Psychological Factors of Women with Infertility Problems Essay

Giving birth to a new born is considered very priceless by their proud mothers. The agony of not having a baby due to several constraints and hindrances proved to be very critical to a women’s health, emotionally and physically. Psychological effects of infertility include anxiety; depression, guilt, isolation, and relationship tension. These can be considered causes or as a result of infertility and often times can affect interventions or treatment to make pregnancy possible. The problem of infertility is considered one of the hindrances that can affect women’s health and their social interactions comes along with it. In the United States, almost 10% of individuals in the reproductive age are affected by infertility and approximately 50 % of which comprised of couple seeking for possible treatment to make pregnancy possible. Aside from the psychological aspects, several factors which are associated with infertility in women include advancing age, endocrine dysfunction, increasing body mass index, and irregular and long menstrual cycle. Women suffering from infertility problems have psychological stress indicators such as long existence of negative emotions during the period of trying to conceive, changes on their partner’s relationship, depressed moods, problems with concentration or memory, low self- esteem, and anxiety. Reported studies also indicate women with infertility problems were more susceptible to have depression, occurring on its first diagnosis. Emotional well being is also affected if the in-vitro fertilization procedures were unsuccessful (Burns and Grambsch, 2002). Also, women with unknown organic cause of infertility would likely to develop a deeper depressive emotions, anxiety, and suppression of anger compared to women with known cause of infertility. However, the measure of the physiological aspects has not been associated with the process of in-vitro fertilization and infertility. Most of the time, women having infertility problems are willing to neglect or have a certain degree of tolerance to related risk factors just to conceive pregnancy and are mostly have less adverse on the risk as compared to their husband or partner. The support of the husband or the partner plays a vital role in such a way that the desire of both for parenthood must have a common perspective. In this way, marital adjustment will take its part to ensure a healthy relationship. If the partner has a greater desire than the woman, this can bring emotional stress too such as depression. Other than the husband or the partner, the society also plays an important part on the woman with infertility problems. The perception of having less support other than the partner can have avoidance as a social or a defense mechanism. If the attempts for conceptions are not successful, the absence of moral or any support coming from the society can also cause depressive emotions and symptoms. Though infertility can cause distinct psychological effects on women, several treatments are being practiced and applied to help conception possible. In general, there are two methods of treating infertility: the psychological treatment through counseling to achieve conception, and the in-vitro fertilization treatment process. Both of which, some way or another, have adverse psychological effects on the mental state of a woman. The psychological treatment through counseling is one method on the treatment of infertility. This treatment of counseling can be conducted either during the process of natural conception, and/or during the process of the in-vitro fertilization. Furthermore, support from counseling has been significant to improve depression and anxiety to couples having fertility treatment. Usually the treatment comprised of a ten-session treatment implying behavioral (cognitive) therapy. On related studies, 42% conceived pregnancies after completing the treatment for 6 months and these women have a relatively higher distress pretreatment compared to women who did not undergo counseling. The process of counseling usually takes place after the application of the in-vitro fertilization rather than before the conception or the pregnancy test. The purpose of which is to help women to have a lesser degree of depression and anxiety. Women who conceived pregnancy after the process of in-vitro fertilization tend to have an improved self-esteem and a lesser degree of depression. Therefore, the psychological process of intervention through counseling will be more successful if applied to women with infertility problems during repeated or unsuccessful in-vitro treatment, absence of a partner and social support, and with a state of greater depression. Medical intervention is another method and is commonly applied if the psychological fertility treatment or counseling has failed though the exposure to medication of a possible fetus if there is a conception should be avoided. The in-vitro fertilization treatment process is another method to achieve conception. This includes the introduction of certain medications to enhance the reproductive state of a woman to achieve conception. This process goes along with the counseling treatment during the period of conception to ensure a high probability of giving birth. But the chemicals involved in the process also have a psychological association to the mental state of the woman. The manipulations of hormone to assist reproduction can have an effect on their psychological state, for instance the clomiphene citrate has been known to be associated with psychosomatic symptoms; the gonadotropin hormone is also associated with increased state of anxiety and depression (Eyal, Toren, Dor, Mester, and Rehavi , 1996). Aside from the side effects caused by the chemicals, the process also have an effect to those women who conceived after the treatment. Some women showed intense muscle tension, and others have emotions of low self-esteem, self-efficacy, and a greater negative behavior as reaction to pregnancy-related stress compared to those women who conceived naturally. More over, women after giving birth through the process of in-vitro treatment have observed their infant as more temperamentally hard. This can be attributed also to the psychological effects to women who conceived because of the treatment. Thus, even if the treatment is successful, support through counseling during the period of conception should be conducted so that the babies as well as the mothers may benefit through having a state of mental wellness. Common outcome in the in-vitro fertilization treatment process is having multiple births, occurring almost 35% on most cases. Reduction of embryo for multiple states of pregnancies has been proven emotionally disturbing and chaotic. Twin births which are assisted have a significant difference compared to spontaneous twin births with regards to low weight after birth, high premature state, and early gestational stage. At some instances, assisted birth twins have likely to develop a greater degree of depression and respiratory diseases at birth. The psychological effect of which to mothers depends on how they cope with the situation but generally they become more aware of the babies health and needs, maternal or parental stress and depression, and unmet needs of the family. The psychological factors proved to be very critical with regards to the concept of infertility to women. These factors can affect both the mental and physical state of a woman. Factors include anxiety, depression, guilt, isolation, and relationship tension. These can be considered as a result of infertility or its related causes and most of the times have a significant effect on the treatment or interventions being conducted. Interventions and treatments include the psychological treatment through counseling and by in-vitro fertilization. The treatment through counseling is being conducted during the pre conception and also after the in-vitro fertilization to primarily help the woman and also the baby inside to have a lesser degree of depression-related emotions and anxieties. The in-vitro fertilization process includes the introduction of chemicals to enhance the reproductive state of a woman, though there are several adverse side effects on the woman’s psychological state such as obtaining psychosomatic symptoms, anxiety, and depression, intense tension on the muscles, lower self esteem, and self efficacy. Eventually the process of realizing infertility and the consequent treatments and interventions proved to be stressful. The technology on the reproductive area can some way or another make the conception of pregnancy possible, but the psychological effects or factors associated proved to be very critical. The early or prompt action through psychological intervention can be very significant in the realization of a couple to have a baby. Furthermore, the support coming from a partner, a husband, and from the society can also help lessen the degree of emotional stress being experienced by the woman having infertility problems. Thus, the psychological factors can influence a woman’s reproductive state or in another point of view can be a cause and effect of infertility.

