Free Essays on Emerson-Melvil

While some literature simply entertains, other literature tries to raise, consider, and answer questions about life’s fundamental purpose, to get at fundamental truth. One author who writes in such a manor is Herman Melvil, author of the popular novel Moby Dick . Melvil used symbolism to raise questions about life in the novel. A symbol is a person, place, or thing that has a meaning in itself and also represents something larger. There are many symbols in Moby Dick. Many raise, consider, and answer questions about the many aspects of life. One symbol is the ship. The ship represents the world. Upon this boat is an extremely diverse crew, symbolising the different people of the earth. The white whale, or Moby Dick, symbolises nature; unpredictable, immortal, dangerous, and beautiful. The situation in the story can consider the questions of respect towards nature. When the whale was harmed, it destroyed the boat and crew. This could be raising questions about respect and the power of nature; as if the whale foreshadows what would happen if we didn’t respect or if we underestimated natures power. I agree with this interpretation. This novel was full of research and truth about life. Another author of this sort is Ralph Waldo Emerson. Emerson wrote such titles as Self -Reliance , and poetry such as â€Å"The Snowstorm† and â€Å"Concord Hymn:. Emerson raised, considered, and answered lives questions while using Transcendentalism. Transcendentalism is the belief that the human senses can know only physical reality. It focused on the human spirit and the natural world and its relationship to humanity. In Self-Reliance, Emerson raises such questions as why should people trust themselves. He explains that what happens within a mans life are lessons to better himself, almost as if he is speaking of fate. I disagree with this statement. The reason for this is because fate, in opinion, is unrealistic, bec... Free Essays on Emerson-Melvil Free Essays on Emerson-Melvil While some literature simply entertains, other literature tries to raise, consider, and answer questions about life’s fundamental purpose, to get at fundamental truth. One author who writes in such a manor is Herman Melvil, author of the popular novel Moby Dick . Melvil used symbolism to raise questions about life in the novel. A symbol is a person, place, or thing that has a meaning in itself and also represents something larger. There are many symbols in Moby Dick. Many raise, consider, and answer questions about the many aspects of life. One symbol is the ship. The ship represents the world. Upon this boat is an extremely diverse crew, symbolising the different people of the earth. The white whale, or Moby Dick, symbolises nature; unpredictable, immortal, dangerous, and beautiful. The situation in the story can consider the questions of respect towards nature. When the whale was harmed, it destroyed the boat and crew. This could be raising questions about respect and the power of nature; as if the whale foreshadows what would happen if we didn’t respect or if we underestimated natures power. I agree with this interpretation. This novel was full of research and truth about life. Another author of this sort is Ralph Waldo Emerson. Emerson wrote such titles as Self -Reliance , and poetry such as â€Å"The Snowstorm† and â€Å"Concord Hymn:. Emerson raised, considered, and answered lives questions while using Transcendentalism. Transcendentalism is the belief that the human senses can know only physical reality. It focused on the human spirit and the natural world and its relationship to humanity. In Self-Reliance, Emerson raises such questions as why should people trust themselves. He explains that what happens within a mans life are lessons to better himself, almost as if he is speaking of fate. I disagree with this statement. The reason for this is because fate, in opinion, is unrealistic, bec...

Quick Facts About the Element Uranium

Quick Facts About the Element Uranium You probably know uranium is an element and that its radioactive. Here are some other uranium facts for you. You can find detailed information about uranium by visiting the uranium facts page. 11 Uranium Facts Pure uranium is a silvery-white metal.The atomic number of uranium is 92, meaning uranium atoms have 92 protons and usually 92 electrons. The isotope of uranium depends on how many neutrons it has.Because uranium is radioactive and always decaying, radium is always found with uranium ores.Uranium is slightly paramagnetic.Uranium is named after the planet Uranus.Uranium is used to fuel nuclear power plants and in high-density penetrating ammunition. A single kilogram of uranium-235 theoretically could produce ~80 terajoules of energy, which is equivalent to the energy that could be produced by 3000 tons of coal.Natural uranium ore has been known to fission spontaneously. The Oklo Fossil Reactors of Gabon, West Africa, contain 15 ancient inactive natural nuclear fission reactors. The natural ore fissioned back at a prehistoric time when 3% of the natural uranium existed as uranium-235, which was a high enough percentage to support a sustained nuclear fission chain reaction.The density of uranium is about 70% higher than lead, but less than that of gold or tungsten, even though uranium has the second-highest atomic weight of the naturally occurring elements (second to plutonium-244). Uranium usually has a valence of either 4 or 6.Health effects of uranium typically are not related to the elements radioactivity, since the alpha particles emitted by uranium cannot even penetrate the skin. Rather, the health impact is related to the toxicity of uranium and its compounds. Ingestion of hexavalent uranium compounds can cause birth defects and immune system damage.Finely divided uranium powder is pyrophoric, meaning it will ignite spontaneously at room temperature.

Qualitative proposal research regarding ARE DOCTORS SUPPORTIVE OR Thesis

Qualitative proposal research regarding ARE DOCTORS SUPPORTIVE OR OBSTICLES IN QUALITY IMPROVMENT PROGRAM - Thesis Example Physicians often view CQI as a threat to professional autonomy (McLaughlin & Kaluzny, 1990) and are skeptical that a management technique can improve patient outcomes. Structural barriers, including inadequate training (Shortell et al., 1995), longstanding social norms (Mittman, Tonesk, & Jacobson, 1992), and the fact that many physicians are independent providers (Chan & Ho, 1997), can also impede physician involvement in CQI and other changes in health care. Physician involvement in CQI becomes critical as quality improvement initiatives turn from administrative functions (e.g., streamlining outpatient registration) to clinical functions (e.g., increasing adherence to clinical practice guidelines). Unfortunately, traditional approaches to physician behavior change are unlikely to increase physician involvement in CQI. A meta-analysis of 102 studies examining the efficacy of continuing medical education strategies found that our most heavily used interventions, educational materials and conferences, tend to have little impact on physician behavior or patient outcomes in health care (Davis, Thomson, Oxman, & Haynes, 1995). There is growing recognition that the success of interventions may depend in part on individual readiness to change (Armstrong, Reyburn, & Jones, 1996; Cantillon & Jones, 1999; Davis et al., 1995). The transtheoretical model (TTM, also known as the stage model), one of the leading approaches to health behavior change, offers a promising approach to behavior change among health care professionals. The model systematically integrates the following four theoretical concepts central to change: The TTM understands change as progress, over time, through a series of stages: precontemplation, contemplation, preparation, action, and maintenance. Nearly 20 years of research on a variety of health behaviors have identified processes of change that work best in each stage to facilitate progress. This research can serve as a

Spreadsheet Models Essay Example | Topics and Well Written Essays - 2500 words

Spreadsheet Models - Essay Example The concept of an electronic spreadsheet was first outlined in the 1961 paper "Budgeting Models and System Simulation" by Richard Mattessich. A spreadsheet program is planned to carry out general computation tasks using spatial relationships rather than time as the primary organizing principle. Many programs designed to perform general computation use timing, the ordering of computational steps, as their primary way to organize a program. A well defined entry point is used to determine the first instructions, and all other instructions must be reachable from that point. In a spreadsheet, however, a set of cells is defined with a spatial relation to one another. It is often convenient to think of a spreadsheet as a mathematical graph, where the nodes are spreadsheet cells, and the edges are references to other cells specified in formulas. This is often called the dependency graph of the spreadsheet. References between cells can take advantage of spatial concepts such as relative position and absolute position, as well as named locations, to make the spreadsheet formulas easier to understand and manage. Spreadsheets usually attempt to automatically update cells when the cells on which they depend have been changed. The earliest spreadsheets used simple tactics like evaluating cells in a particular order, but modern spreadsheets compute a minimal re-calculation order from the dependency graph. Later spreadsheets also include a limited ability to propagate values in reverse, altering source values so that a particular answer is reached in a certain cell. Since spreadsheet cells formulas are not generally invertible, though, this technique is of somewhat limited value. Many of the concepts common to sequential programming models have analogues in the spreadsheet world. For example, the sequential model of the indexed loop is usually represented as a table of cells, with similar formulas. [02] Small and Large Business Businesses, large or small, depend significantly on spreadsheet models. Small businesses depend more on them due to the basic fact that they do not have enough resources to install and maintain a heavy infrastructure for an ERP system. Therefore, their dependence on spreadsheet models is very large. In comparison, large scale businesses have resource allocation for ERP systems. Not only the large scale organizations have more resources, but they also have high set of standards maintained by them. This is also one of the reasons that large scale organizations do not reply heavily upon spreadsheet models for perfect decision making. However, these large scale business organizations do use some of the interim formats and their procedures are taken care of using a spreadsheet model. Financial planning is a critical activity for every business irrespective of its age and size. For new enterprises, the preparation of financial projections is integral to the business planning process.

