Nowadays the effect of modern society have clearly shown on human society Essay Example for Free

Nowadays the effect of modern society have clearly shown on human society Essay Nowadays the effect of modern society have clearly shown on human society after 1950’s; however, there still have people live in minority types of family role in the united states and others Asian, Middle East, and Africa are known that man as breadwinner and woman as homemaker. There are few categories that play primary factors including culture and religion, and they become a barrier for people want to live in modern society. Although the changing gender roles of modern society have been observed and been perceived through times, the acceptance of its transformation still causes negative effects to society and family. In modern society, the idea of changing gender roles seem to be difficult not only woman or man do not have the skills for other one’s tasks but it also brings potentially risk to our society. In 1950s, the gender roles have been defined that man as breadwinner and woman as homemaker. As the society’s evolved, a woman becomes more active, ambitious and independent and a man becomes more emotional and involved in house tasks. According to Aaron H. Devor in his article, â€Å"Becoming members of Society: Learning the Social Meaning of Gender,† â€Å"†¦society demands different gender performance from us and reward, tolerates, or punishes us differently for conformity to, or digression from social norm† (527). Thus, when the gender roles are defined in terms of social interaction, then social norms seem to play a key role with it. The social norms tell us how the male and female should behave, expecting people to have their own personal characteristic an d act in a way appropriate to their gender. Even when the changing gender roles affect society, it still needs to consider and follow particularistic obligation of each gender roles. According to Bureau of Labor Statistics, woman make up 47 percents of the work place between the ages of 25 and 54 worked outside home in 1995. Therefore, woman spends less time with their children or sends them to babysitter. When the society evolves and the value of the society around us has evaluated as more generalized norms of society, it will affect to the next generation. According to Devor in his article, â€Å"Becoming members of Society: Learning the Social Meaning of Gender,† â€Å"†¦.children initially acquire the value of the society around them almost indiscriminately. To the degree that children absorb the generalized standard of society into their personal concept of that is the generalized other† (530). Therefore, the changes of each parent directly affect to their children and its transformation causes the original characteristic of children to disappear or unnoticeable. Most children consider their parent as role model to follow and learn. Thus, the society and family both play a primary affect to the next generation through changing gender roles. As the previous idea, the family will affect to their children’s gender role; however, the reason unnecessarily applies to all aspects. When the families loosen attention on their children, the lacks of familial concern causes more damaged or perverted and leads the children to the wrong path in future. Each of individual family members which play a central help to their children need to consider what they do or how they behave toward their children. According to â€Å"Becoming members of Society: Learning the Social Meaning of Gender,† the family cannot pressure their children to choose the gender, when the time is right, their children will choose the appropriate gender (Devor 534). I deprecate the way of Devor’s thought, there are statistical datas show that the gender roles of children or adults have been modified by their parent and they are more likely becoming their own gender role. It is only right when the parent helps their children to choose the right path. Because of development of modern society, it appears many people not become what they are such as gays and lesbian, and it is because the lack of concern from their family. In conclusion, modern society has tremendous effects toward the development of our society; however, it also brings the potential risk, and affect to each family generation, and the lack of concerning to children in family during their mature. If we can mix the old and modern family types together, it will give us a perfect family formation in reality. The family cannot live either old type or modern type because it rules out the family existence or cannot have rigid family bond.

Capacity Planning And Decisions

Capacity Planning And Decisions Capacity planning is one of the key aspects of operations management as it determines the amount of goods or services which can be produced within a given time duration. Too less capacity indicates that customers wont be satisfied and too much capacity would result in the operation being under-utilized with resultant high fixed costs and also affecting breakeven and profitability. A company, when it has to increase its capacity it has various options to consider, from working overtime to building a new facility or a plant. Forecasting demand is critical to capacity planning and companies can adopt different strategies of capacity planning, to ensure customer satisfaction and maintain the operations well within their budget and other constraints. Short term capacity planning is very important for any company be it a product based or a service based company especially when there are seasonal demands, as those demands are totally unpredictable and there cant a permanent plan in place fo r short term capacity planning for seasonal demands. Momentary plans like employee overtime, subcontracting have to be considered and the best among them and that incur least cost have to be selected and implemented and this has been discussed in detail in this project. Chapter-1 Capacity Planning Decisions 1.1 Capacity Planning Firstly, Capacity of any facility is said to be the rate of productive capability of it. Capacity otherwise can be assumed as the rate at which a facility produces or in simple words, it is the ability of a facility to produce a certain level of output within a specific time period. When a firm decides to produce more of a product or plans to produce altogether a new product, it always starts with deciding how much capacity is needed considering the factors that affect capacity such as number of workers and machines, skill set of workers, defects, suppliers, government regulationsà ¢Ã¢â€š ¬Ã‚ ¦etc. This is termed as Capacity Planning. 1.2 Need for Capacity Planning A firm can determine its facility location and choose the process technologies only after it has found out a need for new or expanded facilities by evaluating the capacity or capacity planning. Lack of capacity planning can result in under or over capacity and would incur unnecessary costs in exploring ways to reduce or increase capacity. Lack of capacity planning can also trigger a series of undesirable events such as poor delivery services, an increase in work-in-process and bring about dissatisfaction in the minds of the sales personnel and the team involved in manufacturing. Decision making such as producing new products, expanding productionà ¢Ã¢â€š ¬Ã‚ ¦etc can be difficult without proper capacity planning. 1.3 Determinants of Capacity The determinants of capacity are: Facilities Product and Service Factors Process Factors Manpower Factors Operational Factors Supply Chain Factors External Factors 1.4 How important are capacity decisions? Capacity decisions have its impacts on many different verticals of a firm. Firstly it affects the ability to meet future demands, as without capacity planning if not done keeping in mind the future demands leads to a shortage of products. If capacity is underestimated or overestimated it directly affects the operating costs as if capacity is overestimated the operating costs involved would get wasted and if underestimated the measures taken to fix it may cost a lot and so is the way it affects the initial costs too. And all these factors affect many other factors such as the competitiveness, managementà ¢Ã¢â€š ¬Ã‚ ¦etc. 1.5 How are Capacity Decisions made? Assessment of Existing Capacity Forecasting Future Capacity Needs Identification of Ways to Modify Capacity Evaluation of Financial, Economical, and Technological Capacity Alternatives Selection of a Capacity Alternative most suited to achieving strategic mission 1.6 Measuring Capacity Measuring capacity is simple for certain organizations. Reynolds, can use number of ballpoint pens produced per year, Hyundai Motors can use number of automobiles per year. But for organizations whose product lines are more diverse it is difficult to find out a common unit of output. As an alternative, capacity can be expressed in terms of input. A consultancy can express its capacity in terms of the number of consultants employed per year. A lathe shop may express capacity in terms of available labor hours or machine hours per week, month, or year. Following table shows some examples of capacity measures. Measures of Operating Capacity Output Organization Measure Automobile Manufacturer Number of Autos Brewery Barrels of Beer Cannery Tons of Food Steel Producer Tons of Steel Power Company Megawatts of electricity Input Organization Measure Airline Number of Seats Hospital Number of Beds Job Shop Labor and/or machine hours Merchandising Square Feet of Display or Sales Area Movie Theatre Number of Seats Restaurant Number of seats or table Tax Office Number of Accountants University Number of Students and/or faculty Warehouse Square or cubic feet of storage space Source: Productions and Operations Management, Text Book Day to day variations such as employees being absent or late, breakdowns of machines, downtime required for facility maintenance and repair make it often difficult to measure capacity realistically. A facility can in some cases operate at more than 100% capacity. Chapter-2 Estimating Future Capacity Needs 2.1 Capacity requirements can be evaluated from two different perspectives viz. short term and long term. 2.1.1 Short-Term Requirements Managers often use forecasting of product demand for estimating the short term work load the facility should be handling. By looking forward up to 12 months, managers expect output requirements for different products or services following which they compare requirements with currently existing capacity and find out when capacity adjustments are to be made. 2.1.2 Long-Term Requirements Long term capacity requirements are tougher to determine as future demand and technologies are uncertain. Forecasting five or ten years into the future is a risky and a tough job. A product existing today may not even exist in the future. It is easily visible that long range capacity requirements depend on marketing plans, product development, and the life cycles of the products. Changes in process technology should also be expected. Even if products remain unchanged, the methods for generating them may change drastically. Capacity planning should be involving forecasting of technology as well as product demand. 