Injustice of Healthcare Essay Example | Topics and Well Written Essays - 1750 words

Injustice of Healthcare - Essay Example The health care system's systematic exploitation of the many for the benefit of the privileged few has been over-looked, underestimated, or conveniently ignored by analysts and policymakers. Contrary to the assumptions of many observers, ordinary Americans are not well served by health policies and practices founded on the premise that health care should be beyond price. There are numerous identifiable ways in which political and legal systems in the United States directly or indirectly foreclose opportunities for lower- and middle-income consumers to enhance their own, as well as aggregate, welfare by purchasing low-cost, arguably lower-quality health care and health coverage. In this essay, the over regulation of the providers has been outlined and the various theological and philosophical perspectives on the injustice have been produced in the subsequent sections. The most wide spread kind of regulation of the health care sector is entry control through occupational licensure. The barring from the market of individuals who do not meet minimum standards of competence in the regulated field of endeavor, can enhance consumers' welfare by minimizing both their exposure to risks of bad service and their uncertainty in purchasing complex services. However, entry controls raise costs by excluding providers who might serve some clients adequately and cheaply, thus forcing those clients (mostly lower-income individuals) to pay higher prices for arguably more reliable services. The resulting higher prices cause some consumers to forgo needed services, with adverse health consequences. The lower-income segment of the population, even if protected against costly mistakes, bears many more of the costs of exclusionary licensure than more affluent interests. In any field in which government regulates entry, entry standards will be inefficiently high, causing more hardship than is optimal. Although quality-enhancing standards limit opportunities for cost-reducing innovations, the consumers tend to value disproportionately the added security they are supplied. Occupational regulation has other costs besides those flowing from state-imposed restrictions on entry. State legislatures typically also delegate responsibility for regulating practice of a licensed occupation to its licensing board. Such boards make rules not only curtailing the supply of competitors but also suppressing advertising, corporate or commercial practice, and other practices that might intensify competition and foster consumer choice. Moreover, at the same time that they largely control the regulatory apparatus, the licensees in each field generally organize themselves privately not only to advance their political objectives, but also to set private standards for professional practice, educational programs, and institutional providers of services. Although such private entities may not directly enforce the standards they set, these standards and their accompanying certifications of compliance usually carry decisive weight in the marketplace and with state regulators. With the public generally unaware of the cost and competitive implications of such publicly sanctioned self-regulatory regimes, the interests of the regulated are commonly advanced at consumers' expense, with cost increases a

Business Ethics in the Footwear, Clothing, and Textile Industries Essay

Business Ethics in the Footwear, Clothing, and Textile Industries - Essay Example   Business ethics and conduct have been a major talking point in the TCF industry, especially with regards to the fairness of its dealings, processes, stakeholder treatment, and competition policies. The principle of fairness seeks to ensure that TCF organizations engage in; fair and free ethical competition deals with all stakeholders in a way that can describe as being equitable and fair and is non-discriminatory during the process of contracting and hiring (Braithwaite & Drahos, 2010: p401). This principle has been a problematic one within the TCF industry. The workforce is 80% female on minimum wage that averages $38 every month. This industry has the lowest costs of labor globally, and the workers’ unions are intimidated with violence in order to stay quiet on industry standard violations (Sajhau, 2013: p34). The industry needs to create a more friendly culture for workers, enforcing freedom of association sans victimization, pro-labor legislation, balance the gender in equality gap, and fire and building inspection codes. This can be achieved with the help of global retailers.   Issues related to diligence and loyalty is an important concern with regards to business ethics in the TCF industry. The industry would be required to act as a fiduciary for investors and the company by carrying out the organization’s operations in a loyal and diligent manner expected of trustees (Braithwaite & Drahos, 2010: p402). Corporate ethics are reflective of the business’ philosophy, and one of its objectives is the determination of the company’s fundamental purposes.

Foreign market entry strategies Essay Example for Free

Foreign market entry strategies Essay â€Å"Firms which participate in the business system as partners complement the company and its suppliers, thereby increasing the value to customers†. Explain your understanding of this view and provide examples to reinforce your arguments. For a company, entering new foreign markets may be achieved in a variety of ways. Each of these ways places its unique demands on the company in terms of organizational and financial resources. Most of the times, entering international markets is not a matter of choice but of necessity to remain competitive in new or established markets by meeting the consumer’ needs and values. The decision to go international represents an important commitment, to go into a new line of activity, this being the reason why it should be taken step by step: obtaining information, analyzing them, formulating alternative action plans, (Tookey, 1975) and of course find the right partners that match the company brand image and values. The international business system model is focused on the advantages determined by the internationalisation process and less on the development process of the internationalisation of companies. The main scope obtained by applying the Uppsala Model is predicting the company’s evolution on foreign markets. Two elements are at the basis of the model: the notion of essentiality attributed to the process and the notion of physical distance. The internationalisation of a multinational company takes place step by step, according to the Uppsala Model, which minimises the risks regarding the new market (Johanson; Wiedersheim-Paul, 1975). Therefore, the company is being involved gradually (investments, control and profit), getting to the point of creating a production subsidiary which ensures also the selling of the products on the new market. The stages of the internationalisation process are presented in Appendix 1. The concept of physical distance, the second element the Uppsala Model is based upon determines the companies to select, in a first stage, the neighbour countries in order to reduce the cultural, economical, political differences. According to this approach, the bigger the physical distance, the bigger is the incertitude about the new market and bigger the risks associated to this market. In the view of the globalisation phenomena, there are numerous criticisms about the â€Å"physical distance† notion. Many papers have developed the subject of the company’s internationalisation; a special place holds J. Birkinshaw who analysed the problems regarding the role of the subsidiaries and the evolution of the mandated in the internationalisation process at the multinational’s level. Therefore, Birkinshaw and Hoods (1998) have shown that creating a subsidiary can be explained on the basis of the interactions between the decisions of the mother-company, the initiatives o f the subsidiary and the specific conditions existing on the new market. The model developed by Birkinshaw (1997) is based on three variables: The relation headquarters – subsidiary; the subsidiary’s initiatives and the local environment. Regarding the internationalisation process, the company has more options (see Appendix 2) The first choice is represented by the development of the existing markets and it is being used by companies that are acting on highly competitive markets; the second choice – the company can choose to develop its activity on new markets, similar to the ones they are already acting on – in this case, they are usually choosing to export their products; the third strategy is developing a new line of products similar to the ones they already have and which will be sold on similar markets- in this case the company can choose between strategic alliances: creating a joint venture or licensing. . Management’s involvement in export operations is different, as we talk about passive exporters (when selling abroad is induced by the demand existing on the foreign market, meaning that the business is initiated by the importer) or active exporters (when the operation is initiated by the seller, which has an export strategy and a suitable business plan (Popa, 2006) From the operational point of view, exporters can be indirect exporters(with the participation of trading houses), when it isn’t necessary to create an organizational structure specific to the export activity or direct exporters, which is made by the producer, which is creating services or departments for international business. The determinants of export behaviour are experience and uncertainty effects; behavioural and firm-specific influences and strategic influences. 