World Class Manufacturing

Why is a manufacturing company which adheres to a world class approach better able to succeed in the contemporary corporate environment? How is world class status achieved? The contemporary corporate environment is hugely different from what the corporate environment used to be in the past. Now the corporate environment is highly competitive, volatile and information is easily available to everyone including the customers. Over the years customers have become more demanding and they are clear about what they want and what they don’t want.They don’t want to settle for anything different from their needs and wants. Markets are more fragmented in the contemporary corporate environment. There is a lot of volatility in the market. This is due to continuous improvements and changes in technology which has a huge impact on the production process of companies in the contemporary corporate environment. Many products now have much shorter product life cycles in the contemporary c orporate environment. Prices and costs of products are also fluctuating a lot due to the volatile corporate environment.Companies have to keep selling prices low since there is too much competition in the market. The more competitors there are the more difficult it is for companies to survive since they have to make sure they offer the customers something better in quality as well as price than their competitors. Companies adhering to world class manufacturing (WCM) are better able to succeed in the contemporary corporate environment. This is because adhering to WCM allows companies to be more competitive in the market. WCM focuses more on what the customers want rather than what the company can offer the customers.Under WCM products are made to meet exactly the needs of the customers rather than something similar to what they want. WCM allows companies to be more customers focused and know exactly what they want. This is achieved by putting more resources into market research and i dentifying effectively the needs of the customers. WCM includes the use of advanced manufacturing technology (AMT) which allows companies to broaden their product range to meet the needs of the customers and also allows the company to customise products which further helps the company to be more competitive in the contemporary corporate environment.Being customer focused makes companies more competitive and reduces the chances of customers rejecting the products e. g. Boeing works closely with its customers to make sure customers get exactly what they want. WCM also helps companies to reduce costs which mean companies can afford to keep selling prices low and be more competitive. When companies work closely with suppliers they can reduce costs. Chrysler corporation established the suppliers cost reduction effort (SCORE) in an effort to work closely with its suppliers and identify opportunities to reduce costs from the vehicle manufacturing process.Working closely with suppliers allo wed Chrysler and its suppliers to make cost savings of $1 billion in just one year. WCM helps companies strengthen external relationships. This helps to open the doors of the global market for companies and have more opportunities. Selling their products globally makes companies more competitive. WCM helps companies to survive in the contemporary corporate environment by allowing companies to be more flexible so they can cope with the volatility in the market. WCM allows companies to adapt flexibility in different areas such as strategic, tactical and operational.From the strategic point of view, WCM helps companies to be able to quickly align the company’s strategic posture with rapidly changing external conditions. To survive in the contemporary corporate environment it is extremely important for companies to be flexible from the operational point of view. WCM requires companies to be flexible in this area which means companies need to be producing on the spot or in a perio d of time that satisfies the customers’ needs from the beginning, not from stock and not to assembling order. Under WCM this can be achieved by reducing lead times relating to the short manufacturing cycle.WCM allows companies to reduce lead times by adopting a process orientation versus a functional orientation as well as using the mushroom concept and also by removing constraints rather than adapting with them and working within the constraints like under the traditional manufacturing. Worker empowerment is promoted under WCM which helps remove the constraints. Employees are the best people to identify constraints and know how to remove them but under traditional manufacturing, employees don’t have the authority to do this but under WCM workers are given much greater power than they had under traditional manufacturing.Under WCM workers are organised into smaller teams which have responsibility for maintenance, hiring, firing etc. A worker has the power to stop the pr oduction line if they see some problems i. e. jidoka. Workers are also encouraged to make suggestions for improvements known as kaizen and they are also given appropriate information which is also a pre-requisite to empowerment e. g. visual factory, andon. WCM is an approach which allows an enterprise to succeed in today’s highly competitive globalised markets.To achieve world class status, companies need to adopt new organisation structure, culture, work methods, supported by a platform of information age technology. The hardware arm is AMT. With the advent of the information age, information becomes the key resource of a company. This has encouraged the switch from ‘M’ form of organisation to networks as information flows more easily through a network. Furthermore if workers are to play their part in process improvement, they need the information to do this.

First Union: An Office Without Walls Essay

Introduction The purpose of this paper is to analyze the Integrative Case 5.0, â€Å"First Union: An Office Without Walls,† found on page 589 of the text book Organization Theory & Design, by Richard L. Daft, and to respond to the questions relating to the case study. Problem Statement First Union Federal is a large savings and loan banking organization at which Meg Rabb has been employed with since she was 18. Meg has been recently promoted to Vice President of her division after serving the last five years as assistant V.P. At the time Meg was hired as an assistant V.P. there had not been a single female in the position of V.P. After a week in her new position, Meg was notified by her boss Dan Cummings that she would be moving into a new office. After three weeks of construction, Meg’s office was complete; however, only a day after settling in, Meg was summoned to her boss’ office yet again. She was informed that the First Union president had performed a walkthrough of the building and ruled that Meg’s office was too large and would have to be torn down and rebuild from the current 12 feet by 12 feet specifications down to the new 10 feet by 10 feet specifications outlined in the new regulations. Meg was angry and questioned herself how this would effect and damage her department’s morale, and how she could possibly lose the respect from her peers she worked so hard to earn. Meg also wondered if this had to do with her being a woman in a position of power – especially when her promotion came after an intervention from the Equal Employment Opportunity Commission (EEOC). The EEOC discovered that First Union did not have any female executives at or above the level of V.P. prior to Meg’s promotion and encouraged First Union to seek out qualified female candidates for promotion to executive status. This paper will identify the main issue at First Union, discuss the forces for cultural change, explain the use of power, and finally determine what political tactics Meg should use to resolver her office situation at First Union. Questions What is the main issue in this case? The main issue in this case is First Union’s corporate culture, the accompanying ethical values and how these are motivated by organization managers. According to Daft (2013), organizational culture exists at two levels – on the surface are the visible characteristics and observable behaviors and below the surface are the underlying values, assumptions, and beliefs that make up the second level (p. 393). At First Union, the issue with corporate culture touches on both levels of organizational culture. The observable behaviors include office layouts, the type of control systems and power structures used by the company and the ceremonies organizations share (Daft, 2013, p. 393). The office layout in Meg’s department was split up into sections and partitioned off for each of her 12 staff. Depending on their level in the organizational hierarchy, employees had variable office furniture for their individual section. The lowest-level employees received minimal second-rate quality furniture and often had to share the space with other employees. Robertson argues with the right approach, a company can become forward-thinking by creating a workspace with flow and function that motivates and inspires people and their business (2006, p. 35). Today, forward-thinking companies are turning to egalitarianism to get the job done. Rather than acting like the office space is symbol of status, all office spaces should be equal, cutting down on costs of space, equipment and furniture (Robertson, 2006, p. 34). Secondly, Meg’s boss, Dan Cummings, is senior V.P. of human resources. With his position, he organized the first annual â€Å"Dan Cummings Golf Invitational† now in its fourth year setup. Invitations to this prestigious event indicated status in the organization – only those V.P.s and assistant V.P.s close to senior management received invitations; yet no female employee had ever been invited to the golf tournament. Disregard to ethics threats substantial harm to reputation and to other significant intangible corporate assets – including employee morale and productivity. The outcomes of unethical behavior can affect an organization’s ability to survive (Doorley & Garcia, 2007, p. 30). In addition to these contributing factors, Meg was the first person to fall victim to stri ct adherence to the miscalculation of  her office size. Not only that, but shortly before her promotion, the EEOC put pressure on First Union to hire female executives since none had been put in place. Meg was the first of her kind. The EEOC was trying to encourage diversity management. Diversity management is defined by the Government Accountability Office (GAO) as a practice intended to produce and maintain a positive work environment that recognizes the value of individuals’ similarities and differences, so that everyone can reach their potential and make the most of their contributions to an organization’s strategic goals and objectives (GAO, 2013, p. 5). What are the forces for cultural change at First Union? Cultural changes will need to start from the top down. According to Daft (2013), culture changes refer to changes in the values, attitudes, expectations, beliefs, abilities, and behavior of employees such as the mindset of the organization (p. 435). Miller and Tucker (2013) suggest the senior leadership must set the tone at the top for integrity and ethics including diversity (p. 56). Consulting with First Union’s outside auditors, internal and outside legal counsel may be helpful in laying the groundwork for an updated diversity plan and Code of Ethics (Miller & Tucker, 2013, p. 56). Miller and Tucker go on to state top management should work with legal counsel to identify possible events that could impact the company’s diversity program, such as the annual golf tournament (2013, p. 56). Discuss the use of power at First Union. The use of power at First Union is interesting as it has many facets. For one, the mortgage division was considered the most powerful as it was the department that made that brought in a substantial amount of revenues. Because of the mortgage division’s contribution to the bottom line, the mortgages offices had been remodeled so beautifully, that they stood out from the rest of the bank. This is an example of reward power (Jing, 2010, p. 220). The president was not happy with the cost of the renovations but kept his displeasure to himself due to the significant profits generated by the mortgage division. Just as stated above, First Union had not employed any female executives until the EEOC intervened encouraging them to do so. And just as there had not been any women executives in a VP status, none had been invited to play in the annual golf invitational either. This is a prime example of referent power, which refers to the ability to provide others with feelings of personal acceptance, approval, usefulness, or worth (Jing, 2010, p. 220). The artwork around First Union was also suggestive of the values perceived by top management as one particular art piece displayed a member of the female body and was hung in the president’s conference room. This is another example of referent power. An example of legitimate and possible coercive power is the president’s influence on the building manager in deciding to downsize Meg’s office. As stated in the text, Meg was the first person to come under scrutiny with the current regulations. This is considered legitimate because of the president’s position to impose a sense of obligation on the building manager to follow the guidelines even though they were casually held in compliance with other executives. It is also coercive as the president has the power to grant and take away rewards and privileges (Jing, 2010, p. 220). What political tactics should Meg use? Political behavior is an important factor of power progressions in organizations and has been found to enhance leader-member relations, career mentoring, and customer satisfaction (Gupta, Singh, & Singh, 2008, p. 16). Meg should only employ sanctioned political tactics that are perceived as acceptable in the workplace as a way to progress positive relationships. She should try to cultivate positive relationships throughout the First Union by learning about their views and developing mutually advantageous coalitions and alliances (Daft, 2013, p. 548). Meg should also use the political tactic of reciprocity which works hand in hand in building coalitions and alliances. Being in a V.P. position, Meg has the prime opportunity to be a mentor to  other females since she is the first woman V.P. at First Union; not only would she be educating females, but educating males on acceptable behavior changing the culture of First Union and its perception of women in the workplace (Gupta et. al, 2008, p. 23). Other political tactics include: promoting self-interests (such as her golf lessons) through creating and maintaining a favorable image with the â€Å"power holders† to help foster a change in culture. Meg can draw the attention to the success her department has in establishing positive staff morale and by developing a reputation as formidable as the mortgage division. Doing so would make her as a V.P. and the department more desirable to the influential members of First Union (Gupta et. al, 2008, p. 24). And lastly, Meg can become a â€Å"mentoree† by looking up to the more senior members of the organization for advice and support. Conclusion In conclusion, First Union’s main issue is the corporate culture and the need for change in the organization. In order to foster this need, top management will need to change their way of thinking and educate the staff from their level on down. With Meg being the first woman hired as a female V.P., she is in a prime position to help pave the way towards this new cultural change. References Daft, R. L. (2013). Organization Theory & Design (11th ed.) Mason, OH: South-Western. Doorley, J., & Garcia, H. (2007). Reputation Management: The Key to Successful Public Relations and Corporate Communication. New York: Routledge. Government Accountability Office. (2013). Diversity management. (GAO-13-238). Washington, DC: U.S. Government Printing Office. Jing, Z. (2010). Cross-cultural study on French and Chinese managers’ use of power sources. International Journal of Business & Management, 5(5), 219-225. Miller, S.K., & Tucker III, J. J. (2013). Diversity trends, practices, and challenges in the financial services industry. Journal of Financial Service Professionals, 67(6), 46-57. Robertson, D. (2006). Does your office work for you?. J@Pan Inc, (66), 32-35. Gupta, B., Singh, S., & Singh, N. (2008) Self-monitoring and perceived job security and use of sanctioned and non-sanctioned political tactics. Vilakshan: The XIMB Journal of Management, 5(2), 15-32.