Chronic Obstructive Pulmonary Disease

COPD which is Chronic Obstructive Pulmonary Disease is known as a condition that progressively makes it harder to breathe because the airflow into and out of the lungs is reduced. This usually occurs because the airways and air sacs lose their elastic quality, the walls between the air sacs are destroyed, the walls of the airways become swollen, or if the airways are clogged because they made more mucus than usual. Three main conditions of this disease are emphysema, chronic obstructive bronchitis, and asthma. Most patients who suffer from COPD also suffer from emphysema and chronic bronchitis as to why they are commonly just defined as COPD. The patients who experience one or more of these conditions usually find it even more difficult to breathe. It is known to be a major cause of disability, and the fourth leading cause of death in the United States. It is said that approximately 12 million people have been diagnosed with COPD while another 12 million may have it and don’t even know it. COPD is mostly caused by cigarette smoke; however, pipe, cigar, and other types of tobacco smoke, as well as, second-hand smoke can contribute to this disease. This disease can also be caused by inhalation of air pollution, chemical fumes or dust either in the workplace or from the environment. COPD is usually found in patients of at least 40 years of age; however, it may affect a patient younger if they happen to have the genetic condition, which is alpha-1 antitrypsin deficiency. Alpha-1 antitrypsin is a protein made in the liver. This is an inherited deficiency that puts patients at a high-risk for lung disease. This deficiency occurs when the AAT proteins are not the right shape, which means they get trapped in the liver cells and cannot get into the bloodstream to travel to the lungs in order to protect them. Signs and symptoms of COPD are chest tightness, wheezing, shortness of breath, and also the â€Å"smoker’s cough. † The â€Å"smoker’s cough† is defined as an ongoing cough in which the patient produces large amounts of mucus. Severe COPD can cause symptoms such as weight loss and lower muscle endurance. If a patient is having a hard time catching their breath or talking, their not mentally alert, their heartbeat is very fast, their lips or fingernails turn gray, or blue or their recommended treatment which usually works isn’t work emergency treatment should be sought. If a doctor is attempting to diagnose COPD, he will first determine whether or not the patient is a smoker, then look into the patient’s family and medical history as well as their signs and symptoms. The doctor will also perform an auscultation using a stethoscope to listen for any wheezing or abnormal chest sounds. If the diagnosis process isn’t completed at that point, the doctor may then perform lung function tests. There are many different lung function tests; those are a spirometry, a peak flow meter, a lung volume measurement, a lung diffusion capacity, pulse oximetry, or an arterial blood gas test. A spirometry is a test to measure how much air you breathe in and out and how fast you blow it out. A peak flow meter is a small, hand-held device that shows how well air moves out of your lungs. A lung volume measurement like a spirometry measures how much air you can breathe in and out, however, it also measures the size of your lungs. A lung diffusion capacity determines how well oxygen passes through your lungs to your bloodstream. Last, are a pulse oximetry and an arterial blood gas test, both of these tests are used to see how much oxygen is in your blood. The arterial blood gas test is usually what is used to determine how severe your COPD condition is. After COPD is diagnosed, different treatments may be advised. There is no cure for this condition, but certain treatments may help a patient to feel better, remain more active and also keep their condition from progressing so fast. First, the doctor will tell you if you are a smoker the best thing to do is to quit. And, depending on the severity of your COPD your doctor may advise you to see a pulminologist, who is a doctor who treats patients with lung problems. Then, different medications may be prescribed such as bronchodilators, short-acting or long-acting again depending on the severity of the disease. Both are used to relax the muscles around your airways to help make breathing easier; however, short-acting is said to only last four to six hours, whereas, long-acting is said to last twelve hours or more. Most bronchodilators are used through metered-dose inhalers. Also, inhaled steroids may be prescribed to reduce the airways from swelling. Doctors will usually prescribe the steroid for a trial period of six weeks to three months. Other treatments to help this disease from progressing may be pulmonary rehabilitation, oxygen therapy, and vaccines to prevent the patient from the pneumonia or the flu. Rarely, a patient may be advised to have surgery such as a bullectomy, which is a removal of one or more very large bullae of the lungs, a lung volume reduction surgery, which is used to removed damaged tissue from the lungs, or a lung transplant may also benefit patients who suffer from COPD. Although emphysema, chronic bronchitis, and asthma are all conditions of this disease COPD, each condition affects the lungs slightly different. Emphysema is the condition that affects the lungs almost the same way because just like COPD it involves damage to the air sacs within the lungs; however, chronic bronchitis and asthma are different. Chronic bronchitis is known as a long-term inflammation of the bronchi, which causes increased mucus and other changes. Asthma occurs when the muscles in the bronchial tubes tighten and the airways become blocked by the extra mucus the airways are producing. Emphysema just like COPD is more progressive than chronic bronchitis or asthma. Patients with emphysema usually have shortness of breath and within later stages of the illness develop a chronic cough or sputum, whereas, patients with chronic bronchitis usually have a cough and develop sputum for many years before suffering from shortness of breath. And, for patients with asthma if proper treatments are followed then symptoms can be controlled. Causes of these conditions are also very similar. The most common cause for all of these conditions is smoking. The AAt deficiency can also play a role on patients who suffer from emphysema like COPD. Other causes for emphysema are known to be the HIV infection, as well as, connective tissue disorders. Other causes for chronic bronchitis can be from bacterial or viral infections. And, many different causes for asthma are airborne allergens, like pollen, mold, animal dander, dust mites, etc. , exercise-induced asthma, cold air, and certain medications, like beta-blockers, aspirin and other NSAID’s. It is said that the menstrual cycle in some women, as well as, the gastroesophageal reflux disease, which causes stomach acids to back up into the throat can lead to an asthma attack. And, allergic reactions to foods, like peanuts or shellfish can also cause an asthma attack. Symptoms of emphysema are known as a mild or chronic cough, loss of appetite and weight loss, and muscle fatigue. Symptoms for chronic bronchitis are known as a cough, spitting out of excess mucus, lips and skin may appear blue, abnormal lung signs, swelling of the feet, and heart failure. And, symptoms of asthma are chest tightness or pain, shortness of breath, a whistling or wheezing sound when exhaling, and trouble sleeping because of the shortness of breath, coughing, or wheezing. The diagnosis and treatments for both emphysema and chronic bronchitis are very similar as COPD, where pulmonary function tests, x-rays, and/or CAT scans may be performed to diagnose the condition. And different treatments may include bronchodilators, oxygen therapy, steroidal medications, and even possible lung surgery. Different procedures that may be used to diagnose the condition known as asthma are a methacholine bronchial challenge, where the patient inhales an asthma trigger called methacholine to mildly constrict the airways and a positive methacholine test will support the diagnosis. Another test is known as the nitric oxide test, which is used to measure the amount of nitric oxide you have in your breath. If your airways are inflamed, that is a sign of asthma. Medications that may be prescribed to treat asthma symptoms are inhaled corticosteroids, like Flovent Diskus, Pulmicort, Azmacort, Aerobid; Long-acting beta-2 agonists, which are long-acting bronchodilators; Leukotrine modifiers, theophylline. Also, short-acting bronchodilators may also be prescribed such as albuterol, atrovent, and oral and intravenous corticosteroids.

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Oce 1 - Essay Example Economically, fossil fuels have become expensive to the extent that it influences greatly the prices of other commodities. To help address the issue, world leaders have been advocating for measures aimed at limiting the use of fossil fuels as a source of energy. This was evident when world leaders with the exception of the U.S. gathered in Kyoto in 2005 in an attempt to come up with an amicable solution to the problem (Krà ¼ger 5). This led to the signing of the Kyoto protocol, which advocated for the use of renewable sources of energy as opposed to fossil fuels. Despite the U.S. not being among the countries that took part in the signing of the Kyoto Protocol, it is finding unwise to rely much on fossil fuels as its main source of energy (Krà ¼ger 8). This is because it is creating economic hardships, as well as environment problems that make the U.S. venerable to many natural calamities such as droughts and extreme flooding among others. As a result, Krà ¼ger notes that the government has recognized the need to increase funding for harnessing alternative sources of energy (8). In this regard, the government is finding it viable to invest more on renewable sources of energy that scientists argue, are more efficient and environmental friendly. This paper will discuss the need for the government of the United States to provide assistance in the harnessing of solar and wind power. Most Americans and scientists agree that in order to fight global warming and achieve energy independence, the U.S. has to avoid the use of fossil fuel and adopt the use of other renewable sources of energy that are efficient and cost effective. These include solar energy, wind power, hydroelectric power, and biomass. Reports show that overreliance on fossil fuels is becoming a big threat to the U.S. economy and the environment (Winkler par.2). The impacts of fossil fuels use on the environment include the