1. Experience and uncertainty effects Knowledge and learning regarding the exporting activity may be possessed or accumulated by the company in time. Experience has a key role, as firm’s involvement in international markets is most of the time a gradual process. During the early stages of exporting, firms have a more concentrated foreign market focus, while increased involvement in foreign market encourages diversification to a wider range of markets. As a firm’s knowledge of an export market increases, the uncertainty factor diminishes. This knowledge allows the identification of concrete opportunities, as distinct from theoretical that may be apparent from objective knowledge. 2. Behavioural and firm-specific influences Recent theories of exporting are strongly influenced by the behavioural theory of the firm, which stresses decision-maker characteristics, organizational dynamics and constraints, ignorance and uncertainty as key variables in decision making. Exporting has been described as a development process based on a learning sequence involving six stages Bilkey and Tesar, 1977): Stage 1: the firm is not interested in exporting Stage 2: the firm supplies unsolicited business, doesn’t examine the feasibility of active exporting Stage 3: the firm examines the feasibility of exporting in an active way Stage 4: experimental exports on neighbour countries Stage 5: the firm becomes an experienced exporter Stage 6: the firm explores the feasibility of exporting to additional countries of greater business distance. According to Welch (1982), the export commitment is influenced by four groups of factors (see figure 4): pre-export activities, direct export stimuli, latent influences on the firm and the role of the decision-maker. 3. Strategic influences The opinion among researchers and managers is divided on the issue of the relation between the firm size and export success. Still, the importance of a positive managerial attitude to exporting and the necessity of committing managerial and financial resources to the internationalization process are crucial to the success of the firm, irrespective of size. As a mode of international market entry, strategic alliances allow the firm (Bradley, 2002): †¢ Access to assets not readily available in the market †¢ Access to technology and markets †¢ The smaller firms can have access to technology and new products †¢ The larger firms can have access to markets †¢ Synergetic effects in the partner firms. Choosing the way to enter a foreign market represents an important part of the foreign direct investment strategy. The companies should select the new market, decide upon the types of operations that are about to be developed on these markets and decide the type of entry –green field investments, acquisitions, joint ventures. Choosing the way to enter a foreign market was also explained through cultural and national factors. Many studies have been concerned about this topic: †¢ Kogut and Singh (1988) after researches have concluded that a big cultural distance between the country of origin and the host country have as a result choosing joint ventures or green field investments. †¢ Gatignon and Anderson (1988) have shown that an important socio-cultural distance, measured with the help of the Index developed by Ronen and Shenkar (1985) goes to the partial propriety right. †¢ Gatignon and Anderson (1988) have concluded that multinational companies avoid having 100% owned subsidiaries in high risk countries. †¢ Cho and Radmanabhan (1995) have shown that companies from Japan are not willing to make acquisitions in developing countries. Choosing the joint venture as a mechanism to enter new markets (especially the developing countries and the ones with centralised economy) is usually a sec ond-best option for the companies from developed countries. Still, the companies show through this the major interest for the local market; the participation in the joint-venture could be qualified as a foreign direct investment. Many times, this mechanism represents the only way to be present on a certain market. Licensing in international markets: License is the purchase or sale by contract of product pr process technology, design and marketing expertise (Bradley, 2002). It involves the market contracting of knowledge and know-how. International licensing takes place when a company provides, for a certain fee-royalty, a technology needed by another company in order to operate a business in a foreign market. Licensing of this firm involves one or more of these elements: †¢ a brand name †¢ operations expertise †¢ manufacturing process technology †¢ access to patents †¢ trade secrets. Licensing may be attractive when host countries restrict imports or foreign direct investment, or when the market is small and when the prospects of technology feedback are high. Franchising to enter international markets: Franchising is a derivative of licensing. In franchising a business format is licensed, not a product or a technology. Trademarks, trade names, copyright, designs, patents, trade secrets and know-how may all be involved in different mixtures in the „package† to be licensed. Franchising is a form of marketing and distribution in which the franchisor grants an individual or company, the franchisee, the right to do business in a prescribed manner over a certain period of time, in a specified place (Ayling, 1986). A franchise is, according to International Franchise Association (IFA), the agreement or license between two legally independent parties which gives: †¢ a person or group of people (franchisee) the right to market a product or service using the trademark or trade name of another business (franchisor) †¢ the franchisee the right to market a product or service using the operating methods of the franchisor †¢ t he franchisee the obligation to pay the franchisor fees for These rights †¢ the franchisor has the obligation to provide rights and support to franchisees. Types of Franchises There are two main types of franchises: product distribution and business format. Product distribution franchises simply sell the franchisor’s products and are supplier-dealer relationships. In product distribution franchising, the franchisor licenses its trademark and logo to the franchisees but typically does not provide them with an entire system for running their business. The industries where you most often find this type of franchising are soft drink distributors, automobile dealers and gas stations. Some familiar product distribution franchises include: Pepsi, Exxon, Ford Motor Company. Although product distribution franchising represents the largest percentage of total retail sales, most franchises available today are business format opportunities. Business format franchises, on the other hand, not only use a franchisor’s product, service and trademark, but also the complete method to conduct the business itself, such as the marketing plan and operations manuals. Business format franchises are the most common type of franchise. The United States, today reported that the 10 most popular franchising opportunities are in these industries: fast food, retail, service, automotive, restaurants, maintenance, building and construction, retail—food, business services, lodging. The many advantages and disadvantages of owning a franchise should be carefully evaluated before deciding to purchase one. Throughout all these different foreign market entry strategies, by understanding every characteristic detailed we can conclude that partnership can be at the core of international marketing decisions and enable possibilities of internationalisation. Partnerships can be structured in various ways depending on their purpose. Wholly foreign-owned enterprises, non-equity/contractual/co-operative strategic alliances, equity strategic alliances/joint ventures, and franchises, are basic types of formal partnerships. There are numerous other types of informal partnerships including; joint marketing promotion, joint selling or distribution, technology licensing, R D contracts, design collaboration, production agreements, and other synergies. Consequently, the ideal partner in a business partnership is one that has resources, skills and assets and values which complement the company. The partnership has to work financially and contractually, but it is also essential that a partner’s areas of strength and weakness are known and that an assessment is made of what actions would be needed to achieve an appropriate level of operational fit between the cultures of the two organisations. To meet the market needs effectively and in a sustained way, the business partnership must be based on a systematic and transparent agreement between the client and the partners (common values). That agreement provides the basis for a partnership deal and has to be sufficiently strong to engage the sustained commitment of both parties but also sufficiently flexible to enable the partnership to be responsive to changes in market needs and conditions. Being at the forefront partners are an extension of the company capability, image and valu es perceived by the consumer, therefore, complement the company by increasing the value to customers. For instance, Sony is an international and reputed company for its high standards range of TVs. Today, within the UK market, Sony position itself as a seller of durable and high end products by practicing a selective distribution. Their products are mostly found at Sony Centres (Sony own shop) or PC Currys World, exclusive partner (distributor) chosen by Sony well known in the market and sharing similar values such as expertise in the audiovisual area or guarantee of quality products and services. It reflects well a relevant and consistent image of the values conveyed by both organisations to the customers.

