I would like to focus on the way behavioral economics effects a Essay

I would like to focus on the way behavioral economics effects a failing market - Essay Example The extent to which different markets are free, as well as the rules defining private property, is a matter of politics and policy (Concised Encycliopedia of Economics, Free Markets). This economic system where government allows a free hand to all the firms and entreprenuers is on the basis of some 'behavioural assumptions'. The two basic assumptions; that all the producers and consumers are rational in their behaviour and that they have complete information, has gone wrong and been violated numerous times! So, one has to be very clear about the reality that when the assumptions or the structure of a building is weak then how can it hold the burden and functioning of the entire economy. Here comes the need for Government Intervention and the system of 'laisaz-faire' is taken over by a 'mixed economy'! Economic role of the Government has four main components: 1. what is to be produced? 2. how is it to be produced? 3. for whom to be produced? 4. how are these decisions made? (Joseph St igletz, 2000). Now, lets see how an incentive structure can influence different markets. Institutional structure shapes the economic framework of a country. They build the basic structure of an economy which influences the level, pattern, and sustainability of growth. As an evidence, same macroeconomic models when applied to different countries produce different outcomes altogether! Institutions are a set of formal rules and informal norms that together with enforcement mechanism structure human interaction. They are to contain both incentives and disincentives which constraint human behaviour. The fundamental determinant of types of organizations emerging in a country is the institutions in place. Organizations are the players of the game and institutional framework are the rules of the game (Douglass. C. North, 1999). Organizations therefore try to play the game within the rules provided by the institutions. Institutions provide incentives for the organizations by reducing uncerta inty and risk .institution help in minimizing the transaction cost and the transformation cost. Countries all over the world are experiencing patterns of growth because of their institutional framework. Inefficient institutions provide high transaction cost and as a result the country struggle to grow. Incentives such as working hard are missing in inefficient institutions. Efficient institutions create an institutional matrix which strives for growth by reducing transaction cost and changing informal constraints through perceptions. Therefore once a country is stuck on a certain path of growth due to its institutions then it is difficult to revert back. The institutions drive organizations into a particular direction depending upon the incentive structure present. Through these incentives and disincentives embodied in rules they induce: efficiency, merit based solutions, hard work, competition and innovation. Hence, productivity increases and so does economic growth. In such an ins titutional framework organizations like 'Microsoft' emerge. Emergence of Microsoft was not a fluke; it was a direct result of institutions shaping the kind of organization. It has the highest sales in the entire World Industry of software. The reason is extensive research and development. It knows that if it's not at the cutting edge then it is going to get driven out of the market and go bankrupt. This will have backward and

Religion and Ethnic Diversity Essay Example for Free

Religion and Ethnic Diversity Essay Religion and Ethnic Diversity Buddhism was first found in India about 2,500 years ago. Buddhism is an increasing popular religion that continues to be the leading religion in the Far East. Buddhism has advanced over to a large amount of countries that have embraced a vast variety of customs, rituals, beliefs, and practices. Buddhist’s do not believe that a God created Earth. Buddha is the only Master, Buddhists believe in. Buddhist’s acknowledge that the ultimate purpose of life is to establish consideration for all living beings without inequity and to perform for their piece, good, and happiness. Buddhists have incorporated the Four Noble Truths in their lives, which are Dukkha, SamudÄ ya, Nirodha, and Magga. According to The Four Noble Truths (2013), 1.The truth of suffering (Dukkha). 2. The truth of the origin of suffering (SamudÄ ya). 3. The truth of the cessation of suffering (Nirodha). 4.The truth of the path to the cessation of suffering (Magga),† (The Four Noble Truths). Buddhism does not share common characteristics with other religion groups. Buddhism is, however, receptive to other religions and beliefs. This religious group acknowledges the way other religions teach those involved. These individuals do not believe in a God. It is a belief system like all other religious groups. There are individuals who do not accept Buddhist and believe that those who do are not going to heaven. Others who refuse to understand Buddhism and how it works dismiss it completely because it is not what they believe in. Even though Buddhism is not America’s most practiced religion, its beliefs and ideas have been passed into American culture. It has helped blend American culture. Today there is a large amount of Buddhists who contribute to promoting peace amongst one another, reaching out to those who are in prison and who are homeless, and some even do advocacy for the environment. Buddhist’s experience hate just like other people in other religions. In 2003, Chung Tai Buddhist Group applied to construct a meditation and worship center in the city of Walnut, California, but the application was later denied. Not only did the City Planning Commission deny the application, but also residents were against building the center. Residents disputed against the plan because they believed there would be an increase in traffic and noise. A few years later the City Planning Commission approved an application to build on some of the area Chung Tai had prepared to use. In 2010, the Department of Justice filed a lawsuit stating the city of Walnut; California treated the group unreasonably while dealing with the permit to build the worship and meditation center for Chung Tai Buddhist Group. The Department of Justice came to the conclusion that it was religious discrimination. After learning what Buddhism is and where it originated from allows me to understand it more. I now know that it is not only about humming and repeating a few words in another language, but also learning how to live a happier, more pure life even with the struggles and unfortunate events that can occur. Not only that, but respecting every living thing as it is. The Chinese are quite different from other racial/ethnic groups. The two most common languages used in China are Mandarin or Cantonese. Mandarin is t he government, education, and media’s main language that is used in China. Known as the ‘common language,’ mandarin is the first language that is spoken. The Chinese are a combined society with the urge to associate themselves in groups, whether it is to their work group, family, country, or associates. The Chinese depend on non-verbal communication like tone of voice and facial expression, to reveal what other maybe thinking or feeling. The Chinese believe in an ethical system known as Confucianism. Confucianism is a set up of ethics and behaviors that signify responsibilities of people towards one another based on their relationship. The Chinese have and continue to contribute to American culture in many ways. Many Americans embrace Chinese religions. Converting to Buddhism and so many other Asian religions. In the 1800’s Chinese immigrants helped working with the gold miners. These men helped construct the intercontinental railway. The Chinese have brought their recipes to American cultures that have been passed down from generation to generation. The Chinese brought their customs, language, and social organization into Amer ican culture. On May 6, 1882 the Chinese Exclusion Act was signed into law. It was brought about in reply to economic concerns in the West Coast, where Americans imputed unemployment and withheld wages to Chinese workers. Americans at the time viewed the Chinese as racially indifferent. Even though the act was repealed during World War II it only allowed 105 Chinese immigrants per year into the United States,  which still showed prejudice against the Chinese. I believe the source of prejudice against the Chinese was economic benefit. A large amount of Chinese immigrants came to the states to seek employment opportunities, but were denied at times because of the direct need for employment. I do believe what I have learned about the Chinese helped me understand this group. I learned what a big contribution to our culture they provided. I also learned that because of their great impact on American culture some individuals take those same customs and values and incorporate them into their own lives. The Chinese and Buddhist experienced similar situations dealing with discrimination because they were both persecuted for being who they are as individuals. Neither one of these groups tried to be something they were not, so they were prejudged and treated unfairly. These groups experienced different situations dealing with discrimination because the Chinese were discriminated against based on real and observed racial dissimilarities. Buddhistâ₠¬â„¢s were discriminated against based on who or what they believed in. Buddhist’s were also discriminated against because of their feeling towards their religion and those belonging to other religious groups. Discrimination towards these two groups and the many others is wrong. It has restricted these groups from opportunities that should have always been available to not only one group, but also all groups of individuals regardless of their appearance or their beliefs. 1. The Four Noble Truths. (2013). Retrieved from http://www.bbc.co.uk/religion/religions/buddhism/beliefs/fournobletruths_1.shtml 2.