HRD Sample

Drawing from theories and models that inform adults and organisational learning, critically evaluate an HRD program or intervention that you deliver or have personally experienced. Introduction This essay looks into a learning program which was personally delivered. It aims to critically evaluate the effectiveness of the program by drawing upon relevant theories and models revolving around adult and organisational learning.Theories are used to substantiate the step by step processes undertaken in the program as well as to critique the areas which could have been performed better or were carried out uccessfully by the program coordinators. This essay is told from the perspective of a facilitator's role in which I was primarily involved in. At the end of this essay, we hope to understand how a successful HRD learning program should be run and what factors significantly influence its success.Learning Program The selected program used throughout this essay as a case study is the ‘C ombat Medical NSmen Ops Refresher Training. The program involved me as one of the key facilitators which was conducted during my national service time. The objective was to ensure the competence of the National Service (NS) men in carrying out their edical responsibilities and performing up to expectations when the time arises for them to do so in future. This was carried out by first refreshing the NSmen's theoretical knowledge of specific medical subject matter, i. . various emergency surgical procedures, that was taught during their NS days. Typically conducted annually, the refresher training would see the NSmen undergoing classroom learning followed by a practical hands-on session of role playing, after which they would be tested under a controlled, simulated setting as a form of learning assessment. The refresher training was a one-day program carried out in the compounds of the Singapore Armed Forces Medical Training Institute (SMTI).The facilitators comprised of regular seni or medical officers and fulltime national servicemen (NSFs), of whom I was one of them. The seniors acted as supervisors while the NSFs were more primarily involved in running the program on the ground. Teaching and demonstrations were conducted by NSFs while assessment was done by the senior officers. The age group of the NSmen participants ranged from 30 to 40 years old, thus the target audience was specific to older adult learners who were most likely married or some even fathers.The program was catered to a batch group of 20 NSmen with 2 facilitators assigned. The four stages of HRD HRD is an ongoing learning process involving training and development activities which seek to groom individuals' skills for the purpose of enhancing organisational productivity (Swanson & Holton 2 ) Adult learning talls within the HRD learning process. Knowles (1998) mentioned that adults tend to follow andragogical assumptions of learning such that firstly, the learning should have practical value for applying in real-life situations and problems.Next is for the learning to utilise the knowledge inherent in the adult and lastly it should actively engage him/her. All hese are reflected in the medical refresher program and will be explained through a series of four step by step stages namely the needs investigation, design, implementation and evaluation stages. HRD Needs Investigation (HRDNI) HRDNI refers to the process of identifying how much is known by the participants prior to the program against what is expected of them to know based on the learning objectives set out (Tovey & Lawlor 2008; Rothwell & Kazanas 1989).It represents an organized way to determine if a HRD solution is needed in the first place. It helps identify the content and learning objectives, the population, resources required, as ell as context and organisational politics. Behind every successful HRD learning program is a good HRDNI carried out in the beginning. The refresher program showed that HRDNI was conducted successfully as clear learning objectives, competencies and learning outcomes were established (Delahaye 2011). The needs were determined through the two levels of HRDNI: surveillance and investigation (Delahaye 2011).Program coordinators had long been monitoring how competent NSmen were in carrying out their medical duties upon completion of their NS time. Through the observation of several past reservists' in-camp trainings where these NSmen were required to demonstrate their medical proficiency in a simulated battlefield environment, their quality and competencies were analysed. Data was gathered through the means of organisational records and observations (Delahaye 2011). It was found that most NSmen were unable to remember much of what they had learnt during their NS days and thus, lacked in several key competencies.One of which was the ability to remember the medical apparatus to be used in assisting the surgeon in the surgical procedures. Thus, as a result of HRDNI, the ‘Combat Medical NSmen Ops Refresher Training learning program came about as form of HRD ntervention. Its aim was to keep NSmen constantly up to date with their medical roles so that when a real emergency breaks out in Singapore, they would be ready for it. Although the need for refresher training was correctly identified by program coordinators, the HRDNI could have been more specific to seek the opinions of the participants as well.Conducting such a program meant that more time, be it for work or family, had to be sacrificed by the working adults so that they could attend. Moreover, not all might feel the need for the refresher as they might be confident of their own knowledge. Thus one investigatory method to gather their opinions would be through holding an online survey questionnaire weeks before the commencement of the program. The questionnaire could ask them for their current level of knowledge and ask if the refresher would be effectively catering to their needs, also for their level of interest in participation.Curriculum Design This is the second stage once HRDNI nas been completed Curriculum represents tn systematic process of putting the learner through action (Smith & Lovat 2003). This stage involves matching the learning structure to the characteristics of the adult learners (Delahaye 2011). To do this, constructive alignment needs to take place. This means that the expected actions the learner has to emulate based on the learning objectives must be coherent with the teaching and assessment style (Biggs & Tang 2007).The refresher program was successful in achieving constructive alignment as the objective to instil confidence in the NSmen to showcase their medical proficiency in carrying out the surgical procedures was well reflected by the practical role- playing sessions demonstrated and taught by the facilitators. The design structure of the refresher program followed closely to Delahaye's (2011) Hierarchy of Learning Outcomes (HLO) model. The model emphasizes the progression from explicit to tacit knowledge and this was seen in the program as facilitators made use of instrumental to communicative learning.The program outlined movements from basic to intermediate to complex, Just as how HLO mentions in its five categories of programmed knowledge, task, relationship, critical thinking and meta-abilities. The refresher program started off with programmed knowledge which was in the form of classroom-based learning to provide the factual and theoretical knowledge to the NSmen. It then moved into task where they were required to be analytical in a role- laying scenario. That involved a linear, diagnostic and complex analysis which in short, refers to using simple information-processing, interpretation, problem solving and decision making skills.The role-playing session incorporated discussions and effective team play as well, which in turn worked on a relationship level of interpersonal communication between partici pants. The program ended off with action learning where participants were encouraged to use mental agility under the meta-abilities category to be able to think clearly under pressure, when performing their learning assessment in a controlled environmental setting. The HLO progression was mapped in accordance to the learning characteristics of the NSmen participants.Facilitators took into consideration that because the participants were older learners, the learning environment created was a similar aged batch of between 30 and 40 years old so that they would feel more comfortable and safe (Delahaye ; Ehrich 2008). Older learners tend to be involved in complex learning, occasionally switching from being dependent to independent learners and thus passively seeking and actively seeking knowledge, respectively. Hence, the design of the refresher program ensured a combination of various learning trategies to meet to these adult learners' characteristics.These strategies will be covered u nder the implementation stage later. It was indeed a good initiative by the facilitators to find out the basic characteristics of their adult learners and thus used HLO as a step by step process to teach them. However, there is room for improvement. All adult learners have different learning styles and so a good HR designer would pay close attention to finding out what styles their participants fall under. This can be done by issuing out a learning style questionnaire which will seek o determine if a participant is a reflector, theorist, pragmatist or activist (Honey & Mumford 1992).Each learning style will differently influence the way an individual learns, and so will impact the design ot a learning program. However, an individual may also have at times a combination of both styles. Thus, a good designer should strive to integrate all four styles in any learning program. Implementation This third stage of the HRD process covers the skills required of a HR developer who is also kno wn as the facilitator. In other words, this section analyses how effective or killed the facilitators are in conducting the learning program, based on the participants' level of engagement.It also covers the various learning strategies used. As one of the facilitators of the refresher program, I exhibited strong micro-skills of questioning and responding, and a high level of enthusiasm, channelling the energy positively to the participants. Delahaye (2011) pointed out that such skills are important in the delivery of a learning program, but are often overlooked by HR developers. Feldman (2007) agrees that with greater enthusiasm demonstrated, the higher are the chances of learner accomplishment. As for the learning strategy, a structured style was used in the beginning stage of the refresher program.This took the form of lecture-style learning. Delahaye (2011) regards lecture as structured due to the teacher-student controlled form where the teacher assumes full responsibility over the learning of the student and controls what and how the student will learn. Facilitators conducting the lecture used PowerPoint presentation to recap the relevant theoretical knowledge of the emergency surgical procedures. The slides included detailed photographs showing how each procedure was to be carried out step by step. This was complemented with a set of the hardcopy handout slides so that the NSmen could write notes throughout.On top of that, the whiteboard was used simultaneously by the facilitator to Jot down the key points of the presentation. This ensured an appropriate usage of visual aids to appeal to the adult learners (Delahaye 2011). The lecture-style teaching made use of instrumental learning, one of the three transformational adult learning domains (Mezirow 2009). Instrumental allows learning to be controlled and can manoeuvre the environment. Under it is the knowledge generation process of combination which sees a transfer of explicit to ven more complex explici t knowledge (Nonaka ; von Krogh 2009).The PowerPoint presentation, for instance, got the NSmen to combine the explicit knowledge they were looking at and listening to with their own explicit knowledge, thus leading into a process of re-sorting and re-understanding of their inherent knowledge. Another point to make was that sufficient breaks were given throughout the lecture presentation so as to space out the learning and carry out part learning so that participants could digest the information better, especially since older learners dislike having big chunks of information (Grattan 1955; Miller 1956).These were some of the principles of learning highlighted during the structured strategy. Subsequently, in the refresher program, the learning strategy shifted from structured to semi-structured. After the theoretical bit was covered, facilitators proceeded onto the practical, hands-on session. The knowledge Just learnt or recapped was to be applied on mannequins which acted as causali ties. Here, the actual whole tray of medical apparatus needed for the surgical procedures is introduced to the NSmen participants, after seeing pictures of them in the PowerPoint slides and the hardcopy andouts.Participants were divided into 4 groups ot 5 in which each group nad a mannequin and a set of tools to work with. Each facilitator was assigned to 2 groups to firstly demonstrate the correct techniques and steps to perform the emergency surgical procedures, using the apparatus provided. Participants observed carefully to learn the steps that they would later be tested, in what was actually known as modelling, one of the 3 basic types of learning. Modelling refers to copying an action after observing how it is done (Bandura 1977; Gardner et al. 1981).Facilitators of the efresher program aimed to see an exchange of tacit to tacit knowledge between the participants and themselves in a socialisation process. This was achieved through the modelling learning behaviour. The semi-str uctured strategy using the mannequins was a form of role-playing as within each group, participants took turns to role play as surgeons and assistants to the surgeons. This role-playing also helped to strengthen the HLO in areas of forging better interpersonal relationships and the use of group processes, Just to name a few (Delahaye 2011).On a separate point, ole-playing illustrates that the NSmen participants also underwent communicative learning, which is known to be a learner's effort to relate to another to understand each other's viewpoints (Mezirow 2000). Evaluation This last stage of the HRD process signifies the importance for proper assessment methods. The evaluation technique that was used for the ‘Combat Medical NSmen Ops Refresher Training program was the assessment of learning.This assessment, as stressed by Delahaye (201 1), paves the way for measuring the effectiveness of the learning program, allowing the examiners to gauge how useful the program had een for t he participants as well as to see if the learning objectives set out from the start had been met in the end. In addition, assessment offers feedback for both the adult learner and HR developer. Through it, they can identify their strengths and weaknesses so that they can make necessary amendments to make their learning processes more effective in future.Out of the six types of assessment of learning methods available, the refresher program used performance tests, which proved to be the most suitable form of evaluation due to the complex nature of the program (Delahaye 2011). Following on after the role-playing session of using the mannequins and medical tools, the NSmen participants were made to undergo a performance test in the outdoors open field which simulated an actual situation of what it would likely be in an actual war zone battlefield environment where the NSmen would encounter multiple casualties suffering from different kinds of wounds and war injuries.They would be requi red to think on their feet using mental agility, under a stressful environment, of which of the following emergency surgical procedures learnt would be best used for treatments. As said by Delahaye (201 1), performance tests need to be conducted by highly skilled trainers whose evaluation makes use of their tacit knowledge. Thus, the assessment of the program was a success as it brought in the senior medical officers, who have years of experience in the field, to evaluate the performances of the NSmen. This also served to be a non-biased evaluation as the seniors were not involved in running the on ground training.In evaluation, a pre- designed evaluation criteria form was used by the senior officers so as to quantify the observed results (Thorndike 2007). The results were then snowed to the NSmen articipants during the program debrief. The outcome of the performance test showed a match to the adult learners' HLO, identified in the curriculum design stage, in the categories of progr ammed knowledge; and task and relationship. It also successfully tested the learners' action learning process of critical thinking and meta- abilities.Conclusion This essay has looked at the ‘Combat Medical NSmen Ops Refresher Training' as a learning program which served as an HRD intervention based on the needs investigation conducted. It found that a refresher program would be beneficial to the NSmen in helping them to familiarise with the medical proficiency knowledge they are required to demonstrate in their annual reservist in-camp trainings. This essay thus went on to elaborate the four stages involved in influencing this successful HRD learning program using theories primarily from adult learning.Following on from a thorough HRDNI, the design of the program saw that a necessary constructive alignment was made between the teaching style and the characteristics of the adult learners. The HLO model was used in this stage. As for the implementation, the acilitators of the p rogram demonstrated strong micro-skills as well as using structured and semi-structured learning strategies through a PowerPoint presentation and role-playing session which reflected on instrumental and communicative learning for the adult learners, respectively.The final stage was the evaluation of the program in which a performance test was carried out as a specific assessment of learning method. Word Count: 2566 Reference List Bandura, A 1977, Social learning theory, Prentice Hall, New Jersey. Biggs, JB & Tang, C 2007, Teaching for quality learning at university: what the student does, 3rd edn, Open University Press, Maidenhead. Delahaye, B & Ehrich, L 2008, ‘Complex learning preferences and strategies of older adults', Educational Gerontology, vol. 34, pp. 649- 662, viewed 30 August 2012, Emerald Database.Delahaye, B 2011, Human resource development: managing learning and knowledge capital, 3rd edn, Tilde University Press, Prahran Australia. Feldman, KA 2007, ‘Identi fying exemplary teachers and teaching: evidence from students' ratings', Perry, RP ; Smart, JC (eds. ), The scholarship of teaching and learning in higher education: an evidence-based perspective, Springer, AA Dordrecht, Netherlands. Gardner, G, Innes, JM, Forgas, JP, O'Driscoll, M, Pearce, PL & Newton, JW 1981, Social psychology, Prentice Hall, Sydney.Grattan, CH 1995, In quest of knowledge: a historical perspective on adult education, Association Press, New York. Honey, P & Mumford, A 1992, The manual of learning styles, Peter Honey, Maidenhead, I-JK. Knowles, MS 1998, The adult learner: a neglected species, 5th edn, Gulf, Houston. Long, HB 2002, Teaching for learning, Malabar, Florida, Krieger. Mezirow,J 2000, ‘Learning to think like an adult: core concepts of adult learning theory, in Mezirow, J (ed. ), Learning as transformation: ritical perspectives on a theory in progress, Jossey-Bass, San Francisco.Mezirow,J 2009, ‘Transformative learning theory, in Mezirow, J & Taylor, EW (eds. ), Transformational learning in practice: insights from community, workplace and higher education, Jossey-Bass, San Francisco. M GA 1956, ‘The magical number seven plus or minus two: some limits on our capacity for processing information', Psychological Review, vol. 63, pp. 81-97, viewed 30 August 2012, Emerald Database. Nonaka, I & von Krogh, G 2009, ‘Tacit knowledge and knowledge conversion: controversy and advancement in organizational knowledge creation', Organization Science, vol. 0, no. 3, pp. 35-652, viewed 28 August 2012, Proquest Database. Rothwell, W] & Kazanas, HC 1989, Strategic human resource development, 4th edn, Englewood Cliffs, Prentice Hall, New Jersey. Smith, DL & Lovat, TJ 2003, Curriculum: action on reflection, 4th edn, Social Science Press, Tuggerah, NSW. Swanson, RA & Holton, EF 2001 , Foundations of Human Resource Development, Berrett-koehler, San Francisco. Thorndike, RM 2007, Measurement and evaluation in psychology and educatio n, 7th edn, Prentice-Hall, Upper Saddle River, New Jersey. Tovey, MD & Lawlor, DR 2008, Training in Australia, 3rd edn, Pearson Education, Frenchs Forest, NSW.

