2007) stress that informal carers also need support to help them manage depression, stress or burnout from providing care to patients who would never recover from their condition. While the NHS continue to practice innovation in delivering care, an evaluation on whether there are enough resources to implement the innovation should be made. Conclusion In conclusion, the recent policy on dementia in the UK sets the direction of care in community or home settings. District nurses are in the position of following this direction since they lead patient care at home and in the community. However, this brief highlights some issues that should be addressed. These include the decreasing workforce of DN and their staff and their need for additional training and education. The political and economic context influencing the dementia policy should also be taken into account. Finally, this brief illustrates the role of DNs in providing quality care to patients in community and home settings. They could lobby for the patient’s rights and coordinate collaborative care between healthcare professionals and those involved in social care. References Adelman, S., Blanchard, M., Rait, G., Leavey, G. & Livingston, G. (2011). ‘Prevalence of dementia in African-Carribean compared with UK-born white older people: two-stage cross-sectional study’, British Journal of Psychiatry, 199, pp. 119-125. Adelman, S., Blanchard, M. & Livingston, G. (2009). ‘A systematic review of the prevalence and covariates of dementia or relative cognitive impairment in the older African-Carribean population in Britain’, International Journal of Geriatric and Psychiatry, 24, pp. 657-665. Alzheimer’s Society (2014). Financial cost of Dementia [Online]. Available from: http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=418 (Accessed: 12th March, 2014). Alzheimer’s Research UK (2013) Dementia Statistics [Online]. Available from: http://www.alzheimersresearchuk.org/dementia-statistics/ (Accessed: 19th February, 2014). Alzheimer’s UK (2007). Dementia UK: The Full Report. [Online]. Available from: http://www.alzheimers.org.uk/site/scripts/download_info.php?fileID=2 (Accessed: 12th March, 2014). Beauchamp, T. & Childress, J. (2001). Principles of biomedical ethics. 5th ed. Oxford: Oxford University Press. Bryon, E., Gastmans, C. & de Casterle, D. (2012). ‘Nurse-physician communication concerning artificial nutrition or hydration (ANH) in patients with dementia: a qualitative study’. Journal of Clinical Nursing, 21, pp. 2975-2984. Casartelli, N., Item-Glatthorn, J., Bizzini, ., Leunig, M. & Maffiuletti, N. (2013). ‘Differences in gait characteristics between total hip, knee, and ankle arthroplasty patients: a six-moth postoperative comparison’. BMC Musculoskeletal Disorder, 14:176 doi: 10.1186/1471-2474-14-176. Cole, D. (2012). ‘Optimising nutrition for older people with dementia’. Nursing Standard, 26(20), pp. 41-48. Department of Health (2013). Improving care for people with dementia [Online]. Available from: https://www.gov.uk/government/policies/improving-care-for-people-with-dementia (Accessed: 19th February, 2014). Department of Health Public Health Nursing (2013). Care in local communities- district nurse vision and model. London: Department of Health. Department of Health (2009). Living Well with dementia: A National Dementia Strategy. London: Department of Health. Fry, S., Veatch, R. & Taylor, C. (2010) Case studies in nursing ethics, London: Jones & Bartlett Learning. Haas, S., Krueger, P. & Rohlfsen, L. (2012). ‘Race/ethnic and nativity disparities in later physical performance: the role of health and socioeconomic status over the life course’, Journal of Gerontology Series B: Psychological Sciences and Social Sciences, 67, pp. 238-248. Hopper, T., bourgeois, M., Pimentel, J., Qualls, C., Hickey, E., Frymark, T. & Schooling, T. (2013). ‘An evidence-based systematic review on cognitive interventions for individuals with dementia’. American Journal of Speech and Language Pathology, 