Reflective Essay on Learning Disabilities †Psychological Well-being The WritePass Journal

Reflective Essay on Learning Disabilities – Psychological Well-being Background Reflective Essay on Learning Disabilities – Psychological Well-being ) emphasised that it is important to do mental notes when doing an assessment since this would provide some clue as to how the person is feeling. Hence, one must look at the appearance, behaviour, speech, emotional state, and thinking of the person being assessed. However, looking into these areas is not enough since misinterpretation or erroneous assumptions may take place. Rather, it is necessary to take into account the context, setting, social norms, and beliefs for the individual being assessed (Pender, Murdaugh, and Parsons 2006). Needs-led assessment will allow the nurse to place more emphasis on finding solutions (Coffey and Hannigan 2003). 2. Risk Assessment A significant role is played by risk assessment and management in the practice of mental health nurses and multi-disciplinary teams. These risks include threat/danger to others as well as self-harm, amongst others. Despite the presence of risks however, a balance must be considered between the needs of each individual service user (client) and people’s safety and protection. A further emphasis is placed on paucity of information and lack of knowledge about such risks, thereby leading to ‘clinical gambling’ that can further result in mishaps (Cordall 2009). It is necessary to provide focus on improved consistency in applying risk assessment and management strategies, considering their central role in the practice of mental health. Admittedly, risk assessment and management went through certain developments, including the area/s to be understood about risk assessment; its clarity and what must be assessed; strategy developments in nursing risk; proposals; and leaned enquiry-based lessons. Hence, risk language must be standardised and simplified, which requires improving clarity in the vital roles of the concept (Cordall 2009). When one speaks of risk assessment in mental health services, he/she deals with the broader possibility (risk) of an event or behaviour (outcome). The outcome is the principal area of interest since it is commonly connected to an extent of severity, which could be associated with the indications of dangerousness/illness. Important regard is given to the impact of such severity because both a high outcome risk with low impact and a low outcome risk with high impact can take place (Kettles and Woods 2009). A useful way to consider the manner through which events take place is much the same as researchers’ predictive ability to test a number of risk assessments, which is also a useful way to evaluate the success of outcomes. Contingency tables allow an examination of correct predictions and error rates, and are hence an excellent means to present these results. On the other hand, the severity of behaviour refers to the level of intensity of risk occurring, and may be classified as mild, moderate, or severe (Kettles and Woods 2009). Clinical practice in a range of settings involves the core feature of violence risk assessment. The focus on risk to others in the mental nursing health practice is that ignoring or failing to acknowledge it can leave medical personnel unprepared and a lack of preparation results in situations where less willingness to work with aggressive and violent patients might be felt by clinical staff. Moreover, as there is a widely-held awareness of the relatio nship between mental illness and violence, an increasing basis of risk assessments will be taking place in clinical, correctional, and legal settings (Woods, 2009). On the other hand, risk to self, which may include suicidal behaviour, physical and social self-neglect, and vulnerability to risk from others, must also be considered. Worthy of note here are the biologic theories of suicide, which look into the link between physical illness, increased risk, and neuro-biological factors of suicide (Murray and Upshall 2009). 3.Case Study The Purpose of Assessment and its Potential Impact for Promoting Inclusion The person who is the focus of this case study is an epileptic patient named Janet. She is 48 years old, very fragile (small and short), and is within the care facility because her medication was not acting on her. She was admitted for her best interest. Janet was admitted to the mental health hospital due to her episodes of self-harming, which is a risk to herself and to other service users (other patients).   Janet is on different psychotic tablets and mood stabilizers; she is unable to sleep despite having been prescribed with sleeping tablets. Her behaviour is very challenging: she bites, screams all day, and is out of control. She came to the hospital to be observed and to allow personnel to research on a suitable drug that could work for her. She came to the ward setting via a referral from both her General Practitioner (GP) and her Psychiatric consultant. In the ward, she was placed on a close observation at Level 3. She was also assessed by the speech and language therapist as well as the behavioural therapist because of her difficulty to swallow. Her mental health is very unstable and she is unable to communicate verbally. However, she uses and understands gestures. She only makes sounds, noises, and screams as a way to co mmunicate. She likes pulling and grabbing, and loves her meal, especially her cups of tea. Janet came from a low-income British family, never married, and never had children due to her apparent condition. She is second amongst four children and still has both of her parents. The above narrative shows an investigation of a patient with a mental and learning disability problem, who was admitted to a mental health setting expecting treatment. It is apparent that an assessment was done on the patient before any clinical personnel would have carried out a specific intervention procedure. The above has not only related the nature of the patient’s illness but also presented other information that may be gathered in order to conduct an accurate assessment that will aid a precise diagnosis. The diagnosis of learning disabilities/mental disorders requires assessment as the initial step, which was evidently carried out on Janet. Mental health assessment is conducted visvis a full clinical assessment, which is a systematic evaluation of the psychological, biological, and social factor of a person who is presented with a potential psychological disorder. Assessment begins with a process wherein a curative alliance occurs between the client and the mental health personnel, thereby forming the basis of a care plan. Empathy and compassion are necessarily involved in the process in order to support the development of trust between the client and the mental health personnel forming an alliance (Elder et al. 2013; Kettles and Collins 2002). The clinical personnel in charge of Janet were empathetic and compassionate of her condition. The health personnel took extra care to understand the client in crisis, taking into account her associated fear and distress level, especially if he r prior service experience had been difficult and/or if she underwent compulsory treatment. The mental health nurse took the major role in the performance of an accurate and ongoing assessment on Janet. Assessment may be generally described as a complicated process since the diagnosis it performs ascertains the treatment for the client. The client’s needs and strengths are gauged by thorough assessment. It must be noted that assessment seldom includes one function; patients might be assessed to determine who they are, to describe and appraise particular problems of living as well as personal and social resources. All of these are embodied in a global assessment. Through assessment, the mental health nurse was able to obtain some understanding of the significance of Janet’s condition and problems (Elder et al. 2013; Morrison-Valfre 2013). The mental health nurse engaged in Janet’s condition acknowledged the different systems and levels of care for the person-in-care and ensured that she received treatment with dignity and respect so as to enable her to go back eventually to the highest possible level of self-care (Griffin, 2012). All patients must be treated with dignity and respect, giving careful considerations to the manner of communication with them (Hindle, Coates, and Kingston 2011). Thus, being aware of Janet’s systems and levels of care visvis her condition allowed the mental health nurse and care specialists to determine her treatment and receive it with respect and dignity. Types of assessment may be classified as global, focused, and ongoing.   Global assessment enables the provision of baseline data, such as the client’s health history and current needs assessment. Focused assessment, on the other hand, has a limited scope in its aim to focus on a specific need or potential risk.   Ongoing assessment pertains to systematic monitoring and observation related to certain problems (Elder et al. 2013).   