Marketing related Essay Example | Topics and Well Written Essays - 500 words

Marketing related - Essay Example Be it professionals or lay people, all are subject to unwanted intrusions as a result of this phenomena. Even if the user follows stringent security measures and installs software to set parental controls, perform regular disk clean-up and remove temporary internet files on a regular basis, cookies can still record and disclose confidential personal/business information to marketers. For some business enterprises, such â€Å"leakage† of strategic information could deprive them of competitive edge. If professionally managed business corporations are at risk, then the individual user (who in most cases is not a computer expert) is even more vulnerable. Sadly though, the cookie aided internet marketing practice has now become a multi-million dollar industry. Needless to say, exploiting gullible internet users in order to increase profits does not meet even the basic ethical standards. In spite of all the justifications that the marketers provide in favor of this practice, spying on unsuspecting customers of a competitor in order to target advertisements at them is not at all ethical. These unethical marketers are not the only ones spying on internet users. A few online companies discreetly distribute viruses such as Trojan horses into the computer hardware, which then sends back the gathered personal information data to the home source. Also, the majority of the cookies that internet users download into their personal computers are innocuous if not actually helpful in making browsing easier. The ease of use can be discerned when the user reopens an already exited website. But this fact is taken advantage of by unethical marketers to maximize their profits at the cost of individual privacy. When it comes to sly marketing practices such as the employment of cookies, the whole enterprise is ethically wrong. To defraud, deceive, abuse, exploit, damage or take from innocent consumers is what this practice

Managerial cost Essay Example | Topics and Well Written Essays - 500 words

Managerial cost - Essay Example Under Average cost method, an average cost is calculated for all units, and this average cost is assigned to all the units remaining in ending inventory and cost of sales for units sold. 'To determine average cost, divide the total number of units available for sale into the total purchase cost for the period of time under examination.'(James o Gill, Moria Chatton, page 46)2 For a company using periodic inventory system, the method is referred to weighted average; and where a perpetual inventory system is in use, this method is called moving average method. As costs are averaged out before applying to ending inventory, the material costs under inflation is not very near to market prices but a lower than that because of the effect of earlier purchases in averaging out. LIFO means last in first out and under this method the prices at which merchandise was most recently purchased are used to determine the amounts charged to cost of goods sold. LIFO assumes that 'goods are all the same and interchangeable.'(Peter J Eisen, page 322)3 Ending inventory is valued using the prices associated with the units acquired the earliest. As a result, cost of goods sold computed under LIFO most closely approximate current cost. During inflation LIFO will result in lowest value for ending inventory and highest amount of goods sold and the lowest amount gross profits and net income. The person requesting the goods p

Organizational Development By Training And Development Management Essay

Organizational Development By Training And Development Management Essay Training and Development, On the Job Training, Training Design and Delivery style are four of the most important aspects in organizational studies. The focus of current study is to understand the affect of Training and Development, On the Job Training, Training Design and Delivery style on Organizational performance. The back bone of this study is the secondary data comprised of comprehensive literature review. Four Hypotheses are developed to see the Impact of all the independent variables on the overall Organizational Performance. The Hypotheses show that all these have significant affect on Organizational Performance. These Hypotheses came from the literature review and we have also proved them with the help of literature review. Results show that Training and Development, On the Job Training, Training Design and Delivery style have significant affect on Organizational Performance and all these have positively affect the Organizational Performance. It means it increases the overal l organizational performance. We also prove our Hypothesis through empirical data. However, results are strongly based on the literature review. KEYWORDS: Training and Development, On the Job Training, Training Design, Delivery style, Organizational Performance. INTRODUCTION Training has the distinct role in the achievement of an organizational goal by incorporating the Interests of organization and the workforce. Now a days training is the most important factor in the business world because training increases the efficiency and the effectiveness of both employees and the organization. The employee performance depends on various factors. But the most important factor of employee performance is training. Training is important to enhance the capabilities of employees. The employees who have more on the job experience have better performance because there is an increase in the both skills competencies because of more on the job experience .Training also has impact on the return on investment. The organizational performance depends on the employee performance because human resource Capital of organization plays an important role in the growth and the organizational performance. So to improve the organizational performance and the employee performance, training is given to the employee of the organization. Thus the purpose of this study is to show the impact of training and the design of training on the employee performance. Training development increase the employee performance like the researcher said in his research that training development is an important activity to increase the performance of health sector organization .Another researcher said that employee performance is the important factor and the building block which increases the performance of overall organization. Employee performance depends on many factors like job satisfaction, knowledge and management but there is relationship between training and performance .This shows that employee performance is important for the performance of the organization and the and the training and development is beneficial for the employee to improve The main objective of our study is how the training increase the employee performance. Training increase or develop the managerial skills. despite focusing on efficiency and cost control the spending on training should increase because organization get more efficiency , effectiveness out of the training and development .This shows that training increase the efficiency and the effectiveness of the organization. I think people are talking more about performance and results and consequences. They are not necessarily doing more about it. From this it is clear that training and development is the important factor. So the significance of our study is that the training improves performance. Thus the purpose of this study is to show the impact training development on the employee performance. Results are strongly based on the literature review. Results show that Training and Development, On the Job Training and Training Design and Delivery style have significant effect on Organizational Performance and all these have positively affect the Organizational Performance. Training is important for the backbone of every organization and it is also the main resource of the organization. So organizations invest huge amount on the human resource capital because the performance of human resource will ultimately increase the performance of the organization. Performance is a major multidimensional construct a imed to achieve results and has a strong link to strategic goals of an organization .As researcher explains that performance is the key element to achieve the goals of the organization so to performance increase the effectiveness and efficiency of the organization which is helpful for the achievement of the organizational goals. But the question arise that how an employee can work more effectively and efficiently to increase the growth and the productivity of an organization. There are many factors which improves the work of the employee such as flexible scheduling, training etc. It is very necessary for the organization to design the training very carefully. The design of the training should be according to