How Nurses are affected by Stress in Psychiatric Unit of Somers Ward Research Paper

How Nurses are affected by Stress in Psychiatric Unit of Somers Ward - Research Paper Example The paper tells that nurses are currently facing great challenges and dilemma in their field of practice to date. This is foreseen to affect significantly the delivery of patient’s care and health of the nurses in the future when left unresolved. Nurses are â€Å"short-handed, understaffed, and overworked† and to some extent, burnout. The emotional stress they carry watching their patients die and see grieving families oftentimes add up the physical stress of overstretching themselves to work on double shifts to cater understaffed hospitals. As a result, new nurses are recruited from different parts of the world, and are placed on probationary period. This period can be very stressful also to both nurses, old and new, taking into consideration the culture shock, the expectations, and language barriers that adds up to being stressed from the hospital work. Looking back, severe shortages of nursing staff working at bedside is not a new dilemma in the health care arena sin ce this problem had already started even during the time of Florence Nightingale in the barracks of Scutari amidst the Crimean War. During that time, significant shortages of trained personnel to take care of the dying young men from the battles and diseases were already noted. But despite of the existing problems, nursing profession continued to thrive until this date. However, Milleken, et al cited that the stressful circumstances and repeated challenges that face the nursing staff contribute to organizational problem in the future that may endanger the health care system. The Rationale of Doing this Research: The continuous shortage of nursing staff all over the world has not exempted the facility where I worked in. Somers ward is an 18-bed unit, and is the only acute psychiatric facility in the Bermuda Island. Being the only specialized facility in the island, it is expected that the nursing staff will be outnumbered by the number of patients who are coming for admission. To dat e, the nurse to patient ratio is 1:8, where only one nurse is assigned to take charge to 8 patients per shift. Every day, I’ve experience this event happening in the ward, and as a nurse, I’ve seen how overloaded we are with our respective responsibilities, and sometimes, we are required to extend the number of hours at work because we are short-staffed. I felt the frustrations, anxiousness, and together with my co – workers, we have a cry to put a stop on this scenario. Otherwise, all of us

IGO and NGO Essay Example for Free

IGO and NGO Essay â€Å"Moraine is a small developing country. Like all nations in the developing world, Moraine needs to develop its economy. The country has a government department which is responsible for developing grassroots entrepreneurs – the Business Assistance Department (BAD). It also has access to funding from The European Union (EU) an IGO and has been offered assistance by the One Business at a Time (OBT), an NGO that focuses on helping local populations start and develop simple, local businesses. A)What are the priorities for the leaders of: (a) BAD, (b) the EU and (c) OBT for their respective operations in Moraine? Why? The priorities for the leaders are the EU, BAD, and OBT. At first, it depends on whether the EU cooperates with developing Moraine or not because the EU is the largest organization in the European Area; therefore, the organization has a large amount of funds to support developing nations. So, if the government were able to convince the EU, it would be a big chance to develop the economy. If the EU supported, BAD needs to play a big role of managing funds from the EU because the funds from the EU must be limited. So, BAD has to assign funds for entrepreneurs. Also, BAD has to decide the standard value and rule to judge entrepreneurs. Finally, OBT has to see through them whether they contribute a developing economy in Moraine or not with the standard value and rules from BAD. 2. List two ways the New Public Management (NPM) could help the Business Assistance Department (BAD) achieve its objectives developing grassroots entrepreneurs and support your ideas.† New Public Management is a public management method to save waste expenditure and offer more convenient service. NPM has basic policies; the introduction of results-oriented approach and customer market focus. Results-oriented approach is based on the clear standard and evaluates the policy of governmental and administrative department. So, this policy makes them motivate to achieve its objectives developing grassroots entrepreneurs. Also, customer market focus is a policy that NPM pursues the customer satisfaction by regarding companies and citizens as the clients of administrative service. Therefore, NPM greatly support BAD by governmental and administrative approaches. Reference: NEW PUBLIC MANAGEMENT: ORIGINS, DIMENSIONS, AND CRITICAL IMPLICATIONS (2013/07/08) Retrieved from http://www.eolss.net/Sample-Chapters/C14/E1-34-04-01.pdf

Experimentation in Music Essay -- Musicians Songs Art Essays

Experimentation in Music For thousands of years, music has been a part of people’s lives and has evolved through many different forms over time. Music is the art of arranging sounds in time so as to produce a continuous, unified, and evocative composition, as through melody, harmony, rhythm, and timbre (American Heritage). One important component of analyzing music is whether it has musical value. In other words, music does not have to be organized sound or produced by instruments. This is what composers and artists of experimental music discover. Experimental music is an art form, makes use of instruments or other items that can produce sound, and can alter or expand the basic foundations of music and musicality. These are the key elements that define experimental music. The genre that is experimental music essentially consists of music and sound that is different than any conventional music written before it. Though nearly all new types of music begin with experimentation of some kind, experimental music has become a specific category of its own in music. In this type of music, sounds and music are redefined and organized in a new way. There is sometimes a visual aspect to experimental music as well. The audience and performance are vital parts of the musical experience to these composers. Methods of sound production, time, and notation are also important aspects of experimental music. These are some of the essential qualities of this type of music as many musical ideas and theories are changed and altered. Experimental music is an art form. Because music is an art form, it can be open to interpretation and creativity. Composers write the music that they want to write because of the way they perceive mus... ...and changes or alters the concepts and perceptions of music. This genre seeks to experiment with sounds in a completely different way than conventional music does. Everything from the audience to musical notation is reconsidered and presented in a new, original manner. It is an important part of the perception and development of music. As musical concepts and technology change, experimental music will continue to modify and broaden the definition of music. Works Cited â€Å"Music.† American Heritage Dictionary of the English Language. Fourth ed. 2000. Davies, John Booth. The Psychology of Music. Stanford , CA : Stanford University Press, 1978. Ewen, David. Composers of Tomorrow’s Music. Cornwall , NY : The Cornwall Press, Inc., 1971. Nyman, Michael. Experimental Music: Cage and beyond. Hampshire , Great Britain : BAS Printers Limited, 1974. Experimentation in Music Essay -- Musicians Songs Art Essays Experimentation in Music For thousands of years, music has been a part of people’s lives and has evolved through many different forms over time. Music is the art of arranging sounds in time so as to produce a continuous, unified, and evocative composition, as through melody, harmony, rhythm, and timbre (American Heritage). One important component of analyzing music is whether it has musical value. In other words, music does not have to be organized sound or produced by instruments. This is what composers and artists of experimental music discover. Experimental music is an art form, makes use of instruments or other items that can produce sound, and can alter or expand the basic foundations of music and musicality. These are the key elements that define experimental music. The genre that is experimental music essentially consists of music and sound that is different than any conventional music written before it. Though nearly all new types of music begin with experimentation of some kind, experimental music has become a specific category of its own in music. In this type of music, sounds and music are redefined and organized in a new way. There is sometimes a visual aspect to experimental music as well. The audience and performance are vital parts of the musical experience to these composers. Methods of sound production, time, and notation are also important aspects of experimental music. These are some of the essential qualities of this type of music as many musical ideas and theories are changed and altered. Experimental music is an art form. Because music is an art form, it can be open to interpretation and creativity. Composers write the music that they want to write because of the way they perceive mus... ...and changes or alters the concepts and perceptions of music. This genre seeks to experiment with sounds in a completely different way than conventional music does. Everything from the audience to musical notation is reconsidered and presented in a new, original manner. It is an important part of the perception and development of music. As musical concepts and technology change, experimental music will continue to modify and broaden the definition of music. Works Cited â€Å"Music.† American Heritage Dictionary of the English Language. Fourth ed. 2000. Davies, John Booth. The Psychology of Music. Stanford , CA : Stanford University Press, 1978. Ewen, David. Composers of Tomorrow’s Music. Cornwall , NY : The Cornwall Press, Inc., 1971. Nyman, Michael. Experimental Music: Cage and beyond. Hampshire , Great Britain : BAS Printers Limited, 1974.

