Discharge Plans: a Case Study

Discharge Plans: a Case Study It may come as a shock to caretakers of the patient that discharge planning may commence as soon as a patient has been admitted. This does not necessarily mean that the patient is being released for home, but rather it means that plans are being put in place for a successful discharge plan to take place. Information is gathered about the patient, how they live, for example, do they live with others, are they dependent or independent (Birjandi Bragg 2009). Caretakers are actively involved in a discharge plan provided the patient gives consent. Once the patient shows improvement, it is clear that further recovery in a hospital set-up is not likely to take place and thus they are sent to an environment they may adopt to their needs; their home. Birjandi, A Bragg, (2009) say that discharge planning is essential and should be done right, whether the discharge is to a rehabilitation center, a nursing home or the client’s home. Medical practitioners should have an ideal discharge plan as studies have shown that improvement in hospital discharges with great outcomes when appropriate discharge plans are made. Healthcare givers, family members and patients themselves have a great role to play after discharge in maintaining good health. Even though discharge planning is essential in patients health there is inconsistence in both the discharge process and the quality of discharge planning in most of the health care system. In this paper, we shall look at a discharge plan for a client with the cerebral vascular accident from hospital to their home. We shall look at initial assessment of the client at the time of admission; determine the possible discharge needs, family involvement in decision making and how to transport the client to their destination. Birjandi, A Bragg, L. (2009) describe discharge planning as a method used to decide the requirements of a patient as they shift from one level of care to another, only doctors may approve patients release from a health facility, but the actual discharge plan may be done by a nurse, case manager, case manager. Complicated conditions such as cerebral vascular accident may have a team approach. Well organized discharge planning may reduce the chances of re-hospitalization and aid in recovery; ensure medications are well prescribed and administered correctly. In general a discharge plan should involve the following; evaluation of the client by qualified practitioner, discussion with both the client and the caregiver, planning of the transfer process and homecoming of the client, determining whether the caretaker needs more training or any other kind of support, referral to support an organization or care agency and finally arranging for follow up activities. In our case we shall look at Ms. Kate a 76 year-old female who was admitted from the emergency department with a diagnosis of Right Cerebra Vascular Accident. Her Past Medical History includes: hyperlipidemia, hypertension, osteoarthritis, and osteoporosis. Neurological: left-sided weakness for the past 2 days, awake, alert, and oriented to person, place, and time. Denied swallowing difficulties, no visual defects and denied pain. Medications: Aspirin 81mg per oral daily; Tylenol 650mg per oral when necessary for pain; Cerebral vascular and pulmonary: Placed on a cardiac monitor, findings indicated normal sinus rhythm. Vital signs taken every 4 hours, pulse 82; blood pressure 168/64; respirations 20. Lung sounds were clear to auscultation bilaterally. Oxygen Saturation on room air 97%. Gastrointestinal: Abdomen soft, non-tender, not distended, positive bowel sounds. Bowel movement present Genitourinary: Voids freely, requiring assistance to the bathroom. Output approximately 1000ml/day. Brief episode of dysuria on admission. Integumentary: skin intact, no lesions noticed Musculoskeletal: Active range of motion right side; limited range of motion on the left side; required assistant to get into a wheelchair. History of recent balance problems. Psychosocial: lives with daughter in a two story home; occupation: retired teacher Discharge needs were discussed with the caretaker, these included the physical condition of the family before and after hospitalization, the details of the kind of care required by the client were discussed, included information of the patients prognosis, what activities she might need to help with; information about the clients medication and diet should be given, any extra equipment that was deemed necessary such as wheelchair, oxygen and who will be in charge of the clients meal preparation, transport to referrals and support groups. The daughter who lives with Mr. Kate was involved in the discharge process, her ability and willingness to provide care to her mother was assessed, and the results were as follows; she felt it was too early for her discharge, as she did not have time to spare to take care of her mother as her work was demanding. She also had concerns about she would go about transporting her mother from the bed to her chair and taking her to the bathroom. She was referred to help agencies that assist in taking care of patients at their homes at a paid fee. Several agency information was availed to her, with instructions to come up with a decision on which one to use. She was also given a choice to hire an individual at a fee or hire nurses or case managers or other persons familiar with the condition. Ambulance services were given as an option to transport the patient to their home at a small fee at the time of discharge or the client may use assisted transport to their homes, wheelchair or stretchers were suggested be used for our client as she could walk with assistance. This was done in advance and the patient was fully responsible for this kind of transport arrangement. Discharge planning varies according to the hospital set up and the person who initiates it, and what kind of follow-up is needed, and whether the care takers are assessed for their ability to cater for the client’s needs. The transition of care and discharge planning all centered on improving the quality of care administered to a client, for example, education the care givers and training them on the conditions of their patients, encouraging preventive care and including caretakers to be part of the health care team. Simple steps such as exchanging patient’s progress regularly with the doctors or the health team increase the chances of effective follow up care. Telephone conversions, post discharge with doctors also helps to anticipate problems and improve care at home. Corey, G., Corey, M., Callanan, P. (2003) suggest that relative to discharge planning