Alliances Balancing and Bandwagoning

Stephen M. Walt’s main purpose in his work is to assert his explanations for the actions done by states in the international arena with regard to their alliances as a response to a certain factor or condition that affects or influences the very well being and situation of a state.The entire point of Stephen M. Walt revolves around the reaction of states when engaged or met with external threat. His analysis illustrates the possible behavioural patterns of states by explaining what kind of actions these states make and why.He thus caters two concepts; balancing and bandwagoning, stating that states tend to either balance or bandwagon depending on where these states perceive that they best fit or may benefit from. Therefore, he develops his analysis by proposing that the states two primary options or actions are to either ally in opposition of an external threat or to ally with the external threat itself. Stephen M. Walt holds that these two concepts are dependent upon the type and level of external threat manifested to them.This is not to discount the fact that the state’s influence, power or how the international community perceives it must also be taken into consideration; whether a state is considered as a strong state or a weak state.In a nutshell, Stephen M. Walt submits that a state may ally with other states in the face of an existing threat or it may arrange itself with this threat. He thus primarily asserts that as part of the natural behavioural pattern of a state, other theorists may say that balancing shall be the more convenient or expected action by a state rather than bandwagoning.It is fundamental to hypothesize that a strong state shall have the automatic tendency to balance. While the weak states may also choose to balance but this is only as a response to other weak states. When the conflict is between a weak and a strong state, it is another story.It is but natural in such a situation for a weak state to bandwagon when respondin g to a threat posed by a strong state. Stephen M. Walt’s alliance theory explains that a state’s action when responding to an external threat is the phenomenon of knowing when will such a state form an alliance and what will influence the state’s choice in making an alliance.This phenomenon is an expected behavioural pattern and a normal reaction. The focal area of concern with regard to this phenomenon is focused mainly on the each state’s duty and responsibility to protect itself. As a means of security, the state will be expected to put its safety as the first priority when an external threat is lurking around.The decision that follows shall take in consideration the state as a whole and how it is perceived by the international community. Primarily, the argument that pushes the theory of Stephen M. Walt falls largely on the shoulders of the two concepts of balancing and bandwagoning.As mentioned earlier, balancing is about allying with other states aga inst the external threat. In other words, states form an alliance against another state or group of states that pose the dominant and greater threat.This is simply a way for a state to deal with another state which is a threat because of its greater aggregate power. A determining factor here is hinged on a state’s capability, particularly its military capability. However, the type of military capability that is in question is on a state’s offensive capability which poses the threat to other states.The defensive military capability is not much given attention due to the fact that such capability will not be a threat unless provoked or initiated by another state. But having a strong and threatening offensive capability is not the only distress and apprehension of other states.The level or aggressiveness of a particular state is definitely taken into account. Each state regardless of their capabilities has their own way of responding and not responding to threats and issu es they encounter. Moreover, alliances formed under the concept of balancing are somewhat situational or circumstantial.Although alliances are forged heavily to answer the call of threat, these alliances change dramatically when that threat is conquered or disposed of. Wars seem to be the common cause of most states to form an alliance but the moment the war ends, the alliance breaks as well. As much as alliance through balancing is very much evident and supported by past occurrences, the opposite concept of bandwagoning is as much evident and present as seen during the Cold War. It is therefore asserted that bandwagoning is most likely to happen than balancing.Stephen M. Walt even stresses that any need for a legitimate justification to be involved in international territories or issues can be covered by bandwagoning. Furthermore, bandwagoning is also used as a means of increasing a state’s military capacity.Proponents of bandwagoning see the logic in this concept by simply knowing that the greater a state’s aggregate capability and offensive capability the more likely it is for other states to form an alliance with it. Even the geographical location is taken into consideration.The states that are located near a powerful state shall have a greater tendency of forming an alliance with the powerful state. The location of states geographically in relation to another state particularly with the stronger state is very important especially in times of conflict.This because the issues on borders and the time it takes to send help and information to an ally will largely depend of their positions. And being the opposite of balancing, the states will not align against the powerful state because of its aggressive perceived intentions.And also, the alliances formed against the greater state will disintegrate as a response to a serious obstacle that they realize is already beyond them. Stephen M. Walt states his theory by deducing it from rational and histor ically based assumptions and behavioural patterns which states have already done to point out that what states will most possibly be doing. The past shows times of numerous instances in international relations which act as an example or as a guide in predicting not necessarily the end result but the processes of interactions between states.Stephen M. Walt cites numerous occasions and incidents in the World War and the Cold War as an example for proving his theory. He thus bases his conclusions and hypotheses knowing that there are only limited possible steps or actions that a state can actually make.The assertion of Stephen M. Walt’s theory by quantifying and qualifying a state’s action to form an alliance as a response to an external threat through balancing and bandwagoning as supported by historical bases makes it logically sound.The argument that is proposed takes root in the rational and natural assessment of how exactly a state will respond to the situation prese nted. In other words, the theory is an anticipation of an expected probable outcome.The explanation is implicated in the concepts of balancing and bandwagoning which are two polar manifestations that show that for every action taken or not taken, there is also another option which is the alternative or opposite action taken or not taken.For example, as stated earlier in balancing, the greater the threatening state’s aggregate power, the greater the tendency of others to align against it. While in bandwagoning, the greater the threatening state’s aggregate power, the greater the tendency of others to align with it.The cause and effect implication is simply related to the relationship between one state’s relation with another, a state’s capability and the other state’s capability and most importantly, one’s external threat confronted by a state as manifested by another state.The threat is the absolute indicator or the absolute cause of how a s tate will react. The level of threat will influence every consideration that a state will take into. Technically speaking, in consideration of the cause and effect analysis, it becomes quite obvious that this theory of Stephen M. Walt is a primary response or a better description and explanation of the forming of alliances of states. It is asserted by other theorists that the overlying source for the alliances formed by states is founded on the power relations between states.Thus, the balancing or bandwagoning of states are simply actions to balance the power in the prevailing status quo of the international sphere. But Stephen M. Walt sees that the states do not seek security from power but rather, states seek security from threat.Power can be threat but it can also not be threat. Power is a neutral factor and cannot be seen as a threat unless used as one. While threat on the other hand is a concept that poses danger and concern to a state making it more definite and ideal to thoro ughly and greatly influence the state’s actions.

Food And Culture Essay

Culture is broadly defined as the beliefs, attitudes, values, customs, and habits accepted by a community of individuals. Cultural behavior patterns are reinforced when a group is isolated by geography or segregated by socioeconomic status. Culture is learned, not inherited; it is passed from generation to generation. The term food habits refers to the ways in which humans use food, including how food is obtained and stored, how it is prepared, how it is served and to whom, and how it is consumed. A. H. Maslow’s theory of human maturation as applied to food habits explains how food use progresses from eating for existence to eating for self-actualization. 1.Physical needs for survival: Daily needs for nutrients must be met before more complex food use can occur. 2.Social needs for security: Once the immediate need for food is satisfied, future needs can be and are considered. The storage of food, in a pantry or in a refrigerator, may represent security. 3.Belongingness: This use of food shows that an individual belongs to a group. The need to belong is satisfied by consuming the foods that are eaten by the social group as a whole. These foods represent comfort and happiness for many people; during periods of stress or illness, people often want the foods they ate during childhood. Sometimes people adopt a special diet to demonstrate belongingness. For example, African Americans who live outside the South, may choose to eat what is called soul food (such as pork ribs and greens) on certain occasions as an expression of ethnic identity. Etiquette, the appropriate use of food, is also a way of demonstrating belongingness. Entirely different manners are required when lunching with business associates at an expensive restaurant, when attending a tea, when eating in a school cafeteria, when drinking with friends at a bar, or when  picnicking with a significant other. 4.Status: Food can be used to define social position. Champagne and caviar imply wealth, beans and potatoes are traditionally associated with the poor. Status foods are used for social interaction. When a man picks up his date, he brings her chocolates, not broccoli. Wine is considered an appropriate gift to the hostess, a gallon of milk is not. In general, eating with someone connotes social equality with that person. Many societies regulate who can dine together as a means of establishing class relationships. Women and children may eat separately from men, or servants may eat in the kitchen, away from their employers. This attempted separation by class was also seen in the U.S. restaurants that excluded African Americans before the civil rights legislation of the 1960s. 5.Self-realization: This stage of food use occurs when all previous stages have been achieved to the individual’s satisfaction. Personal preference takes precedence, and the individual may experiment with the foods of different ethnic or economic groups. Food and Culture in America. A Nutrition Handbook, 2nd Edition. Pamela Kittler & Kathryn P. Sucher. Wadsworth Publishing Company, 1998. Cultural Paper Complete a three to five page paper on the nutritional habits/customs, health beliefs and practices of a specific culture. As you prepare this paper, think about the issues addressed in the previous pages and how these influences shape a culture’s eating habits. As your paper takes shape, you may want to include some of the following points: History of the specific culture Common food rituals Food beliefs: is food used symbolically, spiritually or does the culture use specific food/foods for therapeutic purposes? Are there any traditional or  staple foods used regularly in their diet. What is the meaning of this food? Do the people of the culture follow a specific daily pattern related to diet and meals? Does the culture change their nutritional beliefs or have different food customs throughout the lifecycle, from infancy to adult years, during pregnancy and lactation or during sickness and health? What did you learn about this culture? Feel free to include personal experiences and any recipes to share with the class from this culture. Please include a minimum of two references published within the past five years from a reputable health/nutrition related journal and/or book. Suggestions include Journal of the American Dietetic Association, Journal of Nutrition Education, American Journal of Clinical Nutrition or Journal of the American Medical Association.

