Evil in St.Augustine's Confessions Essay Example | Topics and Well Written Essays - 1500 words

Evil in St.Augustine's Confessions - Essay Example From this paper it is clear that  the presence of good and evil in the world is obvious, but what are the relations between them? Many experts emphasize the conflict between good and evil. The main statement of St. Augustine is that evil is simply the absence of good. This presumption has a long history. It is a well known fact that St. Augustine was initially a Manichean and became Christian only after he realized the drawbacks of Persian Dualism religion-   Manichaeism. The main idea of this religion lies in the belief in two gods, who represent good and evil. In this religion we can see the struggle between the light and darkness. St. Augustine scrutinized Christianity and rejected Manichaeism. He claimed that in this world there could be only one god, a good one. God and the world that he created are the main aspects of the philosophy of Augustine and the relations between them deserve special attention.  This study stresses that  Augustine argued that the world is the cr eation of God, God does not depend on the world and the world is fully dependent on God. Creating human soul, God initially incorporated in it the striving for happiness as the main goal in a man’s life. That is why a man must use all the abilities of his soul to achieve the happiness. Happiness itself consists in the maximum cognition of God and in this case the human reason becomes the main basis for belief. That is why belief is the foundation and the initial point for cognition.... That is why belief is the foundation and the initial point for cognition. Cognition without the belief is sinful. The supreme form of cognition is divine inspiration given by God to humans, who have strong belief. This God’s wisdom can’t be understood by human reason. God gives inspiration to humans only by his own will. Striving for happiness, a man cognizes good and evil. God represents the good, but the question is what evil comes from as God can’t be the creator of evil. This problem was solved by Augustine: all the evil comes from the material nature. All the evil is a product of material body of humans. The first knowledge of Adam and Eve was the product of their cognition, of their material nature and this was a reason of their Fall. Humans were punished for making a fetish of their materiality, their body and after The Fall of the first people their offspring were doomed to death. â€Å"For other than this, that which really is I knew not; and was, as it were through sharpness of wit, persuaded to assent to foolish deceivers, when they asked me, â€Å"whence is evil?† â€Å"is God bounded by a bodily shape, and has hairs and nails?† â€Å"are they to be esteemed righteous who had many wives at once, and did kill men, and sacrifice living creatures?† (Book II) However, the substance itself and human’s body were created by God and consequently, they could not be the source of evil. Augustine comes to the conclusion that evil does not exist at all. Evil is weakened and corrupted good. Here the philosophy of St. Augustine is based on Platon’s theory about the ideas, which are present in material bodies, but can be corrupted by the

Business to Business Office Depot Inc Essay Example | Topics and Well Written Essays - 2000 words

Business to Business Office Depot Inc - Essay Example Office Depot Inc. recorded revenues of $14,278.9 million during the fiscal year ended December 2005, an increase of 5.3% over 2004. Company could not translate this increase into profitability owing to some intense competition in the sector. As a result the company could generate an operating profit of $348 million during FY 2005, a decrease of 34.3% over 2004 while the net profit was $273.8 million in fiscal year 2005, a decrease of 18.4% over 2004. However the quarterly results for FY 2006 have been quite encouraging so far. The final figures for third quarter indicate an operating profit of $55 millions as compared to $42 million for the same period in 2005. Company is now on a massive expansion spree with newer acquisitions like Papirius with operations in Czech Republic, Lithuania, Hungary and Slovakia. Office Depot has also entered the biggest consumer market and one of the fastest growing economies i.e. China with the acquisition of AsiaEC, one of the largest dealers of office products and services in China. It is worthwhile here to mention that the company is not dealing with too many retail customers, therefore it is not possible to interview the retail customers as such. The best method to study and analyze a company operating in B2B environment is; i. To sift through the reports from some of the marketing agencies, company's quarterly/ annual reports, newspapers and journals ii. Speaking to some of the business customers and gathering their feedback. Therefore, I carried out this research mainly by studying and analyzing the latest Internal reports, annual reports/ quarterly reports of Office Depot, market research by Datamonitor, newspapers, Journals and other printed materials. In addition I also studied the reports of some of its competitors like Circuit City Group Inc., IKON Office Solutions, Inc., Staples, Inc., Wal-Mart Stores, Inc., and United Stationers Inc. SWOT analysis Office Depot is the second largest office products company in the US selling a wide range of office supplies, business machines, computers office furniture and related products through superstores in major regions like North America, Europe and Japan, besides using other channels like contract delivery sales force, and the internet. As compared to other divisions, the North American delivery division has recorded strong growth in fiscal year 2005. Strengths Strong Brand Image: Though a relatively newer company, but Office Depot has been able to establish a strong brand image. In the US, Office Depot has become synonymous with office products. Adopting the tagline "Taking Care of Business" into its logo has further given it a unique identity. The company has successfully finalized a multi-year alliance with NASCAR under which it became NASCAR's official office products partner. This has helped in boosting the brand visibility of Office Depot products. While entering newer markets, like the Asian subcontinent, a strong brand image helps in an easy and formidable entry. Balanced Product Mix: Product mix of Office Depot includes branded office products and own brands with general office supplies, computer supplies, business machines and related supplies, and office furniture under various labels, including Office

ECO201-MicroEconomics Mod 5 CBT Essay Example | Topics and Well Written Essays - 750 words

