Current Issues with Health Care Costs Essay

Health care spending in the U.S. continues to soar to unsustainable levels. There are many strategies and views on ways to contain health care costs, while improving the efficiency and quality of health care. Hospital services, physician services, prescription drugs and technology/medical innovation and the aging population are areas that drive the high cost of health care creating an unaffordable dilemma for consumers and employers.(Cowen & Moorhead, 2011) Uninsured individuals who are unable to afford health insurance are less likely to coordinate their care appropriately, leading to poor health outcomes. The aging of the population and the rising cost of health care would cause spending on the major health care programs and Social Security to grow from more than 10 percent of GDP today to almost 16 percent of GDP 25 years from now. That combined increase is equivalent to about $850 billion today. (â€Å"Congressional Budget Office,† 2012) The aging of the baby boomer generation will have an impact on federal spending as well as health care costs. (â€Å"Congressional Budget Office,† 2012) Increase in longevity due to medical advances and technology are a factor in spending growth increases. (Henderson, 2012) The second largest segment of U.S. health care spending is on physician services. (Cowen & Moorhead, 2011) Providers are paid for services rather than patient outcome. This creates little incentive to coordinate patient care with other specialist. A large portion of the aging population has multiple chronic conditions which would benefit from better coordination of care. (White, 2010) With the shortage in primary care doctors and the aging baby boomer generation consuming more care, costs for physicians services will likely increase. A new model of primary care called the patient centered medical home provides better coordination of care, helps lower cost and improve patient satisfaction. (Henderson, 2012) Hospital services account for one of the largest drivers of health care spending. Shortage of  nursing staff is one factor which influences increased wages, as well as the decrease in payment from the Medicare population. (Cowen & Moorhead, 2011) Those costs and differences in reduction of payments are then shifted over to consumers and payers. With the increase in the baby boomer generation, the federal government will need to manage the extra services being utilized through Medicare with an attempt to find ways to reduce payments to hospitals. (â€Å"Congressional Budget Office,† 2012) New and better drugs will help benefit health but may cost more. Prescription drugs are advertised on television each day. Patients are more educated on the drugs used for their conditions and are likely to request from their physician these highly advertised drugs they feel may benefit them. Many physicians are likely to give into the demands of their patients requests leading to more costly medications used that could be avoided. Advancing technology can positively or negatively impact health care costs. Many times over use of technology, especially when there is a less costly alternative can increase health care costs. On the other hand, new technological advances in data collection for a personal health record can be utilized to coordinate care, promoting better quality of care resulting in improved health outcomes and cost savings. (Cowen & Moorhead, 2011) Disease management, Health savings accounts and Retail clinics are just a few of the solutions offered to consumers to help cost. Disease management is offered by many health insurance companies for their members with chronic health conditions such as diabetes, congestive heart failure, asthma and coronary artery disease. Nurses educate the members on their health conditions and help set health goals to help preven t hospitalizations and improve health outcomes. Studies, however, do not suggest this is a proven cost saving strategy. (Cowen & Moorhead, 2011) Health savings accounts allow people to have more control over how their money is spent. Pretax contributions are placed into the account and money can be deducted to pay for medical expenses. There is hope that the HSA will encourage people to focus on lower cost services. Retail Clinics are a creative way to offer routine care in private stores, in large chains and grocery stores. This is a growing trend with health care being provided by a physician assistant or a nurse practitioner. Care is often more affordable and attractive for those uninsured individuals. (Cowen & Moorhead, 2011) Nursing in the future may expand to become more  focused on the role of the primary care provider. With the shortage of primary care physicians states should consider easing the scope of practice restrictions. Nurse practitioners can perform the role of primary care services just as well and effective as physicians do. There are many factors involved in health care costs that the government and private sector must come together in a coordinated effort to improve. There is no single solution to solving the health care spending dilemma. All of the drivers of health care cost must be addres sed in any reform or cost control discussion. Intellectual Honesty Certification I certify that this assignment is presented as entirely my own intellectual work. Any words and/or ideas from other sources (e.g. printed publications, Internet sites, electronic media, other individuals, groups, or organizations) have been properly indicated using the appropriate scholarly citation style required by the department or College. I have not submitted this assignment in its entirety to satisfy the requirements of any other course. Any parts of this assignment from other courses have been discussed thoroughly with the faculty member before this submission so that there is an understanding that I have used some of this work in a prior assignment. References Cowen, PhD, RN, P. S., & Moorhead, PhD, RN, S. (2011). Controlling Health Care costs: Balancing Public and Private Solutions. In J. W. York, & M. M. Gibson (Eds.), Current Issues in Nursing (8th ed., pp. 424-437). The University of Iowa Hassmiller, PhD, RN, FAAN, S. (2010, September). Nursing’s role in health care reform. American Nurse Today, 5(9). Henderson, S. (2012, December 1). The Patient-Centered Medical Home. The American journal of nursing, 112(12), 54. The 2012 Long-Term Budget Outlook. (2012). Retrieved from www.cbo.gov/publication/43288 White, B. (2010, 5/1). How Health Care Reform Will Affect Family Physicians. Family Practice Management, 17(3), 14.