the needs of the employees. Those organizations which develop a good training design according to the need of the employees as well as to the organization always get good results. It seems that Training design plays a very vital role in the employee as well as organizational per formance. A bad training design is nothing but the loss of time and money. On the job training helps employees to get the knowledge of their job in a better way. It is cost effective and time saving. It is good for organization to give their employees on the job training so that their employees learnt in a practical way. Delivery style is a very important part of Training and Development. Employees are very conscious about the delivery style. If someone is not delivering the training in an impressive style and he is not capturing the attention of the audience it is means he is wasting the time. It is very necessary for a trainer to engage its audience during the training sess. Delivery style means so much in the Training and Development. It is very difficult for an employee to perform well at the job place without any pre-training. Trained employees perform well as compared to untrained employees. It is very necessary for any organization to give its employees training to get overall goals of the organization in a better way. Training and development increase the overall performance of the organization. Although it is costly to give training to the employees but in the long run it give back more than it took. Every organization should develop its employees according to the need of that time so that they could compete with their competitors. LITERATURE REVIEW Human resource is the very important and the People learn from their practical experience much better as compare to bookish knowledge. On the job training reduces cost and saves time. It is better for the organizations to give their employees on the job training because it is employees development and the employee development encourage self-fulfilling skills and abilities of employee, decreased operational costs, limits organizational liabilities and changing goals objectives THEORETICAL FRAMEWORK To implement the study following dependent and independent variables are shown in the theoretical HYPOTHESIS DEVELOPMENT Hypothesis development is very important because acceptance and the rejection of hypothesis show the significance of the study. On the basis of literature review and above theoretical frame work we came to develop following hypothesis. In the training development organizational performance is also affected by the training design. Therefore our first hypothesis is: H1: Training design has significant effect on the organizational performance. To increase the knowledge and skills in the job training is given to the employees therefore our second hypothesis is: H2: On the job training has significant effect on the organizational performance. During training development the delivery style of the person who is giving the training also affects the organizational performance so our third hypothesis is: H3: Delivery style has significant effect on the organizational performance. By combining the above mentioned hypothesis our fourth hypothesis is: H4: Training development has significant effect on the organizational performance. METHODOLOGY The study sample comprised of 100 employees of different organizations of Islamabad, capital of Pakistan. The sample is mixed like both male and female. The data is collected through a questionnaire consists of 15 questions. All questions are close ended questions with the use of a five point Likert scale consisted of strongly disagree, disagree, neutral, agree and strongly agree. All questionnaires were distributed and collected by hand from the offices of the organizations in the office timings. Ninety five questionnaires were collected after one weak. 95 of them gave the response to our questionnaire. After checking them 79 were found correct and the respond rate was 83%. These 79 questionnaires were included in the study. The analysis of the questionnaire was undertaken using Statistical Package for Social Sciences (SPSS). All mean and medians were calculated using SPSS. Descriptive statistics was used to determine the independent variables and to conclude the results on the basis of secondary and primary data. Most of the results consist of secondary data. DISCUSSION It is very necessary for the organization to design the training very carefully. The design of the training should be according to the needs of the employees. Those organizations which develop a good training design according to the need of the employees as well as to the organization always get good results. It seems that Training design plays a very vital role in the employee as well as organizational performance. a bad training design is nothing but the loss of time and money . All these results prove our first Hypothesis which is H1: Training design has significant effect on the organizational performance. And it has a positive effect on the organizational performance. It improves the organizational performance. As we see in the table that most of the means are in between the bracket of 4-5 and 3-4, it means that most of our respondents think that Training Design has significant affect on the organizational performance. This also proves our first hypothesis which is; H1: Training design has significant effect on the organizational performance. If we see the z-test value it lies in the critical region. It means the data and the results are significant of our first hypothesis. On the job training helps employees to get the knowledge of their job in a better way. People learn from their practical experience much better as compare to bookish knowledge. On the job training reduces cost and saves time. It is better for the organizations to give their employees on the job training because it is cost effective and time saving. It is good for organization to give their employees on the job training so that their employees learnt in a practical way. All these results prove our second Hypothesis which is H2: On the job training has significant effect on the organizational performance. And it has a positive effect on the organizational performance. It improves the organizational performance. As we see in the table that most of the means are in between the bracket of 4-5 and 3-4, it means that most of our respondents think that On the Job Training has significant affect on the organizational performance. This also proves our second hypothesis which is; H2: O the job training has significant effect on the organizational performance. And it has a positive effect on the organizational performance. It improves the organizational performance. . If we see the z-test value it lies in the critical region. It means the data and the results are significant of our second hypothesis. Delivery style is a very important part of Training and Development. Employees are very conscious about the delivery. If someone is not delivering the training in an impressive style and he is not capturing the attention of the audience it is means he is wasting the time. It is very necessary for a trainer to engage its audience during the training session. Delivery style means so much in the Training and Development. All these results prove our third Hypothesis which is H3: Delivery style has significant effect on the organizational performance. And it has a positive effect on the organizational performance. It improves the organizational performance. As we see the results some of the respondents disagree with the term that Delivery style has a significant effect on organizational performance. But most of the respondents lie between the brackets of 4-5. So if we consider the majority. The majority of our respondents say that delivery style is very important in the training. And it has a positive effect on the organizational performance. It improves the organizational performance. . If we see the z-test value it lies in the critical region. It means the data and the results are significant of our third hypothesis. It is very difficult for an employee to perform well at the job place without any pre-training. Trained employees perform well as compared to untrained employees. It is very necessary for any organization to give its employees training to get overall goals of the organization in a better way. Training and development increase the overall performance of the organization. Although it is costly to give training to the employees but in the long run it give back more than it took. Every organization should develop its employees according to the need of that time so that they could compete with their competitors. All these results prove our fourth Hypothesis which is H4: Training development has significant effect on the organizational performance. And it has a positive effect on the organizational