Abortion Policy and Its Consequences

Abstract In this paper I will discuss the most dominant trends in abortion reports in the modern age. We will discuss the issues of morality, health risks and benefits and socioeconomic factors that are a part of the abortion discussion. There is a great deal of evidence to suggest that the debate of the morality of abortion Is an ongoing and ever-evolving discussion. Some of the points made in the articles discussed are seen as unique or radical, while others are points that have lasted through time and are still strong and relevant today.This paper will analyze the current dialogue that s occurring within our scholarly journals across the globe, including points of view from Japan, Bangladesh, Australia and the United States. The key common point that is made throughout the literature is that despite local laws, religious beliefs, and services provided, women are still seeking and getting abortions. Abortion Policy and Its consequences By the sass's abortion was a very common proce dure. In an article by Alistair El- Muar, it is documented that more than one-third of Australian families were affected by abortion procedures in the sass's.There is a great deal of confusion surrounding he subject because, while abortion is legal in many countries, it is often not discussed, clinics are hidden or not made obvious of their location and purpose, and often times euphemisms are used such as â€Å"getting rid of† or â€Å"taking care of† a Japan, the topic of abortion has been more open for discussion; the subject that is taboo is oral contraceptive pills. While abortion is legal and available to women in Japan, the use of contraceptives – the pill and condoms – are used sparingly or only during â€Å"dangerous days,† when a woman is ovulating.However, this results in a spike in the number of unwanted abortions. Japan differs greatly from other countries such as the United States and Australia in that abortion is not seen as a poor ch oice, but, rather, a better choice than taking oral contraceptives. The legality of abortion varies across the globe. But one thing that has stayed consistent and universal over the past twenty years is the abortion rate. Whether legal or not, women are still getting abortions at the same rate in most countries.In El-Murmur's article â€Å"Representing the Problem of Abortion: Language and the Policy Making Process in the Abortion Law Reform Project in Victoria, 2008,† the recess of legislature reform is described in the light of allowing and extending abortion rights for women. El-Muar shows how the manner in which abortion issues are discussed are commonly over laden with vague language or language that emphasizes a moral bias rather than a logical, rational process of argumentation. Too often the lawmakers are distracted by the colorful language that tugs at heartstrings as opposed to carefully considering the soundness of the arguments being made.The essence of many argum ents is, â€Å"This is wrong because I believe it is wrong. † Legislators consider this – whether knowingly or not is unclear – as valid a mint as an argument in the form of, â€Å"The evidence I have presented proves my point because X, Y and Z. † El-Murmur's concern with the distraction and misrepresentation of issues is a valid point of concern. How can we make measured, calculated decisions for the entire country when such non-rational, non-linear argumentation is employed?While the representation of the issue is most likely going to go unresolved for many more years, the Australian government has already come to a conclusion regarding abortion policies. The legislature now indicates that the controversy over abortion is no longer a legal issue, but, rather, a medical issue. In 1992, the Women's Health Committee of National Health and d Medical Research Council (NRC) gathered an expert panel to review the data regarding abortion and the legality of th e procedure. The expert panel completed their report in 1996, concluding that abortion should be decentralized.However, the NRC rejected their report and argued in opposition – that abortion be illegal. The actual penal code stated that abortion was illegal and punishable by incarceration. However, in the majority of cases in which a woman had an abortion and was prosecuted, the defendants were acquitted due to the defense of necessity – the defense made a strong legal argument that the benefits of the procedure outweighed and Justified the illegal action. This dichotomy of code versus punishment has lead to a great deal of confusion among the Australian population.In 2008, the Abortion Law Reform Bill decentralized abortion for citizens of Australia. Not only did it make abortion a legal procedure, but the bill also extended the window of time in which a woman has the opportunity to receive abortion services after conception. Many who are opposed to this new reformati on believe ND bias without any strict, adhered-to guidelines. Now that abortion is no longer illegal, women are unafraid of punishment. However, there is still a great debate amongst medical professionals as to whether or not they are required to perform such a procedure Just because it is legal.Many doctors who are morally opposed to abortion are turning patients away, despite the new legality. The morality of abortion appears to be an even stronger determinant than the legality of the procedure. In fact, in Robert Audio's article, â€Å"Preventing Abortion as a Test Case for the Justifiability of Violence,† Audio argues that while abortion may be gal, and murder illegal, it is morally acceptable (and he extends this to â€Å"legally justifiable†) to prevent the instance of abortion by murdering the individual providing abortion services.While Audio's stance on abortion is clearly an oppositional one, his argument is not as clear or as understandable – despite one's personal views. In this mixed moral-legal discussion, Audio asserts that a would-be mother and her physician are guilty of murder/harm of the unborn child; while any individual who acts in violence toward either the would-be mother or the physician is morally innocent cause of a commitment to protecting the intrinsically innocent, the fetus.Whether it be a violent, harassing protest or actual physical harm done to an individual involved in providing abortion services, Audio argues that such behavior is morally justifiable and should not be punishable by law. Audio's article is a bitter scholarly attack on all women who receive abortion services and all professionals who provide the service. His unsettling discourse leads us to wonder if, under Audio's reasoning, women should fear being â€Å"Justifiably' killed for desiring or having an abortion.Due to Audio's article and the number of people in society who may agree with him, women who consider abortion services are traumati zed repeatedly before, during and after such a procedure is performed. To make the decision to terminate a pregnancy is traumatic enough. But Audio's suggestions are horrific extensions of an already difficult situation. Furthermore, Audio's language throughout the article is dry and attempts to come across as objective.Instead of using buzz words such as â€Å"God† and â€Å"the Bible† when discussing the religious immorality of abortion, Audio uses weaker trigger words such as â€Å"miracle,† â€Å"divine,† and â€Å"scripture† which do not immediately Jump out at the deader as overtly motivated by Christianity. Audio asserts that, regarding women who accept abortion services, â€Å"We can act wrongly – counterrevolution, one might say – even when we are within our rights† (Audio, 162). This shows the polarity of Audio's perspective with regards to the law and what is Just. On another religious path, F.Cam provides a new, uni que argument in favor of abortion. Gamma's qualitative discussion of the intrinsic value of life and the varying degrees of importance amongst living creatures is a perfect counter-argument to Audio's radical perspective. Cam points out that the reason there is such scrappiness between what one morally believes is right and what one might realistically do in instances that may necessitate abortion services is that â€Å"we believe in the sacredness of individual life (including early fetal life)† (Cam, 222).He argues that there is more human investment – intellectually and emotionally – in the mother, but the sacredness of both individuals – mother and fetus – is equal. Cam calls potential to suffer greatly or even die from a pregnancy that is carried to term, Cam asserts that the woman's death is worse – more undesirable – than if the fetus were ported. This follows a common belief that while no deaths are always preferable, one deat h is more preferable than two. If a mother were to suffer complications or die during childbirth, there would be a great likely hood of facing two deaths.Furthermore, Cam argues that women, as adults, have intrinsic, incremental objective value as well as intentions, goals, and rights. Whereas a fetus only has intrinsic, incremental objective value (sacredness). This argument is particularly moving in that it reflects that desire to promote the health and well being of the adult woman. Gamma's argument considers the quality of live that a woman facing the obstacle of abortion can potentially have due to the benefits that abortion procedures offer.Not many – and clearly no Audio's – arguments take into consideration the fact that once the ordeal is done, the woman's quality of life will be much better than if she had faced the risk of carrying a pregnancy to term and raising a child. Gamma's argument is unique and may even inspire changes within the church and within co mmunities in countries that are primarily Christian. A key deciding factor in the internal debate women face of whether or not to go wrought with abortion procedures is the different aspects of responsibility. In an article by Lawrence B.Finer, Lori F. Forthwith, Lindsay A. Dauphine, Seashell Sings and Ann M. Moore, 1,209 abortion patients were surveyed and interviewed regarding their reasons for choosing to have an abortion. Finer et al found that the results indicated that women today are much more concerned with their education and careers than what was previously understood. The majority of women – seventy-four percent of those interviewed – reported that a child would interfere with their education, their career, or the ability to care for pre-existing dependents.The next most common response – seventy-three percent of those interviewed – was that financial hardship and the inability to adequately provide for a child was the reason for terminating th eir pregnancy. The third most common deciding factor – forty-eight percent of those interviewed – was that the individual was going through relationship problems or was facing being a single mother. An analysis of the study participants showed that 40% of the women had decided that they were through with their childbearing years and wanted no more children.Thirty percent of the women stated that they had no children and were not ready to come mothers at this time. The researchers also found that the percentage of women who said that their reasoning for getting an abortion was because their parents or their partner wanted them to was less than one percent. Also, the issue of health – either that the individual was currently not in good health or that she feared a pregnancy would compromise her health – was rarely a concern. This study, both qualitative and quantitative, revealed a great deal about the population of women receiving abortion services today.T his article has helped to promote a better understanding and lessen the misconceptions of the concerns and oratories of women today. Also, we are able to see that in the majority of cases the decision to get an abortion is not a spontaneous decision, but, rather, a well thought out and planned decision that has been analyzed carefully by the individual. Women with regards to how a child would affect their quality of life and how their current lifestyle would affect a child's quality of life if the pregnancy were carried to term.From 1987 to 2004, the reasons for seeking abortion services have remained consistent and the data have changed little. In the debate of morality, it is notable hat women are consciously considering and reconsidering all aspects of this decision. The majority of the women interviewed in this study felt that they were making the best decision. While the consideration of one's education and career weigh heavily on women in America, the same factors are not as p aramount in other countries such as Japan.In a study by Going IMHO titled Can Have Abortions But No Oral Contraceptive Pills': Women and Reproductive Control in Japan,† the issue of eugenic abortions and unwanted pregnancies is illuminated in a new light. In Japan, a strong emphasis is placed on the natural remedies of the body and healing. Anything synthetic and unnecessary is considered toxic. This includes oral