The case study adopts a global assessment. Prior to assessing the service user being referred to in crisis, it is necessary to find out if she experienced mental health services and consulted their crisis plan. It is also important to enquire of her preference for a male or female care professional to carry out the assessment. In this case, Janet’s family specified female care professionals. Moreover, crisis assessment needs to clarify the information and its potential outcomes, addressing the client’s individual needs. Assessment for mental health must involve the client’s relationships, social and economic circumstances, behaviour, symptoms, diagnosis, and current treatment (NHS 2011). It is evident that amongst these concerns, the assessment made on Janet was focused most on her behaviour, symptoms, diagnosis, and current treatment. Her family history, social and economic circumstances, and the like, were also mentioned in the assessment. It must be recognised that assessments and diagnoses performed must be evidence-based and need the use of accepted methods. Assessments are carried out by suitably qualified staff with training and experience to assess mental health problems, and where possible, in the client’s preferred setting, with respect to the safety of all concerned. Collecting information about the person can be performed by the person himself/herself, or by other people who have prior observation of the person’s behaviour, such as family or carers. In this regard, it was the latter which was applied to Janet due also to her inability to communicate effectively. What the mental health nurse needs to know about the patient determines how he/she gathers the information. Knowing about what the person feels or thinks necessitates asking him directly in order to gather the needed information. Hence, the mental health personnel oftentimes asked Janet about what she thought or felt about certain things , people, or food. If the mental health nurse needed to know the manner in which Janet might behave in certain circumstances, Janet must be asked to reflect on her behaviour, or someone may be asked to observe Janet’s behaviour, or both. Further, it is essential to understand the lived experiences of both Janet and her carers in the assessment. Necessary information for understanding such lived experience involves Janet’s or the carer’s manner of interpreting what is taking place with Janet besides knowledge about her life, including her interests, personality characteristics, social resources, and personal circumstances. Janet’s family was involved in the treatment in the earliest possible way because of their in-depth information about how the symptoms of mental illness have developed, including their knowledge of the social and emotional environments contributing to the flourishing of such symptoms in Janet. Interviews, diaries/personal records, questi onnaires, and direct observations are the major assessment methods that can be performed to obtain the needed information for the assessment (Wilkinson and Treas 2011).   In Janet’s assessment, relevant information was collected through interviews, direct observations, and a referral from her GP and her psychiatric consultant. Interviews were performed with her family members and carers who observed her behaviour.   Models of Assessment and How They Impact on Inclusive, Responsive and Responsible Practice The new model of care is exemplified by new care practices whereby best practices as advanced by research evidence present the new model of care (Kleinpell 2013).   According to Freeman (2005), a biopsychosocial assessment of the patient is considered in an effective intervention, with a recommendation of a multi-method and multi-modal format. Moreover, these domains of information are used for assessment: biological, affective, behavioural, and cognitive domains, alongside the units of assessment, including the patient, his family, the health care process, and the socio-cultural setting in which the patient exists. The mental health personnel must understand the current status and history of the patient, and the assessment must identify problem areas and consider the patient’s assets and resources. This model can be employed in contemplating the patient’s change of behaviour to improve his quality of life, prevent illness, and promote well-being (Freeman 2005). The biopsychosocial assessment model also investigates the interrelatedness amongst the physical, psychological, behavioural, environmental, and social aspects of an individual’s life. The biological system focuses on the anatomical state of disease and its effect on the individual’s biological functioning. On the other hand, the effects of psychological factors, including personality and motivation, are emphasised in psychological system as the individual experiences mental illness. Further, the social system looks at the familial and cultural effects of the experience of illness. The causal ordering of biopsychosocial model is intrinsically biomedical, which means that rather than the causes, biochemical abnormalities can affect a person’s social environment. One criticism of this model is that it tends to rule out structural and social factors, but can however be considered as a useful framework for understanding the experience of mental illness (Freeman 2005) . The psychosocial model, on the other hand, is considered a holistic perspective to mental disorders and presents the interdependent areas of biological, psychological, and social factors in the assessment of mental health disorders (Boyd 2008). It is significant to note that standardised assessment methods promote inclusion in the mental health. The strategy of the European Union (EU) for mental health identifies best practice in the domain and in fostering social inclusion. A holistic approach is required in any effort to recognise best practice in social inclusion rather than to simply emphasise on aspects relating to mental health. Social exclusion cannot be addressed by just looking at the mental health problem of a person since one of the fundamental reasons for social exclusion of people with mental health illnesses is the propensity to take an exclusive emphasis on their medical symptoms rather than resolving the fundamental causes of their problems. Issues needing attention are equality and diversity, access to physical and mental health care and social networks, to name a few (House of Lords, 2007). The relevance of action to promote and improve social inclusion is embodied in mental health policy and is safeguarde d in the National Service Framework, which affirms that discrimination against people with mental health problems must be resisted and their social inclusion must be fostered. This signifies that mental health workers must regard the promotion of social inclusion a primary concern. The Effectiveness of Formal and Informal Assessments as Mechanisms to Develop a Shared Understanding of Need Either a formal or informal assessment may be carried out by the mental health nurse. A formal assessment involves an ordered interview plan and tools including questionnaires, checklists, etc. to acquire important information to aid the assessment interview. On the other hand, an informal assessment is less structured and the questions raised are those that the interviewer views to be relevant at the time he/she asks them. The formal interview has more benefits than the informal one since it is able to carry out a more or less similar assessment of people through the tools and structured interview plan thus devised. In addition, the individual’s biases and value judgments are less expected to influence the interview, as can take place in an informal assessment. The decision to use either formal or informal assessment methods is ascertained by the person in care as well as the adopted standardised assessment procedures (Pryjmachuk 2011). A formal assessment is emphasised on some form of structure and is commonly planned and studied with care, i.e. through some research. An informal assessment, on the other hand, involves information gathered through less structured methods.   Despite the almost similarity in the appearance of both methods, such similarity is however superficial. In both cases, the care personnel (e.g. nurse) would ask the person-in-care certain questions relating to his condition, noting his replies. However, a formal interview will have the questions carefully prepared earlier and might even be worded in a certain way, whilst the informal interview lacks this feature. Instead, the nurse conducting an informal assessment would ask certain questions she thinks relevant at that time, phrasing them in such manner she considers appropriate. Albeit both kinds of assessment are commonly used in mental health settings, it is important to recognise the significant advantages of any formal system over the l ess structured ways of investigating the condition of persons-in-care. The guidelines and procedures embodied in a formal system allow various people-in-care to be examined in a relatively the same fashion. This results in reduction, if not total cancellation, of one’s own prejudices. Regardless of who completes the assessment, its outcome must be the same, and such cannot be said of informal methods (Barker 2004).   The first point of information must be the patient’s basic demographics and condition/illness. An evaluation of physiological symptoms, history, risk factors, and treatment procedures must be considered visvis biological targets. His current moods, feelings about the illness/mental problem, support network, amongst others, constitute the patient’s affective targets. Crucial to his comprehensive evaluation is an assessment of his behavioral targets, which include self-care, functional capabilities, and occupational/recreational abilities (Freeman 2 005). All of these must be embodied in the assessment made on Janet. Critical Application of Legal, Ethical and Socio-Political Factors to the Practice of Assessment The use of assessment and clinical procedures involve some ethical issues. Ethical dilemmas may occur when diagnosis is performed in such situations, whereby diagnosing a person arbitrarily is often entailed. However, health care personnel have the clinical, ethical, and legal obligation to screen patients for life-threatening problems such as bipolar disorder, suicidal depression, and the like. It is necessary to point out that exclusive reliance on standardised treatments for certain problems may invite ethical concerns because of the questionable nature of the reliability and validity of these empirically-based strategies. Along with this is the fact that human change is complex and that measuring beyond a simplistic level is a difficult task, thereby making the change meaningless (Corey 2013). Thorough reflections on ethical considerations relative to health technologies are involved in the assessment for health technologies and value-based decisions. Since methods of retrieving information for effectiveness assessment are not appropriate to retrieving information on ethical issues, it is important to adopt a specific methodological approach (Scholarly Editions 2012). In addition, ethical principles such as autonomy, fidelity, and justice, amongst others, are involved in the provision of mental nursing care. National professional organisations set the standards for professional nurses’ ethical behaviours (Boyd 