2.2 Strategies for Modifying Capacity After currently existing and the future capacity requirements are determined, alternatives ways of modifying capacity must be found out. 2.2.1 Short Term Responses For short-term periods of up to one year, basic capacity is fixed. Majority of the facilities are rarely opened or closed on a regular monthly or yearly basis. Many short-term adjustments for increasing or decreasing capacity are possible anyway. The adjustments to be made depend on if the conversion process is mostly labor or capital intensive and if the product is one that can be stored in the inventory. Capital-intensive processes depend a lot on physical facilities, plant, and equipment. Short term capacity can be modified by operating these facilities more or less intensively than normal. The costs of setting up, changing over, and maintaining facilities, procuring raw materials and manpower, managing inventory, and scheduling can all be modified by making such capacity changes. 2.2.2 Long Term Responses From World War 2 through the 1960s, the US economy was booming and scaling great heights. Since the 1970s, the United States has faced problems of scarcity of resources and a more competitive economy. Organizations today cannot be constrained into thinking only about expanding the resource base; they must also consider appropriate approaches to contracting it. Example: A warehousing operation foresees the need for an additional 100,000 square feet of space by the end of the next five years. One option is to add an additional 50,000 square feet now and another 50,000 square feet after two years. Another option is to add the entire 100,000 square feet now. Estimating costs for building the entire addition now are $50/square foot. If expanded incrementally, the initial 50,000 square feet will cost $60/square foot. The 50,000 square feet will cost $60/square foot. The 50,000 square feet to be added later are estimated at $80/square foot. Which alternative is better? At a minimum, the lower construction costs plus excess capacity costs of total construction now must be compared with higher costs of deferred construction. The operations manager must consider the costs, benefits, and risks of each option. Source: Productions and Operations Management by Everett E. Adam, Jr. Ronald J. Ebert 2.3 Classification of Capacity Planning based on Time Long Term Capacity Planning Short Term Capacity Planning 2.3.1 Long Term Capacity Planning Long Term capacity planning solves strategic issues involving the firms major production facilities. Also, long-term capacity issues are interrelated to location planning. Technology and the ability to transfer the processes to other products are also interrelated to long-term capacity planning. Long-term capacity planning may come in to the picture when short-term amendments in capacity are scarce. For instance, if a firm adds a third shift to its present two-shift plan and if the output is still insufficient, and also if subcontracting options are unavailable, one practical alternative is adding capital equipment and modifying the layout of the plant. An additional space or constructing an additional facility can also be alternatives. 2.3.2 Short Term Capacity Planning In the short term, capacity planning concerns issues related to scheduling, labor shifts, and balancing resource capacities. The goal of short-term capacity planning is to manage unexpected shifts in demand in an efficiently economic way. The time frame for short-term planning is often only a few days but may go on as long as six months. Alternatives for making short-term changes in capacity are numerous and can even take decisions to not meet demand at all. A very easy and most commonly-used method to increase capacity in the short term is working overtime. This is a very flexible and least expensive alternative. While the firm has to pay one and one half times the normal labor rate, it is saved from the expenses of hiring, training, and paying additional benefits. When not used abusively, most workers welcome the opportunity to earn extra wages. If overtime does not provide enough short-term capacity, other alternatives are also available. These include adding shifts, employing cas ual or part time workers, the use of floating workers, leasing workers, and facilities subcontracting. Firms may also increase the capacity by improving the use of their resources. The most common alternatives in this category are employee/labor cross training and overlapping or staggering shifts. Most manufacturing firms inventory some output ahead of demand so that any need for a capacity change in future is absorbed by the inventory buffer. From a technical angle, firms may initiate a process design aimed at increasing productivity at work stations. Manufacturers can also shift demand to avoid fluctuations in capacity requirement by backlogging, queuing demand, or lengthening the firms lead times. Service firms achieve the same results through scheduling appointments and reservations. A more creative approach is to modify the output. Standardizing the output or offering complimentary services are examples of the same. In services, customers might be allowed to do some of the process work themselves (e.g., self-service fuel pumps and fast-food restaurants). Another alternative reduc ing quality is an undesirable yet possible trick. Finally, the firm may take steps to modify demand. Changing the price and promoting the product are common. Another alternative is to split demand by initiating a yield or revenue management system. Utilities also report success in shifting demand by the use of off-peak pricing. 2.4 When capacity doesnt meet demand? When capacity doesnt equal demand, then in short term capacity planning, it can be managed by temporary measures such as increasing or decreasing the labor force or creating and carrying inventory in the lean period to be used in the peak demand period. If there happens to be a mismatch between demand and capacity in long term capacity planning, it can be handled by changing or modifying the capacity. If the capacity is short then a new facility can be built or expand the existing facility. In case of an excess capacity then a temporary shutdown/sale/consolidation of facilities would help. 2.5 Best Operating Level Source: Operations Management by William J Stevenson The term capacity means an attainable rate of output but mentions nothing about till what point of time that rate can be sustained. Thus, if we say that a given plant has a capacity of x units, we do not know if it is a one-day peak or a six-month average. To avoid this issue, the concept of best operating level is brought into being. This is the level of capacity for which the process was designed and thus is the volume of output at which average unit cost is at a minimum. When the output of the facility falls below this level (underutilization), average unit cost will increase as overhead must be allocated to fewer units. Above this level (overutilization), average unit cost also increases-here due to overtime, increased equipment wear, and heightened defect rates. 2.6 Capacity Planning Models Present Value Analysis: It is used to evaluate the time of capital investment and fund flows. Aggregate Planning Models: It helps in examining the way of using the existing capacity for short term planning. Break Even Analysis: It determines the minimum break down volumes of production. Linear Programming: It helps in determining the optimum product mix for maximizing contribution, considering the constraints imposed by capacity. Computer Simulation: It is helpful in determining the effects of various scheduling policies. 2.7 Economies of Scale This well known principle of Economics illustrates the relationship between cost and capacity in an operating system. When output increases in an operating system, the system is likely to experience cost benefits on various factors. Due to the following reasons the average unit cost begins to fall with the rise in output level: Spreading the fixed costs of capacity over a larger output. Improved utilization of several resources in the system. Cost benefit in procurement on account of increased volume. Efficient use of supervisory and management staff. The economies of scale cease to occur beyond a level of production or output. This is called Diseconomies of Scale. There can be several reasons for this: Inefficient management due to large size of operation and the resulting lack of coordination. Overuse of machines and break down of material handling equipments. Over hiring of employees, or overtime exceeding justifiable limits. Service slows down due to increasing complexities. Increase in quality degradations because of mismanagement and lack of focus. An Example for Economies of Scale: Economies/Diseconomies of Scale Source: Microeconomics by Robert S. Pindyck, Daniel L. Rubinfeld, Prem L. Mehta Chapter-3 Capacity Planning Techniques 3.1 Capacity Planning Techniques There are four procedures for capacity planning; capacity planning using overall factors (CPOF), capacity bills, resource profiles, and capacity requirements planning (CRP). The first three are roughly cut approaches that involve analysis to identify potential bottlenecks that can be used with or without manufacturing resource planning (MRP) systems. CRP is used along with MRP systems. Capacity using overall factors is a simple and a manual approach to capacity planning that is based on the master production schedule (MPS) and production standards that convert required units of finished goods into historical loads on each work station. Bills of capacity are a procedure based on the MPS. Instead of using historical ratios, it uses the bills of material and routing sheet that shows the sequence or work stations required to produce the part, as well as the setup and run time. Capacity requirements can then be determined by multiplying the number of units required by the MPS by the time required to manufacture each. Resource profiles are the same as bills of capacity, except lead times being included so that workloads fall into the correct periods. Capacity requirements planning (CRP) is applicable only in companies using MRP or MRP II. CRP uses the information from one of the previous rough-cut methods, plus MRP outputs on existing inventories and lot sizing. The result will be a tabular load report for each work station or a graphical load profile for helping plan-production requirements. This will tell where capacity is not adequate or idle, allowing for imbalances to be corrected by shifts in personnel or equipment or the use of overtime or added shifts. Finite capacity scheduling is an extension of CRP that simulates job order stopping and starting to produce a detailed schedule that provides a set of start and finish dates for each operation at each work station. A failure to understand the very nature of managing capacity can lead to disorder and serious cus tomer service issues. If there is a mismatch between available and required capacity, adjustments should be made. However, it should be taken care that firms cannot Have perfectly-balanced material and capacity plans that easily accommodate emergency orders. If flexibility is the companys competitive priority, excess capacity would be appropriate. 