Evolving Museum And Visitor Experiences Cultural Studies Essay

Evolving Museum And Visitor Experiences Cultural Studies Essay For over a century the museum has been the most celebrated and respected venue for viewing original works of art, however the design and visitor experience of the museum has evolved extensively throughout history. This chapter investigates how the traditional museum has evolved and how the collaborative approach towards the design and internal arrangement of modern art museums affects the spatial experience of the visitor. Duncan and Wallach in (see Carbonell 2004, p.52) state that, Museums belong to the same architectural and art-historical category as temples, churches, shrines and certain types of palaces. Originally, museum architecture shared characteristics with traditional ceremonial buildings to make visible the idea of state within its context (see Carbonell 2004, p.52). Museums were originally built to house collections of objects which are were of scientific, artistic, or historical importance and make them available for public viewing through exhibits that were permanent. This meant that the spaces and collections were fixed and objects were located deliberately to provide a specific spatial experience for each user. However, according to Bordieu and Darbel in the work of Duncan and Wallach (see Carbonell 2004, p.53), Individuals respond in different ways according to their education, culture and class. It is therefore debateable to say that due to the personal background of each user, they may experience a space differently to how a curator, architect or the artist desires. The journey that a visitor experiences through any museum is usually described in terms of aesthetic contemplation and Duncan and Wallach (see Carbonell 2004, p.51) state that this can be affected by the ensemble of art, the architecture and installations, which are contributing factors to the overall spatial experience of the modern art museum. These factors can be altered regularly to affect a user emotionally, visually or physically and are determined by the curators, the artists and the architects, to provide multiple experiences within one space. Todays society is embracing new museums that provide a wealth of subjects, particularly ones that cater for viewers of the popular trend that is contemporary art. The contemporary art museum is considered a fairly modern  category of museum. Also referred to as an art gallery or centre, art museums provide space(s) for the temporary exhibition of art. It is thought that the content of the contemporary art museum primarily consists of installations, including objects  which are of a sculptural nature, paintings, digital art, fine art, and video art. To design a modern art museum in the present century has become a popular challenge that is sought after by most architects and artists. Collaborative approaches towards museum design and layout have been encouraged as it is believed to enhance the users experience on a great scale, by providing them with a better aesthetic and social experience throughout their visit. The users experience can also provide them with lasting memories about the beliefs and values that museums hope to communicate. Contemporary art museums are essentially temporary exhibition spaces, in comparison with traditional museum buildings that house permanent collections. The actual design of the contemporary museum no longer has the traditional architectural values that a museum had in twentieth century for example. The white cube effect has become a popular idea for museums within the 21st century with some artists and architects believing that the focus of a museum should be the art and not the architecture. However an ironic example of this is the Leytonstone Centre for Contemporary Art, launched in 2001 by British artist Bob Smith. Leytonstone is a London suburb which houses no significant arts venues. This space could be viewed as an artwork or as an art centre, as it primarily a single exhibition space at the end of the artists garden. The artist demonstrates that the white cube can be removed from the gallery or museum and reappear in a totally different context. By doing this he has dissolved the boundary between art and architecture as people may be confused as to what this space is: art or institution. Temporary exhibition spaces raise the question; Does the modern art museum provide multiple spatial experience each time a new exhibition is displayed within it? From the 11th June to the 2nd November 2009, The Architecture Foundation provided a series of dialogues in which artists, architects and critics investigated into how collaborative and artistic approaches can change the practice and products of architecture. This series, called Architecture + Art: Crossover and Collaboration, included a dialogue between Adam Caruso and Thomas Demand, chaired by Alex Farquharson, the Director of Nottingham Contemporary. During the dialogue, Caruso argues that a good exhibition shows artists work in relation to other work and how this creates the spatial experience of the exhibition: A lot of exhibitions nowadays dont sufficiently recognise that the point of an exhibition opposed to a catalogue, is that what physically experiences it, is actually the choice of the work and the configuration of the work in a gallery is a specific and unique event and its there and then its gone. (Tate Channel, 2009 2/11/2009, 7.00pm @ 34.08mins-35.04mins)(NOT SURE HOW TO REFERENCE THIS VIDEO?) By saying this, he is implying that contemporary art exhibitions are intended to provide multiple unique spatial experiences for users and therefore when exhibitions have been and gone, a new spatial experience can be achieved within the same space. Todays contemporary art museums have very few artefacts within them in comparison to the traditional museum. This significantly changes the traditional spatial experience, as the focus of the user is on the few items that are displayed within the museum and the often large spaces that have been dedicated to them, unlike a traditional museum where hundreds of items are displayed with no link to context. During the dialogue (2/11/2009, 7.00pm), Farquharson, states that one problem in recent years within art galleries has been that they are too large for art and that the majority or artists are not interested in exhibiting there. Thomas Demand has had many major solo exhibitions at many of the worlds leading modern contemporary art instituti ons and he agrees with this remark by saying that when he looks to exhibit within a building, he inquires into what type of art work architects intend to provide their space for. Demand (Tate Channel 2009 2/11/2009, 7.00pm?) argues, At some point you want to reshuffle things and you want to make more shows downstairsis that possible or not? Some museums only employ selected artists to exhibit within their spaces for various reasons. These could be that they want art work to coincide with the internal spaces and architecture, or that they want to challenge the artwork through architecture, or visa-versa. As an artist, Demand wants art museums to offer flexible opportunities within their spatial layouts for exhibitions of his work. By saying this, he may be implying that he wants his artwork to offer multiple spatial experiences within one building and if the museum architecture does not have this capability, the creative exchange between the art and the architecture is not beneficial for the user as they are not receiving the best out of an art exhibition or the space. Interactive exhibits within contemporary museums have become popular in the 21st century, which give the public the opportunity to make choices and engage in activities which may vary the spatial experience from person to person; particularly content that includes architectural installations as art. With the opening of 21st century building styles, Victoria Newhouse argues: Art as an entertainment is contested by many together with the related trend toward ever more spectacular