performance. It improves the organizational performance. As we see in the table that most of the means are in between the bracket of 4-5, it means that most of our respondents think that Training and Development has significant affect on the organizational performance. This also proves our fourth hypothesis which is; H4: Training development has significant effect on the organizational performance. . If we see the z-test value it lies in the critical region. It means the data and the results are significant of our fourth hypothesis. MANAGERIAL IMPLICATIONS Training and development is very important for an organization to compete with this challenging and changing world. Training and development is basically directly related to employee but its ultimate effect goes to organization because the end user is organization itself. This study will help organization to understand the importance of Training and Development. It will also help organization to understand which factors are important to keep in mind during the training and how a good training can be delivering to their employees. It will help them to understand that it is very necessary for them to give training to their employees so that they could perform the assign task in a better way. RECOMMENDATIONS In this research we review a lot of materials related to the variables used in this research and at the end we also proved our hypotheses. In the light of all this research and all the material which is being used to conduct this research and all the literature review we came to the decision that there should be Training and Development in every organization. Although we have review some disadvantages like it is costly to give training to the employees, but the advantages of Training are much more than its disadvantages which are briefly discussed in this study. We recommend that all organizations should provide Training their employees. We already have discussed that Training and Development have advantages not only for employee but the ultimate benefit is for the organization itself. If the performance of the employee is not good it will affect the whole organization. CONCLUSION Training and Development has positive effect on Organizational Performance. Discussion of all the results proves the hypotheses; H1: Training design has significant effect on the organizational performance, H2: On the job training has significant effect on the organizational performance, H3: Delivery style has significant effect on the organizational performance and H4: Training development has significant effect on the organizational performance. All these have positive effects on the Organizational Performance. It improves the Organizational Performance. On the Job Training is very effective and it also saves time and cost. Training and Development, On the Job Training, Training Design and Delivery style have significant effect on Organizational Performance and all these have positively affect the Organizational Performance. It means it increases the overall organizational performance. FUTURE STUDY Primary data is not collected; the study only depends on secondary data. Study can be conduct on different departments of the organizations that which department needs more training and development. Study focus on gender can also provide different results and one can conduct a study on different types training and development programs. REFRENCES 1. Stone R J. (2002), Human Resource Management 2nd Edition, Jhon Wiley Sons 2002. 2. Fakhar Ul Afaq, Anwar Khan (2008), Case of Pearl Continental hotels in Pakistan, Relationship of training with Employees Performance in Hoteling Industry. 3. Richard Chang Associates, INC., Measuring the impact of traning, demonstrate the measureable results and return on investment. 4. Iftikhar Ahmad and Siraj ud Din,Gomal Medical College and Gomal University, D.I.Khan,Pakistan(2009),EVALUATING TRAINING AND DEVELOPMENT 5. Chris Amisano, (2010), eHow contributer Relationship between traning and employee performance. 6. Robart T.Rosti Jr, Frank shipper, (1998), A study of the impact of traning in a management development programm based on 360 feedbacks. 7. Workforce.com, (May 22, 2006), Special report: Traning and Development). Roger Kaufman-FloridaState University Donald Nickels,M.A,(2009), http://blogs.payscale.com/compensation/2009/09/ef fects-of-training-on-employee-performance.html 8. Michael Armstrong. 2000. Understanding training. Human Resource Management Practice. 8th Edition. Kogan page limited, London. pp:543 9. Mark A. Griffin. Andrew Neal.2000. Perceptions of Safety at Work: A Framework for Linking Safety Climate to Safety Performance, Knowledge, and Motivation. Journal of Occupational Health Psychology Vol. 5(3), pp:347-358 10. Phillip Seamen .Anita Eves. 2005. The management of food safety-the role of food hygiene training in the UK service sector. International journal of hospitality management Vol. 25(2), pp: 278-296 11. Thomas N. Garavan. 1997. Interpersonal skills training for quality service interactions Industrial and Commercial Training Vol. 29 (3) ,pp:70-77 12. Carlos A. Primo Braga.1995. The Impact of the Internationalization of Services on Developing Countries. Article based on a World Bank report, Global Economic Prospects and the Developing Countries Washington. Retrieved from http://www.worldbank.org/fandd/english/0396/article s/070396.htm 13. Ginsberg, L.1997. Training for the long haul. Computer Shopper. Vol: 17, p: 4 14. Tsaur, S.H., Lin, Y.C.2004. Promoting service quality in tourist hotels: the role of HRM practices and service behavior, Tourism Management, Vol. 25 pp.471- 15. Flynn, B.B., Schroeder, R.G., Sakakibara, S. 1995. The impact of quality management practices on performance and competitive advantage, Decision Sciences, Vol. 26 pp.659-91 16. Tom Baum. Frances Devine. 2007. Skills and training in the hotel sector: The Case of front office employment in Northern Ireland. Tourism and Hospitality Research Vol: 7, pp: 269-280 17. Shepard, Jon Robert W. Greene. 2003. Sociology and You. Ohio Glencoe McGraw-Hill. 18. Ruth Taylor, Doug Davies. 2004. Aspects of training and remuneration in the accommodation industry. Journal of European Industrial Training. Vol: 28(6), pp:1-2. 19. Partlow, C.G. 1996. Human-resources practices of TQM hotels, Cornell Hotel Restaurant Administration Quarterly, Vol. 37 No.5, pp.67-77 20. Deming, W.E. 1982. Quality, Productivity and Competitive Position, MIT Center for Advanced Engineering, Cambridge, MA.

Plasma: The Power of the Sun :: physics science plasma fusion energy

As we enter the 21st century the average human's life is dictated by the production and quantity of energy. This energy is produced in many different forms, from fossil fuel to hydro and solar power. Though this production of energy has sufficed up till now, a realization has occurred that the depletion of our current sources is imminent. As a result of this energy crisis, a race to find an alternative energy supply has been put forth. Through plasma fusion's nearly inexhaustible supply of fuel, its lack of greenhouse gases and the amazing spin-off technologies that have developed through plasma research, it is the answer to the current energy crises. Fusion To understand the technology behind plasma fusion, fusion itself must be understood. Fusion is the combining of two or more atoms of low mass, which are initially attracted to each other, to form one atom of greater mass. When two atoms combine to form a single atom, they have fused. This fusing releases a large amount of energy with respect to the amount of mass and energy that was initially put into the reaction. This combination releases energy in the form of light and heat. Energy is created in a fusion reaction through the loss of atomic mass from the beginning to the end of the reaction. The mass of the two atoms is significantly more than the mass of the new atom, which they fused together to form. This loss of mass is subsequently converted into pure energy in the form of light and heat. The reason for this amazing discovery is that mass is just a concentrated form of energy. This understanding between the relationship of mass and energy was discovered by Albert Einstein and illustrated in his famous equation E=mc^2, where E is energy, m is mass, and c is the speed of light. Through this equation the amount of energy held within a mass can be determined. In a plasma fusion reaction between two hydrogen atoms the decrease in mass is about 4x10^-29 kg. This mass is then converted to energy, equaling 23.9 MeV. "To appreciate the magnitude of this result note that if 1g of [hydrogen] is converted to helium, the energy released†¦ would be worth abou t $70,000" (Physics for scientist and Engineers 1276). Fission In a fission event an example of a reaction at an atomic level is an (A)tomic-bomb. The A-bomb harnesses the power of an atom through an uncontrolled reaction.