3.2 Utilization and Efficiency Utilization is the percentage of design capacity achieved. Utilization = Actual Output/Design Capacity Efficiency is the percentage of effective capacity achieved. Efficiency = Actual Output/Effective Capacity Bakery Example: Actual production last week = 148,000 rolls Effective capacity = 175,000 rolls Design capacity = 1,200 rolls per hour Bakery operates 7 days/week, 3 8 hour shifts Design capacity = (7 x 3 x 8) x (1,200) = 201,600 rolls Utilization = 148,000/201,600 = 73.4% Efficiency = 148,000/175,000 = 84.6% Efficiency = 84.6% Efficiency of new line = 75% Expected Output = (Effective Capacity)(Efficiency) = (175,000)(.75) = 131,250 rolls 3.3 Managing Demand There are three cases in which demand has to be managed and they are: Demand Exceeding Capacity Control demand by raising prices, scheduling longer lead time Long term solution is to increase the capacity Capacity exceeds demand Stimulate market Product changes Adjusting to SEASONAL DEMANDS Produce products with complimentary demand patterns Capacity planning in short time or short term capacity planning to meet seasonal demands is explained in detail in the following sections. Chapter-4 Seasonal Demands 4.1 Seasonal Demands Seasonal Demands are those demands those cause unusually large ups or downs in demand. Seasonal demand occurs in a number of different scenarios; most frequent of them is listed in the following: Natural seasonal variations (e.g. greater demand for ice cream in summer and for cold remedies in winter). Specific calendar linked Events like Diwali (Crackers, sweets), Mothers Day (e.g. greetings cards and flowers), and Christmas. Regular every day Promotions that can happen frequently and semi-randomly throughout a year. 4.2 Impacts and Challenges of Seasonal Demand Managing seasonal demand getting a good forecast done, planning production and procurement and managing the fulfillment process introduces considerable additional challenges into the process that is already complex. For most manufacturers, the two key and important planning processes are Forecasting Demand Planning, and Production Planning Scheduling. The challenge in Forecasting and Demand Planning is mainly handling the high demand volatility and variability, and unexpected demands. Specifically, promotions events tend to cause most of the issues, and result in much larger and more frequent demand spikes and dips than natural seasonal variations. If these are not planned well in a timely fashion and introduced into downstream production and distribution plans, the result can be significant reduction in manufacturing and distribution efficiencies, increase in costs, lower customer service levels and satisfaction and all these ultimately can result in a lost business. In Planning and Scheduling, the greatest of problems is dealing with frequent changes in forecasts and orders. The ability to react swiftly while making the best decision on the way of satisfying demand is often the desired strategy of Make to Order manufacturers. For manufacturers who are unable to meet peak demand because of capacity constraints, and for those that Make to Stock or use a combined MTO/MTS strategy, tactical planning requires careful tweaking of demand and production in order to plan for a suitable pre-building of inventory and to ensure that the long lead time items are purchased in synchronization with the modified production plans. Manufacturers, of course, may, to solve some or all of their capacity issues, resort to sub-contracting. The recent upward trend in contract manufacturing, and the increase in virtual manufacturing, that is, purchasing and distributing products from foreign countries significantly add to the overall supply chain complexity. In this, with very long supply lead times, accuracy of forecast is again paramount, and, the ability to give your suppliers precise projections of your requirements in a timely manner is one of the most critical factors. Despite the push of lean strategies and principles of customer driven supply chain, one of the most common ways of dealing with any type of demand uncertainty in many of the companies of today still appears to be to insure against the uncertainty by holding an extra inventory across the supply chain which is an expensive and unacceptable solution. 4.3 Focus on Customers and Demand Getting the demand right approach benefits every subsequent supply chain planning and execution processes from production planning, through sourcing and procurement to fulfillment and this result in reduced costs as well as improvements in the top line sales and market share. On the other hand, getting the demand wrong adds cost to almost all downstream processes, severely affecting competitiveness and again ultimately results in losing the business. In forecasting and demand planning, one very much visible guideline is to focus more on the abnormal than the normal. This does not mean not paying attention to natural seasonal variations, but paying more attention on promotions and events as these are the things that almost cause the highest volatility in demand always and are the most tough to handle. Putting in extra efforts to ensure you understand your customers and the authentic sources of demand can also pay very good dividends. Many manufacturers still use their customers demand from on their warehouses but frequently, their customers ordering process is not that good and is a poor source of history of demands or demand trends. Wherever possible, its a lot better to have eyes on the actual source of demand, namely the consumer. Using their customers POS data as part of the demand planning process often gives much better idea of the actual demand. The ability to maximize and continuously improve forecast accuracy is very important. Increasing sales and market share with the help of improved perfect order performance and influencing and creating demand is equally important. Focusing well on demand and getting nearer to your customers is an essential requirement to achieve these goals. Chapter-5 Conclusion Conclusion Short term capacity planning to meet seasonal demands, thus is critical for any company and proper forecasting of seasonal demands and a proper plan to meet all those seasonal demands should be in place. Any flaw in this, can lead to high inventory costs, employee dissatisfaction, deteriorating customer service levels and high customer dissatisfaction that leads to losing the customers and ultimately losing the business. A firm should be at vigil all the time to see the changes happening in demands and should keep changing its strategies of short term capacity planning and achieve and sustain an outstanding business value. Appendix

A Look At Burnout Psychology Essay

A Look At Burnout Psychology Essay CHAPTER 2 LITERATURE REVIEW 2.1 Introduction This study examined the relationship between emotional intelligence (EI) and burnout among nurses working in private hospitals in Malaysia. Theoretical literature related to this relationship will be presented in the first part of this chapter. The existing literature on the topics was examined and key pieces were brought together to establish a foundation for this study. The next part of the review explores the literature which has supported the proposed relationship between EI and burnout among the nurses in Malaysia. 2.2 Burnout The term burnout has its roots in the medical and nursing disciplines. It was first defined by a psychiatrist, named Herbert Freudenberger in 1974. The theory of burnout was developed through his clinical experience by exploring the turmoil that people experience every day. According to Maslach and Jackson (1981a), burnout occurs in the helping professions, such as nursing due to the chronic stress associated with doing work that involves people. Basically burnout occurs as feelings of emotional exhaustion, negative feelings, and attitudes within the job and the increase of negative self-concept. The earliest use of the burnout term in nursing literature was found in the articles published by Seymour Shubin in 1978. Shubin described burnout as hazardous to nursing and all other helping professions. The study of burnout, although not exclusive to nursing, continues to be an important occupational issue for the nursing profession. 2.2.1 Definition of Burnout There are many definitions of burnout, however most definitions share a view of burnout as a state of fatigue and emotional exhaustion, as a result of emotional depletion and loss of motivation. The term burnout that was first coined by Freudenberger in 1974 refers to wearing out from the pressures of work. It was used to describe the experience of employees in professions that needs high degree of people contract. Freudenberger in 1975 further defined burnout as wearing out, failing, becoming exhausted, and it occurs when excessive demands on energy, strength or resources are made. Cherniss (1980) was among the first to describe burnout within human service field who defined burnout as a process that leads to an individuals attitudes and behavior change in negative ways in response to work stress. On the other hand, Maslach (1982) who has extensively researched about burnout has provided the most commonly accepted definition of burnout as a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do people work of some kind. Maslach identified three related themes: (1) painful emotional experiences often resulted in clinical practitioners feeling emotionally exhausted and drained; (2) as a result, they developed negative and cynical attitudes towards their clients; and (3) personal competence suffered resulting in feelings of failure about their ability to work in the health care profession. These three themes were summarized as emotional exhaustion, depersonalization, and reduced personal acc omplishment and later operationalized to measure burnout using the Maslach Burnout Inventory (MBI) (Maslach, Jackson Leiter, 1996). Garrosa, Moreno-Jimenez, Liang and Gonzalez (2008) pointed out that burnout is a specific form of chronic and occupational stress in the professional social services. According to Westman and Eden (1996), studies have shown a strong relationship between work stress and burnout in many occupations. Especially, burnout has been repeatedly linked to job stress in the human service field due to the frequent and intense interactions with clients (Cordes Doughery, 1993; Lee Ashforth, 1996). Additionally, studies have also shown that nurses who experience occupational stress experience greater burnout (Stechmiller Yarandi, 1993). Thus, burnout is related to stress whereby burnout is a reaction to stress. Prolonged and unrelieved work stress often leads to burnout which results in negative attitudes towards work. Freudenberger (1975) postulates that burnout involves physical and behavioral symptoms. Behavioral consequences of burnout include decreased interaction with care recipients, ine ffective absenteeism, and high levels of job turnover (Maslach, 1982; Maslach Leiter, 1997). 