Organizational Change Plan Essay

Falls are a common cause of morbidity and the leading cause of nonfatal injuries and trauma-related hospitalizations in the United States (Center for Disease Control and Prevention, 2012). Falls can occur in home and as well as in any health care facility. In hospitals, falls consistently make up the largest single category of reported incidents, with most falls occurring as a result of medication related issues, toileting, and hospital environment conditions. With falls accounting for the leading cause of injuries in hospital, it is imperative that environment safety and fall prevention is addressed in facilities. This change plan will include the need for implementation of a fall risk assessment and fall precautions, barriers to change, factors influencing change and the readiness for change as well as resources available to support change. These changes will be implementing with the help of using, Kurt Lewin’s Change Plan Theory. Need for the Proposed Change A fall is defined as an event which there is a downward displacement of a patient’s body from a standing, sitting, or lying position that may result in injury (St Peter’s Hospital, 2012). St. Peter’s Hospital in Albany, New York, is one of the major acute care hospitals committed to promotion of patient safety. Acute care hospitals show that fall rates range from 1.3 to 8.9 falls/1,000 patient days and that higher rates occur in units that focus on eldercare, surgical, neurology and rehabilitation (â€Å"National Quality Measures Clearinghouse†, 2013). Due to the high number of patient falls and increased risk factors in the hospital it is imperative to have fall assessments and fall prevention standardized throughout the hospital. Patients’ will be provided an optimal safe environment during care based on the Environment Safety and Fall Prevention Policy and Procedure. Fall  prevention strategies are to be executed per standard of care and indivi dualized based on patient assessment within the patient plan of care. Certain patients are considered to be at a greater risk for falls. Factors such as patients who are 85 years old or older, osteoporosis, anticoagulants treatment, bleeding disorders and patients post-operative. Every patient who is admitted into the hospital is placed on universal fall precautions and nurses will further assess patients based on the Hendrich II Assessment Tool and Get-Up-and-Go Assessment. Patients are also reassessed every shift, with change in condition, after a transfer, and after a fall. The Hendrich II Fall Risk Model is used to assess a hospitalized patient’s risk of falling. Designed to be administered quickly, it focuses on eight independent risk factors: confusion, disorientation, and impulsivity, symptomatic depression, altered elimination, dizziness or vertigo, male sex, administration of antiepileptic (or changes in dosage or cessation), administration of benzodiazepines, and poor performance in rising from a seated position in the Get-Up-and-Go Assessment (Hendrich, MSN, RN, FAAN, 2007). Along with universal fall precautions, Hendrich assessment and Get-Up-and-Go Assessment, staff members should be monitoring their environment on an ongoing basis for situations that may lead to a fall, such as tubing and equipment posing as a tripping hazard. Staff members must be proactive with assisting patients with unsteady gait, need for assistive devise and patients with weakness to ensure safety. Once a patient is scored a fall risk, the nurse will initiates a fall prevention program and activate fall risk in patient’s plan of care. A yellow arm band is placed on the patient, special skid resistant slipper socks are provider to the patient and fall precaution sign is placed outside patient’s door and over the bed to ensure all staff members are aware of fall risk. Providing education on preventing falls to both family and patient, placing patients closer to the nurses’ station, providing bed alarms, sitters and hourly rounding are other measures to avoid falls. Patients who score five or greater are considered to be risk for falls and fall interventions will be initiated. Another safety measure important to prevention of falls is to include fall risks in all shift to shift reports. Barriers to Change St. Peter’s Hospital is an large organization specializing in Cardiac,  Hepatobiliary, Bariatric, Gastrointestinal and Orthopedic Surgeries. Being such a diverse large organization inconsistency throughout the hospital shows to be the major barrier to change. Other barriers are lack of employee involvement, lack of financial resources and poor communication. To overcome such barriers, an awareness of the need for an effectiveness of fall risk assessment and fall prevention program is essential. Employees, patient’s, and family members need to be aware of fall risks, fall precautions and the fall prevention program. Factors Influencing Change Increasing patient satisfaction and at the same time preventing and reducing the amount of falls on a daily basis is the key factor. Patient satisfaction is ultimately the driving force behind the changes in the hospital. If patients are not satisfied with care, they will go to another provider and thus the hospital will lose money. In order for St. Peter’s Hospital to remain ranked in the top 10 hospitals, they must ensure all patients are pleased and safe with their care. One way to make certain that the hospital patient safety increases is by implementing changes throughout the hospital to standardized the fall risk assessments and fall prevention program. In order to be successful with this change, regulatory changes will be necessary to be made in accordance with fall prevention. St. Peter’s Hospital is committed to patient’s safety and ensures all patients are provided with an optimal safe environment during care. Training is required for all employees to guarantee compliance and full understand of the fall prevention program. Evaluation of the program is another regulatory change that is necessary for the success of the program. Monitoring on a regular basis is required to determine effectiveness of program and deciding if changes should be made or modified. Factors Influencing Readiness for Change When organizational readiness for change is high, organizational members are more likely to initiate change, exert greater effort, exhibit greater persistence, and display more cooperative behavior (Weiner, 2009). Readiness requires both the capability to make change as well as the motivation to make the change. Readiness is contingent on several different factors throughout the hospital. Several factors for implementing the falls  risk assessment and fall prevention program is the high rate of falls throughout the hospital. Readiness is also determined by the financial stand point of the hospital. The hospital must be willing and able to devote extra funds to pay for increased amount of employee training and education. Theoretical Change Model: Kurt Lewin’s Change Theory Utilizing Kurt Lewin’s Change Theory can assist St. Peter’s Hospital to make the change, minimize disruption and assure that the change is adopted permanently. Lewin’s three step model of change are as follows: Unfreezing, Changing and Refreezing. Unfreezing is the readiness for change. During this phase St. Peter’s Hospital will prepare the hospital staff for the implementation of the falls risk assessment and falls prevention program. In order to prepare the hospital staff of the need for change, they must first provide information and research regarding the program and the benefits. Once unfreezing is complete, St. Peter’s Hospital would transition into the second phase known as, Change. Change is the actual implementation of the proposed change. In order to implement these changes, training will be provided and required for all employees to guarantee compliance and full understand of the fall prevention program. Evaluation and monitoring of the program will also be conducted during this phase to ensure compliance as well as understanding. Actually making the falls risk assessment and falls prevention program a permanent entity to the nursing assessment is the final stage of refreezing. During this stage, St. Peter’s Hospital will continue to offer education and support throughout the hospital to standardized the fall risk assessment and falls program. Recourses Available for Change It would be virtually nearly impossible to implement an successful change without having the necessary resources. In order to implement such a plan as the fall risk and fall prevention program, St. Peter’s Hospital must have a team of educated employees throughout the many disciplines and be able to train the remainder of the hospital with the new proposed changes. Education would be in the form of class room demonstrations, on the unit in-services in addition to hospital based website education. Finances is another major resource that is required for the change plan. Without the  proper means, the hospital is not able to pay the employees and implementation would not be in effect. Conclusion Patient education needs to be incorporated into the admission process and continue throughout the hospitalization stay. Education provides the patient with the knowledge of the importance of safety and what part he or she contributes in their care as well as risk factor identified. Fall prevention programs are designed to determine fall risk and prevention strategies while collaborating with the patient’s health care. Informing both the patient and the family will bring an understanding and mindfulness to fall prevention. Falls are devastating to both the patient and the hospital considering a single fall may result in a downward spiral of reduced mobility with a loss of function and further risk of falls. Along with proper education, fall risk assessments are vital to the fall prevention process. These fall risk assessment are implemented hospital wide and are conducted every shift, change in status, during transfers to different units and at discharge (St. Peter’s Hospital, 2012). Compliance and consistency reduces falls and the overall cost of falls throughout the hospital improving the care. References Center for Disease Control and Prevention. (2012). Falls Among Older Adults: An Overview. Retrieved from August 23, 2014, from http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html Currie, D.N. Sc, M.S.N., R.N., Leanne. (n.d. ). Fall and Prevention. Retrieved August 23, 2014, from http://ncbi.nlm.gov Hendrich, MSN, RN, FAAN, Ann. (2007, November). How to Try This† Predicting Falls. AJN, 107(11), 50 National Quality Measures Clearinghouse. (2013). Retrieved August 23, 2014, from http://www.qualitymeasures.ahrq.gov/content.aspx?id=36944 Environmental Safety and Fall Prevention. (2012). Retrieved August 23, 2014, from http://www.sphcs.org/environmentalsafetyandfallprevention.org Weiner, B. J. (2009, October). A Theory of Organizational Readiness for Change . Implementation Science, 4(67)