Lesson plan

Comparison/Contrast Is used to show similarities and differences. It uses examples and comparing. It Is Important to organize your thoughts and information before you do so. Your topic sentence how they are alike and how they are different. Your concluding sentence/ or the clincher is a sentences that summarizes your thoughts. The ability to compare and contrast information can help a student in many areas of his/her life. Students need to compare and contrast products that they purchase, so they get the most for their money.They also need to compare and contrast information from various sources when making decisions about their lifestyles, diet, nutrition, etc. Key questions: What two things are being compared? How are they similar? How are they different? If you compare two things you tell how they are alike. If you contrast two things you tell how they are different. If you compare and contrast two things you tell how they are alike and how they are different. A sentence begins wi th a capital letter and ends with the correct punctuation. An adjective describes a person place or thing.The topic sentence of a paragraph states the main idea and attracts the reader's interest. A complete sentence is a group of words that expresses a complete thought (and has a subject and a verb). Capital letters are used at the beginning of each sentence and for proper nouns. A period is used at the end of a statement or command. A question mark is used at the end of a question. (Must be related to the topic): Teacher will begin by holding up various objects and asking students to compare them. For example, teacher will hold up a male and a female shoe; two books that are different size and two different types of food.Student's response will be written on he board. Teacher will ask students to predict today's topic. Teacher will inform students that in today's class we will be writing a compare and contrast paragraph. (The How and What- The Body of the Lesson) Methods and Techn iques Students' Activities Adaptations for Exceptional Learners Using a chart, discuss the terms compare and contrast. Students will read the definition from the chart then discuss things that they have Show a picture of a dog and a cat. Using a Venn diagram (overhead transparency) to Compare (same) and the Contrast (different) a cat to a dog.Students will work along with teacher to brainstorm the animal's similarities and dissimilarities. A picture of a cat and a dog will be shown to support struggling readers. Teacher will model how to write a compare and contrast paragraph based on information from a Venn diagram. I will write a topic sentence, 2 sentences that compare, 2 sentences that contrast, and a concluding sentence. Students will work along with teacher then read the paragraph aloud. After sharing the Comparison and Contrast Guide, explain to students that they are going to compare and contrast items in cooperative groups.In cooperative groups, each student will be given a Venn diagram. Then give each group an assortment of items (only two each). Explain to students that they will now list all of the characteristics that are the same about the items and all of the characteristics that are different. Using a Venn diagram, students will compare and contrast using an assortment of items in small groups. Peer tutoring: Allow struggling reader to work with a student is reading at grade level to help with pronunciation and word fluency.Direct students to write a paragraph comparing and contrasting the two foods using heir information from the Venn diagram that was discussed in the groups. Remind students to use indention, capital letters, complete sentences and topic sentence, supporting details and clincher. Individual assignment: students will write a paragraph comparing and contrasting the two foods using their Venn diagram. Students will write paragraph with correct punctuation marks, indention, capital letters, complete sentences and topic sentence Gi ve direct instruction after giving whole group instructions, work individually with each struggling readers. Lesson plan Comparison/Contrast Is used to show similarities and differences. It uses examples and comparing. It Is Important to organize your thoughts and information before you do so. Your topic sentence how they are alike and how they are different. Your concluding sentence/ or the clincher is a sentences that summarizes your thoughts. The ability to compare and contrast information can help a student in many areas of his/her life. Students need to compare and contrast products that they purchase, so they get the most for their money.They also need to compare and contrast information from various sources when making decisions about their lifestyles, diet, nutrition, etc. Key questions: What two things are being compared? How are they similar? How are they different? If you compare two things you tell how they are alike. If you contrast two things you tell how they are different. If you compare and contrast two things you tell how they are alike and how they are different. A sentence begins wi th a capital letter and ends with the correct punctuation. An adjective describes a person place or thing.The topic sentence of a paragraph states the main idea and attracts the reader's interest. A complete sentence is a group of words that expresses a complete thought (and has a subject and a verb). Capital letters are used at the beginning of each sentence and for proper nouns. A period is used at the end of a statement or command. A question mark is used at the end of a question. (Must be related to the topic): Teacher will begin by holding up various objects and asking students to compare them. For example, teacher will hold up a male and a female shoe; two books that are different size and two different types of food.Student's response will be written on he board. Teacher will ask students to predict today's topic. Teacher will inform students that in today's class we will be writing a compare and contrast paragraph. (The How and What- The Body of the Lesson) Methods and Techn iques Students' Activities Adaptations for Exceptional Learners Using a chart, discuss the terms compare and contrast. Students will read the definition from the chart then discuss things that they have Show a picture of a dog and a cat. Using a Venn diagram (overhead transparency) to Compare (same) and the Contrast (different) a cat to a dog.Students will work along with teacher to brainstorm the animal's similarities and dissimilarities. A picture of a cat and a dog will be shown to support struggling readers. Teacher will model how to write a compare and contrast paragraph based on information from a Venn diagram. I will write a topic sentence, 2 sentences that compare, 2 sentences that contrast, and a concluding sentence. Students will work along with teacher then read the paragraph aloud. After sharing the Comparison and Contrast Guide, explain to students that they are going to compare and contrast items in cooperative groups.In cooperative groups, each student will be given a Venn diagram. Then give each group an assortment of items (only two each). Explain to students that they will now list all of the characteristics that are the same about the items and all of the characteristics that are different. Using a Venn diagram, students will compare and contrast using an assortment of items in small groups. Peer tutoring: Allow struggling reader to work with a student is reading at grade level to help with pronunciation and word fluency.Direct students to write a paragraph comparing and contrasting the two foods using heir information from the Venn diagram that was discussed in the groups. Remind students to use indention, capital letters, complete sentences and topic sentence, supporting details and clincher. Individual assignment: students will write a paragraph comparing and contrasting the two foods using their Venn diagram. Students will write paragraph with correct punctuation marks, indention, capital letters, complete sentences and topic sentence Gi ve direct instruction after giving whole group instructions, work individually with each struggling readers. Lesson Plan SEMI-DETAILED LESSON PLAN IN ENGLISH 1 I. OBJECTIVES; At the end of the lesson, the students should be able to; a. Define coordinating conjunctions b. Give examples of coordinating conjunctions c. Use coordinating conjunctions in a sentence II. SUBJECT MATTER Topic Coordinating conjunctions Reference Grade 7 learning Package Materials chalkboard III. PROCEDURE A. MOTIVATION I am pretty sure that you have already discussed coordinating conjunctions in your elementary days and this is just a review about coordinating conjunctions. B. PRESENTATION Present the topic about coordinating conjunctions. C. Discussion a.Ask students what are coordinating conjunctions b. Allow students to give examples of coordinating conjunctions c. Allow students to use the examples of coordinating conjunction in a sentence. D. GENERALIZATION E. APPLICATION Ask students to match the sentence in column A with column B to form meaningful sentences. Use and, or, but, and for in coordinating the sentences. COLUMN A COLUMN B 1. Monkeys can be angry anywhere a. they peel it first. from just a few centimeters tall. b. they use them to communicate. . Monkeys never it a banana as it is. c. some pieces can grow more than a 3. When the monkey yawns it is tired. meter tall. 4. Monkey makes different voices, d. it is angry at something. facial expressions and body movements. IV. EVALUATION