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