Geographic Information System Essay Example for Free

Geographic Information System Essay A Geographic Information system or a GIS is a tool to capture, store and managing data which are spatially related to Earth. In close terms, the system is related to managing, integrating, storing and analyzing geographically referenced information. Geographic Information system is used in the process of scientific research, natural resource management, impact of pollution on environment, land use and planning, company sales and marketing and criminology. For example, Geographic Information system is often used energy planners who need to calculate the emergency response times during an emergency like a natural disaster. Also, Geographic Information system is used to find the areas that are affected by pollution – wet lands or used by companies to take advantage of an untapped economy or an unreserved market. HISTORY OF GIS The first use of a Geographic Information system is that recorded in 1854, by Sir John Snow. In the event of Cholera outbreak in London, he used a map which directed signs towards the individual cases of cholera in the city. This study which helped the administration to reach to the source of the outbreak, which was an infected water pump. After knowing the root cause of the outbreak, immediate steps were taken by the administration. This strategy of John Snow to collect all the information about the cholera cases in the city on a geographical map of the city and then to analyze the information at hand, thereby reaching at some conclusions that were helpful in fighting with the outbreak is the true essence of a Geographic Information system. Fig 1: Map showing clusters of Cholera cases in London by John Snow In the year 1962, the true face of Geographic Information system came into existence with the Federal Department of Rural development in Canada. The first Geographic Information system was developed by Dr. Roger Tomlinson, and was to help the Land inventory department to gather and analyze information related to the land use and capability, soil structure and forest area in Ontario. This system possessed some enhanced features like – mapping, overlaying, measurement, scaling and scanning. It also had a co-ordinate system that could inter relate every other part of the continent and could scale huge areas into very small ones. The use of overlays in extending the method of spatial analysis of geographical data was also included in this first Geographic Information system. However, this Geographic Information system was never brought out into the market for commercialization purposes. The first commercial Geographic Information system was developed during the late 1980’s by the MS Computing research Institute and this commercial Geographic Information system had a successful combination of the first Geographic Information system developed in 1962 by Sir John Snow. It had the technique of spatial attribution, and organizing of data with the help of database structures. With the onset of the 20th century, there was a fast growth in the development of commercial Geographic Information systems to transport, gather and analyze data in all commercial fields. Recently, there has been an increase in the number of free open source commercial Geographic Information systems which can be used in accordance with a number of operating systems and can also be customized top match up some specific tasks. DATA CREATION IN GEOGRAPHIC INFORMATION SYSTEM The Geographic Information Systems that exist today make use of the information that is present in the digital form. The methods of data creation for a Geographic Information system are many and the most commonly accepted method for data creation of digital data is digitization. In this method, Computer aided design method is used to transfer the data present on a hard copy, into a digital form, and geo-referencing capabilities. Another popular form of extracting geographical data into digital form is by ortho-rectified imagery, in which head up digitizing is the main way through which tracing of geographical data is done directly rather than traditionally tracing the geographical data on a different digitizing tablet. LINKING INFORMATION FROM VARIOUS ORIGINS With the help of Geographic Information Systems, a myriad of information gathering is possible. Suppose for example, if the rainfall data about a particular state and its aerial snaps or the area are gathered, then it relatively easier to predict the area which dries up during summer. A Geographic Information Systems can make use of various forms of information by linking them together and analyzing the whole bunch together. The elementary requirement for knowing the exact source of data is the knowledge of variables. The location of a certain area is denoted by x,y,z coordinates, where x corresponds to Longitude, y corresponds to latitude and z corresponds to elevation. These values may vary according to the needs and types of data required. A Geographic Information System is capable of changing any form of digital data into usable form that is recognized by the system and is used. For instance, the satellite images that are generated with the help of remote sensing satellites are processed by a Geographic Information System to corresponding map like information which can be easily read by the Geographic Information System. Similarly, the hydrologic tabular data in the tabular form can be converted into a data map, which is used as layers of information in a Geographic Information System. DATA REPRESENTATION The Geographic Information System offers the presentation of real time objects like land, roads, height etc, in the digital form. However, the real time data is further divided into two types: discrete and continuous data. Discrete data includes data like a building, area of land, while continuous data represents level of rain, height of a particular area, or elevation. There are two main methods of storing data in a Geographic Information System for both discrete and continuous forms. 1. Raster method – this form of data is stored in the form of cell rows and cell columns, where a single value data is stored in each cell. Since raster is used to store a single data, in each cell, continuous forms of data an extended table of more than one row or column is used. 2. Vector Method – in a Geographic Information System, it is often needed to express data in the form of vectors. In order to store data which possesses some sort of direction, use of polygons is made in the Geographic Information Systems. These polygons or geometrical shapes are also called as Shape files. Zero dimensional points, one dimensional lines, two dimensional polygons are some examples of shape files used in Geographic Information Systems. Points are used to denote real time objects like location of a school, building, home, well etc. lines are used to denote roads, railway lines, rivers etc. polygons are used to point to an area of land, city boundaries, water bodies etc. Each of these geometric shapes / geometries are associated with single rows in the database of the Geographic Information System, and this describes their characteristics completely. For example, consider a Geographic Information System data base that gives information about the various lakes in a particular area, their depth, and quality of water, color of water and the level of pollutants that are mixed with water. These sets of information can be each used separately to make a map to describe that particular data set. Also, the Geographic Information Systems can be used to identify and locate the wells that are present in the area, in particular that are within the one mile area of the lake. The wells are identified as point geometry and the lakes as polygon geometry in the Geographic Information System data map sets. Vector characteristics in a Geographic Information System data set can also be altered to maintain the spatial characteristic or integrity of a particular data / location, with the application of certain topology rules. A simple basic rule used in Geographic Information Systems is that the polygons must never overlap each other. The vector data sets can be appropriately used to represent the continuous data sets or continuously varying information. The contour lines and triangulated discontinuous areas and networks are used to characterize the elevation / height above sea level and other examples of continuous values. The triangulated discontinuous areas record the values of a point location which are in the form of a mesh formed with the help of lines connected from each other signifying other areas and point locations. For example, the face of a mesh in the form of a triangle is used to represent the terrain surface in Geographic Information Systems.