Group Policy Coursework Example | Topics and Well Written Essays - 500 words

Group Policy - Coursework Example Security: due to the various security breaches evident, it is important to use the group policy to curb that. For instance, an organization can experience security breach due to the employees using very weak passwords. With the group policy, it is easy for an organization to set certain requirements for the users to follow when setting passwords. Cost and time: it enables installation or upgrading of software from one location and ensures that every machine is serviced simultaneously (Moskowitz, Hicks, & Burchill, 2013). Moreover, it is also possible to conduct the upgrade outside the business hours to avoid disruption of the work schedule. There are various potential pitfalls. One, because the SQL server is configured for windows authentication only, it becomes difficult to manage data in all the other relational databases. Moreover, the database can only be accessed from within the local area network. Beyond that, it becomes inaccessible. Lack of firewalls between the servers and the applications of the client becomes difficult to get into the client’s database and gather the additional information required. The types of data elements that will be difficult to capture are the compound data elements. These are data elements consisting of three field’s control, component count field together with the total length of the required data elements. The reason is due to lack of firewall between the server and the applications of the clients. It is able to establish a boundary between a trusted and un-trusted network (Moraes, 2011). Thus, the user is not restricted by any set of rules applicable and can therefor e conceal the compound data elements in such a way that it becomes difficult for them to be found. The main considerations include enhancing security. Among the 120 end users, there can be some using some practices that can lead to breach of security for the organization. This can be quite costly since the

Law and ethics Essay Example | Topics and Well Written Essays - 750 words

Law and ethics - Essay Example The article discusses the regulations of 49 countries in order to determine how they affect equity issuance. The issue is very relevant as, according to Mahoney, there is a â€Å"promoter’s problem† occurs, when the sellers can’t provide guarantees that the equities they sell are reliable (Mahoney, 1995). Thus, the paper analyses the laws regulating the stock market propositions in each state and researches the connection between these rules and the ways stock markets use to increase profits. â€Å"We analyze the specific provisions in securities laws governing initial public offerings in each country, examine the relationship between these provisions and various measures of stock market development, and interpret the evidence in light of the available theories of securities laws† (LaPorta et al, 2004). Also the article provides the results interpretations made in accordance with corresponding theories of security regulation (LaPorta et al, 2004). First, t he authors represent three assumptions as for the influence the regulation may have on the stock market. The conclusions were strongly supported by hypotheses. The authors define three hypotheses: the first states that market regulation is not needed. This hypothesis is supported by Coase (1960) and Stigle (1964). These experts pay attention to the fact of information disclosure that is provoked by security regulation â€Å"Issuers of securities have an incentive to disclose all available information to obtain higher prices simply because failure to disclose would cause investors to assume the worst† (LaPorta et al, 2004). At the same time the next two hypotheses state that market needs regulation as the investors should be protected from cheating. Stock investments usually prescribes high expenses and if the investors are cheated, loses they bear are too serious. Thus, the government should issue special security laws in order to regulate the climate in the stock markets. â €Å"Both reputations and contract and tort law are insufficient to keep promoters from cheating investors because the payoff from cheating is too high and because private tort and contract litigation is too expensive and unpredictable to serve as a deterrent. To reduce the enforcement costs and opportunistic behavior, the government can introduce a securities law that specifies the contracting framework. The two alternative hypotheses differ in what kind of government intervention would be optimal within such a framework† (LaPorta et al, 2004). Therefore, the most important conclusion made by the authors of the article is that stock markets really can’t do without regulation as it makes much for their prosperity. Secondly, the results show that security regulation means much as it help conclude contracts instead of preventing people from concluding them. Precisely, it was revealed that many aspects of public administration do not play the important role. On the contrar y the regulation usually helps investors recuperate the expenses predominantly in the large markets. Thus, the conclusion was made that the larger the market is, the more thorough monitoring it demands (Barth, Caprio, and Levine, 2003). The authors also emphasize the importance of monitoring the disagreements that occur between the stockholders and investors. It is really essential for the market development. Special attention should be paid also to the change in regulation that would promote economic development and eliminate the gap between the states