with some patient, there may be underlying issues that contribute to ethical dilemmas. As case managers, we should take reasonable steps to safeguard the interests and rights of those clients. Ethical dilemma occurs when an individual has to choose between two or more conflicting ethical standards. There is no one right answer and there is no easy answer! Codes of ethics provide guidelines, but don’t necessarily tell us what to do. Using a hierarchical ethical decision-making approach can help you achieve an acceptable resolution. Mattison, (2000) reminds us that utilizing an ethical decision-making model doesn’t result in bias-free decisions. Our values still come into play utilizing an ethical decision-making model and we may not be aware of it! First of all, it is important to remember clients’ rights to self determination and autonomy clients have the right to make poor de cisions. However, the role of the case manager is different in this situation depending on the client’s cognitive capacity for decision making. If the client has capacity, the focus is on ensuring the client is making an informed decision and reassuring the care team, which includes the family, about resources to maximize safety. If the client does not have capacity, the focus is identifying someone who can act on the client’s behalf and exploring alternatives for creating a safe discharge in respect of the client’s wishes. For the client When the care team perceives discharge unsafe; Promote informed consent this involves educating the client about the team’s concerns related to his or her safety and potential consequences associated with an unsafe discharge. Review and encourage the use of resources to maximize safety, this involves identifying the services the client will need in a lesser care environment for the discharge to be successful. For the care team May not be aware of resources available to enable older adults to live safely in their own homes; reviewing these resources can eliminate concerns. May be worried about remote dangers that should not trump client autonomy and self determination, i.e. â€Å"If there was a fire, he would have difficulty escaping.† When the care giver does not appear able to provide care. Sometimes family members or other caregivers wish to care for a client in a lesser care environment, but there are concerns about their ability to do so. In this situation, family/caregiver education is an important intervention. When the caregiver does not seem able to provide care; Approaches to family/caregiver education: Convene a team conference with them to review the client’s level of care and specific care needs. Have the individual assume full responsibility for care for a period of time while in a safe environment (i.e. Work a 4-hour shift as his/her loved one’s caregiver in the nursing home so he/she is fully informed of what to expect in terms of career. Often this will result in the family member realizing for themselves that the care is too much and they will either not be able to do it or will need to have outside support. Alternatively, sometimes family members will actually do well, relieving the team’s fears about their ability. Try a short trial visit in the lesser care environment, say 24-48 hours, with a planned return to the higher care setting to debrief re: problems encountered. When a client or caretaker refuses necessary service; again, it is important to remember clients’ rights to self determination and autonomy clients have the right to make poor decisions. However, sometimes what seems to be a â€Å"poor† decision is based on misinformation or other concerns; it is important for case managers to explore factors contributing to the refusal of services deemed necessary by the care team. Potential factors contributing to service refusal; Cost; sometimes clients and their families don’t feel recommended services are (or will be) affordable. Have referred agency review associated costs with them; sometimes services are not as much as anticipated. Assist client/family to access sources of financial support such as Medicaid. Reframe costs as in terms of future savings, i.e. Paying a little for care now will prevent costly hospitalizations in the future. Discomfort with the thought of strangers in the home. Validate this concern; it is un comfortable having unfamiliar people help with intimate tasks in one’s private domain. Arrange for client/family to meet potential service providers ahead of time to minimize anxiety. Additional factors potentially contributing to service refusal; misunderstandings regarding the purpose of recommended services. Feelings of guilt or shame related to not being able to provide all care independently. Recommended services don’t fit client/family’s cultural belief system. Past negative experiences with similar services Caretaker unwilling to have client return home; this is one of the most heart-wrenching ethical dilemmas to deal with and can bring up many issues of counter-transference; good self-care and supervision is important. Things to keep in mind; Client has a right to return to his or her own home, caretaker has a right not to provide care if this is something he or she is uncomfortable with, There may be a history of domestic violence or other traumatic relationship issues contributing to spouse/partner’s reluctance, Spouse/partner may be unaware of support services available to assist with care management and that the Client may be at risk for elder abuse. For clients with capacity, living environments deemed â€Å"unsafe† may simply represent differences in lifestyle choices between client and the care team. For example, client’s home is cluttered, smells like cats, and there are dirty dishes and dust everywhere, but is not actually hazardous in any way. Case manager’s role: advocate for clients and educate them, offer services to assist client with home management. If home is in disrepair, infested with rats, covered with mold and rotting garbage hazardous situation indicative of deeper problems. Case manager’s role: further assessment regarding client’s capacity and whether interventions can make home livable; recognize that sometimes it is just not possible for clients to return home We may conclude by stating that effective discharge planning and transitional care have real benefit in improving the out-come of a patient and bringing down the rate of re-hospitalization of the same patients. Reference Birjandi, A., Bragg, L. (2009). Discharge planning handbook for health care: Top 10 secrets to unlocking a new revenue pipeline. Boca Raton: CRC Press. Corey, G., Corey, M., Callanan, P. (2003). Issues and ethics in the helping professions, 6th edition. Pacific Grove, CA: Brooks/Cole. Mattison, M. (2000). Ethical decision-making: The person in the process. Social Work, 45 (3), 201-212. The Arnolfini Portrait by Jan van Eyck | Analysis The Arnolfini Portrait by Jan van Eyck | Analysis Jan van Eyck. The Arnolfini Portrait. Jan van Eyck The Portrait of Giovanni (?) Arnolfini and his Wife Giovanna Cenami (?) (The Arnolfini Marriage). 