Palliative care: Clinical experience

Palliative care: Clinical experience The purpose of this assignment is to reflect on a clinical experience in palliative care and demonstrate the knowledge and skills associated with this. The symptoms, symptom management and government guidelines and standards will also be discussed in relation to how this will impact the care of the patients who are experiencing life threatening illnesses. This will be achieved through using Gibbs (1988) model of reflection. I chose this model of reflection because it is clear and cyclical model which allows the reflector to revisit the same problem and also to examine my practice which will help me to develop and improve in the future. Description As an adult nursing student, I will be reflecting on an experience with a patient who was receiving palliative care that I encountered during my community placement. The patient received palliative care and required management of symptoms to help maintain their quality of life for the patient and their family. This involved a patient, who will be named Mr. Jones for confidentiality reasons. Mr. Jones was an elderly patient who had been diagnosed with bowel cancer along with liver metastases, the cancer was in the advanced stages. Mr. Jones was being cared for at home by his wife and carers who visited him at home twice a day to help with getting him up, washing and dressing and helping him back to bed. The district nursing team also visited him on a regular basis. When meeting with the patient his main concern was his pain control and available options which he would be able to receive to manage this. Feelings Initially when I heard about the diagnosis I was intrigued and wanted to find out more about the patient and their condition. When I met the patient I felt sympathetic towards him and the family and upon discussion he revealed that he felt like ‘giving up and ‘ending it all. A mixture of thoughts entered my mind, although I could understand why he would want to give up, the only reason was because he was worried about the pain he was starting to experience. When the nurse and I discussed the pain control options he appeared to be more positive about the situation and apologized for what he had said. On reflection it was a positive experience as it allowed me to see how people cope differently with terminal conditions, and the impact it has on the family and carers. Evaluation During this experience I thought that the nursing team had built a good professional relationship with the patient and their family. The patient had plenty of time to discuss any concerns or issues that he had .The issues discussed such as symptom management were all assessed and prioritized well; how the patient is feeling is important and needs to be taken into consideration. This would also need to be discussed with his wife alone, to find out how she is feeling and to offer her support. When discussed further, the feelings of ‘giving up related to his pain management. This is why the Visual Analogue Scale was used for a couple of weeks to monitor the progression of his pain (Crichton 2001). I found the tool to be beneficial for effective management of pain because it was a good indicator as to when we would need to adjust his analgesia using the World Health Organization (WHO) analgesic ladder (WHO, 2005). This aims to give the correct drug, correct dose, given at the corre ct time and proves to be inexpensive and 80-90% effective (WHO, 2005). This ensured the patient was in the least amount of pain which enabled them to carry on with activities of daily living. Analysis The World Health Organization (1990) has defined palliative care as: â€Å"The active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is the achievement of the best quality of life for patients and their families.† Caring for those receiving palliative care in the community during the end stages of life requires an extraordinary commitment from the nursing team, not only human resource but also competence, compassion and focus in anticipating the needs of the patient and family. It is a complex activity involving a holistic approach, building relationships together with expert professional skills and decision making processes (Melvin 2003). As well as pain, other common symptoms during advanced cancer are nausea and vomiting, with rates ranging from 50-60% (Kearney and Richardson, 2006). It is important to treat the reversible causes of nausea and vomiting before resorting to antiemetics. This can be achieved by appropriate assessment and documentation of symptoms which evaluate the effect of treatment given and can be completed and reviewed quickly to utilize less patient energy and nursing time (Kearney and Richardson, 2006). Cancer patients also experience psychological or affective symptoms of fatigue which include lack of energy and motivation, depression, sadness and anxiety, the sense of willpower and ‘fighting spirit is often lacking and personal resources that have usually kept a person going in the past are ineffective (Juenger, 2002). Fatigue can take away the ability to do things that the patient and family want to do or need to do. The control over life events reduces, further affecting the persons qu ality of life. An essential part of nursing care for fatigue includes returning some of that control. Giving information can be a positive way to do this. Nurses can explain that the person is not alone in the experience as fatigue is an expected occurrence in advanced cancer and discuss the causes of fatigue, effects and side effects of treatment and the impact of stress and depression, this will help the patient to manage the fatigue more effectively (Porock, 2003). Mr. Jones was prescribed oral slow-release Morphine Sulphate for his pain, however he was beginning to experience break through pain, nausea and vomiting which was making it difficult for him to take his morphine. We suggested he kept a record of his pain over a couple of weeks using a visual analogue scale (VAS). When we visited him again we were able to use the VAS to assess his pain and make changes to analgesia as appropriate using the analgesic ladder. From the assessment it was appropriate to increase his analgesia to step 3 of the analgesic ladder (WHO, 2005). A syringe driver was prescribed to administer morphine and an antiemetic over a 24 hour period which could be increased or decreased as required. Providing drug compatibilities have been checked, a combination of three drugs can usually be administered safely with the advantage that vomiting will not affect absorption, as it is given subcutaneously and the gut is not involved (Thompson, 2004). Although using a syringe dr iver improves symptom management with minimal inconvenience, complications can arise and nurses should be able to recognize these quickly and solve the problems efficiently (Lugton, 2002). The disadvantages of using this equipment is the painful injection site, infection risks