Violence Against Nurses In Psychiatric Health And Social Care Essay

Violence Against Nurses In Psychiatric Health And Social Care Essay Violence is currently prevalent in every sphere of social life. Nowadays, health care personnel are facing more harsh behaviours than ever before, here in Jordan. The rising rate of violence in health care settings has become a major problem for nurses. Nurses are at considerable risk of occupational (work-related) violence. Working primarily in psychiatric departments resulted in an increased risk for both physical assault and non-physical violence (Nachreiner, et al., 2007). Psychiatric health care providers have high rates of work place violence victimization, but yet little is known about the strategies used by them and their facilities to manage, reduce, and prevent violence (Peek-Asa, et al, 2009). Their presence in stressful situations such as incidents (violent incidents), suicide attempts, waiting to visit a doctor, or transfer of patients to another ward or another hospital exposes them to more abuse or harsh behaviour from patients, families, relatives and friends than oth er hospital staff (Kwak et al., 2006). The motivation of this paper stemmed from a recently news in the media reporting the increased incidents of violence and aggression faced by nurses in Jordanian hospitals. The media news prompted the author to reflect on current knowledge and understanding of these events in both in Jordan and around the world to make recommendations for managing reducing, and prevention of these events in the future. Recommendations for future research in this area were addressed also. Recommendations for future research will enable nurses to deepen their understanding of violence and aggression in psychiatric settings which in turn will lead to improved strategies, policy and practice leading to increased safety for nurses and patients. This paper was intended to be a commentary paper on the phenomena of violence in psychiatric settings; however, to comment on this phenomenon an extensive literature review was conducted and will be presented also. The paper design compared the violence with the cr ime. The perpetrator of this crime is the psychiatric or mentally ill patient, while the victim is the psychiatric/mental health nurse. The scene where the crime occurred is the psychiatric setting. The Aim This paper aims to provide a general understanding of the whole picture of violence against nurses in psychiatric settings. In order to achieve that, this paper addressed the following topics: (1) Recent epidemiology of episodes of violence in psychiatric words, (2) Defining violence and related concepts, types, and forms, (3) The perpetrator, (4) The victim, (5) Prevention of violent incidents, (6) Assessment of violence, (7) Management of violent episodes. Methods The following databases were searched: EBSCO host service databases (Academic Search complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus), MEDLINE, Psychology and Behaviours Sciences Collection). These databases were searched for English language papers published between 1 January 2006 and 1 April 2011 using the key words violen* (violence or violent) and in-patient or psychiatric words or psychiatric settings. Limiters were used in each database to include and exclude certain studies. The search was limited to full text articles, available references articles , articles published between 1 January 2006 and 1 April 2011 in scholarly (peer reviewed) journals. Special limiters for Academic Search Complete were periodical publications, English language articles, and articles with PDF full text. Special limiters for CINAHL Plus were articles with available abstract, English language articles, research articles only, articles that considered humans only as research subjects, articles with at least one nurse author, studies conducted in inpatient settings only, and articles with PDF full text. Special limiters for MEDLINE were: articles with abstract available, English language articles, articles that considered humans only as research subjects, articles published in nursing Journals only. Only PDF full text articles were searched in psychology and Behavioural Sciences Collection. After completing search, 197 studies resulted. Most of them were included in this paper. However, some were not included because they did not respond to the objects of this paper. Some of studies in references lists of the resultant articles were also reviewed and included for epidemiological purposes even they are older than five years. Some of them were also used for critically reviewing the updated studies (à ¢Ãƒ ¢Ã¢â€š ¬Ã‚ °Ã‚ ¥5 years). Definitions Violence in the workplace can take various forms ranging from abusive language, threats, physical assaults, and even homicide (Wassell, 2009). There are many different definitions of violence. This section will define and differentiate between violence forms and forms. The world Health Organization (WHO) define violence as: The intentional use of physical force or power, threatened or actual, against oneself another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevlopment, or deprivation (WHO, 2005, p.5). Work-related violence is any activity or event occurred in the work environment involve the international use of physical or emotional abuse against an employee, resulting in negative physical and emotional consequences (Nachreiner, et al., 2007). A less restrictive definition was the definition of Baron and Neuman; they define workplace violence as direct attacks which occur in the work place itself or within an organization (Baron Neumann, 1998). Physical assault is hitting, slapping, kicking, pushing, grabbing, sexually assaulted, or any type of physical contact aimed to injury or harm (Nachreiner et al.). A threat occurred when someone used words, gestures, or actions for freighting another one without attempting harm or injury (Nachreiner et al.). Sexual harassment occurred when one is a subject for any type of unwanted sexual behaviour (words or actions). (Nachreiner et al.). Verbal abuse is calling another person -must be associated with the name- with unfavourable words for the purpose of hurting emotionally injuring. Jenkins (1996) believes that even threat of physical violence is considered physical violence (Jenkins, 1996). WHO determined three types of violent acts: physical, sexual, and psychological (WHO, 2005, p.6). Violence and aggression are two interrelated concepts extensively studied in nursing literature. Although, they are not the same, nursi ng literature widely used them interchangeably. In this paper, violence and aggression will be used interchangeably. Epidemiology The risk of being subjected to violence among health staff is 16 times higher than in other occupational groups in the service sector (Kingma, 2001). There is an escalating alarming trend of all forms