Power in Complex Societies Essay Example | Topics and Well Written Essays - 500 words

Power in Complex Societies - Essay Example The gods were worshiped with a lot of respect and anything that was said to come from the god was not taken lightly. The ancient leaders knew this and took the fullest advantage of this. The brains of the communities were brainwashed to trust religion. In ancient Egypt, the king ruled over the people and even owned their wealth. This way, he was able to control the people in totality. The king visited the temple regularly to assert his power. He also participated in the rituals of the community. The kings mainly used this source of power where the military and political power also had other determinants (O’Connor & Reid 176). He could then capture the minds of the people. In ancient Athens, there was great reference to religion. The ways of the gods were respected just like in ancient Egypt. In Athens, there were several impiety trials for those who did not respect religion. For example, Anaxagoras was prosecuted for doubting the existence of the god sun. The leaders knew this too well and thus by using religion, they dictated how the Athenians lived. They also protected their dynasties using religion. The Athenians had a lot of belief in prophecy and there were a lot of divinations. In most instances, the results of the divinations favored the reigns of the leaders who were there at the time. Religion also shaped the political culture at the time and thus was the main source of power in most ancient kingdoms including Athens. Sparta had a sophisticated ideological system. The system of power dictated that few elite people ruled over the majority in the community. Sparta had both military and political power. The king was also the spiritual leader of the people and that used this role to assert his authority in the community. Being militaristic state, the ideologies that the community believed played a great role in propelling the dynasties that reigned at the