22(1), pp. 126-145. Jackson, E. (2013) Medical law: Text, cases, and materials, Oxford: Oxford University Press. King’s Fund (2013). Report of the Mid Staffordshire NHS Foundation trust Public Inquiry by Robert Francis QC. London: The King’s Fund. King’s Fund (2012). Integrated care for patients and populations: improving outcomes by working together. A report to the Department of Health and the NHS Future Forum, London: King’s Fund [Online]. Available from: www.kingsfund.org/uk/publications (Accessed: 12th March, 2014). National Collaborating Centre for Mental Health (2007). Dementia: The NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care. London: The British Psychological Society and Gaskell and Social Care Institute for Excellence and NICE. National Institute for Health and Clinical Excellence (NICE) (2006). Dementia: Supporting people with dementia and their carers in health and social care. London: NICE. National Health Service (NHS) (2012). Health and Wellbeing Profile 2011/12. London: City and Hackney and NHS East London and the City. Nursing and Midwifery Council (NMC) (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC. Office for National Statistics (2013). Ageing in the UK Datasets [Online]. Available from: http://www.statistics.gov.uk/hub/population/ageing/older-people (Accessed: 19th February, 2014). Public Health England (2013). Hackney: Health Profile 2013. London: Public Health England [Online]. Available from: www.healthprofile.info (Accessed: 12th March, 2014). Queen’s Nursing Institute (2010). District nurse is becoming an endangered species (press release, issued 26 March 2010), London: QNI [Online]. Available from: www.qni.org.uk (Accessed: 12th March, 2014). Royal College of Nursing (2013). District Nursing- harnessing the potential: The RCN’s UK Position on district nursing. London: RCN [Online]. Available from: www.rcn.org.uk/publications (Accessed: 12th March, 2014). Royal College of Nursing (2011). The Community nursing workforce in England, London: RCN [Online]. Available from: www.rcn.org.uk/publications (Accessed: 12th March, 2014). Sheehan, B., Stinton, C. & Mitchell, K. (2009) ‘The care of people with dementia in general hospital’, The Journal of Quality Research in Dementia, Issue 8 [Online]. Available from: http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1094&pageNumber=5 (Accessed: 12th March, 2014). Thorpe, R., Koster, A., Kritchevsky, S., Newman, A., Harris, T., Ayonayon, H., Perry, S., Rooks, R. & Simonsick, E. (2011). ‘Race, socioeconomic resources, and late-life mobility and decline: findings from the Health, Aging, and Body Composition Study’, Journal of Gerontology. Series A, Biological Sciences and Medical Sciences, 66(10), pp. 1114-11123. UK Legislation (2007). Mental Health Act 2007 [Online]. Available from: http://www.legislation.gov.uk/ukpga/2007/12/contents (Accessed: 12th March, 2014). UK Legislation (2005). Mental Capacity Act 2005 [Online]. Available from: http://www.legislation.gov.uk/ukpga/2005/9/contents (Accessed: 12th March, 2014). UK Legislation (2000). Carers and Disabled Children Act 2000. [Online]. Available from: http://www.legislation.gov.uk/ukpga/2000/16/notes/contents (Accessed: 12th March, 2014). Yaffe, K., Falvey, C., Harris, T., Newman, A., Satterfield, S., Koster, A., Ayonayon, H. & Simonsick, E. (2013). ‘Effect of socioeconomic disparities on incidence of dementia among biracial older adults: prospective study’, British Medical Journal, 347: f7051 [Online]. Available at: http://www.bmj.com/content/347/bmj.f7051 (Accessed: 22nd March, 2014). Zabalegui, A., Hamers, J., Karrison, S., Leino-Kilpi, H., Renom-Guiteras, A., Saks, K., Soto, M., Sutcliffe, C. & Cabrera, E. (2014). ‘Best practices interventions to improve quality of care of people with dementia living at home’, Patient Education and Counseling, pii: S0738-3991(14)00044-5. doi: 10.1016/j.pec.2014.01.009 [Online]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24525223 (Accessed: 12th March, 2014).