museum architecture. While the latter suits some art, it does not suit all art, and in todays wide variety of museums there is often a lack of harmony between container and contents. The need to coordinate this relationship is all too often ignored by those commissioning new museums (Newhouse 2005, p.215) Newhouse thinks that the link between museum architecture and its content is fading, indicating that the collection is less significant than the architecture. In previous eras the interiors and architecture of the museum were related to its content. If Newhouse is correct, the lack of connection to architecture can affect the spatial experience and the focus of the museum becomes the architecture or the art. If there is no creative exchange between both disciplines, it could be said that the spatial experience will not benefit the user as the contributing factors to the overall spatial experience will not be linked. Collaboration within previous architectural styles The Renaissance was a time that saw integration between painting, sculpture and architecture. The oldest public museums in the world opened in  Rome  during this period. However, many significant museums in the world were not founded until the 18th century and the  Age of Enlightenment. Walter Gropius initiated a school in 1919 called the Bauhaus when he combined two existing institutions: the Academy of Fine Art and the School of Arts and Crafts. The Bauhaus was an attempt to create a new style appropriate for the machine age, whilst achieving integration between disciplines. The Bauhaus attitude (Toy 1997, p. 26) believed that: The new building of the future, will embrace architecture, sculpture and painting in one unity. The Bauhaus was seen to offer a modern vision towards design and education; this attitude demonstrated an objective language set out to relieve design of subjective ideas from the previous century. Like the Bauhaus, the Modern Movement insisted there would be no more architectural styles and introduced architecture as a problem solving activity. The problem solving process encouraged the architect to find the perfect functional solution, given any set of technical, economic or social conditions. This method became a defensive mechanism within architecture, designed to keep others out of the building process. Late Modernism in the 1960s however, led to a rebellion towards reason; this process involved dishonouring previous rules for design by using curved forms. Frank Lloyd Wrights Guggenheim Museum in New York was seen as an example of this subjective reaction. The Percent for Art scheme which was introduced in 1990, which capitalised on the growing public art movement in this country, had an intention to extend the opportunities within architecture and public sites for artists through collaboration with architects. This implied the general thought that artists should to be more involved within public building projects from the beginning of the building process. Since then, there has been an increase within collaborative projects for buildings, public spaces and gallery installations. During the 20th century architects tended to work closely with engineers on architectural projects, these relationships were formed to solve spatial problems with a functional response towards design. These relationships had the underlying issue that some architects refused to develop a self-directed aesthetic communication. This meant that architects held back on their subjective design approach and therefore created architecture based on functional and technical reasoning. This process consequently affected architects subjective judgment and their creativity. As a result, the idea of working with an artist became appealing to architects..

Study on the use of reflection in nursing

Study on the use of reflection in nursing In recent years, reflection has undoubtedly become an important concept in nursing, stimulating debate and influencing nursing practice and education around the world. Much has been written about the theory of reflection, the majority of which has been applied to the educational setting (Price 2004). However, the process of reflecting has been described as a transferable skill which may be incorporated into clinical practice, enabling practitioners to better understand themselves and others, and solve problems (Mantzoukas Jasper 2004). Indeed, the capability to reflect consciously upon ones professional practice is generally considered important for the development of education and, hence, for clinical expertise (Mamede Schmidt 2004). Reid (1993) defines reflection as a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice (Reid 1993, p. 305). The nursing profession seems to advocate the need for nurses to be educated and practice in ways that develop their critical thinking, autonomy and sensitivity to others (Reed Ground 1997). Bulman (2004) contends that reflective practice may provide a means of achieving this. Within an intensive care setting, some evidence exists to suggest a strong relationship between lived experience and learning, with most critical care practitioners learning from previous experience (Hendricks et al 1996). More recently, reflection has been closely associated with the concepts of critical thinking and deconstruction. It is argued that a combination of these principles create a retrospective and prospective dimension, giving the practitioner the ability to deconstruct events, to reason the origins of situations, and to consider what has gone before and what may happen yet (Rolfe 2005). In order to be effective in practice there is a requirement to be purposeful and goal directed. It is suggested therefore that reflection cannot just be concerned with understanding, but must also focus on locating practice within its social structures, and on changing practice (Bolton 2001). This suggests that a structured approach to reflection is of benefit to the practitioner. Indeed the use of a model or framework of reflection is advocated as a tool which can aid and facilitate the practitioner in reflection, promoting a process of continuous development (Bulman 2004). Reflection is seen as a dynamic process and not a static one (Duke 2004), and thus the use of a framework which adopts a cyclic approach to reflective practice seems appropriate. One such framework is Gibbs (1988) Reflective Cycle, which is adapted form a framework of experiential learning, and uses a series of questions to guide, and provide structure for the practitioner when reflecting on an experience. Gibbs (1988) highlights 6 important areas of consideration when reflecting on a specific situation, encouraging the practitioner to consider what happened, why it happened and what could be done differently in the future. The 6 components of the Reflective Cycle are outlined below: Description What happened? Feelings What were you thinking and feeling? Evaluation What was good and bad about the situation? Analysis What sense can you make of the situation? Conclusion What else could you have done? Action Plan If the situation arose again, what would you do? It is clear that the idea of reflective practice has come to have a considerable impact on the nursing profession. This paper will focus on 2 clinical scenarios occurring within an intensive care setting. The issues raised will be discussed within the context of Gibbs (1988) Reflective Cycle. The aim in doing so is to highlight the benefits of a structured reflective process, and to identify ways in which clinical practice may be improved in the future. Scenario 1 Description The first scenario concerns the care of an elderly, critically ill patient, who was being treated in a surgical intensive care unit. At the time of this scenario the patient had been in intensive care for almost 3 weeks, having been admitted with respiratory failure requiring intubation, and displaying clinical symptoms consistent with sepsis. The patient had many other underlying medical problems, was morbidly obese, and despite antibiotic therapy was requiring high