Experts opinion Essay Example for Free

Experts opinion Essay After reading four of experts opinion, their views can be separate into two. Katherine Franks view and advice seems different from three of others which she thinks Galen was doing a good job whereas the other three are thinking of firing him.  John Brown, who is the director of institutional sales and customer relation at Fortis Investments in Boston, has mainly two points: The boss should outline the clear value and principle of business outgoing and how the value system of the organization integrates with employee and clients. He does agree with build business relationship and trust step by step by using acceptable tactic. There are many other ways can be used in business rather than do something unethical. And be aware the feeling of client for every process during the business, a special gift or sweet regards on the holiday helps the business gaining high marks. Also pay attention of what is the clients religious beliefs or any special need and what may be downright offended of them. Denise Rousseau is a professor in both Carnegie Mellons Heinz School and Tepper School of business in Pittsburgh. Both John Brown and Denise think that value system is very important and considerable factor in business. She advises the Bob to stop Galens job then find some new sale man who can follow the rule. She has also mentioned the aspect of female employees benefit. A good company should create a fair and positive environment for employee to work and do not feel any discrimination in the working. Other wise, sex discrimination can cause a risk of reputation of the company. We always can see that female employee go to the court with the company for their deserved right and benefit. Also the company will pay attention of this sensitive topic for the long term development. Another professor is Das Narayandas from Harvard business school in Boston. His idea is mostly similar with the previous experts. He looks the problem in a serious way that Bob has been holding as a hostage by Galen and Bob need to turn the situation into his way. He thinks the biggest mistake is from the CEO Bob. Also Galen may use the company money to satisfy his own need. I do agree with this view: all the problem is from the leader. Bob need to reform and set up new corn value system of the company and also pass his idea and organization culture to all the employees. And newest concept is the service is important as the product and buyer will focus on the other aspects of company also. Katherine Frank thinks that things like go to stripe club is acceptable in business and two-person sales group would make everyone feel comfortable. She has also indicated that going to strip club can make some customer feel special and relax but not a useful way to generate business because no data can improve that any contract is signed in the club. And also makes some customer feel slightly aberrant and titillating environment. So she does not against to go to strip club but have some doubt of this business tool. How should Bob Turn His Company around? The OptiMotors Industry case reflects to several critical issues that manager must undertake sales management, especially heightening ethical selling. After reading experts comments and arguments and according to the professional reference, Several Advices have been given in below, includes reformation of sales department and improvement of internal competitive advantages.  According to The Harvard business review article How low will you go (2006), and due to prevention of sell man Galens poisonous selling who had taken his client into a stripper club in order to make a important sale, three of four experts in the article think that he should be fired. As it is a serious ethical problem, and this kind of problem seems small at first, or even it brings profit for company, however if it happens in long term cooperation , it would be found one day anyway, and at that time, if the scandal is disclosed, it would be a disaster for Optimotor, which could lead company to a break down result. Therefore, we are taking the expertise (fire ethical seller Galen) as the first step for Bobs auto parts company, in order to appease the debate among sale staffs and rebuild the morale of the sales team. Meanwhile, Bob Carlton, as a CEO of the OptiMotors industries, should recognize how important the sales department is in a successful organization. Thus, the next step is selecting a sales manager over controls sale men. It is indispensable action, because the current sale leader Bob seems not really good at managing his sale people, according his background, he is born technician but had never been referring to too much marketing knowledge in most time of his life. Therefore, Hiring a good sales manager may result in a reduction of his workload and the CEO can spend more time on manufacturing or making big decisions for the firm rather than supervising his personnel sellers which could lead to a worse result.

Prevention Of Pressure Ulcer

Prevention Of Pressure Ulcer Pressure ulcers, or bed sores, or have been affecting humans for ages, and addressing the overall prevention of pressure ulcers is now a prominent national healthcare issue. Despite of all the advances in medicine, surgery, nursing care, pressure ulcers still remains a major cause of mortality. Pressure sore is a common problem among old people and those who are immobilise or limited activity like post-operative and other bedridden patients. (Bergstorm, 2005) Many studies state that elderly are prone for pressure ulcer throughout the world and its becoming a crucial issue (Nakagami et al., 2007). Pressure ulcer can be defined as a type of injury that affects areas of the skin or underlying tissue of the body due to application of too much pressure on it. (Grey et al 2006) It develops as a result of tissue necrosis of the skin over the bony prominence, due to the obstruction of the blood vessels flow caused by the application continual pressure on it. (Lyder, 2003) The total expenditure for the prevention of pressure ulcer is substantially less when compared to its treatment (Lapsley H M and Vogels R, 1996). It can cause severe infirmity and high health-care expenditure. The estimated annual expense for the prevention and treatment of pressure ulcers has been expected nearly  £1.4 to  £2.1 billion in the United Kingdom and is measured as a massive economic problem (Bennet et al., 2004). After cancer and cardio vascular disease, pressure ulcers are the third most money consuming disease (Schoonhoven et al., 2002) According to European Pressure Ulcer Advisory Panel (EPUAP) the occurrence rates of pressure ulcers are ranging from 