Discussing Total Quality Management standards

Discussing Total Quality Management standards Many authors have discussed TQM Standards. Samuel K. M. Ho in the article Is the ISO 9000 Series for Total Quality Management? wrote that the philosophy of Total Quality Management is that of promoting continuous improvement in an organization and focuses primarily on total satisfaction for both the internal and external customers, within a management environment that seeks continuous improvement of all systems and processes. He added that the philosophy is based on an intense desire to achieve victory. Achieving victory is a challenge for todays companies. Competition is intense and senior managers and CEOs thrive to achieve a sustainable competitive advantage over their competitors. Though some people see TQM as something necessary to reach competitiveness and emphasize the relation between TQM and success (eg U/s GAO, 1991; Becker, 1993; Ghobadian and Gallear, 1996), others claim TQM to be merely a management fad and point out that many companies have failed to implement TQM (eg B inney, 1992; Harari, 1993; Hachman and Wageman, 1995) (Ulrika Hellsten and Bengt Klefsjo) As Hellsten and Klefsjo mentioned in their article there are different opinions of TQM. The goal of this assignment is to analyze the different views of TQM and identify whether TQM standards do help companies promote quality. It also analyzes whether TQM standards vote for the satisfaction for both the internal and external customers as said by Samuel K. M. Ho, or else they are diminishing the real scope of quality by constraining innovation and creativity in todays businesses. Studies by different authors both for and against TQM will be analyzed to understand whether TQM standards improve or lessen quality of products and services. It is important to add that various authors discussing TQM mentioned that there exists different descriptions of TQM and also (Boon O K, Atumugam V, Hwa T S (2005) said that surprisingly, a limited amount of rigorous research has been done towards identifying the effects of soft TQM practices on employees work-related attitudes. To start with it is vital to understand what is meant by TQM and its purpose. Definition of Total Quality Management In order to define quality one has to first consider who the customer is, and subsequently consider what the requirements of each different customer group are at any one time. (Leicester 2007:1.3) The Total Quality Management book of Leicester says that it is important to remember that when the level of quality the customer expects is perceived by him as being exceeded by the level of quality he has received, then an opinion of good quality is formed. Vice versa the level of quality is said to be poor when the customers expectations of the level of quality he should receive exceed the level of quality the customer perceives he has actually received. Therefore for companies to succeed it is important to understand the level of quality that the customer is expecting. There are various definitions which have been identified by different authors such as; Fitness for purpose Conformance to requirements Zero Defects Though the above phrases of quality all have different meanings in general they all have common characteristics such as; aim of satisfying the customer, provide best quality at the lowest possible price and should be companywide strategy. A definition which gathers the meaning of TQM has been defined in a website of Lean Manufacturing Concepts. TQM is a process and philosophy of achieving best possible outcomes from the inputs, by using them effectively and efficiently in order to deliver best value for the customer, while achieving long term objectives of the organization Anon (2009). This sounds an appropriate definition of TQM since it emphasizes on the value received by the customer and in return the organization attains its objectives. TQM Standards and BS EN ISO 9000 TQM started in 1927 with Elton Mayos Hawthorne experiments through 1932. Later in the 1950s Edward Deming taught statistical methods and Dr Juran taught quality management techniques to the Japanese. Many of the Total Quality Management theories were originated by Armand Feigenbaun. TQM continued evolving. New methods were introduced to support TQM such as Lean Manufacturing and Six Sigma. Broughton (2009) Also organizations can become certified to ISO 9000. Various ISOs have been developed for different sectors such as ISO ISO9001, ISO9002 and ISO9003. ISO standards have been set up to focus on business planning, quality management and continuous improvement. Broughton (2009) Broughton said that the key concepts of TQM are; Structured system for exceeding customer expectations System that empowers employees Drives higher profits Drives lower costs Continuous improvement Management centered approach on improving quality As mentioned above the concepts of TQM are all centered for the benefit of the company and to satisfy the needs of the customer and ensure customer satisfaction. However, what are the impacts of TQM standards on creativity and innovation? Do TQM standards really focus on processes rather than employees thus affecting business innovation? In the next section some arguments for and against TQM standards will be discussed. Literature Review Arguments For and Against TQM standards As Wood and Peccei (1995) stated, TQM is widely agreed as a way of managing organizations with the notion to enhance employees attitudes. Quality practitioners such as Deming (1986), Crosby (1979), Juran (1991) and Feigenbaum (1983) have written much on the