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Law of evidence - Essay Example In this regard, different case laws are implied in the provided case with the aim of having effective evidences in accordance with the law. By reviewing the case study, it has been observed that there are two individuals named Albert and Bart, who were involved in the incident of a burglary in a bookstore. It has been expected that the burglary has taken place on 15th December 2013 at 10 pm. A witness named Mr. Bird gave the statement regarding this incident of robbery. The incident has taken place in a bookshop where the thieves have stolen 500 law books. The witness has also provided a description of one of the burglar. By this statement of the witness, police has been able to recognise a suspect who is expected to be a prime guilty of this robbery incident in the bookshop. After arresting the first suspect, police has started interrogating him by marinating the law and regulation. The first suspect Albert has been arrested from the nearest clinic where he has been having treatment of his wound caused during the incident or robbery. During the interrogation, DC Tracy has put the effort to confess the guilt from Albert, but he refused to do the same. In this context, the suspect has been urged for receiving the solicitor, but DC Tracy did not provide him the minimum chances to receive the facilities of a lawyer. After sometime, Albert confessed his involvement in this burglary incident and mentioned the name of the involvement of another person. Albert also agreed to disclose all the confidential evidence of his prior group in terms of getting the concession in his punishment from the court. However, DC Tracy has denied his request and become able to confess guilt, but suggested that his cooperation will be taken into account in the court at the time of sentencing. As per the theft act (Northern Ireland) 1969, the guilty of burglary needed to be

Impact of climate change on timber engineering structures Research Paper

Impact of climate change on timber engineering structures - Research Paper Example The differing opportunities and threats posed by timber structures and climate change are outline below. 1. TIMBER STRUCTURES AND BUSHFIRES Climate change has been related to bushfires directly and increasing temperatures have been taken as a sign that bushfires are only bound to increase in the future. An estimate puts the change in temperature due to global warming in Australia between 0.4 and 2oC by the year 2030 above the 1990 levels while the change by 2070 is projected between 1 and 6oC. (Preston & Preston, 2006) It could easily be expected that the exposure of timber to bushfires would result in the timber structures being damaged beyond repair by fires. However this is not entirely true as timber structures do not face any real threats as long as the heat from the bushfires is radiant in nature. Appropriately AS 3959-2009 specifies three classes of timber that can be used in areas at risk of bushfires. These ratings are based on the BAL (Bushfire Attack Level) ratings and include timber with a seasoned density of 650 kg/m3, 750 kg/m3 and timber that is resistant to bushfire. Timber is made resistant to bushfire t hrough the use of the materials inherent properties, by dousing and coating with fire retardant chemicals or through the application of fire retardant substrates. (Standards Australia, 2009) However AS 3959-2009 does not place any constraints for using special timber classes in places where no direct exposure to heat is speculated. Such regions of timber usage include the floors, wall frames, roof framing walls, ceiling lining etc. The timbers specified for use in the standard mentioned above are found abundantly in Australia. Seven kinds of timbers with high densities are specified as being fire resistant and their testing has proved the levels of endurance that could be expected with their use. Based on these pieces of evidence it can be inferred that timber can be used in increasing numbers without the risk of significant impacts from climate change on timber engineered structures. 2. Spread of Termites and Other Pests Another major impact of climate change has been its help to spread various species of insects beyond their normal modus operandi. The increase in temperatures is driving more and more species to occupy newer areas. In the Australian context there has b een a net migration of a number of different plants, animal an insect species towards the south as temperatures are on the rise. The increasing temperatures provide these species with better breeding grounds that are favourable so a net migration occurs. The case of malaria moving farther down south is just one such manifestation (McMichael, 2003) where the operating areas for mosquitoes have increased as global temperatures are on the rise. A similar problem is exhibited through the spread of termites to newer locations as temperatures become more and more favourable for their breeding and growth. Regions like Victoria are more at danger than others because 30 of the 78 municipalities in Victoria do not require any anti-termite protection for buildings. This indicates that most of the buildings, houses and other structures in these municipalities will be prone to termite infestations in the near future. At present there is little to no action on the part of the government to mitiga te such threats. The various builders, developers and purchasers should be alerted by the local government as to expected chances of termite and other pest based infestations. Moreover there is dire need for coordination between government regulatory agencies and etymologists in order to identify the migration patterns of termites and other such pests that could cause large damages in the future. 3. Increased

Pleas follow the assignment brief as it has all info thank you Essay

Pleas follow the assignment brief as it has all info thank you - Essay Example Also included in the statements are that smoking kills more than AIDS, car accidents, suicides, murder, drugs and alcohol combined and that second-hand smoke is responsible for 3,000 deaths per day. The environmental change in this case is the changing landscape of public opinion about tobacco companies. Another environmental change is that there has been more evidence about tobacco’s detrimental influence upon public health. A third environmental change is the increasing amount of evidence that tobacco companies have lied, for many years, to the public about the adverse effects of tobacco on the public health, and that they have also lied regarding the addictive nature of cigarettes. The impact of these environmental changes upon Phillip Morris, and other tobacco companies, is that cigarette smoking will become even less de rigueur than it already is. The anticipated impact upon these companies is that they will suffer some degree of public humiliation because of their previo us stances, and the fact that they previously lied to the public, and their sales will suffer accordingly. â€Å"Fox News Suddenly Loves Illegal Immigrants.† Business Week. Elizabeth Dwoskin. November 26, 2012. This article regards the changing environment on the Fox News Network in America. The changing environment is the 2012 Presidential and Congressional election. Before the Democrats won back the Presidency and the Senate, there was a general consensus in the Fox News Network, which is considered to be a conservative network, that there should not be a path to citizenship for illegal immigrants. However, in the 2012 election, President Obama won back the presidency with an overwhelming percentage of Hispanics. The theory is that the hard-line position that the Republicans have taken regarding illegal immigrants, which his that they are either to be deported, or they should self-deport, but, at any rate, they should not be offered a path to citizenship, is much of the rea son why Mitt Romney, the Republic nominee, lost the election. Because of this, Fox News has softened their stance on illegal immigration. This is how the evolving environment regarding illegal immigrants, and the election, has impacted Fox News. In this article, the changes at Fox News regarding illegal immigration is highlighted. For instance, Sean Hannity, who has his own show on Fox News, has recently stated that his own views regarding illegal immigrants has evolved – he now agrees that illegal immigrants should have a path to citizenship. The article notes that the previous position that Hannity has taken on the 11 million illegal immigrants in the United States is that deportation was the only option. The article also said that talking heads, like Hannity, are the main reason why there has not been immigration reform until now. â€Å"Conagra Sinks Its Teeth Into Growth Market.† Wall Street Journal. November 27, 2012. Miriam Gottfried. In this article, the changin g environmental influence is the higher price of food. Another changing environmental influence is that retailers, such as Wal-Mart and Costco increasingly rely upon private labels, which means that these stores, and other stores, sell products under their own line. For instance, Whole Foods sells 365 Brand, which is the

Cell biology Research Paper Example | Topics and Well Written Essays - 250 words

Cell biology - Research Paper Example The study of cells using microscopes can either be through transmission electron microscopy, fluorescence microscopy, scanning electron microscopy, confocal microscopy and optical microscopy (Lodish, 411). There are a number of techniques that are commonly used in cell biology. Immunohistochemisty/ immunostaining is a useful histological technique that locates (tags) proteins in tissues and cells through fluorescence microscopy (towards various desired goals). Another common technique, cell culture, is used to grow cells under special conditions in the lab, outside a living organism while gene knock down is a method used to elicit mutation in a selected gene. Computational genomics identifies certain patterns in genomic data as DNA microarrays are essential in noting variations in transcript levels of various experimental circumstances. The method of PCR indicates the number of gene copies found in the cell and the process of transfection introduces into a cell an entirely new gene. To discover which cells are expressing a certain transcript of RNA, cell biologists use in situ hybridization. During cell biology, purification of cells can be accomplished using techniques such as flow c ytometry, cell fractionation, immunoprecipitation, and so on (Pollard and William, 418). Some of the processes of the cell commonly studied by cell biologists include active and passive transport, adhesion, cell movement, DNA repair (cell death and senescence), gene expression, metabolism, cell signaling, division and autophagy. Knowledge of cell biology is useful in fields such as cancer research and other disciplines like genetics, microbiology, immunology, molecular biology, developmental biology, biochemistry, anatomy, biostatistics, ecology, epidemiology, histology, mycology, reproductive biology, toxicology, virology, bacteriology, and so on (Pollard and William,