contraceptive pills. While condom use is publicly accepted as responsible and sufficient birth control, the use of condoms is not nearly as effective in preventing pregnancy as in the United States.This is because there is a common notion that condoms are only necessary on â€Å"dangerous days,† when a woman is ovulating and most likely to become pregnant (IMHO, 102). When intercourse is had on a day that is not considered â€Å"dangerous† condoms are rarely used. The legalization of abortion came about primarily in order o prevent extra-marital pregnan cies due to the large number of conceptions that occurred because of ineffective contraception use. Micro's quantitative report on the shocking number of abortions performed in Japan shows the striking cultural differences between eastern and western populations.In the post-World War II era in Japan, the desire for procreation and large families flipped to a preference for small families with only one or two children. The decision to proceed with a pregnancy or to terminate with abortion services was largely affected in this era by the advancement of medical science and eugenics. Thanks to new developments in medicine, women are able to have a portion of cells from the amniotic fluid surrounding the fetus tested for genetic defects. In Japan especially, any birth defects – whether they be cystic fibrosis, Downs syndrome, or ATA-cash, etc. Are reason for serious consideration and formability of abortion. However, after a large population of women did decide to use oral contrac eptive pills after the development of a low-dose hormone pill, the number of abortions dropped significantly. Until these numbers decreased, ninety-nine percent of all abortions in Japan were done so legally under the Eugenic Protection Law. This law legalized induced abortions as early as 1948. In 1996, this law was renamed the Maternal Body Protection Law due too rise in opposition against eugenics.In 1955, Japan reported 1. 17 million abortions performed each year. This number slowly declined as condoms became widely accepted as proper contraceptive use and declined further after World War II and eugenics practices became the norm. In the sass's, a group led by Nook Moisakos called for the abolition of abortion laws and the cessation of access to oral contraceptive pills. While many agreed with their stance, Moisakos group was dismissed as radical, militant women's liberation activists. Many saw the pill as a step towards banning abortion.In her article, IMHO says, â€Å"Since t here is such and unfailing contraceptive such as the pill, abortions are no longer necessary' (IMHO, 101). Eugenics played a large role in the popularity of abortions in Japan. In Sabine Frustum's article â€Å"Women's Rights? : The Politics of Eugenic Abortion in Japan,† we are urged to despise the process of screening fetus for defects and the process of eugenic abortion. It is Frustum's position that the advancement of medical genealogy has launched a new era in abortion policy and has skyrocketed the number of abortions performed each year in Japan.While the numbers suggest that abortion rates have leveled and are fairly consistent year to year, Frustums makes a better argument for a negative disposition towards eugenics. For quite some time, as people watch the world of science grow and present new, unheard of feats, there has been concern over whether or not parents will eventually be able to biologically engineer the perfect child, taking all of the chance out of natur e's random order. This is a great concern of Frustum's as well – she calls this concept Freestanding† in its depravity.While many people in America see abortion as something that only affects the lower classes and the poor, Frustums emphasizes the opposite – that those with the financial means to screen their fetus for defects or diseases are the ones who are taking advantage of abortion services the most. However, Rachel K. Jones and her colleagues countered this idea by conducting a study entitled, â€Å"Patterns in the Socioeconomic Characteristics of Women Obtaining Abortions in 2000-2001 . † Jones et al. Adhered a representative sample of 10,000 women receiving abortion services ND analyzed their socioeconomic characteristics. In 2000, twenty-one in every one thousand women had an abortion. This ratio is startling in itself. Further analysis of their study participants gave more details as to the circumstances of our society. Jones et al. Found that t here was a higher rate of abortions amongst women who were between the ages of eighteen and twenty-nine, were unmarried, black or Hispanic, economically disadvantaged, had a previous birth, lived in a metropolitan area, and who were Christian.While there was an eleven percent decline in abortion dates from 1994 to 2000, the decline was mostly in women ages seventeen to twenty, and the rate actually increased amongst women who were poor or on Medicaid. Jones et al. Found that a high pregnancy rate is directly related to a high abortion rate. The researchers concluded that the only way to prevent abortion is to provide better opportunities for the lower classes in the forms of education and better health care.A decrease in unwanted pregnancies can be made possible by increasing awareness of, understanding of, and access to contraceptives – whether they be condoms, intrauterine devices, oral contraceptive pills, etc. Better health care for those who are struggling financially wo uld also provide better access to contraceptives. Similarly, because abortion services generally cost between $400 and $600, many women who are not in a financial position to afford professional services decide to obtain an abortion by other means. In an article by M.Bearer titled, â€Å"Making Abortions Safe: A Matter of Good Public Health Policy and Practice,† women are obtaining unsafe or unsanitary abortion Bearer analyzed the statistics of infection and mortality caused by improper abortion procedures. While the article partially encourages abortion and especially the equalization of such procedures, the emphasis of her article is on the health and safety of women. As many researchers have shown, the number of abortions that are performed is consistent across most countries, whether the process is illegal or not.Women are still resorting to abortion in times of unwanted pregnancy despite the possible legal ramifications. Server's stance is that with this in mind – that abortion is going to be a part of society whether we ban it or not – we might as well approve and legalize abortion so that women have the option of having the procedure done in a fee, clean environment rather than in a broken down storage shed by a man with a coat hanger.Abortion accounts for thirteen percent of maternal mortality (Serer, 580) and menstrual regulation (the process of removing the lining of a woman's uterus, similar to the natural menstrual cycle, to expel any implanted eggs, whether fertilized or not) is steadily increasing. In order to make abortion a completely safe procedure, we must first legalize abortion. Furthermore, training in abortion procedures should be required for all medical professionals – nurses, midwives, even pediatricians – and tot Just obstetrics and genealogy physicians, Bearer says.If we cannot legalize abortion, Bearer recommends at least reducing the punishment for those convicted of criminal abortion. Researchers Hide Bart Johnston, Elizabeth Oliver's, Sashimi Skater, and Diana G. Walker agree with Bearer in their article, â€Å"Health System Costs of Menstrual Regulation and Care for Abortion Complications in Bangladesh. † Johnston et al. Advocate for increasing education and awareness of menstrual regulation as a birth control method in order to bridge the gap between unwanted pregnancy and abortion.These researchers assert that menstrual regulation – a process similar to the implantation of an intrauterine device in which a physician inserts a tube into a woman's cervix and removes via vacuum the lining of the uterus – is cheaper for medical service providers than treating the complications of illegal abortions. When abortion procedures go wrong, complications are a serious drain on medical resources in Bangladesh. This technique has also lead to a decrease in maternal deaths and has improved the economic conditions in the health care sector.In addition to their anal ysis of cost data related to abortion complications versus menstrual regulation, Johnston et al. Emphasize that this method of menstrual regulation reduces unwanted pregnancies without abortion and the terrible consequences that come with substandard abortion services. It is a simple, fast procedure that sidesteps illegal abortions and which can be seen as an ethical middle ground between abortion and carrying an unwanted pregnancy to term. This procedure is legal in most countries that have banned abortion. Johnston et al. Advocate for improved education for women who may benefit from this procedure.The common theme amongst all of the articles we have discussed so far is that ore and better medical services should be available to women – whether it be to prevent unwanted pregnancy, to provide better care for pregnant women, or to provide abortion services. In a case study by Maharani Malaria, S. Sirius, and S. A researchers discuss the tragic case of a twenty-six year old wo man who received an ill-performed abortion by a man with a wooden stick. The woman came into the emergency room suffering from abdominal pain and a sever fever indicating infection. Septic abortion is a spontaneous, therapeutic or artificial abortion complicated by pelvic infection† (Malaria, 149). In India, twelve percent of maternal deaths are caused by septic abortion. After describing this horrific case, Malaria et al. Strongly recommend to the public that abortion policy be reviewed and legalized in order to prevent the instance of septic abortion. In an anonymous article titled â€Å"A Doctor Tells Why She Performed Abortions – And Still Would† and written under the pseudonym â€Å"Dry. X,† a female doctor describes why she refuses to stop providing abortion services.The number of providers of abortion services (that is, licensed and medically trained with sanitary facilities) has decreased from 2,680 in 1985 to 1,787 in 2005. And while doctors are r etiring, the new enervation of physicians are not being taught how to perform abortion services. As teaching hospitals have merged with religious institutions, abortion is no longer being taught to medical students. There are more than 1. 5 million abortions performed each year, making it the most common medical procedure in the United States. However, there are fewer and fewer providers of such services despite the consistent demand.This has resulted in more amateur providers conducting the procedure in less-than-sanitary conditions. Similarly, the aggressiveness and number of protesters outside of abortion clinics has risen to shocking levels. Instead of seeking out abortion services, women are hiding from the shame placed on them by these protesters, staying at home, and attempting to perform the procedures on themselves with reeds or knitting needles (Dry. X, 1265). According to Dry. X, the solution to this problem is, â€Å"All physicians who care for reproductive-age women sh ould have opt-out, rather than opt-in, abortion training† (Dry.X, 1266). This will encourage medical students to participate in the training rather than going through the process of opting out of the course. This is one realistic solution to the problem of declining numbers of abortion service revisers. However, the consensus still seems to be that the most important step for us to take is legalizing abortion and doing away with punishments for those who receive and perform abortion services. In an article posted in the London Lancet, titled â€Å"Abortion in the U. S. A. ,† the statistics of abortion in America are clearly outlined.Nearly half of all pregnancies are unintended. There are twenty-two abortions performed for every one thousand pregnancies. And while the legalization of abortion has changed over time and across cultures, the abortion incidence, rate and ratio have remained the same. Drug induced abortion is a new phenomenon that is peeking the interest of women all over the country. But these articles have left us wondering, is it better for women to experiment with chemicals and knitting needles than to provide professional abortion services? Where do our moral principles lie?Who is the priority in this situation: the health and lives of women all over the globe or unborn fetus that have not yet begun to experience life? While the morality issue is certainly one of open debate, there is a platform on which we all can agree – we must take provide care for all. The statistics have proven omen facing an unwanted pregnancy are still going to seek abortion services if they decide it is the only feasible option. The tone and primary focus of the scholarly journal articles reviewed here vary along a wide spectrum.

