New York City and Palmolive Naturals free essay sample

Created in 1806 by William Colgate, Colgate-Palmolive Company is an American multinational consumer products company dedicated to the production, distribution and provision of household, health care and personal products, such as shampoos, and oral hygiene products. Economic Standing in 2011 , according to Ian Cook, Chairman, President and Chief Executive Officer of this company, the Companys 2011 global business net sales grew 7. 5 percent and global unit volume from continuing businesses grew 4. 0 percent. The company achieved its profit goals, with diluted earnings per share increasing 4%, and despite continuing increases in material costs, an intense competitive environment and volatile macroeconomic conditions worldwide they were able to remain stable (â€Å"Message from the CEO†). Colgate-Palmolive has been a leading brand in the dental care and household industry for many years. Colgate-Palmolive is currently reporting that their 3rd quarter profits have increased 1. 7 percent. Not to mention that the company’s stock has risen 15 percent from the start of 2012. The company is making a dramatic change; Colgate’s current financial situation is very stable. We will write a custom essay sample on New York City and Palmolive Naturals or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page They have been increasing their net sales every year from 2008 to 2012; they have gone from $15. 33 billion in 2008 to $17. 1 billion in 2012. Colgate had a 58. 4% gross profit margin in the fourth quarter of 2012. Colgate is constantly trying to find new ways to increase the sustainability profile of their products. Colgate- Palmolive stresses the idea of meeting customers’ expectations as their needs change. Colgate also has a strong commitment to safety and quality. Taxes- sales tax on purchase of supplies, employee taxes, and income taxes also represent part of their major fixed costs. During 2013- Colgate had a one-time after tax due to the re-measurement of balance sheet of Venezuela as a result of currency devaluation. This obviously contributed to the increase in fixed expenses reported on their latest financial report. COLGATE-PALMOLIVE COMPANY IN THE PHILIPPINES Arthur Brent, as the leader, started operating Palmolive Company in Baracca Street, Binondo, Manila in 1926. Only five people began selling imported products from the United States. The products sold during early days were Octagon Laundry Powder, Crystal White Laundry Bar and Pompeia cosmetics. In 1928, after the slow start, new vigor was added to the Palmolive Peet Company through another merger this time with Colgate Company, Colgate Ribbon Dental Cream and Cashmere Bouquet toiletries were added to the product range. The previous merging and adding Palmolive soap to their product increased the sales during the period of 1928-1930. In 1935, William M. Pearce succeeded W. T. Schraeder as manager of the Colgate-Palmolive Peet Company. In 1942, J. C. Rebaza, foreign sales and advertising manager of the parent company, visited Manila to conduct an extensive study of the Philippine market and distribution techniques. As a result of this visit, a decision was taken to introduce the direct selling system throughout the islands. When Japanese soldiers, during their occupation, sealed Binondo office and looted the nearby company warehouse on Dasmarinas Street, company operations were brought to a half. The officer in charged of the company, James Carpenter, was taken as a prisoner and upon his instruction, some of the employees managed to risk their lives to preserved the company records. War left the company in ruin and in economic depression as well as the country. In 1946, Colgate-Palmolive Peet Company resumed operations as Carpenter reestablished it after his release in 1945 in key areas such as Manila and the nearby provinces resulting a sales of 2 Million for the year. As fast growing demand for Colgate-Palmolive products, the company organized with a capitalization of 1. 5 Million and constructed modern manufacturing complex in Intramuros and Makati and all the products quickly became a great success. After the companys boost in the previous years, they had achieved the key objective of surpassing sales of P100 Million. This achievement was coupled with the second expansion-the Constitution of an additional 22,000 square feet of warehouse and modernized facilities. As each year went by, the company surpassed the expected sales and made them one of the five subsidiaries in the entire Colgate World with the most outstanding performance and won the prestigious Presidential Award. To date, Colgate-Palmolive Philippines, Inc. holds leadership position in the market. It continues to find new ways to innovate in production, marketing and sales as well as in being the best place to work. (www. ColgatePalmolive. com) 2. MISSION AND VISSION STATEMENTS VISSION STATEMENT As we plan our strategies to sustain growth for the years to come, our core values of Caring, Global Teamwork and Continuous Improvement will continue to drive our future initiatives. † (http://www. makingafortune. biz/list-of-companies-c/colgate-palmolive. htm) Caring The Company cares about people: Colgate people, customers, shareholders and business partners. Colgate is committed to act with compassion, integrity, honesty and high ethics in all situations, to listen with respect to others and to value differences. The Company is also committed to protect the global environment, to enhance the communities where Colgate people live and work, and to be compliant with government laws and regulations. Global Teamwork All Colgate people are part of a global team, committed to working together across countries and throughout the world. Only by sharing ideas, technologies and talents can the Company achieve and sustain profitable growth. Continuous Improvement Colgate is committed to getting better every day in all it does, as individuals and as teams. By better understanding consumers and customers expectations and continuously working to innovate and improve products, services and processes, Colgate will become the best. MSSION STATEMENT: As a Company that strives to be the best truly global consumer products company, we are committed to doing business with integrity and respect for all people and for the world around us. (http://www. makingafortune. biz/list-of-companies-c/colgate-palmolive. htm ) 3. CORPORATE OBJECTIVES Having a broad target and goal, the company would be laying out different objectives including: †¢ Increase in market share †¢ Increase market coverage †¢ Maintain marketing lead †¢ Instill brand loyalty †¢ Influence consumer behavior regarding shampoo consumption †¢ Increase satisfaction ratings †¢ Counter possible competitor’s attack strategies. In connection with the enumerated objectives and goals the company is also concerns in: * Engaging To Build Strong Brands: Engaging with consumers is at the heart of Colgates focused global strategy, which drives the Companys strong performance and market share gains worldwide. Stronger consumer engagement begins with better insights. We are obtaining deeper and more meaningful consumer insights and using them to strengthen product development, packaging and the communications we deliver through our integrated marketing campaigns. * Engaging to Build Our Brands with the Profession: Colgate is driving engagement and building our leadership with professionals to strengthen their endorsement of brands. This, in turn, builds market share and brand loyalty. * Engaging to Build Our Brands with Our Customers: Across retail environments, whether small rural stores or large global chains, Colgate is working closely with its retail partners to share expertise and provide shoppers with the best value and service. Colgate is engaging its customers worldwide by sharing unique shopper insights, providing innovative in-store marketing communications and merchandising techniques, and developing and executing joint business planning initiatives. * Innovation for Growth: At Colgate, developing innovative new products is a key driver of profitable growth. Colgates consumer innovation centers, in strategic locations throughout the world, are focused on developing insight-driven innovation that provides value-added new products across all price points. * Effectiveness and Efficiency: Integral to Colgates global strategy is the ability to generate funds to invest in business growth. Through both established efficiency programs applied to all aspects of our business and ongoing identification of new ways to find savings, the Company constantly strives to improve its organizational capabilities and speed, while reducing costs. Programs are wide-ranging and include many small initiatives amounting to millions in savings that fund new product development and marketing activities, as well as helping to deliver strong profitability. * Leading to Win: At Colgate, we have long believed that our values-based culture forms a strong foundation for good governance which leads to good results. Employees at all levels learn to take personal responsibility for being leaders, and they commit to conducting business with the highest integrity, incorporating Colgates values of Caring, Continuous Improvement and Global Teamwork into all business activities. Colgate also demonstrates leadership as a member of the global community. 1. GENERAL ENVIRONMENT ANALYSIS A. POLITICAL LEGAL FACTORS play a vital role for the business prevailing in the country. If the government is inactive then the company advances at a standard rate but the other way round , a drastic fall can be seen. (http://news. morningstar. com/) A number of laws regulating consumer products have a great impact on what type of products Colgate Palmolive is able to distribute, but also legal and regulatory forces serves as a tool to protect their products including shampoo from being stolen or imitated. Because Colgate Palmolive is a multinational corporation operating in more than 200 countries, the manufacturing, packaging, labeling, distribution, advertising and sale of shampoo products are subject to extensive regulation which could have negative effects on the success of the company. For example, there are several products that may contain ingredients considered hazard for human consumption, a new regulation prohibiting the use of a specific substances or ingredients that will affect the distribution of a particular product containing such components. This could also lead to negative reaction from consumers of Colgate Palmolive products. Consequently, Colgate Palmolive must meet requirements for labeling shampoo products accordingly with governmental regulations for each of the countries they operate in. Political forces are very important to a company like Colgate-Palmolive, especially when doing business internationally; it may constitute a disadvantage when trying to engage in international trade and dealing with other countries’ regulations and laws. If Colgate is linked to people getting sick by using their products, one can guarantee that government