Transition Services for Special Education Students Essay Example for Free

Transition Services for Special Education Students Essay Abstract This study examined the issues on life-span transition services for special education students. By exploring the existing approaches to transition services and analyzing outcomes they provide for the disabled persons the study tried to find out the strengths and weaknesses of these approaches as well as to define the future trends able to enhance transition programs designed to increase the likelihood that the disabled person will be able to secure and maintain employment, function independently in the community, and ultimately become a satisfied and productive member of society. The results of the study demonstrated that to be successful transition services have to be transdisciplinary in nature. Besides, the use of collaborative teaming among professionals, agencies, the student, and family members, the use of the curriculum that focuses on the interactions between the student and his/her environments as well as the establishment and use of interagency linkages to facilitate the smooth transfer of support and training from the school to adult and community agencies when the student exits public schools are the most important components of successful life-span transition programs. A few decades ago the society faced disturbing outcome data of the students with disabilities (Repetto, 1995, p. 128) and fully realized that due to little concern given to vocational and transition programs for these students the latter experienced increased school dropout and unemployment rates as statistics showed. Those students have often graduated from the school lacking the skills essential to live or function autonomously in the community, and often failing to find and keep job (Levinson, 1998, p. 29). It is evident such state of things has been costly for both financial and personal considerations. On the one hand, the society was to provide social security for these persons, and on the other hand, the person himself was not satisfied with job career and own dependence. The necessity to change this state of affairs has led to growing concentration upon enhancing transition services for the persons with disabilities within the past one and a half decade. Three factors contributed to this process: adoption of federal legislation supporting and promoting transition services; availability of state, federal, and local funds invested in their development (Shapiro Rich, 1999, p.51); and a number of scientific and empirical studies on effective transition practices (Kohler Field, 2003, p. 174). The purpose of this study is to explore how life-span transition services can ensure smooth integration of the special needs students into the community and provide them with the skills sufficient for successful career development. Toward this end we will scrutinize prevailing approaches to transition services, discuss their advantages and shortcomings; analyze the components making transition programs implementation successful; and make the conclusions as to the ways of these programs improvement. Definition of Transition Services Transition services were defined in by the law as: A coordinated set of activities for a student, designed with an outcome-oriented process, which promotes movement from school to post-school activities, including post-secondary education, vocational training, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation. The coordinated set of activities shall be based on the individual students needs, taking into account the students preferences and interests, and shall include instruction, community experiences, the development of employment, and other post-school adult living objectives, and, when appropriate, acquisition of daily living skills and functional vocational evaluation (P.L. 101-476, pp. 1103-1104). Thus, transition services, mandated by legislation, reflect the major performance areas that are typically addressed by transition services: work or education, independent living including activities of daily living, and community participation, which may include community mobility and transportation, access to community services and activities, recreation and leisure, and socialization and relationships. This definition distinctly implies that transition services should involve a diversity of school and community staff. It also assumes that they have to contain the parents of the children and the children themselves (Shapiro Rich, 1999, p. 132). Besides, the definition entails that a transition program is an outcome-oriented, well-planned and methodical process to be launched long before the student is graduating from school (Levinson, 1998, p. 2) to achieve its goals. Legislative Background of Transition Services As it was mentioned above one of the main factors promoting transition services prevalence was adoption of supporting federal legislation and availability of state, federal, and local funds invested in their development. Since the 1970s the United States Congress has passed several legislative acts that have directly affected the availability and use of transition services for the individuals with disabilities. Since the passage of Public Law 94-142, The Education for All Handicapped Children Act of 1975 (EHA), special education and related services have been made available through the public education system to the nations children and youth who have disabilities (Levinson, 1998, p. 27). The Rehabilitation Act, which was first introduced in 1973 and then rewritten in 1986 (Public Law 99-506), stipulates for provision of transition services to individuals with disabilities to (1) have greater control over their lives; (2) participate in home, school, and work environments; (3) interact with peers who do not have disabilities; and (4) otherwise do acts taken for granted by individuals without any known disability (Repetto, 1995, p. 127). The EHA and its subsequent amendments (Individuals with Disabilities Education Act (IDEA), 1990, 1997) guaranteed the provision of transition services as required to provide free and appropriate education for all children with disabilities (Benz, Lindstrom Yovanoff, 2000, p. 509). An appropriate education is one in which children with disabilities acquire, to the maximum extent possible, the skills, knowledge, and behaviors that will ultimately help them function successfully as adults. After initial passage of the EHA, several major benefits were realized: Formal mechanisms were established to identify and bring children with disabilities into the public education process. Parents and guardians were identified as essential members of the educational team and were provided with legal rights related to their childs education. All identified children were provided with Individualized Education Programs (IEPs) developed by an educational team that included the students parents or guardians (Shapiro Rich, 1999, p. 131). The 1997 amendments to IDEA continued to emphasize the use of transition services to enable the success of students with disabilities in their educational and school-to-career programs. These legislative acts have improved the access to transition services by children with disabilities (Levinson, 1998, p. 29). Moreover, through the Tech Act (Public Law 100-407), states have established resource centers and information systems for consumers of transition services. The goals of this legislation are to foster interagency cooperation, develop flexible and effective funding strategies, and promote access to transition services for individuals with disabilities throughout their life spans (Johnson et al., 2002, p. 520). The Goal of Transition Services – Life-Span Assistance for the Student’s Empowerment Such well-founded legislation on transition services paved the way for their wide spread implementation all over the nation, successful realization and continuous enhancement of the delivered services. From the definition of transition services it is clear they require â€Å"an outcome-oriented approach that looks at future vocational placements, residential options, funding sources, and community resources† (Nuehring Sitlington, 2003, p. 23). A number of studies examined the practical ways of applying this approach. In particular, Wehman Revell (1997) found the following: Transition for any student with a disability involves several key components, including: (1) an appropriate school program; (2) formalized plans involving parents and the entire array of community agencies that are responsible for providing services; and (3) multiple, quality options for gainful employment and meaningful post-school education and community living. (p. 67). All these components in combination are assigned to promote the smooth movement of young children with disabilities from a preschool program to a kindergarten class and into a school setting, and further the movement of young adults from one grade of the secondary school to the next and to post-school activities.   Thus, the special needs children may spend from 12 to 18 years getting the certain form of transition services (Spencer 2001, p. 893) which Donald Super in his theory of career development called â€Å"life-span and life-space transition† (Szymanski, 1994, p. 402). Many scholars agree that early childhood influences are the crucial determinants of later professional behavior (Turner Szymanski, 1990, p. 20). Reflecting this concept, IDEA 1997 while not requiring the local education agency to consider transition activities and sites for students with disabilities before the students 14th birthday, does require that services be provided earlier if the IEP team feels such is appropriate (Daugherty, 2001, p. 45). Therefore, families and educators should consider the child’s abilities, interests, and opportunities for community-based activities and kindergarten- or home-based special education while the child is in pre-school years and in elementary school. Doing so should help the child to develop skills and interests for maintaining that activity later in life (Levinson, 1998, p. 10). Research indicates that such early involvement of the child with special needs into transition programs improves and enhances self-concept, competence, and social skills of him/her (Szymanski, 1994, p. 403). The very important thing here is that professionals and families should recognize that families play an integral role especially in early year’s transition planning (Scott Baldwin, 2005, p. 173). The scholars suggested a number of guidelines for such planning: transition should be viewed within a larger context of community inclusion and participation; transition should be family- and individual-directed; families should be educated and empowered to acquire and assist in the creation of appropriate inclusive services and supports; transition should be embedded in elementary and secondary curriculum reform; the process required to create the Individualized Transition Plan (ITP) should not distract families; to achieve the most satisfactory result for their children, families should provide basic support to one another (Levinson, 1998, p. 3). As to the instruction the basic academic skills in reading, writing, and computation is usually emphasized at the elementary school level, but some elements of them are being taught as early as during pre-school years (Repetto, 1995, p. 125). When structuring instruction, educators sequence skills properly. Each skill is taught in sequence, and only when mastery of one skill is attained the next skill should be introduced. This is particularly important with skills that are dependent upon each other (Levinson, 1998, p. 91). Indeed, it may be difficult for some families to focus on post-school transition needs when their child is just in the kindergarten. If this is the case, professionals should take care not to overwhelm families with transition planning. Professionals should appropriately explain the importance of developing skills and interests in mental and physical activity while the child is young in order to maximize current and future involvement in various activities offered through the school and community. Such explanations, among other advantages, allow to prevent secondary disabilities, to help the child to socialize and get the necessary social skills as early as in childhood (Scott Baldwin, 2005, p. 174). Research proved that it is never too early to begin planning for transition to family- and community-based transition programs. Good planning always includes identification of the childs abilities and the childs and familys interests and goals for education considering their cultural beliefs and values. Such transition plan for the pre-school or elementary student remains flexible, because the childs abilities may change and/or the childs or familys interests and resources may change (Benz, Lindstrom Yovanoff, 2000, p. 512). General education and special education teachers are in the best position to encourage parents of pre-school and elementary school children to facilitate the transition planning. Studies show that children who are participants of transition programs from the early years have a better chance of becoming socially active, intelligent, competent and healthy adults (Carter Wehby 2003, p. 450). Moving from the kindergarten and elementary school to the secondary school implies the new challenges for the students of special education. Scholars defined what secondary transition practices are contributing to the future children retention and success when they enter high school and further get job. These are: direct, individualized tutoring and support to complete homework assignments, attend class, and stay focused on school; 2. participation in vocational education classes during the last 2 years of high school, especially classes that offer occupationally specific instruction; 3. participation in paid work experience in the community during the last 2 years of high school; 4. competence in functional academic [†¦] and transition [†¦] skills; 5. participation in a transition planning process that promotes self-determination; 6. direct assistance to understand and connect with resources related to post-school goals [†¦]; 7. graduation from high school. (Benz et al., 2004, p. 39). Such comprehensive list of factors evidently testifies that due to recent standards-based secondary school reform the requirements to academic performance raised substantially. Accepting this challenge special education teachers have worked hard to make sure that the special needs students are involved in these general reform efforts (Benz, Lindstrom Yovanoff, 2000, p. 511). They developed adoptive methods helping to ease the process of learning. For instance, when the student has difficulty in learning needed skills combined with incapacity to readily transfer or generalize learning to new environments or situations, they provide education in the actual environments that the student will be using, which allows for explicit teaching to the real-life demands of a particular environment and eliminates the need for the student to transfer skills (Spencer 2001, p. 884). At this all it is significant that emphasizing of an environmental curriculum on preparing the students of secondary school to functionate in main life domains (domestic, school, community, leisure, and vocational), efficient transition practices demand continuous assessment of the extent and quality of performance in each domain (Turner Szymanski, 1990, p. 22). Modern science in the sphere of special education developed several methodologies which allow achieving high academic performance by the secondary school students with disabilities. They include direct instruction, meta-cognitive reading comprehension strategies, peer-mediated instruction and interventions, and social skills training (Conderman Katsiyannis, 2002, p. 169). One of the important issues in secondary school transition services is inclusion of the students with disabilities in the general curriculum. Federal legislation gives the clear mandate for educating all