1434. Oil in oak. 81.8 x 59.7 cm. The National Gallery, London. The Arnolfini Portrait startles us by its apparent realism and attention to detail, which seem to anticipate Dutch painting of two centuries later. Much of the effect is owing to van Eyck’s use of oil-based paints. He is often called the inventor of oil painting, though it seems more likely that he and his brother discovered the potential of the new medium by developing a varnish which dried at a consistent rate, allowing Jan to â€Å"make a glossy colour which could be applied in transparent layers or ‘glazes’†¦ and put on the glittering highlights with a pointed brush† (Gombrich, 240). The new medium was miraculous in its suitability for depicting metals and jewels (as well as the individual strands of hair in a dog’s coat!), and, as Sister Wendy Beckett says, â€Å"more significantly, for the vivid, convincing depiction of natural light† (Beckett, 64). Equally original is the setting and milieu, for this is a â€Å"bourgeois commissio n† (Levey, 68), set not in a palace or a church but in a room in an ordinary house, every detail of which is depicted with total accuracy and naturalism, and shown, as Sir Kenneth Clark noted, â€Å"by a miracle that defies the laws of art-history†¦ enveloped in daylight as close to experience as if it had been observed by Vermeer of Delft† (Clark, 104). Despite the naturalism of the scene, it is likely that the objects depicted are rich in symbolic meaning. The couple stand in a room, shown with precise concern for perspective – Levy calls it a â€Å"perspective cube† (Levey, 68). They are dressed very richly, and stand in poses that suggest ceremony and serious purpose, hence the supposition that we are witnessing a marriage – as van Eyck is doing quite literally. He can be seen with another witness reflected in the convex mirror on the wall, i.e. standing at the point from which the perspective view runs, and he has left his signature above the mirror, in a legal Gothic script, saying that he â€Å"was here† (â€Å"only a moment ago, one might think† (Huizinga, 259)), not just that he painted this. The couple stand apart, as if separated by ceremonial considerations. He takes her right hand in his left, and raises his right as if to complete a vow or pledge. She has a shy expression, while he is earnest and solemn. His dress is sumptuous and expensive, hers is lavish and modest, in green, â€Å"the colour of affection† (Baldass, 76). If this is the holy sacrament of marriage, to complete its validity there should be consummation, which is why we are in a bedroom. In other parts of the room are objects painted with scrupulous accuracy, which at the same time have an iconographic purpose which is relevant to the ritual of marriage. The little dog is a symbol of fidelity. The shoes cast aside show that the couple stand unshod â€Å"since this is the ground of a holy union† (Beckett, 64). The fruit on the window sill are either a reference to fertility or a reminder of the fatal apple. The single candle flame in the magnificently rendered candelabra – a light which is not necessary for illumination – suggests the eye of God. Carved on the chair back is an image of St Margaret, a saint associated with childbirth, and the arms of the chair and the prie-dieu are decorated with the lions of the throne of Solomon. Most spectacular of all is the painting of the mirror, which with its convex shape reflects back the whole interior, together with the image of the painter and another man. Its frame is decorated with ten medallions show ing events from the life of Christ, â€Å"intended to emphasise that the Original Sin is atoned for by the Passion of Christ† (Baldass, 75). To emphasise the symbolic meanings of the objects in the painting (of which we cannot always be certain) is by no means to detract from the astonishing realism of the scene. The van Eycks began their careers as manuscript illustrators, and the concern for detail is apparent everywhere. The dog is intensely real, charming, and of no identifiable breed. The texture of materials is rendered in the finest detail, in the gilding of the candelabra and the way the light catches it, the glint of the beads in the rosary hanging by the mirror, and of course the glass of the mirror itself, and its concave shape giving a curved reflection of the room. The light is caught precisely on the inward curve of the medallion roundels in the frame. The presentation of the clothing is meticulous, both in the texture of the cloth and in the way it hangs on the body. Even the grain of the wood in the floorboards is exact. Colour too is handled with great subtlety, the green of her dress, with traces of blue in the undersleeves, set off against the rich red of the bed hangings, both lit by the single source of light, the window to the left. It is as if â€Å"a simple corner of the real world has suddenly been fixed on to a panel as if by magic† (Gombrich, 243). Huizinga makes a point related to this concern for total realism, that it is immensely valuable for us to see a late medieval artist depicting private life, and not bound by the requirements of the court or the Church. â€Å"The Master†¦ need not portray the majesty of divine beings nor minister to aristocratic pride† (Huizinga, 258). Van Eyck’s Gothic signature and declaration on the wall suggests that the whole piece might be a sort of legal act of witnessing. The whole conception marks the shift from the medieval to the modern world, because the witnessing is literally established for us through the precise application of the rules of perspective. The scene is viewed through the eyes of the man reflected in the mirror, and it is the view of the single observer which is to form the convention of painting from van Eyck until the end of the nineteenth century. In the Arnolfini portrait â€Å"the artist became the perfect eye-witness in the truest sense of the term † (Gombrich, 243). Works Cited Baldass, L. Jan Van Eyck. London: Phaidon, 1952. Beckett, Sister Wendy. The Story of Painting. London: Dorling Kindersley, 1994. Clark, K. Civilisation. A Personal View. London: BBC, 1969. Gombrich, E.H. The Story of Art. London: Pahidon, 1995. Huizinga, J. The Waning of the Middle Ages. New York: Anchor, 1949. Levey, M. From Giotto to Cezanne. London: Thames and Hudson, 1962.