Macro economics Essay Example | Topics and Well Written Essays - 1500 words

Macro economics - Essay Example Underemployment and unemployment has had very damaging effects to the social and economic fabric of Europ. Underemployment is an immense social evil and a colossal economic waste. Unederemployment leads to an enormous degree of personal hardship and misery. It also destroys familial relationships, breeds racism and sexism and paves the way to social disintegration. Undermployment is the primordial factor for the alarming growth of inequality and poverty. The aggregate expenditure of the United States in the 1980s were focused on pension provision, education public works, defense spending and healthcare. Education expenditure in most developed countries constitutes 6% of GDP. Private expenditure in education adds two/thirds of a percentage point. United States private spending in education equals 1.6% of GDP. Higher levels of education expenditure reflect the importance attached to education at the policy level and also at the individual levels. Education is helpful for economic and social progress. Between 1970 and 1988 real spending in education had increased by 50% in the US. Numerous public works projects show a favorable benefit-cost ratio. Lifestyle improvements in transportation and communications help citizens enjoy a better lifestyle. Defense expenditures help protect democracy in America and around the world. A portion of the aggregate expenditure also goes to the payment of interest on the national debt. As a result, consumption outlays usually dominate the Federal budget and state budgets. (Joyce and Mullins, 1991) B. DISTRIBUTION OF US AGGREGATE EXPENDITURES The table indicates that, as a component of total state spending, state education and health/hospital spending have experienced a slight relative increase over time, while highway spending has declined dramatically, and public welfare spending has experienced a large relative increase. For local governments, the shifts have been toward health and hospital spending and away from education, highway and public welfare spending.The state's share of total spending has increased slightly overall. State spending on education and public welfare has increased significantly over the 23 year period since the 1970s. The expenditures for capital outlays, health and hospital spending, and highway spending has diminished. In addition, the state share of revenue and taxes should decline, as should the state share of expenditures. There are shifts for states with in four areas: 1) state taxes as a percent of total state general; 2) state aid to local government as a percent of local general revenu

Finland Case Essay Example for Free

Finland Case Essay Finland, the country of ice has been a major force in Formula 1 for the last two decades. A country with a population of about 5.3 million (0.44% of Indias population) has produced 3 F1 champions (Keke Rosberg, Mika Hakkinen, Kimi Raikkonen) and another 4 made it to F1 whereas India has had just a single entry i.e. Narain Karthikayen in all these years. Seems like automobile racing in Finland is just like cricket in India. It just runs in the veins of the Finns. The 1st Finnish driver to enter the formula1 racing scene was Leo Kinnunen. Kinnunen had a short stint in F1 which included just 6 races (1 start and 5 DNQs) and had no success in those. He raced for the team AAW Racing Team and used the Surtees TS16 car with the Cosworth V8 engine in it. The main reasons due to which Kinnunn couldnt succeed in F1 were that his car was underpowered than the other cars and also the team was not allowed to get the top quality tyres from the manufacturers. And at that point of time tyres played an immense role in the result of races in F1. During these 6 races the team faced technical difficulties in almost every race. And then due to lack of funding the team had to retire from F1 and thus also ending Leo Kinnunens carreer in F1. In all Kinnunen played a role of historic importance by being the last driver to wear the open-face helmets in F1. Next was Mikko Kozarowitzky in 1977. He had a blink and you will miss stint in F1 as he just raced a total of 2 races for RAM Racing Team with no successes. Unfortunately he broke his hand while trying to avoid an accident during practice session after which his racing team wanted him to try qualifying in the spare car with broken hand, which lead to spats between him and the team. Eventually he quit the team and retired from F1. Then came Keijo Erik Rosberg in 1978, popularly known as Keke Rosberg. He became the 1st Finnish driver to win the Formula 1 championship in 1982. Keke debuted in 1978 with the Theodore team and came in the limelight during his second race which he won under treacherous rainy conditions on the track. Rosberg was then signed by ATS in the same season but they car they provided was uncompetitive so he moved back to Theodore again. After that Keke had to move to Fittipiladi forcibly as his former team quit F1. 1981 was a lean period in which he did not score even a single point. Kekes career got a lifeline in 1982 when he was signed by Williams. He went on to win his 1st race this season and also went on to win the championship with 44 points. This was a season when no driver had won more than 1 race and the time when Ferrari were facing problems with their car. Rosberg moved to Mclaren in the 1986 season but was given an underpowered car compared to his team mate Alain Prost. He retired soon after the season from F1 as the accident of one his friend(Elio Di Angelis) deeply affected him. Mika Hakkinen joined F1 in 1991. He joined the Lotus team and scored his 1st points in his third race for the team. He joined Mclaren as a test driver 1993 with the hopes that some day he would be promoted to be their race driver. He got his chance soon enough when one of the Mclarens racers left the team. He had a nice debut in which he almost beat Ayrton Senna, his team mate. But this dream start for Mclaren was not to be as he went into the pit wall while trying too hard. He came 2nd in his second race for Mclaren. When Senna left Mclaren in 1994, Mika became their main driver and went on to race for the team till his retirement in 2001. In all these years he won 2 championships for Mclaren during the year 1998 and 1999. He won a total of 20 races in his career. The most by any Finn till date and is the most successful Finnish driver till now in F1. He could have been more succesful has Mclaren got a better car in the year of 1995 and 1996.He is currently an ambassador for the Drink Responsibly campaign by Johnny Walker. Mika Salo was racing along side while Hakkinen was racing for Mclaren. He too started with Lotus in 1994 but raced only the last race that season. But when Lotus did not return for the next season, he moved on to Tyrell for the next 3 years where he scored points some times. He then joined Arrows in 1998 but he didnt race for the team full time in 1999. Salo was selected as a subsitute driver for Schumacher in 1999 during the time when Schumi was injured. He then showed his potential in a better car. He almost won his 1st race while being at Ferrari but was asked to give way to team-mate Eddie Irvine by the Ferrari team as he had chance of winning the championship. Eddie in turn gifted the trophy to him for his gesture. Salo then raced for Sauber and Toyota and eventually quit F1 in 2002 after he was fired by toyota for not giving results. Kimi Raikkonen, popularly known as the Iceman is another great Finnish F1 driver. He started his career with Sauber in 2001. Being relatively inexperienced there were concerns whether he should be granted the super license. But Kimi won his 1st points in his very 1st race. He then moved on to Mclaren in 2002 to take the seat that was left vacant when his fellow countryman Mika retired. He went on to race for Mclaren till 2006 but he did not have much success as he faced a lot of technical failures with the team. But he did win his 1st race in 2003. And went on to be second in the drivers championships in the year 2003 and 2005. Kimi then shifted to Ferrari in 2007 to take the place of Micheal Schumacher and he also became the highest paid F1 driver in the process. He won his 1st Championship in 2007 with Ferrari and raced for them till 2009. After that his contract was not renewed by Ferrari and he has taken a break from F1 for the time being and will be racing in the World Rally championships for the Citroen team. The latest Finn in F1 is Heikki Kovalainen. He started his F1 career in the year 2004 and became the test driver for Renault. He did the testing duties till 2006 and was eventually promoted in the year 2007 to be the race driver for the team. He had a mixed start to his racing career and he finished the season at 7th place with 30 points that year with the record of finishing most number of consecutive races(16) from the start of his career. The next year as Mclaren had problems with Alonso they signed Heikki as their driver. This seemed to be a major boost to his career. In 2008 he set fire on the track as he set the fastest laps of the race at almost every track that year. But he could not convert these into victories but he had his 1st victory that year at Hungary. The year 2009 was a disappointment. The car faced a lot of problems in the starting. KERS was being deployed for the 1st time and overall he could not perform up to his potential. With Lotus F1 coming back to the F1 scene and confirming Heikki as their driver for next year a lot is expected from him. Lets see what this Finn does next year and can he become the fourth Finnish driver to win the F1 TITLE.