The Power of Social Media and Its Impact on the Current Business Environment

The number of internet users has increased over the last decade due to the development of new technologies, internet availability and improved connectivity. Various online communications platforms have been invented and are widely used for both personal and business purposes world wide and social networking is the latest communication platform helping people connect to each other across different places. Its introduction has changed the way groups of people are connecting and communicating in business via online communities and professional networks. In business, many multi-national companies are currently moving beyond traditional media channels and using social network sites as a medium to reach their targets consumers instead. There is no argument that social networking is the key player driving new media communications in the digital era and its benefits and functions are impacting business considerably. There are hundreds of social networking platforms that have been introduced to the market but currently there are only two major sites recognised as the world's most powerful platforms attracting millions of users to participate. Firstly there is Facebook, a social network service that allows users to create their own profile, status, interest and preferences and also share information with friends and contacts. According to Trimpe (2011), reported that Facebook's active user base is 519 million which equates approximately to 1 in 13 of every person on earth. In the Facebook world millions of pieces of content, links and event invitations are shared every 20 minutes indicating the enormous power of Facebook as a social media tool. Secondly there is Twitter, a social network platform that allows users to generate and share messages, or â€Å"Tweets†, up to a maximum of 140 characters. According to Chiang (2011), claimed that there are nearly 200 million Twitter's users worldwide. The most common use is to promote business information about products and services or sometimes to educate industry on a business products or services. Due to the fact that these two social networking services possess millions of people's profiles, demographics and personal interests, thousands of multinational companies have turned their focus on new social media strategy to reach their target online. The term ‘social media’ has become the most recent area focused on by marketers, advertisers and public relations professionals in various business sectors and many experts have studied and tried to understand the benefits and functions of the term social media. According to Turner (2011), the Chief Content Officer of the 60 Second marketer reported that social media is about creating and having conversations among networks in online forums, blogs, and social networking sites. The key fundamental function is to use them as a medium for contacting, sharing and promoting data and contents. But when it comes to business, the main objective of operating social media is far beyond that. In business, social media is currently claimed to be the best tool in helping a company gain larger numbers of their target consumers just by providing a digital experience related to their products and services. Social media is also playing an important role in driving consumers brand engagement. According to Schmitt (2009), studied about digital brand experience and the result indicated that consumers who have a chance to engage with a brand in social networking sites can evolve from passive reactors to support the brand almost instantaneously. Creating a brand presence in social media can create not only opportunities for a company to gain more customers but also help marketers to understand more deeply what their potential target customers think towards their products and services thanks, for example, to Facebook that first invented the â€Å"Like† application that allows users to express their interest towards other websites, links or even competitors brands and share across networks. Thanks considerably to the advantages of social media, and its large numbers of potential target consumers, it is no surprise that many global companies have selected social networking as a key medium to start launching their campaign. According to Parsons (2011), reported that recently, Kellogg’s, the cereal manufacturer, launched a new range of Krave cereal and used Facebook as a medium to communicate and offer free sample packs to around 80,000 consumers on their Facebook fan page. The brand also developed video content to engage their 16-24 year old target age group to create interaction in Facebook. Additional examples show that Dell also gained a major success generating $3 million in sales after it launched its online outlet through Twitter and Starbucks has achieved the top ranking of Facebook brand pages, with nearly 4 million friends, by just offering fans coupons for free pastries and ice cream. Additionally, Whole Foods has topped Twitter with 1. million followers by broadcasting weekly specials and shopping tips (Schmitt 2009, p. 26). Companies in the FMCG industry are not the only sector that is involved in social media. Currently Honda, the Japanese automotive manufacture, is implementing their new marketing initiative from budget-led to customer-led by moving beyond traditional advertising and using social media as a tool to understand, manage and encourage open communication and conversation among their customers (Fisher 2011). In this point, the decision to buy a durable good like a car is a lengthy process, so to ensure that their brand will be in front of mind of consumers, Honda then focuses through a combination of data analytics using, and social influence methodologies, to engage and change consumer perception and increase brand awareness at the same time. In other words the role of social media, in this case, is to help maximise the goodwill and favourable mentions of company and brands. Moreover, not only can a platform of social networking provide a benefit to communicate with customers but it also enhances the capability of internal communications amongst staff as it has benefits of real-time discussion, response and speed to spread out information or opinions internally and reduce the time spent in meetings and it is enormously useful for companies with teams/staff members who working in different locations or time zones. For instance, according to Willson (2011) reported that AT&T, a US telecommunications company, launched a new tool aimed at providing their staff the opportunity to have discussions, brainstorm and refine ideas through its own internal social media platform. Employees have opportunities to be involved by voting their opinion on the company's ideas and strategies. As a result of this implementation, and in just 6 months, there are more than 200 topics that have been discussed with great outcomes and many fresh ideas generated without wasting time in meetings. Undoubtedly, social media platforms help a company communicate to both customers and staff faster and easier, however, the easy access of shared data can be a risk to a company’s confidential products and information. Many companies to date have suffered from the secret leaking of their products before its launch to market and it is not only bloggers or online journalists who cannot keep the information secret but also staff who are caught, sometimes by mistake, sharing confidential information. As recent examples, Coggan (2011), reported that Renault has suspended three senior executives allegedly for passing on blueprints for electric cars, Facebook’s corporate privacy settings went wrong when some of the social network’s finances were published and a strategy document from AOL came to light revealing that the internet and media firm’s journalists were expected to write five to ten articles a day. As a result of this type of leak information many companies, especially in the USA, do not allow employees to use their own computers or use memory sticks for certain online services. Accordingly Robert Half Technology also found in 2009 that more than half of chief information officers in America blocked the use of networking sites such as Facebook at work to prevent leaking of information. In the digital era, today's business is borderless with mobile devices, smartphone and computers helping the world connect with the internet. Social networking is a new communications platform that enhances this borderless world providing users with an ability to contact one another and spread information. Many companies use these social networks as a key strategic media to reach their target consumers or adapt its platforms for internal communications purposes to enhance the productivity of its members. However, with its easy access and ability to disperse information rapidly, social networking is becoming a big challenge for todays businesses on how to control data leaking and to protect information assets whilst, at the same time, sharing data without affecting the company's competitiveness. Ultimately, the challenge of gaining benefit from social media is to operate it in a balanced way and in the same way a company has always managed its confidential information. A company must know what it wants to achieve from spreading information about its products and services and also what information it needs to protect . A businesses staff who are involved in the management, operation and control of these platforms should be trained to know how to add accurate data in an online social context and be able to understand what information is acceptable to share.

Old Order Amish (in the United States) Essay Example | Topics and Well Written Essays - 2500 words

Old Order Amish (in the United States) - Essay Example In fact the history of the community can be traced back in 1700. According to a relevant report â€Å"the first Amish, so named for Jakob Ammann, arrived in Lancaster County and nearby Berks and Chester counties in the early 1700s to take part in William Penn’s "Holy Experiment" of religious freedom; originally called Anabaptists, they came to America from Europe to escape religious persecution by both Protestants and Catholics; the county is now home to three Anabaptist groups called the Amish, Mennonite and Brethren† [2]. The conflict with other religious ‘teams’ like Protestants and Catholics has been intensive since the appearance of the particular religion. These conflicts have led the community to follow a particular code of life away from the centres of ‘civilization’ as the big cities around the world can be characterized. At a next level, in order to keep their traditions, the members of the community followed a particular ‘codeà ¢â‚¬â„¢ that differentiates them from other religious ‘teams’. It should be noticed here that because of the many particular characteristics that the way of life of this community presents, it is rather difficult to proceed to a completed presentation of their intervention in modern social ethics. However, it could be possible to investigate their role in the development of particular ideas and styles of life. The settlements of Amish across USA are many. However, â€Å"the leading settlement of the community in Pennsylvania is in Lancaster County; in the Lancaster Plain near Intercourse and Bird in Hand live the House Amish, who, objecting to churches as worldly, worship in houses or barns† (Klees, 1950, 37). The existence of a central point of reference of the community’s life is important for the reservation of the community’s beliefs as they are presented mainly in the

Shakespeare Essay Example | Topics and Well Written Essays - 1750 words - 1

Shakespeare - Essay Example Cassio: I do. I would have given all that I am to save Othello’s reputation in the least. I deserved all I got for being drunk and brawling in the streets, destroying my own reputation as well as his. As I told Iago, I would rather sue to be despised than to deceive so good a commander with so slight, so drunken and so indiscreet an officer (II, iii). But I was confounded by that evil rogue just as my noble commander. I live my life in darkness thinking perhaps I could have assisted my good commander in his time of confusion. Banquo: Madness can often strike unawares. It did so with my good friend and compatriot, Macbeth. He was always my good friend until the madness of the witches took him and he became convinced I was designing against him. Cassio: Ah, Banquo, would that I could attribute Othello’s madness to something as external as what afflicted your Macbeth. Alas, I fear a good portion of Othello’s madness stemmed from my own actions, ill-advised as they were by the evil Iago though well-intentioned by myself. Cassio: I sought out admission to the lovely Desdemona, Othello’s bride, for assistance in regaining his ear and my position. There was naught in our relations to suspect Desdemona and I had anything other than concern for Othello and a desire to serve him, but Iago was able to convince him, through Desdemona’s pleas for my benefit and my presence with her, that she and I had dishonorable intentions. Had I not sought her assistance, Iago would not have had such a ready weapon to use against so noble a man. Buckingham: You do not hold any blame. A man cannot be expected to do anything other than further his station. You acted correctly in seeking any means possible of regaining your status. You cannot be held to account for the misdeeds of another. Horatio: I disagree. I, too, have held some responsibility for the destruction of a good and noble prince. I knew of Hamlet’s father’s

Why I want to be an officer in the US army Essay

Why I want to be an officer in the US army - Essay Example The US Army is founded upon seven principles i.e. Personal Courage, Integrity, Honor, Selfless Service, Respect, Duty and Loyalty. (US Army Manuals, 2008)Soldiers are taught about these values during training and they soon form part of their lives as they carry out their duties. Because I share in the desire to acquire and live according to these values, then I believe that the US Army would be the right place for me. In the civilian world, many people are familiar with all the latter values; however, very few of them actually embrace them as part of their lives. Most of them may consider these values as theoretical ones and rarely do they adhere to all of them. However, US Army officers are different in this regard. This is because the seven Army values are part of what they are. All US Army officers are expected to bear allegiance to the Army, the US constitution and to their fellow soldiers. Loyalty as an army value is first and foremost directed to the country and its heritage. In theory, this may seem like a relatively easy thing to do. However, there is much that has to be considered in the execution of this value. For instance, when soldiers are out in combat and they are heading towards a location that they may not be sure of, it is essential for these officers to demonstrate their loyalty to the Army by obeying the directions of their Captain. This should be the case regardless of objections that other soldiers may have against the Captain's opinion. (US Army, 2008) In order to be loyal, it is necessary for one to actually bear witness to the US Army ideals. This normally means that one has to be willing to devote oneself to the Army and to other persons in the Army. This is usually displayed by a deep respect and support for one's leaders and colleagues. Every Army soldier can contribute towards the greater good of the institution by carrying out their part. There is only one thing that can prepare an individual to engage or participate in something that poses a serious risk of death. This is having great loyalty to ones country. Such officers usually pledge allegiance to their country and their constitution even when it might cause them great harm or even loss of their lives. To me, there is nothing that can show one's loyalty to their country like sacrificing one's own life for it. While it may be a fact that not all US Army officers are at risk of loss of life, one cannot ignore the fact that it can happen. Consequently, one ought to be ready for this. Source; http://www.cbc.ca/ A memorial for fallen soldiers in the war in Iraq; the latter illustration shows some of the prices that the US has to pay to defend their deals. It may be a scary thing for many people to work in the army because many are wary of its unpredictability. In fact, this is the sole reason why so many people opt not to join the Army. However, the same situation does not apply to me. I have a deep respect and love for my country. My loyalty is so immense to the point that I can be willing to put up with so much just so that I can secure a better life for my generation. Many great leaders in history had to make sacrifices because if they had not chosen to do so, then our nation would not be as it is today. The ideals that hold America today must be protected at all costs and if it takes some injuries or a life to prove this point, then so be it. The US Army is the best place to serve when one has such utmost respect and loyalty for their

Public Administration Research Paper Example | Topics and Well Written Essays - 2250 words

Public Administration - Research Paper Example However, new public management (NPM) overrides the earlier new public administration (NPA) and develops to cover wide areas of management functions. Classical Public Administration establishes principles and structures of organizations, which should guide in public administration, while the NPA counters classical PA through anti positivist, anti technical, and anti bureaucratic aspects and propose for relevance, change, values, and equity goals in public administration. NPM brings in the aspect of governments to operate just like businesses and relies on price change and neo Taylorism theories. Post modernism proposes for active participation of citizens or the society in dialogue and debates of public policies, before and during implementation to reflect their needs. It is build upon Haberman discourse theory. Finally, the paper draws a conclusion between public and private sectors. Keywords: Public Policy, Public Administration, Managers, New Public Administration, Classical Public Administration, New Public Management, Post Modern Public Administration, Organizations, Government, Principles, Change, Theory, Public and Private Sectors, Business, Efficiency Public administration is only a specific part of the broad concept of administration. In the past, people and even scholars have had differences in agreeing to which field the study best fits. Some argued that it best fits in science, while others believed it was an art or philosophy. Basically, since the scientific study of the facts of administration exist, it makes it a science, just as a field of philosophy, it deals with human beings and their management, and due to practical application of knowledge, it then becomes attached to art. The word administration focuses its attention on the cooperativeness of groups’ behavior to generate the basis value, which is efficiency.