and infusion rate problems (Thompson, 2004). Mr. Jones commented on ‘giving up and after further discussion, we found this related to his pain. Evidence shows that there is a link between chronic pain and depression as they share similar physiological pathways, whilst social and psychological factors appear to affect the severity of it and when they co-exist the severity of both conditions appears to worsen (Gray, 2001). Ineffective management of psychiatric disorders can be caused by failure to recognize, diagnose and treat appropriately in palliative care settings with 50% of psychiatric disorders being undetected (Payne et al, 2007). Patients with cancer should have access to appropriate psychological support and should be assessed regularly by trained professionals as recommended by National Institute for Clinical Excellence (NICE, 2004). Many people may wish to try complementary and alternative medicines to improve symptoms of their cancer, the reason being many feel dissatisfied with conventional medicine and feel the desire to experience holistic health care for symptomatic relief with a sense of well being (Nayak et al 2003). Auricular acupuncture (acupuncture to the ear), therapeutic touch, and hypnosis may help to manage cancer pain, whilst music therapy, massage, and hypnosis may have an effect on anxiety, and both acupuncture and massage may have a therapeutic role in cancer fatigue (Mansky and Wallerstedt 2006). However there is a lack of evidence to support that complementary and alternative medicine treatments are effective, the risks associated with them are unknown and can potentially be harmful. There has been increasing concern with the use of botanicals and dietary supplements by cancer patients because of the potential interaction between them and prescription drugs (Mansky and Wallerstedt 2006). During this experience, I realised just how important communication is, not only in this situation, but any situation that includes the patient, relatives, carers and multi-disciplinary team. Communication is an essential part of good nursing practice and forms the basis for building a trusting relationship that will greatly improve care and help to reduce anxiety and stress for patients, their relatives and carers (NMC 2008). Groogan (1999) acknowledges that communication is not something that people to do one another, but it is a process in which they can create a relationship by interacting with each other. From Mr. Jones perspective, patient-focused communication can be the most important aspect of treatment, due to its capacity to exacerbate or relieve the fear that often accompanies cancer, with evidence of effective communication resulting in decreased anxiety, greater coping ability and adherence to treatment (Dickson 1999). Communication can be divided into three types; cogn itive, emotional and spiritual. Cognitive communication involves the giving and receiving of information, emotional communication involves the feeling and expression of psychological responses and spiritual communication involves the expression and feeling of thoughts relating to existing issues beyond the person (Fallowfield Jenkins 1999). When speaking with Mr. Jones and his family the language used was clear and easy to understand. Stress, emotions and fatigue that accompany a terminal illness make it necessary for the information to be repeated to ensure the patient and family have absorbed it and feel reassured (Latimer 2000). Mr. Jones was given enough time to discuss his concerns and issues without feeling like he had a limited period or that the nurses had many other patients to see, however, what often matters is the quality of interaction rather than the length of time. Giving a few moments of time which are totally focused on the patients communication needs can often limit the amount of time spent communicating later when further explanation or clarification is needed (Faull et al, 2005). Mallet and Dougherty (2000) suggested that patients tend to be more dissatisfied with poor communication than with any other aspect of their care and concluded ineffective communication continues to be a major issue in health care. The Department of Health has produced the End of Life Care Strategy (DoH 2008) which promotes high quality care for all adults at the end of life which is the first for the United Kingdom and covers adults in England. Its aim is to provide people approaching the end of life with more choice about where they would like to live and die. In addition, the Macmillan Gold Standards Framework (2003) is another way of combining many different practices. The framework includes 7 Gold Standards which relate to key aspects of care, and guidelines for best practice on teamwork and continuity of care, advanced planning, symptom control and support for patients and their carers. Primary Health Care Teams who join the programme are guided and supported through a combination of workshops, resource materials and networking (Macmillan Cancer Relief 2003). In place is also the NICE clinical guidance on supportive and palliative care (NICE 2004) which advises those who develop and deliver cancer service s for adults with cancer about what is needed to make sure that patients, their families and carers, are well informed, cared for and supported. These initiatives had a positive impact on Mr. Jones as the nurses were able to use these guidelines to offer Mr. Jones the best care suited for him and he was then able to make informed decisions regarding the care he would like to receive. These initiatives also have a positive impact on health care professionals as they are supported and encouraged to improve their knowledge through workshops and resource materials. Action Plan/Conclusion My reflection of this experience has taught me how complex it is caring for someone receiving palliative care. It requires a holistic approach to ensure the patient and the family receive the best possible care in accordance with the guidelines and standards, in which they must remain empowered and make informed choices regarding their care and treatment with the help of health care professionals. I now understand how complicated symptom management can be; cancer patients experience many symptoms from their condition and also side effects from their medication. Assessments are vital to ensure the appropriate treatment and management of symptoms. The importance of communication has been brought to my attention once again, in my future nursing practice I will focus on my communication skills as this is an essential part of good nursing practice and plays a vital role in palliative care. Although this was an upsetting experience it has also been a positive one as this will affect my fut ure nursing practice a great deal as I have gained vital skills to look after those receiving palliative care and I am now aware of the various strategies and frameworks in place to ensure patients and families receive a high standard of care.

