Items filtered by date: December 2021

 

The Federal Government and private businesses

 

 

The federal government is allowed by the constitution amendments to help private businesses and especially big corporations that have a great impact on the economy. This is because if these corporations file for bankruptcy and they are not saved, great loss to the economy would be reported. For instance, the employees would lose their job which is detrimental to the organization as more tax earnings would be lost. These are the taxes that are paid to the government from income taxes by the employees. The same loss is realized when the corporation is lost and thus it closes down. The government would lose the enormous amounts of taxes it gets from the business. It is therefore constitutional that the federal government uses federal budget to help private businesses that have filed for bankruptcy protection from their creditors(Wright, 2010). This is to ensure that the businesses are able to pick up.

However, it is not constitutional for the executive branch to buy shares of private company using the federal budget. This is to avoid control of the company by the executive branch and prevent the private business from pursuing its interests. The executive can use the federal government to help private businesses expand and grow but not to buy their shares. It is not allowed that the executive branch would invest in private businesses through buying shares and thus control their normal functioning. Nevertheless, the executive can use the federal budget to help big corporations that declare bankruptcy (Wright, 2010). However, this is done after thorough investigation to ensure that the corporations contributed much to the country’s economy and there is a probability of them picking up and paying back the offered loans.

 

 

Reference

Wright, J. W. (2010). The New York times ... almanac.New York: Penguin Group.

Published in business

 

Chronic Obstructive Pulmonary Disease (COPD) in Older Adults

Chronic Obstructive Pulmonary Disease (COPD) is one of the devastating diseases among the elderly people. The disease causes considerable mortality and morbidity among the older adults. Despite the fact that the disease can be prevented, managed, and even to some extend treatable, its occurrence continues to increase due to increase in smoking across the world and exposure to hazardous air conditions. Chronic Obstructive Pulmonary Disease (COPD) is linked with massive health care costs and especially in older adults due to their decreased or weaker immunity. The disease has universal outcomes and linked to some other co-morbid conditions – for instance muscle wasting, osteoporosis, and cardiovascular disease. Other common health complications associated with Chronic Obstructive Pulmonary Disease (COPD) among the older adults include: - anxiety, malnutrition, and depression. These health conditions affect an individual’s quality of life and compliance to therapy. However, it is important to note that malnutrition in older adults diagnosed with Chronic Obstructive Pulmonary Disease (COPD) is an independent mortality forecaster and a sign of poor outcome (O'Neill, 2002).  This paper aims at describing the risk factors, symptoms, diagnosis, management, and treatment of Chronic Obstructive Pulmonary Disease (COPD) among the older adults.  

Risk factors for Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a prevalent disease or condition among the older adults. According to Yoost and Crawford (2014) “age and smoking are the two major risk factors for COPD, which is a group of diseases, including emphysema, chronic bronchitis, and a subset of asthma characterized by chronic airflow obstruction” (p. 279). However, it is important to note that smoking is not the not the only predisposing risk factor for Chronic Obstructive Pulmonary Disease (COPD). Other individuals prone to developing the condition at a later stage in their lives are those with a history of emphysema, chronic bronchitis, obese, asthma, and those with persistent airway obstruction infections. Equally people working in hazardous environments (air polluted with noxious vapors, dusts, and gases) and those living with people who smoke are at a great risk of developing the condition.

Symptoms of Chronic Obstructive Pulmonary Disease (COPD) in older adults

In most cases, signs or symptoms of Chronic Obstructive Pulmonary Disease (COPD) infection show up to people aged 50 years and above. However, people young than 50 years can show signs of this condition. Some of the common symptoms of COPD are: - wheezing, recurrent chest infection and especially during cold weathers, persistent coughing and especially in the morning and increased breathlessness and especially when walking or when exercising. The difficult to breath for those with Chronic Obstructive Pulmonary Disease (COPD) is a result of narrowed and inflamed lung airways. As such, when the air sacs continue to get damaged, breathing out continues to get difficult. This is why it is important for people who experience signs or symptoms of the condition are advised to seek diagnosis and begin appropriate treatment immediately to reduce further lung damages. Other less common signs or symptoms of Chronic Obstructive Pulmonary Disease (COPD) are: - swollen ankles, fatigue, tiredness, and weight loss. It is important to note that Chronic Obstructive Pulmonary Disease (COPD) symptoms or signs are mostly worse during the winter (Lotvall and Busse, 2011).

Diagnosis for Chronic Obstructive Pulmonary Disease (COPD) in Older Adults

Any person aged above 40 years who shows signs of Chronic Obstructive Pulmonary Disease (COPD) should be diagnosed for the condition. Typical symptoms or signs of this condition in older adults as previously outlined in this paper are: - chest tightness, persistent coughing, breathlessness, wheezing, recurrent chest infections, production of sputum and especially during the morning hours, and reduced exercise ability. It is worth to note that other health conditions may depict similar symptoms to those of Chronic Obstructive Pulmonary Disease (COPD). This implies that a medical examination is the only sure approach to diagnose the condition. Chronic Obstructive Pulmonary Disease (COPD) can be diagnosed by practice nurses, a hospital doctors or by GPs. The breathing tests and the test X-ray are used to diagnose the condition (Hanania and Sharafkhaneh, 2011).

The breathing tests also referred to as the spirometry are done to a patient in order to determine the presence of COPD or exclude its presence. The machine used to perform the breathing tests is known as spirometer. The breathing tests can “… be performed in many GP surgeries, specialized lung laboratories, hospital wards, or out-patient clinics” (Currie, 2009 p. 16). During the test, the medic professional requests the “… to take a full breath inwards, and then blow out as hard and as fast as possible, for as long as possible, into a plastic tube attached to a  recording device” (Currie, 2009 p.16). This practice or procedure for that case is repeated a number of times until a number of recordings with similar result or values are obtained. Through evaluating the results obtained from these tests and making a comparison with known findings of healthy persons, it is possible to determine whether the person being tested has Chronic Obstructive Pulmonary Disease (COPD) or not. The breathing tests can also be used to determine the level of lung damage caused by the condition. The lung damage caused is classified as severe, moderate, or mild. This is important in order to device the most appropriate treatment approach.

Management and treatment of Chronic Obstructive Pulmonary Disease (COPD) in older adults

Although Chronic Obstructive Pulmonary Disease (COPD) is not curable, it can be managed and especially when diagnosed early. Ceasing smoking is one of the behavioral changes an older adult who smoke can adapt to manage the condition. Continuing smoking after being diagnosed with this condition serves to increase further lung damage up to a level that the condition cannot be managed. As such, early diagnosis is important in order to prevent further lung damage. The condition can also be treated and managed through pneumococcal and influenza vaccination, by using short and long acting bronchodilators, and use of corticosteroid inhalers. In most cases, a combination of therapies is required to treat and manage the condition in older people. It is important to note older adults, and most likely those in severe conditions have insufficient aspiratory force and hence some inhalers cannot work for them (Bourbeau, Nault and Borycki, 2002).  Other available treatment and management option for the condition include oxygen therapy, osteopenia and depression screening, and pulmonary rehabilitation. Care takers looking after older adults with severe COPD exacerbation ought to safeguard them against prognostic negativity (Nici and ZuWallack, 2012).  

Although Chronic Obstructive Pulmonary Disease (COPD) is linked with disability in older adults, there are a range of treatment interventions available to assist the patient. This is especially when the condition is detected early. As such, it is advisable to seek doctor’s advice or diagnosis for that case in case of any sign or symptom.

 

 

 

 

 

 

 

References

Bourbeau, J., Nault, D., & Borycki, E. (2002). Comprehensive management of chronic      obstructive pulmonary disease. Hamilton, Ont: BC Decker.

Currie, G. P. (2009). Chronic obstructive pulmonary disease. Oxford: Oxford University Press.

Top of Form

Hanania, N. A., & Sharafkhaneh, A. (2011). COPD: A guide to diagnosis and clinical       management. New York: Humana Press.

Bottom of Form

Lotvall, J., & Busse, W. W. (2011). Advances in combination therapy for asthma and COPD.       Chichester, West Sussex: John Wiley & Sons.

Nici, L., & ZuWallack, R. L. (2012). Chronic obstructive pulmonary disease: Co-morbidities         and systemic consequences. New York: Humana Press.

O'Neill, P. A. (2002). Caring for the older adult: A health promotion perspective. Philadelphia:      W.B. Saunders.

Yoost, B. L., & Crawford, L. R. (2014). Fundamentals of Nursing: Active Learning for     Collaborative Practice. New York, NY: Elsevier Health Science.

 

 

Published in Health essays
Sunday, 05 December 2021 08:18

Economist: Crimea parliament

Economist: Crimea parliament

 

Summary

On 27th February 2014, Russian soldiers without their uniform first seized the Crimea parliament. This marked the start of Russia’s war against Ukraine. On 27th February 2015, exactly a year later, Boris Nemtsov, an opposition politician in Russia was killed on a bridge in Kremlin. Before his death, he was handing out leaflets for an anti-war rally to be held on March 1st the same month. Ironically, the March he was planning to start hi anti-war campaign turned out to be his memorial procession. His death is the start of the return by Russia to campaign for political violence by Ukraine. It had been noted that aggression by Russia abroad and its repression in the country are closely linked (The Economist, 2015).

According to the state propaganda, Kiev’s revolution is considered a fascist coup while the Ukrainian government is considered a western-backed junta meant to harm the Russian rebels in Ukraine’s east. The media in the country urges all Russian patriots to fight the fascists in the country including Mr. Nemtsov who is considered a ring leader and identify pro-western liberals. Because of fear that Russia could have to face the Maidan revolution, the Kremlin has decided to use the same violence he used in Ukraine. Six days before the death of Nemtsov, Kremlin planned an anti-Maidan rally that forced Maidan troops into Moscow. The anti-Maidan rally supporters had slogans denouncing the Russian, Ukraine, and the West liberals (The Economist, 2015).

The anti-Maidan march acted as the peak of a long struggle of intolerance and hatred. This was supported by Nemtsov some hours before his death in an interview when he said that Russia was changing to a fascist state. This was because of the propaganda that was spreading that there was nucleus of assault brigades. There were also terrorist groups and pro-government extremists whose main aim was to fight opposition in areas where the police could not reach. Russian proved that it was outsourcing repression to fight against non-state groups showing a sign of state weakness. In order to conceal Nemtsov’s death that was believed to be by the government, Putin’s propagandists stated that the killing was by foreign liberals. They further argued that the opposition had warned to murder one of their own in order to blame the Kremlin. For the Russian liberals, this was believed to be a new sign of political repression, similar to what was evidenced in 1934 after the killing of Sergei Kirov (The Economist, 2015). 

Description of the Rhetorical Situation

            The article passes political messages explaining how politicians can use their power to suppress and repress those below them or those who go against them. It such cases, politicians do not care what a person is in the society or how close he is with the person. If a person does not weight his words properly, the politician will decide to silence him for good through murder. However, even when the evidence points on the politician who carried out the murder, the available evidence is not strong enough to incriminate the politician. In this case, the politician (the Kremlin) has the support of the government, which has decided to rule by oppressing anyone who goes against its leadership style. This is the fate Nemtsov suffers after deciding to belong to the liberals and challenge the government. While all the other liberals can clearly point the finger to the Kremlin as the assassin, they do not have sufficient evidence to incriminate him. And in fact, the Kremlin has words to defend himself. He blames the murder on other liberals and external forces (The Economist, 2015).

            The article is constructed for everyone who is interested in political matters and especially how some countries such as Russia are run. The author has decided to bring to light some hidden information that might never come to the surface. His content and style are clear to fit his target audience, the general public. He supports his information from the current issues that prove that Russian government is an oppressing government. The assassin ofNemtsov and the jailing of Alexei Navalny, a blogger and opposition leader to stop him from attending the organized anti-war rally are examples of current issues that have pushed the author to write the article(The Economist, 2015). He has also been pushed to write the article by the anti-Maidan protest that was conducted almost in the whole of Russia to fight against the liberals.