Advantages and disadvantages of job security Essay

Is government in Mauritius legalized training? With over 20 years innovation in information technology services and training for enterprises in Mauritius, the region and internationally, FRCI is today a leader in the ICT sector. FRCI is structured around 5 areas of expertise, all geared towards the same objective; customer satisfaction. FRCI was recognised as Microsoft 2010 Country Partner of the year for Mauritius and received numerous Microsoft awards for the West, East and Central Africa (WECA) region : 2012 & 2011 Best Learning Partner, 2011 Best Virtualisation Partner and 2010 Best Enterprise Software Advisor. Historically, with the exception of the air wing, the armed forces have been poorly trained and suffered from low morale. Beginning in the late 1980s, the government began to establish a military training infrastructure. On May 16, 1987, the first noncommissioned officers (NCOs) passed through a three-month refresher course at the SPDF NCO Training School. At the graduation ceremony, Chief of Staff James Michel told the NCOs that a new career development program would give each of them â€Å"an equal opportunity to develop his career and rise up the promotion scale to the highest ranks.† On May 7, 1988, the SPDF, supported by the People’s Militia, conducted a simulated offensive at the Grand Police Military Training Center. The troops covered offensive and defensive military tactics, weapons training, field communications and engineering, first aid, map reading, and other military subjects. On June 2, 1990, officials opened the Seychelles Defence Academy, which provided training courses for the SPDF, the People’s Militia, and the police. Despite these efforts, the SPLA and the navy wing have failed to improve their capabilities. Personnel suffer from low morale, poor qualifications, and ineffective combat skills. Training is legalized in various aspects in Mauritius so that to help the country to attain economic growth and to be effective in the market, the following aspects are shown below, namely: 1. Training in education 2. Training in construction 3. Training in information technology 4. Training in defense 5. Training in health care 6. Training in development 7. Training in dealing in the international market 0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 Is training really a necessity? How do you find the true benefit of your training? I wish I could tell you it was glamorous and exciting. With the right attitude it can always be exciting, but it is hardly glamorous. The most important aspect is patience. You won’t find the benefits overnight. It may take a couple of years before you really understand. However, your understanding keeps growing from that point. Training is exciting if you look for the Basic Principles. I see many students (even high ranking) who know the movements but don’t understand principles such as body shifting and turning, balanced motion, focus on abdomen and proper breathing. In order to maximize your training experience I would like you to do one thing. Don’t just look on the surface at what you are doing. Dig deeper and try to understand the real meaning. I guarantee you will be amazed at the treasures you will discover. Training is the process through which you find it – whatever it is you are looking for. The color of your belt or the number of stripes doesn’t mean anything. It is the process of training that is important. Training is your journey. The destination is up to you . Training is probably the most important decision a new registrant can make, because it will dictate if this individual will be in the industry in two years from their point of entry. Basing a decision to join a brokerage based on commission structure alone is a short-sighted decision, but sadly this is all too common. If an individual truly wants to be successful in real estate they need to be trained properly. They need to ensure that the person offering the fundamental training is licensed and has had practical hands-on experience. There are lots of stories about the quality of  training, and the depth and knowledge of the individuals doing the teaching. Some are good, but many are weak or hollow at best. Due diligence on the training front is an absolute requirement for all new registrants. The registrants need to ensure there is substance, relevancy and credibility to the training programs being offered. More importantly, research the actual trainers providing the course materials – remember, you get what you pay for. A good rule of thumb: if it is free, you are probably wasting your time. Surina Hart, the director of education for Right At Home Realty (RAH), who heads up RAH University, says, â€Å"Having taught the OREA courses, I have become intimate about the training the registrants receive and the gap that exists before that registrant completes their first deal. The problem is many registrants feel that upon completion of the registrant courses they are ready to sell, and I can tell you they are not yet in that position.† â€Å"Inadequate introductory training is a key factor in why so many individuals leave the industry after only two years in the business, not to mention the negative impact they have on the public who are interacting with them.† We need to continue learning, expanding and developing our core skills, on top of taking the required continuing education courses. 0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 In which countries are training legalized in developing, less or under developed countries? Differences in training in developing countries can be traced to the experiences of colonization, industrialization, and advancing technology. Since decolonization after World War II, developing countries have had to cope with depleted primary resources and unprecedented and unexpectedly rapid industrialization. Industrialization has taken the form of technology transfer, which has contributed to the loss of indigenous technologies. The developing world is becoming aware that the key to its development lies not in transfer of capital-intensive technologies designed for use where labor is comparatively scarce, but in industrial development that uses those technologies that advance the socioeconomic objective of development. Training and development efforts in developing countries should nrelate to an industrialization that uses technologies appropriate to specific environments. From a developing country’s perspective, training and development have an important role in developing the capacity to use and control appropriate technology. Training and development must be dynamic and focus on an understanding of the respective country’s culture in its transition from a low to a higher technology base. Implementation problems include cultural and linguistic diversity of the audience, poor communication, and limited or out-of-date instructional materials, facilities, and training and development personnel. A visit was made to Washington, D.C., to see Dr. Allan McKelvie, who has spent many active years in the voluntary Organisation, CARE/Medico, and who was responsible for starting the voluntary programmes in Indonesia, Jordan and Tunisia. In these programmes surgeons from the United States, Canada, Australia and elsewhere visit developing countries for periods of one month each to develop the orthopaedic services and train the local surgeons and doctors. Dr. McKelvie is also very active in orthopaedic surgical training programmes in the United States, and has a considerable interest in helping in the training of orthopaedic surgeons from developing countries. The relative needs of the developing countries of the world were discussed, and the realistic methods by which the standard of treatment of the patient crippled by orthopaedic diseases or trauma could be improved in over half the world’s population. The following points were agreed upon as being important: 1. Orthopaedic Surgeons. In developing countries surgeons should be trained either in their own countries or in suitable centres in other developin countries. Little good would come of training them in sophisticated centres in developed countries, apart from short courses in specialised types of orthopaedics. Surgeons from developing countries who are trained in centres in Europe and North America often cannot adapt to simplified procedures on returning to their own countries. In addition, many never want to return to their own countries, while others are dissatisfied after their return. It is therefore essential that certain orthopaedic centres in developing countries, with the facilities, staff and patients suitable for training surgeons from other developing countries, should be assisted and recognised by the major orthopaedic associations in the developed countries of the  world. 2. Type of Training Required. Dr. McKelvie felt that the standards of training in developing countries should be much lower than those of developed countries, in order that the maximum number of orthopaedic surgeons should be trained. In Uganda a very different approach has been used. It is felt that it is essential to have a nucleus of well trained ortho-paedic surgeons with international recognition in order that they can in future train other surgeons to a recognised high standard. The problem of training as many doctors and staff as possible is overcome by running courses of variable length from 3 days to 6 months in duration for other doctors and for general surgeons. In addition a large number of orthopaedic assistants (male nursing assistants with 1-2 years’ additional training in all the simple practical aspects of orthopaedics excluding actual operating) are trained. This method has worked well to date in Uganda. 3. Publications on Training. It was agreed that there was an urgent necessity for books, slides and films devoted to the realistic management of orthopaedics and trauma in developing countries. A booklet was also required on the manufacture of simple appliances and artificial limbs suitable for developing countries. 4. Training of Orthopaedic Ancillaries. In addition to orthopaedic assistants, orthopaedic technicians, physiotherapists, rehabilitation workers and nurses should be trained as far as possible in developing countries. Only a small selected ftw of these should visit a developed country for further training and then only for a specialised course. 5. Assistance from Developed to Developing Countries (a) Staff. CARE/Medico orthopaedic surgeons only spend one month at a time on a rota system in a developing country. They teach and do clinical work, but do not take any part in policy making or administration. (b) Many leading surgeons in developing countries, however, feel that a surgeon should spend at least oneyear, and if possible two, in order to be of real value, especially if he has never worked in a developing country before. This is because it often takes 3 to 6 months for a surgeon to re-orientate his management of patients to that which is economicaly realistic to a developing country. The same will apply to orthopaedic technicians and physiotherapy teachers, but in these cases it is essential that the teacher is flexible and realistic in his or her approach. A teacher, for instance,  who will only make calipers and artificial limbs out of imported parts from a developed country at an exhorbitant cost will do more harm than good in a developing country. Financial Assistance. This is required for secretarial and research assistance and for the preparation of books, booklets, slides, films and reprints for teaching purposes. Large sums of money are spent on transport and emoluments and even capital expenditure for buildings by developed countries in developing countries. A small fraction of this amount would achieve many times the good on an international rather than a national scale by distributing teaching aids so necessary for improving standards of orthopaedic care. The amount actxa~ly available is often negligible. There appears to be a universal reluctance throughout the world to help direct6v in the dissemination of knowledge. As a result of this, the lack of communication between countries, except at the highest level, is little short of appalling.

Database Management Essay

In his book Groupware — Computer Support for Business Teams, Robert Johansen defines groupware as â€Å"specialized computer aids that are designed for the use of collaborative work groups.† This definition is better than the â€Å"shared data† definition because it helps eliminate multiuser databases from the groupware category. Yet electronic mail fits this definition, as well as some other software sharing tools that experts are still debating. A more useful definition also appears to be one of the oldest. Peter and Trudy Johnson-Lenz are credited by many as coining the term groupware in 1978. They defined it as â€Å"intentional group processes plus software to support them.† Groupware enhances collaboration by allowing by the exchange of ideas electronically. All the messages on a topic can be saved in a group, stamped with the data, time, and author. Any group member can review the ideas of others at any time and add to them, or individuals can post a documents for others to comment upon or edit. Members can posts requests for help, allowing others to responds. finally, if a group so chooses, members can store their-work notes on the groupware so that all others in the group can see what programs is being made, what problems occur, and what activities are planned. Groupware utilizes primarily a form of database technology. While there are quite a few differences, groupware has many commonalities with the standard database. Groupware is not just a normal database, rather it is a developing technology to form an application to perform a specific task or set of tasks. Database technology is the main technology that makes groupware able to function as it does, as groupware is more of an extension of database capabilities. Groupware must be able to support interactions between large numbers of people for it to live up to its definition, and it is fairly typical to find it utilizing a client/server system of interaction. Databases are well suited to the task of powering the back end of groupware as they are specifically designed for just this type of interaction process. Databases are also well suited for use in groupware as they offer a persistent storage which always necessary in any type of collaboration environment. Therefore most groupware available will utilize a database as a way to provide this client/server interaction and persistent storage. The typical interaction process flows exactly as it would in a standard database. Requests for data manipulation are sent by the client to the server. The server acknowledges the request, performs the action, and stores the result. Once the action is completed, it sends confirmation back to the client. In this way, groupware at its most basic acts exactly as a normal database would be expected to act. However, what makes groupware an interesting concept is how it is different from a normal database. While groupware is not a new technology, it is a new way of combining established technology in order to achieve a new tool to promote productivity amongst a group of people. Groupware not only changes the way in which we think about databases, but also the way in which databases can be utilized to promote group functionality. By pairing databases with standard productivity tools, an entirely different concept emerges. Groupware, and in particular real time collaborative groupware, is the future of productivity.