Making Hotplates

Making Hotplates What changes in the work situation might account for the increase in productivity and the decrease in controllable rejects? According to the article, the company had 10 workers that were responsible for assembling hot plates with the appropriate tools. Each person was responsible for assembling a part of the hotplate instead of the whole thing. One person would start the hotplate assembly, when they were finished they would pass it to the next, who would begin their part, etc. When the company decided to make each person responsible for an entire plate, productivity turned around. The reasons for this turn around are less wasted time and a feeling of completing something by the workers. If worker #2 is faster than worker # 1, he will be waiting on #1 to finish so he can get started on his next one. In addition, many people want to have the satisfaction of finishing a product, and when the product is â€Å"theirs,† they will take more pride in making sure it is done correctly. The worker said, â€Å"Now, this is my hotplate† because he is proud of the work he has accomplished. They now have a sense of ownership when it comes to the hotplate, instead of apiece part of it. Empowering enables people to use their talents and capabilities, fosters accomplishment, invests in learning, finds the spirit in an organization and builds effective relationships, informs, leads, coaches, serves, creates and liberates† (Empowering Manager) What might account for the drop in absenteeism and the increase in moral? Going back to question 1, the reason for the increase in moral is the same reason the productivity increased. It is a sense of completion and satisfaction by the workers with the new assembly process. They feel like they are important to the company and they can now compete to see who produces the most and who produces the best product with rewards as an incentive to try to be the best. When you have a sense of completion, it makes you want to do the best you can. They were also told that if they did not like the new way of doing business they could go back to the old way. This made them feel as if they had some control over the situation and made them feel like their feelings matter, when before they did not have that. What were the major changes in the situation? Which changes were under the control of the manager? Which were controlled by workers? The biggest change with the making of hotplates is the assembly process. They went from an assembly line with the first person doing part, the next person doing their part until the last person who boxed it up to ship. The change put each person responsible for making the entire hotplate. By doing this, they increased morale and productivity. The managers were responsible for making the change from an assembly line and increasing the morale by doing so. Stevenson says that top management has â€Å"the ultimate responsibility for quality† (Stevenson, 2009, pg. 417). Stevenson also says one thing high quality does is in the workplace is yield higher productivity which they had after the quality of work changed for the workers. The workers were in control of the productivity increase. What might happen if the workers went back to the old assembly line method? If the workers went back to the old way of business, everything else would go back to the old way too. This means the workers would start missing days again, morale would drop, and the productivity would drastically decrease. This would happen because the quality of their work has decreased which would then decrease productivity all over again. Now that they have seen how important they feel when they are in charge of the entire hotplates, and not just parts of it, I feel things would be worse than before. References Stevenson, W. , (2009). Operations management (10th ed. ). New York : McGraw Hill/Irwin. The Empowering Manager Is†¦Briefcasebooks. com

IT Outsourcing Essay

Today’s market place continues to shrink due to computer technologies and communication being at the speed of light. This makes the act of doing business on a large scale not only possible but expected. An organization needs implementation of outsource strategy to happen on every level within the company structure in order to function. Many factors contribute to a company’s success or failure. Company is defined by more than just its product or service and the price at which this product or service is sold in the market place. An effective organization has much strength in its favor to remain competitive. Factors such as: flexibility, creativity, openness to use of technology and innovations, communication across the organization and talented employees are a must for competitive advantage. It is an organization’s ability to adjust to changing times that creates a foundation for the public to admire. How an organization continues to reflect such a persona is entirely contingent on so many factors but really it comes down to vision and action. Integrity is crucial. Upholding the company’s value system and word to the public remains a key facet for success. Building any strategy or campaign on this premise presents the best possible and true corporate image to the public and allows for a great amount of trust to form. Building character and trust is very important within the financial world but also the retail forum of health products because there has been a backlash due to corporate lack of governance and scandal but also telecommunications is much like a double-edged sword. With the wrong image, comes poor press and lack of a first impression. It can make or break the situation. In this respect, outsourcing can be a complex game. In order to better understand customers, it is important one understands how marketing works. This means not only having knowledge of traditional methods but also knowing the fundamentals of e-marketing and e-commerce. Today’s Internet is a triumph for human ingenuity and spontaneous order. In some parts it embodies leading edge technology like Asynchronous Transfer Mode but really it is the use of new technologies combined with older ones that makes the Internet so fascinating and vital to business. Specifically the Internet ends distance limitations and it empowers individuals in important new ways to create new enterprise (Gasman, 2005, p. 2). The Internet is relatively vast in its freedom. Unlike the traditional telephone, the Internet is not charged by the mile or any distance. This brings people together. Retailers see the Internet as a marketing tool they can use to target a smaller, regional niche market. One must understand it is in the best interests of companies to make the e-retailing transitions because of the fact that most shopping now happens online. This is due to the increase in e-commerce and instant need for convenience. E-commerce makes purchasing easier and faster. It fits into the lifestyle of today’s 24/7 world where people do not have the time to shop at the mall or pay bills by writing out checks. Statement of the Problem The subject of IT outsourcing and e-business strategy in China’s pharmaceutical industry, its frameworks, convenience and also problems or implications were assessed in this research. As a result of this study, this research presented preliminary findings related to IT outsourcing in China. This leads us to looking at how e-strategy and use of the Internet to facilitate outsourcing has created a whole industry of service for the consumer or in other words, e-services. This required a look at different models to assess strategy and analysis a company’s role in the market. Purpose of the Study The overall purpose of this paper and study is to investigate the role of IT outsourcing within a Chinese drug company. This lead to further study of its use within the health industry in China. As growing importance in an organization’s competitive advantage and globalization makes an Internet presence an expectation, the right marketing strategy becomes all the more important in a company overall strategy but it also equals power. An