On hundredth congress of the united state of amreica Essay

On hundredth congress of the united state of amreica - Essay Example Costs can be improved through more comprehensive and efficient management. Quality improvement programs need to be customer oriented and management led. This will require companies, agencies in businesses in general to make significant changes to the ways they currently operate. Several examples of competing industrial nations tell us that incorporating private sector style of auditing can be beneficial and a national award for auditing quality can improve productivity. This will push American companies to improve the quality of products as they will be getting the national recognition in auditing. Companies that will improve their quality will serve as examples for others to follow. Specific guidance will be provided to those companies who would wish to be enlisted in the leading companies who have considerably improved the quality of their products. The purpose of this act is to provide for establishment and conduct of a national quality improvement program that will; give awards t o those companies who will practice effective quality management and significantly improve the quality of their products/services, and the information is disseminated about successful strategies and

Reflective essay of personal and professional development

Reflective essay of personal and professional development This assignment is a critical analysis and reflection of my continuing personal and professional development (CPPD) needs in practice. This account will identify practical needs that I must improve with supportive evidence based research, and evaluate the impact of this need for my personal development as a future qualified nurse. My learning need was with assertiveness in communication when working with a staff nurse during admission. To meet the need and demonstrate the ability to engage in advancing my care, Gibbs (1988) framework model of reflection will be used. To maintain confidentiality as emphasised by the Nursing and Midwifery Council (NMC 2008), a pseudonym Tommy will be used to protect the patient’s anonymity. In addition, I will be using the post-registration education and practice (PREP) guidelines (NMC 2011) to maintain up to date knowledge and skills as well as empowering a lifelong learning in my nursing career. (NMC 2012) My skills in communication have improved in all contact and this has been acknowledged in every practice. However, I thought of this learning need, when I recognised my weakness was with assertiveness in communication when working with a staff nurse, faced with a difficult patient during admission. I took part in this learning activity in November, 2014 during my placement in hospital. I identified this need during the second week of placement, as I was able to perform patient admissions under the supervision of my mentor. The need to improve this skill was established from my mentor’s feedback and I agreed that it must be developed in order to help avoiding errors in future practice, improving my decision-making skills and professional satisfaction. I have spent a good amount of time to research and critically analyse this learning need However I felt this could be an ongoing process of improvement as Webb (2011) identified, supported by the Department of Health’s (201 3) ongoing process of improvement in the NHS to be more efficient and less bureaucratic. I again felt this was important for me to work on because it had an impact on the patient and me as a future qualified nurse (Fowler, 2008). Tommy is a 50 year old who suffers from right leg cellulitis and lives alone with his cat. I felt my first meeting with Tommy was challenging as I found it difficult to present myself as a self-assured, assertive and empathetic student nurse due to the impression that the situation was out of my comfort zone. I observed from the beginning of the visit that this gentleman was unable to cope; however I felt that I could not make a direct statement without coming across as patronising or a dominant student nurse. On the positive side, I chose to improve this learning need so that I would learn to be prepared with the knowledge and set of skills I must have in managing complex patient care in future placements (Fowler, 2008). Having encountered patients who have refused requests from other student nurses and staff nurses alike by expressing their dislikes, disagreements and sometimes even anger when offered treatment, I have observed that patients sense how the student nurses present themselves and could base their decision on the student nurses’ abilities to communicate assertively (Fowler, 2008). This also made me think about my self-awareness and empathetic skills. As I listened to Tommy’s emotional concerns, he opened up about being terrified of not having anyone in his house to feed his cat while he was in hospital because he had no close relatives. I responded calmly and confidently, using clear language that my intention was to obtain his permission to allow health professionals offer long term support to him (Fischhoff et al, 2011). As student nurses, our main role involves patient interaction and several studies have indicated that student nurses lack assertive skills evidenced by Bekkum and Hilton (2013) McCabe and Timmins (2005) qualitative study in two schools (n=30). It highlighted that most student nurses were assertive but chose not to display this skill to maintain positive interpersonal relations and avoid conflict. However, quantitative study (n=72) by Almost (2006) deemed it important to measure nursing students’ level of assertiveness prior to, and near completion of their pre-registration programme and to offer help throughout their programme to develop their assertiveness. Almost also considered the conflicts mainly developed from the multi-professional roles that student nurses have and that the basic nursing functions of caring and controlling can result in tension. Many researchers have challenged these such as Iglesias and Vallejo (2012) qualitative study identified that work have established that conflict resolution techniques can be achieved through compromise and collaboration which the nurses can use for their specific work environments. However all the previously mentioned approaches suffered from serious limitations as Tommy’s safety could have been compromised when nurses failed to speak up or be heard, identified by Page’s (2004) qualitative study. I found Almost (2013) very appropriate when giving personal care because this technique would have enhanced my learning need earlier in my nursing programme to improve patient care. Bekkum Hilton, (2013) qualitative study support and acknowledgement on these account findings imply that, education programs ought to be taken into account. The perceptions of the participants risks involved