The Subject Of Education In Cambodia Education Essay

Education is really of import agencies to develop and construct up human resources for development of each state and it is besides of import for development of kid as individual. However, educational system in Cambodia has suffered excessively much during Khmer Rouge Regime from 1975 to 1979. After that period, the authorities has tried to better it by cooperated and collaborated with external assistance and non-governmental organisation ( NGOs ) . Harmonizing to the Kampuchean fundamental law, it states that â€Å" the province shall supply free primary and secondary instruction to all citizens in public school. Citizens shall have instruction for at least nine old ages † . Nowadays, though the students have no wage the fee, they still have to pass money on other things such as letter paper, text editions, part fee etc. Furthermore, some states pupils are asked to pass money to teacher for fee ; this is the job that prevent student from hapless households from go toing school . About a half a million Kampuchean kids from 6 to 11 old ages old have no entree to school, so 50percent of those who entered rate one dropped out of school and had to reiterate the category. Those jobs are caused by picture games, karaoke and the presence of whorehouse for the pupils in metropolis, and for female students, they could non go to school because of many jobs. First, parents are hapless, so they can non supply kids to larn and sometime they need their kids, particularly the misss, to gain money to back up the household. Second, the schools are located excessively far off from their house. Merely male child can travel to school at some distance from place because they have given adjustment in pagodas near the school. The last 1 is some parents do non understand about the of import of instruction, so they do non let their kids to go to school. Furthermore, the ministry of instruction has non provided equal instruction for minority kids. Many kids can non entree to school, and there is no proviso for schooling in minority linguistic communications except for categories provided by private ethic associations. Not merely that, there is deficient particular instruction proviso for disablements kids. Even though some organisations co-operated with authorities to supply school for those, this attempt is non yet plenty. Then, the quality of instruction in Cambodia is really hapless. Some schools in urban countries have about 60 to 80 pupils in each category, because there are non adequate category for students, most schools operated two displacements or three displacements per a twenty-four hours that affect the students ‘ feeling to analyze. Other thing is that the limited skilled of instructors cut down the quality of educational system. Technical and pedagogical preparation for instructor is non up to standard yet. There are many learning methods such as child-centered acquisition method has been taught to some instructors ; nevertheless, instructors still follow the old instruction methods. The last point is the deficiency of committedness of instructor because they receive a little sum of wage ( about $ 15 to $ 20 per month ) that lead to the low motive for learning. Then, they need to happen others occupation to supplement their incomes for endurance. In fact, the national authorities budget allotment to Ministry of Education, Youth and Sport was merely 10.3 % in 1997 and increase to 12 % in 1998, which is still really, in peculiar when compared to 52 % for the defence sector. The authorities should pay more attending because this sector is the major sector for development the state. Government should supply the high wage to instructors, and construct more school all around the state, and national budget allotment for instruction should be increased promote and ease the instruction to minority kids and supply particular school for handicapped kids and promote instruction for misss, raise consciousness of parents about the advantage of instruction. Finally, the educational system in Cambodia has faced many jobs that have to work out instantly. Those jobs can be affected on development for state every bit good. Because of that, the authorities needs to join forces or collaborate with international organisations. United Nations Organization is an international organisation that purpose are easing coaction in international jurisprudence, international peace and security, human right, economic sciences development, societal advancement and accomplishing universe peace. United Nations has many specialized bureaus to runing the jobs of member provinces. Those including UNDP, UNICEF, WHO, FAO and UNESCOaˆÂ ¦.and so on. However, we merely concentrate on three specialised bureaus because these bureaus are really of import for development in developing states. First, UNDP is the UN planetary development web. It promotes for alteration and connects states to knowledge, experience and resources to assist people to construct a better life. The specialised bureau has states offices in 166 states, where it works with local authorities to run into development challenges and develop local capacity. UNDP decision maker is the 3rd highest ranking functionary of United Nations after the United Nations Secretary-general and Deputy Secretary-general, and its headquartered is in New York. UNDP is funded by voluntary part from member provinces. UNDP helps the states to accomplish the Millennium Development Goals ( MDGs ) . MDG is adopted by United Nations General Assembly to develop the hapless states in 2002. These precedence MDGs states are concentrated is Sub- African, Central America and Andes, Central Asia, and the portion of Southeast Asia. Millennium Development Goals is related to poorness, primary instruction, gender equity, maternal wellness, kid mortality, HIV/AIDs, malaria and other diseases, environmental sustainability and planetary partnerships for development. Second, UNICEF was created by United Nations General assembly on December 11, 1946 to supply exigency nutrient and health care to kids in states that had been destroyed by World War II. UNICEF provides long-run human-centered and development aid to kids and female parents in developing states. UNICEF support kid wellness and nutrition, quality basic instruction for all male childs and misss, entree to clean H2O and sanitation and the protection of kids from force, development and AIDs. In 1953, UNICEF became United Nations System and its name had shortened from United Nations International Children ‘s Emergency Fund and its headquartered is in New York City. UNICEF fund is provided by voluntary part of authorities, concerns, foundations