2008). Likewise, the healthcare organisation must ascertain its training needs and design structures to enable its healthcare personnel to understand ethical values and principles and hence integrate them into daily practice. With the provision of training, ethical values might not be recognised by several staff personnel whenever they occur, and thus they might impair their ability to recognise a suitable course of action. A formal assessment process is viable in enhancing an ethical framework within the healthcare organisation (Corey 2013). A point to consider is that the mental health care system faces certain magnified legal issues. The legal aspects of the assessment process in the practice of assessment involve such example where the nurse is held responsible for her judgments as well as the safety and well-being of the person-in-care. Every nurse must be aware of the three legal concepts that might affect their practice of care: negligence, malpractice, and liability (Davies and Janosik, 1991). Negligence occurs when a person (e.g. nurse) has become careless or has failed to act prudently, or has acted in such a way that is contrary to the conduct of a reasonable person. Malpractice takes place when a person commits professional misconduct, or has discharged his professional duties improperly, or fails to meet the standard of care as a professional, thereby resulting in harm to another. Liability, on the other hand, occurs as an obligation for having failed to act on something (Davies and Janosik, 1991). Mental health care is also influenced by sociopolitical factors, whereby the power of social justice is emphasised in the rectification of socio-cultural insensitivities (James and O’Donohue 2009). Mental health issues necessitate increased understanding of the sociopolitical context. This would include increased emigration in various parts of the world, which presents greater attention to the manner in which mental health issues may be effectively addressed within a broader global context. Studies involving culturally diverse samples would enable researchers to assess the generalisability of the diagnostic classification of mental problems across cultures and would likewise determine culturally specific events that might be influential to prevalence rates. Not being able to recognise the significant cultural differences amongst peoples impliedly promotes the ‘one-size-fits-all’ approach that is often criticised in the current diagnostic system for mental problems .   It has been emphasised that cultural and sociopolitical factors could indeed influence the assessment of certain mental illnesses, thereby enabling mental clinicians to consider cultural issues as necessary aspects of the assessment and diagnostic process (Chang 2012). Culturally able mental health care involves suitable treatments that take into account the client’s culture and social setting. The literature indicates that the primary objectives of mental health are to return to function, contribute to society, and maintain relationships (Markowitz and Weissman 2012). 4. Application to Practice How the Role and Function of the Nursing Profession Relates to the Theory and Practice of Assessment All mental health practitioners are responsible for developing certain strategies that allow people to maintain and build relationships, social roles, activities, etc. that are vital to social inclusion (Harrison, Howard and Mitchell 2004). The provision of high-quality mental health disqualifies biases and instead understands these biases at a range of levels, such as practitioner level, community level, and practice programme (Shieves 2008). It is recognised in this work that such biases can lead to social exclusion in the domain, which is not desired. Pondering on the provision of mental health care would necessitate its interpretation by psychodynamic theories, which looks at interpersonal concepts and examines the development of the mind within a lifetime (Dillion 2007). Behavioural theories provide emphasis on normal behaviour rather than the causes of mental problems/disorders. The objective is to effect behavioural change by means of conditioning, positive reinforcement, and so on (Dillion 2007). Meanwhile, cognitive theories involve understanding by focusing on behaviour and the individual’s cognition, including the way he processes his thoughts. The value of cognitive theory is seen in patient-therapist collaboration and the client’s active involvement in the occurrence of change (Dillion 2007). This is contrary to the situation where the client has learning disability and hence would find it difficult to pursue all these. Social Theories, on the other hand, involve socio-cultural perspectives and family dynamics, to name two, and convey that the development of a care plan for the patient necessitates certain socio-cultural aspects (Dillion 2007). This is suggestive of an inclusive care plan (Harrison et al., 2004). The importance of these theories to practice is that learning disabilities and mental problems as well as their causes can be more increasingly understood through their aid, thereby providing treatment to the patient with a consideration of their behaviour, cognition, socio-cultural context, and so on.   These theories also aid in pursuing further the concept of inclusion in health care and in understanding further the relevance of the assessment process. Through theories that aid practice, mental illness can be more accurately understood using integrative approaches. The conceptual framework of psychiatric domain involves various theoretical perspectives, with the absence of a single best explanatory model explaining mental illness. As this conceptual framework takes its development towards an increasingly integrative viewpoint, more effective and efficient integrative assessments will be the result of an understanding of complex relationships amongst various processes associated with normal human functioning and mental illness (Lake 2007). The Effectiveness and Efficiency of Assessment Strategies within the Current Practice and Overall Service The extent of effectiveness and efficiency of assessment within the current practice of the mental health nurse are seen in the impact of assessment as a life-changing experience for many persons-in-care. The rapport that the mental health nurse is able to establish with the client with a learning disability/mental problem as a result of the ‘therapeutic alliance’ provides the client a holistic approach to care. It confirms the need for a multi-disciplinary and team approach to the mental health service provision. Through an assessment, the mental health nurse becomes aware of the need for a supportive environment whilst collecting necessary data. The assessment also enables the mental health nurse to liaise with appropriate professionals, such as in Jane’s case where her GP and psychiatric consultant submitted a referral to the mental health hospital in order to aid in her diagnosis. Various tools, such as Life Skills Questionnaire, are used to gather additional information, which assist in developing a relationship with the service user (Acquah 2012).   The mental health nurse pays attention to the person’s feelings, thoughts, and behaviour, which are ways in which humans respond to life problems. If a person experiences increased detachment from one’s surroundings and the people in it, alongside the presence of distorted thought processes, the person can thus become problematic with satisfying to live a meaningful existence. The role of the nurse in this context is to identify how those behavioural changes hold back the person’s ability to pursue his own life and then design a specific care that will aid the person to address them. The utmost goal is certainly to help the person return to his usual normal activities and contribute to society. Through the nurse’s task to identify the effects of behavioural changes on the individual and to carry out a specific plan of care, the nurse thus considers the conseque nces of the learning difficulty/problem the basis of intervention. Further consideration of the client’s needs and interests is the principal value embodied in the establishment and execution of nursing services. This value must be implied in a nursing approach for the care of patients having been diagnosed for learning disability/mental illness. Along with this claim, the notion of a disease in the mental care must be given up as the center of mental health care and instead look at the patient as a person (Barker, 2004). In general, information about the nature and the extent of the patient’s problems are considered in a nursing assessment; hence, the nurse finds out the problem of the patient and how big it is. These questions must be asked in the most detailed manner possible, especially if the focus is to evaluate the impact of various forms of care. However, the means through which such information is gathered usually depends on the problem involved, in which even the personality of the person-in-care can even influence such means of information collection. The things that the nurse must consider are accurate information about the biophysical needs of the person needing mental care; the reflection of the need for precision and reliability for the adopted method; and the influence of the attitude or mood of the person conducting the assessment (Barker 2004). There are similar aims for most assessments; however, the manner in which they are carried out can vary greatly. These differences are very important and can have enormous influences on the value of information being produced. The means through which an assessment is conducted can spell a worthwhile exercise or otherwise.   