Developing Good Business Sense

Developing Good Business Sense Axia College of University of Phoenix BUS 210 Developing Good Business Sense June 29, 2008 The three companies I selected for this assignment are McDonalds, Bose Corporation and Motorola. From the reading I was able to determine the employee’s organizational structure within this company’s by which they complete their jobs. I will review and outline the main kinds of Operations and Materials Management (OMM) processes these companies use, and how it affects their operations. Also, I will discuss how companies design their operating systems to give them a competitive advantage. I will identify which components of operations and materials management costs and the methods companies use to reduce them. McDonald’s is a highly successful and well recognized brand leader of fast food restaurants located around the world. They sell hamburgers and french fries as their primary products, and they work with many different food suppliers such as hamburger bun manufacturers, beef producers, produce suppliers and many others, to ensure their foods are as fresh as possible. McDonald’s sells franchise rights to local owner/operators which allow them to keep costs low and avoid high capital and plant investment costs. Since a great deal of McDonald’s service is reliant on delivering customer’s food fresh, McDonald’s use the Just in Time (JIT) inventory management system. This system reviews stock inventory levels available against product usage, and arranges delivery and restocking to the restaurants just as inventory items are needed. This allows inventory to be kept to a minimum in each franchise location. Foods for the restaurants are not warehoused for days or weeks, and are efficiently managed under this system so they are used quickly and, freshness is guaranteed. Each franchise owner keeps labor costs down by managing store staff schedules against the peak customer periods when the restaurant gets busy. Another technique McDonald’s uses to keep distribution costs low, is to have soft drink company’s ship only the soda syrup mix needed for each brand, which is then mixed with carbonated water at the soda fountain in the store. McDonalds has also begun to employ the use of robotics to complete routine, repetitive tasks such as filling soda orders for the drive through window and dumping fries into the fry maker, as a means of making their food quicker and less expensively. Over time the return on investment for these developments will pay off greatly in saved labor costs. Of course, the most important element in any McDonald’s restaurants is that employees must be organized and communicate effectively. Wasted food equates to wasted money and if a special order is needed, staff must talk to each other to make sure it is done right the first time. By working together as a team the cooks, preparation staff, and cashiers help to keeps the orders organized and production is kept high. The Bose Corporation is a world renowned manufacturer of high-fidelity speakers and audio equipment. The company’s ability to meet customer demand for their products is dependant on the supply chain and availability of components needed to complete customer orders. The company uses a supply chain network that is spread across the globe, with their primary source of over 50% of purchased components coming from the Far East. Logistics managers within the company bear the responsibility of moving the vast amounts of equipment into production, based on a real-time inventory management system called â€Å"ProterLink†. This system is able to locate supplies that are needed anywhere in the shipping chain, and divert them if necessary to meet an accelerated production schedule if necessary. This operational system gives Bose the advantage of meeting large customer’s orders without missing a beat. Transportation costs associated with material movement and management from suppliers to their Bose’ production facility would be a key cost consideration for the company. If supplies needed to fill orders are transported efficiently and are timed to correspond to production schedules, costs would be lower because unnecessary components would not take valuable inventory space away from items that are in need to complete orders, thereby maximizing production effectiveness. Motorola, a global communications leader, is using a unique forward thinking production plan to bring their services and products to market. In their self-named, â€Å"factory of the future†, custom made communication devices can be produced very quickly for customers, giving Motorola a competitive advantage. The process starts with sales person who receives the order and inputs all of the customer’s customization preferences. This information is provided as a barcode and relayed to the production facility, which uses automation technology (robots) to produce the phone in accordance with the customer’s wishes. Using robots gives Motorola a competitive advantage because they are able to mass produce large volumes of customized phones, with only a two-hour turnaround window. The universal operational strategy in any business is to meet the goal of customer satisfaction. The company’s reviewed accomplish that goal through improving quality and efficiency, and ultimately reducing costs. [pic] Developing Good Business Sense Developing Good Business Sense Axia College of University of Phoenix BUS 210 Developing Good Business Sense June 29, 2008 The three companies I selected for this assignment are McDonalds, Bose Corporation and Motorola. From the reading I was able to determine the employee’s organizational structure within this company’s by which they complete their jobs. I will review and outline the main kinds of Operations and Materials Management (OMM) processes these companies use, and how it affects their operations. Also, I will discuss how companies design their operating systems to give them a competitive advantage. I will identify which components of operations and materials management costs and the methods companies use to reduce them. McDonald’s is a highly successful and well recognized brand leader of fast food restaurants located around the world. They sell hamburgers and french fries as their primary products, and they work with many different food suppliers such as hamburger bun manufacturers, beef producers, produce suppliers and many others, to ensure their foods are as fresh as possible. McDonald’s sells franchise rights to local owner/operators which allow them to keep costs low and avoid high capital and plant investment costs. Since a great deal of McDonald’s service is reliant on delivering customer’s food fresh, McDonald’s use the Just in Time (JIT) inventory management system. This system reviews stock inventory levels available against product usage, and arranges delivery and restocking to the restaurants just as inventory items are needed. This allows inventory to be kept to a minimum in each franchise location. Foods for the restaurants are not warehoused for days or weeks, and are efficiently managed under this system so they are used quickly and, freshness is guaranteed. Each franchise owner keeps labor costs down by managing store staff schedules against the peak customer periods when the restaurant gets busy. Another technique McDonald’s uses to keep distribution costs low, is to have soft drink company’s ship only the soda syrup mix needed for each brand, which is then mixed with carbonated water at the soda fountain in the store. McDonalds has also begun to employ the use of robotics to complete routine, repetitive tasks such as filling soda orders for the drive through window and dumping fries into the fry maker, as a means of making their food quicker and less expensively. Over time the return on investment for these developments will pay off greatly in saved labor costs. Of course, the most important element in any McDonald’s restaurants is that employees must be organized and communicate effectively. Wasted food equates to wasted money and if a special order is needed, staff must talk to each other to make sure it is done right the first time. By working together as a team the cooks, preparation staff, and cashiers help to keeps the orders organized and production is kept high. The Bose Corporation is a world renowned manufacturer of high-fidelity speakers and audio equipment. The company’s ability to meet customer demand for their products is dependant on the supply chain and availability of components needed to complete customer orders. The company uses a supply chain network that is spread across the globe, with their primary source of over 50% of purchased components coming from the Far East. Logistics managers within the company bear the responsibility of moving the vast amounts of equipment into production, based on a real-time inventory management system called â€Å"ProterLink†. This system is able to locate supplies that are needed anywhere in the shipping chain, and divert them if necessary to meet an accelerated production schedule if necessary. This operational system gives Bose the advantage of meeting large customer’s orders without missing a beat. Transportation costs associated with material movement and management from suppliers to their Bose’ production facility would be a key cost consideration for the company. If supplies needed to fill orders are transported efficiently and are timed to correspond to production schedules, costs would be lower because unnecessary components would not take valuable inventory space away from items that are in need to complete orders, thereby maximizing production effectiveness. Motorola, a global communications leader, is using a unique forward thinking production plan to bring their services and products to market. In their self-named, â€Å"factory of the future†, custom made communication devices can be produced very quickly for customers, giving Motorola a competitive advantage. The process starts with sales person who receives the order and inputs all of the customer’s customization preferences. This information is provided as a barcode and relayed to the production facility, which uses automation technology (robots) to produce the phone in accordance with the customer’s wishes. Using robots gives Motorola a competitive advantage because they are able to mass produce large volumes of customized phones, with only a two-hour turnaround window. The universal operational strategy in any business is to meet the goal of customer satisfaction. The company’s reviewed accomplish that goal through improving quality and efficiency, and ultimately reducing costs. [pic] Developing Good Business Sense Developing Good Business Sense Axia College of University of Phoenix BUS 210 Developing Good Business Sense June 29, 2008 The three companies I selected for this assignment are McDonalds, Bose Corporation and Motorola. From the reading I was able to determine the employee’s organizational structure within this company’s by which they complete their jobs. I will review and outline the main kinds of Operations and Materials Management (OMM) processes these companies use, and how it affects their operations. Also, I will discuss how companies design their operating systems to give them a competitive advantage. I will identify which components of operations and materials management costs and the methods companies use to reduce them. McDonald’s is a highly successful and well recognized brand leader of fast food restaurants located around the world. They sell hamburgers and french fries as their primary products, and they work with many different food suppliers such as hamburger bun manufacturers, beef producers, produce suppliers and many others, to ensure their foods are as fresh as possible. McDonald’s sells franchise rights to local owner/operators which allow them to keep costs low and avoid high capital and plant investment costs. Since a great deal of McDonald’s service is reliant on delivering customer’s food fresh, McDonald’s use the Just in Time (JIT) inventory management system. This system reviews stock inventory levels available against product usage, and arranges delivery and restocking to the restaurants just as inventory items are needed. This allows inventory to be kept to a minimum in each franchise location. Foods for the restaurants are not warehoused for days or weeks, and are efficiently managed under this system so they are used quickly and, freshness is guaranteed. Each franchise owner keeps labor costs down by managing store staff schedules against the peak customer periods when the restaurant gets busy. Another technique McDonald’s uses to keep distribution costs low, is to have soft drink company’s ship only the soda syrup mix needed for each brand, which is then mixed with carbonated water at the soda fountain in the store. McDonalds has also begun to employ the use of robotics to complete routine, repetitive tasks such as filling soda orders for the drive through window and dumping fries into the fry maker, as a means of making their food quicker and less expensively. Over time the return on investment for these developments will pay off greatly in saved labor costs. Of course, the most important element in any McDonald’s restaurants is that employees must be organized and communicate effectively. Wasted food equates to wasted money and if a special order is needed, staff must talk to each other to make sure it is done right the first time. By working together as a team the cooks, preparation staff, and cashiers help to keeps the orders organized and production is kept high. The Bose Corporation is a world renowned manufacturer of high-fidelity speakers and audio equipment. The company’s ability to meet customer demand for their products is dependant on the supply chain and availability of components needed to complete customer orders. The company uses a supply chain network that is spread across the globe, with their primary source of over 50% of purchased components coming from the Far East. Logistics managers within the company bear the responsibility of moving the vast amounts of equipment into production, based on a real-time inventory management system called â€Å"ProterLink†. This system is able to locate supplies that are needed anywhere in the shipping chain, and divert them if necessary to meet an accelerated production schedule if necessary. This operational system gives Bose the advantage of meeting large customer’s orders without missing a beat. Transportation costs associated with material movement and management from suppliers to their Bose’ production facility would be a key cost consideration for the company. If supplies needed to fill orders are transported efficiently and are timed to correspond to production schedules, costs would be lower because unnecessary components would not take valuable inventory space away from items that are in need to complete orders, thereby maximizing production effectiveness. Motorola, a global communications leader, is using a unique forward thinking production plan to bring their services and products to market. In their self-named, â€Å"factory of the future†, custom made communication devices can be produced very quickly for customers, giving Motorola a competitive advantage. The process starts with sales person who receives the order and inputs all of the customer’s customization preferences. This information is provided as a barcode and relayed to the production facility, which uses automation technology (robots) to produce the phone in accordance with the customer’s wishes. Using robots gives Motorola a competitive advantage because they are able to mass produce large volumes of customized phones, with only a two-hour turnaround window. The universal operational strategy in any business is to meet the goal of customer satisfaction. The company’s reviewed accomplish that goal through improving quality and efficiency, and ultimately reducing costs. [pic]