and persons. Third, UNESCO is a specialised bureau of the United Nations which established on 16 November 1945. Headquarter of organisation is in Paris, with over 50 field offices and many specialized institutes and based in throughout the universe. Its aims is to lend to peace and security by advancing international cooperation through instruction, civilization, and scientific discipline in order to foster cosmopolitan regard for justness, the regulation of jurisprudence, and the human rights along with cardinal freedoms declared in the Charter of UN. UNESCO pursues its aims through five major plans: instruction, natural HYPERLINK â€Å" hypertext transfer protocol: //en.wikipedia.org/wiki/Human_science † scientific disciplines, societal scientific disciplines, civilization, and communicating and information. Undertakings sponsored by UNESCO include literacy, proficient aid, and teacher-training plans, scientific discipline plans, the publicity of independent media and imperativeness free dom, regional and cultural history undertakings, the publicity of cultural diverseness ; international cooperation understandings to salvage the universe cultural and natural heritage ( World Heritage Sites ) and to protect human rights, and efforts to bridge the world-wide digital divide. UNESCO in Cambodia has worked through with the local authorization and NGOs. UNESCO focused on its activities through five major dockets such as instruction, civilization, natural scientific disciplines, societal and human scientific disciplines, and information and communicating. First, in instruction, UNESCO has developed the policy and schemes for ECCE ( Early Childhood Care and Education ) , presenting planetary degree policy tendency and advanced patterns, and lending to outline the policy on ECCE by supplying consultative services. Furthermore, UNESCO has improved on instructor instruction by supplying policy model and policy picks for developing teacher professional criterions and appropriate measuring, planing inducements to actuate the instructors for better instruction and pupil acquisition, deploying qualified instructors to rural and distant countries. Then, UNSECO has focused on proficient vocational instruction and preparation, HIV/AIDs bar instruction, and instruction and planning direction. As the chairs of educational sector working group, UNESCO has played an of import function in easing good coordinated and professional response from the giver community to the demands of the instruction development and the petition from authorities. The chief spouse in instruction of UNESCO is Ministry of Education, Youth, and Sport ( MoEYS ) . UNESCO assists MoEYS for the preparation and constitution of national instruction model and policy to outreach broader populations. A figure of instruction policy are formulated with proficient support from UNESCO and other development spouses including: National Non- Formal Education Policy, the National Plan of Action for Non- Formal Education, the policy on School Health and policy on Education for Children with Disabilities, and National ICT ( Information and Communication for Technology ) policy and scheme. Millennium Development Goals ( MDGs ) are the international development end which focal point on eight jobs such as eradicate utmost poorness and hungriness, achieve cosmopolitan instruction, advance gender equality and empower adult females, cut down kid mortality, better maternal wellness, combat HIV/AIDs and other diseases, guarantee environmental sustainability, and develop a planetary partnership for development. However, in Cambodia, because of acknowledging the major restraint to development is the continued taint of mines and explosive leftovers of war, the Royal Government of Cambodia added the de-mining and victims aid as the 9th major development end. Then, on the subject of the 2nd end of CMDGs, it is reference about Achieve Universal Nine-year basic Education that took root of the Education for all by guarantee that all kids will finish primary schooling by 2010 and Nine-year basic schooling by 2015. UNICEF in Cambodia has provided de-worming tablet to 95 per centum of kids in primary school. Furthermore, UNICEF has supported the fiscal aid for the wage of community preschool instructor in order to better the preschool to all kids. Harmonizing authorities ‘s statistics, the pre-primary school registration rate of Cambodian ‘s five twelvemonth old in school twelvemonth 2006-2007 was 27.7 % including province, community, home-based, and preschool categories. Then, Kampuchean authorities and UNICEF functionary maintain that early childhood development plan have proved over and over that preschool encourages on clip registration in primary school and better academic public presentation. In amount up, those organisations are of import for bettering or advancing the all sector in Cambodia, particularly in educational sector which is of import sector for development. However, the authorities should lend to advancing every bit good, so our state will accomplish all ends early. Since you focused on the functions and models of MDGs, UNICEF, UNESCO, you have known that those models are suited for bettering the instruction in Cambodia. However, do these bureaus and authorities can assure that they will better or advance instruction good as they expect? Harmonizing to the statistic from studies, the primary school undertakings have been complete successfully. In 2000, there are about 85 % to 86 % of kids from urban country can go to school, and for the kids in rural country, there are about 82 % to 83 % go to school, but the kids populating in the distant country can go to school merely 60 % to 63 % . From one twelvemonth to twelvemonth, the Numberss of go toing school from those three countries are increasing bit by bit. In fact, in 2009, in distant country the kids attend school about 90.3 % . Surprisingly, the urban kids which had the figure higher than others do non increasing dramatically as the rural country in 2000. Rural country ‘s kids go to school much more than the urban country ‘s kids, is 95 % and 92.2 % . Nevertheless, undertakings to advancing the secondary school is seem failed because the mark of undertaking predicted that about 65.3 % in 2009 for the kids go toing secondary school, but in world, there a re merely 31.9 for pupils go toing school. By the manner, gender disparities in primary school have been eliminated and regional disparities have besides been eradicated. Then, the proportion of 6-14 old ages old out of school is stagnating. Based on the information from CMDGs, the flow of the line of graph is smooth from 1997 until 2003, but in 2004 the figures of the information is