Monday, September 30, 2019

Research Essay

1. Dadaism- was an art movement of the European avant-garde in the early 20th century. Many claim Dada began in Zurich, Switzerland in 1916, spreading to Berlin shortly thereafter but the height of New York Dada was the year before in 1915. To quote Dona Budd’s The Language of Art Knowledge. Dada was born out of negative reaction to the horrors of World War I. This international movement was begun by a group of artist and poets associated with the Cabaret Voltaire in Zurich. Dada rejected reason and logic, prizing nonsense, irrationality and intuition. The origin of the name Dada is unclear; some believe that it is a nonsensical word. Others maintain that it originates from the Romanian artists Tristan Tzara’s and Marcel Janco’s frequent use of the words da, da, meaning yes, yes in the Romanian language. Another theory says that the name â€Å"Dada† came during a meeting of the group when a paper knife stuck into a French-German dictionary happened to point to ‘dada’, a French word for ‘hobbyhorse’. 2. Cubism- is an early-20th-century avant-garde art movement pioneered by Georges Braque and Pablo Picasso, joined by Jean Metzinger, Albert Gleizes, Robert Delaunay, Henri Le Fauconnier, Fernand Là ©ger and Juan Gris that revolutionized European painting and sculpture, and inspired related movements in music, literature and architecture. Cubism has been considered the most influential art movement of the 20th century. The term is broadly used in association with a wide variety of art produced in Paris (Montmartre, Montparnasse and Puteaux) during the 1910s and extending through the 1920s. Variants such as Futurism and Constructivism developed in other countries. A primary influence that led to Cubism was the representation of three-dimensional form in the late works of Paul Cà ©zanne, which were displayed in a retrospective at the 1907 Salon d’Automne. In Cubist artwork, objects are analyzed, broken up and reassembled in an abstracted form—instead of depicting objects from one viewpoint, the artist depicts the subject from a multitude of viewpoints to represent the subject in a greater context. 3. Impressionism- is a 19th-century art movement that originated with a group of Paris-based artists. Their independent exhibitions brought them to prominence during the 1870s and 1880s, in spite of harsh opposition from the conventional art community in France. The name of the style derives from the title of a Claude Monet work, Impression, soleil levant(Impression, Sunrise), which provoked the critic Louis Leroy to coin the term in a satirical review published in the Parisian newspaper Le Charivari. Impressionist painting characteristics include relatively small, thin, yet visible brush strokes, open composition, emphasis on accurate depiction of light in its changing qualities (often accentuating the effects of the passage of time), ordinary subject matter, inclusion of movement as a crucial element of human perception and experience, and unusual visual angles. The development of Impressionism in the visual arts was soon followed by analogous styles in other media that became know n as impressionist music and impressionist literature. 4. Expressionism- was a modernist movement, initially in poetry and painting, originating in Germany at the beginning of the 20th century. Its typical trait is to present the world solely from a subjective perspective, distorting it radically for emotional effect in order to evoke moods or ideas. Expressionist artists sought to express meaning or emotional experience rather than physical reality. Expressionism was developed as an avant-garde style before the First World War. It remained popular during the Weimar Republic, particularly in Berlin. The style extended to a wide range of the arts, including painting, literature, theatre, dance, film, architecture and music.

Sunday, September 29, 2019

How to Asses Mental Illness

The ability for patients to access mental health services these days are more wide ranging than ever before. This is in part due to the fact that the realm of mental health, once simply governed by physicians, is now peopled by staff of all different types and disciplines. In addition, many mental health professionals are now multiply credentialed, so it is not impossible to see a mental health professional who is all at once a family and marital therapist, a chemical dependency practitioner and a social worker. All these elements only serve to improve the ability of patients/clients to receive quality mental health services, whether it be in a large institutional setting, a community mental health center or in a private clinical office. But what are the different types of mental health professionals who are trained in the identification and treatment of patients with mental health issues? There are many, but for the matter of clarity and brevity, we will focus on just three. Licensed clinical social workers are one type of mental health professional who may be assigned a clinical case. These are individuals who have received graduate level training in the assessment and management of patients with mental illness. They may choose to specialize in a certain type of therapy, such as marital or family therapy or they may provide a more general practice. Clinical social workers are also found in the hospital setting, whether for psychiatric patients or medical patients and are experts in arranging for social services and referral to assisted living facilities, nursing homes, and other post hospitalization care. Advanced registry nurse practitioners are one of the newer types of clinicians in the mental health field. These are nurses who have taken graduate level education which allows them to perform diagnosis and treatment for patients. Many nurse practitioners (also called ARNPs) can prescribe medications for their patients, depending on the laws of the states where they live. ARNPs are also unique in that they can open up clinical practices of their own without having to work under the auspices or licensure of a practicing physician. ARNPs provide medication and counseling services, as well as crisis intervention services. ARNPs are also found frequently in both the inpatient and outpatient settings. Another type of professional who may diagnose and treat a patient with mental health issues is a clinical psychologist. These are men and women who receive post-graduate education and receive a doctorate in psychology. Psychologists are often called â€Å"doctor† but the difference is that they are not allowed to prescribe medications. Psychologists are multifaceted, and are able to diagnose and treat patients with mental health issues, as well as perform and interpret psychological testing to held aid in the diagnosis of patients with personality or learning disorders. Psychologists are usually utilized in the outpatient setting, but it is not unheard of for them to work on an inpatient mental health unit as well. While all these different clinical backgrounds are able to assess patients for the presence of mental illness, the issues which they must consider are the same from patient to patient. Whether the patient is a self-referral, court mandated or identified by a family member, before a true clinical diagnosis can be made, a thorough mental health assessment must be made. This mental health assessment includes several key issues which must be answered. First, the clinician must know what the problem is which brought the patient in for evaluation in the first place. Does the patient feel sad, or depressed, or anxious? To what degree does the mood problem affect the patient†s day to day life? Are they able to go on about their daily business, or are they incapable of holding a job or caring for themselves or their families, because of the severity of the illness. Does the patient actually perceive there is a problem, or has the patient been referred by a medical provider, family member, or friend? The high coincidence of mental health problems and substance abuse makes it necessary for the mental health professional to assess if there is any drug or alcohol abuse issues here. How long has the patient had these symptoms, and are they getting worse, better, or staying the same. A family history is also important, especially as it pertains to issues of mental illness within the family, or a history of physical/sexual or emotional abuse. Above all, when any mental health professional is assessing a patient for mental illness, he or she must assess if the patient has any thoughts of hurting himself or anyone else. This is almost the most important question to be asked of any patient who is being assessed for mental health problems, and when answered in the positive, must be dealt with immediately. As we are discussing suicidal ideation, it is important for any clinician to understand who is at the greatest risk of self harm. There is a disparity in the rates of suicide between men and women, in that it is more likely for a woman to express thoughts of suicide and it is more likely for a man to actually commit suicide. In fact, men over age 45 are more than four times more likely than women to kill themselves as women in the same age (National Patient Safety Agency, 2001). An unemployed man is two to three times more likely to commit suicide. Suicide is also believed to account for 20 percent of all death in young people aged 15-24 and is second only to accidental death. The prevalence of substance abuse in this age group tends to be a contributing factor to suicide rates. The additional issues of academic pressure and relationship problems, as well as possible history of physical and sexual abuse are other risk factors. Interestingly, research has also shown that youngsters who know someone who commits suicide are more likely to commit suicide (Shaffi, et. al. 1985). While issues of race and likelihood to commit suicide have been studied, the pattern changes over geographic distribution. A study done in 1993 by Briget seemed to indicate that gay men and lesbians had higher rate of suicide and attempted suicide than the general population. And, as previously mentioned, research has shown that substance abuse is a significant risk factor for suicide and suicide attempts. One study estimated that among people who abuse drugs, the risk of suicide is twenty times greater than that of the general population (Faulkner, 1997) Any discussion about mental health in the 21st Century is sure to bring some in some element of the Health Insurance Portability and Accountability Act of 1996, commonly known as HIPAA. HIPAA is a federal health benefits law passed in 1996, effective July 1, 1997, which among other things, restricts pre-existing condition exclusion periods to ensure portability of health-care coverage between plans, group and individual; requires guaranteed issue and renewal of insurance coverage; prohibits plans from charging individuals higher premiums, co-payments, and/or deductibles based on health status. It also places strict limits on the type and amount of information which can be released about patients, and to whom the information can be given, and in what manner. While the privacy of patient care information is important, HIPAA can be a stumbling block to the care of patients. For example, should the patient refuse that any collateral information be obtained about his case from a family member or friend, the mental health professional is prohibited by law from making any contact with this person, even if the collateral information could be of help in the care and diagnosis of the patient. In addition, it makes it almost impossible for family members to make appointments or even ascertain that patients are getting care. Health care providers are given leeway in one manner, in that should a mental health patient make what is felt to be a credible threat against another person, the healthcare provider is then able to provide information about the threat to the person in the broadest possible terms, known as a â€Å"duty to warn†. Usually now, before a mental health professional takes on a case, he or she will have the patient sign a document explaining the patient†s rights and the clinician†s responsibilities under HIPAA. In this document, the clinician outlines most common reasons for which the clinician may have to release information about the patient†s care, such as coordinating care with another provider or even obtaining coverage information from the insurer. The patient is also generally advised that he or she may revoke all authorization at any time, but in turn the clinician may choose to discontinue treatment. In this way, both parties are protected. It should be noted, however, that HIPAA restrictions do not apply in cases where abuse is suspected, for clinical health oversight activities, for judicial reasons if evaluations are court ordered, and in cases where the care involves a workman†s compensation issue. The clinician must also provide to the patient a name and number of a person to who concerns about privacy violation may be addressed, and if all else fails, complaints may be made to the Department of Health and Human Services, the federal agency which oversees HIPAA. But should a mental health professional be incautious about the kind of information he or she chooses to release, then he or she may find that they are subject to high fines, sanctions from federally funded agencies and loss of clinical privilege. To me, HIPAA seems like the extreme end of the pendulum, and does little to take into account common sense. I believe that in the future, different legislation will be made to modify the tone of HIPAA and allow a bit of clinical common sense to be used as well. Until that time, mental health practitioners will have to tread lightly and practice with care, keeping in mind at all times the needs of the patient and the rule of the law. So in summary, there are many kinds of mental health professionals, of all different backgrounds and disciplines. It would not be difficult to find a therapist or other mental health professional that would be able to help a client with his or her problems. All are highly qualified. All receive excellent training, and the high degree of diversity allows the mental health patient to almost have a consumer attitude when shopping for mental health care. No matter what kind of practitioner a patient chooses, the patient should be sure that he or she has chosen one who is well versed in the diagnosis and treatment of mental illness. New laws put into affect do much to protect the rights of the patient, but in some ways can tie the hands of the clinical provider. But ultimately, rules are in place to protect both the patient and the practitioner.