Models of Care Essay Example for Free

Models of Care Essay The purpose of this essay is to provide a review of the models which are Chronic Care Model and Patient-Centered Medical Home Model. Also to provide how both achieve quality and safety and add as much information on how both models benefit in providing care to the patients. In comparison and contrast between Chronic Care Model and Patient-Centered Medical Home Model, it is pertinent to know that Chronic is a condition which â€Å"requires ongoing adjustments by the affected person and interactions with the health care system† (Improving Chronic Illness Care, 2006-2011) and is related to the Chronic Care Model which initiates an improved an system between the organization, the community and the level of care. Patient-Centered Medical Home Model however is allocating care that is â€Å"timely access to medical services, enhanced communication between patients and their health care team, coordination and continuity of care, and an intensive focus on quality and safety† (Improving Chronic Illness Care, 2006-2011). Both models provide changes, however, the chronic care relates to patients with an illness where as patient-centered is to provide a improved relationship between the patients and the medical team and to create a transformation of communication and performance as well as provides â€Å"quality improvement approach that promotes a partnership between child, the family and the physician care team† (American College of Physicians, 2011). In the United States, having a model of care has been beneficial because â€Å"treatment of acute condition† (Patient-Centered Medical Home, 2007) has been provided. Along with the Chronic Care Model, an extended support of that model, which is the patient centered, is being implemented to include care â€Å"to include proactive management of the health care needs of all patients† (Patient-Centered Medical Home, 2007) and not just those patients suffering from chronic illness results. Having this new model will also provide a higher quality of care, be cost effective and ensure an improvement to a healthier patient population. The key elements that are beneficial to achieve quality and safety goals are â€Å"a personal physician, a physician-directed team, whole person orientation, coordinated, integrated care, emphasis on quality and safety, enhanced access, and appropriate payment structure† (Patient- Centered Medical Home, 2007). Having these elements is pertinent for both models, however a difference is that the patient- centered medical home model does not require that patients â€Å"get permission from a primary care doctor to see a specialist† (Patient-Centered Medical Home, 2007) however they are required to have a promising relationship with their primary physicians who can advise on what kind of special care is in need and what specialist can advise them in the best medical care and with the best decisions. In conclusion, a structure on lower cost is pertinent to providing the right model for the system. Achieving a prosperous medical outcome in the end requires a cost budget that will benefit not only the Health care organization but the patients as well. Another benefit for patients is to implement a low cost strategy that will allow patients to receive medical treatment and also pay out cost that meets the individual’s budget. Creating an income chart would also be a way to know what a patient can afford to pay. Reference American College of Physicians (2011) Joint principles of a patient. Retrieved February 16, 2011 from http://www.acponline.org/pressroom/pcmh.htm Improving Chronic Illness Care (2006-2011) Patient-Centered Medical Home. Retrieved February 16, 2011 http://www.improvingchroniccare.org/index.php?p=Patient-Centered_Medical_Homes=224 Patient-Centered Medical Home (2007) BCBSM provider group Incentive program patient-centered medical home overall plan. Retrieved February 16, 2011 from http://www.bcbsm.com/pdf/PC-MH_overall_plan.pdf

