Impact of drugs on the social view of health

Stress Is a major Issue amongst teenagers and this can be caused by a variety of Issues but today, I will be talking about drug abuse amongst teenagers. Firstly, stress Is the body's reaction to any sort of pressure. Chemicals are released into the blood and these chemicals give the body more energy and strength (Helped. Org (2014)). Drug abuse is the dependence by teens to illegal substances which can lead to stress and can affect many different aspects of a teenager's life such as physical, emotional and social health aspects.This usually happens at the time of when teenagers are shifting from dependence to independence. However, in building a supportive environment with friends, family and outside organizations will aid in the development of knowledge and personal skills that will increase people's abilities to deal with and overcome stress related to substance abuse. Drug abuse is a stress related Issue which can have an impact on any environment; on peers In school as well as th e environment In a teenager's house. They have an Impact not only on the user but on their surroundings.Firstly, taking drugs can have many stressful side effects as It may damage relationships at home and with friends, leisure as well as the performance in school. In families, the parents may be very attentive with the child which is involved with drugs, forgetting their other siblings and putting stress on them. But drugs do not only affect social health as well as physical health; Heavy use of some drugs can damage organs and lead to illness and sharing needles to inject drugs can transfer serious diseases.Physical damage can also lead to further stress being implemented on the person taking drugs, as well as those who are willing to help or provide support (National Drugs Campaign, (2014)). Over the last 30 years there have been various fluctuations In data relating to drug usage. Drug abuse amongst teens had Its major start earlier In the ass's, where 42% of teens were Involved with drugs; this declined In the ass's, as 34% of Australians had admitted to smoking marijuana.The percentage of teens Involved with drugs has gone from 38% to 20% and the percentage of other drugs such as inhalants, LSI and for the first time cocaine, had declined in 1999. (Gallup, l. (2002)). To obtain recent data, a survey has been conducted amongst several teenagers in Helplessness High to determine the extent of drug usage. It has been demonstrated that half of the students either have experienced drugs or know someone who has, and 80% of the eons that were surveyed find that drugs are a cause of medium or very high stress.Some evidence that supports the data collected amongst the Helplessness students is a study reported August 4, 2008, which reveals that stress and drug abuse of any sort are highly linked. The stress goes both ways as one can lead to the other, setting up a vicious circle; 73% of teens have admitted that school stress Is a primary reason for drug abuse ( Mi randa, L. (2008)). In order to reduce stress related to drug abuse amongst teens, changes are necessary In order to successfully provide social Justice ND improve policies that are currently being advocated.Strategies such as looking even rehab have been suggested by Helplessness High students for those who suffer from the stress linked to drug abuse. Seeking help from an organization has been the most popular option amongst the teens surveyed in Helplessness High as 82% of the students have suggested this approach. This is due to the fact that in organizations, teens are often able to seek advice from a third party. This will increase the supportive environment for teens as they can access more information in order to help them deal with their own issues.Organizations such as the Queensland Injectors Health Network, the Mental Health and Wellbeing that can be found in the Queensland government website, as well as the Australian Drug Foundation have been suggested as good options (S LD. Gob. AU, (2014)). The UDF is a well-known organization which deals specifically with drug and alcohol addiction and seems to have been successful as many suggested this option. Talking to a family member was the second best chosen option with 78% of the students' votes followed by talking to friends with 66%.These two options may help those who are in the early stages of their drug addiction and can yet be talked out of it. The support provided by either one can help the teen to find a healthy way to relieve stress or also, having someone to talk to can further help the teen. Although there are many services available and offering to help those in need, there are also many barriers which can interfere on the success of these initiatives. Barriers such as the denial of help as well as the inaccessibility can deprive many teens from overcoming their addiction.This is why organizations should be positioned in spread out areas. An idea of a strategy could be a school based support g roup for those who are in need of help in Helplessness State High and this group would be funded by the government. Overall, we can see how stress and drug abuse are two major issues which are highly linked and one aspect can lead to the other. However, anyone who suffers from drug addiction is not trapped to the issue as there are many strategies which can offer the help needed and support the teen to going back to living a normal life.The UDF organization is, once again an option that teens can turn to. We can see that these strategies have been successful throughout the past years as the percentage of teens addicted to drugs has decreased. In conclusion, anyone can overcome a drug addiction due to the supportive environment provided by our school and pears, and social Justice that can be created for them if enough effort is displayed on their behalf and also on the government's behalf to continue in providing support and information.

Hyundai Motor Company

Background of the Organization Hyundai Motor Company (Hyundai) is the world’s fifth largest automobile company. It is the South Korea based global manufacturer of automobiles, and operates as a unit of Hyundai Motor Group.The company along with its subsidiaries and affiliates is involved in the design, development and manufacturing of passenger cars under the brand names of Equus, Genesis, Genesis Coupe, Azera, Sonata, Elantra, Accent, Getz, i30, i30cw, i20, i10 and recreational vehicles under the brand names of Veracruz/ix55, Santa Fe, Tucson/ix35, ix20, and H-1 and commercial vehicles which include medium and heavy duty automobiles and relevant parts. The company maintains a global production system consisting of manufacturing plants and operational facilities in Korea, the US, China, India, Turkey, Czech Republic, Russia, and Brazil.It maintains a global base of technical research centers in Korea, the US, Germany, Japan, and India. The company market its products in more t han 180 countries through its operational network of 32 overseas production and sales subsidiaries, and more than 6,000 dealers. Hyundai is headquartered in Seoul, South Korea. The company’s strategic intent focuses on maintaining its leading position in the global automotive market. The company recently adopted a new management concept to focus on the development of a global production system with emphasis on emerging markets such as China India, and Brazil.Recently, the company in collaboration with KOICA and PLAN Korea, planned to launch a project related to the development of technical training centre for automobile repair in several African nations. Key Recent Developments of Hyundai Motor Company Nov 21, 2011: Hyundai Joins European Fuel Cell Electric Vehicle Demonstration Program Oct 04, 2011: EU Officials to Drive Fuel-cell Hyundai ix35 Sep 28, 2011: Hyundai to Expand EV Development Sep 06, 2011: Hyundai to Come Out With New Electric Vehicle Brand For China May 31, 20 11: SK Innovation Commences Construction On EV Batteries Facility HistoryChung Ju-Yung as a small engineering and construction company founded the Hyundai in 1947. In 1965 Hyundai began its operations outside South Korea, expanding production to Thailand, Vietnam and Guam. The name Hyundai is a Korean word meaning ‘Modernity’. The Hyundai motor company was founded in 1967. This famous company has been involved in construction, electronics, chemicals, shipbuilding, heavy industry and financial services. The company’s first model was released with the cooperation with Ford motor company, the Cortina in 1968. In 1967, they began exporting to Ecuador and Benelux countries.In 1991, Hyundai successfully developed its own proprietary gasoline engine. Hyundai Motors India Limited was established in 1996 with its production plant in Irrungattukatoi near Chennai, India. In 1998, Hyundai became a world class brand. During 1999, Chung Mong Koo, son of Chung Ju Yung was given leadership of Hyundai Motors. In 2004 a survey by Power and Associates ranked Hyundai the second in initial quality. In 2006 Chung Mong Koo was arrested for embezzlement of 100 billion SKW, and Vice chairman and CEO Kim Dong-Jin took over as head of Hyundai.Philosophy and Objectives of the Organization The Hyundai Motor Company’s Philosophy represents the values and the principles that are the core of the organization. ‘Realize the dream of mankind by creating a new future through ingenious thinking and continuously challenging new frontiers. ’ Core Values Promotes a customer driven corporate culture by providing the best quality and impeccable service with all values centered on their customers. Embrace every opportunity as greater challenges and achieve the goals with unwavering passion and ingenious thinking.Creates synergy through a sense of togetherness that is fostered by mutual communication and cooperation within the company and with their business partn ers. They believe the future of the organization lies in the hearts capabilities of individual members, and will help them develop their potential by creating a corporate culture that respects talent. Respects the diversity of cultures and customs, aspire to be the world’s best at what we do, and strive to become a respected global corporate citizen.

What is UChicagos Acceptance Rate Admissions Requirements?