Allow students to supply the blanks with and, or and but to complete its thought. â€Å"Animals In Mythology† (an adaptation) page 53 V. ASSIGNMENT; Make a composition with the use of conjunctions. You can make your own titles. DETAILED LESSON PLAN IN ENGLISH 1 I. OBJECTIVES At the end of the lesson, the students should be able to; . Differentiate active voice from passive voice b. Identify the voice of verbs in the sentence c. Change the sentences from passive to active voice d. Appreciate the lessons by showing active participation of students towards the lesson. II. SUBJECT MATTER Topic verb (active voic e and passive voice) Materials cartolina (strips of cartolina) Reference internet souces III. PROCEDURE TEACHER’S ACTIVITY STUDENTS’ ACTIVITY A. MOTIVATION Class I want you to listen to a short scenario â€Å"John saw a pretty girl. He went to talk to her. His wife arrived.The wife hit john right on the nose 1. What did the wife do? (active voice is used in answering) (answers may vary) 2. What happened to John? (Passive voice is used in answering) (answers may vary) B. PRESENTATION VOICE is the quality of verb That shows wether the subject is the doer of the action or the receiver of thE action. C. DISCUSSION Active voice- is used to indicate That the subject of the sentence is the doer of the action. Passive voice- is created when the subject is the receiver of the action (the teacher gives sets of example about ctive and passive voice) D. APPLICATION Change the sentence below to the active voice 1. The bridge was built by the engineers. 2. The patient was examined by the doctors. 3. The decision was made by my boss. 4. The shell was collected by James. 5. Ninoy Aquino was admired by many people. IV. EVALUATION Identify the voice of the verb in the sentence. ___________1. Raul presented an interesting report ___________2. Baseball was played by Joseph. ___________3. Martin removed the old paint. ___________4. The national congress was approved. ___________5. She cooked the breakfast. ___________6. She submitted the a Lesson plan Comparison/Contrast Is used to show similarities and differences. It uses examples and comparing. It Is Important to organize your thoughts and information before you do so. Your topic sentence how they are alike and how they are different. Your concluding sentence/ or the clincher is a sentences that summarizes your thoughts. The ability to compare and contrast information can help a student in many areas of his/her life. Students need to compare and contrast products that they purchase, so they get the most for their money.They also need to compare and contrast information from various sources when making decisions about their lifestyles, diet, nutrition, etc. Key questions: What two things are being compared? How are they similar? How are they different? If you compare two things you tell how they are alike. If you contrast two things you tell how they are different. If you compare and contrast two things you tell how they are alike and how they are different. A sentence begins wi th a capital letter and ends with the correct punctuation. An adjective describes a person place or thing.The topic sentence of a paragraph states the main idea and attracts the reader's interest. A complete sentence is a group of words that expresses a complete thought (and has a subject and a verb). Capital letters are used at the beginning of each sentence and for proper nouns. A period is used at the end of a statement or command. A question mark is used at the end of a question. (Must be related to the topic): Teacher will begin by holding up various objects and asking students to compare them. For example, teacher will hold up a male and a female shoe; two books that are different size and two different types of food.Student's response will be written on he board. Teacher will ask students to predict today's topic. Teacher will inform students that in today's class we will be writing a compare and contrast paragraph. (The How and What- The Body of the Lesson) Methods and Techn iques Students' Activities Adaptations for Exceptional Learners Using a chart, discuss the terms compare and contrast. Students will read the definition from the chart then discuss things that they have Show a picture of a dog and a cat. Using a Venn diagram (overhead transparency) to Compare (same) and the Contrast (different) a cat to a dog.Students will work along with teacher to brainstorm the animal's similarities and dissimilarities. A picture of a cat and a dog will be shown to support struggling readers. Teacher will model how to write a compare and contrast paragraph based on information from a Venn diagram. I will write a topic sentence, 2 sentences that compare, 2 sentences that contrast, and a concluding sentence. Students will work along with teacher then read the paragraph aloud. After sharing the Comparison and Contrast Guide, explain to students that they are going to compare and contrast items in cooperative groups.In cooperative groups, each student will be given a Venn diagram. Then give each group an assortment of items (only two each). Explain to students that they will now list all of the characteristics that are the same about the items and all of the characteristics that are different. Using a Venn diagram, students will compare and contrast using an assortment of items in small groups. Peer tutoring: Allow struggling reader to work with a student is reading at grade level to help with pronunciation and word fluency.Direct students to write a paragraph comparing and contrasting the two foods using heir information from the Venn diagram that was discussed in the groups. Remind students to use indention, capital letters, complete sentences and topic sentence, supporting details and clincher. Individual assignment: students will write a paragraph comparing and contrasting the two foods using their Venn diagram. Students will write paragraph with correct punctuation marks, indention, capital letters, complete sentences and topic sentence Gi ve direct instruction after giving whole group instructions, work individually with each struggling readers. Lesson Plan SEMI-DETAILED LESSON PLAN IN ENGLISH 1 I. OBJECTIVES; At the end of the lesson, the students should be able to; a. Define coordinating conjunctions b. Give examples of coordinating conjunctions c. Use coordinating conjunctions in a sentence II. SUBJECT MATTER Topic Coordinating conjunctions Reference Grade 7 learning Package Materials chalkboard III. PROCEDURE A. MOTIVATION I am pretty sure that you have already discussed coordinating conjunctions in your elementary days and this is just a review about coordinating conjunctions. B. PRESENTATION Present the topic about coordinating conjunctions. C. Discussion a.Ask students what are coordinating conjunctions b. Allow students to give examples of coordinating conjunctions c. Allow students to use the examples of coordinating conjunction in a sentence. D. GENERALIZATION E. APPLICATION Ask students to match the sentence in column A with column B to form meaningful sentences. Use and, or, but, and for in coordinating the sentences. COLUMN A COLUMN B 1. Monkeys can be angry anywhere a. they peel it first. from just a few centimeters tall. b. they use them to communicate. . Monkeys never it a banana as it is. c. some pieces can grow more than a 3. When the monkey yawns it is tired. meter tall. 4. Monkey makes different voices, d. it is angry at something. facial expressions and body movements. IV. EVALUATION Allow students to supply the blanks with and, or and but to complete its thought. â€Å"Animals In Mythology† (an adaptation) page 53 V. ASSIGNMENT; Make a composition with the use of conjunctions. You can make your own titles. DETAILED LESSON PLAN IN ENGLISH 1 I. OBJECTIVES At the end of the lesson, the students should be able to; . Differentiate active voice from passive voice b. Identify the voice of verbs in the sentence c. Change the sentences from passive to active voice d. Appreciate the lessons by showing active participation of students towards the lesson. II. SUBJECT MATTER Topic verb (active voic e and passive voice) Materials cartolina (strips of cartolina) Reference internet souces III. PROCEDURE TEACHER’S ACTIVITY STUDENTS’ ACTIVITY A. MOTIVATION Class I want you to listen to a short scenario â€Å"John saw a pretty girl. He went to talk to her. His wife arrived.The wife hit john right on the nose 1. What did the wife do? (active voice is used in answering) (answers may vary) 2. What happened to John? (Passive voice is used in answering) (answers may vary) B. PRESENTATION VOICE is the quality of verb That shows wether the subject is the doer of the action or the receiver of thE action. C. DISCUSSION Active voice- is used to indicate That the subject of the sentence is the doer of the action. Passive voice- is created when the subject is the receiver of the action (the teacher gives sets of example about ctive and passive voice) D. APPLICATION Change the sentence below to the active voice 1. The bridge was built by the engineers. 2. The patient was examined by the doctors. 3. The decision was made by my boss. 4. The shell was collected by James. 5. Ninoy Aquino was admired by many people. IV. EVALUATION Identify the voice of the verb in the sentence. ___________1. Raul presented an interesting report ___________2. Baseball was played by Joseph. ___________3. Martin removed the old paint. ___________4. The national congress was approved. ___________5. She cooked the breakfast. ___________6. She submitted the a