Posttraumatic Stress Disorder Essay Example for Free

Posttraumatic Stress Disorder Essay This paper examines the diagnosis of Posttraumatic Stress Disorder as demonstrated by David Pelzer in his autobiographies A Child Called It and The Lost Boy, with a focus on the latter book. Dave is the son of alcoholic parents whose mother severely abused him while his father turned the other cheek. Dave has been subjected to torturous mind games, starvation, and physical abuse so horrendous that he is left scarred, bruised, and nearly dead. The staff at his elementary school eventually takes action and David is removed from his parents’ custody. From there, he spends his teenage years in various foster homes while he struggles with the emotional scars left by the trauma he endured. His search for answers to why he was treated this way and effort to understand the frightening nightmares and emotions he experiences becomes a long journey toward self-love and forgiveness. David meets the criteria for Posttraumatic Stress Disorder firstly because he has been exposed to a traumatic event in which he both experienced events that involved actual or threatened death or serious injury, or a threat to the physical integrity of himself and his response involved intense fear, helplessness, or horror. After being caught by his mother begging for food on the way to school because she was starving him, David’s mother decides to punish him by forcing him to swallow a spoonful of ammonia. David says that, â€Å"I could feel the force of my pounding fists weaken The colors seemed to run together. I began to feel myself drift away. I knew I was going to die† (Pelzer, A 75). In addition to beating David on a regular basis and â€Å"accidentally† stabbing him, his mother would order him to clean the bathroom with a mixture of Clorox and ammonia, after which he says he â€Å"coughed up blood for over an hour† (Pelzer, A 109). David has illustrated a markedly diminished interest or participation in significant activities at school, including difficulty concentrating, by the time he is removed from his home. As David is taken into protective custody, he exhibits symptoms of increased arousal through an exaggerated startle response. When the officer reaches out to touch David’s hand in a reassuring way, David flinches by reflex (Pelzer, T 27). Furthermore, once David enters his first Foster home with Aunt Mary, his behavior is uncontrollable. He runs from room to room, jumps on mattresses, and nearly knocks over a lamp. He explains, â€Å"By reflex, Aunt Mary grabbed my arm. She was about to scold me until she looked down at me. I covered my face, and my knees began to shake† (Pelzer, T 43). At ight, David has recurrent distressing dreams of the event, including a nightmare about â€Å"The Mother† marching toward him with a knife. He can feel her rancid breath on his neck and he hears her chanting that there is no escape and that she will never let him go. He becomes fearful of sleeping because he doesn’t want to fall into the nightmare again. For many nights he stays awake while the other children sleep; holding on to his knees while rocking back and forth and humming to himself (Pelzer, T 45). This is also another example of a persistent symptom of increased arousal because he has difficulty falling or staying asleep. David exhibits persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness in his efforts to avoid thoughts, feelings, or conversations associated with the trauma. When David gets his first visit from a Child Protective Service worker, Ms. Gold, he feels as if he does not deserve her kindness and is too scared to have her touch him and hold his hand. She slowly gains his trust and becomes his friend. During their long talks, David says, â€Å"At times I was too scared to talk and long moments of silence followed. Other times, for no apparent reason and not understanding why, I’d burst into tears† (Pelzer, T 46). David’s mother comes to drop off some clothes for him at his foster home. While Aunt Mary is in the other room, his mother tells him she’s going to â€Å"get him back† for telling the family secret of abuse (Pelzer, T 53). This very direct exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event causes David intense psychological distress. The next day Ms. Gold tells David that they are going to court in two days and that she needs to ask him a few questions to clarify their case. However, David is consumed with fear because of his mother’s threat and proceeds to retract as many statements he could; claiming that he had lied about everything, had beaten himself, and that everything was his fault (Pelzer, T 55). In doing so, he is making an effort to avoid activities, places, or people that arouse recollections of the trauma. David illustrates another symptom of increased arousal through his irritability and outbursts of anger. After another of his mother’s visits, David has a breakdown. He cries as he rants and raves to Mrs. Catanze about his mother, asking why she treated him so viciously. He proceeds to tell his foster mother some of the horrendous abuse he suffered at the hands of his mother (Pelzer, T 100-103). After his revelation to his foster mother, she sends him to a therapist. While in the therapist’s office, David starts to feel as if one of the traumatic events were recurring and has a sense of reliving the experience of when his mother held him over the gas stove. He explains, â€Å"I lost track of the doctor’s voice. My right arm began to itch. I scratched it before I glanced down. When I did, I saw that my right forearm was engulfed in flames. I nearly jumped out of my seat as I shook my arm, trying to put out the fire† (Pelzer, T 130). Lastly, David shows that he has a feeling of detachment or estrangement from others when, after being â€Å"set up† to get caught shoplifting, he says to himself, â€Å"I should have known better†¦I knew they couldn’t have liked me for just being another kid† (Pelzer, T 156). While David wants to avoid his mother, he does not make really make an effort to avoid activities, places, or other people that arouse recollections of the trauma. In fact, he continues to keep hope that his father will visit him. He is also able to have loving feelings toward his social worker and certain foster parents. The duration of the disturbances is much more than 1 month and has caused David clinically significant distress or impairment in social and other important areas of functioning. Treatment considerations for David should involve individual therapy including a goal that involves getting his nightmares and flashbacks to stop. David should be gradually exposed to more stressful stimuli in exposure therapy and be taught relaxation techniques to set free all negative consequences and to achieve extinction. He should be offered support and empathy in therapy and be encouraged to express his feelings and to let things out. Also, cognitive restructuring in the form of Rational Emotive Therapy is recommended to help David think rationally and clearly about the abuse and neglect he suffered and about his present situation. It is expected that this form of therapy will also improve his self-esteem, destructive thought patterns, and help him to sleep better. The use of medication does not appear to be necessary.

Women, Men And Competition :: essays research papers

Women, Men and Competition Loudly and often, women insist they don't like competition, and that competition is an act of aggression. Ironically, however, competition as aggression is inevitable in a society where men must compete for the attention of women. Women encourage this. Every time they passively wait for men to take the initiative, or reject nurturing men in deference to domineering men, they sustain the dynamic of dominance. Ignoring this, pop-feminists contend competition is the capitalization of aggression, and men do it to the detriment of all. Does this mean fighting for domination is the only way to compete? That competition is solely a product of masculine socialization and something we can do without? Masculine socialization has nothing to do with it. In one way or another, all living things compete, because wanting creates competition. You want to live, so you offer goods or services to others in exchange for the goods and services you need to survive. The better the goods and services you offer, the more you can get in exchange, and the better you will be able to live. To live well, you make your "stuff" as good as possible relative to what your "competition" offers. That is the essence of competition in a free market. It respects the rights of others, and everybody wins because it works through validation rather than domination. Competition as validation is the process by which the efficacy of ideas, knowledge, and products is validated by consumers. They choose what they value most. To the extent our economy encourages winning through validation, it works. Most women, however, encourage competition through domination by ignoring cooperative, nurturing men to give their love and sex to domineering, "virile" men. What's more, women compete, and they compete to win. This is especially evident in women's response to the invention of the rubber condom. Prior to the 1870's, prostitution in Europe was prevalent. Victorian ladies' distaste for sex encouraged "an explosive increase in prostitution" that caused "an epidemic spread of venereal disease, and a morbid taste for masochism." Then, women began to compete sexually, and prostitution had to go. They began to compete with prostitutes for their husbands' continuing attentions. What changed? Men started using rubber condoms. This gave women the option of enjoying sex without risking pregnancy, and that meant women now viewed prostitutes as sexual competitors. Subsequently, they demanded laws prohibiting prostitution, belying the myth that women don't compete. Women say this is men's fault. That men have forced the necessity of sexual competition upon women and that, left to themselves, women hearken to a more cooperative agenda. But the facts do not support this contention.