Game Theory †Descriptive, Normative or Prescriptive Essay

Going through life we often are surprised by the different ways how people think, make decisions and interact. We believe that most of us are rational human beans (to some extent) and, therefore, our decisions should be grounded in analysis of the situation, our experience and intuition. Therefore, the human mind can be seen as an incredibly complicated machine that runs series of theoretical simulations of possible situations (often subconsciously) to find the most optimal course of action, taking into consideration the possible strategies of others. When the decisions are important to us and the reasoning process is conscious, we engage in strategic thinking. It has always been tempting to develop a theory that would actually explain and predict the human interaction based on strategic thinking, therefore making the strategic decision making more effective to both parties and without risk to going into â€Å"worst case scenario†. Therefore ideally game theory should cover the questions how the decisions should be made in order to maximize the gains, what reasoning does it imply, how to make the best choice of strategy and what will the pay-offs be for both parties. What questions does game theory actually answer – this is how the topic of this essay might be rephrased. In this essay the discussion will be focused on the question whether game theory is a descriptive, normative or prescriptive theory. First, a brief explanation of different types of theories should be given as well as the definition of game theory and the development in this academic field of study as well as the practical applications. Then the standpoint of the author will be defined and supporting as well as contradicting arguments based on various academic articles will be presented and discussed. The last part of the essay will sum up the discussed ideas and draw the final conclusions and remarks. To start with the necessary in-depth understanding of the essay topic, the distinction between normative, descriptive and prescriptive theories should be clarified. As it is known, normative theory deals with how things should be – what ought to be in context of the specific field of study. Descriptive theories are concerned with explaining the way things happen (people behave) in real ife, moreover the prescriptive theories aim to suggest how things should happen (or how people should react) and this could be just on theoretical level or also connected with the real life (therefore not only giving prescriptions on how to act but also the predictions on the future situations). Joseph B. Kadane and Patrick D. Larkey in their paper „The Confusion of Is and Ought in Game Theoretic Contexts† from 1983 reflects on the essay topic and distinguishes between different types of normative and positive theories: Among positive theories, we distinguish three types. Descriptive theories are concerned with empirical phenomena, but stop with a description. Explanatory theories go further by addressing â€Å"why questions. † Finally, predictive theories discuss what behavior will be. We also distinguish between two types of normative theory, both concerned with what behavior should be. Speculative statements are nonoperational usually consisting of a goal or criterion (e. g. , maximize utility or profit) with no precise instructions on how one might accomplish the goal or apply the criterion. Prescriptions are operational in that they give both a goal (or criterion) and feasible procedures (an algorithm) for accomplishing it. From this quotation it can be clearly seen what theory distinctions in game theory context are made. The essay author will adopt this view and within normative theories take into consideration both speculative and prescriptive types of theories, within descriptive theories include both descriptive and explanatory types and within prescriptive theories look at predictive and prescriptive (for real life situations) types. After clarifying the different types of theories in connection with game theory, the short description of game theory and development of modern game theory will be given. In the Oxford English dictionary the definition of game theory is as follows the branch of mathematics concerned with the analysis of strategies for dealing with competitive situations where the outcome of a participant’s choice of action depends critically on the actions of other participants. Game theory has been applied to contexts in war, business, and biology. From the definition we see the important factors are the mathematical analysis, different strategic options with different outcomes (pay-offs) and the interdependence of the players. Therefore it indeed looks like the so desired theory described in the introduction of the essay, however, what does it actually deliver, that is the main focus of this essay. Modern game theory has been developing now for more than 50 years since the book Theory of Games and Economic Behavior by John von Neumann and Oskar Morgenstern was published in 1944. However, it must be noted that some important efforts in explaining the strategic choices – strategic decision making has been done also before, for example by Zermelo. Konong, Kalmar and Borel. Game theory has evolved considerably since the publication of von Neuman and Morgenstern’s book and what is interesting the theory has developed far beyond its initial mathematical boundaries. This is due in a large part to contributions in the 1950s from John Nash (1950, 1951). However, it was in the 1970s that game theory as a way of analysing strategic situations began to be applied in all sorts of diverse areas including economics, politics, international relations, business and biology (Chermichael, 2005). By having established the understanding about the subject of the essay, the arguments can now be presented. The author believes that the game theory at the stage of evolution it is now in is a descriptive and prescriptive theory concerning strategic decision making, however with some limitations. Argument 1: Strategic decision making implies / do not imply rational thinking The first contra argument discussed will be about the assumption of game theory that the players are rational. It can be argued that this indeed does not reflect real life as people often make irrational choices and therefore game theory is not describing the real world nor giving prescriptions on how to act in real situations but is indeed a normative theory. What needs to be emphasized here is that the essay author argues that game theory is a prescriptive theory when dealing with strategic decision making. Strategic decision making involves long term commitments from an organization and therefore it will be carefully analyzed and discussed before the final decision, in order to be sure that the chosen course of action will deliver the highest possible results. Following this thought it can be concluded that the players will act rationally, as they are aware of the huge impact of the decision and have certain decision making skills (which can be assumed as they are high in the organizational hierarchy that they are the ones making strategic decisions). Argument 2: Game theory does / does not describe predict the real world situations Strong critique regarding the interpretation of game theory is expressed by Rubinstein (1991): There exists a widespread myth in game theory, that it is possible to achieve a miraculous prediction regarding the outcome of interaction among human beings using only data on the order of events, combined with a description of the players’ preferences over the feasible outcomes of the situation. [.. ]The mystical and vague word â€Å"rationality† is used to fuel our hopes of achieving this goal. I fail to see any possibility of this being accomplished. Overall, game theory accomplishes only two tasks: It builds models based on intuition and uses deductive arguments based on mathematical knowledge. As we see from this quotation, Rubinstein is critical regarding the game theory having any descriptive or prescriptive characteristics. However, he states that what is missing for it to be a descriptive (and following that prescriptive theory), is the data describing the process of reasoning adopted by the players when they analyze a game. Since this article more than 10 both scientific and empirical articles have been written directly dealing with the problems mentioned in this article therefore the interpretation has evolved as well as the game theory itself. Moreover, game theory has been used throughout the years by companies and has been proven to be a useful tool for strategists. Camerer in his article â€Å"Does strategy research need game theory? (1991) comes to a conclusion that a common criticism that game-theoretic models assume too much rationality is often wrong because first, some games require little rationality to compute equilibria; and second, players may reach an equilibrium by communicating, adapting or evolving to it rather than by calculating it. Indeed, the author agrees that the interpretation of the games needs careful attention, however, the theory can be used as a descriptive theory for strategic decisions and by studying it strategists can come to a better decisions therefore evolving in a prescriptive theory. Another extra point enhancing the previously stated is the evolution of game theory now including cooperation, asymmetric information and other factors which are present in real life situations. Hutton (1996) describes game theory as an intellectual framework for examining what various parties to a decision should do given their possession of inadequate information and different objectives. Here we see that in later works game theory is seen as a more sophisticated theory dealing with various situations not only basic theoretic models. The paper of Kadane and Larkey from 1983 states two suggestions in order to clear the â€Å"is and ought† confusion. First, a Bayesian perspective should be adopted, second, more attention should be given to the model validation. The Bayesian view of games clarifies the proper, respective roles of prescriptive and predictive theory. Taking the Bayesian norm as prescriptively compelling for my play leads me to want the best description I can find of my partner/opponent’s play. Thus both prescription and description have important roles to play in the Bayesian view of games. Therefore, we see that through Bayesian approach the descriptive and prescriptive characteristics of game theory are enhanced. From authors research for relevant literature concerning the question what type of theory is game theory, it can be seen that most papers concerning these questions are around 1980`s and the beginning of 1990`s. Later papers on game theory, however, are more concerned of empirical applications of game theory as well as in depth analysis of the theory. The empirical work in such fields as auctions, M&A, price strategy, marketing strategy etc. as been applying successfully the principles of game theory, therefore strengthening the statement that Game theory is indeed now a descriptive and prescriptive type of theory. Argument 3: Game theorist work has been internationally recognized as applicable to real life and practically useful to make better strategies and strategic decisions Another strong argument supporting the statement of the author is the work of rec ent Nobel Prize winners in economics, in 2007 and in 2012 the winners are game theorists Leonid Hurwicz, Eric Maskin, Roger Myerson and Lloyd Shapley, Alvin Roth respectively. (Nobel Prizes in economics also was awarded to game theorists in 1994, 1995 and 2005). Leonid Hurwicz, Eric Maskin and Roger Myerson won the 2007 Nobel Prize for their work in mechanism design theory, a branch of game theory that extends the application of game theory to how different types of rules, or institutions, align individual incentives with overall social goals. Their work on allocation mechanisms has had a significant impact on the design of uctions, social welfare systems and many organizations. As the theory can be applied successfully to real fields of business and real organizations, it can be concluded that game theory must be a prescriptive and therefore also descriptive theory. Moreover, the Nobel Prize in 2012 to Shapley and Lloyd was awarded for the theory of stable allocations and the practice of market design – the creation of the link from theory to practice. BBC article (15. 10. 012) regarding the winners of 2012 Nobel Prize in economics by Stephanie Flanders, the BBC Economics Editor, states The work of Lloyd Shapley and Alvin Roth reminds us that economics can be both deeply mathematical and abstract, and deeply practical – not to say hugely useful to public and private organizations all over the world. [.. ] In the past 50 years, game theorists – and micro-economics in general – have genuinely made the world a better place. Either they have helped to solve practical real-world problems or, where there is no solution, they have helped us to understand the issues more clearly. So once again we see that game theory when applied correctly can help to solve real life problems and therefore is a prescriptive and descriptive theory. Working on the essay the author read through many articles on game theory including the classic papers of Nash (1950,1951) where the theory is explained in detail but applications explained are indeed rather simple and not that applicable to complex real world situations, however, very useful for simple situations. Looking at the research papers written in late 1990`s and 2000`s, the empirical applications can be seen more clear and grounded in real life. The critique on game theory expressed by researchers in early 1990`s have been taken into consideration therefore helping the game theory to evolve ad become descriptive and prescriptive theory that can be applied to many fields. Moreover, practitioners are indeed using game theory, for example highly successful consultancy company McKinsey is using game theory to help managers make better decisions and foresee the different possible risks of different courses of action (Hagen Lindstadt and Jurgen Muller, 2009). The author believes that the game theory has evolved from being more a normative theory to normative prescriptive theory, then by applying these rules to real world descriptive theory has been developed, and now in hand of a masterful strategist game theory is indeed a predictive and prescriptive theory helping to make better strategic decisions.