Title is Open Essay Example | Topics and Well Written Essays - 500 words

Title is Open - Essay Example Much emphasis will however be given to his noteworthy accomplishments and their importance or influence in the current century. Gauss had a lot of influence in the field of mathematics. He was the first mathematician to prove the theorem of algebra, a concept that is used to solve many mathematical problems even today. Writing of the book by the name Disquisitines Arithmeticae is another great achievement of Gauss. Another significant achievement is the discovery of the Law of Quadratic Reciprocity. This is an incredibly fundamental concept in today’s world. It allows individuals to establish whether there can be a solution to quadratic equations. Gauss also made a lot of contributions to science. For instance, he made it easy to understand the concepts of the nature of electricity and magnetism (West, 2008). Algebra is widely utilized today. Companies use it to project annual budgets. It is also combined with statistics to predict companies’ annual turnover. Algebra is also used in learning institutions to prepare annual reports of students as well as in predicting usage of the different materials used in examinations. It is also used in the calculation of payable income tax, bank interest as well as annual table income. We also use algebra unconsciously in our day to day lives, for example, in comparing of various products with respect to quantities while doing shopping. These are just some of this century’s applications of algebra, a concept attributed to Gauss. The other achievement is the publication of the book; Disquisitines Arithmeticae, at the age of 24years. Although written long ago, it is considered as one of the most significant books in the mathematics field today. This book has made the understanding of various mathematical concepts easier. This is because Gauss brought together the isolated theorems and conjectures from works of other mathematicians thus filling the gaps that

The Main Features and Problems Faced by Service organisations In Essay

The Main Features and Problems Faced by Service organisations In pursuing this Technique(Banks in the UK) - Essay Example More than 74% of the United States work force for example is employed on this sector (Li H. & Smith L.2001).With a dramatic fall in labour cost, the cost of processing information, overheads has become far more important in the present age of advanced manufacturing technology (AMT) with direct labour representing 5%. Thus, it therefore now appears difficult to justify the use of direct labour or direct material as the basis for absorbing overheads.ABC was developed to overcome some of the major problems of the traditional cost accounting. The 80s witnessed an influx of research in to this concept. Activity based costing involves the identification of the factors which cause the costs of an organisations major activities (Lewis; J.R., 1993). In this regard overhead are charged on the basis of their usage of factor causing the overhead. In the UK and the US, information and manufacturing technology are widely used in both manufacturing and the service sector, with both sectors experiencing different degree of the usage (Palmer, A.2000). The four main characteristics inherent to services provide an answer to the main problem of ABC in the service industry. ... There is a strong possibility that the same enquiry would be answered slightly differently by different people. 1.2 Activity based costing and the service industry in the UK (Banking Sector). By the end of the 1980s, ABC became the focal point within the realms of academic researchers, consultants and managers as a means of overcoming the disadvantages of traditional cost allocation methods. Cost accounting was limited to it s usage of one volume sensitive driver (Cooper & Kaplan 1991). By 1990 initial followers of ABC in the manufacturing sector were able to reduce cost, identify opportunities for improvement and determine a more profitable product mix (Cooper & Kaplan 1991). Thus, the concept gradually gain grounds and became popular in the manufacturing sector. In the service sector, the adoption of ABC has been relatively slow, and the concept was rarely used apart from the health and banking sector. A recent study however, by Schultz & Rostocki (2004) concluded that, the rate of adoption of ABC in service and manufacturing industry was now similar. An essential part of managing and ensuring the long term competitiveness of banking institutions in the United Kingdom will be to configure, manage the service deliveries and their chain of distribution processes. The financial sector in the UK, like in any other country is characterised with the following characteristic Banking institutions and other financial houses are price takers. This is so because the prevailing market price has to be accepted. Large number of institutions offering the same services with none of these institutions being able to influence price. However, their actions are not negligible. As a move by institution A will trigger a whole chain of event, in the form of competitive service

Liberalism and Realism Essay Example | Topics and Well Written Essays - 500 words

Liberalism and Realism - Essay Example Realists are more of pessimists in international politics. They agree that it is desirable to have a peaceful world. They view no possibilities of escaping the harsh world that is dominated by insecurity, war, and competition. The need to create a peaceful world is a good but not a practical idea. They also have three beliefs that form their basis. They regard states as the main actors in the world of politics. Great powers shape and dominate international politics as well as being the cause of wars. Realists also believe that the external environment influences the behavior of the great powers. In principles, great powers resemble billiard balls whose only variation is in size. Third, realists consider that power calculations dominate the thoughts of states. States always engage in competitions for power. The competition at times demands the need for war and it is at times considered as a good weapon of statecraft. Zero-sum quality brands the competition that makes it intense and un forgiving. States occasionally cooperate, but they have conflicting interests at their roots. The two theories have various common aspects from which they base their arguments. First is the distribution of Power. It refers to the state’s ability to manage outcomes. It is the ability of state B to get state A do something with state A having no options about it. The second one is war. War is a state-directed violence or violence across state borders. The third aspect is the national interest that makes states do what they prefer.

Community Career Interview Activity Research Paper

Community Career Interview Activity - Research Paper Example The interview takes place at the community center on 15th May 2012 at 5 pm. This paper describes the interview process; dealing with the new information gained that is useful in a professional setting, as well as the course. No difficulties were experienced in the conduct of the interview; this is with regard to finding the venue, locating the interviewee, as well as gaining answers. Immense new knowledge was acquired through the interview, which is applicable in the professional sense. However, the program is also instrumental in showing the effects of drug abuse; hence preventing persons from experimenting with drugs. The center manager highlighted some of the critical elements regarding the organization, its services and its overall importance to the community. The organization provides quality prevention, correctional, and intervention programs for persons suffering from drug addiction. The organization is a meeting point for drug addicts and addiction specialists. The organization centers on affording intervention and rehabilitation services to drug addicts within the community. It also serves as a link between drug addicts and government-based treatment centers that run inpatient programs through support groups for persons addicted to alcohol, heroin, cocaine, marijuana, and other drugs (Siegel, 2005). The drug rehabilitation program run by the community center helps the area residents in many ways. This information is quite important as it ensures others gain knowledge of the problem of addiction and how addicts can obtain assistance. Firstly, the program provides necessary treatment for drug addicts in the community, allowing for the rehabilitation of such persons (Siegel, 2005). Through joint efforts with the government, the program provides employment opportunities to rehabilitated drug addicts.

Shoehorn Sonata Speech + Related Text Essay Example for Free

Shoehorn Sonata Speech + Related Text Essay At age 15, you are thrown into a war, fighting for your life and your will to live is slowly diminishing. Are you scared? Probably, but you know that if you show fear, everyone will see you as being weak. This is what the main protagonists of both the play, Shoe Horn Sonata by John Mistro and the movie, Hunger Games directed by Gary Ross endured. Together with photographs, cinematic techniques and symbols, these texts represent the devastation of war, the bonds of friendship forged during a war and their respective will to survive. Friendship is defined as a relationship between friends. In Shoe Horn Sonata, when Sheila and Bridie first meet, it seems unlikely that they will ever be friends. They are complete polar opposites. Sheila cynical statement ‘People always get on when they’re tossed in together. I’d hardly call that friendship. ’, reinforces that Bridie and Sheila initially formed a friendship out of desperation to survive, not because there was mutual affection for each other. Bitter tone is utilised to convey Shelia’s survival instincts are prioritised over tender friendship. Additionally the alliteration of tossed in together reflects how people in war have no choice of their companions, that it pushes them together in survival. Similarly in the Hunger Games , the friendships that Katniss makes with both Rue and are forged out of necessity and need rather than sentiment. Rue and Katniss team up as they both have valuable skills assets that the other would like to utilise to their advantage such as when Rue manages to take a weapon unnoticed using the trees. In many ways, an alliance with Rue is an alliance to District 11 which Katniss can use to her benefit. Peter and Katniss act as if they are lovers in a ploy for the audience as a means to survive as seen when Katniss receives a note from Haymitch asking ‘You call that a kiss? ’. The sarcastic tone makes Katniss realise that the ploy will be futile as if Haymitch is doubtful then others will be too. Both texts show that although they may not have been friends in normal circumstances, war has pushed them together and this has attributed to them surviving. Symbols are also used in both texts to represent the protagonists’ hope and survival. For example, the shoehorn in Shoe Horn Sonata is first seen when the girls are in the water and Bridie uses it to wake Sheila up and prevent her from drowning. In this scene, it a metaphorical and representative an object of survival and the will to live. As the play goes on, the shoehorn symbolises family for Bridie and sacrifice for Sheila but in the end it unites the girls and demonstrates that not only did they survive the war, they survived the effects of the war as well. Caramel is another symbol of survival. It was the only luxury the girls had during the camp and ‘it had to last till the end of the war’. The caramel was even important enough that it was written into the girls’ wills. This conveys to the audience that the girls clung to the hope that they would eventually be released from the prison camp. On the other hand, in Hunger Games, the mockingbird pin was not only Katniss’s link to her district, but a symbol of her love for her father as well as her survival. The pin is a representation of a creature with a spirit of her own. By breaking free of the Capitol’s control this show that the Capitol does not have complete control of the districts. Katniss, like the mockingjay, has escaped from the Capitol’s clutches which is why the pin symbolises her survival and spirit. The photographs shown during interview in Shoe Horn Sonata support the dialogue and give the audience a visual representation of what the girls went through during the camp. In scene 7, you see visuals of what the prisoners looked like during the camp. They are emaciated, haggard and impoverish. The effects of the imprisonment of the innocent is clearly highlighted during these photographs. The stark black and white photos depicting the harrowing effects of mistreatment of innocents evokes sympathy towards the prisoners from the viewer and loathing for their captors. In contrast, within the Hunger Games, the film is seen as whirs and jolts with sharply edited scenes intercutting from perspective to perspective which represents Katniss’s inner turmoil and her agitation which accompanies those new changes. Her life is unpredictable and this is shown as the camera shakes around representing the sudden changes in her life and well as extreme long shots used to give the audience a general impression of the places she goes. Little detail can be seen in these scenes which corresponds to the insignificance of these places to Katniss. The audience witnesses the consequences of these changes but to everyone else, they are unable to see this because of the defensive stoic mask she wears. In conclusion, the protagonists in Shoe Horn Sonata and the Hunger Games have survived horrors unimaginable to us and through distinctively visual techniques such as , photographs, cinematic techniques and symbols, we are able to grasp a small idea of what they have endured on their journey. Therefore, thus despite common circumstances being the catalyst for friendship in times of war, strife and horror they are able to triumph over their circumstances because of the sustenance that this unexpected friendship provides them.