organization needs careful research prior to investment but also needs to strategize and ponder if the consumer is worth the profit. This paper will look at how a proactive strategic analysis allows an organization knowledge of the market in order to build a lasting presence and customer relationships. This paper will also explore the implications of outsourcing. Review of Related Literature Information Technology is a powerful means that helps organizations meet the challenges of a competitive market environment and enable the firms to stay ahead of the competition. The information revolution is exerting substantial effects on the structure and functions of organizations. From the beginning of the computing era various studies have been made that predicted several positive effects ensuing from the implementation of information technology (IT) (Cash & Konsynski, 1986). Many cases have been published, as well as articles in the professional press, which predicted a net increase in business results of companies that invested more in IT (Buday, 1986). However, during the little more than 10 years of this research line, contradictory results have been found From the 1970s to 1980s, those companies that invested more in IT suffered a relative setback in the work factor productivity indexes. This paper will discuss the relationship between IT and competitive advantage in following content. We believe that IT is necessary to improve competitive position of the organization. Many business professionals point to the use and deployment of IT as a point of weakness, not a point of strength in their organizations. They think that the reason for this is often that IT is being driven from a technical perspective, not from a business perspective. This phenomenon exists because many businesspeople think that the IT is too complicated, too expensive, too risky and too changeable. They would not like to spend time on understanding the complex information technology management. Most businesspeople only understand how specific technologies affect their ability to do their specific jobs. Poorly understand IT initiatives often end in failure. The previous literatures reveal that IT brings huge impact on careers and information technology has impacted many jobs such as IT has replaced human labor and many organizations no longer pay people to simply oversee others and pass along information. The business benefits that are derived from the strategic use of technology are significant, but they are accompanied by risks that must be addressed. The failure to address IT vulnerabilities within their own organizations and throughout the supply chain can have devastating consequences for business operations. China and Outsourcing To this day, the country of China remains an enigma, isolated from the Western world and shrouded in mystery conceptualized by the Communist Red. Its culture both ancient and modern fascinates one on many levels mainly because it is so completely foreign. Aspects of their way of life, customs and lifestyle elements mirror the Communist doctrines and the absence of pure freedom seems sad to Westerners. Still slowly China is opening its doors to the West. There is a changing tide, a force at work. It is the advent of globalization, mass communication and new technologies that changed the atmosphere of China. The world is forever shrinking due to the marketplace is growing at the speed of light and commerce taking place over new mediums. This makes possibility happen. People from every nation have yearned to participate in this explosion. The Chinese have been no exception. They have reached a point in their history where they must not only hold on to their cultural identity but also embrace change from outside. This has been the only way to take advantage of globalization and create a new persona for China. Still the seed of change had to grow from somewhere. This transformation did not happen over night. It can be difficult and frustrating for one to understand yet try to respect. It is out of understanding what one fears that one can be a catalyst for change. Only then can the barriers come down. Much of the emergence of globalization can be attributed to the world economy. China has made steps of change within recent years and as a result found itself at the forefront of economic explosion. At this time the Chinese economy is growing at the rate of ten percent a year, faster than any other country in the world (Richardson, 2005, p. 1). As a result, the region of the Pacific Rim and more specifically South East Asia is considered an emerging market, one that many international corporations are focused on gaining a competitive advantage. This industry of health food and vitamins is no exception. Due to vast changes in available technologies, it is expected and imperative that all companies have an Internet presence or utilize a global e-strategy that involves their business practices to evolve into e-commerce. Two Models This project utilizes two models to analyze IT outsourcing. The models are as follows: (1) Kurt Lewin’s Force Field Analysis theory and (2) SWOT. These two models and others like them assist management and strategists in understanding a company’s standing within the market place. By assessing a company’s strengths and weaknesses or forces at work within a market or organization, one can have a better idea of which areas need attention. Force Field Analysis Theory  Field theories really took the basic form of the fluid mechanics developed in the eighteenth century, in which equations linked a â€Å"flow† or potential for transmitted force to spatial coordinates, but applied this form to situations where no fluid could be found; examples are motion induced by gravity, electricity, or magnetism. I will follow general use and employ the term â€Å"field theory† to denote only those theories that do not involve a clearly existent substantial medium. Lewin’s field theory provides â€Å"a method for â€Å"analyzing causal relations and of building scientific constructs† (p. 01) on several psychosocial concepts involving human actions, emotions, and personality. These psychosocial concepts include human frustration, levels of aspiration, marginality, punishment and reward, and social identity. Lewin’s field theory is built on two constructs (a) human behavior is derived from a combination of mutually interdependent co-existing facts in the life space of individuals, and (b) these coexisting facts have the characteristics of a â€Å"dynamic field,† because â€Å"any part of the field depends on every other part of the field† (p. 87). Using the analogy of â€Å"phase space† in physics, which represents a multitude of factors that might influence events in open systems, Lewin articulated the importance of â€Å"psychological space† in real life. Lewin reasoned that an individual’s life space, including one’s personal characteristics and environmental influences, is an inherent part of the individual’s total situation–momentary and general life situation as perceived by the individua l. He argued that the total situations or fields are more important in studying group behavior because at any given time, individual human behavior, is not only derived from, but is also likely to change, due to the individual’s perception of current situations based on their past cultural orientation, race, status, and experience. To account for such complexities and interdependence of the internal and external factors affecting individuals, Lewin advocated a middle course. By applying these field theory principles to groups in given situations, Lewin observed that it is possible to glean general patterns, underlying relationships, and structural characteristics that can be transposed to other real-world situations. As an example of the field theory principle, Lewin (1997c) advocated the use of a psychological approach to understanding fields that influence individuals and noted that a teacher can never succeed in giving proper guidance to a student if she or he does not learn to understand the psychological world in which