Organizational Systems and Quality Leadership Essay

A. Complete a root cause analysis that takes into consideration causative factors that led to the sentinel event. (This patient’s outcome) The terms failure analysis, incident investigation, and root cause analysis are used by organizations when referring to their problem solving approach. Regardless of what it’s called there are three basic questions to every investigation: 1. What’s the problem(s)? 2. Why did it happen? (the causes) 3. What specifically should be done to prevent it? (Galley, n.d., ∂ 1) In the case of Mr. J, these were multiple issues that led to and contributed to his unexpected demise after what is usually considered a routinely performed procedure in an emergency department setting. The JCHAO (Joint Commission on Accreditation of Healthcare) defines a sentinel event as â€Å"an unexpected occurrence involving death or serious physical or psychological injury†, (Frain, Murphy, Dash, & Kassai, ∂ 1) and in the case of Mr. B, his death would be considered a sentinel event which would warrant a review by a team of interdisciplinary members of the hospital. In this particular case members of the team would include one or more ED physicians, the RN in the scenario and the LPN, a respiratory therapist, a nursing supervisor, a hospital administrator, the ED nurse manager, a hospital pharmacist, and a risk manager. More staff nurses from the ER could also be involved. A credible and successful root cause analysis will identify all of the elements that contribu ted to the event, an action plan will be developed to prevent the event from reoccurring and ensure that those actions are completed. Action plans should be based on best practices and appropriate standards. (Frain et al., ∂ 10) The scenario presented starts out as what  appears to be an average afternoon shift in a small 6 bed emergency department in a rural hospital. Staffing consisted of one emergency room physician, one registered nurse (RN), on licensed practical nurse (LPN) and a secretary. Due to the size of this particular ER, there appears to be limited staffing and therefore limited resources to handle large volumes of patients and or critical patients. There are two patients already being worked up in the department at the time of Mr. B’s arrival and they are stable, have already been evaluated and they are awaiting further treatment or orders. Mr. B is brought to the ED by private vehicle complaining of left leg and hip pain after losing his balance and falling over his dog. The triage nurse noted that other than the patient displaying tachypnea, his vital signs were otherwise within norm al limits. The patient states his pain level is severe, a â€Å"ten out of ten†, and physical examination finds a shortened left lower extremity with calf swelling and ecchymosis. In triage it is noted that the patients leg is stabilized and he is subsequently moved into a patient room where the admitting RN, Nurse J, takes over and gets a more thorough history of this patient, noting impaired glucose tolerance, prostate cancer and chronic back pain. Mr. B regular medications include Atorvastatin and also Oxycodone for his chronic back pain. The doses and how often he takes these mediations is not provided. Although there is no mention of any radiology studies being performed on Mr. B after his arrival, it is assumed that this was performed before the ER physician completed his evaluation and ordered 5 mg intravenous diazepam to sedate the patient to perform a manual reduction of a dislocated hip. After waiting for 5 minutes, the physician then instructed the RN to administer 2mg of hydr omorphone, a powerful narcotic analgesic. The staff waits five more minutes, after which the physician then instructs the RN to repeat both doses of diazepam and hydromorphone because he is not satisfied with the patient’s level of sedation. It is after these medications are administered that the physician notes patient’s weight and history of opiate use. Five minutes after the last dose of medication is administered a successful reduction of the left hip takes place and the patient remains sedated. The reduction procedure, which initially began at approximately 16:05, ended at 16:30. Although Nurse J is monitoring this patient, she is alerted that EMS (Emergency Medical Services) is bringing in an elderly patient with reported acute  respiratory distress. Nurse J, an experienced critical care nurse, elects to place Mr. J on an automatic blood pressure machine with a pulse oximeter. Although not stated, it is likely that this is a portable machine and is not hooked up to any wall monitors. It does not have continuous EKG monitoring. It does not have end tidal CO2 monitoring. Nurse J then elects to leave the patient in the company of his son with a blood pressure of 110/62 and an oxygen saturation of 92% on the portable machine. The patient is breathing room air and does not have any other monitoring. The ambulance patient has arrived to the department and both the RN and LPN are involved in stabilizing this new arrival and discharging the previous patients as the lobby is now becoming congested with more patients seeking care. There is no mention of anyone suggesting that additional staff should be brought in to help with the load. During this time the pulse oximeter alarm fires off in Mr. B’s room showing at saturation of 85%. The LPN enters the room and resets the alarm and repeats a blood pressure, but there is no mention of the LPN assessing the patient’s respiratory and or mental status. At 16:43, almost forty minutes after Mr. B’s procedure had begun, the son who is at the bedside with him states the monitor is alarming. Nurse J finds a Mr. B in respiratory arrest and a stat code is called. A code team arrives and the patient is connected to a cardiac monitor for the first time. The patient is in ventricular fibrillation, CPR is begun, and according to this scenario he is intubated before he is defibrillated. After thirty minutes of interventions, this patient is resuscitated to a normal sinus rhythm with pulses, but is unable to breathe without a ventilator. He has fixed and dilated pupils and no spontaneous movements. Most likely due to the facility being a small rural hospital, they must transport this patient to a higher level of care, and he is flown out to another facility where the patient was ultimately determined to have brain death and was taken off of life support. A-1 Discuss the errors or hazards in the care in this scenario Causative factors in this scenario appear to include poor staffing to patient ratios, inadequate adherence to hospital policy for moderate sedation, and an obvious lack of communication between peers /coworkers. The human factors point to failure of staff to follow an established protocol, possible  fatigue, possible inability to focus on the task, and a lack of utilizing critical thinking skills. There did not appear to be any equipment problems other than the fact that the appropriate equipment that was available was not accessed. The environmental nature of emergency medicine lends itself to hazards in the fact that a department can go from being quiet and mellow in one moment, to being volatile and hectic the next moment. It is an environment of unpredictability and bestows care to a wider population of patients than any other department in the hospital. Common environmental issues to all emergency rooms can include poor location and accessibility of equipment, overhead paging systems that no one hears, security risks, lighting and space issues, lack of privacy due to patients being placed in hallways and other open areas not designated as patient care areas. Organizational factors may include budgeting limitations, staffing to patient ratios and contingency problems. Dealing with unexpected sick calls, inability to fill those calls, power outages and electronic documentation systems that fail, external environmental disasters, rapid influxes of unexpected patients and the media are all common factors that can disrupt hospital care. Well written policies are a must to guide staff in continuing to provide quality care while minimizing errors and hopefully avoiding sentinel events. Potential hazards and errors can be avoided by learning from the literature and past experiences of other emergency departments. Specific protocols for procedures performed in the ER are developed for this very reason. In the given scenario there is the issue of proper staffing which posed a hazard to the patient who eventually expired. Nurse to patient ratios in this scenario were inappropriate due to the fact that a patient who had received moderate sedation was not closely monitored and ideally should have received one on one nursing care for the duration of his procedure and until he met discharge criteria. This would have been possible had the RN asked for back up which was apparently available. Looking back on the scenario, it was noted that immediately after the joint reduction of Mr. B had been performed, a critically ill ambulance patient had arrived and the RN was responsible for that patient as well. In the emergency department, or any department for that matter, nurses are continually subject to frequent interruptions, the need to multi-task, and reliance on â€Å"work-arounds† because of inadequate systems  support. (Cherry & Jacob, 2011, p. 473) In the case of nurse J, she may have been fixated on completing other tasks, such as stabilizing the ambulance patient, thus distracting her from the ongoing developments with Mr. B. who appeared to be resting comfortably with his son at the bedside. Assuming the patient was safe with a family member, the RN missed the opportunity to reverse the downslide of events that unfolded. Not anticipating the need for additional help is a hazard when staff become overwhelmed but continue to proceed as if help is not needed, because they may be accustomed to being understaffed and working only with what they have. Therefore, this presents the issue of the culture of safety, or lack thereof. It did not appear that there was any organized culture of safety and the communication between staff members appeared to be minimal. Possibly there was an environment of distrust between coworkers, or an intimidating environment in which the RN was afraid to speak up to the ERMD regarding the management of the patient’s pain and sedation. Perhaps the LPN was intimidated by the RN and did not chose to inform the RN of the abnormal vital signs. It appears that inconsistent or absent communication skills among the staff present that day contributed overall to a hazardous situation. And lastly, possible poor training and education of staff creates a hazardous environment and the lack of critical thinking skills demonstrated in this scenario suggests that this is an area that needs to be examined closely at this hospital. There is no mention of what the LPN’s responsibility is in assessing the patient but it is difficult to comprehend how an experienced