A Case Study of Change Management from External Forces: Dell Computers

A Case Study of Change Management from External Forces: Dell Computers Two things characterize the business environment today; they are competition and change. Therefore, todays environment puts a premium on effective leadership. In fast- changing, team- oriented environment, managers need effective leadership skills so they can motivate knowledge workers, build self-managing teams, and lead transformation. In 1994, Dell was a struggling, the company ordered its components in advance and manufactured to inventory. Change was needed and was triggered by factors outside the company. The new business model that Dell implemented converted its operations to a build-to-order process, eliminated its inventories through a just-in-time system, and sold its products directly to consumers putting these new supply chain capabilities at the core of its strategy. Dell developed a supply chain mastery that went far beyond the simple pursuit of efficiency and asset productivity. However, the company had to make a series of very difficult strategic tradeoffs to bring its functional activities into alignment with its new business model. (Copacino, 1999). James Burns who wrote a book about called Leadership says changes like these require the guidance of transformational leaders who bring out change, innovation, and entrepreneurship. They are responsible for leading a corporate transformation that recognizes the need for revitalization, creates a new vision, and institutionalizes change. Transformational leaders inspire their followers to want to make the change and attempt to raise the needs of followers by promoting dramatic change in individuals, groups and organizations. Such leaders also encourage and obtain performance beyond expectation by formulating visions and then inspiring subordinates to pursue them. They focus on accomplishing the task at hand and maintaining good working relationship. It is common for the transformational leader to passionately communicate a future idealistic organization that can be shared. He or she uses visionary explanations to illustrate what the employee work group can accomplish in order to motiv ate the employees to achieve these organizational aims. Therefore, a transformational leader could make the company more successful by valuing its associates. One such example is Dell CEO Michael Dell who did it installing one of the worlds most sophisticated direct- sales operations; eliminating resellers markups and the need for large inventories, and keeping a viselike grip on cost. Dells mission statement is be the most successful computer company in the world at delivering the customer service experience in markets we serve. With their markets changing so fast Chairman Michael Dell had to constantly focus his companys and employees attention on the companys mission. He has been quoted saying that looking for value shifts in the companys mission companys customer base is the most important leadership responsibility. In other words, Michael Dell had to constantly monitor what Dells customers want in terms of value. He had to stay in close contact with customers, and make sure that everything Dell does, Dell is addressing the customer needs. How do you build such a company? For Dell computers, the answer meant using technology and information to blur the traditional boundaries in the value chain among suppliers, manufacturers, and the end users; it basically meant that there are no intermediaries like wholesalers or retailers to come between Dell and its customers and suppliers; thus, Dell can be much faster-moving company that it might otherwise be. For most computer companies, the manufacturing process is like a relay race; components come in from suppliers, these components are assembled into computers, and the computers are then handed off to be distributed through wholesalers and retailers to the ultimate customers. Dells system changed all that. Dell interacts with and sells to customers directly, so it eliminates the activities of the wholesalers and retailers in the traditional distribution chain. The current economical crises are having a tremendous impact on how companies do business. Even one of the worlds biggest computer companies, like Dell has experienced this recession and had to make critical and dangerous decisions of lowering down the cost of expenses and tightening their belts. Today, Dell Inc. is cutting costs to weather a soft PC sales market, and even founder and CEO Michael Dell is feeling the pinch. The company disclosed proxy information that showed his total compensation declined by more than $200,000 in the latest fiscal year, to $2.1 million. The decline came mainly in the value of option awards, which were higher the previous year. Michael Dell received $931,731 in salary, stock options the company valued at $16,766 and personal security services valued at $1.1 million. Because Dell Inc.s bonuses for senior executives are tied to company performance, Michael Dell did not receive a bonus in the latest year, just as he has not the past three years. (Ladendo rf, 2009). Meanwhile, to cut operational costs and to save funds, the company has shut down factories and outsourced hardware manufacturing. Also, the company has laid off 1,900 employees and shifted its European PC manufacturing operation from Ireland to Poland. Like many companies, Dell has also been looking down the road and plans on spending $70 billion on computer parts from China between 2007-2009. Thats a lot of cash, but this could also save the company in a recession when people do not have much money and want much cheaper computers. Dell also cut 10% in global jobs last year, and announced further job cuts at its Ireland sites earlier this year. But what I found most interesting is the acquisition of David Johnson the former top IBM Corp. in early June. Although IBM still is pursuing a lawsuit against Johnson, saying his move to Dell Inc. violated a noncompet agreement; recent court rulings have freed him to take an active role guiding Dells acquisition strategies. Johnsons hiring cou ld be a signal that Dell intends to buy other companies, a growth strategy it has used less often than many of its industry peers. CEO Michael Dell also is expected to talk about the companys growth prospects, both from existing operations and from any companies that it might buy. Analysts are split on whether Dell will try to do big, transformational deals that would change the makeup of the company, or