in not being assertive and the focal point must be on changing these perceptions rather tha n attempting to change student nurses’ values or focusing solely on specific assertive behaviours to improve student emotional intelligence. Based on the findings, I realised that my practice was out of date therefore would cost the National Health Service (NHS) and impact negatively on patients’ care. As identified by Smith’s (2012) phenomenological study, 75 per cent (n=20) of student nurses felt unable to verbally express their concerns when working with qualified nurses. Yet Jones’ (2013) qualitative study identified that 60 per cent (n=30) of student nurses felt confident by the end of their training. However, there is little consensus in the research available although I feel my experience reflects Smith’s (2013) findings. My inability to be assertive during patient admission was because I was working with an experienced qualified nurse and hiding behind my mentor limited my development in skill. This impacted on my clinical ability when I failed to be an assertive student nurse. It also shows in these research studies I was not using up to date practice. White’s (2009) phenomenological study identified that 75 per cent (n=28) nursing students in clinical placements suffer from self-doubt, have anxiety about their clinical performance and do not possess the characteristics of strong self-confidence. A qualitative study conducted for student nurses by Jones, Mccoy and Pitt (2013) have indicated that majority of student and staff relationships highlight that a sense of belonging was central for student nurses for a good clinical experience. A students sense of belonging and feeling a part of the team were essential before students could learn. This is reflected in Lathlean and Levett-Jones’ (2009) quantitative study (n=200) of student findings on third year student nurses who participated in the study as they had been on a number of clinical placements. This explanation, however, seemed to overlook the fact that many students feel compelled to work hard in order to fit in the nursing team rather than become motivated to le arn. This has made me realise that although being in a good nursing team, I would still prioritise looking after my patients by paying more attention to the patient needs and expectations. A qualitative study conducted by Lyndon (2006) mentioned that student nurses’ ability to make a clinical decision could be influenced by patient situation, availability of resources and interpersonal relationships. Student nurses, however, on a variety of situations, can experience moral distress as Ganske, Iseminger, Lachman and Murray (2012) have identified in their phenomenological study. These two articles revealed that the ability to communicate with patients should not cause moral distress as student nurses would neither be aggressive nor patronising, nonetheless the interaction would achieve the patient’s best interest. This is reinforced by Grumbach and Bodenheimer, (2004) qualitative study which identified (n=18) of student nurse, who noted that greater disability may be as a result of anxiety in some cases and loss of self-confidence. However, Begley (2010) phenomenological study (n=20) identified and argues, little has been investigated to explain the reasons why assertive behaviour occurs in one situation and not in another. Results suggest that, student nurses’ standard measures of assertiveness and of anxiety are irrespective of their scores p=00.1 chances. One should consider the consequences of student practitioners being assertive, while making a decision regarding how to behave I felt this was helpful in reminding me how important self- confident skills can aid improved patient care. Although, their underlying theories of subjectivity are very different, there are some important affinities between the researches that correlate which I believe would help me care better in future pla cement. In addition, Begley’s (2010) qualitative study established that patients were to be considered as partners in their health care delivery. Trust does not come easily for people and I have since learnt from past experiences that patients need to be included and actively involved in the planning and evaluation of their care. By learning to ask open questions helped promote and encouraged patient expression and enabled patients to enhance trust in a relationship as I have shown my interest and investment in the patient’s care and treatment. This study has an impact in addressing my need and offered help on how to be assertive when dealing with difficult patients. As highlighted by White (2014) qualitative study, majority of student nurse depend on their mentors to be assertive and sometimes adopt it as coping strategies. Even though, this is a small number of student nurses, (n=30) to base a judgement on, it provides statistically relevant data and allows an insight into practical experiences. I also felt this research was significant for me to work on my assertiveness, because it had an effect towards the patient and me as a future qualified nurse. I solely depended on my mentors for assertiveness as a coping strategy. Conversely, these poor coping strategies I adopted were highlighted in a qualitative study by Fischhoff et al, (2011) where common coping strategies utilised by student nurses being assertive in clinical settings are explored. Although this is a small sample size (n=18) which does not provide statistically relevant data, it is qualitative design allows an insight into the student nurses experience of assertiveness coping strategies (Parahoo, 2006). I found these results of the thematic critical analysis linked to my own clinical experience, including the poor coping assertiveness strategy I adopted. This was due to underestimating my capacity from the onset of being self-assured and self-confident without being aggressive (REF). I found that these researches gave me insight into how unethical and limiting avoidance practices are when dealing with patients, which was seen in a small number of participants in this study (n=3) (Morris Turnball, 2006). I felt this was helpful in remindi ng me how important assertiveness skills can improve patient care (Morris Turnbull, 2006). Besides, Fischhoff et al, (2011), descriptive study postulates assertiveness in student nurses who become attached to their mentors remain as consistent helpers for weeks in their placement during the period from the first till the third year, and it is suggested that this is due to the students underestimating their capacity from the onset of being self-assured. Although this is a small sample size (n=207) which does provide statistically significant relevant data, 60 percent (n=127) were more positive compared to 40 percent (n=83). Its quantitative design allows an insight into the student nurses’ experience of