UChicago Accepts 7.2% of Applicants. What Does It Take to Get In? Built into historic Hyde Park, the University of Chicago is home to over 20,000 students across its undergraduate college and seven professional schools. Known for its unusual essay prompts, iconic mascot (t he phoenix),   and tight-knit community, UChicago offers one of the most unique locales for nourishing a developing mind. But with an acceptance rate of only 7.2%, securing admission is no easy task. If you love the idea of spending four years learning deeply with your peers, read this post for insight on how to make your application stand out. We have helped thousands of students apply to UChicago, and we’re eager to pass our experience on to you. You may apply through the Coalition Application or the Common Application . For most applicants, we recommend the Common App. Learn more about it in our Guide to the Common App . You can apply via any of the school’s four decision rounds. Early Action and Early Decision I applications are due November 1. Early Decision II and Regular Decision applications are due January 2. If you’re unsure about whether to apply early, read our post Early Decision vs. Early Action vs. Restrictive Early Action . To apply, be sure to send in all of the following: International applicants are subject to different application requirements, which can be found on UChicago’s page for International Applicants . Optional Components. Students with backgrounds in art, creative media, research, or an uncommon field may submit supplemental materials if they so desire. You should only do so, however, if you plan to continue the featured activity at the college level, if your work is exceptional and adds a new dimension to your application. UChicago is one of the most selective schools in the nation, with an admissions rate of 7.2%. Of 32,291 applicants last year, only 2,329 were admitted. Ultimately 79% of students admitted chose to attend UChicago. 7.2% may sound like an intimidating number. Only a select few top-ranked schools like Harvard and Stanford come in with lower acceptance rates. But it’s important to remember that the strength of your profile impacts whether chances are higher than the average applicant. Be sure to surround yourself with people who have been through the process so that you are receiving accurate and informed advice on how to craft a competitive profile. You may choose to work with a company like or conduct research on your own. Estimating your chance of getting into a college is not easy in today’s competitive environment. Thankfully, with our state-of-the-art software and data, we can analyze your academic and extracurricular profile and estimate your chances. Our profile analysis tool can also help you identify the improvement you need to make to enter your dream school. The University of Chicago prides itself on a holistic application review, so there are a few things you’ll want to keep in mind as you apply. Academics. This includes both grades and test scores. Students with positive trends over time will also be viewed more favorably than those with declining grades. For reference, in the Class of 2021, the middle 50% of accepted students received SAT scores of 1460-1550 and ACT scores of 32-35. Extracurricular Activities & Leadership. UChicago students in particular are known for being independent thinkers who chart their own course rather than following the crowd. Your extracurricular and leadership activities should reflect your passion and uniqueness. Be on the lookout for ways to make lasting, deep, and meaningful contributions in your field and community. Character. UChicago is particularly well-known for valuing freedom of speech and individuality. As much as possible, use your essays, extracurricular activities, and letters of recommendation to highlight how you demonstrate a unique, vivid personality that, among other things, strives to uphold personal freedoms. Contributions to Community. You will set yourself up for success by clearly articulating how you see yourself interacting with and enriching the school. Whether that’s conducting independent research, writing for an online student publication, or leading your intramural wiffle ball team to victory, help UChicago admissions officers understand how your interests connect to specific opportunities to contribute on campus. Demonstrate a voracious intellectual appetite. UChicago prides itself on academic prowess, so show you’re no slouch. To demonstrate your initiative, weave into your application any classes you’ve self-studied, research you’ve conducted, and reading you’ve done for pleasure. Write standout essays . UChicago looks for strong writing skills within its student pool, even amongst students who want to study STEM. UChicago will readily choose students with stronger admissions essays over students with better extracurricular profiles. Academic standards, however, are typically not relaxed for stronger essays. A good way to demonstrate your writing abilities is to get your writing published professionally in any field (even in something like a magazine). Embrace your uniqueness. The ideal UChicago applicant is a little quirky, as reflected in the school’s unorthodox application essay prompts. If you want to break the mold a little, this is definitely an institution that rewards creative essay structures as well as â€Å"nerding out† over your favorite topic. If you’re having trouble thinking of something unique to say, check out ’s post, What If I Don’t Have Anything Interesting to Write in My College Essay? Partner with a professional to find your voice and talents. All of this is much easier said than done. If you want to be competitive at a school like UChicago, no one-size-fits-all advice is going to get you there. Consider working closely with a mentor or your school’s guidance counselor to bring your admissions profile to the next level. UChicago is a long shot for just about everyone, so don’t worry if you receive a â€Å"no thank-you† at the end of the day. You can still go on to do great things. UChicago does not accept admissions appeals due to their long list of qualified applicants on the waitlist. We do not recommend petitioning your decision. Some students transfer into UChicago, but the transfer admissions rate is extremely low and requires a lot of extra work. However, students who maintain a strong academic and extracurricular profile will always have a shot. You can reapply after taking a gap year, but this path is riskier than simply committing to another school and requesting to take a gap year there. To see if a gap year is right for you, visit our posts, What Are the Pros of Taking a Gap Year? and What You Need To Know When Applying to Colleges After a Gap Year . If UChicago closes its doors to you, we recommend moving on. Northwestern University offers a similar undergraduate experience — both are universities in the greater Chicago area of similar size — and it has twice the admissions rate. Students who like UChicago’s focus on deep, independent thinking might check out St. John’s College in Maryland or Santa Fe, as well as Deep Springs College in California. For help adjusting to a different dream, read our post, Envisioning a New Future: Preparing for Life at Your Second-Choice (or Third, or Fourth) School . If you’d like more personalized advice on your admissions profile, offers Elite Universities Application Assistance , where you’ll be paired with a successful mentor at a top school who helps you along every step of the application process.

AACN Synergy Model for Patient Care Assignment Example | Topics and Well Written Essays - 250 words

AACN Synergy Model for Patient Care - Assignment Example st of characteristics is equally conclusive since it covers the most intricate features of patients that enhance the quality of the services they obtain from health facilities. The portrayal of the traits provides nurses with a way of caring for the physical, psychological and spiritual needs of the patients. The three are essential in the wellbeing of an individual. As such, the method ensures effectiveness of the nursing services. While the synergy model is effective in providing care to critical patients, the model is vital in other areas of the specialty such as cleaning patients. Cleanliness of both the patient and their environment enhances their recovery. The model requires nurses to participate in caring for the patient. This includes enhancing the cleanliness of the patients. Participation in both care and decision making further requires nurses to offer counselling to the patients. Counselling enhances the psychological and religious recovery of the patients. This implies that the two character traits enhance the complexity and predictability of the nurses (Kaplow, 2008). In retrospect, the eight patient traits had to connect with the eight traits the nurses present thereby enhancing the recovery of the

Should adults be charged in situations where teenagers are drinking or Essay

Should adults be charged in situations where teenagers are drinking or have been drinking in their presence - Essay Example Many countries around the globe have kept a legal standard where minors are not allowed to gain access to alcohol (as sellers are bound not to sell to the under-aged). These restrictions are dodged by these minors as the under aged tend to acquire alcohol easily through numerous methods. There are many instances within the United States of America that parents of these minors are the providers of alcohol to their own children. This act is done by them to ensure that their children consume alcohol within their house rather than going out and fetching is from some unauthorized bootleggers. Parents in such cases tend to keep their children safe by providing them alcohol within the house so that their children should stay out of trouble by stepping out of their houses and getting involved in some kind of misdemeanor. Such an act is questionable by authorities and usually if such cases are found or caught where parents or any other adults are involved in contributing towards the delinquen cy of a minor, those adults or parents are held responsible both on civil as well as criminal basis. Lack of evidence is always the case where adults or parents escape the charges of supporting minors in acquiring alcohol.

In William Faulkner's A Rose for Emily analyze the personality and Research Paper

In William Faulkner's A Rose for Emily analyze the personality and behavior of Miss Emily - Research Paper Example On the other hand, she becomes an object to be scrutinized by people in her town, and this turns her into a mysteriously mute figure. There are other situations where Emily portrays qualities of stereotypical southern â€Å"eccentric† that are unstable and exceptionally tragic, thereby leading to bizarre behaviors (Qun, 66). Emily is also described as a person who enforces her own sense of law and conduct; for instance, she refused to pay taxes, which was illustrated, when she was purchasing the poison. Besides, this is also demonstrated by her behaviors such as skirting the law through refusal to have numbers attached to her house when federal mail service is instituted. Nonetheless, her effort to dismiss the law began to take more sinister consequences, thereby resulting killing her husband. This paper will focus on analyzing the character of Emily as portrayed in â€Å"A Rose for Emily" by William Faulkner. In this case, this analysis will begin with general analysis of he r character, which will be followed by an analysis in three perspectives, which include; Emily as a daughter and woman, as an artist and her legacy. Emily is presented to be a monument, which is pitied, irritating, and focusing on living her own life in her ways and terms. People in her township gossips her after accepting to be married to Homer without firm wedding plans; in fact, this lead to drawing people’s attention to her way of life, whereby people make various speculations about her. The act of buying the poison is considered to be effort to commit suicide by people in her town. However, Emily had numerous instabilities that resulted to different directions and leading to finals scene of making a conclusion that she had necrophilia (Qun, 67). In this case, necrophilia is a condition, which regards a sexual attraction to dead bodies. In addition, this is a term used to describe a powerful desire to control another person in a context of romantic through an intense pers onal relationship. Therefore, Emily as a necrophiliac, controlled her relationship, which resorted to bonding with unresponsive entities without resistance or will, like the case with dead bodies. Daughter and Woman Emily is also portrayed as the only child in her family, whereby the narrator does not mention of her siblings, and her mother is not mention. Moreover, it is striking that the narrator fails to mention about her mother, since there is not reasonable explanation for this. Instead, the narrator focuses on emphasizing on the way she was her father’s daughter and the loneliness she experienced due to him (Fang, 106). On the other hand, she is completely controlled by his father up to his death and this control continues even after his death. For instance, he separates her from the rest of the world, during his life, whereby he ensures that Emily did not have any friends, lover, or husband. In this case, her father sets up a life that is in a way that is impossible fo r her to change until her death (Fang, 106). Emily is portrayed to be a weak person, who is unwilling to declare a stance against her father; though this idea is in a way that blames has as the victim. Her father is depicted as a person who is strangely controlling, domineering, and willing to treat her daughter with cruelty. However, her behaviors are disguised by this theory after his death, whereby she tried to get rid of the perception that had been created by her father (Fang, 106). Nevertheless, Emily failed to pursue her own desires of love and sex, and the effort to pursue womanhood fails leading to a decision to revert to