Legalism, Taoism and Confucianism Essay

All three most influential philosophical schools of thought i.e. legalism, Taoism and Confucianism originate from the same tenet of peace and accord in the Chinese society in particular and in world in general. But their methodologies and philosophical routes to achieve this objective are different. Legalism suggest a strong and central political body as remedy for all the maladies of contemporary Chinese society whereas Taoism and Confucianism do not favor a strong political entity   and reinforce the ideas of individual freedom and social cohesion.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The doctrine of legalism believes that strict laws and punitive measures are preconditions for a strong central government that can bring peace and prosperity in the society. This doctrine is based on the assumption that human nature is irredeemably malicious and is prone to produce conflicts. These conflicts harm the social cohesion and generate panic and disorder in the community. That is the reason that strong laws and punishments can make them (people) in alignment with needs of the political entity.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In total contrast to Legalism, Taoism and Confucianism are of the view that human nature is constituted of moral virtues. Taoism was directly opposed to the tenets of Legalism and believed in a close association between man and nature. They further reinforce that nature is virtuous in essence and intend at achieving greater unity and universal organization. They view man-made laws as artificial and transient that has limited life. So Taoist are against Legalism and believed that these were fabricated to serve the vested interest of the rulers and they have nothing to do with the common good of the people. This basic difference between the philosophical principles leads the Taoist to rebel against the established social patterns as they considered it a tool to perpetuate the regime of the despotic rulers.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Confucianism is considered a rationalization of these two extremes i.e. legalism and Taoism. Confucianism neither believed in the idea of harsh punishments, impersonal laws and inhuman rules toward the mass nor it gave approval to absolute individual freedom of thought and action as it would lead to utter anarchy. Confucianism adopted an equidistant approach between the two extremes and propagated a philosophy based on the beautiful combination of individual needs and social needs. Confucianism served as a balance between the extreme centralization of power and subjugation of masses as embodied in Legalism and the utter chaos created by the absolute individualistic approach of Taoism.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Legalism was an advanced political system whereas Taoism was inclined toward primitivism. Taoism reinforced the idea of a personal and individual reaction to the mundane and complex social problems. According to its basic precept of Tao (way), human nature can find its own way out of many. So it negated the formulated laws and established social patterns. Subjective judgments were made according to the needs of the occasions. Mostly these judgments were based on the ancient teachings and traditional principles with outsized personal discretion. In complete contrast to Taoism, Legalism established a complete code of laws and they (Legalists) were strictly adhered to these laws. Instead of personal discretion or subjective interpretation, judgments were made according to written laws. This characteristic of Legalism made it the most advanced philosophy of ancient China as compared with Taoism.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In contrast to abovementioned ways, Confucianism suggested another way i.e. to get social harmony through social cohesion of individuals with the society itself. It took care of individuals’ needs as well as the socio-political needs. To Confucius, society was not a mere collection of individual but is has other internal and external dimensions. Internally, it is the substantial device that moulds our beliefs and attitudes while on the external horizon, it exerts and maintains pressures from the society to facilitate conformity to the above-mentioned collective beliefs and attitudes. Confucius perceived society as a separate and distinguished unit. It is an entity independent of individuals. This argument clearly manifests that social facts i.e. norms, values and institutions, have their independent existence and are not sustained by individual actions but individuals react to them. Confucius also suggests that individual desires are cravings are unlimited and individual hankers after more and more. This natural insatiability produces individual propensities in humans. In order to control these propensities society works as a regulative force. Frederick Cheung has comprehensively summed up the differences and similarities in the doctrines of these major philosophies of Chinese history in this way; If we compare and contrast the three schools of thoughts on â€Å"individual freedom and control;† we would find that Taoism was extremely free, while Legalism was extremely strict (a kind of totalitarian control) with Confucianism in the middle (the golden means or moderation).   On political theory and concepts of progress, Legalism was the most advanced and directing to the future; while Taoism was reactionary and returning to the primitive nature; with again Confucianism in the middle.   Indeed, moderation and balance were perhaps the major reasons for the eventual triumph of Confucianism in traditional Chinese history.   (p.3) References Cheung, Frederick. (2006). The Legacy of Ancient China: The Intellectual Foundations — Legalism, Taoism, and Confucianism. The Chinese University of Hong Kong. Website:

Person Centered Care

If you would like to contribute to the art and science section contact: Gwen Clarke, art and science editor, Nursing Standard, The Heights, 59-65 Lowlands Road, Harrow-on-the-Hill, Middlesex HA1 3AW. email: gwen. [email  protected] co. uk Person-centred care: Principle of Nursing Practice D Manley K et al (2011) Person-centred care: Principle of Nursing Practice D. Nursing Standard. 25, 31, 35-37. Date of acceptance: February 7 2011. SummaryThis is the fifth article in a nine-part series describing the Principles of Nursing Practice developed by the Royal College of Nursing (RCN) in collaboration with patient and service organisations, the Department of Health, the Nursing and Midwifery Council, nurses and other healthcare professionals. This article discusses Principle D, the provision of person-centred care. Authors Kim Manley, at the time of writing, lead, Quality, Standards and Innovation Unit, Learning & Development Institute, RCN, London; Val Hills, learning and development a dviser, RCN, Yorkshire and the Humber; and Sheila Marriot, regional director, RCN, East Midlands.Email: kim. [email  protected] ac. uk Keywords Nurse-patient relations, person-centred care, Principles of Nursing Practice These keywords are based on subject headings from the British Nursing Index. For author and research article guidelines visit the Nursing Standard home page at www. nursing-standard. co. uk. For related articles visit our online archive and search using the keywords.THE FOURTH Principle of Nursing Practice, Principle D, reads: ‘Nurses and nursing staff provide and promote care that puts people at the centre, involves patients, service users, their families and their carers in decisions, and helps them make informed choices about their treatment and care. ’ The provision of care that is experienced as right by the person receiving it is at the core of nursing practice. Principle D sets out to endorse and expand on this point, which is often summarised as providing person-centred care – a philosophy that centres care on the person and not only their healthcare needs.The King’s Fund uses the term NURSING STANDARD ‘the person in the patient’ to convey the same point (Goodrich and Cornwall 2008). There is a consensus that person-centred care equates with quality care (Innes et al 2006, Royal College of Nursing (RCN) 2009), although the service users involved in developing the Principles indicated that they wanted to receive person-centred, and safe and effective care. Such inter-related care is based on best evidence, which is blended with the needs of the individual within specific contexts.Healthcare teams, healthcare provider organisations and governments often articulate an intention to deliver person-centred care. However, achieving it is often challenging and difficult to sustain. Achieving person-centred care consistently requires specific knowledge, skills and ways of working, a shared philosophy th at is practised by the nursing team, an effective workplace culture and organisational support. While all members of the nursing team endeavour to provide person-centred care, some nurses have more transient contacts with patients and those important to them.Examples include staff working in operating departments, general practice or outpatients. The challenges in these situations include skill in developing rapid rapport and ensuring that communication systems respect the essence of the person and protect his or her safety in a way that maintains person-centred values and continuity of care. Person-centred care can be recognised by an active observer or the person experiencing care. The following might be experienced or observed: 4 A focus on getting to know the patient as a person, his or her values, beliefs and aspirations, health and social care needs and preferences. Enabling the patient to make decisions based on informed choices about what options and april 6 :: vol 25 no 31 :: 2011 35 art & science principles series: 5 assistance are available, therefore promoting his or her independence and autonomy. 4 Shared decision making between patients and healthcare teams, rather than control being exerted over the patient. Enabling choice of specific care and services to meet the patient’s health and social care needs and preferences. 4 Providing information that is tailored to each person to assist him or her in making decisions based on the best evidence available.Assisting patients to interpret technical information, evidence and complex concepts and helping them to understand their options and consequences of this, while accessing support from other health and social care experts. 4 Supporting the person to assert his or her choices. If the individual is unable to do this for him or herself, then the nursing team or an appointed formal advocate would present and pursue the person’s stated wishes. 4 Ongoing evaluation to ascertain that care an d services continue to be appropriate for each person. This involves encouraging, listening to and acting on feedback from patients and service users. Other attributes of the nursing team include being professionally competent and committed to work, and demonstrating clear values and beliefs (McCormack and McCance 2010). In addition, nurses should be able to use different processes in the development of person-centred care: working with patients’ values and beliefs, engaging patients and mental health service users, having a sympathetic presence, sharing decision making and accommodating patients’ physical needs (McCormack and McCance 2010). People from minority ethnic groups often experience barriers to person-centred care.There is a need to understand the way in which different minority groups within local populations access information and how different cultural understandings, languages and communication styles influence perceptions of personalised care (Innes et a l 2006). A shared philosophy For person-centred care to achieve its full potential, the approach needs to be practised by the entire nursing team. This requires a shared philosophy and ways of working that prioritise person-centred behaviour, not only with patients and those that are important to them, but also within the team.The wellbeing of staff and the way in which they are supported also needs to be person-centred as staff wellbeing positively affects the care environment for staff and patients. For a shared philosophy to be realised in practice, person-centred systems and an effective workplace culture need to be in place (Manley et al 2007, McCormack et al 2008). Such systems focus not only on structures and processes, but also on the behaviours necessary to provide person-centred care. An effective workplace culture has a common vision through which values are implemented in practice and experienced by patients, service users and staff.This culture demonstrates adaptability and responsiveness in service provision, is driven by the needs of users and has systems that sustain person-centred values. Clinical leadership is pivotal in promoting effective cultures. This is achieved through modelling person-centred values, developing and implementing systems that sustain these values, encouraging behavioural patterns that support giving and receiving feedback, implementing learning from systematic evaluations of person-centred care and involving patients in decision making (Manley et al 2007).To determine whether person-centred care is being delivered or how it can be improved, workplaces need to use measures or methods that enable systematic evaluation to take place. These should be embedded within patients’ electronic NURSING STANDARD Knowledge, skills and ways of working Each member of the nursing team is expected to provide person-centred care, although the required knowledge, skills and competences may come from the wider nursing and healthcare t eam. Principle A, through its focus on dignity, respect, compassion and human rights, is the essential basis for providing person-centred care (Jackson and Irwin 2011).However, other qualities, such as the ability to develop good relationships are required: ‘The relationship between the service user and front line worker is pivotal to the experience of good quality/person-centred care/ support’ (Innes et al 2006). Developing good relationships with patients and colleagues requires team members to be self-aware and have well-developed communication and interpersonal skills. These skills enable the nursing team to get to know the person as an individual and enable other interdisciplinary team members to recognise these insights through effective documentation and working relationships.Getting to know the patient is a requirement for nursing expertise, but is also dependent on the way that care is organised (Hardy et al 2009). 36 april 6 :: vol 25 no 31 :: 2011 records to reduce the burden of data collection and analysis. The Person-centred Nursing Framework (McCormack and McCance 2010) identifies a number of outcomes that may inform these measures, including satisfaction with care, involvement in care, feeling of wellbeing and creating a therapeutic environment. The RCN (2011) recognises that different measures may already be in place to support evaluation of person-centred care.It is encouraging teams and organisations to submit their measures to the RCN for endorsement. The measures should meet certain criteria, for example they should be evidence-based, take into account stakeholder and other perspectives, and be practicable. Endorsed measures can be shared with others through the RCN website. Organisational support Innes et al (2006) made the point that organisations have an important role to play in enabling person-centred care through the promotion of user-led services. This can be achieved through overcoming bureaucratic structures such as in creased management and budget-led services.It is important that management provides support to the front line nursing team in its day-to-day work and recognises the importance of nurse-patient relationships to this endeavour. This support may be, for example, through initiatives that release time to care through lean methodology (a quality improvement approach that focuses on making processes more efficient and reducing waste) (Wilson 2010), and practice development methodologies associated with person-centred cultures (McCormack et al 2008). access clinic; service-users are seen weekly for a brief intervention (10-15 minutes).Service-users appreciate this alternative to the usual one-hour appointment every two weeks and find the approach less threatening. The clinic is run by a nurse prescriber who is able to titrate medication against need or therapeutic benefit while delivering high quality psychosocial interventions in a brief intervention format. The clinic is supported by a se rvice user representative. This representative gives confidence to service-users who may be lacking belief in their ability to achieve lifelong abstinence and provides service users with an introduction to other community based self-help support networks.After service users have engaged with the service through the quick access clinic, they progress to an appropriate level of key working intervention to meet their more complex needs. This initiative illustrates a number of elements of Principle D, including the use of a formal advocate service, drawing on a service representative, who supports the patient in his or her choices as well as helping him or her to assert his or her wishes. The approach provides a flexible service whereby clinical interventions are provided by a nurse practitioner, and complex needs are assessed quickly.The service user and the nursing team work in partnership to decide when the patient is ready to embark on the next level of interventions required to mee t the patient’s complex needs. Conclusion Principle D emphasises the centrality of the patient to his or her care. It requires skill from each member of the nursing team. The potential contribution of each member to person-centred care will be enhanced if everyone in the team is using the same approach. Such an approach requires a workplace culture where person-centred values are realised, reviewed and reflected on in relation to the experiences of both patients and staff NSCase study A good example of patient-centred care is illustrated by an initiative from a specialist drug and alcohol service at Avon and Wiltshire Mental Health Partnership NHS Trust. The nursing team treats drug users for an initial 12 weeks in a quick References Goodrich J, Cornwall J (2008) Seeing The Person in The Patient: The Point of Care Review Paper. The King’s Fund, London. Hardy S, Titchen A, McCormack B, Manley K (Eds) (2009) Revealing Nursing Expertise Through Practitioner Inquiry. Wiley -Blackwell, Oxford. Innes A, Macpherson S, McCabe L (2006) Promoting Person-centred Care at the Front Line. Joseph Rowntree Foundation,York. Jackson A, Irwin W (2011) Dignity, humanity and equality: Principles of Nursing Practice A. Nursing Standard. 25, 28, 35-37. Manley K, Sanders K, Cardiff S, Davren M, Garbarino L (2007) Effective workplace culture: a concept analysis. Royal College of Nursing Workplace Resources for Practice Development. RCN, London, 6-10. McCormack B, Manley K, Walsh K (2008) Person-centred systems and processes. In Manley K, McCormack B, Wilson V (Eds) International Practice Development in Nursing and Healthcare. Wiley-Blackwell, Oxford, 17-41. McCormack B, McCance T (2010) Person-centred Nursing: Theory and Practice.Wiley-Blackwell, Oxford. Royal College of Nursing (2009) Measuring for Quality in Health and Social Care: An RCN Position Statement. http://tinyurl. com/ 6c6s3gd (Last accessed: March 16 2011. ) Royal College of Nursing (2011) Principles of Nursi ng Practice: Principles and Measures Consultation. Summary Report for Nurse Leaders. http://tinyurl. com/5wdsr56 (Last accessed: March 16 2011. ) Wilson G (2010) Implementation of Releasing Time to Care: the Productive Ward. Journal of Nursing Management. 17, 5, 647-654. NURSING STANDARD april 6 :: vol 25 no 31 :: 2011 37

Explain the main ideas of a pluralist model in a political process Essay

Explain the main ideas of a pluralist model in a political process - Essay Example In the elections, voters will support only those political parties which stand for their ideologies and beliefs. Pluralism believes that politics and decision making processes are some of the duties of a government. Pluralists believe that no other entities like religion or judiciary has any role in politics or decision making even though such entities may have its own role in other matters. This paper analyses the main ideas pluralist model in a political process. Pluralists note that if a majority of people do not like what their representatives are doing, they can vote them out of office at the next election. Representatives, therefore, have to act in a way that is pleasing to the majority. They consider voting to be of only irregular significance. General elections occur periodically and individuals are asked to vote for packages of policies put together by political parties. Therefore, voters do not have an opportunity to wield influence on the specific issues that concern them; so pluralists claim that people are able to exercise power between elections by joining interest groups - such as political parties, trade unions and other pressure groups. Group activity, they argue, is vital to the successful functioning of the political system (Pluralism) It is practically difficult to allow an elected government to function only for a short time period because of the huge expenses needed for general elections. Tax payer’s money used for conducting elections and if the elections happen in every year, the public will suffer a lot. Because of the above awareness, elections usually held in democratic countries only in every four or five years. In other words an elected government need not worry much about the public support or influence for four or five years. They can function as they like during their four or five year term if they have majority support in the parliament. In other words, public forced to wait for four or five years to defeat the government , if it functions against the will of them. It is not a good practice in a parliamentary democracy. So, public tries to exercise their power or influence on government through other nongovernmental groups such as political parties, pressure groups, interest groups, trade union etc. Trade union strikes or public agitations are happening in most of the democratic countries in order to exert pressure or power on the governments. In India like democratic countries, people often conduct huge protests whenever the government tries to impose certain policies against them. For example, India government recently increased the petrol and cooking gas prices because of the increase in crude oil prices in global market. Public forced to conduct several agitations against the government and succeeded in reducing the prices up to certain extent. Opposition political parties often join public when they conduct agitations against the government in order to increase their public support. â€Å"Inter est group leaders have more knowledge regarding the inner workings of government than ordinary citizens and therefore are able to channel democratic voices to the politicians in power more effectively† (Pluralist Model). In short, group activity is vital in controlling a government according to the principles of pluralism. The role of the government in a Pluralist Democracy is to protect and promote diversity.