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Industrial Property Rights - Essay Example The first software patent ever granted is probably a patent for a "computer having slow and quick access storage, when programmed to solve a linear programming problem by an iterative algorithm, the iterative algorithm being such that (...)" applied for in 1962 by British Petroleum Company . The patent relates to solving simultaneous linear equations. The USPTO has traditionally not considered software to be patentable because by statute patents can only be granted to "processes, machines, articles of manufacture, and compositions of matter". In particular patents cannot be granted to "scientific truths" or "mathematical expressions" of them. This means that most of the fundamental techniques of software engineering have never been patented. The USPTO maintained this position, that software was in effect a mathematical algorithm, and therefore not patentable into the 1980's. The position of the USPTO was challenged with a landmark 1981 Supreme Court Case, Diamond v. Diehr. The case involved a device that used computer software to ensure the correct timing when heating, or curing, rubber. Although the software was the integral part of the device, it also had other functions that related to real world manipulation. The court then ruled that as a device to mold rubber, it was a patentable object. The court essentially ruled that while algorithms themselves could not be patented, devices that utilized them could. This ruling wasn't as straightforward as many would have liked, forcing many electronic device makers into the courts to establish that their inventions were in fact patentable. Due to different treatment of federal patent rights in different parts of the country, in 1982 the U.S. Congress created a new court (the Federal Circuit) to hear patent cases. The new circuit rejected rulings from some parts of the country, and nationalized others. For example, the court made patents generally easier to uphold by presuming patents were valid unless proven invalid and weakening the defense of non-obviousness. This court allowed issues, such as patentability of software, to be treated uniformly throughout the US. Due to a few landmark cases in this court, by the early 1990s the patentability of software was well established, and in 1996 the USPTO issued Final Computer Related Examination Guidelines. See Software Patents under United States patent law. Also in 1998, the U.S. court of Appeals for the Federal Circuit, in the case of State Street Bank & Trust Co. v. Signature Financial Group, Inc. (1998), upheld as valid a patent directed to a computer-implemented business method designed to perform financial calculations and data processing for mutual fund investments. This case was important because prior to this decision, it was widely believed that business methods and systems were not patentable. The State Street case made clear that business methods were to be evaluated in the same manner as any other type of process. In 2000, the JPO followed suit and revised its Guidelines to allow for the patenting of computer-implemented business methods when there is clear "involvement of inventive step." Europe The European Patent Convention (EPC) serves as the basis for a harmonized system of patent protection for all members of the European Union. European patents have the same effect as patents granted by each nation under its own national patent laws. Article 52(1) of

Enders Game Essay Example for Free

Enders Game Essay In a world much different from ours, one with aliens and space travel lives a six-year-old boy from Earth. His name is Ender Wiggin and he is far from the ordinary. He is a â€Å"third† meaning that he was not supposed to be born due to birthing restrictions. Through the consideration of the government, his parents were permitted to have a third child. Due to his superior skills, he is chosen to attend battle school in order to fight the buggers. In the process of becoming a leader in order to save the Earth, Ender is manipulated by Valentine, the teachers and Colonel Graff. This makes him a better soldier by facing many obstacles as an individual and making him self-sufficient. Valentine is Enders 8 year old sister, whom he loves very much. Later on in the book, she manipulates him so that he would be determined to save Earth. She herself was tricked into manipulating Ender by Graff, and later regrets it. Valentine manipulates Ender by writing him a letter that Graff had convinced her to do. â€Å"Ender, the Bastards wouldn’t put any of my letters through till now. I must have written a hundred times but you must have thought I never did. Well I did. Some people might think that because you’re being a soldier you are now a cruel and hard person who likes to hurt people, like the marines in the video, but I know that isn’t true. You are nothing like you-know-who. Maybe you seem mean but you’re not fooling me†¦ All my love turkey lips, Val. Don’t write back they’ll probably sikowanalize your letter (Card, pg. 150). Valentine is manipulating Ender by making him believe that he is not like Peter, which is Ender’s greatest fear. She knows that by doing so he will believe her and will be able to focus on winning. Ender however, does not believe her because he realized that if the teachers did not let the rest of her letters be sent, then why this one? He knows she is trying to pressure him into believing that he was not like Peter. Valentine also convinces Ender to not go back to Earth. She tells him that Peter has big plans for him; he has been waiting for this opportunity his whole life. â€Å"He had plans for you, Ender. He would publicly reveal himself when you arrived, going to meet you in front of the videos. Ender Wiggins older brother, who also happened to be the great Locke, the architect of peace. Standing next to you, he would look quite mature. And the physical resemblance between you is stronger than ever. It would be quite simple for him, then, to take over† (Card, pg. 312). Valentine tells him Peter’s plans but Ender does not seem to understand. He believes that either way he has already spent his life being someone’s pawn. After talking to Valentine, he had finally decided to leave with her. He says, â€Å"I am not going for you. I’m not going in order to be governor, or because I’m bored here. I’m going because I know the buggers better than another living soul, and aybe if I go there I can understand them better† (Card, pg. 314). Finally, Valentine also manipulates Ender by meeting him at a lake and encouraging him to continue to go to battle school. â€Å"If you try and lose then it isn’t your fault. But if you don’t try and we lose, then it’s all your fault. You killed us all† (Card, pg. 240/241). Valentine persuades Ender that it is best for him and the world to continue fighting to win the battle. She tells him it is important for him to at least try rather than not try at all. If he tries then no one will say anything because he did his best. However, if he does not try at all, then everyone will blame him knowing that he could have done more t planet Earth. Valentine is someone very significant in Ender’s life and by manipulating him she helped Graff control Ender further. Throughout the book, the teachers around Ender are constantly manipulating him. They decide that by manipulating Ender, it will be best for him in the long run. One point would be when the teachers decided not to tell Ender that he was actually fighting the buggers. Ender you never played me. You never played a game since I became your enemy. Ender, for the past few months you have been the battle commander of our fleets. This was the Third Invasion. There were no games, the battles were real, and the only enemy you fought was the buggers (Card, pg. 296). No one had told Ender that he was actually fighting the buggers at their home planet. They did not tell him so he would feel no pressure. This lead to his victory over the buggers but still Ender was upset. The teachers had manipulated Ender and pushed him too far. The adults are depending on the computer to tell them when they are pushing Ender more than he can handle. You can’t be serious about this schedule of battles. † â€Å"Yes I can. † â€Å"He’s only had is army three and a half weeks. † â€Å"I told you. We did computer simulations on probable results. And here is what the computer estimated Ender would do. † â€Å"We want to teach him, not give him a nervous breakdown† (Card, pg. 173). The fact is they have already gone past his limit. The adults were by giving him more than he could handle. For example, he was once given two battles in one day during his time at Battle School. Lastly, the teachers manipulate him by never helping him in dangerous situations. Every time Ender was ganged up on the teachers would not help him and so he would fight alone. â€Å"If the teachers were allowing that to turn up on official report, it was obvious they didn’t intend to punish anyone for the nasty little skirmish in the battle room. Aren’t they going to do anything? Don’t they care what goes on in this school† (Card, pg. 117). Ender was frustrated and confused as to why the teachers were never there when he was in trouble. He learned to never count on the adults to come and rescue him. These three points made him a better soldier because t made him stronger, more independent and that helped him prepare for the real battle. Graff’s intention of manipulating Ender was to keep him on track. He wanted Ender to only be able to rely on himself and nobody else. Graff wants Ender to use his intelligence to help him get out of a rough situation. The first example of how Graff manipulates Ender is by changing his armies often. He sends Ender from Salamander to Rat, Rat to Phoenix and from Phoenix to Dragon. â€Å"Ender shook his head. It was the stupidest thing he could think of, to promote him ow. Nobody got promoted before they were eight years old. Ender wasn’t even seven yet. And launchies usually moved into the armies together, with most armies getting a new kid at the same time† (Card, pg. 69). Ender was tired of switching armies often. It was only when everything was settling down, when he made a few friends and had gotten over the fact that he was not with Valentine they decide to transfer him. Colonel Graff also manipulates Ender into going to Battle School. â€Å"You won’t miss your mother and father, not much, not for long. And they won’t miss you long either Well no one wants a third anymore. You can’t expect them to be glad. But your mother and father were a special case† (Card, pg. 21/22). Graff speaks with Ender alone and tells his how his family’s reaction would be. He brings up the past about his parents life and that having a â€Å"third† was such a disgrace for them. He tells Ender that miss them a little but soon he will forget about them and they will do the same. Furthermore, Graff also makes sure that Ender does not get any support from the teachers when he is in problem. He also helps Ender become alienated from the other launchies. â€Å"Ender Wiggins must believe that no matter what happens, no adult will ever, ever step in to help him in anyway. He must believe to the core of his soul that he can only do what he and the other children work out for themselves. If he does not believe that, then he will never reach the peak of his ability† (Card, pg. 202). Graff plays with his mind, mentally making him believe that his teachers will never be there to protect him. He makes Ender believe that he could only depend on himself.