Evaluation of the Rhetorical Choices the Author makes

The author decided to step up and reveal his intentions, emotions, and confess what he thought to be the truth. The contents in the article are a good example of the author’s temper and mood (ethos). In the author’s opening paragraph, the mood is set as he explains the death of the greatest opposition leader in the country. The author chooses strong words that demonstrate his feelings in a country in which the government that should be protecting its people is oppressing them. He explains how the government dislikes challenge and how it mercilessly deals with it in case it happens. He uses active verbs that carry the weight of his information. For instance, the author says, “Prompted by the far-fetched fear that the Maidan revolution could be replicated in Russia, the Kremlin has re-imported the violence it deployed in Ukraine”(The Economist, 2015). This is an indication that the government is not worried of the pleas of grievances of its people but has the solution to the Maidan revolution; using violence.

The author says that there are ‘pro-government extremists and terrorist groups which openly declare that their aim is to fight the opposition where the police cannot”(The Economist, 2015). This metonymic ‘fighting the opposition’ is onomatopoetic suggesting the extent the government is willing to go to achieve its goal of repressing its own people. The author is concerned with the words he chooses to show his emotions. He notes, “The anti-Maidan activists include the leather-clad ‘Night Wolves’ biker gang, who played an active role in the annexation of Crimea and have been patronised by Mr Putin. More alarming are MrKadyrov and his well-trained, heavily armed private militia of 15,000 men, who several months ago swore a public oath to defend Mr Putin”(The Economist, 2015). He uses metaphor ‘Night Wolves’ to explain how the government feels about people who pretend to be on its side and when out sight, they are in the opposition. Here, he also used active verbs and verbals ‘well-trained, heavily armed private militia of 15,000 men’ to explain how the government thinks the private militia is adequately prepared for war.  

Description of Choices I would have done differently

            I do not think there are things I would have done differently. The author uses all the best rhetorical choices that fit his article. His information has to be made clear by use of active verbs, metaphors, metonymic, onomatopoetic, and revealing his mood to show how he feels about the Russian government. This way, he explains how the government considers people who challenge it and how far it is prepared for the fight. From the author’s choice of words, it is evident that the government does not have friends and even those who swore to be by its side are noted to be wolves as night. I would have made the same choices as the author to pass the message to the target audience clearly. 

 

 

Reference

The Economist. (Mar 7th2015). Russia after Nemtsov: Uncontrolled violence. Retrieved from http://www.economist.com/news/europe/21645838-assassination-boris-nemtsov-leaves-liberal-russians-fear-new-wave-violent.

Published in History

 

Reducing the Prevalence of Pressure Ulcers in the Elderly

 

 

 

Abstract

 

Heel pressure ulcers have become common, perhaps due to the fact that limited research has been carried out on the manner in which they can be prevented or treated. Although they are caused by external pressure on the heel, the treatment varies depending with the stage of infliction. Patients who are at risk include the aged, those suffering from diabetes mellitus, and those with mobility problems, among others. The purpose of this paper is to explore methods of prevention and treatment, including the waffle boot; however, most have not been found to be effective. Repositioning the client remains among the most important factors that need to be considered in reducing and treating pressure ulcers.

Keywords include heel pressure ulcers, mobility, blood, and tissue.

 

 

Reducing the Prevalence of Pressure Ulcers in the Elderly

Background

            Pressure ulcers occur when external tissues are exerted with excess pressure, which is not adequately relieved. The tissues that are exerted with pressure are mostly due to bony prominence. It is a common occurrence that pressure ulcers mostly inflicts the heel and the sacrum. The outcome of the pressure ulcers at the heel has some immense consequences, because it is expensive to treat and it is very painful, and mobility of the victim is severely limited. It is imperative to acknowledge that heel ulcers are among the most serious and common lower extremity ulcers and in many instances can result in below the knee amputation among patients suffering from diabetes mellitus (Veves, Giurini & LoGerfo, 2012).

            According to the National Pressure Ulcer Advisory (2007), approximately 19% of patients diagnosed with heel pressure ulcers are not diagnosed with diabetes mellitus, whereas approximately 32% are diagnosed with diabetes mellitus, and the number of people suffering from pressure ulcers continues to rise. The heel pressure ulcers mostly begin in the acute care setting, but the prevalence is higher in the long –term care. As one lives longer, the chances of being infected with heel pressure ulcers. The purpose of this literature review is to answer the question, does use of waffle boot and/or preventative dressings, compared to repositioning, affect the prevalence of pressure ulcers among the elderly adults.

Literature Review

The purpose of this paper is to identify current strategies utilized in the prevention and management of heel pressure ulcers in the elderly.  To that aim, a review of the literature was performed using both Ovid and the Cumulative Index to Nursing and Allied Health Literature (CINAHL).  The following terms were used in the literature search: elderly patients, heel pressure ulcers, prevention, management, treatment, and mobility.  The search was limited to the years 2000 to 2015, and only full-text-articles, or articles available in portable document format (pdf) were included.  The articles were then reviewed for appropriateness to the topic, and for specificity to the emergency department setting.  Eleven articles were identified and are included for discussion in this paper.  The articles have been arbitrarily sorted into categories for discussion in this paper and include factors related to development of pressure ulcers on the heel, prevention and treatment research, implications for nursing, and recommendations.

Factor Related to Development of Pressure Ulcers on the Heels

Anatomy and Physiology

            The calcaneus foot, which is the largest bone in human foot is relatively wide and thus the skin has a large surface area despite the fact it is pointed shape due to the bone prominence, and has little subcutaneous fat cautioning it.  As a result, the pressure from the prominence makes the heel very vulnerable. Graff, Bryant and Beinlich (2000), noted that blood is transported to the heel through the peroneal and the posterior arteries. The heel becomes susceptiblebecause it has a delicate subcutaneous tissue pad with a thickness of 18 mm, while the epidermis and the dermis have a thickness of 0.64 mm, hence making the heel to be at risk of ischemia.

            These mechanical forces result in the occlusion of the blood vessels and tissue ischemia, and that results in death of tissues due to hypoxia. Occlusion is mainly attributed to shear force and the tissue interface pressure.  In addition, there are chances that occlusion can occur when there is shear force and in the absence of interface pressure. The heel vasculature has varying blood pressure depending with the load. When weight is completely loaded on the heel, a higher blood pressure is required to get oxygenated blood to the heel, compared to when there is low pressure on the heel, when it is off loaded using padding and/or pillows. However, Mayrovitz et al. (2002) examined the effect of direct surface load and reduction of flow on incidence of pressure ulcers during the ankle-cuff compression. Despite the fact that flow reduction and baseline flows did not show any difference, hyperemia was more evident when the reduction in flow was as a result of direct heel loading. Therefore, the recovery process after offloading actually contributed to the tissue breakdown.  More so, another study carried out on animals and humans revealed an inverse relationship between the intensity and duration of pressure. Hence a conclusion is reached that when the pressure is high, less duration is need for damage and tissue ischemia to occur (Koziak, 2004).

            It is significant to acknowledge that the sole of the foot lacks skin lubrication; therefore, the skin is vulnerable to damage resulting from friction because it is left dry. As one gets older, the skin gets thinner, and the ability to absorb shock declines with age, and that makes the skin to be left with less potential to resist from destructive forces of load. As one ages, arteriosclerosis and age factors can result in impairment of circulation, and that can also occur to young people who suffer from hypertension or diabetes, or those who smoke. As blood pressure in the capillaries reduces, they, the capillaries, become vulnerable due to external pressure (Kannell & Shurtleff, 2000).

Perfusion Problems

Among those suffering from peripheral arterial occlusive ailment, they have higher chances of being diagnosed with heel pressure ulcers. This is because the blood supply to the area is at the end of arterial plexus from the peroneal and posterior tibia arteries. As the heel area carries the body weight, it is left vulnerable because of the decrease of supply of the arterial blood. Heel pressure ulcers occur frequently on the lateral or the medial surfaces, more so, it has chance of occurring on the posterior and plantar aspects. For those diagnosed with diabetes, it can result from involvement with the peroneal and tibial,rather than the dorsalis pedis, arteries (Creager,  Beckman & Loscalzo, 2013). 

Friction

According to the National Pressure Ulcer Advisory (2007), friction is “the resistance to motion in a parallel direction relative to the common boundary of 2 surfaces”.  Friction occurs as part of the skin shifts, while the other remains stationary, and when  that occurs, there is reduced blood supply to the skin, hence a tissue damage occurs. In the presence of friction, the external pressure required to cause tissue damage reduces. In patients, when they become restless, especially those suffering from dementia cannot move in bed due to friction.

Shear

According to the National Pressure Ulcer Advisory (p. 2), shear pressure refers to “force per unit exerted parallel to the plane of interest”. Shear strain refers to the deformation or distortion of tissues arising due to shear stress. Shear is mainly affected by three critical factors, that include the quantity of pressure exerted, coefficient of friction occurring because of making contact withsolid surfaces, and degree of the body contact with the support surface. Shear occurs mainly among those who elevate their heads while in bed, and those who sit while sliding down in the chair.

Immobility

Those who are immobile have a higher chance of being diagnosed with heel pressure ulcers due to their immobility. Thus, 87% of those diagnosed with heel pressure ulcers are those who are not mobile (Beckrich & Aronovitch, 2000). Most of the immobile people, like the inpatients who suffer from fractures, spinal cord injuries, or stroke, have increased chances of suffering from injuries of the skin around the heel. For example, if one suffers a hip fracture, the innervation to the extremity can be impaired, and since one is advised not to move the injured/ fractured leg, the result is increased risk of tissue breakdown on the heel.

Comorbid Risk Factors

            Older adults have increased chances of being diagnosed with heel pressure ulcers. Others who are likely to suffer from the disease include those who are paralyzed, incontinent, debilitated, and those who are suffering from metastatic cancer. Others include patients who are in the intensive care unit (ICU), those on ventilator, and those with diabetes mellitus. All these have similar level of peripheral vascular compromise, which adversely affect blood circulation, which can contribute to neuropathy and deformities on the foot. A study by Krueger (2006) reported that 25% of those suffering from heel pressure ulcers are also diagnosed with peripheral arterial occlusive disease and diabetic neuropathy. Among the major symptoms for people who suffer from heel pressure ulcers and diabetes include ischemic and neuropathic etiologies associated with lower resting perfusion pressures along with higher pressure when loaded. A person with diabetes mellitus is four times like to suffer from heel pressure ulcers than one who does not suffer from diabetes mellitus.

            Neuropathy is defined as the pathological transformations in the peripheral nervous system that are not easily understood; however, it is prevalent among the old adults who suffer from diabetes mellitus. It is common in individuals who have been diagnosed with diabetes mellitus for a period of five to ten years. It impairs sensation and increases the vulnerability to development of pressure ulcers because one is not able to sense and react to pressure changes. He damage occurs in a series of three stages that include loss of sensation, losing the ankle jerk and intrinsic muscles reflex, and the resultant inability to produce oil and absence of sweating. This combination of factors results in the skin losing elasticity and becoming dry (Sussman & Bates-Jensen, 2007).

            Edema limits the ability of blood to flow to the heels. Limited blood flow compromises the transportation of nutrients, oxygen, and the removal of wastes from the body, resulting in excess fluids being retained in the body, thus increasing weight which can cause tissue pressure, and adversely affect the ability of the tissue to tolerate loading weight. This, in turn, can produce heel pressure ulcers that affect the skin integrity full thickness (Cuschieri, 2013).

            A person who has suffered cerebrovascular injury is likely to suffer from heel pressure ulcers due to inability to move legs or due to shear or friction. Those individuals who have been diagnosed with spinal cord injury (SCI) have chances of suffering from neuropathy due to the impairment of the sensory, motor, and autonomic systems. Skin injuries that are neurological can cause metabolic changes that can take up to five hears to stabilize. The changes may include increase in the level of collagen metabolism, abnormal synthesis of collagen, defective reactions by the skin, and declined skin elasticity. Paralysis may result to reducing of the muscle bulk and that may include that over the bony prominences, hence exposing the skin, and that may cause to be susceptible to injuries. Some patients propel themselves in the wheelchairs using their heels, and that increases their risks to heel pressure ulcers (Dennis, Bowen & Cho,2012).