idea of TQM philosophies and methods. Surprisingly, a limited amount of rigorous research has been done towards identifying the effects of soft TQM practices on employees work-related attitudes. (Boon O K, Atumugam V, Hwa T S (2005) In an article namely Does soft TQM predicts employees attitudes? it is mentioned that a survey of the literature reveals that several TQM proponents believe that the soft aspects of TQM are essential to the success of TQM (Juran, 1964; Ishikawa, 1985; Deming, 1986; Aubrey and Felkins, 1998; Dale et al., 1992; Cruickshank, 2000). Powell (1995, p. 15) concluded that organizations that acquire the soft elements of TQM can outperform competitors without the accompanying TQM ideology. Evidence from the grow ing literature on TQM failure emphasizes the neglect of the soft side of quality management wherein the HR and organizational behaviour aspects of quality management are not given their deserved emphasis (Lowery et al., 2000;Wilkinson et al., 1998; Cruickshank, 2000). TQM, which has been adopted by leading industrial companies, is a participative system empowering all employees to take responsibility for improving quality within the organization. Instead of using traditional bureaucratic rule enforcement, TQM calls for a change in the corporate culture, where the new work climate has the following characteristics: An open, problem-solving atmosphere; Participatory design making. Trust among all employees (staff, line, workers, managers). A sense of ownership and responsibility for goal achievement and problems solving. Self-motivation and self-control by all employees. TQM requires that management, and eventually every member of the organization, commit to the need for continual improvement in the way work is accomplished. Business plans, strategies, and management actions require continual rethinking in order to develop a culture that reinforces the TQM perspective. The challenge is to develop a robust culture where the idea of quality improvement is not only widely understood across departments, but becomes a fundamental, deep-seated value within each function area as well. Anon (2009) On the other hand Crawford (1998) argues that one of the main reasons for the present economic stalemate being experienced in Japan is the obstacle to innovation which is presented by the mindset of continuous improvement. He considers that this mentality reflects, in the main, a wish to avoid the embarrassment resulting from potential failures associated with radical change. The point is also made that a strategy of continuous improvement does not necessarily work in markets which constitute high risk investment, such as pharmaceuticals and microprocessors. These types of arguments tend to imply that TQM is not a valid paradigm in a world where changes are becoming increasingly frequent and need to be made at a faster pace. Martinez Lorent A.R, Dewhurst F, Dale B G (1999) It continues that though TQM is seen as business innovation it does not necessarily mean that it promotes business innovation. Martinez Laurent, Dewhurst and Dale said that TQM tends to lessen business innovation such as improving processes and improving the way in which people are managed with the aim of adapting to the changing environment. On the other hand Curry and Clayton (1992), Imai (1986) and Miller (1995) said that progressive business innovation can be achieved by TQM through continuous improvement. In the article TQM and business innovation it is also mentioned that Companies following TQM approach can more easily assimilate innovations imported from other situations due to the willingness of its employees to accept new ideas as a result of the continuous improvement ethos promoted by TQM Martinez Lorent A.R, Dewhurst F, Dale B G (1999) It is evident from the literature reviewed that TQM is becoming a major requirement for organisations to be successful and gain a competitive advantage. As time goes by customers are becoming more demanding and companies have to focus on identifying customer needs to achieve customer satisfaction. In an article of TQM on the web it says that the views of todays companies of TQM include characteristics such as an open problem solving atmosphere and participatory decision making. Anon (2009) This is an evidence that it is not true that TQM focuses on processes and neglects the people aspect. To adapt to the changing of customers needs and this changing environment TQM promotes employee involvement and as mentioned above participatory decision making. This would also lead to employee satisfaction and motivation. Though it is claimed that TQM has various benefits various companies have claimed that TQM implementation resulted in a failure. Thus it is necessary that companies manage TQM efficiently and effectively. The next chapter of this assignment will outline some of the aspects which need to be considered for the successful implementation of TQM. Successful implementation of TQM Before applying any TQM standards a company should have a well defined strategy and mission in place. Having a strategy in place means that the company has pre defined set of objectives to achieve. The operational and management structure should be adopted to achieve the set strategy. The mission statement should reflect the values and beliefs which underpin all corporate activities. (Leciester 2007:4.5) A mission statement has to be well communicated to the employees and has to inspire people with the aim of achieving the goals set by the company. Last but not least a company should set value statements. Value statements should guide the way people