Emergency department patient satisfaction Essay

Customer service initiatives in healthcare have become a popular way of attempting to improve patient satisfaction. The effect of clinically focused customer service training on patient satisfaction in the setting of a 62,000-visit emergency department and level 1 trauma center is investigated. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse and overall satisfaction. These results suggest that such training may offer a substantial competitive market advantage, as well as improve the patients’ perception of quality and outcome. A practitioner’s response to the case study is also included. Customer service initiatives in healthcare have become a popular way of attempting to improve patient satisfaction. The effect of clinically focused customer service training on patient satisfaction in the setting of a 62,000-visit emergency department a nd level 1 trauma center is investigated. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse and overall satisfaction. These results suggest that such training may offer a substantial competitive market advantage, as well as improve the patients’ perception of quality and outcome. A practitioner’s repsonse to the case study is also included. You  have requested â€Å"on-the-fly† machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated â€Å"AS IS† and â€Å"AS AVAILABLE† and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of th e translation functionality and any output derived there from. Hide full disclaimerTranslations powered by LEC. Translations powered by LEC. Headnote visit emergency department and level I trauma center. Analysis of patient complaints, patient compliments, and a statistically verified patient-satisfaction survey indicate that (1) all 14 key quality characteristics identified in the survey increased dramatically in the study period; (2) patient complaints decreased by over 70 percent from 2.6 per 1,000 emergency department (ED) visits to 0.6 per 1,000 ED visits following customer service training; and (3) patient compliments increased more than 100 percent from 1.1 per 1,000 ED visits to 2.3 per 1,000 ED visits. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse, and overall satisfaction. These results show that clinically focused customer service training improves patient satisfaction and ratings of physician and nurse skill. They also suggest that such training may offer a substantial competitive mar ket advantage, as well as improve the patients’ perception of quality and outcome. INTRODUCTION Recent changes in healthcare have led to increasing competition and the perceived commercialization of the healthcare provided to patients. At the same time, a need for reaffirmation of the importance of the patient-physician relationship has been expressed in the midst of such powerful forces (Laine and Davidoff 1996; Glass 1996; Pellegrino and Thomasma 1989). One aspect of the patient-physician relationship deserving further study is the role of customer service training in healthcare. While numerous customer service training tools exist in business and industry, no studies have clearly delineated the efficacy of customer service training for patients in a clinical setting. This study examines the effect of a required customer service training program taught by healthcare professionals on patient and family complaints, compliments, and satisfaction in a high-volume high-acuity emergency department. METHODS Patient Base All patients presenting to the Emergency Department at Inova Fairfax Hospital, Falls Church, Virginia, between May 1, 1994 and April 30, 1995 formed the control group, representing the period prior to emergency department customer service training. Patients presenting to the emergency department between May 1, 1995 and April 30, 1996 formed the study group, representing the period following customer service training intervention. The mechanism of patient complaint/compliment analysis and the survey criteria were identical in the control and study periods. Patient acuity was assessed by three measures: the number and percentage of patients admitted to the hospital; the number and percentage of patients with Current Procedural Terminology 1996 (CPT) evaluation and management (E/M) codes 99281-99285, (Kirschner et al. 1996); and a nursing acuity rating scale (EMERGE, Medicus Systems, Evanston, Illinois). Inova Fairfax Hospital is a 656-bed not-for-profit institution that is a teaching h ospital, regional referral center, and level I trauma center. Customer Service Training All emergency department staff involved in patient contact (physicians,  nurses, ED technicians, registration personnel, core secretaries, social workers, ED radiology, and ED respiratory therapy) were required to attend an eight-hour customer service training program. The numbers and types of staff involved in training are listed in Table 1. Because of logistic limitations, emergency medicine residents attended a focused fourhour required training course. The eight-hour program consisted of the following modules: basic customer service principles, recognition of patients and customers (Are they patients or customers?), service industry benchmarking leaders, stress recognition and management, communication skills, negotiation skills, empowerment, customer service proactivity, service transitions, service fail-safes, change management, and specific customer service core competencies. (More detailed information on the content of these modules is listed in Appendix 1.) These core comp etencies follow: making the customer service diagnosis (in addition to the clinical diagnosis) and providing the right treatment; negotiating agreement resolution of patient expectations; and building moments of truth into the clinical encounter. Following the initial required training, new physicians or ED employees were required to attend identical customer service training within four months of their initial employment. Additional mandatory customer service training updates were offered three times per year and included modules of conflict resolution, customer service skill updates, advanced communication skills, and assertiveness training. Patient Satisfaction Data Patient satisfaction data in both the control and study groups consisted of patient complaints, patient compliments, and a telephone patientsatisfaction survey conducted by an independent research firm (Shugoll Associates, Rockville, Maryland) that was blinded to the study hypothesis and course content. Patient complaints and/or compliments were systematically identified from all available means, including verbal, written, telephone, or electronic mail sources. Sources of patient complaints, data analysis, and categorization of complaints were identical in the control and study groups, which was coordinated by hospital quality improvement analysts. ED  staff were instructed to report all potential complaints and concerns, regardless of how minor, to appropriate physician or nurse managers in both the control and study periods. Complaints were logged into a central office and were investigated initially by three authors (TM, RC, DR). In cases where classification of type of complaint differed, additional information and/or clarification was sought from staff, patients, and family. Any discrepancies were resolved by group-consensus techniques. All complaints and the classification thereof were independently reviewed and verified by quality-improvement analysts. Patient complaint and compliment letters were referred for comment or clarification to appropriate ED staff in both the control and study periods. Outpatient satisfaction surveys were conducted by an independent research firm (completely blinded to the study and its hypothesis) utilizing a 50-item questionnaire to identify key factors in customer satisfaction. This survey instrument was validated on a sample of more than 3,000 patients prior to implementation in either the control or study group. The study used a telephone survey on a randomized number table basis to 100 ED outpatients per quarter (Appendix 2). Logistic regression analysis performed on these data identified 14 areas of more important/key attributes in the ED (see Table 2). Patient compliment and complaint data, as well as acuity data, were subjected to a two-tailed ttest and the Fisher Exact test. Patient satisfaction surveys were subjected to a two-tailed t-test with a 95 percent confidence level. Patient Turnaround Times Patient turnaround times (TAT) were calculated from time of initial arrival in the ED to either discharge or transfer to an inpatient unit. Turnaround times were routinely calculated on each patient and on an aggregate basis by day, month, quarter, and year. RESULTS ED Volume/Acuity Neither ED volume nor acuity changed to a statistically significant degree between the control and study periods, based on both admission percentage and nursing acuity (see Table 3). Analysis of CPT 96 Evaluation and Management Codes showed a statistically significant increase in codes 99283 and 99285, with a similar decrease in codes 99281 and 99284. The number of pediatric patients did not change in a statistically significant fashion during the study period. The only payor mix category to rise in a statistically significant fashion was managed care (p < .01), with a nearly identical decrease in commercial insurance. Neither compliments nor complaints correlated with payor category. Patient Turnaround Time Mean patient turnaround time dropped from three hours and 24 minutes (204 minutes) to three hours and seven minutes (187 minutes), but this difference was not statistically significant, nor did the percent of patients at one and two standard deviations from the mean change in a statistically significant fashion. Patient Compliments The total number of patient compliments rose from 69 in the control period to 141 in the study period, an increase of more than 100 percent (p < .00001) (see Table 3). Patient compliment letters consistently mentioned warmth, compassion, and skill of the emergency care provider as the reason for contacting management to praise the ED staff. There was no statistical difference between males and females among patient compliments. Patient Complaints Patient complaints dropped from 153 in the control period (2.5 complaints per 1,000 ED visits) to 36 in the study period (0.6 complaints per 1,000 ED visits), (p < .00001) (see Table 3). Complaints about perceived rudeness, insensitivity, or lack of compassion on the part of ED staff dropped most dramatically. Two-thirds of complaints in the study period were a result of waiting times, billing, or delays in obtaining an inpatient bed, compared to 30 percent in the control period. Nevertheless, complaints regarding waiting times, billing, and wait time for an inpatient bed still decreased 50 percent in the study period (p < .001). There were no significant differences in patient complaints based on age or sex, confirming results of the study by Hall and Press (1996). Patient Satisfaction Survey Data Baseline survey data were subjected to logistical regression analysis that indicated that 14 surveyed areas formed a core group of key satisfaction attributes. All of these 14 attributes showed increases in the study period (p < .001, see Table 2). The largest increases were in the following areas: skill of the emergency physician, skill of the nurse, likelihood of returning, overall quality of medical care, doctor’s ability to explain condition, diagnosis, and treatment options, and triage nurse’s sensitivity to pain. DISCUSSION The patient-physician and patient-nurse relationships are arguably the oldest in the history of medicine. These relationships have recently been described as being under siege because of an increase in the tension between the art and science of medicine, as well as the strains attendant to changes in the economic structure of healthcare (Glass 1996). To this list may be added a third causative factor: the lack of rigorous, formal training for healthcare professionals in the customer service fundamentals of the patient-provider relationship. The fundamentals of such training are closely tied to what has traditionally been described as the art of medicine or the concept of beneficence (Pellegrino and Thomasma 1989). Physicians have for the most part learned appropriate patient interaction skills through observing their mentors and peers during the course of graduate medical education. However, there has only recently been substantial study of this important subject (Buller and Buller 1987; Aharony and Strasser 1993). While customer service has been emphasized in American business and industry in recent years (Zeithamal, Parasuraman, and Berry 1990; Jones and Sasser 1995; Reichheld 1996; Berry and Parasuraman 1991; Berry 1995), few training modules are specifically targeted toward physicians and healthcare professionals. For this reason, the authors created an eight-hour customer  service training course for their ED providers, based on principles of adult education, benchmarks from the customer service industry (Sanders 1995; Spectre and McCarthy 1995; Carlzon 1987; Connelan 1997), experience in the clinical setting, and the existing literature on patient satisfaction (Pelligrino and Thomasma 1989; Thompson and Yarnold 1995; Thompson et al. 1996; Bursh, Beezy, and Shaw 1993; Rhee and Bird 1996; Dansk and Miles 1997; Hall and Press 1996; Eisenberg 1997). This literature emphasizes the importance of communication skills, managing information flow, actual versus perceived waiting times, and the ex pressive quality of physicians and nurses. All of these concepts were built into the training modules, including practical clinical examples of behaviors reflecting these and other concepts. Our philosophy in designing this course was simple. Customer service is a skill for which we hold our staff accountable but in which they had never formally been trained. We believed that this dilemma required, at a minimum, two sentinel events to occur. First, the department needed to have a clearly articulated and easily understood cultural transformation to a solid commitment to customer service. Second, staff members needed education in a practical, pragmatic fashion regarding precisely how such customer service principles could be applied in the clinical setting. Just as advanced cardiac life support, advanced trauma life support, and pediatric advanced life support courses can be used to improve cardiac, trauma, and pediatric resuscitation, respectively, we believed customer service outcomes could be improved by well-designed, mandatory, rigorous application of customer service training. The training was provided by active clinicians involved in day-to-day patient care activities (TAM, RJC). We believe this clinical credibility may have played an important part in the customer service transformation, inasmuch as the staff knew the trainers were well aware of the inherent problems of applying pragmatic customer service skills in a busy emergency department. The data from this study strongly support the hypothesis that clinically