health care worker in an ER would not investigate a poor pulse oximetry reading further than simply resetting the monitor. Educational requirements and experience of the staff needs to be reviewed and revised by the interdisciplinary team as part of the improvement plan. Errors made in this scenario that contributed to this sentinel event include the fact that there was a specific protocol for conscious sedation and it was ignored. Although Nurse J was ACLS (advanced cardiac life support) certified, and she had completed the hospital’s training module, she did not follow the guidelines in the written protocol which more than likely would have prevented any of this event from happening. Perhaps she did not understand the protocol, perhaps she was accustomed to taking short cuts, or perhaps she was drug or alcohol  impaired. Another possibility is that the nurse was not able to find the online protocol on the hospital portal. Perhaps the portal was difficult to navigate and the policy was difficult to locate. Being under time constraint, a nurse might decide to forgo looking up the policy because it is too time consuming to look for it. Only Nurse J. would be able to provide us with this critical information. It is not clear as to why an experienced critical care nurse with no history of negligence did not follow proper procedure. Other errors include the fact that sufficient monitoring equipment was available and not utilized, including use of supplemental oxygen and possible end tidal CO2 monitoring. Furthermore, no one in the department called for any back up, such as a nursing supervisor or a respiratory therapist to help manage the patient. The ER physician who ordered the medications did not communicate with the nurse before the procedure about the risks associated with this patient, including the patient’s home use of opiates for his chronic pain. Polypharmacy, possible use of supplements, adherence issues, and the potential for adverse drug events all posed potential hazards that needed to be addressed. (Williams, 2002, ∂ 1) The RN did not question the physician about the orders and the physician in turn, did not question the nurse if she had any concerns. There was no â€Å"time-out† procedure performed by the staff, which would have given staff members the opportunity to voice concerns. The doctor also failed to notice that the patient was not being appropriately monitored, and along with the rest of the staff he did not appear to display a teamwork mentality. The key to a successful root cause analysis is to search for answers as to what system errors and failures need to be corrected, and not to pursue blame on any one individual. Individual blame centers around forgetfulness, inattention, or moral weakness. It is punitive. A systems approach examines the conditions under which health care workers work and sets up defenses to avert errors or mitigate their effects. (Cherry & Jacob, 2011, p. 473) The goal is to bring staff together to design and implement processes that provide uniform standards of treatment and care and provide safety to all involved and minimize the likelihood of harm or a sentinel event. B. Improvement Plan By requiring the staff of the emergency department to reexamine its actions on that day, a dialogue is created that hopefully will create a strong motivation to seek out better and newer ways to handle patients that require sedation and monitoring. If the participation is not there, then the motivation will not be created and change will not occur. One way of developing an improvement plan would be to apply the theories of change developed by physicist and social scientist Kurt Lewin in the 1950s. His change management model, known as Unfreeze-Change-Refreeze, refers to a three stage process of transitioning through change. Lewin believed that to begin any successful change process, one must first understand why the change must take place, and this is where the motivation for change begins. He stated that one must be helped to re-examine many cherished assumptions about oneself and one’s relations to others. This is the stage known as â€Å"unfreezing†. (Thompson, n.d., p. 1) In the case of the emergency department, the entire team needs to be compelled to change the way sedation procedures are performed, as well as how patients are handled before and after the procedure. In addition to reviewing the procedural sedation protocol, the team needs to look at overall hospital care of those receiving any medications that cause respiratory depression. This should not be too difficult to promote since the procedure performed that fateful day resulted in harm and subsequent death of a patient. Not only was the patient and his family harmed, the entire organization was harmed and is liable for this incident. The hospital and its emergency department’s community reputation is going to suffer. Knowing that the staff that day is probably emotionally traumatized and possibly fearful of the consequences, the environment is ripe for change and the unfreezing stage can begin with a review of the sedation policy and why it was not followed. Each individual there and staff that were not there that day need to be made aware and can meet one on one with the department manager to voice their concerns and questions. Barriers hopefully will be identified as to why the sedation protocol was not followed that day. The hospital already provides an electronic educational module on conscious sedation procedures which would have a required date for staff to complete. This module should be reviewed for any inconsistencies  and updated and it should be made easily accessible on the computer portal. The actual written policy should also be easily accessible on the portal as well as in print form in a binder at the nurses station, should staff not have access to the computer. An analgesic protocol could be developed in which there would be a minimum time lapse between opioid doses (for instance 10 minutes versus 5) and the use of a hospital approved sedation scoring system should be in place. Patients in addition to requiring continuous pulse-oximetry monitoring should also be on continuous end tidal CO2 monitoring as well, long considered a more effective way of measuring effective ventilatory status. A new electronic training module on the use of end tidal CO2 monitoring would be mandatory for nursing staff to complete and equipment in the ED would be upgraded to provide for this type of monitoring. A representative could come and demonstrate the use of this type of monitoring and sign off employees for a mini-education module. Although many emergency departments have upgraded their documentation to all electronic, it might be helpful for staff nurses who are continuously monitoring patients at the bedside to use paper forms to document the pre procedure requirements including consents, time-outs, intra procedure medications and response to those meds and vital signs as well as post procedure Aldrete scores and recovery notes. This would be advantageous for simply the reason that not every bed has access to a computer. Health care providers certified in Advanced Cardiac Life Support (ACLS) must be in direct attendance with the patient throughout the entire course of the sedation and until the patient is fully recovered. Their primary responsibility is to monitor the vital signs including heart rate and rhythm, blood pressures, respiratory rate and oxygen saturation, as well as the patency of the patient’s airway. The RN managing the patient should never leave the patient unattended or engage in tasks that would compromise this continuous monitoring. The RN is responsible for taking the leading role in assuring that the care provided is safe. Proper airway equipment and drug reversal agents should be at the bedside and this must be documented. In order to unfreeze the staff and help them to change their behaviors, the ED could hold mock sedation procedures to practice their skills in managing a sedated patient. Annual skills days should be held with  review of the policy and equipment used. Staff would be signed off annually on this module. Certifications for BLS(basic life support), ACLS, PALS(pediatric advanced life support) and possibly TNCC (trauma nurse core curriculum), should be up to date and the hospital should offer these courses on campus to make it easier for their employees to maintain their certifications. Staff members whose scope of practice do not require them to practice ACLS or PALS should be reeducated on what normal vital signs are, how to set parameters on the cardiac monitors, how to take vital signs on the cardiac monitor and they need to review basic BLS skills by attending their own skills day. Teaching should include basics on what normal vital signs are for different age groups, and how medications can alter these vital signs. If the hospital has the funds to open a simulation lab, all nurses and allied health personal could practice simulated scenarios on mannequins and even videotape them. This would be a huge asset for the staff of all the patient care departments. Another part of the improvement plan would include classes for staff on communication and critical conversations. Learning how to communicate as a team and voice concerns about patient safety is a skill that requires practice, confidence and no fear of retribution or intimidation. Staff members who deal in stressful and hectic environments may at times be uncertain when they see behaviors that are unsafe and therefore may elect to say nothing when they believe the care of a patient may be compromised. In the case of the LPN who turned off the SPO2 alarm, I would wonder if perhaps there was a communication barrier between her and the RN and or the MD, or was it simply a knowledge deficit. An action plan needs to be in place for a saturated emergency department in which additional staff can be called in with a less than 30 minute wait time, or perhaps float other available qualified staff from other departments, such as the critical care unit or the telemetry floor. Because critical care nurses are accustomed to working in a 1:1 environment with their patients, it would have been ideal to float a CCU nurse to the department when Nurse J realized she could not take care of the rest of the department without leaving Mr. B unattended. Of course this may not have  been feasible since we do not know the census in the CCU. Chart reviews are also an invaluable tool for improvement. The manager will assign nurse in the ED to perform a monthly audit of all sedation charts with checklists of what was done correctly and what was not. These audits are important for providing data on how the ED needs to improve its performance and safety measures. This data will be provided not only at ED staff meetings but at quality improvement meetings involving the nursing director and hospital administration. If there is a problem convincing the hospital to provide safe staffing levels, the ED must provide strong data in order