Asthma Case Study

University of Perpetual Help System – DALTA Alabang – Zapote Road, Pamplona, Las Pinas City College of Nursing A Case Study of Bronchial Asthma In Acute Exacerbation (BAIAE) Submitted by: Angela Marie Ferrer BSN 3B July 17, 2012 Definition A condition of the lungs characterized by widespread narrowing of the airways due to spasm of the smooth muscle, edema of the mucosa, and the presence of mucus in the lumen of the bronchi and bronchioles.Bronchial asthma is a chronic relapsing inflammatory disorder with increased responsiveness of tracheobroncheal tree to various stimuli, resulting in paroxysmal contraction of bronchial airways which changes in severity over short periods of time, either spontaneously or under treatment. Causes Allergy is the strongest predisposing factor for asthma. Chronic exposure to airway irritants or allergens can be seasonal such as grass, tree and weed pollens or perennial under this are the molds, dust and roaches.Common triggers of asthma sy mptoms and exacerbations include air way irritants like air pollutant, cold, heat, weather changes, strong odors and perfumes. Other contributing factor would include exercise, stress or emotional upset, sinusitis with post nasal drip, medications and viral respiratory tract infections. Most people who have asthma are sensitive to a variety of triggers.A person’s asthma changes depending on the environment activities, management practices and other factor. Factors that can contribute to asthma or airway hyperreactivity may include any of the following: * Environmental allergens: House dust mites, animal allergens (especially cat and dog), cockroach allergens, and fungi are most commonly reported. * Viral respiratory tract infections * Exercise; hyperventilation * Gastroesophageal reflux disease * Chronic sinusitis or rhinitis Aspirin or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity, sulfite sensitivity * Use of beta-adrenergic receptor blockers (including ophth almic preparations) * Obesity: Based on a prospective cohort study of 86,000 patients, those with an elevated body mass index are more likely to have asthma. * Environmental pollutants, tobacco smoke * Occupational exposure * Irritants (eg, household sprays, paint fumes) * Various high and low molecular weight compounds: A variety of high and low molecular weight compounds are associated with the development of occupational asthma, such as insects, plants, latex, gums, diisocyanates, anhydrides, wood dust * Emotional factors or stress * Perinatal factors: Prematurity and increased maternal age increase the risk for asthma * Breastfeeding has not been definitely shown to be protective. * Both maternal smoking and prenatal exposure to tobacco smoke also increase the risk of developing asthma Clinical ManifestationThe three most common symptoms of asthma are cough, dyspnea, and wheezing. In some instances cough may be the only symptoms. An asthma attack often occurs at night or early i n the morning, possibly because circadian variations that influence airway receptors thresholds. An asthma exacerbation may begin abruptly but most frequently is preceded by increasing symptoms over the previous few days. There is cough, with or without mucus production. At times the mucus is so tightly wedged in the narrow airway that the patient cannot cough it up.Prevention Patient with recurrent asthma should undergo test to identify the substance that participate the symptoms. Patients are instructed to avoid the causative agents whenever possible. Knowledge is the key to quality asthma care. Medical Management There are two general process of asthma medication: quick relief medication for immediate treatment of asthma symptoms and exacerbations and long acting medication to achieve and maintain control and persistent asthma.Because of underlying pathology of asthma is inflammation, control of persistent asthma is accomplish primarily with the regular use of anti inflammatory m edications. * Long-acting control Medication Corticosteroid are the most potent and effective anti inflammatory currently available. They are broadly effective in alleviating symptoms, improving air way functions, and decreasing peak flow variability. Cromolyn sodium and nedocromil are mild to be moderate anti-inflammatory agents that are use more commonly in children.They also are effective on a prophylactic basis to prevent exercise-induced asthma or unavoidable exposure to known triggers. These medications are contraindicated in acute asthma exacerbation. `Long acting beta-adrenergic agonist is use with anti-inflammatory medications to control asthma symptoms, particularly those that occur during the night these agents are also effective in the prevention of exercise-induced asthma. * Quick relief medication Short acting beta adrenergic agonists are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma.They have the rapid onset of acton. Anti-cholinergic may have an added benefit in severe exacerbations of asthma but they are use more frequently in COPD. Nursing Management The main focus of nursing management is to actively assess the air way and the patient response to treatment. The immediate nursing care of patient with asthma depends on the severity of the symptoms. A calm approach is an important aspect of care especially for anxious client and one’s family. This requires a partnership between the patient and the health care providers to determine the desire outcome and to formulate a plan which include; * the purpose and action of each medication * trigger to avoid and how to do so * when to seek assistance the nature of asthma as chronic inflammatory disease Anatomy and Physiology The upper respiratory tract consists of the nose, sinuses, pharynx, larynx, trachea, and epiglottis. The lower respiratory tract consist of the bronchi, bronchioles and the lungs.The major function of the respiratory system is to deliver oxygen to arterial blood and remove carbon dioxide from venous blood, a process known as gas exchange. The normal gas exchange depends on three process: * Ventilation – is movement of gases from the atmosphere into and out of the lungs. This is accomplished through the mechanical acts of inspiration and expiration. * Diffusion – is a movement of inhaled gases in the alveoli and across the alveolar capillary membrane * Perfusion – is movement of oxygenated blood from the lungs to the tissues.Control of gas exchange – involves neural and chemical process The neural system, composed of three parts located in the pons, medulla and spinal cord, coordinates respiratory rhythm and regulates the depth of respirations The chemical processes perform several vital functions such as: * regulating alveolar ventilation by maintaining normal blood gas tension * guarding against hypercapnia (excessive CO2 in the blood) as well as hypoxia (reduced tissue oxy genation caused by decreased arterial oxygen [PaO2]. An increase in arterial CO2 (PaCO2) stimulates ventilation; conversely, a decrease in PaCO2 inhibits ventilation. helping to maintain respirations (through peripheral chemoreceptors) when hypoxia occurs. The normal functions of respiration O2 and CO2 tension and chemoreceptors are similar in children and adults. however, children respond differently than adults to respiratory disturbances; major areas of difference include: * Poor tolerance of nasal congestion, especially in infants who are obligatory nose breathers up to 4 months of age * Increased susceptibility to ear infection due to shorter, broader, and more horizontally positioned eustachian tubes. Increased severity or respiratory symptoms due to smaller airway diameters * A total body response to respiratory infection, with such symptoms as fever, vomiting and diarrhea. Diagnostic procedures: * General Physical Examination * Skin: * Observe for the presence of atopic derm atitis, eczema, or other manifestations of allergic skin conditions * Evidence of respiratory distress manifests as * increased respiratory rate, * increased heart rate, * diaphoresis, and * use of accessory muscles of respiration. * Marked weight loss or severe wasting may indicate severe emphysema. * Pulsus paradoxus: * This is an exaggerated fall in systolic blood pressure during inspiration and may occur during an acute asthma exacerbation. * Depressed sensorium: * This finding suggests a more severe asthma exacerbation with impending respiratory failure. * Chest Examination * End-expiratory wheezing or a prolonged expiratory phase is found most commonly, although inspiratory wheezing can be heard. * Diminished breath sounds and chest hyperinflation (especially in children)  may be observed during acute asthma exacerbations. The presence of inspiratory wheezing or stridor may prompt an evaluation for an upper airway obstruction such as vocal cord dysfunction, vocal cord paraly sis, thyroid enlargement, or a soft tissue mass (eg, malignant tumor). * Differential Diagnoses * Airway Foreign Body Heart Failure Allergic and Environmental Asthma Pulmonary Embolism Alpha1-Antitrypsin Deficiency Pulmonary Eosinophilia Aspergillosis Sarcoidosis Bronchiectasis Sinusitis, Chronic * Bronchiolitis Tracheomalacia COPD URTI Churg-Strauss Syndrome Vocal Cord Dysfunction Cystic Fibrosis Foreign Body Aspiration Gastroesophageal Reflux Disease Laboratory Studies * Blood eosinophilia greater than 4% or 300-400/ µL * Eosinophil counts greater than 8% may be observed in patients with concomitant atopic dermatitis. * This finding should prompt an evaluation for allergic  bronchopulmonary aspergillosis,  Churg-Strauss syndrome, or  eosinophilic pneumonia * Total serum immunoglobulin E levels greater than 100 IU are frequently observed in patients experiencing allergic reactions, but this finding is not specific for asthma * British Thoracic Society recommends using sputu m eosinophilia determinations to guide therapy Imaging Studies In most patients with asthma, chest radiography findings are normal or may indicate hyperinflation. * Chest radiography should be considered in all patients being evaluated for asthma to exclude other diagnoses. * Sinus CT scanning may be useful to help exclude acute or chronic sinusitis as a contributing factor.. Pulmonary function testing (spirometry) * Spirometry assessments  should be obtained as the primary test to establish the asthma diagnosis. * Spirometry should be performed prior o initiating treatment in order to establish the presence and determine the severity of baseline airway obstruction. * The assessment and diagnosis of asthma cannot be based on spirometry findings alone because many other diseases are associated with obstructive spirometry indices. * Spirometry measures the forced vital capacity (FVC), the maximal amount of air expired from the point of maximal inhalation, and the FEV1. A reduced rat io of FEV1 to FVC, when compared with predicted values, demonstrates the presence of airway obstruction. Optimally, the initial spirometry should also include  measurements before and after inhalation of a short-acting bronchodilator in all patients in whom the diagnosis of asthma is considered. * Reversibility is demonstrated by an increase of 12%  and 200 mL after the administration of a short-acting bronchodilator Methacholine- or histamine-challenge testing * Bronchoprovocation testing with either methacholine or histamine is useful when spirometry findings are normal or near normal, especially in patients with intermittent or exercise-induced asthma symptoms. Bronchoprovocation testing helps determine if airway hyperreactivity is present, and a negative test result usually excludes the diagnosis of asthma. * Methacholine is administered in incremental doses up to a maximum dose of 16 mg/mL, and a 20% decrease in FEV1, up to the 4 mg/mL level, is considered a positive test r esult for the presence of bronchial hyperresponsiveness. Peak-flow monitoring * Peak-flow monitoring is designed for ongoing monitoring of patients with asthma because the test is simple to perform and the results are a quantitative and reproducible measure of airflow obstruction. It can be used for short-term monitoring, exacerbation management, and daily long-term monitoring. * Peak-flow monitoring should not be used as a substitute for spirometry to establish the initial diagnosis of asthma. * Results can be used to determine the severity of an exacerbation and to help guide therapeutic decisions as part of an asthma action plan. Exercise testing * Testing involves 6-10 minutes of strenuous exertion at 85-90% of predicted maximal heart rate and measurement of postexercise spirometry for 15-30 minutes. The defined cutoff for a positive test result is a 15% decrease in FEV1 after exercise. Eucapnic hyperventilation * Eucapnic hyperventilation with either cold or dry air is an alter nate method of bronchoprovocation testing. * It has been used to evaluate patients for exercise-induced asthma and has been shown to produce results similar to those of methacholine-challenge asthma testing. I. LABORATORY WORKS NAME OF TEST| NORMALVALUE| RESULTS| SIGNIFICANCE| Complete Blood CountPurpose: CBC is ordered to aid in the detection of anemias; hydration status; and as part of routine hospital admission test.The differential WBC is necessary for determining the type of infection. | RBC: 4-6 x 10/LHct: 0. 37- 0. 47Hgb: 110- 160 gm/LWBC: 5-10 x 10 /LLymphocytes:0. 25-0. 35Segmenters: 0. 50-0. 65Eosinophil: 0. 01-0. 06| 5. 480. 481598. 20. 250. 580. 07| Increased segmenters (mature neutrophils) reflect a bacterial infection since this are the body’s first line of defense against acute bacterial invasion. Lymphocytes are decreased during early acute bacterial infection and only increase late in bacterial infections but continue to function during the chronic phase. | I I. DRUG STUDYName of the drug | Classification | Dosage/ Frequency | Route | Mechanism of Action | Indication | Nursing Responsibilities | Generic name:Duavent ( ipratropium salbutamol) Brand name:DuaNeb | Salbutamol Sulfate| Nebule q 1 hour| Oral nebulization | The combination of ipratropium and albuterol is used to prevent wheezing, difficulty breathing, chest tightness, and coughing. | Management of reversible bronchospasms associated with obstructive airway diseases, bronchial asthma| Take care to ensure that the nebulizer mask fits the user's face properly and that nebulized solution does not escape into the eyes. * Evaluate therapeutic response. |