Strategies for Staff Shortages in the NHS

Strategies for Staff Shortages in the NHS Chapter 1 Introduction 1.1 Background: British National Health Service (NHS) has experienced a sensitive shortage of qualified nurses. This has placed retention issues on the political agenda. Nursing shortage is one of the greatest problems for the hospitals in the UK. Hospitals are placing greater importance on retaining their current registered skilled staff. It’s a difficult process and to do this they required to have deep knowledge of the needs and wants of the nursing staff .Management have to know what motivates nurses to stay. From that point of view, many hospitals carry out retention or exit surveys to understand the causes of leaving. According to Seccombe and Smith (1997), from 1987 to1995, within nine years nurse training fell gradually from 19,600 to 14,200 per year. An study (Lader 1995) of the 1991 Census proved that only 68% from them with nursing qualifications in U.K were actually working in nursing profession. Also the research found that 16% of the remaining were working in another profession and 15% out of paid work. Vacancy rate in NHS is very high now. Because of poor recruitment and retention system NHS have been forced to operate with vacancy rates for registered nurses up to 20% which was national vacancy rate of around six thousand six hundred in 1996(Review body for Nursing Staff 1997, cited by Maylor et al. 2000). Suggett (2003) reported that Wandsworth Primary Trust care has 15% vacancy rate for the nursing post at present and same vacancy rate exist for Health Care Assistants. Lowest vacancy rate(8%) exist for Allied Health Professionals. Nursing have the highest vacancy rate (35.9%) of the current labor force within the Trust. Gray and Phillips(1996) said currently NHS facing turnover and it stands at around 14% per annum for registered nurses (RGNs). Supported by (Seccombe and Smith,1997), he also added that it was far higher for nurses who have finished their training in recent times. Research found on turnover which supports these statistics, with around 40% of nurses had a great intention to leave nursing job from NHS within the next three years (Beishon et al., 1995). The reality is that turnover is maximum for nurses under 35 years of age. Hence it is an important economic problem, considering the standard cost of  £50,000 that taxpayers pay to train a RGN(Audit Commission, 1997). Suggett(2003) said from April 2002 to March 2003, statistics report showed that nursing post has turnover rate of 16.3%. Also Allied Health Professionals had 25.2% and Health Care Support Workers had 11% turnover rate. He also said that it was a big issue for the Trust because huge proportions of recruits left the job within two years after appointment. After first two years of employment 22 Allied Health Professionals and 23 Nurses left. Actually from this report it can be found that Nurses are not satisfied with their job and they are leaving early stage of their joining. As a result it creates serious problem for NHS. According to Maben (2008), London has the highest vacancy and turnover rate in the UK, with a dependence on agency and international staff. For example, vacancy rates in London were reported to be twice as high as the NHS average for some occupations, within 2016 the population of the London is projected to grow by 700,000, and well-trained, skilled and motivated nurses are very essential to meet shortage of the city. The Jonas Centre For Nursing Excellence (2006, p.9) reported that substantial attention has been given on improving nurses working environments as a principal approach for improving retention. The Magnet Recognition Program developed by the American Nurses Credentialing Center (ANCC) based on The 1983 Magnet Hospital Study’s findings, have largely supplied the criteria by which such supportive environments are defined and evaluated. According to Kramer and Schmalenberg (2005), the original Magnet study commissioned by the American Academy of Nursing, observed the characteristics of hospitals that enjoyed reputations as good places to work and which, even though a large-scale nursing staff shortage at that time, were successful in retaining nursing staff. One of the Magnet program objectives is recognize nursing services that use the Scope and Standards for Nurse Administrators to build programs of nursing excellence for the delivery of nursing care to patients Nurses across the nation are reporting that stress and dissatisfaction increased significantly with nursing (Boyle et al. 1999). Nurse-physician conflicts add to an already stressful work environment (Rosenstein 2002). One in five nurses plan to leave the profession within the next 5 years (Letvak 2002). Considering all these issues, it becomes vital to search for ways to retain experienced nurses. Researchers are trying hardly to solve the retention problem of NHS. One research (Newman and Maylor, 2000) found on retaining nurses in London region. This study identified the factors of nurse satisfaction and recommended a retention strategy. They recommended improving pay policies, management techniques, training facilities, career progression opportunities, service quality and patient satisfaction 1.2 Why is this area important within the NHS: Audit Commission (1997) reported that High staff turnover and recruitment is a problem for NHS trusts. It causes critical posts to stay vacant for long periods of time with direct consequences for patient care. They explained that Replacing staff can be an expensive business, costing trusts up to  £5,000 for each position filled. There is an also hidden cost of taking on new staff; who may take a year to learn to do the job efficiently and need extra training. Trust managers need to understand why staffs leave, shape the staff attitudes that influence job loyalty, and implement practical measures such as improving opportunities for training, so staffs dont have to leave to increase their skilled. Local and national economic factors may be out of the control of the NHS. The National Health Service is the largest employer in Europe and it has 142,000 staff in London alone .United Kingdom did not have enough doctors and nurses to meet demand. Though, there are staff retention challenges in all the NHS, but the major problems were mainly heard in some busy cites, particularly London(Maben 2008) Finlayson et al.(2002) said that government always feels the pressure of NHS nurse turnover problem. The problem is gradually rising. Government declared to recruit additional 20000 nurses in NHS hospitals within 2004. The demand were to be fulfilled by bringing back nurses who left the NHS, recruiting skilled nurses from abroad and increasing the quality training plan for nurses. Government recruited 6000 and 5797 nurses respectively in 1999 and 2000. In 2001, 713 nurses were recruited. According to The Royal College of Nursing(2000), at present 22000 nursing job are vacant which is whole time  equivalents. The college also reported that NHS will require to recruit more than 100000 nurses by the end of 2004 if retirement levels and other losses remain unchanged. Through training less than half of the demand will be met. From the above report it can be seen that retention is a very big issue for NHS. NHS skilled staffs are leaving their job. Nurses are doing the great job for the society. Those who qualify in Nursing have already demonstrated their intelligence, application and dedication to the sick by undergoing a usually arduous professional training. So, it is our duty to keep the skilled nurses in their profession for the benefit of society by proper retention policy. NHS is concern about how to overcome this problem. Researchers are trying to solve this problem in different ways. Recruiting new people is more costly than retention. Moreover they are not trained and it also time consuming to train them. So it is better to try retain the skilled nurses to reduce the pressure. Considering this situation writer of this report feels the importance of staff retention in NHS. 1.3 Rational: Nurses are the lifeblood of any hospital. The NHS in England employs qualified nurses always. From last 10 years, recruitment and retention of nursing staff has taken on crucial importance; therefore any study that demonstrates that the working environment has an impact on nurses’ recruitment, retention and performance is of importance to the further success of the NHS. NHS facing challenges to retaining nurses at both national and local level. According to Sugget(2003), The local NHS Plan had an aim for Wandsworth primary care trust include 40 nurses and 18 Allied Health Professionals within 2005.The South West London Workforce Confederation recommended that to accomplish these figures Trusts need to attract and support newly qualified nurses and return to practice clinical employees. This means that NHS is trying hard to keep their skilled nurses. Purpose of this research is not only introducing a standardised pay structure but also have a target to improve retention and staff morale. Employees will be identified as facing recruitment and retention problems like works officers or qualified manager. The object of this research is to examine current retention problems for facilities staff experienced by NHS Trusts.  The key purpose of this research is to find out the best Nurse retention strategy for NHS that can be helpful for the other researcher to carry out their future research. As I made my mind to build my carrier as a HR manager, I have chosen research area on staff retention. Staff retention will give me vast experience on HR management. In retention strategy there is a vast scope to gain some practical managerial knowledge and experience relation between manager and staff. Observing the NHS staff problem, I have chosen NHS to carry out my research on staff retention. 1.4 Aims and Objectives: Aim: Aim of this research is to identify good practice in order to make recommendations on how the NHS could retain their nursing staff with a range of skill and experience. It is known that any organisation will have more success in the HRM task if it is committed to valuing its employees by promoting their professional and personal development Research Objectives Review the existing literature on nurse retention Examine the factors that affect retention like pay policies, reward, working flexibility, work-life balance, workload etc. Identify the key retention factors Key theories to be Use: This research will focus on existing HRM model and Retention strategy to achieve the aims and objectives. The conception of new retention strategies will be a major spotlight for nursing administration as a lack of nurses recurs and turnover of staff becomes a strong problem. 1.5 Chapter Outline: Chapter Two provides a critical review of the literature on retain skilled staff working within NHS employment in order to create the context for the research. Key points of this chapter are nurse satisfaction, cause of leaving and retention strategies Chapter Three explains the research methodology, provides information on research process, strategy, data collection, data analysis (qualitative and quantitative) and ethical dilemmas encountered. Chapter Four begins with an data analysis on the research questionnaires. Both qualitative and quantitative analysis was presented. Also analysis findings were presented here. Chapter Five re-evaluates the findings by referring back to the research objectives. It then provides a short review of the research including recommendations for both NHS. It provides an evaluation of the study and suggests areas for further research. It also includes some limitations and shock of the researcher. Chapter-2 Literature Review 1.Introduction: Employee turnover is known as a most important organizational/business phenomenon. Employee turnover is very crucial to organizations, individuals, and society. Employee turnover can cause a considerable cost in terms of socialization, recruiting, training, and disruption. From the company’s point of view turnover also represent the range of indirect cost. Given the impact of turnover, it is vital for the manager and future manager to be able to analyze, recognize, and successfully deal with employee turnover (Mobely 1982). Here he tried to focus on the importance of employee turnover control for an effective management in case of saving cost. (Dell and Hickey 2002) added that turnover has huge economic impact on the organization, both in direct and indirect costs. Translating turnover into numbers that executives understand is essential because they need to appreciate the true costs. Managing retention effectively is a continuous challenge for any business organization. The retention issue had been highly focused since the last decade, and, from all indications, the problem will increase more in future decades. Most HR executives find retaining talent to be big problem even in slow economic times (Phillips and Connell 2003). In a survey during the 2001-2003 recession, ninety percent of 109 executives reported that they were finding it difficult to attract and retain the best people in the organization (Dell and Hickey 2002). Newman and Maylor (2000) reported that National registered Nurse has declined by more than 14,000 leaving the NHS with the worst nursing shortage in 25 years with a record 8-17000 shortfall of qualified nurses. Buchan(2000) said that from 1990 to 1998, the number of qualified nurses decreased by 8000 . This chapter is designed to focus on the existing literature on nursing retention. At first some definition is given. Then cause of nurses’ leaving is focused. Finally some retention strategies are discussed. 2. Definition: An understanding of basic distinctions between retention and turnover is very important. Phillips and Connell (2003, p 2) defined the retention and turnover in following ways: 2.1 Retention: is the percentage of employees remaining in the organization. High levels of retention are desired in most job groups. 2.2 Turnover: On the other hand turnover is opposite to the retention, refers to the percentage of employees leaving the organization for whatever reason(s). 2.3 Turnover rate: refers to the rate of individuals leaving. 2.4 Tenure: is the length of time an individual is employed by the organization and usually related to the concept of the employee loyalty. A loyal employee usually remains with an organization for a long period. In many organizations it is desirable to have long tenured employees, although this situation taken to extreme can also create problem. 3. Retention As a Critical Issue: Retention is a strong critical issue for any organisation. The theory of employer-of-choice has intensified in the last decade. Employees always want to work for best employers. Phillips and Connell (2003, p3) said organisations struggle to be the â€Å"the best company work for†. The statement â€Å"the best company work for† translates into lower rates of turnover. Levering and Moskowitz (1993) supported stating that many companies attempt to build the type of organization that can at least meet the preferred standards. Becoming an employer -of -choice often involves the issue of acquiring the best talent for the organization, motivating employees to improve performance, Keeping them satisfied and loyal, developing employees so they can grow and contribute skills, and ultimately retaining those employees( Fitz-enz 2000) 4. Cause of leaving : 4.1 Social Environment: The social environment of the workplace is the initiator of a nurses plan to stay or leave. Moreover social environment is a determinant of work disappointment (a depressing influence), and work excitement (an encouraging influence). Moos(1994) said that these factors directly influence workplace stress, leading to job satisfaction or dissatisfaction . According to Bratt et al.