2.2.2 Models of Burnout The burnout literature provides several models of burnout. This section describes four models constructed in the early eighties which proceed from the simplest to the most complex model. 2.2.2.1 Cherniss transaction model of burnout Cherniss (1980) was a significant figure of the first wave of burnout researchers and offered a burnout model that articulate transactional imbalance between the personal resources of the giver and the demands of the recipient or situation. Cherniss described burnout as a transactional stress process that involves three stages. The first stage is stress whereby demands placed exceed individual resources for coping. The second stage is strain, the initial emotional response to stress which usually includes feelings of anxiety, tension, fatigue, and exhaustion. Finally, defensive coping occurs which leads to changes in attitudes and behavior such as the tendency of burnout individuals to treat clients in depersonalized way. Two years later, Cherniss modified his model and elaborated on the model that the causes of stress can either be internal or external demands. Additionally, the limited resources contributing to stress can also be external (e.g. availability of time, work space, and equipment) or internal (e.g. skills, knowledge, energy, and personality). In summary, Cherniss theorized that burnout is a coping response in a transactional process that begins with excessive and prolonged exposure to job stress. The uncontrollable stress causes strain in the individual which influences the coping process. If the stress is prolonged or becomes more intense, it will deplete the coping resources of an individual and force the individual to withdraw psychologically. 2.2.2.2 Edelwich and Brodsky: Five stages of burnout Edelwich and Brodsky (1980) suggested five stages of burnout: (1) enthusiasm; (2) stagnation; (3) frustration; (4) apathy; and (5) intervention. At the first stage, employees have great enthusiasm for their new jobs. They do not know much about their job and have unrealistic expectations about outcomes of their effort. Therefore, when the outcome is not as expected, they become disillusioned. During the period of stagnation at stage two, realities of the job become evident. The job is no longer satisfying as it first appeared. Employees are now more concerned with meeting personal needs, working hours, and career development. The third stage is called the period of frustration. Employees begin to question their job effectiveness and the value of their job. The limits imposed by bureaucracy frustrate the individuals and they become dissatisfied with the job situation. At this stage, employees begin to develop emotional, physical, and behavioral problems. Proceed to stage four; employees frustration turns to apathy because individuals feel trapped. On one hand, they feel frustrated by the job situation but on the other hand, they need the salary. The emotional and physical responses of individuals become worse whereby they would avoid clients whenever possible. The final stage is intervention. Nevertheless, it cannot be determined whether this stage would occur in an organization or the individual who is experiencing burnout would recognize their psychological state as undesirable. In summary, Edelwich and Brodsky viewed burnout as an evolutionary process that begins with idealistic enthusiasm and commitment. Subsequently, the loss of idealism, vigor, and purpose is triggered largely by work conditions (Edelwich Brodsky, 1980). 2.2.2.3 Maslach: Burnout caused by social interaction Maslach, a social psychologist, who became a stellar figure in the emerging research of burnout, has provided the conceptual definition that begun the second wave of research. Maslach (1982) described burnout as a three-dimensional syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. Another specific contribution Maslach made was the theoretical emphasis on the relational causes of burnout which linked to the social roots of emotional expenditure (Leiter Maslach, 1988; Maslach Leiter, 1997). Maslach (1982) saw that emotional overload and subsequent emotional exhaustion is the heart of the burnout syndrome. Thus, the first response to a stressful interaction with other people is emotional exhaustion. As people become emotionally depleted, they cope by cutting back on their involvement with others. This detached response which called depersonalization is the second aspect of burnout and leads to various negative attitudes and behaviors. At this stage, individuals who experience burnout feel more emotional distress and guilt about how they have treated those that they are trying to help. Finally, the feeling of reduced personal accomplishment which is the third aspect of burnout appears. At this point, the individuals feel inadequate about their ability to treat or help others. They tend to believe that they have failed professionally and chosen the wrong profession. A major contribution by Maslach was the development of the Maslach Burnout Inventory (MBI). Maslach and Jackson (1981a, 1981b) developed the MBI, which was one of the first reliable instruments for valid measurement of burnout. MBI is still the most widely-used measure of burnout in current research. MBI assesses psychological burnout and has three different versions, which include one general survey, one for human service professionals, and one for educators. The most commonly used measure of burnout is the Maslach Burnout Inventory-Human Services Survey or MBI-HSS (Maslach, Jackson Leiter, 1996) which was developed to measure occupational burnout among people working in the field of human services. 2.2.2.4 Golembiewski, Munzenrider and Carter: Rigorous scientific research While other models focused on the order in which burnout aspects occur and the helping professions, Golembiewski, Munzenrider and Carter (1983) were concerned to make the study of burnout more rigorous and to broaden the population in which burnout was examined. Golembiewski et al. noticed that research was lacking in terms of empirical investigation of the stages of burnout. To rectify both the lack of empiricism and extend the study of burnout to wider work settings, the authors used Maslach and Jacksons MBI (1981a, 1981b) to measure burnout among nursery school teachers and nurse educators. Golembiewski et al.s results in 1983 suggested that depersonalization occurs first and increases greatly before reduction in personal accomplishment occurs and finally emotional exhaustion follows. Their argument was based on the fact that when people sense a loss of control and autonomy, their self-image is threatened. Initially, individuals may seek constructive ways out of the situation such as leaving the job. However, if the situation persists, they may begin to treat others as objects resulting in depersonalization. This will lead to diminished personal accomplishment and ultimately worsening emotional exhaustion. Based on Golembiewski et al.s findings and discussion of the burnout model in 1983, it can be classified that their model is similar to the earliest version of burnout model proposed by Cherniss (1980). Additionally, based on their model, Golembiewski et al. used a modified version of MBI and administered the instrument to a small population. The results allowed them to propose a model of burnout with eight stages. However, their model did not clarify or simplify the understanding of burnout. They moved to more rigorous methods of data collection and analysis using MBI as measurement instrument and expanded the population of employees to which results can be generalized. 2.2.3 Burnout and Nursing Employees in general experience burnout on the job, especially those in jobs with high contact with people. Nevertheless, nurses are considered at high risk of work-related stress and particularly susceptible to burnout among the different healthcare providers (Keane, Ducette Alder, 1985; Kilpatrick, 1989; Schaefer Moos, 1993; Schaufeli Janczur, 1994; Duquette, Kerouac Sandhu Beaudet, 1994; Farrington, 1995; Decker, 1997; Marsh, Beard Adams, 1999; Koivula, Paunonen Laippala, 2000; Taormina Law, 2000; Shimizu, Mizoue, Kubota, Mishima Nagata, 2003; Jenkins Elliott, 2004; Piko, 2006). This is also proven by the fact that burnout in nursing has received world-wide attention (Demerouti, Bakker, Nechreiner Schaufeli, 2000). Several studies have identified nurse burnout rates are as high as 40-50% (Hapell, Martin Pinikahana, 2003; Vahey, Aiken, Sloane, Clarke Vargas, 2004). Nurses are particularly susceptible to the development of burnout, mainly because of the nature and the em otional demands of their profession. Nurses experience considerable stress in their job because they have long working hours, a wide range of tasks, interpersonal conflict with patients and their families, doctors, and other co-workers, exposure to death and dying, and noise pollution (Schmitz, Neuman Opperman, 2000; Maslach, Schaufeli Leiter, 2001; Shimizu et al., 2003). Studies have also confirmed that stressful circumstances for hospital nurses are escalating and including work load (Foxall, Zimmerman, Standley Bene, 1990; Healey McKay, 2000; Koivula et al., 2000). Basically, nurses are subjected to many demands in the workplace which include physical demands and the psychological/emotional demands. The physical demands are related to the physical energy required to perform the daily duties of nursing such as transferring patients in and out of bed and lifting patients onto a bed. On the other hand, psychological/emotional demands are related to the emotional energy required to care for patients with chronic illn ess (Van Servellen Leake, 1993). Therefore, nurses who feel overloaded perceive a lack of meaningful connection with the patients. 