Micromax Mobile : How to Increase Market Share

Consumer buying behaviour report Micromax mobile phones By Mansi Choksey Roll no. 19 PGDM Marketing Product chosen: Micromax Mobile phones Issue to be addressed: How to increase Market share: Background on the company: Micromax Mobile needs no introduction today. Just two years back people were not aware of  the brand  at all but today it’s India’s third largest mobile selling company by volume after Nokia and Samsung (IDC Report). Brand’s success can be attributed to it’s ability to understand the need of the market ,aggressive marketing with a budget of Rs. 00 crore and smart  distribution channel  management. Its one of the leading Indian Telecom Companies with 23 domestic offices across the country and international offices in Hong Kong, USA, Dubai and now in Nepal. With a futuristic vision and an exhaustive R&D at its helm, Micromax has successfully generated innovative technologies that have revolutionised the telecom consumerspace. As pe r IDC report Micromax displaced LG to become third largest selling  mobile handset company  in india with a market share of 6%.Nokia is market leader with 62% share and Samsung is on second place with 8% market share. The company today sells more than a million handsets a month and is now a Rs. 1600 cr worth brand. The company has presence in more than 500 districts and 90,000  retail outlets. The company started its Mobile handset business in 2008 and the challenge was to establish an identity in a market dominated by big MNCs Like Nokia,Samsung,LG and Motorola. Today Micromax has become a brand which people relate and look up to for realizing their individual device preferences and other out-of-the-box solutions.Micromax, is now churning out 1 million phones a month. Micromax is on a mission to successfully overcome the technological barriers and constantly engender â€Å"life enhancing solutions†. The company's vision is to develop path-breaking technologies and effi cient processes that incubate newer markets, enliven customer aspirations and continue to make Micromax a trusted market leader amongst people. Micromax founders : Rajesh Agarwal: handles company finances Sumeet Arora: chief technology officer Vikas jain: handles alliances with other companiesRahul Sharma: risk taker with the big ideas 4 P’s of marketing for Micromax mobiles: 1. Product Micromax has been quite effective in the marking a difference with almost every product that it launched. The range that they have covered varies quite a large variety. Right from the handsets with 30 days battery backup, dual SIM, handsets switching networks (GSM -CDMA) using gravity sensors, aspirational QWERTY keypad handsets to operator branded 3G handsets to the most exciting OMH CDMA Handsets, etc. Every product of Micromax had the potential to grab the attention of media as ell as the consumers in a market which is already flooded with mobile phone handsets and a launch is there in ever y day or two. 2. Price Micromax specialized in entry-level and mid-segment handsets priced between Rs1,800 and Rs2,400 when it started selling the devices in 2008, confining itself to small towns and rural areas in the first 12-18 months. Encouraged by its success, the firm expanded to larger cities and now has a distribution network of 55,000 retailers, which it plans to scale up to 70,000 by the end of March as part of its strategy to raise sales to 1. million handsets a month. 3. Place Micromax is one of the leading Indian Telecom Companies with 23 domestic offices across the country and international offices in Hong Kong, USA, Dubai and now in Nepal. Micromax has invested Rs100 crore to set up a plant in Baddi in Himachal Pradesh as it feels outsourcing manufacturing completely leaves the door open for supply-side uncertainties. Production will be scaled up from an initial 50,000 per month. â€Å"If everything goes right, by the third phase in March 2011, the Baddi plant will b e making about 500,000 handsets,† Jain said.If the plant isn’t able to cope with the numbers, the fallback plan is to acquire a facility in South Korea, Taiwan or China, he added. 4. Promotion Having gained traction, Micromax is also working on a strategy to create awareness in the metros, which includes tying up with MTV for co-branded phones. Micromax has also tied up with a Bollywood celebrity â€Å"AKSHAY KUMAR† as brand ambassador. Micromax has also tied up some pretty big brands like Yamaha for enhancing their audio experiences and the X360 comes with an MTV branding and exclusive content.It is utilizing the integrated market communication tools like sponsoring events (cricket match and film awards), advertising through hoardings, TV, radio etc very effectively. With a 360 degree advertising and marketing strategy sketched out, the company has an optimistic outlook for the telecom consumer space. Currently present in more than 40,000 stores across the count ry, the company plans to have an aggressive market incursion to reach out to its customers through 70,000 operational stores in the coming year The following tools of IMC are being used by Micromax:Events and experiences For marketing of its products the company is riding on two enduring Indian obsessions–sports and films–to build its brand. Following up on its association with the popular Twenty20 cricket Indian Premier League (IPL), Micromax, a brand that is less than three years old, has become the title sponsor of almost all tournaments and series of which India is a part, including the recently concluded Asia Cup, the forthcoming India-Sri Lanka Test series and the India-New Zealand-Sri Lanka tri-series in August.The objective behind the cricket â€Å"roadblock†, as such behavior is termed in advertising, is to drive brand awareness and recall. The company believes that while cricket may boost a brand instantly, viewers may still not remember the brand afte r the match or the tournament. Even if consumers remember a series, they may not remember the advertisers. That's when they thought of a roadblock and decided to sponsor all cricketing properties post IPL. Bollywood is also a major platform for the brand, which is targeting consumers between 18 and 27 years.Bollywood's most bankable star Akshay Kumar was signed on as the brand ambassador six months ago. More recently, his wife Twinkle Khanna was engaged to promote Micromax's bling phone that comes with Swarovski crystals and a vanity mirror. To push its association with films, the firm also sponsored the IIFA (International Indian Film Academy) Awards held in Sri Lanka, where Micromax recently launched its phones. The brand is now ready to enter Bangladesh and West Asia. Advertising Broadcast media micromax use television to broadcast their advertisements. Apart from using cricket, films, celebrity micromax also advertise through news papers.They also utilize hoarding and bill board s to advertise their products. Prime site recently kicked off a month-long campaign for Micromax mobile phones in Delhi, executed mostly through hoardings. Going further, this promotion will be extended to the other regions of northern India as well. All the Medias used by micromax are very carefully selected as to reach its target audience and through each medium the innovative aspect of the product is portrayed. The three advertising objectives of micromax mobile are * To create awareness * To increase recall of their brand * To create brand equity.Company’s current marketing strategy: 1. Tapping the Indian consumers by knowing what they need specifically: a. Indian context: When Nokia or Samsung roll out a new model they do so from its global portfolio rather than launching something specifically for India. Micromax realized the fact that there are certain unmet needs still there in the market which is not being addressed by big brands. Micromax’s strategy ,since th eir inception has been to identify the unmet latent needs of people and come up with a product which no one else has and thus fits well with the consumer need. b. Rural context:Micromax initially targeted rural market and once it established its presence went on to lure urban youth. Micromax’s first innovation – a handset with 30 days of standby battery life — crucial in a country like India where power failures are common. Also in rural areas its not easy to charge one’s mobile phones because not only are there power failures but also they don’t have money to pay for electricity every month and hence such a phone was introduced. Also One of the major aspects that contribute towards the substantial monthly growth of Micromax is its 80% sales in the rural areas.After building a strong presence in the rural market, where the prominence of both subscribers and operators is rapidly increasing, Micromax is now progressively moving towards establishing i ts foothold in the competitive urban towns as well. 2. Value for money & Cost effective: The company didn’t bank on price competition only rather it catered to the needs of people unaddressed by MNC brands. Big brand like Nokia, Samsung had not introduced Dual sim phones earlier. But with the onset of such phones launched by Micromax, Nokia , Samsung etc. ave tough competition and their phones are just a case of â€Å"me-too† products. Also Micromax has made sure that all their mobile phones are value for money and serve the purpose and the need of the customer. 3. R&D and Innovation : Versatile Product Portfolio: It was the first to introduce: a) Handsets with 30 days battery backup b) Handsets with Dual SIM / Dual Standby c) Handsets Switching Networks (GSM – CDMA) using gravity sensors d) Aspirational Qwerty Keypad Handsets e) Operator Branded 3G Handsets f) OMH CDMA Handsets, etc. . First mover advantage: They have introduced phones specially targeti ng the Indian people which were never even thought of remotely by the top players in the mobile phone industry like Nokia & Samsung. So they clearly have a first mover advantage. 5. Outsourcing the manufacturing: Instead of manufacturing itself, Micromax sourced its handsets from 12 factories in China, South Korea and Taiwan. It was model-based sourcing: Micromax would come up with an idea and give it to the factory best placed to deliver it.This is different from, say, Nokia, which would be compelled to stay in-house or go to a vendor-partner, even if another vendor had better capabilities to execute a particular model. 6. Smart distribution channel management: Micromax also looked at distribution in a new way, standing by its cash-only model. While rivals offered a 60-day credit line, Micromax refused to give credit. â€Å"If the distributor does not buy your handsets, there is no pressure on him to sell them,† explains Mr Agarwal. At the same time, Micromax offered to supply distributors regularly to keep inventories down.So, distributors didn’t have to shell out large amounts upfront or have a lot of money locked in. â€Å"If we give a distributor 1,000 handsets and ask him to sell them over a month, he will worry about his daily sales,† says Mr Agarwal. â€Å"But if we supply less, demand will be close to equal or more than supply. †Micromax has 34 super-distributors across India. Unlike a Nokia or a Samsung, it doesn’t interact with the 500-plus sub-distributors. Neither does it intervene in how the super-distributors sell or place the products. â€Å"We offer our super-distributors a 15% margin, which is higher than the ndustry average of 6-10%,† claims Mr Jain. 7. Unmet needs of consumer 30-DAY BATTERY PHONES April 2008: Rs 2,249; Now: Rs 1,999 The X1i, Micromax’s first phone, had a battery that could give 17 hours of talk time and go 30 days on a single charge. DUAL-SIM PHONES July 2008: Rs 1,999-12 ,999 For those who want two numbers but one handset PHONE-CUM-REMOTE May 2010: Rs 2,999 A mobile that can switch TV channels and even change the AC Temperature PHONE-CUM-STEREO Feb 2010: Rs 4,999 With 3D surround sound, fed by Yamaha and Wolfson BLING Feb 2010: Rs 5,500 A big hit with women, comes with Swarovski embellishmentsIN THE WORKS A mosquito-repellent phone. A phone that can be used as a computer mouse Micromax focuses on being different 8. Production related moves: Micromax is investing Rs 100 crore to set up a manufacturing plant in Baddi, Himachal Pradesh, to ensure its outsourcing model does not cause supply-side uncertainties. Production is being scaled up from 50,000 units per month to 500,000 units a month by March 2011. How to increase the market share with respect to the consumer buying behaviour: Steps of consumer buying behaviour: 1) Need awareness:The beginning point of most purchasing is your potential buyer recognition of a need in their life. This need can be established by encountering a problem or prompted by a company's marketing. Already Micromax is into a lot of marketing through promotions, Ads, sponsorships of events, etc. But few suggestions on that front to make sure that their potential consumer hears them rightly is – * Now they are at the 3rd position in the mobile handset industry and they have achieved a good market share in a very short span of time, so their advertisements should focus on brand building. They don`t develop very creative advertisements, sometimes their advertisements are mere noises like the advertisement featuring Akshay kumar. They must add creativity to their advertisements. (Micromax Bling Ad featuring Twinkle Khanna is an exception to this point). * Break the resistance of no need by aligning their marketing with the current needs and wants of your market. * It’s a general norm that whatever is expensive is good to use, of high quality, has more life and is definitely something which wil l increase one’s status.So it would be a good strategy to increase the prices which will work for the image of Micromax because there is a risk of the brand being perceived not as an aspirational brand but a ordinary price warrior if it does not focus on the quality of the communication. * The needs of not even two consumers are the same. Therefore, they buy only those products and services, which satisfy their wants and desires.To survive in the market, a firm has to be constantly innovating and understand the latest consumer needs and tastes it will be extremely useful in exploiting marketing opportunities and in meeting the challenges that the Indian market offers. This reality can be turned into an opportunity by introducing â€Å"Customization of mobile phones†. a) People can goto Micromax mobile stores, and fill a form listing their options of the type of phone they want, color of the phone, screen size of the phone, features like audio player, radio, one  œtouch applications, etc. ;amp; all other specifications of the phone. ) Once that form is filled the Micromax staff can show a picture of the newly designed phone to the consumer on a computer and if necessary can make any changes and then finally place the order for such a phone. c) Payment terms and conditions can be advance payment – half the price of the phone at the time of placing and half at the time of delivery. This makes the consumer feel that the mobile phone company is not only generally consumer centric but it believes in the fact that every person is different and unique in his/ her own way and would have different needs and wants.Also this gives a chance to the consumers to become innovative and its definite that a consumer will definitely want to buy such a phone again from Micromax. 2) Information search: Its important to make sure consumers know about all the new variants and products that the company introduces. With the rise of the Internet, it has never been easier for buyers to research their purchase. It needs to make sure that all information is readily available on the website.They can break the resistance of lack of education by adding an educational seminar to their marketing mix to provide maximum information about their company, phones, promotions, variants, prices, etc. to not just the tech-savvy urban population but also the rural people. Their goal at this point in the buying process is to get their product or service in front of the consumer. They need to make them aware of their solution. 3) Check options: Once the consumer understands his or her situation and has gathered research on possible solutions, the mobile handset buying process enters an evaluation period.The consumer now starts to take a close look at specifics, such as the company providing the solution, the brand name of the product, and the features and benefits of each solution. Branding  and product differentiation are extremely important tools of per suasion during the evaluation stage. This is where the strategies listed above would help Micromax gain an edge over its competitors and increase the market share when a potential consumer would sit and evaluate his options while buying a cell phone. 4) Purchase: After a comprehensive review of solutions and specific products and services, the consumer makes a purchase decision.At this point in the buying process, supporting information needs to be provided to reinforce the decision to buy. Help the buyer by telling them what and why the company/ staff in the store would recommend a certain handset as they are the experts in that. Also Depending on urban / rural population, the company can provide different payment options or billing terms. 5) Evaluation of the purchase: The buyer will look for reinforcement from media, friends, and other sources confirming they made the right decision. Cognitive dissonance or â€Å"buyer's remorse† happens when the buyer begins to feel the p urchase wasn't right for them.To make sure such dissonance doesn’t occur they should offer warranties, there must be after purchase follow-up calls to make sure that the consumer is happy with the handset he/she has purchased, excellent after sales service by opening as many service centers as possible in all parts of India. It is crucial to building strong relationships with customers and encouraging repeat purchases that you not only provide a positive purchase experience and after sale support, but that you strengthen the buyer’s perception that they made the right purchase decision.