based, formal customer service training grounded on these principles can  dramatically decrease patient complaints, increase patient compliments, and improve patient satisfaction, at least in a high-volume, high-acuity ED. Patient complaints dropped by over 70 percent and compliments more than doubled during the study period, such that patient compliments actually exceed complaints in our 62,000 patient visit emergency department and level I trauma center. National data indicate that ED complaints average between three to five per 1,000 emergency department patients, although no data are available regarding rates of patient compliments (Culhane and Harding 1994). Our emergency department was slightly below that national standard level even during the control period. Analysis of the patient satisfaction survey data revealed an extremely important trend. Specifically, patients rated skill of the emergency physician, overall quality of medical care, and skill of the ED nurse as three of the most improved areas during the study period compared to the control period, despite the fact that there were no changes in the ED physician staff during the study and there was very little turnover among ED nurses. This strongly implies that patients rate the quality of care and the skill of the physician and nurse based on elements of the customer service interaction. These data suggest an important causal relationship between the technical component of care and the patient caregiver interaction, which has not been previously demonstrated. It is important to recognize that both customer service and technical skills are competencies to which hospitals and healthcare systems should hold their staff accountable on a daily basis. Hospitals spend substantial dollars to ensure that their staffs are technically competent to deliver quality medical care (Herzlinger 1997). However, to ensure that customer service is effective, clinically based customer service training is essential to give staff the appropriate skills in the clinical setting to deliver service competently. This concept is indirectly supported by data from Mack and colleagues (1995), who found that satisfaction with interactive aspects of emergency medical care produced higher correlations with measures of future intention to use the service than did satisfaction with medical outcomes themselves. Their study, however, did not undertake interventions to improve the interactive,  communicative aspect of healthcare in that setting. Similarly, Smith and colleagues (1995) evaluated the effect of a four-week training program, focusing on patient interviewing, somatization, patient education, and self-awareness, that was taught to first year internal medicine and family practice residents. Their data were not conclusive, but suggested that some but not all aspects of patient satisfaction could be improved by such training. This study tends to confirm the work of Thompson and colleagues (1996) that demonstrated in a much smaller sample size that expressive quality and management of informatio n flow to the patient had an effect on patient satisfaction. However, their study did not assess the impact of strategies and techniques for ED staff to improve patient satisfaction by improving expressive quality. While several studies (Thompson et al. 1996; Thompson and Yarnold 1996; Dansk and Miles 1997; Hall and Press 1996) have emphasized the importance of waiting time and exceeding patient expectations regarding length of waiting time, our study demonstrates a dramatic improvement in patient satisfaction without a statistically significant reduction in patient turnaround time. This supports the work of Bursch and colleagues (1993), who found in a study of 258 patients that the five most important variables for patient satisfaction were the amount of time it took before being cared for in the ED, patient ratings of how caring the nurses were, how organized the ED staff was, how caring the physicians were, and the amount of information provided to the patient and family. However, the study did not assess strategies to improve satisfaction based on this knowledge. All of this information was built into the training modules to assist staff with practical strategies to manage waiting time effe ctively using information flow, queuing theory, and verbal skill training. The implications of the higher ratings of the skill of the emergency physicians and nurses are intriguing and could have a far-reaching impact on healthcare. Perhaps the strongest implication is that perceived skill stands as a marker for quality and/or outcome in the mind of patients and their families. It has been shown repeatedly that patient compliance increases with confidence in the physician (Frances, Korsch, and Morris 1969;  Sharfield et al. 1981; Waggoner, Jackson, and Kern 1981; Schmittdiel et al. 1997). While our study did not directly assess improvements in outcome, quality of care, or appropriateness of care, it certainly appears that patients rated the skill of the healthcare providers as a key quality characteristic in this survey. Furthermore, the fact that ratings of quality of medical care and likelihood of returning also increased dramatically speaks to the importance that effective customer service training may have in offering a competitive market advantage to hospitals and healthcare institutions. This is particularly important as the concept of customer loyalty is closely tied to the likelihood of a patient or their family returning to that healthcare institution. As the focus on outcomes management and evidence-based medicine increases, it is important to take into account the effect that customer service skills have on patients’ perceptions of quality and outcome. This study may be subject to several criticisms. First, while statistical data on patient compliments and complaints obtained substantial statistical significance, the number of patients contacted for the outpatient satisfaction telephone survey may have resulted in sampling bias. While a larger sampling is planned in the future, the patient satisfaction survey data trends were consistent throughout all quarters and appear to be a valid statistical tool, despite the number of patients sampled. Second, it was not possible to blind those responsible for investigating and classifying complaints and compliments. However, we did attempt to reduce or eliminate possible reporting or observer bias by identifying complaints from all sources and ensuring that all complaints and their classification were reviewed and approved by an author who was not involved in ED operations and by quality improvement analysts. Third, information is not available on national or regional trends of patient compl aints and/or satisfaction during the study period. It is possible that the data in this study may reflect local, regional, or national trends toward decreased complaints and increased satisfaction, either globally throughout healthcare or in ED patients specifically. However, this is highly unlikely as no such trends have been previously reported, nor would such trends fully explain the data from this study, even if they were present. The data on patient acuity  indicated an increase in CPT codes 99283 and 99285, suggesting a slight trend toward higher patient acuity. This could mean that patients with higher levels of acuity are more satisfied and less likely to complain. No data are available to either prove or disprove this possibility, but the trend toward higher acuity would not appear to completely explain the dramatic improvement seen in this study. Furthermore, the patient-satisfaction telephone survey excluded inpatients, who comprise a larger percentage of patients in the 99285 service code. Further study is needed to delineate the relationship of ED patient acuity to satisfaction. Despite these potential limitations, this study demonstrates that clinically based customer training for ED staff can decrease patient complaints and increase patient satisfaction in a large volume, high-acuity ED, and that satisfaction is independent of patient turnaround times. Furthermore, the data support the concept that patients rate the skill of the emergency physician, overall quality of medical care, and skill of the ED nurse significantly higher after such training is provided to the ED staff. Additional studies in ED with different volumes, acuities, and geographic locations are needed to demonstrate whether these results can be duplicated. Studies of the impact of customer service training in other healthcare settings would also be of benefit. Nonetheless, clinically focused customer service training has been shown in this study to improve patient satisfaction and ratings of the skill of physicians and nurses. If verified by other studies, customer service training should be considered an important part of graduate and undergraduate medical education to improve both the art and science of the patient-physician relationship. The clinically based customer service training described in this study is now a required part of competency based orientation for all physicians, nurses, residents, and support staff in the emergency department. All professional and non-professional staff interviewed for positions in the emergency department are advised of the institution’s strong commitment to customer service training and the necessity of attending the required training course. As healthcare increasingly emphasizes accountability for customer service in its staff, it is increasingly important that practical and effective customer service training is provided. While not directly addressed in this study, the data on ratings of quality of medical care, skill of the physician and nurses, and likelihood of returning strongly suggest that effectively completing the customer service transition offers a competitive market advantage to hospitals and healthcare systems. References Aharony, L., and S. Strasser. 1993. â€Å"Patient Satisfaction: What We Know About and What We Still Need to Explore.† Medical Care Review 50 (1): 49-79. Berry, L. L. 1995. On Great Service: A Framework for Action. New York: Free Press. Berry, L. L., and A. Parasuraman. 1991. Marketing Services: Competing Through Quality. New York: Free Press. Butler, M. K., and D. B. Buller. 1987. â€Å"Physician’s Communication Style and Patient Satisfaction.† Journal of Health and Social Behavior 28 (4): 375-88. Bursh, B., J. Beezy, and R. Shaw. 1993. â€Å"Emergency Department Satisfaction: What Matters Most?† Annals of Emergency Medicine 22: 586-91. Carlzon, J. 1987. Moments of Truth: New Strategies for Today’s Customer-Driven Economy. New York: Ballinger Publishing. Connelan, T. 1997. Inside the Magic Kingdom. Austin, TX: Bard Press. Culhane, D. E., and P. J. Harding. 1994. â€Å"Quality in Customers: Great Expectations.† Presented to the American College of Emergency Physicians Management Academy, Boston, Massachusetts, May 19, 1994. Dansk, K. H., and J. Miles. 1997. â€Å"Patient Satisfaction with Ambulatory Healthcare Services: Waiting Time and Follow-up Time.† Hospitals and Health Services Administration 42 (2): 165-77. Eisenberg, B. 1997. â€Å"Customer Service in Healthcare.† Hospitals and Healthcare Services Administration 42 ( 1 ): 17-32. Frances, V, B. M. Korsch, and M. J. Morris. 1969. â€Å"Gaps in Doctor-Patient Communication. Patient’s Response to Medical Advice.† New England Journal of Medicine. 280: 535-49. Glass, R. M. 1996. â€Å"The Patient-Physician Relationship: JAMA Focuses on the Center of Medicine.† Journal of the American Medical Association 275: 147-48. Hall, M. F., and I. Press. 1996. â€Å"Keys to Patient Satisfaction in the Emergency Department: Results of a Multiple Facility Study.† Hospitals and Healthcare Administration 41 (4): 515-32. Herzlinger, R. 1997. Market-Driven Health Care. New York: Free Press. Inova Health System. 1997. â€Å"Outpatient Satisfaction Research.† Shugoll Research. Rockville, MD. Jones, T. O., and W. E. Sasser, Jr. 1995. â€Å"Why Satisfied Customers Defect.† Harvard Business Review 73: 88-99. Kirschner, C. G., R. C. Burkett, G. M. Kotowicz, et al. 1996. Physicians’ Current Procedural Terminology-CPT 96, ed 5. Chicago: American Medical Association. Laine, C., and F. Davidoff. 1996. â€Å"PatientCentered Medicine: A Professional Evolution† lournal of the American Medical Association 275: 152-56. Mack, J. L., K. M. File, J. E. Horwitz, and R. A. Prince. 1995. â€Å"The Effect of Urgency on Patient Satisfaction and Future Emergency Department Choice.† Health Care Management Review 20: 7-15. Pellegrino, E. D., and D. C. Thomasma. 1989. For the Patient’s Good: The Restoration of Beneficence in Health Care. New York: Oxford University Press. Rhee, K., and J. Bird. 1996. â€Å"Perceptions in Satisfaction with Emergency Department Care.† Journal of Emergency Medicine 14: 679-83. Reichheld, E E 1996. â€Å"Learning from Customer Defections.† Harvard Business Review 74: 56-69. Sanders, B. 1995. Fabled Service: Ordinary Acts, Extraordinary Outcomes. San Diego: Pfeiffer and Company. Schmittdiel, J., J. V. Selby, K. Grumbach, and C. P. Quesenberry. 1997. â€Å"Choice of a Personal Physician and Patient Satisfaction in a Health Maintenance Organization.† Journal of the American Medical Association 278 (19): 1596-1612. Sharfield, B., C. Wray, K. Hess, and E. M. Smith. 1981. â€Å"The Influence of Patient-Practitioner Agreement on Outcome of Care.† American Journal of Public Health 71: 127-31. Smith, R. C., J. S. Lyles, J. A. Mettler, et al. 1995. â€Å"A Strategy for Improving Patient Satisfaction by the Intensive Training of Residents in Psychosocial Medicine: A Controlled, Randomized Study† Academic Medicine 70: 729-32. Spectre, R., and P. D. McCarthy. 1995. The Nordstrom Way: The Inside Story of America’s #1 Customer Service Co mpany. New York: John Wiley and Sons. Thompson, D. A., P. R. Yarnold, D. R. Williams, and S. L. Adams. 1996. â€Å"Effects of Actual Waiting Time, Perceived Waiting Time, Information Delivery, and Expressive Quality on Patient Satisfaction in the Emergency Department† Annals of Emergency Medicine 28: 657-65. Thompson, D. A., and P. R. Yarnold. 1995. â€Å"Relating Patient Satisfaction to Waiting Time Perceptions and Expectations: The Disconfirmation Paradigm.† Academic Emergency Medicine 2: 1057-62. Thompson, D. A., P. R. Yarnold, S. L. Adams, and A. B. Spaccone. 1996. â€Å"How Accurate Are Waiting Time Perceptions of Patients in the Emergency Department?† Annals of Emergency Medicine 28: 652-56. Waggoner, D. M., E. B. Jackson, and D. E. Kern. 1981. â€Å"Physician Influence on Patient Compliance: A Clinical Trial.† Annals of Emergency Medicine 10: 348-52. Zeithamal, V. A., A. Parasuraman, and L. L. Berry. 1990. Delivering Quality Service: Balancing Customer Perceptions and Expectations. New York: Free Press. You have requested â€Å"on-the-fly† machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated â€Å"AS IS† and â€Å"AS AVAILABLE† and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors fo r your use of the translation functionality and any output derived there from. Hide full disclaimerTranslations powered by LEC. Translations powered by LEC.