ECO201-MicroEconomics Mod 5 CBT - Essay Example With higher profitability, the company is able to have the financial capacity to improve its technology through additional investment. Improvement in technology and bargaining power over its suppliers make it harder for small-scale players to compete with the existing large-scale companies. Not only will the company with highly improved technology be able to produce more product to meet the market demand but also offer a better quality product to the consumers. Therefore, it is more likely that the market structure with cartels is an oligopoly – also known as having a fewer big-time players in the market. Basically, a cartel prohibits a perfect competition to occur since big players within the same industry are able to openly discuss about the fixed price big multinational companies will impose on homogenous products. to compete more on improving the quality of homogenous products they offer to the consumers aside from its marketing and promotional activities. In the process, these companies are required to compete in the market through product differentiation and product diversification. (Salin, 1996: pp. 37 – 38) Basically, the profitability of a large multinational company that manufacture shampoo product may invest some money in research and development in order to enable the company to innovate new product that could stimulate the interest of its target consumers. A good example was when arometherapy gain popularity in the market. In line with aromatherapy, a well-known shampoo brand called Palmolive under Colgate-Palmolive started to produce shampoo with different scent of aromatherapy. (Colgate, 2008) Given that large-scale multinational companies that are into cartel situation still has to compete for the same market. For this reason businesses that are able to continuously develop new strategies and innovates new products that could arouse the interest of its target market are the

Explain the different roles played by (i) the central bank, (ii) Essay

Explain the different roles played by (i) the central bank, (ii) depository institutions, and (iii) depositors in the determina - Essay Example For example, there is a strong proof that when money increases rapidly in an economy, there develops a direct relation between money-supply and long-term price inflation. On the other hand, a decrease in the level of money supply in a country leads to a decrease in economic activity, tightened spending levels and a fall in consumer demand. The quantity theory of money states that money supply has a relationship that is directly proportional in nature to the price level (Friedman, 1956). Different institutions have different but correlated roles to play in the determination of money supply in a country and the global economy. Examples of such institutions are the central bank and depository institutions. Depositors also have a part to play in this. Roles of the central bank Every country has a central bank that monitors and determines money supply in the country’s economy. In the US, the money supply is determined by the US Federal Reserve, the central banking system of the US. Its role is to foster economic growth in the US by regulating the actions of private banks and stabilizing the money supply. The Federal Reserve, also known as Fed, uses the expansive monetary policy as a guide in expanding the US money supply (Shin, 2009). Using the expansive monetary policy, the Federal Reserve channels more reserves to the banking system so as to allow private banks more liquidity and to make sure that they have the required ability to issue loans. In the UK, determination of money supply is the function of the Bank of England while that of the counties under the EU is the European Central Bank (ECB) (Burda and Wyplosz, 1997). In order to stabilize an economy in a country, the central bank has the power to determine the level of money stock through the operation of different monetary policies. These policies include reserve requirements, open market operations and discount rates. The most dominant among the three monetary policies is the open market operations p olicy. According to Howells and Bain (2009), an open market operation is a situation in which the central bank purchases or trades government securities for cash in an effort to contract or expand the total money supply. Money supply in the country will increase if the central bank purchases government securities but it will contract if the central bank sells government securities. The responsibility of the central bank in relation to fractional reserve banking is to hold a particular fraction of all deposits. This can be in account with the central bank or in cash. In order to alter money supply, the central bank alters the percentage of total deposits that needs to be held by commercial banks. In this way, the central bank can increase the monetary base in a country by reducing the reserve requirements or reduce the monetary base by increasing the reserve requirements (Mishkin, 1998). The central banks also determine money supply in a country by controlling discount rates. This is possible because the central bank in every country supplies commercial banks with the money they require to meet consumer demand. Therefore, the central bank can meet and control consumer demand for money by controlling the national interest rates. For example, the consumer demand for money will increase greatly if the interest rates decrease while a decrease in consumer demand for money will arise if the interest rates increase. Roles of depository institutions By definition, depository

Time Management and Productivity Essay Example for Free

Time Management and Productivity Essay Context of the problem. Time management is a term used to refer to the events that individuals follow in order to better their time usage. It refers to the principles and systems that people make use of in order to make conscious decisions about the activities that will occupy their time. Concerns about time usage have a longer history. Effective people manage their time properly. People who are able to manage their time properly are high achievers in everything they pursue. In www.learndirect.business.co.uk/campaigns/finances05/glossary/ time management is defined as the development of tools and processes that lead to an increase in a business’s time efficiency. People who are good time managers are self-starters, organized and do not procrastinate. Time management is usually seen as a concept of balance. Time management in http://www.wisegeek.com/what-time-management.htm is defined as the ability to be able to arrange, organize, schedule and budget personal time with an aim of producing effective work and productivity. According to http://www.articlealley.com/article-28248-24.html there are various advantages that are associated with time management in our daily endeavors. Time management has got many advantages. It