to show administration that there is a need to provide additional nursing. After the uncertainty of the unfreeze stage has occurred, change then begins to take place. Staff will start to believe and act in ways that support the new growth of the department. The transition will not happen rapidly as people take time to learn and embrace new ways of doing things and for each individual the rate of change is personal. In order to accept the new change and contribute to its success, staff will need to understand how the changes will benefit them and not every person will feel this way. Most healthcare workers probably feel that if healthcare delivery is made safer and better for their patients, then they will buy in to the need for changes and produce those changes. Unfortunately some of these people may feel harmed by change, and it is possible to notice some folks not participating in meetings, outside events, or educational updates. They may voice discontent with the whole process and complain that the changes are unnecessary. They may feel the status quo is being challenged and are threatened if they are unable to adapt to the changes. They may eventually leave the department or even the hospital environment as a whole. These are the people who may require the most encouragement and handholding to get them through the transition. Time and communication are of utmost importance and as staff gains understanding of the changes, they also need to feel connectedness to the organization throughout the transition period. (Thompson, n.d., p. 3) Lewin’s third stage of change, or Refreezing, takes place when the organization has identified the barriers to sustain the changes made, and when it has identified what makes the changes work. Employees feel  confident and comfortable using new communication techniques, they participated in learning the new procedures and feel supported by their peers and leadership. There is an established feedback system for employees to participate in regarding their education and training, in which they can voice what works and what doesn’t. Changes are now used all of the time and are incorporated into the normal day to day operations in the ED. If the changes are not used regularly and not anchored in to the culture of the ED, the refreezing state cannot occur and employees may get caught in a â€Å"transition state† where each person is not sure how things should be done and there is no consistency for policies and procedures being followed. For the refreezing states to be successful, the department should celebrate its success with the change. Employees will need to have a sense of closure and management needs to help them feel appreciated for enduring an uncertain and uncomfortable time. It is important to encourage staff to believe that the contributions they have made have made the changes a success. (Thompson, n.d., p. 4) Continuing to provide support and transparency keeps employees informed and motivated to preserve the new changes in place. Allowing staff to voice their opinions and participate in how changes are rolled out is part of this process. Overall, a team approach to care is of utmost importance in the ED and each individual should be encouraged and reminded regularly how important their contributions are to the whole. Reward systems to encourage pride and enthusiasm for work well done can be included at monthly staff meetings. One or two employees might receive a gift or a trophy for hard work, these recipients would be nominated by their peers who anonymously write a nice note about someone who did something nice for a patient or a staff member or just did a particularly great job that day. Team building activities can also include an organized activity outside of the ED where employees and their family members can socialize together and relax. Nursing leaders and managers should strive to build environments that are conducive to friendships, facilitating and promoting good communication and respectful communication between nurses, physicians and administrators. (Blosky & Spegman, 2015, p. 34) Trust is the cornerstone of good communication, which was sorely lacking in the ED that day. C. Use a failure mode and effects analysis to project the likelihood that the  process improvement plan you suggest would not fail. (Identify the members of the interdisciplinary team who will be included in the RCAS and the FMEA) FMEA is a step by step process used to identify all possible failures in a design , a manufacturing or assembly process or a product or a service. FMEA was started by the US military in the 1940s, and was further developed by the aerospace and automotive industries. (American Society for Quality [ASQ], n.d., p. 1) It has been adopted by the healthcare industry successfully as a tool to identify areas of healthcare processes tat may fail, in order to prevent harm or sentinel events before they occur. â€Å"Failure modes† are the ways, or modes in which something may fail. Failures are errors or hazards, which affect the customer and in healthcare the customer is usually the patient. These errors or hazards can be actual, or potential. Effects analysis is the study of consequences of those failures. Failures are prioritized in order of how severe the consequences are, their frequency of occurrence, and their ease of detection. The purpose of the FMEA is to eliminate or reduce the percentage of failures, starting with the highest priority areas. (ASQ, n.d., p. 1) In the scenario of Mr. B, unfortunately the FMEA cannot change the outcome, but it will be a proactive method of developing a new policy and procedure for how sedation cases are handled in the emergency room setting. The FMEA will be used to evaluate the new protocol for sedation procedures as well as staffing protocols related to monitoring 1:1 patients. This evaluation will occur before the actual implementation and will be used to assess its impact on the existing protocols.(IHI, 2015, p. 1) The process that needs to be evaluated and improved specifically to the case of Mr. B, would be the moderate sedation policy and its specifics to requirements of staff during the procedure and the recovery period. Some of the failure modes that may occur or have the potential to occur would be staff resistance to change, inexperienced nurses or practitioners with lack of education, inadequate ability to staff the ED appropriately during influx of patients, sick calls, or inadequate equipment or equipment failure. (Study Mode, 2014, p. 12) The key to a successful FMEA will be the involvement of a interdisciplinary  team, which would most likely consist of the some of the same members of the RCA. An emergency room physician, preferably the director, director of respiratory therapy, the hospital pharmacist, the ED nursing director, a risk manager, a head administrator who can lead the group in decision making, one or two ACLS certified staff nurses from the ED that perform sedation procedures, head of anesthesiology, and possibly even members from other departments where moderate sedation is performed. The team will need to meet regularly and be committed to providing continuing support during the course of implementation. C1: Interventions With the unfortunate scenario of Mr.B, it is now up the the interdisciplinary team to begin testing interventions that will or may be integrated in to the new plan for management of moderate sedation patients, with the goal of improving safety and eliminating adverse events. Once the established team has focused their aim, their next step would be to test a change or a few changes in the ED. This would be done with subsequent procedural sedation procedures which are commonplace in the ED. A small but major change to test would be the mandatory presence of an ACLS certified RN in 1:1 care of the patient from the beginning of the procedure and throughout it to discharge. The goal of this change is to prevent adverse events from respiratory depression in 100% of all patients receiving sedation in the following 6 month period. Performing this test several times will enable the team to see if the staff is actually complying with the new protocol and what barriers there are to prevent it from being successful. Staff will give feedback later as to what is working and what is not, and what they think needs to be done to make the changes work. An effective way to implement testing would be to utilize a PDSA cycle. The Plan-Do-Study-Act (PDSA) cycle is known as shorthand for testing a change by planning it, trying it, observing the results, and acting on what is learned. (Institute for Healthcare Improvement [IHI], 2015, p. 1) According to the Institute for Healthcare Improvement, the reasons to teats changes are as follows: To increase ones belief that the changes will result in improvement To decide which of several proposed changes will lead to the  desired improvement To evaluate how much improvement can be expected from the change To decide whether the proposed change will work in the actual environment To decide which combinations of changes will have the desired effects on the important measures of quality To evaluate costs, social impact, and side effects from a proposed change To minimize resistance upon implementation The Institute for Health Improvement lists these steps in the PDSA cycle to include: Step 1: Plan Plan the test or observation, including a plan to collect the data State the objective of the test: â€Å"Minimize or eliminate adverse events from respiratory depression while being monitored in the ED under conscious sedation† Make predictions about what will happen and why Develop a plan to test the change (Who, what, when where? What data needs to be collected?) Step 2: Do Try out the test on a small scale: maybe only perform the test in a 3 week period, on sedation procedures performed between the busiest times of the ED, for example between noon to 6pm. In a 6 bed rural ED, this might actually be the busiest time period. Carry out the test Document problems and observations, unexpected and expected Begin analysis of the data Step 3: Study Set aside time to analyze the data and study the results, for example: a biweekly or monthly meeting of the FMEA team. Complete the analysis of the data Summarize and reflect on what was learned Step 4: Act Refine the change, based on what was learned from the test. Determine what modifications should be made. Prepare a plan for next test, probably on a larger scale. For example, test all sedations over a month , for actual 24 hour periods in the ED. In addition to performing the PDSA cycles, the ED could appoint a volunteer or volunteers from the department to form a safety committee with a leader being the liaison who would have the authority to come up with quick solutions to certain problems that are encountered in the department on a daily basis. The liaison would take care of fixing broken equipment or replacing it, ordering new equipment and providing user training, communicating with staff about safety concerns