Burnout in Nursing Profession

Burnout in Nursing Profession The aim of this literature review is to identify the significant factors related to burnout in the nursing profession. Nurses are most susceptible and vulnerable to the development of burnout, mainly because of the nature and emotional demands of their job. Burnout in the nursing profession is a significant concern in nursing, because it has detrimental effects both on individuals and organisations. For the individual nurse, the neuroendocrine response yields physiologic reactions that may ultimately contribute to illness. In the health care organisation, work burnout may contribute to absenteeism and turnover, both of which detract from the quality of care. Burnout is reported to originate from work itself as well as from characteristics of the individual nurse. There are also buffers to mitigate the development of burnout. Background Freudenberger (1974) first coined the term burnout to describe the build-up of feelings that professionals experience when their emotional resources are depleted (Janssen, Schaufeli Houkes 1999). Maslach and Jackson (1981) further refined this term as a syndrome of emotional exhaustion, depersonalisation and reduced personal accomplishment. Their study is a piece of seminal work and their concept on burnout has been widely accepted since. Emotional exhaustion manifests in nurses as a general loss of feeling and concern, trust, interest, and spirit. It also involves feelings of fatigue, being used up, irritability, frustration and wearing out (Maslach et al 1981). Depersonalisation refers to showing a detachment of the nurse from the patient by actively ignoring the qualities that make them unique and engaging people (Maslach et al 1981). The third dimension of the burnout syndrome is the tendency of nurses in evaluating their work negatively. Nurses feel unhappy about themselves and dissatisfied with their accomplishments on the job (Maslach et al 1981). Burnout is measured by the Maslach Burnout Inventory (Maslach et al 1981). The internal consistency of this tool has been widely tested using Cronbachs coefficient alpha (Maslach, Jackson Leiter 1996) and hence could be considered to be a standard measure for burnout (Hannigan, Edwards, Burnard, Coyle Fothergill 2000). This survey tool is a 22 item questionnaire consisting of the three subscales mentioned above of the burnout syndrome. The items are scored in a 7-point Likert scale ranging from 0 (never) to 6 (daily). A high degree of burnout is reflected in high scores on the emotional exhaustion (EE) and depersonalisation (DP) subscales and a low score on the personal accomplishment (PA) which is rated inversely. An average degree of burnout is reflected in average scores on the three subscales and a low degree of burnout is reflected in low scores on the EE and DP subscales and a high score on the PA subscales (Maslach et al 1981). Rationale Burnout is often been reported as a causing factor for attrition of nurses from the nursing profession (Armstrong-Stassen, Al-Maaitah, Cameron Horsburgh 1994). In addition burnout in nursing has been associated with poor patient satisfaction and poor patient outcome (Vahey, Aiken, Sloane, Clarke Vargas 2004, Nayeri, Negarandeh, Vaismoradi, Ahmadi Faghihzadeh 2009). These adverse outcomes of burnout could have significant indelible impact on the Singapore governments aim to establish Singapore as a reputable medical hub in the ASEAN region. Studies and statistics have shown that nurses in Singapore are at risk of developing burnout (Boey, Chan, Ko, Goh Lim 1997, Lim Yuen 1998, EnterpriseOne 2006), however, surprisingly, no research have been done in Singapore to assess the level of burnout and the related factors of burnout in their nurses. Therefore, this literature review is initiated to generate a comprehensive understanding of what is known about burnout in the nursing profes sion. This could have implications for understanding the overall well-being of the nurses in Singapore. Aims and Objectives Aim and objective: To identify the significant factors related to burnout in the nursing profession. Method A literature search was conducted using the keywords nurses and burnout on CINAHL and MEDLINE. The search is supplemented with a manual search in journals published in Singapore for further information regarding related research conducted in the local context and a supplementary follow-up of other cited materials in Google Scholar, where appropriate. Findings Collating the evidence from the literature led to the identification of three main themes for the related factors of burnout for nurses. The themes are stress of the health care professionals, individual variables and leadership as the buffering factor. The proposition that high stress clinical care settings as organisational stressors have been extensively examined. Therefore not surprisingly, studies on burnout done in medical, surgical and high dependency units were most prominent (Nayeri et al 2009, Adali Pirami 2002). Gillespie and Melby (2003) purported that the reason is because the nursing staffs working at these demanding areas are likely to spend considerable time during their working day in intense interactions with people. While Maslach-Pines (2000) suggested that it is because the nature of the work of these departments is often described as physically demanding and nurses are also continually faced with heavy demands for pity, sympathy and compassion. However, while many studies demonstrate a strong correlation between high levels of stress in high stress work environments and increased incidence and degree of burnout among nurses (Schmitz, Neumann Oppermann 2000), others produce evidence showing there is no correlat ion (Buunk, Ybema, Zee, Schaufeli Gibbons 2001). In the study conducted by Buunk et al (2001), it is being demonstrated that nurses working in high stress, specialised environments are less burned out than their counterparts working in those perceived as low stress environments. However, it should be noted that the participants for their research are nurses who have at least 10 years of working experience. They would have been able to handle their stress more efficiently and would have been less prone to burnout. Therefore, it can be argued that this research lost its reliability because the sample represents a group of generally healthy workers (Demerouti, Geurts, Bakker Euwema 2004:997). Moreover, the researchers also conducted a face-to-face interview with the participants. By the interview questions, the participants could infer that the researchers are interested to determine their stress related behaviour. Therefore, the sensitive nature of these questions would have inflict ed a response bias as participants do not want to be stigmatised as not being able to cope (Maslach, Jackson Leiter 1996). In more recent years, among the organisational stressors, workload as a contributing factor to burnout is more commonly reported and associated with the emotional aspect of the burnout syndrome (Greenglass, Burke Moore 2003, Lin, St John McVeigh 2009). Taris, Le Blanc, Schaufeli and Schreurs (2005) suggested that a high score on this single aspect of the burnout syndrome will be sufficient enough to predict burnout. Authors proposed that the 21st century health care reform has further intensified nurses workload. The work intensification studies in and around health care are providing convincing evidence on the extent to which efficiencies achieved by health care organisations are largely due to the increased workloads of nurses as a result of both staff reductions and increasing activity and patient complexity (Green 2004, Aiken, Clarke, Sloane Sochalski 2001). It is argued that increased workload will lead to increased stress and in turn leads to higher chances of burnout (Masla ch Leiter 2008). Therefore, it can be speculated