Support for carers of people with schizophrenia The WritePass Journal

Support for carers of people with schizophrenia Introduction: Support for carers of people with schizophrenia Introduction:Definition of carers:  Brief understanding of schizophrenia:Summary  CONCLUSIONRelated Introduction: This literature review will be based on finding evidence for the support received by carers of people with schizophrenia, the focus of this document will be specific to 24 year old male diagnosed with schizophrenia and living at home with parents. For confidentiality purposes, patient will tae on assumed name of Alex. Alex is 24 years of age and was diagnosed with schizophrenia at the age of 19 whilst in university. He had admitted to use of illicit drugs (crack cocaine and cannabis) he ha also stated that he at times was able to consume a bottle of voda in one night. On admission, Alex was presenting with delusional thoughts of persecution, paranoia and thought disorders. Alex is being discharged from hospital and is going back home to stay with parents who will be his main carers. Corcerns raised were, what support they will receive in the community from health practitioners with regards to coping psychologically, physically, socially and economically Definition of carers: Carers can be defined as family members, partners or friends who provide unpaid support to people who experience illness, disability or frailty(Hancock and Jarvis 1994).Although Stalker (2003) makes a distinction between informal helpers and those who take on major responsibilities, Rethink (2006) proposes that all people providing substantive care should be defined as carers. In the UK, half a million people care for people with severe mental illnesses (Princess Royal Trust for Carers 2002) with 40 per cent living with those for whom they care (Rethink 2006). Carers UK (2008) estimates that carers save the economy  £87 billion a year. Of people with schizophrenia, 60 per cent live with significant others (Hughes et al 1996) and the same proportion return home to their families after their first admissions (MacMillan et al 1986).Many carers describe their role as a burden. Caring can disrupt their lives, restrict the activities in which they can take part, bring financial hardship, and reduce their time and energy to take part in paid work (Ferriter and Huband 2003, Oyebode 2003).Meanwhile, by focusing on the mental illnesses of the people they care for, carers can neglect their own social support networks, leaving them isolated (Rose et al 2002).   Brief understanding of schizophrenia: Schizophrenia is a mental illness that affects about one in a hundred people at some point in life. The first acute episode where symptoms of schizophrenia are experienced can be a devastating experience, particularly as both the person experiencing the illness and their family and friends will be unprepared. The highest incidence of first experience of an episode is in the late teens and early 20s, which is a time of change anyway, making it difficult to understand what is happening to a relative or friend who is developing schizophrenia.(Rethink 2011) Research The search for research articles were focused on carers, schizophrenia, carers support and nurses support for carers and patients. National and international research surrounding this topic were sought, the search was narrowed down to between 1999 and 2011. Electronic databases and interenet sources such as google academia were searched as well as websites of ey organnisations such as Mind, Rethink, NHS choices, Sainsburys Centre for Mental Health. Other searches were carried out at the university library and its digital library such as CINHAL, psychINFO and British nursing index. Researh article on this topic were a total of 1435 hits, this was narrowd down to   specific search and this generated 213 hits. 10 researh article were chosen read, evaluated and out of that six research article were determined and selected to be relevant and signnficant contribution for this literature review. Research articles used in this essay are qualitative and quantitative. 