8-23%. In acute care hospitals in the western countries the reported prevalence has wide-ranging between 9-22%. Improving the standard of pressure ulcer care could in ¬Ã¢â‚¬Å¡uence the estimated annual expenditure and quality of life (Tannen A et al., 2004). According to Whittington et al (2000) the prevalence of 15% of pressure ulcers are recorded on admission, whereas for the 60% of the individuals there was no specific information about the presence or absence of the pressure ulcers. In another study, it is clear that 12.8% have already had the infirmity on their admission. According to Rycroft-Malone, (2000) pressure ulcers can develop at any area of the body, but commonly occurs over bony prominences. ( Murdoch, 2002; Jones, 2001) The areas can supposed to develop pressure sores are sacrum, heels, elbows and back of the head. The appearance of pressure sore is very fast and hence the early assessment and steps to prevent is very necessary (George and Malkenson, 2008). Pressure intensity and duration are the two main factors for the pressure ulcer formation because of pressure. Pressure intensity is the volume of external pressure applied on internal tissues whereas duration is the amount of external force is sustained by internal tissues (Cullum et al., 2000) According to NICE guidelines (2003) the risk factors influencing to develop pressure ulcer in an individual includes intrinsic risk factors and extrinsic risk factors. The intrinsic risk factors such as reduced mobility or immobility, sensory impairment, acute illness, level of consciousness, extremes of age, vascular disease, severe chronic or terminal illness, previous history of pressure damage, malnutrition and dehydration. And extrinsic risk factors are pressure, shear, and friction. Shear is defined as the applied force that can cause an opposite, parallel sliding motion in the planes of an object. The amount of pressure exerted has got a direct affect on Shear. (Pieper B, 2007, Nix DP, 2007). Friction is defined as a superficial, mechanical force directed against the epidermis, resulting in increased susceptibility to ulceration (Pieper B., 2007). Pressure ulcers are classified according to different stages as defined by the National Pressure Ulcer Advisory Panel (NPUAP). Originally there were only four stages, but in February 2007 these stages were revised and two more categories such as deep tissue injury and unstageable were added to it. Stage I -Redness of a localized area, usually over a bony prominence. Darkly pigmented skin may not have visible blanching; as its colour may differ from the surrounding area. Stage II loss of partial thickness dermis showing as a shallow open ulcer with a red or pink wound bed, without any slough. It may also present as or open or ruptured serum filled blisters. Stage III The layer of subcutaneous fat may be seen but bone, muscle or tendons are not exposed. Slough may be present but does not cover the depth of tissue loss. Stage IV exposure of bone, tendon or muscle. Slough or may be present on some parts of the wound bed. Unstageable Loss of the thickness of the skin in which in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) in the wound bed. Deep tissue Injury Purple or maroon localized area of discolored skin or blood-filled blister due to damage of underlying soft tissue due to pressure. The area may be preceded by tissue that is firm, painful, and mushy compared to adjacent tissue. (NPUAP 2007) To prevent the formation of pressure sores nurses are adopting a variety of measures such as risk assessment and risk assessment tools, changing the position of the bedridden patients regularly, inspecting the pressure area regularly and while doing personal care, applying ointments or creams over the pressure areas, providing comfortable mattresses such as air bed, water mattress for the bedridden and immobilise patients, placing pillows under the places prone to form pressure ulcer for the vulnerable peoples, maximise nutritional status, etc. However the efficiency of all these methods is in discussion and argument. This essay report will collate all the various available literatures regarding the prevention of pressure ulcer and suggest the better and good practice to prevent the formation of pressure sore among the high risk people. The standard of nursing care is very important for the prevention and management of pressure ulcers. The caring of patients, who are at risk with pressure ulcer, is the main challenge for nurses (Sinclair et al., 2004). According to Lewis M et al 2003 the first step nurses should make out is the risk assessment of patients and it is better to identify the patient at risk in the early stages, so we can prevent the pressure sores. It consists of level of mobility, nutritional status, level of consciousness and neurological status, incontinence, sensory impairment, complete patient history, and physical and psychosocial examination assessing mental status and cognitive ability. To support caregivers there are assessment scales to identify the patients at risk. According to Walker D K et al 2010 skin care and moisture are essential to prevent pressure sore. Maintaining skin integrity is important for the patient`s at risk. Moreover excessive of moisture and dryness can breakdown the skin`s resistance. Wherever moisture is present,it is important to clean the portion thoroughly. Patients identified at risk should be bathed once a day. PH balanced cleanser is used to protect the skin from moisture and dryness,it is a natural protection mechanism of a skin. When cleansing the skin daily or in the presence of moisture, it is necessary not to use extreme force or friction. Eventhough moisture cannot be controlled, use skin barriers to protect skin from moisture. Dry skin also needs to be prevented by using a pH-balanced moisturizer. The studies conducted by saleh et al,(2008) and Lindergren et al., (2002) evidenced that use of risk assessment scale is successful in predicting the formation of pressure sore(Decubitus Ulcer).The studies substantiated the role of risk assessment scales and their usefulness in the prevention and management of pressure sores. According to Lindergren et al., 2002 states the reliability of risk evaluation scale in the prediction of pressure sore formation. However, the revision conducted by saleh et al. (2008), argues about the reduction in the occurrence of clinical acquired pressure scores through the regular application of risk assessment scales. Their learning also states that judgement of clinical assessment is also same valuable as associate with the detection of pressure sore through risk assessment scale. In addition, Defloor and Grypdonck, (2004) also stated that