and bringing these concerns to management and the FMEA team. The safety liaison would be trained in Human Factors Engineering, the science of why people make mistakes. The staff will need to be reassured that this person is their ally and not an informant or disciplinarian. (Institute for Healthcare Improvement [IHI], 2015, ∂ 1) This is a person they should feel comfortable reporting their concerns to. This person could take an active role in the PDSA testing and collect data as which could be added to the monthly chart audits of all the conscious sedation procedures performed since that fateful day with Mr. B. C2: Presteps: Discuss the pre-steps for preparing for the FMEA. Step one in preparing for the FMEA in regards to revising the sedation protocol involves selecting a specific process to evaluate. While there were many factors that contributed overall to the sentinel event that occurred , the FMEA should be focused on a sub process. Conducting an FMEA on a combination of the sedation protocol, the staffing ratio issues, the communication problems between staff members, knowledge deficits of staff and equipment issues would be an overwhelming task, so instead we will consider individual analysis of each variant. In this case, we are going to focus on creating a better defined policy on how to safely perform conscious sedation in the emergency room setting in order to prevent further sentinel events. We want to define in the policy what licensed and certified personnel is to be present and performing the procedure, and step by step spell out what is required of those team members from the time of informed consent to the time the patient is discharged from the ED. The policy needs to be easily accessible and there needs to be a standard way of making sure staff has read the policy and understands how to follow it. The goal is to make sure that the patient has 1:1 care at all times with qualified  personnel and leaves the ED in stable, improved condition. The second pre-step is to recruit the multidisciplinary team, including everyone who is involved at any point in the process. Be clear that not all people need to be included on the team throughout the entire process, but should be part of the discussions in which they are or did participate in the process. For example, In the case o f Mr. B, radiology was probably at the bedside performing pre and post reduction films, in which the RN clearly would not have remained at the bedside unless he or she was wearing a lead apron. Pharmacy may have become involved if they had to mix any post resuscitation drips for the patient after he returned to a sinus rhythm from ventricular fibrillation. The secretary was involved in calling a rapid response team, and members of that team may be able to provide valuable insight as well. The third pre-step is to have the team meet together to create a list of all of the steps in the process. Every step should be numbered and be as detailed as possible. Note that this may take numerous meetings to complete this portion, due to all of the variables and complexities. Using flowcharts helps team members to visualize the processes more clearly and create a more understandable outline of the steps. There needs to be a group consensus that the outlined steps of the FMEA correctly show the process. By creating a step by step flow sheet the team will be able to visualize the scenario in detail and begin the process of elimination of what does and does not work and move on to pre-step 4. The team will now begin to list all of the possible failure modes. Possible failure modes include absolutely anything that could go wrong, such as the following: Staff not trained in protocol Staff not knowing how to properly use equipment Monitor not connected to patient Equipment not plugged in Medications not reconciled Communication problems between peers Assessments not completed Ancillary staff not educated IV fluids not running Patient experienced respiratory arrest These are just of the few of the possible failure modes that could be listed. For each of these failure modes, the team must list a cause. For example, in the case of Mr. B, he was never connected to a cardiac monitor until he went unresponsive, so the team must try and explain the cause of this. Prestep #5 , for each failure mode, the team will need to assign a numeric value which is called the Risk Priority Number or RPN. The RPN is a measurementof three variables: the likelihood of the failure occurring, of it being detected, and its severity. This is a scoring method that assists the team in determining what areas need the most most focus on improvement. C3 Three Steps: Once again, assigning numeric values to three separate variables assists the team in determining the issues which should be prioritized in order of importance, or the need for improvement. The three topics are as follows:( IHI, 2015, p. 4) the likelihood of occurrence: In other words, how likely is it that this failure mode will happen† A score between 1 and 10, with 1 meaning â€Å"very unlikely to occur† and 10 being â€Å"very likely to occur†. In the case of Mr. B, had a FMEA already been in place prior to his visit to the ED, the likelihood of his demise would have been much more unlikely to occur. But the system had failed him and due to all of the multiple mistakes that did occur that day, the likelihood of what happened was higher up on the numeric scale. the likelihood of detection: If this failure mode does happen, how likely is it that it will be detected? † A score between 1 and 10, with 1 meaning â€Å"very likely to be detected† and 10 being â€Å"very unlikely to be detected.† On the day of Mr. B’s demise, there were multiple opportunities for the staff to detect that there was a potential problem, but they did not. No one noted the lack of staff, communication was poor, and proper equipment was not utilized. So, this question goes back to the Root Cause Analysis and in the FMEA the team will need to determine how the staff can detect these failures before harm occurs again to someone else. the severity: If the failure mode happens, what is the likelihood that the patient will be harmed? † A score between 1 and 10, with 1 meaning â€Å"very unlikely that harm will occur† and 10 being â€Å"very likely that severe harm will occur†. According to the IHI, a score of 10 often means death. In Mr. B’s case, the consequence that resulted from the  failures in the ED that day was his untimely death. So the severity rating for that particular day would be a 10. D. Discuss how the professional nurse may function as a leader in promoting quality care and influencing quality improvement activities: The professional nurse plays a critical role in hospital quality improvement, since nurses are the primary caregivers in the system of healthcare. They are pivotal in improving the processes in which care is provided. According to Cynthia Barnard, MBA, the role of the professional nurse in quality improvement is two-fold: to carry out interdisciplinary processes to meet organizational QI goals, as well as measuring, improving and controlling nursing sensitive indicators affecting patient outcomes specific to nursing practices. She states that all levels of nurses, from the direct care at the bedside, to the chief nursing officer (CNO), play a part in promoting QI within the healthcare provider organization. (HCpro, 2010, p. 1) Ms. Barnard lists the following levels of nursing and their professional responsibilities: The CNO: The CNO sets the tone for the nursing departments participation in QI. As an administrator, the CNO is responsible for integrating nursing practices in to the organizational goals for excellence in patient outcomes by communicating the strategic goals to all the levels of staff. The nurse manager (NM) or nursing director: The NM or director is responsible for communicating and operationalizing the organization’s QI goals and processes to the bedside nurse. The NM identifies specific nursing sensitive indicators that need improvement according to the organization’s specific patient population and coordinates QI processes to improve these at the unit level. The direct care nurse: The bedside nurse is the key to quality patient outcomes, carrying out the protocols and standards of care shown by evidence to improve patient care. Important to this provision of quality care is the fact that professional nursing leaders are the key factor in setting the tone and providing an environment in which all health care staff feel empowered to uphold these expectations. If nursing leadership and administration feel that they have less than adequate engagement of staff, it may be simply because the staff may not always understand the rationale and momentum  behind particular quality improvement initiatives. For nurses to be involved in delivering high quality care, it is imperative that leadership allows the participation of staff nurses into the design and implementation of processes by continuously educating and informing them, instead of simply telling nurses what they are supposed to do. A hospital culture that encourages quality as everyone’s responsibility is most likely to achieve sustained and noticeable improvement. Because nursing practice occurs in the context of a larger team, the impact of other departments and practitioners must be included in leadership’s efforts to improve quality. (Draper, Felland, Liebhaber, & Melichar, 2008, p. 4) By having every staff member engaged, including the other members of clinical staff, ie; physicans, respiratory therapy, even housekeeping and dietary management, accountability for patient safety and quality becomes a group effort and does not rest mainly on the shoulders of the nursing population. References American Society for Quality (n.d.). Failure Mode Effects Analysis (FMEA). Retrieved July 3, 2015, from http://asq.org/learn-about-quality/process-analysis-tools/overview/fmea.html Blosky, M. A., & Spegman, A. (2015). Communication and a healthy work environment. Nursing Management, 46(6), 32-38. Cherry, B., & Jacob, S. R. (2011). Contemporary nursing; issues, trends and management. Available from https://online.vitalsource.com/#/books/978-0-323-06953-3/pages/52165015 Draper, D. A., Felland, L. E., Liebhaber, A., & Melichar, L. (2008). The rrole of nurses in hospital quality improvement. Retrieved July 3, 2015, from http://www.hschange.org/CONTENT/972 Frain, J., Murphy, D., Dash, G., & Kassai, M. (n.d.). . Retrieved, from Galley, M. (n.d.). Basic elements of a comprehensive root cause investigation; three steps and three tools that organize and improve your problem solving capability. Retrieved June 29, 2015, from rootcauseanalysis.info HCpro (2010). Ask the expert: Understanding nur sing roles in quality improvement. Retrieved July 6, 2015, from www.hcpro.com/NRS-248978-868/Ask-the-expert-Understanding-nursing-roles-in-quality-improvment.html Institute for Healthcare Improvement (2015). Failure modes and effects analysis. Retrieved July 3, 2015, from