increasing from 18.7 % to 19.81 % . However, the expected mark is merely 14.4 % in 2008 for the out of school pupils, so it seems non travel beyond as outlook. Literacy rates of 15 to 24 old ages old ; hence, in 1998 there is about 82 % of literacy. CMDGs expected that in 2009, there would be about 92.1 % for literacy, but in existent, there is about 87.47 % for literacy because the line of the graph was increasing easy. In amount up, instruction in Cambodia become better than earlier. Even so, those bureaus need to better or advance more because as you known, the instruction is the of import sector for develop state. Then, in instance instruction in Cambodia does non good, how could Cambodia better or develop state good? After you have understood about the functions and models, consequence of the bureaus, you can state that though they could non accomplish all ends as scene, but they could better or advance the instruction in Cambodia. As you can see, educational system in Cambodia has suffered excessively much during Khmer Rouge Regime from 1975 to 1979. After that period, the authorities has tried to better it by cooperated and collaborated with external assistance and non-governmental organisation ( NGOs ) . About a half a million Kampuchean kids from 6 to 11 old ages old have no entree to school, so 50 % of those who entered rate one dropped out of school and had to reiterate the category. Those jobs are caused by picture games, karaoke and the presence of whorehouse for the pupils in metropolis, and for female students, they could non go to school because of many jobs. Due to these jobs, the Kampuchean authorities attempts to pay attending on instruction systems because every bit mentioned before, instruction is really of import agencies to develop and construct up human resources for development of each state and it is besides of import for development of kid as individual. If Kampuchean people hapless at the cognition, how could Cambodia has been developed to go the strong state as the adjacent states. Furthermore, the IOs ( International organisations ) besides pay attending on instruction sector as good. They try to promote and join forces with Kampuchean authorities to bettering the instruction systems. As mentioned, Harmonizing to the Kampuchean fundamental law, it states that â€Å" the province shall supply free primary and secondary instruction to all citizens in public school. Citizens shall have instruction for at least nine old ages † . Then, IOs have besides contributed to betterment every bit good. First, UNESCO has improved on instructor instruction by supplying policy model and policy picks for developing teacher professional criterions and appropriate measuring, planing inducements to actuate the instructors for better instruction and pupil acquisition, deploying qualified instructors to rural and distant countries. Furthermore, UNESCO has played an of import function in easing good coordinated and professional response from the giver community to the demands of the instruction development and the petition from authorities. Second, CDMGs is reference about Achieve Universal Nine-year basic Education that took root of the Education for all by ensures that all kids will finish primary schooling by 2010 and Nine-year basic schooling by 2015. Third, UNICEF has supported the fiscal aid for the wage of community preschool instructor in order to better the preschool to all kids. Harmonizing authorities ‘s statistics, the pre-primary school registration rate of Cambodian †˜s five twelvemonth old in school twelvemonth 2006-2007 was 27.7 % including province, community, home-based, and preschool categories. Then, Kampuchean authorities and UNICEF functionary preserve that early childhood development plan have proved over and over that preschool encourages on clip registration in primary school and better academic public presentation. In decision, some jobs the province could non cover with by herself, so she needs the aid from NGOs, IGOs, and so on. However, in instance the provinces do non pay attending with those jobs, the solution still can non run into. As Cambodia, because the authorities and specialised bureaus try to collaborate each other, the instruction system seem better a small by a small. In my sentiment, in future, Cambodia will diminish the rate of illiteracy from clip to clip.

An Apple a Day Keeps the Doctor Away Essay

The idiom â€Å"to kill two birds with one stone† is used to describe achieving two objectives at the same time. The term references a common hunting tool, the slingshot; slingshots continue to be used to hunt small birds, and at one point, they were very common. As you might imagine, killing one bird with a stone requires an excellent aim and control over the slingshot; to kill two could be considered even more difficult, a task for only the most skilled of hunters. This idiom dates from the 1600s, and it was initially used in a somewhat pejorative way, to describe a philosopher’s attempt to prove two arguments with a single solution. The implication was that killing two birds at one time is extremely challenging and unlikely, and that the philosopher’s attempt should be viewed with extreme suspicion. The philosopher had obviously failed to satisfy his critics, who suggested that his attempt was about as successful as a try to knock out two birds with a single s tone. Over time, â€Å"to kill two birds with one stone† has come to be used more generally to accomplishing two goals at once, and the negative connotations have largely vanished. In fact, people are encouraged to think of ways to accomplish it, thereby living much more efficient lives. This is especially true in the business world, where employers are constantly on the hunt for ways to cut costs and improve efficiency, so something that kills two birds with one stone could be quite useful. For example, someone could be flying to a city on business, and decide to visit a family member while he or she is in the city, or a company might have an employee pick up a shipment somewhere while he or she is already there. From the point of view of both the employee and the company, this can be convenient, because the employee will be reimbursed for mileage and other expenses, while the company can save a trip. Some people feel that this term is a bit negative, given the association with hunting and death, and they prefer more positive twists on the saying. Several organizations have even sponsored contests to come up with a new and more animal-friendly version of â€Å"to kill two birds with one stone.† However, the idea has become so entrenched in many societies that it is unlikely to fade from usage anytime soon, negative or not.