Traffic Accidents Essay Example for Free

Traffic Accidents Essay Traffic accidents are on the rise these days. Most of the accidents caused injuries or either worse death. Research have found that most of the accidents are caused by inexperienced drivers, for example young drivers. Young drivers tend to be more daring and are unable to avoid a crush when they face one. They tend to be more daring after drinking alcohol at night and this causes them to lose control of the car. Drunk driving will not only risk a person’s own life but may also cause an innivent life to be lost. The government should encourage the driving school to conduct driving lessons foryung drivers for a longer period. This will give them a clear picture about how accidents happen and teach them about the safety of others on the road. Drivers that have been in an accident after drunk driving should be ban from driving for at least two years and be given driving lessons again. However, for the aged drivers, the government should not only lowered the age limit but also check the capability of the aged drivers for instance eyesight, hearing and other related health conditions to ensure safe driving. It does not mean that an aged person are not fit to drive and has a problem with the heart but a young or a middle aged person could also have heart failure these days. To conclude, I feel that to raise the agelimit of young drivers arenot the best solution but to give them more driving lessons about the problems they may encounter on the road and to ban them from driving if they have caused an accident due to carelessness. As for the age drivers, as long as they are capable on the road before a certain age and there are no health issues there shouldn’t be a problem.

COLLABORATIVE PRACTICE IN MENTAL HEALTH

COLLABORATIVE PRACTICE IN MENTAL HEALTH This assignment will be based on collaborative working, it will be in two sections, section one will look at definition of collaboration and will then address the highlighted issues within collaboration such as a need for and applying inter professional collaboration between mental health service providers and the way they collaborate with service users and their families which is required by the Department of Health (DoH 1990/91 to 1999/1999a). Within this section will be a brief outline of issues that are relevant to the DoH such as policy initiatives that advocate collaboration within and between teams as well as other service providers. Section one will also look at the barriers, difficulties and challenges that has been highlighted with the usage of effective collaboration workings between both multi professionals and service users. Section two will hopefully show my own personal experience of collaboration through the critical summary of my reflections which i have used The Gibbs (1998) model of reflection (see appendices 1-3) this has been based on my learning experiences during the course involved client assessment and the implementation of their care and treatment packages. Within this section the critical scrutiny will involve re-examining my skills in working collaboratively with both clients and multi-disciplinary team (MDT), within the framework of mental health care, identifying areas for additional development. It must be prominent that the names of all persons contained within this part of the assignment are illusory due to confidentiality which remains in accordance with the Nursing Midwifery Council (NMC 2008) The Code. Part 1: Defining collaboration outline of issues The literal translation of collaboration from the Latin is together in labour, whilst the dictionary definition of to collaborate is to work with another or others on a project (Chambers 1999). However, Clifford (2000 pp103) in re-iterating Henneman et als. (1995) earlier argument stated that, in practice, the process of defining collaboration remained a complex, sophisticated, vague and highly variable phenomenon, which often resulted in inappropriate usage of the term, as issues relating to collaboration were (and still are) referred to using a range of terms, all intended to indicate broadly similar processes e.g.: inter-professional/multidisciplinary, inter-agency/multi-agency, intersectional, teamwork co-operation. However, Hall Weavers (2001) conclusion that although both require people to work together (sharing information, knowledge skills) in achieving common goals, inter-agency partnerships are created at a formal organisational level (service planning), whilst multi/int er-professional collaboration involves different professionals working directly to achieve service-user care/treatment, seems to sum up differences in concept/process Barret et al. (2005) have concluded that in practice even if the composition of team(s) or group(s) varies, these indicate similar ideas of collaborative effort, which Hall Weaver (2001) stressed required co-ordination in order to ensure that each professionals effort is acted upon and that each is aware of what the others are doing. The move towards interagency (across health social care boundaries), multidisciplinary (within between teams) collaboration, began with the shift in emphasis from institutional to community-based care, when it was felt that the demarcations and hierarchical relations between professions were neither sustainable nor appropriate (Barr et al. 1999 Sibbald, 2000) new ways of working that crossed professional boundaries, had to be found, to facilitate a more flexible approach to care delivery (Malin et al., 2002). Thus the promotion of inter-professional working in the delivery of healthcare has long been regarded by the DOH, theorists practitioners as of great importance, in providing a better quality of service, as highlighted by the NMC (2008) and in UK government policy over the last two decades, at least. However Whitehead (2000), also highlighted the fact that one example of team working that was surprisingly neglected in the nursing literature of the time, was the partnership between client and nurse, which she argued should be regarded as part of the collaborative framework as well as in a team context. Although, Whitehead (2000) highlighted the fact that client-professional collaboration was neglected in the (nursing) literature of the time, which she argued was an important element, it should be noted that this was not neglected by the DOH in their policy guidance documents for all mental health workers the DOH has consistently highlighted the need to collaborate with service-users /or their family/carer. For example the Care Program Approach (CPA), its up-date Effective Care-coordination (ECC) the National Service Framework for Mental Health ({NSFMH}: DOH; 1990/1991, 1997, 1999/1999a) all specified the need for all service providers to work with their clients, highlighting the belief that such collaboration increased client satisfaction and improved client engagement. However, research by e.g. the Sainsbury Centre for Mental Health (SCMH 1998, 2003) the DOH (e.g. 2006a) identified that neither the CPA or the ECC initiatives where working there has now been a return to the or iginal principles of the CPA (DOH 2008/9) in an effort to address problems further emphasise the need for collaboration between service-providers with service-users in providing evidence-based agreed care/treatment packages. The rationale for such policy stems from the recognized need to break-down organizational barriers between health social-care services in particular to ensure that service-users received adequate care/support/treatment through integrated services (DOH 1997, 1998/1998a) that they were involved in the planning delivery of care (DOH 1998b). However, as the SCMH (2001/2002) identified in their Keys to Engagement, such changes/initiatives required specific skills for mental health workers (see appendix 4), particularly if the targets of the NSF for Mental Health were to be achieved. Based in this document the DOH (2004) identified core skills/competencies required by all mental health workers to work with each other with service-users in achieving evidence-based outcomes for nurses the Values-to-action document (DOH 2006b) further emphasised the need for such knowledge skills/competencies in the application of an holistic approach based in the Recovery Model. This document is further supported by the NMCs (2008) revised code which reiterates their consistent requirement that nurses should not only work with their peers, but also with other professionals and importantly with clients in developing their care-package in relation to community mental health nurses (CMHNs) one role that was introduced through the NSFMH and ECC guidelines (DOH 1999/1999a) was that of the care-coordinator (previously key-worker), for the DOH acknowledged the CMHNs central position suitability for this role (OCarroll Park 2007). Effective care-coordinators, all nurses, as with other professionals, must appreciate the roles of the other members of the MDT, and possess excellent communication collaborative skills (Bonney. in Davis OConnor 1999, Hadland 2004, Stuart 2005), as emphasised by the DOH (2004, 2006), SCMH (2001) NMC (2008). However, as e.g. Hudson (2002), Hadland (2004) Whitehead (2001) identified besides the benefits of collaboration, a variety of barriers exist, in relation to service-providers, hindering the developments of close collaborative relationships (see appendix 5) However, given the above changes have been proposed to implement across professional common foundation programme of training of all healthcare workers to enhance inter-disciplinary communication (NHS Plan: in Lilley. 2001) although these have been introduced (to varying degrees) within approved educational institutions, the DOH (2008) have now acknowledged that simply providing definitions guidelines regarding the skills required for collaboration /or for a particular role (e.g. the care-coordinator-Nb1) within the collaborative process, although it remains to be seen if their initiatives to address this will have a positive effect. Relating to the role of the nurse as care-coordinator/key-worker, as long ago as 1984 Benner considered that, nurses played an essential role in the management of care of patients both as coordinators and educators, which in line with NMC requirements means that they e.g.: Keep-up-to-date with the latest developments in care and local and National policies to ensure their practice conform to the standards of clinical governance Be central to the MDT to ensure that the patient is the focus of that care This also means that nurses are required to persist in their attempts to actively engage all clients in the shared development or their care-packages, even when clients may be unable or unwilling (at least initially) to become involved (Thurgood 2004) for as the SCMH (2005) argued by 2015, not only should every patient have a comprehensive, tailored care plan, they should have taken the lead in determining how they want their needs to be met according to the NHS plan (1998). Nb1:It should be noted that s/he is not one who simply follows an established pathway but someone who challenges existing practice and leads the way in developing new evidence-based clinically effective care (Seaman in Smith M: 1999:1998). Part 2: Collaborative Skills (see appendices 1-3 for full reflections) The following summarises my insights into my learning/learning needs regarding collaborative skills use relating to firstly my involvement in the collaborative assessment, planning implementation of the treatment/care provided for Jane, a patient within an acute forensic inpatient psychiatric unit (reflections 1-2) secondly the collaboration between my mentor, the team myself to achieve my set mutually agreed learning outcomes whilst on placement. Reflections regarding Janes assessment care plan implementation. Before conducting the initial assessment with Jane, under supervision, I was conscious of the requirements of the NSFMH the then ECC guidelines (DOH 1999/1999a/b) that the assessment must be comprehensive in order for the MDT to develop an appropriate care package. I was also conscious that this required not only my use of effective communication skills with Jane, but also with the nursing and multidisciplinary team members (SCMH 2001, DOH 2004, 2006b). in order for the assessment data to be used as a basis for Janes initial care-plan, which would allow for further assessment data to be gathered prior to her MDT review. While both Barker (2003 Stuart (2005) stated that psychiatric care requires the completion of an assessment of the clients bio-psycho-social status, Barker also asserted that the way in which an assessment is carried out and the methods used in the process make it a worthwhile exercise or largely a waste of time. Therefore I was conscious of the need to not only adhere to the ECC framework but also to the Best practice competencies guidelines for pre-registration mental health nurses (DOH 2006) and those of the NMC (2008) guidelines for students. NMC (2009) I also found that the experience afforded me the opportunity of using in-depth specialist assessment tools like the START Short-Term Assessment of Risk and Treatability (Mental health and addiction services online 2010) in further enhancing the basic ECC assessment framework a guide to areas requiring further discussion and as the START (see appendix 6) focused on risk pertinent to mentally ill offenders I found it useful also discovered that its use was being researched by this other special hospitals, for validity reliability. This I realised was important an assessment management of risk (to the patient /or others) can never be 100% (Morgan Wetherell 2004) therefore valid assessment tools collaborative in-put by the team the patient should be fundamental to risk-management strategies, which should also involve positive risk-taking (DOH 2007, 2008). Even in the absence of identified risk this need for collaboration is further supported by specific National Institute of Clinical Excellence guidelines (NICE 2009) on care provision /or treatment for a variety of client groups specific disorders including: Schizophrenia which applied to Jane. As indicated, the NMC (2008) also requires nurses to work with clients as partners; and there is widespread agreement that mental health service-users and their carers should be fully involved in care planning as this increases their satisfaction and engagement with services (Warner 2005, Rose 2003, SCMH 2009) This involves identifying their preference regarding care the START facilitated this by identifying Janes needs, as Janes key-coordinator it was my (supervised) role to ensure that all due procedure was carried out regarding recording of the outcomes which also included the planning of therapeutic engagement. Record keeping, if accurate, topical comprehensive facilitates collaboration with the team (NMC 2005) Any assessment also requires that the nurse use her observation skills (Barker, 2003, OCarroll Park 2007, Stuart 2005b), which I feel also facilitated my engagement with Jane in the process of deciding together and with the team the best potential strategies to facilitate development of her on-going care-package. Further, although I was aware of Janes history apparent paranoia, despite an aggressive incident during this time (see appendices 1-2) I also realised that to work effectively with Jane that I needed to put my personal feelings aside (Stuart 2005b) and on further reflection, I feel that I was eventually able to therapeutically work with Jane in her on-going assessment care-planning Theoretical knowledge and experience are required to make informed decisions in deciding a plan of action for patients (Stuart 2005a, NMC 2007/8, DOH 2004, 2006) Further although we no-longer utilise the nursing process in statutory mental health services I realised that the ECC/CPA framework is based in the same principles Wilkinsons (2007) argument that the nursing process promotes collaboration, remains pertinent, for when team members have an organised approach, communication is good, and patient problems are prevented. Similarly the ability to transfer/adapt knowledge and skills, especially communication skills, based in self-awareness, mutual-trust and understanding of each others roles facilitates effective collaboration with different people in different situations (Hadland 2004, NMC 2008, Onyett 2004, Stuart 2005a/b) and are required competencies by the DOH (2004 2006). The (NMC, 2008) also make it clear that nurses must always act on what they believe to be the service-users best interests, and the Healthcare Commissions (2005b) core standards emphasise the need for employers to ensure that employees follow their professional codes . As indicated MDT collaboration regarding Jane, began before the formal review meeting, however when I formally presented my initial and on-going assessment findings to the team, using guidelines from The New Ways of Working programme (DOH, 2005b), I encountered barriers to collaboration with Jane in this process, which were primarily due to legal and safety requirements of the environment (Mersey Care Risk Management Policy and Strategy, 2007 DOH 2007) I found that Jane was prevented from attending because the review was held in a non-secure area of the hospital. Although I understand the rationale behind this although an advocacy service is provided for patients to overcome this, none was made available for Jane I still feel that other strategies to overcome the problem should be developed, for as the SCMH (1998) Rose (2003) identified this lack of patient involvement by services was an area of complaint by service-users. Reflections on support for my learning: I feel that I was effective in utilising the skills outlined above in respect of gaining Janes positive and collaborative engagement with me and the strategies agreed by the MDT. To help me develop my self-awareness and skills in relation to such issues, and those outlined above I found that keeping a reflective diary at this placement, was a crucial way of ensuring critical events that needed further review, to benefit my practice, would not be forgotten. Keeping a structured reflective diary facilitates further review (either alone or with a supervisor) of experiences from which the practitioner can learn improve his/her practice (Gibbs 1998, Kirby Hart 2004, Norman Ryrie 2004) throughout my experiences my mentor has proven to be a valuable resource, without whose support I feel collaboration with both Jane and the MDT would have been significantly more difficult. It is the responsibility of the student mentor to work together in identif ying learning needs strategies to achieve them (NMC 2008 2009) Conclusion: In addition to my personal reflections and supervised experiences, which gave me the opportunity to better understand the roles of other team members and helped create a collaborative partnership between people with varying knowledge, skills and perspectives (Hornby Atkins 2000, Nancarrow 2004), I feel that the opportunity for clinical supervision with my mentor has played an important part in my role development. Finally one specific criticism of the collaborative process I have concerns the lack of collaboration with families and carers, as their involvement I feel was actively discouraged, unless clients gave their permission for this (which I have found is not unique to this placement), with the only information given being visiting arrangements and telephone numbers. Although confidentiality patient rights have to be considered (NMC 2008) (Mental health act 2009), I have found that they are never invited to the MDT meetings, Yet the DOH (e.g. 2005) state that to work effective ly in partnership with service-users and carers, it is essential that we are able to form and sustain relationships and offer meaningful choice.