levels of inotropic and ventilatory support. Despite the patients symptoms, no definite source of sepsis had been identified. The above patient was being cared for by the author on a 12 hour day shift and at the morning ward round it was noted that the patients condition had deteriorated significantly over the previous 2 days, with increased inotrope dependence and worsening renal function. With few treatment options left to try, the consultant anaesthetist decided that the patient should have a CT scan to identify or rule out an abdominal problem as a source of the sepsis. The patient was reviewed by a consultant surgeon who felt that in view of the patients co-morbidity, surgery of any kind would not be appropriate, despite potential positive findings on CT. Knowing that a CT scan had been carried out 1 week previously with no significant findings, the author raised concerns about the benefit of such a procedure, and suggested that at the very least the patients family should be informed or consulted about the planned investigation. The patients son had been spoken to the previous day and informed that the prognosis was very poor. Withdrawal of treatment had been mentioned as a possibility in the event of no improvement in the patients condition. The son however was not informed about the scan which went ahead the same day. Transferring the patient to the radiology department for scan proved difficult. The patient was sedated for transfer resulting in a need for increased inotropes due to further hypotension caused by the sedation. The patients large size also created a problem in finding an appropriate transfer trolley to take the patients weight. Again the author voiced concerns, stating that perhaps transfer was inadvisable in view of the patients unstable cardiovascular status. The anaesthetist decided that we should proceed with the scan. The patient remained unstable throughout the transfer, requiring a further increase in inotropes on arrival at scan. Whilst on the CT table, the patient became dangerously hypotensive and bradycardic, and it seemed that cardiac arrest was imminent. Adrenaline boluses were administered, and large fluid boluses of gelofusine were also given. In view of this, the CT scan was abandoned midway, and the patient was quickly transferred back to ICU. Further adrenaline boluses were needed during transfer. On arrival back to ICU, the author was met by the patients son, who was not aware that the patient was being scanned. He was made aware of the patients poor condition. Back in ICU it was decided that further resuscitation was not appropriate. The son was present when the patient died a few minutes later. Feelings On the day these events took place, the predominant thoughts and feelings of the author were ones of guilt and inadequacy. Having considered the multiple health problems faced by the patient at this time, the author felt that the process of transferring the patient to CT scan and carrying out the scan itself may cause the patient stress, discomfort and potential danger, and ultimately be of little or no benefit. During the transfer and scanning process, the author became increasingly anxious about the immediate safety of the patient, and the potential for deterioration in the patients condition. When the patient became dangerously bradycardic and hypotensive, the authors thoughts were concentrated on trying to prevent cardiac arrest. On returning to ICU and meeting the patients son, it seemed that neither the dignity of the patient or the concerns of the family had been respected. The author felt an inadequacy and felt that the interests of the patient had not been properly advocated. The patient passed away in a distressing and undignified manner, and the son did not have the opportunity to spend personal time with the patient prior to this happening. The author felt guilty, as it seemed that the CT scan should not have happened and that the undignified circumstances surrounding the patients death need not have occurred. Evaluation Looking back on the events of scenario 1, it seems that there were both positive and negative aspects to the experience. During transfer to CT scan and the emergency situation which followed, the author felt that there was good teamwork between the different professionals involved in the care of the patient. Because of this, prompt action was taken, preventing cardiac arrest. However, it seems that this situation may have been avoided, which in turn raises many questions relating to the care of the patient. Ethically, one must question how appropriate it was to scan a severely septic, unstable patient, especially when corrective treatments would have been inappropriate in the event of an abnormality being discovered. Should the author have advocated the interests of the patient and family more forcefully? Was there a lack of communication and consensus between the critical care team? The events of this incident culminated in a clinical emergency situation which led to the patients death. Thus, the author feels that the patients clinical condition and the ethical issues and dilemmas surrounding the patients care must be examined and discussed, in the hope that lessons can be learned through the reflective process. Analysis Sepsis Most illness and death in patients in intensive care is caused by the consequences of sepsis and systemic inflammation. Indeed, sepsis affects 18 million people worldwide each year (Slade et al 2003), with severe sepsis remaining the highest cause of death in patients admitted to non-coronary intensive care units (Edbrooke et al 1999). Sepsis is a complex condition that results from an infectious process, and is the bodys response to infection. It involves systemic inflammatory and cellular events that result in altered circulation and coagulation, endothelial dysfunction, and impaired tissue perfusion (Kleinpell 2004). Dellinger et al (2004) define sepsis as the systemic response to infection manifested by 2 or more of the following: High or low temperature (>38 °C or Heart rate > 90 beats per minute Respiratory rate > 20 breaths per minute or PaCO2 High or low white blood cell count (> 12,000 or In severe sepsis impaired tissue perfusion along with micro vascular coagulation can lead to multiple organ system dysfunction, which is a major cause of sepsis-related mortality (Robson Newell 2005). While all organs are prone to failure in sepsis, pulmonary, cardiovascular, and renal dysfunction occur most commonly (Hotchkiss Karl 2003). When multiple organ system dysfunction occurs, Dolan (2003) promotes evidence-based sepsis treatment whereby patients should receive targeted organ support. This includes mechanical ventilation, renal replacement therapy, fluids, vasopressor or inotropic administration, and blood product administration, to maximize perfusion and oxygenation. In recent years new therapies have emerged which have been shown, in some cases, to increase the chance of survival from severe sepsis. Recombinant human activated protein C has been shown to have anti-inflammatory, anti-thrombotic and pro-fibrinolytic properties (Dolan 2003). In a randomised controlled trial, Bernard et al (2001) found a significant reduction in the mortality of septic patients who had been treated with activated protein C. The National Institute for clinical excellence (2004) now recommends this treatment for adult patients who have severe sepsis resulting in multiple organ failure, and who are being provided with optimal ICU support. Steroids, the use of which in ICU has long been debated, have also been shown, in low doses, to reduce the risk of death in some patients in septic shock (Annane 2000). Despite the development of specific treatments to interrupt or control the inflammatory and procoagulant process associated with sepsis, its management remains a major challenge in healthcare (Kleinpell 2004). The patient in scenario 1 was clearly in a state of severe sepsis, with respiratory, cardiac and renal failure, and receiving some of the supportive treatments mentioned above. Indeed