Personal Illness Narratives: Rheumatoid Arthritis (RA)

Personal Illness Narratives: Rheumatoid Arthritis (RA) Introduction This essay employs excerpts from the narrative of a 38 year old woman named Francesca, a lady who has been given a diagnosis of rheumatoid arthritis (RA), to illustrate key concepts form the sociological, and psychological literature. This approach will illustrate the writers ability to critically appraise the literature, its relevance to the narrative in question, and using narrative, places these concepts within a real life clinical situation. This in turn provides insight into the value of narrative as a methodological approach in the 21st Century and how it intertwines with the rich tapestry of sociological theories and concepts that are available to the researcher studying the current sociological evidence base. For the purpose of this assignment, peer reviewed articles and textbooks were searched within the past 10 years. The work introduces RA as a clinical entity (pivotal to understanding the comments of Francesca) and goes on to outline the use of narrative, particularly its utility in the study of chronic disease. The essay then goes on to cover some key important issues, namely: The biomedical versus the sociological approach of illness management The Study of Personal Illness Narratives Sociological perspectives on depression Chronic Illness and Disability Social construction of medical knowledge and the Politics of Disability Labelling Stigma. For each of the above, concepts are presented and mapped against selected statements from the narrative of Francesca (written in italics for clarity). These statements illustrate real world data gleaned from Francesca; valuable comments that are grounded in the experiences of a person living with a chronic disease. The work also contains an appendix comprising a reflective postscript which outlines the way that the work evolved from earliest outline, to the finished product. Rheumatoid arthritis (RA) is a chronic inflammatory disorder that affects not only the synovial joints but multiple body systems (Goodacre 2008). The exact cause of RA remains unknown; it is a disease that affects more women than men, often of a young or middle age demographic unlike osteoarthritis which affects predominately older people. RA follows a somewhat unpredictable course of exacerbations and remissions. RA carries huge psychological problems in view of its unknown aetiology, uncertain prognosis, and loss of function. Additional symptoms include early morning stiffness, pain, limitation of activities of daily living, and socio- economic problems inasmuch as it may have a severe impact upon a persons ability to work and function in society (Kojima et al 2009). The discussion now begins with a section on models of illness. Biomedical and biopsychosocial models of disease The biomedical model of health takes the reductionist view that people are biological entities (Lewis 2009 p745). In the clinical management of RA there is some merit in this biomedical approach, for example the monitoring of inflammatory mediators in the blood as a marker of disease activity or responses to drug intervention is well established in the literature (Lee Kim 2009). This biomedical approach is reinforced by the GP comments from the narrative, i.e. That there was no cure and that the tablets were the key to preserving normal function. This approach may contribute to Francescas frustration, as it ignores the wider psychological and sociological ramifications of living with a chronic debilitating disease such as RA. It is unclear form the narrative whether the GP tempered his comments by adding that there are means by which the signs and symptoms of RA can be successfully managed. Critical appraisal of the literature reveals that biopsychosocial models advocate a more holistic view of illness, for example according to Smith (2002) the biopsychosocial model seeks to address not only the client and his or her illness but also their capacity to deal with being ill. The value of adopting the narrative approach as part of the biomedical model is effectively illustrated at the point where Francesca states I just burst into tears At the perceived effect that this illness will have upon her loss of function in the future. So whereas the biomedical model will operationalise function using objective outcome measures, here the use of narrative permits a biopsychosocial approach that provides rich client centred data on how it feels to be diagnosed with chronic and currently incurable disease. This in turn can help to inform our understanding of Rheumatoid arthritis as a disease thereby influencing the social construction of medical knowledge by giving voice to service users (Balen et al 2009). The Study of Personal Illness Narratives. Illness narratives concern a persons views and beliefs about their illnesses and the effect on their lives (HydÃÆ'Â ©n 2007). There is increasing acceptance and recognition of the valuable role that such grounded narratives play in understanding the journeys that people with chronic diseases such as RA have to embark upon if they are to manage their illness on a day to day basis. For example Haidet et al (2006) found in a narrative study of people with diabetes that people narrated four illness-management strategies whose story elements were in dynamic interplay, each with unique variations for each individual revealing a level of complexity that had not been previously described. As a method, narrative provides rich data (Furman Cavers 2005; Poindexter 2002) and in this case gives a voice to Francesca that would otherwise remain unheard (Grills 1998).Much can be gleaned from studying Francescas narrative, for example Francesca begins to paint a picture of her hopes and fears upon being given a diagnosis of RA combined with an insight into her past and thoughts about the future. Francescas narrative provides us valuable insight into her views of the self- a key component of narrative (Voilmer 2005), her relationships to others, and how these relationships have changed or may change in the future. In her narrative Francesca gives us some insight into the pain of living with rheumatoid arthritis, in her comments we can detect also a stark dichotomy in that she notes how healthy she had been in the past then uses the term Excruciating to describe her current pain, thus Francescas narrative hints at the loss of self in that she will no longer be a dancer or even a valid spouse as exemplified by the narrative quote. I wont be the woman he fell in love with Here she literally describes herself as becoming another person. Here Francesca is able to provide the reader or researcher with valuable information on the loss of the self, which resonates with other narrative research (Roe Davidson 2005; Doba et al 2007). Francesca goes further and also hints at the change in her illness self concept (ISC) that is to say the extent to which a person is defined or consumed by their disease or disability (Morea et al 2008). Francesca also hints at the concept of disease as a biographical disruption, described by Bury, this is said to occur when a persons planned future cannot unfold as planned. (Bury 1982); will he even want to marry me? Im too young to have this. What makes Francescas narrative particularly interesting is the fact that she is a twin; this may emphasise any change in self since she has in essence an unchanging control (her twin sibling) to against which to compare herself as her disease, her self identity (and possibly disability) progresses. The next section outlines sociological perspectives on depression. Sociological perspectives on depression. Francescas depression is likely to be multifactorial; for example there is evidence that the disease RA itself causes depression (Kojima et al 2009) as will living with pain. From a sociological perspective Francescas strained personal relationships may contribute to depression, for example her fear of being rejected as a potential spouse (Waite Gallagher 2001), see below. will he even want to marry me? This feeds in to the earlier section on biomedical versus biopsychosocial models of health and illness and the different paradigms or world views in which they are situated. A biomedical explanation of depression is likely to focus on the biochemical aspects of the person whilst a more sociological approach would acknowledge the impact of socio economics, personal relationships and so on (Covic et al 2003). Caution is needed however here since the short excerpt of narrative that we have provides no direct evidence that Francesca is in fact depressed, indeed a review of the literature suggests that there is a tendency to over diagnose depression (Parker 2007). Chronic Illness and Disability. A chronic incurable disease such as RA would require Francesca to make significant adjustments to her life over time. The sociological literature now provides increasingly refined conceptualisations of these adjustments, acknowledging that the experience of chronic disease necessitates adaptations in multiple domains of the persons life. This adjustment is often referred to as a trajectory (Stanton et al. 2007). This concept, introduced by the sociologist Strauss in an attempt to capture experiences and behaviours occurring in response to chronic illness (Strauss Corbin 1998), goes beyond depicting the physiologic unfolding of disease and encompasses the total organisation of work done over the course of the illness (Strauss et al 1984). Francescas narrative hints at this changing trajectory tracing the commencement of her life changes to a time six months ago when she was much more active and defined herself as a dancer. Furthermore Francesca looks to her future and wonders about h er ability to fulfil the stereotype of a perfect spouse. It is important to engage with how Francesca and her fiancÃÆ'Â © will make sense of the illness. The term illness cognition has been defined as a patients own implicit common sense beliefs about their illness (Leventhal and Nerernz 1985, p. 517). When people experience symptoms, they embark upon a cognitive search which enables them to interpret and make sense of the symptoms they are experiencing. Typically a critical review of the literature distils out into five categories: Identity, including the description of symptoms experienced and their meaning (e.g. pain, fatigue).In the narrative Francesca describes her pain as Excruciating for example. Belief about causes (e.g. accident, genetics or stress). People like to have a label for their symptoms for legitimisation although, once given, people are likely to interpret diverse symptoms as evidence of the label. Francesca has problems with causality and is likely to do so for the foreseeable future since there is no established medical cause for RA. Timeline (beliefs about duration and time for recovery), namely is it acute or chronic? These beliefs will be re-evaluated as time progresses. Consequences (e.g. loss of lifestyle, goals in life). These representations may only develop into more realistic beliefs over time. Francesca uses the narrative to discuss the change in her life from active dancer to unappealing spouse within the space of six months. Beliefs about controllability. (Furnham, 1989; Landrine and Klonoff 1992, 1994) These categories are pivotal to understanding how people make sense of, and decisions about managing a changeable chronic disease such as RA. Evidence of Francesca attempting to make sense of her symptoms by embarking upon a cognitive search may be seen in the example below: I couldnt understand it Im the healthiest person I know. Ive never had problems with my health never had a day off sick in my life. I never go to the doctor, no matter what, Ive always been fit as a flea. From the narrative provided we also have limited information concerning Francescas partners views, for example (although not from Dave himself) Dave wore me down, telling me Ive got to see a doctor This