Saturday, September 28, 2019

Levendary Cafe Case study Essay

Introduction Levendary Cafà © has grown from a small restaurant that offers soup, salad, and sandwiches in Denver to a multibillion quick casual chain that operates 3500 stores around the U.S. The founder of the Levendary Cafà ©, Howard Leventhal managed to establish a strong market position for the Levendary Cafà © in the U.S and succeeded in creating a $10 billion business model. The Cafà © has two important elements that differentiate it from its competitors, which were offering nutritious soup, salads, and sandwiches, as well as, providing exceptional service for their guests in a genuine, and friendly manner. The company’s philosophy is satisfying customers’ needs by trying to make an impact on their life and look for the long run profit as encouraged by founder, Howard Leventhal to his staff. After 32 years of experience operating in the U.S domestic market and after a slowdown in the company’s domestic growth, the company considered expending its operation internat ionally, more precisely in China, a promising market that had shown  a strong annual GDP growth of 14.5% in previous years, as well as, the arisen number of middle class income. The responsibility of overseeing the China operation was given to Louis Chen, a Stanford MBA graduate, after a two-year contract agreement between Leventhal and Chen in September 2009. A year and six months into the two-year term contract, Mia Foster was named the new CEO of the Levendary Cafà © in February 2011. The public press viewed the new CEO as being inexperienced in the international market in addition to some doubt about Foster’s ability to build a multi-national brand. Louis Chen opened the first store in Shanghai in, January 2010; the first location was in a high traffic business area. Within a year Louis Chen was able to allocate 22 additional locations for the Levendary Cafà ©, due to his strong knowledge of the country’s geography and his ability to speak both English and Mandarin Chinese. However, after a review of China’s operation by the new CEO, Foster was not happy with the way the operation was managed in China, she noticed that the accounting report was not formatted in accordance with U.S. Generally Accepted Accounting Principles (GAAP). This was the turning point in the relationship between Foster and Chen, who had not met face to face. The new CEO decided to look more closely into the China operation and planned a trip to China to meet with Chen for the first time. Identification of Main Issue The case presented a number of main issues that Levendary Cafà © faced during the expansion into the Chinese market. From the case the main issue was identified as: the Levendary brand image is not consistent in the United States and China because there is a lack of communication between the parent company and subsidiary. The contributing factors to this were the management styles, the lack of standardization, the cultural differences and the limited experience in the foreign market. These issues have been detailed below. Management style The Chinese operation lacks close mentoring and evaluation by former CEO Leventhal, who gave too much freedom to Chen with a very hand off management style. â€Å"Do right by the concept† was the expression that Chen had as a guideline for how to strategize for the China operations. As a result, Chen  was providing little information to Denver headquarter about how the operation is managed in China, which differs from Foster’s management style who appears to be more demanding than the former CEO. There was no clear strategic plan for the operation in China, when Chen was asked about a plan he mentioned that he had no plan. Standardization Foster is more process driven and valued standardization, she believed that the China operation should align with Levendary Cafà © standards in the U.S in terms of reports, and look and feel of the Cafà ©. However, Chen had a different approach where he was trying to open as many stores as he could in a short period of time, paying little attention to the U.S standardized business model. The issue of standardization clearly was another challenge between Denver headquarters and Chen, as he insists in pushing what he thinks is right and resist what headquarter is asking him to do. Cultural Difference Whenever a company is entering a new market it has to take into consideration the cultural differences between countries. Based on the case study analysis, the difference between the two countries in terms of eating out habits and eating preferences seem not to be understood by the Denver headquarter. Denver headquarter believes that it can enforce the same business model applied in the U.S to its stores in China, regardless of local preference. In addition, Foster seems to lack knowledge about the Chinese culture because she was not familiar with the market in China, as she had no experience working internationally. There was a lack of cross-cultural communication between Chen and Foster; even though, Chen had experienced both cultures while studying abroad in the U.S. Limited experience in the foreign market There was a lack of international market experience since the China market was the second market, Levendary Cafà © entered aside from a partnership in Dubai. Due to this lack of experience Leventhal trusted Chen with implementing the needed actions to grow a successful franchise in China. Leventhal entrusted Chen with this given his strong knowledge of the market in China. Leventhal did not understand that entering a foreign market would  take more than knowledge on the country; it would also take strong communication and management skills. Analysis and Evaluation Operational Analysis The operational analysis will cover the company’s internal strengths and weaknesses as well as their external opportunities and threats. The SWOT analysis will be on Levendary Cafà © U.S. operations. This report will also look at problems with standardization in the China operations. Levendary Cafà © has gained much strength over its 32 years of business (Bartlett & Han, 2013). The company has created brand recognition around the United States with its 3,500 cafà ©Ã¢â‚¬â„¢s (Bartlett & Han, 2013). There is good brand consistency across all 3,500 cafà ©Ã¢â‚¬â„¢s due to standardization of the Levendary product. Each cafà © has a similar design and atmosphere and offer the same core products. Levendary Cafà ©Ã¢â‚¬â„¢s standardization has allowed the company to franchise their product and resulted in expansion across the United States. Currently, two-thirds of the company’s cafà ©s are franchised (Bartlett & Han, 2013). Each region also offers different menu items fr om one and other, on top of the core menu items. For example, fewer soups are offered in the southern regions of the United States (Bartlett & Han, 2013). This adds to the company’s strong business culture of â€Å"delighting the customer† and creating a personalized experience for each customer (Bartlett & Han, 2013). Levendary Cafà © detailed and strict operating standards, policies and practices has allowed for tight control of store level expenses and close monitoring of operations (Bartlett & Han, 2013). The founder, Howard Leventhal, is an entrepreneur who wasn’t afraid to take risks (Bartlett & Han, 2013). His willingness to take calculated risk led to the company using organic grains in its bread and hormone-free naturally raised meats (Bartlett & Han, 2013). Levendary Cafà © became part of the growing trend of consumers wanting healthier and more natural menu options. 81% of Americans over the age of 50 have become more conscious of what they eat (Agriculture and Agri-Foods Canada, 2010). Levendary Cafà © target market is white-collar professionals and upper-middle-class women (Bartlett & Han, 2013). Their choice to shift towards healthier menu options is meeting their target markets change in tastes. A fully scaled test kitchen and food science  laboratory also allows the company to meet the changing tastes of their consumers (Bartlett & Han, 2013). The food team, which includes highly trained chefs from the Culinary Institute of America, is responsible for the test kitchen and laboratory, as well as conducting quality checks across all 3,500 cafà ©Ã¢â‚¬â„¢s (Bartlett & Han, 2013). Levendary Cafà © has a good organizational structure. Each knowledgeable and highly experienced member of the management team knows their responsibilities and who responds to them. There is a clear power structure. Finally, Levendary Cafà © has a strong training program for their retail employees called Operating Tools and Learning (OTL) (Bartlett & Han, 2013). OTL sets operating standards and provides employees with materials to enhance their learning (Bartlett & Han, 2013). All these strengths have resulted in Levendary Cafà © being a successful business in the United States. Levendary Cafà © also has internal weaknesses. The U.S. operations are beginning to slow and investors are losing confidence in Levendary Cafà © (Bartlett & Han, 2013). This is one of the reasons the company chose to expand into China. However, there is no separate international division from the Denver Headquarters and the new CEO, Mia Foster, lacks international management experience. Although Levendary Cafà © personalized touch has led to repeat business, it is also considered a weakness because it slows down the speed of service. Currently, there is a lack of brand recognition in China for Levendary Cafà ©. Finally, financial reports from China are being submitted in their own format and the U.S. operations are then â€Å"massaging† them to apply the U.S. Generally Accepted Accounting Principles (GAAP) (Bartlett & Han, 2013). These are all weaknesses for Levendary Cafà ©. Every company faces external opportunities and threats. As domestic business for Levendary Cafà © is beginning to slow, the company must look at opportunities to continue to be successful. Firstly, Levendary Cafà © is part of an emerging category in the restaurant industry called the â€Å"quick casual†. Another opportunity is to expand internationally. Other than the expansion into China, Levendary Cafà © is experimenting with a licensing deal in Dubai (Bartlett & Han, 2013). Some potential threats for Levendary Cafà © are the rising food costs and shifts in food trends. Food costs are beginning to rise due to a variety of factors such as climate change and a rise in oil prices (Oxfam Canada). A cha nge in food trends is a potential threat for any restaurant. If a restaurants’  product does not meet consumer’s tastes, then revenues will decrease. Levendary Cafà © will need to look at their external opportunities and threats. Levendary Cafà © China operations has three areas that need to be standardized: look and feel of the restaurant, menu options and accounting practices. Firstly, all 23 restaurants have a different design and atmosphere. The first location to open was similar to Levendary design standards, but the second location in Shanghai was a takeaway counter with no seating (Bartlett & Han, 2013). Denver Headquarters should understand that they cannot put the same restaurant that is in the U.S., in China. There should be extensive market research conducted on design and atmosphere that would be successful in China. Another option is to follow what Cafà © Coffee Days did in India. Cafà © Coffee Days offers three different formats of stores, ranging from a smaller grab and go coffee shop to a larger cafà © with areas to sit down. Levendary Cafà © could have different formats for restaurants; however each format would have a similar atmosphere to help standardize the brand in China. Secondly, menu options are vastly different across all 23 locations. For example, the Shanghai Koreatown offers dumplings with an average check of $2 (Bartlett & Han, 2013). The Beijing Embassy location offers sandwiches and soups with an average check of $10 (Bartlett & Han, 2013). Some menu items were offered at all locations, such as the chicken sandwich. A solution to standardize the menu is to do something similar to the U.S. operations. All locations would offer the same core menu items, but each region would have some different menu items that vary from one another. Chefs that have been trained in China and educated on different regional tastes should help create the core menu items and the different regional items. The final area that must be standardized is accounting practices. The current financial reports are being sent to the U.S. and massaged to meet U.S. GAAP (Bartlett & Han, 2013). All enterprises in China are required to use the Chinese Accounting Standards (CAS) such as the Accounting System for Business Enterprises (ASBE) (China Briefing, 2014). ASBE has similar standings to the U.S. GAAP and the International Financial Reporting Standards (China Briefing, 2014). An international financial analyst should be hired in order to deal with both China and the U.S. financial reports and audits. Financial Analysis A financial analysis of the U.S. and China operations provided information on Levendary Cafà ©Ã¢â‚¬â„¢s current financial status. The income statement for China can be seen below. In China, their food and paper cost is at 51%, which can be attributed to their high number of food options on the menu and the lack of distribution system set up. Once a core menu is created and more locations begin to open, Levendary Cafà © will be able to take advantage of economy of scale and lower food and paper cost. China also has a high occupancy cost at 24%. This could be a result of having to pay extra to get the better locations. In addition the Chinese real estate market is very high meaning that any location is very expensive. During the time of the case study the Chinese real estate was going through a â€Å"golden decade† (Ranasinghe, 2014) which can demonstrate the higher occupancy cost that the Chinese division occurred compared to the United States. The pre-opening expenses (12%) also contributed to the loss of income in the first year for China. After the first year of business, China had a loss of $143,620. China operations also have a lower marketing expense. Marketing is generally not a large expense in China because the local population listens more to radio advertisement, which are cheaper, and rely on word of mouth. Income Statement- China The financial statement of the U.S. operations, which can be seen below, shows that Levendary Cafà © generally follows industry standards. Their food and supply cost are slightly lower than industry standards. Generally, food and supply costs are about 29% of total sales, but Levendary Cafà © food and supply cost are at 24% of total sales. Occupancy costs for Levendary Cafà © are about 4% lower than industry standards. Levendary Cafà © spends more on marketing then industry standards, about 2% higher. Income Statement- United States Cultural Analysis **The above information was sourced from The Hofstede Centre Website (Hofstede Centre, 2010).** By completing a cultural analysis on the two countries, United States and  China, it was easy to determine how the key issue, being communication, came about. Geert Hofstede identified five different dimensions that demonstrate how â€Å"values in the workplace are influenced by culture† (International Business Centre, 2014). The different dimensions that Geert Hofstede identified are: Power Distance, Uncertainty Avoidance, Individualism vs. Collectivism, Masculinity vs. Femininity, and Long Term Orientation vs. Short Term Orientation. Through using these five dimensions one can evaluate how each culture approaches these dimensions and how it influences them in the workplace. The score beside each dimension determines how much value they place towards each dimension. It is interesting to note that on only one dimension, Masculinity vs. Femininity, the two countries have a comparative score. It is with these differences that communication issues between the two countries can be seen. Power Distance The Power Distance Dimension looks at the relationship that people hold with others in that country. China scores very highly on this dimension as people value their superiors and do not act outside of their ranking in society. In regards to the case study it is confounding that Chen is unobservant of his superiors power being Mia Foster. In the case Chen is continually rude to Mia and questions her authority. This can be attributed to two different factors. The first of which is that Chen was originally hired by Howard Leventhal therefore Chen believes that Mia is not his superior. Leventhal gave Chen freedom to expand the Levendary business into China with little guidance or instruction. To have a new CEO enter the business Chen will not feel the need to respect Mia, as he still believes his true superior is Leventhal. In addition Chen, while he is from the Chinese culture, had many experiences and training in the United States. Therefore it can be seen that Chen was of American culture and acted as such. The United States had a low score on the Power Distance so while Chen is with the Chinese branch of Levendary he still has the American cultural values. Uncertainty Avoidance Uncertainty Avoidance looks at the way that culture embraces uncertainty. With a low ranking in the Chinese culture it is evident that this country looks at laws as flexible. This is seen in Levendary China as the standards between all the restaurants vary and are different from the brand standards that are seen in the United States Levendary stores. In addition the difference in accounting practices can be seen. The China division was very lenient about their reporting of finance to the US Division. Individualism vs. Collectivism This dimension looks at how individuals think and act, if it is for the greater good or if it is for their own well-being. The Chinese culture looks out for the group when making decisions. This is demonstrated in the case when Chen disrespects Mia Foster. He previously considered Leventhal to be his group and when Mia takes Leventhal’s position then he does not recognize her as an insider. This results in his mistrust