History 82 Essay Example | Topics and Well Written Essays - 1000 words

History 82 - Essay Example 1. The American Indians were passive to the European attack in the beginning as they did not expect the new comers to be rivals. They believed the new people came in search of friendship and were superior to them. 2. The American Indians had ideals much different from the Europeans. They believed in sharing since they had abundance of everything. They did not see any reason to fight. They wondered why the Europeans mercilessly slaughtered the natives when there was so much available for everybody to share. Columbus rightly judged they would fall without resistance if they were attacked initially as they were very unsuspecting. 3. Once the word regarding the Spanish massacres started to spread, the American Indians started to fight against the new comers. But, they were not able to withstand the mighty armies of the Europeans and soon succumbed to them. Protests continued over centuries making the Europeans hate the Indians to the core. 4. African Americans were bought into the pictur e to work in the abducted Indian lands. What was kept common for all was made a particular communities properties and a new community which neither owned the land nor belonged to the nation was forcibly migrated there to work as slaves making their situation very vulnerable. The situation lasted for many centuries. 5. The African Americans accepted their plight due their vulnerable situation for the first few years. They started to voice their concerns in the form of rebellions and strikes after a few decades. 6. Cultural genocide was unleashed on the African Indians with the sole aim of eliminating their pride. Their children and land were abducted, families split and forced to live a secondary life in the name of civilizing them. Forced religious transformations were done to exterminate the Indians and make them follow only the European culture. The African Americans had great persistence through which they safeguarded their culture and spirituality. â€Å"Arawak men and women, n aked, tawny, and full of wonder, emerged from their villages onto the island's beaches and swam out to get a closer look at the strange big boat. When Columbus and his sailors came ashore, carrying swords, speaking oddly, the Arawaks ran to greet them, brought them food, water, gifts.† (Howard Zinn, 1) â€Å"The Indians, Columbus reported, "are so naive and so free with their possessions that no one who has not witnessed them would believe it. When you ask for something they have, they never say no. To the contrary, they offer to share with anyone...." (Howard Zinn, 5) â€Å"When a Spanish armada appeared at Vera Cruz, and a bearded white man came ashore, with strange beasts (horses), clad in iron, it was thought that he was the legendary Aztec man-god who had died three hundred years before, with the promise to return-the mysterious Quetzalcoatl. And so they welcomed him, with munificent hospitality.† (Howard Zinn, 12) â€Å"They lack all manner of commerce, neither buying nor selling, and rely exclusively on their natural environment for maintenance. They are extremely generous with their possessions and by the same token covet the possessions of then; friends and expect the same degree of liberality. ...† (As told by Las Casas)( Howard Zinn, 7) â€Å" We are unarmed, and willing to give you what you ask, if you come in a friendly manner, and not so simple as not to know that it is much better

The Story of an Hour by Kate Chopin Essay Example | Topics and Well Written Essays - 500 words

The Story of an Hour by Kate Chopin - Essay Example Contrary to most racism and sexism stories, there was no implication of any form of abuse inside the house of the couple but the trouble that was happening was within the thoughts of Mrs. Mallard. She recognized the norms and mores of her time and tried her best to be the wife society expected her to be but her natural desire for the outside world was so strong she desired more of the outside world than her home. This circumstance brought the tragedy in her life, not being contented with a life that seemed to have imprisoned her. During Mrs. Mallard’s solitude, it was mentioned that she loved her husband sometimes but often did not, for whatever reason, the author chose for the reader to think about. However, the very following sentence explains that the self-assertion she finally possessed was the strongest impulse of her being, even stronger than the love she felt for her husband. One could almost imagine the husband to be a loving man and probably that was what made Mrs. Mallard love him. However, living in a society that could affect even the events inside the home, Brently Mallard could have been the type who lived according to the suggestions of his environment so that he had to keep his wife inside the house and make the expected homebody wife out of her. Unfortunately, the wife was not the common type of woman who would be satisfied staying in the house all day long. The whispered words of Mrs. Mallard, â€Å"Free! Body and soul, free!† that she kept repeating exposed the perception of the woman of herself. That she had been kept as a prisoner in the house, is what made her want to escape and take the freedom that she always desired. Physically, her being kept in the house could have had a tremendous effect on her way of thinking, considering herself more of a prisoner than a wife who needs to attend to the necessities of housekeeping. However, the line â€Å"There would be no powerful

Compare the housing bubble in US and in China & how can Chinese Essay

Compare the housing bubble in US and in China & how can Chinese government learn from US - Essay Example My goal in this paper is to do a comparative study of the housing bubble in both U.S and China. China has experienced extraordinary growth in the housing market in the recent past; as a result, there has been a substantial increase in residential property. Nevertheless, while accelerating house prices in china may help indicate the presence of the bubble, its existence is still very controversial. Arguably, the current housing boom can be a rational bubble arising naturally from China’s economic transition. With the $580-billion stimulus package injected in 2008, just before the financial crises hit U.S, China’s economy has been able to withstand the global economic meltdown. The stimulus led to banks loosening their lending rate; hence there was excessive lending to home purchasers and thus rapidly raising the housing prices. Unfortunately, should the prices fall, there would be an increase in nonperforming loans and this would trigger china’s housing bubble. In U.S the housing bubble is believed to have been driven mainly by historically low interest rates. However, the low-interest rates, on their own, could not have caused the bubble and these have led to formulation of so many explanations and theories to try and explain what happened. According to (Holt) the correlation between housing price growth and subprime lending across market indicated that the lender took so much risk in booming markets thus increasing to even more the market demand. The meltdown in the housing market consequently, yielded to the devastating financial crisis. Evidently, the effects are still visible and the residential market In U.S is still on the road to recovery, with home prices yet to return to their historical high. Development of housing bubbles follows irrational exuberance for continuous rise of house prices. In the development of U.S Housing bubble, there was a rapid

Timberland †Corporate Social Responsibility Essay Example for Free

Timberland – Corporate Social Responsibility Essay How do Timberlands social responsibility efforts and high ethical standards benefit the company? Timberland’s CSR (Corporate social responsibility) efforts benefit the company in a number of ways: By involving all stakeholders be it consumers, employees or stock holders, Timberland ensures that it is not â€Å"business as usual† but much more towards giving back to the community from which it derives sustenance. By contributing to the local community through PIES (Partners in education and service) and other projects, it ensures that the local community is made to feel like â€Å"part of the family† Timberland is undertaking thirteen different projects with the local community and the employee’s involvement sparks what the management calls a â€Å"revolution† in social justice. Over the past several years, corporate America has been shaken by a series of scandals involving the top management and the whole image of these companies had taken a severe beating. Timberland, by its CSR efforts has ensured that all its stakeholders have a positive approach towards the company and this helps it in its business efforts.       Why is the leader’s personal involvement key? By aligning themselves with the social responsibility efforts, Timberland’s management has ensured that: Their personal involvement ensures that the employees are motivated and â€Å"follow the leader† in their efforts towards CSR By letting employees get a paid leave of 40 hours to contribute towards CSR efforts, the leadership of Timberland is sending a strong message to all the stakeholders about its sincerity and commitment towards the community projects The fact that the leadership was present at the meeting of volunteers to kick off the CSR efforts is a signal that â€Å"everyone is involved†. Timberland is striving to create a brand identity for itself as a caring and ethical company. Towards this, the leadership wants to ensure that it does not fall into the quagmire of profit driven unethical behavior and instead engage themselves with the community at large.