2.3 Emotional Intelligence (EI) Emotional intelligence (EI) is complementary to cognitive abilities (IQ) (Devrim, Nadi, Mahmut, Mustafa Mustafa Kemal, 2005). Goleman (1995) stated that EI is significant to success. Goleman further explains the difference between people with high IQs who experience difficulties in their personal and professional lives and people with moderate IQs who are very successful in all their endeavours. Emotions are separated from that of the rational mind having independent views and a mind of their own (Freshwater Stickley, 2004). Therefore, one has two minds, a rational mind that thinks and an emotional mind that feels. In conclusion, both the rational mind and emotional mind, store memories and influence our responses, actions, and choices. Furthermore, EI such as academic intelligence can be learned and developed with age (Mayer, Caruso Salovey, 2000). Research has shown that people with high EI understand their own and others feelings, know how to manage themselves, deal successfully with others, and respond effectively to work demands (Dulewicz Higgs, 2003; Goleman, 2005). Cooper (1997) stated that people with high levels of EI experience more career success, build stronger personal relationships, lead more effectively, and enjoy better health than those with low EI. Hence, developing EI competencies in existing employees or finding individuals who posses these skills will enhance the organizations bottom line (Goleman, 1998a, 1998b) and ensure long-term success for the company. 2.3.1 Background and Definition of Emotional Intelligence (EI) The idea of EI has its roots in the social intelligences. EI was first proposed by Thorndike in 1921, who noted that it was of value in human interactions and relationships. Gardners (1983) multiple intelligence theory later also contributed to the theory of EI through the identification of intrapersonal and interpersonal intelligences. Interpersonal intelligence comprised of the ability to understand others and to co-operate with them, whereas intrapersonal intelligence comprised of the ability to be self-aware, to recognize ones own feelings, and to use this to operate successfully in life. However, the term EI was not brought into mainstream psychology until 1990s (Mayer, DiPaolo Salovey, 1990; Salovey Mayer, 1990). Hence, EI is a new construct since the first peer-reviewed article that was published in 1990 (Salovey Mayer, 1990). The concept is also described as a new theory which is still in the initial stage of development and testing (Ashkanasy, Hartel Daus, 2002; Cherniss , Extein, Goleman Weissberg, 2006). As a result, definition of EI varies. Salovey and Mayer (1990) first coined the term of EI and defined EI as the ability to monitor ones own and others feelings and emotions, to discriminate among them, and to use this information to guide ones thinking and actions. Mayer et al. (2000) further defined EI as an ability to recognize the meanings of emotions and their relationships, and reason and problem-solve on the basis of them. EI is involved in the capacity to perceive emotions, assimilate emotion related feelings, understand the information of those emotions, and manage them. However, the concept of EI was popularized by Goleman (1995) through his book Emotional Intelligence, which became a best-selling book for business and education leaders. Goleman (1998a) identified EI as the capacity for recognizing our own feelings and those of others, for motivating ourselves, and for managing emotions well in ourselves and in our relationships. In addition, Bar-On (2005) defined EI as a cross-section of interrelated emotional and social competencies, skills, and facilitators that determine how effectively we understand and express ourselves, understand others and relate with them, and cope with daily demands. In conclusion, recognizing feelings and controlling emotions are described as the core competencies of EI. Individuals who are emotionally intelligent can understand one another and each others views to overcome conflict and avoid damaging the relationship. Therefore, EI is about sensing what others are feelings and handling relationships effectively (Dulewicz Higgs, 2000). Previous research also addressed the relationship between EI and work outcome variables such as stress perceptions in the workplace (Bar-On, Brown, Kirkcaldy Thome, 2000; Nikolaou Tsaousis, 2002), job satisfaction (Wong Law, 2002), job commitment (Nikolaou Tsaousis, 2002), leader effectiveness (Higgs Aitken, 2003), and performance (Lam Kirby, 2002; Van Rooy Viswesvaran, 2004; Lopes, Grewal, Kadis, Gall Salovey, 2006). 2.3.2 Theories of Emotional Intelligence (EI) Since the emergence of the concept of EI in 1990s, many theories have been proposed. Nevertheless, three theories have gained acceptance among scholars and practitioners (Dulewicz, Higgs Slaski, 2003). These three major theoretical constructs each focused on understanding the roles of skills, traits, and abilities in EI (Emmerling Goleman, 2003). EI has been defined as an ability (Salovey Mayer, 1990), a set of traits and abilities (Bar-On, 2005) or a combination of skills and personal competencies (Goleman, 1995). The ability model is based on an individuals ability to use emotion as part of the reasoning process (Mayer et al., 2000). Mayer et al. asserted that EI depends on the ability to process emotional information and to use core abilities related to emotions. Bar-On (2005) conceptualized EI as a set of personality traits and abilities that predict emotional and social adaption within environments. Bar-On also affirmed that EI is teachable and learnable. According to Goleman (1995), EI is a set of learned skills and competencies and this conceptualization is most widely accepted outside academia. Golemans ideas have contributed to the development of leadership models that outline skills and competencies related to emotionally competent leadership (Emmerling Goleman, 2003). Additionally, the literature has evolved into two main categories of EI models: (1) ability model; and (2) mixed model (Feyerherm Rice, 2002). The Salovey and Mayer theory is considered an ability model of EI, while the Bar-On and Goleman theories are considered mixed model of EI (Mayer et al., 2000). Basically, the ability model encapsulates EI as a skill and the mixed model go beyond ability by including additional personality characteristics that leads to certain behavior. 2.3.2.1 Ability Model The ability model of EI is the Salovey and Mayer (1990) model which officially launched the field of EI. Salovey and Mayer viewed EI as an ability that exists, interacts, and complements an individuals cognitive capabilities. Ability theory promotes the relationship between cognition and emotion based on mental abilities (Mayer, Salovey Caruso, 2004). Salovey and Mayer conceptualized EI as a set of interrelated skills composed of four branches of abilities, which include: (1) perception and expression of emotion; (2) using emotions to facilitate thought; (3) understanding and analyzing emotions; and (4) managing emotions (Mayer et al., 2004). The four branches can be described as follows: (1) the perceiving emotions branch relates to the ability to detect emotions in oneself and in others; (2) the using emotions branch relates to the ability to use emotions in cognitive activities such as problem solving; (3) the understanding emotions branch relates to the ability to comprehend the complexity of emotional language and emotional relationships; and (4) the managing emotions branch relates to the ability for one to regulate emotions in oneself and in others. The ability model of EI is different from other theories because the model is the only one which utilizes an instrument designed to measure ability (Dulewicz et al., 2003). This model operationalizes EI using ability-based measures: the Mayer-Salovey-Caruso Emotional Intelligence Test (MECEIT) (Mayer, Salovey Caruso, 2002) and its predecessor, the Multifactor Emotional Intelligence Scale (MEIS) (Salovey Mayer, 1990). The ability tests measure how well people perform tasks and solve emotional problems, as opposed to other EI scales which rely on the individuals subjective assessment of his or her perceived emotional skills. However, ability tests are expensive and require more resources to administer and score. MSCEIT instrument is difficult to score and lacks workplace applicability (Brackett, Rivers, Shiffman, Lerner Salovey, 2006). Consequently, self-report assessment outnumbers ability tests are more widely used in the mixed models. 2.3.2.2 Mixed Models EI mixed theories highlight the emotional and social functioning of individuals (Goleman, 2005; Bar-On, 2006). Therefore, Bar-On categorizes his model of EI as a key of emotional-social intelligence (ESI). Bar-On (2005) asserted five key competencies are associated with ESI, whereby the five domains of this mixed model are: (1) intrapersonal capacity (the ability to be aware and understand ones own emotions and to express ones feelings and ideas); (2) interpersonal skills (the ability to be aware, understand, and appreciate others feelings as well as to build and maintain effective and satisfying relationships with others); (3) adaptability (the ability to adapt to various situations by effectively managing personal, social, and environmental changes by employing various skills such as problem solving, reality testing, and flexibility); (4) stress management strategies (the ability to manage emotions and to use those emotions to stay motivated and persistent); and (5) motivational an d general mood factors (the ability to be optimistic, to enjoy oneself and others, and to maintain positive feelings) (Bar-On et al., 2000). The Emotional Quotient Inventory (EQ-i), a self-report measure is considered as the most widely used measure of ESI (Bar-On, 2005). The EQ-i analyzes the concept of emotional and social functioning by measuring a persons ability to deal with daily demands and pressures. People who are taking EQ-i answer questions based on five competencies: (1) intrapersonal skills such as emotional self-awareness, self-regard, self-actualization, or independence; (2) interpersonal skills such as interpersonal relationships, empathy, and social responsibility; (3) adaptability, including problem solving, flexibility, and reality testing; (4) stress management, including tolerance and impulse control; and (5) general mood of optimism and happiness. Goleman developed his mixed model theory of EI by building on the work of Salovey and Mayer, in addition to other researchers in the field (Emmerling Goleman, 2003). Basically, Golemans model of EI can be grouped into personal competencies and social competencies that affect personal success in the workplace. Goleman (2005) stated that a personal competence is the ability to keep self-awareness and manage ones behaviors while a social competence is the ability to understand the behaviors of others and manage relationships effectively. These competencies are described in detail as: (1) self-awareness (knowing ones internal states, preferences, resources, and intuitions); (2) self-management (managing ones internal states, impulses, and resources); (3) motivation (emotional tendencies that facilitate reaching goals); empathy (awareness of others feelings, needs, and concerns); and (4) social skills (adeptness at inducing desirable responses in others) (Goleman, 1998a). Based on the emotional competencies identified by Goleman (1998a), the Emotional Competence Inventory (ECI) was designed to assess EI. ECI is a 360-degree scale which gathers self, subordinate, peer, and supervisory ratings on social and emotional competencies of individuals in organizations. Subsequently, Boyatzis (2007) designed Emotional Social Competency Instrument (ESCI), a multi-rater assessment in real organizational contexts which comprised of four emotional and social competencies, which include: (1) self-awareness; (2) self-management; (3) social awareness; and (4) relationship management. In general, EI mixed models stress performance based on behavioral competencies and personality traits suitable for a wide range of work contexts, job roles, and job levels (Petrides, Furnham Martin, 2004; Goleman, 2005; Boyatzis, 2007). The mixed model is also comprised of other measurement instruments. For examples, measures such as the Schutte Self-Report Emotional Intelligence Test (SSEIT) (Schutte, Malouff, Hall, Haggerty, Cooper, Golden Dornheim, 1998), and Wong and Laws (2002) leadership-focused measure of EI. Many studies in the literature utilize self-report measures of EI based on mixed model perspective that incorporates both disposition and ability (Chan, 2006). According to MacCann, Matthews, Zeidner and Roberts (2003), mixed model scales vastly outnumber ability tests at the stage of EI development, meaning that EI is more commonly assessed as a disposition, rather than as an ability. Additionally, self-report or peer-report measures require less amount of time to com plete and are most cost-effective than the ability based measure. 