Competitive Advantage and Disadvantage Between Minorities and Women in the Workforce

â€Å"It’s a small world. † How many times do we hear this in our everyday life? The internet, mass media, telecommunications, and mass transportation have all contributed to the shrinking of the international market. As companies become more and more diverse, it’s becoming more and more important for the employees to understand and manage it. For my research paper, I’ve decided to find out the competitive advantage and disadvantage between minorities and women in the workplace.Diversity in the workplace is a topic that many industries and organizations spend an abundant amount of time and training on in order to ensure its presence. Today’s workplace is more diverse than it has ever been in the history of America. 1 out of 4 Americans belong to a minority or is foreign-born. Women are making up less than half of the work force. Whether you are a business owner, executives, salesperson, or customers, your success will increasingly depend on your abi lity to function in a culturally diverse marketplace. Women, people of color, and immigrants will soon hold almost ? of all jobs in this country.In order to effectively manage diversity and recognize it as a source of strength instead of conflict, we will need to be educated and reprogrammed to accept and embrace diversity. In the world today, it is a face that a lot of people believe that racism is no longer exists. Little do they know, as of 2010, the National Organization of Women believes that the U. S. still needs an affirmative action plan. African American women earned 63 cents to a dollar for the jobs that men do, and Hispanic women earn 57 cents to the dollar and Blacks have twice the unemployment rates of whites.Minority and immigrant groups are often disadvantaged in gaining access to jobs for which they are educationally qualified and earn less than their white counterparts. Descriptive results showed greater overall underemployment among females than males. Blacks and H ispanics had higher unemployment and working poverty rates compared to non-Hispanic whites and Asians, with job mismatch highest among Asians. Immigrant underemployment was greater than that of the native-born Americans. Asians posted the largest disparity in immigrant versus native-born underemployment, and blacks had the smallest.The double disadvantage hypothesis of minority group and immigrant status is accepted only for Asian men and women with jobs mismatched to their skills and for Asian women, who are most likely to be unemployed or be among the working poor. Asian immigrants’ women have the characteristics to stay at home, cleaning house, shy, and less aggressive, which transform to have less attached to the workforce. Researchers have shown great interest in the study of gender and race effects on promotions outcomes.The evidence suggests that women are disadvantaged such that they are less likely to be promoted than their equal qualified male counterparts. Lacks of advancement opportunities is major contributors to voluntary quit decisions by employees that fitted the job well and contribute to the company they belong. Employment decisions should be based on skills and ability, allowing all employees to put their talents to good use and work together to get the best possible outcome. America is not the only place in the world that’s facing the challenge of workplace discrimination.Within the UK, construction has an unenviable status as being the industry with the lowest representation of women and ethnic minority employees. The construction workplace presents a challenging and hostile environment for non-traditional workers, and women and ethnic minority employees face both similar and different challenges and attitudinal barriers. Discriminatory behavior perform by the dominant white male workforce is unbearable, as are informal recruitment practices, exclusive networks and a competitive culture. As the turn of the new millennium, the proportion of minority members living n poverty, attending poorly funded schools, or experiencing other forms of disadvantage far exceed the proportion of whites under these conditions. It was found that the minority residents of communities with large minority populations were in worse socioeconomic conditions than the minority residents of predominately white communities. Furthermore it was found that as minority concentration increased, white residents tended to do better. In addition, the extent of racial inequality between minority and white residents was greater in communities with larger minority populations.The improvement of education and training to minority residents of racially concentrated communities will be very beneficial, not only to the people itself, also think of it as a better country as a whole. There is little question that the improvement of educational levels and employment skills of minority residents communities will pay dividends in the near future. The growing markets of Latin America, Asia, and Central and Eastern Europe are now playing an ever more important role in global buying, selling and manufacturing.Diversity within a company can help the firm better understand the culture, customs, and the way of doing business internationally. Customers also prefer to do business with a workforce that which they can identify, and that have a strong commitment to their community. There are many advantages to having a work environment that is diverse. A company that is prepared for changes in demographics is prepared for the market changes as well as the changes in the pool of applicants. Having a diverse workplace creates an increase in attracting and retaining the most qualified candidates.Diversity programs within corporations improve corporate culture, help in recruitment, and help to maintain better client relations. In conclusion diversity in workforce is growing in all countries, specially America, Canada, and Europe. With having m ore diverse work environment, organization can produce better performance. It is important for the companies to know diversity and how to handle the issues relating to it. Also the need of the diverse workforce is getting more not only because there are different people but also because they can produce better results with having different types of people working.Leaders in the organizations must learn diversity and how to manage it effectively. One of the reasons, aside that my family is back in Hong Kong, that I will end up going back to Hong Kong as soon as I graduate college is because as much as I don’t want to say it, I can feel discrimination everyday in my life. As little as just playing basketball on a nice day, someone around you will always have the stereotype about how you look and what to expect. We can arguably say that America is the â€Å"melting pot† of the world, but racism, in my book, will never escape in the use of our everyday life.

Strategic-Alternative Bundles Essay Example | Topics and Well Written Essays - 250 words

Strategic-Alternative Bundles - Essay Example The question is directed to the whole alternative and not just certain components. On the other hand, if the check established that the strategic-alternatives are not mutually exclusive, for instance, one may have a thought to combine the first and the second strategy. Second, the bundles need to be plausible. One needs to determine if there are good alternatives and not mediocre ones, whether there are other to put into consideration. This will enable the manager of an organization to be in a better position to establish if the course of action proposed by a certain bundle is doable. Lastly, the strategic-alternative bundles need to be worthwhile. This will determine if implementing every one of them will result to success. Success means realizing a strategic intent and becoming stronger. Creating more than a few bundles is very difficult because they are not just alternatives but business models with alternative visions. This implies that these models can are extremely difficult to implement in the business. Strategic-alternative bundles need to have objective, advantage, and scope, as well as core competencies. Scope entails who the customer is offering and geographic scope. Following this further, advantage involves a sustainable competitive advantage. Therefore, choosing alternative strategies is similar to choosing alternative bundles (Stead, Stead, & Starik,

Event analysis Essay Example | Topics and Well Written Essays - 500 words - 1

Event analysis - Essay Example However, one evening the warehouses and storage manager forgot to switch-on the refrigerating system before installing fruits and vegetables which lead to spoilage. One possible solution to the problem is through the context of change management. Management change is currently one of major domains of organisational research, and the study of organisational change has become one of the major aspects in being able and helping to measure the organisation performance; efficiency and effectiveness. It is important to understand the extent to which formal changes in management systems and role prescriptions have resulted in change in work behaviour and job satisfaction experienced by personnel (Manser, 2004). It is thus essential, when attempting to assess the impact of formally espoused changes within an organisation, to examine the extent to which, and the way in which, managers have adapted new forms of work behaviour in accordance with the new managerial role perceptions. According to Waters (1996) ever since people started to work together to reach a common goal, operations management has been an important ingredient, but since the industrial revolution, it has grown most rapidly. Operations management is the tool behind the technical improvements that makes production efficient. It is the way to plan and organize how the technology and machinery will be utilized the most. The productivity in an organization depends on both the right technology and the right way to manage it (Waters, 1996). However, TQM can be a success or failure depending on how well it is planned, implemented, measured, and encouraged. Few would disagree that continuous improvement offers substantial benefits for manufacturers (McNamara, 1999). As a basic tenet of TQM, continuous improvement can enable manufacturers to meet the competitive pressures of the global economy head-on, and to develop strategies for

Personal skills and self-management Assignment Example | Topics and Well Written Essays - 1250 words

Personal skills and self-management - Assignment Example The new initiative is the work of the ANZ Mortgages that entails implementing a policy requesting the non-issuance of Certificate of Titles for all the mortgages which are registered by the ANZ Bank in Western Australia. The purpose of this project is to eliminate the issuance of duplicate Titles to the bank by the Titles office. This initiative is supposed to be implemented and running in the next three months. The initiative stakeholders will involve several groups among them, customers, solicitors and a government department. This initiative will be facilitated by technology as it will reduce costs and improve service efficiency. Planning of a new project or initiative is usually difficult as many people are usually against the idea because of the perceived change of status quo. To make sure a move successful it is important to talk to all the parties involved of the benefits of such a project and the likely effects that such a project would have on them or their day to day operat ions. The management may also be sceptical of the idea because of the costs involved in setting up such projects. During planning the project goals need to be identified, the project deliverables need to be set, the time frame and the supporting plans need to be established in order to make the project successful. This project is relevant as it will reduce unnecessary paper work and procedures involved in keeping of duplicate titles at the titles office (Haugan, 2002, 2-39). Once the project is identified by the management or proposed by the staff as was the case for this initiative, a major decision process often begins. Several decisions have to be made whether the project should be implemented or not. In the decision making process a variety of things are involved. In this project a decision needs to be made whether this initiative is actually beneficial to the organization or not. It will be of no benefit if a project was begun which does not add value to the organization. The o bjective of this project as explained above is to eliminate the issuing of Duplicate Titles to the bank by the titles office. The current procedure at the Bank is that when taking security over landed assets in the form of a first registered mortgage, the client is supposed to deliver a duplicate certificate of Titles to the Department of Land Administration in Western Australia. The duplicate titles plus a copy of the mortgages are then filled in the security packet at ANZ. The problem here arises as a result of the duplication of the documents in order to have copies left in both offices. Another issue is to do with the entire system and how it operates. There are so many disadvantages of the current system namely: the risk of the certificates being lost, high cost of replacing lost certificates, expensive storage equipment are required for storing the certificates and the rental cost of the storage space. As much as it is a good thing it is a tedious process that needs to be elim inated as it wastes effort, time and space (Project Smart, 2011). According to this plan few options exist. The first option will be to continue having the current system which involves a lot of work and duplication of efforts. The second option that exists is to eliminate the process in totality so as to have a more efficient system that will utilize the available resources at an affordable cost to the organization. This is what the project proposes as it will have a lot of benefits. The benefits include the elimination of misfiled certificate and all the costs and penalties that are associated with them, reduction of the physical space required for the storage of these documents, reduction in paper handling/recording and transfer for both offices, security of the documents as they will be handled once and filed by the Bank staff and efficient customer service. Therefore the implementation of this initiative will go a long way in helping the Bank achieve its objectives and also hel p the