            A study by Black et al. (2007) revealed that among the people who have the highest risk of suffering from heel pressure ulcers are those who have previously suffered from heel pressure ulcers, diabetes mellitus, low serum albumin, poor nutrition, and low Braden scale level. People whose blood circulation has been impaired, those who wear anti-embolus stockings, those with low fluid intake, inadequate sense of temperature or pain and those who smoke, also have high risk factors. More so, patients who undergo surgical procedures lasting for more than one hour are also at risk. Others who have increased chances of being diagnosed with heel pressure ulcers are the patients go through epidural anesthesia/analgesia. This is because this procedure  limits the mobility of the lower extremities, resulting in extended pressure on the heels, and hence losing their protective senses that are responsible for moving the leg as the legs react to increased pressure.

Deep Tissue Injury

            In some instances, heel pressure ulcers may end up developing into deep tissue injury (DTI). According to National Pressure Ulcer Advisory Panel (2007), DTI is a maroon or purple portion of the dermis that is mostly discolored or it may be blister filled containing blood, and it occurs when the delicate tissue, which is under the skin, is damaged as a result of pressure or shear.    Before the occurrence of the deep tissue injury, the injured part may become firm compared with other parts of the skin surrounding it and may be painful and boggy. For the people who are have a dark complexion, it may be complicated to identify the areas that are developing the deep tissue injury. Evolution of the DTI may occur to result to a thin blister covering a wound, them a thin eschar, and sometimes may result to additional layers being exposed. It is a common occurrence for DTI to develop into a stage IV ulcers.

            DTI can appear as a purple or deep red area, have some bruises, or a blister filled with blood. The fluid in the blister is an indication of stage II pressure ulcers, whereas when a blister is filled with blood is a reflection of stage III to IV pressure ulcers. The color of the blister is normally related to the tissue necrosis along with the consequent blood coagulation. Even if the skin undergoes extensive pressure, it cannot lose its viability and can continue to be intact for 14 days even though it is non-viable (Black, 2003).

Heel Pressure Ulcer Prevention and Treatment Research

Many scholars have researched the problem of heel pressure ulcerss in efforts to find a lasting solution. Bots and Apotheker (2004) have studies the manner in which heel pressure ulcers can be prevented. This was using self-adhesivehydro polymer foam for the purpose of dressing. This study revealed that this procedure was only effective in reducing the heel pressure ulcers by only 76.7%. That means the strategy was not quite effective. Another study was carried out on old patients on the impact of shear forces on their heel (Nakagami, et, al, 2006).

In the research, part of the sample was treated by hydrocolloid dressing for prevention of pressure ulcers, while the other was managed using a thin film dressing. The results of the study revealed not differences between the healing of two groups after statistical analysis were carried out; however, statistical differences were noted in regards to the shear forces between the two groups (Ayello & Sibbad, 2012). Further, the results revealed that even though the dressing reduced the shear force, it could not prevent tissue interface pressures, and thus, it was recommended that the dressing could not be employed to elevate the heel for patients who were immobile. The study concluded that the heels needed to be offloaded.

Problem Analysis

            It is imperative to evaluate the products that can employ on patients with morbidity problems arising due to heel pressure ulcers. A device that can reduce heel pressure will end up separating and protecting the ankles, while maintaining heel suspension, and thus prevent the foot drop. Redistributing the pressure will be critical in reducing the interface pressure to be lower than 32 mm Hg. It important to note that, besides the specialty beds and typical dressing, it is important to guarantee that the heel is protected.  A commercial design for elevating the heel is four times more effective than pillows. A 2005 research by Gilcreast, et al, evaluated three devices that were meant to reduce pressure on patients who were vulnerable to heel pressure ulcers. These devices included foot waffle, egg crate and bunny foot. Among those patients who were at risk of getting heel pressure ulcers, 12 of them developed the ailment. However the effectiveness of these devices to prevent heel pressure ulcers among the vulnerable individuals was not significant because the foot waffle, egg crate and bunny boot prevented the ulcers by only 6.6%, 4.6%, and 3.9% respectively.  More so, out of the 41 patients who took part in the research revealed that the heel protector boots and the duoderm are less effective than eggshell foam and foam splints. Among the patients who considered to form the control group, it was found that 22 patients, some whom were under diabetes mellitus medication were not diagnosed with heel pressure ulcers. This is because, as these patients continued with their medication for their respective diseases, they were receiving high level nursing care (Rich, et, al, 2009).

Based on the above research on heel pressure ulcers, it is apparent that the disease continues to haunt the victims because there is not effective medication that has been developed. Despite the disease being discovered long time ago, it appears that the medical researchers have done an insignificant work because it appears that most of the speculated medications and preventative measures are not effective.

Discussion

            Most of the medications used for treatment of heel pressure ulcers are similar to the ones used for prevention of the ailment. Before the health care providers begin to carry out treatment, it is important for them to carry out some risk assessment on the person. Among those who require risk assessments include those with mobility problems or their mobility is impaired, have impaired sensation, are diagnosed with diabetes mellitus, have foot deformities, or their lower extremities have circulation problems. Thus, an extensive research should be done in order to ensure that the assessments are scaled up. It is unfortunate that most of the assessment scales lack the required parameters required for evaluation of the non-movement in the lower extremity as a result, there could be some instances where one can suffer a leg fracture, but lack to be assessed appropriately. More so, the classification of those at risk is not standardized. Nonetheless, most scholars agree that the old adults who have suffered leg or  hip fractures are among those who are at risk. Therefore, appropriate preventive measures should be put in place to guarantee full recovery until they have made full recovery.

It is important that full assessment is done on patients to evaluate their level of risk when they are being admitted. The patients are a higher risk should be monitored closely and frequently. It is required that those in the acute care should be assessed every 48 hours in order to evaluate any significant change in their condition.  For those in the long care, they should be assessed every week, but that can be changed depending on the conditions of the patient. While carrying put the assessment, nurses employ the heel pressure ulcers assessment tool, which has a score. The nurses use the score to tell the patient risk level. Upon carrying out the assessments, patients whose have damaged skins or red skin should be handled with care, and heel protector should be used to prevent further damage of the heel

            The focus for the treatment and prevention of the heel pressure ulcers is the connection between the heel vasculature and the external pressure. In order to prevent cases of heel ulcers arising, comprehensive strategies should be employed, especially among the vulnerable populations. These may include identifying the comorbidities that comprise of skin assessment, the dietary intake, early use of pressure distribution devices, and use of evidence based interventions, among other interventions. According to Black, et, al (2003), among those suffering from diabetes mellitus, it is important that their heel is assessed at least twice in a day. In addition, those who are mentally incapacitated and those in acute care need their heels assessed at least twice or thrice on daily basis.

Implications of the Practice

Among the treatment procedures being carried out on patients suffering from heel pressure ulcers, or the vulnerable aged adults, repositioning or turning the patient frequently is a recommended procedure aimed at preventing the occurrence of the ailment. Defloor, et al (2005) proved that a turning schemes on either viscoelastic foam mattresses or standard mattress proved to be effective after following a preset schedule.

In regards to the heel pressure, it is imperative that this is controlled by use of pressure relief device. Among the people who are at risk of heel pressure ulcers, it is important that such individuals use pressure-redistribution device. This device plays a critical role in ensuring that the heel tissue does not breakdown, and remains protected from the adverse effects of the pressure, shear forces and friction (Black, 2003). Patients with boot type devices are mostly those who have been diagnosed with diabetes mellitus, or those with neuropathy; those with limited or poor mobility, and those who are immobile while recovering. There are varieties of boot type devices for all the diverse clients intending to distribute their pressure, and thus play it safe for their heels. According to Black (2004), the best devices to reduce pressure on are the ones that protect and separate the ankles, whilst at the same time maintaining the heel suspension and preventing the foot drop. In the health care facilities, some specially designed mattresses are built in such a way that they can reduce the pressure on the heels.  Patients normally demand a static device that has the potential to distribute the pressure over a large area, which offers the patients some comfort. Some devices or foam mattresses can be deflated or inflated in order to reduce pressure. In the market, there are some beds constructed in such a way that they have heel area pressure distribution properties. Irrespective of the availability of these devices, there is no device that can replace repositioning. Repositioning of the bed is very important.

            Based on what researchers have found, it is obvious that all the devices are not 100% effective in reducing the tissue interface pressure to the minimum level. The devices normally some limited protection on the heel against bony prominences, shear, and friction. This is mostly when the patient is lying on the side. To some degree, the foam boats are effective because the exterior surface aides in reducing friction. If the foam boot is more rigid, there is a high potential of developing pressure areas in the heel plantar surface or the lateral ankles. The booty type devices can reduce internal and external rotation, but have limited potential but can only manage to reduce the rotation only if they are more rigid. The air boot have less weight and aid in lessening the internal and external rotation, but cannot prevent it. Feet sweat in air bags, thus these bags are required to have air holes to enhance circulation. Boots have surfaces that make them to slip around on the bed surface; however, these allow more positioning checks. Straps ensure the bots stay on, but the straps should not be very tight. Tight straps can cause unnecessary pressure on the dorsum of the feet or the lower leg. Therefore, the boots should be removed at some time, and allow time for the feet to be assessed. Nurses should also check the pressure redistributing device to evaluate whether it is worn correctly.

Recommendations

The integrity of the skin should always be maintained it is important to make certain that the skin is protected from bony prominences and the heel pressure ulcers.  This is achieved by using lubricants removing pressure, and using moisturizers. More so, it is important to maintain protective dressing code. It is important to acknowledge that the dressing does not relief the pressure. At stage I of heel pressure ulcers, the tissues only need to be relieved off the pressure for them to recover. In case of the presence of blisters, one should not break them but should elevate the heel along with the leg. In case the heel pressure ulcers is at the II to IV stage, characterized by eroding of the skin, it is appropriate to dress the heel after cleaning it. In case of any infections, one should not use occlusive dressing because that can hold bacteria and facilitate their spread.  It is critical to monitor the heel closely to evaluate the positive or negative changes. Negative changes indicate deterioration, and they may include fever, odor, pain, exposed bone, and erythema.

            In reference to the literature review, it is apparent that research for stage III and IV of heel pressure ulcers is not inclusively done, and remains controversial. The issue of removal of stable eschar is still being debated. Considering that heel vascularity below the eschar is absent, and there is only fat tissue or subcutaneous tissue, it is susceptible to being infected and had limited potential to fight the infection. It is recommended that in the presence of eschar, the heel should be wrapped with gauze and be relieved off the pressure. Close monitoring of the patient is important. The adults need special care because their immune system may be weak and some bodies’ processes may be hindered by age. While assessing the heel pressure ulcers patient, it is important to take notes about the clinical observations from the score cards and other parameters.  More so, the management of heel pressure ulcers requires nursing nutritional assessment. This nurse should address both the hydration status and the nutrition status. In case the patient is at a nutrition risk, the nurse should give the best recommendation suiting the situation.

The heel pressure ulceris the second most pronounced part of the body infected with pressure ulcers. The current trend in regards to prevalence is a bit alarming, thus posing a real danger to society. Thus, it is important that nursing scholars research on effective mechanisms to prevent and to treat the condition. Identifying the condition at its initial stages is among the most effective ways to ensure that it is effectively managed. Those at high risk need their heels to be assessed frequently. All the health care institutions should have a protocol on the management of the heel pressure ulcers, that must employ evidence based nursing practices.

 

 

 

 

 

 

 

 

References

Ayello, E. A. & Sibbad, G. (2012). NURSING STANDARD OF PRACTICE PROTOCOL: PRESSURE ULCER PREVENTION & SKIN TEAR PREVENTION. Retrieved from http://consultgerirn.org/topics/pressure_ulcers_and_skin_tears/want_to_know_more/

Beckrich, K.,& Aronovitch, S.A. (2000). Hospital-acquired pressure ulcers: a comparison of costs in medical vs. surgical patients. Nursing Economic$, 17, 263-271.

Black, J. (2003). Deep tissue injury. Wounds, 15, 380.

Black, J. (2004). Preventing heel pressure ulcers. Nursing, 34, 17.

Black, J., Baharestani, M.M., Cuddigan, J., Dorner, B., Edsberg, L., Langemo, D.,
Posthauer, M.E., Ratliff, C. & Taler, G. (2007). National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system. Advanced Skin & Wound Care, 20(5), 269-274.