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What Is The CAPM (Capital Asset Pricing Model) And Of What Practical Use Is It - Essay Example When the expected return of a security is determined using the model then it can be compared to the estimated return of security over a given time period. Such comparison will help the investor to analyse whether it is worthwhile investing into the security. CAPM was first conceptualised and pioneered by William Sharpe, Jack Treynor, Jan Mossin and John Lintner through their independent works (Focardi and Fabozzi, 2004, pp.86-87). The Capital Asset Pricing Model The Capital Asset Pricing Model (CAPM) is popularly used to price individual portfolio securities. The CAPM helps to determine the expected rate of return for an asset relative to market risk. Using the CAPM model an investor can eliminate the unsystematic risk through proper diversification by estimating the required rate of return for a given level of non-diversifiable or market risk. The practical application of the model is that the individual investor will be able to modify their investment portfolio according to their r isk taking behaviour. The model also helps the individuals to analyse the risk-return profile in the portfolio (Gallagher and Andrew, 2007, pp.173-175). Assumptions of CAPM Investors are risk averse and rational No single investor can influence security prices No transaction cost or taxes Investors have access to all information at same time Expectation of the investors is homogeneous Mathematical Formula For individual assets, the relation between systematic risk and expected return can be estimated using the Security Market Line (SML). The significance of SML is that it can help the investor to calculate the risk-to-reward ratio for a given security relative to market. (Source: Financial Planning Body of Knowledge, 2010) The market risk-reward ratio is also known as the market risk premium. The systematic risk can be estimated using the Beta factor (?). Beta measures the sensitivity of excess expected return of security to the excess market return. Mathematically, ? = Covariance ( Ri, Rm) / Variance (Rm) Excess market return or Risk Premium = E (Rm) – Rf CAPM = Rf + ? x [E (Rm) – Rf] Where, Rf = Risk-free return Ri = Security Return Rm = Market Return Market Portfolio and Efficient Frontier The concept of CAPM encourages an investor to invest a portion of his or her wealth in risky asset and the remaining portion into risk-free asset. The proportion of asset allocation between risky and risk-free asset depends on the behaviour of the investor. According to this model, a rational investor will prefer maximum return for given risk or minimum risk for given return. The optimum portfolio is a combination of securities which yields maximum returns for lowest risk or volatility. The total portfolio risk can be measured and compared to market risk using beta. The optimum portfolio is derived from the efficient frontier curve that gives the relation between portfolio risk and return. The combination of securities that is formed at the tangency of indivi dual assets and the capital Allocation line (CAL) is called the optimal portfolio (Khan and Jain, 2007, p.16). (Source: krotscheck.net, 2008) The Significance of Beta Factor Beta indicates the stock volatility relative to a benchmark or market. The benchmark can be international index like S&P

United Arab Emirates Essay Example for Free

United Arab Emirates Essay In his article titled â€Å"United Arab Emirates† Sulayman Najm Khalaf gives an interesting overview of the UAE, one of the richest and most prosperous countries in the world. He briefly covers a wide range of subjects that concern the way of life of the Emirati society and vary from the country’s location and geography, its history, ethnic and social composition, political institutions, social welfare, the history of economic development, urbanization to the family life of its citizens, religion, child rearing, education, eating habits, etiquette, etc (Khalaf). Khalaf’s brief account of gender roles and statuses in the Emirati society now make me see the role of women in the country’s social, political, religious, or artistic life in a slightly different way. Although it is a well known fact that Emirati women, like women in many other Muslim countries, do not have the same rights and opportunities as men regardless of whatever the country’s government officials may declare, I did believe they had a greater influence on many aspects of social life and better access to the country’s politics than they actually have. I was also surprised to learn that in spite of the high ratio of the number of educated women in the UAE and their impressive performance in schools and universities, most of them tend to get married early, instead of taking the existing career opportunities, and actually choose to dedicate themselves to raising children and managing domestic affairs. I wrongly believed that the current status of women in the UAE was somewhat approaching the status of women in Western countries. In his article Khalaf describes some aspects of the special relationship between four principal social classes existing in the United Arab Emirates on the one hand, and between the Emirati nationals and the immigrants on the other hand. I was not aware of the high importance which is attached to the division of the nationals into social classes, their roles in â€Å"Page # 2† the Emirati society, and particularly the obvious impossibility for their members to move from a lower social group to a higher one. The article also changed my beliefs about the existence of equal opportunities for the citizens of the United Arab Emirates. Despite apparent openness and equality that I believed were typical of