Personal Reflection on Learning Outcomes of Professional Practice

Personal Reflection on Learning Outcomes of Professional Practice In order to reflect upon my learning throughout this module, I will identify and critically discuss three Module Learning outcomes that reflect the range of possible issues of the Nursing and Midwifery Council (NMC) Proficiencies (2004). I will then identify appropriate literature and reflect on my learning and experience. This will enable me to identify personal strengths and areas for further development. The first learning outcome is: Recognise the importance of reflective practice and understand the process of reflection. The second outcome chosen is: Discuss the difference between data and information?. The third outcome is: Demonstrate appropriate non-verbal and verbal skills, including the use of silence, open and closed questions and summarising, to gather information. *Please note that the names of the patients mentioned in this essay have been changed in order to protect their identity for confidentiality reasons. 1 Recognise the importance of reflective practice and understand the process of reflection This outcome relates to the NMC Proficiency of Demonstrate the responsibility for ones own learning through the development of a Record of Achievement of practice and recognise when further learning is required. Reflection is a new method of learning for me. With regard to nursing, the term reflection and reflective practice has been defined by many academics, resulting in various models and theories being developed. The Oxford Mini-dictionary for Nurses (2008) describes reflection as the careful consideration of personal actions, including the ability to review, analyse and evaluate situations during or after events. It is an essential part of the learning process that will result in new methods of approaching and understanding nursing practice. Johns (2000) defines reflection as a window through which the practitioner can view and focus self within the context of his/her own lived experience in ways that enable him/her to confront, understand and work towards resolving the contradictions within his/her practice between what is desirable and actual practice. Schon (1983) proposed that reflection occurs on action or in action. The first occurs after the incident whereas the latter occurs during the incident and is said to be the hallmark of the experienced professional (Somerville Keeling, 2004). The more traditional theories and models base reflection on critical incidents. Love (1996) states that a critical incident does not have to be negative or dramatic but should provide deep thought and raise a professional issue. Gibbs (1988) developed The Reflective Cycle. The model divides the reflective process into sections; Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan (see Appendix 1). Johns (2000) developed a Model of Structured Reflection (MSR) (see Appendix 2) As with Gibbs (1988) Reflective Cycle, the MSR uses a series of questions to guide an individual through the reflective process. Johns model is based on five cue questions; Description, Reflection, Influencing Factors, Could I have dealt with it better? and Learning. The volume of studies and models on reflection demonstrates the value that is placed on this tool. Newell (1992) described the process of reflection to be a cornerstone of nursing professionalism. Gustafsson and Fagerberg (2004) support the notion that reflection is a vital tool and advantageous in terms of the improvement of a nurses professional development and patient care. Many consider journal writing to be an effective reflection strategy (Johns 2000; Paterson, 1995; Cameron Mitchell, 1993; Lauterbach Becker, 1996). Journal writing is considered to offer writers the opportunity to become participants/observers of their own learning, to describe a significant experience and to reflect on that experience to see what they can learn from having had it (Weisberg and Duffin, 1995). While in clinical practice, I have written a journal of my experiences. I recognise its value to aid reflection as I feel that the act of writing things down is important. This is supported by Somerville and Keeling (2004). To demonstrate my understanding of reflective practice, I will now reflect on an incident that occurred while on placement when I was feeding a patient, named Tom*. I will utilise Gibbs (1988) model as this is my first experience of using reflection and feel that it is concise and appropriate at this stage. Tom had dementia and had recently suffered a stroke, which had left him confined to bed. As Tom had difficulty feeding himself, I offered to assist him; he smiled, agreed and appeared to recognise me. Halfway through the meal, Tom became agitated and asked if the food was mackerel. I told him that it was turkey. He shouted aggressively that he wanted mackerel and then became verbally abusive towards me. I was unable to calm him so I left the room with an assurance that I would be back soon. I then asked a senior nurse for help. This was the first time that I had fed a patient but felt comfortable. I knew Tom well and felt that I had built up a rapport with him. I was pleased that he seemed happy and relaxed. When he shouted I felt shocked, worried and conscious of other peoples reactions; they may think that I had done something wrong. Even though Tom was disabled he did have some use of one arm so I was afraid that he might become violent. I was upset that I had to stop feeding him and leave the room. When I left I felt relieved but also anxious that I may have contributed to the way Tom was feeling. When evaluating and analysing the incident, I was pleased initially with the way the task started as on admission he had a poor appetite. The negative side of the situation was that Tom became angry and didnt finish his meal. I realise that dementia is a complex progressive illness and there may be times when a patient experiences sudden mood changes. I believe that I would now do things differently if a similar situation arose. With hindsight, I questioned whether I should have just agreed with Tom that the turkey was mackerel then this incident may not have occurred. However, this raises ethical issues such as whether it can be acceptable to not tell the truth. A report published by the Nuffield Council on Bioethics (2009) discusses the ethics of dementia care and states that ethical dilemmas arise on a daily basis for all those providing care for people with dementia. Research suggests that challenging someone with dementia could be detrimental and cause unnecessary distress (Shellenberger, 2004). Naomi Feil developed validation therapy between 1963 and 1980 as a technique to communicate with patients with dementia by recognising and accepting their view of reality of people with dementia in order to provide them with empathy and respect (The Validation Training Institute, Inc). In the future I could use this technique; for exa mple, when Tom asked if it was mackerel he was eating I could have replied by asking him if he liked mackerel which would have avoided giving a direct answer. With regard to strengths and areas of development, I feel that I have reflected successfully on this incident. However I would like to strive to reflect in action as opposed to on action as this is the most effective. In terms of development, I believe that it would be beneficial to patients and myself to learn more about caring for patients with dementia. The Dementia UK Report (2007) published by The Alzheimers Society states that there are currently 700,000 people with dementia in the UK. The report also predicts that by 2025 there will be over 1 million people with dementia so it is inevitable that I will be caring for many dementia patients in my career. In summary, although the models of reflection span over 20 years and vary slightly, the principle of reflection is very similar, which implies that reflection is a robust tool and still applies to modern nursing. I have learnt that reflective practice is a vital tool, particularly when associated with journal writing. Continuous reflection will allow me to develop skills and knowledge to enable me to provide the best care possible for patients and their families. 2 Discuss the difference between data and information This learning outcome links to the NMC proficiency of Demonstrate literacy, numeracy and computer skills needed to record, enter, store, retrieve and organise data essential for care delivery. As a student Im not involved in using my computer skills on the ward but eventually will be involved in audit and data entry. My literacy and computer skills are demonstrated throughout my portfolio and assignment. I demonstrate my literacy and numeracy skills when writing patient evaluations, calculating fluid balance and assisting with drug calculations. There are many examples of data and information used within nursing care. Due to the broad nature of this area I have focused on a particular type of data and information to demonstrate my understanding of these terms. My focus is data collected from patients vital signs and the information that relates to this. I will demonstrate how the process of giving information to patients rather than just data is an essential part of nursing. Gathering, giving and recording both data and information accurately is vital. Data can be described as facts and statistics used for reference or analysis. The term information can be defined as the meaning applied to the data (Concise Oxford English Dictionary, 2008). Observation data collected from patients includes pulse rate and rhythm, blood pressure, respiration rate, temperature and oxygen saturate percentage. These measurements are taken on admission as it is important to gain base-line readings to which future readings can be compared. It is necessary to apply meaning to this data to form information to be able to judge a patients condition. Throughout the module I have learnt what data means in terms of acceptable values. As I now have the information about the data I can make judgments about data. For example, I now know that the information I can get from the blood pressure data of 160/110 mmHg is high (Blood Pressure Association). However, this information needs to be put into context to allow use of the information to make a judgement. For example, if a patient has just completed cardiovascular exercise, this may account for a high blood pressure reading. With this information, the plan would be to wait for 30 minutes before repeating to gain more accurate data. Readings can vary temporarily due to a number of reasons; for example, medication, an existing health condition, fluid intake, exercise and alcohol consumption. However, a change in blood pressure can indicate deterioration in condition, which alerts health care professionals to investigate. In order to show my understanding of the difference between data and information I will now give an example of an incident that occurred while on placement. During observations of a 70 year-old lady named Eileen*, I noticed that her systolic blood pressure had dropped from 127 to 90 mmHg. Her other observations remained consistent. I informed a senior nurse who asked a doctor to review the patient. I discussed her fluid intake with her as this could have had an adverse effect on her blood pressure. As she had only drank a small amount I encouraged her to drink more and continued monitoring. Eileens blood pressure eventually returned to her baseline. This example shows how data, such as blood pressure readings, prompts gathering information which, in turn, enables problem solving. As demonstrated, I need to have an understanding of the information gathered from the data but additionally I feel that it is important that patients understand what the data means. Bastable (2006) defined patient education as the process of assisting people to learn health related behaviours so that they can incorporate those behaviours into everyday life and achieve a goal of optimal health and independence in self care. I will now provide an example of my experience of patient education: During a blood pressure check on Paul*, who was hypertensive and took multiple medications, I asked him whether he would like to learn about blood pressures. He gladly agreed so I explained what the reading was and what can affect blood pressure. I explained that exercise, healthy eating, low salt intake and weight control would have a beneficial effect on his blood pressure. He was unaware of how his current lifestyle could have a detrimental effect on blood pressure and said that he now intended to make some lifestyle changes. Research supports my thoughts about the benefits of giving patients information about aspects of their health rather than just the data. Florence Nightingale, who has been described as the founder of modern nursing, recognised the importance of educating about adequate nutrition, personal hygiene and exercise in order to improve well-being (Bastable, 2006). The Department of Health (2009) states that giving people relevant, reliable information enables them to understand their health requirements and make the right choice for themselves and their families. (Bastable, 2008). Partridge and Hill (2000) found that patients who are well informed are better able to manage their health, have improved psychological outcomes, have fewer exacerbations of their condition and less hospital admissions. Glanville (2000) states that if clients cannot maintain or improve their health status when on their own, we have failed to help them reach their potential. Abbott (1998) reported that by involving patients in their state of health by keeping them informed has been proved to improve patient satisfaction and concordance. However, there is research to suggest that providing information may not result in a change in health outcomes (Kole, 1995; Sherer et al. 1998). They found these reasons to be that patients dont understand the information, are unable to absorb it due to pain, anxiety, or that they choose not to act upon it. Additionally, absorption of information is decreased when there is too much information; therefore health outcomes remain unchanged. The question is how much is too much information? This is difficult to determine. In terms of personal strengths, I felt very satisfied that I had initiated this conversation which resulted in Paul considering lifestyle changes. On reflection, this incident highlighted the importance of patient understanding and has encouraged me to take time to educate patients where possible. It has emphasised the need for continuous learning so that I am able to answer questions and educate patients. Additionally, I am aware of my limitations and when to seek advice or refer patients to others. I also need to develop confidence in speaking to patients about sensitive issues such as weight management by researching this area. 3 Demonstrate appropriate non-verbal and verbal skills, including the use of silence, open and closed questions and summarising, to gather information This outcome relates to the NMC Proficiency of Engage in, develop and disengage from therapeutic relationships through the use of appropriate communication and interpersonal skills. Communication is a reciprocal process that involves the exchange of both verbal and non verbal messages to convey feelings, information, ideas and knowledge (Wilkinson 1999; Wallace 2001). In nursing, communication and information gathering is essential to provide quality care. Sheldon, Barrett Ellington (2006) report that Communication is a cornerstone of the nurse-patient relationship. Information gathering commences from when the nurse greets the patient. In order to communicate non-verbal and verbal cues are used. Non-verbal skills are portrayed with body language and impact on communication (Hargie Dickson 2004). These include posture, facial expressions, head movement, eye contact and hand gestures showing active listening. Verbal skills include the use of silence, open and closed questions and summarising. The tone of voice and rate of response are significant. The emphasis is on effective communication; the way we communicate can hinder or enhance the information we gather. Sheldon et al. (2006) state that the power of effective nursing care is strengthened and enriched by good communication. Maguire and Pitceathly (2002) suggest that clinicians with good communication skills identify patients problems more accurately, patients are more satisfied with their care and are less anxious. It has been reported that that ineffective communication can lead to patients not engaging with the healthcare system, refusing to follow recommended advice and failing to cope with the psychological consequences of their illness (Berry, 2007). The scenario below demonstrates my understanding of appropriate verbal and non-verbal cues. It is part of a conversation with a patient on admission regarding current medical history. When meeting Arthur*, a 78 year old, I smiled, introduced myself and explained the purpose of our conversation. I asked Arthur Do you have any chest problems? he answered Yes. I then asked What chest problems do you have and how do they affect you? he answered I have emphysema causing wheezing and a cough. I also get breathless when walking and have oxygen at night I left a brief silence at this point. Arthur then disclosed I cough up a lot of horrible phlegm in the morning which is embarrassing. He then asked will I get a chest x-ray. I asked Have you any particular worries about your chest? to which he replied well I am quite worried about lung cancer. I told him that I would pass on his concern to the doctor and then summarised our conversation. With regard to verbal responses, I initially asked a closed question as I wanted a specific answer. Silverman et al. (2005) supports the theory that closed questions are appropriate when wanting to narrow the potential answer. Due to Arthurs response I asked an open question to encourage him to go into more detail. An open question often results in a lengthy answer, so I used fillers such as mmm throughout, to show active listening and to encourage him to continue. The brief pause was successful as it enabled Arthur to disclose his embarrassment. I summarised his response in order to clarify what Arthur had said for my own benefit but also to give the patient confidence that I had understood and opportunity to correct me if not. With regard to my non-verbal communication, I kept an open posture with eye contact and leant forward slightly to show that I was listening. I also ensured that my facial expressions were appropriate. For example, when greeting Arthur I smiled, but during descriptions of distressing symptoms my facial expression was one of concern. Egan (2002) supports the notion that conveying these non-verbal cues in this way will facilitate emotional disclosure and encourage the patient to talk more freely. Egan derived the acronym SOLER to portray awareness of the non-verbal responses; facing squarely, maintaining an open posture, leaning slightly forward, having appropriate eye contact and being relaxed. There are approximately 700,000 different non-verbal cues that may or may not have meaning (Birdwhistell, 1970; Pei, 1997). As nurses, we must be aware of our use of non-verbal cues as they can convey unintentional meaning. In addition to awareness of our responses it is imperative to be aware of patient cues, as this is part of the information gathering process. Arthurs hesitancy indicated to me to remain silent to encourage further disclosure. Being aware of patients verbal responses is more straightforward than what their non-verbal responses convey and it may be that patients body language contradict the spoken word (Miller, 1995). Barriers to communication include anxiety, language, hearing, sight or speech impairment. During communication, I would like to think that I am non judgemental. According to Underman Boggs (1999) most of us have personal biases regarding others that are based on previous experiences. In relation to my scenario, Fuller (1995) suggests that health care professionals may underestimate the verbal capacity or abilities of older people, which results in their conversations being undervalued. In terms of personal strengths, I feel fairly confident with the use of verbal and non-verbal cues and how these can deter or catalyse communication. I feel that I used silence successfully as Arthur disclosed embarrassment and mentioned about an x-ray, which he may not have done otherwise. I was able to reassure him that we would provide a disposable sputum pot and acknowledged his fear of cancer. I realise that it can be difficult communicating about sensitive information and this is an area of development for me, which I feel will improve with experience. Although at this stage of training I would not be expected to lead consultations for diagnostic purposes, it was informative to research consultation models. I intend to become more familiar with these models in order to utilise some of the communication skills (Newell, 1994). To form an overall conclusion, I feel that through theoretical learning and clinical experience I have demonstrated my achievement of the NMC Proficiencies (2004). I have critically discussed and concluded each learning outcome in turn throughout the essay but to summarise; patient focus and effective communication are paramount. I feel that in terms of reflection, self-awareness is key (Rowe, 1999). This will enable me to look at my skills to recognise strengths and areas of development to ultimately provide best practice in patient care. I realise that I will gain experience and confidence as my training progresses. Word Count: 3289 References Abbott, S. A.(1998) The benefits of patient education Gastroenterol Nursing. 1998 Sep-Oct;21(5):207-9. Bastable, S. (2006) Essentials of Patient Education. London. Jones and Bartlett Publishers. Bastable, S. (2008) Nurse as Educator: Principles of Teaching and Learning for Nursing Practice. Third Edition. London: Jones and Bartlett Publishers. Berry, D. (2007) as cited in Health Communication: Theory and Practice (Health Psychology). Berkshire: Open University Press. Birdwhistell, R. (1970) as cited in Nursing knowledge and Practice; foundations for decision making. London: Bailliere Tindall. Blood Pressure Association www.bpassoc.org.uk. [11th November 2009] Cameron, B. Mitchell, A. (1993) Reflective peer journals: developing authentic nurses. Journal of Advanced Nursing. 18, 290 297. Concise Oxford English Dictionary (2008) Eleventh Edition Revised. Oxford: Oxford University Press. Dementia: Ethical Issues Report (October 2009) published by Nuffield Council on Bioethics (http://www.nuffieldbioethics.org) [13th December 2009] Dementia UK Report (Feb 2007) published on The Alzheimers Society (http://www.alzheimers.org.uk/site/scripts/documents_info.php?categoryID=200120documentID=341) [7th December 2009] Department of Health (2009) Better information, better choices, better health. London. Department of Health. Egan, G. (2002) as cited in The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London: Wiley-Blackwell. Fuller, D. (1995) Challenging ageism through our speech. Nursing Times. 91, 21, 29-31. As cited by Miller, L. (2002) Effective communication with older people. Nursing Standard. 17, 9, 45-50. Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Oxford Polytechnic. Oxford. Gibbs, G. (1988) Reflective Cycle. Queen Mary University http://www.qmu.ac.uk/els/docs/reflection1.pdf. [20th October 2009] Glanville, I. (2000) Moving Towards Health Oriented Patient Education (HOPE). Holistic Nursing Practice. 14(2) 57-66. Gustafsson, C. Fagerberg, I. (2004) Reflection, the way to professional development?. Journal of Clinical Nursing, 13, 271-280. Hargie, O. Dickson, D .(2004) as cited in The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London: Wiley-Blackwell. Johns, C. (2000) Becoming a reflective practitioner. Oxford: Blackwell Science. Kole, L. (1995) A lot of knowledge is not enough: compliance and a positive outcome with asthma require more than knowledge. Journal of the American Academy of Physician Assistants. 8, 3, 8 11. As cited by Caress, A. L. (2003) Giving information to patients. Nursing Standard. 17, 43, 47-54. Lauterbach, S. Becker, P. (1996) Caring for self: becoming a self-reflective nurse. Holistic Nurse Practitioner 10(2) 57-68. Love, C. (1996) Critical Incidents and Post Registration Education and Practice. Professional Nurse. 11(9) 576. Maguire, P. Pitceathly, C. (2002) Key communication skills and how to acquire them. British Medical Journal. September 28; 325(7366): 697-700. Miller, L. (1995) The human face of elderly care? Complementary Therapies in Nursing and Midwifery.1, 4, 103-105. Ac cited by Miller, L. (2002) Effective communication with older people. Nursing Standard. 17, 9, 45-50. Naomi Feil http://www.vfvalidation.org/web.php?request=Naomi_Feil_Bio [7th December 2009]. Newell, R. (1992) Anxiety, accuracy and reflection: the limits of professional development. Journal of Advanced Nursing. 17, 1326-1333. Newell, R. (1994) Interviewing skills for nurses and other health care professionals. London: Routledge, Oxford Mini-dictionary for Nurses (2008). Royal College of Nursing. Sixth Edition. Oxford: Oxford University Press. Partridge, M. Hill, S. (2000) Enhancing care for people with asthma: the role of communication, education, training and self-management. European Respiratory Journal. 16, 2, 333-348. As cited by Caress, A. L. (2003) Giving information to patients. Nursing Standard. 17, 43, 47-54. Paterson, B. (1995) Developing and maintaining reflection in clinical journals. Nurse Education Today. 15, 211-220. Pei, M. (1997) as cited in Nursing knowledge and Practice; foundations for decision making. London: Bailliere Tindall. Rowe, J. (1999) Self-awareness: improving nurse-client interactions. Nursing Standard. 14, 8, 37-40. Scherer, Y.K., Schmieder, L.E., and Shimmel, S. (1998)The effects of education alone and in combination with pulmonary rehabilitation on self-efficacy in patients with COPD. Rehabilitation Nursing 23: 2, 71-76. As cited by Caress, A. L. (2003) Giving information to patients. Nursing Standard. 17, 43, 47-54. Schà ¶n, D. (1987) Educating the Reflective Practitioner. San Francisco: Jossey-Bass. Sheldon, L. K., Barrett, R. Ellington, L (2006) as cited in Nursing knowledge and Practice; foundations for decision making. London: Bailliere Tindall. Shellenberger, S. (2004) Therapeutic Lying and Other Ways To Handle Patients With Dementia. Wall Street Journal, November 11. Silverman, J., Kurtz, S. Draper, J. (2005) as cited in The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London: Wiley-Blackwell. Somerville, D Keeling, J. (2004) as cited in Nursing Times http://www.nursingtimes.net/nursing-practice-clinical-research/a-practical-approach-to-promote-reflective-practice-within-nursing/204502.article [30th October 2009] Underman Boggs, K. (1999) Communication styles. Interpersonal Relationships: Professional Communication Skills for Nursing. Third edition. Philadelphia PA, WB Saunders. Validation Training Institute Inc. http://www.vfvalidation.org/web.php?request=index [10th December 2009] Wallace, P. R. (2001) as cited in The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London: Wiley-Blackwell. Weisberg, M. Duffin, J. (1995) Evoking the moral imagination: using stories to teach ethics and professionalism to nursing, medical and law students. Change, 22. Wilkinson, S. (1999) as cited in The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London: Wiley-Blackwell. APPENDIX 1 Gibbs (1988) model of reflection