Nursing Care Plan & Basic Conditioning

COMMUNITY COLLEGE DEPARTMENT OF NURSING CLINICAL ASSESSMENT TOOL Subjective Data (Basic Conditioning Factors) Student: Date of Care: 10/03/09 Patient’s Initials: P. V. Age: 37 Room #: 3114 Bed 1Allergies: Food: NKA Gender: FMedications: NKA Environmental: NKA Admitting Diagnosis: Pancreatitis Developmental Stage (Erickson and Havinghurst): (List Developmental stage and tasks, assess each task) 1. Selecting a mate: Although patient is single, she has many friends. Patient was happy to introduce her friends that came to visit. Introductions were all made as friends, no boyfriend or husband mentioned. 2. Starting a family and raising children: Patient is not interested in these aspects of life. Patient is more concerned over her friends and their activities that they do together. 3. Managing home: While the patient lives alone, she would prefer to have a roommate to share housekeeping tasks and rent. 4. Taking civic responsibility: Patient is not interest in helping out community. 5. Starting occupation: Patient has been a Title Researcher for two years, she claims that it is just a job to pay the bills. 6. Finding congenial social group: Patient claims that she has a tight group of friends that she enjoys going out with. While the patient was agreeable, she wanted to be left alone. The Erickson stage that the patient is in is adulthood; Intimacy vs. Isolation. I find that Miss F. V. to be in isolation, developmentally. She wanted no socialization from myself, lives alone, and works alone. She is not actively looking for a mate and was demanding to have her door shut my entire shift, which was the norm since she was admitted 20 days ago. History of present illness: On 9/13/09 patient presented with severe ABD pain in ED. A computed tomography Scan (CT-Scan) of the abdomen and pelvis with contrast was performed; showing severe pancreatitis with prominent pancreas demonstrating significant edema. Moderate to large amounts of ABD ascites demonstrating simple fluid attenuation was noted. Peritoneal enhancement was predominantly noted within the left ABD, reflecting significant peritonitis. No bowel obstruction was noted and pancreatic necrosis was not excluded. Moderate bilateral pleural effusions were also noted. Past medical history : Irritable Bowel Syndrome Anxiety Depression Cocaine use (1998) Smoker Past surgical history: none Medications: Drug NameDoseRoute FrequencyClassification Metoprolol Tartrate50mgPO q12hAntihypertensive Enoxaparin Sodium40mgSQ dailyAnticoagulant Esomeprazole Mag Trihy40gmPO dailyAnti-ulcer Hydromorphone hydr2mgPO PRN Opioid Analgesic Ergocalciferol800int unitsPO daily Vitamin Complementary/Alternative Medical Practices Herbal Remedies: None Vitamins/Minerals: Daily multivitamins Meditation/Yoga: None Massage: None Acupuncture/Acupressure: None Aromatherapy: None Other: None Health Care Systems (Current orders and role of health care members): Low fat diet IV [email  protected]/hr q24h Double Lumen PICC line Left AC CBC OOB Sociocultural / spiritual orientation: none Family system: Patient has family support, however lives alone in a walk up apartment. Patterns of Living: A. Employment: Title Researcher B. Education: Some college C. Hobbies / interest: None D. ETOH / drug use: Social only Environment (Conditions of living and working): Client lives alone, although the answer changed from 9/13/09 to 9/14/09 to lives with a friend. Family is supportive. Friends are supportive. Available Resources (Economic, personal, agencies): Primary Insurance: Primary Insurance is a HMO with BlueCross BlueShield. Objective Assessment of the USCR's Pt: F. V. Room 13314 Bed 1 Jennifer Hughes Please use Y, N, NA to indicate Yes, No or Not Applicable Day 1Day 2Additional Data Psychosocial Solitude v. Social Interaction or Normalcy Well groomed/Good hygieneY Appropriate/Full range affect Y Maintains eye contactN Calm moodN Cooperative attitudeY Able to concentrateY Clear speech (volume/tone) Y Psychomotor retardation N Tics/Tremors N Hyperactivity/Restlessness/Agitation N Hallucinations/Illusions N Suicidal/Homicidal Ideations N Activity/Rest Well-rested N FatiguedN Slept through night N Neuromuscular (prevention of hazards) Alert and oriented Y Times 3 Gait steady Y Hygiene independentN Refused AM care Primary notified Pain free NDilaudid 2mg given @ 6am by primary Hand grasp, strong and equal bilat Y Foot push, strong and equal bilat Y Smile symmetrical Y Tongue to midline Y PERL Y Meets developmental task Y Cardiovascular (air or water) Palpable pedal pulses bilaterally Y Oral mucosa pink Y Conjunctiva pink Y Capillary refill within 2 seconds Y Absence of edema Y Apical/radial regular rhythm YRate= 94 Blood pressure YBP= 86/60 primary notified Telemetry Y Integument (prevention of hazards) Temperature YTemp= 98. 0 Skin turgor WNL Y No tenting noted Skin warm to palpation Y Cool to touch Skin intact Y Incisions N Wounds N Day 1Day 2Additional Data Respiratory (air) Resps easy and even Y Lungs clear Y Secretions N Oxygen in use N Oxygen saturationY 98 Cough and deep breathe N Chest tubesN Gastrointestinal (Food or Elimination) Abdomen softY Tender to the touch Abdomen non-distended Y Bowel sounds presentYAll 4 quads Abdominal drainsN Stomach tubesN Bowel movementN Nausea/vomiting N Feeds selfY Breakfast (% consumed) 50% Lunch (% consumed) 75% Dinner (% consumed) Tube feedingN IV solution (type and rate) YTPN @83cc/hr bag @ 1200cc @ 07:40 IV site (location)YLeft AC PICC Double Lumen IV site without redness or swelling Y IV dressing dry and intact Y Chemstick n/a Gastrointestinal (food or Elimination) Voids in bedpan or bathroom Y Pt. using bathroom Foley catheterN Suprapubic tube N Urine clearY Color yellow-amber Y Yellow Amount (cc's)n/a Continuous bladder irrigation N Lab Data (explain abnormal values) RANGE WBC: 4. 5 – 11. 0 HGB: Men 14. 7 – 16. 1 Women 9. 3 L12. 0 16. 0May indicate anemia. HCT: Men 42. 0 – 52. 0 Women 27. 1 L37. 0 47. 0May indicate anemia, bone marrow dysfunction, malnutrition, over hydration Platelet 490 H150. 0 – 450. 0 Could indicate hemorrhage or inflammatory disorder. Glucose 8370. 0 – 110. 0WNR Sodium 140135. 0 – 145. 0 WNR Chloride 10395. 0 – 110. 0 WNR Potassium 4. 3 3. 5 – 5. 1 WNR Calcium 8. 1 L8. 4 – 10. 2May indicate protein & vitamin D deficiency, malnutrition, cushing syndrome, acute pancreatitis Albumin 2. 6 L 3. 4 – 5. 0Could indicate malnutrition, ulcerative colitis, use of penicillin, sulfonamides, aspirin or ascorbic acid. BUN: 127. 0 – 20. 0 WNR CR: . 40. 3 – 1. 5 WNR PT: Not in labs 10 – 12 sec PTT: Not in labs 3045 sec INR: Not in labs 2 – 3

Diploma in leadership and management In Health Essay