Business Plan Essay

IV. Description of Venture a. Services BC Property Forum is dedicated in selling properties of the acquired assets of the banks through bidding. Our main goal is to help our clients especially to those who are working abroad to have a good investments in owning a property. Our area partners are specially trained in doing sales talk in their clients by providing helpful information about the property. Like property location, property size, and any other information describing the property. We will provide our outmost service to provide the needs of our clients. b. Size of Business BC Property Forum is a small size business that has 20 to 99 employees. This business is privately owned by partnership type of business. c. Office Equipment and Personnel The office equipment needed First are computers for recording, keeping and back-up of files and records. Second Telephones and Faxes for communication with the clients. Third are printers for printing of records and files. Fourth are photocopying machines for copying of files and lastly are air cons to make people comfortable. The business strictly chooses our personnel especially for our area partners and in-house partner. We will have are partners that are good in doing sales talk and well trained. We will also hire people for Secretary, IT and Messengers. As owners, we do not want to have problems with our clients that will lower our client’s trust. d. Background of Entrepreneur President – Jenifer Velarde Jenifer Velarde is graduated Magna Cum Laude with the degree of Bachelor of Science in Business Management at the University of the Philippines. She was chosen to be the president because of her abilities of handling a business very well and resolving problems. Vice President – Enrico C. Veluz Enrico C. Veluz is locally known to have many small businesses within areas in Manila. He also graduated at the University of the Philippines and took up Business Management. He also received an award as an Outstanding Entrepreneur last year. Financial Manager – Elenaire Puzon Elenaire Puzon is a graduate of Financial Management in the Mapua Institute of Technology. He is an experienced collector and good in preparing of financial statements and accounts in different companies. Secretary – Bea Faye Libiran Bea Faye Libiran is a graduate of Adamson University and took up Marketing. She is an experienced secretary since she has worked on different big companies such as RCBC and Makisig Group of Companies. Area Partners – Jake Esguerra and Ryan Redecto Jake Esguerra is a graduate of University of Makati and took up Marketing. He is a In-House Partner – Frangelo Alejandro and John Orneza IT – Lawrence Penalba and Mikko Ray Victoria Messenger – Jomaric Santos Jomaric Santos is a graduate of University of Makati and took up V. Marketing Plan (Condominium Units, House & Lot, Lot, Building, Res/Commercial) a. Pricing As we reassess the acquired assets of the banks, we will be meeting halfway with the bank to provide a better price. b. Distribution Since we offer service, distribution is not relevant. c. Promotion BC Property Forum will conduct promotion through advertising. The type of advertising will be using print advertising like magazines, newspaper, posters, brochures and flyers. This would help our company to be recognized by our customers since we offer services for them. We will also plan to develop our own website of the company to promote the services we have. Those promotions will be of great help to our company to be well established in the business industry. d. Product and Forecasts The 1st month will be for the set up of the business. On the 2nd month, the company office will be in order & ready to start. On the next month, many costumers are satisfying the services to an increase in sales every year. e. Controls Based on the market segmentation that BC Property Forum has established, we will require constant updates in terms of the potential sizes, distributions, and purchasing patterns of the quality conscious, technology utilizing executive markets. We will use our historical performance to establish a customer database containing this information. This will allow BC Property Forum to target customers more efficiently as a result of actual experience. Furthermore, as our customer service and follow-up are keys to establishing retained customers, the marketing database will allow us to divide the potential needs of customers.

Free Essays on The Purpose Of Upton Sinclair

The purpose of Upton Sinclair’s The Jungle was to bring the grim conditions of Chicago’s meatpacking industry and its workers to the American public’s attention. After Sinclair was commissioned to investigate labor conditions in the Chicago stockyards he wrote about his observations in The Jungle. He points out that labor unions have failed because in the so-called competitive system owners can also organize. He stresses the capitalistic system in comparison to the socialist reforms. However, the book did not bring about the socialist reforms that Sinclair thought were needed. It does provide many historical events in vivid descriptions which supported the contrasts between capitalist views and socialist reforms. The book begins with the wedding of Jurgis Rudkus and Ona Lukeszaite. In a flashback the explanation of the characters coming to America is described. Ona decides to come to America after her father dies and leaves her with little money. Jurgis joins Ona, Ona’s family, and his family to journey to America. They settle down in a Chicago area known as Packtown, the center of Chicago’s meatpacking industry. As an immigrant Jurgis sees his new home as a hard, dangerous, and filthy place to live. People are having difficulty getting jobs. However, Jurgis gets a job right away because of his physical strength. His job is shoveling guts at Browns. He is shown a tour of the facilities. This is where hard reality sets in. As he starts his job he witnesses the butchering of injured, diseased, or dead cattle that are unfit to eat. As winter comes things become even harsher. Antanes, Jurgis’ father, dies in a cold cellar. Jurgis is forced to work in an unheated packing house. Because of bad weather, work is shorter hours and less pay. This is the time when Jurgis realizes that possibly by joining a union things could change for the better. He slowly begins to understand politics and bribery. He becomes a ... Free Essays on The Purpose Of Upton Sinclair Free Essays on The Purpose Of Upton Sinclair The purpose of Upton Sinclair’s The Jungle was to bring the grim conditions of Chicago’s meatpacking industry and its workers to the American public’s attention. After Sinclair was commissioned to investigate labor conditions in the Chicago stockyards he wrote about his observations in The Jungle. He points out that labor unions have failed because in the so-called competitive system owners can also organize. He stresses the capitalistic system in comparison to the socialist reforms. However, the book did not bring about the socialist reforms that Sinclair thought were needed. It does provide many historical events in vivid descriptions which supported the contrasts between capitalist views and socialist reforms. The book begins with the wedding of Jurgis Rudkus and Ona Lukeszaite. In a flashback the explanation of the characters coming to America is described. Ona decides to come to America after her father dies and leaves her with little money. Jurgis joins Ona, Ona’s family, and his family to journey to America. They settle down in a Chicago area known as Packtown, the center of Chicago’s meatpacking industry. As an immigrant Jurgis sees his new home as a hard, dangerous, and filthy place to live. People are having difficulty getting jobs. However, Jurgis gets a job right away because of his physical strength. His job is shoveling guts at Browns. He is shown a tour of the facilities. This is where hard reality sets in. As he starts his job he witnesses the butchering of injured, diseased, or dead cattle that are unfit to eat. As winter comes things become even harsher. Antanes, Jurgis’ father, dies in a cold cellar. Jurgis is forced to work in an unheated packing house. Because of bad weather, work is shorter hours and less pay. This is the time when Jurgis realizes that possibly by joining a union things could change for the better. He slowly begins to understand politics and bribery. He becomes a ...