EMTs and EMS Stress Management :: Emergency Medical Services

In a perfect world, violence, plane crashes floods and other disasters would not occur. Disease and illness would be non-existent. Emergency medical services would not have a basis for fruition. Unfortunately, the world is not perfect place. EMT's and other EMS workers are vital to all societies globally. According to the American College of Emergency Physicians, the definition of an emergency services is, " Emergency services are those health care services provided to evaluate and treat medical conditions of recent onset and severity that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that urgent and/ or unscheduled medical care is required." The following pages will illustrate the struggles of an emergency medical technician and other emergency medical service workers. Deciding to become apart of an EMS workforce is a life changing decision. One must take into consideration many factors that may hamper one's effort to perform the job correctly. Violence against emergency workers continues to emerge (Anderson 1991). In recent years, EMT's and EMS workers have become targets in urban areas. EMS workers enter urban war zones daily and face many man made dangers. One peril an EMT may face is the continuing growth of gangs. Gangs have branched out from big cities into smaller towns (Staten 1991). Frequently, EMS responders are attacked without provocation. In most cases, the EMS workers are responding to a call when they are ambushed by a variety of things. It has been documented by the Emergency Net New Service that fire bombings on EMS workers and their vehicles have increased in at least ten major U.S. cities (Staten 1995). In addition, EMT's and EMS workers are faced with the dangers of driving into already volatile situations. For example, after the Rodney King verdict, cities such as Los Angeles, California and Atlanta Georgia erupted into massive riots. EMS responders were thrust into physical danger. Both cities were set afire and gangs of people rushed to loot local stores (Feiner 10). EMT's and other EMS personnel put their lives in direct jeopardy to perform their jobs. Besides rioting and gang violence, EMS personnel are often faced with other more maniacal acts of violence, such as domestic terrorism. The most gruesome example of this is the case of the bombing of the Federal Building in Oklahoma City, Oklahoma. The direct targets for this disaster were the civil servants that worked in the building.

Barkovs Hamlet: A Tragedy of Errors Essay -- essays research papers

William Shakespeare authorship: The text of Hamlet contains indications that Shakespeare portrayed himself as an allegedly dead university graduate. HAMLET: A TRAGEDY OF ERRORS, OR THE TRAGICAL FATE OF WILLIAM SHAKESPEARE? by Alfred Barkov To the contents When the text of William Shakespeare: a mask for Hamlet - Christopher Marlowe? William Shakespeare Hamlet is read attentively, and no details are disregarded, it becomes evident that William Shakespeare included in it something quite different from what has been traditionally interpreted. According to the text, prince Hamlet was not a son to king Hamlet, king Hamlet has never been poisoned, pregnant Ophelia was drowned by prince Hamlet's half-brother. Though that might sound odd, the facts Shakespeare included in the text suggest that the plot of Hamlet has been perceived erroneously. In what we traditionally consider to be the plot of Hamlet, there exist multiple contradictions and discrepancies which cannot be explained within the established interpretation. Even the age of the hero is not known for sure: Hamlet of the Act I is around twenty while in the Act V he appears to be thirty years old. If we really rate Shakespeare's talent that highly as we use to proclaim, we have to exercise a different approach to the contradictions in Hamlet. That is, they must be treated as composition means intended by Shakespeare as integral parts of the structure of Hamlet. Attentive reading suggests that the contradictions reflect a sophisticated structure with two plots both containing seemingly the same cast of characters factually possessing with different biographies. Though the real plot of Hamlet as it was intended by Shakespeare can be comprehended without employment of any theory, there was necessary to develop a version of Literary Theory capable to address the problems of decoding and describing the inner structure of special class of fiction called menippeah. Despite that Hamlet belongs to that class, in my paper, I avoided plunging into the issues of literary theory because the hidden content of any menippeah can be perceived with just attentive reading, Shakespeare's Hamlet being no exception. Menippeah is different from the three known classes of fiction: the epics, the lyrics, and the drama. It employs a specific way of narrating widely used even in everyday communication (when irony is intended.)... ...lizabeth?.. The Shakespeare mystery was maintained at the state level as a top state secret. Queen Elizabeth personally tackled two cases threatening the fate of Christopher Marlowe. Chapter VIII: The second Virgin in the history of human civilization? Christopher Marlowe taught Arabella Stuart, a prospective queen. The parliament adopted a decision the throne should be succeeded by Queen Elizabeth's 'natural' rather than 'legitimate' issue. Chapter IX: Is Christopher Marlowe The Swan of Avon? Shakespeare-Hamlet: is Marlowe the Swan of Avon? The place Queen Elizabeth delivered a child in April 1564 is situated on river Avon. That might attribute Ben Jonson's definition to Marlowe. Related pages: Shakespeare Authorship. Hamlet and Marlowe's works: same structure Hamlet by William Shakespeare, and Christopher Marlowe's dramas possess with identical very sophisticated structure. Hamlet, a summary (The complete version, in Russian) Roberta Ballantine's site dedicated to Christopher Marlowe William Shakespeare Authorship Roundtable Alfred Barkov ut5ab alfred@barkov.kiev.ua P.O. Box 36 Kiev 01103 Ukraine Copyright  © Alfred Barkov 2000, 2003 Last updated: Nov. 23, 2003