The key differences between methods of assessment convey the way in which information is gathered (Barker 2004). Upon the assessment process, the nurse explains to the person-in-care such process and its contents, providing feedback for his collaboration with clients and healthcare team members to collect holistic assessments. Such assessments are conducted through interviews, observations, and examinations whilst being aware of confidential issues and relevant legal policies (Videbeck 2011). Additionally, policies and legal issues must be integrated in relation to ensuring the protection of other persons-in-care. Improvements in secondary care teams (e.g. mental health, learning disability, etc.) are necessary to ensure a consistent approach to care (Woods and Kettles 2009). The Nurse’s Role in the Assessment Process It must be noted that the mental health nurse takes the role of a coordinator as he/she interacts with other disciplines in the care delivery. A patient always receives a nursing care plan, but other disciplines are necessarily involved in such plan or individualised treatment plan (Boyd 2008). Further, the mental health nurse plays an important role in the assessment process where data are collected and organised, leading to the identification of diagnoses in which data are as well analysed. This would then lead to the planning phase, whereby prioritisation of problems is highlighted, along with identification of goals, selection of nursing intervention, and care plan documentation. The implementation features the nursing orders being carried out whilst documenting the nursing care and client responses. This leads to the evaluation phase, which involves monitoring the client outcomes and resolving, maintaining, and/or revising the current care plan (Timby 2009). Indeed, the mental h ealth nurse demonstrates a range of roles in the entire nursing process, as much as in the assessment practice. His/her performance in the assessment process determines the delivery of the next stage of the nursing process; hence it is required that such assessment is both precise and correct. For the nurse’s own future learning and development, there are perceived tremendous developments in his role, which are expected to take place within the managed care environment vis-a-vis his professional knowledge, skills, and attitude. Those who have carried out strong assessment and patient teaching abilities would be considered to have the most marketability. The nurse’s role in mental health assessment has radically evolved from merely using the client’s five senses to assessing his overall condition. Today, nurses use communication and physical assessment methods to come up with a clinical judgment relating to the client’s mental state. Additionally, technological advancements have developed the role of assessment, which correspondingly allowed managed care to develop the need for assessment skills (Weber and Kelley 2009). For example, the most broadly functioning measures used for people with learning disability/ mental problems are the Global Asse ssment Scale (GAS) and the Global Assessment of Functioning Scale (GAF), which is a modification of the GAS. The GAS is aimed for clinicians to decide on mental health along a single dimension on a scale of 100 points. The lowest functioning level of the individual during the previous week is the basis of GAS ratings (Thornicroft and Tansella, 2010). Furthermore, assessment helps the mental health nurse to decide the extent that the patient can do independently alongside the extent of help they need and the type of intervention necessary. A patient with a mental health problem for example, may need more encouragement for their hygiene needs, which means that their therapeutic care plan may include this aspect (Spouse, Cook and Cox 2008). This can be further considered in Jane’s case. Reflecting on Policy on Mental Health Capacity Implementation of mental health policy is an intricate process, including a number of different financial, technical, and political issues.   Teaching programmes for mental health policy usually intend to develop the knowledge of the public on health professionals and other people playing a significant role in the development of mental health policy.   Some programmes are specifically focused on issues of policy and service development; in particular, tackling the needs of those who are directly involved in the accomplishment of mental health policy, as well as in the development of research capacity (Patel, Minas, Cohen et al. 2013). Recommendations Recommendations for the nurse’s speciality include the following: Provide specialist skills and special therapeutic orientation to mental health nurses. This will train them to deliver research-based care and treatment to service users with learning disability/mental problems. Identify the need for the mental health nurse to develop skills in psychotherapy, which is resonant to interpersonal relations perspective to mental health nursing. This will highlight the nurse’s central role in mental health, which is his personal relationship with the patient (Norman and Ryrie 2013). Develop electronic health record systems for assessment. This will prepare professionals of health information management assess their situation in a more realistic manner. These record systems are necessary because of their use in storing patient data over time, such as test result data, diagnoses, problem lists, and so on. The client’s clinical information is necessarily retrieved by practitioners through their work station. Standard coding systems defining data consistently are suggested, specifying the capacity to pursue the outcomes of the health care process (Harman, 2001). How the Nurse Can Contribute to Best Practice and Actively Justify and Promote Quality Care The nurse can contribute to best practice by establishing an active participation in the mental health process via the integration of appropriate technology that can speed up the assessment process. Through evidence-based and person-centred intervention, the nurse will be able to help tackle several mental health needs, which can benefit clients like Jane. Evidence-based practice is now a current adoption in mental health care, which involves selecting the best interventions with a specific client and promoting specific interventions for definite problems/illness based on treatments that are supported empirically. Such evidence-based practice includes a consideration of the patient’s characteristics, preferences, and culture (Corey 2013), which the mental health nurse must take account of. These aspects had been mentioned in Jane’s case but needed further highlights to become more viable to the assessment process. The concept of social inclusion in mental health presents best practice to the mental health nurse, who has the primary role in conducting an inclusive assessment process. With the promotion of social inclusion, the mental health nurse becomes culturally competent in providing a service that harmonises with the client’s cultural and social background and value system. This is an area of best practice for the mental health nurse’s task in the assessment process. Further, looking at the cultural and social context of the patient needing care rather than merely focusing on his demographics as well as the historical development of the mental illness provide evidence-based considerations for future practice. Racial and ethnic differences in mental health care had been documented to demonstrate this point. Such factors as gaps in access, disputed diagnostic procedures, and limited specifications of competent treatments are reflective of what needs to be further emphasised in mental health care. In conclusion, the assessment process within the mental health care for patients with learning disabilities and mental problems needs procedures and strategies that are aligned to social inclusion and considers ethical, social, and political aspects of the process. Hence, a specialist assessment may be carried out in order to evaluate the patient’s strengths and difficulties alongside their current distress and potential replicable support. References Acquah, F. (2012) Utilising Untouched Mental Health Nursing Skills in Private Practice. Australian College of Mental Health Nurses: Mental Health Nursing in Primary Care: Putting the Pieces Together. Canberra. Barker, P. J. (2004) Assessment in Psychiatric and Mental Health Nursing: In Search of the Whole Person. Second Edition. 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(2013) Foundations of Mental Health Care. Fifth Edition. London: Mosby, Inc. Murray, B. L. and Upshall, E. (2009) ‘Risk to Self’. In Risk Assessment and Management in Mental Health Nursing. ed. by Woods, P. And Kettles, A. M. West Sussex: Blackwell Publishing Ltd. [NHS] National Health Service (2011) Service User Experience in Adult Mental Health: Improving the Experience of Care for People Using Adult NHS Mental Health Services. Retrieved on November 7, 2013 from nice.org.uk/nicemedia/live/13629/57534/57534.pdf Norman, I. J. and Ryrie, I. (2013) The Art and Science of Mental Health Nursing: Principles and Practice. England: Open University Press. Patel, V., Minas, H., Cohen, A., and Prince, M. J. (2013) Global Mental Health: Principles and Practice. New York: Oxford University Press. Pender, N. J., Murdaugh, C. L., and Parsons, M. A. (2006) Health Promotion in Nursing Practice. PA: Lippincott Williams Wilkins. Pryjmachuk, S. (2011) Mental Health Nursing: An Evidence Based Introduction. First Edition. London: SAGE Publications Ltd. Scholarly Editions (2012) Issues in Healthcare Technology and Design. Atlanta, Georgia: Scholarly Editions. Shieves, R. (2008) Basic Concepts of Psychiatric-Mental Health Nursing. Seventh Edition. PA: Lippincott Williams Wilkins. Spouse, J., Cook, M. J., and Cox, C. (2008) Common Foundation Studies in Nursing. Fourth Edition. London: Churchill Livingstone. Thornicroft, G.   and Tansella, M. (2010) Mental Health Outcome Measures. Third Edition. London: The Royal College of Psychiatrists. Timby, B. K. (2009) Fundamental Nursing Skills and Concepts. Ninth Edition. London: Lippincott Williams Wilkins. Videbeck, S. L. (2011) Psychiatric-Mental Health Nursing. London: Lippincott Williams Wilkins. Weber, J. and Kelley, J. (2009) Health Assessment in Nursing. London: Lippincott Williams Wilkins. Wilkinson, J. M. and Treas, L. S. (2011) Fundamentals of Nursing – Volume 1: Theory, Concepts, and Applications. US: F. A. Davis Company. Woods, P. (2009) ‘Risk to Others’. In Risk Assessment and Management in Mental Health Nursing. ed. by Woods, P. And Kettles, A. M. West Sussex: Blackwell Publishing Ltd. Woods, P.   and Kettles, A. M. (2009) Risk Assessment and Management in Mental Health Nursing. London: Blackwell Publishing Ltd.