The Sony Playstation 2

Game is one of the biggest markets in the world; most of people like to play game for relaxing, or at the spare time with friends. People of all ages are players. Report has pointed out the global spending on video games-games console hardware and associated games-exceeds that spent at cinema box offices and is double the video rental market. Many firm such like Microsoft, Nintendo and Sony seize this opportunity and plan to enter this biggest market. The competition has been intensified among the game market, who will be the winner? The market leader for hand-held, portable consoles is Nintendo-its Game Boy, launched in 1990, has sold well and consistently. Games console which are coupled up to a domestic television screen comprise a larger section of the market , and this is where Sony has become dominate. In 1994, Sony was a ‘non-entity' in the video games market, however by 1996, it was the world leader of its fast growth market. At the end of 2003 Sony's accumulated sales of 12 million games consoles was well in excess of rivals Sega and Nintendo. The stronger financial support is definitely the reason of successful for Sony. However, those just one small part of reason for the success of the Playstation, the mainly reasons for the success of the Playstation are below: * Adequate knowledge form technology, which had been developed over many years. It was able to derive synergy from its competencies in both hardware and software. * Suitable timing to entered the market, to avoid some unnecessary competition with rivals. Sony timed the launch carefully and entered the market just one month after Sega launched its new Saturn console, the first 32-bit machine. This suggested that the real competition in this sector of the industry lay between Sony and Sega, rather than with Nintendo as well, although in 1997 Nintendo launched its 64-bit N64. * Its pricing strategy for consoles. Sony knew the real profits came from subsequent software sales and happy to cross-subsidize a relatively low-priced console. They also enjoying cost saving through the experience curve effect and happy to pass these on to consumers. * A number of attractive licensing deals, which helped it, build up a strong portfolio of games from the outset. A number of key games software companies were persuaded to switch their allegiance to Sony.†1 * Sony's advertising campaign was very specifically planned. Sony worked out exactly what they wanted the adverts to achieve. They also aimed to make people think of the Playstation as powerful and destructive, using the line, â€Å"Do not under-estimate the power of Playstation† in many of its adverts. Those intelligence ideas help Sony become a winner through this competition. So they are the strengths of Sony Playstation, which made Sony's market share grows in creditable rate. And helped Sony corporation build up a good reputation among the consumers that will become advantage for Sony's further competition. Late in 2000 Sony was unable to satisfy the early demand in both the US and Europe for its new Playstation 2. The problem has come. It was experiencing internal supply problems of critical components. This is a real fault for Sony in Christmas – the peak sales period. This could affect the profits of Sony Corporation. When Sony was struggling with the launch of Playstation 2, Microsoft and Nintendo realized this is a good opportunity to launch their new game console into the video games market. They believe there was a real chance that some customers would switch to the game console of Microsoft and Nintendo, if their intended first choice Playstation were no available. This is a real threat for Playstation's position in the video game market. As Nintendo and Microsoft launch their new game console into the video game market, something has been changed. Reports said that sales of Sony's PlayStation 2 console are down but sales of Nintendo's GameCube console seem to be on the rise. The holiday sales of Nintendo's GameCube rose over 70% from a year ago, while Sony's PlayStation 2 sales did not fall as sharply as expected. Nintendo also said that it would easily achieve a global sales target of six million GameCubes for the full business year. Its sales are directly being attributed to GameCube price cuts in Japan, Europe and North America in September and October of 20032. However, Sony Corporation is keeping finding many opportunities for them to keep their opposition in the video game market. They noticed that entered an established market have to offer some value, something clearly different. So they tried to add the new function, new technology into PlayStation 2. For example: the graphics on Playstation 2 are of ‘cinematic quality' and the console has a DVD reader, which can run movies. PlayStation's hard drive would later be able to accommodate and Internet connection and allow users to buy games over the Internet and download them directly on to their machine, they also could play game online. In addition, PlayStation 2 is a 128-bit machine now, but it was not the first 128-bit machine on the market. Another mainly opportunity for Playstation 2 is their software (games). They categorized their games into 5 main types: adventure/strategy games, driving/motoring games and simulations, sports, fighting game and platform games. By Sony's good reputation there are more and more software companies available for the Sony Playstation than are available for any of its rivals. In 1999 Sony had 90 companies developing games for Playstation 2 and was determined that 50 news games would be available for the launch. Playstation 2 also creating a unique opportunity for content providers and third party publishers from their biggest online community. In 2003, the massive Playstation community proved yet again the enviable advantage of strength-in-numbers as games for the number one selling platforms flew off the shelves in record amounts. Playstation 2 software led the industry with close to 3 billion in total video game sales for the year, nearly three times as much as its closest competitor. This is first online console community is also the most popular, with the Playstation 2 online base growing nearly three times as fast as that of Microsoft's Xbox live. Sony wants to hang on its leadership in the computer games industry. That appears to be Sony's thinking as the electronics giant moves ahead with development of the next version of its PlayStation video game console, which is well known as Playstation 3. Japanese media reported on May 6th that the PS3 console is in development. The goal is to make new processor technology, called â€Å"grid† about 200x faster than current console technology. This is almost achieving their original goal of making the PS3 1000 times faster than the PS2. This goal was publicly set by Mr Okamoto, the Senior VP and Chief Technical Officer of Sony Computer Entertainment, at the 2002 Game Developers Conference in San Jose, California. Playstation 3 may become a major threat to the other company in the game industry. So when Sony look for the future, one of the rivals review recent past, Pete Isensee, lead developer for Microsoft's Xbox Advanced Technology Group, used his GDC talk to deliver a mostly positive critique of the Xbox's journey to the market, lauding a product launch that happened on time and without major bugs, a departure from Microsoft history. â€Å"Microsoft has this stigma about not getting it right until version three,† he said. â€Å"We didn't have a choice with Xbox. If we didn't get it right with version one, Sony and Nintendo would eat us alive.†3 Nowadays, Playstation 2 will be outsold by rivals, but who knows what will be happen in the next. When the new game console-Playstation 3 launch to the market in Christmas 2004, maybe everything will have a big change.