Career Management Week 4 Hrm 531

Career Management Plan HRM 531/ Human Capital Management Career Management Plan Introduction The Career management plan begins with the employee themselves. They are the key to their own success. ‘A career is not something that should be left to chance; instead, in the evolving world of work it should be shaped and managed more by the individual than by the organization. † (Grove, 1999). While it is important for the employee to manage their own career it is equally important for their managers to develop a career management plan to guide them within the organization.The employee may take this information and either develop from it or become stagnant. This paper will discuss different aspects of Career Management such as: feedback, how a manager will help employees reach higher levels of performance, opportunities for advancement to increase skills, flexible opportunities for dual-career parents, adaptation to team diversity and a justification of every member’s ca reer and how they will be handled along with the expected benefits and types of costs. Analysis FeedbackDevelopmental feedback should be given to each employee by their manager or supervisor. Feedback is defined as, â€Å"An employee performance appraisal is a process—often combining both written and oral elements—whereby management evaluates and provides feedback on employee job performance, including steps to improve or redirect activities as needed. † (Cascio, 2006, p 327). Feedback may be both positive and negative. Both should be presented to the employee. If negative feedback is offered the manager should be cautious and sensitive on the presentation of the material.There are different kinds of feedback that should be offered to the employee. The different periods that feedback may be offered in are; after thirty days of starting in the position, immediately as needed in a situation or regularly scheduled. New Employee Each new employee will be evaluated 3 0 days after their first day of working in the position. This feedback will allow the employee to see how they are performing to the job description of the position. It will also give the manager the information on how the employee is performing to the expectations of the position.If redirecting and review needs to take place, this is an important time in the career path of the employee. This sets the foundation for good employee habits. Immediate Feedback In a heightened situation a review and feedback should be done in a timely fashion or immediately as the situation requires. This allows the employee to redirect if necessary and build good work habits. While feedback cannot always be managed so quickly, this is the optimal solution. Immediate feedback should be in the manner of oral and written communication.The supervisor should counsel the employee and speak to the employee with immediate feedback, then follow up with written communication. The employee should then have the abi lity to respond to the supervisor in writing within thirty days. Scheduled feedback Feedback will be given to the employee on a scheduled basis. A review will be done both semi-annually and annually. The format for the semi-annual and annual appraisals will be the same. The goal of each manager will be to provide the employee important information on their performance. The appraisal will be non – biased and informational.The employee should be rated on their individual strengths, including: the quality of their work, knowledge of the job, communication between other members of the organization, work habits, job knowledge and the behaviors and relations with others. The feedback from the appraisal should show how the employee can improve their performance and the tools and resources they have available to improve their performance. After the feedback is presented to the employee in oral and written format, the employee will have thirty days to respond to the feedback.The manag ers or supervisors will then have thirty days to respond to the employees’ feedback. How a manager will help employees reach higher levels of Performance The basis of goal setting and the appraisal and feedback process is to assist the employee to reach higher levels of performance within their current position and to set the stage for future performance and growth. This performance may benefit our company or the employee may leave and take the skill sets they have learned with them.It is the job of the manager to assist the employee to gain higher levels of performance so that they will want to stay with our company. Cascio describes performance as, â€Å"A manager who defines performance ensures that individual employees or teams know what is expected of them, and that they stay focused on effective performance. † (Cascio, 2006, p 329). . How do we as managers accomplish this task? â€Å"By paying careful attention to three key elements: goals, measures, and assessm ent† (Cascio, 2006, p 329). Setting goals for employees sets the expectations that they will work toward.Cascio describes the goal setting process, â€Å"Set specific, challenging goals, for this clarifies precisely what is expected and leads to high levels of performance. On average, studies show, you can expect to improve productivity 10 percent by using goal setting. ’ (Cascio, 2006, p 330). The employees should have realistic and measureable goals. The more defined the goals are the easier they will be understood and be able to be assessed. These goals should align and incorporate the corporate objective of increasing market share and customer based sales. The measures and assessments are part of the appraisal and feedback process.Opportunities for Advancement Opportunities for advancement are largely dependent on the employee and their desire to meet and exceed the goals a manager has set for them. The long term goals for each person vary. It is a managers’ job to realistically discuss what the goals of each employee’s are. Individual goals vary from person to person. One goal for an upcoming salesperson may be to be a Sales Manager within five years. For an older person it may entirely different. Cascio describes an older person’s goal, â€Å"Late careers increasingly are defined in terms of phased retirement.In this new world, the ultimate goal is psychological success, the feeling of pride and personal accomplishment that comes from achieving your most important goals in life, be they achievement, family happiness, inner peace, or something else. † (Cascio, 2006, p 376). Options for Advancement Once individual goals are set, the manager may look at the various options available within the company to meet the needs of the employee. There are a variety of options available to the manager to meet the different goals of an employee. The goals may include upward or lateral moves within the company.To meet the indivi dual goals, training or retraining in different areas may be necessary. The employee may need to be challenged so that they do not become stagnant. The manger may identifying skill sets of the employee and suggest vacancies or positions within the company that would utilize the employees’ strengths to move upward. If the company adds a new market segment, retraining may be offered to current employees. The tuition reimbursement plan of $2000. 00 per employee per year allows the employee to have the company pay for further education at an accredited institution.The focus of the education must align with the employees’ position or future goals. The tuition reimbursement plan is part of the employees’ total compensation package. Other offerings to employees may be established if the manager identifies an unmet need that would benefit many employees. Flexible opportunities for Dual – Career Parents In current studies we see that â€Å"forty five percent of t he workforce is made up of dual- career couples. † (Cascio, 2006, p 379) The dual career couples and parents have presented to be a unique concern in our company.To meet the needs of this group we have offered a variety of opportunities to our employees. Flexible work hours have been established in departments that are not schedule based. Employees may use accrued compensation time to meet family needs. They appreciate work times that may tailored to their family needs. Since beginning this policy, we see that the turnover rate of dual career couples has decreased. Telework from home is allowed for approved employees. When employees are sick or have sick children they work from home, which has reduced company absenteeism.This has allowed employees the flexibility to meet the needs of their families while maintaining productivity. On-site daycare facilities have been established in many of our site locations. This allows parents to spend more time with their children. It has de creased absenteeism of parents. Reviews from parents with children in the company day care facilities have stated that they no longer have to take time off because of private care facilities closing during work days. In many instances productivity has increased because of these measures. The goals of a dual career couple employee may also be unique.The manager should be aware of any special concerns regarding lateral, upward or career relocations this may have for the employee. Adaptation to team diversity and a justification of every member’s career Our company has a combined workforce made up with a very diverse set of employees. There are new graduates directly out of high school and college that have little to no work experience. There are seasoned employees that have been with the company for a number of years. There are individuals from a variety of races that speak many different languages.Our workforce is comprised of nearly equal genders. We are a non-biased company that is utilizing each employee’s strengths. When a unique talent is needed in a specialized market we try to fill the position using the employee’s strong points. Culture differences and fluency in different languages is definitely a plus in our company. An example of the current views on cultures shows that most companies are trying to diversify their workforce. â€Å"We feel it’s important to have employees who represent all walks of life from many diverse cultural backgrounds. (Burden, Octo) We have recently marketed to the Health Care industry in a Spanish speaking region. We have realigned the Spanish speaking sales representative and customer support to these accounts. Productivity and sales have increased three times in the account. Participation in these market segments is voluntary and should be part of the personal goals of the employee. Bonuses and salary increases of five percent will be given to bilingual employees that work in these diverse marke t segments. Bias toward any particular group of people will not be tolerated.Justify the report and the expected benefits and types of costs. The process of appraising, rating and feedback allows for clear and concrete goal setting. The cost of the process and employee offerings far outweighs the cost of doing a mediocre job of employee development and career planning. With concise goals and managers that assist in employee development a strong workforce is being developed within the company. There are many benefits to assisting employees with their career plans. We have a workforce that is staying with the company for longer period of times, more nowledgeable about many departments within the company and more loyal. We have workers that are telecommuting, getting more work done at home than at the office. These are just some of the benefits of career planning. There are also many costs that are avoided with having a stronger workforce. These costs are associated with the lack of em ployee development and career planning. Employee retention and turnover is one of the largest costs to a company. In an industry average we see that employee turnover has a great impact. These calculations will easily reach 150% of the employee’s annual compensation figure. The cost will be significantly higher (200% to 250% of annual compensation) for managerial and sales positions. † (Bliss, May) Retraining employees to work in another department allows them to share and expand their knowledge and eventually make for a stronger company. â€Å"While it is true that sales and other financial statistics determine the success of a company, what most people overlook is the fact that employees are among the most important determinants of the success of a company. (Icles, Apri). Conclusion This paper has shown the process of feedback, how managers may assist employees to reach a higher level of performance, a discussion on lateral and upward advancement, dual – coupl e careers, diversity and the benefits and types of costs of having a career plan. It has been seen that having goals that are derived from an appraisal may start the employee on a career plan. While the employee is ultimately responsible for developing their own career, their manager will play a significant role in modeling the way for that development.Developing a career management plan for employees has associated costs, but we have seen that the benefits outweigh these costs. These benefits are retention of happier, more productive and loyal employees. It appears that career management planning is the way to go for any company. References Bliss, W. G. (May 9, 2010). Cost of Employee Turnover. Retrieved from http://www. isquare. com/turnover. cfm Burden, M. (October 15,2010) Flint Journal – Michigan Business Flourish Because of Bilingual Workers. Retrieved from

Disengagement Theory Essay

When people whether old, young, able bodied or disabled are involved in an activities they known to be engaged in this activity by taking part. But some elderly, able bodied or disabled, don’t like to take part in these activities they are disengaged also knew as disengagement. Back in the early 1960’s two authors by the names of Cumming and Henry put forward a theory about older people being disengaged where they would naturally tend to stay away from activities this was branded as disengagement because They would naturally tend to withdrawn from social involvement with other people of their own age or people around their age. They would be restricted to what they could do in a social care settings, this would be either through ill health, travel, and where they live in regards to then getting an organised event in another town or city. Many of them just retired from their jobs away from family and friends. Back in 1975 the author Cummings put an argument forward that older people would experience a larger reduction in social contact as they grew older, they became increasingly lonely as they withdraw from society and they become less concerned with the expectations of other people. His argument was that it was appropriate and sometime healthy for the older to withdraw from others and disengagement was a natural part of the ageing process. This theory of disengagement has been widely accepted in society in the past. An example of this argument was by an author by the name of Bromley back in the 1970’s he argued the following statement, ‘although some individuals fight the process all the way, disengagement of some sort is bound to come, simply because old people have neither the physical nor the mental resources they had when they were young.’ This theory also fits in with the ‘springboard’ view of life, it also suggest that losing contact with friends, family and other people has an inevitable consequences on the biological decline and also withdrawn from other people is a natural appropriate response to the ageing process. There is also very little statistical evidence that suggest that this is a common or general rule to everyone of an older age. An author by the name of Zimbardo also argued on this disengagement issue in the early 1990’s, his argument was that disengagement view of social ageing has been largely discredited on a number of occasions and reasons. But the majority number of older people do remain socially involved with friends and involved with their family, but the majority of many older people become more involved with close family as they age, this is mainly because they become involved in their grandchildren and great grandchildren lives, and sometimes the majority of them do this, rather than seeking out new friends. Does this also mean that with only interacting with their close friends and family, that these people are disengaged? There are many researchers these days that don’t agree with the disengagement theory. it is also important to remember that when the author’s Cummings and Henry first came up with these theory’s in the early 1960’s there was no internet or text messaging, mobile phones and majority of older people in the 60’s didn’t have access to a car and back in those days most house didn’t have a telephone or television in them let alone a computer or mobile phone, whereas now days most house have a telephone, mobile phone, internet access and a car to travel to see friends and family.

Medical Billing and Coding Essay

Medical Billing and Coding (current student) 2013 Medical Administrative Assistant Diploma (GPA 3.34) 2012 Includes: Disease Processes, Surgical Procedures, Life Cycle of an Insurance Claim, Health Care Settings, Health Care Payers, Procedure and Diagnosis  Coding from Medical Records, Reimbursement Systems, Facility Billing, Word Processing and Medical Practice Management Systems. * Promoted a welcoming and safe learning environment for children, helping to develop a well-rounded and respected educational organization. * Assisted the school director in playing a key role in developing a diverse and enlightening curriculum in strict accordance with state mandates. * Communicated effectively with children, peers, parents and directors to ensure smooth operations and eliminate potential issues before they could negatively impact the school. Packer Express Personnel – Jamestown, NY2001 – 2002 Bush Industries – Jamestown, NY2001 – 2001 * Duties included: Packing, stocking and accurately completing labor tickets. * Load materials and products into package processing equipment tools. * Record product, packaging, and order information on specified forms and records. * Performed any combination of light cleaning duties to maintain the establishment. * Inspected for defects and recorded items packed.