Globalisation and Small Medium Enterprises Essay

Globalisation and Small Medium Enterprises - Essay Example executives are required to make frequent visits to foreign markets to meet foreign distributors and to participate in trade missions and trade shows. Global strategic planning is increasingly becoming essential for SMEs. Introduction Globalization as a business concept came to the forefront some twenty years ago. There is much more to globalization than just business conducted through export-import activities and foreign direct investments (FDI). Globalization of enterprises means the set of operations or coordinated actions, which an enterprise may take to make its presence felt in other markets or to benefit from resources originating from other markets. And for the SMEs, with their limited resources, it is one of the toughest choices to make because of the numerous risks inherent in it. A number of SMEs, which are quite prosperous locally, fail to rise in foreign markets.Emerging SMEs in the new economic order in most of the growing market economies as well as in countries in transition are constantly in pressure to cope with the challenges of the opening market economies, especially in wake of the enlargement of the EU. For instance, Austria's inclusion into the EU brought fresh opportunities for the Austrian SMEs, however it brought considerable threats as well, for they come into confrontation with a more complex and dynamic environment. This demands an adapted system of planning and control-tool to secure and strengthen their competencies on part of the marketing-management in SMEs. In recent years, a slew of international strategies for the SME have been analyzed and forwarded by OECD countries, however, there exist a considerable variance regarding the importance and the utilization. Yet, an area, which deserves a fair...They are worried, that there will be an effect of exclusion of SMEs, which will be pushed to the margin of this process to the advantage of better financed and more internationalized giant corporation. In some cases this risk may be a real one." "the majority of our sample enterprises have experienced an evolution in line with the Internationalization Stages Theory, they equally use many other types of inter-enterprise accords (strategic alliances).These more flexible methods insert themselves between the more "popular strategies" within the Internationalization Stages theory (see figure 2). It is plausible to believe that the utilization of accords, as well as alleviating the problem of constraints on resources, which is a frequent problem among SMEs, opens the path towards the adoption of more important strategies as the enterprises commits itself more and more in the foreign market."5 "Often their (that means Entrepreneurs) first attempt at moving outside their local market is to Europeanise their activities. At a European level we are trying to make it easier for them to make that leap forward. It began with the single market process that generated a great deal of excitement at the beginning of the 1990s.

Research Assignment Essay Example | Topics and Well Written Essays - 1750 words

Research Assignment - Essay Example Walker describes the relationship of mother with the daughter that gradually upturned when the mother begins to understand and recognize the thoughts of her daughters, regarding the importance of cultural values. The same theme of parent-child relationship is described in several other narratives including short stories and poems like Tillie Olsen’s short story â€Å"I Stand Here Ironing† and Ben Johnson’s poems â€Å"On My First Son† and â€Å"On My First Daughter†. The authors of these work pieces have discussed the intricate relationship of parent and their children in quite different ways, and shows depth and potential involvedness within parent-child relationships. In â€Å"I Stand Here Ironing†, Olsen depicts a mother worried about the thinking style of her child whereas â€Å"Everyday Use† tells about the mother that is happy after realizing that her daughter possesses some true feelings and thinking in her heart regarding the i mportance of cultural heritage. The poems of Ben Johnsons also talks about the parent-child relationship but in a different manner as these are written to depict the sorrow of the parents on the death of their children. The essay describes these literary works to explain the variation in the depiction of a common theme of parent-child relationship. It is unveiled that the parent-child relationship is commonly used as the central theme in various narratives; however, the topic is so deep and multifaceted that the writers have described this theme in distinct styles. It is also unveiled that regardless of children age, position and social conditions the parents always have a deep love, affection and concern for their children shown these narratives in different styles. The short story â€Å"Everyday Use† depicts the intricate relationship between mother and her two daughters. There was disagreement among them over the issue of preservation of cultural heritage that ultimately a ffected their relationships. The mother and both the daughters understand the value for traditions; however, their perspectives about the treatment of the traditional things were different from one another. The story is written in the context of political and social transformation when African Americans were struggling to preserve their cultural values and identities (Bates, p154). The family described in the story had several things that remind them of their African culture roots, while the family members regard these things as their cultural heritage. However, the standpoint of mother and both daughters were different from each other because they view the traditions and cultural heritage in different ways. The mother earlier thought that her alder daughter Dee has the sense of appreciation for the traditional treasures, and that she understands the values of cultural heritage. The younger daughter, Maggie, seems quite insensible to her mother because she thinks Maggie gives no val ue to the traditional things and just regards those as items of everyday use. The relationship of the mother grew differently with both daughters on the basis of the opinions she held for them. The mother believes that the preservation and protection of cultural heritage shows that one should have value for the memories of their ancestors, so

Cooper-Pearson case study Essay Example for Free