Apple Inc Case Study Essay Example | Topics and Well Written Essays - 2250 words

Apple Inc Case Study - Essay Example Considering the market, one can say that the buyer power of Apple is mediocre. Its operations are limited to geographic areas of Americas, Europe, Africa, Middle East and Japan. However, the impact of forgetting markets like India where IT flourishes has a considerable impact on the performance of Apple. In fact, the company addresses only a single category; those who are willing to pay a premium price for high-quality technology. One has to admit that the threat of substitutes is much higher in the case of Apple, especially because of the premium price the company has set for its products. In fact, according to Marino et al. Apple enjoys ultimate superiority in personal media player industry where it offers four products; the iPod Shuffle, iPod Nano, iPod Classic, and iPod Touch. However, as a response to iTune, Microsoft has started Zune brand which offers all the features of a flash player and in addition, it allows wireless connectivity and beaming of audio and video up to 30 fee t distance. 4) The buyer power Considering the market, one can say that the buyer power of Apple is mediocre. Its operations are limited to geographic areas of Americas, Europe, Africa, Middle East and Japan (ibid). However, the impact of forgetting markets like India where IT flourishes has considerable impact on the performance of Apple. In fact, the company addresses only a single category; those who are willing to pay a premium price for high quality technology. 5) The supplier power In

Context of Advanced Practice Essay Example | Topics and Well Written Essays - 1000 words

Context of Advanced Practice - Essay Example h Authority), Greater Manchester, and Cumbria and Lancashire to focus on the learning curve at a professional level while achieving academic skills (Advanced Practice Framework, 2005). This is a part of the NHS plan to create a patient led NHS aiming toward client focus and their choice of primary care (Cross et al. 2004). North West NHS has developed a workforce strategy to ensure a sufficient workforce capacity in all health organizations by shifting the current roles of the workforce (Advanced Nursing Practice, 2009). The role of the advanced practice nurses especially is undergoing a lot of changes due to the increased rules and regulations of NHS and NMC (Geest et al. 2008). A measure for efficiency has been developed called productive time which measures the time spent by professionals and nurses on core activities of advanced practices (Cross et al. 2004). By implementing such strategy the Department of Health and the NHS is expected to achieve  £6.5bn by 2008 out of which à ‚ £3.8bn is due to productive time (Burgess, 2007). Still enormous progress needs to be made that can make the service more improved (The future: A mini Prospectus, 2002). The HPC is also stepping in to regulate the practice and training of the professionals and to protect the people (HPC, 2007; Guthrie, 2009). On the national level, the European Working Time Directive (EWTD) driver has been seen to create different reactions from medical professionals (Little & Bluck, 2006). The main problem that arises is due to the work hour limit defined by the EWTD (Bates & Slade, 2007). The shift in the time limit from the previous 58 hour per week to 48 hour per week is been felt severely by the education and training medical institutions as well as in the delivery of service (Little & Bluck, 2006). The most effect is on the training of new juniors. According to Bates and Slade (2007), the time constraint has had many implications on the operative experience of the surgical trainees making the level

Business Plan Essay Example | Topics and Well Written Essays - 12500 words

Business Plan - Essay Example The partners have agreed that they should be co-equal partners in this venture, each providing one-third of the equity financing. Based on their experiences, skills and training, Brandon Beaver will take on the financial control and risk management, Kevin Gillin will oversee the organizational management as well as the manufacturing and operations aspect, because of his background in leadership and engineering. Brian Giuliano is a marketing professional in the field of medical devices, therefore his expertise is relevant in the market analysis and the sales and marketing activities for the venture. The line of products that the team proposes to manufacture include devices and technologies that do either one, two, or all of three things: (1) they detect the presence of certain substances, such as alcohol or drugs, which may be detectable in the breath, sweat, or subcutaneous layers of the skin; (2) to sense the physical or mental state of the driver with regard to fatigue, age, or disability by which a driver’s skill or attention may be compromised; and (3) on the basis of these findings, if the detected substance or condition has reached a critical level, to disable the car’s ignition or provide a signal or alarm to the driver, particularly in the case of drowsiness, or a similar signal to a remote location, such as to the parents of the youthful driver, with information as to the location of the vehicle if supplemented with GPS capability. Cannabis, more commonly known as marijuana, has been legalized for medical use in at least three countries (Israel, the Czech Republic, and Canada), and in several states in the United States although US Federal law bans the possession and use of the substance. Its use has been decriminalized in several countries and possession is legal in the Netherlands. Commencing 2013, recreational use of marijuana is legal in the two US states, namely Washington and Colorado. As a result of the increasingly

What are the effects of ethical issues regarding finance in non-profit Research Paper

What are the effects of ethical issues regarding finance in non-profit organizations - Research Paper Example They must practice transparency and accountability and set ethical guidelines to promote the will for public goods. The need for information disclosure mechanisms is a necessity for the survival of these important non-state actors. The paper concludes that ethics in management of NGOs is an area that concerns the government, the clients (Community), donors and the board of management. The areas of focus target public good hence, ethics in practice becomes paramount. The third sector commonly represented by Non Governmental Organizations (NGOs) or non-profit making organizations are governed by private law and with independent legal status pursuing programs of general interest for the improvement of society in the fields of social welfare and sustainability. Such organizations are generally held in high public esteem in both developing and developed societies. Non profit organizations have faced serious challenges recently which are why a rethink in the sector discussion has ensued over the last decade. They are faced with globalization, technological progress, rising living standards in advanced countries. On the other hand, their causes have led to human transformation politically, socially and economically. For these reasons people have become more sensitive to social problems: hunger, disease, income inequalities, lack of opportunity, and impact of natural and man-made disasters (Argandona, 2007). In some cases, NGOs take over the role of governments, by sub-coordinating or complementing those governments. They have become a channel or individual philanthropy or charity organizations which obtain funds from government. One would therefore pose the question whether ethical issues should be incorporated in management of not for profit organizations. An interest in non profit accountability has grown because â€Å"non profit organizations are granted the right to solicit tax

Kiowa& Colorado History Essay Example | Topics and Well Written Essays - 500 words

Kiowa& Colorado History - Essay Example They stationed themselves in southeastern Colorado, western Kansas, and western Oklahoma. They had some fights with Comanche, who were more populous tribe, but eventually these tribes created a confederation, between 1790 and 1806. By 1840 Kiowa became alliances with other tribes as well, such as Lakota, Cheyenne, Arapaho, and Osage. â€Å"Provisions of the 1865 Little Arkansas Treaty forced the Kiowa and Comanche to relinquish lands in Kansas and New Mexico, and the 1867 Medicine Lodge Treaty established a 2.8 million acre reservation in southwestern Oklahoma. There the Kiowa, Comanche, and Apache were confined following their subjugation at the end of the Red River War in May 1875. Kiowa-Comanche-Apache (KCA) Reservation lands were allotted in 1901† (Kiowa, para.2) At the beginning of the 21st century there are about 12000 Kiowa living in Colorado and Oklahoma. Kiowa developed a bison-hunting culture, together with the buffalos they moved around to the places of grazing. Kio wa lived in tee-pees, so it was easy for them to move around. Kiowa captured wild mustangs and trained them to use in warfare, for hunting purposes, as well as the means of transportation. Kiowa organized themselves by age, as well as by sex. As the person would get older he/she would move to the next social age organization. Brothers and sisters avoided interacting with each other after the age of ten.