within the organization function and as such should be a substantial influence on the development of a total quality culture. (Leicester 2007:4.8) Helsten and Klefsjo believe that before applying any TQM standards a company has to start with core values and only then the techniques and tools are selected as shown in the diagram below. Increase external and internal customer satisfaction with a reduced amount of resources. Techniques Core Values Tools The techniques and tools selected will then have to be adopted. For instance an example mentioned by Hellsten and Klefsjo, the core value Let everybody be committed can be implemented by techniques such as improvement groups and quality circles. The tools might be Ishikawa diagram, Pareto diagram and histograms. Core values characterize the organization and as these change overtime the techniques and tools will have to fit these values. Robert Dunn says that most importantly before implementing BS EN 9000 one has to be thinking about quality in the company and in all its activities. It is useless implementing the standard just for the sake because purchasers want the certification. (Dunn R 1995:11) Today, developing quality across the entire firm can be an important function of the human resource management (HRM) department. A failure on HRMs part to recognize this opportunity and act on it may result in the loss of TQM implementation responsibilities to other departments with less expertise in training and development. The ultimate consequence of this loss is an ineffective implementation of the TQM strategy. Thus, HRM should act as the pivotal change agent necessary for the successful implementation of TQM. Based on this customer first orientation, organizational members are constantly seeking to improve products or services. Employees are encouraged to work together across organizational boundaries. Underlying these cooperative efforts are two crucial ideas. One is that the initial contact with the customer is critical and influences all future association with that customer. The other idea is that it is more costly to acquire new customers than to keep the customers you already have. Exemplifying TQM here would mean that the HR department would need to train itself, focusing on being customer-driven toward other departments.   Anon (2009) The effective use of quality improvement teams, and the TQM system as a whole, can be reinforced by applying basic principles of motivation. In particular, the recognition of team accomplishments as opposed to those of individuals, and the effective use of goal setting for group efforts, are important in driving the TQM system. The HR department is in a position to help institutionalize team approaches to TQM by designing appraisal and reward systems that focus on team performance.    For many companies, the philosophy of TQM represents a major culture shift away from a traditional production-driven atmosphere. In the face of such radical operational makeovers, a determined implementation effort is vital to prevent TQM from becoming simply just another management fad. Senior management must take the lead in overt support of TQM.  Anon (2009) Part of HRMs functional expertise is its ability to monitor and survey employee attitudes. This expertise can be particularly important for a TQM program, since getting off to a good start means having information about current performance. Thus, a preparatory step is to administer an employee survey targeting two primary concerns. One involves identifying troublesome areas in current operations, where improvements in quality can have the most impact on company performance. The other focuses on determining existing employee perceptions and attitudes toward quality as a necessary goal, so that the implementation program itself can be fine-tuned for effectiveness. Beyond communicating the TQM philosophy, the specific training and development needs for making TQM a practical reality must be assessed. Basically HR professionals must decide the following: What knowledge and skills must be taught? How? What performance (behaviours) will be recognized, and how will we reward them? HRM has faced these questions before and can best confront them in the TQM process. Training and development that does not fit within the realm of these questions will more than likely encounter heavy resistance. However, training and development does fall within the realm of these questions probably will be accepted more readily. Testimonies from Various Companies TQM standards help you clarify and identify customers requirements. Furthermore TQM help a company deliver what the customers order and on time, spot product deficiencies and improve processes and also improve competitiveness. Alan Davis from Ind Coope Burton Brewery highly believes that the company is committed to a total quality culture. He adds that with this approach all parts of the company are involved in continuous improvement in return this gives the assurance of quality to the customer. He also added that the company will soon be ready to seek registration of its quality system to BS 5750. (Moritiboys Oakland J 1994:35). Acorns Nurseries of Cardiff which is a child care centre claimed that by seeking registration under BS EN ISO 9002 they would be able to demonstrate the quality of their service thus would inspire confidence in their customers. Acorns said that the advantages of having a documented system are; Ensure standards are throughout amongst all their sites. Well kept records, stock control ensures consumables are available and parents concerns are replied quickly. Most importantly