Cooper-Pearson case study Essay Healthcare benefits play a big part in employee satisfaction and retention, though many organizations do not see the importance, according to a recent survey conducted by insurance company MetLife. More than three-quarters of employees who say they have good healthcare benefits also report high job satisfaction, and 71 percent of those workers are loyal to their employers. Conversely, only about one-fourth of staff members who are dissatisfied with their benefits are happy and loyal to their organization. I have been given the task to research different medical insurance plans to assist Cooper-Pearson in selecting an insurance program for their marketing company. My aim is to provide them with enough details to make an informed decision on the different managed care plans. This information will allow them to provide their employees with a compensation package that is both affordable and desirable. Once an attractive compensation plan is in place; we expect the retention rate to improve and the recruitment of quality employees to increase. The primary differences between the HMO plan and the PPO plan is that you are required to have a primary care physician within the primary care network that you are assigned to. You dont have the option of visiting a physician outside of the network. You must have a referral from your physician to see a medical specialist and the specialist must be within the approved network. HMO plans normally cost less than a PPO but you may have a higher co-payment with a HMO plan. The PPO provides more information to the insured concerning cost sharing in or out of the network (Kongstvedt, 2007, p 25). According to (â€Å"benefithouse.com†, 2011), an indemnity plan allows you to use a medical provider of your choice to receive medical care. You must pay an annual deductible for the coverage before the insurance repayment takes effect. Once the deductible is paid then the plan will pay a percentage of your medical coverage and you pay the remaining balance. There is a cap on how much the insured has to pay towards his or her coverage with an indemnity plan. The company spends a lot of time recruiting young men and women directly out of college and are willing to provide them with a good salary to join the company. Most people who are directly out of college don’t have families and don’t focus on medical benefits. Their priorities are on making a good salary. However, over time as they begin to have families and or health issues, they come to the realization that the company doesn’t have an adequate health plan. This can lead to stress which can produce other health issues further complicating matters. It is important for this company to go with a managed care plan that has a customer focus approach. This will encourage current and future employees that the company believes in investing in quality medical care, as employees are there foremost priority. The goal is to have an understanding on what type of medical coverage is most important to the employee and use the information as a way to measure the quality provided in the managed care programs. It is common for the insured to play a key role in decisions concerning their healthcare. They are more apt to accept the cost sharing when they feel they are getting a choice on the type of care received. Once the managed care plan is made available to the employees, the desired result is to see an improvement in retention and recruitment. A possible negative impact could be an increase of cost for both the employer and the employee. However, creating an incentive plan such as a wellness program with an employee bonus could encourage a healthier lifestyle which could lead to fewer visits to a provider. Possibly cutting healthcare costs for the company and the employees. The managed care industry is increasingly using physician credentialing when seeking health care providers. The credentialing process must be conducted in a manner that meets the goals of the managed care program. When it comes to managed –care physician credentialing, it is primarily performed to protect patients. It is one of the most effective controls in medicine today and probably ranks right up there with residency training as a key to quality. Credentialing is also performed to protect the hospital and medical staff in case a patient is (or believes he/she has been) injured. Corporate negligence cases often allege that the hospital did not perform the credentialing function well. Good credentialing practices allow one’s hospital to easily demonstrate that you dotted all of the i’s and crossed all of the ts. Theres no question that if a hospital and its credentials committee do their jobs well, it becomes very difficult for a plaintiff attorney to demonstrate negligent credentialing. Employee benefit plans are dynamic. They need to be adapted to changing economic, business, demographic, and other forces that affect these plans and the business community. Otherwise, they can rapidly become outdated and unnecessarily expensive. The Prescription Drug component of the Employee Benefit program is a critical element of an employer-sponsored health and productivity benefit program. Understanding the organization’s position in relation to other employer-sponsored programs can help one measure the pharmacy benefit plan(s) relative to the employer marketplace. It also can help one compete effectively in attracting and retaining high-quality employees, managing prescription drug plan costs and developing appropriate strategies to respond to the challenges of the current economic environment. Finally, health insurance helps protect an individual or family from financial loss for costs incurred because of sickness or injury. According to the U.S. Census Bureau, an estimated 85 percent of all Americans have some form of health insurance. Roughly half of all Americans with coverage get it through their employer or their spouses employer. There are a number of reasons why it makes good business sense for employers to offer insurance benefits to their employees and their families. REFERENCES: 1. Kongstvedt, P. Essentials of Managed Health Care, 5th Edition. 2007. Jones and Bartlett: Sudbury, MA. 2. Benefit House, What is Indemnity Health Insurance, 2011. Retrieved 14 September, 2012 from 3. http://www.benefithouse.com/insurance/health/indemnity.html 4. https://www.bucksurveys.com/bucksurveys/Surveys/PrescriptionDrugBenefit/tabid/81/Default.aspx 5. http://smallbusiness.chron.com/importance-health-insurance-company-17225.html

Essay --

Participation of hyperglycemia in triggering the multiple oxidative stress pathways in the course of diabetes. AngII: angiotensin II; eNOS: endothelial nitric oxide synthase; Jac/STAT: janus kinase (Jac)-signal transducer and activator of transcription (STAT); LDL: low density lipoprotein cholesterol; MAPK: mitogen-activated protein kinase; MetS: metabolic syndrome; NF-ÃŽ ºb: nuclear transcription factor ÃŽ ºb; †¢NO: nitric oxide; NOS: nitric oxide synthase; †¢O2−: superoxide anion radical; †¢OH: hydroxyl radical; ONOO−: peroxynitrite; PCKÃŽ ´: protein kinase C ÃŽ ´. Adapted from Johansen et al., 2005 The increased oxidative stress in subjects with type 2 diabetes is therefore a magnitude of several abnormalities, including hyperglycemia, insulin resistance, hyperinsulinemia, and dyslipidemia, each of which contributes to mitochondrial superoxide overproduction in endothelial cells of large and small vessels as well as the myocardium[15] COMPLICATIONS OF DIABETES Whether diabetes occurs as a result of type 1, the early-onset and predominantly insulin-dependent form, or type 2, the late-onset... Essay -- Participation of hyperglycemia in triggering the multiple oxidative stress pathways in the course of diabetes. AngII: angiotensin II; eNOS: endothelial nitric oxide synthase; Jac/STAT: janus kinase (Jac)-signal transducer and activator of transcription (STAT); LDL: low density lipoprotein cholesterol; MAPK: mitogen-activated protein kinase; MetS: metabolic syndrome; NF-ÃŽ ºb: nuclear transcription factor ÃŽ ºb; †¢NO: nitric oxide; NOS: nitric oxide synthase; †¢O2−: superoxide anion radical; †¢OH: hydroxyl radical; ONOO−: peroxynitrite; PCKÃŽ ´: protein kinase C ÃŽ ´. Adapted from Johansen et al., 2005 The increased oxidative stress in subjects with type 2 diabetes is therefore a magnitude of several abnormalities, including hyperglycemia, insulin resistance, hyperinsulinemia, and dyslipidemia, each of which contributes to mitochondrial superoxide overproduction in endothelial cells of large and small vessels as well as the myocardium[15] COMPLICATIONS OF DIABETES Whether diabetes occurs as a result of type 1, the early-onset and predominantly insulin-dependent form, or type 2, the late-onset...