smaller, less risky acquisitions. A.M. Toni Sacconaghi with Bernstein Research said he expects Dell to make smaller deals as it tries to bolster its corporate-oriented service and product offerings. He quoted Brian Gladden, Dells chief financial officer, as saying the company is unlikely to do big deals and that it viewed its $1.4 billion acquisition of EqualLogic last year as the sweet spot. EqualLogic, which sells data storage systems, is Dells largest acquisition to date. Sacconaghi concluded that for Dell, smaller deals make sense because no obvious transformational targets exist, the odds of successful integration of the acquired company are better with smaller deals, and large acquisitions could distract top executives from the their two-year campaign to turn the company around integration of the acquired company are better with smaller deals, and large acquisitions could distract top executives from the their two-year campaign to turn the company around. (Ladendorf, 2009). One Wall Street analysts who follows Dell Inc. say theyve been impressed by the companys ability to cut costs and generate cash flow in the face of a steep industry downturn. Forward-looking businesses are using IT to target unnecessary cost and complexity, Dell said. Dell Inc. will continue to tap into IT for innovation and efficiency, and doing so now Dell Inc. will set itself apart as the global economy inevitably improves Dell identified three keys to smart IT: Increased standardization and virtualization; Better resource management that reduces IT maintenance; Greener computing that not only reduces carbon emissions but saves on energy costs. Dell itself has reaped the benefits of such IT improvements: facility improvements and a global power-management initiative that switches off computers when not in use is saving the company about $3 million a year and reducing its carbon footprint by some 20,000 tones. (Greenbang, 2009). Today the Dell machine is firing on all cylinders. In addition to being a PC juggernaut, Dell is moving fast into the $10 billion network server business. In notebook PCs, Dell has become the sixth-largest seller in the $40 billion market. Now, Dell is working on ways to combine its PC knowhow with better networking service. Through a partnership with network equipment maker 3Com Corp., Dell is trying to slash the 60 to 90 days required to test computer and networking configurations to just two weeks. Instead of each running independent tests of the same gear, Dell will deliver to 3Com each new computer so that 3Com can test compatibility with its networking devices (Business week). Leading and organizational change can be treacherous; there are no silver bullets or single- shot method of changing organizations successfully. (Ashford University). Single shot rarely hit a challenging target. Usually, many issues need simultaneous attention and any single, small change will be absorbed by the prevailing culture and disappear the change may require the cooperation of dozens of managers and resistance may be considerable. However, whether the required change is simple or complex, technological or structural or the basic organizational change process remains basically the sameà ¢Ã¢â€š ¬Ã‚ ¦executives must ask themselves three basic questions. What are the forces acting upon them? What should we change? And how should we change it? According to Hesselbein and Cohen (1999), organizations that take the time to teach leadership are far ahead of the competition. By becoming familiar with the transformational leadership approach and combining the four Is, (idealized influence, inspirational motivation, intellectual stimulation, and individual consideration), managers should be able to handle the unforeseen change more effectively. Transformational leadership strategy must also make sense in terms of the business overall competitive strategy. Today, leaders have to be able to transform their company fast. Socio Economic Inequalities: Health Socio Economic Inequalities: Health Research on health inequalities is grounded in social epidemiology, which explains how peoples social circumstances affect their health (Graham, H 2007:5). Explanatory frameworks have been presented and theories proposed in order to explain the variations in health across social class (Asthana, S Halliday, J 2006:45). This essay will discuss and analyze the sociological theory necessary to understand social class inequalities in health within the UK. Implications for health policy and practice will also be discussed. Discussion: Socio-economic inequalities in health: demographic, mortality and morbidity information: Reports outlined since the 1980s the extent of which ill-health and death are unequally distributed among UK: The Black Report (1980), Health Divide (1988), The Acheson Report (1998), The Solid Facts, WHO (2003), The Marmot review (2010). These documents identified a social gradient in health: socio-economic status (SES) influences health, whereby higher position equates to better health (Caspi, A Poulton, R 2003). From here, sociology found a correlation between mortality against social position. Britton et al (1990), Rosato, M et al (1998), Reid, A Harding, S (2000a)(2000b) Asthana, S. et al (2004) Marmot Wilkinson, (2005) Barry Yuill, (2008) Health Survey for England (HSE) provide information on mortality and morbidity by social class: people in class I have longest life expectancy while people in Class IV have the shortest life span; mortality is greater in Wales, Scotland, N. Ireland and N. England than in S. England; same patterns appear for IHD, stroke and cancer mortality in between social classes, but is less evident for accidents and suicide; risk of developing chronic illness in adult life is high for people with low SES; childhood mortality is more prevalent in socially disadvantaged groups; Sociological theory: The cultural / behavioral explanation: In this argument primary responsibility for the differential between social position and health is placed within the individual, rather than the larger society {a culture of poverty approach}(Matcha, D.A 2003:90). Explanations focus on the way individuals from different social groups lead their lives (Clarke, A 2003:122). Smoking, alcohol, diet and exercise are chosen for detailed enquiry, as they are thought to be voluntary choices (Blaxter, M 1990:113). Social epidemiologists identified a hard and a soft version of cultural/behavioral explanation. Both versions start by observing that health-damaging behaviors are more prevalent among the