may be interpreted in various ways, not least that Dave was keen for Francesca to obtain a diagnosis and thereby a label to legitimise the illness, whether such labelling is disabling or enabling is not fully resolved in literature (Huibers Wessley 2006). Francescas comment does however open up the interesting issue of how partners cope with chronic disease, in RA in particular there is evidence that a strong marital relationship correlates with the couples psychological adjustment to the illness (Mann Zautra 1990). These authors go on to claim that in RA, partners are most affected by their perceived vulnerability to disease and coping ability, whereas the wives who have RA were more affected by pain itself and how they will cope with the effects of the disease- reflected in Francescas comments below; I started having excruciating pains in my feet when I woke in the morning To further corroborate the findings of Manne Zautra (1990) concerning male worries about coping at a more abstract level see the example below: Dave has been great but he has his own worries hes just been laid off from his job and hes worrying about paying for the wedding Mann Dieppe (2006) have also more recently acknowledged coping differences between males and females in RA, (n = eight women with RA ages 31-60 years and their partners, and 4 men with RA ages 43-75 years) although methodologically their sampling may be flawed in that those couples currently experiencing severe martial problems are unlikely to submit to the type of phenomenological interviews that they undertook. The social construction of medical knowledge and politics of disability It is not possible in an essay of this length to provide a full account of the politics of disability, primarily since the topic is multi-factorial, fluid and indeed is covered to an extent in the other sub sections of this work, furthermore we have insufficient data from the narrative to comment in depth. Kitchen and Wilton (2003) comment that our views of disability as a medical entity viewed in paternalistic terms have changed in favour or equality and empowerment. However Francesca can expect to experience a host of politically related issues, for example social exclusion and poverty (Foley Chowdhury 2007). Francesca has already stated in her narrative; Ive got to work- we need the money. In terms of medicines social construction, as far back as 1982, Wright Treacher (1982) claimed that medical knowledge inevitably contains a social component incorporating moral values and prejudices, and that diagnosis ascribes a certain meaning. We still see this thirty years later where the GP abruptly (allegedly) advocates of drugs to preserve normal function. This reinforces the paternalistic medical approach. RA in its early stages does not present with any obvious physical deformity and affects the young demographic, it is conceivable that she may experience disbelief from her peers; this may in turn make her life difficult in an era of financial unease, Government budgetary cuts and political uncertainty. Labelling. Labelling theory (social reaction theory) has its roots in the work of sociologist Howard Becker (Becker 1997). It centres on peoples tendency to negatively label those who are different from ourselves. As a person with chronic arthritis Francesca will not be immune to this labelling, for example being labelled as disabled or arthritic are all real possibilities. Arthritis organisations and acts such as the Disability Discrimination Act ( DDA) are at great pains to encourage activity and maintenance of full function and contribution to society, however all this may be negated by her GPs comments that there is; no cure and I had to take tablets everyday to be able to function normally. Labels can however be positive, Francesca describing herself as glamorous for example on two occasions in the narrative, and her previous label of salsa dance teacher is something that defines her in a positive way. Yes, Im a salsa dance teacher Stigma Stigma has recently been defined by Scambler (2009) as a social process, experienced or anticipated by exclusion, rejection, blame or devaluation that results from experience, perception or reasonable anticipation of an adverse social judgement about a person or group(p441) Francesca may feel stigmatised by all of the factors previously discussed, attitude of her GP, loss of self, worry about the future, inability to act out the role of spouse. Factors such as depression, the lack of a cause for her RA and her inability to teach salsa dancing may amplify her feelings of being stigmatised, it is also important form the wider perspective to acknowledge that stigma may affect Francescas partner. Struening et al (2001) for example reported that 43-92% of caregivers (to people with mental health problems) reported feeling stigmatised, again this suggests that living with this disease does not only affect Francesca but also her partner. Conclusion This essay has employed extracts from the narrative of a 38 year old lady with Rheumatoid arthritis, to illustrate some key sociological concepts. The essay has provided a valuable opportunity to map some key concepts from the literature onto a narrative excerpt. Whilst the essay has not been able to enter the field in great depth; It is a testament to the thick description provided by patient narratives that such a wealth of information can be generated form a relatively short piece of description. References Balen,R., Rhodes, C., Ward,L., (2009) The Power of Stories: Using Narrative for Interdisciplinary Learning in Health and Social CareSocial Work Education: The International Journal, pp1470-1227. Becker, H., (1997) Outsiders. New York, NY. Free Press. Covic, T., Adamson,B., Spencer,D., Howe,G., (2003) A biopsychosocial model of pain and depression in rheumatoid arthritis: a 12-month longitudinal study Rheumatology, Vol 42 1287-1294. Doba, K., Nandrino, J.L., Lesne, L., Humez, L., C.(2008) Organization of the narrative components in autobiographical speech of anorexic adolescents: A statistical and non-linear dynamical analysis New Ideas in Psycholog,y Vol 26 (2) pp 295-308. Foley,D .,Chowdhury, J., (2007) Poverty, Social Exclusion and the Politics of Disability: Care as a Social Good and the Expenditure of Social Capital in Chuadanga, Bangladesh Social Policy Administration, Vol 41 (4)pp372-385. Furman, R. ,Cavers, A., (2005) Narrative poem as a source of qualitative data The Arts in Psychotherapy Vol 32 (4) pp313-317. Furnham, A., (1989). Overcoming psychosomatic illness: lay attributions of cure for five possible psychosomatic illnesses. Social Science and Medicine, Vol 29 pp61-67. Goodacre,J., (2008) Common chronic inflammatory arthropathies. in Porter,S (eds) Tidys Physiotherapy 14th edition. Churchill Livinsgtone Elsevier. Grills, S..(1998). Doing ethnographic research; fieldwork settings Thousand Oaks. Sage Publishers. Hahn, H., (1985)Toward a Politics of Disability: Definitions, Disciplines, and Policies Social Science Journal, 1985 Vol. 22(4) pp87-105. Haidet, P., Kroll,T.L., Sharf, B.F., (2006) The complexity of patient participation: Lessons learned from patients illness narratives Patient Education and Counselling, Vol 62 (3) pp323-329. Huibers,M.J.H., Wessely ,S., (2006) The act of diagnosis: pros and cons of labelling chronic fatigue syndrome Psychological Medicine, Vol 36, pp895-900. Cambridge University Press. Kitchin, R. ,Wilton, R., (2003) Disability Activism and the Politics of Scale. The Canadian Geographer, Vol 47, 2003. Kojima ,M., Kojima, T., Ishiguro, N., Oguchi, T., Oba, M., Tsuchiya, H., Sugiura, F., Furukawa, T.A., Suzuki, S., (2009) Psychosocial factors, disease status, and quality of life in patients with rheumatoid arthritis. S.J Psychosom Res , Vol 67(5) pp425-31. Epub 2009 Mar 5. Lee, W.S. Kim, T.Y.,(2009) Measuring of ESR with test 1 is more useful than the Westergren method in rheumatoid arthritis. Am J Clin Pathol, 2009 Nov;Vol 132(5) pp805. Leventhal, H., Nerenz, D.R., Steele, D.J., (1984). Illness representations and coping with health threats. In: Baum A, Singer J, eds. Handbook of Psychology and Health, Hillsdale, NJ: Erlbaum. pp219-252. Morea, J.M., Friend, R., Bennett, R.M., (2008) Conceptualizing and measuring illness self-concept: A comparison with self-esteem and optimism in predicting fibromyalgia adjustment Research in Nursing Health, Vol 31 (6),pp563-575 Published Online: 21Jul2008. Mann,C., Dieppe, P.,(2006) Different patterns of illness-related interaction in couples coping with rheumatoid arthritis Arthritis Care Research, Vol 55, (2), pp 279-286. Mann, S. L., Zautra, A. J., (1990). Couples coping with chronic illness: Women with rheumatoid arthritis and their healthy husbands. Journal of Behavioral Medicine, Vol 13 pp327-342. Parker, G., (2007) Is depression overdiagnosed? Yes. BMJ. Vol 335 (7615), p328. Poindexter, C.C.,(2002) Meaning from methods; Re-presenting Narratives of an HIV affected caregiver Qualitative Social Work, Vol 1 pp 59. Roe,D., Davidson, J., (2005) Self and narrative in schizophrenia: time to author a new story Med Humanities,Vol 31 pp89-94. Scambler, G., (2009) Health-related stigma. Sociology of Health Illness, Vol 31 Issue 3 pp 441-455 Published Online: 1 Apr 2009. Smith, R., (2002) The biopsychosocial revolution. J Gen Intern Med, Vol 17(4) pp309-311. Stanton, A.L., Revenson, T.A., ÂÂ ­Tennen, H., (2007). Health Psychology: Psychological Adjustment to Chronic Disease. Annual Review of Psychology, Vol 58 pp565-592. Strauss, A.L., Corbin, J.M., Fagerhaugh, B.G., (1984). Chronic illness and the quality of life, 2 Ed. St. Louis: Mosby. Strauss, A., Corbin, J.M., (1998) Basics of Qualitative Research: Techniques and Procedures for Developing Grounded theory. Thousand Oaks, Sage Publishers. Struening, E.L., Perlick, D.A., Link, B.G., Hellman,F., Herman, D., Sirey, J.,(2001) Stigma as a Barrier to Recovery: The Extent to Which Caregivers Believe Most People Devalue Consumers and Their Families Psychiatr Serv,Vol 52 pp1633-1638, December 2001. Vollmer, F., (2005) The Narrative Self. Journal for the Theory of Social Behaviour, Vol 35,(2), pp189-205(17) Blackwell Publishing. Waite L,J., Gallagher, M.,(2001).The case for marriage: why married people are happier, healthier, and better off financially. New York, NY: Broadway Books. Wehowsky, A., (2000) Diagnosis as care diagnosis as politics International Journal of Psychotherapy, Vol 5, (3), pages pp241 255. Wright, P., Treacher, A. eds., (1982) The Problem of Medical Knowledge: Examining the Social Construction of Medicine (Edinburgh: Edinburgh University Press. Appendix Reflective postscript This is written in the first person since it is a reflective piece of writing This was a challenging yet fascinating project to complete. I was unsure how to approach the topic and how much weight to attach to the various theories available and the comments of Francesca , once it became clear that I was actually trying to explain what was going on with Francesca by using academic theory to illustrate her comments the task became rather enjoyable. Tight word count restrictions as always meant that I had to do some brutal editing, but the positive side to this is that it makes one more selective in ones writing. For example my earliest version was heavy on sociological theory and light on mapping this theory to the comments of Francesca, whereas the final version makes more explicit links between what Francesca says and the theory behind why she says it. The fact that I had some real comments to sink my academic teeth into made the process of literature searching interesting and relevant since I was able to think about Francescas comments and her personal situation for each search that I undertook. The areas that gave me most difficulty were the political aspects of disability since they seemed so wide ranging and actually intertwined with everything that I was writing about. All in all I have learned a great deal about the usefulness of narrative form this project.