Understand Group Dynamics Essay Example for Free

Understand Group Dynamics Essay I.Introduction To understand Organizational Behavior and Management, we must study three different levels. The first is the individual level, because every individual has its own unique perception of the world and what surrounds him. Individuals behave following how they interpret this and their environment. Each individual is different from the next one, because of its personality and characteristics. However, it’s possible to organize them by categorizing their perceptions. Categories such as Appearance, Social behavior and Status are often considered. Individual’s motivations must be analyzed to understand the next level : the Group. A Group is composed by 2 or more individuals, who come together to accomplish a particular task or goal, which is why their behavior is very important and has to be studied first. A manager leading a group will have to take into account each of the individual characteristics in order for it to work. As individuals join and create a group, shall it be a formal or informal one, we slowly change focus. The individual needs, perceptions and motivations get absorbed and the Group creates its own norms of acceptable behavior for all the individuals to follow for as long as they are part of the Group. They don’t, however, chance the individual itself when he is by himself. As Groups develop its own norms and statuses, its behavior evolves. The third level, is Organizations. That level is different from the Group one because it involves systematic efforts and organizations are engaged in the production of goods and services. It’s also different from the sum of the individuals perceptions because it can impact how individuals behave with each other, thus influencing their perception. An organization though, is comparable to an individual because each is unique and has its own culture. Moreover, if the values of the organization match the values of the individuals, they will enjoy being part of it more than if it’s not the case. The second level, Group Dynamics, is the one that will be focused on in this report. II.Group Characteristics. a)Formal and informal groups. There are different kind of groups, but they can mostly be split into two categories : Formal and Informal. Formal groups are groups officially planned and created by the organization to do a specific task. At ESSEC, we could compare them to the individuals who, in groups, did the OB presentations. They were officially planned in the course to do a presentation. In an organization, a formal group could be the Marketing (or any other) Department. In a formal group, there is a structure. Often, individuals are given specific tasks to complete within the main final task. Sometimes, there is a hierarchy and written rules. Informal groups are not official per say. They are natural social formations established by individuals rather than organizations, and unplanned. In a workplace, it could be a group of employees meeting once a month for dinner to discuss their Fishing hobby. At ESSEC, it could be an unofficial football team made especially for a tournament within the school. The purpose of an informal group can be pursuing a special interest, be social, or even just have fun. b)Group effectiveness Group dynamics concern how groups form, their structure and process, and how they function. Some groups are more successful than others. Why ? A common mistake would be to say that if your group members or employees are hard working, happy, competitive or smart, the group only can function well. But as a matter of fact, that doesn’t mean they are honest, productive, loyal or creative. However, teamwork and communication between members is capital. Managers can help increasing a work group’s performance when they create it by taking into consideration the characteristics of members they assign to particular groups. The members should have tasks assigned to them according to their domain of expertise and appropriate interpersonal skills to facilitate interaction and communication with others. Moreover, a degree of diversity among group members has shown to usually add to performance. If members are attracted to the group because they like members of the group, or the group activities/goals or just because it fills a need for affiliation, they are more likely to be productive. The size of the group also has an influence on the group’s performance. According to recent research, medium sized groups of 5 to 7 people seem to have the higher performance in organizations. If the group is smaller, there’s a chance it can highlight the individual differences and harm the group cohesiveness. If group are too large, people tend to work more by themselves (â€Å"Free riding†) rather than with the whole group, or create smaller teams within the group. c)Group norms. Norms are acceptable standards of behavior within a group that are shared by the members of the group. Norms define the limits of what is acceptable and what is not in terms of behavior. They are typically imagined in order to facilitate group survival, make behavior more predictable, avoid embarrassing situations, and express the values of the group. Each group will establish its own set of norms that may determine anything from the appropriate clothes to wear at a dinner to how many comments to make in a meeting. Groups pressure members to force them to conform to the groups standards. The norms often reflect the level of commitment, motivation, and performance of the group. The majority of the members of the group must agree that the norms are appropriate in order for the behavior to be accepted. There must also be a shared understanding that the group supports the norms. However it may happen that the norms are broken from time to time by some members. If the majority of members do not adhere to the norms anymore, then there is a chance they will eventually change and will no longer serve as a standard to study the group’s behavior. From there, group members who do not conform to the norms risk being excluded, ignored, or asked to leave the group. d)Group Roles Having a diversity of skills and ideas within a group often enriches the group process and can improve the final product. It can, however, also be seen as a challenge to work with people different from ourselves and avoid exacerbating individual characteristics. One way to structure group functioning and benefit from each other’s expertise is to assign roles to each member of the group based on individual’s strengths. It can also be a good idea to switch roles between members periodically so every member understands why those roles are important. I have found that four roles that have the potential to maximize group performance and help understanding group’s dynamics and behavior in the workplace. A group should not be composed of just those 4 people, but the others would only have tasks assigned to them. They are as follow : The first is the Leader, also called Facilitator. He’s the one who clarifies the aims of the group and helps the members set smaller tasks for themselves to work on. Leaders also make sure that all group members understand the concepts of the project and that the group’s conclusions make sense. If the group has meetings, he is the one who introduces the agenda of tasks to complete until the next meeting, mind oriented towards the final goals. Then, the Monitor, also called Arbitrator. Its key role would be to monitor carefully if the group is functioning well. Regularly, he will initiate discussions on group climate and process, especially if he senses tension or sees there could be a conflict between two or more members. During disagreements or conflicts, he will explain each sides arguments and suggests solutions to resolve the conflict. He makes sure that all group members have a chance to participate and learn from the process. There’s also the Note/Time Keeper. Note and Time Keeping are two different things, but the role could be taken by just one person. He keeps a record of what has been decided, shall it be tasks that are assigned to who or other any other information by taking notes when the group meets or when talking to group members. He makes a summary of previous discussions/decisions and makes it available for all the members to see. He also presents the group progress to the supervisor regularly to make sure the group is headed in the right direction. The Time Keeper keeps track of time during meetings to avoid spending excessive time on one topic. This is best handled by deciding how much time will be allocated to each issue in the agenda, and letting everyone know when this time is up. It is also useful to point out when time is almost up so that issues can be wrapped up appropriately. Finally, there’s the Devil’s Advocate. It’s someone who takes a position he does not necessarily agree with, for the sake of argument. In taking such position, the individual taking on the devils advocate role seeks to engage others in an argumentative discussion process. The purpose of such process is typically to test the quality of the original argument and identify weaknesses in its structure, and to use such information to either improve or abandon the original, opposing position. He must keep his or her mind open to problems, possibilities, and opposing ideas at all times. e)Group or Team ? We could say a group is just a collection of people whereas a team is that same collection of people who are working together on a common goal. Example: A group of people get in an elevator. They all have different goals and agendas for being on the elevator, they don’t even know each other, or maybe they do, it’s irrelevant. The group becomes a team when the elevator breaks down. Now they all have the same goal : figure out how to get out of the elevator. The difference between Group work and Team work can be resumed as follow. A group will focus on individual goals. Each member will produce individual work products. Individual tasks, roles and responsibilities will be assigned. Also, in a group, the manager is the one who sets up the purpose, goals, approach to work. A team is slightly different. The focus is on team goals. It also defines roles, responsibilities, and tasks but will often share and rotate them to help team do its work. The goals and approach to work w ill be shaped by the team members together.