Risk management and Planning in Tesco plc Essay - 1

Risk management and Planning in Tesco plc - Essay Example TESCO is the third largest retailer in the world. Tesco was the first major retailer to introduce carbon labeling on products. Initially established as a grocery retailer in the UK, the company has expanded its business to various countries across the world and its operations include from clothing, electronics, furniture and petrol to books, banking, telecom and software. The phrase "The Tesco Way" coined by its CEO Terry Leahy seeks to hold out to the public the company’s philosophy and values. The company has been in the forefront in its risk management policies, technological innovations such as camera and self-service tills in the retail industry and CSR initiatives over the period of time. The business risk is different from the financial risk in relation to a company. While the financial risk is related to the capital structure and debt, the business risk is related to the economic conditions. The prevailing economic conditions in relation to an industry will affect the different companies differently, based on the relative exposure to the economy, which has been strategically structured by the companies concerned. However, failing to react in tune with the external environment is the greatest risk as it will affect the performance of the companies in the background of liberalization and globalization. Current Risk Management Process The company (2010) states â€Å"We recognise the value of the ABI [Association of British Insurers] Guidelines on Responsible Investment Disclosure and confirm that, as part of its regular risk assessment procedures, the Board takes account of the significance of SEE [Social, Ethical and Environmental] matters to the business of the Group... and incorporates SEE risks on the Key Risk Register.†

Global warming Research Paper Example | Topics and Well Written Essays - 1250 words - 3

Global warming - Research Paper Example This letter contains precise and conclusive information as to how and why the scientific community, especially the American Physical Society have lead the general population to believe that Global Warming will melt the earth down and all life will perish. A certain word that has been included in the official statement on global warming by the American Physical Society regarding global warming that Lewis so rightly pointed out is ‘incontrovertible’. This word is such a powerful word that when it is attached with any idea, theory or any form of interpretation, it becomes the undisputed law. The authorities at APS have wrongfully attached this word with global warming which is simply unfair. This word indicates absolution or unanimity which is certainly not the case as Lewis himself is an example of an expert physicist who opposes and rejects the fearful propaganda about global warming. One reason for writing this essay is because of the enormity that it deals with and Antony Watts (a famous science blogger) asked to publish, promote and discuss this issue on every scientific blog or journal. In his letter of resignation Lewis reminds Curt, the president of APS, about the great past and the values that APS was known for when Lewis joined this association. According to Lewis, this organization wasn’t motivated by money back in the time when he joined it. Back in those days, being a physician meant a life of poverty and abstinence. World War II changed the game. Money got involved in scientific research and suggestions. As more money poured in, wealthy people and companies started influencing decisions and researches of scientists at APS. The whole system became corrupt. During the good old times, money or any kind of external factors never influenced the scientific research. It was objective and unbiased as it should be. Even when the research on Reactor Safety Study was in progress, Zealots were right outside the research center

Employee motivation Essay Example | Topics and Well Written Essays - 500 words

Employee motivation - Essay Example This is because the workers feel safe in an environment that is tightly controlled by management. On the other hand, theory Y workers are self-motivated to perform their job responsibilities to the best of their abilities. For these workers, their work is simply an extension of themselves. If they perform poorly in the workplace, then they feel that it reflects badly on them as a person. In business organizations that contain many employees of this type, very little instruction is required from top management because the employees are naturally motivated to perform their tasks and use creative thinking to do so. No matter which type of employees an organization deals with, there needs to be incentives offered that will encourage employees to strive to do their best. An individual goal for an employee could be a bonus depending on how many sales they make in a month. For employees who are not involved in the sales department, this could be translated as how many units of production they do. The added figure to their salaries would be a small percentage based on their work output. Another way could be to offer a promotion if they meet certain company goals. This could be by assigning them to be a manager of a new franchise or factory. Quite naturally, this would result in an increase of pay. For the organization as a whole, the employees can receive a rise in salary based on the total output of the firm. This encourages employees to work well together because it will affect everyone if there is conflict in the workplace. For organizations with a diverse group of employees, the advantage is two-fold: the employees are handsomely compensated for their work, while the total output of the firm increases due to there being less conflict among employees. However, there would need to be an appropriate measure to judge whether some employees are not performing as they should. Any group-based reward system needs to have checks and balances so that no one is

Socioeconomic classes Essay Example | Topics and Well Written Essays - 250 words

Socioeconomic classes - Essay Example On the other hand health issues due to poor nutrition, scarcity of resources, no revelation to the latest technologies, lack of education and awareness hampers the self-esteem of a child belonging to a family with low socioeconomic status. Parents of low socioeconomic group do not possess high degrees and lack exposure as well as confidence to face the competent world. Research reveals that SES is linked with an extensive assortment of physical condition, cognitive, and socio-poignant upshots in kids. These implications are experienced by the child right from the fetal stage and continue throughout the life (Bradley, 2002). Child belonging to high SES gets right to use various information, substances and communal sources or responses to deal with stress generating situations. SES influences welfare at numerous intensities, both within the family and those associated with the family and surroundings. Its implications are restrained by kids 's individual personality, relations and outs ide collaborative procedures (Bradley, 2002). References Bradley, R. H., Corwyn, R. F. (2002). Socioeconomic Status and Child Development.

Catholic School Acccreditation responses Assignment

Catholic School Acccreditation responses - Assignment Example Students are assigned projects and reports, and given exams. To measure the effectiveness of student achievement of the SLEs and curriculum standards, all students present a Graduate Culminating Precis. This report summarizes how they have achieved each SLE. The school further ensures that each student is making acceptable progress toward the achievement of SLEs and curriculum standards. Every once a semester, teachers complete an evaluation. This is done based on a common rubric and using a form that lists SLEs and descriptors for each of them. Students are also given the opportunity to evaluate themselves (St. Joachim School, 30). Technology has further been integrated into the learning process. All classrooms are equipped with Promethean Boards to enhance the process of leaning. Classes also have regular access to the computer lab. There is also the availability of the Zingy Learning program which is an online science program used by the school’s science department. Furthermore, the school has an account with the Madera County Office of Education which gives teachers access to various online teaching resources. To determine how effectively students are making acceptable progress, teachers assess students through a variety of methods. These include; oral questioning, class discussions, exams, reports and projects. To implement plans to assist students, discussions are held during faculty meetings. Implementation is based upon making adjustments to the curriculum. Other strategies include making accommodations such as changing student’s seat, tutoring and modifying assignments and testing. Annually, teachers evaluate the results of the IOWA. On a regular basis, the school assesses programs used to support disaggregate groups and ensure acceptable progress for all students. Each year brings a different culture with strengths and areas of growth. To accommodate these changing trends, an evaluation

Teamwork Coursework Example | Topics and Well Written Essays - 500 words

Teamwork - Coursework Example Resistance to the approach may be due to the struggle over control of the leadership of the group, which may be due to divergent opinions or challenging the decisions made by the team leader (Cragan 78). Another reason for resistance may be due to hostile leadership where the team leader either may be racist, sexist or practices various discriminatory practices. Resistance in the form of a bid to control the team in terms of ideas may be dealt with by brainstorming of opinions shared by the team players and accommodating everyone’s opinion. Hostile leadership can be controlled by action from all the team players as opposed to the challenger and the team leader holding a private dialogue. Experts view teams as means, not an end in that they view the team as a way of achieving the vision of the organization. An end is described as the goal of the organization where the teams created are deemed as a way of achieving the vision and not the vision itself. Companies that focus on creating teams as opposed to achieving its goals is bound to collapse if the strategy is not looked into (Means 56). A company should focus on the ultimate aim of attaining its goals, which may be achieved by formation of teams among other strategies (Rothstein 100). It is important that team members analyze their team role at their work place, their contribution and whether or not they are comfortable with their specific position. The roles of team players may be categorized into task roles, nurturing roles and dysfunctional roles. One can become a better team member by understanding their responsibility and understanding that the decisions that they make affect the overall performance of the team. The concept of self-management of employees is highly successful in organizations where the decision-making by employees is embraced (Cheltenham 60). Self-managed groups are held

Methane Dry Reforming Research Paper Example | Topics and Well Written Essays - 1250 words

Methane Dry Reforming - Research Paper Example The active use of methane and carbon dioxide is also helpful because these gases are not environmentally friendly and their conversion to feedstock will enable better environmental regulation. During the conversion process, one of the major problems is catalyst deactivation resulting from coke deposition. The deposition of coke produces poor catalyst selectivity, activity and longevity. The aim of this project is to investigate the effects of forced periodic cycling between a carbon-gasifying agent (such as carbon dioxide) and methane dry reforming in order to increase the yield of syngases and to improve catalyst longevity. This study will also bolster innovation by developing the traditional Ni-CO catalyst using cerium oxide as a promoter. This approach has been shown to favour synthesis gas formation along with resistance to coking in various studies on the matter. The achievement of these goals may lead to significant improvements in hydrocarbon reforming in context of catalyst d eactivation and would also lead to an improved catalytic reforming system. These improvements would in turn provide substantial economic and environmental benefits through a positive reduction in greenhouse gases. 1. Literature Review 1.1. Introduction Both large scale and small scale industrial technology has depended on hydrocarbon reforming to produce hydrogen [Seo et al., 2009; Rakib et al., 2010]. One of the largest uses for hydrogen is the production of ammonia (NH3) through a reaction with nitrogen using the Haber process [Li et al., 2007]. Steam reforming is also a preferred method to produce hydrogen at high purity and product yields for small energy technologies like fuel cells [Lora et al.; Heinzel et al., 2002]. Overall, the major processes involved in the conversion of hydrocarbons to synthesis gas include dry reforming, steam reforming and partial oxidation or a combination of partial oxidation and steam reforming better known as oxidative steam reforming [Aasbe rg-Petersen et al., 2001; Sarmiento et al., 2007; Rostrup-Nielsen, 2009]. Each of these processes tend to have their own pros and cons based on criteria such as product composition, availability of reactants (CO2, H2O, O2), purity as well as production scale and cost [Pena et al., 1996]. As far as refining and petrochemical processes are concerned steam reforming is the preferred method [AvcI et al., 2004]. However, the industrial production of synthesis gas using hydrocarbon steam reforming tends to leave behind unwanted coke deposits on the catalyst making it not so favourable. Coke deposition has distinct disadvantages including lowered catalyst activity, longevity, selectivity and reduced reactor performance that requires constant maintenance. Within industrial processes, carbon is removed using an excess carbon to steam ratio (generally greater than 3) in order to decrease the chances of coke deposition on the catalyst. Though this method is effective, it requires greater energy investment as more steam is required than normal steam reforming necessitates. On the other hand, dry reforming is seen as an auspicious technology for synthesis gas production as it offers certain distinct advantages such as: i. Depletion of unwanted greenhouses gases (carbon dioxide and methane); ii. Gas separation is not required thereby reducing cost and allowing