that individual student lived. This objective description in psychology actually means describing a situation in its totality–a sum total of facts which makes up that individual. SWOT Assessment It is important to determine the impact a strategy will have on the operations and activities of an organization. The objective is to utilize present technologies and future innovations to plan the future of a company. It is important to allow a flexible framework for strategy to interact within the environment. Further the objective is to gain understanding of the surroundings and behaviors under which they are operating. The key is to create an excellent strategy in which to include within the organizational culture. It is best management remains informed of potential challenges and SWOT allows for clarity. IT Infrastructure and the Practice of Outsourcing As the act of doing business becomes more innovative due to new technologies and high levels of communication, it is surprising that doing business become more complicated and expensive. Is it the factor of elevated expectation and competition from global markets, it is a lack of understanding your own organisation and its cores? Angelo Mozilo believes that outsourcing creates room for improved focus upon core values and it is with the implementation of high speed communication and data systems that enables people to better interact with each other (2002, par. 3). It allows for context to be processed outside the core, only to return when needed. Outsourcing is much like a double-edged sword, it can be seen as a negative as much as a positive. Many believe that it is stealing from American jobs to use cheaper labour sources in countries like India. Timothy Smith surmises that outsourcing has three functions in making organisations more efficient, effective and reduces costs. â€Å"Outsourcing enables organisations to reallocate resources† (Smith 2001, par. 3). This in turn allows the organisation to spend less time on those tasks, saves it money in labour and location by changing focus from survival to enhancing competitive advantage. An organisation can only do this when it becomes people focused. Truly what IT outsourcing does for the business to supplier to the customer relationship is create a new business process that isolates pieces of IT by restructuring the entire segment of the customer’s business. This includes value added improvements in the organisational logic of processes, implementation of best-in-class technology, extensive management and employee training as well as adoption of best practices in the vendor’s field of experience. This may sound like a lot of both monetary and human resource investment but over the long run such implementation will allow the organisation to focus on core rather than context. It goes to show what many successful CEOs would say, â€Å"don’t sweat the small stuff† and this motto will take you to the next level of continual learning and success. Exporting organisations are also seeking ways to lower costs while increasing customer service. A relatively new approach is supply chain management (SCM). Supply chain management differs from traditional materials and manufacturing control in several ways (Burn & Hackney, 2003). First, SCM views the supply chain as a single process. Second, SCM requires strategic decision-making due to its impact on overall costs and market share. Third, supply chain management regards inventories as a mechanism of last resort. Finally, it requires an integrated approach to systems. Integration results in reduced inventory and significant cost benefits (Trunick, 2005). The success of SCM usually involves implementation of an information management system. Still the model is evolving to include new innovations being used as tools. The Amorphous type of chain changes as the company introduces new strategies. This type of model best reflects the continuous flow of ideas and possibilities within the e-commerce construct or Internet medium specifically. It helps anticipate future occurrences. This aids a company’s tracking of Internet use especially when applied to advertising and promotions, as it is known â€Å"the number of businesses utilising the Internet for e-business purposes was significantly low at 28% though an further 33% were actively considering the implementation† (Ritchie & Brindley, 2002, p. 2). The function of procurement within the logistics process is moving to a new plane of sophistication due to new technologies to make the job simpler. Much of it is moving to the platform of the Internet to maximise efficiency and productivity. E-Procurement is now moving from easy-to-automate tasks like invoicing generations to more complex concerns such a E-marketplace implementation, operation and electronic collaboration. Literature suggests that currently focus in on technologies that support E-procurement of direct goods that are mission critical. Also because raw materials that go into production of the finished product many account for â€Å"80 percent of a company’s expenses, the saving derived from implementing E-procurement is compelling† (Thierauf & Hoctor 2003, p. 250). In other words, E-procurement technology offers lower purchase prices to faster fulfilment cycles as well as lower administrative overhead to better control. As a result, companies realise broad, measurable benefits from the implementation of E-procurement. Companies stand to gain even more impressive results from coming generations of the technology that includes connecting to trading exchange with their own industries. This also enables a customer better informed purchases as a company learns to manage production on a daily basis. This means the capability for the supply chain to extend beyond customers and suppliers improves. This also improves the ability for the company to communicate with the customer and the supplier. This leads to new ideas and knowledge about the process as companies and suppliers work in a join environment. Sometimes organisations look to outsourcing inventory as a way to cut costs and speed up the process. GHL will find that by using the Internet as e-strategy that they can achieve multitasking on new levels, allowing for many lines of communication as once. The Internet will allow GHL to tap into a bigger supply base to ensure dependable supply and backup sources. This in turn will reduce the amount it takes to secure shipment of new products. Enterprise Resource Planning (ERP) systems are particularly valuable in new product introduction because it acts as a means of sharing information. Enterprise Resource Planning (ERP) systems are software packages that attempt to integrate the information flow within a company, solving the problem of incompatibility between systems and operating practices. The ERP system will streamline the GHL’s data flows and provide management with direct access to a wealth of real-time information. This is facilitated by the used of database technologies which will link applications together and pass relevant data between them as necessary. Any new information added to one of the system updates the other systems automatically, thus creating complete integration between them (Soh, 2002 and Grandt, 2005). Directory services and middle ware are used in order to connect the applications and provide an infrastructure for users to communicate with each other and connect to the sources of information. There are many benefits and drawbacks to using this method of data transportation. It is important to analyse rather not this will be good fit for a company like GHL. â€Å"A key difficulty is that departments distrust the information provided by another department, be it via an information system or some other mechanism. Therefore checking and cleaning the data should be made an integral part of the implementation† (Bonner, 2002, par. 5). If ERP is integrated with the organisation’s decision-making structure, ERP can begin to deliver business benefits, impacting data delivery levels. Still its success can only be measured by the attitude of the user.