Lessons from Enron: Bad Management, Negative Consequences

One of the classic examples of bad management, Enron's collapse according to the Economist (2002) was a result of bad management and poor decision-making of the auditing firm Andersen in handling the account of the company. The primary root of Enron’s collapse was bad management and the power of the management to delegate auditing and accounting responsibilities to a firm that they have chosen. The dependence of the auditing firm on the management in essence creates the break in the accounting and auditing ethics: in order not to lose an all-too important account such as Enron, they would need to abide by the decisions of the management.The lack of willpower of Andersen to question the unethical practices of Enron made it culpable in the same way as Enron’s managers. This led a domino and cascading effect in the corporate world of America: the government scrambling to look for other companies who are also hiding in their auditor’s books, the deterioration of the auditing and accounting profession, lack of trust in companies, and investor apprehension. The collapse of Enron was largely a decision by the top management which also involves its accountants to provide a bogus statement of finances to make Enron look like a profitable company.Auditors of Enron on the other hand, have sought to protect the company by shredding incriminating documents. From an agency theory perspective, the role of the Enron’s top management to that of the shareholders is one that is governed by the principle that managers will act in a way that will benefit the owners or shareholders of the company (Abrahamson and Park, 1994). In essence, what happened to Enron was that the managers or the agents gained too much power and the shareholders did not perform its function of overseeing the operations of their company.Fundamentally, what the shareholders and the managers who did not take part in the Enron scandal could have done was to have the government to appo int an auditing or accounting firm that will monitor the financial movement of the company. In this way, accountants and auditors will not be obliged to follow what the top managers would want them to do. Managers need to be wary of decisions made by the top management or their colleagues. To a significant extent, appointments should be made independent of the managers.In an era where auditing and accounting fraud are prevalent, managers can protect themselves by safeguarding their companies among their peers. References Abrahamson, E. and Park, C. (1994) Concealment of negative organizational outcomes: An agency theory perspective. Academy of Management Journal, 37: 1302-1334. Barefoot, JA. (2002). What can you learn from Enron? How to know if you are creating a climate of rule-breaking. ABA Banking Journal, 94. The Economist. (2002) The Lessons from Enron. 362, 8259: 9-10. Retrieved 1 July at http://www.csupomona. edu/~smemerson/PLS499%20Greed_Need/Enron. doc. Appendix 1. Enron Ar ticle Title: THE LESSONS FROM ENRON , Economist, 0013-0613, February 9, 2002, Vol. 362, Issue 8259 Database: Academic Search Elite Section: Leaders THE LESSONS FROM ENRON After the energy firm's collapse, the entire auditing regime needs radical change THE mess just keeps spreading. Two months after Enron filed for Chapter 11, the reverberations from the Texas-based energy-trading firm's bankruptcy might have been expected to fade; instead, they are growing.On Capitol Hill, politicians are engaged in an investigative orgy not seen since Whitewater, with the blame pinned variously on the company's managers, its directors, its auditors and its bankers, as well as on the Bush administration; indeed on anybody except the hundreds of congressmen who queued up to take campaign cash from Enron. The only missing ingredient in the scandal–so far–is sex. The effects are also touching Wall Street. In the past few weeks, investors have shifted their attention to other companies, m aking a frenzied search for any dodgy accounting that might reveal the next Enron.Canny traders have found a lucrative new strategy: sell a firm's stock short and then spread rumours about its accounts. Such companies as Tyco, PNC Financial Services, Invensys and even the biggest of the lot, General Electric, have all suffered. Last week Global Crossing, a telecoms firm, went bust amid claims of dubious accounts. This week shares in Elan, an Irish-based drug maker, were pummelled by worries over its accounting policies. All this might create the impression that corporate financial reports, the quality of company profits and the standard of auditing in America have suddenly and simultaneously deteriorated.Yet that would be wide of the mark: the deterioration has actually been apparent for many years. A growing body of evidence does indeed suggest that Enron was a peculiarly egregious case of bad management, misleading accounts, shoddy auditing and, quite probably, outright fraud. But the bigger lessons that Enron offers for accounting and corporate governance have long been familiar from previous scandals, in America and elsewhere. That makes it all the more urgent to respond now with the right reforms.Uncooking the books The place to start is auditing. Accurate company accounts are a keystone for any proper capital market, not least America's. Andersen, the firm that audited Enron's books from its inception in 1985 (it was also Global Crossing's auditor), has been suggesting that its failings are representative of the whole profession's. In fact, Andersen seems to have been unusually culpable over Enron: shredding of incriminating documents just ahead of the investigators is not yet a widespread habit.But it is also true that this is only the latest of a string of corporate scandals involving appalling audit failures, from Maxwell and Polly Peck in Britain, through Metallgesellschaft in Germany, to Cendant, Sunbeam and Waste Management in America. In the past four years alone, over 700 American companies have been forced to restate their accounts. At the heart of these audit failures lies a set of business relationships that are bedevilled by perverse incentives and conflicts of interest. In theory, a company's auditors are appointed independently by its shareholders, to whom they report.In practice, they are chosen by the company's bosses, to whom they all too often become beholden. Accounting firms frequently sell consulting services to their audit clients; external auditors may be hired to senior management positions or as internal auditors; it is far too easy to play on an individual audit partner's fear of losing a lucrative audit assignment. Against such a background, it is little wonder that the quality of the audit often suffers. What should be done? The most radical change would be to take responsibility for audits away from private accounting firms altogether and give it, lock, stock and barrel, to the government.Perhaps such a change may yet become necessary. But it would run risks in terms of the quality of auditors; and it is not always so obvious that a government agency would manage to escape the conflicts and mistakes to which private firms have so often fallen prey. As an intermediate step, however, a simpler suggestion is to take the job of choosing the auditors away from a company's bosses. Instead, a government agency–meaning, in America, the Securities and Exchange Commission (SEC)–would appoint the auditors, even if on the basis of a list recommended by the company, which would continue to pay the audit fee.Harvey Pitt, the new chairman of the Securities and Exchange Commission, is not yet willing to be anything like so radical. He has been widely attacked because, when he acted in the past as a lawyer for a number of accounting firms, he helped to fend off several reforms. Yet he now seems ready to make at least some of the other changes that the Enron scandal has shown to be ne cessary (see pages 67-70. ) Among these are much fiercer statutory regulation of the auditing profession, including disciplinary powers with real bite.Hitherto, auditors have managed to get away with the fiction of self-regulation, both through peer review and by toothless professional and oversight bodies that they themselves have dominated. There should also be a ban on accounting firms offering (often more profitable) consulting and other services to their audit clients. Another good idea is mandatory rotation, every four years or so, both of audit partners–so that individuals do not become too committed to their clients–and of audit firms. The most effective peer review happens when one firm comes in to look at a predecessor's books.The SEC should also ban the practice of companies' hiring managers and internal auditors from their external audit firms. In search of better standards Then there is the issue of accounting standards themselves. Enron's behaviour has co nfirmed that in some areas, notably the treatment of off-balance-sheet dodges, American accounting standards are too lax; while in others they are so prescriptive that they have lost sight of broader principles. Past attempts by the Financial Accounting Standards Board to improve standards have often been stymied by vociferous lobbying.It is time for the SEC itself to impose more rigorous standards, although that should often be through sound principles (including paying less attention to single numbers for earnings) rather than overly detailed rules. It would also be good to come up with internationally agreed standards. Although audit is the most pressing area for change, it is not the only one. The Enron fiasco has shown that all is not well with the governance of many big American companies. Over the years all sorts of checks and balances have been created to ensure that company bosses, who supposedly act as agents for shareholders, their principals, actually do so.Yet the cult of the all-powerful chief executive, armed with sackfuls of stock options, has too often pushed such checks aside. It is time for another effort to realign the system to function more in shareholders' interests. Companies need stronger non-executive directors, paid enough to devote proper attention to the job; genuinely independent audit and remuneration committees; more powerful internal auditors; and a separation of the jobs of chairman and chief executive.If corporate America cannot deliver better governance, as well as better audit, it will have only itself to blame when the public backlash proves both fierce and unpleasant. PHOTO (COLOR) ________________________________________ Copyright of The Economist is the property of Economist Newspaper Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. Source: Eco nomist, 2/9/2002, Vol. 362 Issue 8259, p9, 2p, 1c. Item Number: 6056697

How Much Does It Cost to Buy an Essay Online

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Opeation Compass during World War II