Competition Bike Incs Essay

Horizontal analysis compares a company’s performance from year to year. I will be reviewing Competition Bikes Inc(CBI) balance sheets and income statements. During CBI year 6, 7 and 8 I have found their net sales , cost of goods to be fluctuating, and few various other items. The net sales from year 6 to 7 increase 33.34 %. The cost of goods from year 6 to 7 was 31.82 %. The gross profit increase 30.89. Comparing year 6 and 7 I found that year 7 improved, but when I compared year 7 to 8 the results were not good for year 8. The company had experienced a 15 percent reduction in net sales. Cost of goods drops 14.8 % from year 7 to 8. Advertising Expenses CBI advertising expenses increased by 37.5 % from year 6 to 7. CBI made a great investment from year 6 to 7 because the net sales increase at a higher rate the increased advertising cost. CBI reduced their advertising expenses by 16.3 % from year 7 to 8. I believed this was done because of the fragile economy. Many companies are trying to make cuts back during a weak economy. These reduces expenses will hold them over until the economy becomes stronger. Website/Sales The website creation and maintenance expenses during year 6, 7 and 8 stayed the same price. Sales commission increase 33.371 % during year 7 from the previous year. Sales commission decrease by 15 % the following year (8). Distribution Network The Distribution network expenses had a positive increased in year 7 by33.3 % jump from the previous year. Distribution expenses are normally supposed to maintain similar numbers, but when you have an increase in sales it is acceptable to increase the distribution expenses. Distribution network expenses decreased 15 percent in year 8. This was caused due to less revenue. Transportation CBI had 33% transportation increase from year 6 to 7. This was caused CBI had more products sold and required more products to be shipped. CBI saw 15 % transportation decrease from year 7 to 8. CBI had less products sold and this caused transportation to decrease in year 8. Administrative Expenses from year 6 to 7 saw 21.43% increase. Administrative Expenses maintain the same expenses from year 7 to 8. Executive expenses increased 29.42 % from year 6 to 7. Year 7 and 8 maintain the same level of expenses. Employment taxes rose by 25.81 % increase from year 6 to 7. Year 7 and 8 maintain the same level of employment of expenses. Administrative expenses are expected due to company having increase production and sales. Utilities expenses rose 3.84 % from year 6 to 7. CBI operation worked proficiently in year 7, and this helped them experienced only an increase of 3.8% in utilities. This was caused due to increase production. CBI utilities increased by 11.11 during year 8. I would suggest CBI have their utilities monitor from day to day to see how they can prevent an increase in expenses when the company is not performing well compared to the previous year. Research CBI saw research and development saw a 37.5 % percent increase from year 6 to 7.During year eight CBI reduces their research and development expenses by 16.3 %. A company should never reduces their research and development if they company perform well in the previous year. I believe this was one of the reasons why CBI had a great year during 7 because they knew what consumers wanted. Due to lack of spending on research and development this caused their sales to drop. Research and development is an important component of competition against other companies without a company will fail to succeed. Interest Income CBI interest income rose 38.1% from year 6 to 7. During year 7 CBI income was properly invested. During year 8 CBI investments had a 3.4% reduction. The reduction was small, but small things do add up over time. I would suggest CBI to monitor their investments and make plans to move around their money if the current trend continues. Balances sheets CBI accounts receivable rose 164.3% from year 6 to 7. During year 8 CBI accounts receivable drop 15 percent. CBI should monitor accounts receivable more closely to make sure past due balances are paid on time. This was caused due to the company noticing a large increase on accounts receivable during year 7 and they tried to capitalize on it. This caused their accounts receivable to drop. Raw Materials CBI manages their raw materials well during year 7. CBI had 3.1% percent reduction in year 8. CBI should incorporate lean production method and Just in time production to avoid wasteful spending and production. Liabilities CBI liabilities increase 1.2% from year 6 to 7. This is expected due to year having 7 having an increase in sales and productions. CBI reduces their liabilities by 3.1% from year 7 to 8. This is good because CBI had a 15 percent reduction in net sales. Vertical analysis A method of financial statement analysis in which each entry for each of the three major categories of accounts (assets, liabilities and equities) in a balance sheet is represented as a proportion of the total account. The main advantages of vertical analysis are that the balance sheets of businesses of all sizes can easily be compared. It also makes it easy to see relative annual changes within one business(Investopedia,2013). Income Year 7 net sales were 7% higher than year 6.CBI preserved their selling expenses at 6.7% of total Net Sales. CBI reduced General & Admin Expenses from 17.1% during year 6 to 15.5% during year 7.This would lead to an increase in Operating Income from 2.8% of Net Sales from year 6 to 5.3% in year 7 and CBI Net Earnings would increase from 1.1% (year 6) to 3.3% (year7). CBI did not perform well in year 8 because their expenses increase during year 8. This caused CBI net earnings to reduce.. CBI Administrative expenses increased 15.5% from year 6 to 7. CBI net sales increase 18.4% from year 7 to 8. CBI operating expenses income was reduce 5.3%of net sales to 1.9 % causing CBI net earnings from 3.3% to a .7%. I would recommend CBI to monitor their general and Admin expenses. Majority of expenses stayed the same during year 6,7 and 8. However during year 8 the CBI did not perform well. I believed CBI needs to find ways to reduces expenses when the company is having a low sales volume. CBI should incorporate just in time principles and lean manufacturing principles. I believe this would help reduce wasted production and this would help reduce utilities expenses. Just in time principles and lean manufacturing principles could also reduce employee expenses. ASSESTS CBI in the cash and cash equivalent accounts drop from 6.2 % in year 6 to 2.7%. However, during year 7 more products were sold compared to year 6. CBI accounts receivable had a major increase from year 6(6.5%) to year 7(16.6%).CBI needs to monitor their accounts receivable accounts more closely and make sure they’re collecting the amount owed to them. During year 8 CBI cash and cash equivalents had risen from 2.7 %( year 7) to 10.3%(year 8). The reason why this happen was due to CBI had started to monitor their accounts receivable. This helped them collect the money they were owed on past due accounts. I would recommend CBI to avoid making purchase on accounts and find ways to use the cash in a more efficient way. CBI should realize it important they have enough reserves during a recession. This will help hold them over until the economy bounces back. â€Å"Trend Analysis is the practice of collecting information and attempting to spot a pattern, or trend, in the information (Wikipedia,2012).†CBI sales were lower than year 7, but they still were able to make a profit. CBI should expect to see growth in the next few years based on their current trend. CBI is expected to have 3,510 units sold in year 9. CBI will have 3,660 units sold in year 10. Finally during year 11,CBI will sell 3,800 units. The forecast numbers are based on the economy recovering. This will encourages CBI sponsors to invest in professional riders and this will increase new bike sales. Currently is cost CBI 1,047.50 to make each product. I would recommend CBI find suppliers who have the same quality parts, but at a lower cost. I would also make recommend CBI is following just in time and lean manufacturing principles. This could help CBI increase their profit margin. Ratio analysis- analyzes numbers Ratio analysis is a method used by businesses to assess their financial situation by comparing two sets of linked data. Current ratio will measure a company’s ability to pay short-term obligations. CBI had a reduction from year 7 (5.9%) to 8(5.35%). Two wheel racing (TWR) current ratio was 4.2% for year 7 and 8. A debt ratio will determine if a business is able to handle any unexpected liabilities it that may come up. A business needs to make sure they enough money to pay off debt to avoid problems with their debt. During year 7 CBI debt ratio was 46.8%. The follow year the debt ratio was 46%. The debt ratio only drops .08 percent during year 8. TWR debt ratio was 38% in year 7 and 8. An acid test ratio will determine if a company can back their liabilities. CBI is doing better than (TWR) by 1.12% and .85%. Inventory turnover- determines the number of times a company can sell it average level of inventory throughout the year. CBI bicycles are customizes for customers so I am unable to compared CBI and TWR. Average collection period, This determines how well a company is able to collect money to the customers they extended credit to.CBI has higher collected amount compared to TWR. CBI was 11.3% higher in year 7 and 8. Gross Profit Margin, will tell investors how much revnue was gain after selling the product(Cost of Good-revenue/gross profit. TWR profit margin is 32.10% higher than CBI profit margin in year 7(27.4%) and 8(27.0%). TWR is operating more effectively. Operating profit margin Measures management efficiency (Operating income/total sales). CBI year 7 was 5.3% and TWR was 5.2%. Year 8 TWR performed better with 5.3% compared to CBI(1.9%). Net Profit Margin show investors the percentage of each sale dollar earn as net income. During year 7 CBI net profits was 3.3% and in year 8 it was .8%.TWR was 5.14% year 7 and 8. The portion of a company’s profit allocated to each outstanding share of common stock. Earnings per share serves as an indicator of a company’s profitability(Investopedia,2013).TWR was $.08 for year 7 and 8. CBI was $.20 during year 7 and $.04 in year 8. Return on total assets-determine how successful a company is to earn profit with their assets. TWR total assets was 4.8% for year 7 and 8. CBI was 4.5% in year 7 and year 8 was .8%. Return on Common Equity- Income between net income and stockholder equity. During year 7 CBI equity was 8.5% AND TWR was 8.1%. CBI equity in year 8 was 1.5% and TWR was 8.1% Price / Earnings Ratio- Stock prices and company earning. CBI earning share 49.67 and TWR was 29. During year CBI price jump to 83.73 and TWR was still 29. Times Interest Earned Determines the numbers of times operating income can pay interest expense. Year 7 interest earn was 5.27 and TWR was 4.24. During year 8 CBI interest earn drop to 1.77 and TWR remained 4.24. ‘Working capital is a financial metric(current assets minus company liabilities) which represents operating liquidity available to a business, organization or other entity, including governmental entity(Wikipedia,2013).