Famous for their creative ideas Research Paper Example | Topics and Well Written Essays - 750 words

Famous for their creative ideas - Research Paper Example In short, he helped his country to gain independence from Britain and cope with social suffering connected with this transition (Mandelbaum, 1973). In the essence of his worldview, he strived to solve the lack of morality in modern India (Chakrabarry, 2006, p. 3). Because of this, he invented the moral principle of satyagraha, or truth force, which opposed existing violence by wise authority (Chakrabarry, 2006). On the implementation of his ideas, his leadership skills enabled his achievements. In fact, he headed the national revolution, and was creative in starting it from rural areas not presidency towns (Chakrabarry, 2006, p. 4). Thus, Mohandas Gandhi’s name is an essential part of huge transition for the Indian society. In general, Mandelbaum (1973) shows how different hard situations helped Mohandas Gandhi to turn from the average life plan of his time to become national leader Mahatma Gandhi. For instance, Chakrabarry (2006) says the very simplicity of Gandhi’s la nguage enabled him to become noticeable and easily refer to the grassroots (p. 1-2). Furthermore, numerous obstacles he faced in social life of India strengthened his conviction of the necessity of political reform. For example, he considered poverty as social violence and encouraged people to resist it. Thus, the case of Mohandas Gandhi demonstrates how important it is for political leader to be attentive to social problems. If he did not question the authority of division within Indian society, he would never become as great and creative as we know him. Hence, his idea of non-violence and moral authority is still up-to-date. On another hand, Benjamin Franklin made a crucial contribution to the further development for another part of the world, America. In the time of his living, the question of what does it mean to be American was up-to-date (Houston, 2008, p. 6-7). Thus, the introduced by him concept of improvement mostly referred to this challenge. In wider

Catherines wedding Essay Example for Free

Catherines wedding Essay In act two of the play the family has really broken apart. Beatrice and Eddie barely speak and Catherine and Rodolfo have their first argument. They argue because what Eddie said to Catherine about Rodolfo using her for a passport has really made her think, now that she knows one day they will get married, she asks him if he would live with her in Italy instead of in America. He says, No. I will not marry you to live in Italy. This upsets Catherine, but it infuriates Rodolfo. This part in the passage shows how their relationship is strong, because they make up quickly and she realises he loves her for her not just her papers. The night that Eddie returns home drunk and orders Rodolfo out his house shows just how jealous Eddie really is. Catherine says how she is leaving as well if he leaves but Eddie says to Rodolfo, Get outa here. Alone. You hear me? Alone. Catherine tries to stand up to Eddie, she says how she isnt a baby anymore, but he cuts her off mid-sentence and grabs her, and kisses her, I think he kissed her because he is drunk and he cant control his feelings anymore, but then when he gets her reaction he isnt happy. He thought she might feel the same way but she obviously doesnt. He realises he shouldnt have one it. Then Rodolfo shouts at Eddie to let go of her, Eddie asks if he wants something and Rodolfo bursts out, Yes! Shell be my wife. That is what I want. My wife. Eddie winds up Rodolfo and Rodolfo tries to defend Catherine, he tries to attack Eddie but Eddie is much stronger than him. In attempt to cover up his kiss with Catherine Eddie gets Rodolfo and he, pins his arms, laughing, and suddenly kisses him. This is embarrassing for Rodolfo because it shows how weak he is and its also embarrassing for Catherine because she has to break them up, proving she is stronger than Rodolfo. This however makes Catherine and Rodolfos relationship even stronger because now they are going to get married and Catherine knows Rodolfo will try to defend her in a fight. Eddie goes to see Alfieri for the second time, he tells him about the kiss and says he did it to try and prove Rodolfo was gay. Alfieri says that there is nothing he can do to help Eddie unless he wants him to call immigration and report the two immigrants. Alfieri gives him a second piece of advice, he says, Even those who understand you will turn against you, even the ones who feel the same will despise you. He is warning Eddie not to do anything, not to report Marco and Rodolfo and also not to do anything with Catherine. Leave them both alone. But Eddie doesnt listen to Alfieri; he goes to the phone box outside his house, and calls up immigration. When he gets home Rodolfo and Marco have moved out, into a flat upstairs with two new immigrants. Eddie now panics, one of the immigrants is Liparis nephew and he has a rough family. The last time someone snitched on immigrants, a boy named Vinny, they grabbed him in the kitchen and pulled him down the stairs three flights his head was bouncin like a coconut. And they spit on him in the street, his own father and brothers. Now that Eddie has informed immigration about Marco and Rodolfo he thinks that will happen to him, so hes nervous people will find out it was him who informed immigration. Immigration come and search downstairs and upstairs. They find all four of the immigrants upstairs and bring them down. Marco starts shouting at Eddie, That one! I accuse that one! He killed my children! The one that stole the food from my children! the whole neighbourhood is watching and listening, and then everyone turns away and leaves Eddie. The only one left is Beatrice. Marco and Rodolfo can be put on bail until their court hearing, but Marco has to promise he wont hurt Eddie. Rodolfo will be fine, because he is going to marry Catherine, but Marco will definitely be deported. Marco promises and they both go. Eddie is at home and Beatrice is with him getting ready for Catherines wedding. Eddie refuses to let her go, he says that if she goes, shes not allowed back. Catherine turns and starts shouting at Eddie, Hes a rat! He belongs in the sewer! Rodolfo comes in to warn Eddie about Marco, saying hes praying in the church, and then hes coming for Eddie. Eddie refuses to go away, he stays, waiting in the house. Eddie goes to meet Marco outside and produces a knife. He threatens Marco and tells him to apologise or hell kill him. Marco shouts at Eddie, Anima-a-a-l! Eddie lunges at Marco with the knife, but Marco takes the blade and turns it on Eddie, pushing it into Eddie. Eddie falls to the floor as Marco looks down on him. It is like the ending of act one in that Marco is standing above Eddie, with a weapon, and Eddie has lost. It was inevitable that he would die because he never knew when to stop. However I dont think Eddie deserved to die, he was only doing what he thought was correct, he wanted Catherine, and got jealous that someone else could have her, he never meant to hurt anyone, he just wanted to have Catherine to himself and Rodolfo and Marco to go away. Now there is tension between Beatrice and Marco, and Catherine and Marco, but they are not annoyed, because they knew there was nothing else he could have done.