poor than the socially disadvantaged (Asthana, S Halliday, J 2006). The hard version implies that behaviors are voluntary, the result of individual decisions (Blaxter, M 1990) thus, the fact that people adopt unhealthy behaviors is due to ignorance, recklessness or fatalism (Asthana, S Halliday, J 2006:26). The soft version suggests that rather that seeing health-related behaviors as a cause of health inequalities, they should be seen as outcome or consequences of differences in the material circumstances between socio-economic groups {behavior as a result of culture} (Asthana, S Halliday, J 2006:27). For example, in Britain smoking displays a clear class-gradient: the less advantage social class, the more likely is the individual will smoke (Bartley, M. 2004:65). Townsend, in 1995 shows that 70% of single parents on low income, social housing, manual occupations, with few educational qualifications, are regular smokers. Also, in 1998, The Office for National Statistics showed that levels of smoking for men were 12% for class I and 41% in class V. However, in sociological research focus exists on behavior rather than culture (Woodward et al, 1992; Lynch, Kaplan and Salonon, 1997b) because reckless behavior is not accepted as a definition of culture (Bartley, M. 2004:68). Bosma, Von Mheen and Mackenbach, (1999a) (cited in Bartley, M 2004:66) suggest a direct behavioral model in which people with low status and income are less endowed with intelligence and coping skills which make them unable to grasp the long-term health consequences of things that give them short-term pleasure (e.g. smoking, drinking, etc). Regarding education and behavior Blaxter, 1990; Gran, (1995), Hoeymans et al., 1996 (cited in Bartley, M. 2004) find that education is correlated with health behavior: educated people have a better understanding of health. They also make better use of preventive health measures such as contraception, screening services or immunization. For example, a survey published in 2007 by Health Survey for England (HSE) Healthy lifestyles: knowledge, attitudes and behavior 30% men and 24% women agreed with the statement I get confused over whats supposed to be healthy and what isnt(p. 108). Marmot et al (1981 ) that individuals from class V have high incidence of CHD due to diet being higher in sugar content than in fiber. National Food Survey (1985) shows that low-income groups purchase less vegetables, fruits or whole meal bred. Behavioral explanations view consumption patterns as a reflection of cultural differences in the way people live their lives. Lifestyles are thought to be shaped by traditional views and socially accepted patterns of behavior. The fact that low income may constrain food choice is ignored or rejected (Clarke, A 2001: 123) Critique and weaknesses of the cultural/ behavioral explanation The problem with this explanation is that it separates behavior from the social context in which it takes place and effectively blames the victim of health inequality for the poor health that they experience (Asthana, S Halliday, J 2006:26). Instead, individual decisionà ¢Ã¢â€š ¬Ã¢â‚¬Ëœmaking should be seen in the context of the social structure and of the constraints that impede the behaviors of people. In support to this, Dobson et al 1994(cited in Barry Yuill 2006) researched forty-eight households to observe food purchasing and attitudes toward eating. They found a pattern of life under constant economic restrictions. Also, in 1991, the national Childrens Homes survey on nutrition and poverty finds that 1 child in 10 and 1 adult in 5 skip meals because of costs. Thus, it is not people failing to practice good health habits but their choice is affected by limited funds (Barry Yuill 2006:108). Also, in an HSE survey (2007) 22% men and 20% women agree, it costs too much[to eat healthy] (p. 108). In 2010, The Marmot Review emphasized that insufficient funds to lead a healthy life is a significant cause of health inequalities (p. 29) Although health-damaging behaviors are more common among low groups, these groups also lack: adequate income, decent housing and secure employment. Therefore it is hard to separate behavioral explanation (Gatrell, C.A 2003: 113) from structural/material explanation (poor housing Ġº unhealthy life) and social selection explanation (poor health for low classĠº unhealthy life) Health policy response to inequalities in health linked to social class: Advocating healthy public policies is the most important strategy we can use to act on the determinants of health. (CPHA Action Statement on Health Promotion 1996) Up to date health policies include: The New NHS (1997); A First Class Service (1998); Choosing Health (2004); The Wanless Report (2004) Tackling Health Inequalities (2008); Darzi Report (2008); The Marmot Review (2010) The Marmot review: Policy objectives A-F:  · Give every child the best start in life  · Enable all children, young people and adults to maximize their capabilities and have control over their lives  · Create fair employment and good work for all  · Ensure a healthy standard living for all  · Create and develop healthy and sustainable places and communities  · Strengthen the role and impact of ill-health prevention. (UCL Research Department of Epidemiology and Public Health, 2010) Implications for health care practice: Important documents: Choosing health: making healthy choices easier (2004) and Health Challenge England (2006) people need convenience and choice in advice available to prevent ill health. Health care practice can contribute to reducing health inequalities through:  · Assessment / use of evidence: accurate assessment of peoples health promotion needs; linking evidence of practice outcomes to broader changes  · Strategy: population specific health care strategies; getting the promotion/prevention/treatment balance right  · Communication Collaboration: 1.collaboration with people: involving and engaging most excluded; 2.collaboration with MDT: assessing / implementing / evaluating / updating  · Training: improving training and professional development, particularly in relation to work with most disadvantaged  · Service development: being well informed about health inequality trends, impacts and intervention effectiveness  · Service access: reducing financial barriers to health care  · Resource allocation: making conscious, informed choices about priorities. (Wiseman, J 2007) (Choosing Health 2004) The time for action on health and health inequalities Health in the consumer society Children and young people