The Lizzie Borden Case In American Popular Culture

The Lizzie Borden Case In American Popular Culture The Lizzie Borden case is an intriguing story that captures the mind of any reader. Lizzie Andrew Borden was accused of hacking to death both her father and stepmother in 1927 (Rehak, 2005). These horrific murders, the trial that subsequently followed and the landmark decision by the trial court to acquit the accused made the case very famous.Advertising We will write a custom proposal sample on The Lizzie Borden Case In American Popular Culture specifically for you for only $16.05 $11/page Learn More This fame has continued to date in the American popular culture hence arousing a heated controversial public debate. Researchers and critics have attempted to analyze the circumstantial evidence surrounding this particular case. Several works have recreated the case of Lizzie Borden throughout the centuries through rhyme and fiction. The purpose of the paper is to establish the contribution of the case to the current popular American culture and art. The author will also analyze the methods adapted by the makers of popular culture to transform the story into a popular American legend. The paper will also discuss the impact of the story on authors, choreographers and even composers who have continued to keep it alive in the American culture over the years. The paper is also aimed at establishing the fundamental elements of the case that reverberates around the American culture. This will help the reader to understand how the values and goals of the case can be reflected in this current generation. The literature students and literature lovers, the main audience of this paper, will therefore comprehend the role of the case in the modern culture. The other possible audience would be those people that are interested in crime cases. The author intends to use simple words to explain the concepts to the target audience. It is evident that a murder was committed but it was never established who the culprit really was. Though many works point to t he possibility of Lizzie Borden being the murderer, others steer away from making judgmental conclusion to who the main culprit would have been. The assumptions in the fictional works are based on the fact that Lizzie was acquitted of the murder regardless of all the present evidence that would have incriminated her. It is evident from the works that Lizzie would have been convicted if the incidence had taken place in today’s popular culture. The author intends to use active voice as opposed to the passive voice. This is because the author hopes to achieve his main agenda of clarifying the expressed ideas to the target audience in a convincing manner. The author also intends to rely on secondary sources as his main research methodology hence the need to intensively review the information regarding the research topic.Advertising Looking for proposal on cultural studies? Let's see if we can help you! Get your first paper with 15% OFF Learn More The write r will therefore need to critically analyze the works by the other authors and present the findings in a stylistic and convincing voice. The research will also be presented in a simple but educative manner and it will be free of any grammatical or spelling mistakes that can put off the reader. The Lizzie Borden case has been a creation of mass culture since 1893 when Edwin Porter published his famous book, ‘The Fall River Tragedy’ (Patrick, 2010). This saw an emergence of more works in form of published books, operas, musicals and even movies in an attempt to explain the motive of Lizzie and the correlation to American popular culture. The fictional works adopts romance as one of the main themes to explain the circumstances surrounding the case. The fictional works have succeeded to change the story to become a famous American legend that continues to flourish to date. It is therefore important for the author to analyze the reflective values and goals of Lizzie Borden c ase and the metaphoric connection with the present American culture as argued in the fictional works. Reference List Patrick, S. (2010). Trials of the Century: An Encyclopedia of Popular Culture and the  Law. California: Greenwood Publishing Group. Rehak, D. (2005). Did Lizzie Borden Axe for It?. New York: Wadsworth Cengage Learning.

Important School Tips for Parents From a Principal

Important School Tips for Parents From a Principal For teachers, parents can be your worst enemy or your best friend.  Over the course of the last decade, I have worked with a handful of the most difficult parents, as well as many of the best parents. I believe that the majority of parents do a terrific job and genuinely try their best. The truth is that being a parent is not easy. We make mistakes, and there is no way we can be good at everything. Sometimes as a parent it is critical to rely on and seek advice from experts in certain areas. As a principal, I would like to offer a few school tips for parents that I believe every educator would want them to know, and that will also benefit their children. 1. Be Supportive Any teacher will tell you that if a child’s parent is supportive that they will gladly work through any issues that might arise over the course of the school year. Teachers are human, and there is a chance they will make a mistake. However, despite perception, most teachers are dedicated professionals who do a terrific job day in and day out. It is unrealistic to think that there are not bad teachers out there, but most are exceptionally skilled at what they do. If your child does have a lousy teacher, please don’t judge the next teacher based on the previous, and voice your concerns about that teacher to the principal. If your child has an excellent teacher, then make sure that the teacher knows how you feel about them and also let the principal know. Voice your support not only of the teacher but of the school as a whole. 2. Be Involved and Stay Involved One of the most frustrating trends in schools is how the level of parental involvement decreases as a child’s age increases. It is an extremely discouraging fact because children of all ages would benefit if their parents would stay involved. While it is certain that the first few years of school are arguably the most important, the other years are important as well. Children are smart and intuitive. When they see their parents taking a step back in their involvement, it sends the wrong message. Most children will start to slack off too. It is a sad reality that many middle school and high school parent/teacher conferences have an exceedingly small turnout. The ones who do show up are the ones that teachers often say don’t need to, but the correlation to their child’s success and their continued involvement in their child’s education is no mistake. Every parent should know what is going on in their child’s daily school life. A parent should do the following things every day: Ask your child how their school day went. Engage in conversation about what they learned, whom their friends are, what they had for lunch, etc.Make sure your child has time set aside to complete homework. Be there to answer any questions or assist when needed.Read all notes/memos sent home from the school and/or teacher. Notes are the primary form of communications between a teacher and parents. Look for them and read them to stay up-to-date on events.Contact your child’s teacher immediately if you have any concerns.Value your child’s education and express the importance of it every single day. This is arguably the single most valuable thing a parent can do when it comes to their child’s education. Those that value education often thrives and those that don’t often fail. 3. Do Not Bad-Mouth the Teacher in Front of Your Child Nothing undermines the authority of a teacher any faster than when a parent continuously bashes them or talks bad about them in front of their child. There are times when you are going to be upset with a teacher, but your child should never know exactly how you feel. It will interfere with their education. If you vocally and adamantly disrespect the teacher, then your child will likely mirror you. Keep your personal feelings about the teacher between yourself, the school administration, and the teacher. 4. Follow Through As an administrator, I cannot tell you how many times I have dealt with a student discipline issue where the parent will come in tremendously supportive and apologetic about their child’s behavior. They often tell you that they are going to ground their child and discipline them at home on top of the school’s punishment. However, when you inquire with the student the next day, they tell you that nothing was done. Children need structure and discipline and most crave it on some level. If your child makes a mistake, then there should be consequences at school and at home. This will show the child that both the parent and school are on the same page and that they are not going to be allowed to get away with that behavior. However, if you do not have any intent on following through on your end, then do not promise to take care of it at home. When you practice this behavior, it sends an underlying message that the child can make a mistake, but in the end, there is not going to be a punishment. Follow through with your threats. 5. Do Not Take Your Child’s Word for the Truth If your child came home from school and told you that their teacher threw a box of Kleenexes at them, how would you handle it? Would you instantly assume that they are telling the truth?Would you call or meet the principal and demand that the teacher be removed?Would you aggressively approach the teacher and make accusations?Would you call and request a meeting with the teacher to ask them calmly if they could explain what happened? If you are a parent who chooses anything other than 4, then your choice is the worst kind of a slap in the face to an educator. Parents who take their child’s word over an adult before consulting with the adult challenge their authority. While it is entirely possible that the child is telling the truth, the teacher should be given the right to explain their side without being viciously attacked first. Too many times, children leave out crucial facts, when explaining situations like this to their parent. Children are often devious by nature, and if there is a chance they can get their teacher in trouble, then they will go for it. Parents and teachers who stay on the same page and work together alleviate this opportunity for assumptions and misconceptions because the child knows they won’t get away with it. 6. Do Not Make Excuses for Your Child Help us hold your child accountable. If your child makes a mistake, don’t bail them out by constantly making excuses for them. From time to time, there are legitimate excuses, but if you are constantly making excuses for your child, then you are not doing them any favors. You won’t be able to make excuses for them their whole life, so don’t let them get into that habit. If they didn’t do their homework, don’t call the teacher and say it was your fault because you took them to a ball game. If they get in trouble for hitting another student, don’t make the excuse that they learned that behavior from an older sibling. Stand firm with the school and teach them a life lesson that could prevent them from making bigger mistakes later on.