that there should be widespread concomitant increase in reported severity of burnout due to the increased pressure on nurses. Nonetheless, the question remains as to why in the same situational conditions, some nurses burn out, whereas others show no syndrome. The most likely explanation is that causes of burnout are found in both the environment and the individual. Significant relationships between burnout and certain demographic characteristics have been reported but the results are still far from conclusive. The few socio-demographic variables most commonly being investigated are age, gender and marital status. In their study, Maslach, Schaufeli and Leiter (2001) reported that age has most consistently been related to burnout. Burnout has been observed more often among young workers than among those aged over 30 or 40 years and it seems to occur rather early in ones work career. Schaufeli and Greenglass (2001) accounted that regarding gender differences in burnout, results are mixed and may reflect difference in roles or occupations. Maslach et al (2001) found that emotional exhaustion has usually been reported to be more common among women, whereas depersonalisation has been more common among men. Bakker, Demerouti and Schaufeli (2002) conducted a study in which a wide range of different occupations and organisations were recruited and answered through the internet, women reported higher levels of burnout than men did, particularly when they were relatively young or had relatively little work experience. However, the respondents were mostly men and rather young (Bakker et al 2002). Schaufeli and Enzmann (1998) with regard to marital status, those who are unmarried, especially men, appear to be more prone to burnout compared with those who are married. Singles seem to experience even higher burnout levels than those who are divorced. Personality characteristics as the psychological aspects of individual variables were explored as an important variable in the burnout process in a number of investigations (Simoni Paterson 1997, Allen Mellor 2002, Bà ¼hler Land 2003). However, the specific features of personality that affect the perception of burnout remain unclear. Garrosa, Moreno-Jimà ©nez, Liang and Gonzà ¡lez (2008) proposed a model of prediction of burnout in nursing and they reported that their findings give support that personality factors are significant predictors of the three aspects of burnout. But the authors were not clear on which personality characteristics were investigated. Allen et al (2002) and Zellars, Perrewà © and Hochwarter (2000) reported that neuroticism is associated with the emotional exhaustion aspect of burnout and external locus of control also demonstrated positive relationship with burnout. However, Bà ¼hler et al (2003) and Toscano and Ponterdolph (1998) reported that finding s are mixed for hardiness. Interestingly, more recent studies indentified leadership as a factor related to burnout (Kanste, Kyngà ¤s Nikkilà ¤ 2007, Corrigan, Diwan, Campion Rashid 2002). Leadership issues did not appear as a noteworthy factor related to burnout in earlier studies, even though it had been discussed some twenty years ago by Bass (1985). Nonetheless, leadership issues cannot be considered as new, but rather they appear to have increased in relative significance. Weber (2007) articulated that the increasing calls over the last decade for considering leadership as a related factor of burnout is particularly because of the chronic recruitment and retention issues confronting the nursing profession. There is also a rich source of comment on the impact of health care reform on nurses and nursing in the health care sector research literature (Aiken et al 2001). In a study conducted by Laschinger and Leiter (2006), their findings also support the key role of strong nursing leadership in creating c onditions for work engagement and ultimately, safe, high-quality patient care. Demerouti, Bakker, Nachreiner and Schaufeli (2000), in their proposed model of burnout and life satisfaction amongst nurses, identified that an individuals engagement with their work will predict a degree of low burnout. However, Stordeur, Dhoore and Vandenberghe (2001) warned that if leaders are too tyrannical and control-oriented, their leadership could exacerbate the burnout process. Among the different types of leadership, transformational leadership has been most commonly proposed and viewed as a buffer which moderates the impact of burnout (Stordeur et al 2001). Transformational leaders are visionary, balanced, self-aware and confident of breaking existing professional boundaries (Stordeur et al 2001). Nonetheless, findings from the study by Stordeur et al (2001) have to be viewed with cautious. This is because they only attempted to measure the relationship between leadership and the emotional aspects of the burnout syndrome. The other two dimensions, depersonalisation and lack of personal accomplishment were not measured. Further studies would have to be taken to establish implicit links between leadership and burnout. Ulrich, Buerhaus, Donelan, Norman Dittus (2005) found that effective control over practice resulted in increased status, respect and recognition. Hochwà ¤lder (2008) further emphasised that through a chain reaction, transformational leadersh ip style engenders group cohesion and empowerment in nurses and hence it has been found that transformational leadership is inversely correlated with burnout in nurses. Discussions Past research on burnout in Singapore is generally anecdotal in nature (Tung 2000). Others attempt to investigate the nurses stress level and their association with the psychological well-being and several work-related outcomes such as job satisfaction, organisational commitment, intention to quit and job-induced tension (Boey et al 1997, Lim et al 1998). In a study on stress among nurses in the emergency department in Singapore, Lateef, Ng and Anatharaman (2001) reported that the nurses who are older, have more working experiences and hold higher positional post had lower stress scores as compared to those who are younger, have less working experience and have lower positional post. However, the authors did not proffer insights to explain these observable facts. While such research gives indication that there is a high level of stress in the nurses in Singapore, it cannot be implied that there would be a high degree of burnout in these nurses. While it is clear that stress results i n burnout among some individuals, also apparent, yet not explained by the empirical evidence is the fact that others faced with high levels of stress do not experience burnout. Therefore an implicit relationship of high level of stress and high degree of burnout cannot be deduced because there is evidence of high stress being associated with low burnout (Bunnk et al 2001). Therefore, studies on burnout have to be conducted to investigate the burnout phenomenon among the nurses in Singapore. For the time being, it could only be speculated that nurses in Singapore are at risk of developing burnout. From the findings, it is shown that nursing burnout appears to be the result of not only contextual factors but also individual factors. Results from the studies on the socio-demographic variables and personality characteristics are weak and ambiguous. Only age has been identified as a relatively good correlate to burnout, with younger nurses being more susceptible. It would be reasonable to believe that younger nurses are more at risk to burnout because they have to move from a familiar educational environment into the workforce where there are high expectations of them to rapidly function as a competent nurse (Schaufeli et al 1998). As a result, they experience challenges transitioning from student to practicing professional nurse (Godinez, Schweiger, Gruver Ryan 1999). Transformational