Dementia is caused by damage in the brain, and is characterised by memory loss and difficulties with thinking, problem solving, movement co-ordination or language. It can also cause a person to become disorientated in space and time and to experience hallucinations, a decline in communication skills and personality changes. These symptoms also make it difficult for people with  dementia to learn new things and retain newly acquired information. The most common cause of dementia is Alzheimer’s disease, which is progressive. Proteins build up in the brain, forming â€Å"plaques† or â€Å"tangles†. These cause the loss of connections between cells, and eventually nerve cells die and brain tissue is lost. People with Alzheimer’s disease also do not have enough neurotransmitters, which are chemicals used to transmit messages. Vascular dementia is caused by a range of disease of the blood supply to the brain. Atherosclerosis is when fatty deposits build up in blood vessel walls. This causes them to harden and narrow, reducing blood flow to the brain. When brain cells do not get the oxygen and nutrients they need, they start to die. Pick’s disease or frontotemporal dementia is caused by nerve cells in the frontal and/or temporal lobes dying. The connections between these cells change, and there is a loss of neurotransmitters. Over time, the frontal and/or temporal lobes shrink. Lewy bodies are tiny round protein structures in the nerve cells of the brain. The cause of these or how they cause dementia is unknown. There is also a loss of neurotransmitters, and over time, the nerve cells progressively die and brain tissue is lost. People with dementia experience different types of memory impairment. A decline in memory means that people will often struggle to recall recent events or forget messages, routes or names. They may repeat themselves or ask the same questions repeatedly. They may forget how to do things, such as how to use cutlery, tie shoelaces, get dressed or play chess. Difficulties finding the right word, or understanding the meaning of words, can affect communication. Losing the ability to read or to interpret signs, as well as the person being unable to understand what others are saying can have a big impact on communication. Losing reading and writing skills not only impacts on communicating with others, but can also lead to confusion. People with dementia may no longer understand the normal flow of conversation and might interrupt or ignore people. Changes in behaviour are common in people with dementia. They may repeat an activity over and over, pace up and down, or follow people around. Sometimes people with dementia can shout, scream, or become physically aggressive. They can become restless and may wake up during the night. A lack of  inhibition can mean that somebody with dementia might undress inappropriately, be rude or display inappropriate sexual behaviour. People with dementia may hide and lose their possessions. They might be also suspicious of others, thinking that somebody has stolen an object they have misplaced, for example. People with dementia can struggle with mental processes such as reasoning. This can lead to confusion and difficulty with many everyday tasks. Being unable to weigh up all of the facts to make a sensible decision can have a huge impact on a person’s life. Many people with dementia will lose skills which they used to have, whether this be playing a musical instrument, driving or decorating. Abilities of people with dementia can fluctuate day to day. For example, they might be able to recognise a relative some days, but not others. Sometimes they might be able to write, whereas other days they might not. Dementia can affect the areas of the brain responsible for balance and movement, causing movement difficulties. People with dementia may walk more slowly, be only able to walk for short distances, or struggle to get up from chairs. They might need support to walk, or use a cane or a wheelchair. People with dementia might find it difficult to walk outside or on uneven surfaces and may be fearful of stairs or hesitant while walking through doorways. Stimuli including touch, light, heat and sound waves are input through the sensory organs. This information is encoded into our memory system by the brain. Information can be encoded in terms of what a printed word looks like, what a word sounds like, or what the word means. This information then has to be maintained. This is thought to happen in working memory (when information is stored for a maximum of 20 seconds) by electrical signals travelling through neurons in a loop. The hippocampus and the frontal cortex filter the information and decide if it will be stored in long term memory. If so, it is thought to be stored in some proteins. The information is stored in different parts of the brain, but we do not know exactly how this works. To recall a memory, the information must be retrieved. This is  triggered by a retrieval cue. The brain reconstructs the memory, putting together what may have happened by retrieving the information that the brain stored and could recall. Memories can be reconstructed incorrectly, and this can be influenced by the retrieval cue (such as a leading question). In people with dementia, the hippocampus may be damaged. This can make it much more difficult for the person to learn new information or to form new memories. The person might not remember what they did earlier on that day, or they might forget what they have said moments before, causing them to repeat themselves. The hippocampus is used when memories are retrieved, particularly memories which were formed more recently. This is why many people with dementia still have their childhood memories but cannot remember what they have done that day. When damage spreads through the brain, such as in people with Alzheimer’s disease, more areas in the brain become affected. The brain slowly shrinks and earlier memories are lost. The left hemisphere is responsible for semantic memory (the meaning of words) and language, so when it is damaged, the person might struggle to find the right words. The temporal lobes match visual input with memories of previous experiences, so when this is damaged, the person might struggle to recognise familiar faces and objects. Sometimes, a person with Alzheimer’s disease might know who the familiar person is once they hear their voice, because hearing pathways are separate. When a person’s right parietal lobe is damaged, they may struggle to judge distances, causing problems with navigating stairs, for example. The damage can spread to the frontal lobes, causing somebody with Alzheimer’s disease to struggle with planning, organization and decision making. This might include problems with tasks such as following a new recipe. In people with Alzheimer’s disease, many abilities are not lost, especially skills learned a long time ago. Skills such as playing a musical instrument depend on procedural memories, which are stored deep within the brain. These skills are often maintained for a long time in people with Alzheimer’s disease. People with vascular dementia display a wider range of symptoms than other types of dementia. Sometimes a stroke can cause vascular dementia, if the  blood supply to the brain is suddenly cut off and a large area of tissue on one side of the brain dies. The person may struggle with planning, concentrating, thinking, or with their memory. They may also have problems with speech or vision, or have weakness on one side of the body. Several mini-strokes can also lead to vascular dementia, each one causing a small patch of brain tissue in the cortex to die. The symptoms depend on where the tissue is lost. If this is in the hippocampus, the person might have problems with their episodic memory (personal memories of specific events). Damage in the frontal lobe can cause difficulties with executive function (problem solving, setting goals, making decisions, and following sequences to complete tasks). This might mean the person struggles to make cheese on toast, for example, because they cannot organise what they need to do. Vascular dementia can also follow several mini-strokes over time. Each mini-stroke creates a small patch of dead brain tissue, called an infarct, in the cortex. Early symptoms can be very specific to where the tissue is lost. For example, problems with episodic memory can be caused by an infarct in the