children with disabilities in the regular classroom to the maximum extent appropriate or possible (Daugherty, 2001, p. 48). The inclusion of students who have disabilities in typical educational activities and environments is believed to promote student performance, offer rich opportunities for learning, provide age-appropriate role modeling, increase awareness among all students of diverse learning styles and abilities, and provide opportunities for relationship building that is so important especially during adolescent development (Scott Baldwin, 2005, p. 175). Age-appropriate placement does not mean that students with disabilities are simply placed in a typical class or at a community job site. Appropriate support services and resources that facilitate the students full inclusion and maximum participation in the environment must accompany these placements. Thus, IDEA recognizes that a students successful transition from school to adult life requires opportunities to learn and to practice skills in a variety of relevant school and non-school learning environments. These environments may include the classroom, school lunchroom, home, public transit bus, work site, community recreation facility, and a variety of other relevant settings (Daugherty, 2001, p. 49). But here a danger exists that content instruction could impede the goals of inclusion education. As more special needs students are included in general education curriculum, they often need supplementary assistance from the special education teacher to do class and home assignments, to review the learned material, and to prepare for the exams which sometimes is given by these teachers when their students pass the tests, for example. The pressure on special educators to provide academic progress of their wards could make more harm than good for them. Passing grades in school progress record sometimes do not mean quality of the student’s knowledge and skills (Conderman Katsiyannis, 2002, p. 170). Although the general education curriculum contains both academic (e.g., math, science) and nonacademic (e.g., career education, arts, citizenship) domains, student performance is assessed primarily in academics. As a result, it is not uncommon for portions of the general curriculum as well as transition goals to receive limited or no attention. There also may result a narrowing of curriculum and instruction to focus on content assessed in state or local tests. This may limit the range of program options for students due to intensified efforts to concentrate on areas of weakness identified by testing. Efforts must be undertaken to ensure that students with disabilities remain on a full curriculum track, with learning expectations that guide the instruction of general education students. IEP teams must work to ensure that high expectations are maintained and students are afforded opportunities to develop skills through a wide range of curriculum options, including vocational education, service learning, community work experience, and adult living skills (Repetto Correa, 1996, p. 553). The present challenge is to integrate the IDEA requirements concerning access to the general education curriculum with the transition service provisions. There is an urgent need to view these requirements as unified and complementary in helping students to achieve the broadest possible range of school and post-school goals and results. Strategies for accomplishing this include promoting high expectations for student achievement and learning, making appropriate use of assessment and instructional accommodations, and ensuring that students have access to the full range of secondary education curricula and programs (Benz et al., 2004, p. 41). Another important issue, especially concerning the students with mild disabilities, is availability of continuous instruction of basic skills within the curriculum at the middle school and high school levels. Those skills need to be taught within the context of real-life applications (Spencer 2001, p. 881). That is, in elementary school, students are taught to add, subtract etc. using worksheets and other materials but are rarely given the opportunity to apply those skills to balancing a checkbook or determining whether they have received the correct change during a purchase. Additionally, in elementary school little opportunity is provided to apply those skills to vocationally or occupationally relevant activities. Although to make a successful transition from high school to work, college, or community living, students need to possess basic academic skills in reading, writing, and computation, at both the middle school and high school level students need to be provided with continuing opportunities to practice those basic skills in real-life situations (Conderman Katsiyannis, 2002, p. 172). At the same time after the students with disabilities graduated from the school they are still eligible for the transition services. At this stage namely the student is a person who defines which areas are given emphasis. For instance, the student with learning disabilities planning to enter the college may not need to be provided with extensive vocational and occupational training in high school but may need to focus on the development of academic skills specific to admission to and success in college, and life skills specific to making a successful adjustment from high school to college. In contrast, the student with severe cognitive and physical disabilities may need to focus on vocational and occupational functioning and basic life skills necessary for independent living (Repetto, 1996, p. 553). Besides, several other factors have an effect on the design of the vocational syllabus. Local conditions often define the studens’ plans for the future such as urban or rural district, the peculiarities of local economy and labor market, the rate of employment, the personal traits of the student himself and the type of his/her disability, and indeed availability of transition services. The vocational syllabus has to be designed in such a way to prepare the students with disabilities for jobs in demand on local labor market, because as a rule such students do not leave their communities trying to find job (Levinson, 1998, p. 88). When we consider post-secondary transition services for the college-bound students it is important to pay attention to the differences between high school and college requirements, such as time spent in class, class size, time for study, testing approaches, grading methods, teaching strategies, and freedom and independence. They all pose additional challenges for students with disabilities who are making the transition from high school to college. Discussing those differences and assessing student practices are important for students survival and adaptation. When evaluating post-secondary options, the students need to assess the amount and type of learning disabilities support services they require to be successful (Shapiro Rich, 1999, p. 171). Assisting the students with special needs to cope with the new challenges most post-secondary educational settings have programs for such individuals that provide the necessary support for them. These institutions often have an Office for Students with Disabilities that employs counselors and tutors and that provides a wide array of services for all students with disabilities. For instance, structural accommodations such as ramps and elevators exist to accommodate students with physical disabilities. Large-print and Braille textbooks exist for students with visual impairments. Students with hearing impairments can be provided with prepared lecture notes (Levinson, 1998, p. 152). In addition, modifications in test-taking procedures, tutoring, and academic and personal counseling are available for the special needs students. Given the array of services available, post-secondary educational settings are now an appropriate option for many students with disabilities whose occupational aspirations require advanced formal education (Benz, Lindstrom Yovanoff, 2000, p. 513). Numerous methods are available to provide individuals with the additional post-secondary training they need in order to acquire the skills and credentials necessary for entry into their chosen occupations (Benz, Lindstrom Yovanoff, 2000, p. 510). In addition to the vocational training and work experience programs offered by most school districts, individuals with disabilities may gain additional training after high school via apprenticeship programs, the military, trade and technical schools, community colleges and junior colleges, and four-year colleges and universities. All offer programs that may be suitable post-secondary options for the students with disabilities (Johnson et al., 2002, p. 522). In general, the legislation includes the following in its description of post-school activities: post-secondary education, vocational training, integrated employment (including supported employment), continuing and adult education, adult services, independent living, and community participation. Clearly, then, transition is meant to address not just employment needs, but future needs within the broader focus of life within the community (Repetto, 1995, p. 130). In any case, to the maximum extent possible, the individuals with disabilities should be placed in the least restrictive environment and in settings that facilitate the normalization process. Delivering transition services from high school to work-force, transition personnel should attempt to ensure that a full range of placement options exist for the individuals with whom they work. This often necessitates that transition personnel market individuals with disabilities to employers, neighbors, or admission personnel and conduct public relations campaigns on behalf of their clients. Because many people have unrealistic and faulty expectations and perceptions of individuals with disabilities, transition personnel also have to educate the public about disability issues and have to work hard to overcome the public resistance that so often accompanies the placement of those individuals in occupational, residential, and educational settings (Johnson et al., 2002, p.   520). Both scholars and special educators recognize the importance of specific career development skills to a students success in the workforce. Learning how to search for job openings, write a CV, establish and prepare for an interview, understand the relationship between employer and employee, and be knowledgeable as to the rights of workers are all important areas to address. Additionally, successful transition programs address work ethics, work habits, and motivation issues as well. For instance, the students with disabilities would greatly benefit from preparation regarding employers expectations in terms of work habits. For instance, they should learn the importance of taking responsibility for calling in if they were unable to be at work. Very often these major work habits and ethics are missing from the students skills. Besides, students with disabilities are excessively sheltered and are often not compelled to take responsibility for their own actions while responsibility is crucial for getting and keeping employment (Nuehring Sitlington, 2003, p. 28). Conclusion In summary, the study showed that the transition process is in fact a part of the broader process of career development. Moreover, transition is about societal empowerment not only of the individuals with disabilities, but of all of us. Our communities and our society will be enriched and empowered when all citizens, including those with disabilities, are valued and seen as contributing members. The challenge of transition professionals is to facilitate that empowerment through appropriate transition services that empower individuals and their families and through the actions as community catalysts who work in a respectful partnership with people with disabilities. The conducted study clearly demonstrated the concept of transition-focused education represents a shift from disability-focused, deficit-driven programs to an education and service-delivery approach based on abilities, options, and self-determination. This approach incorporates quality-of-life issues, life span and life space considerations, and suggestions for seamless transition approaches together with the key elements – outcome-oriented, community-based, student-centered, and family-centered transition services. At the same time the study proved that there is no one fitting all transition planning strategy able to effectively prepare students with disabilities who all have unique needs for successful, fulfilling adult roles. Only through continued attention to establishing effective transition services flexible enough to meet individual student needs, the society can arm students with information and opportunities on which they can build their futures. Thus, the society has to bend every effort to ensure that students with disabilities fully access and benefit from the general education curriculum, and leave our school systems prepared to successfully participate in post-secondary education, enter meaningful employment, live independently in communities, and pursue lifelong learning opportunities.       References Benz, M. R., Lindstrom, L., Yovanoff, P. (2000). Improving Graduation and Employment Outcomes of Students with Disabilities: Predictive Factors and Student Perspectives. Exceptional Children, 66, 509-516. Benz , M. R., Lindstrom, L., Unruh, D., Waintrup, M. (2004). Sustaining Secondary Transition Programs in Local Schools. Remedial and Special Education, 25, 39-44. Carter, E. W., Wehby, J. H. (2003). Job Performance of Transition-Age Youth with Emotional and Behavioral Disorders. Exceptional Children, 69, 449-458. Conderman, G., Katsiyannis, A. (2002). Instructional Issues and Practices in Secondary Special Education. Remedial and Special Education, 23, 169-176. Daugherty, R. F. (2001). Special Education: A Summary of Legal Requirements, Terms, and Trends. Westport, CT: Bergin Garvey. Individuals with Disabilities Education Act Amendments of 1990 (Public Law 101-476). 20 U.S.C., 1400. Johnson, D. R., Stodden, R. A., Emanuel, E. J., Luecking, R., Mack, M. (2002). Current Challenges Facing Secondary Education and Transition Services: What Research Tells US. Exceptional Children, 68, 519-527. Kohler, P. D., Field, S. (2003). Transition-Focused Education: Foundation for the Future. Journal of Special Education, 37, 174-186. Levinson, E. M. (1998). Transition: Facilitating the Post-School Adjustment of Students with Disabilities. Boulder, CO: Westview Press. Place of Publication:. Publication Year:. Nuehring, M. L., Sitlington, P. L. (2003). Transition as a Vehicle: Moving from High School to an Adult Vocational Service Provider. Journal of Disability Policy Studies, 14, 23-34. Repetto, J. B. (1995). Curriculum Beyond School Walls: Implications of Transition Education. Peabody Journal of Education, 70, 125-140. Repetto, J. B., Correa, V. I. (1996). Expanding Views on Transition. Exceptional Children, 62, 551-557. Scott, J., Baldwin, W. L. (2005). The Challenge of Early Intensive Intervention. In   D. Zager (Ed.), Autism Spectrum Disorders: Identification, Education, and Treatment (pp. 173-228). Mahwah, NJ: Lawrence Erlbaum Associates. Shapiro, J., Rich, R. (1999). Facing Learning Disabilities in the Adult Years. New York: Oxford University Press. Spencer, K. C. (2001). Transition Services: From School to Adult Life. In J. Case-Smith (Ed.),   Occupational Therapy for Children (pp. 878-894). St. Louis, MO: Mosby. Szymanski, E. M. (1994). Transition: Life-Span and Life-Space Considerations for Empowerment. Exceptional Children, 60, 402-407. Turner, K. D., Szymanski, E. M. (1990). Work Adjustment of People with Congenital Disabilities: A Longitudinal Perspective from Birth to Adulthood. The Journal of Rehabilitation,   56.3, 19-26. Wehman, P., Revell, W. G. (1997). Transition into Supported Employment for Young Adults with Severe Disabilities: Current Practices and Future Directions. Journal of Vocational Rehabilitation, 8, 65-74.