influences reduction of stress, gaining of more time to carry out your tasks and reduces the chances of avoiding some tasks which are meant to be carried out. It also helps in eliminating cramming. Time management is also a motivator when carrying out tasks, this is because the tasks will always be ready at the time they are required. It also helps in avoiding procrastination. To be able to manage your time successfully the management of enterprises should set up goods which needs to be prioritized in order to know which tasks need to be completed at what time. (Covey, 1990) asserts that to be a good time manager, assets need to be enhanced and promoted. He suggested the four dimensions of nature which help in managing time effectively. According to http://learnsmallbusiness.wordpress.com/2006/03/11/are-you-content-with-your-time-management-skills-7-reasons-why-you-must-have-a-to-do-list/ great time management gives individuals chances of developing a timetable which suits their tasks at their tasks at their respective places. Good time management is a saver of health as it reduces stress which may come along due to unaccomplished tasks. According to http://www.gradresources.org/articles/time_management.shtml a schedule should be utilized which outlines all the activities together with the time they will be performed. The planned schedule should always be changed to match the changing activities and also prioritize the activities. Prioritizing enables the completion of tasks at the time they are required. In order to achieve good time management one need not to multitask because it will consume a lot of time. Once you have the timetable it should be followed as it appears hence avoiding skipping of activities which have already been scheduled for. People who do not manage their time thus lacking a time management plan suffer from insomnia, deteriorating health and other discomforting issues. They may even be divorced by their spouses because they do not spend time with them. Effects of poor time management affect not only you but also people around you. Time management reduces cost as the saying goes that time is money. It allows you to use the minimum costs possible in every activity that one may go through. It helps reduce the anxious nature of being when they have not done their tasks accordingly. Time management enhances discipline and efficiency in terms of completing the tasks at hand. It also allows prudence to be a key guider in performing tasks. Time management has also its own problems which have to be dealt with for a business enterprise to be successful. The problems ranges from stress, anxiety and feeling overwhelmed. We become anxious when we realize that there many things that need to be done and we are not able to handle them. (Bly, 1999) claims that when we are not capable of dealing with the present tasks of that need to be handled due to the fact that time is running out we become stressed. We get overwhelmed when there are too many demands that need our time and attention. Also when we are faced with large new projects or tasks and there is no clarify on what need to be done, how, when and where. This is because we cannot be able to take the first important step. Lack of proper organization of our activities take a lot of our time thus wasting our time which could have been used to better and constructive tasks. There are therefore various ways in which time management can affect the productivity of our activities hence those of business enterprises. There is therefore the need to evaluate the impacts that time management would have on productivity, so that we can be able to stop them if they are severe to the business enterprise or encourage them if they are advantageous to the business. The purpose of the research study will be to evaluate the impacts that time management have in the productivity of the call centre workers in the telecommunication industry. Time management is believed to be essential in the success and prosperity of each an every organization. It is said to be the stepping stone for success. Good time management achieves high results in terms of profits and the production of products that a company maybe producing. It therefore becomes important to evaluate the impacts time manage may have in the productivity of workers in their respective areas of work. The research study will deal with the call centre workers in the telecommunication industry. Problem statement Time management has an impact on the productivity of business enterprises. A review of academic and professional books have emphasized the need of time management in our daily endeavors be it school work, business activities or our personal activities. They have outlined the importance of formulating a timetable which will work as a guideline in our daily tasks. For time management to be effective, many have suggested the various ways to do it hence the need to evaluate which are the most effective tools, strategies and techniques that can be utilized in order to have high productivity in business enterprises. Time management has got it own reasons as outlined in http://ezinearticle.com/?Reasons-why-we-Have-To-value-Time-Managementid=506366 hence the need to evaluate the impact that time management has on business enterprises. Time is considered to be gold. No one wants to loose gold, therefore time should be managed well because it will never come back, once a minute have elapsed it does not return. Good results in terms of duties and responsibilities will come forth every time individuals manage their time well. It also gives fulfillment because it enhances our ability to determine what is valuable and should be given more attention. It allows one to achieve a greater social life after a busy day of working and full accomplishment of all activities. The above reasons have emphasized why time management is important hence the need to evaluate its impacts on business enterprises whether positive or negative. Research questions The purpose of this research study is to determine how time management impacts productivity of call centre workers in telecommunication industry. Sub questions 1. What are the problems faced by the workers in managing their time? 2. What are the tools that workers use to manage their time effectively? 3. What are the impacts of poor time management? 4. Does effective time management add benefits to the telecommunication industry? 