Wal-mart’s competitive advantages - Free Essay Example

Sample details Pages: 2 Words: 637 Downloads: 1 Date added: 2017/09/17 Category Advertising Essay Type Argumentative essay Tags: Investment Essay Did you like this example? 1) What are Wal-mart’s competitive advantages? a. Large variety of products and services b. Extremely well known brand name c. Superior IT systems d. Volume purchasing power e. Lots of investment capital 2)How sustainable are those advantages? a. The ability to offer a wide variety of products and services is essential to their business model, however by expanding the number of product/services too much or too quickly, their variety can become a liability. Have a large variety of products/services is also expensive and can be unsustainable in an economy that is experiencing a recession. . Having a well known brand name is fairly sustainable advantage. However if the brand name is in some way tainted, for example how their name has been hurt by the idea that they mistreat their employees then having the well known brand name can be detrimental to the business. c. Superior IT systems can only provide a temporary competitive advantage on account of the fact that technolog y is always changing. Although Wal-Mart may have the best technology systems right now, this may not be the case in 5 years if they choose not to update their systems. Although Wal-Mart has the capital to continue to stay abreast with the newest and best technology, continual implementation of these systems can be cumbersome even for a company as big as Wal-Mart. d. Volume purchasing power is one of Wal-Mart’s most sustainable competitive advantages. This is due to the fact that given the large number of stores and variety of products that Wal-Mart carries they are able to better negotiate with manufacturers for discounts on large volume orders. e. Although Wal-Mart does have a lot of investment capital accrued, this capital advantage may be at risk given a few miscalculated expansions (stores, number of products/services, etc) and negative global economic trends (recessions, droughts, etc) 3)How transferable are those advantages as Wal-Mart moves into new formats and e specially into new international locations? a. The variety of products/services that Wal-Mart is able to offer in other countries won’t be able to compare to the variety that they offer within the US. This is in part because of how expensive potentially unprofitable (based on taste preferences) it would be to offer that many products from manufacturers based in the US. That being said Wal-Mart will undoubtedly continue to use this low-cost/large product variety model of business as they enter new markets where consumers aren’t used to being presented with so many options. b. Although they do have an international brand name, it is necessary that Wal-Mart builds brand name recognition in new markets. This has been accomplished in the past by buying out local companies and co-branding products/stores until the Wal-Mart brand is well recognized enough to sell products on its own. c. Superior IT systems are to some degree is a transferable in the sense that it shoul dn’t be overly cumbersome to implement the new technology outside of training and system updates. However some new markets or different formats that Wal-Mart enters into will have different IT system needs and the availability of this technology may be locally based and thus susceptible to changing trends within the new location/industry. Again the changing dynamic of technology and Wal-Mart’s willingness to stay up to date with the newest/most efficient IT systems can limit their ability to transfer this competitive advantage to new locations. d. The competitive advantage of volume purchasing will be affected by the international location. In some places volume purchasing simply won’t be an option. Whether that is due to politics or cultural customs, Wal-Mart may not be able to maintain their volume purchasing power in all markets. Their investment capital is a transferrable resource however as noted above this is subject to changin Don’t waste time! Our writers will create an original "Wal-mart’s competitive advantages" essay for you Create order

Child Abuse and its Role in Bastard Out of Carolina by...

While reading the semi-autobiographical, Bastard Out of Carolina, by Dorothy Allison, I was stunned by the explicit nature of the novel. We were introduced to a young narrator and protagonist named, Ruth Anne â€Å"Bone† Boatwright. Bones family, like that of the author, experienced a impoverished life, all the while she tried to find her place in a society that had literally labeled her â€Å"illegitimate.† Merriam-Webster defines illegitimate as being: (1) not recognized as lawful offspring; specifically: born of parents not married to each other (2) not rightly deduced or inferred- illogical (3) departing for the regular- erratic (4) not sanctioned by law- illegal (5) not authorized by good usage. As a young girl, how would it feel being†¦show more content†¦It was not until the early 1870s that child abuse was first brought into light. The Child-Protection Movement started with the news of one eight year-old orphan named Mary Ellen Wilson. After the passi ng of her biological mother and father, Mary Ellen was left in the care of her biological fathers widow, Mary McCormack Connolly. Mrs. McCormack Connolly badly mistreated Mary Ellen, and neighbors in the building were well aware of the childs predicament (Mary Ellen Wilson, 2013). It was not until Etta Angell Wheeler, a caring Methodist mission worker, visited the residence and noticed Mary Ellens condition. Ms. Wheeler describes her first meeting with Mary Ellen, as such: â€Å"It was December and the weather bitterly cold. She was a tiny mite, the size of five years, though, as afterward appeared, she was then nine. From a pan set upon a low stool she stood washing dishes, struggling with a frying pan about as heavy as herself. Across the table lay a brutal whip of twisted leather strands and the childs meagre arms and legs bore many marks of its use. But the saddest part of her story was written on her face in its look of suppression and misery, the face of a child unloved, of a child that had seen only the fearsome side of life. These things I saw while seeming not to see, and I left without speaking to, or of, the child. I neverShow MoreRelatedI Am My Mother s Abuser2054 Words   |  9 Pagesfurther apart. I found myself in my own physically abuse relationship at the age of fourteen till seventeen. When I look at myself, I see so much of my mother and the women she is. The most complex relationship a female will have is the one with her own mother. Because of this natural and special connection that exists between a mother and her daughter. A mother is eeply connected to their daughter as soon as she gives birth to her. She believes this child is everything that is good and innocent within