Bots, T.C.,& Apotheker, B. F. (2004). The prevention of heel pressure ulcers using a hydropolymer dressing in surgical patients. Journal of Wound Care, 13, 375-378.

Comparison of two pressure ulcer preventive dressings for reducing shear force on the heel. Journal of Wound Ostomy &Continence Nursing, 33, 267-272.

Creager, M. A., Beckman, J. A., & Loscalzo, J. (2013). Vascular medicine: A companion to Braunwald's heart disease. Philadelphia, PA: Elsevier/Saunders.

Cuschieri, A. (2013). Clinical surgery. Malden, Mass: Blackwell Science.

Defloor, T.,De Bacquer, D., &Grypdonck, M.H.(2005). The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. International Journal of Nursing Studies, 42, 37-46.

Dennis, M., Bowen, W. T., & Cho, L. (2012). Mechanisms of clinical signs. Chatswood, NSW: Churchill Livingstone.

Gilcreast, D.M.,Warren, J. B., Yoder, L. H., Clark, J. J., Wilson, J. A., & Mays, M. Z.(2005). Research comparing three heel ulcer-prevention devices. Journal of Wound Ostomy Continence,32, 112-120.

Graff, M.K., Bryant, K.,& Beinlich, N. (2000). Preventing heel breakdown. Orthopedic Nurse, 19, 63-69.

Kannell, W.B.,& Shurtleff, D. (2000). The Framingham Study. Cigarettes and the development of intermittent claudication. Geriatrics, 28, 61-68.

Koziak, M. (2007). Etiology of decubitus ulcers. Arch Phys Med Rehabil., 42, 19-29.

Krueger, R.A. (2006). Pressure relieving support surfaces: A randomized evaluation.Berlin, Germany: European Pressure Ulcer Advisory Panel Conference.

Mayrovitz,  H. N. (2002). Effects of different cyclic pressurization-relief patterns on heel skin blood perfusion. Adv Skin Wound Care, 15, 158-164.

Nakagami, G.,Sanada, H., Konya, C.,Kitagawa, A., Tadaka, E., &Tabata, K. (2006).

National Pressure Ulcer Advisory Panel (NPUAP). (2007). Terms and definitions related to support surfaces. Washington, DC: NPUAP.  Retrieved from http://www.npuap.org/NPUAP_S3I_TD.pdf.

Rich, S.E, et al. (2009). Pressure Ulcer Preventive Device Use Among Elderly Patients Early in the Hospital Stay. Nurs Res, 58(2): 95–104. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832670/.

Sussman, C.,& Bates-Jensen, B. (2007). Wound Care: A Collaborative Practice Manual for Health Professionals. Philadelphia, PA: Lippincott Williams & Wilkins.

Veves, A., Giurini, J. M., & LoGerfo, F. W. (2012). The diabetic foot: Medical and surgical management. New York, N.Y: Humana Press.

 

Published in Nursing
Sunday, 05 December 2021 08:15

Nursing-LPN to BS Transition

 

Nursing-LPN to BS Transition

 

Nursing LPN to BS Transition

Introduction

            Education is critical for professional growth and it enables one to climb the corporate ladder. Upon securing employment, one is faced with challenges in regard to enrolling for other courses due to commitment to work and family. The tight work schedule along with conflict of interest affect the decision making process; however, technological changes have made is possible for the professionals willing to enroll for part time courses to do so with ease. This is because technological advancement has made it possible for young professionals to enroll for online courses that are flexible. In so doing, they increase their competency and are in a position to climb the professional ladder.  Nursing is among the most critical professionals in regards to promotion of human health and prevention of diseases . Thus, many Licensed Practical Nurses (LPN) or licensed vocational nurses (LVN) are enrolling for Bachelor of Nursing (BN), which is a requirement before enrolling taking the registered nurses examination in some economies. The transition from LPN to RN is not a simple task, but entails a process of professional socialization that makes up eligible for more tasking role in the nursing profession. The chance to bridge between the LPN and RN was traditionally a complex issue that was only available in few universities; however, presently, the transition is offered by numerous universities. This research paper evaluates the LPN to RN transitions, and the differences between the LPN and RN.

Three major role differences between an LPN and RN

            Professional socializing entails learning the norms, values and skills that are required by people of certain social position. Professional socializing is not a simple task. This is because it comes with responsibilities.  In nursing, professional socializing is an important ingredient in their professional competency. The differences between the LPN and RN are caused by the training and education under which the respective nurse goes through. The registered nurses go through extensive training and education more than the licensed practical nurses. The registered nurses have higher chances of earning a higher pay than the LPN due to their differences in training and education.  Having considered that the LPN and RN go through different training and education, it is imperative to consider the role differences between the RN and the LPN.

            According to Duncan and DePew (2011), in regards to the role of the RN and the LPN, the former plays a senior role than the latter. The RN major duties revolve around ensuring that the patient needs are addressed in a favorable environment. Since the registered nurse is the head of the nurses, he/ she takeswritten and verbal instructions from the physicians. The RN must do the initial assessment of the patient, and develop the care management plan on the respective patient. On the other hand, the LPN gets instructions from the RN and performs the follow up for the patient along with daily check up, and must report to the registered nurse. That means the RN has the responsibility of supervising the LPN.  

The licensed practical nurse gives the basic nursing and medical to the patients. This entails routine check-up, which may include checking the blood pressure and inserting catchers among others.  They may also play a critical role in ensuring that patients are comfortable by helping them to bathe, and discuss the patient health status with the patient, and report to the doctor or the registered nurse.  On the other hand, the registered nurse administers treatment and medication to the patient.  They have to carry out the diagnostic tests, analyze them and report to doctors. They advise the patient the required processes of management of the illness after treatment. They also supervise the other nursing aides such as the home care aides and the LPN.

Generally, the RN has more responsibilities than the LPN/ LVN, thus their performance is expected to be higher because they have more medical responsibilities. Even though they can delegate duties to the LPN, the duties should be within the scope of the license of the LVN/ LPN. Therefore, before the LPN performs any medical practice on a patient, it must be approved by the RN.

Strategies and suggestions to the LPN to RN Transition

            Taking into consideration that RN have a more comprehensive medical roles than the LPN/ LVN, the transition require education. The transition can take place in two ways; first, by enrolling for a degree in Bachelor of Science Nursing, and secondly through enrolling for an Associate Degree in Nursing.  There degree courses takes between 1 and 2 years. Upon completing either of them, the LPN/ LVN must take the National Council Licensure Examination (NCLEX-RN) to become registered nurses (Claywel, 2013).  This increases the employment alternatives and guarantees pay increase. Among the courses that one undertakes includes nursing science and nursing theory among many other courses.  Some institutions offer bridging courses that make the LPN to transit to RN. These programs entail using the already acquired skills, knowledge and expertise to enable the LPV acquire the RN license.

Conclusion

Both the registered nurses and the licensed practical nurses are valuable members in health care because they play a critical role in preventing and management of  illness; however, there are some differences in respect to hierarchy. The differences dictate that the RN is superior to LPN, thus the latter is supervised and should report to the former. The differences in respect to their education and training demands that the RN can perform some tasks that LPN cannot perform. Irrespective of the differences, the LPN can go through some education and training and transit to become a RN.

 

 

References

Duncan, G., & DePew, R. (2011). Transitioning from LPN/VN to RN: Moving ahead in your career. Australia: Delmar Cengage Learning.

Claywell, L. (2013). LPN to RN transitions. NY: Elsevier Health Sciences.

Published in Nursing

 

Factors That Influence Medication Adherence in Non-English Speaking Patients

 

ABSTRACT

            This paper provides an overview and analysis of the factors that influence medication adherence in non-English speaking patients. It highlights the barriers to medication adherence and focuses on the barriers to medication adherence in non-English speaking patients. It examines a range of solutions that will help overcome the existing barriers to medication adherence among this group of patients. Analysis of the recent scholarly sources clarifies that the principal barriers to medication adherence in these patients are linguistic and cultural barriers.

            Patients with relatively low level of English proficiency, (e.g. immigrants from non-English speaking countries) have been found to be less adherent to scheduled ingestion of prescribed medication; whereas non-immigrants patients adhered better. The social factor has been found to act as a restrictive force to adherence. Cultural barriers also play a vital role in the non-compliant demographic, along with psychosocial factors such as fears, distrust, prejudice towards the Western medicine, and lack of provider’s interest into the perception and approach of the patients are all the more paramount to the fundamental aversion to medication adherence. Bridge building apparatus, such as interpreting services in hospitals, educational workshops and other measures would help remove the barriers. It has been also found that both parties of the process (the provider and the patient) need to improve their perception of personal accountability for adherence to medication.

Keywords: medication adherence, linguistic, cultural, perception

 

 

 

Factors That Influence Medication Adherence in Non-English Speaking Patients        Introduction

Patients with limited proficiency in English are more likely to face language barriers and miscommunication from their providers with a negligible ratio of shorter and less frequent patient-centered office visits than their English speaking counterparts. Patients’ race and ethnicity have been associated with physicians’ assessment of patient intelligence, feelings of affiliation toward the patient, and beliefs about the patients’ likelihood of risk behavior and adherence to medical advice. Language barriers may also exacerbate that misunderstanding and be used by the practitioners as an explanation to comprehend the misuse of prescribed drugs. The mutual response to race and ethnic relations may either aid or incapacitate the relationship between the health practitioners and the non-English speaking patients. Some may argue that non-English speaking patients who suffer from a mild to severe mental illness, such as depression may in part contribute to poor medication adherence (Klinge, 2001).

Prescriptions given by doctors and nurses are for the benefit of patients and usually given in relation to diagnosed illnesses. A drug becomes effective when used in strict compliance to the unadulterated doctor’s recommendations to maximize its efficacy in the healing process. Such realization in this forum becomes the focal driver to effective adherence to medication. It is undeniably indispensable for all patients to respect the instructions formulated by their physicians on the scheduled ingestion of prescribed medications. The main aim for all stakeholders is for a patient to recover from an existing condition. Generally, patients are advised to only obtain medications from an accredited medical institution and/or licensed medical doctor in order to avoid misdiagnosis, inadequate medications and abuse of drugs (Marsha et al, 2012). The purpose for this forum is to determine the factors that affect non-English speaking patients’ adherence to a medication regimen. Medication adherence is central to good patient outcomes. 

Definition of Concepts and Terms

The current relevant literature was searched by using the electronic databases CINAHL, Pubmed.  Key words and combinations searches included medicationadherence, linguistic barriers, cultural barriers, perception. Abstracts and journals were reviewed for relevance; reference lists from the obtained articles were also reviewed for any additional pertinent articles. Editorials, review articles, and abstracts were excluded.  This yielded 10 articles that were used for this review.

Medication Adherence and Non-Adherence

The intention of the use of the medications is to treat and cure diseases. However, in some instances, these medications may have adverse effect on patients if used improperly. According to Rocha (2012), the Federal Food, Drug and Cosmetic Act (FDA) provides the Joint Commission with lists of medications that health care providers can safely use to treat their patients. Researchers carry out many rigorous clinical trials to provide these safe and effective drugs. Drousel-Wood et al. (2010) suggested that throughout the clinical trial process, researchers need to keep in mind how difficult it may be for patients to take certain medications and to make every attempt to make them accessible and easy to use.

            Medications are more effective when taken as directed. Patients may fail to follow directions and be noncompliant for different reasons. Although patients may be educated on the importance of adhering to the medication regimen, they may still default. The term medication adherence has been commonly used since the 1970s by researchers and clinicians who need to describe the degree to which the behavior of the patients’ matches certain agreed medication recommendations or clinician’s instructions (Rocha, 2012).

As a case study, medication adherence has been the focus of research due to alarmingly low rates of adherence to prescribed therapies, especially among certain groups of patients. As a result, patients may not achieve anticipated medical progress. According to Dr. Yach, WHO’s Executive Director for Non communicable Diseases and Mental Health, lack of adherence to medication regimen prevents the full health benefits from being achieved (WHO 2012, p. 13). However if patients take the medications as prescribed, they would attain the goals set for improvement of population health.