5. What is productivity? Significance of the study This research study will be of help to the call centre workers in many telecommunication industries because they will be able to know which problems they are likely to encounter while managing their time. This will enable them to be able to evade from them in which ever way possible as well as knowing how to cope or deal with the problems that they are likely to encounter. The call centre workers in a telecommunication industry will also get to know which tools they can employ in order to be able to manage their time properly. By the call centre workers realizing which tools to use they will be able to achieve high results in their work hence the productivity of the company will increase. By bringing out the effects and impacts of time management, the workers will benefit from the research study because they will try as much as possible to manage their time so that they do not feel the effects of it on their work. The management of companies by knowing the impacts and effects of poor time management will be able to campaign and urge their workers to manage time properly. They will also put the necessary measures that will allow the worker to be able to manage time effectively. The research study will evaluate whether time management has its own benefits both to the workers and the company. The workers by knowing the benefits they are entitled to as a result of time management will try to their level best to effectively manage their time. The research study will also help the companies because after knowing the benefits that are a result of proper time management the will educate their workers by organizing seminars, debates etc on how to manage time so that they can be able to acquire the benefits of time management. The research study will be of help to many companies which want to maximize on time management. Research Design and Methodology The research design that will be employed in this research study is case study. The case in this research study will be two telecommunication companies where by their call centre workers will become the subject of study. They will be studied in depth in order to give the most reliable information which will allow for generalizations to be made. Call center workers in these two companies will be the objects of study. They will be studied in depth to help reveal the problems that are faced by them when they are trying to manage time in order to achieve productivity.   They will also be studied so as to give information on the tools that they use in managing their time. They will also reveal what they feel are the impacts of time management in the productivity of a telecommunication company. They will also give reliable information on whether time management adds any benefits to the telecommunication industry. Instruments of data collection Data collection is the gathering of information to which will offer critical evaluation to the research questions. They are many and are chosen depending of their validity and reliability. This according to http://ohoiline.osu.edu/b868/pdf/b868.pdf The methods which one has chosen should offer the best answer to the research questions. Also in selecting the data collection procedures or methods one need to consider how the information gathered will be organized, analyzed as well as interpreted. The gathered information should be reported to the various audiences. The research study will utilize the following data collection procedures. a. Face to Face interviews This is oral administration of an interview schedule. To obtain accurate information a researcher needs to establish friendly relationships between the respondent prior to conduct on interview. The face to face interview will be administered because of the following: 1. They provide in depth data, which cannot be collected by use of questionnaires. 2. It will be possible to obtain data required to meet the objectives of the research study. 3. They are flexible because they allow follow up of an aspect as it gets raised in the course of the interview. 4. They guard against confusing questions because they give a room for clarification. b. Questionnaires It is a list of questions that will be asked to the respondents in order to get the desired data. They may be structured or unstructured. They will be used in this research study because: 1. They are easy to administer. 2. They are economical in terms of money. 3. Their responses may give an insight to the background motivation, feelings and interests. c. Observation Observation is where by the researcher utilizes check list and records what he/she observes during data collection. The researcher in this case observes the behavior and how it occurs. Observation will be used in this research study because: 1. It enhances accuracy because the researcher himself or herself observes what exactly happens and does not depend on what the respondent has to say. 2. Observation can be used alongside other instruments or procedures of collecting data e.g. Interviews. 3. It can be done repeatedly thus increasing its level of accuracy. Reliability and validity of the research instruments According to http://www.nova.edu/ssss/QR/QR8-4/golafshani.pdf reliability and validity have got their roots in positivist perspective. Reliability of instruments in data collection determines the appropriateness of the research instruments for particular study. It tells how well the instruments managed or failed to measure what they were supposed to measure. To test the reliability of the instruments, the research study will conduct a pretest study where the original interview schedules, questionnaires and observation schedules will be administered to selected persons in the sample. Validity ensures that what an instrument claims to measure has been measured. To ensure that the instruments are valid advice will be sought to experts in the area. Based on the comments that will be given as well as guidelines adjustments will be made before the final version of the interview schedule, questionnaire and observation schedule will be administered. Population of the Study The population of the study will be call centre workers in two telecommunication industries. Since they are many and it will take a lot of time to access and study them, they will be randomly selected using simple random sampling technique to obtain a number of 90 respondents only. From this sample data will be collected to help answer the questions addressed by the research study. Simple random sampling technique will be chosen because it ensures that the population is representative. Data Analysis The data that will be collected will be analyzed by descriptive and inferential statistics. This is because descriptive statistics will help in summarizing the data while the inferential statistics will help infer the sample results to the general population of the study. Organization of the study Chapter One In chapter one the research study will explain the context of the problem in details and give a detailed statement of the problem that the research study will deal with. The objectives, purpose, research questions, sub questions and the hypotheses will be stated clearly. The scope that the research study will cover