the efficient management system allows the nursery nurses to get on with what they are best at looking after children. (Dunn R 1995:7) Below are some of the benefits of TQM standards by Robert Dunn; Motivate staff to improve performance Define key roles in the company Consistent in orders and delivery Good management of customer complaints Continuous improvement Glossop Carton a company which achieved certification in 1992 says that since the certification gross profit has risen and when things go wrong, they can now pin point where they have gone wrong. Therefore then they can adjust accordingly and learn from mistakes thus promoting a better quality product for the customer. Conclusion In the book of Leicester in an article by Moritiboys Oakland it is mentioned that The International Standards Organisation (ISO) Standard 9000 Series sets out the methods by which management system, incorporating all the activities associated with quality, can be implemented in an organization to ensure that all the specified performance requirements and needs of the customer are fully met. In the article Implementing BS EN ISO 9000 it is said that the standard is flexible and companies big or small can adapt it to their needs and be compliant. A proof of this is the write up by Pat Martin founder of Stelmax a business employing 12 people. I used to think BS EN ISO 9000 was just for the big fish in the sea. She emphasizes that quality is important to all firms no matter the size. She says that the quality of the products improved which is highly required factor in this increasingly competitive market. (Dunn R 1995:6) It is evident from the literature reviewed that TQM standards are important for organizations and as time passes its popularity is increasing considerably. TQM standards are also required to outcompete competitors in this increasing market. However for a successful implementation and to promote innovation and creativity it is necessary that organizations primarily identify the core values and also do not neglect the human resources aspect. Training and development, setting up TQM focus teams, support from senior managers, involvement in decision making, communication and rewards are the essence of successful TQM implementation. These all lead to employee satisfaction and in return will ensure customer satisfaction which is the fad of TQM. Last, TQM is necessary because it works. The pioneering firms in TQM include American Express, IBM, Xerox, 3M, Toyota, Ricoh, Canon, Hewlett-Packard, Nissan and many others. Samuel K.M (1993)

censorship sucks @*$ Essay examples -- essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  The word censorship dates back to the sixth century B.C. in the Roman Empire. Roman officials titled censors would assess citizen’s property, and they would proclaim its value. The wealthier a citizen was the more rights that citizen received. Censorship is defined presently as the suppression of all or part of a publication, play, or film considered offensive or a treat. Unfortunately due to current political and social circumstances, or just very wealthy right winged conservatives; the oppression of censorship has been stretched over the very head of the first amendment like the lower lip of a man stretched over his head. Countless times in our society we find cases of over censoring, causing many to question whether or not censorship has a rightful place anymore?   Ã‚  Ã‚  Ã‚  Ã‚  In The New York Times there was an article printed about a censorship issue at New York University’s Tisch School of the Arts. In October of 2003 a film student named Paula Carmicino was told to stop production on four-minute documentary of the â€Å"portrayal of the contrast between unbridled human lust and banal everyday behavior.† They administration felt that her film was inappropriate, even for a university. The film required two actors to have sex on camera in front of the class. Her professor approved, but the administration of the Tisch School saw it as not acceptable. The matter caused a very tempestuous situation on campus.   Ã‚  Ã‚   ...

Critical Incident

Rich & Parker 2001 defines critical incidents as snapshots of something that happens to a patient, their family or healthcare professional. It may be something positive, or it could be a situation where someone has suffered in some way. Reflecting on critical incidents will allow me to explore and analyse incidents and how it has affects me and what I hope to do with these effects in the course of my training towards becoming a registered practitioner. It also gives me the opportunity of changing my way of thinking or practice, as I learn valuable lessons when I reflect on an incident. This helps me to develop self-awareness and skills in critical thinking and problem solving (Rich & Parker 2001). On the other hand, Johns 2003 defines reflection as â€Å" being mindful of self, either within or after an experience, as if a window through which the practioners can view and focus self within the context of a particular experience, in order to confront, understand and move towards resolving contradiction between one’s vision and actual practice†. I will be using the Beckwith model of reflection which states clearly that reflection is a tool to deal with challenges that will influence the speed and amplitude of one’s development, to explore these effects in other to understand and learn from this incident, with the hope of improving my practice (Beckwith & Beckwith 2007). The incident I will be reflecting upon occurred while attending a clinical placement in the critical care unit at my placement