Adherence problems arise in all situations when patients are required to self-administer the treatments, in particular with such diseases as asthma, diabetes, depression, HIV/AIDS, hypertension, tuberculosis, dependence on narcotic substances and tobacco. In the industrialized countries, on average, the rate of adherence to the prescribed medication therapy is fifty percent (50%), whereas in less developed countries the figures are much lower (Rocha, 2012).

            The manifestations of non-adherence to medication include: patient’s discontinuation of medication use, modification of restrictions and specific instructions, changing dosage amounts,  compromised regularity and/or time interval between dosage perturbing the rhythm and efficacy of the way the prescribed medicine should be taken; inclination to take someone else’s drug for an apparently common symptom, and contraindication of improvised compound of drugs for seemingly identical symptoms (e.g. use of old prescriptions, herbal medicines, drugs prescribed by different healthcare providers, etc…) (Jonathan, 2012).

 

Issues Contributing to Non-Adherence

Multiple factors may affect adherence to prescribed medications and treatment plans. Gilmer et al. (2009) cited the classification of factors of medication adherence suggested by Osterberg and Blaschke. It includes factors that impact both patients and providers. The patient level factors encompass such things as forgetfulness, intentional omission of prescribed doses, other priorities of patients, and emotional factors. As for the provider-level factors, these encompass such things as prescription of the complex regimen of medications, disregard for the lifestyle or economic resources of the patient, failure of the medical staff to explain side effects as well as benefits associated with the prescribed medication, and poor relationships between patients and providers (Gilmer et al., 2009).

            Non-adherence takes place intentionally or unintentionally. Reasons that are classified as intentional relate to personal attitudes, lifestyle choices, perceptions, while the demographic and economic status of people are classified as non-intentional reasons. Sorkin et al. (2008) found that medication non-adherence correlates to a set of factors including, sex, age, health status, as well as annual income. One common factor is chronic diseases. According to the data by WHO (2011), fifty percent of the population who have at least one chronic disease do not take their medications. How did they discover that? This would be a good place to stratify the study in order to collect data pertinent to the number of patients who were involved, their purpose for looking for medical assistance, demographic and socio-economic correlations from either a survey or an interview? Was its statistical significance scientifically compliant?

Across all groups of patients who do not adhere to scheduled ingestion of prescribed medications, age is a significant barrier. With the elderly, the declines in everyday functional capability make it hard for the older people to differentiate between tablet colors, remove child proof lids on medicines, read directions, and swallow the medication (Doggrell, 2010).

Financial problems is a common concern that non-English speaking migrants may face along with the U.S. citizens. Doggrell (2010) found that medicine’s high cost is a key factor why patients cannot procure and adhere to scheduled ingestion of prescribed medications. People who can pay out-of-pocket co-pays tend to be more adhering to medication than those with lower income. Little money prevents people from purchasing adequate medical insurances and use prescribed medicines.

Additionally, medication non-adherence has been found to be impacted by the use of multiple medication prescription. In the study carried out by Beusterien et al. (2008), it was reported that taking multiple medicines to treat every co-occurring medical illness increases the risk of non-adherence to prescribed medication. Pertinent material facts seem to have been omitted, (e.g. how many patients, how was it done, how many did not comply, etc…).Henriques, Costa, &Cabrita (2012) suggested that the elderly populations are not loyally taking their medications due to medical conditions. In cases where the elderly live at home alone, sometimes cause them to not remember if they have taken their medication earlier, later, a contraindicated extra dose, or not taken it at all. The elderly population sometimes have too many medications to take at one time and that could cause them to be involuntarily non-compliant. Quine et al. (2012) put forward that lack of adherence especially in anti-hypertensive medication cause more injuries to the patients and the health care system.

            Furthermore, depressive symptoms have been found as a significant barrier that prevented patients with hypertension from medication adherence (Krousel-Wood &Frohlich, 2009). The depression in these patients is thought to stem from adverse health outcomes, excessive use of healthcare resources, and poor life quality.

Cultural and linguistic barriers have been found to prevent certain minority groups from adequate medication adherence. Minority groups with limited English comprehension and low educational attainment are likely to experience the adverse effects of medication non-adherence most of all. Across all age groups, including the oldest, immigrants without knowledge of English and those for whom English is the second language have very low health literacy and are prevented from adequate medication adherence. For instance, language problems, as well as issues with health insurance coverage are typical barriers for Latino populations. This was confirmed in a study by Tripp-Reimer et al. (2001) in which it was found out that 34% of Latinos lack health insurance coverage and thus have to depend on out-of pocket payments for medications from their unreliable low incomes. They also reported that Latinos among other non-English speakers could not communicate effectively in English and this prevented access to health care.

Literature Review

Taylor et al. (2010) reported that patients of color are likely to suffer from language barriers as well as miscommunication with their healthcare providers, which prevents them from adequate adherence to medication. This is particularly true about Spanish-speaking patients: (51% versus 45%, p<0.05). This was reported on the 2166 Spanish speaking patients out of the 131, 277 patients from the Kaiser Permanente Northern California patients who were studied. The data was collected using probit models to study the effect of patient and physician ethnicity/ race and language adherence to cardiovascular disease medications after the patients’ as well as the physicians’ characteristics were controlled.

            Another factor is the subjects’ experience of having shorter and less primary symptom-centered visits to the physician and potential risk of being negatively perceived by their doctor (Traylor et al., 2010). Thus, negative physician perceptions are an additional factor, which influences how well the physician will assess the intelligence of a patient, will form affiliation towards the patient and shape certain beliefs about the likelihood of risky conduct, and will adhere to medication.

            Gilmer et al. (2009) compared the groups of Latino and Asian immigrants on the basis of their levels of English proficiency and rates of medication adherence.They found that Latino patients who had a higher level of English proficiency were less likely to adhere to schizophrenia medication treatments than those Latino patients with low levels of English proficiency were. On the contrary, among the Chinese patients who were prescribed antipsychotic drugs, those with higher level of English proficiency adhered better those with the lower of the English language knowledge. Besides, Latino and Asian patients with limited English proficiency were likely to be excess fillers. Caucasian patients were the most likely to act as excess fillers (20% vs. 15% for Latinos and 13% for Asians). Further, for both large groups of respondents with different levels of English, the probability of non-adherence increased with age, regardless of language proficiency.                          

Gilmer et al. (2009) found that Latinos with lower English proficiency, who better adhered to prescribed treatments, were less likely to get hospitalized and had better outcomes for their psychotic disorders compared to Latinos with the higher level of English proficiency. However, the researchers do not attribute this outcome solely to the language factors. Instead, they assume that these Latinos have better outcomes because of higher levels of social and familial support. “Family social support may serve as a cultural buffer, and family involvement in the client’s life and treatment plan may improve medication adherence and independently affect service utilization” (Gilmer et al., 2009). The language factor may not be the sole defining factor of medication adherence, but it goes along with familial and social support.

            Renfew et al. (2013) studied which factors acted as barriers to care for the patients of Cambodia origin who had diabetes. In a qualitative study, five focus groups were conducted with three study groups: frontline bilingual Khmer staff, Cambodian immigrants with diabetes, and health care providers. It was found that the quality of care for Cambodians was negatively affected by differences in cultural beliefs as well as barriers to language and health literacy. Psychosocial factors and patients’ fears impacted the quality of healthcare and is a challenge when interacting with the American healthcare system.

            Out of those, language barriers along with low levels of general and healthcare literacy were the key barriers to adherence. Clinicians reported inconveniences of interaction with the help of an interpreter. One cultural barrier that was reportedly important was deference to physicians and the Cambodians’ desire to please them. It was found that adherence to treatment plans was hampered by the psychosocial factors of fear of starvation (which has its roots in mass starvations under Khmer Rouge and prevents the patients from limiting themselves in eating) and close family interaction, where a few generations live in one household. It is hard for grandparents to get out to the healthcare center for a consultation, since they are caregivers to their grandchildren (Renfew et al., 2013).

Additional language barrier factors are the fears and challenges non-English speaking patients face while interacting with the American healthcare system. The Cambodian patients face difficulties when requesting for pharmacy related services especially during medication pickups and refills, which can be attributed to literacy and language barriers. Non-adherence to prescribed medication by non-English speaking patients may happen involuntarily, as a result of mistakes. Other fears include fear of medical procedures and distrust in relations to the clinicians and to the system of healthcare in general (Renfew et al., 2013).

            A special group of studies into the factors impacting adherence levels in patients with low levels of English proficiency targeted the elderly immigrant population of the Vietnamese and Chinese. In particular in the study by Johnson (2012), it was established that the Vietnamese American at the age of 65+ were likely to have poor medication adherence levels because of language barriers, lack of initiative between patients and prescribers to work out an agreement and high level of understanding of prescribed medications, poor health, and low income levels, as well as lack of counseling on the part of healthcare providers, education levels, and reliance on alternative medicine. Eighty-eight percent of the Vietnamese Americans aged over 65 years have little to no English fluency.  Similarly to the results of the previously discussed study into the factors affecting the Cambodian patients, the Vietnamese elderly patients turned out to have poor adherence levels due to their general mistrust in relations to the U.S. doctors and our healthcare as representatives of the Western medicine. Finally, lack of informative health services is a factor that affects the elderly Vietnamese patients’ adherence.

            In the study by Salt & Frazier (2011), the medication adherence barriers were researched with references to patients with rheumatoid arthritis. With this category of patients, medication adherence remains a considerable problem. In a cross-sectional descriptive study, based on self-reported data of 108 research participants, it was found that ethnicity was a crucial determinant of medication adherence: non-Caucasian (Hispanic and African-American) patients were 3-10 times less likely to be adherent to the medication that was prescribed. In addition, to ethnicity, living in remote rural areas was said to be a predictive factor of decrease adherence, along with the need to take multiple medications by prescription.

            Finally, being of Latino origin, with a low level of English proficiency, was found to be a factor of non-adherence among the subjects in the studies of Banta et al. (2009) and Compton, Haack, and Phillips (2010). In the study of Banta et al. (2009), Latino respondents were found to be less likely to adhere to prescribed medications in comparison with other ethnicities. Besides, the factors that affected the level of adherence were non-U.S. citizenship, low level of education, lack of insurance, lack of regular medical care, and younger age. Interestingly, binge drinking was not found to be a barrier to medication adherence.

            The qualitative study by Compton, Haack, and Phillips (2010), focused solely on Latino respondents and was based on the pharmacy in Des Moines, Iowa. It found that cultural influences and the language issue were not significant in preventing the Spanish-speaking respondents from medication adherence. This was explained by the fact that the pharmacy and medical staff who prescribed the medication were bilingual. So the respondents did not face difficulties in dealing with the prescribed medications and talking with the staff. Instead, chronic illnesses were found to be the factor that affected the adherence. Other factors named by the study subjects were “communication issues (i.e., content matter, such as when the prescription was ready), logistics, and limited hours of pharmacy operation as the primary barriers in picking up their medications” (Compton et al., 2010).

Solutions

Just as one of the factors to medication adherence is the language barrier, patients who do not speak English or with limited English proficiency will benefit from translations of medication instructions and detailed explanations of how to use them. Following the experience of the European countries, the United States is recommended to make available the medication information on multiple languages. This can increase medication adherence and will help prevent medical errors (Regenstein et al., 2013).

            Further, based on the study implications from Glenn et al. (2008), the services of interpreters should be made readily available in hospital, given the large percentage of families in the United States with limited English proficiency. Interpreters should be hired as regular, full-time staff or may be reimbursed by the third-party affiliates. Additionally, volunteer help is welcomed. This will make the basis for prevention of medication non-adherence through removal of cultural, communication barriers, barriers to empathic understanding on the part of clinicians and to distrust on the part of the non-English speaking patients. This will help provide the patients with detailed and comprehensible explanations for how to adhere to medication.

            Patients who live in rural and remote areas should be provided with the opportunity to get in touch with the medical professionals. Also, they should be educated by nurses and physicians as to how to take the prescribed drug and how to avoid non-adherence (Salt & Frazier, 2011).

            Involvement of non-English speaking patients in decision-making process as to the prescription of the medication and its application is a predictor of successful adherence. Physicians should be educated as to boost their cultural competence along with increasing health literacy for the patients. Bridging the gap in communication is possible through increasing providers’ cultural awareness of the non-English speaking patients they work with (Renfew et al., 2013).