leadership could result in low burnout. It is important to note that low degree of burnout represents a positive psychological state and an effective state of well-being (de Rijk, Le Blanc, Schaufeli de Jonge 1998). In the emerging literature, there is a shift from the traditional focus on weaknesses and malfunctioning toward understanding human strength and optimum functioning at work (Gustafsson Strandberg 2009). Conceiving of low burnout as wellness makes a contribution to the literature because it focuses on the positive aspects of work. Positive research has the potential to improve the image of nursing and attract a new generation to the profession. It also have implications for identifying and modifying possible areas of frustration that would result in burnout and thus help relieve the high costs of turnover by improving nurse retention (Teng, Shyu Chang 2007). The major contribution of such an approach is that it enhances the understanding of how the mana gement of the health care organisational can affect nurses well-being. This knowledge is essential for the future development and well-being of all nurses and the profession of nursing. Research implications Current research focuses on examining the burnout phenomenon in acute settings and their findings have presented evidence that the level of burnout might not be influenced by different clinical settings. Therefore, future studies should move beyond the acute care settings to better understand the burnout phenomenon. Except for one, all authors of the research used for this literature review utilised cross-sectional methodology, therefore, casual relationships cannot be made from their results. Their findings also cannot be generalised in another milieu. Longitudinal research is required in order to enhance the understanding of the burnout process. Maslach et al (1981) had pointed out that longitudinal research although presents a large challenge, it is of critical importance for the comprehension of burnout. Future longitudinal examinations should establish a profile of the nurses at the beginning of their employment then follow up over a longer period of time in correlation with burnout status and the related factors influencing the development of the burnout process (Ekstedt Fagerberg 2005). For all of the studies used for this literature review, the data are collected using self-reports from the participants. Many authors warned that self-reported data might be contaminated by common method variance, because both the independent and dependent variables are based upon one source of information which is the participants (Demerouti et al 2000). Therefore, future research should also utilised objective means for collecting the result findings. Conclusion The concept of burnout has sustained the interest of nurses and researchers for several decades. Despite the large amount of studies done in attempt to investigate and predict the related factors of burnout, no conclusive data could be drawn. This is because the health care system is in constant change. The factors that relate to burnout will present different relative significance with the changes. Notwithstanding this, the related factors to burnout could generally be classified as both organisational and personal related. Therefore, to base practice, burnout intervention programmes should be multidimensional consisting of work-related as well as personal directed approaches.

Closed Head Injury

Closed Head Injury Case Study Y. W. is a 23-year-old male student from Thailand studying electrical engineering at the university. He was ejected from a moving vehicle, which was traveling 70 mph. His injuries included a severe closed head injury with an occipital hematoma, bilateral wrist fractures, and a right pneumothorax. During his neurologic intensive care unit (NICU) stay, Y. W. was intubated and placed on mechanical ventilation, had a feeding tube inserted and was placed on tube feedings, had a Foley catheter to down drain (DD), and had multiple IVs inserted. He developed pneumonia 1 month after admission.Closed Head Injuries: Closed head injuries result from a blow to the head as occurs, for example, in a car accident when the head strikes the windshield or dashboard. These injuries cause two types of brain damage. 1. Define the term primary head injury. A primary head injury (or primary impact) is also known as a â€Å"coup injury. † The injury occurs under the site of impact with an object such as a hammer or a rock. The brain strikes the skull after the head strikes the object of impact (Lewis, et al, Fig 57-14). This is the site of the direct impact of the brain on the skull.Often there is edema around the site of impact. 2. Define the term secondary head injury. The secondary head injury is also known as contrecoup injury occurs on the side opposite the area that was impacted. These injuries tend to be more severe and overall patient prognosis depends on the amount of bleeding around the contusion site (Lewis, et al, 1425). Often it is the secondary brain injuries that show few initial symptoms and then have serious side effects days to weeks later. 3. What is normal intracranial pressure (ICP), and why is increased ICP so clinically important?Normal intracranial pressure ranges from 5 to 15 mm Hg. A sustained pressure above the upper limit is considered abnormal. Pressure changes in the brain effect the brain’s compliance. Complianc e is the â€Å"expandability of the brain† With low compliance, small changes in volume occur and result in greater increases in pressure. Elevated intracranial pressure is clinically significant because â€Å"it diminishes CPP, increases risks of brain ischemia and infarction, and is associated with a poor prognosis† (Lewis, et al, p. 1425-1427). 4. Identify at least five signs and symptoms (S/S) of increased ICP. signs and symptoms of increased ICP are †¢Decreased LOC (level of consciousness) †¢Respiratory problems (maintaining a patent airway is critical in the patient with increased ICP. Pt is at increased risk of airway obstruction (Lewis, et al, p. 1434). †¢Elevated systolic BP due to ischemia and pressure on the brainstem. †¢Bradycardia due to the ischemia and pressure on the brainstem as well. †¢Pulmonary edema due to increased sympathetic activity as a result of increased intercranial pressure. 5. List 4 medication classifications that the ICU nurses could use to decrease or control increased ICP.Some of the medications that the ICU nurses could use to decrease or control increased ICP would be: †¢Opioids (morphine sulfate and fentanyl) †¢IV anesthetic sedative propofol (Diprivan) to manage anxiety and agitation. †¢Vecuronium (Norcuron), cisatracurium besylate (Nimbex): nondepolarizing neuromuscular blocking agents: achieve complete ventilatory control in the treatment of refractory intracranial hypertension. (These agents paralyze muscles without blocking pain or noxious stimuli, therefore they are used in combination with sedatives, analgesics, or benzodiazepines (Lewis, p. 436)). †¢Dexmedetomidine (Precedex): alpha-2 agonist; used for continuous IV sedation of intubated and mechanically ventilated patients in the ICU setting for up to 24 hours. †¢Benzodiazepines are usually avoided in the ICU in management of the patient with increased ICP because of the hypotensive effect and long hal f-life. (Lewis, et al, p. 1436). 