Cataracts Surgery Term Paper

Cataracts Surgery Term Paper Abstract The eyes form quite an important part of the body. They are very sensitive as compared to the other parts. The main of the eyes is to facilitate a person’s ability to see. Situations may arise whereby the visionary capacity of an individual becomes affected and the normal way of seeing is hindered. A good example relates to Cataracts which form part of these hindrances that lead to eye problems. A cataract is but a cloud that undergoes development in the eye more specifically in the crystalline lens. It can also develop in the lens capsule (Cassin and Solomon 1990). A cataract varies in degree ranging from slight to total cloudiness hence hindering the passage of light into the eye. Cataracts of are of different types hence depicting deferent signs and symptoms. They include; cortical cataract, sub-capsular cataract and a nuclear cataract. A cortical cataract is that which involves wedge- like opacities characterized by whiteness in the eye. The opacities begin in the periphery of the lens then gradually move to the center of the eye in a manner that resembles spokes. The occurrence of this type of cataract takes place in the cortex lens which forms part of the lens surrounding the eye’s central nucleus. The occurrence of the sub-capsular cataract takes place at the back of the lens (avitt, Wang and West 1996). There are people who have very high chances of getting this type of cataract. These people include; those who take medications that constitute high steroid dosage and those with diabetes or high retinis pigmentosa. A nuclear cataract undergoes formation deep in the nucleus of the lens. Usually the occurrence of this type of cataract is relates to aging (Barbara and Grady 2006). Cataracts are characterized by certain signs and symptoms. Early in their development they begin as small with very little impact on vision. One may notice some blurredness in vision which may be like one is looking through a piece o glass that is cloudy. Cataracts are known to make the light from the sun to be like it is so bright or rather glaring. Also for a person who is driving at night the headlights of oncoming vehicles have increased brightness than before which might not be the case. In line with the appearance of colors they may not seem bright as they did before occurrence. Basically the type of cataract that one has is what determines the symptoms and signs experienced and how soon their occurrence is. For instance the development of a nuclear cataract may result to some improvements being made temporarily in line with near vision known as second sight (Javitt, Wang and West 1996). It is quite unfortunate that second sight vision does not last for long. It disappears as the cataract continues developing to the worse. With a subcapsular cataract signs or symptoms may not appear until it has fully developed. Researchers have and are still looking for factors that cause cataracts. To begin with the eye constitutes a lens. The lens functions like a camera lens which basically focuses light entering the eye onto the retina. It also adjusts the ability of the eye to focus thus enabling a person to things that are far away and those that are near. The lens is mostly composed of protein and water. The protein is arranged precisely thus enhancing clarity of the lens and allowing passage of light (Cline and Griffin 2007). As one continues aging some protein may clump up clouding the lens at a small region of the lens. This is basically a sign of a cataract which with time it may develop in size thus causing increased cloudiness on the lens. It therefore becomes quite difficult to see. The eye condition in relation cataracts is cannot be reversed. The only option for the treatment of cataracts is surgery. With cataracts treatment concerning eye contact lenses and prescription eye glasses are deemed to be ineffective. On the other not all types of cataracts necessitate surgical removal. During the early stages of their development they are usually very small and cannot be noticed and are understood not to cause much hindrance to vision in a person’s daily living (Javitt, Wang and West 1996). After they have developed to an extent of causing an impact to the execution of day to day tasks fir instance driving, in this case doctors usually recommend that the cataract be removed through surgery. But at the progression stage of cataracts there is need for patients to get regular monitoring of their eyes by the doctor. Cataracts removal involves a surgery mostly seen as an outpatient process. Before the surgery is carried pre-operative test are carried out. The entire surgical procedure has little discomfort for the patient being operated. As the surgeon performs the procedure the patient cannot see what is being done other than shadows and colors. For most patients no injections or shots are used instead eye drops that numb the eye are used. In order to reduce anxiousness some patients are given some medication though for most people it is usually not a requirement. As long there is no presence of any other eye disease cataract is of great importance. This test involves the length of the eye being measured through a process known the A-scan (Shearing and Steven 2002).The cornea curve is also measured through a technique known as keratometry. These measurements are quite o great importance. They aid the eye Medical Doctor in the selection process of the proper lens implant for a patient’s ey e. In this step the patient is also provided for the various lens options available. During the preparation of a cataract surgery it is of great importance that the patient provides the ophthalmologist with information concerning the nutritional supplements that they have been taking including medications. This is due to the fact that some medications have been seen to impact to the surgical process. For instance being under the medication of alpha-blocker drugs which are meant to meet prostate problems it is seen that the drugs has the impact of preventing proper dilation of the pupil during the surgical process. At this time complications may occur. By the surgeon having the knowledge that their patients are under the prescription some certain drugs the surgical technique may undergo some adjustments in order to fit the need in as required (Shearing and Steven 2002). From this perspective the success for the procedure of removing a cataract is facilitated. Information concerning the taking of sedative medications should also not be left out. For the purpose of red ucing infection risks after the surgery the ophthalmologist may give a prescription of antibiotic eye drops to be used either one or two days before the surgery is carried out. The commonly used procedure to carry out surgery to remove cataracts is known as phacoemulsification. This