will be stated together with the limitations that will be encountered during the research study. Chapter Two The second chapter will deal with literature review where by literature that is related to the research study will be   evaluated to give various trends that may exist which will be helpful in the research study. Chapter Three It will basically deal with the methodology of the research study. It will deal with the research design the research study will utilize, instruments of data collection together with their validity and reliability. The population that the research study will utilize will be discussed and how the data collected will be analyzed. Chapter Four It will deal with data presentation and interpretation. It will include analysis of the data which have been collected and how it will be presented. It will also include how the collected will be interpreted for the audience to be able two understand. Chapter Five This chapter will include with the conclusions that will be drawn from the study. The population of study will be representative to allow for the generalizations to be drawn from it be inferred to the whole population. This chapter will also include recommendations which will be given to allow a room improvement. References Bly, R.W (1999) 101 Ways to Make Every Second Count: Time Management Tips and Techniques for More Success with Less Stress. Franklin Lakes: Career Press Covey, R.S (1990) The Seven Habits of Effective People. New York: Simon and Shulter Inc http://www.nova.edu/ssss/QR/QR8-4/golafshani.pdf http://www.wisegeek.com/what-is-time-management.htm www.learndirect-buisnes.co.uk/campaigns/finaces05/glossary/ http://ezinearticles.com/?reasons-why-we-have-to-value-time-managementid=506366 http://www.articlealley.com/article-28248-24.html http://ohoiline.osu.edu/b868/pdf/b868.pdf http://learnsmallbusiness.wordpress.com/2006/03/11/are-you-content-with-your-time-management-skills-7-reasons-why-you-must-have-a-to-do-list/ http://www.gradresources.org/articles/time_management.shtml

Importance of Documentation Care in Nursing

Importance of Documentation Care in Nursing This scenario presents a number of problems to the staff nurse. In relation to the sphere of practice, as a D Grade Staff Nurse I have a senior nurse present on the ward, who will be in charge during the shift. This provides me with a source of support and experiential knowledge, and also someone with whom to liaise over any issues which arise. However, as a Registered Nurse I am responsible for my own practice, accountable for all aspects of nursing practice and therefore must act on everything pertaining to practice that should arise. In an ideal situation, the E Grade will act on any information or concerns I bring to her. If she does not, then it is my responsibility to act on these concerns myself. The NMC Code of Conduct (NMC, 2004) requires that all qualified nurses act in the best interests of their patients at all times. The NMC code of conduct also states that all nurses are accountable for their own practice, and must account for their own acts or omissions (NMC, 2004). The focus of this analysis of the scenario is on documentation and the nurse. The nursing literature suggests that the completion of nursing documentation has been one of the most important functions of nurses, even from the beginning of the profesion in the time in the time of Florence Nightingale (Cheevakasemsook et al, 2006). Documentation of nursing care is an important source of reference and communication between nurses and other health care providers (Martin et al, 1999). Documentation is a fundamental component of nursing activities such as assessment and care planning, according to the various models which have been designed for these functions (Nazarko, 2007). The importance of proper documentation may also be because it serves multiple and diverse purposes for nurses, for patients, and for the health profession, because current health-care systems require that documentation ensures continuity of care, furnishes legal evidence of the process of care and promotes and facilit ates the evaluation of the quality of patient care delivery (Cheevakasemsook et al, 2006). In this instance, following handover, the first source of information to be checked will be the nursing records and care plans of each patient, as part of an individualised approach to care. The nursing records for Mrs Smith, for example, should provide the medical history and social history which will allow me to provide holistic nursing care. However, one of the problems with nursing documentation, as found in some empirical nursing studies, is that the complexity of nursing documentation does not always allow it to serve its many functions (Cheevakasemsook et al, 2006). However, the medical record is a legal document that tells the story of the patient’s encounter with the nurse and other professional caregivers, and as such should provide a complete and accurate account of his condition and the care he received (Austin, 2006). Whatever the difficulties of the documentation processes concerned here, the documentation should have been complete and correct. Documentation issues here include the improper recording of the administration of intravenious antibiotics. Given the strong nature of this medication, their specific nature and mode of action which can be tailored to the individual disease following culture and sensitivity tests, and the need to ensure they are given at the correct intervals, particularly as some such drugs can become toxic in larger doses, the proper recording of their administration is a vital part of the administration process. Bjorvell et al (2003) in a study of 377 nurses in Sweden found that nurses believed documentation to be fundamental to nursing practice, in particular, in promoting and ensuring patient safety. Protocols for the administration of intravenous medications exist, which, if followed, should promote safety. For all medications that nurses give to patients, they must know indications, contraindications, dosage parameters and adverse reactions (Austin, 2006). Nurses must always ensure that the ordered medication is appropriate for the patient, and that the prescription is clear and legible (Austin, 2006). And once a nurse has administered a drug, they must monitor the patient for signs and symptoms of drug toxicity or other adverse reactions, and these monitoring activities must be fully documented, including any actions taken on notable findings and the patient’s response to these interventions (Austin, 2006). This creates a record which demonstrates that the nurse met the prescribed standards of patient care when administering medication (Austin, 2006). Two qualified staff should have checked the drug dosage, route and timing, and the prescription against the patient identfication