hospital which for the purpose of this essay will be referred to as X Hospital. Critical Care is the multi-professional healthcare specialty that cares for patients with acute, life-threatening illness or injury, (Sheppard & Wright 2005). Critical care can be provided wherever life is threatened. Critical care provided at the scene of an accident or in an ambulance is basic life support. Basic life support is the emergency treatment of any condition where the brain stops receiving adequate oxygen; it could be a cardiac or respiratory arrest, (Kumar). A cardiac arrest is one where there is no pulse and is unlikely the patient will recover with basic life support alone but advanced life support with a defibrillator is required. It is important to carry out basis life support until defibrillator arrives even after careful assessment one discovers it’s a cardiac arrest, as one usually leads to the other, (Kumar). The importance of recognizing, assessing and reacting to cardiorespiratory arrest is very important. Immediate response increases the chances of a successful outcome, (Davey and Ince). Shostek says critical care in a hospital setting is provided by multi-professional teams of highly experienced and professional personnel who use their unique expertise and ability to interpret important therapeutic information, manage highly sophisticated equipment and provide care that leads to the best outcome for the patient. Patients are usually admitted from the emergency room or surgical area where they are first given care and stabilized to CCU, (NHS Careers). The management of the critically ill patient ranges from eye care(Appendix 1), oral care(Appendix 2), infection control, health and safety issues, tissue viability among other vital issues like care bundles for this high risk group of patients who are dependent these care to maintain integrity and dignity according to trust policy. Suction pumps are also vital in the critical care setting as airway hygiene is impaired in critically ill patients as a result of depressed cough reflex and ineffective mucociliary clearance from sedation, high inspired oxygen concentrations, elevated endotracheal tube cuff pressure, and tracheal mucosal inflammation and damage, (X Hospital Policy). Due to this, care of intubated patients includes tracheal suctioning to facilitate the removal of airway secretions (suction therapy) is carried out on all unconscious patient, as it maintains airway patency and prevents pulmonary infection, (X Hospital Policy). A tube or catheter is passed down inside the endotracheal tube and attached to a suction pump, the size of the catheter must be chosen carefully using a simple formula of doubling the size of ET tube minus 2. One should be careful to suction on withdrawal using a suction pressure that is appropriate. Suction depth varies depending on the size of the trachea tube hence suction can be shallow, pre-measured and deep suctioning. Despite the importance of suctioning some complications like hypoxia, cardiac arrhythmias, hypotension, tracheal trauma, laryngospasm and bronchoconstriction are associated with it. Hence tracheal suctioning of intubated patients should be performed on a when needed basis defined by the quantity of secretions obtained, not at prescribed, set intervals, (X Hospital Policy). The incident I will be reflecting on is about a Twenty-Nine-year-old male admitted to the critical care unit with a closed head injury sustained in a motor vehicle accident. His young wife, parents and other family members faced real fears. Most of the family members had never been inside a critical care unit, and found the array of pumps, tubes, machines, monitors and lines, as well as the rush of staff members overwhelming. Just by looking at them and watching their reaction each time they come visiting was enough to tell me how scared and worried they were of their son’s illness and the environment they were in. I started to wonder what was going on in their minds and was drawn to them not only for this reason but because the patient and his family members were the youngest I ever saw in the unit. I was thinking to myself if they have asked questions or done any research about CCU they will most likely be thinking their son’s situation is hopeless. It is important to label and date all the lines as this helps to know what each is used for and how long it has been in situ for. Also care should be taken when moving patients to ensure the stay in place as it can be very uncomfortable and difficult to reinsert a cannula on a patient as most of them are oeadematous. As I was involved in the care of the patient I had to explain to the wife why her husband was connected to a ventilator and it use. A ventilator is an artificial breathing machine that moves oxygen-enriched air in and out of your lungs. If your lungs have failed and you cannot breathe on your own, you will need to be attached to a ventilator (See appendix 3). Being helped to breathe by a ventilator means that you will usually need to be sedated. Ventilators can offer different levels of breathing assistance. If you only need help breathing for a couple of days, it is likely you will have an endotracheal tube from the ventilator to your mouth or nose. The tube will usually be held in place behind your neck as was the case with my patient. However, if you need help with breathing for more than a few days, you may have a short operation called a tracheostomy. This replaces the tube in your mouth with a shorter tube that is placed directly into your trachea. As well as being more comfortable, a tracheostomy makes it