6. List 8 nursing measures that the ICU nurses could use to decrease or control increased ICP. * Maintain the patient in the head-up position. Elevation of the head of the bed reduces sagittal sinus pressure, promotes drainage from the head via the valveless venous system through the jugular veins, and decreases the vascular congestion that can produce cerebral edema† (Lewis, et al, p. 1436) * Position the bed so that it lowers the ICP while optimizing the CPP; not above 30 degrees. * Turn the patient with slow, gentle movements. Rapid changes in position may increase ICP. * Avoid extreme hip flexion—this risks raising intra-abdominal pressure which increases ICP. Turn pt every 2 hrs (minimum). * Protect the patient with ICP from self-injury with adequate padding on the bed.Because of likelihood of decreased LOC, confusion, agitation, and the possibility of seizures increase the risk for injury. * Be prepared to explain situations to fam ily and caregivers and the patient. With increased ICP, anxiety is likely and the prognosis can be distressing. By providing short, simple explanations that are appropriate, it allows the patient and the caregiver to acquire the amount of information they desire (Lewis, p. 1438). * Decorticate or decerebrate posturing is a reflex response in some patients with increased ICP. The nurse can use turning, skin care, and even passive range of motion. Monitor fluid and electrolyte status. Disturbances can have an adverse effect on ICP. Closely monitor IV fluids with the use of an accurate intravenous infusion control device or pump; monitor intake and output and daily weights. (Lewis, et al, 1437) * Perform neurological assessments every hour. 7. Y. W. ’s medication list includes clindamycin 150 mg per feeding tube q6h, ranitidine (Zantac elixir) 150 mg per feeding tube bid, and phenytoin (Dilantin) 100 mg IV piggyback (IVPB) tid. Indicate the reasons for each. †¢Clindamycin 1 50 mg per feeding tube q6h: Treatment of respiratory tract infections; to treat Y.W. ’s pneumonia. (Skyscape, 2012). †¢Ranitidine (Zantac elixir) 150 mg per feeding tube BID: Used to treat and prevent stress ulcers (stress-induced GI bleeding in critically ill patients). Due to head injury, overstimulation of the vagus nerve from TBI. †¢Phenytoin (Dilantin) 100 mg IVPB TID: Used to treat and prevent tonic-clonic seizures and complex partial seizures. Seizure is seen in 5% of patients with a non-penetrating head injury (Lewis, et al, p. 1445). 8. A STAT portable chest x-ray (CXR) is ordered after each central venous catheter (CVC) is inserted.According to hospital protocol, no one is permitted to infuse anything through the catheter until the CXR has been read by the physician or radiologist. What is the purpose of the CXR, and why isn’t fluid infused through the catheter until after the CXR is read? The chest x-ray confirms the proper placement of the central venous catheter. If fluid is infused through the catheter before a CXR has confirmed placement, the patient is at high risk for systemic infection or possible pneumothorax (which would occur if the catheter were to be entered into the lung by mistake instead of the superior vena cava).CASE STUDY PROGRESS Y. W. spent 2 months in acute care and is now on your rehabilitation unit. He follows commands but tends to get agitated with too much stimulation. His tracheostomy site is well healed, and the pneumonia is finally resolving. He is still receiving supplemental tube feeding and has some continued incontinence of both bowel and bladder. Y. W. has a supportive group of friends who are students at the university; several of them are also from Thailand. 9. Y. W. ’s latest lab results are as follows: Na 149 mmol/L, K 4. mmol/L, Cl 119 mmol/L, total CO2 21 mmol/L, BUN 12 mg/dl, creatinine 1. 2 mg/dl, glucose 123 mg/dl, WBC 15. 4 thou/cmm, Hgb 14. 9 g/dl, Hct 36. 4%, platelets 140 t hou/cmm. Are any of these of concern to you, and what would you suggest to correct them? I am concerned about 3 of the labs. Sodium: high (increased); hypernatremia; high sodium levels cause neurologic problems including intense thirst, lethargy, agitation, seizures, postural hypotension, weakness, and decreased skin turgor. Chloride: High, increased; High chloride levels occur because of increased sodium levels.It is important to correct the sodium level so the chloride level can follow suit. Again, hypernatremia and the nurse must watch out for dysrhythmias, HTN, and impaired mental response. –> Correcting increased sodium would include: Hypotonic saline (via IV) and 5% dextrose in water (IV)- (Lewis, et al, p. 312) WBC count:15. 4 increased; this increased level indicates infection. This can be attributed to the patient’s diagnosis of Pneumonia. Administration of appropriate antibiotics will help bring the white count back to a normal level. 0. Are you surprised by Y. W. ’s agitated behavior? Explain. YM’s agitation is of no surprise. Patients that have head injuries often express agitation easily. Increased intracranial pressure and the head injury the patient has experienced can cause agitated behavior to arise. It is imperative for the nurse to use interventions to decrease the agitated behavior which can further lead to feelings of anxiety. Providing a calm and non-stimulating environment, free of stressors, is a good way to do this (Lewis, et al, p. 1438).Also, the nurse can elevate the bed 15-30 degrees with appropriate oxygenation applied. 11. Outline a general rehabilitation plan for Y. W. based on the above data. The rehab plan will include -physical therapy- working on gross motor skills, walking, sitting, transferring, and range of motion -occupational therapy- aids in completion of ADLs and learning of new techniques to complete these tasks of daily living -nutrition- proper nutrition to keep patient nourished and als o consuming enough vitamins/minerals/proteins to aide in healing. nursing staff- administer antibiotics, pain medications, and supportive care. -speech therapy- to evaluate and aide with swallowing, eating/drinking, and eventually verbal communication improvements. 12. Y. W. ’s mother has just arrived in the United States and speaks no English. What measures can be taken to facilitate communication between medical personnel and the mother? First and foremost the nurse should find out what language is the mother’s native language. Most people are unaware but it is not safe to assume there is one language that will apply to an entire country.Quite a few countries speak a language based on their village. The nurse will need to acquire an interpreter that will speak the language that best suits the mother. If the patient’s friends/classmates are around, they can also be used to aid in interpretation and communication between health care staff and family. 13. Y. W. à ¢â‚¬â„¢s mother will need a place to stay while in the United States. What can you do to facilitate the initial contact with the Thai community? Hopefully the other Thai students are around or could make a suggestion for the patient’s mother.I would also ask the social worker if they know of any thai-specific cultural centers in the area. I could check with the interpreter, and see if they have a lead. I would also google Thai community San Diego and see what I could find. 14. What special discharge planning considerations are there in this case? Discharge considerations for this patient will involve knowing where the patient is discharging to. The nurse will need to know if the patient is staying in the US and continuing with follow-up outpatient rehab with our facility and if not, then where will they be.The nurse and other members of the healthcare/rehab team need to educate the patient on his injury and what comes next for him in terms of rehabilitation. The nurse needs t o consider what modifications YM has made to his lifestyle post injury. Discharge planning should include an outpatient schedule for OT, PT and Speech (assuming he will stay here). Education for caregivers and family is also very important so that the patient has a support system available during the recovery and rehabilitation process.The patient will need to be sent home with any tools he will need for ADLs, with medications or supplements that are still necessary for recovery. If the patient is in need of special services or devices (i. e. wheelchair, ramps, vehicle to accommodate special devices, etc. ), a case manager should be sought out to ensure that these needs are met. References Lewis, et al, (2011). Medical-Surgical Nursing Assessment and Management of Clinical Problems. 8th ed. Vol 1. St Louis, Missouri: Mosby. Skyscape. (2010). Skyscape Medical Resources (Version 1. 9. 11) [Mobile application software]. Retrieved from http://itunes. apple. com/