the country, and also tolerance for other ethnic or religious groups, now I am quite aware of the visible existence of gender discrimination and discrimination against other cultural or religious groups which, what is particularly shocking for a Westerner, are overtly encouraged by the state. As far as discrimination against the immigrants is concerned, now that I have read Khalaf’s article I am inclined to believe that the incomers are tolerated in the UAE not out of a sense of Emirati hospitality that is often advertised abroad, but because the country needs them and their low paid labor and services. This can be substantiated, for example, by the fact that the nationals that are just a minority group representing only 20% of the population are favored by most state laws or business regulations (Khalaf). Despite being a multiethnic society, the UAE grants privileges to and appears to protect the interests of only one ethnic group reserving other groups for a sustainable but nonetheless a relatively decent, by local standards, existence. It can be thus concluded that equal opportunities as we understand them in the West simply do not exist in the United Arab Emirates. The author explains that apart from Islam which is the country’s official religion foreign incomers can open and attend their own places of worship, too. But, as he emphasizes in the article, the majority of immigrants are of Asian or Arab descent following Islam. Khalaf does not mention, for example, how many, if any, practicing Christians or Buddhists as well as their churches or temples there are in the country. It would be also interesting to find out more about how the UAE regulates the inflow of immigrants from the much poorer countries of the region. Little does the author say about certain aspects of the country’s â€Å"Page # 3† political life, for example, how the president and his deputy are elected and by whom, how the judiciary is formed, etc. REFERENCES: 1. Khalaf, S. N. United Arab Emirates. Retrieved April 17, 2008 from the World Wide Web: http://findarticles. com/p/articles/mi_gx5228/is_2001/ai_n19144272

Othello: Character Analysis of Iago

Othello: Character Analysis of Iago In order to understand the personal motivations of Iago we need to consider not only the personal actions of the character but also the society in which he lived. Many examples of Iagos malignity can be found throughout the play demonstrating the malevolent streak that permeates the actÄÂ ±ons and feelings of Iago. It was Samuel Taylor ColerÄÂ ±dge who came up with the term, The motive-hunting of motiveless Malignity, to describe the character of Iago. Coleridge referred specifically to the end of Act 1, Scene 3 in which Iago takes leave of Roderigo: Iago weaves a web of deception that ensnares the Othello, Cassio and Roderigo. He succeeds in destroying a marriage and two noble characters as well as his wife, (Emilia), and Roderigo. Iagos true delight in his own cunning can be witnessed in his Act 2 Scene 1 soliloquy. Here he revels in the power he wields, that which can turn Desdemonas virtue into pitch. Also ammoral is Iagos mercenary use of Roderigo to line his coat. He readily accepts money for a service that is impossible to achieve Desdemona has no feelings for Roderigo, and Iago knows this. At the heart of Iagos duplicity is his ability to play a number of roles convincingly; to adapt his tone and style to suit any occasion. With Cassio , he is bluff, coarse and genial. He offers plausible, practical solutions for his problems. With Roderigo and Emilia, he is self-serving, materialistic and cynical. This can be seen in Act 1 Scene 1 where he makes it clear to Roderigo that his pride was hurt when Cassio was promoted before him. he becomes furious. This anger was not founded because there is no evidence of any kind that Othello takes any interest sexually in Iagos wife Emilia. Cassio, by contrast, whom Iago also suspects of intimate dealings with his wife, has at least done more to raise that fear when he kisses Emilia on the lips in front of Iago in 2.1.99-100. These feelings are made clear in lines 270 280 of Act 2 Scene 1 He states that his soul will not be sated: With no remedy for his condition, with a job that is beneath him, with a superior that he knows and will eventually demonstrate has vices incompatible with military leadership, with a system that has shown that its values are inverted, what can he do? Strike back at the system and people who have failed him. Iago then tries to create civic anarchy in Venice. First, he suggests to Roderigo that he wake Brabantio, Desdemonas father, in the middle of the night to announce her elopement with Othello. While Brabantio is rousing his family to action, Iago slips away for his second provocative act. He meets up with Othello and tries to goad him on to violence. The phrase, Motiveless Malignity is not an accurate portrayal of Iago. There are many examples throughout the play which show clearly Iagos villainy. Iago manages to turn all his friends, who trust him most, against each other. These actions eventually lead to the murder of Roderigo. While the act of murder cannot be condoned, this shows the utter desparation of Iago as a man whom was pushed to the edge by a society which failed to show him sufficient respect. Iago himself offers several possible motives for his actions to the audience throughout the play in his different soliloquies. Evil and hopeless Iago clearly is, but this needs to be set also against a class-based society which trapped Iago in second class citizenship, a status which he did not deserve. The absolute loyalty and dedication Iago showed towards his masters was never rewarded and it is this which led him to engage in malevolent acts against everybody including his loved ones.