easier to keep your lungs clean, and usually requires less sedation. There are two kinds of ventilators, negative pressure and positive pressure. Negative pressure ventilators are not commonly in use today. In my trust we have only the positive pressure ventilators. Mode of ventilation should be tailored to the needs of the patient. Understanding these settings is important as they may need to be changed quickly. Once my patient’s next of kin fully understood the treatment he was receiving I could see this young lady’s face soften a bit. I later learnt from my conversations with her that their 5years-old daughter, had been in the back seat with him when the accident occurred. She had not slept properly since the incident, expressing that she was afraid he would â€Å"never come home. † She has continually asked her mother and grand parents, â€Å"When is daddy coming back home? † The 5-year-old girl would not enter the parents’ bedroom at home and insisted that the light remain on and has refused to take her bath as her dad always gave her a bath each evening. From this conversation I concluded that this little girl needed to see, touch, smell and be with her dad to understand what had happened. I believe that she needs to be allowed to grieve and participate in the healing process surrounding her dad’s trauma. However, there were barriers, because our institution’s written policy was to not allow anyone under the age of 12 to visit patients even though the majority of published studies evaluating family member presence in surgery have shown the positive effect it has on family members irrespective of their age, (Kingsnorth et al 2010). Some of these benefits included removing the family’s doubt about the patient’s situation and allowing them to see that everything possible is being done in caring for that patient, reducing their anxiety and fear about what is happening to their loved one, maintaining the family need to be together even at this time. In addition, when and if death occurred, families have reported that their presence gave them a sense of closure and facilitated the grief process, (Kingsnorth et al 2010). With this information I spoke with my mentor and she agreed how awful it must be for her and promised to look into it. Three days after the accident, my mentor came to me and said they have come up with something that will help this young family and asked if I wanted to be involved with it, I said yes. We approached our patient’s family about scheduling an educational conference for the family. We agreed to include aunts, uncles, grandparents a young niece and two nephews. There were fears about how the children will handle the information but the adults were advised that, if the children exhibited fear or discomfort, they can be allowed to leave the conference room. At the conference, I sat with the children at the table and provided them with crayons and paper. Drinks and cookies were available. I was glad the atmosphere was gentle, quiet, comfortable and conducive to learning. We began the session by discussing definitions of grief, mourning, loss and coping. The adults agreed that this was the first trauma in the family and were giving the children explanations such as â€Å"God may take him† and â€Å"Dad may never wake up. †It was now time to listen to the children. They were asked to talk about a time when they had been sick. We went over what each part of the anatomy did and how they worked together. The children were asked to draw picture of what they understand of the discussion, drew pictures of lungs, a heart, a brain and a rib cage. When the patient’s daughter drew her Dad, she placed wires and tubes in his organs. At this stage I could see that the little girl now understands what had happened to her Dad. The adults who previously did not fully understand the injury to their son appreciated the education. The patient’s young wife had her eyes full of tears but I saw relief on her face regardless. As the clinical picture becomes clearer, the little girl asked if she could see her dad. All agreed this might be beneficial. Now we were confronted with the hospital policy prohibiting children in the critical care unit. The sisters spoke among themselves. I was praying silently that they can make an exception here. It is believed that every patient should be treated as an individual and critical care involves the care of family members as well (Kingsnorth et al 2010). I was glad when the sister came back and asked the patient’s wife to take her daughter to the ICU door, while all the staffs were informed of the plan. The decision was to allow the young daughter to see her dad and hospital policy was explained again, they all understood and were evidently glad like I was. The daughter entered the unit with wide eyes and stood at her dad’s bedside, where she was told about every tube and its purpose. The little girl took her dad’s hand and cried, as did the entire staff. Except for the hum of ventilators, the unit was quiet as the little girl held hands with her father, stroked his hair, sang him a song and said goodnight with prayers. I savored this moment as I realized it was an important journey in the little girl’s life. As a student I concluded that surely there can be nothing superior to this type of care giving. Through out the lecture I couldn’t help but think that God forbid if this was me or my family member I would hope for a care team as nice and understanding as these ones looking after my family. I imagined if these were my children I sure would want them to understand what is happening and to be able to confront it if they