Black social movements Essay

Race is used by social scientists to refer to distinctions drawn from physical appearance (skin color, eye shape, physiognomy), and ethnicity is used to refer to distinctions based on national origin, language, religion, food, and other cultural markers. â€Å"Race has a quasi-biological status and among psychologists, the use of race terminology is hotly debated In the United States, race is also a socially defined, politically oppressive categorization scheme that individuals must negotiate while creating their identities. † (Frable , 1997, 139) Before the Black Power Phase of the Black Social Movement, blacks displayed a decidedly dualistic worldview. After 1968, a trend toward a black perspective, which is almost as significant as the dualistic frame, becomes apparent. A reactionary, extreme pro white position is seldom advocated: The dualistic, integrationist ethic was perhaps stronger in the past than it is today, although it is probably still the dominant ideology among blacks. Finally, over the past 25+ years, a nationalistic black oriented ideology has become increasingly important in discussions of black affairs. The racial and ethnic identity terms are often used inappropriately in psychology. While black immigrants to the United States may have a racial identity as black, their ethnic identity reflects their country of origin; racial identity is much more likely to be problematic in the United States than ethnic identity. Whether a researcher assesses racial identity, ethnic identity, or some combination may only be clear after reading the Methods section of their report. EVIDENCE OF IDENTITY CHANGE: 1968-PRESENT The Black Social Movement had two phases: (1) the Civil Rights Phase, which lasted from 1954-1967 and (2) the Black Power Phase, which began to take hold from 1965-1967. (See Exhibit 1) 118 or 73% were conducted during the period 1968-1977. Of these, 22 (19%) were Black group oriented, 84 (71%) were personal self-worth related and 12 (10%) applied personal self-worth and Black group oriented measures on the same sample. A significant number of both Black group and personal self-worth studies from this period show blacks with an increased in-group orientation and adequate to above average levels of self-esteem. (Allen et al, pg. 161)The Black Movement has increased the probability that more blacks will superimpose a black orientation upon a greater variety of situations. As a perspective, the extent to which the world view of the mainstream group (Americanism) has been internalized by a Black person is not one of self-rejection as it was in the past. As a result, some 20 years later and as a side product of the mind set change, Hip-hop (music) was created in the mid-seventies as black social movements began to take less noticeable role in the African-American communities and mainstream media, and replaced by electoral politics. â€Å"It has deep sixties cultural and political roots; Gil Scott-Heron and The Last Poets are considered the forebears of rap. But once the institutions that supported radical movements collapsed or turned their attention elsewhere, the seeds of hip- hop were left to germinate in American society at large-fed by its materialism, misogyny and a new, more insidious kind of state violence. † (Ards, 1999, p. 11) This suggests racial motivation impetus more of a political-cultural propensity rather than a psychological trait. All along, even during the racial segregation and Jim Crow, Blacks have consistently had a high sense of personal worth. The Black Movement probably had a less dramatic effect on the personal identity as opposed to the reference group orientation of black people as whole. Blacks have had, and continue to have, a multifaceted reference group orientation that determine behavior depending upon the situation being confronted. BLACK ELITE LIBERAL CONCEPT â€Å"Is this America? Land of the Free and Home of the Brave? † Fannie Lou Hamer’s question still rivets attention, for it is at once radical and conservative, communitarian and individualistic, a plaintive cry and a hardened protest, fiercely American and defiant of America. (Robinson, 1997, p. 179) While not a new paradigm in and of itself (and while certainly reductionist), Cedric J. Robinson, in Black Movement in America, calls for framework forces one to consider social movements. He points out that the very success of black activism during the Civil War would point the way toward future divisions within black political culture. Both free black leaders and the masses of Southern slaves who rebelled against their masters turned a white war into a battle over slavery and racial injustice. (Newman, 1999, 683) Slavery’s destruction, ironically, removed a common focus of protest, and more importantly, enticed certain â€Å"black elites† to accept the â€Å"liberal concept† of changing American political culture by trying to join it and reform it from within. These elite representatives were â€Å"largely irrelevant† in Robinson’s eyes, for the black masses focused on community-building and autonomy (Robinson, 1997, p. 92). The black social movements of the 60’s and 70’s single indicator of common social beliefs may simply be related with other dimensions and intangibles yet to be discovered or even recognized. In brief, due to the impact of during the ten to fifteen year span, black consciousness and awareness had become so pervasive throughout the black population that by the late seventies†¦Ã¢â‚¬  a single item tapping common-fate solidarity was adequate to capture a fully politicized sense of group consciousness. Of course, other changes in the political landscape may also contribute to such a shift. For instance, collective political efficacy among black Americans may have been enhanced by the growing number of black elected officials. † (Bobo & Gilliam 1990) A generation has almost passed since the social activisms of the late 50’s and upheaval turbulent 60s and birth of modern day public black social movement. There are now thousands of black elected and appointed officials throughout the United States. Southern presidents have been elected to the White House since 1976, both of whom received the overwhelming support of the African American electorate. A great deal of literature has been devoted to the position that Black working people and the poor challenged the â€Å"system† by establishing, ad hoc or organized significant black social movements that were rooted simultaneously in a political and social tempest. However, thus knowing that a person has a strong black identity will not inform the listener about the nature of his/her personal identity; however, it gives considerable insight into the person’s value system, political posture, and cultural stance. REFERENCE(S) Deborrah E. S. Frable , 1997, Article Title: Gender, Racial Ethnic, Sexual andClass Identities. Journal Title: Annual Review of Psychology. Volume: 48. Page Number: 139+. Angela Ards, 1999, Organizing the Hip-Hop Generation. Magazine Title: The Nation. Volume: 269. Issue: 4. Publication Date: July 26,1999 Page Number: 11. Cedric J. Robinson, 1997, Black Movements in America. (New York: Routledge,. p. 179, 92 ) Rich Newman, 1999, Black Movements in America. Journal Title: The Historian. Volume: 61. Issue: 3. Publication Page Number: 683. Walter Recharde Allen, Geraldine Kearse Brookins, Margaret Beale Spencer,1985, Beginnings: The Social and Affective Development of Black Children. Publisher: Lawrence Erlbaum Associates. Place of Publication: Hillsdale, NJ. Bobo, Lawrence. 1988 â€Å"Attitudes Toward The Black Political Movement: Trends, Meaning, and Effects on Racial Policy Preferences. † Social Psychology Quarterly 51:287-302. Gilliam, Franklin D. , and Kenny J. Whitby. 1989 . â€Å"Race, Class, and Attitudes Toward Social Welfare Spending: An Ethclass Interpretation. † Social Science Quarterly 70:88-100.