Adolescence And Emerging Adults Adolescence - 2029 Words

Adolescence is a period of various biological, cognitive and socio-emotional changes. The storm and stress view of adolescence sees this developmental period as a turbulent time period with stress, conflict and mood swings. In-between the transition from adolescence to adulthood, a period called emerging adulthood occurs between 18 to 25 years of age. During this period the emerging adult explores identity, opportunities and independence. This is a period of instability for the emerging adult in various fronts such as work, love and education (Santrock, 2014). Being a time period of changes and identity formation, a wide spectrum of problems affects adolescence and emerging adults. The biopsychosocial approach emphasizes that biological factors, psychological factors and social factors interact together and influence the problems faced by adolescence and emerging adults. During adolescence and emerging adulthood, various problems such as drug abuse, emotional problems, relationship problems and academic problems affect individuals due to various risk factors. Risk factors are predictors of problems that an individual may face. The risk factors do not guarantee that an individual would develop the problems; it instead predicts that individuals may have an elevated probability of developing the related problems (Santrock, 2014). A scale developed by Peter Benson suggests 40 developmental assets, both internal and external factors that adolescence need in order to facilitateShow MoreRelatedEssay on Developmental Issues That Come with Emerging Adulthood901 Words   |  4 PagesTopic- Developmental issues that come with emerging adulthood (Transition from adolescence to young adulthood) Adolescence is the transitional period in a persons life time that links childhood and adulthood. The factors that influence development during adolescence include genetic/biological and environmental/social. There are many developmental issues that take place during the transition from an adolescent to a young adult. The issues of emerging adulthood(18-25) are characterized by new experiencesRead MoreWho Is An Adult? Essay1338 Words   |  6 PagesThe article titled â€Å"Who is an adult?† is a blog published by Psychology Today on March 3rd, 2010, in which Jennifer Tanner attempts to show the debate on when a person is considered an adult by presenting two sides of the debate and their similarities. On one side of the debate Tanner uses Dr. Jeffry Arnett’s research study of the 1990’s. He interviewed three hundred eighteen to twenty-nine year olds to discover if they felt that they were adolescents or adults. The conclusion was that the majorityRead MoreThe C onflict Of Adolescence And Early Adulthood1037 Words   |  5 PagesIntroduction What is adulthood? Adulthood can be defined as a stage of being self-sufficient, or it can be defined by demographic transitions such as marriage, parenthood or financial independence. In the United States, one is legally considered an adult at the age of 18, regardless of any cognitive or demographic factors. Human development is divided into several different stages starting at infancy all the way to the last stage of maturity. One of the most influential theories on development wasRead MoreChapter Questions On Vocabulary Words1283 Words   |  6 PagesQuotations â€Å"What is like to be an adolescent or and emerging adult in the American middle class is different in many ways from being a young person in Egypt, or Thailand, or Brazil-and also different from being a young person in certain American culture or the culture of recent Mexican American immigrants.† (Arnett, 2013. P. 25). I chose this quotation because it made me think differently which I like. I did not think as much into the fact the adolescence is so different in many cultures. I thought everyoneRead MoreAdolesent Self-Portrait Essay868 Words   |  4 Pagesadulthood.  Ã¢â‚¬â€Ã‚  Christine Bachrach  (Adolescence Quotes | Quotes about Adolescence, n.d.). Adolescence is a time to dramatic change, challenges, and growth, it is a miraculous that anyone survives. The experience of adolescence has not changed much until recently because of the access to technology. Prior to this adolescence was a predictable period of growth, a rite of passage for many young people. What it feels like to be an adolescent Adolescence is a time of self-discovery; it isRead MoreAdolescence : Everything Changes? Essay1199 Words   |  5 PagesAdolescence: Everything Changes Adolescence is a transitional stage of development that has been defined as starting with puberty and lasting the years a person is roughly aged ten to twenty. Dramatic changes take place during adolescence; no other time period of a person’s life except infancy contains so much development into such a short time span. Puberty has historically been viewed as the starting point of adolescence and several factors play a role in determining the timing of puberty suchRead MoreEmerging Adulthood As A Group Of Individuals Who Lack Discipline And Express Self Destructive Behavior1301 Words   |  6 PagesThe older generations view emerging adulthood as a group of individuals who lack discipline and express self-destructive behavior’s for no apparent reason, however studies have shown that it is more complex and dynamic than just lacking discipline. The group comprising emerging adults surpasses every other group in the use of drugs, alcohol, and sexually transmitted diseases (STD’s). Emerging adults have a feeling of being â€Å"in-between† and are focused on figuring out who they are while trying toRead MoreEmerging Adulthood : A Step Up From Childhood1102 Words   |  5 PagesIn sociology, emerging adulthood is the period in time of an person’s life where they are between adolescence and adulthood. This term was proposed by Jeffrey Arnett, a Professor in the Department of Psychology at Clark University, in an article called American Psychologist. In the article he describes emerging adults as young individuals who do not have their own children, don’t own a home, or do not have a sufficient source of income to become completely independent (Arnett, 2000). There is anotherRead MoreArticle Analysis of Lynn Smiths Betwixt and Bewildered: Scholars are Intrigued by the Angst of Emerging Adults1455 Words   |  6 PagesThe article Betwixt and Bewildered: Scholars are Intrigued by the Angst of Emerging Adults by Lynn Smith discu sses a societal trend towards young adults (18-25) who are struggling to achieve the traditional markers of adulthood. The article covers some of the scholarly debate of the subject, wherein some researchers accept the phenomenon, others reject it, and between them they find little in the way of clear definition of the problem and its ramifications. There are some interesting points toRead MoreAdolescence Is Defined By The Novel The Scarlet Letter 890 Words   |  4 Pages​According to out textbook, adolescence is defined â€Å"as the period of transition between children and adulthood that involves biological, cognitive, and socio-emotional changes† (Santrock, 2014). According to Santrock there are two stages in adolescence, late and early adolescence. Early Adolescence corresponds to the middle school or junior high school years and includes most pubertal changes, while late adolescence refers approximately to the latter half of the second decade of life. In the film