assessment tools have a vital role for the prevention of pressure sore. There are many limitations for the risk assessment tools which may lead to provide wrong positive results. The reliability, specificity and feeling of the scale are influenced by the preventive method applications. Nurses are using a variety of risk assessment tools based on practical experience they acquired. The risk assessment tools are assessed by means of numerical scores. The variables like level of continence,medications and nutritional status will give an average score for the risk patients(Whitening, N. L., 2009). Braden scale is the universally used risk assessment scale which includes the variables like sensory perception, activity, mobility, moisture and the nutritional status. The risk assessment scale works in such a way that as soon as the patient admitted in the hospital two step evaluation is carried out within the first six hours. The t wo steps include the skin assessment and the risk assessment to identify the possibility of formation of pressure sore (O Neil, 2004). Frequent evaluation and assessment should be done in every consequent evaluation at every 12 hours on patients who are at high risk .In the same way patients who are at low risk also needs to be evaluate frequently to observe or to identify any new risk factors and providing suitable preventive measures (O Neil, 2004). The most commonly used tool assessing the pressure sore in U.K is the Waterlow pressure ulcer risk assessment tool. And it is user friendly and recommended by the nurses in U.K. Pancorbo-hidalgo et al. (2006), suggests that the Waterlow pressure ulcer risk assessment tool has well pressure sore guessing ability and sensitivity which may result to get wrong positive results. With the waterlow pressure ulcer risk assessment tool among the seven assessment studies conducted by pancorbo-hidalgo, P.L. et al. (2006) they got only few findings with corrects values. Bergstorm et al. (2001) agrees that risk assessment is done by scales like Braden scale or the Norton scale in the hospitals which is more reliable. However there is no universally accepted risk assessment tool to be adopted to prevent pressure sore. Besides this, the utilization of the risk assessment tools has their own limits in clinical systems. Alternatively, Saleh et al. (2008) argues that medical judgement is successful as risk assessment tools to determine the suitable to be delivered. Nevertheless, Pancorbo-Hidalgo et al, (2006) Braden and Norton scales were noticed to be well again at risk calculation than the scientific judgements. On the other hand, according to NICE guidelines (2003) risk assessment tools can only be used as an aide-mà ©moire and should not replace clinical judgment. Normal supply of oxygen and nutrients are essential for the tissues, to maintain health. (Gottrup 2004). When patients sitting or lying, the pressure form particular part of the body results in the decrease of oxygen causes pressure sore (Defloor 2005). The study conducted by Kaitani et al., 2010, Vanderwee et al., 2007 and Pearson et al., 2010 reveals the importance of changing the position for the bed ridden or immobilize patient in preventing pressure sore occurrence. Their studies evidenced the effectiveness of repositioning in regular intervals among the vulnerable patients. Repositioning is considered as an effective control method against pressure sores (decubitus ulcer). According to Vanderwee et al., (2007) the effectiveness of force of pressure greater in sideway position. He also suggested that supine position is the comfortable position to reduce the effect of pressure on the bony prominence. The experiment conducted by Vanderwee et al. (2007 reveals that more regular rep ositioning does not actually decrease the occurrence of pressure sore. But he recognizes that turning of patients is an effectual preventive method. The incidence of pressure ulcer is more in patients who are lying down in side way position. The risk has been reduced when the patients are lying down in supine position. On the other hand the study conducted by Peterson et al. (2010) argues that the effectiveness of repositioning is less or not reliable even though it is done by any experienced nurse. And he found that after maintaining an appropriate pressure below 33 mm of Hg reduce the incidence of pressure ulcer. He states that by doing this there is still chance of occurring pressure sore in the risk areas. While turning the patient they are not unloading the all areas prone to pressure effect with the skin. Even though the standard methods for preventing pressure sores are maintained the skin breakdown happening as the risk areas are not relieved from pressure. The study conducted by Kaitani et al. (2010) evidenced that patients suffering from pressure sore have done only a fewer change of positioning and turning. In their studies they states that they didnt noticed any patients with pressure sore who has been changed their position frequently in a regular intervals. From the findings of Hobbs (2004) also reveals that there is no decline of incidence in pressure sore in the hospital due to the routine repositioning on older people. Similarly Peterson et al 2010 found that still the incidence of pressure ulcer are increasing in the clinical settings where standard turning of patients has already been done. In EPUAP guidelines (2009), suggests that repositioning is an effective method which will decrease the extent and occurrence of pressure over susceptible points like sacrum, heels, elbows and back of the head bony prominences. However, there was no research study conducted by any researchers to calculate the time gap needed to turn the patient that means there is no evidence of turning intervals from any previous studies or researches. It is very important to inspect the support surface while doing repositioning. Patient must be repositioned in regularity after inspecting the tissue viability, mobilising level, medical condition and evaluation of skin integrity. It is also subjected by the supportive surface So repositioning can reduce the incidence of pressure sore to an extent. In hospitals and health care homes it is suggested that repositioning to be done in every 4 hours and by the use of air mattress the incidence of the occurrence of pressure sore can be prevented. Many of the patients feels very discomfort while turning frequently, to avoid frequent turning pressure reducing support surfaces can be used to relieve pressure. Importantly pressure relieving support surface devices has vital role in the prevention of pressure. According to Cullum et al., 2001 it is divided into two, low tech devices and high tech devices. Low