Apple And Its Customer Product Service Marketing Essay

Apple And Its Customer Product Service Marketing Essay Introduction Strategic management involves the analysing of organizational tactics and factors that may contribute to results or performance. In view of achieving this, organizational culture must be looked at as it greatly forms the base of establishing good strategic management. In this essay, we will find out what defines organizational culture and its importance, its impact on strategic management, how the public views the culture and how the culture has affected its strategic decisions, choices, options, etc. We will also discuss about some successful companies and organizations to showcase their organizational culture to see how it has worked for them. Organizational Culture Oxford dictionary distinctly states that organisation is, â€Å"an organized group of people with a particular purpose, such as a business or government department.† (Oxford 2012) Culture on the other hand is, â€Å"the ideas, customs, and social behaviour of a particular people or society.† (Oxford 2012) Organizational culture is then therefore essentially based on shared attitudes, beliefs, customs or written and unwritten rules which the organization has developed over time and that have worked well enough to be considered valid. Factors of organizational culture that will be discussed are the company’s structure, decision making empowerment, the company’s hierarchy and employee commitment towards company goals. Depending on how these factors are effectively diffused through the company, the productivity and performance of the company will be affected directly as these factors serve as guidelines for customer care, safety, product quality, etc. They may also extend to marketing and advertising practices and to new innovations. Apple and its customer/product service To help us understand better, we will now look at a company which has an outstanding organizational culture in its customer/product service. Apple is a company that is very user/customer orie nted. When someone buys an apple product be it a MacBook or an iPod, they are guaranteed excellent customer/product service after they make their purchase. A standard warranty of at least one year is issued upon purchase and its offer is that the entire product can be sent for a ‘one-for-one’ exchange if the product is found to be faulty (Apple 2012). â€Å"A guarantee is not only an assurance that things will go right – it’s a promise that you will make things right if they ever do go wrong† (Kaufman 2012, p.168).Aside from the mandatory warranty on all products, all Apple products are able to be linked up online via iTunes for many updates and product software upgrades (Apple 2012). This culture of having the products constantly up to date even after purchase is a critical one which makes Apple stand out by keeping users constantly updated to the newest trends in IT and enables the user to accessibly and efficiently receive updates and upgrades fr om the internet. Denove and Power IV (2007, p.200) state to â€Å"Reach out to your customers and don’t wait for them to contact you. Smart companies proactively create and sustain a steady line of communications with customers.† This maintains the relationship that Apple has with the customer not only through the purchase of the product but throughout the customer’s entire usage of the product. Also, product servicing centres are available in several areas and are known as Epi Centres. At these places, any Apple product can be sent for servicing, warranty exchanges or troubleshooting, depending on the problem.

Evaluating accounting control systems Essay Example | Topics and Well Written Essays - 1000 words

Evaluating accounting control systems - Essay Example The meaning of internal control has changed over the recent years with the development of various internal control models. The COCO model is one of those models. Stone Creek Church in Urbana, Illinois has adopted the COCO framework model for their Internal accounting control system. The Coco model, which builds on COSO (another internal account control model) is the most user-friendly and concrete method. â€Å"The COSO framework is the reference model, which is written from the point of view that basically it makes the organizational member of the internal control be thorough who includes the manager from the standpoint of the shareholder† (COSO Framework Para 10).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  The COSO framework describes internal control as a procedure, influenced by an entity’s management, board of directors and other workers, which is planned to provide reasonable assurance concerning the attainment of objectives. As stated the earlier Stone Creek Church in Urbana, Illin ois has used the COCO framework model. The Stone Creek Church in Urbana always has to in excess of two persons to handle the cash. The money is never in one person’s situation anytime for protection. ... And it protects the person and the structure. The Stone Creek Church in Urbana provides cash dispersement process. It means payment or Cash outflow of money to resolve commitments for instance interest payments for loans, operating expenses and accounts receivables throughout a particular period so as to carry out business actions. Usually in the form of plastic money, cash, check, Electronic fund transfers and warrants. CoCo model distinguishes four interconnected elements of internal control such as containing purpose, commitment, capability and learning and monitoring. An industry that performs a task is directed by an understanding of the function of the task and supported by ability. To execute the task well over time, the industry wants a sense of commitment. At last, the industry has to monitor task performance to develop the task process. These fundamentals of control, which contain twenty particular control criteria, are seen as the steps an industry takes to promote the rig ht action. As mentioned earlier Stone Creek Church in Urbana, Illinois has adopted the COCO framework model. The task was to evaluate the accounting control systems of Stone Creek Church in Urbana, Illinois on the basis of the interview of the Stone Creek manager and the attached notes on COCO framework. The Coco framework states that the organizations should be able to measure their performance in quantitative terms and should use budgets and financial statements to evaluate their performance. The Coco framework also advocates the use of qualitative measures such as target setting in order to assist the performance of a firm. In the Stone Creek Church case no quantitative measures like the setting up of budgets has been done as well as no qualitative measures like

International etiqute Research Paper Example | Topics and Well Written Essays - 1250 words

International etiqute - Research Paper Example India hosts people from different religions and languages. There is a majority of Hindus, followed by Muslims, Sikhs and Christians. Languages spoken include but are not limited to Hindi / Urdu, English and Punjabi. Business trends in a country are immensely influenced by the social and cultural norms prevailing in that country. Likewise, business in India is unique in nature. Indians are greatly influenced by the English people who have ruled them for centuries in the past. Accordingly, good business culture in India is considered one that would conform to the Western standards in terms of business language, dress codes, ethics, organizational structure and functionality. Generally any person who can speak good English is considered literate and qualified for many types of opportunities in the market. Indians are generally polite and sharp. Usually, they would frequently be observed making promises on petty matters to convince the other person. India generally has a 5 day working week, Monday through Friday, with 8 working hours in a day, which includes a 1 hour lunch break. However, in some organizations, it is also compulsory for workers to work on Saturday. â€Å"Business hours are usually from 9.30 to 5.30pm (weekdays) with a lunch break from 1pm to 2pm, and Saturdays from 9.30am to 1pm.† (www.iexplore.com, n.d.). However, (Nita, 2008) mentioned in her report that the official work week in India consists of 48 hours which starts from Monday and ends on Saturday. Sunday is officially declared as a holiday. Use of fax as a medium of communication is quite frequent in Indian business culture. Although this seems quite simple and easy, yet managers can not be approached directly through a phone call, unless a formal appointment has been taken following the proper hierarchical procedure. Confidential matters are not discussed in emails and spams are not replied. Additionally, in writing business letters or other documents,

Response letter for article Video Game Violence by Mark and Keisha Essay

Response letter for article Video Game Violence by Mark and Keisha Hoerrner - Essay Example For this reason, it is necessary to consider the skills the game is trying to teach your child. If the game emphasizes on shooting, killing, robbery and other antisocial behaviors, it may not be a good idea to purchase it. Video games reward their players for various behaviors. In most violent video games, behaviors such as shooting and killing are highly rewarded with points (Anderson& Warburton, 2012). As your child continues to play these games, he is encouraged to do more of the killings and shootings in order to earn more points (Hoerrner & Hoerrner, 2006). These activities, although violent in nature, attract the biggest rewards. Since your child is still developing, it is likely that he will grow up cherishing violence. Therefore, the video game you purchase for your child will make him gravitate towards negative social action over time. Because video games increase the child’s appetite for violence, he is likely to want more of this entertainment as he grows; both in real life and in the gaming world (Gentile & Anderson, 2003). These games train children to view the world as a dangerous place in which they have to constantly look for enemies and other threats. Unfortunately, the only wa y of dealing with such threats, as promoted in these games, is through violence (Giumetti & Markey, 2007). Because of the link between video games and violent behavior, it is important for you as a parent to understand the ratings given to the various games. In the article by Mark and Keisha Hoerrner (2006), it is noted that it is the responsibility of parents and society to understand what is being told in these video games. Before making the purchase, it is necessary to check the ratings of the game you intend to buy. This will help in purchasing a video game that is appropriate to the level and age of the child. In these games, elements such as

Supply Manager are making a difference in todays global markets Article

Supply Manager are making a difference in todays global markets - Article Example Zapko, there are several important strategies of modern day supply chain management (Handfield, 2013). One of the strategies is to ensure the timely global procurement of materials and products needed to complete the production deadlines. To achieve this goal, Zapko reassigns and assigns individuals in certain slots along the supply chain management process, attracting the best talents to work for Lenovo to achieve the critical demands of the Lenovo global supply chain. For each important step in Lenovo’s global supply chain process, individuals (including graduate students) who can deliver the required quotas are hired. For those who cannot meet expectations, line and staff employees must prioritize the successful implementation of their individual tasks and responsibilities within the global supply chain strategy. The preparation and implementation of supply chain-based contracts will increase compliance with previously established global supply chain benchmarks. Further, the success of the global supply chain is grounded on the cooperation and coordination of the different parties. One of the parties is the manufacturer. The manufacturer acquires raw materials from the suppliers. The manufacturer uses the supplies to produce its completed or finished goods. Another party is the global customer. The goods are then sold to the manufacturers’ global customers. A delay in the delivery of the suppliers delays the manufacturers’ production output. The delay in the manufacturers’ outputs triggers the corresponding delays in the customers’ purchases. The manufacturers or sellers must ensure the customers will be able to find their required product and service demands on time. Consequently, the products must reach the store shelves before the store shelves are empty. The stores and manufacturers must ensure products are reordered to prevent stock outs, or empty store shelves. The twice stage model ensures customers will