Outrageous Greek Mythology Argumentative Essay Topics Tips

Outrageous Greek Mythology Argumentative Essay Topics Tips Introducing Greek Mythology Argumentative Essay Topics Should you ever find an opportunity to compose an essay about Greek mythology, you should go right ahead and grab it. There are various legends in Greek and Roman mythology about the way the world together with the humans and assorted animals that inhabit it were created. The 2 mythologies have always been confused with one another. Unique myths define the 2 mythologies. You will need to not just guess what people wish to read about, but in addition pick a topic that matches the particular format of the essay. The procedure for getting good argumentative research essay topics is hard. Job essay writing is a kind of writing that you have to master. Writers often need to do some thorough research on the subject. You don't need to acquire super technical with legal argumentative essays, but remember to do your homework on what the recent laws about your favorite topic actually say. As a way to define a topic, you ought to think about the objective of the essay. If you own a list of strong and intriguing topics, you are going to have better probability of writing a compelling essay. If you're in a college and wish to compose an argumentative essay, you should select a subject of high importance. Greek Mythology Argumentative Essay Topics When you choose a topic, make certain you choose a well-defined, controversial matter. Therefore, the topic needs to be debatable! Popular topics are simpler to write about since there are a lot of sources to back up your statement, but from a reader's point of view, a favorite essay topic isn't exactly helpful. There are a few intriguing topics that it is possible to write on. Greek Mythology Argumentative Essay Topics: No Longer a Mystery Once you are finished with presenting your ideas and evidence, you want to conclude your arguments. It is very important to reinforce the principal points in the conclusion sensibly. It's important to select debatable argumentative essay topics as you need opposing points you can counter to your own points. To write an excellent argumentative essay the students first must investigate several sides of the argument, which permits them to make an educated stance. The Dirty Facts About Greek Mythology Argumentative Essay Topics In case it happens, do not neglect the professional academic writing services created to fulfill every student's expectations regardless of what his field of study is! Students should select a compelling topic to impress the audience and their teachers. To write a strong argumentative essay, they should begin by familiarizing themselves with some of the common, and often conflicting, positions on the research topic so that they can write an informed paper. They often look for the Odyssey paper topics on the internet, and there is nothing weird about it. Your introduction, as an example, should match the type of topic you're given to write on. After all, it's one of the most truly effective techniques to resist corruption and other consequences of false authorities. Your language selection will be dependent on the subject. The format isn't even essential, but it's good when you're starting out. The Lost Secret of Greek Mythology Argumentative Essay Topics However soon you're anticipated to file your college argumentative essay for grading, we'll write the paper for you. You would like your paper to differ. An argumentative paper is part of the persuasion. Understanding how to compose a strong argumentative paper can help you advance your very own argumentative thinking. Many employees have to compose a number of papers that are thought to be job essays. Even though the reading procedure may take at least 10 hours, it won't be boring. The role of assigning an essay to middle school students is to make awareness and permit them to develop writing skills. How to Get Started with Greek Mythology Argumentative Essay Topics? There are lots of aspects about a sport that may be argued in an essay. It's possible to always structure your issue so that it's unique to the argument which you are proposing in your essay. Rather than choosing the obvious stance, pick the opposite to create your essay unique. Persuasive essays are a fantastic method to encourage the reader to check at a particular topic in a different light. It's important to understand that essay topics are just basic ideas that leave you pondering a notion that might be a huge deal to another person. Argumentative essay is a sort of academic paper that demands profound understanding of analyzed problem and a huge collection of personal opinions and facts. It is all about arguing and debating on a topic, which is debatable. Regardless of the popular myth, a superior argumentative essay is more than simply attempting to demonstrate your point with a couple arguments.

The Epidemic Of A Public Health Crisis Essay - 2557 Words

While the age-old adage may read that ‘bigger is better,’ America as a whole has taken this phrase to heart in regards to its general population. In a society where food is cheap, easy to come by, and engineered to be incredibly palatable, overconsumption and unhealthy eating habits leads to an excess of calorie and fat intake. Coupled with this, the increasingly sedentary lifestyle of the average American often produces full days without physical exercise that, when combined with poor eating habits, leads to extreme weight gain and other subsequent severe health problems. America is in the throes of a public health crisis unlike that ever experienced in medical history: where the proportion of its constituents – both child and adult – that is obese is increasing at epidemic rates. First and foremost, the term â€Å"obesity† is defined by the Center for Disease Control (CDC) as a measure of BMI, or Body Mass Index, which is â€Å"calculated as weigh t in kilograms divided by height in meters squared, rounded to one decimal place.† Adults are considered obese if this BMI value equals or exceeds 30 and children are based on age- and gender-specific CDC growth charts from 2000, where obesity is categorized as reaching the 95th percentile or above (Ogden, 2014, p. 6). Likewise, the term â€Å"epidemic† implies that â€Å"a disease has increased in frequency in a defined geographic area far above its usual rate† (Riegelman, 2015, p. 136), which holds true for the American adult demographic: the CDCShow MoreRelatedObesity Epidemic in the United Kingdom698 Words   |  3 Pagesobesity epidemic in UK newspapers from 1996 to 2010. It claims that during this fifteen year period there was an increase in media reporting on obesity. These figures may reflect the claims that obesity was on the increase during this period. However, an article in the Sociolgical Forum suggests that â€Å"Journalists sensationalise what th ey report on by using certain themes, language or metaphors to attract public attention† (Saguy Almeling, 2008, p.57). By using words and phrases such as ‘epidemic’, ‘battlingRead MoreIs Ebola Hemorrhagic Fever ( Ehv )?1471 Words   |  6 Pagesfunction, and finally, internal and external bleeding. The virus can be from wild animals, as well as through human to human interaction. To be specific, contact with bodily fluids (such as blood, urine and feces) is required for transmission (World Health Organization (WHO) Media Centre, 2014). The average fatality rate of EHV through history has been roughly 50%, but it varies greatly from outbreak to outbreak. 