Summarize the reasons for the failure of Lehman Brothers Essay

Summarize the reasons for the failure of Lehman Brothers - Essay Example hat the problems of the Lehman Brothers were well published over the media which gave time to the derivatives market to prepare for the worst (The Economist, 2008). The statement was pretty correct as the credit-default swaps market had not been broken but buckled up (The Economist, 2008). The bank was unable to assess the risk of the borrower or trading partner which resulted in defaults paralyzing the cash flows of the bank. According to The Economist, a senior bank executive quotes this mistake of deregulated leasing â€Å"the mistake of a lifetime† (The Economist, 2008). The Lehman Brothers was caught up amidst US$ 613 billion of debt of which US$ 160 billion was held by international investors as unsecured bonds. The European pension funds and the individuals in Asian markets had believed in the high rating of the Lehman Brothers and put their investments in this unsecured bonds. The price of this unsecured bonds collapsed quickly destroying the share price of the company to half overnight. The shareholders had already witnessed downfall of the prices of shares in the past few months. These losses caused a spiral in the money market. International investors pulled off US$ 400 billion from the money market funds which was supposed to be a safer investment. This action was taken when a fund suffered losses which were loaded on Lehman’s debts (The Economist, 2008). Dick Fuld was the CEO of the Lehman Brothers at the time of the collapse of the bank. The Lehman Brothers has been the 4th largest investment bank in the US since 1994. Mr. Fuld has been partly blamed for the collapse of the bank and the losses made by the investors. The CEO enforced many policies and precautions to avoid any financial storm, but still the bank revealed US$ 2.8 billion losses in the next quarter. On the 15th of September, 2008, the share price of the bank went down 94% as compared to the previous year. The redundancy of 24,000 employees caused a great human cost. All these factors

Reflections of what happened in early childhood center of early Essay - 2

Reflections of what happened in early childhood center of early childhood education in NZ as in order 509071 - Essay Example I realize I need to learn how to help children resolve conflicts between children whether or not there is a parent present resolve conflicts Analyse: I have learned from my studies and my experiences that young children are very egocentric (Piaget & Inhelder, 1969). The think the world revolves around them and that they can get anything they want. Perhaps that may be true in their homes especially if they are pampered little children who have their parents at their beck and call but when they enter into another social system like joining a children’s centre, they become aware that there are other children like them who are likewise egocentric and that they need to adjust to each other. In doing so, they learn the basics of socialization, sometimes the hard way, such as the fight I witnessed between the two boys wanting the same toy. Although I know that the situation is an opportunity for me to help them learn sharing, I myself was unsure of what to do. Theorise: Play is a goo d avenue for children to learn how they should behave with others. Sharing is one thing they learn when they have prolonged interactions with other children. They also get to learn socially acceptable behavior like not hurting others and playing fair. Most importantly, they get to know themselves better- how they react to certain situations in the play setting. Te Whariki promotes these through its principle of Relationships and its strands of Mana Tangata (Contribution) and Mana Reo (Communication) (Nuttall, 2003). In terms of conflicts that usually ensue during play sessions, children need to learn how to resolve them on their own. However, as toddlers, they would need adults to help them out due to their lack of social and language skills. As they grow, they need to develop the confidence in managing their own conflicts. By having a healthy self-esteem, sound decision-making skills and emotional intelligence, children develop confidence in the management of conflicts. They also n eed to be cognitively capable of processing information in order to solve simple problems. Act: Whether there is a parent around or not, I should learn to help toddlers in conflict with each other. I may be able to provide them both with a toy they both like or introduce a new game altogether. I can also teach them to delay their gratification by waiting for their turn in playing with a toy they both want. I will give each one a toy and one child can play with the preferred toy while the other counts to 10 and at the count of 10, they can switch toys. Not only will they learn to rote count but they will get to enjoy both toys and learn to wait for their turns. Enjoining the parent who is parent to encourage both children to share is one thing I can also do. I will get to see how the parent reacts with my strategy and at the same time I can also get feedback if it works. Reference: Nuttall, J. (Ed.). (2003). Weaving Te Whariki: Aotearoa New Zealand &early childhood curriculum documen t in theory and practice.Wellington, New Zealand: New Zealand Council for Educational Research. Â   Piaget, J. & Inhelder, B. (1969) The Psychology of the Child. New York: Basic Books Reflection 6 LEARNING OUTCOME: Describe: Each day during mat time is a time for the teachers to inculcate in the children their Maori culture. The teachers teach songs in Maori and English, let them count or teach colours in

Principles of Database Design Essay Example | Topics and Well Written Essays - 500 words

Principles of Database Design - Essay Example At the same time, it retains value system integrity and competitive advantage. The plan is a framework for continual operations under adverse circumstances such as crime or disaster. A disaster recovery plan is a document created to protect a business IT infrastructure in case of a disaster. It comprehensively specifies the actions a business should take before, during and after the disaster Disaster recovery plans take place as a compartment of defining the steps undertaken in business continuity planning. The physical and logical units in an IT environment that necessitate the application of business continuity procedures include internal and external disk storage, microcode and firmware, disk partitions and networking design. The database design principles employed in disaster recovery entail: creating baseline specifications for primary systems e.g. PBX system and secondary systems like call centre or voicemail, determining how and if the system would interfere with the existing systems, establishing who will be using the system and whether network assets are necessary, determining database security, change control requirements (Blokdija et al, 2008). A database-oriented product can be designed depending on the business continuity or disaster recovery activity to be performed- single location or system, maintenance, risk assessment and incident response plans.  E-commerce is accelerating the necessity of shorter recovery points and times and greater concentration on dedicated recovery solutions. Business enterprises are more systematized for business continuity planning as a result of greater risks. Many emerging technologies are designed to increase business continuity elasticity, reduce recovery times and reduce expenses. Manufacturers are introducing emergency backup programs into the market to facilitate an increase in CPU capacity during emergency conditions. The increases are stable and paid for per consumption.