The Human Resource Planning Of Asda Management Essay

The Human Resource Planning Of Asda Management Essay The human resource planning is a persistent process by which it looks to assurance flexible re-sourcing connected to internal and external environmental pressures. An effective Human Resource planning can facilitate those two companies anticipating possible usual problems. Forward planning will allow the two companies developing and implementing successful approaches in relation with: à ¢Ã… ¾Ã‚ ¢Recruitment à ¢Ã… ¾Ã‚ ¢Selection à ¢Ã… ¾Ã‚ ¢Induction à ¢Ã… ¾Ã‚ ¢Training à ¢Ã… ¾Ã‚ ¢Retraining à ¢Ã… ¾Ã‚ ¢Career progression à ¢Ã… ¾Ã‚ ¢Development ASDA and Tesco both are the leading supermarket in UK. As I left ASDA and join in Tesco. Therefore I know the aim and objective of the both company. Both companies strategies are to ensure good customer service and increase the sales for business development. A good plan will help both companies following activity: ASDA: Evaluate future recruitment needed because ASDA needs staff that know the products that the company is selling and know how to put those products and make great offers in order to catch the customers attention and interest so they can buy them despite the actual economic situation Creating training programs for the employees as for example the store staff needs to have good communication skills, they need to put the products in the right place and always be updated Building up promotion and careers development to motivate the staff and offer them a better place to work so they can perform well. Avoid redundancy as it can have a bad effect on the other employees Evaluating future needed equipments, technology and premises. Controlling the staff wages and salaries while keeping the competitiveness of the salaries TESCO: Evaluate future recruitments needed as Tesco is increasingly expanding businesses and actually have more than 2482 Tesco Extra, superstores, Metro, Express etc. in more than 14 countries across the world. Creating training programs for the staff as the staff for example in the till needs to serve customer fast, also they need to have a good customer service. And they also have self-scanned tills for customer that make customer happier. Build up promotion and career development strategies which will benefit both the staff and the organization Avoid redundancy as this can affect the other workers they will be de-motivated and it will give a bad image to the organization Build a flexible workforce to meet up with the changing requirement and environment. Controlling the staff wages and salaries while in the mean times guaranteeing the competitiveness of the salaries Evaluating future necessities from equipments, knowledge, technology and premises. HRM MODEL USED IN BOTH COMPANIES: According to Truss et al. (1997) the development of human resource management from personnel management has produced a number of models and theories. There are two models most widely used in human resource management are the hard and soft forms which are based on different analyses and thoughts of management control plans and human nature. Soft and Hard models are used in ASDA and Tesco organisations as human resources planning which are most important in the organisational development. Hard and Soft models of HRM are discusses as follows: HARD HRM: Hard HRM pushes the resource characteristic of human resource management; Legge cited in Gill (1999) refers to this as Practical Instrumentalism. This hard model pushes HRMs give attention on the vital consequence of the close combination of human resource strategies, systems and performance with business strategy. Besides this viewpoint human resources are mainly an issue of production, cost of doing business more willingly than the only resource capable of turning inorganic factors of production in to wealth. Human Resources are analyses as passive, to be provided and organized as numbers and skills at the correct price, rather than the foundation of original force (Legge, 1995, cited in Gill, 1999). Hard HRM is as calculative and tough minded as any other branch of management, communicating through the tough language of business and economics. This emphasis on the quantitative, calculative and business-strategic aspects of managing the headcount has been termed human asset accounting (Storey, 1987). The hard HRM approach has some kinship with scientific management as people are reduced to passive objects that are not cherished as a whole people but assessed on whether they posses the skills/attributes the organisation requires (Legge, 1995; Vaughan, 1994; Storey, 1987; Drucker et al, 1996; Keenoy, 1990 cited in Gill, 1999). A different view of HRM is associated with the Michigan Business School (Fombrun, Tichy and Devanna, 1984). There are many similarities with the Harvard map but the Michigan model has a harder, less humanistic edge, holding that employees are resources in the same way as any other business resource. People have to be managed in a similar manner to equipment and raw materials. They must be obtained as cheaply as possible, used sparingly, and developed and exploited as much as possible (www.hrmguide.co.uk). SOFT HRM: Storey (1989) cited in Price (2011) describes that Soft form of human resource management characterised by Harvard model. Soft HRM put pressures on the human aspects of HRM. It is giving more attention with communication and motivation in the organisation. This model distinguished that people should guide properly rather than managed. They are more involved in influential and realizing planning objectives in the organisation (www.hrmguide.co.uk). However, Soft HRM places an importance on human and is linked with the human relations school of Herzberg and McGregor (Storey, 1987 cited in Gill, 1999). Legge (1995) cited in Gill (1999) refers to this as Developmental Humanism. at the same time as emphasising the significance of integrating HR strategies with Business objectives, the soft model emphasises on taking care of employees as valued resources and a source of competitive benefit through their promise, flexibility and excellent skill and performance. Employees are positive rather than inactive inputs into dynamic processes, competent of development, worthy of confidence and teamwork which is accomplished through contribution (Legge, 1995, pp 66-67 cited in Gill, 1999). The soft version is seen as a method of releasing untapped reserves of human resourcefulness by increasing employee commitment, participation and involvement. Employee commitment is sought with the expectation that effectiveness will follow as second-order consequences. Walton (1985, p. 79) suggests that a model that assumes low employee commitment and that is designed to produce reliable if not outstanding performance simply cannot match the standards of excellence set by 5 world-class competitors and discusses the choice that managers have between a strategy based on imposing control and a strategy based on eliciting commitment (Gill, 1999). The soft model of HRM is based on viewing the individual as a human being utilising human talent and capability and generating commitment from employees (linked with the Human relations movement-see work of Maslow, Mayo, McGregor and Herzberg). Other features of the soft approach include: Generating a motivated, skilled and harmonious workforce. Generating commitment to the organisation and its goals objectives, Strategies and organisational culture Winning individuals hearts and minds Treating human being as humans and not a resource or commodity Generating two-way communication between management and the workforce to promote commitment and harmony. HRM PLANNING AND DEVELOPMENT METHODS USED IN TESCO AND ASDA: Recruitment and selection process within ASDA. The recruitment processes within ASDA consist of 2 steps: Online application by which the applicant needs to fill in the information required in the application which may include some verbal, numerical and personality tests, which will enable the company gathering all the information that it need. And this will let ASDA decide whether the candidate is suitable or not. If the candidate succeed, the next step will depend on the role that the candidate applied for, the applicant will may be asked to attend interviews, or to a group assessment centre which the applicants will be asked to perform tasks designed to highlights the skills. Recruitment and selection process within Tesco The recruitment process of Tesco for example team members consist of two steps application. Online application which consist of filling in the information that the candidate is asked to do online which contain personal details, previous work experiences, qualifications, and additionally a questionnaire that put the candidate in real life situation for example if the customer service, dealing with complex situation with customer etc. Is the candidate have effectively passed the first application step, he or she will be called to the store for an OJE (On Job Evaluation) and a face to face interview. With the OJE which only last 15 minutes the manager will give the applicants tasks to do so he or she can see how the candidate perform in real life situation and the manager evaluate the candidate customer service and skills and then he or she reflected against what they are looking for in a candidate. And then after that the candidate will have an interview with the business managers. Finally he will asses the candidate meet their requirement or not. In comparing the two processes we can see that Tesco spend much more on recruiting and selecting than ASDA by using on job evaluation (OJE) system but despite it is taking more time, it is very effective as it shows and indicates if the candidate is the right person for the right job. STAFF TURNOVER: Marchington, M. Wilkinson, A (2007) in a study of CIPD (2004) finds that labour turnover rates vary considerably between industry sector and occupational group, at the same time as do the costs of recruitment. Most employers are more concern about collect statistics on labour turnover, but they also facing problem with lack of data or software issues (IRS Employment review 2004). Many employers also performs exit interviews, and both of these tasks are usually carried out by HR department where no involvement of line manager. The information is used to improve HR practices and policies such as communication, induction, learning and development and selection in an effort to reduce turnover (CIPD 2004b, p31). Perhaps the issue is the most difficult due to all cases of labour turnover are treated in the similar way, without giving any allowances for the performance levels and latent of the employees who quit from organization doing comparison with available employee. It is pointed that, manager is comparatively happy if an unskilled or poor performer were to leave, and there are suggestions from the researchers that if the future of the company is uncertain then employers in reality encourage turnover for not to carrying staff (Smith et al 2004 cited on Marchington, M. Wilkinson, A., 2007). On the other hand, if turnover was determined along with high-flyers or high skilled or highly experience and those who remained were unskilled or poor performers or lacked of ambitions, in that case this could have serious penalty for the organization. However, a high rate of labour turnover could be benefited for the company if the organizations aim is to trim back the workplace or reduce costs of production (Sadhev et al 1999 cited on Marchington, M. Wilkinson, A., 2007). Alternatively, Rubery et al (2004); Smith