of Mia and her authority within the Levendary Cafà © company. Masculinity vs. Femininity The Chinese culture has high ranking in this and is seen through Chen’s demeanor. He is very competitive and is eager to be successful. This is seen through his urge to keep his position with Levendary China and the fast pace in which he opened the stores in China. In addition his actions of being very abrasive with Mia Foster is because he feels threatened that she is trying to take over his position with Levendary. He had never had his business interfered before by anyone from the Denver Headquarters so he put his back up when Mia started to interfere with how he was running his operation. Long Term Orientation vs. Short Term Orientation Long Term and Short Term Orientation looks at how a culture is prepared for the future. The Chinese culture is very focused on planning for a long-term future. This dimension demonstrated the American culture that Chen must have picked up on his time in America. With his time managing the Chinese division of Levendary, Chen was very short sighted and opened up a large amount of stores in a short period time. Instead of formulating a business plan, which would encourage growth for the future of the business, Chen did not have one and was simply opening businesses when he found an available location. Parent Company vs. Subsidiary In this case, the parent company would be Levendary Cafà © U.S. operations and  the subsidiary would be Levendary Cafà © China operations. In terms of restaurant size, U.S. restaurants range from 2,500-4,000 square feet. China restaurants are smaller in size; they range from 500-1,500 square feet. These results in less staff needed for China restaurants, approximately 13-20 staff members. The U.S. restaurants need about 24-26 staff members. The larger U.S. restaurants are able to accommodate more customers; they usually have 84-120 seats and can serve anywhere from 560-3,210 guests per day. Due to smaller size, China restaurants have a maximum of 80 seats currently and can serve 260-430 guests per day. In terms of menu options, the only item that is offered in both the U.S. and China is the chicken sandwich. The Suburban U.S./Denver restaurants make more revenue and have a larger square footage then the China restaurants. However, the China restaurants have higher average revenue per square foot. Restaurants in Beijing make $537.33 revenue per square foot and restaurants in Shanghai make $576.00 revenue per square foot. The Suburban U.S./Denver restaurants make $531.50 revenue per square foot. A chart can be seen below which clearly details the difference between the parent and subsidiary company. Alternatives and Recommendations Alternatives Mia Foster is left with a very difficult decision at the end of the Levendary Cafà © case study. As the new CEO of the company she has to make a decision that will result in profitability for the company and chose an action plan that ensures long-term success for the business. As such that are a variety of alternatives that Mia Foster will have to chose from in order to move forward with the company. The following list presents the many alternatives that should be considered: 1. Shut down all operations and solely focus business in the United States. The China division stores look and feel vary from what the Levendary Brand is trying promote in their US Division. In order to continue with the stores in China then restoration will need to be completed to all the stores. Mia Foster will need to determine if the China division profits are worth the renovations and continuation of Levendary China. 2. Fire Louis Chen and hire a new manager for the China Division. Louis Chen has proven hi mself as a capable entrepreneur and someone who is  knowledgeable of the Chinese retail market. However he lacks communication skills, which was noticeable through the expansion of 23 Levendary shops in China that do not fit with the brand image. Chen is also extremely confrontational and may not be the best fit with the new CEO, Mia Foster, as he already had built a rapport with Howard Leventhal, the previous CEO. If Louis Chen cannot properly function and communicate with the US Levendary division then he may need to be replaced by someone with a fresh perspective on the business. 3. Hire a management firm to manage the China Division of Levendary. It is apparent through the case study that the US Division of Levendary has not been able to communicate in an effective manner with an international branch of their company. The Hofstede Dimensions that were listed above demonstrates the cultural differences that separate the two branches of Levendary. With no cultural training Mia Foster and the US Division are not communicating properly with Louis Chen. An alternative to the situation would be to hire a management firm to look after the China division. A management firm with International experience would be a solution to the communication problem because they would understand how to conduct business while ensuring good communication. 4. Create a separate division of Levendary for the China stores. The Levendary stores in China are off brand from the original concept that is seen through out the United States. This is largely due to the fact there is limited communication because the key players in the United States and Louis Chen in China. In order to fix this problem it would be wise to bring the structure that works so well in the United States and duplicate this order in China. With 23 stores in China, Levendary will need a separate branch in China, as it will provide structure to that side of the business. With more supporting players in China, asides from Louis Chen, then Levendary will be able to maintain the brand and in addition, more supporting managers will ensure that communication is maintained between the US Division and the China Division. 5. Make a joint venture with TATA Group to expand into China. The TATA Group is a â€Å"global enterprise headquartered in India, and comprises over 100 operatin g companies, with operations in more than 100 countries† (TATA, 2015). TATA has operating companies in China and as such they will be able to reduce the large operating costs that Levendary China is currently experiencing. As noted in the Analysis and Evaluation section, the operating  costs are very high. Entering into a joint venture with a company who has established infrastructure will help eliminate these costs and allow Levendary to increase their profits for the first couple of years. In addition the joint venture will allow Levendary to be partnered with people who are culturally aware and possess cultural intelligence. 6. Replace the US Division Chief Operating Officer, Nick White. It was easy to identify that communication was a large issue between the US and China Division Levendary. It is easy to target Louis Chen as the main culprit of this issue as he was combative and disrespectful to Mia Foster. However the blame can also be placed onto the COO of the US Division, Nick White because he was responsible for keeping communication with China and overseeing the brand image in China. Nick White clearly let this responsibility go and as a result the China Division does not reflect the US vision for Levendary. If someone has to answer for the mistakes that were made in China than perhaps it should not be Louis Chen but instead it could be Nick White. Recommendation After evaluating all of the above alternatives for Mia Foster and Levendary Cafà © to pursue it was decided that the best alternative would be number 4, create a separate division of Levendary for the China stores. This alternative includes renewing the contract for Louis Chen and brings more managers to China to help grow Levendary in the China market with the vision and brand image of the US Division. Levendary in the United States can contribute a large portion of their success to their hierarchal structure as it allowed for proper communication and good reporting methods. If Levendary China were to create a China Division then it would allow for better communication between the United States and China and Chen would have the support he needs to ensure the brand image is seen between all stores. Action Plan In order to properly implement the alternative that was stated above, an action plan is needed. The action plan is detailed below through three different stages. The Short Term Plan looks at what the business should do in one years time, the Medium Term plan looks at what the business should do in two to three years time and the Long Term plan encompasses a five year  outlook. This is detailed below: Short Term: 1) The first critical step that needs to be taken is to ensure that proper communication starts immediately between Mia Foster and Louis Chen. If the two parties were to sit together and put all of their issues out then they can sort their current problems. Starting with good communication between Foster and Chen will ensure that it continues into their future business dealings. 2) Renew the contract with that Louis Chen has with Levendary China. Louis Chen has proven to be a valuable asset with Levendary Cafà © as he knows the retail market and is passionate about the work that he is doing. While it is arguable that Chen did not complete his work in a successful manner, he was with out support and was given little direction and free reign from the former CEO, Leventhal. With support and proper structure Chen should be able to work within these constraints. Therefore it can be seen that his contract should be renewed for another term with the stipulation that Chen will be working underneath other Levendary managers in China. 3) Denver Headquarters will need to create a business plan for their operations in China. With 23 locations currently in China they will have to decide which locations needs renovations and if all 23 should be maintained. By restructuring the current operations in China, Levendary Cafà © will have a more focused plan that will allow for the China operations to strive. If the Denver Headquarters were to work with Chen and use his knowledge of the China market than they can collaborate and develop a structured business plan. 4) Once a proper business plan has been developed Chen will need immediate support in China. By creating a separate China Division Chen will have the support he needs to standardize operations and reinvigorate the Levendary brand. Managers with cultural training should be placed into the new China Headquarters. Chen will be a regional Vice President however a new top manager will be placed in this division who will be above Chen on the hierarchy and will be the direct contact between itself and Denver. Medium Term: 1) Standardize operations all throughout the China Division. This includes a standardized brand image through all stores and a consistent menu. As with all locations in the United States there are set menu items in all locations  with special items according to the region. Levendary China will need conduct market research that will allow them to understand menu staples that should be available in all locations. In addition regional specialties should be included on the menu. 2) In addition to the standardization of restaurant practices the accounting practices will also need to be redeveloped. As per Chinese law all foreign business enterprises must follow the Chinese Generally Accepted Accounting Principles (China Briefing , 2013). Levendary China must follow â€Å"Accounting Standards for Business Enterprises† (China Briefing , 2013) and the Denver Headquarters should hire an international auditor who can then transfer all numbers to follow the US GAAP. 3) Monitor the new business plan for Levendary China and ensure that it is being properly followed and that brand standards are being maintained. Long Term: 1) Mia Foster should monitor and evaluate China operations on a constant basis. This will ensure that communication is kept to a high standard and that the brand image remains constant. 2) Once operations in China find their place in the market, Levendary China should appoint a Chief Franchise Officer who will develop franchise opportunities in China. This will allow more stores to be built and the brand to have more exposure with less of a expense put on the company. 3) A re-evaluation of their foreign expansion should be completed. The company should decide if they would like to find other potential foreign markets where they could continue the growth of Levendary or if they should focus directly on their domestic growth. Additional Questions 1. As it relates to the case, explain what this passage implies: An old mentor had once told Foster that there were three types of managers in a new business’s evolution to greater scale: the go-getter, the local baron, and the professional manager. All three types could be entrepreneurial in spirit, but not all were equally well suited for the various stages of a business’s growth. Chen was clearly a go-getter who had evolved to become a local baron. The question in Foster’s mind was whether he could transition to become a professional manager. Before answering the question of whether or not Louis Chen can become a professional manager, it is important to  identify the characteristics of one. The discussion in class brought to light that a professional manager is someone that has an understanding of the long term goals of a company, understands the value of standardization among all locations and understands the value and importance of brand image. A professio nal manager should also be educated and trained; furthermore, this individual needs to assume the role of middleman and understand top management’s goals and relay this information to his employees while collecting their feedback. Lastly, the class discussion brought to the surface that a professional manager should have extensive core knowledge on how the company should operate. Further research has shown that a professional manager should know how to plan, organize, lead and control all the efforts of his/her employees to complement the company’s values and standards (Sandeep, 2013). Howard Leventhal chose Louis Chen for his role because of Chen’s energy and enthusiasm. On a personal level it reminded Leventhal of himself at a younger age. Howard had told Chen to establish a strong market position as a base to eventually franchise outlets throughout China with the instructions to â€Å"do the right thing by the concept† but was given the freedom to operate the restaurants as he saw fit (Han & Bartlett, 2013). To enter the market in China Chen said himself â€Å"We just have to be flexible†¦Chinese eat few dairy products, so we should downplay our cheese soup†¦most people arenà ¢â‚¬â„¢t familiar with turkey, but they love chicken, so we’ll adapt the menu just as we do in the States† (Han & Bartlett, 2013). Chen believed that Levendary could succeed if it adapted its food and concept. According to Merriam-Webster Dictionary a go-getter is a person who works very hard and who wants very much to succeed (Encyclopoedia Britannica Company). Chen demonstrated the characteristics of a go getter as he opened up the first Levendary Cafà © only three months after returning from Denver. This location was a corner ground floor location in a new high-rise office building and the concept of the restaurant was prominent and luxurious. This restaurant was positioned as casual dining with table service and higher prices than local fast food concepts (Han & Bartlett, 2013). This location proved to be a hit among the white-collar employees working in the building. Because of competition Chen was forced to move quickly to purchase locations for the remaining restaurants and in the first year managed to secure prime locations for good prices and grow the chain to  23 restaurants. Then Chen demonstrated he was a local baron with his in depth knowledge of the Chinese market and was familiar with the neighborhoods in Shanghai and Beijing; his real estate knowledge was a major asset for the Levendary brand. He said it himself that he wa s in the trenches running 23 restaurants that he had built by reading market needs and sending opportunities (Han & Bartlett, 2013). Based on the information collected from the case it does not appear that Chen could develop into a professional manager. Because Chen wasn’t given any direction, he took it upon himself to change the concept, the look and feel and the menu items of Levendary Cafà ©. However, the way he handled Mia Foster and her colleagues from Denver and based on the definition of a professional manager Chen can’t develop into a professional manager and Levendary should look for someone to lead the China team while he continues to focus on the 23 restaurants that he has already built. Chen also became very defensive when Mia tried to communicate with him and based on the definition of a professional, he should be open to listen to their suggestions and input and adapt them to Levendary in China. If Chen had the instincts of a professional manager he would have taken it upon himself to contact his colleagues in Denver to update them on the progress he was making in China and should have taken the standards and values of Levendary Cafà © and applied them in China because that was his responsibility. To become a professional manager Chen would have to see the value of standardizing all the restaurants; however he did provide a great platform for the future growth of Levendary in China and should be kept on the team with certain responsibilities and be made aware of the expectations from Mia Foster. Works Cited Agriculture and Agri-Foods Canada. (2010). Health and Wellness Trends : U.S. Market. Ottawa: Government of Canada. Bartlett, C., & Han, A. (2013). Levendary Cafe: The China Challenge. Boston: Harvard Business School. China Briefing . (2013, February 5). China GAAP vs. U.S. GAAP and IFRS. Retrieved February 10, 2015, from China Briefing: http://www.china-briefing.com/news/2013/02/05/china-gaap-vs-u-s-gaap-and-ifrs.html China Briefing. (2014). Retrieved February 10, 2015, from China GAAP vs. U.S. GAAp and IFRS:

Friday, September 27, 2019

Rhetoric Essay Assignment Example | Topics and Well Written Essays - 1250 words

Rhetoric Assignment - Essay Example Chapman’s immediate purpose appears to be to delight Americans living in Chicago about crimes in the city and how they can be reduced. He acknowledges the significant reduction of crimes in the city in recent years but still feels the rates are high compared with other cities in the country. Chapman wants some underlying issues such as poverty and racial segregation that contribute to crime to be addressed. He also wants the number of police to be increased so that they can tackle crime efficiently. Chapman effectively fits his message to the circumstance, times and audience. The message fulfills his intentions of creating awareness and fighting crime in Chicago. The initial setting of the article is a column for Chicago Tribune and Creators Syndicate. The immediate community and content of the article are the present high rates of violent crimes in Chicago, which Chapman argues that they have reduced in comparison with the past. According to Chapman, some Chicagoans, especial ly the ones from crime-prone neighborhoods, may not be aware of the large reduction of murders in the city. In the article, Chapman argues that the security has improved in Chicago City in general, but some areas still experience high rates of crime. Chapman uses figurative language such as hyperboles, metaphors, and personification in his article. He seeks to address the misconceptions of homicides and other crimes in the city. His immediate purpose is to inform Chicago residents about crimes in the city and how they can be reduced.