MacBeths Ambition :: essays research papers

The thematic importance of ambition is revealed throughout MacBeth in a manner that is not always instantly visually evident to a conscientious reader. Although it is responsible for MacBeth’s rise to power, his â€Å"vaulting ambition† is also to blame for MacBeth’s tragic downfall. MacBeth would not have been able to achieve his power as King of Scotland, or have been able to carry out his evil deeds, if it was not for his ambition. In these instances, ambition helped MacBeth achieve his goals to a certain subdued degree. Consequently, however, MacBeth's ambition has another face and is what leads him to his disastrous fall from grace. Had he not been fixated with becoming King and remaining powerful, he would not have continued to kill innocent people in order to keep his position. In due course, MacBeth’s removal from power is attributable to these killings, along with his over bearing attitude. MacBeth, at the beginning of the play, seems to be an exceptionally noble person. He is characterized as being vastly loyal and honorable. He courageously and victoriously fights a battle for his country and this establishes a strong sense of his loyalty. MacBeth is later appointed Thane of Cawdor, which, once more, proves that he is honorable in the eyes of royalty. However, the instant the witches spark ambition in him, using their prophecies, he is no longer trustworthy because his mind fills with evil and deceit. Even before he reaches his home, thoughts of murder creep into his head and he is overcome with the desire to be powerful. In the following quotation, MacBeth admits, metaphorically, that it is only his ambition that prompts him. â€Å"I have no spur to prick the sides of my intent, but only vaulting ambition, which o’erleaps itself and falls on the other† (I, 7, 25 ff). At this point in the play, Macbeth's unruly ambition begins to become apparent. A seed of evil has bloomed into a flower of defiance and MacBeth has reached a point of no return. MacBeth becomes bloodthirsty and power stricken, forcing him further and further into a web of ambition from which he is unable to detach.  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  MacBeth's ambition is the fuel that ignites his fire to become fierce and eventually gather the nerve to kill Duncan. This murder is performed in the dark of night and by MacBeth's own blood-spattered hands. At this point, MacBeth makes a subconscious decision to construct his future on his own by overcoming any further obstacles that may fall in his way.

Seven Major Changes in the Workplace

Running head: SEVEN MAJOR CHANGES IN THE WORKPLACE Seven Major Changes in the Workplace Seven Major Changes in the Workplace With the ever-growing population and technological changes many employers are going to have to adapt. Robert Barner highlights seven major changes that will affect the places where we work, both for the employer and employee (Kreitner, 2004, p. 76). The seven major changes are (1) The virtual organization (2) The just-in-time workforce (3) The ascendancy of knowledge workers (4) Computerized coaching and electronic monitoring (5) The growth of worker diversity (6) The aging workforce and (7) The birth of the dynamic workforce (Kreitner, p. 76). I will discuss how these seven changes major changes will affect the managers at my company, Blake Inc. The Virtual Organization We are living in a time where technology is in the forefront. Things are constantly changing and companies must be able to keep up with it. Right now in my company my managers are scrambling to keep up with the constantly changing technological world. Managers are now being set up with access to their computers from home. So if they are unable to come in to work or need to leave early they can still communicate with us. They can do everything from home that they can do at the office. They are also working on a plan, in case of an emergency or the office building is no longer usable that we can set up shop somewhere else within 48 hours. My manager is also setting up a web site that will be accessible by all employees to get update information concerning the company, such as business decisions, software help and 24 hour technical support. The Just-In-Time Workforce At Blake we are aligned with Temp Agencies that are able to supply us with workers at a moments notice. My managers know that must be able to meet high demands. They also set up incentives for employees wishing to put in extra work. They understand that is better to have people who know the business to do the work rather than a temp who really has no interest or knowledge in the company. The Ascendancy of Knowledge Workers Now more than ever it is important that companies hire very knowledgeable people. My managers are now trying to hire more people with a technical or analytical background to help with reports and other information needed by employees. Employees must know what they want and what they need so that they can effectively communicate this to the technical staff. Also, the managers at Blake must be able to step up and jump in when needed. This means they must know their job and all aspects of the company. The managers must know the responsibilities of each of their employees and make sure that their employees are knowledgeable as well. We have recently been asked to create a manual entailing our job responsibilities so that if something happens someone else will have knowledge of what we do. Computerized Coaching and Electronic Monitoring Being an internet-based company all employees has access to a wealth of information through the intranet. From the intranet you can look up other employees, find customer information such as contracts and orders placed, to information on employee benefits. At Blake employees just found out that their internet access was truly being monitored. Upon finding this out Managers took away internet access from all employees in which it is not a job necessity. This did not go well with employees as they felt as though their privacy was being invaded. As a supervisor I had to make sure that my employees had access to the websites they needed but nothing more. Employees feel that they are not trusted and treated like babies. Managers at Blake must be careful not to alienate employees in order to try and gain more efficiency. The Growth of Worker Diversity Blake employs a very diversified group of people. In fact some employees can barely speak English well. At times it gets kind of hard to understand them. My Managers must work hard not to alienate any one group of people. Every employee must be given the same chance to excel. They also must be proactive in learning about each group’s backgrounds and or culture as to not offend anyone. Managers at Blake are becoming more understanding o different beliefs and cultures and do not punish people for partaking (taking a day off) in these beliefs. The Aging Workforce Managers at Blake encourage continuing education. In fact anyone who wishes to go to school can do so for free, it is mentioned on our website how they will provide up to $50,000 for each employee towards their education. Education is encouraged whether you are young or old. Managers really respect the older employees because the hold so much knowledge and experience, so they must be careful not to quickly replace them with a younger face. It is important to have a good mix, as not all young college grads are a good fit as not all older people are. The Birth of the Dynamic Workforce Blake managers must work to be more encouraging. They will have to be able to motivate employees and encourage cross training. Employees must be able to help out in other departments when needed. Slow times in one department may mean a chaotic time in another. Being able to meet the demands in the high productivity department and use workers from the slow department can decrease cost. Managers must be able to think ahead in order to keep up with competition and stay ahead of the game. Blake is a pretty good company to work for but has been behind the times for a while. My managers are proactively trying to keep up with industry standards. This has caused a lot of revamping and the recruiting of more knowledgeable employees. Blake Managers understand that if they want to stay in business they must come to terms with the changes in the 21st century. Reference Kreitner, R. (2004). Management (9th ed. ). Boston, NY: Houghton Mifflin Company.