2.3.3 Emotional Intelligence (EI) and Nursing There is a large body of knowledge related to EI exists outside nursing whereas EI theory and research within nursing is scarce and a more recent phenomenon (Akerjordet Severinsson, 2007; Smith, Profetto-McGrath Cummings, 2009). Smith et al. (2009) conducted a literature review related to EI and nursing during 1995-2007. Smith et al. found only 21 theoretical and 9 empirical articles related to the subject and concluded that although the body of theoretical literature in nursing is growing, scientific research about EI and nursing is just beginning. Apart from that, researches that link EI and nursing are mostly correlation designs using small sample sizes. Akerjordet and Severinsson (2007) asserted that EI has significant implications for nurses quality of work in healthcare. Therefore some qualitative studies have been conducted to explore the concepts and ideas of EI in nursing (Akerjordet Severinsson, 2004; Freshwater Stickley, 2004; Kooker, Shoultz Codier, 2007; Hurley Rankin, 2008). Akerjordet and Severinsson (2004) used qualitative interviews to gain insight into mental health nurses emotional experiences in practice and sought to understand the connection between nurses articulations of emotions in practice and EI concepts. Four main themes emerged from the study, which include: (1) relationship with the patient; (2) the substance of supervision; (3) motivation; and (4) responsibility which are related to different aspects of EI. For instance, relationship with the patient which was a central research finding is linked to EI through the ability to interpret and communicate emotional information. Akerjordet and Severinsson co ncluded that EI implies important personal and interpersonal skills in nurses therapeutic use of self, critical reflection, and stimulates the search for a deeper understanding of professional nursing identity. Additionally, quantitative studies in nursing have linked EI with coping strategies (Rochester, Kilstoff Scott, 2005; Montes-Berges Augusto, 2007) and burnout (Gerits, Derksen, Verbruggen Katzko, 2005). Montes-Berges and Augusto (2007) investigated links between nursing students EI, coping with stress and success at school or work. They indicated that nursing students who possess EI competencies are more likely to manage the pressures of school and continue throughout the nursing programs. The findings further pointed out a moderate correlation between nurses EI and coping within work-related environments. Another study found a clear link between EI and burnout in nurses measured at two different points in time (Gerits et al., 2005). Gerits et al. conducted a two-year longitudinal study on the EI profiles with 380 nurses working in 56 Dutch residential facilities for people with mental retardation. The fewest symptoms of burnout were reported by female nurses with relatively high EI profiles and relatively low social skills. EI has been identified as important for leaders in healthcare environments (Vitello-Cicciu, 2002; Cummings, 2004; McQueen, 2004). Organizational literature supports the notion that strong leaders who know how to manage emotions within complex healthcare systems is needed and will further benefit patient care, nurses, and organizations (Snow, 2001; Herbert Edgar, 2004; Feather, 2009). Emotionally intelligent leaders use emotionally intelligent skill to recognize the professional and emotional needs of colleagues, establish positive relationships with nurses, motivate passion and dedication in the workplace and ultimately influence patient care practices (Vitello-Cicciu, 2003). In a nutshell, emotionally intelligent leaders secure a commitment for excellence in practice through emotionally intelligent relationships that promote improvements in thinking, critical decision making, and care delivery (Strickland, 2000; Snow, 2001; Goleman, 2005). In summary, EI concept is increasingly recognized and is making an appearance in nursing journals (Cadman Brewer, 2001; Evans Allen, 2002; Freshman Rubino, 2002). The literature revealed EI is important and relevant to nursing from both an empirical and a theoretical perspective. EI influences emotion within caring relationships, quality of care and stress management. Emotionally intelligent leaders influence employees retention, quality of patient care, and pati

Heroes and the Journey Home Essays -- Hero Muir Adams Roosevelt Essays

Heroes and the Journey Home A hero is someone who works to change things toward a certain ideal or succeeds in making change, usually to the benefit of many others besides him or herself. Heroes come in just about every form and almost every group or cause has its heroes. One of the definitions for a hero is that they are someone who is "admired for qualities and achievements and is regarded as an ideal or model."(New World Dictionary, 657) There have been many men and women who I consider to be heroes for the National Parks, because they sought change, preservation, appreciation and protection for our National Parks. Most of the heroes that I have focused on used a form of art or a skill to draw people to want to experience the wilderness, and in turn protect it. These heroes for the Parks include John Muir, Ansel Adams, Theodore Roosevelt, and the many boatwomen of the Canyon Country, particularly Georgie White. All of these heroes sought to establish, preserve or improve the parks, for the benefit of the public, so that anyone could experience and understand the love affair with the wilderness that they so loved. They saw these expanses of raw wilderness, and felt that they should be passed on to and enjoyed by everyone for generations to come. They also sought to educate people by using their own forms of expression and influence such as writings and photographs of these natural treasures. Their motivations were not just in the public interest, but also had more selfish goals in mind. All of these people felt it necessary to fight for the protection of the parks because they had formed intimate bonds with the places that they tried to save. Edward Abbey, yet another hero of the parks, expressed it best by calling it the... ...e in some way they all believed that it is important to find a home for your spirit; that place in your mind must exist, and when you find it, it will seem as though heaven has come to Earth. Works Cited 1. Roosevelt, Theodore. "A Speech at the Grand Canyon." New York Sun 7 May 1903 Taken from Filler, Daniel. "Conservation as the Guardian of Democracy". <http://pantheon.cis.yale.edu/~thomast/essays/filler/filler.html> 2. Abbey, Edward. Desert Solitaire: A Season in the Wilderness. New York: Ballantine Books, 1968 3. Teal, Louise. Boatwomen of the Grand Canyon: Breaking into the Current. Tucson: U of Arizona Press, 1994 4. Library of Congress. "Today in History: July 19". <http://memory.loc.gov/ammem/today/jul19.html> 5. Muir, John. Our National Parks. Madison: U of Wisconsin Press, 1981 6. The New World Dictionary 7. Video: John Muir

Risk Assessment with Relation to Falls in the Home in the Elderly Popul

This assignment will focus on the issue of Risk Assessment with relation to falls in the home in the elderly population. It will discuss the relationship between the community healthcare team and the individual client, the government policies related to the topic, and the influences of health policy upon the provision of community care. The role of the community nurse in public health education and promotion will also be explored. The client, in this particular instance, is Mrs Pugh. She is an 84-year-old female who lives alone since her husband's death 3 years ago. Mrs Pugh has a previous medical history of 'unexplained falls'. Her medical records also highlight the fact she is suffering from osteoporosis and arthritis. Mrs Pugh has recently been discharged home from hospital following surgical repair of a fractured tibia and fibula, the result of another 'unexplained fall' at home. Mrs Pugh has a carer who comes in daily to assist with hygiene, helping Mrs Pugh have a shower each day; she also supports Mrs Pugh with general domestic tasks. It is important to emphasise that the pair of them have developed a very good relationship. Mrs Pugh has always been a fiercely independent lady and doesn't take kindly to any, as she puts it, interference in her personal life. However, the relationship she has with her carer is very important to her. Health promotion is based on theories about what influences peoples' health and then what constitutes an effective intervention or strategy to improve health (Naidoo and Wills 1999). These theories are based on research. Research may be defined as 'any systematic information-gathering activi... ... totally irrelevant to them can lead to time wasting and frustration (Spicer 1982b). The clients' ability to learn must then be ascertained, the nurse must approach the client in a manner appropriate to the client, using language the client will understand. Finally, the nurse should assess the clients' readiness to learn. Luker and Caress (1989) emphasise that the physical and psychological consequences of ill health can affect the learning process. The client's carer and family will also require information, education and support from the nurse to enable them to provide the appropriate support for the client. The nurse may also have to make referrals to colleagues, such as the occupational therapist; so all the information should be available to other health professionals who may be involved in the clients' care.