Movie Critique Essay Example | Topics and Well Written Essays - 2000 words

Movie Critique - Essay Example Through the relationship between these two men, the viewer is able to see many psychological factors at work which help to make this work environment so unbearable. It is also possible to see that Bill Lumbergh’s style of leadership is responsible for the majority of these problems and, therefore, he should be blamed for the eventual destruction of the company. A force that allows for employers to have a psychological advantage over their employees is job security. There have been massive layoffs lately and those who were lucky enough to keep their jobs must work hard to ensure that they are just as lucky when the next cuts are made. This gives the employers all of the power, as they can work the employees harder, without any backlash because there are so few jobs in many sectors. The employers know that if an employee does not perform up to expectations, then someone else will be readily available to take his or her place. The employees also know this so they must work hard to keep their jobs. In Office Space, Lumbergh utilizes this as a method of employee motivation, as many of the characters are terrified of losing their jobs. He also uses this threat to get certain members of the company to work on weekends, as they must do so in order to keep their jobs. This movie shows a negative form of employee motivation, as employees do not resp ond will to threats like this, as can be seen in this film. A manner of employee motivation that would work better would be incentives for working overtime and working harder than everyone else. If Lumbergh would offer employees like Peter bonuses for doing extra work, he would be able to get more out of them on a regular basis and would keep them more motivated. Happy workers are much easier to deal with and Lumbergh does not do an adequate job of keeping his employees happy. Longer hours and averted overtime pay would completely ruin employee moral and

The Role of Jim in Huckleberry Finn Essay Example | Topics and Well Written Essays - 1500 words

The Role of Jim in Huckleberry Finn - Essay Example We meet Jim in the second chapter, in a role next to only Huck. He remains throughout a 'noble cause and an ignoble foil' in Twain's masterpiece supposed to be a departure from usual European literary work, which was initially denounced for the irrepressible need of better treatment to slaves. It used frontier humor, vernacular speech and according to Ernest Hemingway, is the novel from which "all modern American literature comes. There has been nothing as good since." http://www.enotes.com/twentieth-century-criticism/adventures-huckleberry-finn-mark-twain Ralph Ellison defends Twain's presentation of Jim as ""not only a slave but a human being, a man who in some ways have to be enviedJim is drawn in all his ignorance, and superstition, with his good traits, and bad. He like all men, is ambiguous, limited in circumstances, but not in possibility," Callahan (1995, p.88). Twain presents natural justice and raises the characters above the prevailing selfishness of society and racism. While doing so, he introduces perhaps one of the most endearing characters to literary world rivaled only by his protagonists, Huck and Tom for reader's affection. "The test and proof of natural goodness, which raises Jim and Huck above religious hypocrisy and selfish romanticism, is its transforming power upon him. The fear-ridden slave becomes in the end a source of moral energy. The shifting of Jim's shape is reversed at the end, as he sinks back from his heroism to become the bewildered freed darky of reconstruction days, grateful to the young white boss for that guilt-payment of forty dollars," Mensh (2000, pp.110-111). When most African Americans were depicted as fools, superstitious, ignorant and idiotic, Twain dares to initiate a diverse characterization in Jim, who, from being a humble servant, goes up to be the savior of both boys, traveling the distance with ease and kindness. "He embodies all the qualities-loyalty, faith, love, compassion, strength, wisdom-of the dynamic hero, and his willingness to sacrifice his freedom and his life for two young boys establishes him as a classic benevolent character" http://www.cliffsnotes.com/WileyCDA/LitNote/id-20,pageNum-94.html Huck becomes the inheritor of Jim's worthy qualities, an entirely different angle where a white boy learns generosity and kindness from a slave black. Jim's ability to predict the storm shows the inherent simply cleverness, even though uneducated and roughly used. The runaway black slave, fearing for his freedom, with entire world against him, reveals several things about himself, subtly showing that slaves are human, as human or perhaps more human than their American owners, and value their freedom and yearn to be treated in a humanitarian way. The message is loud and clean that Twain wanted slavery to perish. An aggressive message would not have been so suitable. "The 'fury' is certainly an important element in Huckleberry Finn, but it is not itself patently active; it is subsumed into the whole critical and poetic view of the human condition so wonderfully resented in the book," Grant (1962, p.80). It is surprising to note how reader thinks more often about Jim and less of

Apple Computer Culture Essay Example | Topics and Well Written Essays - 1250 words

Apple Computer Culture - Essay Example The positive feature of Apple is that it uses informal communication method which helps it to achieve the goals. It helps to provide satisfaction of members' social needs, and a sense of personal identity and belonging. This type of communication provides additional channels of communication and provides a means of motivation, for example, through status, social interaction, variety in routine jobs, and informal methods of work. Informal type of communication provides a feeling of stability and security, and through informal 'norms' of behaviour can exercise a form of control over members. "The informal approach to management meant that influence was a primary way of The culture and structure of Apple develop over time and in response to a complex set of factors. "Employees expressed great concerns about both Apple's management and its working environment. Many felt that executive management did not have a clear business direction, and that they did not keep employees adequately informed' (Gibbs, Beer, 1991). Apple management team did not take into account that the nature of the 'business' and its primary function have an important influence on its culture. Usually large organizations like Apple have more formalised structures and cultures. Increased size is likely to result in separate departments and possibly split site operations. Nevertheless, this created a problem for Apple's "old" employees who felt that, "There is not as much chance to talk at Apple now. There is less passion or personal commitment. Hotlinks keeps Apple people passionate." (Gibbs, Beer, 1991). This caused difficulties in communication and inter-departmental rivalries with the need for effective co-ordination. A rapid expansion, or decline, in size and rate of growth, and resultant changes in staffing will influence structure and culture. Unfortunately, Apple management did nothing to improve this situation because information through Hotlinks went round them, and they "need managerial shift from control to context" (Gibbs, Beer, 1991). It is important to note that Apple "encouraged individualism". Individuals in the organisation are not guided at all times by the primary goals of the organisation. On the other hand, Apple culture is based on a team work: "people in Apple valued teamwork and liked to work in teams' (Gibbs, Beer, 1991). Goals and objectives pursues profitability, but this is not by itself very clear for its effective management. Apple must give attention to objectives in all key areas of its operations. The combination of objectives and resultant strategies influence culture, and may themselves be influenced by changes in culture. The problem is Apple is that employees have to complete "immediate objectives". It means that the main focus is made on "to get the job done than to get it right" (Gibbs, Beer, 1991). The primary function of Apple determines the nature of the technological processes and methods of undertaking work, which in turn also affect structure and culture. Employees doe not know long-term strategies which prevent them from effective performance. In order to be effective Apple tries to be responsive to external environmental influences. Apple operates within a dynamic environment and it requires a structure and cul

Cross Cultural Managemant Essay Example | Topics and Well Written Essays - 4500 words

Cross Cultural Managemant - Essay Example Prominently, it has been found that Egyptian culture favors authoritative leadership and team orientation; emphasizes the present and avoids risk or change; emphasizes laws and regulations and does not adhere to time schedules. Recommendations to managers have been made keeping in mind these and few other attributes. Table of contents 1. Introduction 4 2. Cultural assessment in global business: rationale and objectives 4 3. Determinants of culture 6 4. Analysis of Egyptian culture 7 4.1 Based on Hofstede’s cultural dimensions 8 4.2 Based on Trompenaars’ cultural dimensions 10 4.3 Based on Edward T Hall’s intercultural aspects in communication 11 4.4 Based on the GLOBE project by House et al., 12 5. Implications for business 14 5.1 From GLOBE’s cultural dimensions perspective 15 5.2 Other perspectives 17 6 Conclusions and Recommendations 19 Bibliography Appendices List of appendices Appendix 1: Steers et al.’s (2010) Comparison of models of cultural dimensions Appendix 2: Nardon & Steer’s (2009) Core cultural dimensions: an integrative summary Appendix 3: House et al.’s (2004) Summary of social cluster rankings for culturally endorsed implicit theory leadership 1. Introduction: Egypt, an African country, is known for its historical origins of world civilizations. Its culture is influenced by the Mediterranean, African and the Arab countries, and therefore predominantly follows Islamic religion. From international perspective, Egypt’s social and cultural considerations act as the constraints for business and management due to their vast dissimilarities with other nations’ cultures (Rice & Mahmoud, 2013). In view of this fact, Egypt’s conduciveness for business in international arena will be explored by using findings from literature. Literature on various researches related to world cultures will be studied, with main focus on the most significant studies, like those by Hofstede, Trompenaars, H all, and House et al will be used as reference points. Critical implications for effective management such as motivation, leadership, organizational policies and procedures will be identified based on analysis carried out on Egyptian culture using various cultural dimensions. Finally, conclusions will be drawn and recommendations will be made, if required, from management viewpoint. 2 Cultural assessment in global business: rationale and objectives Business management attracted a different perspective during the beginning stages of globalization owing to the various determinants of successful business run by people belonging to various backgrounds. This perspective was from the cultural aspect, which management specialists and scholars have been studying in detail to identify the role of national culture on various aspects related to organizational behavior. Business anthropology has thus permeated management field owing to various needs in globalized world, such as communication, b usiness growth, international relations, international laws and regulations etc, all of which are influenced by culture. For instance, the human resources perspective demands a thorough understanding and analysis in different countries, considering the similarities and variations of national and organizational cultures, for effective management of people. Extensive research work and evidences in the areas of marketing, consumer behavior, international business,

Tv Boon or Bane Essay Example for Free

Tv Boon or Bane Essay One hardly comes across a house today that does not have a TV set. Even those who belong to the lower income group invest in a TV set as soon as they can afford it. Most Indians spend their evenings glued to the television as this is the most easily available entertainment for them. Now there are cable connections in most of the houses and with the advent of international channels on our television, the popularity of TV has grown many folds. How TV does affect our lives today? We have to consider its advantages and disadvantages. In some ways TV is a boon. It is a vital source of information and helps to shape our lives in many ways. It keeps us posted with the latest political, social and cultural developments in the world. Hence, it educates us. It brings the people of the world closer by removing the distances that exist between us. Sitting in our rooms, we get a view of the entire world. TV also takes us nearer to the cultures of the world. While entertaining us with soap operas, dances, plays, music, etc. , it educates us about the lifestyles of the foreigners in those lands where these programmes are produced. We can compare our own culture with theirs and can learn something from them. With a television set in the house, a person can never get lonely. It can be mans best friend. However, the television turns into a curse when it interferes with the normal routine of our day. When children neglect their school books and homework, the television becomes a curse. It is a source of great temptation for children to watch a cartoon show or a movie on TV rather than study. Adults often become less social because of the television. They tie themselves down to the house according to the timings of their favourite television programme thus making themselves unavailable for various social gatherings. They might skip meeting a friend or calling on their relatives because they would rather watch a movie on television. This keeps them confined to the house and they often miss out on activities which are equally, if not more important, outside the four walls of the house. If one balances the TV viewing time and time for work, then TV is a boon all the way, else it may become a curse.