Importance of Exercise for the Elderly: Literature Review

Importance of Exercise for the Elderly: Literature Review Sports studies with business Chapter 1 Introduction The importance of physical activity and physical fitness in terms of â€Å"†¦ health and longevity †¦Ã¢â‚¬  have been linked since the â€Å"†¦ earliest records of organized exercise used in health promotion †¦ (which were) †¦ found in China around 2500 B.C†¦.† (Hardman et al, 2003, p. 3). Hippocrates, who is â€Å"†¦ often called the Father of Modern Medicine, wrote †¦Ã¢â‚¬ : â€Å"†¦ all parts of the body which have a function, if used in moderation and exercised in labours in which each is accustomed, become thereby healthy, well-developed and age more slowly, but if unused and left idle they become liable to disease, defective in growth and age quickly† (Hardman et al, 2003, p. 3). The link between exercise and health has been a long established fact in medicine that also traces back to â€Å"Cicero in 44 BC (who was himself echoing Aristotle) †¦Ã¢â‚¬  who believed that health as one ages is improved by having a good diet along with exercise and mental stimulation (Harlow, 2006). In fact, Cicero â€Å"†¦ saw old age as something yet to happen to him †¦Ã¢â‚¬  when he was in his sixties and writing his treatise in an period when less than â€Å"†¦ seven percent of the population reached sixty† (Harlow, 2006). The preceding three factors of diet, exercise and mental stimulation as mentioned by Cicero are ingredients that are present in when one participates in sports. The subject of elderly participation in sporting activities in the United Kingdom represents one of considerable importance as the percentage of older adults increases in proportion to the UK’s total population. This examination shall seek to equate the participation rates for sports in the United Kingdom, delving into how, and if social class represents a contributing factor concerning the potential of this group participating in sporting activities in later life. The prospect of sport participation in later life shall also be undertaken along with whether social class enters into this facet as well concerning participation rates. The importance of age is impacting the population in the United Kingdom whereby the number of people over the age of 65 has increased to 16 percent, with the age group 85 and older comprising 12 percent of the total population (National Statistics, 2007). The significance of the foregoing is that people are living longer as a result of better nutrition, health care, and living conditions as well as life styles (Quanten, 2004). Interestingly, Quanten (2004) makes the observation that medical science has determined that our basis for calculating the longevity of ancient civilizations is faulty in that the technique utilized in estimating age was based upon bone density. The bone samples generally belonged to middle aged men and women, thus the formula utilized to determine age was based upon the weakening of said density which was slower then than it is now (Quanten, 2004). Thus it was found that the estimation of age has been seriously under represented, putting the average life span of early man in the range of somewhere between 80 and 100 years, meaning that in modern terms civilization has lost ground in aging as opposed to gaining, as was the consensus of thought (Quanten, 2004). Evidence supporting the preceding in today’s world can be found in the fact that there are many examples of individuals living to 120 to 130 years, with the vast majority of them living in extreme conditions where a high degree of physical labour is required for survival, as represented by jungles untouched by modern society, and harsh climates as found in Northern Russia (Quanten, 2004). The common fact linking the ancient study and present day examples of individuals living 120 to 130 years is that their environments were and are more physical in their demands, with the lifestyles requiring more exercise. Kligman and Pepin (1992, pp. 33-34, 37-44. 47), the American College of Sports Medicine (1998, pp. 992-1008), Dishman (1994, pp. 1087-1094) and Nelson et al (1991, pp. 1304-1311) along with numerous other sources all attest to the benefits of exercise in early life as well as throughout life as beneficial in staving off disease as well as prolonging life. Studies as undertaking by Shepard (1993, pp. 61-64) and, Paffenbarger et al (1989, pp. 605-613) for example, cite incidences in Finland as well as Harvard University in the United States where those who consistently exercised lived on average 2 to 3 years longer that their more sedentary counterparts. The foregoing brief examples and analysis of age and exercise has been conducted to provide an initial foundation for understanding the framework of this examination which shall delve into elderly sports participation rates in the United Kingdom. The topic of this study is to attempt to determine, if possible, how social class affects the likelihood of doing sporting activities in later life, with its aim to see if social class does have an influence on people taking/carrying on sporting activity in this context. In conducting this examination, the foregoing also seek to compare individuals in the age group representing 55 years of age and above who participate in sporting activities against those who do not through a comparison of their social class backgrounds as represented by working middle class and upper middle class classifications to determine if any correlation exists. Chapter 2 – Literature Review Resnick et al (2006, p. 174), in â€Å"Screening for and Prescribing Exercise for Older Adults† advise that there is substantial scientific evidence that supports the benefits of exercise in maintaining â€Å"†¦ function, health, and overall quality of life for older adults. The article advises that physical activity represents â€Å"†¦ one of the greatest opportunities to extend †¦Ã¢â‚¬  an individual’s active as well as independent life and reduce the incidence of disability, and that regular physical activity by older adults are more likely to have better health (Resnick et al, 2006, pp. 174-182). In spite of the clear evidence of the preceding, most adults do not participate or engage in either sport or physical activity, and unfortunately the prescription of a regular physical regime is not yet a routine clinical practice (Resnick et al, 2006, pp. 174-182). The article went on to state that the best methodology via which to engage in a sport or ph ysical exercise is to first seek the aid of a physician to reach a determination of one’s present medical and physical state in order for a person to understand the types of activities they should / can engage in, as well as seeking help with a program to ease them into a proper regime. The Council of Europe (1993) defines sport as encompassing â€Å"†¦ all forms of physical activity †¦Ã¢â‚¬  which includes casual participation for which the aim of the activity is to improve â€Å"†¦ physical fitness and mental well-being †¦Ã¢â‚¬  along with the formation of social relationships and or obtaining competitive results. As such, the foregoing expands what one traditionally understands as the defintion of sport into a broader context that includes individual sport as well as fitness activities that include certain dance activities, and aerobics along with walking and cycling (Rowe et al, 2004). The Council of Europe’s (1993) definition includes informal and casual participation, along with the more serious club and professional pursuits (Rowe et al, 2004). The study conducted by Rowe et al (2004) defined participation as at least once a week in the activity, and found that the evidence collected indicated that the United Kingdom had moved t owards stagnation with regard to participation levels. The following chart reflects these findings: Table 1 – Sport, Game and Phyisical Activity Participation in the United Kingdom (Rowe et al, 2004) The preceding indicates the fluctuating levels of particpation occuring at the rate of at least one time a week over a four week period for the indicated periods. The following Table shows the foregoing, but excludes walking. Table 2 – Participation in Sports, Games and Physical Activity (Excludes walking) (Rowe et al, 2004) Social class differences explored in the study by Rowe et al (2004) showed a marked difference in sport participation between the highest and lowest social classifications, as one would expect owing to differences in the ability to spend time on pursuits as a result of disposable income and time, in addition to living closer to facilities and or having the transportation and or a circle of friends who also participate, thus making sport an increased part of their lifestyle. Table 3 – Differences in Social Class, Sport Participation 1987 – 1996 (Rowe et al, 2004) Table 4 – Projected Chanages in Number of Sport Participants between 1996 – 2026, Based on Trends Established 1990 – 1996 (Rowe et al, 2004) The total number of estimated particpants in varied sports activity is shown projected into the year 2026 in the above Table. The increased number is due to the rise of the number of people in these age groups as opposed to actual increased participation (Rowe et al, 2004). Older aged individuals, as shown by Tables 1 and 2 have significantly lower sport activity participation rates which to a large degree, as expressed in the study conducted by Rowe et al (2004), is due to reduced participation in their social group, aliments, lack of income, non-inclusion in their lifestyle as well as being uninformed that sport and exercise represent a healthful benefit that should be continued throughout an individual’s life. Thurston and Green (2004, pp. 379-387) support the previous contention of the development of more active lifestyles for older individuals, as does the Department of Health (1995) in their document â€Å"More People, More Active, More Often. Physical Activity in England†, and Department of Health douments in the years 1999, 2000, 2001 and 2002 that all make references to the overwhelming evidence that indicates that frequent and regular physical activity is beneficial to health. The foregoing includes an increased life expectancy, diabetes, control over obesity, reduction in coronary heart disease, positive health outcomes, increased mobility and coordination as well as other benefits (Thurston and Green, 2004, pp. 379-387). Studies have shown that even if an adult begins sport and exercise programs as late as 60 years of age they can improve their life expectancy by 1 to 2 years, however 40% of adults in the above 60 year age group do not partake in such a regime even if they were aware of the benefits (Thurston and Green, 2004, pp. 379-387). The understanding of the importance of the older generation as a part of the overall national profile as well as economic, health, medical and social system, the House of Lords published is document titled â€Å"Aging: Scientific Aspects†, in 2005 (House of Lords, 2005). The Report stated that the â€Å"†¦ economic implications of changing life expectancy are †¦ of great importance †¦Ã¢â‚¬ , with the â€Å"†¦ urgency of these matters †¦ â€Å"made plain from statistics that point out â€Å"†¦ for the first time the number of people in England and Wales aged 60 and over was greater than the number aged under 16† (House of Lords, 2005). When the figures for what is termed the ‘oldest old’, meaning individuals above the age of 85 are included, the implications are even more striking: Table 5 – Oldest Old Comparisons, UK and the World (House of Lords, 2005) The growth rate of the aging population in the United Kingdom is outstripping the global rate to the point whereby the UK is projected to reach a figure of 20% of its total population in 2020, fully thirty years before the global population will reach that figure, thus making the prospect of old age health an important one for the country. Table 6 – Life Expectancy, United Kingdom (House of Lords, 2005) The above Table indicates that the life expectancy in England is higher when counted alone. In examining the elderly sports participation rate for the older population in the United Kingdom utilizing social class distinctions, it is important equate the defining aspects of these groups. The following defines the preceding as found in the House of Lords document â€Å"Aging: Scientific Aspects†: Table 7 – Social Class Segments (House of Lords, 2005) Table 8 – Life Expectancy by Social Class (House of Lords, 2005) The preceding Table represented an aid in the later determination of social class and if this factor has any bearing, and or influence upon participation in carrying on sporting activities in later life. The House of Lord’s report on â€Å"Aging: Scientific Aspects† did indicate through the study of varied reports as well as consultations that it came to the conclusion, which is a consensus view, â€Å"†¦ that aging is caused by lifelong accumulation of molecular and cellular damage †¦Ã¢â‚¬  as opposed to the theory of a â€Å"†¦ rigid inner clock †¦Ã¢â‚¬  (House of Lords, 2005). Importantly, the ‘Report’ indicated that the process of aging â€Å"†¦ is more malleable than has been generally appreciated †¦Ã¢â‚¬  and that the â€Å"†¦ mechanisms governing health in old age †¦Ã¢â‚¬  are processes that are ongoing throughout the lives of individuals (House of Lords, 2005). In reference to the implications of this examination, the ‘Report’ â€Å"†¦ summarized what appears to be a consensus view †¦Ã¢â‚¬  regarding the key factors promoting good health as well as slowing down the ageing process as (House of Lords, 2005): physical activity; having a social role and function; good nutrition; absence of risk factors such as smoking and drinking to excess; and good mental health and well-being The ‘Report’ stressed that physical activity represents a ‘key’ facet of good health and â€Å"†¦ is the major modifiable influence on health in old age† (House of Lords, 2005). In making such a statement the ‘Report’ referred to ‘The Royal Society of Edinburgh’ which stated that exercise has been shown as being a critical factor in maintaining as well as modestly increasing bone density of adults, and more importantly can aid in the minimization of bone loss in older individuals (House of Lords, 2005). The overall ‘Report’ on â€Å"Aging: Scientific Aspects† provided key background information that proved helpful, with regard to general information, and indispensable with regard to demographic groups, exercise, and the government’s recognition of the importance of the issue as well as the specific and key identification of key points. With regard to sport, the Department for Culture, Media and Sport (2007a) aims to encourage wider sports participation, and in regard to the focus of this examination, to promote sport at the grassroots level, which has implications concerning facilities that the older generation either has available, and or needs (Department for Culture, Media and Sport, 2007b). In its Report â€Å"Where are we Now: The State of Sport Today†, it clarifies that the government does not run sport, but recognizes it as an important factor in the health, and well being of children, adults, and the older generation (Department for Culture, Media and Sport, 2007b). Overall, across all age and demographic groups, the United Kingdom ranks in the middle of the European Union in sports participation by the general public, as shown by the following: Table 9 – European Union General Population Sport Participation (In Percent) (Department for Culture, Media and Sport, 2007b) In terms of intensity, individuals in the United Kingdom participate in sports on a less regular basis, and with less intensity (Department for Culture, Media and Sport, 2007b). The last aspect does not have applicability with regard to older adults, however the former is a telling statistics concerning its bearing on older sports participation. Table 10 – UK Sport Participation (In percent) (Department for Culture, Media and Sport, 2007b) Rate of Intensity The following table indicates the rates of participation of residents in the UK. Table 11 – Competitive and Organized Sport Participation in the UK (Department for Culture, Media and Sport, 2007b) The ‘Report’ indicates participation rates among social economic groups varies, however it does not break out these statistics into age groups. Table 12 – UK General Population Sports Participation by Social Economic Group (Department for Culture, Media and Sport, 2007b) Table 13 – UK Sport Participation by Ethnic Minority (Department for Culture, Media and Sport, 2007b) Sport England (2005) undertook a study that systematically reviewed published and unpublished research studies regarding children, and adult reasons concerning participation as well as non-participation in sport, which this examination utilized to add to the other research and literature sources. An important facet that was identified in the study was one representing an individual’s personal appearance and proficiency levels. The preceding two aspects are generally overlooked factors that are a part of a person’s sport participation consideration. The very real concern of having an unfit body, being out of shape, not able to conduct certain aspects of sport participation performance on a level that could potentially lead to personal embarrassment, are very real concerns that could and do enter into dissuading individuals from participating in a sporting activity (Sport England, 2005). Facilities and availability are also factors that enter into the participation equation, along with costs. For example, the incidence of parks, walkways, golf, tennis, cricket, bicycle paths, gym facilities and the like are more likely to be located near to upper income neighbourhoods than lower income