officials are going to intervene. Consequently, political forces of the marketing environment have a great potential to influence marketing decisions and strategies. B. ECONOMIC ENVIRONMENT FACTORS could directly affect decision making process. If the country experiences inflation then, it will have a negative impact on the running business. (http://news. morningstar. com/) Economic forces are one of the main evaluators of a business because it influences both customers and marketers. A little change in the economy can affect supply and demand, buying power, willingness to spend, and competitive behavior. Colgate-Palmolive company relies strongly on a customer’s buying power and willingness to spend, which will be affected by economic circumstances. C. SOCIO-CULTURAL FORCES are factors to be considered like religious and cultural key values which are relevant for the survival of the product in the industry because people will repel the product that there religion and culture do not prefer. (http://news. morningstar. com/) Understanding sociocultural forces is a prerequisite in order to successfully conducting business, especially in such a competitive market. In Colgate Palmolive this forces greatly influence the marketing mix. Hence, in an international market sociocultural forces have an enormous effect on how marketers design their marketing strategies and approaches to customers. Demographic and Diversity characteristics can lead to changes in how people live and ultimately influence their choices of products, brands, and spending behavior. When launching Ta new product or promoting existing ones, Colgate Palmolive have to take into account each one of them to successfully market its products and decrease its risk margin, population demographic focus on whether the product is gender neutral or not, how will it be promoted, does it appeal more to females or males? , what age group will be more interested in obtaining the product, and ways they can reach this market to let consumers know about the product. D. TECHNOLOGICAL FORCES are factors that on which values cannot be ignore. Technology vary in the passage of time. Techniques and methodologies must be up to date for keeping the product preferable in the market. (http://news. morningstar. com/) Technology can sometimes be a key tool in maintaining competitive advantage. Social media has change the ways we communicate and market our products especially shampoos, making it easier for marketers to introduce new products to consumers and get almost instant feedback on products or ideas marketers introduced or are planning to introduce to consumers. It can also represent a threat when the disclosure of negative information about the product rapidly spread through social media. For a company like Colgate Palmolive technological forces can mean new ways to distribute their product and advertising as well. Maintaining a positive image and consistency in the quality of products can minimize the risks of negative feedback. 2. TASK ENVIRONMENT ANALYSIS A. COMPETITORS. As customer prefer certain brands , switching cost in this industry are low. It does not cost anything for a customer to buy one brand of shampoo instead of another. (http://news. morningstar. com/) â€Å"Keep your friends close, and your enemies closer. † This quote is the perfect definition of describing Competitive forces. Almost every business has a rival, Pepsi vs. Coke, and many others. Colgate is no exception; it has to deal with other companies , which produce substitutes products like Pantene , sunsilk and others. With all these potential competitors Colgate needs to constantly develop new products and new marketing strategies to make their products stand out to the consumers. B. THREAT OF NEW ENTRANTS. Given the amount of capital investment needed to enter certain segments in household consumer products, we suspect the threat of new entrants in fairly low in the industry. (http://news. morningstar. com/) Along with intense rivalry from existing competitors, Colgate-Palmolive Company has to deal with new competitors. Today, the shampoo market is exploded with a dramatic increase in new entrants. These numbers reinforce the seriousness of the threat of new entrants that Colgate-Palmolive will have to contend with when they launch Colgate Palmolive Naturals Shampoo. C. THREAT OF SUBSTITUTE PRODUCTS. With in the consumer products industry ,brands succeed in helping to build a comparative advantage , but even the pricing power of brands can be eroded with substitutes such as store branded private label offerings. (http://news. morningstar. com/) The introduction of the new products and the high competition in advertisement promotions will be a big threat deals with substitute products. Products whose offering discounts would be a big threat in Palmolive naturals Shampoo. Naturally, consumers would prefer those substitute products offers discounts and low prices than products offers none and a high one. D. BARGAINING POWER OF SUPPLIERS. More than likely , consumer products company face some amount of supplier power ,simply because of the cost they incur when switching suppliers. (http://news. morningstar. com/) Colgate Palmolive company depends for its outsource manufacturing for the Palmolive naturals shampoo ingredients. Hence, Palmolive Naturals shampoo has decided supplier advantage in the relationship with the Colgate Palmolive Company. The company needs to maintain a healthy relationship with suppliers to reduce risk of a costly supplier switching process. E. BAGAINING POWER OF CUSTOMERS . Consumer products company face weak. Major consideration that we should take into account were the retailers rather than individuals. (http://news. morningstar. com/) One of the factors which can cause customers bargaining power to grow is when the switching costs for customer are low. Even if Colgate-Palmolive Company were to position Palmolive shampoo as the most expensive shampoo brand on the market, it is still a relatively inexpensive product, compared to many daily purchases . Therefore, buyers can easily switch between shampoo brands without giving the decision much thought. To combat this threat, Colgate-Palmolive could position Palmolive naturals shampoo as a superior shampoo brand that customers can not afford to be without. The Colgate-Palmolive Company culture, company values, the people, the diversity, the way the company respects all their employees, the opportunities to grow, the fairness in decisions, the transparency of doing business, the management that takes care of company performance and financial health to guarantee the business for shareholders and employees, and of course the products are what the company differ from others. 1. CORPORATE STRUCTURE Colgate-Palmolive Company, is a global leader in the area of oral care and personal care. It is a company serving hundreds of millions of consumers worldwide. The small soap and candle business that William Colgate began in New York City early in the 19th century and now for over 200 years, Colgate has focused on driving growth by continuously improving products and processes. History reflects the strength and innovation that Colgate people have used to constantly transform the Company and identify new opportunities. Governance is an ongoing commitment shared by Colgate’s Board of Directors,the management and all Colgate people. At Colgate, good corporate governance believes strongly accompanies and greatly aids long-term business success. This success has been the direct result of Colgates key business strategies, including its focus on core product categories and global brands, people development programs emphasizing pay for performance and the highest business standards. 2. CORPORATE CULTURE The Colgate culture is one that reflects values of caring, global teamwork and continuous improvement, as well as an unwavering commitment to integrity in everything that was done. Building skills and developing Colgate people is critical part of success. Colgate provides all employees worldwide with a series of training programs focused on building leadership skills. Valuing Colgate People, Managing With Respect and Fostering an Inclusive Work Environment are only a few of them. Fostering an Inclusive Work Environment provides a broad awareness of diversity and skills to work with diverse teams and to serve an increasingly diverse customer base. Colgate leaders take responsibility for valuing the contributions of all Colgate people and have the knowledge and skills necessary to transform the work environment into one where all employees can contribute fully to meet the business goals. Colgates success is created by Colgate people who work together as a worldwide team, using their individual strengths to achieve business results. This strong global teamwork requires a company culture in which everyone works well together and truly values one another. The company supports an environment where everyones ideas are shared and respected. Colgate Palmolive Company believes that culture and values afford opportunities for everyone to have an important impact on the building of business. The company is constantly striving toward a more diverse workplace, which benefits the Company and enables them to more successfully meet the needs of consumers around the world. 3. MARKETING Colgate is seen as a market leader and a company that cares. The company is involved in the community and have a non-typical corporate image. Colgate-Palmolive Company are selling internationally for a long time. Financial records show that the company’s net sales are increasing from:15564 (dollars in millions) in 2010 ,16734 (dollars in millions) in 2011, to17085 (dollars in millions) in 2012. Financial summary of the company shows: Net income attributable to Colgate-Palmolive Company and earnings per common share in 2012 include $70 (dollars in millions)of charges related to the 2012 (dollars in millions)Restructuring Program, $18 (dollars in millions)of aftertax costs related to the sale of land in Mexico and $14 of aftertax costs associated with the business realignment and other cost-saving initiatives. To date, Colgate-Palmolive Philippines, Inc. holds leadership position in the market. It continues to find new ways to innovate in production, marketing and sales as well as in being the best place to work. 4. RESEARCH AND DEVELOPMENT Colgate is a very well known Company. In Research and Development the company has the opportunity to create products that at the end will be used by millions of people. The company is concern most on product development and quality of the products produced. One should be responsible in communicating to each other to assists each others work. Research and development is a continuos process. Currently the company is still spending more in this department to assure long term goals and in the process of innovating products to cope up with economic changes and consumer expectations. 