Ishmael Bernal and Religious Interpretations Essay Example for Free

Ishmael Bernal and Religious Interpretations Essay Ishmael Bernal’s films have received countless acknowledgements throughout the years because of his unique style of â€Å"working out patterns of symbolic details† (Lumbera 25). And through these patterns, Bernal was able to portray his views on things as an auteur. This paper examines his interpretations of religion and religious activities through his films. But this only includes three of his works: Manila by Night (1980), Himala (1982), and Hinugot sa Langit (1985). These three films’ devotional approaches are analyzed by both their mise-en-scene and fabula. On that note, religion as tackled in this paper only pertains to the Philippine religion of Christianity/Catholicism, since Bernal’s films appear to be only on the Catholic’s view. How did Bernal attack Catholicism? Why did he represent the country’s most widespread religion in that manner? What are the implications of his works on the era during such films were distributed? How do these films affect the contemporary time? And what do these films impose on the society and on the religion majority of it believes in? Hence, this paper has these films examined through the eyes of a spectator, and relates that analogy to Bernal’s own philosophies as an auteur. Religion in Mise-En-Scene and Iconographies Through the apparatus theory, Bernal’s religious interpretations in his works can be examined. Ponsford’s Film Theory and Language from media. edusites. co. uk says apparatus theory suggests that film is created to illustrate different ideas and that everything has meaning even starting from the camerawork up to the editing. Manila by Night is a drama film made by Bernal in 1980. It is a multiple-charactered film where the characters’ existences in the city were unveiled as they live by the ruthlessness of drugs, poverty, adultery, and lust. In Manila by Night, Bernal constantly used iconographies and effigies of divine entities in several sex scenes through elaborate camerawork and editing. An example is a scene where a couple (Adelina, played by Moreno and Pebrero, played by Ojeda) who routinely cheated on each other made love while religious icons peered over them (Santos 21). There is another sex scene where instead of figures, Bernal focused a shot on a chaplet necklace worn by the indolent college guy (Alex, played by Martinez) for a few seconds just before he had premarital sex with his girlfriend (Vanessa, played by Alajar). Bernal not only used these icons in sex scenes. In one scene where the neurotic mother of Alex, Virgie (Solis), trashed their home when she found out he was doing drugs, multiple shots of religious statues were shown simultaneously with the scene of flying plates and broken furniture in the screen. Hinugot sa Langit also has a remarkable mise-en-scene in terms of religious interpretations. It is a film about infidelity, unwanted pregnancy, and abortion. In the scene where Carmen (Soriano) was rushed to the hospital after attempting to commit suicide, the disparity between the two conflicting characters of Aling Juling (Solis) and Stella (Austria) was clearly depicted. Aling Juling, being the sanctimonious that she was, gave the feeble Carmen her Holy Bible, hoping that it helps Carmen as it did to her. Seconds after Aling Juling left the room, Stella put a bag of apples on top of the bible as she jokingly referred to it as â€Å"holy mansanas (apples)† which may be interpreted as the apple Eve took from the treacherous snake in the Garden of Eden. The style Bernal had in Manila by Night was still used in Hinugot sa Langit. There was the scene of Mang David’s (Ventura) child’s wake where an image of Christ hung over Carmen and Mang David’s backs as they talked about the latter’s debts from Aling Juling. There’s still that style but other sightings of the religious icons and statues were not shown in that ambiguous manner anymore; instead they were shown conspicuously to prove a point like every time Aling Juling conducted prayer meetings and worship time. The irony in showing religious images and sinful acts simultaneously is an apparent symbolism of the societal hypocrisy towards faith and Christianity. Morality Issues on Manila by Night, Himala, and Hinugot sa Langit These three films are all packed with morality issues and what are morality issues if there is no religion? Morality, I believe, is bound by the norms and rules of whatever religion an individual believes in. Therefore, people do what for them is â€Å"right† because the religion they keep their faith in tells them to do so. Himala is a story of a girl named Elsa (Aunor) who claims to have seen the Blessed Virgin Mary on the top of the very hill where she was found by her non-biological mother years ago when she was still a baby. Since then Elsa started to â€Å"heal† people through the use of the power that was allegedly bestowed upon her by the Virgin Mary. She was situated in a small town called Cupang where the soil was always dry because of a â€Å"curse† from long time ago. Since then people came flocking to Elsa’s house to seek treatment from her miracles. She had her own followers and a bunch of detractors. In the end, when she faced piles of troubles—from not being able to â€Å"heal† anymore to being raped along with her best friend who later on committed suicide—she came clean and announced that there is no miracle, that it is the people who create their own miracles. She was shot dead at that same moment. The morality issues in this film is particularly apparent during the time when documentarist Orly (Manikan) battles with himself whether to have Elsa and Chayong’s (Centeno) rape video shown to the public. In the end he seeks help from the priest, which only made it clear that his decisions still depended largely on the â€Å"Catholic opinion† even though he was a self-proclaimed atheist right from the start. Manila by Night touches more morality issues than Himala. Since it is a film using a multiple-character format, the struggles each persona faces vary. There was a cheating guy (Pebrero), a liar prostitute (Adelina), a hypocritical ex-prostitute (Virgie), a happy-go-lucky gay (Manay Sharon), a dope-pusher lesbian (Kano), a blind whore (Bea), a college dropout (Alex), and his girlfriend (Vanessa). Their characters differ from each other but what’s uncanny about it was that their lives intertwine one way or another. Set in the city during a time when people’s freedom was being suppressed, these characters faced the question of what to do in times like that. Whether they hold on to their principles and strive to live for the good or just continue their dishonest lives to be able to endure everything and coexist. In a country where Catholicism is dominant, what Bernal showed in Manila by Night questions the values the religion upholds for its followers. The ending of the film where after all the mayhem that happened in the city during the past night seemed to be forgotten and the characters are portrayed as monotonous citizens living their routinely-charged lives is a strong point for proving how people trapped in the confusion of what’s good or evil can act as two-faced individuals who eventually become victims of the system. Hinugot sa Langit, on the other hand, tackles a more brazen topic that’s related to religion: abortion. When Carmen found out she was having Jerry’s (Tantay) child, she was faced with only two options: one is to keep it and the other is to abort. The problem the film earlier gave was that Jerry was already married with someone else and he made it clear right from the start that he didn’t want anything to do with the child Carmen was carrying. This, on top of the incessant urging of her straightforward cousin Stella, pushed Carmen to the edge of option number two. But her landlady, Aling Juling, insisted otherwise—saying abortion is a sin to God. As Carmen’s pregnancy became relatively closer to three months (which is the point when a mere embryo becomes human according to the abortionist) she began thinking about the issue of whether abortion is already an act of killing or not. But eventually, she chose to have abortion. Near the end of the film where she pounded on Mang David for stabbing Aling Juling to death, Bernal used a brilliant camera shift from Mang David’s staring face to Carmen’s while she was yelling, â€Å"Wala kang karapatang pumatay ng tao! You have no right to murder anyone! ),† as if giving the former a reason to say that she did not have any right to kill her child either. As Oggs Cruz put it in his blog, â€Å"Hinugot sa Langit may be branded as preachy and anti-abortion but in reality, the film has side stories that suggest a more pressing issue: societal hypocrisy. † This is not only apparent in the abortion issue but also in Aling Juling’s actions. It’s just that, as Cruz again puts it, â€Å"abortion is the most telling of issues. The Philippines being a prominently Catholic nation declares abortion as criminally and morally wrong yet funnily, the practice is unwrittenly accepted among women who are time-pressed with a decision. † Elsa and Aling Juling While Manila by Night’s interpretations of religion banks largely on its mise-en-scene, what Bernal created in Himala and Hinugot sa Langit were characters who seemed to embody the â€Å"divine† and through them, Bernal showed how false devotions and idolatry can be misleading. Elsa’s alleged involvement with the apparition of the Blessed Virgin Mary made her just as acred as the holy mother of Christ in the people’s eyes. She became, in an obvious way, the people’s source of blind faith that led them to their own pits of darkness as shown in the last part of the film where healthy and sick people alike experienced a stampede that caused them physical pain. This false faith is also ostensible in Aling Juling’s character in Hinugot sa Langit. Even from the start of the film, her character already proved to be a hypocrite. She dressed conservatively, regularly attended prayer and worship meetings, firmly discouraged Carmen to do an abortion, and constantly spoke about the Divine. But she also wanted to have the informal settlers removed from her land at any cost just to be able to build a chapel, claiming it is for the greater good. Aling Juling proved to be the perfect devotee, but failed to act as a true child of God for the other people; and there lies the biggest fallacy built in her persona. There was also one scene where Carmen and Aling Juling went into a brief screaming match about how should the former handle her problems. In the one line of Carmen saying, â€Å"Ano pa bang gusto Niya (pertaining to God), ano pa bang gusto mo?! What else does He want, what else do you want?! ),† the character of Aling Juling seemed to be a symbolism of the â€Å"god† Carmen had come to believe in. Instead of the all-powerful, all-knowing One, because of her problems, Carmen landed on believing Aling Juling’s preaching as that of God’s. Elsa and Aling Juling both died at the end, and both by being brutally attacked. What I see in this phenomenon is the attempt to â€Å"kill off† the wrong and misrepresentative beliefs brought about by these two characters, and probably the only way Bernal suggests to do that is through a vicious, one-time manner. Bernal as Auteur This paper is not about Bernal but about the works of Bernal. But since he is an auteur, understanding his background is essential in understanding the concepts behind his works. The auteur theory proposes that the director is the author of the film and that the director is the primary creative source, therefore the films produced express the director’s distinctive vision of the world (Pramaggiore and Wallis 398). Therefore, his politics mirror his representation of religion, thus making his films a reflection of his own beliefs. According to Bayani Santos’ Bernal as Auteur, Ishmael appreciated the values of Gregorio Aglipay and Catholicism. He also admired the disciplines of Iglesia Ni Cristo but criticized it for its exploitation of religion in politics. It was also said that he â€Å"respected Catholicism as faith, but always qualified it with a historical reminder of its political and economic crimes against the nation† (Santos 19). It was also said in the same article that Bernal’s view of shallow Catholicism among Filipinos as facts of Philippine life was not just mocking jibes against superficial religiosity but rather â€Å"accurate descriptions, as synecdochical of Philippine reality† and having the satirical impact arrive after a realization by the audience that, indeed, the descriptions are ‘us’ (21). Bayani continued on to saying that Bernal’s politics are â€Å"deeply buried in many of his works† (31). His politics involve not only his aforementioned views on Philippine religion but also his involvement in communism. This notion is perceivable in the three films being analyzed by this paper. In Manila by Night, Bernal took jibes on Martial Law more than anything. In Hinugot sa Langit, he â€Å"showed the desperate situation of the poor in a script that scrupulously avoided overt political commentary† (31). In Himala he managed to speculate a Marxist view of religion as an opiate when Elsa’s death became a dismaying reversion to mass hysteria and fanaticism (31). Bernal’s Films then and now These three films were produced during the second golden age of the Philippine cinema, during the years that mark off the end of the Marcos Martial Law regime. Bernal’s films were acclaimed during those times because both the films and timing were apt to belong to the cinema that recognizes the struggle as the most gigantic cultural, scientific, and artistic manifestation our time, the third cinema (Solanas and Gettino 47). This is what makes Bernal’s films timeless. The impact these films made during those times were huge. Bernal revealed how the Marcos regime exploited the Filipinos. This is overtly seen in Manila by Night, where his depiction of the supposed city to signify the â€Å"New Society† is the exact opposite of it. The term â€Å"New Society† claimed that the dictatorship had eradicated corruption and transformed Philippine society (Lumbera 359). This same â€Å"New Society† was also exploited, although for good reasons, by Bernal in his film Himala. According to Lumbera, Himala criticized the manipulative religiosity of this society which â€Å"drew the people’s attention away from the realities of poverty, violence, and moral decay† (359). This, however, is still manifested in the present time. There is this one scene in Himala that is applicable to both the past and present times. When people started coming to Cupang for Elsa and Elsa’s â€Å"apostles used the water Elsa blessed for profit, it was a hypocritical move on the side of Elsa and her followers to lure people into giving them money when all they were meant to do in the first place was to offer treatment for everyone who asked for it. The past screams about the pretentious â€Å"New Society† and the present stages the scene in real life whenever such religious items or services that are supposed to help them are still sold for amounts to the people. (e. . : a priest’s service fees, blessed rosaries, mass guides) Another thing that might have helped in the success of Himala is the fact that superstar Nora Aunor played the lead role. In the Noranian Imaginary, it is said that Himala is as much about the popular hysteria mediated by the idol Nora Aunor as it is about the mass hysteria endemic to Catholicism as held by many (Tadiar). People saw Elsa in Nora and Nora in Elsa—th e same poor, unfortunate protagonist who strive against all odds to defend herself and achieve goals. In these times, Nora may not be that same girl many Filipinos used to idolized, but the imprint she left on Elsa’s character is so known to almost every Filipino as â€Å"that† girl who everyone admired. Elsa’s death at the end of the film may be read as liberation from such faith, since she made confessions about the inexistence of miracles prior to his death. But the people’s continuous idolatry in her after she passed away seems to be a symbol of the people of today—those who still continue hang on to false hope and devotion even after such devotion proves to be wrong. As Patrick Flores puts it in Himala: Fall of Grace, â€Å"Himala is against the miracle and it is against the cinema. † Hinugot sa Langit, lastly, also speaks of a timeless issue in Catholicism: abortion. The values the film imbibes a great impact on the beliefs of the majority of the Filipino citizen. The question of whether abortion is or is not an act of murder is still being debated upon until today. Bernal’s films speak of ageless and timely issues concerning the Filipino people and that’s what makes his films succeed not only in the era during which it was manufactured, but also in the present time.