Prochaska and Di Clemente Stages of Change

Prochaska and Di Clemente Stages of Change The transtheoretical model of change is one of several models of health promotion used by health care professionals in an effort to recognise and foresee health behaviours. The model is supported by various authors as a successful tool and framework within health education. (Warner 2003) This assignment will introduce the model and briefly discuss its input to health promotion together with further developments since its beginning. A concise account of its use in present health education will be given and referred to where applicable. The assignment will go on to discuss the relevance of the transtheoretical model of change within nursing practice and provide an understanding of the model by explaining the main theories. In addition the assignment will discuss and provide further information on what areas impact on how the model is used and why. Further discussion will take account of the strength of the approach used by this model and include theories on why it is used giving consideration to the patient as well as the health care professional. It is recommended that successful health education models can be used to asses goals in order to engage in pre-emptive behaviour and consequently it is crucial that the model is explained in order to take full advantage of its use. (Downie et al. 1997, Ogden 2004) The approach will be investigated in order that the reader can form an opinion on its use and why it is needed within health education. It is acknowledged that nursing and health care practice should be established on the most current and reliable research available and nurses must practice in partnership with equally the patient and other health authorities (NMC 2008). The writer hopes to establish the reader with the necessary information that satisfies these requirements and gives further discussion on how the transtheoretical model of change can be applied to clinical practice. This will include criticisms and challenges against the model and look at how the model is included within broader professional health care such as current health promotion campaigns. Finally a conclusion will be provided which will summarise the findings of this assignment and emphasise any significant features that add to the validity of the model and its use within health care. The transtheoretical model of change was developed by Prochaska and Di Clemente (1983) and grew from systematic integration of more than 300 theories of psychotherapy, along with analysis of the leading theories of behaviour change (Prochaska and Velicer, 1997). Consequently following the inception of public- health programmes this model has been implemented and is used within current health promotion. (Wood 2008) Health promotion is defined by the World Health Organisation (WHO 1986) as the process of enabling people to increase control over, and to improve, their health. Health education is considered an approach of health promotion which also includes many theories, beliefs and concepts in regards to effective intervention. (Tones 2001) The transtheoretical model of change focuses on the decision-making abilities of the individual rather than the social and biological influences on behaviour as other approaches tried (Velicer, Prochaska, Fava, Norman, and Redding, 1998; Scholl, 2002). This model was developed to provide a framework for understanding how individuals change their behaviours and for considering how ready they are to change their substance use or other lifestyle behaviour. The stages and processes by which people change seem to be the same with or without treatment these include the individuals perceptions of susceptibility to illness, severity of illness, barriers to changing behaviour, benefits to changing behaviour and finally action and maintenance. Although the model has been adapted and modified to include further components for the purpose of this assignment it is necessary to explain the theory behind the original before discussing modifications. (Ogden 2004, Bennett and Murphy 1997, Naidoo and Wills 2000) In addition it is suggested that by using these concepts in the transtheoretical model of change it will predict the likelihood that behaviour will or will not change depending on the individuals perception. The idea of anticipating behaviour and therefore adjusting intervention is supported by various researchers who suggest that using cognitive models can assist in how individuals perceive health by conscious thought as to the behaviours and the cost of those behaviours. (Yarbrough and Braden 2001, Roden 2004a, Wood 2008) This supports healthcare professionals to allow the patient to change behaviours based on their own awareness as opposed to medical tactics to health promotion that have been used previously. Ewles and Simnett (2003) recommend that using a client centred approach empowers the patient to change behaviour and independently manage behaviour and as a result the health care professional becomes a facilitator instead of an instructor. Using a client centred approach does not discount the benefits of the medical approach as it may require various tactics depending at what stage of the model the individual is identified as being at. However by using an effective health promotion model, it encourages the patient to become an active participant and more responsible for their health related decisions. Ogden (2004) describes the concept of an individuals perception of control on their health as the Health locus of control which will be discussed later within this assignment. Based on the understanding of individual perceptions influencing behaviour it reinforces the use of the components previously discussed and by looking at these separately it is hoped that health care professionals will be able to detect the risks of behaviour and the probability of change. (Naidoo and Wills 2000, Ogden 2004) The previous mentioned components can be identified in the Transtheoretical model of change; these include pre-contemplation, contemplation, action, and maintenance. However the aspect that makes the transtheoretical model of change unique is the theory that change occurs over time, an aspect generally ignored by other models of change (Prochaska and Velicer, 1997; Velicer et al., 1998; Scholl, 2002). This temporal dimension of the theory suggests that an individual may progress through five stages of change when trying to adjust their behaviours (Prochaska and Di Clemente, 1983; Prochaska et al., 1992; Prochaska and Velicer, 1997). In the transtheoretical model of change, behaviour change is treated as dynamic, rather than an all or nothing phenomenon. This distinction is considered one of the theorys strengths (Marshall and Biddle, 2001). The first stage of change within the transtheoretical model of change is the precontemplation stage, where individuals have no intention of taking action within the next six months (Prochaska et al., 1992; Prochaska and Velicer, 1997; Scholl, 2002). Individuals at this stage may or may not be aware of the consequences of their behaviour (Prochaska et al., 1992;Scholl, 2002) or may have tried to modify/change their behaviour and failed several times and as a consequence are dejected and unwilling to have another attempt (Prochaska and Velicer, 1997). Prochaska et al (1992) propose that the main characteristic of someone in the precontemplation stage is that they struggle to accept that they have problem behaviour and as such they cannot move on from this particular stage of the model. In order for the individual to move on they must experience cognitive dissonance which is acknowledging that there are negative aspects to continuing with this behaviour (i.e. smoking and the possibility of contracting lung cancer as a result) (Scholl, 2002). Following on from precontemplation, contemplation is the individual trying to make significant changes within another six month period, this includes evaluating any benefits or disadvantages to the individual changing their behaviour (i.e. cost of smoking, as opposed to loss of social activity) as a consequence many people stay within this stage for longer (Patten et al., 2000; Prochaska et al., 1992; Prochaska Velicer, 1997; Velicer, 1997; Velicer et al., 1998). Therefore the behaviour may seem more attractive than the change needed to be made (Scholl, 2002). This is known as chronic contemplation or behavioural procrastination (Prochaska and Velicer, 1997). Whilst within this phase the individual will still continue with the risky behaviour despite being aware of the consequences that this behaviour could cause (Patten et al., 2000). However it is widely accepted that someone within the contemplation stage is genuinely trying to resolve their problem behaviour (Prochaska et al., 1992) and as a result will only move on to the next stage when the positive aspects of change outweigh the negative aspects of remaining the same (Scholl, 2002). Preparation proceeds contemplation and in this area of change the time scale for the individual to modify their behaviour reduces to within the next month (Patten et al., 2000; Prochaska et al., 1992; Prochaska and Velicer, 1997; Velicer et al., 1998). An individual in this stage has tried to change or adjust their behaviour within the last year and has been unsuccessful however this has not discouraged them from continuing to i.e. binge drinking, smoking, or misuse of drugs. As a result of this the individual is at a loss as to how to proceed with any changes and if they are ultimately able to make these changes given that they have up until now failed (Scholl 2002). In this instance a plan of action can be produced by the healthcare professional in order to identify how to reduce or eliminate the problem behaviour and therefore give the person the opportunity to choose between alternative solutions i.e. smoking 10 cigarettes as opposed to 40 cigarettes a day or to stop smoking with the help of nicotine patches (Prochaska et al., 1992; Prochaska and Velicer, 1997; Velicer et al., 1998). Consequently when an individual feels confident and in control of the situation and has identified a suitable plan of action they will naturally move on to the next stage of the model (Scholl, 2002). The action stage follows on from preparation and as a result efforts have been made to adjust the individuals, behaviours, experiences, or environments over the previous six months in order to conquer their predicament. This stage requires a considerable amount of time and energy and is the stage where the individual receives the most amount of attention from others because of their obvious hard work (Patten et al., 2000; Prochaska et al., 1992). However it should be noted that research has stated not to mistake trying to change with actual change, this only occurs when the criteria is reached for the individual and will reduce the risks associated with their particular problem behaviour (Prochaska et al., 1992; Prochaska and Velicer, 1997; Velicer et al., 1998). Prochaska, DiClemente, and Norcross (1992) suggest that the main ways of identifying a person within the action stage is by the individuals obvious lifestyle changes i.e. healthy eating and documented weight loss to a more acceptable criterion level. Progress into the final stage happens when the individual perceives positive changes to their lifestyle, health and as a result feels better whilst also receiving encouraging feedback from family, friends and health professionals (Scholl, 2002). Lastly the transtheoretical models maintenance stage is where people work to prevent a relapse and only after six months of being free of the problem behaviour can it be recognised as the criteria of an individual being within the maintenance phase. Research also recognises that maintenance is a continuation of change not an absence of it (Patten et al., 2000; Prochaska et al., 1992; Prochaska and Velicer, 1997; Velicer et al., 1998). Consequently individual perception is referred to the threat of illness and modifying factors can be referred to as behavioural response. In addition the likelihood of action is influenced by environmental cues. As a result the behaviour change occurs because of a threat to illness and therefore the behaviour changes or is adapted. Mc Clanahan et al. (2007), Warner (2003) and Clark (2000) all describe the threat as an individuals susceptibility to illness or disease. If an individual believes they are open to the illness or disease they may identify this as a danger to their health. This is only applicable if there is a significant risk factor such as smoking, diet, alcohol or drugs misuse. If an individual does not take into consideration their own vulnerability then it is unlikely that the transtheoretical model of change will be successful in predicting associated behaviour. Ogden (2004) suggests that perceived susceptibility can not be used as an effective predictor of behaviour change. Furthermore consideration must be applied to adolescents who are more likely to expose themselves to risks but be less aware of the consequences to their associated health. Naidoo and Wills (2000) suggest that health promotion can be challenging when dealing with young people in regards to risk behaviour