The Woman Warrior :: essays research papers

The Woman Warrior The most important theme that really stood out to me was the talk stories. The whole book mainly deals with the talk stories. The second theme that I felt that had a major impact in this book was ghost. Ghosts have an impact because the stories that are told about them that affect the kids resulting in their isolation from society. These themes are very important in The Woman Warrior because they help the narrator’s life and unite the stories of the book. Talk stories to me, seem to have a major impact in the lives of Chinese people. These talk stories teaches the children valuable lessons; each different from each culture. The talk stories make the children fear or learn from the mistakes or triumphs of the characters in the talk stories. These stories have major impacts on the main character of The Woman Warrior. She learns what to fear, like ghosts, and having a child without being married and also learned to stand up to what she feared or believed in. The story of the aunt is the first talk story we learn about in this book. The aunt who had a child before marriage was treated as a outcast. This teaches the girl not just to avoid getting pregnant before marriage, but to avoid embarrassing the whole family. This story though, grows weaker for the girl as she rebel at what her mother wants her to be. She tries to be the best she can be and looks for her mother’s praise but all she got was â€Å"you’re too ugly† or â€Å"you talk like a duck†. She starts to question these stories as these talk stories become very confusing in the life of the girl. The second talk story was clearly still in the mind of the girl when she grew up. The story was about Fa Mu Lan who joined the army as a girl to rise up to be a hero when female weren’t allowed in the army. This is good story that really matched up to what the girl represented when she grew up. Fa Mu Lan went against the rules of being a woman in China and triumphed to be one of the greatest heroes of China. The girl decided to be like Fa Mu Lan and break tradition by rebelling against her mother. Ghosts seems to be very important in the story of this book. Ghosts plays a major part because of the way they are used as to isolate the children or to make them stand up against a foe.