starting on the right path Local communities leading for health Health as a way of life A health-promoting NHS Making it happen national and local delivery Consultation making it happen Assessment suitable assessment of local needs (collaborative therefore patient and public involvement / use of evidence) Strategy Communication appropriateness (methods and means) Service Needs (recruitment, training) Resources (access, materials, skills mix {MDT?, suitable tools and interventions) References: Asthana, S., Gibson, A., Moon, G., Brigham, P. and Dicker, J. (2004) The demographic and social class basis of inequality in self reported morbidity: an exploration using the Health Survey for England. Epidemiology and Community Health, 58, (4), 303-307 Blaxter, M. (1990) Health and Lifestyles, London: Tavistock Payne J, Coy J, Milner P, et al. Are deprivation indicators a proxy for morbidity? A comparison of the prevalence of arthritis, depression, dyspepsia, obesity and respiritory symptoms with unemployment rates and Jarman scores. J Public Health Med 1993;16:113-14. Dahlgren G Whitehead M (1991). Policies and Strategies to Promote Equity in Health. Stockholm: Institute for Future Studies.Davey Smith G, Hart C, Watt G, et al. Individual social class, area-based deprivation, cardiovascular disease risk factors and mortality: the Renfrew and Paisley study. J Epidemiol Community Health 1998;52:399-405. Drever F Whitehead M (1997). Health Inequalities. London: The Stationary Office. Graham, H (2007) Unequal lives: Health and Socioeconomic Inequalities, Open University Press, McGraw-Hill Education: England Graham H (2004a). Social determinants and their unequal distribution: clarifying policy understandings. Milbank Quarterly, 82, 101-24. Graham H (2004b). Closing the Gap: Strategies for Action to Tackle Health Inequalities. Presentation at the 1st Business Meeting of the EU Project Closing the Gap on 27/28 October 2004, Cologne. Lynch, J.W., G.A and Salonen, J.T (1997b) why do poor people behave poorly? Variations in adult health behaviors and psychosocial characteristics by stages of the socio-economic life course; Soc Sci Med 44, 809-19. Marmot M Wilkinson RG (2005). Social Determinants of Health. Oxford: Oxford University Press (2nd edition). Williams, A. Cooke, H. May, C (1998) Sociology, Nursing and Health, Elsevier Health Sciences: London Woodward, M., Shewry, M.C., Smith, W.C.S and Tunstall-Pedoe, H. (1992), Social status and coronary heart disease, Preventive medicine 21, 136-48. Mackenbach JP Bakker M (2002). Reducing Health Inequalities: a European Perspective. London: Routledge. Williams, A. Cooke, H. May, C (1998) Sociology, Nursing and Health, Elsevier Health Sciences: London Caspi, A Poulton, R Personality and the socioeconomic-health gradient, Oxford Journalls online, International Journall Of Epidemiology, vol. 32, number 6, pp. 975-977, accessed online on February 27th 2009, http://ije.oxfordjournals.org/cgi/content/full/32/6/975 The Marmot Review( 2010) UCL Research Department of Epidemiology and Public Health, accessed online February 29th 2010 http://www.ucl.ac.uk/gheg/marmotreview/FairSocietyHealthyLives Social Inequalities in Health. New Evidence and Policy Implications. J Siegrist and M Marmot (eds). Oxford University Press, 2006 Rickards L, Fox K and Roberts C (2004) Living in Britain: Results from the 2002 General Household Survey. London: The Stationery Office; Bambra C, Joyce K and Maryon-Davis A (2009) Task Group on priority public health conditions, final report. Submission to the Marmot Review http://www.ucl.ac.uk/gheg/marmotreview/consultation/Priority_public_health_conditions_summary Wiseman, J. Health Inequalities: Key Trends and Implications for Health Care, Presentation to Primary and Community Health, March 2n 2007

Gibbs reflective cycle

Gibbs reflective cycle Gibbs’ reflective cycle has 6 stages. They are usually given the following headings: 1. Description 2. Feelings 3. Evaluation 4. Analysis 5. Conclusion 6. Action Plan As part of my Overseas Nurse program, I am required to make a reflective essay. This essay is based on my experience in clinical placement in the Operating Theatre. The aim of this essay is to discuss my learnings about the importance of team briefing, principles of asepsis, and Surgical Handscrubbing, as well as experiences throughout my placement. I have come to select the Gibbs reflective framework for this for I feel that through this framework I can better express in a systematic manner the describe the incidents, feelings, and how I was able learn. Learning Outcome 1: Team Brief and WHO Surgical Safety Checklist In June 2008, the World Health Organization (WHO) implemented a second Global Patient Safety Challenge, ‘Safe Surgery Saves Lives’, to reduce the incidence of surgical deaths across the entire world. The initiative was developed to strengthen and improve the commitment of clinical staff to address safety issues within the surgical setting. This included improving anaesthetic safety practices, ensuring correct site surgery, avoiding surgical site infections and improving communication and teamwork within the team. The WHO Surgical Safety Checklist is a core set of safety checks, identified for improving performance at safety critical time points within the patient’s intraoperative care pathway. It is for use in any operating theatre environment, including interventional radiology with the expectation that it can be adapted to fit local practice. The three steps in the checklist (sign in, time out, sign out) are not intended as a tick box exercise, but as a tool to initiate meaningful and purposeful conversation between relevant members of the clinical team to improve the safety of surgery. According to the National Patient Safety Agency, NHS, there are five steps to safer surgeries. Namely Briefing, Sign in, Time out, Sign out and Debriefing. During my placement, I was assigned to circulate in theatre two. One of the five running theatres that our hospital has. The there was only one case. Patient Keiser (not the real name). 