et al (2004) cited on Marchington, M. Wilkinson, A., (2007) argued that employers may come to a decision to use temporary employment agencies for recruiting staff so that they pass the problem to somewhere else. Glebbeek and Bax 2004 cited on Marchington, M. Wilkinson, A., 2007 point out that company should decide whether an optimum level of labour turnover with the mix of internal labour market and keep new recruits coming in, or whether the cost of turnover make most cases costly and unnecessary. According to Linda Maund (2001) some internal causes of an increasing labour turnover: The recruitment and selection procedure is not enough and imperfectly matches individuals to jobs. Employees are not well motivated and dont feel the organization from the core. S/he will consider better opportunities outside the organization and employee does not feel any interest to do better for the organization. Not equality in wages and salaries with competitors. THE EXIT PROCEDURES Tesco and ASDA both company paying attention of staff turnover percentages. They both are dedicated to find the way to reduce staff turnover in their company. For that reason they follow exit procedures who are leaving the job. Concerning Tesco and ASDA the exit procedures that this company follow is similar to other companies as it undertake an exit interview with the person who is leaving the job, so the staff will have the opportunity to give explanation their reasons for leaving the job, or in the case of the staff choosing another employer, or to air their grievance, all this helped Tesco to what it is now as those criticism helped the company to take decisions to change their policies, especially if this employee is leaving for a competitor. What Tesco and ASDA do is that despite the interview that make the manager listen to the staff and know the reason of leaving such as challenging work environment, salary, discrimination, promotion. If the employee is a good performer they try to keep him or she in the organization, as he or she is beneficial to the company and the organization doesnt want to loose of their staff because he may give more with the competitors and they can use the staff knowledge and what this staff has gained of knowledge against the previous company. And this is including the resignation of the staff. RETAIN EMPLOYEE: In the case of redundancy Tescos transfer staff to other superstores that are in need of workforce because as we know that Tesco in one of the fastest growing companies in the world, so in redundancy situation the company offers alternative job and all this is with discussion with the worker. The same thing applies to ASDA because this outplacement can keep this employees working and performing in the same level and improve confidence of the other employees and also it gives a good image about the two companies. However, Tesco and ASDA both companies are giving employee discount to motivate employee which is more effective to retain employees. By following those procedures the two companies can get better in the domain knowing if it comes to keeping good employees working for them, and those solution that were mentioned above are measured as the best and the commonly used by professional and leading organizations around the world. TRAINING AND DEVELOPMENT: One major area of the human resource functions of particular relevance to the effective use of human resource training and development. A number of academic people would argue against the significance of training as a main influence on the success of an organisation. Training works outside-in; education works inside-out. Therefore training is benefited for the organisation if they learn to be wise in how to use of an individuals capability and it helps to achieved business goals. Training has four main levels such as output training, task training, performance training and strategic training. However, these four main levels of need for any organisation for improve the skills. Different levels of training will required different time period based of staff capabilities. Training for change is important for the long-term survival of an organisation. Increasing importance is being placed both on the necessary for continual training to maintain change and on training as a very important investment for the future. THE BENEFITS OF TRAINING: The main reason of training is to develop knowledge and skills, and to change approach is one of the important motivational factors. This helps to many potential benefits for not only individuals but also organisation. The key benefits of training are as follows: Boost the self-confidence, motivation and loyalty of employee. Give recognition, increased responsibility, and the opportunity of employee promotion. Give a feeling of personal satisfaction and achievement, and broaden opportunity for career development and Assist to improve the availability and quality of employees. Finally it can say that Training is the main factors of organisational performance development. Tesco and ASDA both company giving more attention of the employee training as they know that it is the major issues for the employee developments which lead to the increase organisational performance achieved the goals. HR PERFORMANCE IS CURRENTLY INDICATED AND MONITORED: The organisational performance fully depends on human resource management activities (Ulrich 1997a) in the organisation. Employees are the key resource of the organisation. Therefore, HR will make a significant impact on company performance when a suitable HR strategies and procedures are developed and implemented effectively. Apparently Tesco and ASDA both companies focus on the HR activities which leads to increase the organisational performance. The HRM-performance model (Phillips, 1996b) is discussed as follows: Human resource