5. OPERATIONS AND LOGISTICS Colgate-Palmolive Company was a strong multinational company and has a real commitment in caring its people which is essential to the success of company,s operation. Also the company should value Consumer Marketing, Customer Development/Sales caused they are the primary source of income. Aside from that :Two key factors have played a role: The leadership that the company exhibits and the commitment and passion that has to put into achieving goals and leading change (innovation). 6. HUMAN RESOURCES Colgate company has a strong company values, focus on people development and long reputation as a company with high ethical standards. The company values its people most that s why the company should spent time ensure appropriate payment for performance and recruitment. 7. INFORMATION SYSTEM The company must have an information system especially for its operations internationally. Since Colgate-Palmolive Company is dealing with the local and international market ,it must use the internet for customer orders , marketing and promotions. With the aid of internet and information system ,the company can improve its performance better than usual. Information technology system can increase revenue by online promotion and advertisement. An inventory management system and accounting system could be an aid in inventory maintenance and assist managerial decision making process. STRENGTHS WEAKNESSES OPPORTUNITIES THREATS WOT analysis (alternatively SWOT Matrix) is a structured planning method used to evaluate the Strengths, Weaknesses, Opportunities, and Threats involved in a project or in a business venture. A SWOT analysis can be carried out for a product, place, industry or person. It involves specifying the objective of the business venture or project and identifying the internal and external factors that are favorable and unfavorable to achieving that objective. (HTTP://en. Wikipedia. org/) THE FOLLOWING ARE THE STRENGTHS , WEAKNESSES , OPPORTUNITIES , AND THREATS FACED BY THE COLGATE-PALMOLIVE COMPANY. 1. STRENGTHS: PALMOLIVE NATURALS is a well-known brand of shampoo produced by Colgate-Palmolive Company. It is the best brand market leader in the Philippines since 1996. COLGATE-PALMOLIVE COMPANY as the worlds leader in personal care sales which includes shampoos, toothbrushes, and toothpaste. It is globally recognized brands that provides a competitive advantage to the company and strengthens its dominant position in the market. The company’s good distribution system and strong relationship with wholesalers and big retailers can be used to create an extensive coverage for the brand. It can influence the way Filipinos see the benefits of using Palmolive Naturals as it claims to contain natural ingredients. Palmolive Naturals is the mass market shampoo of Colgate-Palmolive. It was positioned as a shampoo made from natural ingredients . (a). Palmolive Naturals Shampoo is a well-known brand of shampoo produced by Colgate-Palmolive Company. (b) It was positioned as a shampoo made from natural ingredients. (c)It belongs to a company with strong consumer research group ,that is good in pioneering products (d) The company’s promotion and good distribution system including strong relationship with wholesalers and big retailers can be used to create an extensive coverage for the brand. (e) An imported shampoo brand that offers low prices compared to other competitors. 2. WEAKNESSES Colgate-Palmolive Company Inc. does not have as many internal weaknesses as it does strength. (a)Packaging is capital intensive and can be too costly. (b)Company support for brand presence in the small sari sari stores was weak and some regions in Visayas and Mindanao have poor coverage. (c)Product life cycle for shampoos are becoming shorter due to weak promotional support. (d)Company’s failure to consider other cultures and lifestyles. 3. OPPORTUNITIES Opportunities can be identified in the environment. A high growth rate could project probable consumption in the future. High satisfaction rating would lessen the tendency for trying new brands. This situation can be targeted by quality products which can be satisfied thus creating such loyalty in the product brand. The increasing sales growth for sachets opens a greater market for the shampoo industry which could be targeted and considered through marketing. Opportunities in general environment include: (a)High demand of product consumption in some populated location such as Metro Manila. (b)High satisfaction ratings decrease the tendency to try new brands as a result consumer loyalty ends to increase. (c)Technological advancements which are relevant in management decision making process. (d)Rapid growth of demand in personal health care products including shampoos. (e)Preferences of customers toward Palmolive Naturals Shampoo other than some brands. 4. THREATS Aside from the opportunities that can be identified in the external environment, there are also threats that could have impacts on the company. There is intense competition, which is common in any industry. It could force the product brand to spend on defending and keeping its market lead. This is considered as a serious threat because if the brand is not able to compete, it may lose its current position which is being the market leader in the shampoo industry. Aside from intense competition, there is also a decrease in consumer loyalty. It is a threat because it leads to brand switching, which is very common in the current environment. The areas in which these brands are good are in distribution and therefore its availability, and its lower price relative to Palmolive Naturals. Some of these threats include: (a)Potential competitors exist in shampoo industry including competitors offering cheaper products with packaging advantage. (b)Growing competition from other domestic and international brands including branded and those unbranded ones. (e. g Pantene , Sunsilk) (c)Many fake and expired products are sold by some retailers. (d)Product development of substitute due to technological advancement. (e)Change in economic conditions. (eg. Deflation, inflation) Alternative 1: Intensified marketing and product developments in current markets. Luzon area is a good market in the present and contains much potential in the future. Though its growth rate is relatively slow compared to the national market, opportunities lie on the consumption which is double the national market. Thus, it creates the following advantages and disadvantages. ADVANTAGES: This alternative will enhance products through, 1. ) innovations and additions, 2. ) intensive product promotions, 3. ) creation of new products or new variants of the product 4. ) strengthen product positioning in the market, 5. ) increase in market share is possible, 6. ) consumer loyalty in goods can occur 7. ) market will arise DISADVANTAGES: 1. ) a high competition can drool this down. 2. ) the nature of frontal attacks from major competitors would be hard for the company to take again the lead in shares . 3. ) more costly cause of the marketing efforts. 4. ) intense changes, innovations, product development, packaging, promotions and advertisements will be too costly to the firm since these require technologies which are cost-generator. 5. ) high opportunity cost . Alternative 2: National market expansion and development (outside Metro Manila) and new Palmolive Naturals variant development . The Metro Manila market for shampoo is saturated and the competition within the area is quite intense. With more than hundred brands of shampoo available to the market, the slowing market growth and increase in shampoo consumption, chances for growth in Metro Manila seems to be small. The following are related advantages and disadvantages in this alternative. ADVANTAGES: 1. ) it adopts a mobile defensive strategy and a bypass attack strategy against its competitors. 2. ) gain boosts in market share by expanding the market itself, and by attacking holes in the shares of the competing markets. 3. ) the company will take advantage of the current high market growth rate capture as much of the market as possible. 4. ) could lead Palmolive Naturals to be a cash cow in the long run, in the future being a market leader in a slow growing national market. 5. ) it aims to increase sales and presence nationwide. DISADVANTAGES: 1. ) expansion and market development may be too costly. 2. ) strong relationships with sari-sari stores need to be established and distribution to these other places could be cost intensive. 3. ) cost intensive process would be in increasing consumption of shampoo and influencing their buying behavior. 4. ) the company needs to increase promotion and visibility in the form of commercials and advertisements. 5. ) research development would also need to be generously funded because of proposed new product developments that the department would have to work on. Alternative 3: Shift of Focus to brand. This alternative will shift the focus intensity to Palmolive Naturals brand. Since in the shampoo industry, cannibalism of products can highly occur, this strategy could be a way in further attaining higher market shares in the industry. Upon shifting to more promotions for the Palmolive Naturals better opportunities can be captured. Naturals will be now positioned premium and will be then used to attack other shampoo brands. If given much advertisements Palmolive now can acquire higher market shares. Furthermore, this creates the following advantages and disadvantages. ADVANTAGES: 1. ) could also make the company avoid cannibalism of products. Since it is also becoming too costly for the company to promote Palmolive Naturals. 2. ) investing the fund to its product line could possibly bring more cash inflows . DISADVANTAGES: 1. ) it would be hard for the consumers to have a repositioning change. It would confuse them of what really is which. 2. ) a shift upward in positioning would be harder compared to a shift downward. Alternative 4: Product promotions , positioning and strong consumer research group. This alternative will tackle more of innovations and appearance, and position of the product in the market. Being a market leader before in the area of Metro Manila, and being frontally attacked by Pantene and other brands through same strategies like salon penetration and same variants introduction, Palmolive Naturals in now a market challenger and is eager to capture again the lead in the Metro Manila market. Advantag

Treatment Of Patients With A Dual Diagnosis Social Work Essay Essays