Scientific Management Theory Analysis

Scientific Management Theory Analysis The emphasis on increasing productivity from individual worker impels the emergence of F. W. Taylors scientific management at the beginning of 20th century. His philosophy of rationalizing work and organization to achieve maximum productivity, cooperation and prosperity has influenced the production and management model of his age profoundly. Despite the past 100 years, the shadow of Taylors philosophy in terms of production approach and management practice is still alive at the times of information technology, flexibility of production and the industrial restructuring. As Stern has written, The scientific management of Fredrick Taylor shaped the first coherent school of thought with its twin goal of productivity and efficiency- still influences management thinking 100 years on. This essay will assess the influence of scientific management on contemporary organization. Before assessing the influence, it is also important to introduce what scientific management is. It is a set of systematic theory of the correlation between labour and tasks for the purpose of increasing productivity by redesigning the work process. Based on the famous time-motion-study, Taylor developed four principles to increase efficiency: Study the way workers perform their tasks, develop a science for each element of a mans work, which replaces the old rule- of-thumb method. Codify the new methods of performing tasks into written rules and standard operating procedures Carefully select workers who posses skills and abilities that match the needs of the task, and train them to perform the task according to the established rules and procedures Establish a fair or acceptable level of performance for a task, and then develop a pay system that provide a reward for performance above the acceptable level Scientific management is a complete and interrelated system, but this essay will examine Taylors four principle separately to simply the analysis. One best way and division of labour Generally, Taylor believes that there is a one best way of each task to achieve maximum productivity and during his age, He firmly believes the division of labour is the best way to achieve this. Though nowadays, due to the diversification of the market and the organization, the simple one best way can hardly be defined, such as business adopt mass-production strategy can have a completely different optimal method of production than those focus on niche marketing, his spirit of pursuing the best way is still vivid presented. Just as the quality circle pioneered by Japanese car manufacturing, modification is being discussed continuously to make the work process more streamlined, more efficient and not wasteful in its activity, which is essentially the goal of Taylors system.(Stoney, 2001:p27) Especially when information technology has become the means of analyzing the underlying flow of material and information, it is more convenient and prevalent for contemporary organization to deci de the best redesign of business process to pursuing productivity, quality and competitive posture. Incorporated in his spirit, division of labour is the specific outcome of scientific management, the best way Taylor advocates to minimize skills required, and assembly-line, the creation of his age, are also still utilized successfully in contemporary fast-food industry. Such as MacDonald, the unskilled tasks from broken-down cooking procedure and sophisticated time record make it a completely modern duplication of Taylorism. The assembly lined production mode underpins the repetitive work cycle on the line by setting standard times. By doing this, efficiency improves dramatically as unnecessary tasks are eliminated, physical layouts improved, and work speeded up. (Fincham Rhodes, 2005: p678) Despite that deskilling () will de-motivate employees significantly on a general scale, which may result in absenteeism and high staff turnover, its ability of integrating new workers in production processes and dismissing workers without losing knowledge form the organization can successfully overcome it. Besides, the emphasis on quantity rather than quality (Ritzer, 2004) of the fast food industry also highlights the need of efficiency. Taylors influence goes beyond the bounds of manufacturing, the growing army of clerks in the rising service sector are automatically divided into departments and specialized in function. (Fincham Rhodes, 2005: p608) This means the philosophy of division of labour apply to most clerical works to rationalize the working procedure. A merging characteristics of clerical and production labour () becomes one remarkable feature of modern society. However, the anomie and alienation brought by the absolute division of labour limit its further application. The knock-on effect of de-motivate employees on quality and service can have more significant negative impact on contemporary organization than ever when they become the key to profitability at modern times. Despite the limitation of his method, this principle has a considerable profound and lasting influence because of Taylors preoccupation with the efficient use of resources. This philosophy can almost apply to every organization because whichever the work structure is taken, such as the prevalent team work and job enrichment; one of its ultimate goals should be improve efficiency. It can be proved by xxs argument that ()quality circles, rather than being a transformation of labor relations toward democratic participation, are managerial strategy to facilitate workers cooperation with managements goals for efficiency and productivity improvements. Standardization and direct control Taylor proposes standard rules to capture the best practice and direct control of workers to maintain efficiency. As Braverman (1974, p. 47) recognised, Taylorism never was a science, but a control system. Due to separate conception and execution, managers should design, allocate tasks and supervise workers performance without consulting employees opinions.(McGeorge Thoery X) Actually the appliance of Taylors efficiency through rationalization (Stoney, 2001: p.27) builds a mechanistic organizations, with strict rules, standardized defined tasks and top-down communication. Contemporarily, there are still cases where mechanistic organization proves to be optimal. A classic example is call centre where standard script must be followed, number of calls per hour is strictly monitored, as well as managers can listen in calls momentarily. Though it is argued that this complete control will alienate employees as it erodes the sense of freedom and self-determination, only this mechanic struct ure, where all tasks are designed to be consistent and coordinated, rigid rules are followed and instructions are obeyed immediately, can achieve the speedy service and uniform quality. Besides, despite its formalized and hierarchy nature causes inflexibility, organizations, such as call centre, which exist in a relatively stable environment where not much innovation and adjustment are required, has proved to be more effective because of the systematically rationalize procedures. (Burns Stalker, 1961) Thus, it still exists where efficiency dominates effectiveness. More commonly, only element of direct control can be seen in most contemporary organization. For instance, in public accounting firms, supervisor accountants supervise lower-rank accountants assigned with them to each audit. Junior accountants should work under the direct guidance of a senior accountant.(Hall, 1968) This is still due to Taylors inherent advantage, direct control can boost efficiency by rationalizing complex accounting procedure and adopting tasks efficiently and accurately. A further reason is that when meticulousness it the first requirement and errors may cause serious consequence, it is direct control that can maintain efficiency at the same time safeguard the quality. Efficient as it is, the reasons for not being fully adopted is that the drawbacks of direct control largely limit its influence. As Friedman (1977) points out, it neglects the positive aspects of labour. That means know-how and practical experience cannot be reflected and diffused. And the formalized system develops passive organization culture which undermines innovation, commitment and flexibility. This contradicts to the requirement of contemporary organization, especially for manufacturing. At modern times, in manufacturing sphere, the key to profitability lies in innovation.(Ackroyd, 2002) It means how to improve application for existing technology, how to create market advantage by good design and exclusivity become the very crucial issues. This is why most of contemporary organizations only retain elements of direct control and tend to be decentralized to emphases on democratic participation. To a broader extent, Taylors standardization philosophy is more widely used, and the new globalized era makes it an urgent requirement for business. Due to the great advantage of diffuse best practice, standardization becomes the key to facilitate the diffusion of businesss know-how to a new area for achieving a competitive advantage. Meanwhile, it is necessary for coordinating activities on a world wide scale and maintaining strict quality to safeguard firms reputation. However, exposed to a greater level of external complexity, the drawback of rigidity brought by standardization must be overcome, thus standardization is a continuous improvement process nowadays, just as the standard operation in Japanese car manufacturing where work is performed according to standard work sequence to insure quality, meanwhile standard if frequently updated to standardize improvement.(Edwards et al, 1993) To achieve this, standardization tends to be combined with a flatter and organic organization s tructure highlighting integration and decentralization to keep innovative and flexible. Scientific selection and training This is perhaps the most relevant principle today because these processes, selection, performance, as well as appraisal and development have been highly formalized in many organizations today (Cole, 2004). In the knowledge-based economy, talent has become the very valuable asset of business to achieve competitiveness. Much effort is devoted by contemporary organizations on selecting the right person. The contribution of Taylor is that he introduced the importance of selection criteria by management, such as the common competencies (i.e. communication skill, initiative) listed by recruitment department. In line with his emphasis on scientific approach to selection, Taylor advocates scientific training as he argues that it is only when business systematically cooperating to train the competent manà ¢Ã¢â€š ¬Ã‚ ¦that it shall be on the road to national efficiency. (Taylor, 1911: p 98)In the context of the knowledge society, companies are generally encouraged to develop employees skills and knowledge (Hansson, 2007) Such as Nissan UK believes the key way for being the most productive car plant in Europe is its ambitious training scheme involving its entire manufacturing workforce.(Lydon, 2007) Costly as it seems, the long-term benefits of quality, safety performance and manufacturing costs overweight it. Moreover, training is usually positively related to promotion (Bayo-Moriones OrtÄ ±Ãƒâ€šÃ‚ ´n-Angel 2006) it means it can motivate employees by satisfying their growth, achievement needs. Overstepping Taylors efficiency idea, nowadays the meaning of training is also related to be flexible and acuity enough for competing in a more complex global market, such as the widely-used management trainee schemes in multinationals to cultivate managers with practical experience and global perspective. Money as a motivator Taylor advocates piece-rate payment scheme based on his assumption that human nature is essentially self-interest, workers would be motivated by obtaining the highest possible wage by working in the most efficient and productive way. (Mullins, 2001: p23) In modern age, despite his method can rarely be seen due to the decadence of manufacturing, Based on his philosophy, money motivation still play a crucial role in other form, such as the incentive-based pay system. One common example is sales bonus. The rush of a sales force to place orders before month end reflects highly targeted performance. Thus there is little doubt that this system will work if designed appropriately. In the new context, when various approaches (i.e. job enrichment, team work) are applied to improve personal commitment, money motivator is not narrowed for efficiency as well. For instance, bonuses assessed on cooperation can represent up to 50% of wage packet in Japanese system and group bonuses are also given. (cf. Dohse et al., 1985, pp. 137-8) It means money motivator is now used flexibly according to organizations strategy. Ryness study of pay motivation in contemporary organization also support Taylors assumption, as there is overwhelming evidence that money is an important motivator for most people. Furthermore, he found that for high academic achievers, high performing employees and individuals with high self-efficiency and high needs for achievement, pay are the most important motivator.(Rynes et al, 2004) It means nowadays pay maybe more crucial than ever as those kinds of person are just the valuable human resources that organizations compete for. However, it is undoubted that Taylors idea of motivation is narrow minded and not suit as an extrinsic motivator, the emphasis on money will decrease staffs intrinsic motivator. Despite that, contemporary organizations usually adopt compromising approach as nowadays, the satisfaction of social needs and achievement needs are regarded as almost equality important motivator. Thus, multiple motivators, money in conjunction with other intrinsic motivator are more prevalent. For instance, performance-based pay and challenging work are used in such successful firms as Microsoft. Conclusion remark It should be admitted that there is almost no other management theory can overstep the influence of scientific management. As Braverman says, the principle of scientific management is not a failed system, but a set of guiding principles which continue to inform and influence the role and function of modern management. Some of the methods he advocates, such as division of labour, scientific selection and training, have become the features of modern society. More primarily, as efficiency is one of the enduring needs of all organizations, his preoccupation with the efficient use of resources thus becomes the driving force behind the evolution of subsequent management theories () and the root of management practice. Due to its extensive and deep influence, it is institutionalized not only in contemporary corporation, but also ideologically embraced in other institutions, modelling the modern world with the character of efficiency, calculability, predictability and control through technol ogy. (Ritzer) However, its inherent drawbacks of inflexibility, dehumanization require modification in current situation. Therefore, it can be argued that management of contemporary organization is based on a modification of Taylorism and a combination with more sophisticated management theories.