band, and then recorded the adminstration of the antibiotics on the chart and in the patient records . Incomplete records in this instance could be suggestive of improper procedures in the adminstration of this medication, a serious issue which could lead to legal action and professional sanction, even dismissal and loss of registration (Austin, 2006). Similarly, the issue of the blood transfusion error should be highlighted, because again patient safety is the fundamental point of nursing care. If proper procedures had been followed, this error could not have occurred. Administration of blood and blood products is subject to strict surveillance, and each Trust will have clear guidelines and protocols which govern and support this kind of activity. Checks should have been carried out on collection of the blood – the documentation should have been checked against the blood bag – patient name, number, blood group and type. The blood form, with the number of the blood bag, should have been checked properly. This should have been carried out by two qualified staff. The same checks should have been carried out at the bedside, checked against the patient notes and his identification band. Had the documentation been checked in this way, by two qualified staff, the wrong rhesus factor blood could not have been administered. T his demonstrates how correct documentation supports safe nursing practice and facilitates patient safety as well as recording nursing actions. Not only should the mistake be rectified, the doctor in charge of the patient informed and sumoned to examine the patient, and ongoing observations be carried out to ascertain if there are any side effects from the administration of the blood, but all of this should be clearly documented. Further, it should also be documented how this mistake occurred, through an examination of the documentation pertaining to the error and the actions of those who administered the blood. All medically releveant facts realted toan incident should be recorded in the medical records, according to the Trust and ward policies and protocols (Austin, 2006). A critical incident reporting from should also be completed, according to Trust policy, in order to ensure that risk management are informed and actions can be taken to prevent such occurrences in the future. Thus, such a form should also be completed for the percieved drug error. The NMC code of conduct states that nurses should act to identify and mini mise risk to the patient or client (NMC, 2004), and this applies to the action taken in the current situation and the potential protection of all clients in the future, in the avoidance of future errors of a similar nature. Another error which relates to documentation is the issue of the patient who was discharged inappropriately. It is understandable that the relative should be distressed and should be dealt with sensitively and apologetically. Liaison with management, risk management and any hospital or Trust agencies which deal with patient complaints should commence immediately. The most important issue here is to address the error, and not to question whether or not the error took place. It obviously did, because the patient arrived home in that state, and the usual discharge protocols cannot have been adhered to. If they had been, the discharge documentation should have been complete, and would have been communicated with the receiving district nursing team. The nurse plays a unique and pivotal role in discharge planning, as a key member of a multidisciplinary team (Fielo, 1998) role. If, as Bull and Roberts (2001) suggest, a proper discharge occurs in stages, and can be characterised by involveme nt of all team members within interacting circles of communication, then this discharge error should not have taken place at all. Therefore, any work done to address this error must examine where communication processes failed, and the documentation here should provide the evidence of where this failure occurred. Communication is fundamental to discharge planning, both between nurse and patient and between professionals across the divide between hospital and community services (Fielo, 1998), and so the documentation here should have been both individualised and comprehensive, functioning both as a record and as a communication tool. Effective discharge planning is also a vital link for continuity of care (Bull and Roberts, 2001), and so the failure of this process will lead to negative impact for the patient and their carers. Similarly, patient and carer participation is important in discharge planning (McLeod, 2006; Bull and Roberts, 2001). Research by Cleary et al (2003) demonstrates that consumers want information on medication, treatment, awareness of their rights and opportunities to participate in decision making. The nurse engaging in discharge planning also needs to take into account the needs and capabilities of carers (Qualey, 1997). The failure of the discharge planning process in this case therefore has a number of complex effects and may be shown to have failed in a number of key areas. It is also imperative that nurses value the social aspects of patient care and that this is seen as an integral part of the discharge process (Atwal, 2001). There are some ways in which this could be improved, and a close examination of what went wrong might highlight ways in which this could be avoided in future cases. The discharge documentation may need to be adapted to better reflect the processes and knowledge involved (Reed, 2005). This might ameliorate relationships between the acute and community sectors (McKenna and Keeney, 2000), and may prevent these errors occurring in the future. It might also be necessary, from the evidence of the available documents relating to the case, and from the ward rota, to identify who failed to properly discharge the patient so they can be engaged in education and development activities to develop their competence in this area. The documentation used should have served to enhance the ability to deal with this difficult situation (Sollins, 2007) by providing the family with the answers to their questions about what went wrong. Cheevakasemsook et al, (2006) in their study found that complexities in nursing documentation include three aspects: disruption, incompleteness and inappropriate charting. Of these, this scenario shows occurrences of incomplete documentation, whereby the documentation related to discharge planning has not been completed. Related factors that influenced documentation comprised: limited nurses competence, motivation and confidence; ineffective nursing procedures; and inadequate nursing audit, supervision and staff development functions (Cheevakasemsook et al, 2006). These findings suggest that complexities in nursing documentation require extensive resolution and implicitly