4 are qualitative and 2 quantitative. In all six article nurses were chosen at random to help in the support of carers. In all research articles, in depth interviews were conducted to collect data, these were recorded on audio tapes and in field notes. Interviews were focussed on the views of carers concerning nurses, and nurses concerning carers. Summary The research   article reviews the findings of a study of the views of 13 carers of people self-identified as having schizophrenia on the nature and extent of their role, and its effect on their lives and identities. According to these findings,carers experience stress and illness, and thinkthat the support they receive from professionals is inadequate. As a result, they think that help and psychotherapeutic interventions, such as family therapy, should be more accessible. The purpose of the research articles were to identify the support needed by carers of people with schizophrenia. On reading the research articles, it was noted that Mental Health nurses and carers were used as samples in the reseach work. RESEARCH 1 Registered Mental Health Nurses aged between22 years and 51 years with clinical experience ranging from1 to 14 years. The sample consists 10 nurses, nine being female and one male. Three were charge nurses and six staff nurses. One nurse moved on to a managerial post leaving nine nurses in the research. They were assigned a client each with the carer   of that particular client. Nine carers received support. Community based psychiatric nurse in Taiwan gathered data on the coping experiences of carers living with and taking care of someone who has a family member with schizophrenia were compiled. The   carers selected needed to be the major caregivers and the patient must have had clinically diagnosed schizophrenia for at least one year and carers had to have been living with the patient for at least one year since the onset of the illness. The sample size comprised 10 carers (five men and five women). All of the carers were contacted by their community home care nurses first to gain consent to participate in this study. The other four remaining research articles used a sample of nurses and carers which comprised in the range of 10- 30. Findings; In the research articles two types of burdens were broadly discussed, these being objective and subjective burdens. Many carers describe their role as a burden.Of people with schizophrenia, 60 percent live with their significant others (hughes et al 1996) and the same proportion return hometo their families after their first admissions(MacMillan et al 1986). Van Wijngaarden et al (2000) state that ,these burdens are described as ‘objective’ burdens because their effects can be measured by others. However, many carers experience ‘subjective’ burdens, which can be measured only by the carers themselves. These subjective burdens can include depression, feelings of anxiety, and a sense of loss, particularly in those for whom family life has become chaotic and disorderly (Karp and Tanarugsachock 2000). Those who have become isolated often feel vulnerable (Rose et al 2002) and, in 625,000 carers in the UK, the stress of caring has even led to mental or physical illnesses (Carers UK 2008).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Carers’ main objective burden concerns lack of employment and finance (Magliano et al 2005, Sreeja et al 2009) and the main form of practical help carers need is more responsive and user-friendly support services. Carers’ subjective burdens include feelings of chronic stress, isolation, despair, fear and exhaustion(Ward-Griffin and McKeever 2000), and healthcare professionals can respond to these by offering carers more psychotherapeutic interventions, including family therapy, to help them cope and to reduce disruption in the home. Carers have an enormous amount of responsibilit for the welfare and managementof people with a mental illnessin Britain (Cuijpers, 1999). This is recognized in recent Government policies that stipulate the support required to enable carers to continue caring (Scottish Intercollegiate Guidelines Network (SIGN), 1998; Department of Health (DOH,2000). Further findings were the perception of health professional about carers and vice versa were varied in the research artilcle . These are in bullet points below. Their view of carers and health and social care professional were at odds with each. Below in bullet points were some of the thoughts expressed: Carers are of the view that Health care professionals must engage with carers rather than criticise them for notconforming to professional assumptions. The study also shows that the burden of care is rarely taken up fairly. Most major responsibilitiesare usually taken on by one person, and the chancesthat this person is male or female are fairly even. However, the burden of care can be greater forwomen, who are often assumed to be the maincarers for all of their family members, not only for the people with schizophrenia. Healthcare professionals, more specifically mental health nurses, need to   understand that their views and perceptions of mental illness, the appropriate care for people with mental health problems, and those of the carers, differ. They should also understand that, to support carers appropriately, they must provide practical help: for example, more support for carers of mental health patients. In the literature, moreover, health and