Book Banning Essay

Tony Ballantyne once said, â€Å"The Unprepared will eventually be destroyed; ignorance is no hiding place. † With this he meant that ignoring certain topics in life sets a person up for failure. This is exactly what is happening in public schools by banning books and limiting a child’s variety of reads. Banning books stunts the expansion of the creative and intellectual mind while withholding information on scandalous subjects that are apparent in everyday life. By taking certain books away from students you cap a lid on a child’s perspective of the real world and isolate their minds into what is known as â€Å"safe. †Taking books away from the public eye demolishes the chance for people to think beyond their comfort zones and challenge their minds. Book banning prevents students from extending their minds to foreign concepts and slows the development of their brains by withholding information needed. As Americans we have the right to pick and choose what we do and do not want to read. Books of all subjects deserve the right to be available to all students because every book has a message portray and it’s those messages that further the development of the brain. â€Å"Not every book will be right for every reader, but the freedom to choose for ourselves from a full array of possibilities is a hard-won right that we must not take for granted in this country,† (Platt). Just because a book is put on a shelf does not mean society is forcing you to read it! It’s your freedom of choice to decide what books you want to read, but it isn’t your decision to control what other people read. The choice to read a certain book is all yours and it’s your job to allow other people to choose for themselves. A full selection of books on every topic you can possibly think of is the type of shelf every library should have. One’s mind cannot be challenged by â€Å"playing it safe† with books that take no risk, and you cannot learn from or about topics you have not been exposed to. Book banning tries to hide controversial topics from the adolescent mind but in an attempt to protect the children; we’re simply harming them by limiting their minds. â€Å"It is through fantasy that children achieve catharsis. It is the best means they have for taming Wild Things. † (Bancroft). If we didn’t allow all books to be available for students to choose from than they wouldn’t be able to access the creative sides of their minds. Fantasy created by authors opens doors that unlock a world of creative outlooks in a child, if those books aren’t accessible for students, than art in the future might as well be dead. They say the Earth without Art is â€Å"EH,† if that’s so than libraries that allow book banning are contributing to a future society on earth with a lack of art. Parents banning books are blinding the children of America from issues and risky topics surrounding them in their everyday life. Book banning denies students from engaging in controversial conversation and refuses to open the eyes of the adolescent to the beauties of the natural world around them. â€Å"Books dealing with edgy, dark subject matter such as addiction, abuse, suicide, and teen prostitution can offer young adult readers a broader perspective on the world, but these qualities often make such books and their authors a target for would-be censors† (Manning). Books teach and inform students all over the nation in ways that cannot simply be taught in a classroom. They allow the reader to paint a picture in his/her head and visualize scene by scene. Books questioned for censorship are ones that introduce new concepts for readers which then give them a position on the topic and an opinion of their own. By taking that away from the students, you strip them of their potential of a broader outlook in life. With that also comes the lack of knowledge to understand and accept their peers. Books introduce characters and personalities like ones who surround you daily, but they also provide insight on how to better understand those characters and feel empathy towards them. â€Å"They experience crippling difficulties in school, in social relations and in all matters of self-esteem. They use the language I use in the story and worse because it is all they have to try to match what is inside to the outside world. They need to be recognized, and brought into your fold. Often we adults can’t help them, but you can. I write the stories I write to bring things like this to your attention because I believe if kids who are treated badly are to survive, they will survive through the acceptance of their peers, and that acceptance will come from understanding. † (Cutcher). Parents try to take away books that may contain any ‘inappropriate’ content to shield their child of foreign concepts, but this content labeled as inappropriate is what their children have to face daily. All that book banning is doing is under-educating students about the real world and life as it stands in modern day. In school teachers prepare their students for anything and everything that comes next in their students journey, yet they ban the books that will best prepare them and inform them of the aspects of life never  covered in a Social Studies Textbook. Some may argue that topics in certain books are too corrupting for students to know about, these topics include: graphic language about sex, drinking, and drugs. These very subjects, whether you like it or not, are always going to be a part of life no matter what the situation. Instead of avoiding the topic, parents should inform their children of it so that they are prepared for whatever crosses their path in the future. As care-takers, parents have the duty of setting their child up for success in any way, shape, or form, and by allowing all books to be available to the children of public schools, they’re doing just that. Books shouldn’t be banned from public schools because by limiting the variety of novels on shelves, you limit the horizons of a student’s creative mind. Banning books withholds information on subjects that are thought of as scandalous and controversial and by doing so, under-educates the students who are the future of society.

Analysis of Anaesthetic Nursing Research Paper Example | Topics and Well Written Essays - 3250 words

Analysis of Anaesthetic Nursing - Research Paper Example Since nurses have to play a significant role in the patients’ care, tactfulness, knowledge, experience in handling an emergency situation, discretion, judgment, alertness, and empathy on their part are very important for overall efficiency in treatment to the patients. Evidence-based anesthesia nursing practice calls for placing more emphasis on literature evidence than scientific studies for enhancing the expertise in the field of anesthesia. For use of current evidence in providing care to the patients, it is essential to analyze the existing evidence in terms of definition of the problem, applications used to overcome the problems, methods adopted, reliability of the evidences used for the study, clinical trials, surveys, expert opinions or case reports and applicability of the evidences to the present case for formulating strategies and implementation by establishing standards. Evolution of Anaesthetic nursing Though Nightingale’s ideology is considered as the start ing point for modern nursing, the theoretical basis for nursing has evolved later in history. Frederic Hewitt’s textbook on Anaesthetics and their Administration in 1893 was an important milestone in training in the field of anesthesia (Scurr, 1971, p. 275). Ether and chloroform had been used as anesthetic agents for a long time as they were effective and fast. A patient â€Å"under ether, sinks into a calm and dreamless sleep† and surgery is performed successfully without suffering pain, but â€Å"the danger in breathing ether is chiefly from impeded or failing respiration† (Cheever, 1884, p. 509). However, after the advent of advanced and safer inhalation anesthetic agents, the use of ether and chloroform has been gradually stopped. Chloroform was widely used as an anesthetic agent. However, it was later found that it caused cardiac problems to the patients and abandoned also due to its toxic properties. Brandy, opium, and cocaine were used as anesthetics thro ughout the world in various countries. There is a number of derivatives such as amylocaine and procaine that are cocaine based. Regulations and standardization in different countries brought control over their manufacturing and use. Opioid compounds have been used in the treatment of pain for a long time in medical history due to its analgesic effects. Opiate-based drugs like Codeine and Hydrocodone have been used as pain killers. These drugs have addictive properties which lead to dependence on these drugs. Morphine is a widely used opiate analgesic drug and regarded as a standard analgesic. The advent of morphine which could be injected hypodermically changed the course of anaesthesiology completely. Diamorphine called a heroine used to treat severe pain can also be administered intravenously. Nitrous oxide is commonly used in dentistry as inhalation analgesia. It is considered effective and safe to provide moderate sedation. It is effective as a general anesthesia for suppressing all sensations. It should be cautiously used in some cases like schizophrenia or pregnancy. â€Å"Nitrous oxide (N2O) has been used for about 150 years in clinical anesthesia.  Ã‚  

Are reason and emotion equally necessary in justifying moral decisions Essay - 5

Are reason and emotion equally necessary in justifying moral decisions - Essay Example A second way of knowing is through personal experience or self-witnessing. The media sources like newspapers and television may or may not always be trustworthy. One needs to use his or her own discretion elaborately before trusting the information. Sometimes we may believe in a certain aspect merely by our personal inspiration or intuition. This is the third way of knowing. Some concepts and ideas take birth in our brains and remain there as a piece of knowledge gained. Sometimes we might just rely on a feeling and an inner guidance that may lead us to the truth or the right path. A fourth way of knowing is by using reason and careful analysis. This is a powerful approach where knowledge may be gained by critically and logically analyzing the other three cases. (â€Å"Measurement, Evaluation & Research: Ways of Knowing†, 2008) Now, when we look at all the ways of knowing, we may conclude that finally each of them is flawed. As far as the first way is concerned, the book or text might consist of misprints and errors. There may be some information, which might differ from one book to another. Personal experience or eye witnessing is also dependent upon optical illusion or error of vision. Personal inspiration or intuition might also become invalidated or reason might not support this personal opinion. Again, reason might be right to one but wrong to another. Hence this way of gaining knowledge is not a valid one. However, Kerlinger provides a different angle to validate the four different ways. The first case, that is gaining knowledge by reading signifies a group’s belief and can be taken as the truth. This is the process of tenacity where the knowledge is common to a certain group. (Kerlinger 1973) In the second case, the personal experience one gains is at least true to the person concerned. The third method may be justified on the basis of personal intuition. Such a way of knowing may be justified on the basis of individual belief and

What is the impact of SOA in industry Essay Example | Topics and Well Written Essays - 1000 words

What is the impact of SOA in industry - Essay Example oach that asserts the intention to build software assets in an organization in order to improve the organization efficiency in meeting its needs (Marks, 2013, p.98). In this context, the term service refers to a unit of functionality that is self-contained like doing and online shopping or a retrieval of a bank statement in the internet. It is as a result of SOA that computer that are interconnected in an organization are able to cooperate, with adoption of the SOA rapidly gaining some popularity in the modern world especially in the large businesses and centralized organizations. Service-oriented architecture creates a situation whereby every computer in the network can perform indiscriminate number of services while still capable of exchanging different information in an easy way. Exchange of information between the various computers that are interconnected is made possible without any need for human interaction or change in the primary program .Application of SOA is associated with numerous advantages that make it appear like it is the dominant form of enterprise architecture in the modern world. One of this key advantage that has made the system become popular is the ability of the system to allow continuous use and easy-sharing of data between various programs vendors without necessarily having to buy an additional program or make changes to the services. Moreover, in most cases the services provided by the system are reusable, a factor that lowers the total cost in terms of the development and maintenance cost, while at the same time providing much valu e after the development and testing of the service. However, SOA is not likely to make any difference or be beneficial to a business organization especially if the organization adopting is small (does not have two or more primary systems that require a degree of integration), or the organization is large but is far much decentralized. Despite the above-mentioned benefits of using SOA in an organization, there