Thursday, September 26, 2019

Internet plagiarism among college students Essay

Internet plagiarism among college students - Essay Example In this argument, the author asserts that students break this trust and prevent any possibility of being educated. The professor feedback will not allow the student to reflect on the assignment and identity new ways of improvement since the student does not own the work (Sadler 361). Fourth, Sadler asserts that plagiarism disadvantages other students especially in research papers. In this argument, the author asserts that the professor develops negative perceptions of the other students’ ability to deliver high quality work especially if the plagiarized work is of higher quality than the others. In addition, the professor may change the grading scale and will not be able to evaluate the effectiveness of his teaching strategies and instructions. Plagiarism is an injustice to the other students (Sadler 361). Fifth, the students who plagiarize do not benefit from the plagiarized materials or work since they have no opportunity of learning or engaging with the ideas. Much of the s tudent learning consists of preparing the assignments, thus students do not acquire any skills from presenting plagiarized work. In the sixth argument, plagiarism induces the student to laziness and low-self esteem that leading to habits of dishonesty and cowardice. The seventh argument why plagiarism is wrong is that it will make the student to believe that dishonesty is good in their later live (Sadler 262). This belief will curtail the ability to seek internal good through competition with others in order to secure self-interests. This behaviour will advance the notion that institutions such as universities do not promote social goods, but provide an avenue to attain private ends. In the eighth argument, plagiarism diminishes the purpose of university education since students do not acquire skills and knowledge that is essential in corporate world or public service (Sadler 362). In addition, this leads the public to suspect the value of higher education if graduates cannot demons trate skills and knowledge acquired after their higher education. The author asserts that plagiarism denies the student the opportunity to take a pride in his work through creativity and self-expression of knowledge acquired in class. It violates the academic integrity thus limiting the ability to engage in long-term scholarly commitment. Own academic work inspires humility and creates interest in further intellectual development. On the last argument, the author assert that students learn from interpersonal engagements thus this opportunity is limited if the students only provides the professors with pre-packaged goods (Sadler 362). The student will experience a limitation in self-expression and navigating concepts. One of the strengths of this article is that it provides the impact of plagiarism on both the student and professors. The article clearly outlines the purpose of university education and the negative impact of plagiarism on the life of the student (Sadler 362). However, Hunt Russell argues that the internet revolution provides reasons why students should be happy with internet plagiarism. In the first argument, Hunt notes that institutional rhetorical writing environment does not support internet plagiarism. Literary essays, research papers and term papers cannot be used to assess the skills and knowl

STEEPLE Analysis of UK Supermarket Term Paper Example | Topics and Well Written Essays - 2500 words

STEEPLE Analysis of UK Supermarket - Term Paper Example STEEPLE (Social, Technological, Environmental, Economic, Political, Legal and Ethical) analysis is amongst the most effective tools that are used to monitor changes taking place in the environment of the business (Brown, 2007; Griffith & Harmgart, 2008); the analysis is done to identify all important factors that can have a significant impact on any organisation operating in the UK supermarket industry. Li (2008) and Vasquez-Nicholson (2011) emphasized that Morrison PLC is a dominant brand in the UK supermarket industry as it derives its competitive edge by doing STEEPLE analysis frequently. It has successfully achieved its target market size by exploiting all strengths and availing opportunities present in its external environment. STEEPLE Analysis of UK Supermarket Every market is significantly impacted by both micro and macro environmental factors, but macro environmental factors have more influence on operational activities of a business (Jarett, 2012). Each factor of STEEPLE ana lysis with its relation to the UK supermarket industry is discussed below: Social Analysis The current trends of consumers in the UK market depict that they are moving from one stop shopping to a bulk buying mode as there are various social changes happening in the country. Supermarkets have availability of various non-food items which are usually on sale in the market. There have been demographic changes because there is an increase in old people, the number of female workers is increasing, and there is a significant reduction in homemade meals (Davis and Relly, 2009). There is more emphasis on the private label share of every business mix, efficiency in supply chain, and improvements in operational activities so that the overall cost of business is reduced. Most of the retail giants in the UK are now shifting to local suppliers for their purchases and stock requirements (Vasquez-Nicholson, 2011; Waterman, 2007). In addition, consumers’ demand of products and services has ch anged because of their social conditioning along with their beliefs and attitudes (Lyan, 2007). Technological Analysis Technological developments have enhanced the service level of supermarkets in the UK as they have benefitted both consumers and companies. With the help of technological gadgets, products are available quickly, personalized services are offered to customers and shopping has become convenient (Akter, 2012). The major systems that have enhanced UK supermarkets’ functioning are Electronic Point of Sale, Efficient Consumer Response, Electronic scanners and Electronic Funds Transfer System; these systems have assisted inefficient distribution and merchandising activities so that requirements of each company are effectively communicated on time to the supplier (Grugulis, Bozkurt and Clegg, 2010). Environmental Analysis All organizations have to show that they engage in environmentally friendly activities; there is increased pressure on various managers and companie s for acknowledging their social responsibility and they are required to behave in a beneficial way for the society (Smith, 2004).

Wednesday, September 25, 2019

Film review fido Movie Example | Topics and Well Written Essays - 250 words

Film fido - Movie Review Example I enjoyed the film due to its unpredictability nature. It has a lot of suspense in it, and the overall movie itself is interesting (humorous). For instance, humor exists when the government comes up with a remote control system of switching off and controlling the zombies (Currie). The major characters of the film are Timmy, Fido, and Hellen. Timmy is a malicious and inhuman character. She kills the zombified next-door neighbor; an act that causes the outbreak whereby many people within the area turn into zombies. The minor characters include Cindy Bottoms, Jonathan Bottoms, Theopolis, and many others (Currie). Generally, the major characters are associated with an anti-societal practice of supporting the zombie practices. The minor characters, on the other hand, are against the infestation of the society by the zombies. The minor characters influence and support the major characters by going against their plans and wishes, thus completing the plot of the film. Action is one of the main techniques that have been used in the movie. It is portrayed when Fido is killing the next-door neighbor (Currie). The technique ensures that the movie maintains its nature, that is, the horror character in it. It also ensures that the plot of the movie is maintained, thus enhancing the theme of the movie. Finally, it depicts the editor’s ability of using various movie techniques and picture and image editing styles. The film is based on a story. It has fulfilled and portrayed the literary work successfully using certain devices such as flashbacks, contrast, and

Tuesday, September 24, 2019

647 W3D "identify risks associated with a project " Essay

647 W3D "identify risks associated with a project " - Essay Example If a project fails to attain its short term objectives, risks can be easily detected. In an argument by Hubbard (2009) identifying risks at the early stages of a project life span can be done accurately, easily and effectively. In the case of general motors, early detection of risks was effective. The company had rebranded and required to increase its income. The first step in creating the project required the creation of an IPO. The short-term of the project was to identify how the market valued the stock and how much money the process would generate and its impact to the general outcome of increasing company income. In analyzing the risk, the early stages of the project depicted significant increase in the company income. In an instance where the company failed to identify the risks that may arise, the IPO would have been replaced by a less efficient strategy (Hopkins,

Monday, September 23, 2019

Business ethics Essay Example | Topics and Well Written Essays - 750 words - 2

Business ethics - Essay Example Most of the organizations have defined formal corporate ethics because most of the decisions of organizations are influenced by ethical issues. The employees feel very comfortable when a predefined corporate ethical is present in the organization because they get a clear understanding of what is right and what is wrong. The compliance of employees to corporate ethics is usually ensured by organizations by setting a formal corporate ethics program. Organizations have developed different programs and procedures to enhance the compliance to corporate ethics. For example, at TEPCO, there is a Corporate Ethics Committee consisting of top management, which work closely with ethical lines and establish corporate ethics carefully.1 The diagram (Appendix I) shows that once the corporate ethical conduct is formulated at top management level of TEPCO, it is promoted through incorporating the norms into culture and by revising the regulations and manuals. Moreover, through formal training programs and continuous monitoring, the compliance to corporate ethics is ensured. In this way, formal regulations and cultural norms strengthen the values, thereby, ensuring corporate ethical norms at TEPCO. There are some ethical guidelines, which are defined to develop corporate ethics programs. The ethical guidelines are the guidelines that are established to oversee what is suitable within the quest of specific objectives such as guidelines published by BPS (ITS, 2009). The ethical guidelines of companies usually differ and tend to be more specific. For example, American Mathematical Society has defined few ethical guidelines, which can be categorized into four sections including ethical guidelines related to mathematical research and its presentation, social responsibility of mathematicians, education and granting of degrees and ethical