tech devices are comforting support surface to dispense the body weight over an area whereas high devices are alternating support surface where inflatable cells consecutively inflate and deflate. According to Lewis M, et al (2003) if the patients having a moderate to high possibility of developing pressure sore, dynamic support surfaces include a large cell alternating pressure mattress, a low air loss or air fluidized bed, or other pressure redistributing systems can be recommended. In a study conducted by Nixon et al (2006)found that in operating tables, specialized foam mattress overlays are effective to reduce the incidence of postoperative pressure sores while in other settings, specialized foam and overlays were the only surfaces that were constantly better to standard hospital mattresses in reducing incidence of pressure ulcers. To decrease the contact between bony prominences and support surfaces, pillows and foams are used. In addition to that for reducing the friction and shearing damage, lifting devices such as slide sheets, slings or sleeves can be used to move the patients. On the other hand, it is unclear about the evidence for the advantages of higher-specification constant low-pressure and alternating-pressure support surfaces for preventing pressure sores. However, there is clinical evidence of a difference in risk of developing pressure ulcers when using high-specification foam mattresses, compared to standard hospital mattresses. (NICE 2005) Decisions for pressure relieving device should determine at risk assessment. It must include level of risk, comfort, patient`s preferences, general health and timing of the surgery. . The studies conducted by Holm et al. (2007) and Ferguson et al. (2000) evidenced the significance of nutrition in pressure ulcer prevention. This study suggests that older people are mostly affected due to pressure ulcer. This is because of their less skin integrity and low nutritional status. The nutritional status of the elderly people is usually related with the level of intake of food and fluids along with various nursing intervention methods (Holm et al., 2007). Management of pressure sore and its treatment closely related with the clients nutritional status. The people with less nutritional status have a high risk of occurrence of pressure ulcer. The nutritional status of the patient has to be assessed by the nurse initially. Adequate quantity of proteins, calories, minerals, vitamins and fluids are necessary to maintain the skin integrity and wound healing promotion (Ferguson et al., 2000). The advancement and management of pressure sore highly influenced by their nutritional status. For doing an successful preventive measures it is essential to carried out with proper nutritional evaluation techniques and planning (Ferguson et al., 2000).pressure sore and nutritional status are closely related to each other and are directly proportional to each other.patients who are with less nutritional status or malnourished are likely to be more prone to develop pressure sore (Thomas, 1997).To reduce the incidence both dieticians and nurses should work jointly. To assess the nutritional status of the patient and the level of malnourishment and proper planning and interventions to be done to improve the status if inadequate (Ferguson et al., 2000).According to EPUAP (2009) recommendation every health care system should do screening and evaluation tests of the nutritional level of the vulnerable people who are at risk of pressure sore. Pressure sore in majority cases are preventable and controllable. A targeted control measure is far better than pointing on treating previously recognized pressure sores. Preventive measures to deceits (pressure) sore saves time and money. By doing an effective preventive techniques can also minimise the loss of energy and reduction in the work load over the health care delivery personnels and staffs mainly nurses. Bergstrom N., Braden B., Kemp M., Champagne M. Ruby E.(1998) Predicting Pressure ulcer risk. A multisite study of the predictive validity of the Braden scale. Nursing Research. 47(5), p.261-26 Bergstrom N, Braden B. A prospective study of pressure sore risk among institutionalized elderly. J Am Geriatric S Bennett G, Dealey C, Posnett J. The cost of pressure ulcers in the UK. Age Ageing 2004; 33:230-5 Cullum N, Nelson EA, Nixon J (2000) Pressure sores. Clinical Evidence: 979-98 Defloor, T. and Grypdonck, M. F. (2004) Validation of pressure ulcer risk assessment scales: a critique. Journal of Advanced Nursing. 48(6), p. 613-621. Defloor T, De Bacquer D, Grypdonck MH. The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. International Journal of Nursing Studies 2005; 42(1):37-46. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel (2009) pressure Ulcer Prevention Quick Reference Guide. NPtJAP, Washington DC. Ferguson, M., Cook, A., Rimmasch, H., Bender, S. and Voss, A. (2000) Pressure ulcer management: the importance of nutrition. MEDSURG Nursing, 9(4). Gottrup F.( 2004) Oxygen in wound healing and infection. World Journal of Surgery;28(3):312-5. Gray,J.E.Enoch,S.Harding,K.G.(2006) ABC of wound healing.Pressure ulcers.British medical journal.332.p.472-476 Holm, B., Mesh, L., and Ove, H. (2007). Importance of nutrition for elderly persons with pressure ulcers or a vulnerability of pressure ulcers: a systematic review. Australian Journal of Advanced Nursing, 25(1), p. 77-84. Jones I, Tweed C, Marron M (2001) Pressure area care in infants and children: Nimbus Paediatric System. Br J Nurs 10 (12): 789-95. Kaitani, T., Tokunaga, K., Matsui, N. and Sanada, H. (2010). Risk factors related to the development of pressure ulcers in the critical care settings. Journal of Clinical Nursing, 19, 414-421. Lewis,M., Pearson,A., Ward,C. (2003) Pressure ulcer prevention and treatment: Transforming research findings into consensus based clinical guidelines. International Journal of Nursing Practice, 9, p.92-102. Lindgren, M., Unosson, M. and Krantz, A. M. (2002) A risk assessment scale for the prediction of pressure sore development: reliability and validity. Journal of Advanced Nursing. 38, p.190-199. Lyder, C., Yu C, Stevenson, D., Mangat, R., Empleo- Frazier, O., Emerling, J. and McKay J. Validating the Braden Scale for the prediction of pressure ulcer risk in blacks and Latino/Hispanic elders: a pilot study (1998). Ostomy Wound Manage. 44(3A) p.42S-49S. Murdoch V (2002) Pressure care in the paediatric care unit. Nursing standard 17(6): 71-6 National Institute for Clinical Excellence. (2003) Pressure ulcer prevention. Clinical guideline 7. Nix DP. Support surfaces. In: Bryant R, Nix D, eds. Acute Chronic Wounds: Current Management Concepts. 