Treatment Of Patients With A Dual Diagnosis Social Work Essay Essays Treatment Of Patients With A Dual Diagnosis Social Work Essay Essay Treatment Of Patients With A Dual Diagnosis Social Work Essay Essay A mental wellness nurses position of the issues environing the intervention of patients with a double diagnosing of psychiatric upset and larning disablements in mainstream mental wellness units. This essay is traveling to research from a mental wellness nurses perspective the issues environing the intervention of patients with a double diagnosing of psychiatric upset and larning disablements in mainstream mental wellness units. Including a treatment around prevalence, proviso of services, entree to services, authorities policy and whether staff in mainstream mental wellness units have the cognition and accomplishments necessary to supply effectual attention for this potentially vulnerable service user group. The modern-day construct of larning disablements focuses on the physical and societal troubles that can happen as a effect of being labelled a individual with a learning disablement and how any damages a individual may hold impact them ( Swain et al, 2004 ) nevertheless it neglects to place the mental wellness issues people with larning disablements on a regular basis and more normally face If people who meet the diagnostic standards for boundary line acquisition disablement are included the prevalence of larning disablements in the UK equates to 12 % of the population or around 8 million people ( Hassiotis et al, 2008 ) It is by and large recognised that people with a larning disablement have a higher rate of psychiatric upset compared with the general population with the prevalence estimated at 40 50 % ( Raghavan and Patel, 2005 ) . In comparing to 10 20 % of the general population ( The Office for National Statistics, 2000 ) Assorted factors have been cited as being conducive towards this exposure including encephalon harm, centripetal damage, chronic physical ailment wellness, epilepsy, repeated loss or separation issues, hapless self-image, get bying mechanisms and societal accomplishments, communicating troubles and household jobs ( Fraser A ; Nolan 1995, Hardy et Al, 2007 ) Mental wellness nurses are specifically trained to handle a diverse group of people including kids and immature people, working age grownups, the aged and new female parents all with mental wellness jobs. Experiences from clinical pattern demonstrate an addition in the figure of people with larning disablements admitted to general acute mental wellness infirmaries and the increasing incidence of complications that can frequently come along with the attention of this group of people. These include jobs with appraisal and intervention, normally stemming from communicating troubles, behavioral issues and barriers to collaborative working between the acquisition disablements and mental wellness squads. They can frequently take to an addition in length of stay in infirmary and inappropriate or unequal attention being delivered. Problems arise for the most portion when a individual with a learning disablement develops a psychiatric upset to the extent that requires acute psychiatric admittance. It is now more common to happen that they are being admitted to general psychiatric beds under the attention of general grownup head-shrinkers and mental wellness nurses, many of whom have had small preparation in the appraisal and intervention of mental unwellness in this group. The communicating troubles people with a learning disablement may confront can do assessment highly complex. Peoples with larning disablements frequently require a longer stay and may besides be vulnerable ( i.e. Abuse and development ) without extra support on the ward. Peoples with a learning disablement may besides hold unusual presentations of common mental upsets due to encephalon hurt or other long standing conditions such as epilepsy taking to trouble in diagnosing and an idiosyncratic response to intervention. Furthermore, people with larning disablements represent a diverse group with a varied scope of complex mental wellness demands, which mainstream staff may experience ill-equipped to run into. Boundary disputes between general grownup and larning disablement services often lead to a decreased quality of attention for people with complex demands Death by Indifference ( Mencap, 2007 ) highlighted alleged attention weaknesss in general infirmaries and primary attention scenes It led to the constitution of an independent authorities enquiry in England. The enquiry unluckily did non widen to mental wellness services It found that there is small grounds refering the quality of attention received by people with larning disablements in these scenes but anecdotal grounds from pattern has indicated that it is sensible to believe mental wellness services face the same sort of jobs as general medical attention. It seems pertinent to undertake these issues head on in order to run into the demands of this client group who have a diverse scope of demands that can cross across all subdivisions of nursing and whose attention can endure as they seem to be on a regular basis forgotten or pushed to the underside of the heap Until 20 old ages ago, people with larning disablements did non usually come into contact with mainstream services. Most people with a learning disablement who had complex demands including mental unwellness, were cared for in specialist mental disability infirmaries, and all medical and psychiatric attention was provided on site. Deinstitutionalisation has transformed their attention and now this group can populate in the community and entree mainstream wellness services, irrespective of the grade of their disablements. This procedure has been guided by the rule of standardization since the early 1970s, which is a doctrine that remains influential today. Standardization represents a cardinal statement of human rights saying that forms of life and mundane life which are every bit near as possible to the regular fortunes of society should be made available to all mentally sick and larning handicapped people ( Nirje, 1976 ) . Closely associated with the principal of standardization is the construct of mainstreaming, which advocates the usage of criterion instead than specialised services, for illustration, schools, Employment and wellness attention it is now a steadfastly established rule and characteristics to a great extent in authorities policy which supports the usage of mainstream services and the question of the acquisition disabled population back into society but besides recognises the demand in some instances for specializer services. ( The Department of Health, 1992 ) stated that: wherever possible people with larning disablements should be enabled to utilize ordinary wellness services every bit good as specialist appraisal and intervention services . Advocates of standardization by and large back up the mainstream attack ; they may reason that specialized services lead to labelling, stigmatization and negative professional attitudes. The statement for this attack at first glimpse appears sound and is supported widely by literature. It is, for illustration, current policy in the UK and USA. However, in pattern mainstream community mental wellness and inmate squads have found it progressively hard to run into the demands of people with larning disablements and psychiatric upsets ( US Public Health Service, 2002 ) . Each of the four United kingdom states has its ain policy construction turn toing how the demands of people with larning disablements should be met in a mental wellness environment. England s policy is set out in the undermentioned studies. Valuing Peoples: A new scheme for larning disablement in the twenty-first century ( Department of wellness, 2001 ) , Health Services for Peoples with Learning Disabilities ( Department of Health, 1992 ) and Mental Health: National Service Framework, ( Department of Health, 1999 ) , The common subjects and issues that underpin this policy construction, include: advancing collaborative working between mainstream mental wellness services and specialist acquisition disablement services ; leting people with larning disablements to entree mainstream mental wellness services wherever possible but making little specializer inmate services for those whose demands can non be met by mainstream services, implementing a changing function for specializer larnin g disablement services to supplying support and facilitation for mainstream services including supplying mainstream mental wellness and attention staff with equal preparation on the demands of people with learning disablement ; using a attention programme attack for people with learning disablement and mental wellness jobs and making mental wellness publicity stuffs which are made accessible for people with a learning disablement. Advice is available to assist care suppliers and staff support people with larning disablements in accessing mainstream mental wellness attention scenes ( Hardy et al, 2006 ) . The Green light toolkit ( Foundation for People with larning disablements et Al, 2004 ) is one illustration of a counsel papers that demonstrates how policy construction and specific policies are being implemented in pattern. It is used throughout England as an audit tool to mensurate how the National Service Framework for mental wellness ( Department of Health, 1999 ) is being implemented for people with learning disablements. The toolkit provides a gilded criterion that can be used by local mainstream mental wellness services to mensurate services against. It offers a traffic visible radiation hiting system and provides counsel on how services can be improved, covering countries such as local partnerships, planning, accessing services, attention planning and work force planning. After a green light toolkit a ppraisal, each local country should develop an betterment program from the action points identified and have a clip frame to implement the necessary alterations. Anecdotal grounds from observations in pattern suggest that the green light tool kit is still being used in pattern today but similar countries for betterment are identified clip and clip once more such as entree to wellness promotional stuffs in apprehensible formats. This would propose that although appraisals of services are being undertaken the results of these appraisals and action points are non being carried frontward into pattern. The Disability Rights Commission ( Disability rights committee, 2006 ) supports this position by stating that old counsel paperss intended to assist people with larning disablements gain entree to mainstream wellness services have had limited consequence. A working group from the royal montage of head-shrinkers ( Royal College of Psychiatrists, 1996 ) acknowledged that enabling people with larning disablements to entree mainstream mental wellness services can be a complex and demanding undertaking necessitating input from specializers in the psychopathology of larning disablement. To react to this statement they have advocated two rules for the mental wellness nursing of people with larning disablements: joint working between mental wellness and larning disablement squads with the usage of Mainstream psychiatric installations at every possible chance every bit good as emphasizing that commissariats for specializer services are still to be available if needed. The independent authorities enquiry instigated by Death by Indifference ( Mencap, 2007 ) , while non widening to mental wellness services, promoted research into the experiences reported by people with larning disablements of acute mental wellness units. This provides a assorted image. The negative experiences are similar to concerns expressed by other patients. These include: deficiency of control and information ; larceny of belongings ; intimidating multi disciplinary