Sunday, September 22, 2019

Marijuana Legalization Essay Example for Free

Marijuana Legalization Essay Marijuana legalization is a unique issue currently gaining momentum in America. Over 25 million Americans have used marijuana in the past year, 100 million have tried the drug at least once, and 14 million use regularly (â€Å"About Marijuana†). The growth, sale, possession, and consumption of marijuana for any reason are against federal law. Two states, Colorado and Washington, have legalized recreational marijuana use for adults over the age of 21, and sixteen additional states and Washington D. C. have legalized medical marijuana (â€Å"Pot Legalization Could Save†). However, all of these states are acting illegally according to federal law. Marijuana legalization is a complex issue that could upend cultural tradition, affect the economy, potentially affect crime and individual health, and challenge the balance of state and federal powers. The government’s purpose as stated in the Preamble of the Constitution is â€Å"to form a more perfect Union, establish justice, ensure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty†¦Ã¢â‚¬ . The constitutionality of marijuana criminalization thus depends on its effectiveness in promoting these goals. Three central areas to consider in the debate for or against legalization are the medical risks, the social effects, and the economic effects. The medical effects of marijuana have been fairly well studied. It is important to compare the medical risks of marijuana use versus use of drugs that are commonly and legally used and abused, such as tobacco and alcohol, as well as to distinguish between use and abuse. Smoking marijuana is widely presumed to have adverse effects on lung health. Smoking marijuana leads to the inhalation of up to three times as much tar as smoking cigarettes, probably because marijuana users inhale differently, breathing more deeply and waiting longer to exhale. Marijuana smoke can also contain up to 70 percent more carcinogens than tobacco smoke (Dohney). However, few marijuana users smoke as frequently as tobacco users. A study that was published in the Journal of the American Medical Association looked at marijuana smokers who averaged one joint per day for seven years and found no adverse effects on lung function (Dohney). In another study, called the CARDIA study (Coronary Artery Risk Developments in Young Adults), occasional and moderate marijuana users actually had increased lung capacity over tobacco smokers and non-smokers. For those who smoked marijuana 20 or more times per month, lung capacity dipped back to normal non-smoking levels, but only the most chronic marijuana smokers experienced lung capacity below an average non-smoker (Szalavitz, â€Å"Lung Damage†). Studies have thus far failed to link marijuana smoking and lung cancer. Although marijuana smoke is carcinogenic, THC (the active drug in the marijuana plant) also has anti-inflammatory and tumor-inhibiting properties, decreasing the risk of lung disease (Szalavitz, â€Å"Lung Damage†). Based on these conclusions, marijuana use is much less dangerous than tobacco use from a pulmonary standpoint. Additionally, many marijuana users ingest THC by inhaling vapor, eating it in baked goods, drinking it after simmering, or by swallowing concentrated capsules. These methods are increasing in popularity and don’t cause the same exposure to carcinogenic smoke (Dohney). Reduction in brain function is another commonly cited negative health effect of marijuana use. Judgment, coordination, attentiveness, reaction time, perception, and other mental functions can be altered while under the influence of marijuana. The assumption of such a statement is often that performing activities such as driving while high on marijuana is dangerous, but that assumption has not been emphatically confirmed in the consistent and extensive array of studies on drugged driving. Marijuana users are typically aware of slowed reaction time and impaired coordination, and they compensate by driving more cautiously (â€Å"Marijuana and Driving†). In one study, researchers compared driving under the influence of marijuana with driving under the influence of alcohol. They concluded, â€Å"Subjects who have received alcohol tend to drive in a more risky manner. Both substances impair performance; however, the more cautious behavior of subjects who have received marijuana decreases the impact of the drug on performance, whereas the opposite holds true for alcohol† (A.  Smiley). Of course, no one is advocating for impaired driving of any kind, be it under the influence of alcohol, marijuana, over the counter or prescription medication, or even fatigue. It is important to note, however, that driving high is less dangerous than driving under the influence of alcohol or some other drugs (Marijuana and Driving). Long-term concerns about impaired brain function from marijuana use are unfounded. Impairment of memory and learning ability don’t appear to extend beyond the time of the high itself. The popular image of young people ‘smoking themselves stupid’ has perpetuated an assumption that marijuana use is to blame for decreased intelligence. In a comprehensive study by the Centre for Mental Health Research at Australian National University, however, researchers concluded that apparent differences in intelligence among non-users, former users, light users, and heavy users were actually linked to participants sex, socio-economic backgrounds, and levels of education rather than to marijuana use itself. When these factors were considered, the effect disappeared and even heavy marijuana users did not show cognitive decline (Szalavitz, â€Å"Cognitive Impairment†). It is harder to determine the effect of marijuana on adolescents with developing brains. Legalization laws apply to adults over the age of 21, however, rendering that concern irrelevant. It is also notable that marijuana overdose can not cause death, while alcohol poisoning is responsible for numerous deaths every year (â€Å"About Marijuana†). Overall, the negative health effects (if any) of responsible, adult marijuana use are consistently found to be far less significant than the negative effects of the legal drugs alcohol and tobacco. In no proven way does marijuana pose a significant public health hazard. Different countries and states have and enforce very different drug laws, but in many places possession or cultivation of small amounts of marijuana has been decriminalized. Certain Australian states, Canada, some European countries, including the Netherlands, Germany, Switzerland, Spain, and Belgium, and several Latin American countries, including Peru, Argentina, Mexico, Chile, and Paraguay, are key examples of countries where personal use is legally acceptable (â€Å"World Marijuana Laws†). Many critics of marijuana legalization cite increased crime rates, increased use of marijuana and other drugs, and increased underage usage as potential issues. Exploration of the effects of legalization in other countries, as well as recently in Colorado and Washington, can show that these concerns are largely unfounded. Studies consistently find that decriminalization does not lead to increased usage of marijuana or other drugs (â€Å"Marijuana Decriminalization†). A study in the Journal for Public Health Policy, for example, stated: The available data indicate that decriminalization measures substantially reduced enforcement costs, yet had little or no impact on rates of use in the United States. In the South Australian community, none of the studies have found an impact in cannabis use which is attributable to the introduction of the Cannabis Expiation Scheme [decriminalization] (E. Single). As far as underage usage is concerned, drug dealers will of course never be bothered by the age of their clients. Legalization would be the only way for underage usage to be controlled, as licensed dealers would not be able to sell to those under 21 (â€Å"Legalization Will Reduce Crime†). No one has successfully linked marijuana use to increased violence, reckless behavior, or injury (E. Single). Alcohol abuse, however, is widely linked to violent crime, with an estimated 32 to 50 percent of homicides preceded by alcohol consumption (Gywenne). One of the only dangers associated with marijuana is a direct result of its illegality: innocents that stumble upon illicit farms or stashes are sometimes killed by farmers or traffickers to protect themselves from exposure (Quinones). These deaths, as well as deaths and injury due to fighting between traffickers, dealers, and clients, could be avoided by government regulated growth and sale of marijuana. Illicit drug producers and cartels seek one thing: profit. Because of marijuana’s illegality, secrecy is a key component of their success. They are not afraid to use extreme, ruthless measures to accomplish that end, and the legalization of marijuana would result in the loss of their most widespread market (â€Å"About Marijuana). The potential economic effects of decriminalization of marijuana are huge. It would cut criminal justice spending enormously by decreasing costs associated with catching and processing users (Bradford). Again, there is no established link between marijuana legalization and increased use, as well as no connection between use and crime (â€Å"Marijuana Decriminalization†). Nearly 850,000 people were arrested on marijuana-related charges last year, and ninety percent were for possession only (â€Å"Legalization Will Reduce Crime†). Prosecution for marijuana possession and time spent incarcerated can have devastating effects on an individual, shattering opportunities and creating massive obstacles in nearly every area of life (Gywenne). Beyond saving monetary resources and protecting the future of individuals who use marijuana responsibly, legalization would save time and human resources for more significant crimes in an overwhelmed legal system. More than 300 economists have signed a petition showing their agreement with a report stating that, between savings in the law enforcement department and potential tax revenues, the U. S. could save $13. 7 billion dollars per year. Other economists cite much larger savings, up to $100 billion (â€Å"Pot Legalization Could Save†). Marijuana is the largest cash crop in twelve American states, and in the top five in thirty-nine states (â€Å"Legalization Will Reduce Crime†). Nationwide, the industry is valued at around thirty-six billion dollars annually (Bradford). A market that large has huge economic implications and power, could create a considerable number of jobs, and legalization could reduce the cost of marijuana and thus inject a significant amount of money previously used for marijuana into other areas of the economy. Marijuana use does have the potential to be harmful, just as alcohol has the potential to be harmful. However, most marijuana use is not harmful. Legalization should allow for responsible use by adults only. Underage usage, impaired driving, smoking marijuana in public non-smoking areas, and the abuse of marijuana should be defined and prosecuted accordingly. The distinction between marijuana use and abuse is critical. Legalization would allow for more effective control of marijuana abuse, while decreasing violence, conserving resources, avoiding the dangers of questionable quality and purity due to unreliable dealers and farmers, and allowing for responsible use. Use of marijuana and other drugs would not increase significantly, crime would not increase, and health is a minimal concern. The marijuana debate comes down to a question of constitutionality. Does criminalizing marijuana promote the goals stated in the preamble, or is it counterproductive? Criminalizing the drug does not â€Å"form a more perfect union†, but rather raises a conflict between state and federal governments and the American population. Does it â€Å"establish justice†? It instead takes resources away from more serious issues of social justice to prosecute individuals who wish to responsibly exercise a choice. The criminalization of marijuana certainly works against the effort to â€Å"ensure domestic tranquility† by encouraging an underground market whose ruthless perpetrators resort to violence to protect their profit. On a similar note, it can be said that criminalization does not â€Å"provide for the common defense† or â€Å"promote the general welfare† because it promotes violence and because marijuana use does not pose a significant threat to public health or safety. Finally, legalization would â€Å"ensure the blessings of liberty† by allowing adults to make their own informed decisions about the use of the drug. Looking at each aspect individually, it becomes more and more clear that recreational marijuana legalization would be beneficial and constitutional. Word Count: 1906