it seems that the severity of this condition should not have been underestimated. In view of this, the ethical issues surrounding the decision to take this patient to CT scan must now be considered. Ethical Dilemmas and Consensus Ethical issues have emerged in recent years as a major component of health care for critically ill patients (Friedman 2001). Thus, caring for these patients in an intensive care setting necessitates that difficult ethical problems must be faced and resolved (Fisher 2004). Traditionally, much of the literature in biomedical ethics comes from theoretical perspectives that include principled ethics, caring ethics and virtue ethics (Bunch 2002). Although these perspectives provide an ethical awareness, which can be helpful, they do not of necessity give much direction for clinical practice. Melia (2001) supports this notion, suggesting that many discussions of ethical issues in health care are presented from a moral philosophical viewpoint, which as a consequence leaves out the clinical and social context in which decisions are taken and carried through. Beauchamp Childress (1994) identify 5 principles pertinent to decision making in intensive care. These are: salvageability, life preservation, non-maleficence, beneficence, and justice. Ethical dilemmas occur when two or more of the above principles come into conflict. The principles of beneficence (doing good), non-maleficence (doing no harm) and justice (fair treatment) are well established within the field of bioethics. Within a critical care context however, the dilemma between salvageability and life preservation becomes an important focus for health care professionals. Indeed, Prien Van Aken (1999) raise the question of whether all medical means to preserve life have to be employed under all circumstances, or are there situations in which we should not do everything that it is possible to do. This question becomes particularly relevant when a patients condition does not improve but rather deteriorates progressively. Curtin (2005) suggests that at some point in the course of t reatment, the line between treating a curable disease and protracting an unpreventable death can be crossed. In such incidences Prien Van Aken (1999) identify a transitional zone between the attempt to treat the patient, and the prolongation of dying, in which a conflict between the principles of life preservation and non-maleficence develops. These concepts seem particularly relevant to scenario 1 where the interests of the patient may have been neglected in favour of further attempts to treat the patients condition. This, in turn created a conflict between the principles of salvageability and life preservation. The decision to perform a CT scan on a patient with such cardiovascular instability and a very poor prognosis, meant that the patient was subjected to dangers and harms when there were few, if any benefits to justify this. Hence, the conflict between the ethical principles was not resolved, and the professional duty of non-maleficence toward the patient was not respected. Such conflicts and dilemmas in intensive care can be made all the harder by the availability of advanced technologies. Callahan (2003) writes that one of the most seductive powers of medical technology is to confuse the use of technology with a respect for the sanctity of life. In addition, Fisher (2004) contends that it has become all too easy to think that if one respects the value of life, and technology has the power to extend life, then a failure to use it is a failure to respect that value. This is particularly true of diagnostic technologies (such as CT scanning) which must be used with caution, especially in cases where the diagnostic information will make little or no difference to the treatment of the patient, but can create or heighten anxiety and discomfort for the patient (Callahan 2003). Medical technology is a two-edged sword, capable of saving and improving life but also of ending and harming life (Curtin 2005). Good critical care medicine carries the responsibility o f preserving life, on the one hand, and making possible a peaceful death, on the other. Callahan (2003) concludes by warning that any automatic bias in favour of using technology will threaten that latter possibility. Consensus between members of the intensive care team is also highlighted as an important issue in ethical decision making. Effective communication and collaboration among medical and nursing staff are essential for high quality health care (Woodrow 2000). Collaboration can be seen as working together, sharing responsibility for solving problems, and making decisions to formulate and execute plans for patient care (Gedney 2000 p.41). In intensive care units where ethical problems are faced frequently, care has to be a team effort (Fisher 2004). In a qualitative study, Melia (2001) found that there was a strong desire within the intensive care team that ethical and moral consensus should be achieved in the interests of good patient care, even though it was recognised that there is no legal requirement for nurses to agree with ICU decisions. Cobaoglu Algier (2004) however, found that the same ethical dilemma was perceived differently by medics and nurses with the differences being related to the hospitals hierarchical structure and the traditional distinctions between the two professions. Similarly, it has been observed that differences between doctors and nurses in ethical dilemmas were a function of the professional role played by each, rather than differences in ethical reasoning or moral motivation (Oberle Hughes 2001). It seems therefore that while the medical and nursing professions share the same aims for patient outcomes, the ideas surrounding how these outcomes should be achieved may differ (Fisher 2004). These differences have contributed to the development of the concept of the nurse as patient advocate, which sees advocacy as a fundamental and integral role in the caring relationship, and not simply as a single component of care (Snowball 1996). The role of the nurse advocate should be that of mediator and facilitator, negotiating between the different health and illness perspectives of patient, doctor, and other health care professionals on the patients behalf (Mallik 1998). Empirical evidence is sparse and philosophical arguments seem to predominate in the field of patient advocacy. There is some evidence to suggest that nurse advocacy has had beneficial outcomes for the patient and family in critical care areas (Washington 2001). Hewitt (2002) however found that humanistic arguments that promote advocacy as a moral imperative are compelling. Benner (1984) writes of advocacy within the context of being with a patient in such a way that acknowledges your shared humanity, which is the base of nursing as a caring practice (Benner 1984, p. 28). It has been argued that advocacy, at least in a philosophical sense, is the foundation of nursing itself and as such should be regarded as an issue of great importance by all practitioners (Snowball 1996). Conclusion It can be concluded that sepsis in a critical care environment is a complex condition with a high mortality rate, requiring highly specialised treatments. As such, the ethical issues and dilemmas faced by health care staff caring for a septic patient can be both complex and far reaching. It must be noted, that there can be no general solutions for such ethical conflicts; each clinical case must be evaluated individually with all its associated circumstances. A study of ethical principles would suggest that it is important that the benefits of a specific treatment or procedure are established prior to implementation, and that these benefits outweigh any potential harms or risks to the patient. The ultimate decision maker in the scenario under discussion was the consultant anaesthetist, who should have provided a clearer rationale for performing a CT scan on such an unstable patient. As the nurse caring for the patient, the author recognises that the final decision regarding