want to and what better way to do this. Following the visit, we were told how the little girl had become more agreeable at home. She says â€Å"I have to keep things in order until Dad comes home. † Making a difference is what care exemplifies, particularly when the art of humanity in a technologically driven healthcare system is advocated, (NHS Careers). I truly agree with this statement. For me the critical environment was a different setting and honestly I believe there can be no other like it. It is a very emotional setting that requires strong willed people yet competent in their jobs as well as having a heart full of love to care for their patient and family members. This is an experience that will stay with me throughout my career and influence me in a positive way as I can clearly understand that delivering quality care goes beyond what is done for the patient but for family members around as well. In my trust eye care is recognized as a basic nursing care procedure required by critically ill patients to prevent complications such as eye infections or injury. This care involves regular eye assessment on each patient in the ward to ensure that all patients receive individualized evidence based eye care which ranges from no action required to hydration treatment with and sterile water to a more complex treatment prescribed by a doctor. If hydration or cleaned care is taken to wipe from the nasal corner outwards starting with the lower lids using a different wipe or gauze each time. If there is an infection the non-infected eye should be cleaned first. Sometimes a bacteria barrier cream may be applied if the doctors deem it necessary, (X Hospital Trust Policy). Appendix 2- Oral Care Similarly, all critical ill patients who are intubated receive individualized evidence based mouth care. All orally intubated patients will have moisture, integrity and cleanliness of all oral surfaces. Intubated patient are especially vulnerable to complications if inadequate oral care is practiced. Also there are many factors that pose as barriers to carrying out effective oral care such as: difficulty to access oral cavity, changes in mucosa and normal bacteria flora of the mouth, immunocompromise and medication, presence of endotracheal tubes, oral suctioning and therapeutic dehydration. Based on the above, assessment is carried out daily using the Eilers assessment guide. Whatever the outcome of this assessment oral care on all critically ill patients on a daily basis involves using a soft tooth brush and toothpaste every 12hours in a circular stroke away from the gums, cleaning the tongue and inside of the cheeks. A through rinse using a syringe and gentle suction to remove secretions thereby minimizing trauma to soft tissues in the mouth. Foam sticks and sterile water can be used in cases of extreme dryness as it’s is effective for moistening oral cavity. Soft paraffin can also be used to prevent lips from cracking. Dentures are usually removed and cared for till when patient needs it, (X Hospital Trust Policy). Appendix 3 – Understanding ventilators settings Tidal volume This is the lung volume representing the normal volume of air displaced between normal inspiration and expiration with no extra effort. Typical values are around 500ml or 7ml/kg. To avoid adverse effects of barotrauma and volutrauma it is recommended to use lower tidal volumes. An initial TV of 5-8 mL/kg of ideal body weight is generally indicated. The goal is to adjust the TV so that plateau pressures are less than 35 cm H2 O. Continuous mandatory ventilation (CMV) Breaths are delivered at preset intervals, regardless of patient effort. This mode is used most often in the paralyzed patient because it can increase the work of breathing if respiratory effort is present. CMV has given way to assist-control (A/C) mode. Many ventilators do not have a true CMV mode and offer A/C instead. Assist-control ventilation The ventilator delivers preset breaths in coordination with the respiratory effort of the patient. With each inspiratory effort, the ventilator delivers a full assisted tidal volume. Spontaneous breathing is not allowed. This mode is better tolerated than CMV in patients with intact respiratory effort. Intermittent mandatory ventilation With intermittent mandatory ventilation (IMV), breaths are delivered at a preset interval, and spontaneous breathing is allowed between ventilator-administered breaths. Spontaneous breathing occurs against the resistance of the airway tubing and ventilator valves, which may be formidable. This mode has given way to synchronous intermittent mandatory ventilation (SIMV). Synchronous intermittent mandatory ventilation The ventilator delivers preset breaths in coordination with the respiratory effort of the patient. Spontaneous breathing is allowed between breaths. These modes are beneficial for patients who require high minute ventilation. Full support reduces oxygen consumption and CO2 production of the respiratory muscles. A potential drawback of A/C ventilation in the patient with obstructive airway disease is worsening of air trapping and breath stacking. Pressure support ventilation For the spontaneously breathing patient, pressure support ventilation (PSV) has been advocated to limit barotrauma and to decrease the work of breathing. Pressure support differs from A/C and IMV in that a level of support pressure is set (not TV) to assist every spontaneous effort. Airway pressure support is maintained until the patient's inspiratory flow falls below a certain cutoff. PSV is frequently the mode of choice in patients whose respiratory failure is not severe