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The declaration, which will last 90 days with the option to be extended, will allow agencies to reallocate resources and make temporary appointments to expand treatment services. Trump said at the White House East Room the current drug crisis is the worst in the nationsRead MoreShould We Assign Personal Responsibility For Obesity Epidemic?1649 Words   |  7 PagesShould we assign personal responsibility for obesity epidemic? Obesity is a growing threat to public health in the World and in the United States. Since 1960, the prevalence of obesity increased twice in the United States. According to a latest report by the Centers for Disease Control and Prevention  on November 11, 2015 obesity rates among U.S. adults increased from 30 % in 2003 to 36.5 % in 2011-2014. The estimated annual health care costs of obesity-related illness is approximately $190 billionRead MoreObesity : The Fight Against Obesity1425 Words   |  6 Pagesmy America and it has to be a matter of public discussion. This fight can be done through a lot of places, churches, physician offices, dietary and nutrition offices this fight cannot be done by individual, people that are obesity need the public to pitch and help them in how to lose weight and start a healthy life style. This paper will address why and why not obesity is considered an epidemic, and address why the fight against obesity should be a public discussion and concerned . It is hard forRead MoreThe Opioid Crisis : What Goes Up, Must Come Down955 Words   |  4 Pages THE OPIOID CRISIS 1 The Opioid Crisis: What Goes Up, Must Come Down Pam Lane Incest, Sexual Abuse, and Trauma MHT214 Spring May 1​st​, 2017 Professor Bonnie Cole Lesson 13 Assignment THE OPIOID CRISIS 2 Abstract My personal perception of opioid addiction used to be someone shooting up heroin, an illicit drug, and overdosing was just the inevitable end on the pathway of addiction. It was something distant to me, and in my mind, only happened in the back alleys ofRead MorePrescription Opioid Abuse : An Increasing Epidemic With Solutions945 Words   |  4 Pages Prescription Opioid Abuse: An Increasing Epidemic with Solutions in Prescribing The rate of poisonings associated with drug overdoses has been on the rise, especially concerning those involving opioids (Paulozzie, Budnitz, Xi, 2006). The Centers for Disease Control and Prevention (CDC) does not mince words regarding the status of opioid utilization in the United States: ?The United States is in the midst of an opioid overdose epidemic? (CDC, 2016). Opioids are now the most common cause of prescriptionRead MoreEvidence Based Policy Making And The Influence Of Intangibles1635 Words   |  7 Pagesdecision. The $200 Million Decision During the 1990s, New Zealand experienced an epidemic of group B meningococcal disease, for which there was no vaccine. The rate of infection was nine times higher in New Zealand than other developed nations; and there was concern and fear among the public about the epidemic (Tyson 2007). The incidences were particularly high among Maori and Pacific Islander communities. The Ministry of Health (the Ministry) proposed an ambitious (and expensive) plan to work with privateRead MoreEssay about H1N1 Pandemic1608 Words   |  7 Pages1. During the H1N1 flu pandemic, risk communicators expected the public to experience certain outrage factors. These risk factors include but are not limited to the following. Controllability, the flu virus seemed to spread rapidly among the public. Controlling the virus appeared to be a problem during the early stages of the pandemic, this made people feel anxious and unsure. Catastrophic potential was another factor that played a major role. The H1N1 virus had the potential to cause a significant

Analyzing The Industry Forces That Affect Competition And...

INDUSTRY FORCES One way to determine the profitability of a firm is to analyze the industry forces that affect competition and drive profits down. Michael porter proposes a framework to analyze the level of competition within an industry; according to porter these forces directly influence the system profitability. The stronger the forces are the less profitable the firm becomes. The forces are defined to be strength of competition, barriers of entry, the power of buyers, power of suppliers, and the substitute products. In the other hand, complementors, cooperation with buyers and suppliers, and coordination among competitors will be the forces that drive the firm profits up. This framework will be followed through to perform the analysis of Whole Foods Market firm, to determine the firm’s profitability and future returns for the long-term investor. The first step in the Porter’s framework is to define the industry boundaries to which the forces affect the firm. Whole food market is d efined to be in the grocery industry by its technological similarity and the market interdependence, it can be inferred that the firm falls in the grocery business targeting the consumer interested in healthy organic products. Whole Foods Market strives to distinguish themselves among competitors by offering high quality organic products, with good customer service and introducing proprietary brands that offer a higher profit margin and quality to the consumer. In an industry that faces highShow MoreRelatedThe Framework Developed By Michael Porter999 Words   |  4 PagesThe Five Forces Model The framework developed by Michael Porter, which identify and analyze the competitive landscape in an industry that impacted by five forces. These forces are the existing competition in the industry, threat of new entrants, the power of suppliers, the power of buyers, and the threat of substitutes. The model helps to determine the profitability of an industry and create a competitive strategy for the business. If the five forces in an industry are strong, this industry will beRead MorePorter Five Forces Analysis1500 Words   |  6 PagesPorter five forces analysis From Wikipedia, the free encyclopedia A graphical representation of Porters Five Forces Porter five forces analysis  is a framework for industry analysis and business strategy development. It draws upon  industrial organization (IO) economics  to derive five forces that determine the competitive intensity and therefore attractiveness of a  market. Attractiveness in this context refers to the overall industry profitability. An unattractive industry is one in which theRead MoreWest Lake Home Furnishings Ltd1166 Words   |  5 Pagesintending to stay at top of its business and is very eager to grow. After analyzing the benefits like increase in profit, growth of sales, market penetration, effect of reduced price on other businesses and the rapport with the wholesaler, it has been decided to accept the offer. Large and promised order for a year is the justification for accepting the reduced price in the offer. The main objective of the company is to maximize the profit. In order to achieve this at retail price of $29.99, quantity ofRead MoreWhat Is An Industry? Essay1397 Words   |  6 PagesWhat is an Industry? So, what is an industry? This sounds like an absurd question. At least that was what I thought while I twirled my pencil around while sitting in my MBA economics class at 7PM. However, when the professor began to discuss the renowned Harvard Professor Michael Porter and his â€Å"Five Forces† model, I immediately became more interested. The diagram of his five forces model shown below is widely used to analyze the intensity of the competition and the profitability and attractivenessRead MoreMarketing Environment Of Cardswap, Canada s # 1 Site For Discounted Gift Cards1575 Words   |  7 Pagesmarketing environment of CardSwap consists of factors and forces that affect the business’s ability to build and maintain successful relationships with customers (Marketing