A Fairy Tale :: creative writing

He knew that his first prey, the firebird, lived high up in the trees in the heart of the forest. Like lightening, they were hard to miss, and the piercing of its beak left a burn that could never be forgotten. Suddenly, the boy heard a shriek, and he whirled his head to see the blood-red bird swooping toward his face. Panicking, the boy lunged for the ground, and for the net that the wise man had given him. He hurled it at the bird - and missed. The bird, angry, made another giant swoop at the boy - and tore its flesh as it flew straight into the blade of the boy's sword. That was one creature taken care of. His next target, the freezing spider, could be either much harder, or much easier, the boy knew not which. The spider could not run, or jump, unlike some of its relatives, but it was harder to find, and its poison froze the human blood and made its victims helpless, lying on the ground shivering until the arachnid finally took pity on his prey and ate it. He tried not to think about it.  Ã‚  Ã‚  Ã‚  Ã‚  Instead the boy thought of ways to attract his prey; if he could get it to come to him, the killing would be easier - and definitely much safer. The freezing spider would eat any kind of flesh it could, but it was well known that the spider loved most to eat the flesh of humans. Well, what should he do? Obviously bait was safer than waiting for an attack, so the boy pulled out his dagger and held it to his upper arm. That was when he saw the grey bristles of the freezing spider. It was sitting quietly on a nearby shrub, its back toward the boy. Holding back a sigh of relief, he took one quiet step toward his prey, holding the dagger high, and stabbed it through the spider before it knew what hit it. A little less active a kill than the firebird, but just as exhilarating. Now the only victim left in this task of the boy's was the netherworld wolf, and what a creature. About the size of a pig, these dogs could tear up a man in two minutes flat, or so it wa s said. However, being the largest of the creatures made it the easiest target.

Comparing Barry Lopezs A Presentation of Whales and Scott Russell Sand

Comparing Barry Lopez's A Presentation of Whales and Scott Russell Sander's Buckeye Was it just a coincidence that I had my first—televised—encounter with sperm whales only a day after I read Barry Lopez’s essay, â€Å"A Presentation of Whales†? Was my strong spiritual response to Scott Russell Sander’s â€Å"Buckeye† a sign that I, too, will feel the ghostly presences of my beloved kindred when they leave this world? No way! I am not a mystic. I am not supernaturally connected to sperm whales or spirits, but I will admit that I entertained self-important thoughts while reading both essays. Not only did I stare at the professional headshots of the writers before I read their essays; I adored them and empathized with their visions. Perhaps nature writers are advantaged: they can be scientific and not be perceived as being such by non-scientific readers. After all, the word ‘nature’ generates images of the earth and all of its sensory treasures, whereas ‘science’ generates images of laboratory coats, long calculations, laborious extractions, and obscure words like genome, polypeptide and spermatozoa. Nature writers are free to incorporate various genres in their writing, which interests a broad population of readers. Readers are attracted to writing styles that reinforce their subjective perceptions of themselves and the world. A readers’ opinion does not necessarily indicate the success or failure of a writer, but rather the state of mind of the reader when she approaches the piece. This is also how we approach people and events in our lives. We are animals, and therefore we must engage with nature. While Barry Lopez and Scott Russell Sanders have a keen sense of t he innate connection between animals and landscapes, ... ...aren’t scientific or historical, they are still objects in his immediate landscape. Alone, they are solitary objects, but together they create a story of human life. Curiosity and neediness attract humans to philosophy, in a similar way that they attract humans to religious dogma, cults and magic. Fortunately, nature narratives draw on human interests in various disciplines without simultaneously wreaking havoc on society. Writing helps us create and understand ideas. Personal values and scientific information are often used interchangeably by Barry Lopez and Scott Russell Sanders. Unless the reader is indifferent, both writers prove they are capable of illustrating essential elements of the human experience in both public and private moments. As readers, we are bonded to Lopez and Sanders because of our role in the innate chaos of human interaction.

CORPORAL PUNISHMENT Essay

Positive Effects of Corporal Punishment Corporal punishment in regards to spanking has been used for hundreds of years in educational systems and in house holds and is still legal in all fifty states for parents to use in there household because it is an effective way to punish a child for wrong behavior. Even though in the last couple of decades this topic has been very controversial, many countries and educational systems have decided to outlawed corporal punishment because of the belief that it has created more and more violent behavior in children. But, there is still no direct link to spanking causing children to have more violent behavior. However, if youth violence and dysfunction is increasing at the same time that corporal punishment is decreasing, we should be open enough to consider whether the two trends are related. Maybe there is no connection. But maybe lawmakers and child welfare workers should pay more attention to the research suggesting that physical discipline can be helpful in certain contexts (Larzele re,2005). The whole reason for ‘punishment’ is to stop a behavior from happening again by applying an unpleasant stimulus immediately after a bad behavior has occurred. Therefore, we use corporal punishment because it is a method of punishment called punishment by application which spanking is applied to the child after a bad behavior, preventing it from happening again, which also help implement discipline. But corporal punishment is being apposed because other studies say it promotes more anger and aggression in juveniles, but places where it has been totally outlawed have shown different results. For instance, after Sweden outlawed spanking, violent behavior did not decrease. Instead, there has been substantially more violence in Sweden than ever before– violence by children, violence by parents, and violence by society in general (Grusec, 1994). That being said, there is no direct link to corporal punishment being the cause of violence increase because this shows it did just the opposite. But research does show that it could be linked to  something else, journalist Patricia Hersch tells of the ‘deluge of adolescent dysfunction sweeping the nation, manifesting itself in everything from drugs, sex, and underachievement to depression, suicide, and crime’; and it is being seen in younger and younger children. About 20% of kids now ‘have some sort of developmen tal, learning, or behavioral disorder.’ And as the Carnegie Council on Adolescent Development warns, ‘substantial numbers of American youth are at risk of reaching adulthood unable to meet adequately the requirements of the workplace, the commitments of relationships in families and with friends, and the responsibilities of participation in a democratic society.’(Hersch, 1998) And a lot of this is being caused by the lack of parenthood and how parents are raising their kids now days with substantially fewer parents staying home with their kids and we have become addicted to TV, movies, and videogames (Rosemond, 1989). Parents don’t have to attend to their kids as much because they just put a T.V. or some kind of videogame system in front of them to keep them occupied. Thus, giving the kids less interaction with other people and their parents, which can lead to bad relationships and also antisocial which leads to aggression as well. So we see all these thin gs that easily effect our children and their behavior but people still try to link all of it back to corporal punishment when we should look at the big picture. A common misunderstanding is how to use corporal punishment correctly, and the primary goal most parents have in administering corporal punishment is to stop children from misbehaving immediately (Gershoff, 2002) and is indeed a good method when used correctly. When a parent is using corporal punishment out of anger, frustration, or aggression, the child will learn that same action you apply on them. Therefore, the punishment can be classified as abuse to an extent and when pain is being forced on a child out of your own aggression and anger they learn those same attributes and those later on cause behavioral problems down the road. But when used just to stop a specific behavior with out trying to inflict pain on the child is when it is most effective, and yes spanking is a primitive discipline method. But a child’s mind is also primitive. As researchers like Dr. Jean Piaget of the University of Geneva have popularized, kids learn from the tangible to the intangible—fro m the concrete to the abstract. It is during  the tangible, concrete stages when physical discipline seems to be the most helpful (Fuller, 2010). Thus, when using corporal punishment correctly and not abusively, the child understands immediately at a younger age. It is just like a dog, you need to train them at a very young age for the training to be most effective. Same thing goes for children because at a young age is when it becomes concrete, and just like dogs again, and when they start getting older it’s harder to get children to obey, and you cant teach a dog new tricks. But statistics from Sears, Maccoby, and Levin (1957) show that they found that 99% of the children they studied experienced CP at least occasionally. If that’s true and corporal punishment causes aggression, promotes violent activities, and learning disabilities like people say then why doesn’t everyone have aggression, behavior problems, and learning disabilities? They don’t because spanking is to be better at controlling aggression than mental punishments like timeout, reasoning, scolding, â€Å"non-contact† punishment, privilege removal, love withdrawal, or diverting. Also showing that calm and controlled spanking, and spanking in response to defiance, is uniformly more beneficial than other punishments. (Larzelere,2005) Growing up in a household where corporal punishment was definitely used by my parents, I feel my experience has had a huge impact on me because it has honestly helped me now more than anything. I say that because at a young age I learned fast what was right and wrong and have always been able to pick up onto things fast, and as I grew up I might have had some family problems and what not but I feel like me being disciplined at such a young age, it has kept with me all along. And I’m not just disciplined because I think I will be punished or something, but I have learned to be more, I’ve learned to be self-disciplined, and being disciplined has helped me in school, sports, living life on a daily basis, and my future. And that is another reason I believe corporal punishment is effective; it teaches discipline at such a young age, and with discipline comes responsibility, and these two traits are key for healthy lifestyle not just at a young age but through your whole life . Because no matter how old you are their will always be a punishment for your disobedience, whether it’s disobeying your parents or it’s  disobeying a police officer, either way your going to have to disciplined enough to take responsibility for your actions. And if your making bad decisions or choices then you’ll probably have a worse punishment whether it’s a spanking or you go to prison. Punishments just get worse as we get older so might as well be disciplined now then end up in jail. In conclusion, I see corporal punishment as a very effective way for children to learn not to disobey your parents but to also just be obedient in general. Even though some researchers say it has evidence leading to violent behaviors and aggression, their research seems to be inadequate when it comes to the results and observations of research. Research trying to support the outlaw of corporal punishment even says the evidence presented is not strong enough to permit a conclusion that it has been proven that smacking causes long term adverse effects on children (Larzelere,2005). Proving my point that corporal punishment is not a direct link to issues down the line, and I would like to reinforce that corporal punishment is an effective way of punishment if used for the right reason and depending on the context of the behavior, and that it has personally directed me and influenced me in more of a positive way. Abstract After using the information I was able to gather from R. E. Larzelere, J. E. Grusec, P. Hersch, as well as J. Rosemod to help support my idea that corporal punishment is still an effective way of punishment in today’s society. Even though there is so many argued topics on the issue at the moment, I still concluded from my research that corporal punishment has no direct link to violence, aggression, and behavioral problems. Even after looking at evidence from E. Gershoff that tries to support the idea that corporal punishment causes behavioral problems as well as violent behaviors, a thorough understanding of whether and how corporal punishment affects children has not been reached. It hasn’t been reached because the research that is being used is unreliable and some of the parents are not aware of how to properly use corporal punishment on a child, so they are actually doing harm to their child because they are punishing the child out of anger rather than the sole reaso n to stop a behavior. Therefore, I believe  corporal punishment is an effective way of punishment and helps direct children the correct way down the road in life with quality traits like discipline, responsibility, and respecting and obeying your authorities. Reference Robert E. Larzelere & Brett R. Kuhn, Comparing Child Outcomes of Physical Punishment and Alternative Disciplinary Tactics: A Meta-Analysis, 8 CLINICAL CHILD & FAM. PSYCHOL. REV. 1, 32 (2005) [hereinafter Larzelere, Meta-Analysis] Joan E. Grusec & Jacqueline J. Goodnow, Impact of Parental Discipline Methods on the Child’s Internalization of Values: A Reconceptualization of Current Points of View, 30 DEV. PSYCHOL. 7 (1994) PATRICIA HERSCH, A TRIBE APART: A JOURNEY INTO THE HEART OF AMERICAN ADOLESCENCE 12 (1998) JOHN ROSEMOND, JOHN ROSEMOND’S SIX-POINT PLAN FOR RAISING HAPPY, HEALTHY CHILDREN 179-80 (1989) Gershoff, E. (2002). Corporal punishment by parents and associated child behaviors and experiences: A meta-analytic and theoretical review.Psychological Bulletin, 128(4), 539-579. Retrieved from http://www.comm.umn.edu/~akoerner/courses/4471-F12/Readings/Gershoff (2002).pdf