Critical Analysis on the Context of Multi-agency Team Work

This essay will focus upon a critical incident analysis in the context of multi-agency team work and inter-professional working. The details of the incident will be drawn from the authors recent experience with the Community Housing Support Team, in particular from Care Programme Approach meetings. The names of both clients and staff, as well as details pertaining to their locale have been changed or omitted to comply with the UKCC†s Code of Professional Conduct, Clause 10, (UKCC, 1992). The situation used within this assignment is based upon two clients who co-habit in a first floor maisonette as common law husband and wife. Mr Client has a diagnosis of paranoid schizophrenia which is controlled with xenobiotics and is the main carer for Mrs Client who has a diagnosis of chronic schizophrenia also controlled by xenobiotics that are administered by Mr Client. Mrs Client also has a prolapse of the uterus which causes her to suffer from double incontinence. Arrangements have been made for Mrs Client to have the required operation to repair the problem, however prior to admission Mrs Client becomes very anxious and has twice refused to have the operation. Both clients have a poor dietary intake, poor personal hygiene, high caffeine intake, and a heavy smoking habit. The conditions that the clients are now living in due to the above being ongoing for some time are now less than satisfactory, and to that end the present situation and what should be done about it, has become the primary focus of the various professionals and agencies involved in care of the clients. Each client has their own keyworker representative from the agencies and professionals involved in their care, these are a community psychiatric nurse (CPN), social worker, and a member of the housing support team (HST). Both the clients have home care workers visiting as part of the social work input, and they also share the same general practitioner (GP), and psychiatric consultant. Housing support team input was on a daily basis with both clients and their role was to assist the clients with shopping and encourage the clients to use leisure facilities and local transport. The housing support team although referred to separately within this essay are officially part of the social work team, as this is the source of their funding. The social work keyworkers roles were to visit the clients on a regular basis and to assist with benefits, finances etc, as well as assisting the clients in conjunction with the rest of the care team if a crisis arose. The social work department had also arranged for home help to visit on a regular basis to assist with housework and hygiene. The clients community psychiatric nurse†s role was to monitor medication and mental state. These are the defined roles as the author understands them, however the care team as a whole interchanges, shares, or crosses over roles as a matter of course throughout the care deployment. In order to properly analyse the inter-professional working of the clients care team, it is important to collate the differing aims of each profession involved. Mr and Mrs Client†s keyworkers from the housing support team were of the opinion that the client†s accommodation had reached the stage where it was posing a health risk for both the clients and other residents in the building. Because the housing support team had daily input with both clients they were also able to pick up on various other aspects of care that appeared to require revaluation, such as medication and mental state, and had encountered such an issue with Mr Client giving Mrs Client the incorrect dosage of medication. Taking into account the issues raised the housing support team felt that they were maintaining a poor quality of life for the clients, and that alternative sheltered accommodation, and care approach should be discussed as this was unacceptable. The social work keyworkers in addition to their normal visits had arrangements for further visits outside of the care plan agreement as there was a recognised need for more intense support at this time. It was felt that placement in a nursing home as a couple with continuing input from the housing support team and community psychiatric nurse, would improve the clients quality of life. The clients general practitioner and consultant had made a referral to residential services. Both clients community psychiatric nurse felt that the clients mental state did not warrant an admission into hospital, however further arrangements should be made regarding medication and accommodation. These various agencies and professionals come together, in this case every six months, to partake in a care programme approach meeting (CPA). The care programme approach was first considered in nineteen eighty-nine then again in nineteen ninety in a Department of Health circular, before being implemented in nineteen ninety-one as an official guideline. However inter-collaborative working has been an aim of government policy in mental health services since the nineteen seventies, (COUCHMAN, 1995). Its target group being psychiatric clients in hospital, community or other specialised mental health service. The aim of the guidelines were to encourage greater efficiency and co-operation between the various agencies and professionals involved in the care of a client or clients. This was to be done by systematically assessing all the clients needs and the agency or profession that could best meet those needs, the appointment of a keyworker from one of the agencies or professions involved, to reach agreement between the carers involved and the client, and then to implement, monitor and set regular review dates, (COWART & SEROW, 1992), In addition to the care plan approach meetings there is almost daily interaction between the agencies and professions involved. In addition to this there are meetings within each individual agency or profession, usually on a weekly basis, concerning the most appropriate delivery of care within the role of the individual agency or profession. The diagram in Appendix A shows the ways that clients enter the psychiatric services, and where inter-professional collaboration happens, it also shows that this care team is a hybrid parallel pathway team. Efficient inter-professional collaboration exists only where there is good group dynamics and working relationships, both within the care team and within the government who†s laws and guidelines that care team follows. However when reviewing the history of British social policy it is easy to become pessimistic, Webb, (1991) points out, â€Å"exhortations to organisations, professionals and other producer interests to work together more closely and effectively litter the policy landscape, yet the reality is all to often a jumble of services fractionalised by professional, cultural and organisational boundaries and by tiers of governance†. In order to overcome these problems they must first be identified and then strategies devised to overcome them. Whilst in the community with the housing support team the author observed that the main problem or cause of problems was communication, whilst ironically, most if not all of the problems encountered could have been avoided or solved more efficiently with effective communication. However the author feels this may be viewed by many as an over-generalisation, and so will break this down further into some of the ‘sub† problems. A key difficulty is that working together appears to be the logical way forward, yet it is the authors experience that little consideration is given to the effects of such an activity, (CARLING, 1995). From an agencies or professions point of view collaborative activity raises two main difficulties first it looses its freedom to act independently when it would prefer to maintain control over its domain and affairs. Second, it must invest scarce resources and energy in developing and maintaining relationships with other organisations, when the potential returns on its investment are often unclear or intangible, (HUDSON, 1987). The main sources of conflict within an organisation and inter-professional collaboration are communication, power, goals, values, resources, roles and personalities. As mentioned previous a major source of conflict is the misunderstanding or breakdown of communication. However communication can also be used as a tool for clarifying opposing views. It is the authors observation that most values within an organisation are internalised and are therefore difficult to change, but they can be clarified through communication so as not to become a barrier. This kind of logic is a skill that can only be learnt through the application of common sense and the wisdom of experience, (BILLIS & HARRIS, 1996). Conflict situations often arise suddenly, the author has observed that the more people that attend a meeting or that are involved in a decision regarding care organisation the more potential there is for conflict to occur. Power causes conflict when there are relationships within organisations between individuals of unequal power, the classic example being the doctor/patient relationship, or the nurse and the consultant. This can cause additional conflict where there are differently structured organisations working together as the power differences between individuals then become unclear. For example the power relationship between the community psychiatric nurse and the social worker. Another common cause of conflict is different goals, different methods of reaching those goals, different values, unclear or overlapping designation of responsibilities, lack of information and personality conflicts. It is acknowledged within health care that some conflicts can not be resolved, Mallory, (1981) states that unresolved conflicts need to be managed carefully within any work group in order to balance the level of conflict. Banton, (1985) remarks that the essential point is that conflicts of interest are of fundamental importance in all major areas of life in our society and therefore full consensus is only possible when people are prepared to restrict themselves to the trivial. Conflict in an open environment can be beneficial to the work environment as when handled in a mature and professional manner conflict can lead to creativity, innovation or growth, however if to much energy is expended in non productive activity then conflict becomes destructive. It is the authors opinion that conflict is an inherent part of the nursing and general health care culture, and that psychiatric nurses in the community are prime candidates for this because of the need to work collaboratively with people both professional and non professional of varying social, ethnic and educational backgrounds. Collaboration suggests that the combined power of the agencies or professions is distributed evenly, yet nurses are employed in a hierarchical system. Huber, (1996) suggests that nurses find that working in groups creates a situation in which there are a number of different colleagues and a variety of client types and different personalities to work with, these are complex interrelationships, and added to that complexity is the fact that there are multiple providers requiring co-ordination and communication to manage the care for any client. Within healthcare as a whole there is an interdependence between its members. The multi-disciplinary team breaks down into multiple care providers each relying on the other to carry out a portion of the work. For example a member of the housing support team can not monitor a clients medication if the clients community nurse has not organised the Doset box from the pharmacy. The