Opeation Compass during World War II Operation Compass - Conflict: Operation Compass took place during World War II (1939-1945). Operation Compass - Date: Fighting in the Western Desert began on December 8, 1940 and concluded on February 9, 1941. Armies Commanders: British General Richard OConnorGeneral Archibald Wavell31,000 men275 tanks, 60 armored cars, 120 artillery pieces Italians General Rodolfo GrazianiGeneral Annibale Bergonzoli150,000 men600 tanks, 1,200 artillery pieces Operation Compass - Battle Summary: Following Italys June 10, 1940, declaration of war on Great Britain and France, Italian forces in Libya began raiding across the border into British-held Egypt. These raids were encouraged by Benito Mussolini who wished the Governor-General of Libya, Marshal Italo Balbo, to launch a full scale offensive with the goal of capturing the Suez Canal. After Balbos accidental death on June 28, Mussolini replaced him with General Rodolfo Graziani and gave him similar instructions. At Grazianis disposal were the Tenth and Fifth Armies which consisted of around 150,000 men. Opposing the Italians were the 31,000 men of Major General Richard OConnors West Desert Force. Though badly outnumbered the British troops were highly mechanized and mobile, as well as possessed more advanced tanks than the Italians. Among these was the heavy Matilda infantry tank which possessed armor that no available Italian tank/anti-tank gun could breach. Only one Italian unit was largely mechanized, the Maletti Group, which possessed trucks and a variety of light armor. On September 13, 1940, Graziani gave into Mussolinis demand and attacked into Egypt with seven divisions as well as the Maletti Group. After recapturing Fort Capuzzo, the Italians pressed into Egypt, advancing 60 miles in three days. Halting at Sidi Barrani, the Italians dug in to await supplies and reinforcements. These were slow arriving as the Royal Navy had increased its presence in the Mediterranean and was intercepting Italian supply ships. To counter the Italian advance, OConnor planned Operation Compass which was designed to push the Italians out of Egypt and back into Libya as far as Benghazi. Attacking on December 8, 1940, British and Indian Army units struck at Sidi Barrani. Exploiting a gap in the Italian defenses discovered by Brigadier Eric Dorman-Smith, British forces attacked south of Sidi Barrani and achieved complete surprise. Supported by artillery, aircraft, and armor, the assault overran the Italian position within five hours and resulted in the destruction of the Maletti Group and the death of its commander, General Pietro Maletti. Over the next three days, OConnors men pushed west destroying 237 Italian artillery pieces, 73 tanks, and capturing 38,300 men. Moving through Halfaya Pass, they crossed the border and captured Fort Capuzzo. Wishing to exploit the situation, OConnor wanted to keep attacking however he was forced to halt as his superior, General Archibald Wavell, withdrew the 4th Indian Division from the battle for operations in East Africa. This was replaced on December 18 by the raw Australian 6th Division, marking the first time Australian troops saw combat in World War II. Resuming the advance, the British were able to keep the Italians off balance with the speed of their attacks which led to entire units being cut off and forced to surrender. Pushing into Libya, the Australians captured Bardia (January 5, 1941), Tobruk (January 22), and Derna (February 3). Due to their inability to stop OConnors offensive, Graziani made the decision to completely abandon the region of Cyrenaica and ordered the Tenth Army to fall back through Beda Fomm. Learning of this, OConnor devised a new plan with the goal of destroying the Tenth Army. With the Australians pushing the Italians back along the coast, he detached Major General Sir Michael Creaghs 7th Armoured Division with orders to turn inland, cross the desert, and take Beda Fomm before the Italians arrived. Traveling via Mechili, Msus and Antelat, Creaghs tanks found the rough terrain of the desert difficult to cross. Falling behind schedule, Creagh made the decision to send a flying column forward to take Beda Fomm. Christened Combe Force, for its commander Lieutenant Colonel John Combe, it was composed of around 2,000 men. As it was intended to move quickly, Creagh limited its armor support to light and Cruiser tanks. Rushing forward, Combe Force took Beda Fomm on February 4. After establishing defensive positions facing north up the coast, they came under heavy attack the next day. Desperately attacking Combe Forces position, the Italians repeatedly failed to break through. For two days, Combes 2,000 men held off 20,000 Italians supported by over 100 tanks. On February 7, 20 Italian tanks managed to break into the British lines but were defeated by Combes field guns. Later that day, with the rest of the 7th Armoured Division arriving and the Australians pressing from the north, the Tenth Army began surrendering en masse. Operation Compass - Aftermath The ten weeks of Operation Compass succeeded in pushing the Tenth Army out of Egypt and eliminating it as a fighting force. During the campaign the Italians lost around 3,000 killed and 130,000 captured, as well as approximately 400 tanks and 1,292 artillery pieces. West Desert Forces losses were limited to 494 dead and 1,225 wounded. A crushing defeat for the Italians, the British failed to exploit the success of Operation Compass as Churchill ordered the advance stopped at El Agheila and began pulling out troops to aid in the defense of Greece. Later that month, the German Afrika Korps began deploying to the area radically changing the course of the war in North Africa.   This would lead to fighting back and forth with Germans winning at places such as Gazala before being halted at First El Alamein and crushed at Second El Alamein.  Ã‚   Selected Sources History of War: Operation CompassWorld War II Database: Operation Compass

Philosophy of Love and Desire Assignment Example | Topics and Well Written Essays - 750 words

Philosophy of Love and Desire - Assignment Example A relationship simply cannot count as love if the two people involved are not physically and emotionally compatible with each other. Sufficient Condition: Two people are said to be in love if they are taken by a strong feeling that they simply cannot live without each other. That is if two people are possessed by a strong feeling that they cannot live without each other, than it is sufficient to establish that the two people are in love with each other. Socratic Definition of Love: Love may be defined as a relationship in which the two people are physically and emotionally compatible with each other and are possessed by a strong feeling that they simply cannot live without each other. If the two people in love are not physically and emotionally compatible with each other than they are not in love. Similarly if the two people in a relationship can do without each other than they are not in love. These two criteria are sufficient two include within their ambit a range of love relations hips. Section B First Objection to the Definition of Love: In many Asian and African cultures, there is a tradition of arranged marriage in which the two people are made to marry each other in consonance with the desires of their families and communities and many of these individuals though not being physically and emotionally compatible and being able to live without each other, still manage to fall in love with each other. Then it could be said that the marital relationship between these two people is sans love, though for discernible purposes they may be taken to be in love with each other. Defense of the Definition: There is no denying the fact that emotional and physical compatibility and a strong sense that the two people cannot do without each other in a relationships tend to be two necessary and sufficient conditions for love. In some cultures as in the Western culture the two people involved in a love relationship are able to or allowed to establish their emotional and phys ical compatibility before marriage and are allowed to verify as to whether they can do without each other before marriage, so as to assure that they are in love with each other. There are other cultures as in the above mentioned objection where the two people are married as per the familial and social wishes and it is after marriage that the two people tend to discover their emotional and physical compatibility and a sense of belonging to each other. Thereby the two people in an arranged marriage can also fall in love with each other and are required to fulfill the before mentioned necessary an sufficient conditions to establish that they are in love. Thereby, an arranged marriage does not make an exception. Second Objection to the Definition of Love: What about the relationship between a prostitute and her customer, this relationship could be deemed to be love as it satisfies both the necessary and sufficient conditions for love. A prostitute and her customer are physically and emo tionally compatible. That is why they are able to make love to each other. They also cannot do without each other. A prostitute cannot do without her client as she draws her sustenance from him. The client also cannot do without the prostitute for that is why he agrees to pay her to make love to her. This is indeed a love relationship as it satisfies the above mentioned definition of love. Defense of the Definition: The relationship be

English Essay Example | Topics and Well Written Essays - 1000 words - 23

English - Essay Example The absence of the physical identity of the individuals in the internet tended to loosened them up as they become invisible behind their digital personality. This has created problems such as; â€Å"the growing incidence of online fraud and identity theft, privacy incursions, copyright infringements, trademark violations, domain name disputes, spamming, computer viruses, inadequate or vaguely defined consumer protection laws, and terrorist-related and pornographic websites† (David 2006). These issues became so alarming that the idea of regulating internet came into mind. Many people are suggesting that perhaps it is now time for the government to step in to enforce its police power to stop these issues online. But one cannot help to think whether it is proper for the government to step in the cyberspace and whether it will be effective if ever it has to step in. Without doubt, the internet needs some sort of regulation of acceptable conduct but whether it should be the government who should enforce it is questionable. Governments are limited by geography and laws are relative depending on what country are you from. What is acceptable in one country may not be permissible in another. Say for example in China where it is not advisable to speak against the government while it is perfectly alright in the United States and such right is even protected by its laws. Given such relativity of laws, it would be difficult for any government to enforce its laws on other sovereign state for that would tantamount to conflict. Government is also a suspect in terms of policing the cyberspace. We have already seen in other countries how government can react when given the prerogative to regulate the internet. It abridges information and censures freedom of speech. Classic example is Libya where anti-government forces has to find creative means to access the internet just to share to the world what is happening there during its revolution. Libyan government literally