Saturday, September 21, 2019

Relevance of Psychology in Primary Health Care Delivery

Relevance of Psychology in Primary Health Care Delivery Critically discuss how an understanding of psychology can enhance the delivery of primary health care. (District Nursing) Essay The concept of psychology as relevant to district nursing and the primary healthcare team can be examined on a number of different levels. An understanding of psychology is clearly important to the nurse when she interprets a patient’s reaction to events in their personal illness trajectory. (Yura H et al. 1998). It is equally important as she considers her professional approach to the patient and the understanding of how a patient will react to the delivery and impact of healthcare, particularly in her considerations of how to achieve maximum patient compliance in any given therapeutic regimen. (Dean A. 2002).There are other, arguably less immediately obvious, ramifications of the impact of psychological implications in the delivery of primary health care when one considers the interactions and dynamics of the primary healthcare team and the interplay between various members of the team. In this essay we shall consider all of these implications. We start with the general plan that the topic of psychology in this context is potentially vast and for this reason we shall consider individual illustrative episodes in some detail in order to demonstrate an overall understanding of the area. The perception of any given situation and indeed, the evaluation of the probabilities that arise from it, are generally dependent on its presentation. This in turn gives rise to differences and variations in the number and scope of the possible outcomes from that situation. This is the so called Theory of Rational Choice (De Martino B et al. 2006). The perception of a situation is dependent on its â€Å"framing†. It therefore follows that the outcome is also dependent on the same concept of framing of the presentation. This has great relevance to our question, as the District Nurse can make decisions that are influenced by the â€Å"framing† of the presentation by the patient, but more significantly, she can seek to modify the decisions that a patient ultimately makes by framing her presentation of the situation in a number of different ways. There is a substantial evidence base in the literature which cites examples of how decisions can be changed or even reversed if t hey are presented with different emphasis on different factors in the presentation (van Osch S M C et al. 2006). A full consideration of the implications of this statement will suggest that these psychological concepts will have a direct bearing on other professional considerations such as autonomy and other ethical issues. (Hendrick, J. 2000). How can a patient be considered to be making a truly autonomous decision if that decision is being influenced by the abilities of a nurse to â€Å"frame† the presentation of the relevant factors in order to suggest that one outcome is better than another? (Green J et al. 1998). How can a patient be considered to be â€Å"empowered and educated† about a course of treatment if the nurse has been selective in the way that treatment has been explained to the patient? (Sugarman J Sulmasy 2001). We do not presume to suggest that such concepts are necessarily wrong. It may be entirely reasonable for a nurse to use her professional skill and judgement to suggest to a patient that one particular course of action is preferable to another by framing the presentation in such a way that the patient is guided towards a certain decision. In a commonly experienced clinical situation such as a frightened patient with an extensive skin wound to the leg which clearly requires suturing and who is saying that they don‘t want anything to be done, we could probably all agree that it would be quite appropriate for a nurse to suggest that the procedure of suturing is not very painful and will give a good cosmetic result whereas to leave the wound open will give rise to infection and other difficulties. From an analytical viewpoint, this approach could be viewed as detracting from the patient’s autonomy and ability to make their own valid consent. (Gillon. R. 1997). A pragmatist mi ght equally suggest that the nurse is employing valid psychological principles in her professional desire to achieve what is probably the best outcome for the patient (Coulter A. 2002) One of the major areas that we shall consider in this appreciation of the significance of psychology in the delivery of healthcare, is that of attitude of those delivering the particular intervention to the patients concerned. This area is examined in commendable detail by the paper by Johansson (K et al. 2002) which specifically considered the effectiveness of the delivery of alcohol awareness programmes in a group of problem drinkers. The reason that we have selected this paper for an initial consideration is that, unusually for a research paper, it does not simply consider the efficacy of a particular healthcare package, but it reviews and critically analyses the attitudes of the healthcare professionals on the overall outcomes with specific focus on their readiness to participate in such a venture. This is seminal to the major thrust of this essay and therefore merits a detailed examination. In essence, the entry cohort to this study was a collection of about 150 primary healthcare team workers who could potentially be involved in the delivery of an alcohol awareness programme. Each was asked to fill in a questionnaire which was designed to evaluate a personal profile of the respondent and covered areas such as: experiences with patients with alcohol-related health problems, knowledge and perceived capacity concerning early identification and intervention, attitudes towards the role of primary care staff in early identification and intervention and current intervention methods in use at the health centre. The results are interesting insofar as there was general agreement that the likelihood of a patient generating or triggering an enquiry into their alcohol usage was most likely to be when issues relating to the alcohol-related health-risks were perceived by the healthcare professionals. The relevance of the psychological aspects of such an enquiry became clear when it was found that nurses were more likely to enquire than the doctors in the sample and that on average, nurses tended to drink less alcohol than doctors. (Dihn-Zarr, T et al. 1999) Those who drank the least were more likely to be concerned about the health risks than those who drank more. Clearly the effects of alcohol in any individual patient are specific, but the willingness of a healthcare professional to instigate healthcare measures to minimise the health-related effects of alcohol appears to be dependent on their own attitudes towards alcohol and this may be reflected in their own levels of consumption. There is an old adage that the definition of an alcoholic is a patient who drinks more than their doctor. (Fleming, M et al. 1999). In the light of this study, this comment may not be as flippant as it initially appears. In alcohol-related problems, there is frequently an element of denial, both in terms of alcohol intake and its effects. (Herbert, C et al. 1997). If the healthcare professional involved has a degree of denial of their own intake, clearly this will have repercussions on their presentation of the problem to the patient and their subsequent evaluation and willingness to invoke therapeutic or interventional measures for that patient. (Kaner, E. F. S et al. 1999) Other significant factors that contributed to the likelihood of a healthcare professional instigating therapeutic measures were found to be their individual perception of their own degree of knowledge on the subject, both in terms of the effects of alcohol on the body and also in terms of the interventions that were available. (Aalto, M. et al. 2001) Many nurses expressed the fact that they were concerned that patients might react negatively to such enquiries and that this would affect the degree of patient empathy. Doctors appeared to be generally more confident about handling the possibility of a negative reaction. The same study pointed to the fact that it appears that such fears were unfounded in reality, as the same proportion of patients reacted in a negative way in both groups. >From this brief overview, it can be seen that psychology plays a role at many different levels in what is basically a fairly straightforward healthcare professional / patient interchange, and the attitudes of both patient and healthcare professional can have a profound impact on the eventual outcome of the care package for the individual patient. The paper itself makes the comment that: Nurses appear to be an unexploited resource, in need of training and support. Nurses may need to be convinced that an active role does not interfere with the nurse–patient relationship. Building teams of GPs and nurses in primary care might enhance the dissemination of alcohol prevention into regular practice. A further psychological input that is relevant in this area is the perception of the healthcare professional of just how effective the intervention that is proposed is likely to be. A previous paper on the same subject (Andrà ©asson S et al. 2000), concluded that healthcare professionals were much more likely to recommend a healthcare intervention that they had personally experienced or witnessed as successful, with greater frequency than one which had been shown to have a secure evidence base in published literature. The paper concludes with the suggestion that specific training in the subject needs to be implemented and this training not only needs to address the knowledge gap that has been identified, but also the belief systems and attitudes of the healthcare professionals in the primary healthcare team in order that it can reach its maximum potential. Although this paper was targeted and written in relation to a specific alcohol related intervention, it is reasonable to assume that the selected comments cited in this essay are sufficiently general to apply to most specific health related interventions and we will consider and explore other psychological rationales in specific relation to Health Promotion initiatives together with the inferences that can be drawn in relation to team building issues at greater length later in this essay. One of the major areas where psychology is relevant to the success (or otherwise) of a particular treatment is encapsulated in the concept of empowerment and education. (Howe and Anderson 2003). The patient who is both empowered and educated by the nurse will approach their illness trajectory in a completely different psychological frame of mind than one who is not. Time spent in explanation to a patient of the parameters and reasons for their treatment is rarely wasted. (Holzemer W et al. 1994). Marinker’s concept of the differentiation of compliance and concordance. (Marinker M.1997) is particularly useful in this respect. Although his original paper was written with specific regard to the taking of medication, the principles that it expounds are sufficiently general that they are now commonly extrapolated to cover most aspects of the interaction between the healthcare professionals and the patient. The patient who understands why he is being asked to undergo a particular th erapeutic regimen is far more likely to complete is successfully than one who is simply told what to do. This can be encapsulated in the professional advice on the subject from the RCN Patients are as fully involved as practicable in the formulation and delivery of their care (e.g. through the use of self-care plans) Where appropriate, patients are offered treatments other than medication Treatment plans are individually tailored for each patient Patients are involved, unless impracticable, in any decisions about referral Where practicable, patients are informed of the reasons for referral to specialists or other professionals (cited in CSAG 1999) This element of compliance is frequently cited in many of the tools of quality indication that are used in formal studies in this area. The degree to which a patient complies (or concords) with instructions can be viewed as a measure of success of the presentation of that treatment directly to the patient. (Campbell S M et al. 2000) As we have intimated in the introduction, the title of this essay can be interpreted at several different levels. In this segment we shall consider the impact of formal psychology services in primary health care. The rationale for our consideration of this topic specifically lies in the fact that an understanding of basic psychological principles is fundamental in allowing the nurse to appreciate the elements of treatment commonly undertaken in a psychology clinic. The excellent and informative article by Sobel (A B et al. 2001) provides a good starting point for this consideration. In practical terms, the average attendance at a psychology clinic is about five outpatient attendances. (Arndorfer, R. E et al. 1999). This means that the contact of a patient with the primary healthcare team is likely to outnumber the attendances at the clinic over a period of time. To give a specific example, it is clearly important for the nurse, who may come into contact with (for example) an anorexic adolescent, to understand the issues revolving around body dysmorphia, self-image enhancement and self-esteem (Lavigne, J. V. et al. 1999) if they have been undergoing treatment, if the nurse is to consider giving any degree of holistic consideration to whatever problems are being presented to her at the time. It is clearly of little value, if requested to give advice on the subject of weight loss (which is a common enquiry at nurse-run clinics), (Hogston, R et al. 2002) . to attempt to give such advice without a background knowledge of the psychological principles that have been employed in trying to restore the patient’s eating habits to a more normal pattern. (La Greca, A. M. 1997). Equally the parents of a child who is undergoing treatment for enuresis may have questions that they have not felt able to ask at a busy clinic and these may be presented to the practice nurse. A background knowledge of current treatment (both interventional and behavioural) is clearly vital t o being able to answer the questions with a degree of professional confidence. Another area where the nurse’s knowledge of psychological issues may be important is that, given the fact that a comparatively high number of patients default from follow up before being formally discharged, the nurse should know that psychological treatment is rarely successful if the â€Å"less than optimum† course of treatment is completed. (Sobel, A. B et al. 2001). Encouragement to return to complete the full course may be a useful remit for the nurse confronted by a patient in this situation. It follows that a sensitive exploration of the reasons for default my also be helpful and a knowledge of the subject is clearly helpful here as well. The patient who has defaulted from follow up through apathy needs completely different handling from the patient who has defaulted because of a resurgence of painful or difficult memories during a course of cognitive behavioural therapy. (Street, L. L.et al. 2000). In the latter case, empathetic handling is of great importance a s the issues involved may have a deep significance for the patient and completion of the course may be fundamental to a complete resolution of the issues involved. (Mitchell M C et al. 2004). When dealing with the patient who has specific emotional or psychological issues, the professional nurse would commonly have to employ a degree of psychological understanding which may be deeper than in many other cases for both of the reasons set out above. Let us now consider a different aspect of psychology and its relevance to nursing practice in primary care. A large proportion of the work of the