 

Summary

This paper has provided an overview of multiple barriers to medication adherence faced by non-English speaking patients in the United States. Having carefully analyzed the up-to-date scholarly sources on the issue, key barriers to medication adherence include linguistic and cultural barriers. People with low level of English proficiency (immigrants) have been found less adherent to the prescribed medication, whereas Caucasian patients adhered the best. However, it is important to differentiate between different groups’ of immigrants and the impact of the language factor: Latino patients who are illiterate are more likely to adhere due to the powerful impact of other cultural factors (family and social support). With Asians, everything is different; their non-adherence is proportionate to their level of the English language knowledge.  Moreover, the social factor (family binds) acts as a restrictive force to adherence.

             Cultural barriers have been found to be very important, along with psychosocial factors, fears, distrust, prejudice towards the Western medicine, and of providers’ interest into the perception and approach of the person who is to be prescribed a medication. It has been found that interpreting services in hospitals would help remove the barriers. It has also been found that clusters of factors should be considered when looking into what impacts the adherence. These may include depression, poor health status, need to take numerous drugs, and low income. They are typical for all patients and can often be found in non-English speaking patients. Finally, it depends upon the nature of the illnesses and on the providers’ knowledge of their non-English patients to determine which factors are more impactful. Overall, both parts of the process need to improve their perception of personal accountability for both prescription of and adherence to medication. This should be followed by the practical measures described above.

 

References

Banta, J. E., Haskard, K. B., Haviland, M. G., Williams, S. L., Werner, L. S., Anderson, D. L., &DiMatteo, M. R. (2009). Mental health, binge drinking, and antihypertension medication adherence.American Journal of Health Behavior, 33(2), 158-171.

Beusterien, K. M., Davis, E. A., Flood, R., Howard, K., & Jordan, J. (2008).HIV patient insight conditions.Drugs & Aging, 27(3), 239-254.DC: U.S. Government Printing Office.

Doggrell, S. A. (2010). Adherence to medicines in the older-aged with chronic conditions.Drugs & Aging, 27(3), 239-254.

Drousel-Wood, M., Muntner, P., Islam, T., Morisky, D., & Webber, L. (2009). Barriers to and determinants of medication adherence in hypertension management: Perspective of the cohort study of medication adherence among older adults (CoSMO). Medical Clinics of North America, 95(3), 753-769.

Flores, G., Torres, S., Holmes, L. J., Salas-Lopez, D., Youdelman, M. K., &Tomany-Korman, S. C. (2008). Access to hospital interpreter services for limited English proficient patients in New Jersey: A statewide evaluation. Journal of Health Care for the Poor and Underserved, 19(2), 391-415.

Gilmer, T. P., Ojeda, V. D., Barrio, C., Fuentes, D., Garcia, P., Lanoutte, N. M., & Lee, K. C. (2009).Adherence to antipsychotics among Latinos and Asians with schizophrenia and limited English proficiency.Psychiatric Services, 60(2), 175-182.

Henriques, M., Costa, M., &Cabrita, J. (2012).Adherence and medication management by the elderly.Journal of Clinical Nursing, 21(21/22), 3096-3105.

Jonathan, N. (2012). Adherence to medications among Vietnamese Americans 65 years of age and older.California State University Master’s Thesis.Retrieved from ProQuest database.

Krousel-Wood, M.,&Frohlich, E. (2010). Hypertension and depression: Co-existing barriers to medication adherence. Journal of Clinical Hypertension, 1(7), 481-486.

Regenstein, M., Andres, E., Nelson, D., David, S., Lopert, R., & Katz, R. (2012).Medication information for patients with limited English proficiency: Lessons from the European Union. The Journal of Law, Medicine, and Ethics, 40(4), 1025-1033.

Renfrew, M. R., Taing, E., Cohen, M. J., Betancourt, J. R., Pasinski, R., & Green, A. R. (2013).Barriers to care for Cambodian patients with diabetes: results from a qualitative study. Journal of Health Care for the Poor and Underserved, 24(2), 633-655.

Steadman, L., Thompson, S., &Rutter, D. R. (2012). Adherence to anti-hypertensive medication: Proposing and testing a conceptual model. British Journal of Health Psychology, 17(1), 202-219.

Traylor, A. H., Schmittdiel, J. A., Uratsu, C. S., Mangione, C. M., & Subramanian, U. (2010). Adherence to cardiovascular disease medications: Does patient-provider race/ethnicity and language concordance matter? Journal of General Internal Medicine, 25(11), 1172-1177.

Tripp-Reimer, T., Choi, E., Kelley, L. S., &Enslein, J. C. (2001). Cultural barriers to care: Inverting the problem. Diabetes Spectrum, 14(1), 13-22.

 

Published in Health essays
Sunday, 05 December 2021 08:14

Proposal: Moller & Maersk (M&M) Group

 

Proposal: Moller & Maersk (M&M) Group

 

Abstract

Even though Moller & Maersk Group currently operates in over 130 countries across the globe with five core businesses namely Maersk Line, APM Shipping Services, APM Terminals, Maersk Drilling, and Maersk Oil, it is notable that it faces a number of challenges. Even with the understanding of the importance of human resources in an organization, Maersk Group is faced with a number of challenges in human resource management. The talent management issues according to Maersk Group that need to be addressed are increased employee turnover, increased employee diversity, internal training and development programs, rehiring previous employees, and hiring experienced employees from the external labor market. These problems can easily be resolved using cloud-based human capital innovation applications. Cloud innovation alludes to a type of processing where numerous gatherings of remote servers are organized with a specific end goal to encourage incorporated information preparing and stockpiling that gives online access to PC frameworks, assets, and administrations. The essay below explains how cloud-based human capital innovation applications would be applied to solve the HR problems, how it would be implemented, the expected benefits, and recommendations. 

Brief Company background

Moller & Maersk (M&M) Group was founded in 1904 in the Danish City of Svendborg. It currently operates in over 130 countries across the globe. It has five core businesses namely Maersk Line, APM Shipping Services, APM Terminals, Maersk Drilling, and Maersk Oil. The core values in the company that guide the way business is done are constant care, the name, the employees, humbleness, and uprightness. The company policies and core values work together to guide how each business unit as well as how the employees engage with the customers, with the suppliers, colleagues, and the entire community.

Discussion of business problem(s)

Human resources are very important assets in an organization. This is not the era in which human resources were considered objects that could be ordered around. All the activities and tasks in organizations are carried out by human resources. Irrespective of the size of the organization as well as the extent of the resources, the organization succeeds as a result of the performance and capabilities of the people who are the employees. The human resource function in an organization incorporates several activities including the staffing needs the organization has and how to fulfill them, recruitment and training strategies to have the top talents, handling performance issues, and ensuring that the human resource practices conform to the stipulated regulations (Ofori, Sekyere-Abankwa&Brquaye, 2012).

Organizations are required to ensure that human resources continue to be productive assets for the organization. This is done through training and development in which the employees are equipped with the necessary skills that will enable them perform their tasks effectively and to satisfactory levels. Even with the understanding of the importance of human resources in an organization, Maersk Group is faced with a number of challenges in human resource management. The talent management issues according to Maersk Group that need to be addressed are increased employee turnover, increased employee diversity, internal training and development programs, rehiring previous employees, and hiring experienced employees from the external labor market.

 

High level solution

Even with these evidenced challenges, Maersk Group has to have the right talents in the right job at the right time. However, this does not mean that the company should always be losing top talents and hiring new fresh employees from colleges. There is thus need of the company coming up with a training and development program that would help solve the identified human resource issues. Even though there are different ways of ensuring effective training and development programs in organizations, the cloud-based human capital innovation applicationsis among the best. This model has major phases that make the training and development program easy to plan and implement. This is because the training and development program should not only align with the goals of the organization but also with the learning needs of the employees who will participate in the training program (Taylor&Asburry, 2011).  

            Even though all employees in an organization are important, there are some who are critical to others because of their indispensable nature. This is based on the fact that some employees are hard to replace and leaving the organization is a big blow. It is easy to replace the junior employees because their assigned tasks are general and less complicated and new employees can easily learn them. This is not the same case for top managers who require not only the knowledge and skills learned in schools but also the experience that is earned by working in a certain organization (Alagaraja, 2013). These are some of the challenges Maersk might be exposed to as a result of increased employee turnover. Increased employee diversity is also a great challenge to the organization since if not effectively managed, the organization might evidence conflicts. However, with effective management of employee diversity, Maersk would benefit from the advantages of diversity such as varying skills/ talents.

As a result of changes in technology, there is also need of an effective training and development so that they do not get obsolete. With changes in technology, employees should be trained to be conversant with the applied technologies in the organization. Maersk also requires a hiring, training, and development program that will enable it hire experienced and skilled talents from the labor market. This is possible with cloud-based human capital innovation applications (Leavitt, 2009). Maersk should be able to hire and retain top talents by matching them with the right jobs. This also requires rehiring previous employees who have maybe left and become more skilled and experienced in the same positions they held or even in higher positions. The main aim of the developed training and development program is to have the best talents who match the assigned tasks and thus report excellent results. 

Cloud innovation alludes to a type of processing where numerous gatherings of remote servers are organized with a specific end goal to encourage incorporated information preparing and stockpiling that gives online access to PC frameworks, assets, and administrations. Mists can either be private, open, and crossover. Because of this, it turns out to be clear that human capital innovation that is cloud-based includes the sharing of diverse HCM applications between a few clients (Heisterberg&Verma, 2014).

The tasks of the HR manager include handling all HR issues in the organization including hiring the right talents for each job so that they perform the assigned tasks satisfactorily. The HR manager should ensure that the hired employees are trained to fulfill their learning needs. This is beneficial for the organization as employees would be able to perform the assigned tasks effectively and efficiently, meeting targets and standards. With the cloud-based human capital innovation applications, employees would be able to use the applied technology in the organization to achieve the set objectives of the firm through improved performance and productivity (Bidgoli, 2010). The expected constraints include limitation of non-human resources and a strict timeline. The cloud-based human capital innovation applicationswould thus help in decreasing employee turnover rates, increasing and understanding employee diversity, increasing rehiring of previous employees, and attracting the best talents from the labor market.

Benefits of solving the problem

In the course of recent decades, the part of HR has confronted various weights and subsequently is quickly evolving. Due to this, the part of HR is relied upon to give customary operational and staff benefits too suspect, react to particular, and key business needs. As of now, there is a major test that human asset proficient face and that is the test of addressing business needs utilizing an innovation that is as a part of quick change. Cloud-based human capital innovation applications have presented new channels that can help HR experts change HR to be an administration supplier as well as a corporate counsel. By continually adopting cloud-based human capital applications, it will become easier to deal with ongoing personnel issues, eliminate inefficient processes, increase profitability, and improve corporate communications (Taylor&Asburry, 2011).

In the later past, it has turn out to be clear that these common applications have the capability of giving various advantages to all clients that prompts the expansion of business results. Because of this combination, it turns out to be clear that HR offices and IT divisions cannot be isolated any longer in the wake of this innovation that looks to join their capacities to facilitate business needs and operations. Along these lines through these applications organizations will have the capacity to convey better information, increase the value of items and administrations, and in addition be more vital in their business operations. Through these applications and given the way that the innovation is still experiencing significant change then we expect or foresee real changes in administration procedures for ability, hierarchical structure, ways to deal with danger administration, and capital speculation choices (Leavitt, 2009).

From this discernment, it is clear that HCM applications that are cloud-based will help CEOs to select and hold the most skilled representatives. This will be based on the grounds that the information they gather utilizing these applications goes about as a type of insight that empowers the scout to survey a man’s inward ability given their obligations in light of their intrigues, certificates, and skill. In this way cloud-based, human capital innovation gets more adaptability to the business environment that empowers successive development, improvement of portable access, appropriation of basic achievement components, and parity secrecy that will accompany better social procedures (Heisterberg&Verma, 2014).