Airlines and the Oligopoly Market Structure Assignment

Airlines and the Oligopoly Market Structure - Assignment Example These advantages are witnessed in service pricing, destination services, marketing, and promotion, as well as the established hub philosophy that drives either point-to-point destination services or major hub development. Much of these competitive advantages come from establishing a market-oriented culture, defined as â€Å"delivering superior value to customers† (Narver, Slater & Tietje 1998, p.242). It is about aligning the business model based on three dimensions, having a customer orientation, a competitor orientation, and the ability to coordinate all business units with an inter-functional, systems-based philosophy and structure (Gauzente 1999, p.2). The majority of the airlines identified in the research article have established a market-oriented business model and internal culture, that provides both competitive advantages over other airlines in this oligopoly as well as a strong brand in the consumer market. A market orientation strategy â€Å"is a powerful competiti ve advantage, because it is an invisible asset that takes a long time to establish and one that is difficult to imitate† (Johnson & Verayangkura 2001, p.2). ...   a market structure, constant environmental scanning occurs to witness the competitive behaviors of rival firms to avoid market share losses or loss of brand reputation in consumer markets. Nickels, McHugh & McHugh (2005) identify a competitive advantage as better development of core competencies. These are â€Å"functions that the organization can do as well or better than any other organization in the world† (Nickels, et al., p.257). In the article â€Å"the joys of oligopoly†, it is identified that the core competencies of Southwest Airlines, as one example, is the ability of the firm to structure its scheduling, labor, and point-to-point destination services to provide low-cost, no-frills service that continues to bring the business significant revenues from satisfied customers. While larger competitors with more market presence continue to provide customers better in-flight services that require a higher pricing model, Southwest is able to manage its services ef fectively and with limited perks for the more frugal consumer. Southwest is also able to follow an A to B flight philosophy which fills more seats daily rather than waiting at a regional hub for connecting traffic that allows for almost instantaneous departure after a flight has arrived at the airport (Associated Press 2001). The core competencies of Southwest are labor-related, flight capacity scheduling, and independence from hub philosophy. However, other airlines that do utilize a hub philosophy consider this a competitive advantage in this market structure as it provides â€Å"greater frequency, more destinations and lower fares than customers could expect without it† (Associated Press, p.3).

Effective Leadership in Virgin Group Company Assignment - 3

Effective Leadership in Virgin Group Company - Assignment Example Sir Branson has the quality of effective leadership, and he has the quality of being punctual and gives results to the organization. He also ensures that other employees working for him should consider the efficiency an important factor in their performance. Punctuality and hard works are the best things to measure the performance of the leader in the organization. He is famous in an organization because of his quality of the risk taker. The risks on investments are clearly identified by Sir Branson. The outcomes of the performances of the employees are the proof that the leadership of the organization is working effectively to enhance the position of the organization. Sir Branson communicates the requirement of the work to its employees in the much better way to increase the efficiency of workers. His workers easily got the idea about the instructions of their leader. Past performances of the employees of the organization are the evidence that the leadership is quite effective and efficient. The leader of the organization could be made more effective if the leader does not change for a couple of years. Unnecessary changing the leader because of the reason except the performance will be harmful to the organization. Performance of the effective leader could be recognized for his contribution towards the organization. His qualities of performance will put a reflection that has put a positive impact on the organization.Sir Branson is the quality of a passionate leader that take into his account the performance of the employees of the organization. He always remains punctual and teaches others to be punctual. Hardworking practices of the CEO of the company could be seen in the financial reports of the company for past many years.

Violent Games Essay Example for Free

Violent Games Essay In the process of media reform and editing, is it appropriate to limit video games? Nonthreatening things like games should not be banned by our fears, but we should look at the facts. Violent video games should not be banned for their content because no means of art or communication should be banned. Our first amendment is our sacred rite of passage that should be upheld with all of our power. We can benefit from these works of art like we can from a song or picture because of their substantial meaning and portrayal of our own lives. These video games are not even truly bad for your health, they can actually improve it. As Mr. Jacob Sullum said, â€Å"Depictions of violence, unlike obscenity, have played a longstanding and celebrated role in expression properly consumed by minors, from Greek myths to the Bible to Star Wars and Harry Potter. Violent tendencies are an issue in the young mind, and certain people would say that seeing these violent images in video games triggers these feelings and makes their children become irrational. Zackary Morzaini stated in his study that â€Å"violent video games trigger the same response as violent passages in the bible. † So why ban these images. It is up to the individual to react to these violent messages. The vast majority of gamers does not emulate the â€Å"homie-G† of grand theft auto, but instead understand the social norms in video games are Peterson 2 not the social norms of real life. The game merely implies violence. For example, Call of Duty is a demonstration of warfare not unlike chess and battleship has for years. â€Å"Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances. † That is these United States’ Bill of Right’s first amendment, and never shall it be silenced. Our forefathers made this law so no form of media would ever be banished by harsh critics. Our arts shall be protected and regarded in the highest degree, and video games shall be no exception. With their version of interactive storytelling they are no less valuable than movies or music. Art can never be banned under America because we provide our people with the freedom they deserve. What is a little blood between friends? Cooperative and multiplayer games have recently been added in huge numbers to classic games such as the Call of Duty franchise and the Dead Space franchise. These games are violent to the extreme—specifically Dead Space. In these games you have to cut off limbs and kill anyone opposing you so you and your teammates may succeed. In a study co-written by David Ewoldsen he states that â€Å"We think that cooperating with another human overrides the effects of playing a violent videogame. This means that even violence is counteracted by jolly cooperation. This is not only a way to spend time with friends shooting zombies, but also a time for families to come together. Games like Super Mario and Wii Sports are great examples of fun games from ages 8-80. This allows us to Peterson 3 come together, so rather than sitting and playing Monopoly for fifteen hours straight, you can just pop in Wii Sports and start playing virtual tennis. The responsibility of handling violent images does not go into the hands of Electronic Arts (EA), but some of the responsibility falls on the parents. When children play games they might not be ready for the graphic images presented, but our friends at the Entertainment Software Rating Board (ESRB) give us ratings to represent these and sometimes children will pick up a game because it’s fun. They do not however, check that it is rated for players seventeen and up and that a ten year old should not have to see those things just yet. Parents do actually do monitor some of these things according to a study for the article Video Games Unplugged, but some is not enough. It is up to the parent to judge whether or not their child is ready for a graphic game, not EA’s. Critics of video game violence say that games are not mandated enough. They also say that violence is too prevalent in them and it is too easy for children to get their hands on them. So, to stop this, we must put more restrictions on video games. Video games are not lawless. ESRB not only rates these games, but requires you to be a certain age to purchase these games depending on their rating. For example, Call of Duty Black Ops Two was rated M for Mature, so you must be 17 or older to purchase the game. Violence was another issue they claim, but these works of art are no different than others. When the movie Zero Dark Thirty came out, the media’s first reaction was not â€Å"This movie is an awful Peterson 4 influence to our children†, but instead gave it praise. Violence has always been important to our culture, from gladiators to Dexter, and video games have the same effect. Art is divinity. Art is beauty. Art is alive. Music and pictures have always entertained us and should never be banned. Video games are a form of storytelling, a way to see beautiful things and witness the greatest sagas. Video games should not be banned because they contribute so much to us and are beautiful in their own right. Violence in video games is no different that violence in 300, but violence in video games have to fight for their rights. We should all support the rights of our arts and support video games. Peterson 5 Works Cited Computer games unplugged. Computer Graphics World Feb. -Mar. 2012: 2. General OneFile. Web. 26 Feb. 2013. Sullum, Jacob. The terminator vs. the constitution: Californias video game law does violence to the First Amendment. Reason Feb. 2011: 60. General OneFile. Web. 26 Feb. 2013. Johnson, Ted. VP urges game study: Biden: violence link should be probed. Daily Variety 25 Jan. 2013: 7+. General OneFile. Web. 26 Feb. 2013. Sanders, Laura. Gamers crave sense of control: feeling competent matters more than violence, blood. Science News 14 Feb. 2009: 14. General OneFile. Web. 26 Feb. 2013.