hippocampus, and problems with executive function can be caused by an infarct in the frontal lobe. When a person has frontotemporal dementia, their temporal and/or frontal lobes shrink. Damage to specific areas causes different problems. The person might become withdrawn and lose motivation, or they might lose their inhibitions. This could cause them to take their clothes off inappropriately, or make inappropriate comments. When the frontal lobes are damaged, the person might repeat themselves constantly. People with dementia with Lewy bodies have less shrinkage of the brain than people with Alzheimer’s disease or frontotemporal dementia. The Lewy bodies form in the cerebral cortex, brain stem and limbic system. Common early symptoms are problems with attention and vision. Lewy bodies in the brain stem can also cause difficulties with movement. Sometimes people can have other conditions which might cause symptoms similar to those of dementia. Depression can mean the person’s mood is irritable,  sad or hopeless. They might be agitated, restless, or tired with no energy. They might lose interest or pleasure in activities that they used to enjoy. Sometimes depression can cause disturbances in sleep, like early waking, along with memory or concentration problems. It can cause a person to eat too much or too little, to have aches and pains with no physical cause, or to experience suicidal thoughts. However, depression usually develops over weeks or months, which is faster than the onset of dementia. People with dementia often experience problems with reasoning, speech and orientation in time and space, which depression would not usually cause. If a person with depression struggles to remember something, they will often remember when prompted, but people with dementia often try to cover up their forgetfulness. People with severe depression may struggle with their memory and reasoning due to poor concentration. These symptoms disappear with treatment, whereas this will not happen in people with dementia. People with depression and dementia can lack motivation, but people with depression are likely to show other symptoms of this, rather than other symptoms of dementia. People with infections, such as urinary tract infections, can also have symptoms which may appear similar to those of dementia. The pain caused by UTIs can cause people to become depressed or agitated, especially if they cannot communicate that they are in pain. Infections can also cause dizziness, confusion, hallucinations or memory problems, which could be mistaken for dementia. However, the confusion caused by infections is acute and comes on suddenly with the onset of the infection, rather than over a much longer period of time, as experienced by people with dementia. Once the infection has been treated then any agitation and confusion will disappear, which is not the case with dementia. Drugs including prescribed medications can have side effects which may mimic those of dementia. These can include confusion, dizziness, problems with movement or speech, difficulties with memory or thinking, agitation or hallucinations. People with these symptoms may appear to have dementia. This is more likely to be the case in older people, because they metabolize medication less efficiently, causing a build up of the drug. However, once  the person is on the correct type and dosage of medication, the symptoms should resolve themselves. People may become confused for reasons other than dementia, such as changes in their environment. Moving home, having different support workers or changing activities could cause a person to be confused. These changes could also cause depression, which in turn can mimic dementia. Once a person becomes more settled in their routine then the symptoms should disappear. Alcohol abuse can destroy brain cells responsible for memory, balance, thinking and decision making. People that drink heavily may also have an unhealthy diet low in thiamine. A severe deficiency in thiamine can lead to Wernicke-Korsakoff Syndrome, which causes symptoms such as memory loss, confusion and agitation. This could mean the person appears to have dementia. However, a history of alcohol abuse might suggest that this is not the case. Treatment for Wernicke-Korsakoff Syndrome can reverse the symptoms, which would not happen if the person had dementia. Vision problems caused by conditions such as cataracts or age-related macular degeneration can cause people to become confused and struggle to read or to recognise faces. This can be scary and can mean the person becomes depressed or agitated. Macular degeneration can come on rapidly, furthering the possibility that the person’s symptoms could be viewed as those of dementia. Once a diagnosis is confirmed and symptoms are treated or the person is supported to manage their condition, it would become apparent that the person does not have dementia. There are many reasons why the abilities and needs of an individual with dementia might fluctuate. In people with Alzheimer’s disease, as the condition progresses, the person’s abilities decline over time. People with dementia often have lucid moments, where they may suddenly be more able to communicate or do certain things for a short period of time. People with Dementia with Lewy bodies are more likely to experience fluctuating abilities. Medication changes can cause withdrawal symptoms such as confusion, dizziness or flu-like symptoms. Side effects of the new medication, such as those mentioned above, may be more apparent until the body gets used to this medication. These can mean the person is more agitated or confused than normal and they might need extra support until the symptoms have eased. Sometimes a person may have been on a strong medication for a long period of time, and once this is changed, their abilities and needs can change. Several people that I have worked with have been more able to make and  communicate their decisions, more mobile, alert and independent after certain medications were reduced or withdrawn. Abilities can often be mood dependent – when anyone is in a good mood, they are more likely to want to do things and to communicate more effectively. Being less able to communicate or having to rely on others for support can cause frustration or agitation, particularly where support with personal care is required. Once agitated, the person might be less able to do things independently due to the way they are feeling. People with dementia are often awake at night and they may struggle with their day/night orientation. This can lead to them being tired during the day, affecting their cognitive abilities, communication skills and co-ordination. The support a person receives can impact on their abilities and needs. If there is a lack of continuity in the support provided, the person can become unhappy and more confused, causing their abilities to change. It is important for the person to build trust and familiarity with their support workers. Likewise, better support and improved continuity might mean that the person becomes more independent as they are more settled and have better routines. Developing effective communication methods can mean the person becomes more able to communicate with those around them. Different ways in which the person is supported could also result in fluctuations in abilities while they are supported by different support workers. If a person is experiencing abuse committed by anyone around them, they are likely to become depressed, confused or agitated, meaning their abilities