How Does the Talent Pipeline Impact on the Employment Relationship Essay

How Does the Talent Pipeline Impact on the Employment Relationship - Essay Example The involvement of recruiting and selection in the successful development of the employment relationship is explored in this study. Different approaches have been used in the literature for explaining the interaction between the recruiting/ selection processes and the employment relationship. All of these approaches lead to a particular assumption: both recruiting and selection are critical for the success of employment relationship; however, the level of involvement of these processes in employment relationship is not standardized being depended on the organization’s internal and external environment but also the skills and competencies of the individuals, i.e. the HR managers, who overview these processes. 2. Recruiting and selection and impact on employment relationship Recruiting and selection can highly influence the employment relationship. As explained above, the specific processes are parts of the first component of the Talent Pipeline model, as developed by CIPD in 20 06 (Figure 1, below); an alternative form of the Talent Pipeline, as developed in 2007 is also presented in Figure 2. The impact of these processes on employment relationship is analyzed below, using the views of the literature, as related to the particular subject. Figure 1 – The Talent Pipeline Figure 2 – The Talent Pipeline, CIPD 2007 CIPD 2006 (Source CIPD 2006) (Source: London Management Centre 2011) 2.1 The recruiting process as part of the talent pipeline and its effects on employment relationship The impact of recruiting on the employment relationship cannot be doubted. In fact, it seems that the power of recruitment to affect the employment relationship is verified by the law. A critical example is ‘Conciliation and Arbitration Act 1904, Australia’ (Stewart 2011, p.143). The specific legislative text promotes the following idea: the recruitment process can directly affect the employment relationship (Stewart 2011); for this reason, a dispute relat ed to the recruitment process should be characterized as ‘an industrial matter’ (Stewart 2011, p.143). Indeed, in the case Re Manufacturing Grocers (1986), the Court held that ‘an employment matter should be characterized as industrial only when it affects directly the employment relationship’ (Stewart 2011, p.143). It was also held that the recruiting process can be an industrial matter, since ‘it has the power to affect directly employment relations’ (Stewart 2011, p.143). The research of Guest and Conway (2002, quoted by Lewis, et al. 2003, p.15) verified the power of the recruitment process to impact the employment relationship. In the context of the above research, 1300 HR managers were asked to mention the factors that are most likely to influence the psychological contrac

Final Class Project Essay Example | Topics and Well Written Essays - 1750 words

Final Class Project - Essay Example As noted by his expert witness, the sacral bedsores and the ulcers first appeared while he was immobile in a Minerva bracer and also when he was on the ventilator. In the nursing profession, patients who face high risk for skin breakdown are to be turned every 2 to 3 hours. The turning of the patients helps in blood circulation throughout the body and eases the pressure on the surface of the skin, which is in contact with the bed. In this case, it can be argued that consistent turning didn’t happen. This is because if the actual turning took place, the patient would not have developed such sores and ulcers. The Florida nurse practice act under section [464.018(8) (h)], clearly discourages the nurses from acting inappropriate and unprofessional. The nurses deviated from the standards as stipulated in the above-mentioned legislation and hence are bound to provide compensation to the patient. It is through the negligence and unethical conduct of the nurses that made Mr. Paul contract the skin lesions. As professionals, they were supposed to provide quality care and hence could have prevented the occurrence of skin lesions on the patient. The nurses’ conduct of unprofessionalism is a deviation from the standards and legislations governing all nurses. A good expert witness must be a good public speaker. Due to the demanding nature of the court proceedings, an expert witness must be able to explain ideas in a clear and precise manner. He/she should also be very conversant with the court terminologies and hence represent the client fully. In addition, he/she should show confidence while speaking because confidence shows professionalism and hence the jury builds trust on your witness account. Therefore, good speaking is necessary for a nurse aspiring to be a good expert witness. It is a requirement that an expert witness should be actively involved in his field of specialization. The active involvement in the medical field

Managing in a global society Essay Example | Topics and Well Written Essays - 1500 words

Managing in a global society - Essay Example In this scenario, strategies are adopted in taking into account different layers of parameters with the first being culture of the host nation, and subsequently situational as well as strategies pertaining to the process of centralization or decentralization. Understanding and adopting culture of the foreign subsidiary nations, current global industrial trends, pertinent values, and important principles are the contributing factors for the successful global commercial venture. Conventionally economic and management factors are considered while framing strategies for developing international business relations however research and studies have found tremendous impact of culture on establishing strong foreign relations in the form of joint ventures as well as fully owned subsidiaries. Some of the studies suggest joint venture as the most adequate strategically motivated move with the nations having vast cultural differences or vice-versa. However to achieve success, trustworthiness and reliability should be taken into consideration while reducing risks for any opportunistic tendencies. As different cultures have different levels of trustworthiness, it is equally important to weigh all the possible outcomes, opportunities as well as obstacles before forging international relations. ... ould forge a new relationship with the host nation having vast cultural differences by fully utilizing its extensive knowledge (Lee, Bang, Ha & Lee, p. 3). As a CEO of UK firm, I need to take into consideration various cultural parameters if subsidiary in USA and Japan has to enter into success. There is no doubt a fact that in both the USA and UK, language is same and United Kingdom would need little of adjustment while dealing with Americans in contrast to Japan, yet for Americans this assumption puts them in the most difficult situation and less productive. As Craig Storti suggests, â€Å"Because we speak the same language, Americans think they’re not going to have any communication problems with the English,† (Doke 2004, p. 1) but in reality there is a vast difference as the language that appears to be same but have different phrases, unfamiliar terms and meanings. George Bernard Shaw, 20th century Irish playwright and a political strategist, once claimed that Unite d States and England are the two nations having same language still they are divided. It is quite true that the major difference is in English language and its usage can cause many problems and obstacles for the Britons and Americans who are working together as for instance Americans make use of the sports metaphors quite often while having business talks which can be very difficult for us to understand. On the other hand, Britons are habitual in speaking more but with fewer words and this often become the most ordeal task for the Americans to understand (Doke 2004, p. 1). According to Doke, â€Å"Unfamiliar nuances and British attitudes about work, personal ambition, individualism, efficiency, business meetings and communications may run counter to your employees’ experiences and expectations† (2004,

Predictiveness and the Level of Processing Research Paper - 1

Predictiveness and the Level of Processing - Research Paper Example M, 27 September 2008). Memory does a very important job which is to remember and the same has some vital subdivisions such as attention, encoding, rehearsal and retrieval. It is believed that the durability of the memory depends on the functions of the depth of processing. Going by this statement it is believed that the deeper the functions of various processes which go on in human mind, sharper the memory. "Older adults typically experience two main types of difficulty with their memory; the first is memory for names, and the second is memory for details of occurrences. The difficulty with names sometimes generalizes to infrequently used words and to names of objects, but is most evident in names of people. The second difficulty shows itself in forgetting where a possession was left, in the source of newly acquired information, and in ''telling the same tale (at least!) twice'' (Koriat, Ben-Zur, &Sheffer, 1988). It is extremely important to know about the process of remembering because it is closely related to Predictiveness. In this regards the above information is very handy. "While information-processing models of human memory have been concerned largely with structural aspects of the system, there is a growing tendency for theorists to focus, rather, on the processes involved in learning and remembering." (Craik, Fergus I. M, 27 September 2008). So there is importance given to the process involved in learning and remembering these days, Predictiveness and the process of remembering go hand in hand, the rest of the paper will explain the same with the help of apt examples. Method An experiment will clear all the doubts related to this topic and the result of the experiment will provide an in-depth analysis on how Predictiveness effects the level of Processing. There are 132 students who are participating in an experiment to determine how Predictiveness affects the level of Processing. Of these 132 students no of female students are 82 with the mean age of 19.8, so the mean age goes to show that the experiment is conducted on young students to get the exact results. The experiment showed a Power-point presentation to the students, the presentation consisted of 40 sentences of which 20 were composed of Predictive sentences and the other 20 were Non- predictive sentences. These 40 sentences shown to the students did not have the last word, in other words the last word each sentence was intentionally left blank. The organizers of the experiment probed the students to think of the missing word. After sometime all the forty sentences were shown with the last word f or 2 seconds each. After the experiment the students were asked to take a recognition test and the test consisted of 80 different items. Of these 80 items 20 were Predictive were and 20 were Non- predictive words, the rest 40 were fillers, these fillers were included to get to know the result better. The result of this experiment is on the next page and the ambiguities regarding this topic will be settled after looking at the results. Results The

Woolf Professions of women Essay Example | Topics and Well Written Essays - 500 words

Woolf Professions of women - Essay Example I wanted to know more about the challenges that a modern woman faces at work, and this curiosity and interest has inculcated the motivation in me to research this topic. I am eager to learn about the psychological barriers holding modern women back. We see that women are getting more and more independent and a break from their traditional domestic and familial responsibilities generally as they are integrating into the socioeconomic system. While the physical barriers to freedom have been eradicated to a large extent, most women still cannot use their skills and competencies optimally because of the psychological barriers. (Woolf) has expressed this very clearly in her writing as she said, â€Å"The Angel was dead; what then remained? You may say that what remained was a simple and common object – a young woman in a bedroom with an inkpot. In other words, now that she had rid herself of falsehood, that young woman had only to be herself. Ah, but what is â€Å"herself†?† (Woolf cited in Rainbolt and Fleetwood 302). I want to learn what sort of psychological barriers are encountered by working women in general and how they deal wi th them. I also want to know more about what are the goals of a vast majority of the working women. I want to learn their preferences and priorities. I want to know if personal freedom and autonomy is more important for women in the modern age or they generally want to work and earn money in order to be able to take care of their families better domestically as well as financially. In order to find answers to my queries, I shall first conduct a thorough review of literature. I shall read the novels, autobiographies, and journals of famous women writers, and note down any quotations, passages, and narrations that qualify as answers to my questions in any way. It would take me five to six drafts to finalize my research paper that would be structured in a way that