treatment rested with the anaesthetist. However, the author could have challenged the anaesthetists decision further, advocating the patients interests, with the aim of reaching a moral consensus within the team. Perhaps then the outcome would have been more favourable for all concerned. Action Plan By reflecting on this scenario, the author has gained an understanding of sepsis and the potential ethical problems which may be encountered when caring for a septic or critically ill patient. As a result, the author feels more confident to challenge those decisions made relating to treatment, which do not seem to be in the best interest of the patient, or which have the potential to cause more harm than good. The author now has a greater understanding of the professional responsibility to advocate on a patients behalf, with the aim of safeguarding against possible dangers. It is hoped that this will result in improved outcomes for patients in the authors care. Scenario 2 Description This incident occurred in a surgical intensive care unit while the author was looking after a ventilated patient who had undergone a laparotomy and right sided hemi-colectomy 2 days previously. Around 10.30am the patient was reviewed by medical staff and was found to be awake and alert with good arterial blood gases, and requiring minimal ventilatory support. In view of this, it was decided that the patients support should be reduced further, and providing this reduction was tolerated, that the patient should be extubated later in the morning. In the intensive care unit in which the author works an intensive insulin infusion protocol is used (see Appendix A). This is a research based protocol which aims to normalize blood glucose levels and thus improve clinical outcomes for critically ill patients. All patients on this protocol require either to be absorbing enteral feed at à ¢Ã¢â‚¬ °Ã‚ ¥30ml/hr, on TPN or on 5% dextrose at 100ml/hr (Appendix A, note 2). The patient involved in this incident was receiving enteral feed via a naso-gastric tube, and was on an insulin infusion which was running at 4 U/hr. When it was decided that the patient was to be extubated, the author stopped the enteral feed as a precaution, to prevent possible aspiration during or after extubation. The author however did not stop the insulin infusion which breached the protocol guidelines. About 12 noon the patients blood gases showed that the reduction in support had been tolerated, and so the patient was extubated. Shortly after this the author was asked to go for lunch break and so passed on to a colleague that the patient had recently been extubated but was managing well on face mask oxygen. Returning from lunch 45 minutes later, the author found the patient to be disorientated and slightly confused. With good oxygen saturations, the author doubted that the confusion had resulted from hypoxia or worsening blood gases. The author then realised that the insulin infusion had not been stopped with the enteral feed earlier. A check of the patients blood glucose level showed that it was 1.2mmol/L. The author immediately stopped the insulin infusion, administered 20mls of 50% dextrose intravenously, as per protocol, and recommenced the enteral feed. Twenty minutes later, the patients blood glucose level had risen to 3.7mmol/L. The patient continued on the insulin protocol maintaining blood glucose levels within an adequate range. There were no lasting adverse effects resulting from the hypoglycaemic episode. Feelings When it was realised that the insulin infusion had not been stopped, the author felt a sense of panic, anticipating correctly that the patients blood glucose level would be dangerously low. Thoughts then became concentrated on raising the blood glucose level, to ensure that no further harm would come to the patient as a result of the authors mistake. Following the incident, when the patients glucose levels had risen, feelings of guilt were prominent. At this point the author realised how much worse the outcome could have been for the patient. The author felt incompetent, knowing that the patient could have been much more severely affected, or could even have died as the result of such a simple mistake. Evaluation The events of scenario 2 highlight the fact that clinical errors, while easily made, can have potentially disastrous consequences. This is especially true of those errors which involve the administration of drugs intravenously. In the interest of patient safety, it is important that all such errors are avoided. The clinical error outlined above could easily have been avoided. It seems that there was not sufficient awareness, on the authors part, of the insulin infusion protocol and the guidelines concerning the administration of insulin. As a result, the insulin protocol was not adhered to. The following analysis therefore will focus on the importance of insulin therapy in critical care areas, and will consider the safety issues surrounding intravenous drug administration. Analysis Blood Glucose Control in Intensive Care It is well documented that critically ill patients who require prolonged intensive care treatment are at high risk of multiple organ failure and death (Diringer 2005). Extensive research over the last decade has focused on strategies to prevent or reverse multiple organ failure, only a few of which have revealed positive results. One of these strategies is tight blood glucose control with insulin (Khoury et al 2004). It is well known that any type of acute illness or injury results in insulin resistance, glucose intolerance and hyperglycaemia, a constellation which has been termed the diabetes of stress (McCowen et al 2001). In critically ill patients, the severity of this condition has been shown to reflect the risk of death (Laird et al 2004). Much has been learned recently about the negative prognostic effects of hyperglycemia in critically ill patients. Hyperglycaemia adversely affects fluid balance, predisposition to infection, morbidity following acute cardiovascular events, and can increase the risk of renal failure, neuropathy and mortality in ICU patients (DiNardo et al 2004). Research suggests that there are distinct benefits of insulin therapy in improving clinical outcomes. Such benefits have been seen in patients following acute myocardial infarction, and in the healing of sternal wounds in patients who have had cardiac surgery (Malmberg 1997; Furnary et al 1999). More recently Van den Berghe et al (2001) conducted a large, randomized, controlled study involving adults admitted to a surgical intensive care unit who were receiving mechanical ventilation. The study demonstrated that normalisation of blood glucose levels using an intensive insulin infusion protocol improved clinical outcomes in critically ill patients. In particular, intensive insulin therapy was shown to reduce ICU mortality by 42%, and significantly reduce the incidences of septicaemia, acute renal failure, prolonged ventilatory support, and critical illness polyneuropathy. The length of stay in intensive care was also significantly shorter for patients on the protocol. It is unclear as to why improved glycaemic control has been associated with improved outcomes in several clinical settings. Coursin and Murray (2003) have summarized several leading hypotheses including maintenance of macrophage and neutrophil function, enhancement of erythropoiesis, and the direct anabolic effect of insulin on respiratory muscles. The potential anti-inflammatory effects of insulin have also been evaluated (Das 2001). There is also uncertainty over whether it is the actual insulin dose received per se, or the degree of normoglycaemia achieved that is responsible for the beneficial effects of intensive glycaemic management. Van den Berghe (2003) analysed the data derived from their 2001 study and have concluded that the degree of glycaemic control, rather the quantity of insulin administered was associated with the decrease in mortality and organ system dysfunction. In a follow up to Van den Berghe et als 2001 study, Langouche