and needs could change. Early diagnosis can help reduce the anxiety experienced by the person which is caused by not knowing what is causing their symptoms. The diagnosis can help the person to feel empowered and they can learn about their condition and what their future may hold. The person or their family might be in denial about the diagnosis, refusing to accept that they have dementia. The diagnosis can make a person feel as if their life has been turned upside down. They are likely to be scared and might feel like they have lost their identity, dignity and control over their life. They may be scared of losing  their home and their privacy and dignity. Sometimes people may be viewed or treated differently by others once they have a diagnosis, including their family and friends, or they might be worried about this happening. However, early diagnosis is important because it enables access to support groups. The person can gain advice on how to manage their condition while living as full a life as possible. The support groups introduce people who are in the same situation, so the person and their family and friends can build a support network. The support group can also provide specialist information related to the person’s condition and their symptoms, with a real understanding of how dementia impacts the life of the person and their friends and family. If the person is diagnosed with dementia early, the underlying cause can be discovered and they can access treatments for their condition. Alzheimer’s disease and dementia with Lewy bodies gradually damage the brain. Medications are available which improve symptoms by increasing the function of the remaining healthy brain cells. These medications do not slow the progression of the disease but they do improve symptoms, which improves quality of life. Other medications can also be reviewed, as they could be affecting cognitive functioning. Risk factors such as smoking, being overweight, high blood pressure, high cholesterol and poorly controlled diabetes contribute to vascular dementia. The presence of these risk factors can also make Alzheimer’s disease worse. Early diagnosis might mean that more attention is given to keeping these risk factors under control, which could slow the progression of vascular dementia or Alzheimer’s. A diagnosis is essential for organising support, including day services, respite care, occupational therapists, dieticians, mental health teams and speech and language therapists. This can not only improve quality of life for the person, but give family and friends a break from supporting the person. Early diagnosis means the person will get the support sooner, possibly improving their long term outcome. A diagnosis will also make financial support accessible to the person, such as Personal Independence  Payment. It may make it easier for the person and their family to receive advice regarding their finances, as well as financial support such as Carer’s Allowance. An early diagnosis will give more time to plan for the future to ensure that everything is in order. A Lasting Power of Attorney may need to be arranged if the dementia is progressive. Safer ways of taking medication can be set up, such as blister packs, for example. This will help the person to take their medication correctly, and can make it simpler for family and friends. This can empower the person, increase independence and reduce the risk of medication errors which could cause health issues. If a person is already diagnosed with dementia, then nurses and doctors will be aware of any difficulties they may encounter and will work harder to communicate with the person effectively. It is essential to record accurately to aid early diagnosis. Recording anything that is unusual for the person or any possible symptoms of dementia, in detail, will give a good picture over time of any changes in a person’s ability or memory. It is important to have agreed methods of recording and reporting within the organisation and for all employees to follow these. These might include verbal, written and electronic communication. Information must be kept confidential and all records and reports must be timely and accurate. Reporting might include communicating with colleagues, key workers and line managers, GPs, nurses, occupational therapists, physiotherapists, speech and language therapists and specialist consultants. Records must be legible, factual, dated and signed. Recording all of these symptoms will help to see if there is a pattern and reporting them to the person’s GP can obtain a referral for diagnosis as soon as possible. When a diagnosis is made, they may use the support records, as well as looking at times where concerns have been reported to the relevant bodies. It is important that all records are detailed to ensure that an early, correct diagnosis can be made. Before and after diagnosis, detailed records will show if a person’s symptoms are improving or worsening over time. It is also essential to record accurately to highlight any risks that arise and to report these. This ensures that the risks can be addressed, reducing the likelihood of harm coming to the person and their support workers. When a support worker records and reports a risk they encounter to  the relevant person or authority, they are also protecting themselves in the event of legal action arising. The organisation would be required to prove that they have agreed methods of recording and reporting in place and that they ensure that these are followed. Having robust support plans and risk assessments in place should mean that they hold up to scrutiny in court. This would mean that employees would be liable for their own actions if they did not work in accordance with them. Part 3 Person centred care is support planned and delivered around the needs of the person. This means involving the person as much as possible, as well as any other people that they wish to be involved, such as family, friends and other professionals. Support workers will be matched to the person being supported, who might be involved in recruitment. The person should be as involved as possible in choosing where they wish to live, who they want to live with, who they want to be supported by, what they want to do each day, what and when they eat and drink, how they are supported with day to day activities, etc. The person will be supported to be as independent as possible and staff will be trained to meet the needs of the person. Support workers will always respect the dignity, privacy and rights of the person. They will work to ensure a holistic approach, meeting all of the person’s needs, including religious and cultural. They will support the person to develop and maintain meaningful relationships and will build a trusting, professional relationship with the person. Support workers will have a positive approach, focusing on what the person can do, what their strengths are, and seeing the person as an individual rather than by their condition. They will work within guidance and legislation, act in the best interests of the person and work to safeguard them from abuse. A multidisciplinary team will often be involved, to support the person in all areas of their life in the best possible way. Non person centred care is the opposite of all of this and is based on a more institutional approach – which is easiest for the staff or the organisation, what fits in best with the other people who live there, or which is  cheapest. Non person centred care is more likely to occur in large group