Managing Quality In Health And Social Care Social Work Essay

Managing Quality In Health And Social Care Social Work Essay 1.0 Introduction to the Case In this assignment I am going to use a nursing home for elderly residents, both male and female with both dementia and different medical conditions like diabetes, Parkinsons disease and hypertension. Some of the service users in this nursing home are bed bound while others are mobile or self dependant. It has two floors with 42 bed capacity. 1.1 What quality means to the following stakeholders Service users These are residents or clients in our Nursing home. Quality to our service users means any service that is offered to their satisfaction for example: Respect: Most of our residents prefer to be addressed by the names while some prefer to be addressed as Mr. or Mrs. We respect their wishes and this makes them happy. Also when we are offering personal care like washing or bathing we ensure that doors are shut for privacy and dignity purposes we also respect their age as adults and treat them as adults according to their wishes Choice: Residents choices in our nursing home are usually observed as this makes them to have their freedom of choice in whatever they want to have for example we have different menu choices for foods and drinks and before we serve them we ask them what they prefer to have. The same applies to the way they prefer to dress and so we offer them a choice on their own clothes and activities that they would like to participate in and at the end of it all they are happy and the quality of service offered is satisfactory to them and everybody else. Confidentiality: Anything concerning a resident in our Nursing home is private and confidential unless for medical reasons like consultation and to those who are concerned like family and relatives. Friends and family: They usually appreciate when they are involved in care plans of their relatives and they are satisfied when what they have agreed on is followed through. Safety they are always appreciative and supportive when they know that their parents and friends (residents) are free from harm by the care they are provided with for example safe from falls, abuse and infections within the nursing home. They like their relatives to be treated equally like other residents without discrimination because of either their conditions, disabilities or ethnicity. Carers: These are the major service providers in our nursing home and quality to them means: Equity- all service providers should be treated equally regardless of their race, ethnicity, gender and knowledge and skills they have on their job when this is put into consideration they are motivated and tend to offer the best quality of care to residents which in turn leads to customer satisfaction. Safety all service providers in our Nursing home ensure they are safe on the environment they work on for their sake, residents, relatives and friends and anyone concerned. We ensure proper procedures are followed such as moving and handling by using proper equipment on residents like hoists and slings to avoid accidents to ourselves and to residents. Carers are always happy when they are not abused either by residents, relatives and friends or their fellow carers. We have four different models of quality Total quality management: a way of managing people and business processes to ensure complete customer satisfaction at every stage internally and externally (Department of Trade and Industry, DTI 2010). Although different quality experts emphasize different experts of this methodology, its major components can be summarised as follows: processes, people, management systems and performance measurement. According to Ross and Perry (1999), in addition to creating delighted customers through empowered employees, total quality management processes also lead to higher revenue and lower cost. In our Nursing home, every department is involved in implementing quality management to offer the best quality of service; we always work as a team and ensure we have offered the best quality of care that our residents need. Continuous quality improvement: is a system that seeks to improve the provision of services with an emphasis on future results (Marshall, 2003). In our nursing home, the manager ensures that every service provider receives training, implements what they have learnt and they are supervised if there is need for retraining again we are retrained this ensures that we receive updated information to offer the best quality of service. Quality standards: The Care Quality Commission for England has produced a guidance to help providers of health and adult social care to comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009 (CQC, 2010b). This guide contains the regulations and the outcomes that the CQC expects people using a service will experience if the provider complies. This forms the basis for the quality standards in care homes. There are 16 core ones range from respecting people receiving the services to safety and suitability of premises and staffing levels just to mention a few. In my care setting, we get an annual inspection from UKAF over and above inspections from CQC and have been given a star rating of three. All activities this year are geared towards a rating of four. Quality cycles: According to QCC (2010b) quality cycles represent periods within which care homes should be reviewed to determine compliance in its service provision. This may be annually. However private organisations like the United Kingdom Accreditation service also offers a quality cycle inspection called the Residential and Domiciliary care Benchmarking (RDB). The RDB annual quality cycle supports strategic planning by providing comparative feedback on a homes care provision and enables the identification of performance gaps and cost/benefit assessments to be made (UKAF, 2010). In this model we have four major aspects to be looked into namely: planning, doing, checking and acting. Quality and principles of care Legislation -these are laws and rules set by the government on how the provision of care should be for example protection of vulnerable adults. In our nursing home, every service provider should be ready to protect all residents from any form of abuse we attend mandatory trainings such as safeguarding vulnerable adults according to regulations by the CQC (2010b). Safety- in our nursing home we always do risk assessment on every service user and put measures in place like using bed rails to prevent falls by doing this we have protected residents from accidents and this ensures quality service to our residents. Independence-service users should be made in control of their lives by allowing them to do some of the things like arranging their wardrobes, making and tidying their rooms by themselves because some of the residents are very active and would like to do what they used to do before and we always encourage them to do while we supervise them and this makes them happy hence promoting the quality of service as they are satisfied. Rights- service users should continue to enjoy the same rights when in nursing homes like they used to when they were living independently. Every service user supported in nursing homes has the right to say NO, right to have a relationship and the right to have a say in their care plan. Service providers always tend to balance service users rights against their responsibilities whether both are at risk or not. 1.4) External agencies: These are bodies that regulate quality of care including: The Care Quality Commission an independent regulator for health and social care in England (CQC 2010a; 2010b). They regulate care provided by NHS, local authority, private company and voluntary organisations. Their aim is to make sure better care is provided for everyone. In our nursing home Care Quality Commission makes a minimum of three inspections annually (two announced and one unannounced) on such things as how we provide care in terms of cleanliness of the home and to service users.. It has a wide range of enforcement powers to take action on behalf of service users  if services are unacceptably low. The  CQC makes sure that the voices of service users are heard by asking people to share their experiences of care services. It makes sure that users views are at the heart of its reports and reviews. The CQC takes action if providers do not meet essential quality standards, or if there is reason to think that peoples basic rights or safety are at risk (CQC, 2010) through a wide range of enforcement powers, such as fines and public warnings, and can be flexible about how and when to use them. It can apply specific conditions in response to serious risks. For example, it can demand that a hospital ward or service is closed until the provider meets safety requirements or is suspended. The National Institute for Health and Clinical Excellence (NICE)- this is an independent organisation responsible for providing national guidance on promoting good health preventing and treating ill health (NICE, 2010). In our Nursing home, residents who have anxiety, panic attacks request for sedatives in order for them to sleep they are usually reassured and instead a government practitioner is consulted to review and advice them accordingly. Service providers take NICE guidelines trainings on different medical conditions for example diabetic foot (identification and care of the foot). 2.1) Quality Standards Benchmarks: According to Philip B. Crosby (1999) benchmarks are indicators of best practice including access to care environment and the culture of a home. The Benchmarks is one of the most comprehensive sets of social and environmental criteria and business performance indicators available (Daniels et al 2000). Our nursing home is accessible publically, to wheel chairs, a spacious car park and a section for activities for residents and relatives. We also have a signing in visitors book stating whom they are visiting. Code of practice for social care workers and employers for social care workers This document is developed by General Social Council and it contains agreed codes of practice for social care workers and employers of social care workers describing the standards of conduct and practice within which they should work ( GSCC, 2002). Employers use this set of code of practice to make decisions about the conduct of staff and support social care workers to meet their code of practice. Service users and members of the public use the codes to help them understand the behaviour of social workers (how they should behave towards them) and also how employers should support social care workers to do their job well. It is the responsibility of social care workers to make sure that their conduct does not fall below the standards set in the code of practice and no action or omission harms service users (NCSC, 2010). Social care workers must protect the interests of service users, maintain confidence, respect rights, promote independence, be accountable for the quality of their wor k and take responsibility for maintaining and improving their knowledge and skills. The general social council expect social care workers to meet the codes and may take actions (deregistering) if registered workers fail. 2.2) Different approaches to implementing quality Communication is a means of passing information from one person to another. In our nursing home we have different ways of communication like when doing care plans we always document what we have done for a resident so that whoever takes over knows what to do next to ensure continuity of care. Also when handing over is done during change of shifts information about residents is shared and everyone is aware of any changes in care plans in accordance to CQC guidelines (CQC, 2010). We also have staff meetings where certain information is passed on and in cases where staffs have a problem it is addressed and solutions are given out. For effective communication systems there should be a language that everyone understands. Policies and procedures These are guidelines set on how to do things often informed through regulations as outlined in various government documents (GSCC, 2002; NICE, 2010; CQC, 2010a. 2010b). In our Nursing home we have different policies and procedures for example in cases of accidents to residents we are required to fill a resident incident report and pass it on to the supervisor families, friends and relatives are informed about the accident then precautions are put into place walking frames, to avoid future occurrences of similar accidents. Infection control policy helps to prevent spread of infections within our nursing home. We always use personal protective equipment when offering personal care to residents, handling of any infectious wastes. We also use the proper technique for hand washing. There are also hand gels in each residents room, in public toilets and at the entrance of the building for sanitation purposes and all wastes like clinical and kitchen wastes are usually put in the bins ready for collection. In cases of disease outbreaks like diarrhoea and vomiting residents are isolated and managed separately and proper hand washing techniques are used to prevent further spread of the infection. Whistle blowing policy is designed to deal with issues that do not directly affect the employee and their employment but are a cause for concern in relation to the harm that may be done to other employees, residents or the wider community. Any employee who is concerned about their personal situation should raise their concern with their line supervisor or manager. This policy is for reporting issues like elderly abuse, misuse of drugs, faulty machinery that may cause accidents, illegal dumping of waste. The policy protects not only employees but the wide community. Confidentiality- all residents or service users information is private and confidential. It is not a proper practice to discuss residents information in public like their conditions and behaviours by doing that is breaching the policy and legal action should be taken. In nursing homes all information is kept safely and only accessible to relevant persons. This