Case Study: Osteoarthritis with a Total Knee Arthroplasty Essay

DN is a 68 year old Caucasian male who lives in Pomona, Missouri. On September 14, 2009, DN underwent a scheduled left total knee arthroplasty at Baxter County Regional Medical Center. A consultation appointment about a total knee arthroplasty was scheduled when DN had increasing pain in his knees while doing chores and working on his dairy farm. The increasing pain DN was having been due to a history of osteoarthritis and the wear-and-tear on his joints throughout his life, no specific injury was noted. Depending on the outcome of the left knee, DN was consulted on having his right knee done in the future due to his active lifestyle as a dairy farmer. DN is presently in very good health despite his pain from osteoarthritis. Osteoarthritis is caused from wear and tear on the joints. The bones between a joint is cushioned by cartilage which after many years of use decreases. When the bones no longer have the cushion, pain and stiffness develops when the bones rub together (Total Knee Replacement, 2009). His health history includes overcoming prostate cancer approximately six years ago. After a prostatectomy to remove his cancer, DN continues to experience erectile dysfunction even after seeing many specialists and trying many treatment options. In 1999, DN had his appendix removed at Ozark Medical Center. DN has a herniorrhaphy and cataract surgery prior to this hospitalization. DN has no known allergies to drugs, food, or environmental allergens. The patient lives at home with his wife on a dairy farm. He handles about 170 head of dairy cattle that are milked twice a day. He retired from Howell-Oregon County Electrical approximately five years ago to help manage his farm on a full time basis. DN and his wife raised three children and have several grandchildren who come and visit frequently. DN does not have any significant history of nicotine, alcohol, or drug use. His diet has consisted of fresh fruits and vegetables from the garden throughout his life. These factors have all played a part in helping DN stay healthy without any underlying chronic disease processe s. Physical Assessment My physical assessment was performed on September 16, 2009. DN’s vital signs consisted of an apical pulse of 98, a respiration rate of 20, a temperature of 99.1 degrees Fahrenheit, an oxygen saturation of 96%, a lying blood pressure of 117/78, a sitting blood pressure of 116/75, and a standing blood pressure of 116/74. Patient was alert and oriented to person, place, time, and situation. Patient was able to spell WORLD forward and backwards. PERLA and noted cardinal field of gaze were intact. Eyes were clear with conjunctiva pink and no discharge noted. Patient’s head and face was symmetrical with no apparent skin breakdown. Patient had dentures intact in mouth with healthy, pink gums with no lesions present inside the mouth. Thorax was symmetrical with no signs of pulsations or lesions. Breath sounds clear in all lobes. Unlabored breaths. Heart sounds S1, S2 were heard upon auscultation in all four cardiac areas with normal rhythm. Abdomen is soft, symmetrical with hyp oactive bowel sounds present in all four quadrants. Last bowel movement was on Sunday, September 13. Patient was passing flatus. No masses, distention, or lesions noted on the abdomen. No tenderness was noted in the abdomen. No edema was noted in the upper or lower extremities. Upper and lower extremities had no sign of lesions or discoloration. Saline locked on left forearm was intact with no redness or swelling. Surgical incision on lower left extremity had scant amounts of serosanguineous drainage, wound edges were well-approximated, slight erythemateous around incision, no odor present, and dressing was dry and intact. Pulses were strong and equal bilaterally- including carotid, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibialis. Skin was warm and pink with no signs of cyanosis, rash, or skin breakdown. Gait was symmetrical and coordinated when using a walker, without the supportive device there is some unsteadiness due to the left total knee arthroplasty. There was no hearing deficit noted with normal conversation. Patient only had complaints of pain at surgical site after ambula tion, physical therapy or the CPM. Patient was taught he could ask for the pain medicine prior to these events to hopefully avoid intense pain. Current Medications Throughout DN’s hospital stay he was prescribed medicine to alleviate the pain caused from the total knee arthroplasty, help prevent any infection that had potential to be a problem, and prevent any complications. DN’s urrent medications while in the hospital were as follows: 1.) Docusate-Senna (Trade Name: Peri-Colace) 1 tablet by mouth, twice a day; used for softening and passage of stool for the relief of constipation caused by post operative anesthesia and decreased activity (Deglin & Vallerand, 2007). 2.) Enoxaparin (Trade Name: Lovenox) 40 mg by subcutaneous injection, once every morning; used for the prevention of thrombosis formation (Deglin & Vallerand, 2007). 3.) Psyllium (Trade Name: Metamucil) 1 tablespoon by mouth, twice a day; used for relief and prevention of constipation (Deglin & Vallerand, 2007). 4.) Acetaminophen-Oxycodone (Trade Name: Percocet 5/325) 1-2 tablets by mouth, every four hours; used for decreasing pain as well as decreasing a temperature (Deglin & Vallerand, 2007). 5.) Magnesium Hydroxide (Trade Name: Milk of Magnesia) 30 mL by mouth as needed; used for replacement in a deficient state or evacuation of the colon (Deglin & Vallerand, 2007). 6.) Morphine (Trade Name: Astramorph) 8 mg by intravenous piggyback, every three hours as needed; used for a decrease in the severity of pain (Deglin & Vallerand, 2007). 7.) Promethazine (Trade Name: Phenergan) 12.5 mg by intravenous piggyback, every four hours as needed; used for diminishing nausea and vomiting, as well as provide some sedation (Deglin & Vallerand, 2007). Diagnostic Tests DN had diagnostic tests prior to being admitted to the hospital for his total knee arthroplasty to determine the best treatment option for his osteoarthritis. After his surgery, more diagnostic tests were done to monitor for complications of the procedure. The results were compared to normal and were as follows for the patient: 1.) White Blood Cells (Normal Value: 5,000-10,000/mm3) Patient’s white blood cell count was 12,800/mm3, which is a high value. This value indicates the stress on the body and inflammation around the knee involved after the operation. The value is also a possible indicator of infection, which would require continued monitoring (Pagana & Pagana, 2006). 2.) Red Blood Cell Count (Normal Value: 4.7-6.1Ãâ€"106/ µl) Patient’s red blood cell count was 3.74Ãâ€"106/ µl, which is a low value. This value indicates the blood lost during surgery, which is a common finding after an invasive surgery. A decreased level may indicate a hemorrhage, overhydration, or a dietary deficiency, which may need to be corrected (Pagana & Pagana, 2006). 3.) Hemoglobin (Normal Value: 14-18 g/dL) Patient’s hemoglobin was 11.8 g/dL, which is a low value. This value is a common finding after surgery due to the blood loss, but the value may also indicate anemia or nutritional deficiency (Pagana & Pagana, 2006). 4.) Hematocrit (Normal Value: 42-52%) Patient’s hematocrit was 34.4%, which is a low value. This is a normal finding after surgery, but may indicate anemia, malnutrition, or a dietary deficiency that may need to be corrected (Pagana & Pagana, 2006). 5.) Mean Corpuscular Hemoglobin (Normal Value: 27-31 pg) Patient’s mean corpuscular hemoglobin was 31.8 pg, which is just slightly elevated. This value could possibly indicate a macrocytic anemia, but is not elevated enough to be a significant concern (Pagana & Pagana, 2006). Basic Conditioning Factors and Power Components Dorthea Orem identifies ten basic conditioning factors that identify the patient and help assess the need for care in her Self-Care Deficit Theory of Nursing. The basic conditioning factors identified by Orem consist of age, gender, Erikson’s developmental state, health state, sociocultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and availability of resources (Caton, 2008). DN is a 68 year old Caucasian male who lives in Pomona, Missouri where he and his wife own a house. DN grew up in Dora, Missouri where he graduated high school, then relocated to Pomona at the age of nineteen. DN has three grown children and several grandchildren. DN’s family remains very close and visit often to where DN lives. DN quit his job at Howell-Oregon Electric in 1980 to become a full time farmer. DN and his wife own approximately 300 acres to operate a dairy and beef cattle farm with 170 head of cattle. They milk the cows twice a day keeping them very active throughout the day. DN considers himself to be in the middle-class economically, but with the unpredictable cattle market economic status can change throughout the year. DN has Medicare as primary insurance with supplements. Before his admission to the hospital, DN’s health state was good. DN’s health care system factors consist of a medical diagnosis of osteoarthritis. The treatment of choice for DN was a left total knee replacement. After discharge, home health will help organize physical therapy closer to home. DN does not have any underlying diseases, such as hypertension or diabetes, which can cause complications or alter the ability of DN to have a speedy recovery. He has a primary physician in Willow Springs for yearly check-ups and minor problems. DN’s patterns of living include hunting and fishing, going to church, and taking care of the farm. DN does not smoke or drink alcohol. According to Erikson, he is in a developmental stage of ego integrity versus despair (Berman et al., 2007). DN belongs in this psychosocial developmental stage because he is at a stage where he is content with his life and satisfied with everything that has happened in his life thus far. He is able to reflect on his past without regret. DN feels as if he has lived a life full of happiness. Orem identifies ten power components that are important in evaluating how much nursing care is needed by the patient. The ten power components consist of attention span and vigilance, control of physical energy, control of body movements, ability to reason, motivation for action, decision making skills, knowledge, repertoire of skills, ability to order self-care actions, and ability to integrate self-care actions into patterns of living (Caton, 2008). DN’s attention span ad vigilance is a strength because throughout the physical assessment and health history, he remained very attentive and honest when answering the questions. His control of physical energy is a potential weakness due to the fatigue DN could experience after his knee replacement. After surgery, becoming fatigued is easier due to the pain and inability to get a good night’s rest in the hospital. DN seemed to know his limits with what kind of physical energy he had to use throughout his stay. The patient’s control of body movements is a strength. Even though DN is recovering from a total knee replacement, he maintains good control over his movements. He also has a steady gait when walking with a supportive device. The patient’s ability to reason is a strength. When he needed help, he knew to ask his wife, a nurse, or an aide for help. He understood that Home Health would be a benefit once he was discharged from the hospital. Motivation for action is definitely a strength. DN was very motivated to get back on his feet as soon as he could. He knew physical therapy was what would help the most so he was always ready to go when physical therapy came to take him to the Joint Club. After returning after a trip to physical therapy, the patient stated, â€Å"The physical therapist said I did better than all of the other patients with knee replacements.† The patient’s decision making skills were strength because he took all options into consideration prior to getting his knee replacement. He knew it would be the best option with the active lifestyle that he has. Knowledge was a potential deficit for the patient because he had never had a knee replacement surgery before. The patient was informed of all the procedures, hospital stay, and expected outcomes during consultation appointments, but all the information at once can be overwhelming for the patient. Even after the surgery, the patient still questioned the health care team members throughout the hospital stay to refresh his memory. Repertoire of skills is a strength because the patient has a high school education, as well as the same occupation throughout his life. He is able to retain information and repeat skills if needed. DN’s ability to order self-care actions is a strength because he is able to decide what actions are most important and follow through with them. He decided to have his knee surgery to benefit his lifestyle and made it a priority to get it done as soon as he could. The ability to integrate self-care actions into his patterns of living is a strength for DN. He integrates a healthy diet and active lifestyle to prevent complications of his osteoarthritis. After trying minor treatment options to control pain and discomfort from the osteoarthritis, DN opted for surgical treatment and he realizes the physical therapy he will have to integrate into his lifestyle for full recovery. Universal Self-Care Requisites Orem’s General Theory of Nursing involves self-care, self-care deficit, and nursing systems. Orem’s definition of self-care is what people plan and do on their own behalf to maintain life, health, and wellness. The nursing systems that Orem identifies are wholly compensatory, partly compensatory, and supportive-educative. The universal self-care requisites that patient may be deficient, potentially deficient, or a strength in consists of air, water, food, elimination, activity and rest, solitude and social interaction, prevention of hazards to human life, and normalcy (Berman et al., 2007). Air: Potential Deficit Air is a potential deficit for this patient. Upon assessment, his respiratory rate was within normal range at 20 breaths per minute. Normal respirations for the age group of the client range from fifteen to twenty per minute (Berman et al., 2007). The patient has a stable respiration rate between this level, but with decrease red blood cells, hemoglobin, and hematocrit the patient’s oxygen level may increase to compensate for the lack of cells that can carry the oxygen, especially during physical therapy. DN’s lung sounds when auscultated were clear in all lobes, bilaterally. A critical side effect of morphine, one of the medications DN was taking while in the hospital, is respiratory depression, which can happen in a matter of minutes causing a deficit (Deglin & Vallerand, 2007). Water: Strength Water is a strength for DN. No edema was noted upon assessment. Good skin turgor was indicative that there was adequate hydration for the patient. DN’s average intake was 2000 mL of fluids, usually water and ice tea. This was within normal range with the requirements being set at a minimum of 1500 mL of fluids daily (Berman et al., 2007). Food: Strength Food is a strength for the patient. The patient was on a regular diet and had no trouble eating. On some occasions, his wife brought meals to the patient. DN consumes a healthy diet, full of fruits and vegetables from his own garden when home. Protein consumed in his diet usually consists of very lean beef from home grown cattle. DN consumed enough calories to aid in recovery of his surgery. Elimination: Deficit Elimination is a problem for the patient. He has not had a bowel movement since the day before he had the surgery. DN had an epidural anesthesia until the first day post-op and is taking narcotic analgesics for pain control, which both contributed to the impaired elimination. The side effects from the medication cause the intestines to decrease peristalsis. Monitoring bowel functions, as well as administer the stool softeners and laxatives that are ordered, are two important nursing interventions (Lemone & Burke, 2008). Activity and Rest: Deficit The patient had a deficit in both activity and rest. The patient stated he was not getting adequate rest in the hospital due to the different environment and the pain he was experiencing from his surgery. In the hospital, the patient was also put on activity restrictions due to his total knee arthroplasty. He was able to go to physical therapy three times a day, but normal activities were limited for DN. At home DN does not have activity or rest deficit, he participates in an active lifestyle with lots of walking and daily physical labor. He also gets approximately 7 or 8 hours of sleep a night which is adequate for a man his age (Berman et al., 2007). Solitude and Social Interaction: Potential Deficit The patient did not have a deficit with social interaction. His wife was in the room majority of the time and he also had many people drop in and see him throughout his hospital stay. DN also interacted with people on the health care team, whether it was the nurses or physical therapists, he was always having a conversation with someone. Due the many visitors and activities DN had during the day, solitude was a potential deficit. The physical therapists and nurses that came in the room consistently make it difficult for the patient to get any time to rest and relax by himself. Adequate rest is easier to obtain when there are no interruptions in the rest period and some solitude is allowed. Hazard Prevention: Deficit Hazard prevention is a deficit for DN. The total knee arthroplasty causes the patient to be at an increased risk for infection due to all the invasive procedures done. Prophylactic antibiotics were being considered to help prevent any infection that may develop. The patient is also at risk for falls. The intravenous line and pole make it difficult for the patient to ambulate on his own while dealing with his surgery. The medications DN were taking could cause confusion, dizziness, and sedation which could lead to a fall. The patient is also at risk for a deep vein thrombus due to the surgery, which could