Teacher, 2014). Marketing environment is made up of the Microenvironment and macroenviroment. The Microenvironment refers to the internal factors of the business, such as the company, suppliers and marketing intermediaries (Marketing Teacher, 2014). Through analyzing CardSwap’s strengths, weaknesses and their opportunities andRead MoreToy R Us Analysis: Five Forces.1965 Words   |  6 Pagesthe on the Internet. Being in the specialty online retail industry of toys and hobbies, firms within this industry must analyze various parameters that could influence their attractiveness in the market. Once a firm understands their own specific industries environment, they can make strategies that will ultimately provide them with a competitive advantage to outperform their rivals. In order to understand the online toy retail industry, John Barbour, the CEO of Toyrus.com must look at the variousRead MoreEssay on Analysis of Ocbc Banking Industry2548 Words   |  11 Pages[pic] Topic Of The Report: The Analysis Of Porter’s Five Forces Model Towards OCBC Banking Industry Table Of Contents Table Of Contents...................................................................2 1. Introduction.........................................................................3 1.1 Introduction of the work......................................................3 1.2 Relative backgrounds of OCBC Bank............................Read MoreGlobal Competition1344 Words   |  6 PagesGlobal Competition Starbucks is the unquestionable market leader in the U.S. and is in the early stages of an international expansion plan that could lead to more revenue coming from international than domestic locations within the decade (www.beta.fool.com). Starbucks has significant strengths in coffee business. It is the current market leader with over 17000 stores worldwide. It has no debt and uses internal cash flow for expansion. Also since all of its stores are company-owned, itRead MoreThe Nature of Competitive Advantage4497 Words   |  18 Pagesfactors e. Physical/Environmental Factors IDENTIFICATION OF INDUSTRIES OPPORTUNITIES AND THREAT pg. 7 a) A Model For Industry Analysis- Porter’s Five Forces b) Rivalry c) Threat Of Substitutes d) Buyer Power e) Supplier Power f) Barriers to Entry / Threat of Entry g) Generic Strategies To Counter The Five Forces INTERNAL ANALYSIS pg. 13 a) SWOT Analysis Read MoreMktg522 Marketing Plan3311 Words   |  14 PagesUniversity MKTG522 Situation analysis When it comes to marketing the idea of a drive through grocery store there are several advantages and disadvantages to look at. This would include the current idea through company such as The Tesco concept store which is currently a drive through concept established in Baldock, Hertfordshire. The concept used is similar to the idea of my store but does not offer the complete idea of a grocery

Knowledge and Power Free Essays

Knowledge is power – or is it?   The assertion that knowledge is power has been variously attributed to Sir Francis Bacon and Albert Einstein, as well as many other notable and obscure figures.   But perhaps Eudora Welty, Flannery O’Connor, and Richard Wright all know otherwise, as demonstrated in their respective stories:   â€Å"The Worn Path,† â€Å"A Good Man Is Hard To Find,† and â€Å"The Man Who Was Almost A Man.† These stories each show that knowledge is not an absolute bestower of power; that power does not logically and necessarily follow once one possesses knowledge. We will write a custom essay sample on Knowledge and Power or any similar topic only for you Order Now    Neither are the terms knowledge and power mutually exclusive, but, as can be seen in the following analysis of the short stories mentioned above, the power resulting from knowledge only comes if the person possessing the knowledge knows how to use it, and if the person then also feels powerful.   The power gained from knowledge is not an absolute power, but is, to a certain extent, subjective. Let us first look at Phoenix Jackson, the central character in Eudora Welty’s â€Å"A Worn Path† and perhaps the most powerful character in any of the three stories.     Phoenix has gained knowledge, and therefore power, from years of quietly studying human behavior, from paying close attention to her surroundings, and from her own self-awareness of how she affects others in the world.   Phoenix Jackson might appear at first glance to be lacking any power: she is an elderly, frail-looking woman whose eyesight is failing. Phoenix is also a very poor woman with few valuable possessions; poor people in her position are virtually always seen as lacking power.   However, upon closer observation the reader can see that Phoenix is a very powerful woman indeed.   Phoenix uses her knowledge of her physical surroundings to enable her to move about in a rather dangerous world, full of obstacles both animate and inanimate.   On her journey into town Phoenix encounters many potential dangers, but because she is knowledgeable about their existence, she avoids harm.   This capacity to keep herself safe is one trait which makes her a powerful woman. Phoenix even appears to use visualization to help her get across the creek; her ability to visualize the log and her safe passage is another form of knowledge which makes her powerful.   Phoenix has â€Å"body knowledge† – she has developed the capacity to remember where her body should go, even as her eyesight fails her.   The reason this body knowledge makes Phoenix powerful is that she is conscious of the knowledge and of how to use it; for example, when Phoenix reaches the city and â€Å"depended on her feet to know where to take her.† (Welty, p. 5).   Later in the story we see Phoenix walking up the steps of her destination, â€Å"until her feet knew to stop.† (Welty, p. 6) Phoenix Jackson has also gained power during her long life with her knowledge about human behavior.   Phoenix knows how to use both her own self as well as others’ reactions for her own purposes.   Phoenix is seen manipulating the white hunter so that she can put his fallen money into her own pocket.   Phoenix knows, after only a very brief encounter, that the hunter’s ego can be easily manipulated for her own purposes.   The hunter wishes to appear strong and in control, which Phoenix knows as she reminds the hunter that she needs to be â€Å"rescued† from the cur which ahs knocked her over.   Phoenix is able to pocket the money while the hunter is occupied with ridding her of the dog. One cannot manipulate others without possessing some sort of power, and powerful Phoenix is seen manipulating others at least twice more as the story proceeds.  Ã‚   Phoenix knows, almost instinctively it seems, who she can stop on the street to ask for assistance with her shoes.   But this small gesture is full of knowledge; Phoenix could have stopped any number of people on the busy street, but consciously chose to stop a certain woman.   Perhaps Phoenix knew that this particular woman would be more inclined to help her, as she appears to be a â€Å"nice lady† (Welty, p. 6) full of Christmas spirit, heavy as her arms are with presents. Phoenix again uses her knowledge about human behavior in order to manipulate the attendant at the clinic, who feels compelled to give a pitiful old woman some money.   It is not clear whether Phoenix is manipulating the nurse in order to get medication for herself or whether she does indeed have a grandson waiting at home, but the nurse is manipulated by Phoenix nevertheless, as she uses her age as an excuse for memory loss. The grandmother in Flannery O’ Connor’s short story, â€Å"A Good Man Is Hard To Find,† is not so self-aware as Phoenix and it is her failure to use her knowledge powerfully which gets her killed in the end.   The grandmother does indeed have knowledge but somehow is unable to use it to her advantage. It is an interesting side-note that the grandmother, the mother, and Red Sam’s wife are the only characters in O’Connor’s story who are not given names; even the cat has a name.   