and who have an adequate respiratory drive. It can result in improved patient comfort, reduced cardiovascular effects, reduced risk of barotrauma, and improved distribution of gas. CPAP is an acronym for â€Å"continuous positive airway pressure†, a variation of the PAP system. Respiratory rate A respiratory rate (RR) of 8-12 breaths per minute is recommended for patients not requiring hyperventilation for the treatment of toxic or metabolic acidosis, or intracranial injury. High rates allow less time for exhalation, increase mean airway pressure, and cause air trapping in patients with obstructive airway disease. The initial rate may be as low as 5-6 breaths per minute in asthmatic patients when using a permissive hypercapnia technique. Positive end-expiratory pressure Positive end-expiratory pressure (PEEP) is a term used in mechanical ventilation to denote an airway pressure that is kept above atmospheric pressure at the end of the expiratory cycle. The equivalent in a spontaneously breathing patient is CPAP. One obvious beneficial effect of PEEP is to shift lung water from the alveoli to the perivascular interstitial space. It does not decrease the total amount of extravascular lung water. This is of clear benefit in cases of cardiogenic as well as noncardiogenic pulmonary edema. An additional benefit of PEEP in cases of CHF is to decrease venous return to the right side of the heart by increasing intrathoracic pressure. References Amitai, A. and Kulkarni, R. Medscape (2010), Ventilator Management. Available at: http://emedicine. medscape. com/article/810126-overview,assessed on 13/03/11 Beckwith, M. A. R. ; Beckwith, P. T. (2008) â€Å"Reflection or Critical Thinking? : A pedagogical revolution in North American health care education†. Refereed Program of the E-Leader Conference at Krakow, Poland, Chinese American Scholars Association, New York, New York, USA June 2008, Courey, A. J. and Hyzy, R. C. Up to date 19. 1(2010) Over view of mechanical ventilation. Availableat: http://www. uptodate. com/contents/search? earch=ventilators&source=USER_INPUT&searchOffset=assessed on 13/03/2011 Hatfield A, Tronson M, (2009), The Complete Recovery Book, 4th edn. New York: Oxford University Press. Chapter 2, Page 29. Johns, C. (2004) Becoming a Reflective Practitioner, 2nd edn. UK: Blackwell Publishing Ltd. Kingsnorth, J. , O’Connell,K. , Guzzetta, C. E. , Edens, J. C Atabaki, S. Mecherikunnel, A. and Brown, K. (2010) Journal of Emergency Nursing: Family Presence During Trauma Activations and Medical Resuscitations in a Paediatric Emergency Department: An Evidence-Based Practice Project,36/2,pp115 NHS Careers (2009) Operating Department Practice. Available at: http://www. nhscareers. nhs. uk/details/Default. aspx? Id=255 (assessed 11/03/2011) Pirret, M. (2002) Utilizing TISS to differentiate between intensive care and high-dependency patients and to identify nursing skills requirements. Intensive and Critical Care Nursing. 18(1) pp. 19-26. Rich, A. and Parker, D. L. (1995) Reflection and critical incident analysis: Ethical and moral implications of their use within nursing and midwifery education, Journal of Advanced Nursing 22(6): 1050-1057 Sheppard, M & Wright, M (2005) Principles and practice of High Dependency Nursing. nd ed. Philadelphia. Bailliere, Tindall Elsevier. The Intensive Care Society (2010) An Introduction to intensive care medicine for junior doctors [Online] Available from: http:/ /www. ics. ac. uk/education/2010_trainee_handbook: Accessed 19 January 2011. Unknown Author (2006) Eye care for critically ill patients, X Hospital Policy. Unknown Author (2006) Mouth care for intubated patients, X Hospital Policy.

HR Roles and Responsibilities Paper - 997 Words

HR Roles and Responsibilities Paper Human resource management is described as the policies, practices, and systems that influence employees behavior, attitudes, and performance.(Noe, R., Hollenbeck, J., Gerhert, B., Wright, P. (2003). Fundamentals of human resource management, 1e. McGraw-Hill Companies.) The human resource department is essential to the progress of an organization. When a company is equipped with a good human resource department it will tend to grow and prosper. The role of the department is to identify employees who are worthy of hiring, and knowing how to determine where they will fit into the†¦show more content†¦The person will be introduced to an entirely new culture as well as new and different laws that govern that country. In addition, considering ones family and how it will be affected is important in order to know if the person will be able to function effectively and efficiently without family concerns. If a company is able to expand globally it will be beneficial to the progress of the business as well as adding experience to the transferring employee. 2. Diversity: in todays business diversity is beginning to become very important in the growth of an organization. The argument that organizations should structure responsibility for reducing inequality may seem commonsensical, but todays popular diversity programs often focus on changing individuals. Failure to designate accountability may cause efforts to fall by the wayside as managers juggle competing demands. Hastings, R. (2007, February 1) In order to have a more harmonious workplace one must invest in extensive diversity training and hiring practices. Although, companies think diversity is a good idea they do not truly know how to handle the change. Employers not willing to step out of his or her comfort zone may in the long run find it hard to complete. 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