be a fatal complication if not prevented. Compression stockings and devices were used to decrease the chance of venous stasis. Promotion of Normality: Deficit Promotion of normality is a deficit for the patient. He has only been hospitalized two other times in his life and feels uncomfortable. Since DN is not used to being in the hospital, he is hesitant to ask for pain medication until the pain is already present. Teaching DN to ask for the pain medicine prior to activities and when he recognizes the pain coming back. DN’s normal routine at home will be changed to accommodate for the knee surgery he underwent. He will have to adjust to the limitations on his activities until he is fully recovered. For example, he will have to depend on his wife and other family members to help milk the cows and take care of the farm until he has full range of movement so he does not damage his newly replaced knee. Developmental Self-Care Requisites Developmental self-care requisites are associated with conditions that result in maturation (Berman et al., 2007). DN has lived a long, productive life and many life changing events have occurred throughout his life. He graduated high school and worked multiple jobs which gave him the experience he needed to now be a self-employed farmer. He and his wife raised a family with three children, and now have several grandchildren. All of these different aspects in DN life have helped DN mature, which puts him in a developmental stage of ego integrity versus despair. According to Erikson, people in this stage should have acceptance of their life and self-worth (Berman et al., 2007). DN seems very satisfied with everything that has happened in his life. He is able to reminisce about the things that have happened in his life with a smile. He does not have any regrets about his life. At this point in DN’s life, he is always thinking of others and enjoying the small things in life. Even though DN is in this developmental stage, he has not fully completed this stage. DN is in a position where he still works and provides for his family. He is not ready to leave his family at this point in his life. Health Deviation Self-Care Requisites According to Orem, there are six health deviation self-care requisites. The health care deviation self-care requisites consist of seeking and securing medical help when needed, responsibly attending to the effects and results of pathologic conditions, effectively carrying out prescribed interventions, responsibly attending to the regulation of effects resulting from prescribed interventions, accepting the fact that sometimes self or others need medical help when faced with certain life challenges, and learning to live productively with the effects of pathologic conditions and treatments while promoting continued personal development (Caton, 2007). The patient is strong in seeking and securing medical help when needed. As soon as the patient realized his pain was increasing in his knee, he scheduled an appointment with his family doctor who referred him to Dr. Know the orthopedic surgeon. The patient is also responsible in attending to the effects and results of pathologic conditions. The patient is aware of the physical therapy regime he needs to complete for full recovery, as well as the preventive measures he needs to take to protect his right knee. The third health deviation self-care requisite is to effectively carry out prescribed interventions, which is a strength for the patient. DN realizes he will continue with physical therapy after discharge on the hospital and will be on a few prescription medications. Other interventions, such as wearing TED hoses, limiting activities, and allowing home health to help with his care, will all be followed by the patient. The fourth health deviation self-care requisite is to responsibly attend to the regulation of effects resulting from prescribed interventions is a potential deficit. Even though the patient stated he will do the interventions asked of him, the task of depending on others for help may be difficult. As a farmer, it is difficult to let someone else do the chores the patient is usually doing on a daily basis. The fifth health deviation self-care requisite is accepting the fact that sometimes self or others need medical help when faced with certain life challenges. This health deviation self-care requisite is a strength for the patient. When DN realized his knee was not functioning at the level he needed it too, he sought help from professionals after trying alternative treatments. When DN had his prostate removed due to prostate cancer, he also pursued help from many specialists to deal with the many complications a prostatectomy can cause. The sixth health deviation self-care requisite is learning to live productively with the effects of pathologic conditions and treatments while promoting continued personal development. This is a strength for the DN because he looks forward to having better function in his knee to live a more productive life. The chores he does on the farm were becoming difficult with the increasing pain in his knee prior to the surgery. The patient now talks enthusiastically about getting back out on the farm to do the things he loves to do. Nursing Diagnosis I. Nursing Diagnosis #1: Acute Pain related to tissue trauma caused by surgery and intense physical therapy regime as evidenced by patient verbalizing his pain an 8 on a 1-10 scale. a. Expected Outcome: Patient verbalizes relief of pain as less than a 3 on a 1-10 scale at least thirty minutes after administration of pain medication. i. Intervention #1: Assess the patient’s description of pain and effectiveness of pain-relieving interventions. 1. Rationale: Assessing pain description leads to the best interventions to control the pain, as well as assess for any complications with a different pain description. Every patient has a right to effective pain relief (Gulanick & Vallerand, 2007). ii. Intervention #2: Instruct the patient to request pain medication before the pain becomes severe. 2. Rationale: Relief will take longer if the patient waits until the pain is too severe (Gulanick & Vallerand, 2007). The best pain control is proactive, not reactive. iii. Intervention #3: Administer narcotic analgesics as ordered by the doctor. 3. Rationale: With all of the tissue damage done during surgery, the nurse should assume the patient is in pain and needs analgesics (Gulanick & Vallerand, 2007). a. Implementation/Evaluation: Nurse assessed the patient’s description of pain to adequately treat the pain symptoms. Nurse taught the patient the request the pain medication at the onset of pain to reduce the amount of time it takes to start working. The goal was met because the patient verbalized his pain less than a 3 on a 1-10 scale within 30 minutes of administration of pain medication. b. Expected Outcome: Patient appears comfortable as evidenced by absence of facial grimacing and use of stress management techniques between doses of pain medication and throughout hospital stay. iv. Intervention #1: Nurse will teach patient to use guided imagery and progressive relaxation. 4. Rationale : Use of guided imagery and progressive relaxation will distract patient from the pain he is experiencing (Gulanick & Vallerand, 2007). v. Intervention #2: Nurse will teach patient to change position frequently. 5. Rationale: Changing positions (within limits) will relieve pressure and pain on bony prominences, reduce muscle spasm, and undue tension (Gulanick & Vallerand, 2007). vi. Intervention #3: Nurse will apply ice packs as ordered. 6. Rationale: Applying ice packs may decrease edema and enhance comfort (Gulanick & Vallerand, 2007). b. Implementation/Evaluation: Nurse taught the patient different comfort measure to relieve pain in between doses of pain medication. Using repositioning and relaxation measures helped the patient stay comfortable between doses of pain medication. The goal was met. II. Nursing Diagnosis #2: Impaired physical mobility related to pain after surgical procedure as evidenced by limited ability to ambulate. c. Expected Outcome: Patient will maintain optimal mobility within limitations throughout hospital stay. vii. Intervention #1: Assess postoperative range of motion in affected and unaffected joints. 7. Rationale: Assessment of range of motion will give a baseline to see if the patient is improving. Range of motion exercises are important to strengthen affected joint (within limitations) and unaffected joints need to maintain current mobility in periods of decreased activity because joints with arthritis lose function more rapidly (Gulanick & Vallerand, 2007). viii. Intervention #2: Nurse will assist patient to ambulate with less assistance as tolerated. 8. Rationale: This will allow for patient to become more independent before discharge (Gulanick & Vallerand, 2007). ix. Intervention #3: Nurse will encourage the patient to move from the bed to the chair as tolerated, as well as ambulate in the room three times a day. 9. Progress will be monitored toward normal activities patient will do once discharged from the hospital (Gulanick & Vallerand, 2007). c. Implementation/Evaluation: Nurse assessed postoperative range of motion to have a baseline of function. Improvement was noted th roughout shift that the patient was able to move more independently. d. Expected Outcome: Patient participates in rehabilitation program throughout hospital stay. x. Intervention #1: Assess the patient’s fear or anxiety in ambulating and going to physical therapy. 10. Rationale: If the patient’s fear and anxiety is too great, the patient may not get the full benefit of physical therapy and is at a greater risk for falls or other injuries (Gulanick & Vallerand, 2007). xi. Intervention #2: Nurse will encourage use of supportive walking devices, such as a walker. 11. Rationale: Use of a walker will help the patient feel more independent and encouraged to go to physical therapy as ordered. More weight bearing will progress throughout the use of walker (Gulanick & Vallerand, 2007). xii. Intervention #3: Nurse will reinforce instructions for rehabilitative activities as ordered. 12. Rationale: Reinforcing instructions will help the patient achieve mobility throughout the hospital stay and adhere to the physical therapy program (Gulanick & Vallerand, 2007). d. Implementation/Evaluation: The patient was enthusiastic about physical therapy and gaining full mobility of affected leg. He participated in the rehabilitation program and was able to go home on schedule, so the goal was met. III. Nursing Diagnosis #3: Self-care deficit related to impaired mobility as evidenced by inability to perform activities of daily living, such as dressing, bathing, and ambulate independently. e. Expected Outcome #1: Patient will safely perform all self-care activities of daily living independently before discharge. xiii. Intervention #1: Nurse will assess the patient’s ability to perform activities of daily living. 13. Rationale: This will provide a baseline to know where the priority deficits in the patient’s performance of ADLs and help nurse assist with the patient’s needs (Gulanick & Vallerand, 2007). xiv. Intervention #2: Assist the patient in accepting help from others. 14. Rationale: The patient may need to realize after a total knee replacement, some assistance may be needed and dependence on people or supportive devices may be necessary temporarily (Gulanick & Vallerand, 2007). xv. Intervention #3: Nurse will implement measures to facilitate independen ce, but be available to help patient when needed. 15. Rationale: Giving the patient independence will help encourage patient to attempt ADLs on his own, but with assistance when needed will prevent falls or other injuries (Gulanick & Vallerand, 2007). e. Implementation/Evaluation: Nurse assessed the patient’s ability to perform activities of daily living and realized where the patient needed assistance. Patient was encouraged to do ADLs on his own, but to recognize and ask for help if he needed it. Patient was able to ambulate on his own the bathroom, perform most activities independently, but required some help from his wife by discharge. This goal was met because the patient realized when he needed help and performed all ADLs safely by discharge. f. Expected Outcome #2: Resources are identified that are useful in optimizing the autonomy and independence of the patient by discharge from the hospital. xvi. Intervention #1: Nurse will assess what assistance will be needed when the patient is discharged. 16. Rationale: This will be helpful to the patient and other caregivers to recognize deficits until they are overcome (Gulanick & Vallerand, 2007). xvii. Intervention #2: Nurse will encourage patient to use assistive devices until no longer needed, and reassure patient that use of them can prevent falls and injuries. 17. Rationale: This allows patient to know total independence is not expected just because the patient is being discharged (Gulanick & Vallerand, 2007). xviii. Intervention #3: Nurse will help the patient set short term goals to becoming more independent. 18. Rationale: Setting short term goals will decrease the frustration the patient may have in not being able to do activities he could do before surgery (Gulanick & Vallerand, 2007). f. Implementation/Evaluation: Nurse assessed what assistance may be needed to help with activities of daily living. Patient used assistive devices and help from others when he recognized he could not do them independently. Short term goals were set and patient was able to be discharged with a walker and home health services. This expected outcome was met. IV. Nursing Diagnosis #4: Risk for ineffective tissue perfusion related to surgical procedure and impaired physical mobility. g. Expected Outcome: Patient maintains adequate tissue perfusion and remains free from deep vein thrombosis, as evidenced by warm extremities, good capillary refill, bilaterally equal pulses, negative Homan’s sign, and stable vital signs. xix. Intervention #1: Assess neurovascular status of affected limb preoperatively and postoperatively, as well as assess for signs and symptoms of deep vein thrombosis. 19. Rationale: Preoperatively a baseline should be established and assessing for changes postoperatively will be indication of a problem. Signs and symptoms could be an early indication of a blood clot which leads to early intervention (Gulanick & Vallerand, 2007). xx. Intervention #2: Nurse will assist patient in using thromboembolic disease support hoses and sequential compression devices as prescribed. 20. Antiembolic devices, such as TED hose and SC Ds, increase venous blood flow to the heart and decrease venous stasis, which could prevent a blood clot (Gulanick & Vallerand, 2007). xxi. Intervention #3: Nurse will administer thrombolytic and anticoagulant agents as ordered. 21. Rationale: Prophylactic anticoagulants will reduce the risk of deep vein thrombosis and thrombolytic drugs may decrease the complications if a blood clot does develop (Gulanick & Vallerand, 2007). g. Implementation/Evaluation: Patient was assessed preoperatively and postoperatively for neurovascular status. Patient was monitored closely for any signs of ineffective tissue perfusion. Nurse encouraged use of antiembolic devices and patient adhered to regimen. The goal was met because ineffective tissue perfusion was not a problem and not deep vein thrombosis developed. V. Nursing Diagnosis #5: Deficient knowledge related to a new procedure and unfamiliar with the discharge plan as evidenced by patient questioning health care team members about the process. h. Expected Outcome: Patient verbalizes understanding of procedure and discharge instructions. xxii. Intervention #1: Assess the patient’s current understanding of process in hospital and discharge instructions. 22. This will allow the nurse the individualize the teaching plan for the patient and teach only what the patient does not understand (Gulanick & Vallerand, 2007). xxiii. Intervention #2: Nurse will review total knee arthroplasty precautions according to what the patient does not already know, for example, using the walker, maintain proper body weight, and when to notify the physician. 23. Rationale: Reviewing the information will reinforce adherence to the rehabilitation program (Gulanick & Vallerand, 2007). xxiv. Intervention #3: Nurse will explain the discharge follow up instructions, and reinforce the need to continue with home health for physical therapy. 24. Rationale: Home health and physical therapy will increase the patient’s strength to have a full recovery. When the patient understands the process, he will be more motivated to continue with the program (Gulanick & Vallerand, 2007). h. Implementation/Evaluation: This goal was met. The patient had a full understanding of the limitations of a knee arthroplasty, in the hospital and after discharge. He understood the follow-up appointments and how home health would assist in his recovery. VI. Nursing Diagnosis #6: Constipation related to inactivity and medication use as evidenced by patient having frequent but nonproductive desire to defecate. VII. Nursing Diagnosis #7: Risk for infection related to invasive procedure. VIII. Nursing Diagnosis #8: Risk for falls related to unsteady gait and pain in left leg. References Berman, A., Snyder, S., Kozier, B., & Erb, G. (2007). Fundamentals of nursing: Concepts, process, and practice (8th ed.). Upper Saddle Road, NJ: Pearson. Caton, B. (2007). Orem’s self care requistes. Handout for NUR100 Fundamentals of Nursing. Missouri State University-West Plains, Fall 2007. Deglin, J.H., & Vallerand, A.H. (2007). Davis’s drug guide for nurses (10th ed.). Philadelphia: F.A. Davis. Gulanick, M., & Myers, J.L. (2007). Nursing care plans: Nursing diagnosis and intervention. St. Louis: MO: Elsevier. LeMone, P., & Burke, K.M. (2004). Medical-surgical nursing: Critical thinking in client care (3rd Ed.). Upper Saddle Road, NJ: Pearson. Pagana, K.D., & Pagana, T.J. (2006). Mosby’s manual of diagnostic and laboratory tests (3rd ed.). St. Louis, MO: Mosby. Total Knee Replacement (2009). American Academy of Orthopaedic Surgeons. Retrieved October 19, 2009, from http://orthoinfo.aaos.org/topic.cfm?topic=A00389.