Case Analysis on Hilton

The Hilton family started its first hotel in the year 1919 by the name of Mobley Hotel in Cisco, Texas under Conrad Hilton. The firm launched its IPO under the name Hilton Hotels Corporation in 1946 to make its presence felt in the hospitality business. With time the firm expanded to compete and serve at the global level. In the highly competitive Global Lodging Business the challenges mainly faced by the firms included difficulty in achieving a standardized service of operation all throughout.With economies of scale and to focus on consistency as well as superior service delivery across the Hilton brand of Hotels, the importance of CRM was realized and the firm came up with the strategy of Customers Really Matter (CRM) in 2002. To build customer equity it is important to embrace technology and Hilton implemented this using its infrastructure called OnQ which acted as an enabling agent helping employees to deliver great customized customer experiences. Hilton introduced the Customers Really Matter with the objective to provide outstanding services to the customer.CRM enabled Hilton Corporation to focus more on building and managing its relationships with its customers. With CRM it was possible to acknowledge customers and provide personalized attention to each of them. It helped to store personal records of a person to access information for knowing the customer better. It helped maintaining people’s preferences, which directly reduced time spent on websites assistance or call center’s phone call costs and it also helped providing offers suited according to an individual and even helped promoting cross-selling and improving conversion rates.With CRM, the hotels front desk could have a comprehensive report each day of the guest list in an easy to scan format. The pre-assigning of rooms, the classification/segmentation of membership and exclusive benefits for privileged customers could all be done using CRM. However, there were few problems involved with pre-assigning of rooms and changing priorities of the customer. By adopting CRM and adapting with the technology it all became easier for Hilton, the guest profile managing, online profile maintenance, building more relationship, andhave more information (emails, phone no. ) of the customers and record complaints and feedbacks. All of these could be integrated by Hilton to bring more consistency as well as standardization to its services across its diversified business. The existence of the SALT (Satisfaction And Loyalty Training) survey, which helped significantly to improve the services by monitoring customer experiences and better measure the important factors that could help the business, added great value to the CRM initiative.On the other hand, OnQ also assisted property level operations and could enable the corporation to open more hotels for the customers and expand the brand image. Although CRM had its own benefits, the success boiled down to execution. OnQ incorporat ed huge costs and maintenance expenses. Apart from them, the CRM technology also required many other organizational factors to be addressed. The focus required on measurement, executive championship, training of the employees to use the technology, the feedback incorporation, etc. all had to be taken in account which couldn’t be overlooked.Taking in consideration the presence across 78 countries, the technology helped maintaining central database accessible from all the service points. Having variety of products across different price points throughout the organization, CRM also assisted segmentation of customers into modules such as Diamond, Gold, 4+ for improving services. A difficult task was to deduce the Return on Investment for the CRM. To conclude, CRM did help Hilton in its goal to enhance its competitive advantage, and to become the one of the premier choices of the world’s traveler in the global hospitality business.

Exploring Business Purpose Essay

Introduction: In this assignment I will be focusing on 4 different organizations and explaining their purpose, ownership, size and scale in full detail. Organization 1 ASDA: ASDA is a huge British supermarket which retails Mediterranean Food, CDs, Books, Videos, Clothing, Jewellery and House wares. ASDA is the UKs second largest food retailer after Tesco, ASDA was owned by Wal-Mart in 199ASDA is Wal-Marts largest non-US subsidiary. Furthermore ASDA is a private sector business (a business run for private profit and it is not controlled by the government). Purpose of ASDA: The purpose of ASDA is mainly to make profit but apart from that ASDA’s purpose is to provide goods and services that are cheap and affordable to consumers or the public. Also to reduce the cost of their products, in addition ASDA has another purpose which is packaging their products well and to support voluntary sector services. ASDA lives by a set of values that makes them unique, the company’s values include respect for individuals (staff, and customers) and good customer service and a try hard for excellence. ASDA takes corporate responsibility (management on a company’s impact on society and the environment) very seriously, ASDA believes that supporting corporate responsibility can make their products more affordable for customers. Ownership: ASDA is a Public Limited Company PLC (A PLC is a type of limited company which is permitted to offer shares to the public) an American retailing company called Wal-Mart owns ASDA. Its shareholders own the company and this causes the ownership to constantly change, as the share are constantly bought and sold. Size/Scale: ASDA is a very large business because it currently has 356 stores, which has 160,00 employees 95,00part-time employees and 65,00full-time employees. Also ASDA is a very large business because it sales in excess of 17 billion with over 17 million customers. This shows that ASDA is a very big business. ASDA is a national business which is all around the UK, they also have a brand George which is global, George is ASDA’s clothing brand name, so any clothing that is sold will be a George brand. This means that ASDA will be known more and will be making more money. Organization 2 Richer Sounds: Richer Sounds is a business which is owned by Julian Richer, Richer Sounds retails electronic goods such as; TV gears, hi-fi, home cinema systems etc. Previously Richer Sounds was in the Guinness book of records for the highest sales per square foot any retail outlet in the world and in 2002 Richer Sounds was judged as the best British owned company by the Sunday Times. Purpose of Richer Sounds Richer Sounds purpose is to expand their business, also to work as a team and to provide us their greatest products at a price which beats other company’s prices. Ownership: Richer Sounds is in the private sector, however in1987 they have decided to become an unlisted Public Limited Company (PLC) and since 1990 they have been an unlisted plc. Richer Sounds is 100% owned by Julian Richer (the founder and managing director of the company), Richer sounds decided to become an unlisted PLC because they did not want to offer any shares to the public. Size/Scale: Richer Sounds is a medium sized business, it currently has 48 stores nation wide 10 stores in London and 38 stores out of London. It has around 500 employees, 180 workers in their office or in their management and 320 employee’s works in retailing and warehousing. Moreover in 2003 Richer Sounds sales turnover was nearly 87 billion and their profit before tax was 4.5 million this means Richer Sounds has sold almost 280,000 of goods (in 2003). Richer Sounds is a nationwide business (businesses owned through out the whole nation). Organization 3 Royal Mail/Post Office: Royal Mail is the national postal service of the United Kingdom, the Post Office is a retail company in the United Kingdom formerly part of the postal service Royal Mail. Post office is an independent agency of the regional government responsible for mail delivery (and sometimes telecommunications) between individuals and business in England. Post Office is the operator for the royal mail, it delivers mails and parcels for the royal mail. Purpose of Post Office: The purpose of Royal Mail is the leading postal service operator in the UK, Providing national and international distribution of mail and parcels, the Royal Mails operating unit is mainly Post Office. Furthermore the Post Office provides different types of services which are; licenses, taxes and insurance, stationary (in store). Ownership: Royal Mail/Post Office is a public sector business (the part of economy concerned with providing basic government services), the public sector deals with delivery of goods and services by and for the government whether national or regional. Size/Scale: Post Office is a very large business because, everyone uses Post Office because they have to send off their mails which is very important to them. Post Office has a network 12,500 branches, Post Office is the largest network in Europe and the largest retail branch in the United Kingdom handling more cash then any other businesses. Post Office has more than 400,000 members of staff in addition it has had a profit of 16 billion. Post Office is a nation wide business it operates in the United Kingdom. However Royal Mail delivers mail through out the world but they do not operate globally. Organization 4 Oxfam: Oxfam is a confederation , that has joined hands to help find solutions to poverty and injustice with 13 organizations working over 3,000 partners in more than 100 countries. Oxfam works to improve the lives of the poor and to influence the powerful so that their message can be spread. Purpose of Oxfam: The purpose of Oxfam’s being is so that they can help people who are in need of shelter, food and money Oxfam does by collecting donations from us which is their customers. Oxfam does not just receive donations they also have stores which sales second hand clothing for a very cheap price, the money they receive is given to people in need. Ownership: Oxfam is a Voluntary Sector business (Business that involves workers who do not work for profit and operate with a meaningful degree of volunteer involvement) because it is done for the sake of helping people, private sector is mainly done for profit and to supply goods, so therefore I think that Oxfam is a voluntary sector business because it is a business organized to help people and it is not done for profit. Size/Scale: Oxfam is a medium-large business but it is not as large as other businesses e.g. ASDA and Post Office however Oxfam is a very important business. Oxfam has more than 13 organizations working with over 3,000 partners in more than 100 countries to find lasting solutions to poverty and injustice. Oxfam is a Global organization because it has 13 stores in different places all around the world.