63 year old male consented for a Primary Total Knee replacement under general anesthesia using a Zimmer â€Å"NexGen† Knee system. I was nervous because it was a major case and I needed to be quick with my actions and be focused. I did my reading a day before so I had an idea of about the sequence of the operation. Before the patient was escorted to the theatre, the surgical team together with the anesthesia team had a team brief. In the briefing the patient details, laterality of site were confirmed as well as medication allergies, number of staff and availability of implants were all discussed. Everything went smoothly. The patient was then escorted to the anesthetic room and additional checks, verifications, and the sign in was done in the anesthetic room. The patient claimed that he had a nickel allergy and that he would get mild rashes when in contact with the metal property. The ODP (Operating Department Personnel) the person who is responsible for assisting the anesthetist and initiating the WHO Checklist was fully aware of this metal allergy as it was also reflected in the care plan and preassessment. The incident happened when the ODP and anesthetist failed to inform the scrub team about the specific allergy because they thought a nickel allergy had no significance. They were only conc erned with medication allergies. So they continued and put the patient to sleep with propofol and other anesthetic agents. The patient was then brought in the theatre with use of the trolley and placed safely on the Operating table. The scrub team on the other hand was almost done preparing the field and assembling equipment needed for the operation. When everything was ready. Being the circulating nurse, I then continued the WHO checklist and initiated the Time-out. The consent, patient verification and allergies were then reviewed but this time the ODP informed the team about the nickel allergy. The surgeon went ballistic! And ordered that the patient be woken up. There was a heated discussion between the surgeon and anesthetist and it they eventually had to wake the patient up. It was then explained to us by the surgeon that the System and implants to be used during the operation had a very small percentage of nickel present in its components which could cause a reaction if used to the patient. He was angry because it was the second time it happened to him and he did not want to go through all the paper works again. The patient was brought to recovery and woke up in a few minutes. The surgeon then explained the incident and unfortunately the operation was cancelled. The opened sterile instruments, supplies, and consumables were all put to waste. As I analyzed what happened, the mistake clearly rooted back to the team brief. There were vital information that the anesthetic team knew about the patient that was not shared to the scrub team because they did not see it as important. I personally think every allergy, be it medication, metal or objects should be taken into consideration. It was a major case and the team had to know everything relevant. I realized how important the team brief was. Often I would observe other teams not taking the team brief seriously. They would just breeze through it as if was just some unimportant routinely work. After the incident I learned a lot and the view I had on the team briefing and the importance of the WHO checklist drastically changed. It is a very important tool in ensuring a safe, effective and successful operation. I now plan to practice a thorough team brief as well as executing a proper WHO checklist. You never know, missing out on one important fact could mean a life of a patient. Learning Outcome 2: Principle of asepsis: Asepsis can be defined as the absence of pathogenic microorganisms that cause disease. It then can also be referred to as clean technique (Phillips, 2013). However, elimination of infection is the goal of asepsis, not sterility. (Ayliffe et al. 2000) suggest that there are two types of asepsis: medical and surgical asepsis. Medical or clean asepsis reduces the number of organisms and prevents their spread; surgical or sterile asepsis includes procedures to eliminatemicro-organismsfrom an area and is practised byhealth care workersand nurses in operating theaters and treatment areas. There are several principles of surgical asepsis. Although all are equally important, I have come to be more cautious and alert of specific principles more often than others. One principle I have chosen to share with is a principle stating that People who are sterile touches only sterile items or areas. (reference) It may seem as a very simple principle to follow but it could be at times difficult to imbed in our system. May it be a scrub role or circulating role this is one of the key things one should always keep in mind. I had one incident during placement relating to this. It happened during an early shift of a busy Friday. There were 52 operations to be done that morning. Everyone was on the go. For some time now I have been with an orthopedic team but this time I was assigned with my mentor to assist a list of over 6 cataract extractions with ocular lens implantation. She was to scrub and I was to assist with the circulating role. Coming into this list I had not assisted a cataract extraction in the last 4 years. My knowledge was very minimal although I knew the purpose and roughly the length of time needed to finish the procedure in general but I did not know much about the fine instruments needed, supplies and set up of the Centurion Vision. Everything was new to me and I felt much pressured to deliver and I was uncomfortable knowing I could make mistakes. As the operation began my mentor scrubbed in and she was too busy to guide me thoroughly at the moment. The surgeon and scrub started asking me to position the machine according to the surgeon’s preference. I was reprimanded for being slow and hesitant since the surgeon was ready to start. After finally connecting the plugs, foot pedals as well positioning the Centurion Machine above the patients head, the surgeon placed sterile plastic covers over each of the handles of the machine. These sterile plastic handles where used as a sterile field so that the surgeon can hold the machine. Like the principle states, only sterile people should touch sterile things and the other way around for unsterile. Already being reprimanded I was nervous that I would make another mistake and unfortunately I did. The surgeon wanted me to reposition the machine yet again to his preference but this time I unconsciously forgot my principles and touched the sterile handle and I compromised the sterility of the field. The surgeon requested for another sterile handle and the case was delayed. I felt very bad knowing that I knew the principle but still it just slipped my mind and I committed an error which compromised the operation someway. After the incident I knew what I needed to do and how to position the machine efficiently and quickly. I already knew the preferred position and supplies