The Bio Psychosocial Model In Healthcare

The Bio Psychosocial Model In Healthcare The theory of bio-psychosocial model was introduced in 1977 by Mr. George Engel, a professor of psychiatry and medicine. It is a comprehensive model explicating a strong relationship between health and disease by integrating cultural, social, and psychological considerations (Engel 1977, p. 132). There has been a consistent effort since 1980s to examine the interconnectedness between social, psychological, behavioural factors and the functioning of immune system to explore their contribution in causing human illness (Karren, Hafen, Smith, Frandsen, 2002; Kiecolt-Glasser, McGuire, Robles, Glasser, 2002) followed by a bio-psychosocial model. The bio-psychosocial interventions are conceptualized to target the combination of biological, psychological and sociological factors that contribute in deteriorating human body functions thus producing illness. These interventions are the collaborative efforts with service users by integrating a number of evidence based practices by encompassing the medical, social and psychological paradigm with intent to accomplish swift recovery (Brooker Brabban 2004). The main objective of these interventions is to analyze and identify the underlying causes of the disease by evaluating the causes of biological dysfunction, psychological problems affecting mental and emotional health and assessing the sociological issues including marital status, financial positioning, culture or religion that may serve as the root cause of sickness. The core elements of bio-psychological interventions are the management of medication, symptoms and relapses, the cognitive-behavioural therapy (CBT) for psychosis, collaborative assessments and structured family interventions. The effectiveness and responsiveness of mental health services rely upon the easy access of psychological interventions to the people diagnosed with severe and enduring mental health issues (Layard 2004). The Department of Health has been consistently emphasizing on the need for Ear ly Interventions in Psychosis Services (EIPS) and bio-psychosocial interventions specifically focussing on CBT, to be implemented across diverse clinical settings particularly in acute inpatient units (DoH 2001, 2002, 2004, 2006). The accessibility of such interventions facilitates in optimizing treatment concordance, reducing relapse rate and mental health problems and improves the overall clinical outcome which encourages resurgence of patients wellbeing (Gray et al. 2001). However, it is significant to note that psychosocial interventions can only be effective when implemented with the help and support of adequately trained healthcare workforce. 1.1 Rationale of the Study In accordance with the fundamentals of bio-psychosocial models, it can be constituted that the core forerunner of an ailment belongs to the three vital elements including physical, psychological, and socio-cultural components. Stevens Smith, (2005), in their study examined the bio-psychosocial model and constituted that it helps in comprehending with the interactive and reciprocal effects of environment, genetics, and mental behaviour (Stevens Smith, 2005, p. 25). To support the validity of the bio-psychosocial model, several pragmatic evidences have been put forward advocating the relationship of social, psychological and immunological factors that produce negative impacts on human health conditions (Trilling, 2000). Over the last decade, the need for education and training of healthcare workers in order to develop their PSI skills has been amplified however, the literature suggests that the implementation of PSI in routine service provision is extremely challenging (Kelly Gamble 2005). This paper is designed to examine the role of psychiatric in an acute in-patient ward. Moreover, the study in intended to highlight the policy and research related to bio-psychosocial interventions that help in managing crisis and complexities of an acute ward. The study will also facilitate in identifying the barriers of implementing psychosocial interventions and thereby, propose effectual strategies to prevail over these difficulties. 2. NATIONAL POLICIES FOR MENTAL HEALTH Mental illness along with cancer care and coronary heart disease were identified as the three national priorities in the year 2000 followed by which the UK government increased the funds for NHS up to 9% of GDP (Kings Fund, 2005). The budgetary limits for adult mental health services were also extended from  £983m to  £3,770m in 2001-2002 and up to  £4,679m in 2005-2006 (Mental Health Strategies, 2006) and it was also constituted that maximum financial resources will be utilized to support the inpatient services (Mental Health Strategies, 2006). The evidences suggest that the acute inpatient units have been facing a tremendous amount of dissatisfaction (MIND, 2004) and therefore, numerous healthcare bodies including Department of Health (DoH), the National Institute for Mental Health England (NIMHE) and Care Services Improvement Partnership (CSIP) collaborated to institute acute inpatient programme (DoH, 2002). The collaborative efforts by these healthcare bodies resulted in th e development of standard policies and guidelines for the betterment of acute inpatient services (Healthcare Commission 2007). Concerned with the conditions of mental health treatment, the national guidelines on acute psychiatric care were published in 2002 as the acute inpatient services were considered to be unsatisfactory (Department of Health, 2002a: 3). The main objective to institute standard policies and guidelines in accordance with Mental Health Act Commission is to ensure that all the inpatient mental health services are consistent in providing their patients with adequate sense of privacy, security and absolute care (MHAC, 2005: 19). ACUTE IN-PATIENT WARDS In accordance with the description proposed by the Department of Health (2002), the main purpose of introducing acute wards is to offer high standards of humane treatment and care facilities readily available to the patients within a safe and therapeutic setting during the most acute and vulnerable stage of their illness (DoH, 2002a: 5). The acute inpatient services have been developed to ensure that the spread of diseases is lessened and maximum treatment and support is made available for the patients that are unable to be treated in an alternative, less restrictive setting (********). The acute in-patients wards are meant to facilitate both health care providers and service users however, a number of studies have illuminated on the difficulties of managing the acute in-patient wards. A series of issues has been outlined by various studies including leadership crisis, deficient clinical skills and poor risk management process (SNMAC, 1999). The robustness of interaction between nurs e and patient and lack of therapeutic activities has also been questioned (Ford, Duncan and Warner, 1998); and a number of studies indicated a frequent state of confusion and chaos that builds up in the in-patient acute wards (SCMH, 1998). The effectiveness of CBT for psychosis is also challenged where there is a lot of complaint about non-therapeutic environment and non-cooperating overworked staff (MIND, 2004). Several studies also point out the dissatisfaction of patients due to surplus admissions in wards causing uneasiness and certain overly restrictive rules ended up in lack of privacy. The issues of in-patient acute wards also involved grievances of patients having less or no formation about treatment and which is considered to be unresponsiveness towards their civil rights (Walton, 2000). The study is therefore, focussed to critically examine the underlying issues and dig in the factors that aggravate them in order to suggest effective management strategies to improve the re ceptiveness of the nurses and open ways for easy accessibility to highly developed in-patient wards. ROLE OF NURSE IN ACUTE IN-PATIENT WARDS A critical care nurse working in acute in-patient ward has comprehensive mix of knowledge, skills and competencies required to fulfil the needs of a critically ill patient without having a direct supervision of a ward manager. The blend of knowledge, skills and competencies are not characterised by the therapeutic setting including intensive care unit or a high dependency ward instead, these blend of knowledge, skills and competencies must compliment the needs of psychotic patients. Psychotic patients need extensive care in order to reduce the chances of ill-fated crisis and complications. The level of therapeutic care can be enhanced by the careful interventions of experienced critical care nurses having advanced observational skills and holistic approach to deal with both the psychotic patients and their families. Following are some basic interventions employed by the critical care nurses in an acute in-patient ward to maximize operational efficiencies. 4.1 Ensure Positive Alignment Acute in-patient wards are critical in nature and therefore, a tactful and positive alignment of nurse-managers and nurse-patients is essential to maintain a functional ward. The role of nurse in an acute patient ward is to effectively respond to patients requests and offer maximum level of help and information. Patients are entirely dependent on nurses as they are the key point of contact in a ward and therefore, it becomes imperative for the nurses to establish a respect element for their clinical ability. Working closely with managers and regular staff meetings are all part of positive alignment that ensures smooth work process of an in-patient acute ward. 4.2 Supporting the Ward Manager A high-quality therapeutic skill of the nurse is to understand the organizational hierarchies and respect the decisions of the ward manager. Ward leader is involved in the positioning and staffing and the most crucial element of ward managers job description is to take prompt decisions. Acute wards are critical in nature so chaos and confusion adversely affects the mental health of patient and therefore, nurses are required to perform their duties by supporting the decisions and following the rules as set by the ward manager. 4.3 Safety and Containment Nurses in the acute in-patient wards are required to safe management system and prompt resolution of acute distress. The motherly relationship between nurse and patient supports the concept of containment by the benefitting the mental health of the patient. Physical restraint is the core element of containment which helps in the therapeutic progression. The role of a nurse in psychiatric wards is fundamental in preserving the safety and containment as the skilful and qualified nurses are specifically trained to reduce anxieties and fears of the patients and supporting them to resume a balance between idealism and realism. 4.4 Effective Communication Nursing in general supports a holistic approach towards the service users and the role of nurses become even more significant in an acute in-patient wards where the patients are extremely vulnerable. Nurses are the immediate point of contact to provide significant information about the patients mental health to the interdisciplinary team and the family members of the patients. Moreover, it has been observed that a nurse-patient relationship maintain effective communication, achieves better results in terms of fast recovery. 4.5 Observation Improving Patient Outcomes Acute in-patient wards require careful observations to reduce sedation and weaning from ventilation and to offer physical rehabilitation, and psychological support in a timely manner. Role of nurses in acute wards are required to be adequately skilful to monitor the dependence of patients on support equipment and to make proactive predictions and prevention of agitation by significant interventions in case of sudden deterioration. Recovery of a psychotic patient can be enhanced by using patient-centred care and vigilant management practices to cope with reckless events (Ball and McElligot, 2002). CBT FOR PSYCHOSIS Cognitive behavioural therapy is designed to evaluate the symptoms of psychosis and at the same time examine the relative impacts of illness on the patients mental health. A psychotic patient experiences a number of difficulties in terms of isolation, societal rejection, feelings of aggression as a result of which there is an increased risk self-harm and substance misuse. The main purpose of adopting CBT for psychotic patient is to gain symptomatic and functional recovery of the patient however, in case of persistent symptoms due to disrupted developmental trajectory; it is advised to continue with the therapy. CBT develops enhanced understanding of psychotic disorders and promotes adaptation to disorder by initiating coping strategies in order to reduce the degree of secondary morbidity and prevent relapse (Trilling 2000). CBT aims to improve the emotional and mental wellbeing of patients by reducing distress and offering helpful strategies to manage the residual symptoms of psychos is in daily life. The treatment therapy for psychosis involves a number of key phases and management strategies to progress speedy recovery. 5.1 Assessment Formulation The psychosocial intervention that involves CBT for psychosis primarily requires a therapeutic alliance between the healthcare provider and the service users. The initial phase of CBT involves engagement of therapist and patient in the assessment of the illness so that the patients mental health can be analyzed and their psychotic experiences can be recorded. The assessment phase of CBT helps in identifying the problem areas, factors sustaining the problem areas and the underlying causes of the psychotic disorder. Therapists strive to understand the nature, complexity and extent of the disorder by probing in the biological, psychological and social background of illness. During the assessment phase a therapist attempts to summarize the aetiology, development and maintenance of psychotic disorder and thereby, outlines the length and frequency of necessary interventions. Engagement of both therapist and the patient facilitates in the formulation phase where a specified course of action is established to undertake the therapy. 5.2 Psycho-education The early phase of psychotic disorder is identified by the onset of certain symptoms after which a the healthcare providers diagnose the ailment by taking into account numerous theories of psychosis and a number of individual explanatory models that helps in understanding of the precise form of psychosis. The patients are required to be informed about the impacts of substance misuse, compulsory medications and the inception of warning signs in order to keep them in the loop of the overall recovery process accompanied by CBT. The psycho-education also involves details about the helpful agencies and the nature of recovery which is usually conducted as part of a group programme. Educating the patients about facts and essential information is always useful however, it is imperative that the psychosis education programs are designed in a way that the patients comprehend the concept of these programs intended to restore their mental health. Depending upon an individuals coping style and wi llingness to absorb the information, the reaction to such educating programs might differ. 