et al (2005) found that a significant part of the improved patient outcomes were explained by the effects of intensive insulin on vascular endothelium. The vascular endothelium controls vasomotor tone and micro-vascular flow, and regulates trafficking of nutrients and several biologically active molecules (Aird 2003). Langouche et al (2005) conclude that maintaining normoglycaemia with intensive insulin therapy during critical illness protects the vascular endothelium and thereby contributes to the prevention of organ failure and death. Whatever the reasons for improved patient outcomes, the study by Van den Burghe et al (2001) has prompted much research in this field, all of which has yielded similar results. In a similar study, Krinsley (2004) found that the use of an insulin protocol resulted in significantly improved glycaemic control and was associated with decreased mortality, organ dysfunction, and length of stay in the ICU in a heterogeneous population of critically ill adult patients. Thus it seems that with the strength of the emerging data in support of a more intensive approach to glycaemic management, insulin infusions are being utilised with increasing frequency, and are considered by many to be the standard of care for critically ill patients (DiNardo et al 2004). It is important to note that a well recognised risk of intensive glucose management is hypoglycaemia. Indeed Goldberg et al (2004) emphasise that in the ICU setting where patients often cannot report or respond to symptoms, the potential for hypoglycaemia is of particular concern. The events of scenario 2 highlight the authors error in the administration of insulin resulting in hypoglycaemia. For this reason some issues surrounding intravenous drug therapy will now be discussed. Intravenous Drug Therapy There is an increasing recognition that medication errors are causing a substantial global public health problem. Many of these errors result in harm to patients and increased costs to health providers (Wheeler Wheeler 2005). In the intensive care unit, patients commonly receive multiple drug therapies that are prescribed either for prophylactic indications or for treatment of established disease (Dougherty 2002). Practitioners caring for these patients find themselves in the challenging position of having to monitor these therapies, with the goal of maximizing a beneficial therapeutic response, as well as minimizing the occurrence of any adverse drug-related outcome (Cuddy 2000). The Nursing and Midwifery Council (NMC) (2004) identifies the preparation and administration of medicines as an important aspect of professional practice, stressing that it is not merely a mechanistic task performed in strict compliance with a written prescription, but rather a task that requires thought and professional judgement. Heatlie (2003) found that the introduction of new insulin protocols and regimes could give rise to problems, espe

To Kill a Mockingbird by Harper Lee :: To Kill a Mockingbird Essays

â€Å"To Kill A Mockingbird†   Ã‚  Ã‚  Ã‚  Ã‚  After watching To Kill A Mockingbird, the characters I see the author trying to teach me through is Atticus Finch, Scout and Jem, and Arthur â€Å"Boo† Radley.   Ã‚  Ã‚  Ã‚  Ã‚  To begin, Atticus Finch has experienced and understood evil throughout his life. He has been confronted with prejudice and racism, but has not lost his faith in the human capacity for goodness. Atticus understands from his own experiences and reflection that most people have both good and bad qualities. Also, through Atticus, the important thing in life is to appreciate the good qualities and understand the bad qualities by treating others with sympathy and trying to see life from their perspective. He tries to teach this ultimate moral lesson to Jem and Scout to show them that it is possible to live with conscience without losing hope or becoming cynical. For example, in this way, Atticus is able to admire Mrs. Dubose’s courage even while deploring her prejudice. In much the same way, Scout’s progress as a character is defined by her gradual development toward understanding the lessons Atticus Finch tries to teach her when Scout at last sees Boo Rad ley as a human being. Her newfound ability to view the world from his perspective ensures that she will not become jaded as she loses her innocence.   Ã‚  Ã‚  Ã‚  Ã‚  Secondly, I believe the most inspirational and in depth character in this movie was Jean Louise â€Å"Scout† Finch. From beginning to end, she learns to control her temper, to back away from fights, and to respect Calpurnia. She really learns her value to the family. Scout is also able to maintain her basic faith in human nature despite the shock and unfairness of Tom Robinson’s courtroom conviction. However, Jem’s faith in truth, justice and humanity is very badly damaged. He does not understand why all of this is happening. Prejudice and racism does not make any sense to Jem. Initially, Scout and Jem assume that all people are good by nature and tolerant of others. It is not until they see things from a more realistic adult perspective that they are able to confront evil, as well as prejudice, and incorporate it into their understanding of the world.   Ã‚  Ã‚  Ã‚  Ã‚  Lastly, Arthur â€Å"Boo† Radley has for decades been maliciously slandered in the county. The people that have done so do not know Boo and the reason they can make such judgments escapes me. When there was a series of pets being mysteriously slaughtered, the consensus was that it was performed by Boo.

Auditor Independence Essay -- Auditing

1. Introduction 1.1 The objectives of audit Under the regulatory, directors are required to produce financial statements annually which give a true and faire view of the affairs of the company and its profit and loss for the period and accountable to shareholders. Auditors have a responsibility to plan and perform the audit to obtain reasonable assurance to the shareholders and other stakeholders of a company on the financial statements. The objective of an audit of financial statements is to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, thereby enabling the auditor to express an opinion on whether the financial statements are prepared, in all material respects, in accordance with an applicable financial reporting framework; and to report on the financial statements, and communicate as required by the HKSAs, in accordance with the auditor’s findings. (HKSA 200.11) In order to maintain the auditor’s integrity, objectivity, and independence, auditing standards have been issued for measuring of the quality of the auditor’s performance. Auditing standards are general guidelines to aid auditors in fulfilling their professional responsibilities in the audit of financial statements. They include consideration of professional qualities such as competence and independence, reporting requirements and evidence. (Soltani, 2007) 1.2 Code of ethics for auditor independence Audit independence is a very critical component if a business wishes to have an audit function that can add value to the organization. The audit report and opinion must be free of any bias or influence if the integrity of the audit process is to be valued and... ...to aid auditors in fraud detection and increase emphasis on professional skepticism. 4. Recommendations Since professional independence and skepticism are more important for an auditors on audit engagement. It is recommended that auditors should enhance professional skepticism to the financial statement audit. It includes increase the ability of auditor to detect fraud by training, enhancing ability through experience and paying more effort in audit plan. In order to enhance auditor independence, directors should disclose the audit and non-audit services fee to investors and let investors to evaluate the independence of the auditor. By separating of auditor duties for audit and non-audit services, it can be help to maintain auditor independence. By enhancing the internal control system and corporate governance, it can be help to reduce fraud risk.