socialcare professionals characterise the role ofcarers as ‘overprotective’ (Croydon-Smith 1982,Haddock et al 2003). With half a million people in the UK caring for peoplewith severe mental illnesses, (Princess Royal Trustfor Carers 2002) this article research article also identified the findings of a study of the views of 13 carers of peple clinically diagnosed as having schizophrenia on the nature and extent of their role, and its effect on their lives and identities. These views are in bullet points below According to these findings,carers experience stress and illness, and thinkthat the support they receive from professionals isinadequate. As a result, they think that help and psychotherapeutic interventions, such as family therapy, should be more accessible. Participants also thought that their perceptionsof schizophrenia and of those who have thecondition differ from those of health and social care professionals, and that this difference addedto their burdens.   For instance, one participant said of what he and the healthcare professionals he encountered thought was best for his son: ‘As far as I was concerned, he needed to be in hospital, but they would not agree.’ Another participant made a related point about the care given to her daughter: ‘Sometimes,the hospital staff would give advice. They said,â€Å"involve her in your decisions†, but we thought thiswas a terrible idea. She could not think properly.She was unable to.’ One carer was angry at healthcare professionalsbecause they appeared to override his concernsabout his wife, saying: ‘The psychiatrist said to mywife, â€Å"Do you want to come in to the hospital?† and she said â€Å"No†. I was amazed because the doctor agreed with her. I told them about her behaviourin the house but it was not my decision. It was her decision.’ Some participants’ relationships with healthcareprofessionals were unsatisfactory for practical reasons. For example, one said of his wife: ‘It was unfair to leave her to me. These nurses start their shifts, do eight hours and then go home. I had it 24 hours a day.’ Another said, also of his wife: ‘I tried so hard to care for her, but the community psychiatric nurse did nothing to help.’ Other staff also came in for criticism, with oneparticipant commenting on healthcare professionals’ lack of understanding and availability in caring for her son: ‘He would go berserk and, I called the doctor and the social worker. But they came and said he did not need sectioning.’ Those who have become isolated often feelvulnerable (Rose et al 2002) and, in 625,000 carersin the UK, the stress of caring has even led to mental or physical illnesses (Carers UK 2008). Findings:Who becomes the carer? Typically, one person in each family had become the main carer,which means that the burdens of caring were not shared equally. Nearly half of the participants inthe study were male carers, although some of thesereported that extra burdens of caring had been placed on their daughters.One male carer said of his daughter, who had taken on some of the routine caring role: ‘I felt bad enough that my oldest girl was doing all the work around the house. There was time for all this when she was a married woman.’ Another male carer said of his eldest daughter:‘She looked after the youngest when her motherwas sick. She seemed to know her mother was mentally ill. She had to grow up quick to do thingsround the house.’ The objective burden Generally, carers tended toidentify the burden of caring in practical terms,citing the need to undertake tasks such as cooking,cleaning, housework and shopping, and of ensuring that the people they cared for were not left alone. gets one a day. For some participants, providing practical carewas a major challenge. ‘He has become extremely difficult to control. More than difficult. It is worse now.Over a period of time, he has got worse. He actuallyattacked his dad. There was a widely held belief among participantsthat the people they care for are unable to cope withtheir illnesses, and have become irrational. One said,for example: ‘I was worried about leaving her alone in case she got it all wrong and did something stupid.Some days she cannot take care of herself.’ Another reported: ‘I had to take care of her andprotect her. She could not cope. I could not leave heralone, she was too sick.’There was a perception among participants thatthe people they care for are in a position analogousto that of children. my wife and I could not leave her. It was like she wasa child again.’ A participant whose family had become carerssaid: ‘We could not leave her alone because she mightdo something. She is ill. We cared about her.’ And a carer said of her son: ‘I think I must takecare of him. It is like the umbilical cord is still there.’ The subjective burden Participants also mentionedthe subjective burden of caring. All of them saidthat they had experienced anxiety, some saidthey felt depressed and others that they feltconstantly sad. Most of them also felt angry,although a few had become resignedtotheir situations. Most paticipants also reported physicalproblems such as headaches, stomach pains orconstant tiredness, often caused by insomnia. One participant’s comment that she felt ‘tired,drained and worn out’ was typical. Some participants said that the people they caredfor had changed so much because of their illnessthat they had become unrecognisable, and that thesechanges added to the burden of caring.One participant said of her son: ‘He is not my sonany more. He is just some creature, some monster. I told the social worker, â€Å"I am tired, I cannot have my son living with me much longer†. I have forgottenwhat it means to have a normal life. I have taken tolocking my bedroom door when my husband is away. I am afraid of my son.’The realisation among participants that the hopes they had once invested in the people they care forwould not now be fulfilled was a further cause ofdistress. Views of health and social care professionals. Over the last 20 years, a number of initiativesaimed at supporting carers of people with mental illness have been developed,many of them involving nurses (Leff andVaughn, 1985; Hatfield, 1990; Falloon et al, 1993; Atkinson and Coia, 1995).   The number of sessions delivered by the nurses ranged between 1 and 12 and the duration varied between 45 minutesand 2 hours. Eight carers requested homevisits, and one nurse met the carer in a private room withinthe hospital. The number of sessions varied in response to carers’ needs. Some had few support needs but still found it helpful to talk about carer related issues. Carers reportingmore complex needs required more intensive support.   CONCLUSION Training nurses to support carers of peoplediagnosed with schizophrenia appears to have been overlooked in some psychosocial intervention programmes. The research articles outline how a training programmefor nurses, based on the work of Nolan et al (1999), and building on training developed by Atkinson and Coia (1995), was developed. This has helped formulate a needs-led support service for carers whose relatives arc diagnosed with schizophrenia.The key components of the support arc thoroughneeds assessment and meetingneeds through agreement and careful planningwith carers.Nurses should work in partnership withcarers in order to achieve these aims, and this is dependent on mutual respect of eachothers status and expertise. The present study will allow evaluation onhow far the training programme enables nursesto meet carers needs, and how confident the nurses are in offering support to carers.Carers views are important concerning theappropriateness of the support programmein meeting their needs. Following this study,training and intervention will be refined. As such, it represents the first phase of aresearch programme investigating rhe trainingneeds of nurses and the usefulness of support for carers. Current United Kingdom (UK) health and social care policiesplace the needs of carers to the fore on the service provision agenda (Hancock Jarvis 1994, Department of Health[DoH] 1999a, 1999b). Commitment towards care in thecommunity explicitly relies and builds on the family system toprovide unpaid support to clients (James 1992, Nolan et al. 1999, Hirst Arksey 2000, Nolan 2001). Evidence,however, consistently indicates that carers’ needs for support remain largely ignored by health professionals (James 1992,Twigg Atkin 1994, Atkinson Coia 1995, Henwood1998, Rose 1998, Warner Wexler 1998, Hatfield 2000, Nolan 2001). Further, the most effective ways of meetingcarers’ needs remain unclear (Nolan et al. 1995, Rose 1998,Clinical Standards Board for Scotland [CSBS] 2001). If professional support offered to carers is to improve then health service professionals, including nurses, need to develop their understanding of carers’ needs and develop interventions to meet these needs (Atkinson Coia 1995, Casey1995, Nolan et al. 1995, Kellett Mannion 1999, Hatfield 2000, Magorrian 2001). Background The research studies focus on the primary carer: i.e. a family ornonfamily member who provides care or support to someonediagnosed with schizophrenia and is living in the community. Evidence indicates that caring for a relative diagnosed with schizophrenia can be stressful and may result in increasedburden (Cuijpers 1999). The UK National Strategy for Carersrecognizes this and introduced measures to support carers(DoH 1999b). The National Framework for Mental HealthEngland (DoH 1999a) places high priority on carers. Arisingfrom this, clinical standards were set for