assertiveness skills (Begley, 2010). Nonetheless, Phillips and Simmonds (2012) phenomenological study supported this descriptive study and further on said this is a key concern for some student nurses within practice setting. The concept of assertiveness and understanding concept as student nurses will enable them to consider that the patient’s aggressiveness might be about other issues rather than their care. In a phenomenological study of (n=50) nursing students in London, Monsu (2014) identified that greater disability may be as a result of anxiety and loss of self-confidence dealing with a difficult patient. Findings of these researches do not seek to be generalised but were reliable to me due to the appropriateness of the methodology and the thematic analysis being correctly applied. This will aid me in caring for my patients in future practice. In a questionnaire survey of (n=200) student nurses in London, Smith (2013) identified that 70 per cent (n=49) of university students preferred mentors to do all the assertiveness communication for them due to underestimating their ability. Only 20 per cent (n=4) of students responded and of those who did respond, many of them did not fully complete the questionnaire. The data suggested that 70 per cent of students who preferred a mentor to do all the assertiveness communication do not constitute very strong evidence. Yet Monsu (2013) argues that from his own experience as a student in placement, there was a strong attachment with mentors being assertive in all him / her communication which did help with the assertiveness skills needed for future practice. This cannot be generalised as Monsu (2013) is not referring to a piece of empirical research but to his own experience. Having identified the context of Monsu’s (2013) own experience argument, I found it very relevant to me and it topped my hierarchy of evidence, but does not appear to have been undertaken in a thorough manner to help my caring for patients in future due to their lack of a soundly-based qualitative theory compared to Smith (2013). Having discussed with my mentor what happened during the admission; it felt good to have attempted the interaction with the patient and recognised some of his needs. Even though the patient seemed reluctant, I demonstrated the ability to remain calm although I did struggle with my approach when I spoke to him about offering more support. Instead, I focused to help the client respond to my questions and identify what his concerns were. I believe during that incident, I showed assertive behaviour because I maintained my duty of care to the patient. I have reflected that this would have an effect on my clinical ability if I had failed to be the patient’s advocate. With the DOH (2009) updated work on providing guidelines on consent to treatment and putting these principles of consent into practice, my actions caused me to consider my practice whether obtaining informed consent would be an issue. Tommy fully realised that he should comply with the nurse as she understood the conseq uences if his pains were not treated (Cole, 2012). According to Baldwin, Duffield, Fry and Merrick (2011) the interaction between the decision-making, skill development opportunities, social support and identity comes with the nursing role so as to be prepared for the upcoming nurse population to meet new challenges. When this type of situation happens again, I believe I have the skill to show my assertiveness skills by using compromise as well as recognising the boundaries of my actions. Using clinical decision skills and asking open questions, which I can gain from meeting other patients would enable me to show that I am a self- assured, reliable and trustworthy student nurse. I need to try and achieve leadership skills that could be essential for patient satisfaction and to achieve this, I have learnt to engage in leadership activities such as handovers and undertaking tasks on behalf of my mentor. I recognised that once I fitted into the clinical environment, I needed to be more actively involved in challenging clinical situations such as detecting unpredictable patient deterioration and learning to make quick clinical decisions. Cook Leathard (2004) suggested that good student nursing leadership and good quality nursing care will be effective if nurses go through leadership training program mes during the early stages of their career. This can help me in preparation to become more aware of how I feel, think and act in front of my patients. Reflecting and learning to be assertive can increase my confidence and self-esteem through appreciating what I have done well and maturely, accepting the improvements I must make to become a better nurse in the future. Having said that, I was satisfied that I had the opportunity to practice nursing handover, as it is one of the vital roles of a qualified nurse and one aspect of nursing care that is required of me when I am qualified.Loseby, Hudson Lyon (2013) wrote, handovers are information that can influence the delivery of care. In the process of this learning experience I felt well supported by my mentor giving me several opportunities to practice my handover until I felt more confident and less anxious because she created quality time for me and necessary feedback that helped my learning need as well as other aspects ofnursing. McCloughen, O’Brien Jackson (2010) defines a mentor as someone that helps others grow by teaching them, encouraging them and being interested in their success. This is also further supported byHamric, B.A., Hanson, M.C., Tracy, F.M., OGrady, T.E.,(2013) who indicated that a good mentor is one who spends quality time to foster growth, committed to the developme nt of their learning need, willing to share and feedback on any rough spot in their career development. In conclusion, I have critically analysed and reflected on clinical learning needs, which are essential for my continuing professional development. As a student, critical analysis and reflection helped to facilitate good learning outcomes so that I can relate and apply concepts to clinically orientated situations as well as explore and evaluate evidence. Also my clinical learning need was acknowledged through mentor feedback by showing assertive skills in communication with difficult patients. This need is an on-going process of development for me. However; I recognised that attempting interactions with patients and collaborating with nursing staff will help in my development to be a more self-assured nurse. Participating and engaging in leadership activities such as handovers and task delegation would be beneficial at this stage of my learning. Through the reflection and recognition of these learning needs, I could only move forward and continue to develop my learning proficiency as a student nurse towards professional competency as a qualified nurse. 1 | Page