3rd ed. St Louis MO: Mosby; 2007:235-248. Nixon, J., Nelson, E.A., Cranny, G., Iglesias, C.P., Hawkins,K., Cullum, N.A., Philips, A., Splisbury, K.,Dorgerson,D.J., Mason, S.,2006b. Pressure relieving support surfaces: a randomised evaluation. Health Technology Assessment 10(22) Nakagami G., Sakai K., Matsui N., Sanada H., Kitagawa A., Tadaka E. and Sugama J. (2008) Validation and determination of the sensing area of the KINOTEX sensor to develop a new mattress with an interface pressure-sensing system. BioScience National Pressure Ulce Advisory Panel (NPUAP) (2007, February). Pressure ulcer definition and stages. Retrieved 4/13/2007, from http://www.npuap.org Pancorbo-Hidalgo, P. L., Garcia-Fernandez, F. P., Lopez-Medina, I. M. and Alvarez- Nieto, C. (2006) Risk assessment scales for pressure ulcer prevention: a systematic review. Journal of Advanced Nursing. 54, p. 94-110. Peterson, J. M., Schwab, W., Oostrom, V. H. J., Gravenstein, N.and Caruso, J. L. (2010). Effect of turning on skin-bed interface in healthy adults. Journal of advanced Nursing, 66(7), p. 1556-1564. Pieper B. Mechanical forces: pressure, shear, and friction. In: Bryant R, Nix D, eds. Acute Chronic Wounds: Current Management Concepts. 3rd ed. St Louis, MO: Mosby; 2007:205-234. Rycroft-Malone J and McInnes E (2000) Pressure ulcer risk assessment and prevention-technical report London, Royal College of Nursing Saleh, M., Anthony, D. and Parboteeah, S. (2009). The impact of pressure ulcer risk assessment on patient outcomes among hospitalised patients. Journal of Clinical Nursing. 18, p. 1923-1929 Schoonhoven, L., Haalboom, J, R, E., Bousema, M, T., Algra, A., Grobbee, D, E., Grypdonck, M, H., Buskens, E. (2002) Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers. BMJ, 325, p.1-5. Sinclair, L., Berwiczonek, H. and Thurston, N. (2004) Evaluation of an evidence based education program for pressure ulcer prevention. Journal of Wound, Ostomy, and Continence Nursing. 31(1), p. 43-50. Tannen A, Dassen T, Bours G, Halfens RJG. A comparison of pressure ulcers prevalence: concerted data collection in the Netherlands and Germany. Int J Nurs Stud 2004;41:607-12 Thomas, D. R. The role of nutrition in prevention and healing of pressure ulcers. (1997). Clinical Geriatric Medicine. 13, p. 497-511. Vanderwee, K., Grypdonck, M. and Defloor, T. (2007) Non-blanchable erythema as an indicator for the need for pressure ulcer prevention: a randomized-controlled trial Journal of Clinical Nursing .16, p.325-335. Walker D K, Sell S V, Kindred C. (2010) Pressure Ulcer Prevention Utilizing Unlicensed Assistive Personnel Crit Care Nurs Vol. 33, No. 4, pp. 348-355 Whitening, N.L. (2009) Skin assessment of patients at risk of pressure ulcers. Nursing Standard. 24(10), p.40-44. Whittington, K., Patrick, M., Roberts, J, L. (2000) A national study of pressure ulcer prevalence and incidence in acute care hospitals. Journal of Wound, Ostomy and Continence, 27, p. 209-215.

Who Was Benjamin Franklin Religion Essay

Who Was Benjamin Franklin Religion Essay Benjamin Franklins ideas on God and human nature were significantly different from the puritan norm at the time.   While Franklin saw God as a good and wise creator, the puritans feared Him as an almighty being.   The puritans saw human nature as the ultimate conduit for sin, while Franklin believed that humans as products of God were good at heart.   Franklin believed in a God discrete from both mans activity on earth and the puritan ideal of who He was, and in humans not as slaves to sin and redemption, but as masters of their own destiny. Puritanism was a very widely held belief system in the early colonies. A direct descendant of Calvinism, Puritanism had strong roots among a vast number of the colonists throughout early American settlements. As a sect of Christianity, they believed in the bible as the word of God, and Jesus as Gods son. It was common for puritans of the time to fear God and look at all misfortune that befell them as punishment for their sins. And as it struck my hand, so it struck my heart; for I suddenly rose up and went into a wood; and there I cried bitterly, and now concluded that God, God had found me out. (Dane, 4) The puritan God can almost be seen as a tyrannical leader; one who strikes fear into the hearts of His subjects, yet demands their love and respect. Franklins semi-present creator-God was distinctly different from that of the punishing overseer of the puritans. Franklin was one of few deists at the time. It is said that had he published his deism tract thirty years earlier, he would have risked imprisonment and execution in the British Empire. The norms of the time, the puritans, were an overwhelming majority. The puritan God was always there, always watching over his creations. As John Dane repeated from his mother, à ¢Ã¢â€š ¬Ã‚ ¦Go where you will, God he will find you out. (Dane, 2) The puritans spent their lives with the ever present notion of Gods wrath hanging over their shoulders. Franklins God was not the same entity. He was the creator, and that to Franklin was as far as His relationship with man went. God did not inspire man to write the books of the bible, nor did he send His Son to die on a cross for mans sin. à ¢Ã¢â€š ¬Ã‚ ¦after doubting by turns of several pointsà ¢Ã¢â€š ¬Ã‚ ¦ I began to doubt of Revelation itself . (Franklin, 5) Franklins God gave man life and free will, and then gave him the reigns to control his own destiny. The puritan conception of human nature was based on the idea of original sin. Original sin is a term used to describe the bibles story of Adam and Eve eating the fruit from the tree of good and evil under temptation of Satan. Puritans believed that because of this original sin, humans are all inherently corrupt and impure of mind; because man is born into sin, it is impossible for him to escape it. Your best duties are tainted, poisoned, and mingled with some sin, and therefore are most odious in the eyes of a holy God. (Wigglesworth, 4) In the eyes of the church, the only redeeming quality of human nature was that they themselves were made by God. They were obedient to God and His word because they were afraid of his punishment. The only hope the puritans had in life was that they might be chosen in Gods eyes as worthy of redemption. Franklin saw the nature of humans in a very different light. While he did look to God for wisdom and insight, he believed that man could be good without God. He came to this conclusion not with religion, but with intellect and logic. He created a list of thirteen virtues that he believed could bring a man to moral perfection. These too were not created with any particular religious sect in mind, but rather with the idea that all people could better themselves