dictate strategies for nurse managers and nurses to take part in solving these complicated problems (Cheevakasemsook et al, 2006). These are learning points to take forward into future professional development and practice. However, the more immediate needs would be to address the problems associated with these fail ures. The nurse must act to redress the balance and to minimise, for example, the potential litigation which may arise from this unfortunuate situation. The family are likely to make a formal complaint, and, depending on how this has affected the discharged patient, may even take legal action for compensation. In this instance, the incomplete discharge documentation demonstrates that the required nursing care did not take place (as there is no evidence of it in the records). Therefore, legally, the nurse taking care of this patient will be liable for the errors that have occurred. There are other issues to be considered, taking the wider view, in perhaps understanding why such errors occurred and how they can be avoided in subsequent cases. Hyde et al (2005) highlight the limitations of the forms of documentation (and the forms of communciation which characterise that documentation) within nursing practice. They suggest that this nursing documentation depicts the domination of reductionist medical models, utilising scientific rationality in linguistic and communication forms, rather than reflecting the holistic nature of nursing practice (Hyde et al, 2005). Therefore the documentation may be at odds with the autonomy of the patient, bringing up issues of control and power, where the documentation may serve to exert and maintain the power of the nurse or the medical profession rather than support the wellbeing of the patient (Hyde et al, 2005). Professional autonomy on the part of nurses demands a degree of mature clinical and ethical judgement in emergent and complex situations, and it is the documentation, if correctly completed, which should also signpost this process of judgement and decision making. But if the documentation is difficult to complete, onerous or time consuming, it may be that it detracts from the quality of patient care and the easy recording of this, rather than supporting it. Documentation provides the legal protection nurses require in modern healthcare practice (Frank-Strombourg et al, 2001). Educating nurses about the principles of documentation and the importance of implementing risk-reduction practices may help guard against liability and ultimately improve patient care (Frank-Strombourg et al, 2001). Perhaps developing better charts and records, in liaison with all staff, might also ameliorate the situation. The literature demonstrates unequivocally that nurses are the professionals that patients have the most interactions with in the hospital environment (Williams, 1997). The work and competence of the nursing staff is therefore perhaps the most significant factor in determining quality of patient care (Williams, 1997), and so it is vital to ensure that nurses record their practice accurately so that their competence can be audited, and the effectiveness of their practice evaluated. If, as suggested, evidence-based practice is now at the heart of nursing care (DOH, 2001), then documentation will also allow the implementation of evidence based practice, through care protocols and pathways, and through auditing processes and reflective practice which reviews care against the available evidence. Martin et al (1999), in their research of nursing documentation activities, found that good nursing documentation supported the implementation of evidence-based practice. This takes us back to the quality of the documentation processes, and it may be that they are under development – towards evidence-based care pathways or the like, or this kind of thing may need implementing. Utilising alternative modes of documentation may also enhance practice and recording behaviours. Lee (2006) in a study of one computerised documentation system in practice, found that nurses generally viewed the content of the computerized nursing care planning system as a reference to aid memory, a learning tool for patient care, and a vehicle for applying judgement to modify care plan content. This suggests that such tools may do more than simply streamline nurses work (Lee, 2006). It may be that using a computerized care plan system can also enhance nurses’ knowledge, experience and judgement of descriptions of patient problems and care strategies (Lee, 2006). It is my opinion that it may also serve to minimise the kinds of errors that have occurred in the assignment scenario. The nature of the documentation (ie the content and structure) may therefore need to be changed. O’Connor et al (2007) show how new, streamlined nursing charts improved planning and evaluation of care and served promote patient involvement in the care and documentation processes. In reference to the discharge planning incident in particular, this might be an area to develop within the clinical area. One innovation which supports this is that described by the NHS (2007) in The Essence of Care, which was launched in February 2001, as providing a toolkit to help practitioners to implement a structured approach to sharing and comparing practice, through principles of clinical governance, enabling them to identify the best and to develop action plans to remedy poor practice. This would appear to be a key activity in the longer term to develop from the learning points contained within this problematic scenario. These kinds of benchmarks and guidelines can provide useful guidance, in association with other activities such as evidence-based care pathways and protocols, to develop more streamlined and effective practices. Another point of action is the need to carry out specific empirical research into this area. In a systematic review of research literature to test the hypothesis that care planning and record keeping in nursing practice has no measurable effect on patient outcomes, the authors were unable to identify any robust studies for review (Moloney and Maggs, 1999). This suggests that the potential effects of documentation failures cannot be fully evaluated, anticipated or described without future research. This also underlines the need to ensure the highest possible standards of care are both implemented and fully documented throughout every stage and componenet of nursing practice. This analysis shows that documentation serves a number of purposes within nursing practice. It records care, demonstrating and communicating what procedures were carried out, when, and why. It rationalises clinical decisions and evaluates clinical and nursing actions. It also allows the direction and planning of care. It provides legal proof that nurses have followed proper protocolsand procedures for the