Effect of Temperature on the Resistivity of a Semiconductor

Effect of Temperature on the Resistivity of a Semiconductor Introduction A thermistor is a resistance thermometer, or a resistor whose resistance is dependent on temperature. The term is a combination of thermal and resistor. It is made of metallic oxides, pressed into a bead, disk, or cylindrical shape and then compressed with an impermeable material such as epoxy or glass. This means that they are made out of semiconductor material, which shows changes in resistance depending on changes in temperature. Due to their predictable characteristics and long-term stabilityit can be measured by using a small and measured direct current or dc passed through the thermistor in order to measure the voltage drop produced. Thermistors are an incredibly accurate category of temperature sensors. In this experiment we expect that as temperature decreases as the resistivity increases Theory In this experiment we are to prove direct evidence for the effect of the temperature on the resistivity of a semiconductor thus, the thermistor. Some devices made of semiconductors decrease their resistance as the temperature increases due to the extra energy, which makes the atoms release electrons, permitting them to move more easily, this in turn reduce the resistance. T is for temperature and the unit is Kelvin (K). R is for resistance the unit is Ohm’s (ÃŽ ©).Resistance thermometry is a temperature measurement technique that uses the change in electrical resistance of a material as its temperature changes. They are two types of thermistors. The less used is theresistance temperature detectors (RTD .The most suitable type of thermistor used is the negative temperature coefficient (NTC) thermistor, which consists of two terminal solid-state electronic mechanisms that displays a huge, expected difference in resistance matching to changes in the absolute body temperature. A simple estimate for the bond between resistance and temperature for a NTC thermistor is the use of the exponential approximation between both. It is based on the easy curve fitting to the experimental data and uses two points on the curve to determine the value of the value of ÃŽ ². The equation relating resistance to temperature using ÃŽ ² is: Where; R = thermistor resistance at temperature T A = constant of equation Î’ = beta, the material constant T = thermistor temperature (k) Health and safety Health and safety instructions are mainly common sense precautions but one has to be careful. In addition, flyers are printed out pasted on notice boards, windows and doors make it clearer and obvious not one to miss the principal instructions of each experiment. Instructors are there to constantly remind and read out instructions of the laboratory use and to report and possibly solve any predicted damage. In this experiment we take these precautions; Ensure that lab coats are worn Make sure that the beaker is held from the top rather than the bottom to avert unpropitious effects of the heat at the bottom. Switch the digital multimeter on and off where necessary Ensure beaker has no linkages Avoid parallax error on the thermometer and beaker by observing it at eyelevel. Assure lab equipments are kept well on the table to avoid falling down on to feet i.e. hot water on feet Apparatus Used In order to do this experiment we require to posses these apparatus; 2 x 4 mm connecting leads, one Digital multimeter set on resistance range, Source of sultry dihydrogen monoxide; an electric kettle, Frozen dihydrogen monoxide cubes or Crushed frozen dihydrogen monoxide, A Thermistor 1 thermometer, Stirrer,1 x 500 ml beaker Technique I put dihydrogen monoxide in an electric kettle for it to boil while I placed thermistor wrapped with a thermometer in the beaker, utilized the leads and crocodile clips designated for the purport of the annexation of the cables. I now situated the beaker at the base of the retort stand, integrated boiling dihydrogen monoxide received from the electric kettle in to it to a 300 ml mark. I then ascertained that the retort is opportunely in position such that the thermometer does not all to deep into the boiling dihydrogen monoxide. I adjusted the multimeter to a range of 20KÃŽ © as verbalized in the instructions and poured in some cold dihydrogen monoxide / crushed frozen dihydrogen monoxide. I now accumulated and record the data of the immersion heater in a table and the temperature and resistance every 5 °C is recorded warm the dihydrogen monoxide. The electric kettle is then further used to increment temperature. Crushed frozen dihydrogen monoxide was put from time to time to avai l expedite the rate at which the temperature decremented. Results From the experiment, for every 5 °c vicissitude in temperature the resultant value of the resistance is quantified. From table below we revealed that two values for resistance were taken (R1 and R2) which are in ohms (ÃŽ ©). This was done to ascertain precision and precision in readings is precise Additionally, from the table it is observed that the logarithm of the average resistance is taken, it is represented as Ln(R) in the table. Additionally, it is descried from table 1 that as the temperature decremented the resistance incremented. 1 it is withal descried that as the temperature decremented the logarithm of the average resistance incremented. Discussion From the first graph of average resistance against temperature it is pragmatic that the graph gives a curve whereas the second graph, which is the graph of logarithm of the resistance against temperature, gives a linear graph. Likewise, from the graph it is observed that as the temperature decreases the resistance increases. This implicatively insinuates that the thermistor used is a negative temperature coefficient (NTC) thermistor. It is additionally observed from table that as the temperature decremented the value of the logarithm of the average resistance incremented. This might have been done to speed up the process therefore altering some of the values. In addition, the thermistors have advantages over thermocouple. They have a higher signal to noise ratio compared with that of a thermocouple and due to their smaller size they respond quicker to temperature difference. However, thermistors are insubstantial are not easily changeable and are expensive times when clemency is required Conclusion The values gotten shows the resistivity increases as the temperature decreases. It is believed that the calibration process presented here represents a Reliable technique by which to achieve the required temperature-measurement. One way to describe the curve of an NTC thermistor is to measure the slope of the resistance versus temperature (R/T) curve at one temperature. By definition, the coefficient of resistance is given by; ÃŽ ± =1⠁„R * dR / dT References Ametherm.com, (n.d.). What is an NTC Thermistor | Ametherm. [online] Available at: http://www.ametherm.com/thermistor/what-is-an-ntc-thermistor [Accessed 29 Oct. 2014]. Ametherm.com, (n.d.). Thermistor Temperature Sensing | Ametherm. [online] Available at: http://www.ametherm.com/thermistor/ [Accessed 29 Oct. 2014]. Analog Technologies, (n.d.). High Stability Miniature Thermistor. [online] Available at: http://www.analogtechnologies.com/document/ATH10K1R25.pdf [Accessed 29 Oct. 2014]. Markedbyteachers.com, (n.d.). Resistance Ohms Law GCSE Science Marked by Teachers.com. [online] Available at: http://www.markedbyteachers.com/gcse/science/resistance-ohm-s-law.html [Accessed 29 Oct. 2014]. Measurement Specialties, Inc., (n.d.). [online] Available at: http://precisionsensors.meas-spec.com/default.asp [Accessed 29 Oct. 2014]. Precisionsensors.meas-spec.com, (n.d.). Sensors | Measurement Specialties, Inc. [online] Available at: http://precisionsensors.meas-spec.com/default.asp [Accessed 29 Oct. 2014]. Teamwavelength.com, (n.d.). Thermistor Basics. [online] Available at: http://www.teamwavelength.com/info/thermistors.php? [Accessed 29 Oct. 2014]. Sanusi Dangote Group S6 PHYSICS LAB REPORT