Business/technical approach

With strategic HR goals aligned with the organization mission and vision, Maersk is likely to succeed. This is supported by Mohammed, Bhatti, Jariko and Zehri (2011)when they argue that human resources are the resources in delivering organizational services. This training and development programs would help the organization with plans to meet current and future human resource needs in order to succeed. Strategic human resource management helps in ensuring that human resource management decisions support the organization’s future direction, which is ensured by having employees who up to date with the current technology. The cloud-based human capital innovation applications at Maersk should also ensure that the organization keeps up in pace with social, technological, economic, and legislative trends that are linked to human resources so that the organization remains flexible and ready for change if the future is not as expected.

            According to Ali(2013),the cloud-based human capital innovation applicationsshould aid the training and development program to be in such a way that it helps in predicting the future human resource management needs after considering the current human resources of the organization, the labor market, and the future human resource environment the organization will be involved in. It is also through the program that Maersk will be able to effectively analyze human resource management issues that are external to the environment. As noted by AlYahya, Mat and Awadh (2013), a training and development program helps an organization determine where it is headed, the human resource strategies required to help the organization get the planned destination, and the skill sets required for the move.

Business process changes

The cloud-based human capital innovation applications should be concerned with different human resource initiatives including recruitment, talent nurturing, compensation and reward, training and development, and performance management among others. The compensation and reward function would ensure that the organization designs and administers compensation benchmarking as well as competency/ function based compensation strategies. This function should also create benefit programs that attract and make employees committed to their jobs. This package includes salaries, vouchers, bonuses, medical insurance, life assurance, commission, dental plans, company cars, profit sharing, and pensions among others. Through the cloud-based human capital innovation applications, there is right compensation to the right talents at the right time. This implies that employees are assured of adequate compensation for the services they offer to the organization (Alagaraja, 2013), which increases satisfaction decreasing turnover rates. The hard-working employees in this case are rewarded fairly and in an effective manner resulting to motivation and increased performance of the employees. With effective compensation and reward scheme for the company, the cloud-based human capital innovation applications helps in recruiting, retaining, and motivating employees as well as attracting new talents to the organization.

Technology or business practices used to augment the solution

The identified problems at M&M Group would be resolved using the cloud-based human capital innovation applications. It is expected that the cloud-based human capital innovation applications helps managers work together with the employees to monitor, plan, and review the contribution of the employees to the organization. This way, the organization management is able to set objectives for the employees, assess their progress, and provide continuous coaching/ training and feedback so that employees are meeting their career goals. This function is meant to ensure that employees’ effectiveness is promoted and improved. Further, it would be ensured that the jobs are well-designed, there are clear written jobs descriptions, employees are effectively supervised, the employee training and orientation is comprehensive, and the work environment is supportive and positive (Ofori, Sekyere-Abankwa&Brquaye, 2012).

The cloud-based human capital innovation applications should be designed in such a way that it helps in predicting the future human resource management needs after considering the current human resources of the organization, the labor market, and the future human resource environment the organization will be involved in (Bidgoli, 2010). It is also through the program that Maersk will be able to effectively analyze human resource management issues that are external to the environment.

Conclusions and overall recommendations

This program is also a major component for Maersk since it ensures that the organization is able to hire the best talents for any job position in a timely and cost-effective way. The recruitment process according to Anyadike (2013) involves analysis of the job requirements, attracting the right talents for the identified position, screening the probable candidates, hiring the best candidate, and integrating the hired employee to the position and to the entire organization. Training and development on the other hand is noted as a function that betters the performance of individual employees to ensure increased productivity of the organization. Talent nurturing is also an important function for training and development programs and is meant to ensure that the organization has the best talents and these talents are retained in the organization.                    

The reactions of the employees should be positive for the program to be regarded successful. The employees involved in the training and development program should also prove that they have learned what was required as evidenced through their behavior in the work place. The organization-level results would also evaluate the program (Bidgoli, 2010). With reduced turnover rates and increased retention as well as attraction of the top talents from the top market, it would be evident that the program is effective. 

High-level implementation plan

After the HR issues faced in the organization are identified and the            learning objectives set, the next step would be the training program of few selected senior employees in the organization to test the planned training and development program that should be applicable to all the employees. The next step would be the implementation process as the tested program is employed in the entire organization. The implementation process would start with identification of the implementation team. This would be done with a project team comprising or organization members as well as the external aid of experts in the field. Maersk would hire the help of a HR personnel expert who would help in implementing the training and development program. He would help to ensure that the learning needs of each employee are identified and addressed appropriately. He would also foresee arrangement of how employees would get time off work to get into formal education to improve their skills and match with advancing technology. The expert would work closely with the HR team selected from the company.    

Summary of project

Notwithstanding the way that the appropriation of this innovation has its merits, it is essential to guarantee that the procedure of reception is the right one to forestall future difficulties. In addition, it is important to note that the use of these applications will help the senior managers, suppliers, customers, and general employees to experience a better business atmosphere because these applications will help to make service delivery easier. Employees will also have more time to do other chores, as their workloads will be reduced. This in turn will lead to increased business efficiency. Employees would be satisfied with their responsibilities and this increases retention of existing and attracting of new talents, which is beneficial to the company. 

 

 

References

Alagaraja, M. (2013). The strategic value and transaction effectiveness of HRD: A qualitative study of internal customer perspectives. European Journal of Training and Development, 37(50, 436-453.

Ali, A. (2013). Significance of human resource management in organizations: Linking global practices with local perspective. Journal of Arts, Science & Commerce, IV(1), 78-87.

AlYahya, M. S., Mat, N. B., &Awadh, A. M. (2013). Review of theory of human resources development training (learning) participation. Journal of WEI Business and Economics, 2(1), 47-58.  

Anyadike, N. (2013). Human resource planning and employee productivity in Nigeria public organization.Global Journal of Human Resource Management, 1(4), 56-68.

Bidgoli, H. (2010). The handbook of technology management. Hoboken, N.J: John Wiley & Sons.

Heisterberg, R. J., &Verma, A. (2014).Creating business agility: How convergence of cloud, social, mobile, video, and big data enables competitive advantage. New Jersey: Wiley.

Leavitt, N. (2009). Is Cloud Computing really ready for prime time?Retrieved from http://www.hh.se/download/18.70cf2e49129168da0158000123279/1341267677241/8+Is+Cloud+Computing+Ready.pdf.

Mohammed, J., Bhatti, M. K., Jariko, G. A., &Zehri, A. W. (2011). Importance of human resource investment for organizations and economy: A critical analysis. Journal of Managerial Sciences, VII(1), 127-133.

Ofori, D. F., Sekyere-Abankwa, V., &Brquaye, D. B. (2012). Perceptions of the human resource management function among professionals: A Ghanaian study. International Journal of Business and Management, 7(5), 159-178.

Taylor, J., &Asburry, L. (2011).How Cloud-Based human capital management can impact business results.Retrieved from http://thecloud.appirio.com/rs/appirio/images/Appirio_Cloud-Based_HCM_White_Paper.pdf.

 

Published in business
Sunday, 05 December 2021 08:13

cloud based human capital technology

cloud based human capital technology

In the course of recent decades, the part of HR has confronted various weights and subsequently is quickly evolving. Due to this, the part of HR is relied upon to give customary operational and staff benefits too suspect, react to particular, and key business needs. As of now, there is a major test that human asset proficient's face and that is the test of addressing business needs utilizing an innovation that is as a part of quick change. Cloud-based human capital innovation applications have presented new channels that can help HR experts change HR to be an administration supplier as well as a corporate counsel. By continually adopting cloud-based human capital applications, it will become easier to deal with ongoing Personnel issues, eliminate inefficient processes, increase profitability, and improve corporate communications.

Investigation

Cloud innovation alludes to a type of processing where numerous gatherings of remote servers are organized with a specific end goal to encourage incorporated information preparing and stockpiling that gives online access to PC frameworks, assets, and administrations. Mists can either be private, open, and crossover. Because of this, it turns out to be clear that human capital innovation that is cloud-based includes the sharing of diverse HCM applications between a few clients.

In the later past, it has turn out to be clear that these common applications have the capability of giving various advantages to all clients that prompts the expansion of business results. Because of this combination, it turns out to be clear that HR offices and IT divisions cannot be isolated any longer in the wake of this innovation that looks to join their capacities to facilitate business needs and operations. Along these lines through these applications organizations will have the capacity to convey better information, increase the value of items and administrations, and in addition be more vital in their business operations. Through these applications and given the way that the innovation is still experiencing significant change then we expect or foresee real changes in administration procedures for ability, hierarchical structure, ways to deal with danger administration, and capital speculation choices.

From this discernment, it is clear that HCM applications that are cloud-based will help CEOs to select and hold the most skilled representatives. This will be based on the grounds that the information they gather utilizing these applications goes about as a type of insight that empowers the scout to survey a man's inward ability given their obligations in light of their intrigues, certificates, and skill. In this way cloud-based, human capital innovation gets more adaptability to the business environment that empowers successive development, improvement of portable access, appropriation of basic achievement components, and parity secrecy that will accompany better social procedures.

Conclusion

Notwithstanding the way that the appropriation of this innovation has its merits, it is essential to guarantee that the procedure of reception is the right one to forestall future difficulties. In addition, it is important to note that the use of these applications will help the senior managers, Suppliers, Customers, and general employees to experience a better business atmosphere because these applications will help to make service delivery easier. Employees will also have more time to do other chores, as their workloads will be reduced. This in turn will lead to increased business efficiency.

 

 

Published in Management

 

Income, Size, Number of Years and Credit Balance

introduction

This analysis aims at analyzing the variables income, credit balance and number of years. The analysis aims at establishing the relationship between these variables including the effect of number of years and credit balance on income and the effect of years on credit balance. Results inchoate a strong relationship between income and credit balance, also a strong relationship between income and number of years. However there is a very weak relationship between number of years and credit balance. The following is the analysis using Minitab.

Income:

Central tendency

The income variable is quantitative; the following table from Minitab is a summary of the data:

Descriptive Statistics: Income ($1,000)

 

 

Variable          N  N*   Mean  SE Mean  StDev  Variance  Minimum     Q1  Median     Q3

Income ($1,000)  50   0  46.02     1.96  13.88    192.75    25.00  33.00   44.50  57.25

 

                                                        N for

Variable         Maximum  Range    IQR            Mode   Mode  Skewness  Kurtosis

Income ($1,000)    74.00  49.00  24.25  30, 33, 54, 57      3      0.26     -1.09

 

From the table, the mean income level is 46.02, the median value is 44.50 while the mode value is 57. In normal distributions, these values are usually equal and this therefore means that this variable is skewed as shown in the histogram below:

 

The graph above indicates that income is positively skewed, this is also evident from the table whereby the Skewness value is 0.26.

Income Dispersion:

Values that indicate dispersion include standard deviation, minimum, maximum and range. The standard deviation value is 13.88 which mean that income deviates 13.88 units from the mean. The minimum value is 25 whereas the maximum value is 74, this indicates and range of 49 meaning that income is highly dispersed.

Number of years:

The Number of year’s variable is quantitative; the following table from Minitab is a summary of the data:

Descriptive Statistics: Years

 

 

Variable   N  N*   Mean  SE Mean  StDev  Variance  Minimum     Q1  Median      Q3  Maximum

Years     50   0  9.600    0.641  4.531    20.531    1.000  6.000  10.000  13.000   19.000

 

                               N for

Variable   Range    IQR  Mode   Mode  Skewness  Kurtosis

Years     18.000  7.000    10     10      0.06     -0.54

 

From the table, the mean Number of year’s is 9.6, the median value is 10 while the mode value is 10. In normal distributions, these values are usually equal and this therefore means that this variable is almost normally distributed given that these values are almost equal, the histogram below indicates this:

 

The graph above indicates that the number of years variable is almost normally distributed, this is also evident from the table whereby the Skewness value is almost zero at 0.06.

Number of years Dispersion:

The standard deviation value is 4.531 which mean that number of years deviates 4.531 units from the mean. The minimum value is 1 whereas the maximum value is 19, this indicates and range of 18 meaning that number of years is not highly dispersed.