administration of medicines and blood products, for the implementation of medical and nursing orders, and in particular supports complex activities such as discharge planning. Lack of proper documentation can indicate that proper procedures were not carried out. Poor documentation can lead to confusion and to patient compromise, whereby a patient may not receive the medication required, or may erroneously receive an overdose. Similarly, the blood error could have had significant consequences, and should not have occurred, given the nature of the procedures involved, and the clear li nks between safety and existing documentation. These errors point to either a lack of competence in basic nursing procedures, or a lack of care on the part of the staff who made them. Documentation would also have supported the D grade nurse here when dealing with the problems. The discharge planning errors could have been dealt with more effectively if the documentation had been complete. This would be their primary source of information when dealing with a patient complaint and a complaint from a district nursing colleague. The expectation on all parts that such records will be complete and will answer the questions raised by all parties places the responsibility firmly on the nurse to ensure they properly fulfill this vital part of their role. Nurses can engage in proper documentation of the errors and incidents noted so that they are appropriately and comprehensively dealt with now that the errors have been identified, and so can meet all the professional requirements of their role within this siutation (NMC, 2004). And all staff can learn from these incidents, and be included in processes of research, improvement and development to implement better documentat ion and care practices in the future. References Atwal, A.. (2002) Nurses’ perceptions of discharge planning in acute health care: a case study in one British teaching hospital. Journal of Advanced Nursing 39 (5) 450-458. Austin, S. (2006) Ladies and Gentlemen of the Jury, I present: the nursing documentation. Nursing 2006 36 (1) 56-65. Bjorvell, C., Wredling, R. and Thorell-Ekstrand, I. (2003) Prerequisites and consequences of nursing documentation in patient records as perceived by a group of Registered Nurses. Journal of Clinical Nursing 12 (2) 206–214. Bull, M.J. and Roberts, J. (2001) Components of a proper hospital discharge for elders. Journal of Advanced Nursing. 35 (4) 571-581. Cheevakasemsook, A., Chapman, Y., Francis, K., Davies, C. (2006) The study of nursing documentation complexities. International Journal of Nursing Practice 12 (6) 366–374. Cleary, M., Horsfall, J. and Hunt, G.E. (2003) Consumer feedback on nursing care and discharge planning. Journal of Advanced Nursing 42 (3) 269-277. Department of Health (2001) ‘National Service Framework for Older People’, England: HMSO. Fielo, S. B. (1998) Discharge Planning for the Elderly: A Guide for Nurses. Nursing and Health Care Perspectives Volume 19(2) 94-95. Frank-Stromborg, M., Christensen, A.and Elmhurst, D. (2001) Nurse documentation: not done or worse, done the wrong wayPart I. Oncology Nurses Forum 28 (4) 697-702. Hyde, A., Treacy, M., Scott, P.A. et al (2005) Modes of rationality in nursing documentation: biology, biography and the voice of nursing. Nursing Inquiry 12 (2) 66–77. Ting-Ting Lee, T-T. (2006) Nurses perceptions of their documentation experiences in a computerized nursing care planning system. Journal of Clinical Nursing 15 (11) 1376–1382. Macleod, A. (2006) The nursing role in preventing delay in patient discharge. Nursing Standard. 21 (1) 43-48. Martin, A. Hinds, C. and Felix, M. (1999) Documentation practices of nurses in long-term care. Journal of Clinical Nursing 8 (4) 345–352. Moloney, R. and Maggs, C. (1999) A systematic review of the relationships between written manual nursing care planning, record keeping and patient outcomes. Journal of Advanced Nursing 30 (1), 51–57. Nazarko, L. (2007) Care planning and documentation. Nursing Residential Care. 9(7). 333-6. NHS (2007) Essence of Care Available from: http://www.tin.nhs.uk/local-networks/essence-of-care/background. Accessed 10-5-07. Nursing and Midwifery Council (2004) Code of Professional Conduct Available from www. nmc-uk.org. Accessed 30-4-07. OConnor, K., Earl, T. and Hancock, P. (2007) Introducing improved nursing documentation across a trust. Nursing Times. 103(6) 32-33. Qualey TL. (1997) Assessing the patients caregiver. Nursing Management. 28(6): 43-4. Reed, J. (2005) Using action research in nursing practice with older people: democratizing knowledge. Journal of Clinical Nursing14 594-600. Sollins, H. (2007) Handling difficult family situations: practical approaches. Geriatric Nursing. 28(2) 80-2. Williams, S.A. (1997) The relationship of patients’ perceptions of holistic nurse caring to satisfaction with nursing care. Journal of Nursing Care Quality 11 (5) 15-29.

The Pearl by John Steinbeck :: The Pearl John Steinbeck

The Pearl by John Steinbeck   Ã‚  Ã‚  Ã‚  Ã‚  The Pearl by John Steinbeck. This book takes place in Mexico during the nineteen hundreds in the city of La Paz.   Ã‚  Ã‚  Ã‚  Ã‚  The main characters are Kino an Indian pearl diver who finds the magnificent pearl and whose life is partially destroyed by this pearl. Juana is Kino's wife and faithful partner and she is obedient and devoted to her family. Coyotito is Kino and Juana's infant son he is bitten by a scorpion and recovers miraculously only to be later killed by a bullet.   Ã‚  Ã‚  Ã‚  Ã‚  The theme of this book is not to let greed or money to get in the way of you or your family. Greed is a destructive force and if not controlled it will effect you a lot maybe even forever, like the death of Kino’s son Coyotito. Another theme is fate because fate was a major aspect to why Kino did not succeed in his dreams of having a luxurious life. When Kino discovered the Pearl he thought that it would take him out of poverty and into a life of happiness. The pearl was not meant for anyone to find, and the finding of one was luck, â€Å"a little pat on the back by God.†Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  The problem in this story is that Kino is trying to sell his pearl and every one bids a low price. That means he keeps it longer and everyone is trying to steal it from him. The conflict is man vs. man the reason why is that a lot of people are trying to steal it from him the day he got it. It went to the point that people were tracking him for it and attacking him in his sleep.   Ã‚  Ã‚  Ã‚  Ã‚  I hated it when Kino went pearl diving and found the â€Å"pearl of the world,† and started making a scene. When you find something very valuable like that you keep that a secret and under ground. When you make a discovery with something valuable like that you do not deal in front of an audience you do it privately.