Existentialism in the Stranger and the Metamorphosis Essay Example for Free

Existentialism in the Stranger and the Metamorphosis Essay â€Å"We are thrown into existence first without a predetermined nature and only later do we construct our nature or essence through our actions. †(Existentialism)This quote is present through the main characters of The Stranger, Blade Runner, and The Metamorphosis in each of these works the characters create their own nature. These works are similar several ways; in all three the men create their own nature by the free choices they make. Through these choices they also create their own values. The characters values and meanings of life are where these works differ. Initially, in The Metamorphosis, Gregor’s life seems to have meaning, through providing for his family, until he changes into a bug and determines for himself that his life really has no meaning. This is very unlike The Stranger because Meursault, throughout the entire work, lives his life as if there is no meaning to life and he dies knowing this. Finally Deckard, at the beginning of his life, seems to have lived his life with no meaning or values, until he encounters Roy and Rachael who change his perspective. Throughout these works these men make makes choices that determine who they are and what their about, but ultimately every one of them knows their subsequent mortality. It is clearly understood through Meursault’s narration that life to him is meaningless. The choices he makes and things he says are without thought or meaning. They are usually in the spur of the moment of what will please him. For example the novel starts by Meursault telling the audience â€Å"Maman died today. Or yesterday maybe, I don’t know. I got a telegram from the home: Mother deceased. Funeral tomorrow. Faithfully yours. That doesn’t mean anything. Maybe it was yesterday†(The Stranger). Meursault treats his mother’s death with the same demeanor with which he will later treat the death of the Arab. Both of these events are usually different in the types of emotions they reveal, but Meursault shows no emotion at all. He just goes through the day to day motions of life. Through his narration and the tone of the novel the reader is clearly able to determine Meursault lives with no emotion or essence. He accepts who he is and his mortality. In the end he accepts a punishment that is not worthy of the crime. He knows even if he doesn’t get executed he will die anyway whether its ten years from now or fifty. Clearly The Stranger questions the reader whether humans really have a meaning for life since in the end everyone will die and be forgotten. It seems that Camus meant to get the point across that in life there is no predetermined nature people create it through their choices. Meursault chooses to live his life with little or no meaning. Unlike Marie who falls in love with Meursault and chooses to support him even though he didn’t care if they got married. Like Marie in The Stranger Gregor, who is the main character, in The Metamorphosis has a mean and value to his life. Gregor supports his family because his father failed and never went back to work. Gregor had it all good job, money, and ability. He chose to support his family and allow them to live a nice life while he worked and traveled with little time for himself. Gregor doesn’t like his job, but he chooses to stay because it offers good money and he will pay of debt. All of these choices are Gregor’s they are what he based his life off of. When he changes into a bug his mentality is altered. He begins to realize that all that he did for his family eventually is forgotten and soon he is forgotten about too. Kafka relates this to the human race and its inevitable end. When humans die in the beginning they are remembered, but slowly people forget, or lose interest, until eventually that person is totally forgotten about and life goes on. This previous statement is clearly seen in the novel when the family moves and decides that is time to marry off their daughter. They never mention anything about the loss of their son. In Blade Runner the main character Deckard destroys replicants. He does his job and usually never questions the reasons why he destroys the human-like robots. The director seems to try to get across the point early that Deckard lives a meaningless life. He does whatever he wants whenever he wants. At first it seems like he lives a life much like Meursault, but later it becomes clear that he is trying to find a meaning for life. When talking to Roy, Deckard realizes that in life everyone is going to die and that everything that person did would be forgotten and lost. At the same time Roy explains the value of life, the choices, love, and things humans can experience. Blade Runner tries to get across to the viewer that they are who they want to be and that in the end the choices and things they’ve seen will be forgotten and meaningless. In all three works the slogan â€Å"Existence precedes Essence† (Existentialism) is present. Each one of the main characters makes their choices which determine their nature. Every one of the characters at some point realizes that they all share a common trait with the rest of the human race and that is death. They also know that in the end they will be forgotten about and eventually everyone will move on with their lives as if they never existed. These works differ in the way each character goes about their lives. Meursault believes there is no meaning to life so he lives his life on the fly. He does whatever pleases him. Gregor begins with a life he has chosen for himself only to realize that eventually all that he has done will be forgotten and lost. Finally Deckard begins with no meaning and tries to determine a meaning through replicants. He realizes that the choices in his life are what makes his life meaningful. Throughout these works Existentialism was present. The characters offered a glimpse of the reason for existence. Whether it was for providing for a family or killing replicants each one of the character in the end determined that life was only the choices that they make. Ultimately they all learned that everything they did and chose to do was meaningless when they were dead and there is no way to avoid it.