meetings ; hapless nutrient and hapless attention. However the presence of larning disablements may change their significance for illustration, service users with larning disablements may happen it harder to understand information about their admittance and intervention, unless it is shared in a format which is appropriate to their cognitive and communicating accomplishments. Psychotropic medicine may farther impair already hapless cognitive operation and may stand for an extra restriction on persons capacity to und erstand and take an active portion in their intervention. Relatives and paid carers are likely to hold a much more important and long-standing function in back uping the service user than would be the instance with other grownups with mental wellness jobs, Often a individual with a acquisition disablement has specific modus operandis that merely person near like a carer would cognize and following these modus operandis can do nursing them much easier. this is something to which mainstream services in peculiar seem to pay small attending. Not emphasizing engagement with carers in peculiar with a client from this group can take to either a deficiency of support for carers or carers experiencing pushed away by services and left without a function which in itself can take to the presentation of depression and low temper in the carer. ( Scior and Longo, 2005 ) Finally, the hazard that marks and symptoms of mental wellness jobs will be misattributed to a individual s acquisition disableme nt ( diagnostic overshadowing ) is specific to this group. These issues need to be considered by practicians nevertheless, grounds indicates that healthcare professionals frequently lack the cognition, accomplishments and experience necessary to run into the health care needs of people with learning disablements. ( Fraser, 1999 ) The Royal College of Nursing ( Royal College of Nursing, 2008 ) commented that the recent development of an outlook of the mainstream mental wellness services to react to the demands of the bulk of people with larning disablements and co-morbid mental unwellness has frequently proved an unrealistic end for the mental wellness nurse. It has been proven that particular expertness and preparation every bit good as the usage of specialist mental wellness squads are required for the appraisal, diagnosing and intervention of mental unwellness in the acquisition handicapped population. Although it is theoretically possible to develop staff in mainstream scenes, the little figure of instances gives small chance for staff in the assorted subjects to derive the necessary accomplishments. Additionally, mainstream mental wellness staff frequently feel that caring for this group of vulnerable people is non portion of their function, and the resources of big mental wellness services are already stretched ( Day, 1988 ) . The support deductions that arose from such a monolithic displacement in service duty that came out of the execution of the mainstreaming attack neer seem to hold been adequately addressed ( Bouras et al, 1995 ) Collaborative working between professional groups in health care is critical across the board for bettering criterions of attention for patients and their carers ( Pollard,2004 ) . In relation to this professional competitions between mental wellness and larning disablements squads are common and the apprehension of each other s function is hapless taking to chiefly uneffective collaborative working ( Bouras et al, 1995 ) There has besides been no evident or unequivocal dialogue between the two service squads in the UK to develop clear local operational policies or service understandings and merely obscure definitions of who is entitled to entree which service exist, which can sometimes take to a patient having inappropriate intervention, being bounced between services or, in rare instances, even being denied attention wholly as neither squad is willing to take duty for that patients attention. Distinguishing between psychiatric upsets and behavioral issues in people with larning disablements is non ever a straightforward procedure. Both empirical and conceptual issues associating to the nature of such behavioral upsets question both the cogency and dependability of a diagnosing of mental unwellness in a individual who has a learning disablement ( Krose et Al, 2000 ) This raises the inquiry what does a nurse dainty foremost? As with double diagnosing of a drug dependence and mental unwellness, in many instances the drug job needs to be tackled foremost before the full extent of the mental unwellness can be seen ( Drake,2007 ) .However, with a learning disablement this is non a possibility as a acquisition disablement is a long standing status that can non be treated. The inquiry is hence, is the behavior being exhibited by a patient due to their mental wellness jobs or the learning disablement? When a individual with a acquisition disablement requires admittance to hospital due to a psychiatric unwellness, the first aim is to hold on whether the general or learning disablement head-shrinker acts as the responsible clinician. The admittance of a individual with larning disablement frequently happens as a last resort in response to an exigency that can non be managed elsewhere such as in the community or via the usage or reprieve services. The community larning disablement squad should be able to offer some preparation to nursing staff or even transport out specific pieces of work straight with the patient. The allotment of a named nurse is highly of import and, if available, person with particular accomplishments or involvement should be appointed in order to develop a more effectual curative confederation with the patient. The increased exposure of people with larning disablements to mistreat even during admittance should be considered and protection from this possible hazard given. This may necessitate to be in the signifier of separation from high-risk patients or an increased degree of nursing observation such as is policy with under 18s admitted to adult acute psychiatric units. In all instances, the importance of coaction with the acquisition disablement squad should be stressed. This becomes peculiarly of import during discharge planning. In the scenario of an admittance under a Mental Health Section, people with learning disablement and mental wellness jobs are entitled to all the commissariats of the Care Programme Approach and Section 117 after-care. It is besides indispensable that mental wellness nurses have a good working cognition of mental wellness jurisprudence and statute law. Experiences from clinical pattern have demonstrated that frequently mental wellness statute law is misused or disregarded for people with co morbid acquisition disablements which denies them the precautions and protection of the jurisprudence that statute law such as the mental wellness act was designed to set in topographic point ( Mental Health Act, 1983 ) . The relevant statute law should be applied to this group of people if and when it is appropriate to make so and the same classs of detainment used as for other persons sing mental sick wellness. Although it is of import to observe that a individual with a learning disablement can still be sectioned if it is deemed they behave abnormally sharply or earnestly irresponsibly, without any marks of mental unwellness it is hence of import to find that that there be existent mental wellness jobs presen t if a individual is admitted under subdivision to a mainstream mental wellness infirmary. Assessment is a specific portion of the nursing procedure where mental wellness nurses can fight when covering with people with larning disablements For illustration, The Mental State Examination, which constitutes an indispensable constituent of the preparation procedure and is indispensable for measuring hazard and explicating a intervention program, may be debatable. This could be for a figure of grounds, including high rates of conformity or an avidity to delight in certain interview state of affairss ( Sigelman et al, 1982 ) . Moss argues that people with learning disablements are besides less likely to kick or near members of staff to inquire for aid which may farther perplex the Assessment and hazard direction procedure. ( Moss,1999 ) Simple linguistic communication and direct oppugning including communicating and in depth treatment with carers could be a manner to get the better of this trouble. Higher degrees of nursing observation may besides be utile, non merely in guarant ing a individual s safety on the ward but besides in giving critical information sing a individual s mental province ( Appleby,1999 ) ( Gibson, 2007 ) highlighted some cardinal factors that nurses without specialist preparation may happen complicate effectual appraisal and intercession The two chief factors that affect mental wellness nurses are: rational deformation, which may ensue from cognitive shortages in countries such as memory and concentration which can do comprehension and communicating of ideas and feelings hard ; and Cognitive decomposition, which can happen in state of affairss where the individual is overwhelmed by the anxiousness of the demands being placed on them, ensuing in an inability to soldierly ideas and bizarre behavior Communication is cardinal to doing a sound and accurate appraisal. It is estimated that upwards of 50 % of people with larning disablements have important communicating troubles ( Matson, 1998 ) A nurse demands to turn to the peculiar communicating demands of each person as each will change in their abilities, This is another point in which collaborative working becomes really of import as if the individual is involved with a acquisition disablements squad, that squad may be able to supply the nurse with accurate information about the degrees of a individual s communicating and how best to pull off these issues. Many of the jobs in relation to direction of people with larning disablement by mental wellness nurses relate to the deficiency of cognition accomplishments and preparation ( Lennox A ; Chaplin, 1995 ) . Evidence suggests that qualified nurses on a regular basis feel out of their deepness and unsupported when covering with this client group and observations in pattern indicate a certain sum of turning away tactics from mental wellness nurses when it comes to volunteering for the named nurse axial rotation which could be due to a deficiency of assurance in this country. The current pre-registration nurse instruction programme for mental wellness nurses was originally validated by the English National Board ( English National Board,2000 ) , and the course of study follows the Nursing and Midwifery Councils Fitness For Practice Guidelines ( United Kingdom Central Council for Nursing, Midwifery and Health Visiting,1999 ) , which states that pupils set abouting pre-registration programmes must hold certain other fortes included. However, larning disablement, as either a practical or theoretical constituent of the subdivision programme, is non one of them. With authorities policy ( Department of Health, 2001 ) saying that people