Case Study: Patient With Shortness Of Breath

Case Study: Patient With Shortness Of Breath Patient Identity The patient is a 54 year old female, Mrs SK who is a housewife with a BMI of 25.7kg/m2. Presenting Complaints She was brought in to the Accident and Emergency (AE) department, complaining of shortness of breath (SOB) and a productive cough. History of Presenting Complaints The patient was experiencing SOB for the past 2-3 days, and was progressively worsening on the day on admission. It was not associated with chest tightness and she was able to sleep the night before. She was also having persistent productive cough with white sputum since she was last discharged 12 days ago. Past Medical History She was diagnosed with diabetes mellitus and hypertension 8 years ago and has history of gastritis for the past 5 years. She was newly diagnosed with bronchial asthma in her last admission two weeks ago. Social History The patient is a widow since 6 years ago and is a housewife with 3 children. She stays in a factory area and has a cat at home. She is a non-smoker and a non-alcoholic. Family History Her mother and father have no known medical illness, but she has a cousin who suffers from bronchial asthma and is frequently admitted to the wards. Drug History The patient was on Salbutamol and Budesonide inhalers, 200mcg when necessary and 200mcg once at night respectively for her bronchial asthma. For her hypertension, she was on 40mg Telmisartan tablets once at night. She was also taking Gliclazide tablets, 80mg twice daily and Metformin tablets, 500mg three times a day for her diabetes mellitus. For her hypercholestrolaemia, the patient was taking Lovastatin tablets 20mg once at night. Based on the Morisky Scale, she was compliant with her medication and she had no known drug allergy. Examination Details On examination, the patient was alert and conscious. She was pink and appeared to be fairly hydrated. She was also able to speak in full sentences, and was not tachypnoeic. A Chest X-ray showed that there was a pneumonic consolidation at the right lower lobe of her lungs. Her blood pressure (BP) was 152/82mmHg, pulse rate (PR) was 109 beats per minute (bpm) and was afebrile. Her oxygen saturation (SpO2) was 96% under 3 litres of oxygen and her blood glucose was measured to be 4.7mmol/L. Investigations Upon admission, standard laboratory investigations were carried out and were obtained. From the renal function test, it was seen that the patient had a low potassium level of 2.8mmol/l and her calculated creatinine clearance was 60.0ml/min which indicated that she had mild renal impairment. The liver function test showed that she had normal liver function. The following shows the results that were out of the reference values for her haematological tests. C-Reactive Protein (CRP) 31.1 à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ Erythrocyte Sedimentation Rate (ESR) (0 15 mm/hr) 110 à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ Haemoglobin (Hb) (13.5-18 g/dl) 10.3 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Haematocrit (0.36-0.46 L/l) 0.303 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Red Blood Count (RBC) (3.8-4.8 x 1012 /l) 3.45 à ¢Ã¢â‚¬  Ã¢â‚¬Å" White Cell Count (WCC) (4-11 x 109 /l) 15.1 à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ Neutrophil (Neutro) (2 7.5 x 109 /l) 10.57 à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ Diagnosis/Impression Patient was initially diagnosed with Acute Exacerbation of Bronchial Asthma (AEBA) secondary to an upper respiratory infection (URTI) to rule out pneumonia. However, later in the day when the chest X-ray came back, she was diagnosed with pneumonia with right parapneumonic effusion. Management Plan The patients current medication was continued and was given 3 litres of oxygen via a nasal prong (NP). She was commenced on prednisolone tablets, 30mg once a day and was given nebulised Combivent (Ipratropium 20mcg/salbutamol 100mcg), every 4 hours. Her peak expiratory flow rate (PEFR) and SpO2 was to be monitored. Antibiotics were kept in view to be started if necessary after the total white blood count results came back. Clinical Progress Upon admission, the patient was afebrile, was tolerating orally well, did not have any sorethroat but was having a non productive cough. An echocardiogram (ECG) was done and it showed that she had sinus rhythm with no ischaemic changes. As her chest x-ray showed a right lower zone consolidation, she was diagnosed with pneumonia. She was immediately commenced on 2g Ceftazidime intravenously, and then continued on 1g three times a day. She was also under nebulised combivent every 6 hours. Her metformin and gliclazide was stopped and she was started on subcutaneous 10 units of Humulin  ® three times a day and 12 units of Humulin N once at night. On Day 2 of her stay, her blood results came back and as she has low potassium levels, she was given 15mls of Mist KCl three times daily and two Slow K tablets once daily. She was still complaining of cough without sputum and was given 15mls of Benadryl (diphenhydramine) syrup three times a day. The patient did not have any major complaints on the third day and was tolerating orally well. There was no SOB seen and she had good inhaler technique. She was then taken off the nebulizer combivent and the oxygen. By day 4, the patient was comfortable, and her cough and sputum had decreased. Examination on her lungs showed that she had prolonged expiratory phase. She was stopped on the Benadryl as well as Mist KCl and Slow K. After reinforcement on the inhaler technique by the pharmacist, the patient was discharged on day 5 as she was afebrile and had minimal cough. On discharge, she was then switched back to her oral hypoglycaemics and her intravenous antibiotic was switched to oral Cefuroxime 500mg twice daily for the next 10 days. She was also given Neulin SR 250mg once at night. Table 1 shows the vital signs chart for Mrs SK throughout her hospital stay. Table 1: Vital Signs Chart Day Time BP (mmHg) PR (bpm) SpO2 Blood Glucose (mmol/l) 1 13.00 178/102 109 100% 6.9 14.00 152/82 109 98% à ¢Ã¢â‚¬  Ã¢â‚¬Å" NP 15.40 4.7 18.40 133/73 114 97% à ¢Ã¢â‚¬  Ã¢â‚¬Å" RA 21.15 6.2 23.05 151/82 119 2 03.15 143/81 106 06.00 6.3 08.30 119/67 94 100% 10.35 4.8 11.24 100/61 107 97% 15.20 112/82 100 16.30 128/70 100 6.2 22.00 3.6 23.50 118/59 66 98%à ¢Ã¢â‚¬  Ã¢â‚¬Å"3L O2 3 04.10 124/64 104 100%à ¢Ã¢â‚¬  Ã¢â‚¬Å"3L O2 06.15 8.2 09.40 100/60 96 11.50 8.5 15.30 108/67 94 17.20 7.4 20.00 121/75 86 4 04.00 110/56 62 06.00 7.9 08.00 110/70 63 4.2 16.00 105/75 91 96% 17.00 9.7 22.00 138/67 114 6.1 5 05.00 9.6 07.15 11.1 Pharmaceutical Care Issues The first care issue is to review the management of AEBA based on the British Guideline on the Management of Asthma. The dose of prednisolone should be increased to 50mg once a day for at least 5 days or until recovery. Since the patient is prescribed with theophylline on discharge, she should be counseled on the signs and symptoms of theophylline toxicity such as confusion, dizziness, diarrhoea, nausea, fatigue and headache. The second issue is regarding the choice of antibiotics for the treatment of community acquired pneumonia in this patient. A sputum full examination microscopic examination (FEME) should be requested to identify the causative microorganisms of the lung infection. If empirical treatment is to be started the preferred drugs of choice would be amoxicillin 500mg three times a day plus either erythromycin 500mg four times a day or clarithromycin 500mg twice daily. Alternative choices would be levofloxacin 500mg once daily or moxifloxacin 400mg once a day, should the patient be intolerant of the preferred regimen. Thirdly, there is no clear indication of the prescription of the diphenhydramine in the first place, as it would only suppress the patients cough, which is inappropriate. Hence it should be stopped immediately. Next, the patients updated blood cholesterol levels should be taken and the appropriate use of statins should be reviewed. As she is on long-term statin use, her liver enzymes should be monitored regularly and if is raised by three-fold, she should stop taking the Lovastatin. She should also be counseled on the symptoms of rhabdomyolysis which is related to the long term use of statins, such as unexplained muscle pain, stiffness, weakness and the darkening of urine colour. The following issue is regarding the patients diabetes management. A HbA1c test should be done to determine her glycated haemoglobin level to see how well her self-management has been. She should also be advised on diet and lifestyle to keep her diabetes under control. Lastly, as she has low red blood count, haemoglobin and haematocrit levels, it is suspected that she has anaemia. Further tests should be done to confirm this, and if it is diagnosed, she should be given ferrous supplements such as ferrous sulphate tablets 200mg twice daily. DISEASE OVERVIEW AND PHARMACOLOGICAL BASIS OF DRUG THERAPY Acute Exacerbation of Bronchial Asthma: An Overview Asthma is a chronic inflammatory disorder of the airways where many cells and cellular elements play a role. This leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the morning. These inflammatory symptoms are commonly associated with extensive but variable airflow obstruction within the lung as well as airway hyperresponsiveness and this is reversible either on its own or with treatment. 1 Asthma is a worldwide problem as it is estimated that about 4.5% of the worlds population is affected, which amounts to 300million individuals approximately. The global prevalence of asthma varies from 1-18% of populations in countries all over the world. Asthma has three distinguishing characteristics which are airflow limitation, airway hyperresponsiveness, and bronchial inflammation. Airflow limitation is usually resolved by itself with or without treatment but for individuals with chronic asthma, inflammation may result in irreversible airflow limitation. Stimuli such as irritants or allergens may pose as triggers in airway hyperresponsiveness and bronchial inflammation is associated with eosinophils, T-lymphocytes and mast cells which cause plasma exudation, smooth muscle hypertrophy, mucous plugging and epithelial changes. It is shown that inflammation of the airways play a major role in the pathology of asthma and this starts when allergens or irritant trigger the activation of cells such as epithelial cells, macrophages, lymphocytes and mast cells. This leads to cytokine or mediator release and smooth muscle contraction resulting in cellular infiltration of eosinophils and neutrophils causing airway inflammation including oede ma, epithelial permeability or injury, mucous secretion and vascular permeability which eventually leads to airway obstruction and hyperresponsiveness. The diagnosis of asthma is based on a collection of signs and symptoms without a reasonable explanation for them and spirometry is an early test which is easy to assess if there is any airflow obstruction present and its extent. For diagnosed patients with asthma, acute exacerbations may occur and because patients with severe asthma are at increased risk of death following exacerbations, assessments of exacerbations are crucial. Clinical features of acute asthma exacerbations include severe breathlessness, tachypnoea, tachycardia, silent chest, cyanosis, or syncope. Peak Expiratory Flow (PEF) or Forced Expiratory Volume in one second (FEV1) is also used to measure the lung capacity. Oxygen saturation (SpO2) is measured using a pulse oximetry and this aids oxygen therapy as oxygen therapy is given in order to keep SpO2 levels at 94-98%. Measurements of arterial blood gases (ABG) are usually not necessary unless patients present with features of life-threatening asthma or have SpO2 of less than 92% as there may be a risk of hypercapnea if SpO2 is lower than 92%. Chest X-rays are also not recommended unless patients are suspected of pneumonia or lung consolidations, suffering from life-threatening asthma, having unsatisfactory response to treatment or if they require ventilation. Pharmacological Intervention in the management of AEBA2 Oxygen Oxygen therapy is needed most of the time as patients who are having acute asthma usually present with hypoxia as well. Hence, all patients with hypoxia who are suffering from acute severe asthma should be given oxygen and their SpO2 levels should be kept at 94-98%. ÃŽÂ ²2 agonist bronchodilators As first line therapy, high dose inhaled ÃŽÂ ²2 agonist bronchodilators are used as soon as possible as rapid relievers of bronchospasm. For patients who are unable to use inhaled therapy, intravenous ÃŽÂ ²2-agonists are used instead. ÃŽÂ ²2 agonist bronchodilators work by stimulating the ÃŽÂ ²2 adrenoceptors in the lungs, thus causing relaxation of the airways. Examples of short acting ÃŽÂ ²2-agonist are salbutamol and terbutaline, and a long acting ÃŽÂ ²2-agonist is salmeterol. Glucocorticosteroids Steroids should always be given in all cases of acute asthma. Examples of these are prednisone, prednisolone, dexamethasone, and hydrocortisone. They exert an anti-inflammatory effect by inhibiting transcription of the genes for the cytokines implicated in asthmatic inflammation and hence reduce airway hyper-responsiveness. Anti-cholinergic agents Ipratropium bromide is one of the anti-cholinergic agents that is used widely in treatment of acute exacerbations of asthma. Nebulised ipratropium bromide is used in combination with a ÃŽÂ ²2-agonist bronchodilator as treatment for patients with severe acute or life-threatening asthma. Anti-cholinergic agents work by inhibit muscarinic receptors M1 and M3 which then reduces cGMP formation and decreases smooth muscle contractility in the lungs. This eventually results in bronchodilation and reduces mucus secretion. Other therapies Other therapies include the use of magnesium sulphate. A single bolus dose of intravenous magnesium sulphate is administered to patients with acute severe asthma with previous unsatisfactory