through them. à ¢Ã¢â€š ¬Ã‚ ¦that vicious actions are not hurtful because they are forbidden, but forbidden because they are hurtful, the nature of man alone consideredà ¢Ã¢â€š ¬Ã‚ ¦ (Franklin, 15) He believed that evil or morally wrong actions were wrong, not because God said so, but because they were hurtful to humanity. Human nature by itself was not corrupt, and it was possible for a man to be truly good. Franklins beliefs on human nature were different in many ways than that of the puritans. While the puritans saw man as essentially evil from conception, Franklin saw man as able to create his own destiny. While both parties believed in God as being important to the life of men, Franklin saw his importance as more of a guide, and less as a strict path like that of the puritans. The Puritans had only one way to achieve completion in life; to earn Gods redemption. Franklin believed that as man tried to be a better person, he was achieving his destiny in life. à ¢Ã¢â€š ¬Ã‚ ¦tho I never arrived at the perfection I had been so ambitious of obtainingà ¢Ã¢â€š ¬Ã‚ ¦ I was, by the endeavor, a better and happier man than I otherwise should have been if I had not attempted ità ¢Ã¢â€š ¬Ã‚ ¦ (Franklin, 14) The puritans did not believe this was the case, as good works to them meant nothing if God did not give favor. Your good duties cannot save you, yet your bad works will damn you. (Wiggleswort h, 4) The separate parties idea of human nature was directly affected by their respective ideas of God. The puritans believed in a God that was almighty and all encompassing. They thought of themselves as unworthy beasts without purpose, and only with the favor of God did they have any chance of happiness on this earth or after it. à ¢Ã¢â€š ¬Ã‚ ¦everyone sinned in Adam and everyone deserves eternal deathà ¢Ã¢â€š ¬Ã‚ ¦ (Wigglesworth, 4) Franklin saw a God that was less involved in the lives of men. He put much more emphasis on the worth of a persons works and endeavors, and less on whether or not this person had been chosen by God. à ¢Ã¢â€š ¬Ã‚ ¦there was in [my scheme] no mark of any of the distinguishing tenants of any particular sect. I had purposely avoided themà ¢Ã¢â€š ¬Ã‚ ¦ that it might be serviceable to people of all religionsà ¢Ã¢â€š ¬Ã‚ ¦ (Franklin, 15) Both groups ideals were founded in belief, and were distinctly different because of the differences in the belief of each re spective God. As much as the puritan ideals were similar to that of the deist Benjamin Franklin, the differences of each faith is what defines them. Franklin believed in a God based in logic, while the puritans God was founded in faith and tradition. From this belief in separate Gods, separate belief in human nature arose; the puritans believing in Human nature as evil and Franklin believing in it as independent and just. Franklin found that the path to righteousness could be obtained through good works that bettered humanity; while the puritans believed that only strict adherence to the guidelines set forth by God could bring salvation. Each point of view has its own foundations and each gives historians a different yet equally relevant perspective on life in the early American colonies.

gender changes in the sun also rises Essay example -- essays research

The Sun Also Rises, by Ernest Hemingway is a story of being apart of the â€Å"Lost Generation† in the 1920's. The Great War had changed the ideas of morality, faith and justice and many people began to feel lost. Their traditional values were changed and the morals practically gone. The â€Å"Lost Generation† rejected Victorian ideologies about gender, sex and identity. The main characters, Brett and Jake, redefine masculinity and femininity, drifting away from the Victorian ideals of sexuality and identity.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Lady Brett Ashley is a perfect example of how women in the â€Å"Lost Generation† changed. Brett strives for an individuality that Victorian women would not look for. She also seeks more activity in the social sphere. By doing these things, Brett rejects the Victorian ideals of proper behavior of women and marriage. The time after the Great War is a perfect stage in which Brett can begin to express herself freely. She enters the social scene, which is predominately male, even though she is not socially accepted. She goes to bars and gets drunk, she even goes to bullfights, which are bloody and violent, to try to become accepted by her male counterparts as not just a ‘woman’ but a person equal to them. Brett also uses sex to break free of the traditional Victorian ideals and to explore a new lifestyle where women are free to do as they please. â€Å"Victorianism established clear [emphasis added] sexual boundaries and a single standard of monogamy for men and women that ensured a stable family and allowed for passion within committed relationships. † (White) Brett obviously throws these boundaries out the door. She is characterized as a female unconstrained by sexual repression, going about sleeping with whomever she feels fit, unstoppable by the Victorian ideologies of what women and sex should be. However, her many meaningless, broken relationships with men are repeatedly as tumultuous as the new, modern world in which she lives.   Ã‚  Ã‚  Ã‚  Ã‚  Throughout her many attempts to set herself apart from the traditional world, she still acts uncertainly about what she wants. Lady Brett in many ways is torn between the new modern woman and the idealistic Victorian woman. You can see this in her dependence on men for money, as in her engagem... ... to be with Brett, but he can not because of his accident. Since sex is such a driving force in Brett’s life, she could not stand to be with him. Jake can only be friends with Brett, this gives us the idea of a new kind of relationship between men and women.   Ã‚  Ã‚  Ã‚  Ã‚  In conclusion, Jake and Brett do a very good job of making the transition from Victorian ideas to modern beliefs visible to readers. Not only do they redefine their sexuality, but they seem to go though a sort of role reversal, where females aggressively express their feelings and men cry.   Ã‚  Ã‚  Ã‚  Ã‚   Works Cited Elliott, Ira. â€Å"Performance Art: Jake Barnes and Masculine Signification.†   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  American Literature Mar. 1995: 1-2 Fulton, Lorie Watkins. â€Å"Reading Around Jake’s Narration: Brett Ashley and   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  The Sun Also Rises.† Hemingway Review Fall 2004: 20-61 White, Kevin. Sexual Liberation or Sexual License?: The American Revolt   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Against Victorian Sexuality. Chicago: Ivan R. Dee, 2000.