Parabolic Dish Receiver

Question: Describe about the Parabolic Dish Receiver? Answer: Introduction Parabola is a mathematical term that shows a curve bulging inside. Parabolic antennas or called as parabolic dish are very useful in high-gain antennas for point to point communication that carries data or information from one point to another. The antenna is a term that refers to an electrical conductor and carries two related terms with it termed as transmitter (that will radiate electromagnetic energy into space) and receiver (it will collect electromagnetic energy from space). Communication medium is the most valuable area in networks and in the world of communication systems today. Combination of guided and unguided medium made it possible to communicate among various networks. As the field and study of radiations and antennas is vast one, incomplete information does not make sense and that was a major reason to select such project that will enhance the knowledge of communication networks through microwave radiations with to make a parabolic dish receiver located at the fixed focus of dish. The IEEE definition of an antenna as given by Stutzman and Thiele is, That part of a transmitting or receiving system that is designed to radiate or receive electromagnetic waves. Theory of Operation Overview Basically a parabolic antenna has a parabolic reflector that reflects from its focus point. We can take an example of a parabolic reflector with diagram which is as follows:- The reflector can be of various materials like sheet metal, wire grill construction etc., a metal screen reflects radio waves that comes to it and that are linearly polarized. System Structure There are some principles and parameters associated with the parabolic antenna and they are as follows:- b.1. Antenna Gain- this is a measure that has the ability to direct input the waves in particular direction and measured at the radiations on its intensity of working. An isotropic antenna can increase the intensity of its peak and it is given by: S = P0/4R2 Gain can be achieved by directing the radiations in different ways based on their patterns. b.2 Antenna efficiency- it can br measured through the integral of the radiation over the radiation input power and can be measured according to the antenna efficiency. b.3 effective area-antenna captures through passing the waves and passing the data to the data terminals who are ready to send and receive the data and power is delivered to the terminals and that will be a product of the same. b.4 directivity-is the measure of concentration that a radiations has on the dish that gives it a power. Taking an example of radiation intensity It can be plotted as a 3D graph or as a 2D polar or Cartesian slice of this 3D graph. It is an extremely parameter as it shows the antennas directivity as well as gain at various points in space. It serves as the signature of an antenna and one look at it is often enough to realize the antenna that produced it. b.5 Beam width- The angular width of the beam radiated by high-gain antennas is measured Example of equations is as follows- For parabolic antennas, the HPBWis given by: wherekis a factor which varies slightly depending on the shape of the reflector and the feed illumination pattern. For an ideal uniformly illuminated parabolic reflector andin degrees,kwould be 57.3 (the number of degrees in a radian). For a "typical" parabolic antennakis approximately 70. For a typical 2 metersatellite dishoperating onC band(4GHz), this formula gives a beamwidth of about 2.6. For the Arecibo antenna at 2.4GHz the beamwidth is 0.028. It can be seen that parabolic antennas can produce very narrow beams, and aiming them can be a problem. Some parabolic dishes are equipped with aboresightso they can be aimed accurately at the other antenna. It can be seen there is an inverse relation between gain and beam width. By combining the beamwidth equation with the gain equation, the relation is Block Operation Diagrammatically, microwave radiations can be represented as follows undertaking the development part of the hardware for the same that is given below:- Internal eg. :- Technical The example of focal length calculation is as follows:- Determining the focal length of a parabolic dish (axi-symmetric, circular) Focal length = f Depth = c Diameter = D f = ( D * D ) / ( 16 * c ) Measure the depth using a tight fishing line across the dish and a rule to measure depth c. Parabolic dish showing measurements needed to determine focallength. Project Narration Communication medium is the most valuable area in networks and in the world of communication systems today. Combination of guided and unguided medium made it possible to communicate among various networks.As the field and study of radiations and antennas is vast one, incomplete information does not make sense and that was a major reason to select such project that will enhance the knowledge of communication networks through microwave radiations with to make a parabolic dish receiver located at the fixed focus of dish. Parabolic antenna works on the principle of a point source of radio waves which mets at the focal point of reflector, also known as paraboloidal reflector of material which will be reflected into a plain surface beam along the axis of the reflector. Validation Basically a parabolic antenna has a parabolic reflector that reflects from its focus point. As the field and study of radiations and antennas is vast one,The reflector can be of various materials like sheet metal, wire grill construction etc., a metal screen reflects radio waves that comes to it and that are linearly polarized. Conclusions Concluding the report a parabolic antenna works on the principle of a point source of radio waves which meets at the focal point of reflector, also known as paraboloidal reflector of material which will be reflected into a plain surface beam along the axis of the reflector. Antenna Gain is a measure that has the ability to direct input the waves in particular direction and measured at the radiations on its intensity of working. Bibliography https://en.wikipedia.org/wiki/Parabolic_antenna https://www.satsig.net/focal-length-parabolic-dish.htm