Impact of Affordable care act in North Carolina Essay

The Affordable Care Act (ACA) 2010 is one of the most radical healthcare moves in legislation of United States after Medicare and Medicaid. The main goals of ACA were to decrease the number of uninsured and provide cost-effective high-quality care to all in US. According to Kaiser Family Foundation, the potential plan of ACA was to expand coverage to 47 million nonelderly uninsured in the nation, which included 1.6 million uninsured North Carolinians (2014). The purpose of this paper is to review the effect of ACA on the North Carolina uninsured population, the influence of the economy of care provided care and the ethical implications. Impact of ACA on North Carolina Population North Carolina has the highest index of the uninsured population approximately 1.6 million. Being uninsured has a profound impact on the health and well-being of the people. The ACA had a significant impact on the different population categories of North Carolina. According to The Affordable Care Act 2014, Medicaid will cover most low-income people if Federal Poverty Level (FPL) is no greater than 138 percent (Milsted, 2013). The people that have more impact are the children six to eighteen, working parents, nonworking parents, and childless adult. Prior to Affordable Care Act, Medicaid was limited to a specific group of low-income individuals, such as children less than six, pregnant women, elderly and disabled. Childless adult who was homeless or unemployed did not qualify for Medicaid. The Medicaid also did not enroll undocumented immigrants and lawful immigrants that resided lesser than five years in United States (Milstead, 2013). Medicaid expansion became optional with Supreme Court rule 2012, and North Carolina chooses not to expand Medicaid and put their most vulnerable in jeopardy (Kaiser Family Foundation, 2014). Consequently, the newly eligible uninsured adults in North Carolina will remain without coverage. The reason for this was, ACA envisaged that Medicaid would expand and provide coverage for people below 138% FPL and thus did not provide Marketplace subside for these low-income people. Therefore, the people that did not qualify for Medicaid nor subsides fell into a â€Å"coverage gap† which was estimated as 318,710 or 28 percentage of all uninsured nonelderly adults (Angster & Colleluori, 2014). This brought up ethical dilemma. The people in the coverage gap are facing barriers to health services and financial consequences. The Safety net of clinics and hospitals that had been traditionally serving these populations are still stretch in the state to provide care for the uninsured. Financial Impact of ACA on North Carolina The biggest challenge that US health care is facing is the rapid escalation of health care costs. The United States spends more when compared to other developed centuries in the world. The United States spends 17.7 percent of gross domestic product (GDP) in health, and in terms of per- capita cost, US spend $ 8,247 in 2010 (Silberman, 2013). The ACA has put forward many provisions to reduce the health care cost. Some have immediate results, and some may take time to bend the cost curve. The Patient-Centered Medical Home (PCMH) is a model of care that aims to deliver comprehensive care which includes preventive, acute and chronic care to children, adolescents, and adult (Kovner & Knickman, 2011). North Carolina was the first state to get a demonstration grant for the Medicaid and Medicare innovation, and this was used for test PCMH model in seven rural counties. Bundle payments, Accountable Care Organization (ACO), Medicare diagnosis-related group (DRG), and Value-Based Purchasing (VB P) program are all aimed at reducing healthcare spending in the long term by the ACA. (Silberman, 2013). The Federal government will be paying the state â€Å" most of the costs for covering the new eligible: 100 % of the Medicaid costs for newly eligible clients for the first three fiscal years 2014 to 2016, and declining to 90% in 2020† (North Carolina Institute of Medicine, 2014, p. 2). The Affordable Care act also funded North Carolina for Prevention and Public heath Trust  for promoting prevention, wellness, and public health, â€Å"ACA granted $750 million in FY 2011 increasing to dollar two billion in FY 2015 and each year thereafter† (Silberman, 2013, p 28). According to Middle Class Tax Relief and Job creation Act 2012, â€Å"the cut $6.25 billion over 9 years†, the fund instead of reach dollar two billion in 2015, it will reach it only in 2022 and the funds will remain at one billion until 2018 (Silberman, 2013, p 28). Effect of ACA on Cost, Quality, and Access to Treatment According to the North Carolina Institute of Medicine(NCIOM), the Health Benefit Exchange (HBE) created by States or federal government provides standardized information on quality, cost, and network providers, which helps people and small business to select the health plan of choice (2013). Since North Carolina did not meet the deadlines for HBE for 2014, the state created partnership arrangement with North Carolina Department of Insurance for consumer assistance and plan management (Silberman, 2013). The ACA provides cost effective and high quality health coverage through the Health Insurance Market (exchanges). There are different health plans and eligibility factors; to determine what savings and benefits the people can quality. The ACA provides people with income 100% and 400% of FPL to be eligible for the premium tax credits for purchasing marketplace insurance (Kaiser Family Foundation, 2014). The tax credits are based on income, cost of insurance and are only for people that are not eligible for other coverages. People with income greater than 400% FPL can purchase unsubsidized insurance from marketplace (Kaiser Family Foundation 2014). Agency for Health Research and Quality ranked North Carolina performance score for overall health care quality as â€Å"average† when compared to other states. (Silberman, 2013). To improve the quality of care ACA helped the state to accelerate their effort. ACA recommended the secretary of US Department of Health and Human service to define â€Å"quality†, and healthcare institution should give a report on quality care measures adopted by them. To improve quality ACA also changed the reimbursement policies. The way health care providers were paid was based on quality and outcome of care provided. Increasing incentives and rewards was also emphasized by ACA to  improve the quality of care in North Carolina (Silberman, 2013). PCMH model funded through ACA will improve the quality, effectiveness and efficiency of care delivered, which meets patients unique need and preferences. (Kovner & Knickman, 2011). Ethical Implication of ACA on the Organization and the Patient Health care reforms bring controversial ethical issues to the population as well as to the legislators. There is a critical need for reforms in healthcare to reshape the healthcare delivery system in United States. However, it is always challenging to meet all demands of the people. According to Sorrell (2011), there are be four essential goals that shaped our health care system. First, there is always a want for high-quality care with great benefits. Second, the peoples needed the freedom of choice of â€Å"who, when, and where† for their health (Sorrell, 2011, para.4). Third, the health care should be affordable and fourth the people wanted fellow citizen to share the benefits of the health care (Sorrell, 2011). When people are not treated with equal moral concerns, social injustice occurs. As in North Carolina, it is unfair that the populations that are in the â€Å"coverage gap† who are the poorest of the poor are denied of health care. Here, if North Carolina has opt-in to expand Medicaid, which would have extended coverage to an estimated 1.6 million uninsured people in the state (Kaiser Family Foundation, 2014). According to American College of Physicians (ACP), being uninsured poses a hazard to once health, chronic disease, and morbidity and mortality is high in the uninsured group (2014). Lack of health insurance also effects the people and the community financially, 60 percent of all bankruptcies are related to cost of medical care expenses due lack of insurance (ACP, 2014) Summary Expanding of Medicaid is the North Carolina is one of the solutions to decrease the uninsured population. The Affordable Care Act gives funding to states that opt-in; it would improve not only the health care system but also the economy of the state as a whole in the future. Ethically it is not fair to deny treatment to any patient. With the new health care reform and newer evidence-based researches we can develop better Healthcare Models to  contain this rising cost and provide universal health care to all. Affordable Care Act has to work against the obstacles, and it is still unfolding (ACP, 2014). It will take time, â€Å" to know the real impacts of Affordable Care Act reform experiment is a success, a failure or a little of both† (ACP, 2014, p.305). But once thing for sure, Affordable Care Act have decreased the number of uninsured in United States. References American College of Physicians (2014). How North Carolinians can access affordable, comprehensive health insurance. Retrieved from http://www.acponline.org/advocacy/state_health_policy/aca_enrollment/states/nc.htm Angster,D., & Colleluori, S ( 2014, April1). Study: Top NC newspapers Miss Coverage Gap in reporting on Medicaid expansion. Media Matters for America. Retrieved from http://mediamatters.org/research/2014/04/01/study-top-nc-newspapers-misses-coverage-gap-in/198701 Kaiser Family Foundation. (2014, April 7). How will the uninsured fare under the affordable care act. Retrieved from http://kff.org/health-reform/fact-sheet/how-will-the-uninsured-fare-under-the-affordable Kaiser Family Foundation. (2014, January 6). How will the uninsured in North Carolina fare under the affordable care act. Retrieved from http://kff.org/health-reform/fact-sheet/state-profiles-uninsured-under-aca-north-carolina/-care-act Kovner, A. R., & Knickman, J. R. (Eds.). (2011). Health care delivery in the United States (Laureate Education, Inc., custom ed.). New York, NY: Springer Publishing. Milstead, J. A. (2013). Health policy and politics: A nurse’s guide (Laureate Education, Inc., custom ed.). Sudbury, MA: Jones and Bartlett Publishers. North Carolina Institute of Medicine. (2014). Examining the impact of the patient protection and affordable care act in north Carolina. Retrieved from http://www.nciom.org/wp-content/uploads/2013/01/Medicaid-summary-FINAL.pdf Silberman, P ( 2013, January 25). The ACA: an essential first step towards improved population health. Retrieved from http://publichealth.nc.gov/shd/presentations/2013/AffordableCareAct-2013SHDConf-Silberman-012513.pdf Silberman, P. (2013, August 1). Implementing the affordable Care Act in North Carolina: The rubber hits the road. North Carolina Medical Journal. 74(4), 298 -307. Retrieved from http://www.ncmedicaljournal.com/wp-content/uploads/2013/07/74403.pdf