Free Speech -- essays research papers

The Constitution of the United States states in its First Amendment that "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances" (Funk & Wagnalls 162). This Amendment guarantees each person of free speech. Does this mean that a person can stand in the middle of the street and yell anything he wants? No, society, even though it cherishes freedom of speech, does give this freedom certain restrictions. Why does society find it necessary to restrict freedom of speech? Does this ensure a more controlled society? Let us imagine a society that has no restrictions of speech. For example, anyone can publish a false story of another person, just for revenge perhaps, and the offended person would not be able to defend himself because there is no restriction of speech. A neighbor in a residential area decides to use a loud microphone to announce his beliefs in the middle of the night, and wakes everybody up. Because that person has every right to speak, nobody can do anything. Even though this is "freedom of speech" it is not allowed in a civilized society. Free speech is a very controversial issue because who is really the one to decide what can or cannot be expressed. The freedoms stated in the First Amendment have been controlled for the prot...

Jungian Analytical Psychology and the Process on Individuation

The process on individuation is central to Jungian analytical psychology, as Jung believed that individuation is the driving force behind humans’ â€Å"yearning for completeness within the human experience, and the search for wholeness† (Russell, & Ryback, 1996, p. 2) in their life-long conquest to achieve a distinctive but coherent and balanced personality.Besides the genetics and the psychosocial environment, Jung believed that a third force influences the dynamic formation of human individuality and that is the ‘collective memory’ of previous civilizations, memory stored and available to humans, in the ‘collective unconscious’ (Munteanu, 2012; Douglas, 2011). While hard to prove scientifically, quantum physics does not refute this concept (Science Channel, 2011; Munro, 2011).As a therapist, I believe that I should be the open-minded guide and facilitator of client’s individualized explorations and life experiences, supporting clientâ €™s pursuit of holistic self-realization; guiding client’s exploration of his/her archetypes, the attitudinal type and the preferential decision making mode, would facilitate client’s understanding of own psychic energy flow, and would empower the client to address and develop his/her unconscious/conscious balance, advancing the individuation process (Munteanu, 2012; AtheneWins, 2011; Russell, & Ryback, 1996).The counselling methods I would use to sustain this process, while client centred, would also need to be very creative and interactive on my part, as the counsellor; I would be making use of a variety of strategies within an environment of customised but constantly challenging and supportive at the same time.I would need to maintain myself on an perpetual self-development and self-reflection ‘carousel’, in order to ensure that I continuously upgrade my skills to the levels required to provide that balance of challenge and support, to all of my cli ents; within my practice, I would use a variety of methods, such as instructional interventions, questioning, clarifying, hypothesising, silences if/as required (to allow the process of assimilation and internalisation), dream interpretation or sequential drawings, journaling, art and sand therapies (especially for clients who have difficulties verbalising feelings), mandalas, mask making, etc.I could see how my teaching experience will serve me well in Jungian counselling, since I already use many of these methods, to provide personalised learning, to my students. I have always thought of myself as ‘work in progress’, and therefore I learn something new every day from my students; hence, learning from and alongside my clients I see it as a continuation of my own holistic individuation (Dehing, 1992; Russell, & Ryback, 1996).