the professionalsupport of carers of people diagnosed with schizophrenia within Scotland (CSBS 2001).There is a lack of robust evidence on the most effectivemeans of providing support to these carers (DoH 1999a, CSBS 2001, CSBS 2002). As a result, the clinical standardsfail to indicate how carer support should be achieved. Keyfindings from a national review of clinical standards forschizophrenia (Scotland) (CSBS 2002), found that while someinnovative practices existed a comprehensive range of serviceswas lacking. A review of support interventions for carers of people diagnosed with schizophrenia indicates that mostprofessional support has an educational focus (Mari Streiner 1994). However, carers also want emotional andpractical support (CSBS 2002). Not surprisingly, many carersreport that their needs are ignored or given low priority(Nolan et al. 1994, Twigg Atkin 1994, Wray 1994, Atkinson Coia 1995, Chambers et al. 2001). Spaniol(1987) and Milleken (2001) suggest that professionals are often unaware of carer needs and level of service dissatisfaction.Nolan and Grant (1989) highlight that this may lead toirrelevant support and Walker and Dewer (2001) indicatethat this may result in misunderstandings that can increase carer stress and dissatisfaction and inhibit them from seeking further help Complex needs arose from the carers mental health or family problems, social isolation, the client’s mental health problems or admission to hospital. Carers experienced no difficulties arranging sessions with a nurse. Nurses accounts of practice working collaboratively with carers Prior to training, nurses described their contact with carers as largely occurring during crisis or when carers required specificinformation about the client. Nurses described the nature of this contact as informal, ad hoc and unstructured, with no guarantee that carers received the input that they needed. None of the nurses had prior training in carer support and reported that their basic training had not preparedthem to work with carers. A key practice outcome was that nurses work collaboratively with carers. To achieve this nurses had to: listen to andacknowledge the carers’ perspective; remove barriers preventing carers from openly communicating with them; acknowledge the expertise of the carer and adopt an expert to expert approach in their interactions with the carer. Following training, most nurses found working collaboratively with carers to be one of the easiest aspects of their practice. Before I used to think I was the expert. I was there to give information. Now I am more prepared to listen to what carers have to say. I learned a lot from (carer). I really did, about the illness. It is not that I didn’t know about it but I learned what it is like, I suppose, for somebody caring 24 hours a day, 7 days a week. The purpose of the study was to understand the coping experiences of carers living with a family member with schizophrenia by describing their experiences through a qualitative phenomenological approach. Our research may be a valuable reference for mental health professionals seeking to improve the quality of care for people with schizophrenia and their carers.

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For example; the nurse’s position in supporting the patient deciding among a therapy that will lengthen life, but comprehending the quality of life. The patient’s life may be extended, but will experience major unattractive effects from the therapy. Nurses are called upon to use moral perceptions in delivering patient care.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Ethical perceptions include provision of accurate, good and coherent care. Patients necessitate to be offered prospects to put across their autonomy of preference in determining how they desire to be attended and in acquiring services. Ethical nurses identify that they are obliged to offer individualized care which will help the patient to realize their highest welfare. Ethical nursing care is based on lucid decision making and science. There are four fundamental concepts which are significant to a proficient nursing practice. 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Patients need medication to relief the sicknesses, though, in the process of relieving the symptom, the nurse might cause distress. Non-mischief must be balanced by kindness, while providing patient care. The intention of the nurse provides a treatment whose gain must outweigh the discomfort caused. The nurse aim must be to assist rather than causing impairment. Equality and justice in nursing care is usually linked to the delivery of services. The current health care restructu ring strategy is an end result of people acknowledging that the present health care structure requires streamlining. Controversy arises over what is practical, fair, and efficiently realistic.