Solar Energy Informative Speech

Heather Smith Informative Outline Michelle Talasis Topic: Solar Energy General Purpose: To inform Specific Purpose:To inform the uses of Solar Energy to my audience. Thesis:When all of our natural fossil fuels are low or gone, solar energy will be one of the leading sources of energy that we will need in the future. Introduction Attention Getter: Natural fossil fuels, such as coal used for burning, oil used for gasoline, and natural gas used to heat and warm houses, are a threat to the Earth and everything in it. Fossil fuels pollute the air and they are non-renewable and non-recyclable.We need different energy sources that are renewable and recyclable for our future existence. Unlike fossil fuels, solar energy is renewable and recyclable. When all of our natural fossil fuels are scare or gone, solar energy will be one of the leading sources of energy that we will need in the future. With all of the technology we have today, we can develop different ways to use and harness these ener gy sources. Reason to Listen:Solar energy is making a big impact on lives today all over the world. The development of solar energy in all ways and technologies is making our world a cleaner, safer, and less dependent nation.A. Thesis Statement: When all of our natural fossil fuels are low or gone, solar energy will be one of the leading sources of energy that we will need in the future. B. Credibility Statement: My dad is an electrician that puts up solar energy plants for businesses. I had to research for this paper. C. Preview of Main Points: 1. First I will explain solar energy technology and how it can be used in houses. 2. Next, I will explain the uses of solar energy and how it will be helpful saving water. 3. Finally, I will explain the unique uses of solar energy in transportation and military weapons. II. Body A.People have created new technologies for others to use in their homes, vehicles or buildings. 1. One of the technologies that people have created to be energy effi cient is the photovoltaic cells or â€Å"solar cells† which use sunlight and convert it into electricity automatically. PVs can be used in anything from watches to an electric grid. They can also be used to provide energy to places where power lines cannot be attached to buildings. â€Å"Thermal technologies use the heat from the sun and use it directly in space or water heating in homes and buildings or it is directly converted into electricity,† says Fischer and Finnell.Thermal technologies are also used for agriculture needs that farmer’s livestock or crops require. With solar energy being used in electrical, heating, and transportation applications, the idea for an energy efficient house would be more probable. Energy efficient improvements can cut energy costs by over 40% in most affordable housing. They help reduce health risks from mold, dust mites, radon, and combustion by-products and other contaminants. These houses have less condensation, and better m oisture control and temperature. These energy improvements usually cost less than the savings they offer on utility bills.Increasing the value of a home is a great investment-paying high energybills are not. Transition:Now that I have discussed new solar technologies that people use in their homes, and for electricity, I will now explain the uses of solar energy in water. A. Solar power has helped with electricity and heat, but it can also help with the growing need for fresh water. 1. â€Å"Instead of using fossil fuels and electricity to desalinate water, engineers at the University of Florida have developed a system that uses a gravity-induced vacuum and solar energy. † (â€Å"Here Comes the Sun†) The desalination of water is the same process as nature. . A U-shaped pipe is place in two different containers, one side in salt water and the other in fresh water. ii. A vacuum is then surrounded by a circulator that heats the saltwater and the salt water is then evapora ted. iii. The evaporated steam is then condensed and finally the fresh water drips down into a tank. This system have been proved to be 90% efficient, while the solar â€Å"stills† only proved to be 50% efficient. Water has been desalinized by solar power for more efficient and inexpensive drinking water and fresh water supply, but it is also being detoxified by solar power for other usages around the house.Detoxification of water by solar power has proved to be one of the most promising methods to disinfect water, an earth-friendly operation and it does not create harmful emissions. â€Å"One way was ZED or Zero Effluent Discharge,† says Inamdar and Singh. i. ZED disposed of inadequately cleaned waste water that is contaminating fresh water resources, the waste water will recycle water properly if it is forced to generate fresh water from the waste water generated by them, and it is economical to use recycled water than to pay for consuming fresh water and wasting was te water.Transition:Now that we have learned the uses of solar energy in water, I will explain the uses solar energy in military weapons and transportation. Solar power is being used for disinfecting water and electricity, but for transportation and military weapons? 1. Solar power has been used in cruise boats and ferries. â€Å"The first boat that used solar power was in Australian waters that won a contract to build another ferry to carry passengers between San Francisco Harbor and Alcatraz Island,† explains Thwaites, a science writer and broadcaster in Australia. i.The guy who built the solar powered boat is Robert Dane. ii. He wanted to build a boat that was powered by solar power and wind power. iii. He called it the Solar Sailor, which has an electric motor they can power to drive the propeller properly, meaning the boat will be more efficient and easy to move and back up without stalling them. Solar Sailor technology also helped the Navy create UOVs or Unmanned Ocean Vehicles. i. These vehicles could be used to collect data for climate research, ocean exploration, offshore oil exploration and production and even surveillance of pipelines and telecommunications.Solar power is also being used in the US Military and even some weapons too. â€Å"The US Military have installed black and blue solar panels to use in solar-powered battlefield radios and even in tents with solar panels woven into their fabric to power military equipment,† says John Naish, an environmental campaigner. The solar panels are also being used for sensors and radars, which saves troops from being predictable targets when they regularly refuel generators. I. Conclusion Review of Main Points: Today, I explained how solar energy technology can be used in houses.Second, I discussed the uses of solar energy and how it will be helpful saving water. Finally, I talked about the unique uses of solar energy in transportation and military weapons. Restate Thesis:When all of our nat ural fossil fuels are low or gone, solar energy will be one of the leading sources of energy that we will need in the future. Closure: If we don’t continue to develop different ways and technology to lessen our needs on all of our natural fossil fuels, water, natural gas, and the environment, we will soon be living in our own human and mechanical waste.