Lego Branding Community Essay

Online communities are becoming â€Å"places† of belonging, information, and emotional support that people cannot do without. These social groups have a real existence for their participants, and thus have consequential effects on many aspects of behaviour. This article examines collective value creation and empowerment in an online brand community. It presents the main features of an online brand community, the process of value co-creation, and motivators for participating in online brand communities. These key factors jointly characterize collective value creation and empowerment. This netnographic study focuses on an online brand community called BrickBuilders, which is a meeting place for LEGO builders in Finland. BrickBuilders’ members feel a sense of belonging, they share similar motivations, and they create value together. Introduction A brand community can be formed by any group of people who share a common interest in a specific brand and who create a parallel social universe rife with its own myths, values, rituals, vocabulary, and hierarchy (Muniz and O’Guinn, 2001; Cova and Pace, 2006). Brand communities become more than a place. They become a common understanding of a shared identity, which can be found in both face-to-face interactions and in cyberspace (Muniz and O’Guinn, 2001). Analysts no longer question whether the concept of community should have a place in the domain of marketing (Cova and Pace, 2006). However, the concepts of brand community and online brand community are relatively new and have yet to find their place in the academic world. Traditionally, companies produced products relatively independently. Today, consumers and other stakeholders can create value more collectively. The purpose of this article is to describe and analyze collective value creation and empowerment in an online brand community. Main Features of Online Brand Communities Muniz and O’Guinn (2001) used three constructs to identify the distinguishing features of brand communities. First, a sense of belonging is a connection that members feel toward one another and the collective sense of difference from others outside of the community. The second feature is the presence of shared rituals and traditions that surround the brand. Rituals and traditions perpetuate the community’s shared history, culture, and consciousness. Traditions include certain behavioural norms and values. The third feature is a sense of moral responsibility, which is a felt sense of duty or obligation to the community. The sense of moral responsibility is what produces collective action. Heinonen and Halonen (2007) have identified motivators for online brand community activities. Members want to belong to something, build and strengthen their identities, get feedback from others, and create something new. The Process of Collective Value Creation Schau and colleagues (2009) have identified the process of value co-creation in online brand communities. The process consists of four thematic practices, which are social networking, impression management, community engagement, and brand use. Social networking is a practice that focuses on creating, enhancing, and sustaining ties among brand community members. These include welcoming, empathizing, and governing. These practices operate primarily in the intangible domain of the emotions and reinforce the social or moral bonds within the community. Impression management includes evangelizing and justifying. Online brand community members act as altruistic emissaries and ambassadors of good will. Members devote time and effort to the brand, share the news of the brand, and inspire others to participate in the community. Community-engagement practices are those that reinforce members’ escalating engagement with the brand community. These include staking, milestoning, badging, and documenting. Staking, milestoning, and badging mean that community members bring out brand experiences and proclaim openly that they are fans of a particular brand. Documenting occurs when brand community members construct a narrative of their brand experiences. Brand-use practices are specifically related to improved or enhanced use of the focal brand. These include grooming, customizing, and commoditizing. Grooming means that members share, for example, homemade tools and advice. Customizing means modifying existing ideas and discovering new ideas, which result in customized products. Commoditizing means that members rant or chastise some products, but at the same time, they have new ideas on how those products could be developed. Synthesis of the Theoretical Framework The main features of online brand communities, value co-creation, and motivators for participating in online brand communities (Heinonen and Halonen, 2007; Kozinets, 2010; Muniz and O’Guinn, 2001; Schau et al., 2009) are the key factors that jointly – realized in various combinations – characterize collective value creation and empowerment in an online brand community. The collective value creation and empowerment in the online brand community may occur when its members have a sense of belonging, they create value together, and they have similar motives. The collective value creation and empowerment of the online brand community allows mutual interaction between the online brand community and the company as well as other stakeholders. Companies have an opportunity to communicate with consumers and influence their opinions (Kozinets, 2010) and vice-versa. We have moved away from one-way transactions to a relationship-based interaction model that emphasizes consumers’ and other stakeholders’ roles in networks and communities.