homes, though can happen anywhere. Carers might be very limited by time or resources. Staff may subscribe to the biomedical model of health. The biomedical model focuses on the person being physically healthy, as in having an absence of physical illness. It does not consider wellbeing as a whole, ignoring social and psychological factors. This way of thinking means all of the factors outlined above could be ignored, because staff might think the person is well supported just because they are physically healthy. There are many techniques which can be used to meet the fluctuating needs of the person with dementia. The reality-orientation approach is a type of therapy which reduces confusion and helps the person to understand their surroundings. Information relating to time, place, a person, etc. is presented and repeated regularly. This might be clocks, schedules for the day or a board showing the date, which is reinforced using prompts in conversation. This is helpful because people with dementia may forget what day/time it is, where they are, or who they are with. The validation approach means seeing the world through the person with dementia’s eyes and trying to enter their reality, rather than bringing them back to our reality. This sometimes means not challenging their reality – doing this would often just lead to more stress and confusion. This approach improves the person’s self esteem and can mean they feel more settled. The validation approach subscribes to the idea that there is a reason why people with dementia do and say the things they do, and that we should validate these things and try to understand them. The behaviours are attempts to communicate. It says that we must empathise with the person and try to understand what they are trying to express. The validation approach theorises that the person is expressing things which they have suppressed for many years. Expressing these feelings reduces the intensity of them and enables the person to communicate more. It is based on the idea that when a person has severe short term memory loss, they revert to the more familiar past. This is thought to be to due to having less control over the present, to relive past experiences or to resolve unfinished conflicts. This approach reduces stress experienced by the person with dementia and encompasses the  holistic approach, focusing on the person’s dignity and happiness. This often results in the person displaying less behaviours which challenge. Using the right aids and assistive technology can help carers to meet the changing needs of a person with dementia while maintaining their dignity and independence. Assistive technology such as pressure sensors, door alarms, calendar clocks, talking photo albums, reminder messages and personal alarms can help family or support workers to meet the variety of changing needs of the person with dementia. Changing the environment to meet the needs of the person might include fitting hand rails, ramps or different flooring such as non slip flooring. Practical aids to help the person be more independent are useful, such as touch sensitive lamps, kettle tippers, adapted cutlery and non spill cups. Equipment for personal care, continence and maintaining dignity might include dressing aids, raised toilet seats, bath seats, commodes and continence pads. Some mobility and transfer aids are walking frames, wheelchairs, hoists, transfer turntables and chair raisers. Working with the person to find the best combination of aids and techniques is important as part of a person centred approach. Support workers should use reminiscence techniques such as discussing old pastimes, looking through photo albums, watching old films or listening to music can help stimulate a person’s memory and enhance their quality of life. Alternative therapies such as aromatherapy and massage can mean the person feels more relaxed in what can be a stressful, confusing world. It is important to address sensory needs, whether this is through touch, smell, activities such as swimming or use of sensory rooms, etc. Using effective communication is essential for person centred support. Support workers should be aware of their verbal and non verbal communication, using techniques such as physical prompts where appropriate. As previously discussed, needs and abilities can fluctuate on a daily basis so different techniques might be useful on different days or with differen t people. Myths and stereotypes related to dementia can have a big impact on the individual and their carers. Some of these stereotypes are that people with dementia are aggressive, that they do not have rights or that they do not  understand anything. Some people assume that people with dementia automatically lose their independence so cannot drive or be involved in decisions. This could mean that people are automatically excluded from being involved in decisions regarding their support, which is not person centred. The person’s independence might be compromised as they might not realise that their diagnosis does not prevent them from doing things, including driving. These stereotypes can lead to social isolation for both the person and their carers in attempt to avoid coming into contact with people who hold these beliefs. Negative interactions with professionals such as GPs can negatively impact the person’s self esteem and dignity, as well as that of the carer. This in turn may mean that the person struggles to access the services which they need, or avoids seeking access to these services in fear of discrimination. A lack of access to services can also affect the carer because they can be left to care for the person without any respite or support network around them. The involvement of professionals such as occupational therapists, for example, can greatly improve the lives of both the person and the carer. All of this can negatively impact on the person’s behaviour, further affecting their quality of life (and that of the carer). Individuals and carers can be supported to overcome their fears through person centred planning. Support to do this can empower the individual to be in control of their life rather than fearful about what will happen to them. This support could come from advocates, charities, support groups, friends, line managers, etc. Carers are likely to be less scared and more informed about how they can effectively meet the person’s needs to improve their quality of life. Information about accessible services can demonstrate to the person with dementia that they can still be supported to live a full and active life. They can choose which services they would like to use and can see what is on offer, which might be in contrast to views they already hold about care providers. This information can ease the fears of carers, particularly where family carers are involved, because they may feel more at ease when they know that a wide range of person centred support is available. Where an organisation is providing support, training can help the support worker to feel more informed and confident in their ability to provide person centred care. This can ease any fear which the person has,  along with supervision meetings where they can discuss their development. Team meetings are also helpful, because the team can discuss their ways of working and address any issues that they have come across. Support groups and organisations can greatly help to ease the fears of both the individual and their carers, not only by providing practical advice and support, but through moral support too.