source of conflict can be organisational, interpersonal or a combination of both. Personal and organisational goals and values may also be in conflict with or over general policies, a general policy being the course of action taken by an institution, department or unit. Policies in the main are meant to soothe conflicts over specific issues, they are designed to give about standard ways to make decisions in recurring situations. However different people within the care team may approach situations with differing viewpoints on how to best deal with certain issues, differences may occur over such things a clerical or managerial routines, or over record keeping and information sharing. Clashes may result at the intersection of a nurses professional judgement as an autonomous professional with standardised policies developed by the institution and designed to produce uniform behaviour, (AJN, 1987). Resource allocation comes under organisation issues and is especially important in the case of Mr and Mrs Client as the general consensus is that sheltered accommodation of some description is required, which inevitably will require funding. Budgeting has caused conflict over scarce resources within organisations. In the case of Mr and Mrs Client the funding for the accommodation should come from the social services department. Power conflicts can be both organisational and interpersonal and result in role conflicts. Role conflicts have been identified as being of two types, role overload and role ambiguity. Role overload is when a carer is expected to perform the work of other employees or disciplines in addition to providing their normal care tasks. Whereas role ambiguity is when the role and responsibilities of the carer expands faster than is officially recognised, (JOHNSON, 1994). To assist in making interprofessional collaboration joint working recommendations such as those stated in Building Bridges, (1996) have been suggested these include commitment on all levels of care approach and delivery, to maintain a primary focus on the service users, jointly owned or shared strategies for care of people with severe mental health problems, agreed procedures for access to services, agreed procedure for information exchange, clarification of roles and responsibilities and regular reviewing of interprofessional dynamics. vretveit, (1997) states that UK policy in the nineteen nineties has asked the question, what is wrong with the service? Rather than what problems need tackling in the outside world. In future it should re-focus on how partnerships between the users of the service, professional workers and managers can be achieved, in other words how can we make an integrated service truly democratic? The solutions to nearly all the crisis encountered by the care team can be or could have been solved or at least minimised through the effective use of communication. It is felt that it would also be important in interprofessional collaboration to have shared values and cultures, while a mismatch along these lines between health and social services has been well documented. (SMITH, 1993). Collaboration is the basis for team building and with the changes to healthcare, work redesign, restructuring and reengineering depend on effective collaboration, co-operation and group accomplishment. Proactive conflict resolution in work groups is the essence of building successful teams which are flexible and adaptable, and have a high degree of trust and communication. Therefore the ingredients for successful interprofessional collaboration may be a common goal, interdependence, co-operation, co-ordination of activities, task specialisation and therefore role clarity, equal division of effort and mutual respect. Team building is defined as being the deliberate process of creating and unifying a group into an effective functioning work unit to accomplish specific goals, (FARLEY & STONER, 1989). In conclusion, collaboration has been called the most effective strategy for managing conflict to achieve long term benefits. However a wide differential in power (both felt and actual), exists between nurses, social workers, and consultants, and this hinders effective collaboration. Therefore with wide differences in power the most commonly used techniques seem to be compromise and accommodation. There are indications however that this is changing as the health service as a whole is and has undergone some major changes with the implementation of the care plan approach, care management and the formation of community teams such as housing support and community support teams, and as a result effective interprofessional collaboration could soon become more commonplace. (BALDOCK, 1974).

Mythic proportions Essay

Linton Heathcliff is a contradiction in terms. His name signifies the unnatural union between Heathcliff and the Lintons or between passion and convention and his sickly nature demonstrates the impossibility of such a union. In Linton both love and convention emerge as corrupted by each other. He is described as ‘a pet’, a ‘puling chicken’ and a ‘whelp’. Like both his parents, however, Linton’s view of the world is singular, and it is his inability to see it in any way but his own terms which renders him absolutely available for manipulation by Heathcliff. Hareton Of his generation, Hareton’s character is perhaps the most intriguing, reversing the comparative lack of interest we feel for his father, Hindley. Hareton is brutalised by Heathcliff, structurally repeating Heathcliff’s own suffering at the hands of Hindley. Hareton’s relationship with Cathy has similarly been read as mirroring Heathcliff’s with Catherine, in as much as he is desirous of impressing her, and he is proud in her presence. His love of Cathy, however, might be said more closely to resemble Edgar’s love of Catherine in as much as it is moderate yet tender, devoted yet restrained. Hareton also exhibits an unwavering love for Heathcliff, in spite of the ill-treatment he has received at his hands. Like Catherine, Hareton is constant in his initial affections, and when Heathcliff first arrives into his life they form an alliance against Hindley. Although Hareton’s name is inscribed above the door of Wuthering Heights, his inability to read, coupled with the repetitious doubling of names and signatures, means that he fails to inherit his rightful property. Hareton is dispossessed by Heathcliff, but can also be seen as a rewriting of Heathcliff, a surrogate or symbolic Heathcliff. The development of Hareton’s characterisation revolves around his education. He is initially nursed by Nelly, the novel’s surrogate mother, and under her tuition he begins to learn his letters. However, left to the ministrations of his dissolute and unpredictable father Hindley, Hareton grows wild and uncultivated, unable to read, and with no social skills. His attempts at self-improvement are the source of mockery and derision by Linton and Cathy, and it is not until the end of the novel that he is able to acquire the skills necessary for him to achieve social status with Cathy and come into his rightful inheritance. The domestic romance which typifies the final union between Cathy and Hareton may well resolve some of the conflicts that thwart the other relationships in the novel, but their union lacks the grand passion, the wild power of the original love between Catherine and Heathcliff. Cathy Structurally the second Cathy can be seen as revising her mother’s story. She achieves her identity at the price of her mother’s, and Edgar always differentiates her in relation to the first Catherine, whose name he never diminished. Unlike Linton, who has the misfortune of inheriting the worst of both his parents, Cathy appears to have inherited the best from both of hers. Nelly sees Lockwood as a possible escape route for Cathy should he be induced to fall in love with her. We are privy to reports of Cathy’s pride, and her insensitive mockery of Hareton’s lack of formal knowledge. The revolution of the novel in which she and Hareton form their attachment is something of a mythical resolution, a romantic conclusion which transcends the central conflicts of the novel to restore a traditional novelistic plot of courtship and marriage. Cathy and Hareton’s relationship restores to the novel and version of domestic bliss that was the Victorian ideal, but it is well to bear in mind that Bronte’s is a version in which Cathy clearly has the upper hand. Nelly Nelly Dean is the second and dominant narratorial voice in this novel. She takes up the story from Lockwood and gives it both substance and credence. Lockwood’s inability to read the signs of the culture in which he finds himself cannot sustain the story, though it acts to remind us that all narratorial voices, including Nelly’s, are partial. Nelly Dean is a local, and has known each generation of the Earnshaw and Linton families. She is therefore well-placed to offer Lockwood a commentary upon the events she describes. Her position of servant is differentiated from that of that of other servants, both in terms of the fact that she appears to move effortlessly between the two houses, mediating between their differences, and in terms of her voice. Nelly Dean does not share a regional dialect with the other servants but she understands it perfectly. She also emerges as an educated woman, having read most of the books in the library at Thrushcross Grange – the house of culture – and in having experienced the vicissitudes of Wuthering Heights – the house of nature. In keeping with her dual roles, Nelly has two names, Ellen, her given name which is used by those wishing to accord her respect, and Nelly, the name her peers and familiars employ. Nelly is one of the most interesting characters in this novel, not least because of the language she uses. She occupies a unique cultural position in this novel. She has access to a range of discourses that might be considered beyond her ken in terms of her position as a family servant; yet as the central narrator Bronte presents her as a speaking subject, partially excluded from culture but nonetheless positioned so as to be able to comment upon it. Nelly acts as a surrogate mother to many of the motherless characters in this novel: she brings up Hareton for the first five years of his life; she cares for Cathy from birth through to her marriage to Linton; she regrets the brevity of her charge of Linton, which is forced by circumstance; and she acts as confidant and advisor to Catherine and Heathcliff. She also acts as a mother-figure to Lockwood as she nurses him back to health. As surrogate mother Nelly provides food and moral sustenance to her nurslings. Nelly Dean is most carefully, consistently and convincingly created for us as the normal woman, whose truly feminine nature satisfies itself in nurturing all the children of the book in turn. This reading of Nelly as the mother-figure alerts us to another of her roles, for Nelly is a mother goose, the teller of this fairytale, the keeper of its wisdom. The name might also be a corruption of Mother Gossip. Both of these definitions are pertinent to the figure of Nelly, since the knowledge she conveys is at least twofold: it is about women’s experience, and it is about the nature of love. Nelly knows that her story has to entertain and ensnare us. Yet her voice is rooted in the realist narrative. With her love of a well-brushed hearth and gleaming copper pans, Nelly weaves for us a fairy tale of mythic proportions. Given our narrator’s sympathies we are inevitably drawn to the novel’s celebration of passion, and find the strictures of its dominant discourses of marriage and religion as stifling and incomprehensible as do its main protagonists.