Quality Care In The NHS

Quality Care In The NHS 1. What is meant by quality in the phrase quality of care? Quality, broadly speaking, is a subjective measure of excellence and when applied to health care, quality can be understood as systems and provisions of care said to be free from defects, deficiencies, and significant variations. Within the NHS, this encompasses the provision of high quality primary, secondary and community care in which the interests of patients are protected through a comprehensive set of nationally aligned policies. Lord Darzi defines quality of care as clinically effective, personal and safe. How is this achieved? Within the NHS, quality is achieved through robust regulation, inspection, standard setting, change management, community and patient advocacy, alongside continual assessment of clinical competency (Leatherman and Sunderland, 2003). Quality is about effectiveness of care, from the clinical procedure the patient receives to their quality of life after treatment. The Equity and excellence: Liberat ing the NHS white papers assertion is that to achieve our ambition for world-class healthcare outcomes, the service must be focused on outcomes and quality standards that deliver them. Leatherman S, Sutherland K, (2003) The quest for quality in the NHS: a mid term evaluation of the ten year quality agenda. London: The Stationery Office, 2. In 2008, the Department of Health published the report High quality care for all: NHS Next Stage Review final report. 30 June 2008. (a) Please summarise the main approaches to improving quality proposed by the report (b) compare and contrast these approaches to those described in Gwyn Bevans editorial (quoted from above). The Department of Health report approaches improving quality by: High Quality Care for All proposes that all providers of NHS healthcare services should produce a Quality Account: an annual report to the public about the quality of services delivered. The Health Act 2009 places this requirement onto a statutory footing. Stringent regulation from bodies with increased statutory powers. The Care Quality Commission will have new enforcement powers. NICE will be expanded to set and approve more independent quality standards. New Quality Observatories will be established in every NHS region to inform local quality improvement efforts Strategic health authorities will have a new legal duty to promote innovation. This will be twinned with a portal to share evidence-based, best practice among clinicians and other NHS staff. Devolvement of power to ensure the involvement of clinicians in decision making at every level of the NHS. The introduction of medical directors and quality boards feature at regional and national level Increasing patient information and choice will be introduced in the first NHS Constitution. Patient information will include the systematically measure and publish information about the quality of care from the frontline up. Individualisation will become the key to the way in which patients are handled with a personalised care plan. Noting that one size doesnt fit all. Incentivisation of care outcomes will include a new best practice tariff and the paper suggests this will make funding reflect quality of care. Partnership will be embraced, utilising local authorities, with the services offered personalised to meet the specific needs of their local populations Prevention not just treatment will be paramount with focus on improving health as well as treating sickness. Bevans editorial evaluates the internal market systems that have been tested within the NHS according to the Audit Commission and the Health Care Commissions paper Is treatment working? Suggesting that despite the core intention of the internal market models to improve quality and efficiency of services for patients, as Black insists, there is little evidence to suggest that this has resulted from past models or alternatively the scrapping of the internal market when Labour came to power in 1997; i.e. formation of foundation trusts, increased commissioning autonomy, patient choice or the incentivisation of health outcomes (payment by results). The NHS internal market models aimed to keep healthcare costs low by forcing providers to compete for patients not compete on the basis of quality. A stark contrast in rhetoric is seen in the proposals that are raised in the report, where marketization is the key driver of systemic improvement in quality of care. The High quality care for all: NHS Next Stage Review final report shows the need for a more market-orientated strategy: a patient choice-led approach to hospital funding, the removal of barriers preventing the use of private health providers to carry out NHS work, and the devolution of management and budgetary control from Whitehall to local communities. It appears reform is circular and the report bears a resemblances to pre-1991 measures where received funding was based on local populations. While the Report is indicative of the need for a tripartite arrangement for achieving quality, with stakeholders as informants and agents for change, Bevan argues that the internal market model proposed, although attractive, relies on the assumptions that purchasers can be effective commissioners and that failing providers will be removed from the market. The centrepiece of the White Paper reforms and Operating Framework is the handing over of decisions on care, treatments and commissioning solely to GPs, ultimately creating a stable internal model where there will be a quality equilibrium. GPs will be burdened with the challenge of acting as a middleman between the patient and provider, ultimately as a gateway to funding and care. They with fundamentally be dismantling the current monopoly of care provision. Their decision making will be accountable to local communities and a board. This new buyer position is thought to remove duplication of population care commissioning and streaml ine decision making to where the Government foresees a natural place to put this responsibility. Propper et al, (2003) noted that in 1991, the Conservatives created a set of buyers, funded by central government, who were free to purchase health care for their populations from both public and private sector suppliers. Public sector suppliers were therefore not given direct funding, but were set to compete with each other, alongside a small private sector, for contracts from these public buyers. The autonomy of Foundation Trusts as buyers, in Bevans opinion, has led to a free market of care with little standardisation, with the private sector benefitting from the poor levels of governance most. Bevanss editorial suggests this may have benefit to the population because so much healthcare cost is driven by decisions that GPs make and should not be guided by ministerial change. Unviable providers will be pushed out of the market by new entrants, creating a self-regulated, internal market. The White Paper suggests there is evidence that health systems work better where budgets and spending power are moved as close to patients as possible. Providers will be paid according to their performance. Furthermore, that a bottleneck on the road to driving the quality agenda is linked to ministerial involvement in the day-to-day running of the NHS. This new public management gives GPs greater autonomy, placed them at arms length from the government, interlinks purchasing and providing functions, and increases competition with quality in mind. GPs will be responsible for all aspects of performance; acting as bureaucratic gatekeepers for all care needs their patients, and potential scapegoa ts for ministerial politicking. As it stands, effectiveness of this system is being hindered by hierarchical bureaucracy and political micromanagement on both a local and national level, including politically driven reforms with each new government. The report suggests the forced autonomy of GP Consortia, comparatively to Bevan whom notes the earned autonomy system, in which, the independent health care inspectorate awarded each NHS provider an annual star rating of zero to three stars. Providers that scored well on the star ratings gain small financial bonuses but win much greater operational freedom, and the ability to apply to become an independent not-for-profit NHS foundation trust status. Autonomy was the incentive as this gave managers more choice. At the other end of the spectrum, providers that score zero stars are placed on special measures, and if progress is not soon forthcoming, their management is replaced. Bevan suggests that measures of Provider performance (cost, equity of access, outcomes, patient satisfaction etc.) have proved difficult to progress forward and that only patients acting as consumers has left a marked change on the system. I think it is questionable whether in the short term, GP buying powers wi ll drive quality in a market in which there are few providers. The 2008 DH report takes note of such and relays the importance of an individualised service in which patient information to inform choice will breed quality. Patient choice and measures of satisfaction will simultaneously puts more pressure on providers to increase performance of measured care outcomes, which in turn become incentivised by cash rewards. They foresee GP consortia, evaluating Services considered to be sub-standard and withdrawing them from service if patient satisfaction and quality care outcomes are not met. Propper, C., Burgess, S., and Gossage, D. (2003).Competition and quality: Evidence from the NHS internal market 1991-1999. Unpublished paper, University of Bristol. 3. As one of the accompanying papers to the White Paper Liberating the NHS, the DH has recently published Transparency in outcomes a framework for the NHS.http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_117583 Please summarise the main approaches to improving quality proposed by this consultation. The NHS Operating Frame is an accountability framework which should, if followed, ensure that the NHS Commissioning Board works to deliver better healthcare outcomes. This will be through measures that are valid, reliable and sensitive to change, notably evidence-based outcome measures, not process targets. The outcomes and incentives emerging from the frameworks will be organised around 5 national outcome goals /domains that cover all treatment activity for which the NHS is responsible. Outcomes appear to be related to feasibility, cost of improvements and pre-existing data sets. Quality of care as advocated by Lord Darzi in realised in three of the domains; patient experience, safety and effectiveness. The domains fail to include outcomes of access/equity, expediency in service or efficiency, which seems to underlie previous national reforms imposed by the Labour Government in 1997. The Operating Framework fails to identify purposeful ways of addressing deficiencies and poor outcom e performance. Incentives and regulation are suggested but may not be drivers. Each of these five areas will have: outcome indicators improvement areas according to evidence (collected data, patient surveying of experience, etc) Quality standards, developed by NICE, will inform the commissioning of all NHS care and payment systems. Measuring and reporting on outcomes will focus the attention of clinicians and managers on how well they are doing, where the gaps might be between actual performance and the high aspirations of those who use the NHS. I dont believe all the outcomes are necessarily reliable measures of quality. In Domain 2, for example, there is a focus on functional outcomes and qualities of life for long term illness, which may lead to patients to receive care they do not want. A great deal of the outcomes will be developed through incrementalism, for example those related to compassion, dignity and respect as indicators of the quality of care. The measured outcomes should represent the overall quality of healthcare provided by the NHS, as well as being responsive to population need and demand. The outcomes should also be attributable directly to the actions of health care provided within the NHS, to enable accountability. Best practice should be identified and used as a basis for ensuring that the framework itself does not propagate practice that in itself leads, however indirectly, to inequalities. Key to the five high level outcome/domains is the need for a whole system approach in aspiring for complete transparency, effectiveness and patients exercising appropriate choices, alongside a need to balance local priorities. Seven principles underpin the framework which are intended to improve the quality of health care, these are: Balanced between need and demand Accountability and transparency Internationally comparability Patient and clinician centred environments and service delivery. Excellence and equality promotion Adaptability and focus on outcomes that can be forged in partnership with other public services. International comparability The Health Secretary will be able to hold the new independent NHS Commissioning Board to account for securing improved health outcomes, and measuring the outcomes that are most important to patients and healthcare professionals. These will be backed up by authoritative, evidence-based quality standards that will ensure everyone understands how those outcomes can be achieved Based on past experience, what do you think are the likelihoods of success of this latest initiative? Please ensure that you consider these in the context of the likely challenges for the NHS over the next few years. (Please cite references if referring to evidence of the impact of previous initiatives). The attention of policymakers is always firmly fixed on the future and rarely on documented measures of progress to assess the impact of one set of reforms, before the next wave of organizational change. Political values dominate empirical evidence for reform. With such levels of political uncertainty, it is hard to evaluate if in five years time, a general election will lead to a change in leadership and new Health Minister. With this in mind, change often does not necessarily make best use of available resources, skills and knowledge. The direct influence of research evidence on decision making is often tempered by factors such as financial constraints, shifting timescales and decision makers own experiential knowledge (Elliott 1999). With devolvement of power to local government, there is need for a precise balance to be struck between strategies based on choice and competition on the one hand, and local voice and democratization on the other. On its own, I dont think the NHS reforms will create a patient-led system. It is the people, the leaders and staff of the NHS, who will make or break the change process. Central to this, is the way in which the White Paper reforms will radically change the way in with GPs work collaboratively with providers to better the health and social care of the population they serve. Reorganisation will ultimately mean GPs will have to create new organisations and learn new skills. This will take behavioural change that is likely to be unwelcomed, as theres a shift towards increased paperwork and decreased patient time. GPs have shown considerable levels of apathy towards working reforms and changes in service delivery in the past, including contracted hours. For example, previously published opinion has indicated that the medical profession were predominantly opposed to the package of NHS reforms outlined in the Working for Patients and were especially opposed to the administration of hospital s by self-governing trusts (Lister, 1990). GP consortia will be exactly that, self-operating. As the Operating Framework enters its live consultation it will be important to gather evidence as to strength of feeling with which those opinions, either for or against various aspects of the NHS reforms are held. Reform is costly, since managers and other NHS professionals invest a huge amount of time and effort with each re-organization. The NHS faces the need to make cost savings of  £15-20 billion over the next four years. It is faced with the challenge to create better health outcomes with less resources. Moving to the new system, maintaining control of day-to-day services, and implementing these savings is going to require skilled management. This at time when the NHS is shedding much of its management workforce and when managers have been under political attack. Introduced in 2004 as part of the General Medical Services Contract, the QOF is a voluntary incentive scheme for GP practices in the UK, rewarding them for how well they care for patients. the higher the score, the higher the financial reward for the practice. The very suggestion that this was voluntary implies that not everyone welcomed such change. The introduction of a free market, in which providers can tender for supplying a service as opposed to an internal market, could serve to drive efficiency savings and quality of care. However, accountability and patient choice would require considerably management and information sharing across GP consortia. Department of Health. Payment by Results. London: DoH, 2002. 5. One of the differences in the current UK coalition governments approach to improving quality, compared to previous governments, is in the use of targets. Targets are defined by the DH (DH 2004) as: Targets refer to a defined level of performance that is being aimed for, often with a numerical and time dimension. The purpose of a target is to incentivise improvement in the specific area covered by the target over a particular timeframe. List the possible benefits of using targets to improve health/health services and then list the potential disadvantages of using targets. Use examples (either from your experience or from what youve heard on the media) to illustrate your points. On balance, are you for or against publication? The benefits of health/ health services targets include: Supports priority setting Promotes consistency Improves commitment and fosters accountability Guides allocation of resources Milestones for incremental improvements The disadvantages of health/ health services targets include: Priorities may be misdirected and are often politically engineered Not always evidence based Hard to measure/quantify Not always related to health care outcomes Often cost related, not need related. Clouded by bureaucracy Often incentive driven ie pay to treat. One such health target in the Labour Governments Health Policy, the four-hour target, imposed in Accident and Emergency Departments has received mixed reviews. It was just one of a range of centrally imposed standards, most of them designed to speed up treatment. With such a target, volume of patients being treated and the expediency of their treatment is implied to be of greater importance that the quality of care or health outcomes of patients. The Guardian, (2010) reports In opposition Lansley had been critical of the way that targets distorted the behaviour of doctors, saying in the case of AE that people should be treated in relation to the severity of their injury not an arbitrary time limit. 6. The current government is strengthening the role of the regulator. Please summarise the role of the Care Quality Commission (CQC). What challenges do you think the CQC will face over the next few years? In April 2009, as the result of passing of the Health and Social Care Act 2008 (2008 Act), the outcome-based regulator, Care Quality Commission (CQC) was officially established. Their primary role is to act as an independent regulator of the quality and capacity of health and adult social care. They are responsible for registering, reviewing and inspecting health, adult social care and mental health services to judge the clinical quality of healthcare. Regulation directly relates to the quality of care experienced by people, so called end users, who use the services and align to the Coalitions vision of a user-centred, integrated service with a strong focus on quality (CDC, 2010). Indeed, when services fail to meet the health and safety legal requirements of their compulsory registration, action against them is taken through strict enforcement powers. In the next few years, as we transition from one governance model to the next, exchanging power to a local level, improvements must be closely aligned to quality and substantial, evidence-based research. Research grants are being cut and it is likely public sector research, including health research, will suffer as result of such austerity. The CDCs broad remit to oversee NHS organisations is not limited to particular service areas or functions, like that of many of the existing regulators. They may find themselves over extending and unable to fully engage with the public in a transparent and meaningful way. As quality of care is embedded to offer assurance and to deliver improvements over time, there is potential for major disruption to be caused by the scale of the change management discussed within the White Paper. The CQCs model of regulation puts user involvement and community level accountability at the core of their actions. Though this is consistent with the changes implied within both the White Paper and Operational Framework, there is still considerable ambiguity surrounded where responsibility will lie across all regulated services, especially with the introduction of GP consortia. Until this is resolved and clarity found, ambiguity will only be escalated by poor engagement of stakeholders and insufficient information dissemination through the crucial transitional points. As patterns of service provision change, consistently identifying providers and commissioners, and then allowing for local communities to hold them to account for the services they provide may prove difficult. Once established within a professional capacity, the CDC will need to be aware of the information on outcomes and how it should be presented in a format that is accessible and meaningful to influence patient choice. Furthermore, in their role as an advocate of patients, as a consumer champion, the CDC will also be required to ensure that people who use services understand the care choices available to them and are involved in making decisions about their own care and support. The CDC (2010) note that Patient and public involvement in health organisation will be strengthened by the creation of HealthWatch England a new independent consumer champion within the Care Quality Commission. As a so called consumer champion, this suggests end user expectations may be heightened. Questions must be asked of how HealthWatch England shall be regulated.