promotes quality of service 2.3) Quality systems ISO 9001 involves a set of procedures that cover all key processes in the business, monitoring processes to ensure they are effective, keeping adequate records and facilitating continual improvement. They have certain requirements like internal regulations, claims and procedures for residents, suggestion box and contract with uses. It also covers the importance of understanding and meeting customer requirements, communication, resource requirements, training and products, Leadership, Involvement of people, Process approach, and System approach to management and Continual improvement (Tricker and Sherring- Lucas, 2001). In our nursing home for the provision of all these elements and reporting them on day to day basis for example there is a clear procedure for residents complains. Carers, residents and relatives are informed and logged in a special complaints book and complains are followed up. When all this are put into practice, there is employee and customer satisfaction, resulting from better defined and implemented business processes. As a result of this we have motivated staffs, who understands their roles and how their work affects quality, improved product and service quality, happier customers, and improved management and operational processes, resulting in less waste (both time and materials) Business excellence is a widely used framework that helps companies to review their performance and practices in a number of areas and identify targets and actions for improvement based on principles of customer service stakeholder value and process management ( British Quality Foundation, BQF 2010). Managers develop the mission, vision and values and are role models of a culture of Excellence. Studies in Taiwan have shown that in care homes where this model is applied, managers are personally involved in ensuring the organisations management system is developed, implemented and continuously improved are involved with customers, partners and representatives of society and also motivate, support and recognise the organisations people (Cheng B, Chang, C and Sheng L. 2005). In our nursing home we use a balanced score card to keep track of activities by staff and measure consequences arising based on the British Quality Foundation model ( BQF, 2010).Service users families and relatives m easure in a scale of 1-5 where one is poor and five is excellent. We work hard in poorly rated areas to improve the quality of service. At the same time managers set a number of targets on key areas of each staff members roles which are then assessed on monthly review and awards are given to the best. This motivates other team members to work hard and best to attain the best and by doing so they provide best quality and we excel. 2.4) Trainings this refers to a learning process that involves the acquisition of knowledge, sharpening of skills and concepts (Stevens, 2004. In our nursing there are mandatory trainings offered to service providers before commencing to work like basic food hygiene, manual handling Healthy and safety is ensuring that the environment where we are working is safe for service users, other staff and others in general by our actions and omissions. It is a responsibility to all staff to ensure that the environment is safe to work on. For safety purposes in our nursing home we do not use equipment unless it has been checked and serviced. Also default equipments are labelled DO NOT USE to prevent and avoid accidents. We also have controlled cupboards where substances that are hazardous to health are stored and locked away. When there is a defect on the environment like chipped floors, loose hanging electricity wires we report to the maintenance coordinator and they are rectified immediately to avoid accidents. Again when housekeeping team are doing cleaning they always display cleaning boards and everybody is aware that cleaning is on progress or the floor is wet and they avoid using it until it is dry by doing this they minimise chances of accidents like falls 2.5) According to Marshall (2003) and Stevens (2004), external and internal barriers to delivering quality are any obstacle which prevents a given policy instrument being implemented or limits the way in which it can be implemented. They include: Resources: lack of adequate resources hinders quality of service for example inadequate or shortage of staff affects the quality of services offered and this leads to unsatisfaction of service users as they get services that are not adequate and for service providers because they are overworked. In nursing homes when there are staffs shortages they arrange cover shifts earlier by either bank staff or some agencies registered with the home. Financial barriers include budget restrictions like food supplies and other supplies like incontinent products limits the overall expenditure and this leads to inadequate provision of quality services to residents Personal Appearance: Hygiene and grooming, eating habits and attire can vary from country to country and culture to culture. For example, some people may wear attire such as a headdress as part of their custom and beliefs. To remain true to their beliefs, some workers may want to continue to wear this dress at their workplace. Employers may view this as inappropriate or unsafe. It is particularly problematic in workplaces where workers wear uniforms. Religion: In many cultures, religion dominates life in a way that is often difficult for employers to understand. For example, workers from some cultures may want to pray while at work times in accordance with their values and beliefs. There may also be religious holidays on which people of certain religions are forbidden to work. These differences need to be respected, where possible, and not ignored and they affect the quality of service. Language barriers often go hand-in hand with cultural differences, posing additional problems and misunderstandings in the workplace. When people cannot communicate properly they are frustrated when communicating with supervisors, co-workers and residents this can be dangerous because people may end up performing poorly in their work thus affecting quality of service offered. Legal and institutional barriers -these include lack of legal powers to implement a particular instrument and responsibilities which are split between agencies limiting the ability of an institution. Like the law states that students should work for twenty hours only which creates shortages at work affecting quality of services. 3.1) According to Business Dictionary.com (2010), policies are principles, rules and guidelines formulated or adopted by an organization to reach its long term goals. They are designed to influence and determine all major decisions, actions and activities take place within the boundaries set by them and procedures are specific methods employed to express policies in action in day to day operations of the organization. For example, in nursing homes the National Care Standards Commission for England, NCSC (2010) has outlined requirements that these homes must meet which in effect guide their policies and principles. These policies include, but not limited to: manual handling procedures, Risk assessment and Infection control. Manual handling These are techniques used to handle or move service users like hoisting, using belts and sliding sheets to move residents these are safe procedures for both residents and service providers as they minimise accidents to both cases and this promotes quality of service (CQC, 2010). On the other hand, they have disadvantages like time consuming when doing procedures like hoisting which requires two or three persons and also residents may not like the experiences of hoisting and thirdly it needs trainings to be carried out. Risk assessments According to healthy and safety at work act (1974) the Management of Health and Safety at Work Regulation (1999) states that it is the responsibilities of managers to do risk assessment to employers and employees. to reduce and prevent risks to them in future and they are included in their care plan so that quality of care can be improved for example residents with risks of falling have walking frames, falling mats and bed rails put in place to avoid falls but again things like bed rails have caused accidents in that residents are trapped and some sustain fractures which affect quality of service 3.2) factors that influence the achievement of quality of personal care Quality is a difficult concept to capture directly. However, resident or organisational outcomes are often used as a proxy for quality (Marshall, 2003). There is considerable debate about the relationship between quality of care and quality of life as joint, but not necessarily competing, measures of quality. A study for the Joseph Rowntree Foundation indicates that residents perceptions of nursing staff are a good indicator of quality of care (JRF, 2008).The importance of measures of social care and of homeliness epitomise the divide between health and social care provision in care homes. Factors influencing residents satisfaction with care are discussed below: Team working Heath care workers working in teams has been recognised as an improving the quality of care (Stevens, 2004; Borill et al 1999). According to Stevens, the intention is for carers to share tasks and learn from each other and possibly improve based on their experiences. This can be illustrated by the quotation below: The best and most cost-effective outcomes for patients and clients are achieved when professionals work together, learn together, engage in clinical audit of outcomes together, and generate innovation to ensure progress in practice and service. (Borill et al 1999 p.6). Stevens has for example reported from a number of surveys from UK nursing homes to suggest that there is a reduction in carer burden and significant reduction in stress when staff work in teams resulting in better coping and satisfaction. Both these studies (Stevens, 2004; Borill et al 1999) found that service users surveyed showed more satisfaction when carers and health workers worked in teams Healthy and safety at work The responsibilities of care home proprietors are subject to a range of health and safety legislation among them the Health and Safety at Work etc. Act 1974, the Management of Health and Safety at Work Regulations 1999 which require employers to assess the risks to employees and other who may be affected by their undertaking, (residents) and the control of Substances Hazardous to Health Regulations ( Care Quality Commission, 2010). These regulations have led to dramatic improvements in the safety of residents and people working in care homes according to the care quality commission. For instance, guidelines requiring minimalist manual handling has significantly reduced the numbers of health workers staying off work due to illness which has a positive effect on the level of personal care of residents ( CQC, 2010a). However, a report for the Joseph Rawtree Foundation (JRF, 2008) showed that the percentage of medication errors and adverse events in nursing homes have increased despite regular inspections by the CQC. Stevens (2004) has also reported survey results from 27 residential homes with dementia patients where 19% cases of medication errors were reported. In my care setting, clear improvements can be seen from less harm to residents when using the hoist but not many service users like to use the hoist. Some risk assessments in care homes have made it very difficult to take residents outdoors or even for activities outside the home for fear of not meeting the Health and safety requirements and this ends up reducing the quality of care. 3.3 The following recommendation can improve the quality of care in Nursing homes Training /education This means acquiring knowledge and skills or new information on how to do things according to the recommended regulations and standards ( Stevens 2004). This is a very important aspect in nursing homes all trainings as it provides ongoing trainings to update service providers and equip them with relevant and current information that enables them to provide the best quality of care that will be satisfactory to service users. In our nursing home trainings are offered and need to be implemented then supervision is done and in cases where need for retraining arises, arrangements are done and they are offered for the benefits of service users, service providers and the community at large as it reduces or minimises preventable accidents and this promotes the quality of service Review This means going through the set of targets or planned activities to see the progress whether it is improving or getting worse. This alerts and actions or precautions are put in place to make the situation improve for better quality of service ( Stevens, 2004). For example in our nursing home there are always monthly reviews of care plans of service users this includes individual or family interviews to determine whether residents are improving or need some improved care plans like in moving and handling procedures (use of hoist or belts) and then action is taken accordingly. Also for staff there is quarterly staff meetings or when need arises and previous discussed or current issues are raised and a way forward on how to carry on is agreed. There are always individual supervisions done by allocated persons and each employee identifies areas that need improvement and good performing areas by doing this there is improvement of quality of service Conclusion It has been shown that in order to improve services to users in the social care sector, it is important to follow principles, guidelines and procedures set by government, industry bodies or even individual homes. There is also need for planning, doing and checking and then reviewing to assess shortcomings in order to design improvement regimes. Similarly, it has been shown that although there is legislation and care industry standards, it will require long term commitments in developing methods, instruments and communication procedures involving all stakeholders at care or residential home level.