Global Warming Research Paper Example | Topics and Well Written Essays - 1000 words - 1

Global Warming - Research Paper Example History of Global Warming. The notion of the ‘greenhouse effect’ was mentioned by a French scientist Fourier in 1827, who prompted the possibility that the earth trapped part of the longer-wave radiation coming from the surface of the earth (Grubb et al. 3). The issue of global warming was then introduced later in 1896, by a Swedish scientist named Svante Arrhenius (1859-1927), who claimed that the combustion of fossil fuels would eventually lead to a global temperature rise (Weart 205). However, this work was overlooked, due to the fact that human activity was too insignificant to have any impact on the planet, because of its sheer size and nature (Maslin Ch. 2). Improvements in infrared spectroscopy, in the 1940s, opened up a new chapter in the global warming phenomenon, where scientists were able to measure long wave radiation. It was up until now that they truly discovered through experimentation, that carbon dioxide did trap the radiation of infrared radiation withi n the atmosphere. However, this too was still considered insignificant, with more attention being given to the effects of water vapors into the atmosphere (Maslin). In 1955, after the world witnessed the Second World War, Gilbert Plass concluded that adding more carbon dioxide into the atmosphere would result in its capturing more infrared radiation, rather than it being lost into space (Maslin). From then onwards towards the end of the century, various treaties have come to form to tackle the issue of global warming, which I shall address later. Financial and Emotional Impact and Assessments The IPCC’s (Intergovernmental Panel on Climate Change) Third Assessment Report projected various emission outcomes, under which North America, over the next century could warm at 1-3?C in under low emissions, or 3.5-7.5?C in a high emissions scenario (Gupta 41). It is also common knowledge now that as the planet’s temperature increases, polar region ice melting would lead to incre ased sea level, leading to the destruction of coastal regions all around the world. These include much developed areas such as Florida, whose insured property alone exceeds US$1 trillion (Gupta 44). Global warming will lead to global climate change, which leads to various financial impacts. For example, in parts of Siberia and Northern Canada, an increase in temperature and carbon dioxide, would lengthen the favorable climatic conditions for crops and plants leading businesses to reap in more revenue (Houghton 143). However, given the nature of the sensitivity of global climatic changes, the financial impacts would tend to be more adverse in terms of cost. Adaptation to climatic changes would induce affected communities to alter their complete lifestyle, or in the worst case scenario, to migrate to more suitable conditions (Houghton). Roeser states in her book with regards to global warming and emotions that â€Å"Global warming is not just a scientific curiosity. It is something t hat makes any sensible person extremely anxious, and it shames all of us who are such extravagant degraders of the environment† (viii). Controversy surrounding the topic Regarding the controversy of anthropogenic global warming, which is global warming caused by human behavior, the climate modeling community has taken a blind eye to the findings of various published research, which conclude that the effects of global warming are not caused by human b

Review of the Current Macroeconomic Situation in the US Essay

Review of the Current Macroeconomic Situation in the US - Essay Example Unemployment situation in the US Young Americans are one of the worst sufferers of recession that has followed the global financial crisis of 2008. Although almost all open economies in the world have been affected at varying levels, research suggests that unemployment situation in America is grave. While other developed and developing economies have gradually been able to create employment opportunities for citizens, rate of unemployment in the USA for the age group of 16 years to 24 years is approximately 16.2 percent. This rate of unemployment is considered very high by policy makers in USA and also other countries across the globe. It has been apprehended that even if the rate of unemployment falls over the years, the impact of current unemployment would linger around for several years in the near future. Over the next ten years, members of the American labor force would experience a drop in total expected earnings by US $20 billion. Building on recent research reports published by Center for American Progress, economists have estimated that approximately US $22,000 per person has been lost in earnings (Ayres, 2013). This loss in earnings (depicted by fall in wages) holds serious economic implications for individuals, private corporations as well as the government. Higher unemployment would result in delay in repayment of student loans that would lead to ballooning of student-loan debt (Ayres, 2013). In the short term, the delay in repayment of debt would lead to loss in earnings by the financial institutions. These institutions would be unable to extend fresh debts, thereby, foregoing opportunities of higher earnings. Besides, the long... This essay aims to comprehensively observe current set of macroeconomic policies, carried out by American government to tackle the economic consequences of global financial turmoil In the essay, the stability in the price level is regarded the main aspect, that affects healthy economic growth in the country. One of the major reasons of concern for the US government is the high rate of unemployment prevalent in the economy. It is undoubted that the economy is recovering, but at an unsatisfactory rate. This rate of growth is frustrating for the economists and policy makers in the economy, since such rates of growth are deemed insufficient. In order to take the economy to higher levels of growth, economic performance by the country has to be boosted up. Different aspects of the economy have to be considered for the study of performance of US economy. These aspects are represented by the variables, such as rate of inflation and unemployment and level of recession in the economy. Persistent weakness of the housing market in U.S. is one of the major concerns for the economy. The US economy is characterized by tightening of credit conditions and availability of credit in different sectors in the economy, which is responsible for deleveraging of the U.S. households. The government has adopted contractionary fiscal policies along with accommodative monetary policies. Policy of large scale asset purchases is aimed at sustaining downward pressure on the long term rates of interest that would support the mortgage and real estate markets

Conditions of enslavement and resistance by the women in barbados Essay

Conditions of enslavement and resistance by the women in barbados - Essay Example More pointedly and often ignored, the enslavement of women and their resistance to their lot presents not only an interesting historical recount, but in its impact on the island’s culture, a crucial aspect of its development and singular identity as a country rich in African tradition and lore—a tradition kept alive by the passive resistance of slave women. Colonialism and the Beginning of Slavery According to Appiah and Gates ( 1999), some time after 800 c.e. , several South American native tribes began migrating to Barbados; most were eventually driven out by the notoriously fierce Caribs, also from South America. The Caribs eventually took over the population of the island. In the first decade of the sixteenth century, Spanish conquistadors conquered the Caribs and began enslaving Barbados’s inhabitants, removing many to work on emerging sugar plantations throughout the Caribbean and on the mainland. Those remaining quickly fell victim to small pox and tubercu losis. (Barbados.org, 2009) By the time the British arrived in the early 1600s, the island was virtually uninhabited and seemed a prime place for the British to take over for their own expanding plantations in the region. In 1627 the first African slaves along with eighty British colonists landed on the island at Holetown Village. Appiah and Gates (1999) provide the following overview: Barbados was a colony founded entirely on slave labor. As early as the seventeenth century black slaves outnumbered whites by nearly four to one, culminating in the creation of legal and political institutions that dominated and subjugated the island's black majority for more than 300 years. The authoritarian style with which the white minority ruled Barbados was admired and emulated by white colonists throughout the Caribbean... By the mid-seventeenth century Barbados was the prototype for European colonialism, and the demise of that system on the island bears vivid testimony to the ability of Africa n slaves to overcome enormous obstacles on the road to freedom. (par. 3) Most of the slaves were provided by Dutch merchants†¦from Sierra Leone, Guinea, Ghana, the Ivory Coast, Nigeria and Cameroon. Many, as was usually the case due to the harsh environment of slave ships themselves, died before reaching their destinations. The harshness of the trips is attested to in eyewitness accounts that describe a scene after a gale. â€Å"By the time the tarp was removed and the portholes opened nearly a third of the people below had perished† (World Sagas.com, no date, par. 16). From the very beginning unrest among the slave population was evident. Laws regulating the slaves were quickly put into place and harshly enforced. By the 1800's, there were laws prohibiting slaves from leaving their plantations without permission and curtailment of cultural traditions of communication, such as the beating drums or any other instruments. Runaway-- men and women-- were treated harshly; law s required the return of runaways and leniency for anyone who killed runaways was institutional. The Lot of Women Slaves When it comes to slavery in general, history and other portrayals of enslaved people tend to focus on the role of men. This male dominated history fails to acknowledge and even devalues the role of women at all levels of slavery. Shepherd, Brereton and Baily (1999) in Women in Caribbean History states that until

Forum APA Essay Example | Topics and Well Written Essays - 500 words

Forum APA - Essay Example In academic writing, it is critical to understand the type of sources that are allowed for use. Books are one of the academic sources of information in writing. These sources may be accessed from the library or from online libraries. The other authentic source of information when researching for academic writing are journals and peer reviewed articles that are also available from libraries and online (Jager and Bak, 2003). Students may also use reports from governments and different organizations as the source of information when writing. Published theses are also used as authentic sources in writing (Adams and Forsyth, 2006). Lastly, a student is allowed to use some online materials when researching. Despite the numerous numbers of sources that a student can use, one is warned against using some online sources such as Wikipedia, blogs and websites ending with â€Å".com†. Whenever a student uses any source, one is required to cite it accordingly within the text and provide a list of references after the work is completed (Adams and Forsyth, 2006). Citing of references may be carried out based on different referencing styles. The most common referencing styles are American Psychologist Association (APA), Modern Language Association (MLA), Harvard, Chicago and Oxford. References are cited in any research work to avoid cases of plagiarism and to give tribute to the source of any idea (Jager and Bak, 2003). One of the reasons for the use of quality reference in writing is to assure that the student accesses authentic information. In the sources such as Wikipedia and blogs, the information contained may be changed by different people. This makes such information untrustworthy and incredible for use. However, quality sources contain accurate facts that have been tested through research and over a long period (Jager and Bak, 2003). Quality sources are also important as they provide

Strategic Choice and Evaluation Essay Example | Topics and Well Written Essays - 1000 words

Strategic Choice and Evaluation - Essay Example A grand as well as the generic strategy will also be adopted to enhance growth. Such strategic plan components will guarantee that Wal-Mart remains a leader in the industry (Giudice, Carayannis & Peruta, 2011, pp. 104-105). This paper gives a limelight to the strategic alternatives and offer sound recommendation on the best strategies to implement based on the current climate in the retailing industry. It is undoubtedly obvious that all the value disciplines, including product leadership, customer intimacy, and operational excellence are likely to benefit Wal-Mart in exceptional ways. However, one of the most effective disciplines that the firm can adopt is operational excellence since it will enhance the internal operations and do away with wastes within the internal processes. Using such a value discipline will also continue giving the firm a competitive edge and improve on its logistics as well as purchasing. To do this, it must continue focusing on offering low prices by negotiating with the suppliers to reduce their costs through economies of scale. As a result, this helps it to offer diverse products with competitive service, while at the same time maintaining affordable or reasonable prices. Placing an immense focus on operational excellence will also help in mitigating the prevailing risks in the business world of been undercut on prices by the rival firms such as Target ( Lynch, 2013). Coming up with an excellent supermarket chain that is capable of accommodating growth requires high degree of operational excellence. In that case, the firm must also be focused on adopting projects that boosts productivity and reduces costs. It should also continue investing in information technology to improve on the inventory system, communicate promptly with the suppliers, and deliver the necessary data on time. Continuous improvement on operational excellence will go a long way to improve the firm’s productivity, offer