Decolonization and Revolution Essay

From 1945 and beyond, leaders have selected different paths to affect change. Some encouraged independence through violence, peaceful actions, diplomacy, and the commitment of their struggling nation. Others sparked revolutions by appealing to the peoples’ needs. Through policy, and sometimes uniting a people, trailblazers changed the face and structure of their nation. A column from a journalist during the time period would help to see a broader perspective during such varying and exciting time. Decolonization, revolution, and nation building are all goals of any effective leader willing to make a change. Spanning from 1945 to 1975, countless independence movements have changed societies across the globe, led by leaders and organizations who all yearned for better. The â€Å"Declaration Against Colonialism,† adopted by the United Nations, took a firm stand on the demise of colonialism. The document petitioned for a definite end to colonialism and encouraged self-determination, stating that all human beings have a right to their own societal and political choices. Such a statement coming from an organization comprised and backed by countless nations surely stands its ground. The United Nations, supporting the end of colonialism, inspired countries to strive for freedom through the organizations obvious power. It also displayed the end of a colonial era, seeing as though many colony-yielding nations were members of the UN. (Doc 1). Ho Chi Minh, Vietnamese nationalist, too felt the need for freedom. Minch expressed the Vietnamese’s determination to end French colonization i n their country. Minch made it clear that violence would be condoned and encouraged to win this battle. Ho Chi Minch embodied Vietnams’ fighting will for a separation and willingness to shed blood in the process. (Doc 2). In a similar suit, Jomo Kenyatta of Kenya shared his hate for colonialism and his approval of violence. He claims that Kenya belongs to its inhabitants, not colonizers who held his people back. Kenyatta believed that the only way to approach self-rule is through bloodshed. (Doc 6). Mohandas Gandhi of India had a quite parallel approach. From an excerpt written by him, it is seen that  Gandhi believed the path to independence was paved with nonviolence and self-sacrifice. Gandhi in many ways led Indians to Independence. Even after his death, he was a guiding light for those who coveted an India without the British. (Doc 3). Kwame Nkrumah, leader of Ghana’s independence, expressed his goal dismay for colonialism. He saw the system as contractual and exploitive to his country. He calls the independence movement â€Å"the greatest awakening ever seen on this earth†. By portraying colonialism as a heinous and abusive practice, Nkrumah led Ghana to independence. (Doc 5). A letter from the British monarchy as a response to colonial independence would give insight as to whether they see themselves as negatively as their colonies do. In South Africa, China, and Cuba, social and political revolutions pioneered by inspiring people occured. Nelson Mandela, speaking on his fight against apartheid, conveyed his commitment to the cause. Mandela dreamed of a South Africa where equality and democracy was not a scarcity. Unfortunately, his reality at the time was far different. Nelson Mandela was willing to die for the cause. His dedication inspired others to continue to fight for justice in South Africa. This infectious determination is was enabled Mandela to lead the campaign for termination of this policy. (Doc. 4). In China, Mao Zedong led his country to the communist revolution. In a speech he delivered, he vocalized a goal to build faith in the party. The method applied by Zedong focused on uniting China under one belief in order to implement communist ideas in the country, widely changing the country’s structure. (Doc 7). At his defense trial, Cuban revolution leader Fidel Castro appealed to those struggling in his country. He spoke to those who hoped for a brighter future and who have been betrayed by their country. By addressing their battle, Castro urged them to fight for a better Cuba. His relentless and undying commitment ultimately granted Castro his wish for a revolution. (Doc 8). An additional document consisting of a diary entry from a Chinese citizen during the communist revolution would create a clearer vision as to how convincing Mao Zedong truly was. Some modern leaders look more inward as to their nations’ policies and people to affect change. Hosni Mubarak, former President of Egypt, aimed to unite his country and better certain systems to strengthen the nation. When in a hard and confusing time, Mubarak provided Egypt with a steady guiding hand. In the midst of this chaos, instead of addressing the questions and wants of the people, Hosni Mubarak demanded they offer themselves to supply the needs of their country and support their leader. This mindset calmed Egyptians as Mubarak reopened Egypt to the Arab world, tried to reaffirm the constitution and judicial system, and tackled social issues. (New Leaders of Nations #1). Former prime minister of India Narasimha Rao was first questioned by the Indian people as to his ability to lead. This was turned around as he implemented many policy changes in India. India, fairly unfamiliar with outside involvement, now encouraged foreign investment. Rao’s programs for economic growth and investment, both foreign and Indian, faced opposition from possible disorder. However, Rao’s use of intellectual thinking and a new, open India, aided his decisions. A documentary depicting evolving countries as they face modern challenges would be helpful in grasping what qualities leaders who create change possess. Those who create ripples of change in their societies all have varying methods and roles. Some strive for revolution, others independance or policy reboots. It is important to keep in mind that each situation creates unique circumstances; some changes require new methods. To further understand which methods are suitable for particular situations, letters from different leaders who have created change would be helpful.

"Escape"- by Nina Cassian

Escape- by Nina Cassian Essay Escape is a poem addressing the age-old, yet somehow more modern, issue of unhappy and detrimental yet addictive relationships. The form, showing the effects of this relationship and her awakening from it, along with the dark, sometimes even morbid, diction and imagery make the poem a very personal and touching one; subsequently it also helps the reader relate to his own experience, thus proving to be very effective. The diction and the literary devices generally set the mood in Escape; the poem begins with two rather shocking contradictions in which Cassian compares his love to a prison ( these two not being commonly associated in our society) and proclaims that His words and looks were like padlocks. To a certain extent, this immediately shows her addiction to him, at that time either conscious or subconscious, as, although she claims that he locked me in, she herself could not, or did not want to open these padlocks. Moreover, I think that they covey a feeling of claustrophobia for the reader, thus persuading him to immediately notice how harmful this relationship was for the poet. The description of how she lost her senses, becoming blind and mute, makes us understand her helplessness, her entrapment as without those vital senses there was little she could do to escape. Everything around her is distorted, as she is unable to tell a curtain from a river (therefore the indoors and the outdoors) apart. As the poem progresses, her senses become increasingly deformed and she creates a morbid, almost frightening image for the reader, by declaring that she could not see the difference between a bracelet and a muzzle, conveying the idea of death as a muzzle is associated with guns. Nonetheless, the poet seems to also be having a feeling of longing at the same time, as she mentions the call of the pomegranate seed or that kind invitation of frogs into the sunset which are reminiscent of the Romanian countryside, considering that those are her native lands. The concluding line of the stanza highlights the overall effect this transformation has had on her as she lost a lot of friends; the caesura underlines that this is the direct result of everything she has mentioned throughout the stanza. The repetition running throughout the first stanza emphasizes the extent of her desperation and change, as she repeats the idea that she could no longer tell apart things. Nonetheless, the repetition of dead in dead hair and dead nails probably show how she herself felt inside, like she was growing into a lifeless corpse while she was still actually young. This description also lies in line with the metaphor of this love being like a prison as I think we are encouraged to see her as a convict as well. The use of threatening, frightening verbs such as invaded or covered again reveal her helplessness and how lonely and scared she must have felt at one point. The form of the poem helps reveal how much effort it took for Cassian to escape, as after delivering her feelings during the relationship and its effects, she then suddenly wakes up from her haunting nightmare in the second stanza. I think that she wants to stress this feeling of a nightmare by describing what she felt when she touched herself as always tend to check ourselves when waking up from a nightmare to see if we are whole. Unfortunately, in her case her nightmare was a reality, so she notices how her cheeks had become hollow to the touch/my hands uneven and the shock of seeing herself this way persuades her to have the strength to free herself from all those horrible things. READ: Poetry Essay Compare with the speed of disgust. Moreover, the form takes another important role in the second verse as the short lines illustrate the speed of her actions to rid herself of the harmful effects of this relationship, from cut(ting) off the dead nails until break(ing) the lock/ and run(ning) out. I feel like the increasingly short lines convey a sense of urgency, as the quick pace makes it seem like she is really breaking out of a prison, thus making her metaphor highly effective. The imagery Cassian uses, whereby she compares this love to a prison, runs throughout the second stanza, the poem ending with this metaphor just as it began. After she finally gains strength and willpower to break the lock she realises that There was no guard. I think that this short sentence highlights the ambivalence of her feelings, as on one hand she must have been relieved to be able to free herself so easily, while on the other hand she may have felt some disappointment, as she was probably expecting him to care, to not simply let her go. The repetition of No one in the last 5 lines highlights her loneliness and desperation as nobody was there on either sides, her lover not caring enough to ask her to stay or to raise the alarm and her friends not greet(ing) her or supporting her once she got out of the relationship. The use of Not a soul again brings into question the idea of death which is expressed in the first stanza; she was probably hoping that a soul, or somebody, would revive her from being so lifeless and full of dead things but unfortunately this soul is absent. The idea that she ends the poem with only No one is an extremely poignant conclusion, highlighting the peak of her lonesomeness, towards which the second stanza was building. In my opinion, this creates a heartbreaking mood, making us feel even more sympathy for the poet.