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Nurses are involved at every phase of current health care classification, assisting with policy development and decision making. Professionals propose that nursing concept of ethical care is outstanding case and needs staid implementation throughout the nursing practice. It is related to medical replica of ethics since it deals with life and death matters. The nursing model is one of the personal patient empowerment. Ethical nurses control health care reform plan which put emphasis on healing even in situations where curing is impossible. It position quality of life at the front line. Ethical dilemmas which the nurses face everyday are diverse. They include assorted topics such as end of life care and staffing ratios.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Nurses might face ethical dilemma as they attend patients with disabilities which might position them at peril for self-harm. For instance, an aged patient might be eager to stroll without directive. The nurse desires to endorse patient sovereignty, though the possibility of patient harm because of falling may be large. The dilemma is how to balance the contrasting situations. The nurse is in a dilemma to choose which one is more significant between security and independence. Each family, patient and health care staff faces these challenges in daily basis. Momentous challenges may be experienced by nurses operating with parents who have infants with mental or physical disabilities. The nurse is left to decide whether it is moral to subject the infant to an inexperienced process which will impose pain if it provides them with distinct chance of survival. The nurses have to decide whether it is ethical to prolong life while the quality of li fe is being comprehended.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Recent research findings reveal that, nurses as caregivers central to health care, face a growing rate of ethical dilemma. The know-how is helping patients to endure serious sicknesses. However, recent studies disclose that people are surviving, but they are not living decent lives. Nurses have a task of executing clinical and educational operations which deal with the subject that professional care provides. The other dilemma is that there are insufficient health care resources across the world. The resources are also not equally scattered. The nurses are left to ensure that there is equitable distribution of health care resources. Patients from various cultures and personal experiences may present with different opinions of what is moral. The nurse can serve as resource to make sure that every individual feels that their opinions were considered. They have to decide who should get the scarce resources? For instance, nurses working with p atients living in vegetative state; nurses decide whether these patients should be left on life maintenance? The outlay of sustaining these patients is high. The patients might be consuming possessions that could be utilized by patients whom such expensive interventions, if reachable, could set aside their lives. The dilemma is determining the position of the nurse when a family wishes to go on with life hold up for a medically ineffective patient.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In conclusion, ethical principles are very noteworthy in the nursing practices since they direct the nurses to make their every day decisions. The nurses, however, face ethical dilemma since they are not able to settle to a superior decision. Nursing is a profession that requires a lot of decision making since they are working to save patient lives, though they are required to make decisions depending on the code of ethics. References Blasi, A. E. (2012). An Ethical Dilemma. Journal of Legal Medicine, 33(1), 115-128. Burkhardt, M. A., Nathaniel, A. K. (2008). Ethics issues in contemporary nursing (3rd ed.). Clifton Park, NY: Thomson Delmar Learning. Butts, J. B., Rich, K. (2008). Nursing ethics: across the curriculum and into practice (2nd ed.). Sudbury, Mass.: Jones and Bartlett Publishers. Garber, P. R. (2008). The ethical dilemma. Amherst, Mass.: HRD Press. Garber, P. R. (2008). The ethical dilemma. Amherst, Mass.: HRD Press. Harris, D. M. (2011). Ethics in health services and policy a global approach. San Francisco: Jossey-Bass. Harris, D. M. (2011). Ethics in health services and policy a global approach. San Francisco: Jossey-Bass. Hendrick, J. (2000). Law and ethics in nursing and health care. Cheltenham: Stanley Thornes. Hoffman, J. (2003). A Knotty Ethical Dilemma. Emergency Medicine News, 25(1), 36. Johnstone, M. (2007). Clinical risk management and the