The Meaning And Definition Of Brand

The Meaning And Definition Of Brand Due to the intensive competitiveness between the different producers and sellers in todays contemporary world, the phenomenon of joint branding is increasing at a rapid rate. With the traditional brand extension and the various brand alliance strategies like dual branding and advertising alliance, joint branding is a way of distinguishing the products from their competitive alternatives. By utilizing, the concept of product integration whereby a single entity is branded with that of one or more entities, companies can derive the favorable outcomes for both the entities. 2.1 Meaning and Definition of Brand The concept of branding is existing for past many centuries now. It is the primary means of distinguishing the product of a single manufacturer from that of another. The term brand is a derivative of the Old Norse word brandr, which implies to burn, (Kotler, 1982). As defined by (Keller, 2009, p 17), a brand is a name, term, sign, symbol, or design, or a combination of them, intended to identify the goods and services of seller or group of sellers and to differentiate them from those of competition. Technically, whenever a marketer creates a new name, logo, or symbol for a new product, he or she has created a brand. Brand resembles the total experience that consumers relate to the products (Keller Lehman, 2004, p.1) in order to create and retain the monetary performance (Haigh Knowles, 2004) which results in the visibility of the brands at three different levels customer, product and financial areas (Keller Lehman, 2004). Haigh and Knowled (2004) have suggested in their theories that brands are the primary source through which the competitive products could differ. The construction of competitive superiority (Keller Lehman, 2004, p.2) could be obtained by handling the various brand channels. The significance of brands have changed in the modern world due to the global trends, for instance, the deregulation of industrial sector, the privatisation of public organisations, the establishment of independent firms, extensive utilisation of franchises and the eradication of trade barriers ( McDonald, de Chartony and Harris, 2001). Brand Equity Brand Equity is a combination of the brand assets and liabilities associated to a specific brand, its name, image, logo or symbol that appreciates or depreciates the value provided by the product to its consumers (Aaker, 1991, p.15). In simple terms, it is the added value provided to products which reflects the consumer attitude towards the brand (Kotler Keller, 2006). Appendix A lists the world top 10 brands in the year 2010. It has been observed that for products in order to gain brand equity must be associated with the name or symbol of the brand (Aaker, 1991, p.15) however, on either amending or altering the name following a joint branding activity the product value might get effected. Furthermore, Aaker (1991) suggested the assets and liabilities which effects the brand equity as brand loyalty, brand awareness, quality perception, the brand association with quality and other factors like patents, trademarks etc. 2.1.1 Brand Vs Product A product is anything that is offered to a market for attention, acquisition, use or consumption that might satisfy a need or want (Kotler, 1984, p.137). Therefore, a product could be a tangible good like bread, cricket bat, or vehicle; however, a Brand is wider in scope than a product, because it can have dimensions that differentiate in some way from other products designed to satisfy the same need (Gregory, 1999, p.54). These variations may be rational and tangible- released to product performance of brand- or more symbolic, emotional, and intangible-related to what the brand represents (Rosson Brooks, 2004, p.57). Developing apparent branding differences among products through branding and by developing a loyal customer franchise, marketers create value that can translate to financial profits for the firm (Bruner, 2005, p17). However the fact is the significantly low numbers of tangible assets are considered to be valuable and so is the case with the intangible assets. 2.1.2 Creating New Brand Associations By associating a brand with another entity, consumers make a pre-conceived image linking the attributes of these brands to the other entity and to every other entity and association which is in liaison with this brand (Homburg Bucerius, 2005). In a wider sense, this secondary brand knowledge is most likely to affect evaluations of a new product when consumers lack either the motivation or the ability to judge product-related concerns (Morall, 1996, p.131). In other words, when consumers either dont care much about or dont feel that they possess the knowledge to choose the appropriate brand, they may be more likely to make brand decisions on the basis of secondary considerations like what they think, feel, or know about the country from which the product came, the store in which it is sold, or some other characteristics (Shelton, 2002, p.147). Therefore, the association of brands with other brands improves customer retention, enhances service quality, influences customers perception of the brand and proves to gain an edge over the competitors (Perry Herd, 2004). According to Kumar (2004), when a specific brand is linked to any entity, it not only creates a new relationship but also it affects all the existing relationships of the brand. The basic mechanism states that the consumer is aware of the attributes of entity. When a brand is identified or linked to that entity, consumer may infer that some of the particular associations, judgments, or feelings that characterise the entity may also characterise the brand (Kumar Blomqvist, 2004, p.26). A number of different theoretical mechanisms from psychology predict this type of inference. One is cognitive consistence  [1]  , in other words, the consumers perception is, what is true for the entity, must be true for the brand. 2.2 Joint Branding According to signaling product, the combination or collaboration of two brands provides greater assurance of quality than what a single branded product provides, which should lead to higher evaluations of products and premium prices (Rao, 1999, p37). Through a brand extension strategy, a new product can become linked to an existing corporate or family brand that has its own set of associations (Swystum, 2001, p117). Further, Sinclair (2007) is of the opinion that a presentg brand could influence its relationship with other entities by getting into an association with a brand from the same industry (Sinclair, 2007). Joint branding also called Joint branding, brand bundling (Keller, 2004, p 19) or brand alliances is formed with the association of two or more brands who decides to produce a new brand and as well sells it together. Joint branding is in existence for past many decades; for instance, Betty Crocker partenered with Sunkist Growers in 1961 to profitably sell a lemon chiffon cake mix. Interest in Joint branding as a means of building brand equity has increased in recent years (Grobel Forbes, 2006, p203). For instance, the toffee candy bar produced by Hersheys Health has not only been extended into several new products-Health Sensations (bite sized candies) and Health Bits and Bits of Brickle (chocolate-covered and plain toffee baking products)-but also has been licensed to a variety of vendors, such as Dairy Queen (with its Blizzard drink), Ben and Herrys, and Blue Bunny (with its ice cream bar). Some other notable supermarket examples of Joint branding are Kellogs Pop- Tarts with Smuckers fruit filling. Yoplait Trix yogurt, and Smuckers Dove ice cream sauce. In the credit card market, Joint branding often links three brands, as in the Shell MasterCard from Citi Cards. With airlines, brand alliances can unite a host of brands, such as Star Alliance, which comprises of 16 different airlines such as United Airlines, Lufthansa, and Singapore Airlines. Although the joint branded products are into use for quite some time but surprisingly, it has a very minute quantitative observational research on the subject. Norris (1992) was the person to describe the potential benefits of the Joint Branded products. This study was then preceded by the various theoretical articles by Rao Rueckert (1994) on Joint Branded Products on signaling Perspective and the other one by Hillyer Tikoo (1995) to understand the influence of Joint branded products on brand evaluation. 2.2.1 Merits De-merits of Joint Branding The primary benefit provided by joint branding is the ability to position a product distinctively and credibly amidst the large number of multiple brands in the market industry (Norris, 1992). Joint branding can create more compelling points of difference or points of parity for the brand -or both-than otherwise might have been feasible (Hillyer Tikoo, 1995, p57). The outcome would see it producing higher number of sales in the current market and additionally opening good opportunities with new customer groups. Joint branding can reduce the cost of product introduction because it combines two well-known images, accelerating potential adoption (Levin, 1996, p87). Joint branding also may be a valuable means to learn about consumers and how other companies approach them. In poorly differentiated categories especially, joint branding may be an important means of creating a distinctive product (Desai Keller, 2002, p 136). The possible limitations of joint branding could be the risks and lack of control that arise from becoming aligned with another brand in the minds of consumers. Consumers expectations about the level of involvement and commitment with joint brands are likely to be high (Levin, 1996, p 147). Unsatisfactory performance thus could have negative repercussions for both (or all) brands (Rao, 1997). Levin, in his study further emphasizes on the fact that If the other brand has entered into a number of joint branding arrangements, there also may be a risk of overexposure that would dilute the transfer of any association. It may also result in distraction and a lack of focus on existing brands. A summarized tabulate version of the merits and de-merits of joint branding is listed in Appendix B. 2.3 Comparison of joint branding against the different branding strategies Joint branding is a long term brand alliance in which a product is identified and branded with the other brand (Levin, 1996, p7). A joint branding strategy should constitute following characteristics; the participant of the joint branding should be independent before, during and after the alliance of the joint branded product (Ohlwein Schiele, 1994). Secondly, the joint branding strategy should be implemented on a purpose by the owners of the brand (Blackett Russell, 1999). Third, the potential buyer should notice the cooperation between the two brands (Rao, 1997). Fourth, there should be incorporation of more than one brand at a single instance (Hiller Tikoo, 1995; Levin, 1996) The joint branding practically shows that there are two variations in it. The first one can be said as Vertical joint Branding often called as ingredient branding (Desai Keller, 2002, p 113), it refers to a vertical combination of products where manufacturers of different value chain steps in one product (E.g. Pepsi and Nutra Sweet; Dell and Intel). On the contrary the horizontal joint branding is characterised by producers stepping in the same value chain for the manufacturing and selling of a multi-branded product. In addition, a joint branded product may also appear in a category where both the producers are already established (Sony Ericsson Mobile phones). Joint branding strategy can become the brand extension strategy by introducing new product with the same brand name on the existing or new product category or the new product in the new product category (Desai Hoyer, 1993, p 176). The figure below represents the overlaps and differences among the joint branding and brand extension strategies. Figure 1: Joint Branding and Brand Extension (Source: Helming, Huber Leeflang, 2008) Only one single brand is involved in classical brand extensions where as joint branding includes multiple brands. Because of this difference there is no information on how customers utilise the brand attitude and association to deliver their response to the combination of two brands can be derived from the study and practice of classic brand extension (Simonin Ruth, 1998). On the other side brand extension appears much frequent in practice and corresponding literature is much sophisticated and comprehensive (Aker, 1990; John, 1998; Balachander Ghose, 2003; Volckner Sattler, 2006). Both brand extension and Joint branding strategies work on the same subject line, to strengthen the parent brand and extend the customer value perception to a new product (Aaker, 1990. P76). However, joint branding strategy can be seen as more advantageous because a second brand can contribute an additional value perception to the parent brand and itself that a parent brand cannot gather itself. In addit ion their might be some negative effects to the potential advantages caused by the combination of two brands reasoning either they dont fit or unfavorable perception among the partnering brands. Further to this the joint branding involves great complications in the operational activities because this strategy needs the alignment of interest of a minimum two associated partners. The choice on aligning requires a careful and comprehensive study of related cost and advantages levied on certain operational objective and the situational surroundings. Additional to joint branding strategy there lays few more brand aligning strategies, they are; Joint sales promotion Advertising alliance Dual branding Bundling The Joint Branding strategy can be closely related to advertising alliance approach. The primary reason to utilise the different branding strategies similar to that of joint branding strategy is the improvement of interdependent image accompanying the collaboration with complementary partner (Wernerfelt, 1988, Erdem Swait, 1999). The signaling theory explains that, the collaboration of two brands assures the customer with greater product quality that in turn provides higher evaluations and premium prices (Rao, 1999). However, joint branding strategy is the only approach where a single product collaborates with two or more brands (Wernerfelt, 1988, p 36). Even though the new brand alliance strategy may not contain the severe unfavorable spillover effects and less difficulty but they may not involve such strong benefits as the joint branding strategy. The table below shows the differences between the joint branding strategy and other strategies. This table demonstrates that the joint branding and brand extension strategies are very similar where as the other strategies are completely different. Table 1: Branding Strategy and their distinction from Joint Branding Strategy Example Characteristic Difference from Joint branding Relevant Literature Product Bundling Vobis Hardware, software and services for PCs Combined offer from two or more goods in a package with one total price No simultaneous branding of a single physical product by two brands Gaeth, 1990; Yadav, 1994; Stremersch Tellis, 2002. Advertising alliance Wasa (bread) Due Darfst (diet butter) Simultaneous mention of different supplier of different products in one advertisement Berndt, 1985; Schroter Waschek, 1996; Bergen John, 1997; Samu, 1999 Joint sales promotion Reebok (sports outfit) and Pepsi (soft drink) Timely, limited appearance of two independent brands in promotional activities Varadarajan, 1985; Varadarajan, 1986; Palupski Bohmann, 1994. Dual Branding Burger king (fast food) Shell (Gas station) Common usage of store location (shop in shop concept) Levin, 1996; Levin Levin, 2000. Brand Extension Boss Brand transfer from cloths to perfume Extension of brand to a new product in either a new or an existing product category Equals joint branding , if new product is branded by two brands simultaneously Aaker Keller, 1990; Balachander Ghose, 2003; Volckner Sattler, 2006. 