Credit balance:

The Credit balance variable is quantitative; the following table from Minitab is a summary of the data:

Descriptive Statistics: Credit Balance($)

 

 

Variable            N  N*  Mean  SE Mean  StDev  Variance  Minimum    Q1  Median    Q3

Credit Balance($)  50   0  4153      132    932    868430     2047  3292    4273  4931

 

                                               N for

Variable           Maximum  Range   IQR  Mode   Mode  Skewness  Kurtosis

Credit Balance($)     5861   3814  1638  4073      2     -0.15     -0.72

 

From the above table, the mean Credit balance is 4153, the median value is 4273 while the mode value is 4073. These values indicate that Credit balance is skewed, the histogram below shows this:

 

The graph above indicates that Credit balance is negatively skewed, this is also evident from the table whereby the Skewness value is almost zero at -0.15.

Variable            N  N*  Mean  SE Mean  StDev  Variance  Minimum    Q1  Median    Q3

Credit Balance($)  50   0  4153      132    932    868430     2047  3292    4273  4931

 

                                               N for

Variable           Maximum  Range   IQR  Mode   Mode  Skewness  Kurtosis

Credit Balance($)     5861   3814  1638  4073      2     -0.15     -0.72

 

Credit balance Dispersion:

The standard deviation value is 932 which mean that Credit balance deviates 932 units from the mean. The minimum value is 2047 whereas the maximum value is 5861, this indicates and range of 3814 meaning that Credit balance is highly dispersed.

 

Pairing of variables

Income versus number of years:

A scatter plot will aid in identifying the relationship that exists between Income and number of years, the following is a scatter plot using Minitab for these variables:

 

The graph indicates a strong positive relationship between Income and number of years, as the number of years increase, income also increases.

Income versus number of years R squared and regression:

The R squared shows the relationship between Income and number of years, the R suared value for these two variable is 33.5%, this value indicates a weak relationship between the variables, this value also means that number of years explain 33.5% of changes in income. The regression results are as follows:

Income = 28.98 + 1.775 years

This regression means that as the number of years increase by 1 unit, then income will increase by 1.75 units.

 

Income versus credit balance:

A scatter plot will aid in identifying the relationship that exists between Income and credit balance, the following is a scatter plot using Minitab for these variables:

The graph indicates a strong positive relationship between Income and credit balance, as the credit balance increase, income also increases.

 

Income versus credit balance R squared and regression:

The R squared shows the relationship between Income and credit balance, the R squared value for these two variable is 64.1%, this value indicates a strong relationship between the variables, this value also means that credit balance explain 64.1% of changes in income. The regression results are as follows:

Income = -3.516+ 0.01193 credit balance

This regression means that as the credit balance increase by 1 unit, then income will increase by 0.01193 units.

Number of years versus credit balance:

A scatter plot will aid in identifying the relationship that exists between Number of years and credit balance, the following is a scatter plot using Minitab for these variables:

 

The graph indicates a very weak relationship between years and credit balance, however as the years increase, credit balance also increases.

Number of years versus credit balance R squared and regression:

The R squared shows the relationship between years and credit balance, the R squared value for these two variables is 2.1%, this value indicates a very weak relationship between the variables, this value also means that years explain 2.1% of changes in credit balance. The regression results are as follows:

Credit balance = 3864+ 30.15 years

This regression means that as the years increase by 1 unit, then income will increase by 30.15 units.

Conclusion:

From the above analysis, it is evident that credit balance can be used to predict the level of income, also the number of years can also be used to predict the level of income. However due to the weak relationship between number of years and credit balance, it is evident that number of years will be a poor predictor of credit balance.

Published in Statistics analysis

 

David Ives’ “Sure Thing”: Ideas on Courting and Relationships

Sure Thing is a very short comic play by David Ives focusing on a chance meeting between people, Bill and Betty. The conversation between the two is reset by the ringing bell that manages the conversation to start all over again until a positive response is given. The play starts in a café where Bill finds Betty seated and wants to sit next to her as he asks “is this chair taken?” only to be informed that the seat next to her is occupied. After the bell rings, the second response for the same question is that the seat is not occupied but Betty is expecting someone in a short while. The bell rings again severally until the fifth response for the same question is that Bill can have the seat. For this question, the bell rings every time Betty gives a negative response to the question and only stops the time Betty allows Bill to take up the seat. In this case, it is evident that the bell is a buffer against all barriers to building their relationship as it rings every time a negative response to a question is given (Ives). Considering the ideas presented by David Ives in this short play, it is evident that they are comparable to the ideas present in the time period we live in now.

To start with, the manner in which Betty and Bill start the interaction is similar to the way people in today’s society start before a relationship builds up. Betty does not want to accept that she is lonely and would wish to have company. Even though she is seated alone at the café pretending to read and wait for someone, she is in fact waiting for no one. Nevertheless, she pretends to be waiting for someone or even with someone who she argues is occupying the seat next to her. This is similar in the way people interact at first in today’s society. It is not possible for people to create a direct relationship during the first meeting. This is the reason some people argue that some parties and especially women are playing hard to get with their ‘no’ meaning ‘yes’. It is not expected that a woman would easily interact with a male stranger in the name of forming relationship. In fact, it is possible that women and men would meet in functions such as weddings, exchange their contacts, and have one of the parties argue that she deleted the phone number of the male stranger (Pramaggiore and Tom 24).

Similarly, after playing hard to get, in both the film and in the real society today, the two parties end up together. Many of the relationships made today are not of people who knew each other since they were young. After the first meeting or interaction in public places or during functions, the strangers would exchange their contacts. Even though Betty starts arguing that she is waiting for someone and later that she wants to read her book in silence, she eventually gives in to Bill’s requests. Bill is after building up a relationship and would only rest when this is achieved (Ives). This is the same manner in which women behave today. They would argue to be attached or in relationships but after serious insisting by the men, they would eventually give in. It is also possible for women to start by arguing that they are not interested or ready for relationships. However, this change after men’s insisting. 

In the same manner Bill makes the tirelessly efforts to have Betty, men in today’s society are the ones who tirelessly follow women after their first interaction. In today’s society, after a man and a woman exchange their contacts after their first encounter, a woman would most probably delete or ignore the given contacts. However, men would not probably delete the contact if they had the intention of building a relationship. The man would tirelessly contact the woman and until he ensures that she gives in. This is the same way Bill makes the tireless efforts. Even though not through anyexchanged contacts, Bill persistently persuades to be allowed to occupy the seat until Betty does so. He also continuously nags the woman until she agrees to be in a relationship with him and share her life with him. When Bill asks, “and you will love me?” Betty responds, “Yes”; again Bill asks, “And cherish me forever?”, and Betty agrees (Ives). This is an indication that Bill has pushed his motives to the extent that he gets what he is after. This is the same way men in today’s society would not give up easily. They are not likely to agree that a woman means ‘no’ when she says so. Most men and especially the serious ones would rest after they achieve their goals.

It is also notable that wealth and status are important factors both in the play and in today’s society. Before Bill and Betty agree that they do not value each other’s wealth and status, it is evident that they consider it important at first. When Betty asks Bill where he went to college, Bill responds, “I went to Oral Roberts University”. The bell rings and the same question is repeated. This time Bill says that he went to Harvard (Ives). Changing the response shows that Bill is likely lying. It might be possible that he has never been to any college or if he was, he feels that he was at a lesser college than Betty might want and thus chooses the name of a big university. This is an indication that education, which amounts to status is highly valued in the society. Bill feels that Betty might not be interested in a man who has never been to school. He feels that Betty wants a man of high status and thus pretends to be educated.This is the same way people are in today’s society. A person would not get into a relationship before considering the social status of the other. It is argued that women consider the pockets of the men more. When people get married, they need money for their upkeep and this cannot be provided by the love they share. They and more so, the man should be able to provide for the family.

Every time the bell in the play rings, it signifies a chance to do-over. There are present day equivalents in dating and relationships even this is done differently. In the play, every time a bell rings, it is time to repeat the earlier done conversation to see whether Betty can give a different response. It is notable that the bell rings only when Bill does not get a positive response, which is what he is looking for. This is an indication that Bill has to start over the conversation all over. Once he gets the response he is after, the conversation changes. This is similar to today’s dating and relationships even though it is done differently. It is likely that a man would get a negative response every time he gets a negative response. This implies that the man should change his approach. If he had got a negative response after a phone call, the man should try inviting the lady for coffee. Getting a negative response during a coffee date can require the man to try inviting her to the movies(Pramaggiore and Tom32).      

Even though women might play hard to get as Betty does, not in the manner she does so. While Betty does not allow Bill to have a seat in the first place, women in today’s society are likely to share seats in a cafés, as they travel, and in other public places. Women today are not likely to give rude responses as Betty does. If a man makes advances to an available or lonely woman, it is likely that the woman would respond in a better manner. A good example is when a woman and a man meet in at a wedding. The man seated next to a woman at the wedding might ask for the woman’s contacts, which the woman would most probably provide. It is not necessarily that the man makes declares his intentions immediately. However, with the contacts, he might make follow-ups in which he ensures that he manages a first coffee invitation and later a dinner before an invitation to the movies. After several meetings, the man would then declare his intentions to the woman who might ask for time to think about it before she makes a final decision, which she might have already made but afraid of communicating(Pramaggiore and Tom11).

How people behave in today’s society is different from Betty’s behavior. She should not assume she knows why Bill is asking for the seat next to her. Since it is a café where everyone has a right of entry, Betty should not refuse sharing a seat with Bill. Since she is waiting for no one, she should agree to have the seat occupied by Bill the first time he asks for it. She should also be rude when asked for anything by Bill. In fact, she should respond to greetings. This means that how Bill and Betty behave is different from how people behave in today’s society. A woman would not fail to share a seat with a stranger simply because she does not know him(Pramaggiore and Tom19). A woman would normally share a seat with a male stranger anywhere and even share a small chat.

It is also different the manner in which Bill approaches Betty from the way men approach women in today’s society. Even though a man is after a relationship, he would not directly show it during the first encounter. When Bill meets Betty, it is evident that he is after something. This is the reason he keeps on asking for the seat next to her despite the several times Betty gives negative responses. Even though Betty puts it clear that he does not want to be involved in any conversation as she says that she is waiting for someone and the next time she wants to read her book in silence, Bill still insists to engage her in a conversation (Ives). This is different in today’s relationships. After a woman proves difficult during the first meeting, the man should not insist until she gives in. Even though the man might be interested in building up a serious relationship, he should not show it during the first meeting. He should evidence that he respects the woman and her decisions.

Just as it is in the play, people tend to have similar likes and dislikes after they start dating. This is evidenced in the film. Before the two get into a relationship, Betty and Bill seem to be so different in their likes. At first, Betty cannot even stand Bill seated next to her. After she allows him to sit next to her, she wants to be left alone to read her book. When Bill asks her about the book she is reading, it is evident that Bill has never read it and does not even like it. Bill argues that it is written by Hemingway and the next time it is by Faulkner implying that he does not know it. Later, it is evident that both Bill and Betty share the same likes. A good example is when Betty asks Bill if he loves Faulkner and he agrees saying that he is incredible and he “was so excited after ten pages that I (he) went out and bought everything else he wrote”. At first, Betty argues that “it’s pretty boring” (Ives). The next time, she agrees that she also went and bought everything he had written. This is the point in time in which their likes are becoming similar.

This is the same way people’s likes get similar the moment they start dating. While a woman might be interested in soap operas and the man in football, it is possible to find both watching a football match. It becomes apparent that the two support each other in their likes when no one is forced to love what the other does. For instance, a woman would support the football team the man does and would even start learning the players while initially she despised football. However, in most cases, the woman is forced to sacrifice her likes to like those of men. Most women in today’s society are naïve and would take a man for what he is not. When a woman falls in love, she is blinded by that love that she cannot see the faults in her man. Women as noted by Pramaggiore and Tom(27)are likely to enter into relationships with false hopes and stupid expectations that make them withstand unbearable faults in men. Even with the challenges a woman faces in her relationship, she would still hope that she can change her man. This is different from Bill and Betty who agree on the same things as evidenced in the play.

The play has several similarities and differences to the relationships in today’s society. Bill and Betty depict how people start dating. It shows how a woman plays hard to get at the initial stages even when her ‘no’ means ‘yes’.

 

 

Works Cited

Ives, David. Sure Thing All in the Timing: Six One-act Comedies, Dramatists Play Service, Inc., 1994.

Pramaggiore, Maria, and Tom Wallis.Film: A Critical Introduction. London: Laurence King, 2005. Print.

 

 

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