Change Essay -- essays research papers

Change is something that is constantly occurring in our lives. Not a single moment goes by when everything in our lives will remain consistent. Indeed, it has become apparent to us that the only thing which in fact survives change, is change itself. Time and experience allows change to eventually reform and alter everything from the way it originally was. From ourselves physically, to those around us emotionally, to the way in which we perceive the entirety of the world everything it eventually changes. Most of the time we are not even explicitly aware of such changes occurring, but none-the-less they are indeed occurring. Change is a natural process that cannot be easily stopped or controlled. When we think of the things we valued at the age of, five, ten and even fifteen, the constant abundance of change in our lives become apparent. However, it is due to the unpredictability that change promotes in our life, that has made many perceive the ideology of change to be something which should be viewed as a negative in our lives today. However, we should passionately revolt against this notion. It is change which has bought about some of the greatest events in history. Had their not have been change in our past, there would never have been an industrial revolution and we would not be able to live in the liberalist country in which we do today, where we can voice our opinions without being under threat of persecution. This embracement of change which we sh... Change Essay -- essays research papers Change is something that is constantly occurring in our lives. Not a single moment goes by when everything in our lives will remain consistent. Indeed, it has become apparent to us that the only thing which in fact survives change, is change itself. Time and experience allows change to eventually reform and alter everything from the way it originally was. From ourselves physically, to those around us emotionally, to the way in which we perceive the entirety of the world everything it eventually changes. Most of the time we are not even explicitly aware of such changes occurring, but none-the-less they are indeed occurring. Change is a natural process that cannot be easily stopped or controlled. When we think of the things we valued at the age of, five, ten and even fifteen, the constant abundance of change in our lives become apparent. However, it is due to the unpredictability that change promotes in our life, that has made many perceive the ideology of change to be something which should be viewed as a negative in our lives today. However, we should passionately revolt against this notion. It is change which has bought about some of the greatest events in history. Had their not have been change in our past, there would never have been an industrial revolution and we would not be able to live in the liberalist country in which we do today, where we can voice our opinions without being under threat of persecution. This embracement of change which we sh...

Little Jake :: essays paper

Little Jake It all started when little Jake was one month old. He quickly learned that boisterous wails would cause his grandmother, Betsy, to rush to his crib. He was well on his way to becoming a little dictator. Betsy, being a kind-hearted and compassionate woman, felt sorry for the boy because he had no father or mother to speak of. Betsy would perform on command every time the child uttered a whimper. Her doctor suggested that she let the boy cry. He further explained that, in time, the child would get the hint that no one would be coming at his every whim. Jake's rein of terror would have ended if his grandmother had taken her doctor's advice, but she ignored the suggestion. The effect was predictable: soon, Betsy was suffering from exhaustion. Is it any surprise that, by the time Jake reached his first birthday, his first word was "no"? "Jake, please don't throw your toys," his grandmother would plead sweetly. "No!" was Jake's reply as he hurled a hard plastic ball at Granny. "Eat your cereal," his Granny would say. With a sweep of his little hand, Jake knocked the cereal bowl to the floor while he bellowed another "No!". "All right, Jake," Granny replied, "If you don't like the cereal, I'll fix you something else." Filled with hope, she mistakenly thought the boy would outgrow this behavior. By the time he was five years old, Jake did not hesitate to throw very public tantrums. He once sprawled out on the department store floor, kicking and screaming because he had been denied a toy he wanted. Embarrassed by his behavior, Betsy quickly placed the toy in the shopping cart and proceeded through the checkout line. When they arrived at home, Betsy informed Jake that his behavior had been inappropriate. "We don't act like that in public," she explained. I am certain that the boy was thinking, "Why not? It works." When Jake was ten, Granny warned him that if he did not do his homework he would not be allowed to go camping with his friends the following month. Jake promised to do his homework, but a phone call from the school confirmed that he had not turned in a single homework assignment during the

Renaissance :: European Europe History

Renaissance The Renaissance has been described as consisting of "a rebirth of the human spirit, a realization of the human potential for development." This quote, as well as the word, "Renaissance" imply a massive change in society and tradition. Contributing to this change was 17th century poet, John Donne. His style, combined with intellectual thoughts and ideas, set the foundation for what would become known as metaphysical poetry. Donne's style of writing was not only a significant factor in the Renaissance, but also the transition into "The Age of Reason". In Sonnet 10, from Holy Sonnets, he is able to contribute to the Renaissance ideal described in the preceding quote. "A rebirth of the human spirit...," describes a change in emotion that stems from a religious belief. Before the Renaissance, life and death were thought to be predetermined. Towards the end of the Renaissance, poets began to question parts of this belief, and as a result, the value of life came into question. In Sonnet 10, John Donne questions how powerful death is. He first challenges "Death" as he says "Death, be not proud, though some have called/thee/Mighty and dreadful, for thou art not so;" in lines one and two. Yet, in lines seven and eight, Donne declares the power of "Death" by saying "And soonest our best men with thee do go, /Rest of their bones, and soul's delivery." These two quotes contradict each other, however, the question is clear: What is the power of death? Donne answers this question in the last line: "And death shall be no more; Death, thou shalt die." However, the reader at that time had his/her own answer to find. Donne had introduced a new thought. He spoke of "death" as a noun, yet spoke to "Death" as a being, without relating it to God. To dissociate God and Death, and then treat Death as an entity was indeed a new idea. "A rebirth of the human spirit" may have been the realization of the value of life, as a result of the questioning of the set belief. "...A realization of the human potential for development," is an accurate description of the Renaissance. People were beginning to accept change in social institutions as well as in many traditional beliefs. Poets, such as John Donne, were questioning ideas that seemed to be set in stone. They were also changing the structure and style of poetry.