procedure involves a small incision being on the side of the cornea. A tiny instrument is inserted on the front part of the eye. The instrument uses high frequency ultra sound for breaking up the central part of the lens with the cloud and carefully suctioning it out. After the removal of the cloudy lens it is replaced with an intraocular lens implant that is made of either acrylic, plastic or silicone. The new lens usually has clarity allowing light into the eye and focusing it more properly on the eye’s retina. The intraocular lens permanently form part of a persons eye. In many cases insertion of the intraocular lens is usually behind the iris and it is known as the posterior chamber lens. Sometimes need arises that the intraocular lens be inserted before the iris. In this case the lens is known as the anterior chamber lens (Shearing and Steven 2002). The incision is u sually closed when the intraocular lens has been properly put in place. Stitches may be used or not. After the surgery process is over a protective shield is placed over the patient’s eye. Cataract surgery also constitutes the cost that is involved for the procedure to be performed. This type of surgery has fairly standardized costs across all geographical regions. Cataract patients have many options to choose from in regards to the type of technique to be used during the surgery procedure. Ophthalmologists who are skilled are supposed to help patients in the decision making process of the technique that they best wish to be used. During the process of deciding about the surgery technique patients should ensure that they put into their overall needs for the surgery. Patients should therefore give proper thought of the initial consultations, the process of scanning and mapping of the eye being part of the process that involves the construction of a model that enables the surgeon to make the right incisions after they are through with follow up consultations (Shearing and Steven 2002). There are other things patients should consider while choosing a surgery technique. They include, the post operation medication, the cost of implants, surgeon’s fees and Optometrist’s fees. This they will be able to choose the best technique that meets their need and which is cost effective. The cataracts surgery procedure as already explained involves removal of the cataract and a new lens implant that is clear replaces it. The time taken in the performance of the surgery is mostly less than one hour. In the case whereby the patient needs cataract surgery for both eyes the procedure is usually carried on one eye first then the other. A simple cataracts surgical procedure takes about ten minutes. Nevertheless, more time may be spent in the outpatient section up to ninety minutes or even more due to the some extra time that is required during the preparation and recovery processes (Shearing and Steven 2002). The time between the performances of the surgeries may be a few days or weeks in order to give ample time for the recovery of the already operated eye as well as time for evaluating and assessing for the possible problems. When comparing the time taken by modern and that taken by traditional techniques of carrying out cataract removal (Barry 2003). The traditional techniques are seen to take lesser time. This is due to the fact that the traditional did not require much patient positioning as it with the modern techniques. With modern techniques more time is taken to position the patient under the laser. There is increased safety and quality of surgery due to technology. For example the older cataract surgery technique which involved the use of a large incision being made into the wall of the eye with the next step being removal of the cataract manually has undergone replacement through the technology already mentioned known as â€Å"phacoemulsification†. It which involves removal of the cataract through an incision of 2.2mm only that is made on the wall of the eye. Another example is the old techniques that involved the removal of the lens in the eye completely leaving the eye without a lens. C orrection was made to the patient’s vision through the use of contact lens or very thick eyeglasses. In the modern world there is what is known as Extra-capsular cataract extraction a procedure under phacoemulsification whereby the entire lens is not removed completely. The lens that is left in the eye enables for the implantation of intraocular lens. The method of choice of cataract removal usually has an impact on the healing process. Recovery from a cataract surgery can be within few weeks. Nevertheless, the healing process time differs from one patient to another. From this perspective patients are advised not to compare their recovery times with others. This is due to the fact that different techniques may have been used from one patient to another. For instance a patient whose surgery involves a small incision will heal faster than the one whose surgery involved a large incision. The former could begin their daily activities immediately while latter is required to refrain from performing any heavy tasks. Studies have shown that exposure to the ultraviolet rays of the sun may be associated to the development of cataracts (Barry and Patrick 2008). In this case people should take caution hence recommendations are made that they should wear sunglasses or hats with a wide brim in order to prevent direct exposure to the rays. In conclusion the technology in relation to the removal of cataracts is still evolving. This is evidenced by surgery equipments that have been recently developed. It is quite important even with the increasing technological advances that patients who want to undergo a cataract that they put into consideration whether they genuinely need the use of the newly developed surgical equipments. If the cataracts are so severe such that they have significantly impaired vision or the patient has complications or the previous surgery was unsuccessful then patients should consider an increased budget in order to be able to access the newest technology in the performance of cataract surgery. References Javitt, Wang and West (1996). Blindness Due to Cataract: Epidemiology and Prevention. Annual review of public health. Barry and Patrick L. (2008) Blinding Flashes. Science.nasa.gov Barbara K. and Grady L. (2006). Statin Use and Incident Nuclear Cataract. Journal of the American Medical Association. Shearing and Steven. (2002). History of the PMMA Intraocular Lens. Ophthalmic Hyperguide; Vindico Medical Education. Cline D. and Griffin JR. (2007) Dictionary of Visual Science. Butterworth-Heinemann, Boston. Cassin, B. and Solomon, S. (1990).Dictionary of Eye Terminology. Gainsville, Florida: Triad Publishing Company. Barry W. (2003). History of ophthalmology at Baylor University Medical Center. Hi Proc (Bayl Univ Med Cent).