Forum APA Essay Example | Topics and Well Written Essays - 500 words

Forum APA - Essay Example In academic writing, it is critical to understand the type of sources that are allowed for use. Books are one of the academic sources of information in writing. These sources may be accessed from the library or from online libraries. The other authentic source of information when researching for academic writing are journals and peer reviewed articles that are also available from libraries and online (Jager and Bak, 2003). Students may also use reports from governments and different organizations as the source of information when writing. Published theses are also used as authentic sources in writing (Adams and Forsyth, 2006). Lastly, a student is allowed to use some online materials when researching. Despite the numerous numbers of sources that a student can use, one is warned against using some online sources such as Wikipedia, blogs and websites ending with â€Å".com†. Whenever a student uses any source, one is required to cite it accordingly within the text and provide a list of references after the work is completed (Adams and Forsyth, 2006). Citing of references may be carried out based on different referencing styles. The most common referencing styles are American Psychologist Association (APA), Modern Language Association (MLA), Harvard, Chicago and Oxford. References are cited in any research work to avoid cases of plagiarism and to give tribute to the source of any idea (Jager and Bak, 2003). One of the reasons for the use of quality reference in writing is to assure that the student accesses authentic information. In the sources such as Wikipedia and blogs, the information contained may be changed by different people. This makes such information untrustworthy and incredible for use. However, quality sources contain accurate facts that have been tested through research and over a long period (Jager and Bak, 2003). Quality sources are also important as they provide

The History of Rock and Roll Essay Example | Topics and Well Written Essays - 1000 words

The History of Rock and Roll - Essay Example However, crossover music may also be a combination of two dominant styles that are each distinctive. Jerry Lee Lewis' "Great Balls of Fire" went to the top 3 of the C&W, R&B, and Pop charts because it had distinctive elements of all three styles. Musical styles can sometimes be combined into 'fusion' music, such as Rockabilly, that forms a new style but is still considered a form of crossover. Crossover is important because it increases the size of the available audience. This is especially true when radio stations are categorized by genre. An audience will have a loyalty to a certain station and by getting airtime on both a rock station and a country station, the artist has doubled their exposure. This phenomena was critical to 45-RPM record sales in the 1950s. Exposure to new music was through the radio and record sales were directly linked to airtime and radio station promotion. A crossover record could double their sales or as in the case of "Great Balls of Fire", sales could triple. Elvis Presley's musical career peaked in 1960 before he left for the Army. The previous 6 years had an enormous impact on rock and roll that his later career would never have been able to capture. When Elvis signed with Sun Records in 1954, he brought the right ingredients to an environment that meshed perfectly with his style (Stuessy and Lipscomb 36). Rock and Roll had been introduced to a rebellious post war youth in an affluent economy. The 45-RPM record had made music on demand accessible for everyone and it was most popular with the younger audience. To this scene, Elvis brought his unique mix of musical talents. He had a broad range of style from Gospel to hard core Rock and Roll that held a wide appeal (Stuessy and Lipscomb 40). He could successfully blend these styles or use them independently. His physical appearance and performances were just rebellious enough to mirror James Dean and entrance the emerging TV viewers. Elvis was able to dominate the youth culture and explo it the new mediums of recording and television. After his release from the Army, Rock and Roll had taken new directions and had a life of its own. Music was getting more sophisticated and the audiences had generated expectations of a continually changing sound. His 1960s hits "In the Ghetto" and "Suspicious Minds" lacked the spark that had ignited the Rock revolution (Stuessy and Lipscomb 38). They were generic sounds that could have been performed by a dozen other artists. Though he would always remain one of the most popular figures in music, without the early years he would never have reached the success that he has today. A Good 1950s Rock and Roll Song The Rock and Roll of the 1950s was a pulling away from the Big Band era and the crooners of the 1940s. It had to be counter to those sounds. Where Big Band had been highly structured, Rock was required to have little if any structure. This often resulted in songs that were simple and direct with few chords and simple progressions. This was part of Rock's appeal. A good song needed a familiar structure that the audience could immediately relate to. Buddy Holly's "Oh Boy" was built on the I IV V chord progression that had permeated Country and Blues for decades (Stuessy and Lipscomb 30). The successful song would take these familiar progressions and escalate the tempo, timbre, and volume to create a good Rock and Roll

The Consequences of Colonization Essay Example for Free

The Consequences of Colonization Essay Dr Clionadh Raleigh Human Geography. GG1023. Name: Louise Schriek Student ID: 11759835 Extension Granted for ad misericordiam reasons (Due on the 18/04/2012, Handed 26/04/2012). Word count: 1500 (excluding bibliography). Title : The consequences of colonization: an interpretation regarding the nature and causes of the ongoing issues around nationalism, ethnicity and stately power in sub-Saharan Africa since decolonization. Colonial occupation and the manner in which independence was gained and free states were organized may be a possible explanation for the matters of contention revolving around ethnicity, nationalism, and states in Sub-Saharan Africa to this day. A first part will expose the reasons for multiple ethnicities being situated in the same territory, and contrast it with the mainly mono-ethnic governments. A second part will deal with the consequences of this colonial inherited and induced system, holding that the nature of most sub-Saharan African states and their relations to the nations encompassed within their territories does not necessarily lead to secession, violence or power-contestations, but may partly account for the problems faced by these countries. Many of the territorial boundaries in Africa today have not changed since their definition by colonizers at the Berlin Conference (1884-1885); native societal systems were barely taken into account, the emphasis having been on the maximization of territory and resources (p93, Cole 2007). The individual colonial institutions and territories formed the inescapable frame that African nationalists had to confront and operate within to effectively challenge colonial occupation (p11, Young 2004). Mobilizations against the colonial states thus had to identify to and mobilize through the territory and populations imprisoned by this state, and thus colonial boundaries were kept as models for the new rising civic nationstates. The hyphenation of nation and state embodied ideological requirements to be impersonated to legitimize a discourse of independence in the eyes of European powers (p164, Hutchinson 2004). All groups encompassed in one delimited colonial territory thus needed to be presented as one nation claiming its rights to selfdetermination and due national territory, through a demotic form of  nationalism (Preface, E. K. Francis 1968) with respect to the specific colonial power occupying it. As Robert Stock explains, much of the weakness in African political institutions can be traced back to the colonial period, especially to the transition of political powers with the gain of independence (p136, Stock 2004). The governments put into place were composed by an African elite highly influenced by western values and ideologies, having benefited of colonial education (p70, Potter 2008). Elections were impacted and controlled by the colonial powers efforts to set up governments (p7, Saha 2010) that would not seriously challenge the interests of the metropole (p136, Stock 2004), hereby staying implicitly imperialist to keep economical advantages, to not be challenged politically, to impose their political ideologies on these rising free states, and to keep an upper hand on the exploitation and trade of resources in the globalizing economy. The new African governments were thus closely correlated with the previous colonizing powers, and were not necessarily a reflection of the people and nations within these states, of their desires and interests, but rather of that of a designated elite monopolizing the power in its own interest. Autonomy itself came from a popular strive of Africans, and vast independence movements fighting for political and economical freedom, encompassed in the continent-wide Pan-Africa ethnic phenomenon as a unitary reaction to colonization (p106, Cole 2007). But the consequent autonomous states set up did thus not rise from  a common will of the people, but of westernized decisions and a certain disguised continuation of the society model set up during the colonial era; The struggle for African autonomy and the creation of the independent states lacked substantial connection, as it seems that the first did not give birth to the second. It is thus not surprising that in general Sub-Saharan African States do not identify to the nations they were attributed or feel a strong duty of promoting the entirety of their citizens interests, and vice versa. Moreover, it seems that the elite holding political power will have a stronger connection to their own ethnic-nation than to the whole of the population in their territory (p235, Saha 2010). The importance of the  ethnic-factor in the process of nation-building is argued by such figures as Anthony Smith or Walker Connor to be of fundamental importance (p5, Young 2004). Ethnic belonging seems to be a fundament of the current African societal model. This may be traced back to the fact that the civic form of nationalism bringing all ethnic nations of one state together had by no means been pursued by colonial rulers, hereby facilitating control of populations and minimizing the amplitude of possible nationalistic protest. Most African Governments are constituted by one political party that will promote the interests of this one ethnicity, and be supported by it. These Uni-party governments are an inherent part of the system installed by the colonizing powers. A possible interpretation is as that of a vicious circle. The first governments of the new states at independence were mainly representative of only one of the ethnicities comprised in the state. Valuing this fraction of their states population that they shared ethno-national belonging with induced the growing loss of identification and trust of other ethnicities and of their sense of citizenship and belonging to the state as an inherent part of its nation. Support thus declined, the state responded by growingly disregarding these often numerous nations peripheral to their system, whom in turn in this opposition may aspire to overthrow the group in power, to defend their interests and gain recognition . Complications seem to derive from the probl ematic mono-ethnic governmental institutions holding stately power. This, amongst other factors, may be a cause for corruption and violence in SubSaharan Countries. It seems that The peripheral ethnicities subjugate themselves to the state, not by motive of civic nationalism and positive support, but by lack of means of contestation and politicization, by bribery as they are payed off or compensated (the least possible) for their passivity, through repression by violence, or elimination by mass murder. Various ethnic nations being encompassed in the same state thus usually seems to not lead to the secession of African states. Instead it leads to the fight over the monopoly of state-power between the various ethnic groups concerned (p240 Saha 2010). The state, due to its mono-party and mono-ethnic  constitution, only represents a fraction of the citizens that the officially homogenizing civic nation-state, indeed exhibiting national symbols, hymns, history etc (p443, Dirlik 2002) is supposed to take into account. Substantial civic-nationalism and equal treatment of the whole population on its territory, through the distribution of power and wealth, is not reflected. In fact, very few ethno-nationalist socio-political movements in Sub-Saharan Africa have made intractable demands to form their own ethnic states (p5, Saha 2010). Many movements, such as the Sudans Peoples Liberation Movement or the Oromo Liberation Front in Ethiopia do not consider secessions as the solution to their ethnic issues (p5, Saha 2010). These movements are rather looking for better recognition from the political elite, and for a better politico-economic position. It seems thus that ignored ethnicities, or the peoples nations on the social margins (p6, Young 2004), aspire more to a civic type of nationalism in the states that encomprise them, rather than to the creation of their own ethno-nationalist state, the latter, due to past and present situations, appearing to not be the key to development and stability. Ethnicity is thus an issue in state-politics. Ethnic divisions are very much observable in economic and political hierarchies, and this poses a problem for democratization and civic-nationalism which should be the prominent form of nationalism manifestations in most African countries south of the Sahara due to their multi-ethnic nature. Monopoly of the state by one ethnicity also holds as consequence the latters ample control of natural resources, which are of major importance in the developing countries of Sub-Saharan Africa, whose economies depend largely on the exploitation of primary resources. Contemporary nationalism advocates the fragmentation of  the states resources monopoly amongst its citizens (p22, Guiberneau 1999), which is rarely the case in Sub-Saharan Africa. It may be suggested that internal contestations of power and overthrowal- attempts of one ethnic group by another happen to gain access to the resources and wealth that the large national territories that each state rules over comprise. Added to  this is the large amount of development aid that governments gain access to, but that seems to mostly disappear amongst the elite and be used to secure its power-monopoly through bribery, financing violent repressions, and corruption of the populations that are not of the system supporting the party in power(p62, Orijako 2001). The access to this wealth may thus also be an incentive for intra-state tensions. Ethnic differences within nations do not seem to be the reason for intra-state conflicts in Sub-Saharan Africa. But they still make the situation of these states problematic. One possible interpretation is thus that it is the mono-ethnic nature of most subSaharan African governments causes intra-state tensions. The cause of this may be traced back to the political, economic, social and territorial structuring imposed by colonial powers during colonial occupation, and generated by the way independence was gained, that is, through the colonial system, and influenced by colonial interests. Bibliography: . Montserrat Guibernau and John Hutchinson (2001), Understanding Nationalism, Polity Press, Great Britain. (Library 320.54 ). . Robert B. Potter, Tony Binns, Jennifer A. Elliot, David Smith (2008- Third Edition), Geographies of Development- An Introduction to Development Studies, Pearson Education Limited, UK. . M. Crawford Young (12/07/2004), Revisiting Nationalism and Ethnicity in Africa, James S. Coleman African Studies Center, UCLA, (Academic article, http://escholarship.org/uc/item/28h0r4sr ). . Arif Dirlik (2002), Rethinking Colonialism- Globalizatio, Postcolonialism, and the Nation, University of Oregon,The International of Postcolonial Studies, RoutledgeTaylor and Francis Group, USA. (Academic Article) . Robert Stock (2004), Africa South of the Sahara- A Geographical Interpretation (Second Edition), The Guilford Press, USA. . Santosh C. Saha (Mar 01, 2010), Sub-Saharan Ethnic Attachment And Civil Conflict: A Methodological Approach To State-Building And Ethnicity. Journal of Third World Studies; Vol. 27, No. 1, p. 235-251 (Academic Article). tcd library- EBSCO. . Roy Cole and H.J. De Blij (2007), Survey of Subsaharan Africa- a Regional Geography, Oxford University Press, USA. . E. K. Francis (1968), The Ethnic Factor in Nation-Building, University of North Carolina Press, USA. (Oxford Journals, Academic Article, http://sf.oxfordjournals.org/ content/46/3/338.short ). . Humphrey Orijako (2001), Killing Sub-Saharan Africa with Aid, Nova Science Publishers, USA.