5.3 Adaptation to Psychosis The theory of adaptation to psychosis entirely depends upon the patients understanding of the disorder and how he/she addresses the recovery process by reacting to the underlying situation. The process of adaptation involves acknowledging the impact of psychotic disorder on patients life by estimating the damages caused to the patients self-esteem and his/her realisation of personal potential to combat with disorder. CBT helps the psychotic patients to identify their personal strengths and limitations to fight with ailment by expanding their coping skills and formulate realistic plans to facilitate the patient. The main objective of the CBT for psychosis is to enable the patients to learn the concept of overcoming the negative aspects of life and focusing on positive things including healthy activities, friendly relationships and personal accomplishments in order to enhance their self-esteem. The psychotic patients are extremely vulnerable and cannot stand social fears which eventual ly deteriorate their mental health. CBT enables them in adapting to their psychotic conditions by making them realise their strengths and capabilities to prevail over internal fears and hence contribute significantly in the recovery process. 5.4 Treatment of Secondary Morbidity Failure in adaptation to psychosis results in secondary morbidity state in which the patient is unable to cope with internal and external fears and thereby, experiences extreme level of depression, anxiety and substance misuse. It is important that CBT for psychosis is continued and the nature of the secondary condition has to be explained to the patient. Failure in adapting to psychosis leads the psychotic patients to develop irrational beliefs and assumptions which make it even more difficult and challenging for the therapists. However, an approach of cognitive challenging supplemented by group-based interventions for anxiety management or substance misuse is followed by examining the underlying beliefs and assumptions and replacing them with rational beliefs and assumptions. 5.5 Coping Strategies A number of behavioural and cognitive strategies have been formulated to help patients work towards improved functional outcome despite of psychotic symptoms. The functional and emotional problems that arise with the positive and negative symptoms of the psychotic disorder are controlled by coping strategies included in CBT for psychosis. It is however, necessary to identify the target symptoms to manage the recovery process. The most commonly used strategies in CBT include coping strategy enhancement, distraction and focusing techniques for voices after the identification of positive symptoms (Trilling 2000). Self-monitoring of behavioural activities, scheduling of paced activities, assertiveness training and diary recording of mastery and pleasure are some of the interventions used to cope with the negative symptoms. 5.6 Relapse Prevention The relapse prevention phase is amongst the integral phase of CBT in which the therapists are required to prudently monitor and intervene where there are early warning signs for relapse. It has been constituted that after the commencement of treatment approximately 80-95% of the psychotic patients experience the relapse prevention (*******). CBT incorporates several interventions to address the issue of relapse prevention including cognitive restructuring of enduring self-schema in which there is an elevated risk of relapse. BARRIERS TO IMPLEMENT PSYCHOSOCIAL INTERVENTIONS The clinical effectiveness of psychosocial interventions has been emphasized in a number of evidence based studies as the significance of these interventions has exceedingly grown over the last 20 years. The growing awareness and enhanced need and inclination towards the espousal of psychosocial interventions suggest that these interventions should be routinely implemented (NICE 2002). However, there has been a considerable amount of literature indicating the potential difficulties and challenges associated with the integration of psychosocial interventions within the routine mental health service provision (Brooker Brabban 2003, Forrest Masters 2004). The challenges are multifactorial and are primarily concerned with the workforce development and education (Brooker et al. 2002, Brooker Brabban 2004, Forrest et al. 2004); clinical and managerial leadership (Cook 2001, McCann Bowers 2005); and the impact of limited resources on service development in the context of increasing dema nds (McCann Bowers 2005). 6.1 Education Training Mental health services are currently challenged by policy, service user and professional drives. In order to establish the early intervention in psychosis services a range of initiatives are required. The foremost requirement to entrench the bio-psychosocial interventions into all levels of service delivery is to maximise the number of trained practitioners (Brabban Kelly 2006). More importantly the integration of the principles of the recovery approach and evidence-based practice has to be included in the education and training of the healthcare workforce (Repper Perkins 2003, Kelly Gamble 2005, NIMHE 2005, DoH 2006). However, it is unfortunate that despite of consistently mounting awareness and need for the psychosocial interventions within the clinical settings and mental health service provisions, the fraction of PSI trained workforce is still inadequate (Layard 2004). The situation becomes more intricate when a segment of trained healthcare workforce is not practicing their P SI skills due to other contributing factors including excessive workload and lack of time, limiting the scope of implementing psychosocial interventions (Brooker Brabban 2004). 6.2 Managerial Leadership Crisis Management and the senior staff have a better understanding of the complex nature and clinical significance of PSI training and its implementation and therefore, the role of managers become crucial in determining the success and failure of implementing psychosocial interventions in acute wards. It has been observed that regular communication between managers and trainees and careful check and balance maintained by the programme leaders enables successful PSI implementation (McCann Bowers 2005). However, the managers and programme leaders find it difficult to sustain the precision of PSI implementation due to workload pressures across the service (Cook 2001). 6.3 Limited Resources The most frequent complaints and issues regarding the failure of implementing psychosocial interventions in the acute wards have been identified by the literature and the most common issues are the unprecedented gap between theory and practice. Limited resources on service development in context of increased demand also tend to hinder in successful PSI implementation (Repper Brooker 2002). In order to fill in the gaps between theory and practice of PSI implementation the aims and objectives of the interventions has to be illuminated so that the practicability of the interventions can be sustained. It is therefore, essential to improve ward-based information and clarify the ward rules for users (Flood et al, 2006). On the other hand, sufficient resources including caseload size, access to assessment and intervention materials are required to undertake the interventions (McCann Bowers 2005). 6.4 Staffing Issues Excessive workload and staffing issues are the key problems of an acute in-patient wards where there is extreme need of practising psychosocial interventions. It has been observed that even after the completion of training and courses the trainees are compelled to resume the same job description. It is extremely unfortunate that the work overload doesnt allow the trainees to utilize their skills and knowledge at an advanced level (Williams 2008). Managers of the in-patient wards also complain about the workload pressure as being the critical factor for not adjusting the job descriptions of the trainees after the completion of their relevant course. On the other hand, trainees also complain about the excess workload and lack of time to focus on and practice their PSI skills. 6.5 Excessive Workload The most problematic barriers in the implementation of PSI are the emergency excessive and unpredictable admissions of the critical psychotic cases which require immediate attention. The presence of critical care nurse is therefore, extremely significant at any point of time which is one of the major staffing issue. Critical care nurses are already under immense workload pressures and conversely, the reduction in the number of beds has added to the situation (Williams 2008). The rise in demand due to high case loads has made it extremely difficult to effectively employ the structured PSI interventions into routine work. REQUIREMENTS OFACUTE IN-PATIENT WARDS The threshold of admission in acute inpatient wards has considerably increased and the role of critical care nurses has also become more complex. Systematic assessments by highly skilled critical care nurses by involving service users and their carer allows formulating a plan for significant interventions which are targeted to reduce the burden of in-patient wards provided if the necessary care and interventions can be continued at home (Royal College of Psychiatrists, 2006b).The complexity of the contemporary acute in-patient ward is enhanced by the reduction in the number of beds however, it is considered to be a small component of the multifaceted care system (Clarke, 2004). The most critical aspect of the decision making process is the comparison of psychotic patients awaiting the admission therefore, critical care nurses are required to carry out vigilant assessments by making careful considerations about the individuals circumstances (Meehan et al, 2006). Patients expect the nu rses to function in a collaborative way and treat them with respect (Baguley et al, 2007) however, a number of studies indicates dissatisfied service users complaining about the services being intimidating, demeaning and often humiliating (NIMHE, 2007). To address the underlying issues and in order to maintain the accreditation standards for the acute in-patient wards a full multidisciplinary ward round, at least once a week has been recommended (Royal College of Psychiatrists 2006b). Moreover, the government has also introduced crisis management and home intervention teams in order to lessen the burden of admissions in acute in-patient wards with intent to focus on recovery by involving community efforts. A combination of psychological and social interventions by reintegrating the service users into the community can be achieved by adopting a holistic approach. STRATEGIES TO OVERCOME THE BARRIERS A number of strategic measures have been identified by the study which is likely to enhance the benefits of implementing psycho social-interventions in the acute in-patient wards. The main objective of the proposed recommended strategies is to address extensive issues encompassing diverse areas and segments related to the acute in-patient wards, to accomplish utmost advantages for both the practitioners and service users. 8.1 Enhanced Flexibility The level of emergency admissions and dependency of patients in the critical care unit cannot be predicted and may considerably vary in between allocated shifts. The complex structure and nature of the acute in-patient units require flexibility in the number of critical care nurses per shift in order to effectively respond to changes in demand (******). Moreover, the critical care nurses are required to consistently examine the trends in elective patient admissions so that the capacity planning and nurse staffing may comply with the change in demand. 8.2 Employment of Healthcare Assistants Critical care nurses are highly skilled and trained to understand the needs of an acute in-patient ward. Therefore, while determining staffing levels, the recruitment of health care assistants must not interfere with the skill mix of critical care nurses. Considering the excessive workload pressure on the critical care nurses, it is beneficial to employ the health care assistants to facilitate in providing quality care services. However, to create a balance between critical care and general care services, it is advisable to specify the registered nursing hours so that the quality of critical care may not be compromised (Needleman et al, 2002). 8.3 Definite Policies Procedures Clearly defined policies and protocols helps in maintaining a healthy work environment and organizational structure. It is imperative to clarify the roles and responsibilities with respect to the specified job title in order to ensure that smooth workflow has been maintained across the entire ward. Moreover, definite policies and protocols also facilitate in successful implementation of PSI and practising of CBT by the trained staff. Depending upon the past experiences as a critical care nurse and knowledge of working in the critical care facility it has been recommended that for at least 30 days nurses should maintain supernumerary position in the intensive care wards (DHSSPS, 2000). To address the staffing needs, managerial support complying with policies and procedures, is required so that the chaos and confusion shall be avoided. 8.4 Professional Development Critical care services can be improved by consistent training and staff development programmes specifically designed to focus on the psychosocial interventions practice. It is highly recommended to incorporate evidence-based interventions in the curriculum of PSI-trained staff and their skills and knowledge must be employed in their respective job descriptions (Brabban and Kelly 2006). Moreover, the professional and developmental needs of the nurses working acute in-patient ward must be considered during staff appraisals to promote professional excellence of the critical care staff. 8.5 Reduce Workload Pressure Support of healthcare assistants shall be obtained to encourage superior care services by disseminating the excessive workload pressure. It has been observed that during PSI training, the staffing is greatly affected and therefore, it is advisable to utilize the replacement funds to relieve workload pressures in the critical care units. Moreover, rational strategies and centralized measures might be helpful in addressing the substitution arrangements in an effective manner. 8.6 Training and Education Development of leadership skills for critical care nurse is highly recommended for improving the PSI implementation, advanced patient care. It is also advisable to provide the critical staff with mandatory training including essential fire training, manual handling and basic life support in addition to the training for psychosocial interventions (Brabban and Kelly 2006). Moreover, a tripartite structure for communication in between ward managers, program leaders and the trainees would help in successful implementation of the psychosocial interventions. 8.7 Dissemination of Knowledge The significance of the psychosocial interventions has to be widely encouraged and therefore, the content and levels of PSI programme shall be kept diversified which may involve modular provision and training specific to certain interventions e.g. family work, medication management or clinical areas including acute inpatient, forensic etc. (*****) To establish the efficacy and implementation of the PSI, it is imperative to disseminate the basics and core PSI knowledge and values to the healthcare staff across the clinical environment. Furthermore, the local training needs for PSI shall be regularly reviewed by the stakeholders to ensure that adequately trained and skilful staff is maintained at all times to provide extensive care in critical wards. 8.8 Evaluating the Impacts of PSI Psychosocial interventions integrate collaborative participation of service users and carers at every stage including planning of services, training programs, formulation and implementation of strategies and diffusion of the recovery approach therefore, the impacts of these interventions can be evaluated by collating feedback from both critical care nurses and service users. 8.9 Regular Audits To estimate the effectiveness of the evidence