ethics of open disclosure when things go wrong: Implications for the nursing profession. Australasian Emergency Nursing Journal, 10(4), 215-216. Liaschenko, J., Peter, E. (2004). Nursing ethics and conceptualizations of nursing: profession, practice and work. Journal of Advanced Nursing, 46(5), 488-495. Retrieved February 8, 2009, from http://dx.doi.org/10.1111/j.1365-2648.2004.03011.x Linzer, N. (2003). An Ethical Dilemma in Volunteer Professional Relationships. Social Thought, 22(4), 37-51. Lowe, M. (2000). Ethical dilemma. A question of competence. Age and Ageing, 29(2), 179-182. Martin, C. W., Vaught, W., Solomon, R. C. (2010). Ethics across the professions: a reader for professional ethics. New York: Oxford University Press. Mcmahon, R. L. (2003). An ethical dilemma in a hospice setting. Palliative Supportive Care, 1(01), 35. Miller, S., Selgelid, M. J. (2008). Ethical and philosophical consideration of the dual-use dilemma in the biological sciences. New York: Springer. Monga, M. (2007). An Ethical Dilemma. Monash Business Review, 3(3), 34-35. Pattison, S. (2010). Emerging values in health care the challenge for professionals. London: Jessica Kingsley Publishers. Spector, T. (2001). The ethical architect: the dilemma of contemporary practice. New York: Princeton Architectural Press. Spector, T. (2001). The ethical architect: the dilemma of contemporary practice. New York: Princeton Architectural Press. Tschudin, V. (2003). Approaches to ethics: nursing beyond boundaries. Edinburgh: Butterworth-Heinemann. Tschudin, V., Davis, A. J. (2008). The globalisation of nursing. Oxford: Radcliffe Pub.. APA formatting by BibMe.org. Source document

Essay on Social Order in The Tempest -- Tempest essays

The Social Order in The Tempest  Ã‚        Ã‚  Ã‚   In Shakespeare's time, the social order was as powerful and rigid as law. Shakespeare provides an example of this social structure in his play, The Tempest. In the course of his play, the reader sees superior men dominating lesser beings on the basis of race, financial status, and gender. Not all upper class are completely corrupt, however. We see a semi-virtuous hero in the character of Prospero. Prospero has every reason to feel superior and exercise his social power, yet he doesn't always treat others disrespectfully. Although he does have some sense of charity, Prospero is still a good example of the social condition of the time.      Ã‚  Ã‚  Ã‚   One way in which The Tempest reflects Shakespeare's society is through the relationship between characters, especially between Prospero and Caliban. Caliban is the former king of the island, and Prospero and his daughter Miranda teach him how to be "civilized." Immediately thereafter, Prospero and Miranda enslave Caliban and he is forced to be their servant. Caliban explains "Thou strok'st me and make much of me... ...otte Porter and Helen A. Clarke (eds.) Thomas Y. Crowell & Co. 1903. Knight, G. Wilson. "Shakespearian Superman" The Tempest D.J. Palmer (ed.) Macmillan & Co. 1968 Murray, J. Middleton. "Shakespeare's Dream" The Tempest D.J. Palmer (ed.) Macmillan & Co. 1968 Palmer, D.J. Shakespeare's Later Comedies: An Anthology of Modern Criticism. Harmondsworth, Penguin, 1971. Shakespeare, William. The Tempest. 1611. Ed. Stephen Orgel. New York: Oxford UP, 1994. Tillyard, E.M. "The Tragic Pattern" The Tempest D.J. Palmer (ed.) Macmillan & Co. 1968

Economic constraints Essay

As part of my applied business GCSE, I have been asked to compare two different companies. The two companies I am going to compare are Nike and McDonald’s. Nike is an LTD, while McDonald’s is a franchise. At the end of this course I aim to get a better understanding of how businesses run.  The business location (McDonalds)  Most of McDonald’s earliest restaurants were opened in the UK during the 1970s, many customers were willing to travel miles to visit them. This specific McDoands is located in archway (N19) McDonald’s believe that their customer convience & research are the things that drive force behind McDonald’s restaurants and locations. Such development has led to new McDonald’s in sites as varied as cross-channel ferries, a bowling alley and London’s former County Hall. The Company is committed to responsible growth, and works closely with local planning officers and community groups when developing a new restaurant. When McDonalds decide to open a new restaurant, it is considered as a long-term proposition. For McDonalds, local knowledge is a key factor to choosing new locations. McDonald’s relies on discussions with local managers who are involved at the grass roots level with their local communities.  