† The financial metric system will analyzes if a company will be able to pay their short term liabilities or do they need to take an alternative solution. CBI working capital in year 6 was $382,394: CBI working capital at the end of year was 1,306,617. CBI increased their working capital by 70.7% at the end of year 8. After reviewing CBI working capital the results indicated they will be able to pay their short term liabilities Recommendation I would recommend CBI to have their accounts executives to build a better relationship with customers and make sure they’re satisfied with the work they are receiving. One of the most important things a company can do is listen to their employees. I would also recommend CBI to reduce their accounts receivables. This could be done by making sure that larger orders from customer are sent out faster. CBI inventory cost increase over 24% from year 6 to year 8.CBI should follow the just in time and lean manufacturing principles. This will reduces inventory cost for CBI. CBI transportation expenses are one of their highest expenses. I would recommend CBI to consider to purchasing their own delivery truck and see if this will help them reduce their transportation expense. Internal controls Internal controls helps a company infrastructure run smoothly. Internal controls also help protect and prevent fraud. Internal control will try to remove the temptations for employee to act unethically in the aspect of putting the company at risk of lawsuit. CBI purchase department (PD) will purchases orders from suppliers based on their monthly budget. Once the order has been received the PD will evaluate bids from different suppliers. Once the order has been received they’re given to the production line. The invoice will be sent to the PD. If there are any supplies left they will be sent to raw materials. The PD will then send an accounting department who issues a check to the supplier. Recommendation I would recommend the whole entire processed be revamped. The first thing I would recommended is to separate the duties of researching the bid and purchasing orders. The next thing I would suggest is to make the receiving department in charge of verifying the shipping when the packages arrive. The receiving department needs to verify every item is there from the supplier and their no missing item from the delivery. The receiving department should maintain an inventory control system. After the receiving department has approved the invoice, they should forward to the purchasing department. The purchase order will be forward to the accounting department for payment. Accounting has currently been only receiving unverified invoices. Risk Accounting has currently been only receiving unverified invoices. The lack of verification could cause CBI to get double charge for item they already paid for. Currently their lack of inventory control system. Currently unused supplies are being sent to raw material without anyway of tracking it. This would make it easy for employees to steal because lack of inventory control system. Recommendation I would suggest an inventory control system be implemented. I would make sure all packages received by receiving department be verified by management to avoid being double charge. The inventory control system will help prevent theft from employees. I would also hire outside firm every quarter to check inventory levels to make sure no one is stealing from the company. Sarbanes-Oxley Act Sarbanes-Oxley Act is government regulation that congress pass in order to improve financial disclosures. This would help prevent accounting fraud and improve financial disclosures from corporations(Wikpedia,2013).†Section 302: A mandate that requires senior management to certify the accuracy of the reported financial statement Section 404: A requirement that management and auditors establish internal controls and reporting methods on the adequacy of those controls. Section 404 had very costly implications for publicly traded companies as it is expensive to establish and maintain the required internal controls (Investopedia,2013). CBI does not mention that they were audited by outside firm. I highly recommend CBI to hire auditing firm to review the company’s annual statement before releasing the numbers to the public to make sure there is no accounting errors. Internal controls are implemented and effective at the end of year 8(Dec 31). The CEO, and CFO certification is need because it is required by SOX and this could not be located. Auditor releases the following statement to shareholders. A material weakness is a control deficiency, or a combination of control deficiencies, in internal control over financial reporting, such that there is a reasonable possibility that a material misstatement of the company’s annual or interim financial statements will not be prevented or detected on a timely basis Recommendations CBI needs to make sure they are in compliance with the regulations set forth by Sarbanes-Oxley CB. The first thing I would recommend is to conduct a internal control assessment. The next thing I would recommend CBI to hire accounting firm to review their internal controls. The control needs to be based on Sox guidelines. The CEO and CFO needs to certify they’re aware of the CBI internal control and the actions the company have taken to protect investor’s investments. It is very vital CBI CEO and CFO certifies they’re aware of internal control because Sarbanes-Oxley requires this to be done. Since the accounting firm made assessment that the internal control is effective their might be some problems that could arise from the following statement, â€Å"A material weakness is a control deficiency, or a combination of control deficiencies, in internal control over financial reporting, such that there is a reasonable possibility that a material misstatement of the company’s annual or interim financial statements will not be prevented or detected on a timely basis.† I would recommend the CEO or CFO to take action fix the internal control problem because they could face jail time for making statements that were not true. .† CBI should base their guidelines set forth by the Committee of Sponsoring Organizations of the Tread Way Commission(CSOTWO). CSOTWO is joint inivate five private sector organizations devoted to providing leadership through progress and guidance on enterprise risk management, internal control and fraud dictation. This is a great way for C BI to improve the internal control process. References Free Dictionary(2013) http://legal-dictionary.thefreedictionary.com/Sarbanes-Oxley+Act+of+2002 Investopedia(2013) http://www.investopedia.com/terms/h/horizontalanalysis.asp#axzz2Hh4rgfuE True Bussiness(2013) http://truetobusiness.com/finance/ratio-analysis Wikipedia(2013) http://en.wikipedia.org/wiki/Internal_control

Essay on Anti-bullying Programs in Schools Are They Truly...

Many schools make sure that structure and education come first in their students’ career paths. Education is important and necessary for future life, but sometimes there is something else going on in these schools besides the education and structure. In recent years bullying has risen in school settings. Schools through out the world are starting to take precaution in their fights against bullying and are organizing anti-bullying programs. The problem is many schools do not even realize that bullying is happening right under their noses: â€Å"research indicates that 15% to 20 % of all students are victimized by bullies at some point in their school careers† (Shore 40). Based on the statistics it shows that many times bullying is happening†¦show more content†¦While many schools are starting to realize that they need to step in and help their students, many have already been taking precaution in their schools for instance â€Å"The first scientifically tested anti-bullying program for primary schools in Australia has been developed and is operating in 49 Perth primary schools†(Alison 3). This shows that not only are schools in North America taking precaution but all around the world bullying seems to be a problem. Not only are schools getting more involved but the families are getting involved â€Å" The Friendly Schools and Families program has reduced both the number of children being bullied and the number of children who are bullying in the schools where it is being used† ( Alison 3). Schools in Northern America are also starting to stand up against bullying in brief: On Monday, in the high school auditorium, the district kicked off the Olweus-Anti Bullying Program in different assemblies for various grade levels. It is not done, either. A community meeting on the program will be held tonight in the auditorium. All districts residents, including students in grades K-12, parents, friends and family are invited to attend this kick-off event. 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