needed. I just needed to be more focused, less anxious and hesitant and be more confident this way I would not make mistakes of that degree. The first case finished and I was able to effectively circulate on the remaining cases with carefulness, confidence, focus and efficiency. Learning outcome 3: Surgical Hand scrubbing Microorganisms transfer from the hands of health care providers to patients; this is an Important factor with regard to health-care associated infections (i.e. nosocomial). Skin is a major source of microbial contamination in the surgical environment. Although the scrubbed members of the surgical team are wearing surgical gloves and gowns, their hands and forearms are to be cleaned preoperatively to significantly reduce the number of microorganisms (AORN 2006) According to the WHO Guidelines on Hand Hygiene in Health Care, Surgical hand scrubbing is the surgical hand preparation with antimicrobial soap and water performed preoperatively by the surgical team to eliminate transient flora and reduce resident skin flora (2009, World Health Organization). There are two methods of scrub procedure. One is a numbered stroke method, in which a certain number of brush strokes are designated for each finger, palm, back of hand, and arm. The alternative method is the timed scrub, and each scrub should last from three to five minutes, depending on facility protocol (Deborah Gardener 2011). In the operating theatres there are three most probable routes of infection transmission between successive/sequential surgical patients are via the air, from instruments, or from environmental surfaces. Journal of Hospital Infection (2002) I have always felt and understood the importance of keeping our hands clean even since I was a little boy. This was a practice taught to me by my parents. As I studied nursing in my country I got to know more about it and how it was properly practised in the wards and theatre settings. During my placement I would always observe my mentor thoroughly before gowning and gloving. I knew the importance of this. She would use repetitive strokes on the hands and arms to further remove any microorganisms. She would be very meticulous and patient while stroking her hands and arms with soap and an antimicrobial agent but as Ive observed, along with most of the scrub nurses, together with my mentor did not use brushes when doing surgical hand scrubbing despite brushes being available just at the side of the scrubbing area. This made a big question mark in my head and I was really confused. I wanted to know why they didn’t bother to use the brushes. So I decided to research about it. There was a study that compared surgical hand scubbing with and without the use of brushes. Two groups were involved during this study. One group to scrub without a brush and another group to scrub with brushes. According to Life Science Journal 2014, the result showed that the group which used brushes had slightly higher bacterial counts, this could mean that brushes traumatize the skin creating an environment where bacteria thrived. Whereas using no scrub brush resulted in no skin damage and significantly lower bacterial count. (AORN journal, 2004. 79: p. 225-30). Based on this research, I was amazed on how the United Kingdom healthcare setting applied evidence based practice. I applied this research findings to how I scrub. I learned more about because of research and from that moment on I have been scrubbing without using a brush. Surgical site infections (SSIs) are the second to third most common site of health care associated infections. When providing health services, it is es sential to prevent the transmission of infections at all times. (Engender Health 2001). I applied this research findings to how I scrub. I learned more about because of research and from that moment on I have been scrubbing without using a surgical brush.

Essay --

Risks Summary This case is about the aggressive price behavior of the TA Orange that has recently been in the joint venture with other Thai companies. Risks The risks that TA Orange faces while entering in to the Thai market are as follows: Lower profit margin risks Shareholders’ risk Increased competition in the market risk and market saturation risk As the joint venture between TelecomAsia-Orange and Thai companies CP Group and TelecomAsia and France's Orange SA adapted the strategy of aggressive price-cutting strategy aimed at picking up a million subscribers in 2002. This strategy has increased the risk of price wars between the service providers and as experts like J. P. Morgan points out, this would let them lower their profit margins, and eventually this price war would end up eroding all the profits that was initially intended. As indicated â€Å"all of this threatens to erode margins across the board, analysts warn, with the prospect of declining handset sales cast ing particularly long shadows over the profit profile at AIS. Last year, AIS derived nearly 35% of its net profit f...

Death Of A Salesman: Willy Loman Essay -- essays research papers

Willy Loman: Failure of a Man In Arthur Miller’s Death of a Salesman, Willy Loman is an example of a failure as a good father. He did not discipline his sons well by not punishing them. He did not set a good example to his sons by not admitting his faults. He did not make his family his number one priority. Instead, it was his work, coming before his family, his friends, and even himself. Not only is Willy Loman not a good father and husband, but he was a failure by not becoming successful, not achieving the American Dream. Willy is not a good father for many reasons. He made his occupation his number one priority. For years, he traveled for his work many times that he never had the opportunity to truly get to know his own sons. As a result he did not love them as a father should, his love for his son, Biff, was based on his achievements as an athlete. And when Biff was not able to go to University of Virginina, Willy was so devastated that he no longer loved Biff how he once did before. He was disgusted that Biff had become a bum, Biff had different jobs working at farms. Willy wants Biff to be the successful man that he never was and feels that Biff will not achieve success in the occupation he has taken. Furthermore, Willy was unable to admit his faults. His pride was so great that he even lied to his own family, borrowing money weekly from his neighbor, Charley, and then saying it was his salary. He tried to justify his affair with a strange woman when caught by Biff. He...