with larning disablements should wherever possible entree generic services, there would look to be the demand for a more specific and in-depth attack to larning disablement instruction for all pupils throughout their pre-registration instruction. Experiences from local preregistration nurse instruction show that presently nursing instruction provides a 12- month common foundation programme for nurses who intend to develop in all countries of nursing including Adult, Mental wellness, Midwifery, kid and learning disablement nursing. Although non required by the NM, Learning disablement theory is taught but arrangements in this country are non common. After common foundation period of preparation, pupil nurse instruction in mental wellness has little or no farther chances to derive learning disablement experience. Comparisons with larning disablements mental wellness can be made to both kid and adolescent mental wellness, every bit good as to older people s psychopathology in that they are both specialist groups with their ain issues and mental wellness nurses are expected to analyze these client groups in item during their subdivision preparation in order to go familiar with the complexnesss of this type of mental wellness nursing. As these countries are compulsory fortes in order to run into the demands of making as a mental wellness nurse ( English National Board, 2000 ) and, coupled with the authorities s policy for people with larning disablements to entree generic mental wellness services, it would look indispensable that mental wellness nurses address the forte of people who have larning disablements and extra mental wellness jobs during their pre-registration instruction as they do with other specific patient groups. Many senior mental wellness nurses have received no larning disablement preparation at all. This deficiency of preparation may ensue in jobs with communicating and apprehension, every bit good as negative attitudes toward people with learning disablement. On the impudent side, nurses in larning disablement have likewise limited preparation in the country of mental wellness, although there are freshly available post-registration classs. One such class gives an experient nurse from either ramify a six month endorsement to the other nursing subject which is backed up by 2 faculties of theory. Anecdotal grounds gained from talking to a mental wellness nurse who has late completed this class has shown that general nursing accomplishments that every nurse should be competent in upon making can be transferred across the board to other subdivisions of nursing. The feeling of this nurse is that presently, mental wellness mainstream services see merely those with mild or marginal learning disa blements coming into the service and the appraisal and intervention procedure for these people is non much different to that of non larning handicapped people. Currently specializer services provide the bulk of attention for the patients with more complex demands. ( Scior and Longo, 2005 ) In decision the grounds presented in this essay suggests a figure of issues that need to be addressed if mental wellness nurses are to run into the demands of their clients with a carbon monoxide morbid larning disablement efficaciously. There are: pre and Post enrollment preparation for mental wellness nurses, collaborative working between the mental wellness and larning disablement squads and proviso and entree to services. It seems that specializer larning disablement in-patient units with a mental wellness focal point offer a more positive experience for the patient than mainstream mental wellness units, and hence should be developed farther ( Scior and Longo, 2005 ) . However, realistically mainstream services are extremely likely to go on to supply attention for this group, if merely because of the resource restrictions in specializer services and the fact that 30 % of NHS trusts provide no specializer admittance installations ( Bailey A ; Cooper, 1997 ) . There seems a demand now for major alterations to be made to the constructions and daily patterns in these services. Such alterations should include enterprises to advance more positive attitudes and behavior towards persons with acquisition disablements through preparation and regular input from specializer larning disablements services. Closer attending must be paid to the demand to do information about diagnosing and interventions accessible, in media such as cusps utilizing simple linguistic communication pictures and audio information ( Forster et al, 2001 ) and the demand for stronger engagement of and co-operation with service users regular carers. Current pattern experience has shown nevertheless that in the most portion mental wellness services in this country merely seem to come into contact with patients who have a boundary line or mild learning disablement as there is a big supply of specializer beds. Currently merely in rare instances would mainstream mental wellness units be acknowledging a individual with terrible or profound acquisition disablements whereby little changes to pattern and movable nursing accomplishments would non be plenty to give that patient the best attention available. Referances Appleby L ( 1999 ) National Confidential Inquiry into Suicide and Homicide by Peoples with Mental Illness. Department of Health Bailey NM A ; Cooper SA ( 1997 ) The current proviso of specializer wellness services to people with larning disablements in England and Wales. Journal of Intellectual Disability Research 41 52-9. Bouras, N. , Holt, G. A ; Gravestock, S. ( 1995 ) Community attention for people with larning disablements: shortages and future programs. Psychiatric bulletin, 19, 134-137. Day, K. ( 1988 ) Services for psychiatrically disordered mentally disabled grownups. Australia and New Zealand Journal of Developmental Disabilities, 14,19-25. Department of Health ( 2001 ) Valuing Peoples: A New Strategy for Learning Disability for the twenty-first Century. The Stationery Office, London. Department of Health ( 1999 ) mental wellness: national service model, The Stationery Office, London. Department of Health ( 1992 ) Health Services for Peoples with Learning Disabilities ( Mental Handicap ) . HSG ( 92 ) 42. London: Department of Health. Disability Rights Commission ( 2006 ) Equal Treatment: Closing the Gap. Final Report of a Formal Investigation into Health Inequalities. DRC, London. Drake, R E, 2007. Double diagnosing of major mental unwellness and substance upset: An overview. New Directions for Mental Health Services, [ Online ] . 50, 3-12. Available at: hypertext transfer protocol: //onlinelibrary.wiley.com/doi/10.1002/yd.23319915003/abstract [ Accessed 20 November 2010 ] . English National Board ( ENB ) ( 2000 ) Education in Focus. Strengthening Pre-registration Nursing and Midwifery Education.Curriculum Guidence. Part 13 of the Professional Register. ENB, London. Forster M, Wilkie B, Strydom A, Edwards C A ; Hall I ( 2001 ) Medication Information Leaflets. London: Elfrida Press. Foundation for people with larning disablements, valuing people support squad and national institute for mental wellness in England ( 2004 ) Green visible radiation: how good are your mental wellness services for people with larning disablements? A service betterment toolkit, London: Foundation for people with larning disablements Fraser, B. ( 1999 ) Psychopharmacology and people with learning disablement. Progresss in Psychiatric Treatment, 5, 471-477. Fraser W. A ; Nolan M. ( 1995 ) Psychiatric upsets in mental deceleration. In: Mental Health in Mental Retardation ; Recent Advances and Practices ( ed Bouras, N. ) , pp. 79-92. Cambridge University Press, Cambridge. Gibson, T, 2007. Peoples with larning disablements in mental wellness scenes. Mental Health Practice, 12/7, 30-33. Hardy S, Chaplin E, Woodward P ( 2007 ) Mental Health Nursing of Adults with Learning Disabilities. Royal College of Nursing, London. Hardy S, Woodward P, Woolard P et Al ( 2006 ) Meeting the Health Needs of People with Learning Disabilities. Royal College of Nursing, London. Hassiotis A, Strydom A, Hall I et al ( 2008 ) Psychiatric morbidity and societal operation among grownups with marginal intelligence life in private families. Journal of Intellectual Disability Research. 52, 2, 95-1-6. Krose B. , Dewhurst D. A ; Holmes G. ( 2000 ) Diagnosis and drugs: aid or hindrance when people with larning disablements have psychological jobs? British Journal of Learning Disabilities 29, 26-33. Lennox, N. A ; Chaplin, R. H. ( 1995 ) . Intellectual disablement: the positions of psychiatric trainees. Australian and New Zealand Journal of Psychiatry, 29, 632-637. Matson, JL. and Bamburg, J. dependability of the appraisal of double diagnosing ( ADD ) , research in developmental disablements 20,89-95 Mencap ( 2007 ) Death by Indifference. Mencap, London. Moss S. ( 1999 ) Appraisal of mental wellness jobs. Tizard Learning Disability Review 42, 14-19. Government of England ( 1983 ) The Mental Health Act. Stationary Office, London. Nirje, B. ( 1976 ) The standardization rule and its human direction deductions. In Normalisation, Social Integration and Community Services ( eds R. J. Flynn A ; K. E. Nitsch ) . Baltimore, MD: University Park Press. Pollard, KC, 2004. Collaborative acquisition for collaborative working? Initial findings from a longitudinal survey of wellness and societal attention pupils. Health A ; Social Care in the Community, 12,4, 346-358. Raghavan R, Patel P ( 2005 ) Learning Disabilities and Mental Health. A Nursing Perspective. Blackwell Publishing, Oxford. Royal Collage Of Nursing, 2008.A Mental wellness nursing of grownups with larning disablements: RCN GuidelinesA . London: South London and Maudsley NHS Foundation TrustA Royal College of Psychiatrists ( 1996 ) Meeting the Mental Health Needs of People with Learning Disability. Council Report CR56. London: Royal College of Psychiatrists. Scior K, Longo S ( 2005 ) Inpatient psychiatric attention: what can we larn from people with larning disablements and their carers? Learning Disability Review. 10, 3, 22-33. Sigelman C.K. , Budd E.C. , Winer J.L. , et Al. ( 1982 ) Measuring alternate techniques of oppugning mentally retarded individuals. American Journal of Mental Deficiency 86, 511-518. Swain J, French S, Barnes C et Al ( 2004 ) Disabling Barriers, Enabling Environments. Second edition. Sage, London. The Office for National Statistics. 2000.A Psychiatric Morbidity among Adults populating in Private Households. [ ONLINE ] Available at: A lt ; hypertext transfer protocol: //www.statistics.gov.uk/downloads/theme_health/ psychmorb_sumrep.pdf gt ; . [ Accessed 16 November 2010 ] United Kingdom Central Council for Nursing, Midwifery and Health Visiting ( 1999 ) Fitness for Practice the Report of the UKCC Commission for Nursing and Midwifery Education. UKCC, London. US Public Health Service ( 2002 ) Closing the Gap: A National Blueprint for Bettering the Health of Individuals with Mental Retardation. Report of the Surgeon General s Conference on Health Disparities and Mental Retardation. Washington, DC: US Department of Health and Human Services.