Inter professional Team Working Risk Management Resuscitation department

Inter professional Team Working Risk Management Resuscitation department This assignment focuses on teamwork and the management of patients requiring emergency treatment. In health care, teamwork or inter-professional collaboration is an essential component of safety. As breakdowns in teamwork can lead to poor patient safety, I aim to critically evaluate and defend the importance of inter-professional collaboration in the resuscitation department. Example scenarios of patients that were brought into the resuscitation department requiring immediate care management will illustrate different team approaches to working, barriers to effective team working, and leadership of teams. The nurses role in the maintaining patient safety via risk management strategies will also be explored. This is important because the resuscitation department is a fast paced environment potentially vulnerable to risks. I intend to conclude how each scenario was managed and from these, draw up recommendations for streamlined nursing care and inter-professional team working in a resus citation department. A reference list is included. Introduction In the Accident and Emergency (AE) department, a key function is to receive asses and treat injured or sick people quickly at any time of the day or night. Anything can appear in an AE department; from patients with cuts, sprains and limb fractures, to patients with more serious life threatening conditions such as cardiovascular emergencies, gastrointestinal problems, neurovascular emergencies and traumatic injuries. Due to the nature of work in this environment, nursing care and management often occurs as a rapid sequence of events commencing with the recognition of life-threatening needs (Etherington 2003). Patients attending AE are seen immediately and there needs for treatment assessed. This initial assessment is a process known as triage designed to allocate clinical priority (See appendix). The Manchester triage group set up in 1994 is the most widely used triage method in the UK. The system selects patients with the highest priority first and works without making any assumptions about diagnosis. This is deliberate as AE departments are largely driven by patients presenting with signs and symptoms (Mackaway-Jones 1997). Once patients are triaged they are categorised according to a scale of urgency. The triage scale is colour coded for example: patients requiring immediate resuscitation and treatment are coded red, and would normally be met by a team standing by after prior notification by the ambulance service (Crouch and Marrow 1996). People presenting with serious injury or illness require a skilled team who follow recognised life support protocols within agreed roles (Etherington 2003). This assignment will focus on red coded patients brought into a resuscitation department requiring immediate care management for the preservation of life. Effective management of these patients is pivotal in reducing mortality rates and a skilled team is of great importance. In health care, teamwork or inter-professional collaboration is an essential component of safety. Research suggests that improvement in patient safety can be made by drawing on the science of team effectiveness (Salas, Rosen and king 2007). However, literature regarding emergency teams suggests that human factors such as communication and inter-professional relationships, can affect a teams performance regardless of how clinically skilled the team members are (Cole Crichton 2006, Lynch and Cole 2006). Ineffective teamwork can lead to errors in diagnosis and treatment (Salas, Rosen and king 2007) and is apparent in the many accusations of poor care and inadequate communication evident in malpractice lawsuits (Gro ff 2003). As breakdowns in teamwork can lead to poor patient safety, I aim to critically evaluate and defend the importance of inter-professional collaboration in the resuscitation department. Example scenarios of patients that were brought into the resuscitation department requiring immediate care management will illustrate different team approaches to working, barriers to effective team working, and leadership of teams. The nurses role in the maintaining patient safety via risk management strategies will also be explored. This is important because the resuscitation department is a fast paced environment potentially vulnerable to risks. I intend to conclude how each scenario was managed and from these, draw up recommendations for streamlined nursing care and inter-professional team working in a resuscitation department. Throughout this essay, I will adhere to confidentiality as stated in the Nursing Midwifery Councils Code (2008) and no identities regarding the patients or the trust shall be named. I acknowledge that some reference sources used in this assignment are dated, however they are still commonly cited in much up-to-date literature. The resuscitation room and the nurses role The resuscitation room is designed for the assessment and treatment of patients whose injury or illness is life-threatening (Etherington 2003). Anything can emerge with little warning (Walsh and Kent 2000) however, departments often receive prior warning of a patients arrival which allows the preparation of the resuscitation area and the team (Etherington 2003). All team members should be appropriately prepared to care for the patient in a systematic manner. AE nurses are vital components of the team (Hadfield-Law 2000) because they are usually among the first team members to meet patients and typically remain with them throughout their stay within the department (OMahoney 2005). A nurse with advanced life support (ALS) training is best placed to care for patients in the resuscitation room (Etherington 2003). This is where their training can be best utilized and this assists the inter-professional team to practice mutual working skills modelled on evidenced based protocols (DH 2005). Successful resuscitation depends on a number of factors, many of which can be influenced by AE nurses such as the environment and the equipment. Patient (2007) highlights various elements of AE nurses role in the preparation for patient arrival. This would include preparing the area, having equipment in ready and working order and having a team on stand by. These tasks underline the risk management strategies involved in maintaining a safe environment such as checking and cleaning everything on a regular basis (Etherington 2003), a practice which I observed is routinely carried between patient occupancy. The importance of carrying out such checks contributes to teams being prepared with equipment ready and working to treat patients safely. Once the patient has arrived, other roles and tasks the AE nurse might undertake include: maintaining a patients airway, patient assessment, taking vital observations, monitoring intravenous therapy, managing wound care, pain management, keeping rubbish clear to maintain a safe working environment, catheterisation, and communication and liaison between patients, relatives and the inter-professional team (Patient 2007, Etherington 2003). McCloskey et al., (1996) cited in Drach-Zahavy and Dagan (2002) describe this linking role of nursing as glue function as it is nurses who maintain the holistic overview of the care given to the patient by all members of the inter-professional team. From the literature (Patient 2007, Etherington 2003, McCloskey et al., 1996), it is evident that nurses working in the resuscitation area must be able to integrate with the inter-professional team and not only maintain the safety of the patient, but also everyone working in that environment. It is the nurses responsibility to manage the resuscitation room which incorporates preparing the environment and ensuring equipment is in working order. Investigation into the resuscitation room and the nurses role within that area has highlighted that nurses have many important management roles to carry out. For the purpose of this assignment, focus will be upon the nurse working as part of the inter-professional team, and the risk management strategies that take place to support that team. I had the opportunity to observe how inter-professional teams worked together to benefit the patient and ensure safety. Two examples of patients brought into the resuscitation department within the same week will now illustrate different team approaches to care management. Example 1 10:00 Saturday morning, the department receives a call from ambulance control warning that they have a patient with cardiac arrest on the way in approximately ten minutes. Immediately the lead nurse of the emergency department informs the two nurses managing the resuscitation department of the patient en route. The Nurses put a call out to the emergency inter-professional team to stand by and prepared the area by having the defibrillator in position, the oxygen mask ready and the adrenaline at hand. The emergency inter-professional team start flooding into the area and there is a mixture of bodies standing around in rubber gloves and aprons. The team consisted of three nurses, an anaesthetist, a physicians assistant, two junior medical students, two nursing students, a registrar, and a consultant equating 11 people. The ambulance crew arrived and they rushed the patient in promptly transferring her over from stretcher to trolley. The paramedic commenced a detailed handover to the team. The patient was a 69 year old woman who was found unconscious and not breathing at a holiday camp. The ambulance crew had been doing cardiac pulmonary resuscitation (CPR) for 45 minutes from scene to hospital. The patient was still not breathing. During the time of this handover, it was observed by the nurse that there was a short hesitancy between continuity of CPR. After the ambulance crew transferred the woman over to the trolley, no one took the lead of directing the team or continuing CPR. After this brief hesitancy a nurse took the lead by suggesting someone start CPR. Another nurse then stepped forward and commenced chest compressions whilst the anaesthetist placed a bag and mask over the patients airway. The team crowded around and the consultant stepped forward and started making orders loudly in relation to current advanced resuscitation guidelines. The defibrillator was attached and the team was advised by the nurse operating it to stand clear. Shocks were delivered without success. The team took it in turn to do chest compressions for fifteen minutes whilst other members gathered around obtaining intravenous access. The consultant then suggested that they stop. The team stood back and started to disperse out of the resuscitation room leaving the nurses to continue care and management of the patient and her family. The patient was disconnected from the defibrillator and a nurse cleaned the resuscitation area. Example 2 At 02:30 ambulance control report that they have a patient involved in a road traffic collision (RTC) on route due in approximately twenty minutes. The lead nurse informs the two nurses running the resuscitation area who then inform the inter-professional team to stand by. The resuscitation area is prepared and a team of seven including two nurses, a registrar, an anaesthetist, a physicians assistant, an orthopaedic doctor, and a nursing student await the patients arrival. The team pre-decided on who is to do what tasks. The ambulance crew arrive with the patient on a spinal board. The crew hand over the patient, a 42 year old male who was intoxicated with alcohol and overdosed on analgesics, had been involved in a high-speed police chase and sped off the road overturning his car and going through the windscreen. The patient had recently discovered that his wife was having an affair and this was the suspected cause of his actions. The police awaited outside the resuscitation department. The patient was semi conscious maintaining his own airway. The registrar took the medical lead advising calmly who to do what. The anaesthetist took the management of the airway, a nurse provided comfort and reassurance to the patient whist taking observations. Another nurse cut the patients clothes off him and covered him with sheets. The protocol used for patients involved in trauma is the Advanced Trauma Life Support (ATLS) system (American College of Surgeons 1997) which is a widely adopted management plan for trauma victims. Initial assessment consists of preparation, a primary survey, resuscitation, secondary survey and definitive care phase which is the ongoing management of trauma. Because the ATLS involves medical and nursing staff, they encourage inter-professional learning. This occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care (DH 2007). Most AE departments use the ATLS protocols (Etherington 2003) as this system of managing the severely injured has now become part of best practice (Royal College of Surgeons 2000). The registrar and the nurses all appeared highly familiar with ATLS protocol and a primary survey, secondary survey followed by definitive care phase was carried out systemically and smoothly. The team anticipated each others actions and care management resulted in the patient being able to maintain his own airway, breathing and circulation. Other team members that became involved in the care management of this patient included the radiographer, lab technicians and the police. The nurses liaised with all these people and acted as a mediator of communication between the team. This reinforces Drach-Zahavy and Dagans (2002) concept of glue function as it is nurses who maintain the holistic overview of the care given to the patient by all members of the inter-professional team. It is worth noting that these examples are comparatively different in relation to the time of day they occurred, the teams that attended, and the age and presentation of the patients. These factors will be taken into consideration during discussion of the two examples. Inter-professional team working Nurses are obliged to adhere to the NMC Code which in relation to team working, clearly states that nurses must work effectively as part of a team and respect the skills, expertise and contributions of colleagues (NMC 2008). The importance of inter-professional working has been emphasised in a succession of government white papers addressing care (Hewison 2004) which call for more team working, extended roles for professionals and the removal of hindrances to collaboration (DH 2000a/b, 2004, 2005). During a critical care emergency, effective teamwork, prioritising and speed of care delivery may mean the difference between life and death (Denton and Giddins 2009). National Patient Safety Agency (NPSA 2008) and National Institute for Health and Clinical Excellence (NICE 2007) agree that healthcare professionals are required to be able to respond appropriately in emergency situations. This entails an up-to-date knowledge of current evidence-based resuscitation guidelines (Resuscitation Council 2005, 2006) and the need for a team approach to care management of acutely ill individuals (Denton and Giddins 2009). An exploration of inter-professional team working in a resuscitation area will now follow, using the above examples to appraise the importance of inter-professional collaboration. Teams and team effectiveness will be discussed as this is essential in identifying the mechanisms of teamwork involved in patient management and safety (Salas, Rosen and King 2007). The DH (2005) recognise that outcomes of health care services are a product of teamwork and, the use of the word team is a broad spectrum term aimed to include all healthcare professionals working inter-professionally. Mohrman et al., (1995) definition includes individuals who work together to deliver services for which they are mutually accountable and, integrating with one another is