Crisis Management Overdose of Premature Babies in Indianapolis, Indiana

Crisis Management Overdose of Premature Babies in Indianapolis, Indiana Introduction All organizations face crisis of different natures and scales at one time or another and how the organizations responds to the crisis may well determine its future success or failure. Devlin (2006) states that it is the responsibility of an organization through its public relations office to ensure that the organization recovers gracefully from a crisis and that this recovery occurs in a timely manner.Advertising We will write a custom research paper sample on Crisis Management: Overdose of Premature Babies in Indianapolis, Indiana specifically for you for only $16.05 $11/page Learn More This paper will analyze the role that public relations played in the recovery from the over-dosage of premature babies’ incident by the Methodist Hospital. The success of the response by the hospital will be reviewed and anything that may have been done differently noted. The Crisis The case in question involves the death of a number of babies as a result of a medical error in the Methodist Hospital in Indiana. A total of six premature babies were given an overdose of heparin due to an inventory error. As a result of this, there was a wide public uproar as the relatives of some of the deceased babies expressed their discontent and anger over the incident. The hospital crisis was further heighten by the appearance of the relatives of one of the dead babies on national television (Indiana News, 2006b). The relatives expressed their anger over the incident and blamed the death of their baby on the misconduct of the hospital staff whom they claimed should have known better than to deliver the wrong dosage to their baby. How the Hospital Responded The hospital was quick to respond to the issue and it gave details of the error that had led to the death of the premature babies. It took responsibility for the actions of its medical personnel and acknowledged that human and procedural errors were the cause of the overdoses that resulted in t he fatalities. The hospital CEO also pointed out that the fact that the babies were very premature may have contributed to their death (Jones, 2006). However, he noted that it was the huge influx of the drug that led to their death. Since an oversight on the part of the nurses is what had led to the wrong doses, the hospital enacted new policies that would require a minimum of two nurses to validate heparin doses so as to avoid any future administration of wrong doses. The nurses who had administered the wrong dosages were also given counseling so as to help them come to term with their actions and help them return to normalcy and continue serving the community. The report also noted that hospital staff had met with the families of the affected babies and offered their apologies for the incident.Advertising Looking for research paper on communications media? Let's see if we can help you! Get your first paper with 15% OFF Learn More Why it was Necessary to Re spond The response of the hospital was necessary for a number of reasons. To begin with, the public needed information on the crisis. The response was also needed to disseminate information to the public. Being one of Indianas largest hospitals, the error at the Methodist Hospital had attracted wide public attention and everyone wanted to know what was going on. Theodore and Webber (2006) report that the hospitals spokesman kept the public up to date with news of how the affected babies were faring and also in case a fatality occurred. The official news provided by the hospital which was credible and truthful became the primary source for the public. By being the major source of information on the issue, the hospital ensured that sensational gossip did not become the primary source of information for the public on the issue. The hospital had admitted that it was its traditional procedures of stocking vials from the inventory to the drug cabinet that had resulted in the fatal error. For the public to be reassured that such errors would never occur again, the hospital had to make major changes to the old system. To this end, the hospital stated that it would not keep vials of the adult doses of heparin (10,000 units) in its inventory (Indiana News, 2006). The response also helped to put the public’s mind at ease. The hospital took full responsibility for the error with the CEO stating that the blame for our errors falls upon this institution; a weakness in our own system has been exposed (Pinto, 2006). In anticipation of the public questioning whether the error was not only limited to the premature babies, the hospital took the time to clarify that infant doses had not been given to adult patients (Jones, 2006). How the Response promoted the view of the hospital The hospital was keen to demonstrate that it had learnt from the mistake and would take measures to ensure that such an error never occurred again. For example, all employees were expected to sign a document on the importance of correct drug administration so as to demonstrate their commitment to ensuring patience safety in future (Indiana News, 2006). A senior figure in the hospital administration, the president of the organization which owns the Methodist Hospital, reassured the public that this error was an isolated case and it would not pose any risk to other babies who were being treated at the hospital. The view of the hospital was further advanced by revelations that errors occur in a number of hospitals over the country and that technology was used to try and reduce the number of this errors (Pinto, 2006). Outcome of Response The public’s positive perception of the hospital was encouraged by the response. The fact that the top management of the hospital was willing to go on record accepting responsibility for the deaths of the two babies showed that the facility has integrity.Advertising We will write a custom research paper sample on Crisis Management : Overdose of Premature Babies in Indianapolis, Indiana specifically for you for only $16.05 $11/page Learn More Emphasis was placed on the fact that it was a veteran technician who accidentally stocked the drug cabinet with the wrong dosage of heparin (Theodore Webber, 2006). Such a revelation demonstrates that the error was not cased by the hospital employing incompetent staff but rather by an honest mistake on the part of the seasoned pharmacy technician. The public would like to be reassured that such an accident would never be allowed to happen again. As a result of the response, information about the hospital’s new measures to avoid a repeat of the tragedy was disseminated to the public. The only way for this to occur was through a thorough change of the hospitals system and the response detailed how the hospital had gotten rid of the old system and replaced it with a new more thorough system. An investigation by the Indianapolis Police Department asc ertained that the fatal errors were accidental in nature and that the nurses who were responsible for the mistakes had not done it intentionally (Pinto, 2006). The radical changes implemented by the hospital ensured the public that the same error would never occur again therefore restoring trust in the facility. How I would have handled the Response If I were in charge of the public relations of the hospital, there are a number of things I would have done differently. I would have placed some emphasis on the long successful relationship that the hospital has had with the community. I would also have placed emphasis on how the hospital has always been keen to safeguard the interest of the patients. With such a background, the public would be more inclined to view the death of the two babies as a tragic accident. By reminding the public that patient interest has always been the Methodist Hospitals driving force, the publics would be put at ease in spite of the incident. Expressing con cern for the public will result in a better perception of the organization by the public. With this in mind, I would have ensured that the public is constantly reminded that the hospital is working overtime not only to resolve the current crisis but also to ensure that future patient safety is observed. Conclusion This paper set out to review the crisis that followed the over dosing of premature babies in the Methodist Hospital. It has been noted that the response made by the hospital was very appropriate and yielded good results. A positive in the hospital’s handling of the situation was that it did not attempt to downplay the issue and publicized its responses as much as it could.Advertising Looking for research paper on communications media? Let's see if we can help you! Get your first paper with 15% OFF Learn More Future speculations that the hospital tried to hide the problem by withholding information from the public could therefore not arise. The primary concern in the crisis was the safety of the consumers and the public at large and since the hospital addressed this very efficiently, the level of damage from the crisis was limited and the organizations reputation was not badly damaged. References Devlin, S.E. (2006). Crisis Management Planning and Execution, NY: CRC Press. Indiana News (2006). Hospital Changes Procedures After Babies Fatal Overdoses. Retrieved from: theindychannel.com/news/9879402/detail.html. Indiana News (2006b). Infants Family Speaks Out Following Hospital Deaths. Retrieved from: theindychannel.com/news/9884927/detail.html. Jones, K. (2006). Heparin Overdosage Kills Two Premature Babies at Methodist Hospital. Retrieved from: http://foodconsumer.org/7777/8888/Other_N_ews_51/Heparin_Overdosage_Kills_Two_Premature_Babies_at_Methodist_Hospital_printer.shtml Pinto, B. (200 6). Hospital Procedures Questioned After Death of Two Babies. Retrieved from: http://abcnews.go.com/WNT/Health/story?id=2465287page=1. Theodore, K. Webber, T. (2006). Third baby dies after error at Indiana hospital. Retrieved from usatoday.com/news/nation/2006-09-20-baby-deaths_x.htm