2.3.1 Joint Branding and its Effectiveness Different theories were propagated to gain an understanding on the efficiency of joint-branding when compared with various other brand extension strategies. Below listed is a brief description on these theories: Concept Combination Theory: This was propounded by Park, Jun and Shocker in the year 1996. In this theory, the researchers have observed the evolution and usefulness of combined brand partnerships. A combined brand is described to be the outcome of aligning two significant brands. The findings were based on the influence on perception of the consumer towards the new composite brand resulting from the earlier perceptions of the combining brands. The concept combination procedure enlisted evaluating two self sufficient concepts which are to form a new concept (Wisniewski, 1996). According to Park, Jun and Schocker (1996) a composite joint brand comprises of at least one parent brand and one modifier brand, each of which are determined according to their position in the composite brand. As per the concept combination theory, a set of core attributes in a concept is the most essential and salient set of attributes for understanding a concept (Eysenck and Keanne 1990), and it is difficult to change when the concept is combined with others. b) Signaling Theory: This theory was utilized by various realists (Rao, Qu Ruekert, 1999; Rao and Rueker1994; Washburn, Till, and Priluck 2000) in order to evaluate and assess the creation of joint branding and its usefulness. As stated by Spence (1974), signaling could be observed when the observer takes actions to communicate data and information to the ones who are ignorant of it, in order to facilitate their decision making. By utilizing this theory, Washburn, Trill Priluck (2000) had studied the effects of joint branding on the brand equity of the partnering brands. The four components  [2]  of the brand equity were evaluated based on the changing perception of the consumers. c) Assimilation and Contrast Theory: Levin (2002) has engaged social judgment theory in investigating the impact of joint branding. According to the social judgment theory (Shrif Hovland, 1961), judgments towards a stimulus are affected by the context within which it is evaluated. Furthermore, Sherman (1978, p107) states a stimulus is judged not only by its own features but also by the other stimulus that are present concurrently. Based on the occurrence of a stimuli the contexts are classified into contrast and assimilation effects (Meyers-Levy and Sternthal 1993). 2.3.2 Direct Effects Considering the empirical theories of Rao Rueckert (1994) and Rao (1997), Rao (1999), an in depth study of Joint Branded products from signaling perspective, whereby they show that the customers evaluates the brand qualitativeness better in relation to unidentifiable characteristics where a particular brand is collaborated with another brand which is presumed to be at risk of consumers acceptance. The combined outcome of the dual branding nature, joint branded products offers a better quality signal when compared with mono branded products. Levin (1996) findings displayed that matching a reputed brand name with an non reputable or slightly known host brands improves consumers product evaluations than adding a non reputable brand. Thus, it could be concluded that consumers brand awareness on the partner brands has a positive direct effect (Rao, 1997, p 118). Fang and Mishra (2002) also supported this claim, stating that consumer perception of a non reputed brand enhances when combined with a reputed, good quality associate; and Voss Tansuhaj (1999), proves that consumer evaluation of a joint branded products improves if a well known domestic brand is incorporated with unknown foreign brand partner. Vaidyanathan Aggarwal (2000) has also analyzed joint branded products formed by a well known national brand and an unknown private brand, and found that a joint branded products received positive valuation if it is incorporated with a well known ingredient brand. By differentiating a joint brand product as having either an unknown branded element or a reputed brand, Desai Keller (2002) clarifies the extended effect of the host brand. With the extension which transforms the intensity of a prevailing product feature, a stabilized component facilitates early growth recognition, however a self brand ingredients results in favourable successive group expansion assessment. The brand extension which adds a whole new feature to the product would inculcate an existing component, as doing this will lead to high assessment of the original product and its preceding expansion. Park (1996) states that the positive attitude of consumer towards a brand leads to positive direct effects, and the joint branded products involving two complementary brand gains a better attribute profile in the mind of consumers than that of a direct brand extension of dominant brand or a joint branded product involving two highly favourable but uncomplimentary brand. Walchli (1996), When measuring the evaluation of joint-branded products according to the agreement of the partner brands, displays that in high associated situations, the high dissimilar or similar partner brand possess less positive evaluation that it may have in rather disimilar partner brand. This astounding result is a task of the amplification that consumers undertake to seek resolutions that are partial towards positive clarification for the inaptness (Mandler (1982)) The prior positive attitude generates the positive direct effect towards each partner brand, and also from the positive perception toward the brand and the offered product fit of the partner brand. The term fit refers for the consumer perception on congruity of both the partner brand and their offered product categories and the branding concepts (Simonin Ruth, 1998). The model of Simonin Ruth had been modified by Hadjicharalambus (2001) to gain an evidence that overall fit (i.e., the joint venture of two brands A B as a new joint brand product) effects the evaluation positively of the joint branded products, but overall the fit is influenced by the transfer fit positively, or partner brand fit with product category of the joint branded product and fit of the brand. There is a possession of synergitic effect on the high transfer fit, which generates positive direct effects. The direct link with the brand equity and the joint branded products has been stated by Washburn (1999) and W ashburn et al. (2000, 2004) , this displays that the higher brand equity of partner brand enhance the perceived brand equity of the joint branded product and thus radiates positive direct effect. The study conducted by Janiszewski Van Osselaer (2000) and Van Osselaer Janiszewski (2001) shows how the consumer predicts the products performance through brand names and product features by different training methods. As explained by Simonin Ruth (1998) and Park et al.,(1996) that joining two or more established brands improves the face value of a joint branded products because the well known ingredient of a brand gives positive direct effects. The two most recent study conducted on the direct effect of joint branding is done by Baumgrath (2003) and Huber (2005). These studies agree and support to the previous studies of Simonin Ruth (1998) and Hadjicharambouss (2001) findings. The most comprehensive study on direct effects is given by Baumgarth (2003). He had analyzed a biggest simple, the great variety of joint branded products, and the most path relationship. He also states that advertising has a relevantly great importance in terms of evaluating the joint branded products. Huber (2005) proved evidently that involvement of product and orientation of consumers brand influences the success of joint branded product. The comparison of brand extension and joint branding studys displays some interesting similarities and differences. The requirement of fit in a high degree in a brand and the product extension is the main factor of success for brand extension, high involvement of parent brand, acceptance from the market and retailer (Volckner Sattler, 2006). The success of joint branded product is influenced by the transfer fit and support from market, but it carries much significance obtained from the product fit and the partner brand. This is because the joint branding introduces the new evaluation dimensions, unlike the brand extension. The collaborating concept of joining two or more brand from a single product to a joint branded product can achieve much benefits of that it may not achieve from its own. This finding is supported by Park et al (1996). The experimental test conducted shows that a joint branded product is assumed much favorable than that of the direct brand extension in the parent brands product category The literature of joint branding still need to analyze the addition factor of success of brand extension, like retailer acceptance and parent brand involvement. The table 2 below shows the relevance of relationship from the brand extension that may serve as a potential factor of success for joint branded product. Such combination can be considered for further research. TABLE 2; Succes Factors for Direct effects Success factors for direct effects A Joint branded product is more successful if.. source Relative Importance Characteristics of constituent brands/products Awareness brand awareness of the constituent brand is high Levin et al. (1996) Fang and Mishra(2002) Voss and Tansuhaj(1999) Vaidyanathan and Aggarwal(2000) Desai and Keller(2002) Medium Quality the perceived quality of the constituent brands is high Rao et al. (1999) McCarthy and Norris (1999) Park et al. (1996) Simonin and Ruth (1998) Janiszewski and van Osselaer (2000) van Osselaer and Janiszewski (2001) Baumgarth (2003) Lafferty et al. (2004) Huber (2005) High Brand equity the brand equity of the Constituent brands is high Washburn (1999) Washburn et al. (2000; 2004) High Characteristics of Joint Branded product Advertising the evaluation of advertising campaigns with regard to the joint branded product is positive. Baumgarth (2003) HIgh Retail Acceptance retailer acceptance is high Volckner and Sattler (2006) NA Fit constituent brands/products Degree of Complimentariness the constituent brands are highly complimentary regarding an attitudeof the joint branded product Park et al. (1996) Medium Brand fit Brand fit of the constituents brand is high Simonin and Ruth (1998) Baumgarth (2003) High Product fit Product fit of the product categories of constituents brandsis high Simonin and Ruth (1998) Baumgarth (2003) Huber (2005) HIgh Incongruence Partner brands are moderately incongruent under high involvement conditions. Walchi (1996) Medium Fit constituent brands with Joint branded product Fit of constituents brands and Joint branded product The fit between the brands and the joint branded product is high Hadjicharalambous(2001 Baumgarth (2003)) HIgh Person specific variables Product involvement Involvement with the product category of the cobranded product is high Huber(2005) Medium Brand Orientation Brand orientation is high Huber(2005) Low Constituent brand involvement Constituent brand involvement is high Volckner and Sattler (2006) NA (Source: Helming, Huber Leeflang, 2008) 2.3.3 Spillover Effects Studies on joint branding that delivers spill-over effect are scarce. A structural equation model has been developed by Simonin Ruth (1998) that displays consumers attitude towards the joint branded product, influencing positive attitude towards each partner brand. These authors have also proved that the brand that are less familiar in the market gains weak impact on the consumer attitude by the joint branded product (Lafferty, 2004). Baumgrath (2003) states that, great brand stability has less image erosion due to unfavourable extension, which may deliver weak spill over effect. Joint branded products may increase evaluation of an unknown brand if those unknown brand are joint with well known brand. A joint branded product which has two high equity partners can get a win-win potential, which can lead to great spill over effect. Brands with low brand equity gain the higher benefit from the joint branding and that carrying high brand equity does not suffer down grading of reputation, even if they are joined with a lower equity partner (Washburn, 1999; Washburn et al. 2000; 2004). Vaidyanathan Aggarwal (2000) states that the brand equity of a national brand does not decrease if collaborated with the unknown private brand. Musante (2000) finds that a joint branded products improves its evaluation if it cooperates with the second brand which is perceived to be higher in that dimension. Table 3; Success factor for spill over effects Success factor for spill Spill over effect on one/both brand(s) Source over effect are stronger more positive if.. Characteristics of constituent brand(s) Brand Awareness Brand awareness of one of the constituent brand is high Voss Tanssuhaj (1999) Brand Personality/attitude The brand personality of one of the constituent brand is positive Musante (2000) Brand Equity The brand equity of one of the constituent brands is high Washburn (1999); Vaidyanath Aggarwal (2000); Washburn (2000; 2004) Brand Familiarity The brand familiarity of the constituent brand is low Simonin Ruth (1998) Brand stability The brand stability of the constituent brands is low Baumgarth(2003) Success factor for Spill over effect Spill over effect on one/both brand(s) are stronger /more positive if.. Source Charac