district nurses can be taken up with the care of the dying patient. The dying, or terminally ill patient typically has a psychological profile that is quite different to the â€Å"average† patient. This was explored in the fascinating and very well written paper by The (The et al. 2000) who considered the elements of denial and cognitive distortion exhibited by a patient when being given news that they do not want to hear. The diversity of psychology shown by these patients is virtually unique to this group and a firm grasp of the essential elements is vital if the district nurse is going to handle the situation both professionally and well. The concept of â€Å"a good death† (Seale C et al. 2003) is one that is frequently cited in the modern literature and a fundamental prerequisite to a good death is that the patient is surr ounded and treated by healthcare professionals who have broad understanding of the psychological issues that are relevant to this spectrum of patient. (Wilkerson, S. A et al. 1996) There are many patients who confront the inevitability of death with a stoical inevitability that makes their management a relatively straightforward matter (Wadensten et al. 2003). The patients that we shall specifically consider in this segment however, are those who have a positive diagnosis of a life threatening condition but employ a number of coping mechanisms so that they do not have to directly confront the possibility of imminent death. These mechanisms can range from false optimism right through to frank and abject denial (Weeks et al 1998). We have already considered some of the ethical implications of autonomy and consent earlier in this essay, but they also are of great relevance in this section. It follows that if a patient is to have any degree of meaningful input into their treatment plans and consideration of the various options that are open to them, they must be both fully aware of, and quite prepared to confront, the implications of the situation that they find themselves in. If they chose to distort some or any of the relevant facts of the case, it equally follows that they cannot make a reasoned and rational decision about the options and choices that they have in front of them. Once again we return to the issue and concept of framing the presentation, the only difference here is that it is generally the patient who deliberately distorts the frame rather than it being distorted or manipulated by the healthcare professionals. This specifically is the issue that The and his colleagues considered in their paper (The et al. 2000). We should start a consideration of this issue however, with a reference to an earlier paper by Jennings (1997) who described the â€Å"emotional roller coaster† experienced by patients who deal with a malignant diagnosis and that this â€Å"evolution of emotional landscapes† can be predicted with a degree of certainty. This can be best examined with a verbatim extract from the The paper which refers to patients with small cell carcinoma of the lung: â€Å"False optimism about recovery is usually developed during the (first) course of chemotherapy and was most prevalent when the cancer could no longer be seen in the x ray pictures. This optimism tended to vanish when the tumour recurred, but it could develop again, though to a lesser extent, during further courses of chemotherapy. Patients gradually found out the facts about their poor prognosis, partly because of physical deterioration and partly through contact with fellow patients who were in a more advanced stage of the illness and were dying. False optimism about recovery was the result an association between doctors activism and patients adherence to the treatment calendar and to the recovery plot, which allowed them not to acknowledge explicitly what they should and could know. The doctor did and did not want to pronounce a death sentence and the patient did and did not want to hear it. Clearly an understanding of the psychology of what colours the patient’s reactions is vital to the district nurse if she is to handle this type of situation both professionally and empathetically. If we take a completely detached and dispassionate consideration of this situation the healthcare professional can say with almost complete certainty, that the patient with a positive diagnosis of small cell carcinoma of the lung is going to die. Statistically we know that over 90% of patients are dead within two years of diagnosis and the overall five year survival figures are nil. (Seale C et al. 2003) The practicality of the situation is therefore that it clearly makes sense to discuss options in terms of treatment, palliation and support as soon as a positive diagnosis is made. In real terms, this is rarely done because healthcare professionals frequently find it difficult to effectively pronounce a â€Å"death sentence† on patients. In this respect the psychology of the situation is as much a reflection of the attitudes and feelings of the healthcare professionals as it is of the patient. On a fictional level one can cite the classic literary example of A J Cronin’s Dr Findlay (Cronin A J 1934) who disagreed with his partner Dr Cameron. Dr Findlay felt strongly that the eponymous Mrs McIver should be told of her hopeless prognosis on the grounds of being completely truthful with the patient and this was against the advice of the older, more experienced partner, Dr Cameron who had been hitherto managing the situation by keeping the lady’s spirits high by telling her how well she was looking at each occasion he had contact with her. Dr Findlay confronts the situation by telling Mrs McIver the truth and within a few days she has died. The relevance of the story is seen at the end where Dr Findlay is depicted talking to the dead lady’s husband and Dr Findlay expresses his shock at the speed at which the old lady died and the husband concludes the episode by observing that: â€Å"She was doing really well until you took away from her the one thing that she had left – and that was hope†. In short, this episode highlights some of the difficulties and dilemmas that are frequently faced by healthcare professionals in general and district nurses in particular. The practicality of the situation could have been handled better with a more thorough understanding of the thought processes and psychological mechanisms employed by Mrs McIver in her last few weeks. One can see the point of view of Dr Findlay who took the view that the lady would not have been in any realistic position to make appropriate arrangements to confront her own death if she had never faced the possibility in the management plan that Dr Cameron had adopted. Dr Findlay’s approach could be argued to have allowed her to consider a number of timely treatment options if the truth was confronted. The fact of the matter was that she chose to actively collude with the optimistic approach of Dr Cameron and she derived strength and the ability to cope from the transparent belief (a cognitive distortion) that her prognosis was not hopeless. Dr Cameron was clearly of the opinion that this was of greater benefit to her than confronting her imminent death. What the story does not tell us (and we can only surmise) is that Dr Cameron, in common with many other real healthcare professionals, also has psychological difficulties in dealing with the subject himself. A number of different mechanisms may be active in this situation. It is possible that, by telling a patient that they are soon to die, it may challenge the notion that medical science can cure everything and that healthcare professionals are infallible (sadly, a still all to common belief). Equally it could be that the healthcare professionals involved do not like to be vicariously reminded of their own mortality and therefore collude willingly with the patient’s false optimism. Others again may take a rational view that â€Å"if the patient wants to know the truth then they will ask, if they don’t want to know then they won’t ask† and thereby actively avoid confronting the situation (Curtis J R. 2000) The The paper examines this issue in considerable depth with a commendable degree of scientific scrutiny. In the words of the paper, the authors suggest that: The problem of patient / doctor collusion does actually require an â€Å"active, patient orientated approach from the doctor†. A practical and novel solution to this problem is suggested in the form of the use of a â€Å"treatment broker† who is defined as: â€Å"a person who is trusted by both patient and doctor and who can help both parties to clarify and communicate their (otherwise implicit) assumptions and expectations†. The’s analysis suggested that the majority of patients in the study did actively want to know if the illness that they had was terminal with over 85% stating that they would wish to be told the truth rather than be given false optimism in an unrealistic fashion. This is contrasted with the finding that, in the study, when a patient was given a terminal diagnosis, the next question was almost invariably a variation of â€Å"what are the chances of a cure?† (Meredith et al 1996). It is also the case that other studies on the psychology of this type of situation have shown that when patients ask about their condition (and this applies not specifically to terminal conditions) they do not want to hear anything other than good news (Costain et al 1999). This argument is extrapolated even further in a study by Leydon and his co-workers (Leydon et al 2000) who provide an excellent qualitative study into patient’s reactions and they cite examples of patients who were interviewed directly after a recorded conversation with a healthcare professional and who overtly denied that they had been given a terminal diagnosis even though this was demonstrably not true. An interesting twist in these discussions of the psychology of the situation is provided by Dean (Dean 2002), who offers a specific insight into the way patients perceive the differences between nurses and other healthcare professionals. He takes the arguments of false optimism and overt denial and examines them further. Again, this paper is specifically concerned with the patient with a terminal diagnosis, and it looked at the differences in the content and tone of the conversations that patients had with both doctors and nurses. A significant finding from this paper was that a patient may choose to overtly collude with the doctor during discussions of â€Å"a cure† but within a very short space of time may choose to talk in a much more open way with a nurse when pretences of a cure are actively dropped. Dean suggests that â€Å"such a dichotomy of approach is not unusual†. He suggests that: Patients may well feel a need for a theatrical faà §ade to bolster their own psychological states as well as to collude with the doctor and indicate that they are remaining positive and confident in the doctor’s ability to try to achieve a cure. And this suggestion is echoed and expanded in the Curtis paper (Curtis 2000) with the observation that, in their more candid moments patients may well wish to get a more â€Å"down to earthâ€Å" response, which they perceive that they will get from the nurse, who they think may not require a faà §ade or even indulge in the sophisticated game play of the doctor. Lynn (Lynn 2001) adds a counter-intuitive note of caution for the nurse with the thought that this situation requires a great deal of careful handling by the nurse, as the psychological mechanism that underlies the nursing approach is that the patient may actually be looking for reassurance and (possibly unexpected) reinforcement of their own false optimism. This is an exemplification of the constant calls in the literature for a holistic and patient centred approach to patient care rather than a blanket approach to this type of clinical problem. The rest of The’s paper is concerned with the psychological theory behind the explanations of just why it is that patients do adopt these defensive positions and just why it is that healthcare professionals frequently collude with them on this issue. It is not particularly relevant to explore this in any further detail as the point is clearly made that a basic understanding of the mechanisms by which patients cope with their adversity and the psychological constructs that are frequently presented in these circumstances is of great importance to the nurse who has to deal with, interpret and empathise with the patient’s particular needs at any given time in their illness trajectory. Nurses are often involved, both overtly and in their everyday work, in the business of Health Promotion. Psychology plays a very important part in the overall success and implementation of health promotion strategies on a both a population and an individual level. The theoretical basis of much recent work in the field of Health Promotion is in the concept of the Attitude-Behaviour theory (A-B theory) (Rise J 2000). This theory suggests that the optimum change in behaviour patterns (at least in the field of health and self-interest) is achieved with the optimum change in attitude (or â€Å"realignment† in the jargon). We opened this essay with a reference to the Theory of Rational Choice. An offshoot of this theory (the Theory of Reasoned Action) modifies the A-B Theory to the extent that it provides a model framework by which one can assess the many divergent processes by which attitudes guide behaviour. The hypothesis states that if people can become highly motivated to make a correct decision and are in a position (because they have been given relevant information), then they are likely to spontaneously engage in a â€Å"deliberate and thoughtful process in deciding how to behave† (Rise J 2000). In the context of Health Education (which was the field that the theories were originally developed in) the theory suggests that if people are given sufficient and persuasive information in relation to their health, then a significant proportion will spontaneously indulge in lifestyle changing activity which can be consistent with healthier living. The significance of these theories is that, if t he nurse has a remit to promote a healthier lifestyle (which is arguably part of a professional remit), she is most likely to have the greatest success in providing significant amounts of information to patients rather than simply dictating to them how they should alter their lifestyle without any significant explanation. This comment effectively brings us full circle to the concept of compliance and conformance as postulated by Marinker. Another issue that has deep seated psychological implications, is the current trend towards teambuilding in primary health care. The ramifications of this concept are huge, and therefore we intend to only discuss the issue by considering a number of the most relevant points. To a large extent, team building overlaps with the concept of multidisciplinary team working. This move has required a redistribution of both power and authority (and thereby a redistribution of responsibility) within the team. (Shortell S M et al. 1998).The psychological implications of this are that if one considers the NHS of more than about twenty years ago its structure was more isolationist and based on individual practice (DHSS 1988). Individual speciality teams and individuals worked in a degree of comparative isolation and this also implied a greater degree of individual responsibility than they have at present. This change has brought about a number of major changes in areas such as ethics and work prac tices which are not particularly relevant to our topic in this essay (and therefore will not be discussed further), and also the psychology of working, which clearly is. The first consideration is the psychology behind the concept of leadership. Leadership is clearly important if one is to have an effective team. In psychological terms styles of leadership can be divided into several categories. The two most prominent being congruent leadership and transformational leadership. A full discus