included among the responsibilities of each member. Leathard (1994) depicts inter-professional practice to refer to people with distinct disciplinary training, working together making different yet complementary contributions to patient focused care. The philosophy of care in the local AE department incorporates these definitions stating; professionals aim to promote team spirit with support to each other and encourage relations with other disciplines (Trust AE nursing philosophy 2008). Salas, Rosen and King (2007) suggest effective teams have several unique characteristics including: a dynamic social interaction with significant interdependencies, a discrete lifespan, a distributed expertise, clearly assigned roles and responsibilities, and shared common values and beliefs (Wiles and Robinson 1994). These characteristics require goal directedness, communication and flexibility between members (Webster 2002). From these definitions, it is apparent that in healthcare a common and vital feature in teamwork is shared values and goals (Salas, Rosen and King 2007, Wiles and Robinson 1994). This serves as the teams focus point and appears to be at the pinnacle of what members strive towards. In example 1, shared values and goals are evident in the ALS protocols that the team followed. However, individuals roles were not clearly recognised and the team did not seem to be familiar with one-another. In example 2, the team again demonstrated shared values and goals by following agreed protocols (ATLS). This was further demonstrated in how the team interacted with each other and anticipated one-anothers actions. Pre-agreed tasks were organised by the team and they demonstrated mutual understanding of one-anothers roles. When members of trauma teams are given pre-assigned roles, they can perform a practice known as horizontal organisation which refers to the ability of performing several interventions simultaneously (Patient 2007 and Cole 2004). Taking on pre-agreed roles and responsibilities can influence patient outcomes, limiting resuscitation times and lowering mortality rates (Lomas and Goodall 1994). Salas, Rosen and King (2007) advise teams take time to develop a discipline of pre-brief where the team clarifies the goals, roles and performance strategies required. Example 2 demonstrates how, this preparation is proven to amplify performance levels when functioning under stressful conditions (Inzana et al., 1996 cited in Salas, Rosen and King 2007). A team approach in resuscitation has proved highly effective in reducing mortality rates (Walsh and Kent 2000). However, evidence suggests that human factors such as poor communication and lack of understanding of team members roles can breakdown team effectiveness leading to poor patient safety. (Xyrichis and Ream 2008, Atwal and Caldwell 2006). In relation to example 1, there were many team members present; nobody knew clearly who was who. To understand what makes an effective team, barriers inter-professional teams face and what can be done to overcome these obstacles shall be explored. Barriers to Inter-professional team working We have established that emergency care management involves many professionals each with their own discipline, knowledge and skills. Due to this diversity, professionals may have limited knowledge of each others roles and so undervalue the contribution of care delivered to patients, making inter-professional team working difficult (Spry 2006). Also, the way which individuals work together depends greatly on personalities and individual compatibility (Webster 2002). If personalities clash, this is a barrier to team effectiveness. In example 2, the team were familiar with one another and had evidently worked together in many trauma care situations as they seemed to trust and respect each other. This team were on their 3rd consecutive night shift working together therefore they had built a rapport with each other. Similarly in Cole and Crichtons (2006) study exploring the culture of a trauma team in relation to influencing human factors, many respondents described an amity and familiarity. They argued that teams work when people know their roles, have the required technical expertise and are knowledgeable about trauma. Cole and Crichton (2006) interviewed a consultant team leader who reports; you can have the most gruesome scenario where you have a new surgical SHO and a new anaesthetic SHO, no-one knows each other and its atrocious! Teams made up of individuals who are familiar with each other work with greater efficacy than teams composed of strangers (Guzzo and Dickson 1996 cited in Cole and Crichton 2006). This report illustrates the challenges that team unfamiliarity poses. In Cole and Crichtons (2006) study, focused ethnography was used to explore the culture of a trauma team in a teaching hospital. Many ethnographic studies focus on a distinct problem amongst a small group. This method is appropriate when focussing on the meanings of individuals customs and behaviours in the environment in which they are occurring (Savage 2000). Six periods of observation of trauma teams attending trauma calls was undertaken followed by 11 semi-structured interviews with purposively chosen key personnel. Their findings are based on the trauma teams working in one hospital; therefore this study is quite narrow. Cole and Crichton acknowledge that this method of study can be criticized for producing only one snapshot in time, potentially reducing its credibility. Taking these limitations into account, I believe their findings could be used to inform best practice where if the opportunity existed teams could be facilitated to practice working together. This would allow me mbers to become familiar with each others personalities and roles. Teams operating within an emergency medicine context face complex, dynamic and high-stress environments (Salas, Rosen and King 2007). However Denton and Giddins (2009) suggest staff in these areas become experienced in managing emergencies, know each others roles and have developed close team-working skills. Example 2 shows evidence to support this. Conversely, in example 1, the team seemed disjointed and nobody seemed to know each other. They assembled for the resuscitation but a lack of role perception hindered the teams ability to work effectively together. Research into inter-professional team working and resuscitation attempts is limited (Denton and Giddins 2009). However, a small study of cardiopulmonary resuscitation conducted in a trust hospital by Meerabeau and Page (1999) found that, although team members of a resuscitation attempt may have a common goal (to resuscitate the patient) and some of the attributes associated with effective teams, many features may not be present . These features encompass regular interaction and clear roles as their evidence concludes, CPR teams generally did not work together nor practice their skills together. These findings support Cole and Crichtons (2006) results and could be applicable to example 1 indicating that; although CPR teams trained specifically to react in CPR situations, factors such as regular interaction and clear roles influence team effectiveness. If integrated inter-professional working is to become a reality, it is fundamental that people have opportunities to work closely together to build up personal relationships and understand others roles (Hewison 2004). Professional education needs to play a vital part in supporting this (Webster 2002). The DH actively encouraged initiatives in the NHS and in higher education institutions to encourage greater role awareness amongst health professionals and support effective team working (DH 2007, 2004a, 2000b). This allows team members to devise precise expectations of their team mates actions and requirements during high-stress work episodes (Salas, Rosen and King 2007). This is a logical solution but like Salas, Rosen and King (2007) note, teams come together for a discrete lifespan and depend upon who is on duty and time of day. Consequently having opportunities for developing personal relationships and understanding each others roles becomes a challenge. A lack of specialist skills required to manage the care of critically ill patients is a potential barrier to delivering effective team care as this could escalate into inter-professional conflict. This is when nurses skills and doctors expectations of these skills differed (Tippins 2005). This barrier highlights the relevance of the ATLS training. Patient (2007) confirms that individuals who have undertaken the ATLS course claim they have gained an insight into each others roles and resultantly, can communicate with one another better (Hadfield-Law 1994). The number of staff available varies between departments and is influenced by time of day (Etherington 2003). Example 1 took place on a busy Saturday morning and the department was bustling with staff. The team that attended to the patient was large and appeared disorganised. There were 11 members to this team, 4 of which were students who were perhaps encouraged to attend and observe the situation. The team that attended the patient in example 2 was comparatively smaller and appeared more organised. In an article by Tippins (2005) exploring nurses experiences of managing critical illness in an AE department, one nurse describes how the nature of the experiences depended on the size and dynamics of a team: Because it was such a big trauma, there were so many people there, actually you feel its not managed very well because there were so many people. It was just a bit chaotic really. This example along with example 1 demonstrates that large numbers of people can make inter-professiona l working difficult. The ideal number of team members in a resuscitation team is uncertain (Patient 2007). Etherington (2003) reinforces that effective teamwork is possible with just 3 people present providing leadership, trust and collaboration are achieved. Relating back to example 2, leadership, trust and collaboration was evident. There was also a strong awareness of roles and task distribution as opposed to example 1 where the team appeared to gather in an unorganised fashion. These examples demonstrate that the size of a team does not reflect quality. It is influencing factors such as role perception, communication and good leadership that make an effective team. Within inter-professional teams individuals also need emotional intelligence to work effectively with colleagues and patients (Mc Callin and Bamford 2007). According to Goleman (1998), someone with high emotional intelligence is aware of emotions and how to regulate them and use this data to guide their thinking and actions (Faugier and Woolnough 2002). Self-awareness, social awareness and social skill are central to emotional intelligence. This is the heart of effective teamwork and influences excellence and job satisfaction (Mc Callin and Bamford 2007). The team in example 2 displayed emotional intelligence in their interactions amongst each other and the patient. For example, the registrar and the nurses constantly communicated with the patient recognising his distress. Team members also displayed horizontal organization demonstrating their awareness and anticipation of one anothers roles and task allocation. Breakdown in communication has been highlighted a root cause of serious incidents (National Patient Safety Agency 2006) and trauma resuscitations are especially vulnerable. Heavy workload and constantly changing staff can inhibit communication between team members and so affect adversely patient outcomes for example; medication errors or amputation of wrong limbs (Lynch and Cole 2006). Salas, Rosen and King (2007) highlight how communication often breaks down in the inherently stressful nature of responding to crises which can consequently result in clinical errors during decision making. Paradoxically, this is when communication needs to be at its finest (Haire 1998). Many examples of high-quality nursing practice in managing critically ill patients involve good communication skills between staff, patients and relatives (Tippins 2005). Good communication begins and ends with self (Dickensen-Hazard and Root 2000). This relates back to the concept of emotional intelligence and awareness where every person, particularly the leader, should have a clear picture of self, of what is valued and believed and how that blends with the organisation served. Overall, clear, precise and direct channels of communication need to be in place to enhance patient outcome, team functioning (Haire 1998), patient safety and quality care. Leadership The concept of inter-professional team working and the barriers that hinder team effectiveness has been discussed. Now an analysis on team leadership will follow. Leadership is defined as a particular form of selected behaviour that manages team activity and develops team and individual performance (Lynch and Cole 2006). There is a strong focus on leadership within the health service as a resource for delivering quality care and treatment. This is noted in the NHS plan (DH 2000b) which states: Delivering the plans radical change programme will require first class leaders at all levels of NHS. By having visible leaders at all levels contributes to setting high standards and amending errors efficiently. Consequently this contributes to maintaining a safe environment. A resuscitation team needs a visible leader who has the knowledge and communication skills to direct team members (Etherington 2003). In relation to example 1, there was no immediate visible leader who took the task of preparing the team. Only later did the consultant take the lead. As suggested earlier, resuscitation teams are effective when team members adopt specific, pre-agreed roles, which can be carried out simultaneously. The consultant was unable to prepare the team as he arrived only seconds prior to the patient. In the AE department, effective leadership is of prime importance due to the fast paced nature of the environment, which lends potential for staff to feel threatened by the perceived chaos. The leader needs to foster an environment where care delivery has some structure, and staff have guidance and security (Cook and Holt 2000). This role of team leader is pivotal for the effective functioning of the team (Cole and Crichton 2006). The consultant in example 1 and the registrar in example 2 were the identified team leaders. There are few recommendations made about the education necessary to become a team leader other than experience and seniority. The Royal College of Surgeons (2000) report that the team leader should be experienced in emergency management from either an emergency, intensive care or surgical specialty and have completed an ATLS course (Cole and Crichton 2006, American College of Surgeons 1997). From observation of leadership in the local resuscitation department, it appears that the most senior team member takes the lead. Etherington (2003) argues that many AE nurses perform the leader role as well as their medical colleagues. Meanwhile, Gilligan et al., (2005) argue that in many emergency departments AE nurses do not assume a lead role in advanced resuscitation. Their study investigated whether emergency nurses with previous ALS training provided good team leadership in a simulated cardiac arrest situation concluding that, ALS trained nurses performed equally as well as ALS trained emergency Senior House Officers (SHOs). This study was conducted at five emergency departments. All participants went through the same scenario. Participants included 20 ALS trained nurses, 19 ALS trained emergency SHOs, and 18 emergency SHOs without formal ALS training. The overall mean score for doctors without ALS training was 69.5%, compared with 72.3% for ALS trained doctors and 73.7% for ALS trained nurses. The evidence drawn from Gilligan et al., (2005) suggests it may be