Symbolic Images: The Poetry of Emily Dickinson Essay -- essays researc

The poetry of the Imagists is short, simple, and quite literal in its meaning in order to create a vivid picture in the reader’s mind. When they describe an object, it means just what they say. A tree is a tree, a flower is a flower, and a bird is a bird. Imagists have little use for abstract words or ideas, and tend to shy away from them as much as possible. Emily Dickinson doesn’t fall under the same category as the Imagists, as she doesn’t use the same techniques as the Imagists.   Ã‚  Ã‚  Ã‚  Ã‚  Dickinson’s poems center on very vivid images, with very different takes on them. They very often contain abstract concepts, which are often given concrete principles and are incorporated as part of her images. She implants deeper meanings behind her images, and tends to rely on a different technique than the Imagists. The majority of her work relies heavily on a different type of imagery – symbolism.   Ã‚  Ã‚  Ã‚  Ã‚  One of the poems where this symbolism is most evident is â€Å"My Life Had Stood – A Loaded Gun.† This poem is obviously based around a strong metaphoric image, as Dickinson is comparing herself to a gun belonging to someone else. In the poem, she uses the gun as a symbol to show her role in the patriarchal society she lived in. The first stanza shows this feeling:   Ã‚  Ã‚  Ã‚  Ã‚  My Life had stood – a Loaded Gun –   Ã‚  Ã‚  Ã‚  Ã‚  In Corners – till a Day   Ã‚  Ã‚  Ã‚  Ã‚  The Owner passed – identified –   Ã‚  Ã‚  Ã‚  Ã‚  And carried me away – In this stanza, Dickinson never explicitly mentions the owner to be a man, but as women didn’t use guns in those times, it is understood that the owner would be male, which she does clarify later in the poem. Even without an outright declaration of male ownership, these lines imply the role that women were supposed to take in Dickinson’s time, sitting silently in the background until a man wishes to take them away.   Ã‚  Ã‚  Ã‚  Ã‚  In the last stanza of the poem, Dickinson echoes the same theme of needing a man to access her power.   Ã‚  Ã‚  Ã‚  Ã‚  Though I than He – may longer live   Ã‚  Ã‚  Ã‚  Ã‚  He longer must – than I –   Ã‚  Ã‚  Ã‚  Ã‚  For I have but the power to kill,   Ã‚  Ã‚  Ã‚  Ã‚  Without – the power to die – These lines tell of Dickinson’s feeling of dependence... ...ase of the speaker’s reality, her sense of reason, was faulty and gave way, showing her much more beyond her reason that she could now be aware of. She now holds a new idea of reason and common sense to replace her old ideas. The use of the word â€Å"I† in the second line shows us that inside the coffin is in fact the speaker of the poem. This stanza suggests that the person being buried is perhaps the speaker’s innocence. It tells us that with the death of her naivety, she falls into a whole new set of worlds that she didn’t know about previously. After her fall, she now has a new grasp of reality and knows more than she had before.   Ã‚  Ã‚  Ã‚  Ã‚  Emily Dickinson loved to use images. Her poems are all heavily based around images, and she has an amazing talent for describing them. Each of these poems contains a different theme, and revolved around different images. While each of these poems would stand up on its own, Dickinson tied many of them together with her tendency to come back to symbolism. Like the Imagists after her, she liked to paint pictures in the reader’s mind with her words, but what made her stand out was the deeper meaning she laid beyond those images.

1800’s Era of Good Feelings Essay

Although many seemingly happy events such as the â€Å"Era of Good Feelings† and the granting of universal white manhood suffrage occurred during the early 1800’s, the statement that nationalism and not the fear of sectionalism caused westward expansion is an invalid statement. Westward expansion was truly an effect of a growing sectionalism in the country originating from events such as the Tariff of 1828 , the National Bank, and the Missouri Compromise. Preceding the Missouri Compromise was the Tallmadge amendment. When the Tallmadge amendment was passed, the South was infuriated. The amendment decreed that the slave state of Missouri had to gradually free all of their slaves and prohibited any more slaves to be brought into Missouri before they could be admitted into the Union. See more: Homelessness as a social problem Essay This made slave-owning Southerners upset because they viewed the amendment as a threat to sectional equality and balance. With the South suspicious of the North trying to ban slavery and the North suspicious of the South trying to expand slavery, both sides naturally flocked to the West in order to gain another slave or free state to tip the balance of power in their direction. Even in the Florida Purchase Treaty of 1819, after war hero Andrew Jackson exceeded his orders from the White House and tore through Florida, motives for acquiring new land seemed to continually hint towards the growing sectionalism and concern about the issue of slavery. Also, the uneasy Missouri Compromise gave both North and South even more reason to expand westward. The Missouri Compromise established Missouri as a unrestricted slave state which gave abolitionists and Northerners great concern about the spread of slavery while the establishment of the Missouri Compromise line that prohibited slavery above it caused Southerners to worry about slavery too. All the suspicions and fears of the two sections resulted in a fast and furious expansionism in the west. Then, during the presidency of John Quincy Adams, his nationalistic policies of roads and canals laid a heavy financial burden upon the federal government requiring the continuation of the tariff which caused tension among the South. The National Bank, although established by the nationalist Alexander Hamilton, played a big role in sectionalism in the United States. When the Bank of the United States irresponsibly overspeculated in the West, the financial crisis of 1819 arose in which many western banks were shut down and had to foreclose mortgages on numerous farms in the West. The foreclosure of farms in the West made the National Bank extremely unpopular in the West and fueled western sectionalism, pushing western farmers to lean towards the slave-owning Southerners in the battle for influence in the West. In addition to these events, the Tariff of 1828 made Southerners angry yet again and widened the rift between the North and South even more. The extremely high tariff was not for revenue but rather for the purpose of protecting American manufacturing. This made the Southerners upset because it showed partiality to the northern factories and hurt the southern farmers who were large consumers of manufactured goods. The hated tariff would then prompt South Carolina to take action and bring out the old Kentucky and Virginia resolutions to nullify the tariff. Thus, these two events added to the worries of both sides and to the westward expansion fever.