and types of violence towards nurses in health care settings (Whelan, 2008). Nurses are at the highest rates of nonfatal workplace assault and violent victimization in all health care settings (Lanza, Zeiaa, Rierdan, 2006). There is a considerable difference in the prevalence and incidence of episodes of violence in mental health settings, depending on the countries in which the studies were carried out. A survey of 4.826 nurses conducted by the American Nurses Association, 17% reported that they have been physically assaulted, and 57% reported that they had been abused in the last year (Peek-Asa, et al., 2009). Also, only 20% reported that they felt safe in their current work environments. Psychiatric nurses are the highest subjects of violent victimization rates of all types of nurse s (Islam, Edla, Mujuru, Doyle, Ducatman, 2003). In an analysis of the results of the Assaulted Staff Action Programme (ASAP) that persists for 15 years; 1.123 mental health nurses (69.58%) were victims of violence by patients. They were the subjects of physical (85.32%), sexual (1.18%), nonverbal intimidation (1.67%), and (6.01%) assaults. 46.34% of injures were soft tissue bruises, 10.16% were head and back injuries, 5.76% were bone/tendon/ligament injures, 12.39% were open wounds, scratches, or spitting incidents, 1.8% were abdominal wounds, and 18.65% were psychological fright. 36.69% were mild injures, 31.52% were moderate, and 14.13% serious and intense (Flannery, Farley, Rego, Walker, 2007). A survey in psychiatric institutions in Switzerland reported that 70% percent of nurses reported being physically attacked at least once in their career (Needham, et al., 2004). A multiregional study of nursing staff members from acute psychiatric settings showed that 76% of the particip ants reported that they were assaulted at least once (Peek-Asa, et al., 2009). In a study in Iran, verbal abuse was experienced by 87.4% of nurses during a 6-month period, and physical violence by 27.6% during the same period of time (Shogi, Sanjari, Shirazi, Heidari, Salemi, Mirzabeigi, 2008). The most frequent and most severe forms of verbal abuse reported were judging and criticizing, accusing and blaming, and abusive anger (Kisa, 2008). In one Arabic study, a national cross sectional survey was conducted in Kuwait to document the prevalence and determinants of violence against nurses in healthcare facilities. 48% of nurses experienced verbal violence; and 7% only experienced physical harm over the previous six months (Adib, Al-Shatti, Kamal, El-Gerges, Al-Raqem, 2002). Another Arabic study in Bahrain, Hamadeh and colleagues found the average assault rate on nurses is 4.4%. (Hamadeh, Al Alaiwat, Al Ansari, 2003). No similar studies were conducted in Jordan. However, this high results may be an emergent indicator of the escalating trend in Jordan and other Arabic countries because of their similar Arabic culture to Kuwait and Bahrain. Epidemiological studies were recommended to conduct to determine the incidence and prevalence of this phenomenon in Jordanian health care settings and especially in mental ones. Despite the high prevalence of violence acts toward nurses, only 20% of violent incidents are reported by nurses. This is due to staff being accustomed to violence; peer pressure not to report; differential reporting based on gender of the victim, fear of blame; excessive paper work; and incomplete or invalid information on reports completed by persons not witness to the event (Crilly, Chaboyer, Creedy, 2004). This problem should also be addressed in future studies to investigate its causes and to solve it. The Victim Nurses are usually the subjects of violence victimization. However, Other mental health care professionals such as physicians and physiotherapists are also at a considerable of violent acts (Stubbs Dickens, 2009). This paper addressed nurses only as subjects of victimization from psychiatric and mentally ill patients. Psychiatric patients assaults on nurses victims are a worldwide occupational problem. There is remarkable consistency in victim characteristics over time (Flannery, Juliano, Cronin, Walker, 2006). Men nurses were exposed to more abuse than women (Shagi, et al., 2008). However, there is an inconsistent finding in the literature identifying whether males or females are more violence-prone (Camerino, Estryn-Behar, Conway, Der Heijden, Hasselhorn, 2008). The risk of experiencing abuse was higher in nurses with more job experience or who worked more hours (Shagi et al.). On the other hand, a longitudinal cohort study showed that younger nurses with less job experiences are at increased risk violence (Camerino et al., 2008). However, exposure to violence was not significantly associated with age, gender, duration of employment in nurses working in child and adolescent psychiatric units (Dean, Gibbon, McDermott, Davidson, Scott, 2010). Having a lower job title (air or practical nurse), b eing in closer contact with patients, having special personality traits, using drug or alcohol, reporting extreme fatigue , may lead to higher risks for aggression and harassment at the workplace (Cooper Swanson, 2002). Nachreiner et al, agree with Copper Swanson on that LPNs an increased risk for both physical assault and non-physical violence compared to RNs (Nachreiner et al, 2007). Violent incidents are often related to the low awareness of nurses about the adequate therapeutic communication skills in dealing with patients (Cooper Swanson, 2002). Perceptions attitudes of nurses on patients violent incidents in psychiatric settings are extensively studied in the literature. Psychiatric nurses attitudes are different across countries (Jansen, Middel, Dassen, Reijneveld, 2006). According to some nurses violence is perceived as dysfunctional/undesirable. Whereas in others, violence is perceived as a functional comprehensible phenomenon (Abderhalden et al., 2002). 