Tarasoff v. Regents of University of California

Tarasoff v. Regents of University of California An ethical dilemma alludes to the mental conflict that emerges from differing moral goals. Confidentiality and the safeguarding all private information is essential in healthcare especially about the treatment of mental illness. Because of the privatization of mental health treatment coupled with the closing of many state institutions, emergency department doctors and nurses are often faced with patients who are a danger to themselves, family members.   A breach in privacy can negate the trust between the provider and the patient and lead to negative outcomes and legal issues however, concern for public safety must also be considered. The duty to warn others of the potential commitment of violent acts came to the forefront of healthcare in 1974(amended in 1976) in the case of Tarasoff v. Regents of University of California (Henderson, 2015). Details of the case Tarasoff v. Regents of the University of California, was a landmark case that dealt with the duty of mental health providers to notify those individuals who are threatened with harm. The Supreme Court in California heard The Tarasoff cased, which dealt with a complex area of tort law regarding duty owed of a medical provider to an individual to whom a threat of harm has been made. In 1969, while attending the University of California, Berkeley as an exchange student, Prosenjit Poddar met Tatiana Tarasoff.  Ã‚   After the demise of the relationship, Poddar became increasingly despondent and obsessed with Tarasoff. During this time, Poddar began outpatient treatment and was subsequently diagnosed with paranoid schizophrenia by a psychologist at Berkley, Dr. Lawrence Moore. It was during one of the treatment sessions, Poddar that discussed his intention to harm an unidentified female. Although the intended victim was not named directly, Tarasoff was easily identified.   Dr. Moore, concerned for the safety of Tarasoff, requested to have Poddar detained by campus police. Dr. Moore then requested to have Poddar involuntarily committed, believing that he was suffering from an acute episode of paranoid schizophrenia. Poddar was detained by campus security but was released after a brief interview during which time he answered questions rationally. Poddar was warned to stay away from Tarasoff with no further action taken. After the release, Dr. Harvey Powelson, medical ordered the destruction of all notes taken by Dr. Moore as well as the returns of all letters from the police.   Tarasoff nor her parents were not notified of the threat. On October 27, 1969 Poddar viciously attacked Tarasoff, causing her death. Tarasoffs parents filed a lawsuit against Dr. Moore and employees at the University alleging that Poddar had confided his intention to kill Tarasoff, Additionally Dr.   Moore nor his associates failed to warn the Tarasoff family of the imminent threat against Tatiana. At trial, Poddar was convicted of second-degree murder.   The wide-ranging implications of the case focus on the health care provider-patient relationship. Because of this landmark case, health care providers have the duty to protect potential victims from harm caused by the patients under their care. As of 2014, thirty-three states have instituted a duty to warn law (Henderson, 2015). Defendants Argument Dr. Moore argues mental health providers cannot with certainty predict the likelihood that a patient with act on threats of violence. Dr. Moore and the medical team further state that a breach in confidentiality will have detrimental effects on treatment. Further, the act of warning by revelation of confidential information would constitute a breach of trust. Plaintiffs Argument Tarasoffs parents argued that Dr. Moore violated the professional standards by neither warning them of a patient considered to be dangerous, nor detaining a patient considered to be dangerous. The defendants also asserted that Dr. Moore and others abandoned a patient deemed dangerous by ordering the destruction of all therapeutic notes. The plaintiffs further argued that Dr. Moore failed to provide adequate follow up care with Poddar to ensure he was not a danger to himself nor the public. Summary of the ruling The ruling by the Supreme Courts required a balance between the need to protect privileged medical communication between a mental health provider and the patient to protect against potential threats.   The special relationship in this case is the one that is established between a patient and his mental health provider. Such a relationship may increase obligations of protection. A duty of care may arise from the establishment of a special relationship between the health care provider and patient which imposes a duty upon the clinician   to control the patients conduct, or a special relation between the provider and the other individual, which gives to the other a right of protection (Bersoff, 2014).   This relationship was crucial to the ruling regarding the circumstances of the Tarasoff case. When a health care provider has direct or indirect knowledge of information that a reasonable individual may determine that a patient may harm himself or others, this provider must exercis e reasonable and prudent judgement to prevent harm. The court in California ruled that mental health professionals have an obligation to both the patient and individuals who are threatened by a patient. Justice Mathew Tobriner ruled that protective privilege ends about public safety and further states that mental health providers should notify the authorities as they are charged with public safety. Lastly, about the liability of the officers who failed to detain Poddar, the court held that a public employee cannot be found liable for an injury resulting from a discretionary decision. Therefore, the police officers involved were granted immunity from prosecution. Summary argument The plaintiffs in this case presented the best legal argument. For example, the psychiatrist is found to violate the professional standards. Dr. Moore was to be held liable for the failing to protect and warn. Regardless of whether the plaintiffs interests are qualified for legitimate protection from the defendant under the law is relative to the establishment of a duty to care. Obligation of care is the aggregate of foreseeability, degree of certainty of harm to the individual, establishment of a special relationship. Once a health care provider, in this case psychotherapist, determines that a patient represents a genuine peril, he bears a lawful obligation to his patient, as well as to his patients intended victim. The pros and cons of the argument on each side By notifying the police, the provider tried to detain the defendant and protect the public after he became aware of an acute episode of paranoid schizophrenia. He did not warn nor protect the intended victim which eventually led to her death. Thus, the ruling was made in favor of the plaintiffs, the parents of Tatiana Tarasoff.   Despite the defendants argument that the more public good would be accomplished through the support of mental health treatment and complete protection of confidentiality of patients undergoing treatment. References Bersoff, D. N. (2014). Protecting victims of violent patients while protecting confidentiality. American Psychologist, 69(5), 461-467. http://dx.doi.org/10.1037/a0037198 Henderson, E. (2014).   Potentially dangerous patients: A review of the duty to warn.   Journal of emergency nursing, 41(3), 193-200. http://dx.doi.org/10.1016/j.jen.2014.08.012 Tarasoff v. Regents of University of California. (2009). Scocal.stanford.edu. Retrieved 11 February 2017, from http://scocal.stanford.edu/opinion/tarasoff-v-regents-university-california-30278