Evidence Based Practice In Nursing

INTRODUCTIONResearch studies are conducting all over the world, throughout the year . Research is conducted to improve the existing practices. If the study findings are implemented to practice only , the study is effective. Evidences getting from the study which are utilized into practice makes the profession more fruitful, bright and effective. Most nurse researchers want their findings to contribute to nursing practice and there is growing interest among nurses in basing their practice on solid research evidence RESEARCH UTILIZATION IN NURSING The terms research utilization and evidence based practice are used synonymously.Although there is overlap between these two concepts they are in fact distinct. Research Utilization is: â€Å"A process of using findings from conducting research to guide practice† (Titler, Mentes, Rake, Abbott, and Baumler, 1999). â€Å"The process by which scientifically produced knowledge is transferred to practice† (Brown, 1999) DIFFERENCES: N urses should not confuse EBP [Evidence Based Practice] with research utilization. While research utilization overlaps with some of the same philosophic threadworks of EBP, EBP goes beyond just the rigorous scientific research steps.Research Utilization refers to the review and critique of scientific research, and then the application of the findings to clinical practice. Evidence-Based Practice (EBP) represents a broader concept. When clinicians use the EBP approach, they go beyond the expertise of clinicians and researchers, and consider the patient's preferences and values to guide patient care. THE RESEARCH UTILIZATION CONTINUM The start point of research utilization is the emergence of new knowledge and new ideas. Research is conducted and over time knowledge on new topic accumulates.In turn knowledge works its way to use to varying degrees and different rates. Theorists who have studied the phenomenon of knowledge development and diffusion of ideas typically recognize a continu um in terms of the specificity of the use to which research findings are put At one end of the continuum are discrete , clearly identifiable attempts to base specific actions on research findings. . This type of utilization has been referred to as instrumental utilization. Research findings can be used in a more diffuse manner. In a way that promote cumulative awareness, understanding or enlightment.Caplan and Rich [1975] refer to this as the end of the utilization continuum as conceptual utilization. Conceptual utilization then refers to situations in which users are influvanced in their thinking about an issue based on their knowledge of studies but do not put this knowledge to any specific , documentable use. The middle ground of this continuum involves the partial impact of research findings on nursing activities. This middle ground is the result of a slow evolutionary process that does not reflect a conscious decision to use an innovative procedure but rather reflects what Weis s termed knowledge creep and decision accretion.‘ knowledge creep’ refers to an evolving percolation of research ideas and findings. ‘Decision accretion’ refers to the manner in which momentum for a decision builds over time based on accumulated information gained through informal discussions , readings , meetings and so on. Increasingly now a days nurses are making conscious decisions to use research in their clinical practice and the EBP movement has contributed to this change. Estrabooks [1999] studied research utilization and found evidence to support three distinct types of research utilization.Indirect research utilization: involving changes in nurses’ thinking and therefore analogous to conceptual utilization. Direct research utilization: involving the direct use of findings in giving patient care and therefore analogous to instrumental utilization. Persuasive utilization: involving the utilization of of findings to persuade [typically those i n decision making positions] to make changes in policies or practices relevant to nursing care.These varying ways of thinking about research utilization clearly suggest that both quantitative and qualitative research can play key roles in guiding and improving nursing practice The research utilization process; Rogers’ diffusion of innovation theory Rogers’ theory is one of the most accepted theories that has developed models of how knowledge gets disseminated and used. It has influvanced several research utilization projects in the nursing community. Rogers postulate that knowledge diffusion is an evolutionary process by which an innovation is communicated over time to members of a social system.The key elements in this process, all of which influence the rate and extent of innovation, adoption include the following, 1. The innovation is a new idea, practice or procedure that if adopted will result in changes the nature of innovation strongly affects the decision about adoption. 2. Communication channels are the media through which information about the innovation is transmitted and can include both mass media or individual face to face communication. Communication is most effective when there are shared believes , values and expectations on the part of the sender and receiver of information.3.  Time is component of theory in that the process of knowledge diffusion occurs over time. There are varying amounts of time that elapse between the creation of knowledge and its dissemination and between knowledge awareness and the decision to use or reject the innovation 4. The social system is the set of interrelated units that solve the problems and seek to accomplish a common goal. Diffusion occurs within the social system that vary in their norms and receptivity to innovations Rogers Characterized the innovation adoption process as having five stages knowledge, persuasion, decision, implementation and confirmation.During the knowledge stage individu als or groups become aware of the innovation and during the persuasion stage they form appositive attitude towards it. In the decision stage , a choice is made about whether to adopt or reject the innovation. The innovation is actually put into use during the implementation stage. Finally the effectiveness of the innovation is evaluated during the confirmation stage, and decisions get made about continuation or discontinuation of the innovation. Recent research on utilization has challenged the linear nature of the process Evidence-based practice.During the 1980s, the term â€Å"evidence-based medicine† emerged to describe the approach that uses scientific evidence to determine the best practice. Later, the term shifted to become â€Å"evidence-based practice† as clinicians other than physicians recognized the importance of scientific evidence in clinical decision-making. Various definitions of evidence-based practice (EBP) have emerged in the literature, but the most commonly used definition is, â€Å"the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients† (Sackett, Rosenberg, Gray, Hayes, & Richardson, 1996).Subsequently, experts began to talk about evidence-based healthcare as a process by which research evidence is used in making decisions about a specific population or group of patients. Evidence-based practice and evidence-based healthcare assume that evidence is used in the context of a particular patient’s preferences and desires, the clinical situation, and the expertise of the clinician. They also expect that healthcare professionals can read, critique, and synthesize research findings and interpret existing evidence-based clinical practice guidelines.Definitions of research utilization, quality improvement, and nursing research Evidence-based practice is not research utilization, quality improvement, or nursing research, although it may be rela ted to each of these processes. For example, quality improvement projects may be evidence-based, and the findings may contribute to other EBP or research initiatives. Also, an evidence-based practice project can lead to a research study or quality improvement initiative. What is research utilization? For decades, nurses have used available research to guide nursing practice and their efforts to improve patient outcomes.This process involved critical analysis and evaluation of research findings and then determining how they fit into clinical practice. Incorporating pertinent research findings into clinical practice (and evaluating the changes’ effectiveness), helps close the gap between research and practice. More recently, research utilization efforts in nursing have been replaced by evidence-based practice, What is quality or performance improvement? Quality, clinical, or performance improvement focuses on systems, processes, and functional, clinical, satisfaction, and cost outcomes.Typically, quality improvement efforts are not designed to develop nursing practice standards or nursing science, but they may contribute to understanding best practices or the processes of care in which nurses are actively involved. A commonly accepted view is that quality improvement activities in healthcare are not intended to generate scientific knowledge but rather to serve as management tools to improve the processes and outcomes within a specific healthcare organization or setting.More recently, experts have focused on improving care by examining and working within clinical Microsystems or the specific places where patients, families, and care teams meet (Nelson, et al. , 2002). To improve and maintain quality, safety, and efficiency, clinical teams must blend analysis, change, and measurement into their efforts to redesign care within these clinical Microsystems. Quality improvement initiatives generally address clinical problems or issues, examine clinical processe s, and use specific indicators to help evaluate clinical performance.Data are collected and analyzed to help understand both the process and the related outcomes. The findings help contribute to efforts to achieve and maintain continuous improvement through ongoing monitoring and improvement activities. Quality improvement projects vs. research projects Many have asked whether quality improvement projects are the same as research projects—they are not. In clinical practice, these efforts may seem similar in that, for example, both may seek answers to clinical problems and use similar data collection and analysis methods.However, factors that may differ include participant or subject recruitment, the study’s methods, and how the results are used. For example, in most quality improvement activities, the participants generally are the patients within a specific clinical micro system. In research efforts, the investigator recruits human subjects using approaches that will ensure a representative sample of the population. In many improvement activities, the intervention may change as it is evaluated, whereas in a research study the treatment or intervention remains the same.Furthermore, in most quality improvement initiatives, the healthcare team is trying to solve a problem in a particular setting instead of trying to generalize the results of the study to other settings and populations. Although it might be helpful to learn about the activities and experience of other improvement teams, their findings may not apply to or be appropriate in other settings or patient populations. The intent of research, however, is to develop new knowledge that can be generalized to other similar populations and clinical settings.Despite the differences between research and quality improvement projects, however, one must consider the protection of human subjects in both. To ensure that you adequately protect the rights of patients or subjects, always ask an Institution al Review Board (IRB) to review the research proposal or quality improvement project before implementing the study and beginning data collection. Also note that, whether the effort is research or quality improvement, one goal may be to disseminate the results of the project in a published paper or oral report.For any dissemination project, address adequate human subject protection and adherence with the Health Information Portability and Accountability Act of 1996 (HIPAA) guidelines before beginning the improvement project or research study. Individuals involved in either quality improvement or research projects should seek advice from their organization’s IRB, privacy officer, and risk management department to ensure that data are managed in a manner consistent with any pertinent federal or state regulations and organizational policies and procedures..Multidisciplinary effort Within clinical settings, many such opportunities exist for both nursing and multidisciplinary impro vement efforts. Improvement activities for nursing can be as simple as reducing time in giving verbal report or improving compliance with documentation requirements. Multidisciplinary collaborative efforts may address complex health issues, such as the care of acute myocardial infarction patients or individuals with community-acquired pneumonia.These initiatives are becoming more important in acute care hospitals as the national focus on public reporting increases. Such efforts help consumers compare the quality of care that various hospitals provide. The Centers for Medicare & Medicaid Services (CMS); various organizations that represent hospitals, doctors, and employers; accrediting organizations; other federal agencies; and the public have combined efforts to develop Hospital Compare and, thus, have made key clinical outcome measures available to the public.In this way, the public can monitor performance indicators to related common medical conditions and certain evidence-based i nterventions that are consistent with achieving the best patient outcomes. Collaboration within multidisciplinary teams creates opportunities to address clinical problems and issues using various perspectives and expertise. Nurses play key roles in such efforts and often benefit from the synergy that can be realized by working with others interested in or concerned about the problem.The group can work together while measuring their progress against pre-determined objectives What is nursing research? Nursing research involves systematic inquiry specifically designed to develop, refine, and extend nursing knowledge. As part of a clinical and professional discipline, nurses have a unique body of knowledge that addresses nursing practice, administration, and education. Nurse researchers examine problems of specific concern to nurses and the patients, families, and communities they serve. Nursing research methods may be quantitative, qualitative, or mixed (i.e. , triangulated):†¢ In quantitative studies, researchers use objective, quantifiable data (such as blood pressure or pulse rate) or use a survey instrument to measure knowledge, attitudes, beliefs, or experiences †¢ Qualitative researchers use methods such as interviews or narrative analyses to help understand a particular phenomenon †¢ Triangulated approaches use both quantitative and qualitative methods Regardless of the method they use, researchers must adhere to certain approaches to ensure both the quality and the accuracy of the data and related analyses.The intent of each approach is to answer questions and develop knowledge using the scientific method. Examples of nursing research projects Examples of nursing research projects include the following: †¢ Randomized clinical trial examining best practice for orthopedic-pin site care †¢ Efficacy of examination gloves for simple dressing changes †¢ Reliability of methods used to determine nasogastric tube placement †¢ The effects of relaxation and guided imagery on preoperative anxiety †¢ Quality of life in patients with chronic pain†¢ The relationship of a preoperative teaching program for joint replacement surgery and patient outcomes The scientific method involves collecting observable, measurable, and verifiable data in a prescribed manner so as to describe, explain, or predict outcomes. For example, one might collect data to describe the effects of massage on blood pressure, explain decreased needs for sedation, or predict lower levels of anxiety. Research methods demand that the collected data remain objective and not be influenced by the researcher’s hypotheses, beliefs, or values.In the massage example, the researcher could easily bias the results by administering the massages or collecting the data. Using certain approaches to subject recruitment, performing faulty data collection, and not controlling for other confounding variables also can bias research findings. Therefor e, when developing a study proposal, the researcher must develop a plan that minimizes these risks and supports the development of reliable information and results. EVIDENCE BASED PRACTICE EBP begins with search for information about how best to solve the specific problems.Findings from rigorous research are considered the best possible source of information but EBP also draws on other sources. A basic feature of EBP is that it deemphasizes decision making based on custom, opinion of the authority, or ritual. Rather the emphasis is on identifying the best available research evidence and integrating it with clinical expertise, patient input and existing resources. EBP movement has both supporters and critics. Supporters say that EBP offers a solution to sustaining high health care quality or in our cost constrained environment.Their position is that a rational approach is needed for providing best possible care to most people, with most cost effective use of resources. Critics worry that the advantages of EBP are exaggerated and that individual clinical judgments and patient inputs are being devalued. TYPE OF EVIDENCE AND EVIDENCE HIERARCHIES Positions about what constitutes useful evidence have loosened, but there have been efforts to develop evidence hierarchies that rank studies according to the strength of evidence they provide.The most accepted hierarchy is given below 1. Meta analysis of controlled studies 2. Individual experimental studies 3. Quasi experimental studies [eg; time series, non equalant control group] or matched case control studies 4. Non experimental studies [eg; co relational studies , descriptive and qualitative studies] 5. Programme evaluations, research utilization studies, quality improvement projects, case reports 6. Opinions of respected authorities and expert committeesThe nine alternative sources include Bench marking data, Cost effectiveness analysis, Pathophysiologic data, Retrospective or concurrent chart review, Quality improv ement and risk data, international, national , and local standards, institutional data collected for infection control purposes, patient preferences and clinical expertise EBP implications for nurses Nurses serve instrumental roles in ensuring and providing evidence-based practice. They must continually ask the questions, â€Å"What is the evidence for this intervention? † or â€Å"How do we provide best practice?† and â€Å"Are these the highest achievable outcomes for the patient, family, and nurse? †Nurses are also well positioned to work with other members of the healthcare team to identify clinical problems and use existing evidence to improve practice. Numerous opportunities exist for nurses to question current nursing practices and use evidence to make care more effective. Nurses throughout the country also have been involved in multidisciplinary efforts to reduce the number and severity of falls and pressure ulcers/injuries. Such projects can help save m oney and improve care processes and outcomes.By implementing existing evidence-based guidelines related to falls and pressure ulcers/injuries, care has improved, and the number and severity of negative outcomes have decreased. Importance of evidence-based practice Evidence-based practice helps nurses provide high-quality patient care based on research and knowledge rather than because â€Å"this is the way we have always done it,† or based on traditions, myths, hunches, advice of colleagues, or outdated textbooks. Why is EBP important to nursing practice? †¢ It results in better patient outcomes †¢ It contributes to the science of nursing †¢ It keeps practice current and relevant†¢ It increases confidence in decision-making †¢ Policies and procedures are current and include the latest research †¢ Integration of EBP into nursing practice is essential for high-quality patient care often, nurses feel that they are using â€Å"evidence† to gui de practice, but their sources of evidence are not research-based In a study conducted by Thompson, et al. , (2003), nurses reported that the most helpful knowledge source was experience or advice from colleagues or patients. Of concern were reports that up-to-date electronic resources that included evidence-based materials were not useful to nurses in clinical practice.This barrier contributes to significant gaps in clinicians applying research findings to practice and dissemination of innovations. The failure to use evidence results in care that is of lower quality, less effective, and more expensive (Berwick, 2003). Evidence-based practice can be easier for nurses to use if they refer to already-developed evidence based or clinical practice guidelines. Numerous expert groups have already undertaken systematic efforts to develop guidelines to help both healthcare providers and patients make informed decisions about care interventions.Guideline developers use a systematic approach to critique the existing research, rate the strength of the evidence, and establish practice guidelines. The overall goal of these types of efforts focuses on guiding practice and minimizing the variability in care MODELS FOR EVIDENCE BASED NURSING PRACTICE During the 1980,s and 1990’s a number of different models of research utilization were developed. These models offered guidelines for designing and implementing a utilization project in a practice setting. The most prominent of these models were the Stetler model and The Iowa model.These two models were updated to incorporate the EBP process rather than research utilistion alone. THE STETLER MODEL The Stetler model of research utilization was designed with the assumption that research utilization could be undertaken not only by organizations , but by individual clinicians and managers. It was a model designed to promote and facilitate critical thinking about the application of research findings in practice. The updated and refined model is based on many of the same assumptions and strategies as the original but provides an enhanced approach to the overall application of research in the service setting.The current model involves five sequential phases 1. Preparation ;- in this phase the nurse defines the underlying process, purpose and outcome of the project ; search, sort, and select sources of research evidence; consider the external factors that can influence potential application and internal factors that can diminish the objectivity and affirm the priority of the perceived problem. 