97% of participants believed that dealing with aggressive behaviour was a part of work in mental health inpatient unit (Dean, Gibbon, McDermott, Davidson, Scott, 2010). In the same study, 69.7% of participants believed that the current level of physical aggression in the ward was unacceptable, whereas only 12% report that it was acceptable, and the others reported feelings of uncertainty (Dean et al, 2010). They rationalize that by recognize that staff with more positive attitudes exhibited lower state anxiety. There are negative attitudes of nursing students to violen t incidents, and these attitudes are deteriorated over time (Bowers, Alexander, Simpson, Ryan, Carr-Walker, 2007). The perception of aggression scale (POAS) is a newly developed attitude inventory assessing nurses attitude toward aggressive patients (Palmstierna Barredal, 2006). Consequences of violent incidents on nurses were also extensively investigated in the literature. Responses to violence encompassed three major categories relating to physical emotional and professional impact (Dean, et al., 2010). They found that physical injuries divided to: direct injuries from the violent incidents, injuries while implementing restrictive interventions, and physical symptoms such as headache and muscle tension (Dean, et al.). Major physical injuries were on the head, the trunk, the upper and lower extremities (Langsrud, Linakker, Morken, 2007). Ongoing mental fatigue, stress, shock, helplessness, anger, vulnerability, feelings of being emotionally drained, anxious, impaired sleep and concentration were all emotional responses of nurses as a result of being violent (Dean, et al.). Nurses also respond with the following emotions and behaviours: frustration, despair, hopelessness, substance abuse, absenteeism, retaliation and the development of I do not care attitu de (Bimenyimana, Poggenpoel, Myburgh, Niekerk, 2009). The results of verbal abuse or violence by patients, often result in a severe psychological impact in nurses (Inoue, Tsukano, Muraoka, Kaneko, and Okamara, 2006). The most common emotional reaction to violence was anger, followed by shame, humiliation and frustration (Kisa, 2008). The Perpetrator Violence is common among individuals entering mental substance abuse words. Episodes of violence on psychiatric wards have been extensively studied, with one of the main aims being to identify who is more likely to be violent during hospitalization. However, it is difficult to determine that, because violence is a complex behaviour links with a variety of biological, psychopathological, and social factors. 15-years study concludes that older male patients with schizophrenia and younger personality-disordered patients are high-risk assailants (Flannery, Juliano, Cronin Walker, 2006). Antisocial personality disorder poses a great risk for violence among women than men (Yang Coid, 2007). Anxiety disorders and any personality disorder are more severe among violent women; alcohol dependence and hazardous drinking are more severe among violent men (Yang Coid). In a recent literature, Cornaggia and colleagues found that the psychiatric diagnosis most frequently associated with aggressive behaviour is paranoid schizophrenia. As patients with paranoid schizophrenia retain sufficient ability to plan and commit acts of violence related to their delusions (Cornaggia, Beghi, Pavone, Barale, 2011). Higher levels of hostility-suspiciousness predict the worsening of the pattern of violence (Amore et al., 2008). Persecutory delusions appear to increase risk of violence in some patients; co-occurren ce of persecutory delusions and emotional distress may increase the risk of violence (Bjorkly, 2006). Lower social class of origin, offending behaviour in the parental generation loss of the father, a new partnership of the remaining parent, growing up in blended families promoted the development of offending behaviour in general (Stompe, et al., 2006). Past history of violence toward others, substance abuse disorders are risk factors for future violence (Flannery, Julliano, Cronin, Walker). Past history remains the most consistent and stable predictor of future violence (Amore et al., 2008). Dual diagnosed patients with substance abuse disorders and bipolar sample have more violent acts (Grunebaum, et al., 2006). Black and minority ethnic are more often perceived as potentially violent to others (Vinkers, Vries, Van Baars, Mulder, 2009). Internalizing symptoms and affective reactivity contributed to aggression severity more than impulsivity and demographics (Kolko, Baumann, Buks tein, Brown, 2007). Even the month of birth of patients is considered a risk factor of violent behaviour (Cailhol, et al., 2009). Repeatedly violent patients had a higher length of residency, a higher number of previous violent behaviours (Grassi, et al., 2006). A past history of head injury with loss of consciousness was more frequent among persistently physically aggressive patients (Amore, et al., 2007). Assessment Many studies also discussed high risk children in the literature. Aggression appears associated with a wide variety of commonly psychiatric disorders in children (Connor McLaughlin, 2006). Children of bipolar parents are at high risk of hostility, aggression, violence (Farchione, et al., 2007). Adolescent conduct disorder patients are more likelihood to be violent (Ilomak, Viilo, Hakko, Marttunen, Makkikyro, Rasanen, 2006). Children with learning disabilities who had a comorbid psychiatry diagnoses reported a significantly higher amount of peer victimization than children without a cormobid psychiatric disease (Baumeister, Sterch, Geffken, 2007). Many other results showed results opposed to what known. Foley and colleagues found that violence at presentation with first-episode psychosis is not associated with duration of untreated psychosis (Foley, Browne, Clarke, Kinsella, Larkin, O`Callagham, 2007). No substantial evidence support the relation between insight and violence risk (Bjorkly, 2006). The Scene The scene of violence victimization against the psychiatric nurses by psychiatric and mentally ill patients is the psychiatric settings. The structure of the setting can provoke the manifestation of violence (Steffgen, 2008). Also, environmental design have been demonstrated to deter violence (Wassell, 2009). Inadequate staffing levels and lack of opportunities for clients to participate in therapy may provoke violence behaviour (Sturrock, 2010). The role of uncertainty concerning job stability represent a casual factor Also, lack of job security may cause violent behaviour The absence of social support and co-workers increases the risk of nurses in this setting to physical and verbal violence (Steffgen). The occurrence of workplace violence may cause damage to both the individual and the institutions. Organizations may face increased absenteeism, sick leave, property damage, decreased performance and productivity, security costs, litigation, workers compensation, and increasing turn over rates (Jackson, Clare, Mannix, 2002). Prevention Previous nursing literature suggested a number of strategies that can be considered by nurses to prevent violence. There is limited research on effective interventions to prevent patient violence (Kling, Yassi, Smailes, Lovato, Koehoorn, 2010). However, failing to accept and implement preventive measures in psychiatric settings has an impact to reduce violence in these settings (Wassell, 2009). Improved reporting may be of big benefit of reducing physical violence (Nolan Citrome, 2007). This may be occur by early recognition and intervention of potentially occurring violent incidents in the future. After conducting the Violence Prevention Community Meeting (VPCM), a significant decrease in patients violence were found across day, evening and night shift for pre-treatment vs. treatment and pre-treatment vs. post treatment comparisons. VPCM is a