response to inhaled bronchodilator therapy or for patients who are suffering from life-threatening or near fatal asthma. It is believed that magnesium sulphate works by reducing calcium uptake by the bronchial smooth muscle cells, causing bronchodilation and also inhibits mast cells degranulation, thus reducing the release of inflammatory mediators such as histamines, and leukotrienes. EVIDENCE FOR TREATMENT OF THE CONDITION The management of asthma can be divided into two parts; acute treatment, and long term management. Management of acute asthma It has been shown that most patients suffering from acute severe asthma are hypoxaemic. Therefore it is essential that supplementary oxygen therapy be given to them.3-6 This is administered via a face mask or nasal prong with the patients SpO2 kept between 94-98%.7 Where nebulisers are needed in therapy, oxygen-driven nebulisers are favoured instead of those that are air-driven due to oxygen desaturation when driven by air alone.8-10 However, the lack of provision of supplemental oxygen should not pose as a factor in omitting nebulised therapy from administration if deemed appropriate.11 Referring to the case presented above, the patient was treated accordingly as she was immediately given supplemental oxygen and her SpO2 was maintained well above 96% throughout hospital stay. As acute asthma is associated with symptoms of bronchospasms such as wheezing and tachypnoea, the main aim of treatment is to quickly resolve these symptoms and most often, high doses of inhaled ÃŽÂ ²2 agonist bronchodilators are effective with minimum adverse effects.12-14 Salbutamol is usually the drug of choice although there is no significant differences in terms of efficacy as compared to Terbutaline. It is shown that there are no significant clinical benefits by using a non-selective ÃŽÂ ²2 agonist such as epinephrine instead of selective ÃŽÂ ²2 agonists.15 Based on a meta-analysis, it is seen that ÃŽÂ ²2 agonists administered via inhalation are more preferable and has similar efficacy with those administered intravenously in adult acute asthma.16 In ventilated patients or those in life-threatening conditions, parenteral ÃŽÂ ²2 agonists may be added to inhaled ÃŽÂ ²2 agonist treatment although there is little evidence supporting this treatment. Although a sing le bolus nebulisation may relieve most acute asthma cases, it is shown that continuous nebulised treatment of ÃŽÂ ²2 agonists is more effective in relieving acute asthma for those with unsatisfactory response to initial therapy.17, 18 Steroid therapy is always given in acute exacerbations of asthma and it is proven that it has better result if given earlier. It not only reduces mortality but it also reduces relapses and the number of hospital admissions as well.19, 20 Oral steroids given are seen to be equally as effective as parenteral treatment hence there is no need for the use of parenteral administration of steroids unless the patient is unable to tolerate orally.19 Prednisolone 40-50mg is given daily for at least five days or until recovery and this can be stopped abruptly after the patient has recovered.2 As long as the patient is on inhaled steroids, there is no need for the dose to be tapered down slowly prior to discontinuation.21 In the case presented, the patient was commenced on steroid therapy but was under-treated as she was only given prednisolone 30mg once daily for just one day. Hence, there is a need to increase the dose of prednisolone to 50mg and to continue is for at least another four days or until recovery before stopping this treatment. In hospital therapy, anticholinergic treatments are given to severe exacerbations of asthma and nebulised ipratropium bromide is always the drug of choice used in clinical settings. A combination of nebulised ipratropum bromide with a ÃŽÂ ²2 agonist bronchodilator is often given as treatment as it is proven that a combination of these two agents has a significant increase in bronchodilatation as compared to the use of a ÃŽÂ ²2 agonist alone. Hence, there is faster recovery and will reduce the length of hospital stay. However, it is also seen that anticholinergic treatment is not particularly effective and favourable for cases of mild exacerbations of asthma as well as after the patient has been stabilized, thus is not necessary in these cases.22-24 The patient in this case was seen to be having a mild exacerbation of acute asthma and hence nebulised ipratropium bromide treatment was not necessary. However, the use of nebulised Combivent, a combination of ipratropium bromide and salbutamol was justified since this patient was re-attending with a relapse and she was also suffering from pneumonia as well. Hence, there was probably a need for a quicker rate of bronchodilation as well as faster recovery for her. The use of magnesium sulphate in hospital treatment of AEBA is not widely seen, however there have been some evidence showing the bronchodilating effects of magnesium sulphate when used in adults.25 There are also studies which report that nebulised magnesium sulphate combined with a ÃŽÂ ²2 agonist shows positive outcomes and good clinical effectiveness in hospital settings.26, 27 The use of an intravenous bolus administration of magnesium sulphate is believed to promote lung function in patients who have severe asthma without harmful side effects.28 Nevertheless, there have been no studies on the repeated administrations of magnesium sulphate, though it is presumed that repeated use may lead to hypermagnesaemia, causing muscle weakness and respiratory failure. As further extensive studies need to be done to determine the most suitable route and dosing of magnesium sulphate, this treatment is reserved only for patients with acute severe asthma without satisfactory response to inha led bronchodilator therapy and patients with life-threatening of near fatal asthma. Monitoring should be carried out constantly throughout hospital stay and in acute asthma cases, monitoring of PEF is crucial. PEF readings should be measured and recorded every 30 minutes after treatment has been started. PEF should also be monitored pre- and post- nebulisation therapies as long as the patient is in hospital and until the asthma is well under control after discharge. It is seen that after hospital discharge, a relative amount of patients either experience relapse or are readmitted into the hospital with at least 15% within two weeks following discharge.29 Therefore it is essential that patient education such as proper inhaler technique, and well-documented PEF recordings with action plans depending on symptoms experienced should be instilled in order to reduce rate of relapses as well as minimize problems associated with exacerbations after discharge.30 Monitoring of the patients PEF was done consistently throughout her hospital stay and the patient was given sufficient counseling prior to discharge on her inhaler technique. However, there was no evidence that the patient was educated on self-documenting PEF recordings as well as action plans based on symptoms experienced following discharge and this should be done in this case to avoid another exacerbation of her condition. Long Term Management of Asthma The aim of management of asthma is to keep it well-controlled without the need of rescue medications, asymptomatic, no exacerbations, no hindrance to daily activities including exercise as well as normal lung function. A stepwise management approach is adopted for asthma patients and this is to acquire initial control and maintain it by stepping up treatment to improve control if necessary or stepping down treatment if there is good control over the condition to maintain the lowest step that will control the patients condition. As the patient is currently on regular preventer therapy with inhaled steroids, she is currently on step 2 of the management of asthma. There have been many studies being carried out to compare the different inhaled steroids that are being used for asthma and it is shown that beclomethasone diproprionate and budesonide are both similarly clinically effective although there may be different devices for delivery. It has also been seen that fluticasone and mometasone being administered at half the dosage of beclomethasone and budesonide shows equivalent clinical effectiveness, however there is somewhat inadequate evidence that fluticasone possesses fewer side effects and further studies need to be carried out on establishing the safety profile of mometasone.31 A new inhaled steroid has been introduced which is ciclesonide and clinical trials have shown evidence that it has more local activity than systemic and less oropharyngeal side effects as compared to the regular inhaled steroids.3 2-35 Although this seems promising, this clinical advantage is still controversial as its safety to efficacy ratio has yet to be established and compared with the conventional inhaled steroids. Inhaled steroids are recommended as preventer drug therapy for adults as they are most clinically effective in controlling asthma based on the treatment goals outlined.36-39 The frequency of dosing of inhaled steroids are generally twice daily and it is shown that there is slight clinical benefit obtained when taken twice a day than once daily, however a once daily dosing may suffice for those with milder asthma. There is also limited evidence of advantage with increased frequency of greater than twice a day.37 In addition to that, starting at higher than recommended doses have no significant effectiveness in management of mild to moderate asthma.40 Hence the recommended dosage for inhaled steroids would be 200-800mcg daily. This would be an add-on therapy to the step 1 management of using in haled short acting ÃŽÂ ²2 agonist bronchodilator as required. Based on the presented case, the patient was on budesonide 200mcg once at night prior to admission but this was immediately increased on admission and was in line with the recommended guidelines as she was continued on budesonide 400mcg twice a day together with salbutamol 200mcg as required following discharge. Other preventer therapies may be included for the patient despite inhaled steroids being the first choice of drugs for preventer therapy. These alternatives are less effective although they have shown some clinical benefit in patients who are on short acting ÃŽÂ ²2 agonists only. Chromones which act as mast cell stabilizers such as sodium cromoglicate and nedocromil sodium have shown to be beneficial in adults.41, 42 Apart from that, leukotriene receptor antagonists montelukast and zafirlukast too have clinical benefits.37, 43, 44 Theophylline also have some evidence in showing benefits in adults.36, 45 The patient in the case presented above was prescribed sustained-release theophylline on the last day of admission. Although it is another option that may be added to daily controller medications for step 2 management, there is very little evidence on the clinical efficacy of it as a long term controller. There is no reason to justify the use of theophylline in this case as the patient is responsive and can be controlled on inhaled steroids. Further more, theophylline has a narrow therapeutic index and close monitoring of plasma theophylline levels is necessary because at concentrations above 25 µg/ml, there is high risk of tachycardia and seizures may occur if concentrations exceed 35 µg/ml. CONCLUSION After reviewing the management of the patients condition throughout hospital stay, it can be concluded that SK was treated adequately based on the current guidelines and evidences attainable. She was given all necessary treatment at point of admission and there was no lacking of medications in all four days of her hospital admission. Apart from that, monitoring of her condition was carried out consistently and all data was updated, leaving no room for questioning and doubt. However, there were a few issues that came to attention which were the prescribing of several drugs that were unnecessary such as diphenhydramine and theophylline. There were little and no clear evidence that these drugs prescribed would be of benefit to the patient, and may also increase the risk of harmful effects to her as well. Alongside treatment of her acute condition, SKs controller medications were reviewed and subsequent changes were made as appropriate. Besides that, her other co-morbidities were also managed well as treatments for her hypertension and diabetes mellitus were given accordingly. PATIENT MEDICATION PROFILE PATIENT DETAILS Name S.K. Consultant Dr YKS General Practitioner Address Gender Female Weight 65kg Height 1.59m Community Pharmacist Date of Birth (Age) 54 years old Known Sensitivities NKDA Social History Widow of 6 years, Housewife, Non-smoker, Does not drink PATIENT HOSPITAL STAY Presenting complaint in primary care / reason for admission Admission date 17/04/09 Shortness of breath for the past two days, progressively Discharge Date Discharged to 21/04/09 Home worsening today and productive cough. RELEVANT MEDICAL HISTORY RELEVANT DRUG HISTORY Date Problem Description Date Medication Comments 2001 Diabetes Mellitus T. Diamicron 80mg BD 2001 Hypertension T. Metformin 500mg TDS 2004 Gastritis T. Telmisartan 40mg ON 2009 Bronchial Asthma MDI Salbutamol 200mcg PRN MDI Budesonide 200mcg ON T. Lovastatin 20mg ON RELEVANT NON DRUG TREATMENT Prescribed Medication Start Stop Clinical/Laboratory Tests Date Result 1 T. Telmisartan 40mg OD 18/04 21/04 2 T. Gliclazide 80mg BD 17/04 17/04 3 T. Metformin 500mg TDS 17/04 4 T. Lovastatin 20mg ON 17/04 19/04 5 MDI Salbutamol 200mcg 2 puffs PRN 17/04 6 MDI Budesonide 200mcg 2 puffs BD 17/04 7 T. Prednisolone 30mg OD 17/04 17/04 8 Neb. Combivent 6-hourly 17/04 19/04 9 IV Ceftazidime 2g STAT, then 1g TDS 17/04 21/04 10 S/C Humulin R 10units TDS 17/04 21/04 11 S/C Humulin N 12units ON 17/04 21/04 12 Syrup Diphenhydramine 15mls TDS 18/04 20/04 13 T. Slow K 2tabs BD 18/04 20/04 14 Mist KCl 15mls TDS 18/04 20/04 15 T. Theophylline 250mg OD 20/04 CLINCIAL MANAGEMENT Diagn