Baxton Technology

Student name: Joseph Maloney Student number: 10391669 Word count: 940 I hereby certify that this project is entirely of my own work and has not been taken from the work of others save to the extent that such work has been cited and acknowledged within the text of the project. Signed: _____________ Alkermes’ human resource (HR) strategy is all about acquiring employees who show personal initiative and who get satisfaction of knowing that they are helping to make a difference in the lives of millions of people every day.Alkermes ultimate goals are to develop medicines that address unmet patient needs, to help its customer’s live happier, healthier lives. The Athlone facility of Elan must choose a strategy that supports the corporate objectives of Alkermes. They must align and prioritise the various activities of the strategy to accomplish their objectives. HR strategies need to simultaneously focus on building skills, motivation and behaviour for a successful business str ategy. In my opinion the generic HR strategy most appropriate to align with Alkermes corporate strategy, is the resource-based view (RBV) model.The RBV model works towards identifying the firm’s potential key resources and developing and manipulating them to build a value-creating strategy. When Alkermes decided to merge with Elan one of their main reasons for doing so was that they could use Elan’s most valuable resource, the Elan drug technologies (EDT) unit. The EDT develops proprietary drug technologies that can be applied to a number of products, improving the effectiveness of the drugs. With Alkermes now having obtained a technological resource with a rarity that will help them gain a competitive advantage over their rivals, they must now focus on their human resources.They look to acquire talented employees who show initiative and feel good about improving people’s health. Combing and developing these resources will help them build a strong RBV model. Whe n Alkermes employees are asked what is the main objective of the organization the reply should always be, â€Å"Excellence in everything we do†. They pursue this excellence because they know they are working towards improving the wellbeing of other people. Alkermes hopes to instil this same hypothesis in the Athlone facility of the organization.They plan to acquire talented employees who show initiative, motivation and know their commitments are ultimately towards improving the health of their customers. They plan to set up a R&D programme where employee engagement is encouraged and rewarded. Most importantly they want to manage performance so that all processes are carried out in the most successful way. If all of these objectives are met the success of the organization should be easily obtained and worthwhile. RBV shows that people are strategically important to a firm’s success and that they are a potential source of sustainable competitive advantage.Alkermes have o btained a rare and valuable organizational capital in the form of the EDT unit; they now must match this with a highly skilled human capital that will get the best out of this technological resource. RBV focuses more on the HR pool, i. e. the employees than on the actual HR practice, so employees should have both a high level of skills and a willingness to achieve. Creating a good HR pool can be hard to imitate by competitors, so it can create a competitive advantage. High pay is always a major pull in attracting the best employees, as is perks, i. . company car and health benefits, as is bonus and new job opportunities for good work. Yet, Alkermes states that their commitments are ultimately towards the wellbeing of the patients that use their products. This will attract employees who feel they have a morale obligation to help people in need. This is an example of attracting potential employees using a non-monetary policy. When trying to create a performance management policy for a n organization you have to look at all the types of capital that affect performance, i. . human, social and organizational capital. RBV looks to integrate all the capital resources of an organization to create the most suited HR policy. Alkermes have already greatly improved their social and organizational capital by merging with Elan and using the EDT unit respectively. Now Alkermes have to look at managing the performance of their human capital. When trying to collect data on performance you cannot completely rely on employee reports via surveys about how they feel the HR strategy is working.You have to collect more quantative data. Collect data on things such as production per hour rate and job turnover rate, this will give you a more in depth idea as to how employees are preforming. You can now use this information to decide on what reward and training systems to put in place to improve performance. Communication must be both upward and downward in an organization to discover ho w employees are performing. It will give you an idea on what employees want and if they are best suited to the post they are in.Good performance management will result in higher operating performance, which will translate into increased profitability. Reward management is concerned with the implementation of strategies and policies that aim to reward people fairly, equally and consistently in accordance with their value to the organization. The objectives of reward management are to recruit and retain, motivate employees and to strengthen psychological contracts. They can be both monetary (bonuses) and non-monetary (esteem, i. e. job title).RBV looks at obtaining and holding onto the best possible employees, and the best way to retain them is through a strong reward system. Overall I believe that if Alkermes adopt the RBV approach and combine all of their resources by carrying out the objectives entailed they should be able to achieve their cooperate strategy. I feel that the inform ation presented in this report is a good guideline as to how they should carry out their objectives. Hopefully the merger between Alkermes and Elan will run smoothly and will be profitable. References: http://www. alkermes. com/ www. shrm. org. digitalcommons. com.