semi-structured protocol for the purpose of violence prevention (Lanza, Rierdan, Forester, Zeiss, 2009). Early recognition has strong practical implications for psychiatric nurses by helping them to assist patients with the detection of early warning signs. Early recognition is pay special attention to the early social and interpersonal factors that may deteriorate the patient behaviour to violent one (Fluttert, Meijel, Webster, Nijman, Bartels, Grypdonck, 2008). Steffgen identified many preventative measures of workplace violence such as: measures concerning the physical environment, measures concerning the management of the organizations and the behaviours of the members in the organizations, policies, counselling and training measures (Steffgen, 2008). A 6-module program have been shown to be effective in reducing and preventing violent incidents in a 6-months evaluation period. The 6 modules were about violence risk assessment, theoretical models of violence, assertive training, ethical legal issues of violence management (Anderson, 2006). Dubin et al identified six gold recommendations to prevent violence incidents in psychiatric emergencies. Firstly, all newly admitted patients should be assessed for risk of violence; those who have risk factors should be continually assessed. Second, nurses should avoid evaluating and/or treating patients at risk for violence alone or in an isolated office. Third, nurses must remember that patients violence is a response to feelings of helplessness, passivity, and perceived or actual humiliation; therefore nurses should avoid becoming verbally or physically towards them. Fourth, nurses are supposed to use non-coercive methods such as de-escalation to prevent escalation of patients aggression. Fifth, limit setting should always offer the patient two options with one option being the preferred option. Sixth, an armed patient should not be threatened and the clinician should respond in a non-threatening manner offering help and understanding. Finally, evaluation of environment safety s hould occur periodically and changes should be implemented that will enhance safety (Dubin, Julius, Novitsky, William, 2009). Assessment The first step in mental nursing process and one of the most important duties in psychiatric settings is assessment. Psychiatric nurses are faced with a great number of situations in which risk assessment are needed. Risk assessment is a process concerned with a variety of issues à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬risk for what, when, where, and to whom-not just the were Prediction of future violence (Haggard-Grann, 2007). Predicting violence has been compared to forecasting the weather. Like a good weather forecaster, the nurse does not state with certainty that an event will occur. Instead, he/she estimates the likelihood that a future event will occur. Like weather forecasting, predictions of future violence will not always be correct (Scott Resnick, 2006). Three major types of violence risk assessment are extensively reviewed in the literature. The three types are: (1) Clinical violence risk assessment, (2) Structural risk assessment tools, (3) Functional assessment. The number of risk assessment instruments has increased in the recent years (Haggard-Grann). Risk assessment tools should include situational aspects, behavioural patterns, and predicted events or stressors (Haggard-Grann). The first step when determining which instrument to use for a specific risk assessment is to determine the purpose and context for which the instrument is needed (Haggard-Grann). Decision should be made regarding whether the assessment is for the first time (to separate the highly risk patients from others) or for continuous ongoing assessment (Haggard-Grann). If adopted in clinical practice with a professional way, these instruments will indeed aid in the assessment and early recognition of violent incidents. However, they are inescapable part in the clinical practice in psychiatric settings. (Haggard-Grann). Awareness of the limits and abilities of such instruments is required. Lurigio and Harris underscored the importance of performing more accurate assessment tools that can for example determine the upcoming type of violence, or the likelihood of weapons use (Lurigio Harris, 2009). A risk assessment tool mainly contains two types of factors: static and dynamic. Dynamic factors are of a great importance in a decision context whereas static factors are at less importance. Dynamic factors should be assessed regularly in a structured time schedule (ex. every 1 hr). (Haggard-Grann). Static variables are based on intrapersonal factors (ex., personal biological characteristics) that served as risks factors for a patient to be potentially violent in the future. (Haggad-Grann). Many violent risk assessment tools were developed for the aim to assess the violent incidents in psychiatric settings. Sexual Aggression scale is an effective assessment tool to record systematically the occurrence of sexually aggressive behaviours for patients who reside in psychiatric hospitals. (Jones, Sheitman, Hazelrigg, Camel, Williams, Paesler, 2007). It is a brief scale consists of 4 sub scales with a brief description of them. The Alert System is a system includes a risk assessment form used by nursing staff to assess patients upon admission to the psychiatric setting in order to identify these at an increased risk of violence (Kling, et al ., 2010). If identified as at risk for violence, a flag is placed on the patients chart and wristband to contain staff of a patients potential for violence (Kling et al). The warning is intended to allow workers to take precautions to prevent violent incidents in flagged patients. These precautions may include: wearing a personal alarm, being near a security personals, not having sharp objects in the patients room, and not entering the patients room alone (Kling et al). Study results indicate that the Alert System is effective in identifying potentially violent patients. However, the ultimate goal of implementing the Alert System is to reduce the risk of violent incidents (Kling et al). Risk for in-patient violence in acute psychiatric intensive unit can be a high degree be predicted by nurses using the Broset violence checklist (Bjorkdahl, Olsson, Palmstierna, 2006). The BVC is a method to predict risk for violence from patients within the coming 24 hrs in acute psychiatric inpatient settings (Bjorkdahl, Olsson, Palmstierna). BVC is used to assess the patient three times daily: in the morning, noon, and night shifts (Bjorkdahl, Olsson, Palmstierna). The BVC assess absence or presence of six behaviours: confusion, boisterousness, irritability, verbally, threatening, physically threatening and attacking object (Bjorkdahl, Olsson, Palmstierna). The HCR-20 is a structured professional checklist designed for the assessment of risk future violence in