Key customers & competitors. (McDonalds)  McDonald’s are one of the leading providers of quick service food globally. In the UK, the company has 1,250 restaurants – around 500 of which are franchised operations. Seen as how McDonalds are a very big and successful franchise, they are bound to have competitors such as:McDonald’s are one of the only franchises to have a goal of no more than two complaints per restaurant per month. Using Business Objects to spot problems early, such as staffing levels, some 500 stores have achieved zero complaints for more than two months. In McDonalds, customer service is improved by information from the three â€Å"Mystery Shopper† visits to each restaurant monthly. This information includes, amongst other criteria, whether or not there was a friendly greeting, whether the server was wearing a name badge, as well as the overall cleanliness of the restaurant.  Some of McDonald’s external influences may affect the way that the business is managed and run. For example, if there were complaints being made about the level of pay for its workers then McDonald’s might have to respond to this. Even though it could be argued that the workers demands are not an external influence the company would still face pressure to make judgments about the nature of its decision-making.  The business location (Nike) Nike are known worldwide and have many stores throughout different countries, these include of:  Austria, Belgium, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Israel, Italy, Netherlands, Norway, Poland, Portugal, Russian federation, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, Turkey, UK and Ireland.  In Nike’s case, it is very important that all of their locations suit to their liking because Nike aims to get out of their store locations including, profit and popularity. Before building a new store, Nike may need to take into account the following factor.

Program Evaluation And Measurement Tools - 1480 Words

Program Evaluation and Measurement tools Hypertension (HTN) is a chronic illness that serves as a main risk factor for cardiovascular disease (Hanus, Simoes, Amboni, Ceretta, Tuon, 2015). Although medication can manage HTN appropriately, lifestyle modifications make a substantial difference as well. However, many patients go through behavior stages in which he or she contemplate on making the necessary changes to improve their health. One solution to the problem is the development of an educational Hypertension Intervention and Follow-Up program (HIFP). Studies have shown that active educational interventions that incorporate small groups are more effective than passive delivery of educational materials (Pimenta, Caldiera, Mamede,†¦show more content†¦Utilizing the CDC’s framework for evaluation will allow the program design to be tailored for implementation. Efficacy is defined as the ability to produce the desired result (â€Å"Efficacy,† n.d.). One way to establish efficacy is to test the knowledge of the health care providers. The blood pressure program will be ineffective if the providers lack HTN knowledge. The author will plan to evaluate fluctuations in employee knowledge, attitudes, and viewpoints about blood pressure screening and control. Furthermore, the health care team members need to understand how to measure a manual blood pressure adequately. Accurate blood pressure readings will facilitate more validity in the results (CDC, 2014). Efficiency distinctly represents the ability to accomplish tasks in the least amount of time and effort (â€Å"Efficiency,† n.d.). Measurement tools used for determining efficiency will be proper staffing, working equipment, various sizes of blood pressure cuffs, and acceptable space for the program. Quality is the characteristic or feature that something possesses ( "Quality,† n.d.). Trained health care providers will aid the program in obtaining good quality. Also, new sphygmomanometer that are calibrated and education pamphlets will serve as increasing the quality of the program. Intervention Plan Outcomes Short-term outcomes The short-term goals ofShow MoreRelatedPolicy Monitoring vs. Policy Evaluation Comparison712 Words   |  3 PagesPolicy Monitoring vs. Policy Evaluation Comparison Team D: Aaron Sawyer, Paulette Banks, Buck Charley, Greg Bradley CJA/385 Criminal Justice Policy Analysis amp; Program Evaluation May 23, 2016 Professor: Dr. Duane Benton Policy Monitoring vs. Policy Evaluation Comparison Policy Monitoring Monitoring policies allows the gathering of factual information as to the causes and outcomes of criminal justice policies. For policy monitoring to be effective the information gathered must be relevantRead MoreSeen from the responsibilities definitions only, the objective shown in Figure 1 presents the800 Words   |  4 Pagesthe scope of the responsible authority actions in the evaluation. 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