2. Validation ;- This phase involves a utilization focused critique of each source of evidence focusing in particular on whether it is sufficiently sound for potential application in practice.The process stops at this point if the evidence sources are rejected. 3. Comprehensive evaluation and decision making ;- this phase involves the synthesis of findings and the application of four criteria that , taken together are used to determine the desirability and feasibility of applying findings from validated sources to nursing practice. These criteria include Fit for setting:- Similarity of characteristics of samples to your client population. Similarity of study’s environment to the one which you work FeasibilityPotential risk for implementation to patients, staff and organization Readiness for change among those who would be involved in a change in practice Resources requirements and availability Current practice Congruency of the study with theoretical basis for current practice behaviour Substantiating evidence Availability of confirming evidences from other studies Availability of confirming evidences from Meta analysis or integrative review The end result of comprehensive evaluation is to make a decision about using the study findings. If the decision is a rejection, no further steps are necessary4.  Translation/ Application;- this phase involves activities to Confirm how the findings w ill be used formally or informally Spell out the operational details of application and implement them. It involves the development of a guideline, detailed procedure, or plan of action, possibly including plans for formal organizational charge. 5. Evaluation:- in this final phase the application is evaluated. Informal use of the innovation versus formal use would lead to different evaluative strategies.Although the Stetler Model originally was designed as a tool for individual practitioners, it has also been the basis for  formal research utilization and EBP projects by group nurses. THE IOWA MODEL Efforts to use research evidence to improve nursing practice are often addressed by groups of nurses interested in the same practice issue. Formal EBP projects typically have followed systematic procedures using one of several models that have been followed systematic procedures using one of the several models that have been developed, such as The Iowa Model of the research in practice . The model was renamed as Iowa Model of Evidence Based Practice to Promote Quality Care.The current version of the Iowa Model acknowledges that a formal EBP project begins with a trigger- an impetus to explore possible changes to practice. The start point can be either a knowledge focused trigger that that emerges from awareness of innovative research findings and thus follows a more traditional research utilization path, or a problem focused trigger that has its roots in a clinical or organizational problem and thus follows a path that more closely resembles ad EBP path. The model outlines a series of activities with three critical decision points. 1.Deciding whether the problem is a sufficient priority for the organization exploring the possible changes; if yes a team is formed to proceed with the project ; if no a new trigger will be sought. 2. Deciding whether there is a sufficient research base ; if yes , the innovation is piloted in the practice setting; if no , the team woul d either search for other sources of evidence or conduct its own research. 3. Deciding whether the change is appropriate for adoption in practice ; if yes a change would be instituted and monitored; if no the team would continue to evaluate quality of care and search for new knowledge.The 5 steps of EBN 1. SELECT A TOPIC OR PROBLEM The first step is to select a topic. Ideas come from different sources but are categorized in two areas: Problem-focused triggers and Knowledge focused triggers. When selecting a topic, nurses should formulate questions that are likely to gain support from people within the organization. An interdisciplinary medical team should work together to come up with an agreement about the topic selection. The priority of the topic should be considered as well as the severity of the problem.Nurses should consider whether the topic would apply to many or few clinical areas. Also, the availability of solid evidence should be considered because providing proof of the research will increase staffs' willingness to implement into nursing practice. Problem & Knowledge Focused Triggers Problem focused triggers are identified by health care staff through quality improvement, risk surveillance, benchmarking data, financial data, or recurrent clinical problems. Problem focused triggers could be clinical problems, or risk management issues.Knowledge focused triggers are created when health care staff read research, listen to research conferences or encounter EBP guidelines published by federal agencies or organizations. Knowledge based triggers could be new research findings that further enhance nursing, or new practice guidelines. It is important that individuals work closely together to reach the optimum outcome for the chosen topic. Some things that would ensure collaboration are working in groups to review performance improvement data, brainstorming about ideas, and achieving consensus about the final selection.With both types of triggers, it is impo rtant to ensure that there is a general consensus about the importance of the problem and the need for improving practice. The method of selecting a topic does not appear to have any bearing on the success of an EBP project. What is important however is that the nursing staff who will implement an innovation are involved in topic selection and that key stake holders are â€Å"on board. † 2 . FORM A TEAM TO ASSEMBLE AND EVALUATE EVIDENCE Some might become overwhelmed when they first learn about EBP and apply it for reasons other than improvement of patient care.Forming a team increases the chance of EBP being adopted. A team becomes paramount in implementation, and evaluation of the EBP. It is important to have representatives of the team from authority members of the organization and also grassroots members. It is also important to consider interdisciplinary involvement to decrease rejection, and for all to have an understanding of the project. All these individuals have a gr eat impact on the possibility of successful implementation.Other factors to put into consideration include power figures in the organization that may directly or indirectly sabotage the efforts if they are not consulted, and fully included in EBP implementation. The EBP team should have explanations that clearly define the types of patients, setting, outcomes, interventions and exposures. This should be in simplified language that is comprehensible to a lay person. The role of the practitioners is remarkable in any meaningful gains, they are therefore inevitable and their role becomes pivotal.The approach they adopt and their ability to educate the co-workers, answer their questions, and clarify any misconceptions greatly improves the outcomes. In doing a literature reviews background for a new study, a central goal is to discover where the gaps are and how best to advance knowledge. For EBP projects which typically have as end products, prescriptive practice protocols or guidelines , literature reviews are typically much more formalized. The emphasis is on amassing comprehensive information on the topic, weighing pieces of evidence and integrating information to draw conclusions about the state of knowledge.Commentators have noted that integrative reviews have become the cornerstone of EBP. If an integrative view already exists it is wise to make sure that it is as up-to-date as possible and that new findings published after the review are taken into account. Moreover, even a published integrative review needs to be critiqued and the validity of its conclusions assessed 3. ASSESSING THE IMPLEMENTATION POTENTIAL One of the most challenging issues in using EBP in the clinical setting is learning how to adequately frame a clinical question so that an appropriate literature review can be performed.When forming a clinical question the following should be included: the disorder or disease of the patient, the intervention or finding being reviewed, possibly a compari son intervention, and the outcome An acronym used to remember this is called the â€Å"PICO† model: P = who is the Patient Population? I = what is the potential Intervention or area of Interest? C = is there a Comparison intervention or Control group? O = what is the desired Outcome? Once the topic is selected, the research relevant to the topic must be reviewed, in addition to other relevant literature.It is important that clinical studies, (including meta-analyses, metasyntheses and meta-aggregation) and well-known and reliable existing EBP guidelines are accessed in the literature retrieval process. With the internet at one’s fingertips, a plethora of research is just a few clicks away. However, just because you found it in a respectable journal does not signify high quality research. When reviewing any article for evidence retrieval read it very closely. Articles can appear to be precise and factual on the surface but with further and much closer examination, flaws can be found.The article can be loaded with opinionated and/or biased statements that would clearly taint the findings, thus lowering the creditability and quality of the article. Use of rating systems to determine the quality of the research is crucial to the development of EBP. There are several rating systems available online. Time management is crucial to information retrieval. Nurses making their way through the vast amount of research available may find it helpful to read research articles or critical reviews instead of clinical journals.To maintain high standards for EBP implementation, education in research review is necessary to distinguish good research from poorly conducted research. Equally important is that the materials being reviewed, consider if they are current. To assess the implementation potential of an innovation in a particular setting several issues should be considered particularly the transferability of the innovation, the feasibility of implementing it, an d it’s cost benefit ratio Transferability :- The main issue with regard to transferability is that whether it makes good sense to implement an innovation in the new practice setting.If there is some aspect of the practice setting that is fundamentally incongruent with the innovation in terms of its philosophy, types of client served, personal, financial or administrative structure, then it might make little sense to try to adapt the innovation Feasibility :- Assessing the feasibility concerns address various practical concerns about the availability of staff resources, the organizational climate, the need for and availability of external resources and assistance and the potential for clinical evaluation.An important issue here is that whether the nurse will have control over the innovation. When the nurse do not have full control over the new procedure, it is important to recognize the interdependent nature of the project and to proceed as early as possible to establish the n ecessary co operative arrangements. Cost benefit ratio:- It is an important aspect of EBP project innovation. The cost benefit assessment should encompass likely cost and benefits to various groups including clients, staff and the overall organization.Clearly the most important factor is the client. A cost benefit assessment should consider the opposite side of the coin as well that is the cost and benefits of not instituting an innovation. Documentation of the implementation potential is an innovation is highly recommended. Committing ideas to writing is useful because it can resolve ambiguities, serve as a problem solving tool if there are barriers to implementation , and be used to persuade others of the value of the project. 4.APPLY THE EVIDENCE/IMPLEMENTING AND EVALUATING THE INNOVATION After determining the internal and external validity of the study, a decision is arrived at whether the information gathered does apply to your initial question. It’s important to address questions related to diagnosis, therapy, harm, and prognosis. The information gathered should be interpreted according to many criteria and should always be shared with other nurses and/or fellow researcher. Building on the Iowa model, this phase of project likely would involve the following activities Developing an evaluation planCollecting baseline data pertaining to those outcomes, to develop a counterfactual against which the outcomes of the innovation would be assessed. Developing a written EBP guideline based on the synthesis of evidence, preferably a guideline that is clear and user friendly, and that uses such devises as flow charts and decision trees. Training relevant staff in the use of the new guideline and if necessary marketing the innovation to users so that it is given in a fair test.Trying the guideline out on one or more unit or with a sample of clients Evaluating the pilot project in terms of both processes and outcomes. 5. DISSEMINATION OF THE RESULTS OF THE PRO JECT It is the final optional step but it is the one which is highly advisable. It is done so that the results of the project can be disseminated to other participating staff members. How to Critique a Research Article The critiquing process is the building block and foundation for the multiple steps that are to follow in the successful implementation of EBP.This is so because you must first ensure that the material and research that you are trying to convince others to accept is reliable and accurate. By taking the time to thoroughly critique a study you can point out both the strengths and weaknesses of the findings and weigh them accordingly. Successful completion of this vital step will help â€Å"weed out† the material lacking the needed proof of effectiveness, therefore minimizing useless, or even harmful, implementation of new practices in the healthcare field.Once the literature is located, it is helpful to classify the articles as either conceptual (theory and clinic al articles) or data-based (systematic research reviews). Before reading and critiquing the research, it is useful to read theoretical and clinical articles to have a broad view of the nature of the topic and related concepts, and to then review existing EBP guidelines Critiquing criteria are the standards, evaluation guides, or questions used to judge (critique) an article.In analyzing a research report, the reader must evaluate each step of the research process and ask questions about whether each step of the process meets the criteria. Remember when you are doing a critique, you are pointing out strengths, as well as the weaknesses. To critique an article you must have some knowledge on the subject matter. There is no replacement for reading the article many times. The reader must search the article for contradictions, illogical statements, and faulty reasoning.It is important to evaluate every section of the research article. Each section has different criteria to meet, in order to be considered a well-written addition to the article. What are the barriers to implementing evidence-based practice? The barriers that prevent nurses from using research in everyday practice have been cited in numerous studies, and some common findings have emerged Nurses often report the following: †¢ Lack of value for research in practice †¢ Difficulty in changing practice†¢ Lack of administrative support †¢ Lack of knowledgeable mentors †¢ Insufficient time to conduct research †¢ Lack of education about the research process †¢ Lack of awareness about research or evidence-based practice †¢ Research reports/articles not readily available †¢ Difficulty accessing research reports and articles †¢ No time on the job to read research †¢ Complexity of research reports†¢ Lack of knowledge about EBP and critique of articles †¢ Feeling overwhelmed by the processDespite these barriers, nurses are engaging in EBP and making a difference in patient outcomes. Furthermore, barriers can be overcome through organizational efforts focused on integrating research in practice and using strategies such as journal clubs, nursing grand rounds, and having research articles available for review The use of evidence based practice depends a great deal on the nursing student's proficiency at understanding and critiquing the research articles and the associated literature that will be presented to them in the clinical setting.According to, Blythe Royal, author of Promoting Research Utilization in nursing: The Role of the Individual, Organization, and Environment, a large amount of the preparation requirements of nursing students consists of creating care plans for patients, covering in depth processes of pathophysiology, and retaining the complex information of pharmacology. These are indeed very important for the future of patient care, but their knowledge must consist of more when they begin to practice.Evidence base d nursing in an attempt to facilitate the management of the growing literature and technology accessible to healthcare providers that can potentially improve patient care and their outcomes. Nancy Dickenson-Hazard states, â€Å"Nurses have the capacity to serve as caregivers and change agents in creating and implementing community and population-focused health systems. † There is also a need to overcome the barriers to encourage the use of research by new graduates in an attempt to ensure familiarity with the process.This will help nurses to feel more confident and be more willing to engage in evidence based nursing. A survey that was established by the Honour Society of Nursing and completed by registered nurses proved that 69% have only a low to moderate knowledge of EBP and half of those that responded did not feel sure of the steps in the process. Many responded, â€Å"Lack of time during their shift is the primary challenge to researching and applying EBP. † There is always and will always be a desire to improve the care of our patients.The ever increasing cost of healthcare and the need for more accuracy in the field proves a cycle in need of evidence based healthcare. The necessity to overcome the current issues is to gain knowledge from a variety of literature not just the basics. There is a definite need for nurses, and all practitioners, to have an open mind when dealing with the modern inventions of the future because these could potentially improve the health of patients. There are many barriers to promoting evidence based practice.The first of which would be the practitioner's ability to critically appraise research. This includes having a considerable amount of research evaluation skills, access to journals, and clinic/hospital support to spend time on EBN. Time, workload pressures, and competing priorities can impede research and development. The causes of these barriers include nurse's and other professional practitioners lack of knowledge of research methods, lack of support from professional colleagues and organizations, and lack of confidence and authority in the research arena.Another barrier is that the practice environment can be resistant to changing tried and true conventional methods of practice. This can be caused because of reluctance to believe results of research study over safe, traditional practices, cost of adopting new practices, or gaining momentum to rewrite existing protocols It is important to show nurses who may be resistant to changes in nursing practice the benefits that nurses, their patients, and their institutions can reap from the implementation of evidence-based nursing practice, which is to provide better nursing care.Values, resources and evidence are the three factors that influence decision-making with regard to health care. All registered nurses and health care professionals should be taught to read and critically interpret research and know where to find articles which rela te to their field of care. In addition, nurses need to be more aware of how to assess the information and determine its applicability to their practice. Another barrier to implementing EBN into practice is lack of continuing education programs.Practices do not have the means to provide workshops to teach new skills due to lack of funding, staff, and time; therefore, the research may be tossed dismissed. If this occurs, valuable treatments may never be utilized in patient care. Not only will the patients suffer but the staff will not have the opportunity to learn a new skill. Also, the practitioners may not be willing to implement change regardless of the benefits to patient care. Another barrier to introducing newly learned methods for improving treatments or patients' health is the fear of â€Å"stepping on one's toes†.New nurses might feel it is not their place to suggest or even tell a superior nurse that newer, more efficient methods and/or practices are available. The pe rceived threat to clinical freedom offered by evidence-based practice is neither logical nor surprising. Resistance to change and to authority is part of human nature. When we make decisions based upon good quality information we are inconsistent and biased. Human nature offers many challenges to evidence-based practice. Can we do a better job of promoting evidence-based practice?And even if we find and use the evidence, will we make consistent unbiased decisions? Even if clinicians do act consistently it is possible that their decisions are consistently biased. People put different values on gains and losses. CONCLUSION Nursing is truly an art and a science. EBP not only provides elements of each aspect, but also contributes to the profession’s overall development. As a result EBP improves everyday practice in by providing empirical data to guide the nursing interventions. Use of research in EBP provides opportunity for research utilisation by all in the field of profession.