(2000), Job satisfaction or dissatisfaction is the powerful forecaster of intent to stay or leave the job. 4.2 Burnout: Burnout can cause job dissatisfaction. Garret and McDaniel(2001) said that enviro- nmental uncertainty are very important in all features of burnout. Aiken et al. (2002) reported that nurses with the lowest nurse-to-patient ratio experience less burnout and dissatisfaction than those with highest ratios. The researchers claim that 43% of nurses who said strong levels of burnout and disappointment intended to quit their jobs within a year. Only few nurses did not complain of dissatisfaction. When nurses work rotating shifts, there is a significant decrease in job satisfaction (Bratt et al. 2000).Newer nurses experiencing more job stress as compared to experienced nurses. 4.3 Autonomy: Nurses always desire increased autonomy working environment. (Nevidjon and Erickson 2001).Aiken et al.(2002) claim that autonomy is one of the factors which has decreased emotional exhaustion of nurses in American magnet hospitals. In another research on this hospital showed that autonomy had influenced the managerial trust, their appraisal of the quality of patients care and also job satisfaction (Laschinger and Thomson 2001). Davidson et al. (1997) established the value of autonomy by representing that decreased job satisfaction is connected with decreased autonomy. Bruffey(1997) said autonomy is ultimately influenced by the leadership of their managers. There is a positive connection between job satisfaction and nursing leadership. Management system, allow the nurses to do their jobs effectively, was related to job satisfaction( Bratt et al.,2000). Tumulty et al (1994) found that though autonomy had a significant impact on job stress, it was not a major determinant of stress as task orientation. Also Ingersoll et al. (2002) said that autonomy was a positive observation of task orientation related with increased job satisfaction and aim to stay. This idea is supported by Davidson et al. (1997) with the result of increased scheduling and decreased work load leading to decreased job stress. The researchers argued the advantages of better communication improving the awareness of nurses concerning autonomy burn out, work pressure and task orientation. Some researcher stressed the significance of management or leadership behaviours. Managers or leaders perceived as equitable decreased staff perceptions regarding work pressures and increased perceptions regarding autonomy(Taunton et al. 1997). Bruffey(1997) said these factors collectively led to lower job stress and its expected association with intent to quit. 4.4 Work Pressure: Bratt et al. (2000) identified the work pressure as the most familiar and important factor of organizational work satisfaction/dissatisfaction. McNeese-Smith(1999) identified several factors of work load which bring job stress for nurses. These were: (a) overload due to heavy patient assignment, too many patient needs, and/or too few staff members to meet these needs. (b) exhaustion; (c) fear of making a mistake due to exhaustion and (d) high patient acuity. Bratt et al. (2000) reported some additional work stress factors which influence the nurses to leave the job. These include rapid turnover of patients, shift work, lack of available equipment, managerial pressures, excessive noise and lack of space. According to Aiken et al.(2002), Nurses with increased patient loads in workplace were more likely to explain experience of burnout, job dissatisfaction and emotional exhaustion than their colleagues with less patient loads. So autonomy is a key factor to reduce work stress for work load. Because work load is a originator of nurse intention to leave 5.1 Job Satisfaction of Nurses: There is a lack of agreement on the meaning of nurse satisfaction (Hale 1986, cited by Maylor et al 2000).Two definitions stemming from the 1980 stand out. The first one highlights psychological factors according to Bush(1988), the perception that one’s job fulfils or permit the fulfilment of one’s significant job values, providing and to the extent that those values are congruent with one’s requirements. The second one highlights workplace factors like recognition of achievement, enough staffing, appreciation, autonomy, childcare facilities and quality patient care.(Butler and parsons,1989). Nurse satisfaction can be depends on effective patient care. Maylor et al.(2000) noted that it is very crucial to have ability to give good patient care. 5.2 Determinant of job satisfaction: Job satisfaction analysis is driven by attempts to concentrate on the issues of industrial action, leaving or turnover and personal joy at work. Researchers are interested in the bond between job satisfaction and efficiency and financial and non-financial reward. According to the influential work of Freeman (1978), job satisfaction can be separated into those considering labour force as a whole, those analysing qualified groups such as lawyers, nurses and academics, those which inspect the impact of individual characteristics like age, sex, race/education and those which explore the outcome of job-related features such as trade union membership, self employment and establishment size. Some important determinants of work place satisfaction have been recognized which may be supportive in the thought of job satisfaction in nursing. Diversity of individual characteristics have been identified to have special effects on reports of job satisfaction. That diversity includes gender, race, age, marital status, children and education. The major effects are usually connected with gender and age. According to British Household Panel Survey (Clark and Oswald 1996), Females are highly satisfied with their job in the UK. Earlier proof recommends that age has either a linear or U-shaped bond with job satisfaction (Clark et al. 1996). That means older workers usually being more satisfied with their current job. A set of studies have focused on the analysis of comparison effects on job satisfaction. Comparison effect means, staff may have several idea of relative or ‘comparison’ earnings which enters their utility function. So job satisfaction is not only influenced by a staff’s personal total earnings, but also by their earnings that is comparative to some comparison group/desired level. Clark and Oswald (1996) summarized that satisfaction or dissatisfaction can be created in workers mind because of individuals’ comparison of their present job with the other job. So, job satisfaction is not only affected by individual earnings but also by their earnings related to expected level. Both absolute and comparative incomes have positive influence on the job satisfaction of staff (Sloane and Williams 1996). Clark and Oswald (1996) gave some proof that expectations are influenced by staff’s age, educational background and profession. Determinant of job satisfaction can be found from the inconsistent job features of staff. Working hours, establishment size, union membership and profession have important effects on job satisfaction. In the case of nursing staff, it is very crucial to evaluate the impact of improved working environment on their job satisfaction. Clark (1997) discovers a important influence of ‘work values’ on job satisfaction. More exclusively, staffs that highlight the importance of payment are more likely dissatisfied with job whilst staffs that highlight job place relations are associated to support job satisfaction. Nurses are more likely dissatisfied with their job because they are normally considered as low-paid staff. 6. Nursing in Multi ethnic minority: The racial harassment of ethnic minority nurses continuous to be a regular feature of their working lives in the NHS. This racial harassment from patients could be broken down into two distinct forms. According to (Beishon et al. 1995) First, there was a form of harassment where racial motivation in the incidents was clear because of accompanying verbal insults or because the patients had made it clear they did not want to be ‘nursed’ by an ethnic minority nurse. Secondly there, there was a more subtle form racial harassment where white patients did not explicitly mention nurse’s ethnicity, but rather treated ethnic minority nurses in a relatively unfavourable way to their manners with white nurses. A black nurse reported how differently she was treated from her white colleagues (Alexander and Dewjee 1984). However the things have begun to change and NHS training authority has taken on training projects directed specifically at race issues (Beishon et al. 1995). 7. Retention Strategies: 7.1 Creating A Motivating Climate: Because the organization has such an impact on the factors that extrinsically motivate employees, it is important to examine organizational climates or attitudes that have direct influence on worker morale and motivation. Huston and Marquis(1989) said that frequently organizations overtly or covertly reinforce the image that each and every employee is expendable and that a great deal of individual recognition is in some way harmful to both the individual and the individual’s productivity within the organization . Just the opposite is true. Individuals who have a strong self-concept and perceive themselves to be winners are willing to take risks and increase their productivity to achieve their productivity. Peters and Waterman(1982) stress that organizations must be designed to make individual employees feel like winners. The focus must be on degrees of winning rather than on degrees of losing Another wrong attitude held by some organizations is at the opposite extreme. Korman et al (1981) supported that if a small reward results in desired behaviour, then a larger reward will result in even more of the desired behaviour. That means an employee’s motivation should increase proportionately with the amount of incentive or reward. Nurse managers should think excellence and achievable goals, and reward performance in a way that is valued by their staff. These are the cardinal elements for a successful motivation-reward system for the nursing organization (Kirsch,1988). To the contrary, more incentives or reward systems were actually less motivating, as they produce a felling of distrust or being bought. Increasing incentives may be perceived as a violation of individual norms or of guilt (Bowin,1987). Managers can also create a motivating climate by being positive and enthusiastic role models in the clinical setting. Studies by Jeskins and Henderson (1984) demonstrated that managers’ personal motivations are the most important factor affecting their staffs’ commitments to duties and morale. Positive outlooks, productivity and accomplishment are contagious. Radzik(1985) stated that employees frequently determine their job security and their employer’s satisfaction with their job performance by the expression they see on their manager’s face. That means unhappy managers frequently project their unhappiness on their subordinates and contribute greatly to low unit morale. 7.2 Managing Career Development in nursing: Some philosophies about responsibilities for career development have been reflected in nursing. Donner and Wheeler(2001) have argued that nurses do require to take greater responsibility for career planning and development. They should follow a framework discussed by King (2001) which includes identifying opportunities, developing and implementing a good career progress. Donner and Wheeler(2001) added that to deliver high quality of caring service all educators, employers and professional business organizations should work with nurses on their career development plans and activities . According to (UKCC 1999 ), in UK, for long period it has been known that continuing professional development (CPD) has an significant function in nurses’ individual career development and retention. It also enhances the quality of patient care. There was a debate for a long time that local health service employers must recognize and understand the value of appropriately controlled CPD programmes in attracting, motivating and retaining high quality staff (DH 1998). Strategy for CPD for nurses were set out in Making a Difference ( Robson and Banett 2007) in which it was debated that CPD should include not only attending courses but also learning at work through experience, critical incidents, audit and reflection, maintained by peer review ,mentorship and clinical supervision. It was a matter of great concern that practitioners and employers were puzzled by the creation of new courses and lack of apparent links to career paths and that a more determined structure was needed 7.3 Working Condition: From a human resource management viewpoint, it can be said that working conditions have an affect on staff morale. Good working conditions will contribute to improving retention staff (DH 1997). The different ways in which working environment can affect nurses and manipulate their decisions about direction and retention in the occupation have raised from a substantial body of study on job satisfaction and workplace stress. Reconsidering the previous history on stress among general nurses, McVicar (2003) expressed that the major sources of stress identified are leadership, work pressure, management style, coping with emotional or touching demands of care, and relationships between occupational groups. He also added shift working and lack of reward also emerging from more recent research. Deep study on job or workplace satisfaction in nursing profession has exposed that aspects of work which recognized in the stress literature also come into view as sources of satisfaction or dissatisfaction. Nolan et al (1999) said, staffing levels enough for nurses to feel confidence to offer better quality care if there are availability of supplies and equipment. And it also depends on the nature of work place relationships with colleagues and nursing managers. Positively it has long been acknowledged that both physically and mentally nursing is a challenging work (Davies 1995). Handling and lifting patients and ‘being on one’s feet’ every day is not very easy. It can cause not only work stress but also bodily injury like strained backs. The emotional element of nursing can be equally important and demanding, involving caring for patients when they are dealing with death and dying and loving for upset patients and relatives. Rise of these demanding emotional elements to overcome the challenge can be a source of satisfaction. On the other hand, low moral and work stress can be created when nurses feel under-supported and under resourced in working environment, particularly in relation to staffing. (Cameron and Masterson 2003). McVicar (2003) said study on stress has exposed the level to which a range of physiological and psychological symptoms have been linked with diverse sources of stress and that distress is very much correlated with absenteeism, ill-health and poor retention . Shields and Ward (2001) expressed that Job frustration has been reported as the distinct most vital cause of intention to leave among NHS nurses. In US, it was suggested that when staffing levels are decreasing there is low levels of job satisfaction which causes poor effects on work stress and quality of patient care (Aiken et al 2002). He also added it also affect the retention of nurses in clinical practice. According to Coomber and Barriball (2007), a current review of the international literature illustrates that stress caused for workload, workload scheduling and leadership issues influence disappointment and retention for nurses. From policy development, a range of strategies have been identified and impl