International Business - Value and Supply Chains Essay

International Business - Value and Supply Chains - Essay Example This exemplifies the concept of value chain. The concept of value chain was introduced and popularized by Michael Porter in his bestseller, Competitive Advantage: Creating and Sustaining Superior Performance (Value Chain 2005). In this book which was published in 1985, he clearly describes what value chain is. He has identified a set of interrelated activities common to a wide range of firms. Value chain is "a high-level model of how businesses receive raw materials as input, add value to the raw materials through various processes, and sell finished products to customers (What is value chain 2005)." This is possible, since Michael Porter, as stated above, has already devised a way to classify the activities of a firm in its operation. Value chain therefore, categorizes the "value-adding activities of an organization (Value Chain 2005)." Michael Porter classified business activities as either primary or support activities. Primary activities include: inbound logistics, production, outbound logistics, sales and marketing, maintenance. Meanwhile administrative infrastructure management, human resources management, R&D, and procurement comprise the support activities. ... Primary activities involves those activitieswhich starts as the procurement of raw materials from suppliers to bringing them to customer. Inbound logistics involve the "receiving, warehousing, and inventory control" of the company's input. Meanwhile, operations comprise the value adding activities which transforms the raw materials into the final output. Outbound logistics are the activities which are necessary to bring the finished product to customers like storage, order fulfilment, warehousing, etc. Marketing and sales are the company's effort to attract buyers to purchase the products (The Value Chain 2004). Maintenance and ehancement of products' value through customer support and repair services. All these activities in the value chain are designed to add value that the customer derived from the company's products or services. Figure 1. Primary Activities of the Value Chain The main goal of support activities is to facilitate the primary activities. Procurement is essentially the purchasing of raw materials and other inputs utilized in value adding activities. On the other hand, technology and development, process automation and other technologies which are used to simplify and aid in the company's production. Human resource management involves the process of recruitment, development, motivation, and compensation of employees working for the business. Firm infrastructure is comprised of activities such as finance, legal quality, management, etc (The Value Chain 2004). This paper will look at the value chain of Dell Incorporated. It will focus on the trends currently happening in the global market and how these changes may influence the value chain of the business entity. Dell Incorporated and its

Is terrorism ever justified Essay Example | Topics and Well Written Essays - 750 words

Is terrorism ever justified - Essay Example Terrorism cannot be justified because it causes fear and anxiety among peaceful populations. To some extent, it must be acknowledged that the fear of Arab terrorism among the American population has been cultivated, and that this cultivation clearly implicates the American media. This does not mean that other of the "institutional means of influence" are without fault (Reich and Laqueur 71). For example, fundamentalist Christianity inside the United States (whose churches and televangelists frequently view Israeli dominance as the fulfillment of biblical prophecy) clearly contributes to the real anti-Semitism in the United States. However, compared to the other ideological institutions, media influence is virtually universal and potentially life-long for the population. In a context of alienation, the media becomes both a tranquilizer and a source of the sharpening of images for dramatic effect (Kushner 360). Violence as a part of the terror attack cannot be justified. In the dominant view, those who perpetrate outsider violence are often portrayed as irrational or crazed, exercising a twisted thirst for blood. A political economy of terrorism must take note of such efforts, probing theoretically the structure of ideological systems, and placing these in a material context. Following Singh: "There is almost an infinite variety of violence of anti-social nature-homicide, acts of vandalism, arson, destructive rage, or other expressions of an essentially irrational urge to strike at someone or something" (Singh 377). Beyond this, a political economy of terrorism must place statist behavior in a world system context. However, terror is not confined to purely instrumental linkages between specific nation states and the misdeveloping world. The modern state may be quite "rational" in its projection of national power on a world scale through military force, covert intelligence operations, and e conomic sanctions (Edwards n.d.). State power may be used quite "systematically" to maintain an order of inequality with both global and domestic dimensions. And all of this may be done in the name of national sovereignty and international law. Indeed, it may be a function of lawyers working for the state to find "lawful" reasons for policies of international and national intimidation (Egendorf 2004). Terrorism cannot be justified because it involves the systematic use of torture and the rise of military and police forces engaged in an internal war against a subject population. This form of terrorism may also be waged through shadow organizations, death squads, and the like that have no official power but that are clearly linked with the national elite (Egendorf 2004). However, to focus on regime terror is often deceptive. To cast the issue of terrorism as the abuse of state power by political deviants may be to ignore the more endemic, taken-for-granted, higher forms of sanctioned violence that avoid the terrorist label. It may also ignore state structural imperatives (expressed in policy and action, including the threat or use of force) designed to preserve a transnational market system. At the international level, the higher terrorism takes different forms. It is ironic that in the political lexicon of terrorism, war between states is routinely omitted. Indeed, the architects o f the state may subscribe to humanitarian codes

The Continuing Evolution of Reconstruction History by Eric Foner Essay Example for Free

The Continuing Evolution of Reconstruction History by Eric Foner Essay In this article, Foner states in his thesis that â€Å"since the early 1960s, a profound alteration of the place of blacks within American society, newly uncovered evidence, and changing definitions of history itself, have combined to transform our understanding of race relations, politics, and economic change during Reconstruction.† The article essentially encompasses the meaning of three different views of reconstruction: traditional, revisionist, and post-revisionist. After Foner defines these and explains his thesis, the article becomes somewhat of an advertisement for his own articles on the topic. Foner defines the traditionalist view as the interpretation that when then civil had finally come to an end, the white population of the south more or less accepted their military defeat and wanted to preserve their supremacy while simultaneously reuniting with the North. The first problem with this view is if the south were to continue on the path of white supremacy and never really grant African Americans any civil rights to enjoy the same freedoms as white people, then reuniting with the north would be pointless. The entire idea of the civil war and reconstruction was to abolish slavery and to also grant the freedmen some, if not most or all, of their civil rights. While discussing the traditional view, Foner also identifies two separate eras of reconstruction. The first of the two eras was Presidential Reconstruction, in which Johnson attempted to continue Lincoln’s policies. The second would be Congressional or Radical Reconstruction. In this era, the southern white community joined together in the fight against the efforts to overthrow the new governments that promoted reconstruction ideals and also to carry out Home Rule. This would essentially become the enforcement of the Black Codes, which restored the plantation lifestyle that had existed before the civil war and in turn kept the freedmen in the position of slavery. The description of the traditionalist viewpoint almost seems to be valiant in nature, almost holding the southerners to a sort of esteemed position in keeping with their traditional way of white supremacy. This raises the question, were the traditionalists either mainly southerners or racists who wanted to preserve the idea that the south was betrayed by the north and had the right to enforce the black codes? This question will go unanswered, for the article does not investigate each viewpoint to this  degree. The second viewpoint described by Foner is revisionism. Revisionists consisted of mainly African American and supporters of the freedmen who wanted to refute the ideas of the traditionalist group. This group also applies the idea of some sort of valiant effort being made, but this time by the African Americans of the era. This group defines reconstruction as â€Å"an idealistic effort to construct a democratic, interracial political order from the ashes of slavery, as well as a phase in prolonged struggle between capital and labor for control of the South’s economic resources.† In fact the entire explanation of the motives for the revisionist group makes them seem terribly offended. Revisionists believe that most traditionalists cannot view a black man as a man. Simply put, the freedman is still considered a slave. A statement like this leads to questioning of the relevance of the traditionalist viewpoint. If the south never stopped seeing the freedmen as slaves, and went out of their way to try and preserve the aspects of slavery, then how can traditionalists even support that they have a view on Reconstruction? What exactly was reconstructed? As time had progressed, the revisionist view eventually stamped out traditionalists, it was all inevitable once everyone caught on that African Americans were equal and started to look into the history of slavery and Reconstruction. The revisionists also portrayed Johnson as the racist that he really was and praised the Radicals for being so committed to the rights of the freedmen. In the most recent view of reconstruction known as post-revision, Reconstruction is seen as a time of radical change. They argued that â€Å"persistent racism had negated efforts to extend justice to blacks, and the failure to distribute land prevented the freedmen from achieving true autonomy and made their civil and political rights all but meaningless.† This raises the question of who can there be any radical change during reconstruction if the freedmen were prevented in achieving true autonomy? And if this wasn’t achieved, then what was achieved as a result of reconstruction? to answer this question, Foner explains that the post-revisionists see reconstruction as not merely a specific time period, but an extended historical process. America was readjusting after the war  and it was not a â€Å"tragic era†. Schools were established and there was social and political process for freedmen. Overall, this is by far the most optimistic viewpoint. Foner ends his explanation of post-revision rather abruptly in order to what comes off as marketing his books. He even appears to be a tad arrogant when he more or less describes his collection as the most definitive grouping of historical information and personal opinion of the entire topic. He never actually states which viewpoint he associates himself with, but it can be inferred that he is a combination of revisionist and post-revisionist. The reason for this is that holds that blacks were active agents in the making of reconstruction and reconstruction produced a variety of economic, political, and social change for the freedmen. Foner does an impeccable job at explaining each view of reconstruction as well as providing the evidence to support his reasoning. He ends on a collective note, pressing to the reader that when viewing Reconstruction, one should keep in mind different points of view and it is best to take and comparative approach to emancipation to broaden one’s perspective and to bring about questions and new conceptual ideas.