green mile (paul edgcombe) essays

green mile (paul edgcombe) essays Paul Edgecombe A Peculiar Man Paul Edgecombe, the narrator of Stephen Kings novel The Green Mile, is a character faced with many moral dilemmas. He works at a job where he sees injustice and the judgment of the state placed on the inmates there. Looking at the economic situation of society, he sees good men going without work and unable to provide for their families. "Better men than me were out on the roads or riding the rails. I was lucky and I knew it." (p.46) Paul tries in his own personal way to right the wrongs of the brutal treatment of the inmates with kindness, and tries to quiet his conscious when the time comes to put a man to death. Paul Edgecombes meditations and thoughts on other characters are insightful and show us a great deal about his personality and beliefs. Mr. Edgecombe is a married man with grown children. He took a job at Cold Mountain Penitentiary to support himself and his family long ago. Now, during the economic depression of the nineteen thirties is unable to quit, despite how he feels. The narrator seems to be an educated man with a definite ethical standpoint, a conscience, and strong religious beliefs. He makes references to Edgar Allen Poe (p.100) and Lewis Carroll s Alice in Wonderland (p.56) when commenting on his surroundings in the prison. This is not something one would expect from a prison guard in the South during the depression. Paul is tormented by the duties his job requires of him. "I couldnt do this job much longer. Depression or no depression, I couldnt watch many more men walk through my office to their deaths." (p.65) Paul experiences empathy for the prisoners on the green mile that is touching and surprising. "For a moment I imagined to myself to be that mouse, not a guard at all but just another convicted criminal there on the green mile, convicted and condemned but still managing to look bravely up at a desk." (p.54) ...

Diffusion Confusion

Diffusion Confusion Diffusion Confusion Diffusion Confusion By Maeve Maddox The Latin verb diffundere, â€Å"to pour in different directions,† gives us the noun diffusion, the verb diffuse, and the adjective diffuse. The noun and the adjective present few difficulties, but the verb is often used ambiguously or incorrectly. Note: The si in diffusion represents the zh sound. The adjective is pronounced with a soft s sound; the verb is pronounced with a hard s sound: diffusion noun /di-FJU-zhn/ diffuse adjective /di-FJUS/ diffuse verb /di-FJUZ/ The noun diffusion refers to the action of spreading or dispersing something. In the context of physics, diffusion is â€Å"the permeation of a gas or liquid between the molecules of another fluid placed in contact with it.† Photographers and painters use the word diffusion to refer to â€Å"the process of slightly scattering a portion of the image-forming light to give a pleasing artistic softness to a photograph [or painting].† Figuratively, diffusion refers to the spreading or scattering of people, customs, or knowledge: In his Researches into the Early History he  ascribes the  curious custom of couvade  to diffusion, an interpretation that few modern ethnologists would countenance. Carnegie donated $300,000 to build Washington, D.C.s oldest library. The building was dedicated to the diffusion of knowledge. The adjective diffuse means â€Å"spreading out.† A tree, for example, might have â€Å"diffuse branches.† A â€Å"diffuse writing style† is wordy. An artist paints a picture in which the light is â€Å"diffuse and ethereal.† A population that is not concentrated in one area, but scattered over a region, is diffuse: Variation in state laws is related to whether the gay and lesbian population is concentrated (where laws permit inequality) or  diffuse  (where laws promote equality).- The Washington Post. Like the other words derived from diffundere, the verb diffuse conveys the sense of â€Å"scattering or spreading abroad†: The Japanese  intended to diffuse  Japanese language and culture throughout the archipelago. Efforts have been made  to diffuse Christianity  throughout the world.   When an artist diffuses the light in a painting, the particles of paint that represent light are spread out, producing a softened effect. Perhaps it is this use of diffuse that causes some speakers to use diffuse as if it means â€Å"to soften† or â€Å"to make less tense.† For example: While there have been signs that China’s leadership is taking some initiatives intended to diffuse the situation, there are no indications whatsoever that the present tough policy on Tibet will mellow.- Institute of Peace and Conflict Studies. Or, the writer of the above example may have confused the words diffuse and defuse. Literally, the verb defuse means â€Å"to remove the fuse from an explosive device.† Taking the fuse out of a bomb makes it totally ineffective. Figuratively, defuse means â€Å"to make a situation less tense† or â€Å"to make something ineffective.† If the intended meaning is â€Å"make less tense† or â€Å"forestall,† ambiguity may be avoided by choosing defuse or some word other than diffuse to express it. Here are some options: ease calm soothe mitigate palliate moderate reduce lighten Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:When to Capitalize Animal and Plant NamesHow Long Should a Paragraph Be?6 Foreign Expressions You Should Know

Andre Kertesz, Oskar Schlemmer and Herbert Bayer photo analysis Essay

Andre Kertesz, Oskar Schlemmer and Herbert Bayer photo analysis - Essay Example The essay "Analysis of photos by Andre Kertesz, Oskar Schlemmer, Herbert Bayer" explores works of famous photographers such as Andre Kertesz, Oskar Schlemmer, Herbert Bayer. The Bayer's work was of seemingly a bloodless cement-like portion that’s broken away. The artist’s self-portrait as both amputee dispenses and classical sculpture with the view of the unitary self or considered to take a stand against the unrealistic Aryan body obtained in Nazi art or mass culture in the mid-1930s. The era in history of this particular picture is of the uneasy political climate and in one way or another affected the way in which artists such Herbert Bayer approached the human body. For instance, Herbert Bayer turned to Photomontage for subversive political impacts seen. To oppose psychic hygiene of the Fascist propaganda tool and the corporeal perfection, the artist uniquely created hybrid anatomies of arrangements that were animate, but just ambivalently so. Das Triadische Ballett popularly known as holds a preeminent place in the totality of Oskar Schlemmer’s work. Oskar Schlemmer based his prototypical figures on the discoveries and deeper understanding accumulated during the undertaking and conception of the figurines for the ballet. Through keen analysis the work is based on symphonic dance. What is more interesting is how the artist conceived the three dancers— two males and one female. The artistic work correlates with surrealist’s ideology that seeks to demolish contemporary society rules.

Managing Change Research Paper Example | Topics and Well Written Essays - 1000 words

Managing Change - Research Paper Example Of the factors marked with an * rank them and identify which represent a threat and which an opportunity. 3) Page 6.1 p99 of text (Think of an occasion in the past three years when the organ. recognised the need for change in good time, and think of another time when it failed to do so. List the factors which may have contributed to these different outcomes. (Factors that contributed to the recognition for the need for change and factors that contributed to the failure to recognise the need for change (Table) Reflect on your unit's past record for recognising the need for change. Note anything that you or others could do to help ensure that in the future your unit or organisation will be more alert to the need for change. (Notes) The company chosen for analysis is VTech. It is, to use their own words, "one of the world's largest suppliers of corded and cordless telephones" (TEL) "and a leading supplier of electronic learning products" (ELP's). "It also provides highly sought-after contract manufacturing services" (CMS). "Founded in 1976, the Group's mission is to be the most cost-effective designer and manufacturer of innovative high quality consumer electronics products and to distribute them to markets worldwide in the most efficient manner." (Results FY 2007) It may be noted that VTech has made several changes in the past five years (2001-02 to 2006-07), some on its own, and some in response to environmental stimuli. It must however be noted that none of these changes are transformational in nature. This is not to deny the major changes that have occurred. But even the major changes may be classified as 'incremental' because there has been no change in the basic structure of the Company. (Hayes, ch1, pp15-17) Q2 Current Nature of the External Environment faced by VTech Political 1) Hong Kong (HK) where VTech is located was a British Colony, which has reverted to China in 1997. 2) HK has a unique history of being politically close to both China and the West.* Economic 3) HK can retain its economic independence from China for 50 years after 1997*. 4) VTech has access to cheaper labour in China, where it has located some of its production facilities.* 5) HK, like China and Japan, has a unique set up of manufacturing of an imitative nature, where it competitively produces the same products made by the West. Some of VTech's products also fall into this category. Technological 6) Technological changes in the telecom sector have been rather fast* Socio-Cultural 7) The age at which people start using hand phones is getting lower. Even children use these phones* Linkages PI, P2, E3 and E4 are linked directly or positively.E5 and T6 are indirectly or negatively linked. Quick technological changes make it difficult to come out with good imitations. Besides, tightening of patent laws to include products and not only processes, make it more difficult to 'imitate'. T6 and S7 are also positively linked. A decrease in the age of users could speed up technological changes to meet the demands of the new clientele. Classification of Factors Vital for VTech's Survival into Threats and Opportunities. Threats