The Case Of John Lacking Capacity Social Work Essay

The Case Of John Lacking Capacity Social Work Essay Within adult social care, people, issues, organisations and regulatory bodies are always involved in the discussions on risk and safety. Responsibility, duty of care, adult safeguarding and capacity are of concern. The balance of keeping service users who are viewed as vulnerable safe in society can be contradicted with living independent lives and being able to take the risks others take in everyday life. Therefore, perceptions and assessments of risk is an individual matter for each service user, the communities and society and is fraught with decisions and choices. Mitchell and Glendinning (2007) suggest that the states role and pre-occupation with risk management is under constant evaluation rather than exploring and seeking to understand service users perspectives of risk. They highlight the need for more service users and carers involvement in risks, decision making and protection (Parrott, 2006). Events during the life course such as genetic/biological factors, and childhood experiences can have a huge impact on the ability of the mind and body to develop and maintain good mental health. Ones life course can encounter a combination of stressful events which can test the human bodys ability to cope emotionally, which sometimes can trigger anxiety, depression and/or other mental health conditions. Risk factors which can have a negative impact on ones mental health can be addressed by influencing supportive relationships, a healthy lifestyle, stress management techniques and emotional coping strategies, in which social workers can be apart of ensuring happens. On an individual factor John could be facing depression/grief from the loss of his wife who passed away a year ago. John could still be in the seven emotional stages of grief (Carers UK, 2012). This involves shock or disbelief, denial, bargaining, guilt, anger, depression, and acceptance/hope. Social workers and other prof essionals should be aware that, there are no time limits on grief and no set pattern of emotions and behaviours that people can follow, everyone is different and grief does not always happen straight away. The risk factors for experiencing more serious symptoms of grief/loss of a loved one is that John could be at an increased risk of being psychiatrically unstable due to a decline of his emotional well being. The change in Johns life events/situation could have a huge impact on his mental wellbeing, not only because he has lost his wife but he was also a carer for his wife which would have meant John would have had responsibilities daily. Therefore John also faces having to deal with the loss of his caring role, which he may include him feeling guilty/ relieved, exhausted and alone. John may also feel angry that someone has contacted social services as they feel worried about him, as at this moment in time John may be thinking he is coping fine. Johns family/social factors may be a potential risk as John lives alone and his two children live some distance away and only visit monthly. John could be feeling isolated and due to lack of family support and limited social networks, John could be at risk of deteriorating emotionally and physically. John could be feeling a loss of control over his life due to these changes and he could experience all types of symptoms such as significant loss of appetite, diminished energy levels, suicide thoughts, depression, anxiety and many more (NIMH, 2012). The issues around the perceptions of risk and rights for mental health service users are different as people are sometimes perceived as a risk rather than considered at risk in vulnerable situations. Therefore, John could be at risk of being overlooked by safeguarding practices and his individual rights comprised by the Mental Health 1983 if he is assessed as lacks capacity, when maybe all John needs is some support in getting his life back together and learning how to cope w ith all his life changes. This would be a multidisciplinary decision and user involvement in risk assessment and informed decision making about risks to John and others (Ray, Pugh, Roberts Beech, 2008). Regardless of whether John is assessed as having the capacity or not to make decisions under the Mental Health Capacity Act 2005, then professionals need to raise the awareness of human rights and enable John to have these rights realised. Independence, choice, control and experiences and feelings associated with danger, fear, abuse and safety would need to be addressed with John. Sheldon (2010) suggests that in any case of risk management, the service user should have their rights explained, including their human rights and risk management should not interfere with the service users rights to dignity, respect and privacy as also suggested by the Care Council Code of Practice for Social Workers (CCW, 2002, 1.3, 1.4, 3.1). It is important that the key role of assessments of adults allows people to make their own decisions whilst minimising risk or harm. By placing John at the centre of the caring process, it would be the social workers role to discuss options of support for John as a first option. Fair Access to Care Services would enable the social worker to focus on health, safety, autonomy and involvement with his family and the community but without overlooking risks of self harm, neglect, abuse and risks to carers and others. FACS was launched in 2003 by the Department of Health, so that adults in need can be assessed for eligibility of services (DOH, 2003). It focuses on four levels of risk to independent living, which would be of use in Johns case. Risk taking is a normal part of life, however the social worker needs to ensure they have taken all the steps needed to minimise risk. With John by considering the consequences of actions and the likelihood of harm he could cause to himself, and discussing the benefits for independence and well being, a support plan for managing risk could be put in place with Johns consent (CCW, 2002, 4.3). Risk assessment will help in developing risk management plans that minimize risks (Coulshed Orme, 2006). The social work ers role would be to provide John with support to enable him to help himself. Under the National Health and Community Care Act 1990, the local authority would have a duty to assess Johns needs and to ensure thats services are available for John. Protecting and safeguarding John from harm, abuse and neglect including financial, physical, sexual, emotional and institutionally would be the social workers main role. An assessment based on the needs of John would enable the social worker to build a positive relationship with John, to gather the relevant information, form an overview of the situation and identify possible solutions for the best way forward (Parrott, 2006). Assessment and care planning will enable the local authority to provide practical and emotional support for John. During assessment and care plan the social worker would be able to treat John holistically, promote his independence whilst clarifying risks that can follow from decisions made independently and also being a ble to involve other health professionals to benefit John. Through the care plan, John would be able to access a wide range of information and services, designed specifically for him. Social workers use the Mental Health Act 2005 as a criterion to minimise risk of harm to self or others, however the downside for service users is that of potential threat to independence and freedom that sometimes makes seeking help a hard decision to make in some cases, therefore social workers working in multidisciplary teams and having the use of assessment and care planning tools, makes decision making easier. Therefore all professionals and John would have some responsibility for making decisions and every professional would have input into providing and sharing information to arrive at a considered decision (Milner OByrne, 2009). This also minimises the risk of one person being involved and making decisions solely without having the right knowledge or support to reach appropriate outcomes with John. The autonomy of John to decide whether to engage with social services, and accept that he is not coping well at the moment, conflicts with social services and his neighbours concerns of him putting himself in danger/neglect. The professionals would need good social skills and value the principle of inclusion into society and autonomy to enable John to make his own decisions and make positive changes on his own behalf. The conflict in this case is that facing the social worker in assessing Johns needs. On one hand, John doesnt seem to be coping well however he has been assessed as having capacity, but on the other hand, John is exercising his own right to self determination and autonomy as he wont accept any support. The issue the social worker faces is that of John not engaging if John is able to understand some of the presenting problems in his current situation. In order to assess whether intervention is required, three categories of risk may be required. Johns physical risk could be causing harm to himself or others. Johns social risk of becoming isolated and acting in a way that is considered outside of the social norm and emotional risk, his physical and emotional health (Webb, 2006). In the case of John lacking capacity the social worker and other professionals would be working under the framework The Mental Capacity Act 2005 (MCA) in order to provide protection for John, who is unable to make decisions for himself. The Act contains provision for assessing whether people have the mental capacity to make decisions, procedures for making decisions on behalf of people who lack mental capacity and safeguards. Professionals would be working under the philosophy of the MCA, which is any decision made, or action taken, on behalf of John who lacks the capacity to make the decision or act for himself must be made in his best interest (Coulshed Orme, 2006). The Act is also supported by its own Code of Practice which has to be interpreted when using the Act. It is important that all professionals working with John understand his capacity might be affected only for a temporary period. The phrases used in the MCA section 2 in relation to a matter and at the material time mea ns that capacity must be assessed on a decision-by-decision basis. Therefore, capacity may not be a permanent status and John should not be described as having or lacking capacity. The level of capacity needed by John would depend on the decision to be made. For example, John may need a lower level of mental capacity to make decisions about everyday matters, such as what to eat or where to go at this moment in time. Professional should ensure John has not been assumed as lacking capacity due to his age, appearance, and mental health diagnosis or disability/medical condition (Webb, 2006). In 2007, under the Mental Health Act for England and Wales, Approved Social Workers were replaced by Approved Mental Health Practitioners (AMHPs) with the role and remit extended to other disciplines. The primary role of an AMPH is to act as the guardian of the patients rights. The AMHP has the responsibility of contacting the patients next of kin and to help any appeals against the order that the patient wants to make. In the case of John not having capacity, the AMHP may control access to some services such as day centres, respite care, residential care and other community support services, if needed (DOH, 2001). The social worker would also need to refer to other health/social care professionals if not already done so such as GP, community psychiatric nurse, physiatrist, counsellor, advice services, specific therapies to ensure an holistic approach is taken (Ray et al, 2008). The consultation report on safeguarding adults in Wales In Safe Hands (WAG, 2000) found that people were c oncerned about the balance between safeguarding and personalisation, between choice and risk. Social workers and other professionals need to ensure people have informed choices and introduce support systems. Social workers will have a distinctive role in multiagency settings and will need to ensure they develop practices to enable service users with mental health to identify and realise their own needs. The team involved in working with John will need to have broad experiences and social views of mental health problems especially in regards to discrimination, oppression, civil rights and social justice. They will need to co-ordinate efforts to support John so that he does not have negative experiences and /or perceptions of mental health and ensure he received services fairly and equably. The social worker will work with John to ensure he is not a victim of social isolation, poverty, unemployment, insecure housing and limited social and support networks and will have an independent view in assessment and care planning (Faulkner, 2012). In Johns case risk management will minimize the dangers both to and from John. However risk factors are individual and differ from professional to professional due to personal factors and the degree of control they have over the risk. A risk can be viewed as negative and positive. Risk is associated with decision making processes and should never be made in isolation. Social workers must take every precaution to protect the service user and the public, as the law makes people responsible for behaviours whether or not they were the ones who took the risk, intended or not. Practitioners can be held liable for negligence and a breach of duty. Trying to predict possibilities and risk assessing is a very important part of the social workers role (Parrott, 2006). Part 2