Sex Change Complicates Battle Over Child Custody :: Free Essays Online

Sex Change Complicates Battle Over Child Custody Florida state law does not recognize same sex marriage. In this case, the law had no way of proving whether or not Michael Kantaras is a man or a woman, since having a female to male sex change. Depending on this, it will decide whether or not he (pending on decision) will be able to keep custody of his adopted children. If society had not let technology surpass their conventional thinking and laws, this case would be easier to decide, or at least not pending on the sex of Mr./Mrs. Kantaras. If Florida law, and that of other places, had thought about all the consequences of technology, such a case as this never would have come to be so controversial. So, is Michael Kantaras really a man, or is she the woman she was born as? Janice G. Raymond would say that Michael Kantaras is really Margo. She believes that transsexuals can never really relate to the female persona and therefore never truly be a woman. She bases this belief on the idea of male privilege. This is the privilege that men receive just for being men; they get higher pay, more leadership opportunities, are always seen as more competent, etc. Even though men are born with this privilege and may not realize they have it, they still experience it and have that edge to allow them to advance in society. Because of this, Raymond claims that male to female sex changes cannot know how it really is to be a woman. They do not realize they have this privilege, but continue to live being dominant because it is inherently within them. Sandy Stone, a male to female transsexual, is angered by Raymond's view. She became a successful employee at Olivia Records, and obtained a head position. Olivia records emerged during the 1970s toward the end of the women's movement in an attempt to produce lesbian feminist music. It wanted for women to obtain the head positions and dominate the company, so once word got out about Sandy Stone's natural born sex, there was much controversy and debate on whether or not to keep her at the head position. Those who believed she should be fired sided with Raymond's view, that having been a male, Stone had an advantage in being brought up to be competitive. Sex Change Complicates Battle Over Child Custody :: Free Essays Online Sex Change Complicates Battle Over Child Custody Florida state law does not recognize same sex marriage. In this case, the law had no way of proving whether or not Michael Kantaras is a man or a woman, since having a female to male sex change. Depending on this, it will decide whether or not he (pending on decision) will be able to keep custody of his adopted children. If society had not let technology surpass their conventional thinking and laws, this case would be easier to decide, or at least not pending on the sex of Mr./Mrs. Kantaras. If Florida law, and that of other places, had thought about all the consequences of technology, such a case as this never would have come to be so controversial. So, is Michael Kantaras really a man, or is she the woman she was born as? Janice G. Raymond would say that Michael Kantaras is really Margo. She believes that transsexuals can never really relate to the female persona and therefore never truly be a woman. She bases this belief on the idea of male privilege. This is the privilege that men receive just for being men; they get higher pay, more leadership opportunities, are always seen as more competent, etc. Even though men are born with this privilege and may not realize they have it, they still experience it and have that edge to allow them to advance in society. Because of this, Raymond claims that male to female sex changes cannot know how it really is to be a woman. They do not realize they have this privilege, but continue to live being dominant because it is inherently within them. Sandy Stone, a male to female transsexual, is angered by Raymond's view. She became a successful employee at Olivia Records, and obtained a head position. Olivia records emerged during the 1970s toward the end of the women's movement in an attempt to produce lesbian feminist music. It wanted for women to obtain the head positions and dominate the company, so once word got out about Sandy Stone's natural born sex, there was much controversy and debate on whether or not to keep her at the head position. Those who believed she should be fired sided with Raymond's view, that having been a male, Stone had an advantage in being brought up to be competitive.

Qualities of a Good Nurse Essay

Qualities of a Good Nurse Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   I was prompted to join nursing because of several life experiences. I used to feel helpless when I saw one of my family members fall ill and I could not do anything to help them ease their agony. I would sit and get deep thought and wishes that I could help if only I had appropriate training. I observed how the nurses were kind and caring whenever any of my family members fell ill. I usually became compassionate since their agony could not be alleviated. I am happy to join nursing and cannot regret about of my decision. Nursing is more of a calling than just a mere career. The validation of this paper is to highlight the life experiences and desirable traits of a nurse.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There are both good and worse experiences in nursing profession; however, they never scared me away from this profession. I am gradually learning and developing as an individual and become more enthusiastic about nursing profession every day. The satisfaction I accrue everyday is overwhelming, since it feels great to help others in their time of need. The experiences I got when I saw my family members fall ill made me acknowledge that I wanted to be part of the nursing profession and that I had capacity to fit in nursing profession. I got struck with a feeling of fulfillment, purpose, knowing that I could touch someone’s life. I learnt a lot of things from the nurses who attended my mother when she was ill (Bluni, 2009).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   My experience with the nurses helped me to learn that listening skills and communication alongside care and comfort help the nurses to promote patients’ health mentally, physically and emotionally. The nurses attended my mother on a daily basis and honestly cared about her situation. The nurses were capable to communicate with other patients, doctors and the other workers effectively. Stellar nurses are able to follow instructions with minimum supervision and easiness in communicating with families and patients. A good nurse should be an advocate for their patients and predict their needs. Successful communication ability in nursing profession builds up high level of satisfaction while putting off medical misfortunes. Nurses should also listen keenly to orders from their doctors and make notes where necessary (Watson, 1898).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   I came to learn that nurses can work in various tasks, but they should also collaborate with fellow workers. Nurses cannot provide effective care to all patients without help from others, because some situations are hard to handle and random. For the nurses to provide effective services to their patients, they require teamwork (Gokenbach, 2013). I realized that a good nurse should be compassionate. They should be concerned about the family and the patient who is undergoing pain. A great nurse should be empathetic by listening and understanding the challenges facing their patients. Finally, I learnt that a good nurse should be helpless. The nurse who was attending my mother could miss lunch to hold her hand. In other experiences, some nurses did extraordinary things for patients simply because they were helpless (Bluni, 2009).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In conclusion, life experiences with ailing family members provoked me to join nursing profession. I came to learn I had capacity to touch someone’s life, and this was only through nursing. There are several desirable traits of a stellar nurse that are compassionate, selfless, caring, excellent communication skills and self-awareness. These qualities help nurses to provide efficient services to their patients and be able to work as a team to accomplish their duties. References 5 Things That Make a Good Nurse Great. (n.d.). NurseTogether.com. Retrieved September 10, 2014, from http://www.nursetogether.com/5-things-that-make-a-good-nurse-great Bluni, R. (2009). Inspired nurse. Gulf Breeze, FL: Fire Starter Pub..Watson, F. S. (1898). On Some of the Qualities Necessary for Being a Good Nurse. The Boston Medical and Surgical Journal, 138(10), 217-220. Source document