Examining the challenges of Clinical Leadership

Examining the challenges of Clinical Leadership A health care setting institution with advanced health technology and high calibers doesnt mean quality nursing care can be offered, unless accompanying with effective clinical leadership. This essay has a strong focus on all aspects of clinical leadership. A case will be used to find out how should effective leadership skill be. Both internal and external factors should be analysed. The latter factors can be found out by PESTEL. Change management is helpful to develop strategies for handling the issue. In recommendations, teamwork, power, communication and presentation skills, conflict management, emotional intelligence and autocratic leadership style all are crucial to solve the issue and a clinician should equip with them. Before concluding all the discussion, training myself as a reflective practitioner is helpful to develop my future practice. Clinical leadership- What is this? It has various definitions. Harper (1995, p.81) defines a clinical leader as one who possesses clinical expertise in specialty practice area and who uses interpersonal skills to enable nurses and other healthcare providers to deliver quality patient care. More elaborately, it also involves an environment where nurses are empowered and where there is a vision for the future. Clinical leadership requires leadership skills for team building, confidence and respect of others, as well as vision and empowerment. Equally important, clinical leaders must also be good communicators. Meanwhile, Stanley (2006) suggests not only the abovementioned elements clinical leaders have to demonstrate, but also the followings- approachable and role model. Approachable means a clinical leader should be friendly and openness rather than controlling and dictatorial (Stanley, 2006). Role model means clinical leader who serves as an example, whose behaviour is emulated by other nurses (Stanley, 2006). To summ arise the above elements, clinical leadership is effective if clinical leaders are expert in their field, and because they are approachable, effective communicators and empowered, are able to become a role model, motivating other nurses by matching their values and beliefs about nursing and care to their practice (Stanley, 2006). Leadership is important in healthcare today. In Hong Kong, Hospital Authority emphasises any potential or experienced leaders should be educated and trained. Enhancing professional competencies and building up effective leadership is the top priority. In action, providing simulation skill-based training for nurses; developing new in-house specialty training programs for nurses; offering corporate scholarship for overseas training; creating full-time executive development positions; organising senior executive development program and other leadership development all are beneficial to nurture competent clinical leaders (Hospital Authority annual plan, 2010). Case scenario This short paragraph is going to describe a case I experienced at my area of practice. Having been a senior nurse at my workplace, I am mainly responsible for nursing administration, such as arranging vacation leave for my colleagues. One day, one of my subordinates requested annual leave during the Chinese Lunar New Year as she hasnt been a long vacation leave during the festival for a few years. Her request was simply rejected because of compelling reason- inadequate manpower. I think it was reasonable to reject her request. However, the colleague had seemed disappointed my decision and complained this incident to my senior. It is time for me to contemplate which aspect, for example, communication and interpersonal skills or poor decision making, which I was doing wrong in this leadership issue. In short, there might be conflict issues between the subordinate and senior. Analysis There are many external factors which affecting the leadership issue. It is important to reveal them so as to maximize the opportunities and minimize the threats to my work environment. PESTEL is an analytical tool to help decision-maker to consider what external factors are important. Political, economic, social, technological, ethical and legal factors or PESTEL factors in short should be discovered. The following grid shows the analysis: Grid 1: PESTEL analysis grid P E S T E L e.g. Any inequality legislation committed due to subordinates request being rejected A lot of alternative nursing employment may contribute staff submitted resignation Staff social life may be affected due to imbalance work and social time Outdated IT equipments impede work flow and efficiency Unfair to the subordinate or not, lack of respect as her wish is rejected Take precaution of any changes in employees holidays policy/protocol Having listed the key factor in each PESTEL area, elaboration will be given regarding to individual area. Political factor can be interpreted as what is happening politically in the environment in which a decision-maker operates (Mennen, 2007). A decision-maker should pay attention that any inequality ordinance may be committed, for subordinates request for holidays during public holidays is refused. Economic factor can be interpreted as what is happening within the economy (Mennen, 2007). A decision-maker should take notice on every decision. Careless decision may incur angry healthcare staff submitted resignation, for there are a lot of nursing vacancies offered by other clinics, hospitals and old age homes. Social factor can be interpreted as what is occurring socially in an environment in which a decision-maker operates (Mennen, 2007). Having vacation leave during special festival is a reasonable desire for all shift-based healthcare staff. A decision-maker may be in dilemma whos e staff can have vacation leave as manpower is so tight. Technological factor can be interpreted as what is happening in technology which can impact what a decision-maker does (Mennen, 2007). In this regard, outdated healthcare technology can affect the leadership issue also. Inefficacy may be caused by the outdated equipment results time-consuming in a simple procedure, such as preparing a roster for frontline staff. Ethical factor can be interpreted as what is right or wrong philosophically (Mennen, 2007). A decision-maker should underscore any decided judgment should be morally acceptable, such as frontline staffs request should be fairly arranged. Prejudice and bias should be avoided. Legal factor can be interpreted as what is happening with changes to legislation (Mennen, 2007). A decision-maker should update his/her understanding in any staff vacation leave protocol or policy in order to maintain the staff maximum benefit. To make a brief summary, PESTEL can enable an organiza tion to anticipate future threats and take action to escape from their impact. Change management The term-change management is coined by Lewin (1951).Change management model is known as unfreeze, change and refreeze (Mind Tools Ltd, 2010). Change is unavoidable of something is needed to be amended. This paragraph is going to explore how the change management model can be applied in the clinical issue. Before application, force field analysis should be performed. The analysis starts from the premise that any situation is held in a stable position by a series of equal and opposite forces. Change occurs about when the forces become out of balance. The analysis is useful when a decision-maker knows where he/she wants to go but is stuck. The following shows the analysis: Restraining forces forces Pushing forces Maintaining adequate manpower is the top priority Staff discontents the holiday during the Chinese New Year Poor mood and low work efficiency due to no holidays during the special festival Power and discipline are paramount to uphold better patient services/benefit Involved staff politicizes the issue (i.e. complaint the issue to management level) Frontline staff is an important asset in caring-demand work environment To execute change, pushing forces must be greater than restricting forces and the need for change has been recognized. In application of the Lewin (1951) model, the first step should prepare the organization to accept that change is necessary, which involves break down the existing status quo before building up a new way for the next stage (Paton McCalman, 2008). In practical step, ensuring there is strong support from management team. Compelling message should be disseminated vacation leave during special festival is possible if manpower is enough. Maintaining stable manpower is essential to provide quality nursing care. At the same time, managerial staff should remain open to subordinates concerns and address in terms of the need to change. The second stage is where people begin to resolve their uncertainty and look for new ways to do things. People start to believe and act in ways that support the new direction (Paton McCalman, 2008). In practical step, effective communication and empowerment are significant. More clearly, managerial staff should prepare every staff for what is happening if staff requests annual leave during special festival. Also, explanations exactly by the managerial staff how the changes will affect every staff. The third stage is when the change (i.e. no one is approval for vacation leave during special festival unless manpower is allowed) is taking shape and subordinates have embraced the new ways of protocol, the organization is ready to refreeze (Paton McCalman, 2008). In practical step, the organisation should anchor the changes into the culture. Establishing feedback system is helpful to sustain the change. Having vacation leave immediately after special festival is encouraged. Recommendations There are six recommendations to solve the leadership issue. The concept of teamwork should be imparted into the ward practice. Nursing care is teamwork-based. The importance of teamwork should not be ignored. Teamwork in health care can be defined as a dynamic process involving two or more health care professionals with complementary backgrounds and skills, sharing common health goals and exercising collaborated physical and mental effort in assessing, planning, or evaluating client care (Agich, 1982). I have to explain her that the importance of teamwork. All colleagues need to understand how important it is for them to work smoothly together if they want to provide quality care. All colleagues must be dedicated to the whole nursing team and be willing to act unselfishly. In other words, sacrifice, in a certain extent, is necessary. To build up teamwork culture, making sure that the team goals are completely clear and understood and accepted by each frontline staff. In addition, I have to be careful with interpersonal issues. Early recognising them and dealing with them in full are highly recommended. Power There is a famous proverb-nothing can be done without power (Power, 1999). The appropriate use of power is important for clinical leadership, for a healthcare setting environment depends on social relationship based on power. Power (1999) defines power in terms of control or influence over the behaviour of other with or without their consent. Power can be classified as physical, position, resources, expert and intuitive. Position rather than other power should be used in the issue. Position power equals legitimate power. It means occupancy of a role entitles one to the rights of that role in the organization (Power, 1999). As a decision-maker, I have considerable right to determine something. Not approving staff with vacant leave during the special festival during the Chinese New Year is a logical and reasonable decision. Both parties interest (i.e. patient and ward) can be preserved. Presentation and communication skills Oral communication skills consistently rank near the top of competencies valued by clinical leaders. As a clinical leader, promoting positive workplace relations through conservation is highly recommended (Burnard, 1997).. In the leadership issue, I have to offer constructive criticism pertinent to the issue rather than directly rejecting her request. Think currently about what I want to say is the first step. Next, be specific in conveying core message during face-to-face communication. Clear rather than vague assertion is preferred. I do wish there is enough manpower during the special festival so you can have holiday us better than your request is banned due to inadequate manpower. On the one hand, I have to offer help and empathy her. More clearly, holiday after the special festival should be arranged immediately and understanding that the mood of no holiday during the festival. Conflict management Since different staff will have different viewpoints, ideas and desire, conflict is unavoidable in any group. The sources of conflict are disagreement on how things should be done, personal interest as well as tension and stress (Shortell Kaluzny, 1997). The outcomes of conflict include polarization, low morale and regrettable behaviours produced. Therefore, conflict should be well encouraged In this regard, understanding how conflicts arise is important. Obviously, the above mentioned conflict can be categorized as personal interest (i.e. requesting on holidays during the special festival). To handle the conflict due to personal interest, compromise or negotiation is effective to settle down the incident. I have to talk with her gently as manpower is too tense, your compromise is critical. At the same time, I have to manage the issue intelligently, banning her request straightforwardly seems provoking her emotion. Rather, I have to refuse her request euphemistically. For example, y our request must be approved if manpower is enough. Emotional intelligence Emotional intelligence is recognition of our own feelings and those of others (,). A clinical leader who accurately perceives others emotions can handle change better and build stronger social networks. To achieve so, three emotional intelligence skills a clinical leader should possess. The skills include social skills, motivation and self-awareness. Social skills are the ability to influence or persuade others (Pahl, 2008). Good communication skill is a typical example. Motivation is able to enjoy challenges and be passionate about work and initiate optimism (Pahl, 2008). Motivating all frontline staff to work at the special festival is a big challenge task. Self awareness is a deep understanding of ones emotions or self-assessment in short (Pahl, 2008). Understanding my own strengths and weaknesses is helpful to deal with emotional event. Authoritarian Autocratic rather than laissez-faire and democratic styles should be considered. Autocratic style is an autocratic leader who is directive and makes decisions for a group. Being autocratic does not mean the leader is a dictator. Instead, the leader usually provides direction and makes decisions (Northhouse, 2010). Meanwhile, laisser-faire style is noninterference in the affairs of others and democratic style is subordinates have an equal say in the decision-making process (Northhouse, 2010). In the leadership issue, if a lot of subordinates requests annual leave during the special festival, inadequate manpower is guaranteed. Therefore, laissez-faire and democratic styles mustnt be adopted because it is impossible for subordinates to freely choose the period of vacation leave. To prevent any chaos in holiday arrangement, autocratic style is the best style to be adopted. Development of future practice This experience should be in my heart because the experience I engaged is helpful to my future practice. Reflective practice is highly recommended. It is associated with learning from past experience, and is regarded as an important strategy for health professionals who embrace lifelong learning (Johns, 2009). Due to the ever changing context of healthcare, there is a high level of demand on healthcare professionals expertise. Healthcare professionals could benefit from reflective practice, since the act of reflection is seen as a way of promoting the development of autonomous and qualified professionals. Engaging in reflective practice is associated with the improvement of the quality of care and stimulating professional growth. In practical step, there are several frameworks for reflection, for instance, Gibbs reflective cycle. Gibbs (1998) developed the reflective cycle in order to provide structure for reflecting on a nursing situation. The cycle involves six phases. The first ph ase is to describe what happen (i.e. the case scenario). The second phase is to think and feel about the scenario (i.e. unwisely to handle the issue). The third phase is to evaluate what was good and bad about the experience (i.e. adequate manpower can be maintained but the involved subordinate become angry). The fourth phase is to analyse what sense can I make of the issue (i.e. managing conflict of personal interest intelligently). The fifth phase is to think what else could I have done (i.e. managing conflict tactically). The final phase is to prepare contingency plan (i.e. if it arose again, what would I do). Conclusion So far, all aspects of clinical leadership have been covered. To solve the issue due to personal interest, negotiation with involved staff, wisely-used conflict management skills, fully utilizing position power and compelling presentation skills all are constructive to the issue. Before settling down the issue, both PESTEL analysis and change management should be engaged. The strengths of the above are to discover any threats as soon as possible and implement related changes immediately. Successful settling down the issue doesnt mean a clinical leader demonstrates effective clinical leadership. As clinical leadership is a persistent phenomena performed by a clinical leader, reflective skill a clinical leader should have so as to enhance clinical leadership in an advanced level. (Words: 2711)