patients with violent history / or a major mental disorder or personality disorders. (De Vogel De Ruter, 2006). The HCR-20 consists of 20 items, divided into three subscales: historical scale, clinical scale, and risk management scale. The predictive validity of the HCR-20 was good (De Vogel De Ruiter). The Forensic Early Warning Signs of Aggression Inventory (FESA) was developed to assist nurses and patients in identifying and monitoring early warning signs of aggression in forensic patients (Fluttert, Meijel, Leeuwen, Bjorkly, Nijman, Grypdonck, 2011). The Maudsley Violence Questionnaire contains 56-items measure a number of cognition (including: beliefs, rules, distortions and attributions) that are related to violence (Warnock-Parkes, Gudjonsson, Walker, 2007). The Psychopathy Checklist (PCL) is a clinical rating scale designed to measure psychopathic attributes in mentally ill patients, Patients who score higher have higher rates of violent recidivism (Scott Resnick, 2006). The PCL uses a semi-structured interview, case-history information, and specific criteria to rate each of 20 items on a three- point scale (0, 1, 2). (Scott Resnick). Total scores (ranging from 0 to 40) reflect an estimate of the degree to which the patient matches psychopathy (Scott Resnick). The Violence Risk Appraisal Guide (VRAG) is a risk assessment instrument of 12 items. It is probably the most well-known assessment instrument aimed to assess dangerousness in high-risk mentally ill patients. It is used to appraise the violence risk in psychiatric and other health settings (Scott Resnick, 2006). It is constructed by taking variables known to predict violent behaviour among men with mental disorders who have records of previous violent behaviour then summarizing the variables into one scheme (Haggard-Grann, 2007). Interactive Classification Tree is a recent tool for assessing the violence risk of patients discharged from psychiatric facilities (Scott Resnick, 2006). This tool utilizes a sequence of questions related to risk factors for potential violence (Scott Resnick). According to the answers, another related question is posed, until the pt is classified into a category of high or low risk of future violence (Scott Resnick). Structured risk assessment tools have inherent limitation when used alone. Criticisms of instruments include the following: they provide only approximations of risks; their use is not generalizable beyond the studied populations: they are rigid, and they fail to inform violence prevention risk management (Scott Resnick, 2006). Functional assessment approaches seek to clarify the factors responsible for the development, expression and maintenance of problem behaviours. This is achieved through assessment of the behaviour of interest, the individuals predisposing characteristics, and the antecedent events, considered important for the initiation of the behaviour, and the consequences of the behaviour, which maintain and direct its developmental course (Daffern, Howells, Ogloff, 2007). They identify 9 common functions of violent behaviour in psychiatric settings in the literature: demand avoidance, to force compliance, to express anger, to reduce tension, to obtain tangibles, social distance reduction (attention seeking), to enhance status or social approval, compliance with instruction, to observe suffering (Daffern, Howells, Ogloff). Functional assessment have many implications for the prediction and prevention of inpatient violence and for the treatment of violent patients. The distinction of functional assessment approaches and structured assessment tools is that the first emphasize the correct classification of the form of a particular behaviour and the other one emphasize the purpose of the behaviour (Daffern, Howells, Ogloff). The clinical risk assessment method is the oldest method of violence risk assessment. It is the classical method of expecting, predicting, and assessing of risk. This means that the nurse gathers the information that he or she believes to be useful and on the basis of that information makes a judgment of the risk (Haggad-Grann, 2007). Unfortunately, this method cannot predict future violence with high accuracy. The accuracy of a

Roger’s Theory as compared to that of Ellis’ Theory Essay -- Psycholog

Anderson (n.d) states, â€Å"Carl Rogers, a pioneering psychotherapist and the most influential psychologist in American history was one of the most prominent people of his time.† Rogers’ ideas and practices brought about a change in the school of humanistic psychology. What he learned in philosophy and philosophy of education influenced his personal life experiences which led him to a revolutionary of theory of therapy (Corsini, 2011 p. 148). According to an electrical resource, Client –centered therapy is a form of talk psychotherapy developed by psychologist Carl Rogers in 1940s and 1950s (â€Å"PCT†, n.d.). Certainly, Rogers’ non-directive approach to client- centered therapy focused on the importance of individual feelings and perceptions of self in the present. Rogers believed that this process increased understanding of self-awareness within the client. If the clients can identify, fully accept, and clarify feelings in their conscious, it wil l help them to determine the solution to their own problem. Since Carl Rogers was the one the first influential therapist, Alert Ellis became the second most influential therapist of all times in cognitive behavior therapy. Ellis developed a theory called Rational Emotive Behavior Therapy (REBT) in the mid-1950s. Wikipedia (n.d.) explain this theory as , â€Å"A comprehensive, active–directive, philosophically and empirically based psychotherapy which focuses on resolving emotional and behavioral problem and disturbances and enabling people to lead happier and more fulfilling lives.† Unlike client-centered therapy, Ellis active-directive approach to rational emotive behavior therapy focused on The ABCD technique. This ABCD framework is defined as: (A) activating even not from an emotion, (B) bel... ... (Corsini, 2011 p. 153). However, rational emotive behvior therapist provided much direction, whereas the person centered approach encourages the client to determine direction (Corsini, 2011 p. 153). Furthermore, Rogers emphasize the conditions of a person’s right freely express themselves in solving their own problems. However, Ellis theory pays attention to the development of thoughts and emotions people experience. Similar, outcomes are evident in both client-centered therapy and rational emotive behavior therapy after the patients have received valuable assistance. The clients continue to show growth and healing in their conscious as they revealed about life’s current problems. Likewise, Rogers and Ellis neither focused the patients past lifestyle or relied on unconscious. The clients were able to gain a sense of self-awareness at the end of the therapy.