Geographically Based Multicultural Education :: social issues

Geographically Based Multicultural Education Many Whites in the United States have a strong sense of ethnic identity that is tied to their immigrant ancestors’ country of origin (Italian Americans, Irish Americans, Swedish Americans) or to their experience in this country (New England Yankees, Midwestern Hoosiers, Appalachians, and so on). There are many subgroups within the White experience, but ...[m]any United States Whites with a strong sense of ethnic identity do not have a strong sense of racial identity. Indeed, ...many Whites take their Whiteness for granted to the extent that they do not consciously think about it. Nevertheless, their identity as members of the White group in the United States has a profound impact on their lives. "White Racial Identity Development in the United States" by Rita Hardiman in Race, Ethnicity, and Self: Identity in Multicultural Perspective, edited by Elizabeth Pathy Salett and Diane R. Koslow (Washington, DC: NMCI Publications, 1994). Among the challenges that face all Americans is to explore race and to educate their children about its impact in society. America is the "melting pot" of society and the most diverse nation in the world. Making it seem from the media that flashes pictures upon our retinas almost everyday. In reality, we live our lives in increasingly homogenized communities composed of single races. Many people never learn or are taught the difference that divide and bring us together. There needs to be a change in the way history is shown to children in America, including whom is a part of it and how it is taught. We need to create an environment that promotes a geographically based multicultural education. In school our children have been historically educated and taught history, epitomized by the glorification, or at least passing reference to Christopher Columbus’ atrocities in the Americas. There is no conspiracy to neglect others views and the hardships of history. Rather the European dominance that forms the basis for the general American culture manifests itself in skewed views of history. The dominate societal segment always writes the text, but the problem now is that, white America, no longer controls the culture as much as it did. As other populations of people grow, their side of history is added to the texts. This change in education started back in the thirties as "white" students examined their cultural heritage. As the non-Anglo Saxon population of whites came into power and position, they also wanted their heritages to be explained and glorified.

Characteristics of an Ideal Entrepreneur Essays -- Entrepreneur

What an Entrepreneur Is An entrepreneur is a person who finds it worth risking, especially in term of his or her finances, in a particular project with a hope of introducing new related ventures that will culminate into visible success financially (Foley, 2006). Sometimes, an entrepreneur can also be taken to mean a person who is in the verge of organizing a virtually new project and targeting to use previously unused channels after discovering a hidden opportunity in the eyes of others. Evidently, in both cases, there is a risk factor and therefore maximum care and guided moves are things to take care of first. More often than not, the term entrepreneur is employed in a business context. Some other people argue that entrepreneurship is not a real profession. No, not until one has started something that can be seen on the ground. In short, one cannot create fame in the name of becoming an entrepreneur by just portraying mere intensions nor even when the whole planning of scope and schedule are complete. A person will be termed as an entrepreneur once the first foundation stone is laid on the ground. That means that the effectiveness of one’s ideas is crucial. Therefore the qualities or characteristics of such a person must enable a confident kick-off and somehow guarantee success. Characteristics of an Ideal Entrepreneur An ideal entrepreneur must be innovative enough. This means that his or her venture must be backed by relevant knowledge and creativity but encased in achievable limits. Past experience and technical knowhow are integral components that will enhance confidence and enthusiasm while kick starting. In most cases, entrepreneurs act as revivers of a falling business by convincingly intervening with new ideas and ap... ...l of Developmental Entrepreneurship. 8(2), 133-151. Fuller, D., & Dansic, P. (1999). Indigenous Australian and self-employment: small enterprise research. The Journal of SEAANZ. 7(2), 5-28. Harper, L. (2010). 5 Successful Australian Entrepreneurs. Mademan.com. Retrieved 04 21, 2012, from http://www.mademan.com/mm/5-successful-australian-entrepreneurs.html. Rola-Rubzen, M.F. (2009). Critical success factors for aboriginal businesses in the desert, DKCRC Working Paper 38, Desert Knowledge CRC, Alice Springs, Retrieved 04 22, 2012, from http://www.desertknowledgecrc.com.au/publications/downloads/DKCRC- Working-Paper-38-Critical-Success-factors-for-aboriginal-businesses-in-the-Desert.pdf. Thomson, J. (2010). Our Top Female Entrepreneurs. SmartCompany. Retrieved 04 22, 2012, from http://www.smartcompany.com.au/entrepreneurs/20100304-female- entrepreneurs/2.html