Affermative Action Essay -- Affirmative Action Essays

Affirmative Action   Ã‚  Ã‚  Ã‚  Ã‚  Affirmative Action efforts were started in 1964 to end the long history of overlooking qualified people of color and women from higher education. Affirmative Action sets standards for a business or office of admissions, so that a white man does not have the upper-hand over an equally or greater educated minority. The initial way the government tried to justify Affirmative Action was to develop a human resource approach: first identifying the problem, which is racism then establishing the solution (Phillips 67).   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  The intent of Affirmative Action helps cut down discrimination in the work place and in schools, despite the fact that some believe that affirmative action is a form of reverse discrimination. In contrast, the first goal of Affirmative Action was to help people who were poor or badly educated, elevating them to positions for which they were not objectively qualified (Buckley 95). Cousens, author of Public Civil Rights Agencies and Fair Employment indicates that the Affirmative Action techniques have the advantage of not only persuading employers not to discriminate when hiring or accepting, but to expand employment and educational opportunities for minority groups (22). Therefore, Affirmative Action is legitimate because it does reduce discrimination in the work place and related areas such as University acceptance of college students. In the end, it should in no way be abolished.   Ã‚  Ã‚  Ã‚  Ã‚  However, Affirmative action is highly controversial. Right now Proposition 209, in California which bans all programs involving race and sex preferences run by the state, has passed but it will not be put into total action due to some questions of constitutionality (Ayres 34). The law will start slowly first, ending Affirmative Action in the schools of California, leading up to the abolishment of Affirmative Action all together. An argument was declared by Mark Rosenbaum of the Southern California Branch of the American Civil Liberties Union, â€Å" Proposition 209 should be declared unconstitutional because it singles out women and minorities and, at a time when discrimination still exists, sought to preclude them from attaining constitutionally guaranteed right, like jobs and schooling.† (Ayres 34). As R... ...Maybe the world hasn’t exactly found equality as a result, but with Affirmative Action, the world is a lot closer to equality than without it. Works Cited Applebome, Peter. â€Å"Affirmative Action Ban Changes a Law School.† New York Times   Ã‚  Ã‚  Ã‚  Ã‚  2 July 1997: a14. Ayres, B. Drummond, Jr. â€Å"Affirmative Action Battle Moves to Courts.† New York   Ã‚  Ã‚  Ã‚  Ã‚  Times 1 Dec. 1996: 34. Benac, Nancy. â€Å"Clinton Defends Preference Programs, Backs Reforms.† Associated   Ã‚  Ã‚  Ã‚  Ã‚  Press Writer. . 19   Ã‚  Ã‚  Ã‚  Ã‚  July, 1995. Buckley, William F., Jr. â€Å"The Two Sides.† National Review 14 Oct., 1996: 95 Cousens, Frances. Public Civil Rights Agencies and Fair Employment. New York:   Ã‚  Ã‚  Ã‚  Ã‚  Praeger, 1969. Hair, Penda D. â€Å"Color Blind-or Just Blind?† Nation 14 Oct. 1996: 12. â€Å"Once to Every Man.† National Review 16 June, 1997: 12. Phillips, D. Rhys. Equality in Employment. Ottawa: Canadian Gov., 1985: 285 Porter, Horace. â€Å"Affirmative Action: 1960’s Dreams, 1990’s Realities.† Chronicle of   Ã‚  Ã‚  Ã‚  Ã‚  Higher Education. 29 Nov. 1996: B6

Bullying speech Essay

What does it feel like to wake up in the morning and look forward to a day of teasing and name calling? What does it feel like to be engulfed in a world of negativity? Bullying†¦ Unwanted and aggressive behavior among school aged children involving real or perceived power imbalance. Bullying is no man’s best friend and it shouldn’t be. We see it all around us in our daily lives. All across the United States, this form of victimization has become an infamous trend among scholars. About 3 million out of America’s 21 million students are affected by bullying. That is about 1 student in every 7 students! Numerous people have different perspectives on what bullying is. Some think it means physical hurting while others think it is only emotional hurting. All of these are correct due to the fact that there are different ways one can be bullied. Bullying is unwanted and repeated behavior among students which includes Physical, Verbal, Indirect, social Alienation, In timidation and Cyber Bullying. see more:speeches on bullying Physical bullying is a serious problem it is when one person or a group of people picks on or harasses another person in a face to face confrontational manner. Verbal bullying is the most common form but it is just as bad as the other types. It is when an individual uses verbal language (e.g., insults, teasing, etc.) to gain power over his or her peers. Social Alienation is one type of bullying whereby exclusion is occurring between students due to social differences. The devastating part about this form is that it is not easily recognized as a form of bullying. Intimidation is the acts of making someone feel fearful by using threats. Last but not least, Cyber bullying which happens when kids bully each other through electronic devices. Over 25 percent of adolescents and teens have been bullied repeatedly through their cell phones or the Internet. With the increase in our use of technology, this form of bullying is increasing to higher rates. How can you stop this from happening? How can we put an end to bullying? It’s simple. The best way is NOT ignoring it whenever you see it going on. STEP UP! And be an advocate for your fellow peers that are hurting. Bulling is BAD! And it is up to YOU if you would let it happen when  you see it going on or stop it. experience