The training and development of employees in William Hill is imperative

The training and development of employees in William Hill is imperative for the performance or the company as they are in a competitive market. William Hill has to inform workers to be aware of surroundings in the area that they work. Training and Development Training Training is essential for both employees and employer if they want to be effective within the organisation and also for a company like William Hill to stay competitive within their market. The reason why training is important to employees is to enable them to achieve their maximum potential in their current position, it is needed also to develop them to create further opportunities within the organisation because employees are likely to be better educated and become multi-skilled. Training should be ongoing within William Hill in developing the employee’s skills within the business. William Hill believes training is very essential for their company especially when it proves for employees to develop within the organisation and continuing to meet objective. The training and development of employees in William Hill is imperative for the performance or the company as they are in a competitive market. William Hill has to inform workers to be aware of surroundings in the area that they work. The main types of training which businesses are using are Induction, on and off the job training and induction because they are successful in degree of the work format in different organisations needs. Training firstly takes place with induction in William Hill plc to enable new employees settle in quickly and feel comfortable to stay within their organisation. Induction programmes are not usually about a specific job the employee will be doing, but the way in which the business works. Then they have off and on the job training, which takes place in different methods. Induction This is the training provided for new employees and in this program they will learn the following: * Where everything around the workplace is such as the essentials which are fire exits, toilets, staff canteen, basically they will get a guided tour of their place of work. * They will go through the employee’s hour of work, who their manager is, name tags, uniform and training which will be provided for them in the future. * Booklets will handed out concerning sickness proc... ...otion, job rotation, job enlargement, and job enrichment. William Hill offer all staff all the opportunity to develop themselves, that is why if one has the ability can progress to management level and then given the opportunity will have to go through management induction program, this will aid William Hill as workers will be more motivated as they will gain a sense of achievement which leads to greater employee retention. Training is very important for William Hill as well staff because well trained workers will be more productive and this will enable the company to meet objectives set which will increase profit. This is also good for employees especially concerning performance relate pay because a higher dividend is given. It will help save cost as there will be less waste due to fewer mistakes made also the corporate image will be enhanced because the work force are better skilled and motivated. Training and Development can increase customer satisfaction and loyalty indirectly as work will be done more efficiently and they will be more motivation to keep customers happy also it can make William Hill more competitive as they will be performing better at work.

Fredrick Douglass Essay example -- Biography Biographies Bio

Frederick Douglass, an abolitionist who altered America's views of slavery through his writings and actions. Frederick's life as a slave had the greatest impact on his writings. Through his experience as a slave, he developed emotion and experience for him to become a successful abolitionist writer. He experienced harsh treatment and his hate for slavery and desire to be free caused him to write Narrative of the Life of Frederick Douglass. In his Narrative, he wrote the story of his miserable life as a slave and his fight to be free. His motivation behind the character (himself) was to make it through another day so that maybe one day he might be free. By speaking out, fighting as an abolitionist and finally becoming an author, Douglass's transformation from a slave into a man. In a preface of Douglass' autobiography, William Lloyd Garrison writes, "I am confident that it is essentially true in all its statements; that nothing has been set down in malice, nothing exaggerated, nothing drawn from the imagination; that it comes short of the reality, rather than overstates a single fact in regard to SLAVERY AS IT IS."(Garrison, 34). The significance of this statement validates and promises that Douglass' words are nothing but the truth. This made the narrative more marketable to the white audience and people were listening. Douglass realized that he did not need assurance from white people to be respected. That's why he addressed his master for all the wrong things done to him. Slaves are looked as not human. Douglass completes his journey from slave to man when he creates his own identity. He speaks out, fighting as an abolitionist and finally becoming an author. Douglass tells his story not simply as a search for fr... ...e torture and pain of slavery, he had an excellent reason to fight for the abolitionist movement. He became successful in his fight against slavery. His works documented the rise of a slave to a free man, to a respected speaker, to a famous writer and politician. In his narrative, Douglass simplifies his experience to that of other slaves showing the cruelty, psychological and physical struggle of slaves. Douglass went through several life changes, from being a slave to having freedom. He went from the south to the north, from a young man to a well known and respected speaker. This man helped America come to terms with slavery which was an important factor in the abolitionist movement. Works Cited Frederick Douglass, Narrative of the Life of Frederick Douglass, An American Slave, Written by Himself (New York, N.Y.: W.W. Norton and Company, 1997).

Carl Jung Essay -- essays research papers

Carl Jung 1875 - 1961 Anyone who wants to know the human psyche will learn next to nothing from experimental psychology. He would be better advised to abandon exact science, put away his scholar's gown, bid farewell to his study, and wander with human heart throught the world. There in the horrors of prisons, lunatic asylums and hospitals, in drab suburban pubs, in brothels and gambling-hells, in the salons of the elegant, the Stock Exchanges, socialist meetings, churches, revivalist gatherings and ecstatic sects, through love and hate, through the experience of passion in every form in his own body, he would reap richer stores of knowledge than text-books a foot thick could give him, and he will know how to doctor the sick with a real knowledge of the human soul. -- Carl Jung Freud said that the goal of therapy was to make the unconscious conscious. He certainly made that the goal of his work as a theorist. And yet he makes the unconscious sound very unpleasant, to say the least: It is a cauldron of seething desires, a bottomless pit of perverse and incestuous cravings, a burial ground for frightening experiences which nevertheless come back to haunt us. Frankly, it doesn't sound like anything I'd like to make conscious! A younger colleague of his, Carl Jung, was to make the exploration of this "inner space" his life's work. He went equipped with a background in Freudian theory, of course, and with an apparently inexhaustible knowledge of mythology, religion, and philosophy. Jung was especially knowledgeable in the symbolism of complex mystical traditions such as Gnosticism, Alchemy, Kabala, and similar traditions in Hinduism and Buddhism. If anyone could make sense of the unconscious and its habit of revealing itself only in symbolic form, it would be Carl Jung. He had, in addition, a capacity for very lucid dreaming and occasional visions. In the fall of 1913, he had a vision of a "monstrous flood" engulfing most of Europe and lapping at the mountains of his native Switzerland. He saw thousands of people drowning and civilization crumbling. Then, the waters turned into blood. This vision was followed, in the next few weeks, by dreams of eternal winters and rivers of blood. He was afraid that he was becoming psychotic. But on August 1 of that year, World War I began. Jung felt that there had been a connection, somehow, between hims... ...ates, they are a little dangerous, especially economically. They are good at analysis and make good entrepreneurs. They do tend to play at oneupmanship. ESFJ (Extroverted feeling with sensing): These people like harmony. They tend to have strong shoulds and should-nots. They may be dependent, first on parents and later on spouses. They wear their hearts on their sleeves and excel in service occupations involving personal contact. ESFP (Extroverted sensing with feeling): Very generous and impulsive, they have a low tolerance for anxiety. They make good performers, they like public relations, and they love the phone. They should avoid scholarly pursuits, especially science. ESTJ (Extroverted thinking with sensing): These are responsible mates and parents and are loyal to the workplace. They are realistic, down-to-earth, orderly, and love tradition. They often find themselves joining civic clubs! ESTP (Extroverted sensing with thinking): These are action-oriented people, often sophisticated, sometimes ruthless -- our "James Bonds." As mates, they are exciting and charming, but they have trouble with commitment. They make good promoters, entrepreneurs, and con artists.