It’s a Hard Knock Life for Them Essay -- Literary Analysis

In both Katherine Porter’s â€Å"The Jilting of Granny Weatherall† and Eudora Welty’s â€Å"Why I Live in the P.O.†, the main characters deal with family members they frankly do not like. Due to both of their being jilted by men, they are full of resentment and anger causing these women to leave their families on bad terms. Porter and Welty are presenting through the character’s flashbacks and memories that we should pick our battles wisely when it comes to our families because one day they will be gone and, some of us might miss our deceased loved ones, like Granny from â€Å"The Jilting of Granny Weatherall†, or be filled with a hatred towards them, like Sister from â€Å"Why I Live in the P.O.†. Porter and Welty both provide flashbacks and memories in their stories to help the reader see what Granny and Sister’s lives were like before everything fell apart with their families. Porter’s â€Å"The Jilting of Granny Weatherall† is packed of the flashbacks and memories of Granny’s past relationships with the only people she loves even though are all dead. She reminisced about her youthful days when she was strong, independent, and with John, the man who stood her up at the altar and died when Granny was young. She still loves him and wants to see him, but â€Å"John would be looking for a young woman with the peaked Spanish comb in her hair and the painted fan,† (Porter 81) she believed he would not recognize her. Granny also lost one of her daughters, Hapsy along with her newborn who also died. When Granny brought those memories to the surface a fog of darkness, clouds reality and she gets lost and recalls that, â€Å"there was the day, the d ay, but a whirl of dark smoke rose and covered it, crept up and over into the bright field where everything was planted so c... ...to be pertinacious like Sister. The flashbacks allow the reader to go back with the characters and see what we missed out on, example; Granny’s happier days, when she had her man and she was strong and young, or Sister’s happier days when she also had her man and was treated respectably by certain members of her family. Furthermore, I believe the point both authors proposed was this, â€Å"Choose battles wisely and forgive or, forever suffer continuous loss.† Works Cited Porter, Katherine. â€Å"The Jilting of Granny Weatherall.† Literature: An Introduction to Fiction, Poetry, Drama, and Writing. Ed. X.J. Kennedy and Dana Gioia. 11th ed. New York: Longman, 2010. 79-86. Print. Welty, Eudora. â€Å"Why I Live at the P.O.† Literature: An Introduction to Fiction, Poetry, Drama, and Writing. Ed. X.J. Kennedy and Dana Gioia. 11th ed. New York: Longman, 2010. 42-50. Print.

American Gun Laws

Gun laws in the United States of America need to be altered in order to make American society safer. The Second Amendment of the Constitution reads â€Å"A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed. † This means that from the point any American child is born they have the right to possess a gun and use it for their own safety. How can a child as young as the age of ten years old know the difference between using a gun for their safety and playing with a gun putting themselves into danger? One state in America called Virgin has its very own law that every person must possess a gun. The law in the United States approves of blind men or woman having the right to possess a gun. If you are mentally affected you are also eligible to possess a gun. How can this be legal? Semi- automatic and automatic guns can be legally purchased in most US states by anyone who doesn’t have a violent criminal record. What is a violent criminal record? The law itself is not worded correctly. Semi-automatic guns are weapons which perform all steps necessary preparing the weapon to fire again after one shot. Automatic guns are firearms which keep firing bullets until the trigger is released. Why should every day American citizens need these sorts of weapons to â€Å"protect themselves†? Ammunition for guns can be purchased at nearly every store around the United States including Kmart and even in a barbers shop. Not only are you able to buy ammunition for very powerful guns but you are also legally allowed to buy as many sets of ammunition as you desire. Seventeen cents is all you need to purchase one bullet in America. If Americans wanted fewer people dying from guns every year they would change the price and the fact that guns are so easy to access dramatically. If bullets were 7,000 dollars each they would be used more carefully. This would influence a massive change in people dying per year from â€Å"gun accidents† as Americans would become very cautious in using their ammunition wisely. In 1999 two boys, Eric Harris and Dylan Klebold went on a shooting rampage at Columbine High School. They purchased their weapons legally from the local Kmart. They used semi-automatic guns, shot guns and even possessed 99 explosives and 4 knives. They shot 900 rounds of ammunitions killing a total of 12 students and one teacher and then themselves. The massacre started a debate over gun laws and the availability of firearms to high school students. It resulted in an increase emphasis on school security. Students in American schools now must go through metal detector before entering their daily lasses. Security also checks for any sharp metal such as nail clippers but they do not focusing on the fact that guns are a large cause of death. One child was suspended from his school because he was carrying around a stapler. Guns are still legally allowed in schools. 45% of US households have at least one gun. Around 59. 1 million adults in the United States own a gun. There is no law stating that you need to register your gun so it is impossible to know exactly who owns a gun and how many guns are being sold. 31,593 helpless lived were killed in 2011 by guns. This is a clear message. Guns are not doing any good. Therefore they should not be allowed. Guns should not be used to take others lives. They should be used in the military to protect the country not to kill. They should be used for people that like to go hunting. Semi-automatic and automatic guns are not used to kill a dear so why are they allowed to be sold to any civilised person in the United States? It is said that the availability of a gun makes it more likely that you will have feelings of anger or thoughts of suicide. 381 people have died from gun shooting in Germany, 255 in France, 165 in the UK, 59 in Japan and 39 in Australia. Why is it that approximately 100,000 American people die every year from guns? This is 300 people per day losing their lives because of guns. This is screaming out to Americans that they have to act now. Waiting another year is just losing 100,000 more lives. The news in America impacts greatly on the way society looks at their safety. The TV advertises violence sending a bad message across to any children in the United States. One hour before the Columbine shooting America bombed a school and a hospital in Iraq. This is not setting a good example. Changing the gun laws is a battle between freedoms and safety. It is a battle between freedom for the American people as they have lived their whole lives with the idea that they are safe as they have possession of guns. They have grown up with parents teaching them how to use a gun and in many cases this can lead to good and bad. It can be bad because a child might accidently use a gun for the wrong reasons or their parents have taught them the wrong way of using one. Putting themselves into danger and for good as some families might be smart enough to tell their children there are other ways of protection over guns. It is a battle between safety for all the reasons above. Guns have been seen to be used for nothing but bad in the past and this needs to change. 20 people in America are dying every single hour from a gun. This is not only telling us that they are not used for safety precautions but it is telling us that the American citizens are not very educated in their actions and the way they act. Most Americans might be very good at handling guns and not using them for the worse but to think that so many are dying from one machine and nothing is changing is not good at all. In Australia around about 65 people are killed by guns every year. In America around about 11,127 people are killed by guns every year. 40% of guns sold are not sold without a background check. This means that people with criminal records are easy accepted to own a gun when they are said not to be. The Law says that is you have a criminal record you are unable to possess a gun but many Americans are still easily getting one. This is a wakeup call. America should not be allowing possession of guns for the safety of their own country. Where there are more guns, there are more deaths. America has to start acting now before another 100,000 people are dead.