measurement, demonstrating the link between HRM strategy and organisational performance needs the examination of some set of variables. The methodology for make sure high central strength would preferably allow a calculation of how different human resource management strategies or individual activities affect economic performance of the company at the same time as controlling other issues that might pressure those performance results. High internal validity indicates to the level to which the outcomes can be indiscriminate to conclude the impacts of human resource management practices (Bratton and Gold, 2007). Phillips (1996) model (see appendix I) is showing the relationship between HRM practices and organisational performance. Tesco and ASDA both companies HR performance is currently indicated and monitored by Phillips (1996) HRM-organisational performance. The human resource management added-value model is indicates the total relationship between three major elements. Human resource management Human resource performance measures, at both individual staff and work team levels. Organisational performance measures. HUMAN RESOURCE MANAGEMENT: The human resource management element consists of HR strategy, policies, programmes, practices and system (see appendix I) which be present in work organisations and that impacts on staff and team performance, and cause effects individual and organisational performance (Bratton Gold, 2007). STAFF PERFORMANCE MEASURES: The second element of Phillips (1996) model (see appendix I) indicates the performance effects of human resource management, approximately in part by staff performance measures. Academicians have a few options to measuring individual employees and groups. Saks (2000) cited in Bratton Gold (2007) draws three measurements they are discussed as follows: Traits: Evaluating the individuals personal traits is more important, and it is one of the significant tasks of HRM. It may find out the employees loyalty or commitment to the organisation. Behaviours: It is focus on what employee does and does not do in the organisation such as absent from work, poor time-keeping and resigning from service. Outcomes: It focuses on the employee outcome in workplace during the time of workplace that helps to measure employee performance such as number of unit completed, accident level or customer complaints etc. Moreover, at present team work became more common in the organisation. According to Saks (2000) cited in Bratton Gold (2007) team performance is strongly influenced by four input variables for example team structure, team norms, team composition and team leadership; and process variables such as team working and team learnings which impacts on the team performance outcomes. ORGANISATIONAL PERFORMANCE MEASURES: Organisational performance depends on the individual employee and team work measurements (see the appendix I). According to the researchers cited in Bratton Gold (2007) discussed several organisational performance measures techniques such as labour productivity ratios, product and service quality, unit cost ratios, revenue productivity and return on investment (ROI). However, researchers also design organisation performance measures techniques on the basis of goal achievement. This technique is relying on four specific indicators such as profit-related directories, productivity, quality and perceptual measures of goal achievement. Bratton and Gold (2007) also states three important reasons for organisational outcomes measures: Employee-related outcomes as they are directly influenced by HR practices. Different rewards and training programmes are to influence on the employee outcomes. These outcomes such as productivity, quality and employee unit cost which can manipulate the organisations financial operational goals. The outcomes can manipulate the individual psychological contact as well as behaviour which involves with the outputs. CONCLUSION AND RECOMMENDATION: Human resource management is a planned technique to managing employment relations which highlight that influencing peoples potentiality is critical to getting competitive advantage, this being achieve throughout a distinguishing set of incorporated employment policies, programmes and practices (Bratton 2007). Employees are the key driven force in any organisation. Organisational success depends on the employee performance. Discrimination in workplace plays psychological impact on the employees mind which may lead to negative impact on employee performance. Therefore, HR main duty is to most effective uses of human resources in organisation. They need to employ right person for the organisation and build up employee based on the current requirement by the training and development process. UK is a multi-cultural country. Different cultural people lives and come to shopping in the superstores. Consequently HR should be fair for all employees and keep in eye on the employees to make sure equal opportunity ground in workplace for each employee. To get potential benefit from the employee motivation is significant for the organisation. HR required to ensure reward systems to motivate employees. Tesco and ASDA both HRM is works for the business development. For that reason both company is continuously developing their system on the basis of current business trends. I recommend ASDA to follow the on job evaluation (OJE) system to recruit best person for the organisation. And both company need to focus on the skills development process and evaluation process which are linked to employee motivation. Finally it can say that human resource management has thought new prominence as concerns persevere about international competition, the development of technology and the productivity of employee (Bratton 2007) in both companies to increase business efficiency.