Psychiatry and control of human behavior Essay

I. In order to create such a resolution and usually to resolve an ethical dilemma nurses use four fundamental ethical principles of nursing care and practice, which are considered by many experts as a cornerstone of ethical guidelines. Autonomy The first one is autonomy. This principle means â€Å"that individuals have a right to self-determination, that is, to make decisions about their lives without interference from others† (Silva, M. Ludwick, R., 1999b, p. 4). It is also possible to define empirically that autonomy consists of two elements: data acquired or proposed as a presupposition and reaching the decision as the action. Beneficence The second is beneficence. This principle is thought to be a basis of day-to-day nursing care and practice. â€Å"The principle of beneficence and utilitarianism direct health care professionals to make an ethical decision to provide the maximum benefit and to minimize harm to the greatest number of people involved† (Silva, M. Ludwick, R., 1999b, p. 4). Beauchamp and Childress (1994, p. 192) state that â€Å"Each of †¦ three forms of beneficence requires taking action by helping – preventing harm, removing harm and promoting good†¦.† (cited by Silva, M. and Ludwick, R., 1999b, p. 4). This ethical principle may cause some ethical questions when a dilemma regarding performing of a mentally ill patient’s wishes appears. Nonmaleficence The third fundamental ethical principle is nonmaleficence or â€Å"do no harm†, which is easily connected with the obligation of a nurse to defend safe keeping of the mentally ill patient. â€Å"Born out of the Hippocratic Oath, this principle dictates that we do not cause injury to our mentally ill patients† (Silva, M. Ludwick, R., 1999b, p. 6). Justice The fourth basic ethical principle is justice. This principle implies â€Å"giving each person or group what he/she or they are due† (Silva, M. Ludwick, R., 1999b, p. 7). This principle applies to parity, integrity or another point that may be fundamental for the justice decision. In nursing care and practice the principle of justice usually centered on rightful admission to nursing care and on rightful allocation of scarce resource. Rightful admission to the care means that nurses are easy of access to provide nursing care and a mentally ill patient as well as any member of a society realizes that nursing care is completely accessible. â€Å"The principle of justice †¦ guides health care professionals to treat every client with fairness and equity regardless the prognosis of illness, social and economic status of clients, the social and financial consequences impose on others† (Wilcockson, M., 1999, p. 21). Though it is necessary to remember what actually has the priority if we will compare it with nurse’s good, a nurse sometimes mixes up with what the nurse considers to be a mentally ill patient’s good. It is questionable what composes â€Å"good† for a mentally ill patient without violating his or her autonomy or allowing the mentally ill patient to suffer bitterly. And can it be ethical to abolish the choice of the mentally ill patients. For example Beauchamp and Childress (1994, pp. 277-278) maintain that paternalism can obtain two forms a weak and a strong one. They assert that weak form paternalism implies is that a nurse defends the mentally ill patient’s good when he or she is incapable to resolve some questions as a consequence of problems like depression or the effect of medicaments. But a strong form of paternalism, they say â€Å"†¦involves interactions intended to benefit a person despite the fact that the person’s risky choices and actions are informed, voluntary, and autonomous† (cited by Silva, M. and Ludwick, R., 1999b, p.5). II. In the proposed case study the old lady didn’t write DNR order, thus, the nurse behaved just adequately. She remembered about her duty to a mentally ill patient to preserve her autonomy but it was no possibility for her and for her mentally ill patient to â€Å"identifying and addressing problems in the decision-making process† as the lady was too depressed. Her quality of life was decreasing ad she couldn’t live independently but it was still questionable were these reasons adequate enough to make end-of-life decision. On this ground it is necessary to investigate the notion of â€Å"quality of life†. This obscure notion implied the situations when decisions concerning the question of withdrawing nursing care are formed and â€Å"†¦based on the likely low levels of self-awareness, reasoning, communication and activity that the mentally ill patient will have and the low probability of improvement† (Thompson, E., Melia, K. M. and Boyd, K. M., 2001, p. 44). Usually it is not up to mentally ill patient to make quality-of-life decisions as they are often reached by doctors or relatives. In other words â€Å"quality of life† should be determined by mentally ill patients themselves being able to evaluate it adequately. The unproved understanding of notion is often used in statements like: â€Å"After all, we shouldn’t waste any more money on this person because their quality of life will be so low, anyway† (Hunt, G., 1994, p. 125) Considering the case study we may that the â€Å"quality of life† of the old lady was not so low as to bring to end-of-life solution. However it was up to the mentally ill patient to decide that problem independently as it was her right to create DNR order but she didn’t do it, besides her depressed state and, thus, low self-determination was among the main reasons for reasonable nurse’s acts. III. If we try to use these four fundamental ethical principles to the case study that was chosen for our investigation beforehand we will be able to evaluate the deeds of nurse from ethical point of view. For example, it is clearly evident that nurse violated the principle of autonomy because autonomy of a mentally ill patient means the opportunity to make decisions about his or her life without interference of others. If taking into account this principle then it was up to a seventy three year old woman to decide either she needs to obtain emergency CPR or not. This principle was thus violated by the nurse, and the reasons for such behavior are not deciding in this matter. She might have ignored this principle basing on the other principles that prevent a nurse from doing harm, meaning to rescue the life of her mentally ill patient because human life is valuable and unique. But while the nurse deprived her mentally ill patient of the possibility to choose life or death, the nurse thus made herself responsible for this decision, which is evidently wrong. At least, the nurse should have noted that the mentally ill patient didn’t want to be rescued. As for beneficence, we may suppose, on the other hand, that it was a demonstration of weak form of paternalism. In such case the nurse protected the good of a seventy three year old lady as she was incapable to resolve end-of-life questions as a result of her depression and decreasing of the quality of her life. Consequently the deeds of the nurse were well-taken and righteous. But the nature of the action is also ambivalent, as the nurse might have been directed by her own notion of good, or the notion that the nurse obtained while studying ethics. The nurse shouldn’t have been define independently if the woman was really unable to make reasonable decisions, the nurse must have at least objectively estimate the problems and conditions of the mentally ill patient that led to such mentally ill patient’s intention.   This thought may also be confirmed and at the same time called in question by the principle of nonmaleficence. The nurse protected the safety of her mentally ill patient, but without mentally ill patient’s wish. It is questionable, would be the note of DNR be regarded as the injury caused to the mentally ill patient. If the life and conditions of this old woman were so poor, they made her suffer; the nurse must have taken it into account while deciding what would be more or less painful for her mentally ill patient. This may be regarded as the intention to take off responsibility from the nurse. Observing the last principle of ethics, justice, it is necessary to note that this principle was violated by the nurse. Her mentally ill patient was at least due to be heard. Her wishes and demands should have been taken into consideration, moreover, the mentally ill patient did not ask to help her die, and she just wanted to prevent her from suffering in future. Thus taking into consideration these four main principles, the case seems to be contradictory. It seems that the nurse acted basing upon her own notion of what is good, safe and just for her mentally ill patient, without taking into account the demands, wishes, living conditions and problems of her mentally ill patient. Of course, definite peculiarities of these principles allow justifying the actions of the nurse, if we look at the situation form the point of view of value of human life. One more issue that should be examined is the absence of mentally ill patient’s order for DNR. This may also be a reason to justify the actions of the nurse. But as soon as the demands was heard by the nurse, the nurse should have defined this problems with the mentally ill patient and helped the woman write a necessary order, if it was her wish. Nurses often can’t decide what their actual point of view about some ethical dilemmas is and how far those perceptions go. Anyway nurses should have to do with their own system of moral values but at the same time to determine whether it â€Å"fits into the big picture† (Stacey, J., 1998, p.8). It is necessary for a nurse to take a turn for the better foreshortening of problems and challenges in the area of care by forming at any rate a â€Å"bifocal view† of the problems (Stacey, J., 1998, p.7) Of course, not all ethical dilemmas concern death. â€Å"Nurses deal with ethics on every eight-hour shift. †¦for example, the Nursing Code of Ethics says to hold all things confidential, but sometimes there is information others need to know,† explains Freeman (cited by Stacey, J., 1998, p.4). However nurses often can appear in the situation of resolving of a complex moral dilemma that regards an appeal for assisted death. This problem is one of the most complicated issues in nursing practice. This question is also a key one in the case study that we have in some way already investigated earlier. Given the poor quality of life that seventy-three years old woman would probable suffer she demanded not to perform any heroic measures in the event of cardiac arrest. So she does not want to live anymore. But when the nurse sees the mentally ill patient next she is being resuscitated as there was no Do Not Resuscitate order (DNR) in her notes. Reference List Hunt, G. (1994) Ethical issues in nursing. Routledge. Silva, M. and Ludwick, R (1999a). Ethical Thoughtfulness and Nursing Competency. Online Journal of Issues in Nursing, 10 December, 1999. Available from http://www.nursingworld.org/ojin/ethicol/ethics_2.htm [Accessed 17 February 2006] Silva, M. and Ludwick, R. (1999b). Interstate Nursing Practice and Regulation: Ethical Issues for the 21st Century. Online Journal of Issues in Nursing, 2 July, 1999. Available from http://www.nursingworld.org/ojin/ethicol/ethics_1.htm [Accessed 14 February 2006] Silva, M. and Ludwick, R. (2002). Ethical Grounding for Entry into Practice: Respect, Collaboration, and Accountability. Online Journal of Issues in Nursing, 30 August, 2002. Available from http://www.nursingworld.org/ojin/ethicol/ethics_9.htm [Accessed 14 February 2006] Silva, M. Ludwick, R., (2003) Ethical Challenges in the Care of Elderly Person. Online Journal of Issues in Nursing, 19 December, 2003. Available from http://nursingworld.org/ojin/ethicol/ethics_14.htm   [Accessed 15 February 2006] Stacey J. (1998) A Question of Ethics. Emory Nursing University[online]. Available from http://www.whsc.emory.edu/_pubs/en/ [Accessed 17 February 2006] Thompson, E., Melia, K. M. and Boyd, K. M. (2001) Nursing Ethics. 4th ed. [n.p.] Wilcockson, M. (1999) Issues of life and death. [n.p.]