as risk taking is essentially a part of adolescence. On the other hand it is usually accepted that if an individual perceives themselves to be vulnerable to a disease (i.e. lung disease from smoking) they will also consider the severity of that disease. (Daddario 2007, Simsekoglu and Lajunen 2007) The perception of severity or seriousness of a disease is subjective depending on the individuals understanding of the potential threat. Browes (2006) refers to the variance of perceived severity in relation to sexual health. The severity can vary from the belief that most diseases can be treated to the belief that sex can result in contracting potentially fatal diseases such as HIV. Therefore it may be necessary for the health care professional to encourage learning in relation to the severity of conditions in relation to the susceptibility. Finfgeld et al (2003) outline that to facilitate learning effectively it may be necessary for the health care professional to apply a more direct attitude which would involve the nurse addressing the increase of behaviour (susceptibility) as well as identifying potential risks (severity). However with this intervention the approach becomes nurse led as opposed to patient led which may compromise empowerment and likelihood that risk behaviour will return when the intervention is reduced. As a result the delivery of the necessary information to the patient may result in feeling of fear or guilt. Although it is suggested that fear and guilt can be effective in changing behaviours , it is criticised as it does not change behaviour long term and can contribute to feelings of denial and therefore affect the relationship between both patient and healthcare professional. (Naidoo and Wills 2000) Based on perceived susceptibility and severity the transtheoretical model of change believes that behaviour change will take place if the benefits outweigh the barriers to changing behaviours. However it is expected that potential benefits may be small compared to the barriers that prevent changes to behaviour. (Daddario 2007) Then again as previously discussed the transtheoretical model of change has had several modifications made to it in order to maximise its use within healthcare in order to apply it to other more complex health conditions. The psychologists who developed the stages of change theory in 1982 did so in order to compare smokers in therapy and self-changers along a behaviour change continuum. The idea behind this was to allow health care professionals to adapt a plan of action for each individual and as a result their therapy would be tailored to their particular needs. This process was then added to by a fifth component (preparation for action) as well as ten processes that help predict and motivate individual movement across the stages of the continuum. In addition, the stages are no longer considered to be linear; but are components of a cyclical process that varies for each individual (Diclemente and Norcross 1992). Used correctly and by incorporating the various modifications to the model, it is recognised that the transtheoretical model of change can assist health care professionals in health education. However as a psychological theory, the stages of change focuses on the individual without assessing the role those structural and environmental issues may have on an individuals ability to enact behaviour change. In addition, since the stages of change presents a descriptive rather than a causative explanation of behaviour, the relationship between stages is not always clear. Consequently each stage of change may not be appropriate for characterising every population. An example of this would be the study of sex workers in Bolivia which highlighted that very few of the participants were actually in the precontemplative, contemplative stages with regards to using condoms with their clients (Posner, 1995). However mass media campaigns can motivate individuals to change behaviours by highlighting the benefits of safer sex by the use of condoms. The use of positive messages as opposed to negative messages within mass media campaigns increases the likelihood of retaining the relevant information for longer. (Bennett and Murphy 1997) Naidoo and Wills (2000) also suggest individuals may have personal experiences of illness and disease within their family or friend network therefore this will influence how the benefits are perceived.These modifying factors will influence the likelihood of action and therefore determine if behaviour will change. As a result research conducted by Charron-Prochonwnik et al. (2001) found that changes to individual sexual behaviour correlated to the consideration of modifying factors such as social support, culture and positive attitudes resulting in safer behaviour. Additionally there are other features of the Transtheoretical Model of Change that are not easily applied to non-addiction type clinical problems. Howarth (1999) noted that the application of Transtheoretical Model of Change has promise in the field of eating behaviours but the translation is made difficult because the goal of smoking intervention is cessation whereas eating interventions is reducing intake of some foods and increasing the intake of others. Also in smoking interventions the main aim is to stop and is clearly understood by everyone. However in eating interventions the main aims are not so easily understood. Whereas in smoking research the outcome variables are reasonably simple compared to eating research where outcomes are more complex and the results variable. Ultimately smoking interventions target one behaviour whereas eating interventions focus on multiple behaviours. Furthermore there is the degree of difficulty in discontinuing smoking in the initial stages but as time progresses things get easier for the individual whereas eating more healthily can be easy at first but hard to maintain. Moreover when smoking discontinues it produces immediate physiological changes but eating interventions in the early stages only produce distant and subtle changes. As a result behaviour change will not only be on the basis of potential benefits but may also be subject to internal and external cues. As previously mentioned campaigns can promote changes to behaviour and this would be considered an external cue, the individual is motivated by the message that is projected. (Naidoo and Wills 2000) However internal cues may also influence behaviour, this may be a change in physical health or psychological wellbeing which encourages the individual to ask for help from health care professionals. Daddario (2007) suggest that internal cues are most likely to change behaviour in individuals that are over weight. Clarke et al, (2000) further suggest that with the incorporation of self-efficacy, health models can be more effective in predicting behaviours; this concept was developed by Bandura (1977) and can be described as an individuals confidence in their ability to complete a task. Finfgeld et al. (2003) also acknowledge that nurses can promote self-efficacy alongside models of health by reinforcing the importance of the contribution of individual capability in changing behaviours and can be used within educational and client centred approach to health education. In addition to self-efficacy Hughes (2004) considers the concept locus of control in order to maximise the use of various models of health. Locus of control refers to how the individual perceives control over their life and physical health. An individuals beliefs may be based on the idea that their health is subject to internal actions such as diet, lifestyle and as a result able to be changed. However in contrast others may believe that health is subject to external factors such as bad luck or fate. Just as important is the belief that religion and culture can contribute to the belief that health is predetermined and therefore cannot be influenced by behaviour changes. (Niven 1994, Naidoo and Wills 2000) Consequently Syx (2008) suggests effective questioning technique to establish where an individual places the locus of control, which should then determine how likely they are to engage in health education behaviours. In conclusion despite conflicting evidence for the transtheoretical model of change Macnee McCabe (2004) do not have conceptual concerns regarding this, but question the applicability of the model to specific populations. Sutton (2001) also suggests that there are some serious problems with the existing methods used to measure the stages of change. For example, stage criteria are not consistent across studies that use the approach. Some studies do not include questions about past attempts to change, and various time frames are used as reference points which alter distribution of people across stages (Lerner, 1990; Nigg et al., 1999; Stevens Estrada, 1996; Weinstein et al., 1998). Finally, Littell and Girvan (2002) suggest that a continuous model of readiness for change may be more integrated with related concepts from other theories. It is also documented that healthcare professionals be able to distinguish readiness for change from readiness to participate in particular treatments, and that change may come about quickly as a result of life events, or external pressures. Accordingly at this time there is an increase in the number of studies criticising the model over conceptual, methodological analytic concerns. On the other hand there is an equal amount of evidence supporting the model, verifying the constructs, and showing support for application to modifying health behaviour. Therefore the benefit of understanding this model and maximising it to its full potential can support nurses and other health care professionals to practice in accordance to guidelines set out by both clinical and academic bodies. The NMC (2008) outline the responsibilities of nursing professionals to work in a professional manner and ongoing research provides evidence in how the model can be used with modifications to suit different needs. (Roden 2004a, 2004b) REFERENCE LIST Bandura, A. (1977) Self-efficacy; toward a unifying theory of behavioural change. Psychology Review, Vol. 84, no.2, pp. 191-215 Bennett, P., Murphy, S. (1997) Psychology and health promotion, Open University Press: Buckingham. Browes, S. (2006) Health psychology and sexual health assessment. Nursing Standard, Vol. 21, no. 5, pp. 35-39 Charron-Prochownik, D., Sereika, S., M., Becker, D., Jacober, S., Mansfield, J., White, N., Hughes, S., Dean-McElhinny T., Trail, L. (2001) Reproductive health beliefs and behaviours in teens with diabetes: application of the expanded health belief model. Paediatric Diabetes, Vol. 2, no. 1, pp. 30-39 Clark, A. V., Hildegarde, L., Williams, A., Macpherson M. 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(2000) Health promotion foundations for practice, 2nd ed., Bailliere Tindall: Edinburgh. Nigg, C.R., Burbank, P.M., Paddula, C., Dafresne, R. (1999) The Gerontologist. Available from. http://www.oxfordjournals.org Niven, N. (1994) Health psychology: an introduction for nurses and other health care professionals, 2nd ed., Churchill Livingstone: Edinburgh. Nursing and Midwifery Council. (2008) Standards of conduct, performance and ethics for nurses and midwives, Nursing and Midwifery Council: London. Ogden, J. (2004) Health Psychology A Textbook, 3rd ed., Open University Press: Maidenhead. Patten, S., Vollman, A., Thurston, W. (2000) The utility of the transtheoretical model of behaviour change for HIV risk reduction in injection drug users. Journal of the Association of Nurses in AIDS care, Vol. 11, no. 1, pp. 57-66 Prochaska, J., DiClemente, C. (1983) Stages and processes of self-change of smoking: Toward an integrative model of change. 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A review of applications of the transtheoretical model to substance abuse. Addictions, Vol. 96, pp. 175-186 Syx, R., L. (2008) The practice of patient education. The theoretical perspective. Orthopaedic Nursing, Vol. 27, no. 1, pp.50-54 Tones, K. (2001) Health promotion: The empowerment imperative. In Scriven, A., Orme, J. (ed) Health Promotion professional perspectives, 2nd ed., Palgrave: New York. pp. 3-16 Velicer, W., Prochaska, Fava, j., Norman, G., Redding, C. (1998) Smoking cessation and stress management: Applications of the Transtheoretical Model of behaviour change. Homeostasis, Vol. 38, pp. 216-233 Warner, P. (2003) Factors influencing intentions to seek a cognitive status examination: a study based on the health belief model International Journal of Geriatric Psychiatry, Vol. 18, no. 9, pp. 787-794 Weinstein, N.D., Rothman, A.J., Sutton, S.R. (1998) Stage theories of health behaviour: Conceptual and methodological issues. Health Psychology, Vol. 17, pp. 229-290 Wood, E.M. (2008) Theoretical framework to study exercise motivation for breast cancer reduction . Oncology Nursing Forum, Vol. 35, no.1, pp. 89-95 World Health Organisation. 1986. Ottawa charter for health promotion. (policy statements) [Online]. Available from. http://www.euro.who.int/aboutwho/policy Yarbrough, S.S., Braden C.J. (2001) Utility of health belief model as a guide for explaining or predicting breast screening behaviours. Journal of Advanced Nursing, Vol. 33, no.5, pp. 677-688