Perhaps O’Connor used this as a subtle indicator of who did and did not have power.   Indeed, neither the grandmother nor the mother appear to be very powerful characters in this story; and Red Sam’s wife, though not a central character, is portrayed as simply chattel for her husband, who orders her around and treats her dismissively. John Wesley’s and June Star’s grandmother knows from her years on earth that a good man is indeed hard to find; she knows that truly trustworthy people are rare treasures among the human race.   The grandmother’s discussion with Red Sam shows us that she is aware of just how devious people can be.   The grandmother knows that people are inherently untrustworthy. However, the grandmother’s knowledge does not then result in her having power, for she does not use the knowledge correctly.   The grandmother gave up the potential power of her knowledge when she revealed what she knew during the encounter with the Misfit.  Ã‚   When the grandmother recognized the Misfit, she could have used this knowledge to protect her family. Perhaps Eudora Welty’s Phoenix Jackson would have used the grandmother’s knowledge in some cunning way to manipulate the Misfit.   But O’Connor’s grandmother is not as powerful as Welty’s character, simply because she fails to cultivate her knowledge into a powerful tool.   The grandmother was knowledgeable but still powerless to save her own and her family’s lives. The third character who shows us that knowledge is not necessarily power is Dave, in Richard Wright’s â€Å"The Man Who Was Almost a Man.†Ã‚   Dave shows us that the power from knowledge is partially subjective and not an indisputable fact.   The reader sees very quickly that Dave feels â€Å"small,† not only in his physical stature but in his standing among his peers in the community.   This feeling of smallness is what makes Dave feel virtually powerless. Dave appears to have very limited knowledge of human behavior and of himself as a developing man.  Ã‚   Fear is a large factor in Dave’s twisted perception of what will give him power.   Dave is scared of other boys who are all bigger than him; he has also been raised to be scared of the adults in his life.   This fear has given Dave the â€Å"knowledge† that, if one is feared, one has power.   Of course this knowledge is flawed. But Dave’s knowledge is not a mature, conscious knowledge; it is a knowledge born of his own very limited backwoods experience in the world.   Dave sees that, if he can scare others as others have scared him, he will become a powerful man.   Once Dave has knowledge of how a gun makes him feel, he thinks he has discovered an important part of becoming a man.   Perhaps the most important discovery made by Dave is that his actions have consequences; once Dave kills the mule, he sees that something he has done has made a difference, albeit a negative difference, but a difference in the world all the same. Although Dave’s knowledge has the potential to give him power, it is not well developed and is based in fear.   Therefore his knowledge may make him an even less powerful person.   Dave does not know how to use his new-found knowledge.   Instead of making him a powerful person, his knowledge may be turning him into a dangerous person as the flawed knowledge becomes more entrenched into his personality. Knowledge is power†¦.the central characters in the stories analyzed above each show us, in their own way, that this statement is very over-simplified and not necessarily true.   Power can indeed come from having knowledge.   But that knowledge must be carefully cultivated and used appropriately in order to then provide power.   And there are occasions when we can have knowledge but lack the awareness to use that knowledge to our advantage, or power. Last, if we have knowledge but lack the conviction that we have power to use our knowledge in useful ways, we are still left as powerless as if we did not have the knowledge at all.   So power resulting from knowledge must also include self-awareness, awareness of others, and the ability to adapt our knowledge to particular situations.   Only then can we say that knowledge is power. How to cite Knowledge and Power, Essay examples Knowledge and Power Free Essays â€Å"Scientia Potentia Est†, a famous aphorism that is otherwise translated as â€Å"For also Knowledge itself is Power†, was conceptualized during the late 16th century by the world-renowned Philosopher and Statesman of that time, Sir Francis Bacon. Indeed, Sir Bacon developed an understanding of the idea that by accumulating knowledge, one is able to exert, impose or influence power (as can be inferred) towards another. For instance, a person who has accumulated knowledge can withhold himself or herself from sharing this knowledge to others. We will write a custom essay sample on Knowledge and Power or any similar topic only for you Order Now Thus, a sort of personal advantage develops between those who have knowledge and those who want knowledge. The former, if desired, can ultimately influence the actions of the latter if the existing desire for knowledge is used against them. Otherwise, the same result could also be inferred from the opposite: once knowledge is shared by the person who has accumulated them, power is reflected in the sense that the person who has shared it had the privilege of sharing it. Such an example only perpetuates the idea of ambiguity of the concept of power. Indeed, power, in all its forms and contexts, is a concept that has been contested my many scholars and philosophers alike for decades, even centuries. Some relate power in the form of having the ability of exercising coercion. Others relate the concept with the possession of material wealth. Still further, others profess that power is somehow related to social class. Unfortunately, these credible attempts at establishing links to the concept of power only express supplementary ambiguity to the term. For example, even though power can be somehow related to the ability of using force (coercion), the term can also be associated with the ability of persuasion – a rather mild version of quasi-coercion that does not involve the usage of force.   The same thing goes with the idea of power as equaled to the possession of material wealth and as represented by social class. Contrary to the latter statement, intangible or incorporeal wealth can also be associated with power as a substitute for material wealth. Also, behind social class lie the idea of power as related to personal or group charisma and expertise. In other words, a person belonging to the highest social class in society cannot be more powerful over those that are below his social class if those individuals under his class are more charismatic and more adequate and excellent in terms of abilities and skills. Having identified the cumbersome and volatile nature of power, is it still plausible to conclude that knowledge is indeed power? Is there a relevant connection between the two concepts? If none, can a relevant connection be established; no matter how arguable or refutable? Basically, does the possession of knowledge represent the possession of power? To answer this question, let us first understand how scholars and philosophers of the past have identified and/or defined power during their time. The great 19th century philosopher, Sir Friedrich Nietzsche, often described the concept of power as something that expresses one’s domination over other human beings. If so, then knowledge could indeed be a source of power since the ignorance of knowledge denotes inferiority in logical thinking and skillful know-how; thus, disavowing the ability or opportunity of the individual to dominate others who do possess knowledge. However, another dilemma may arise from the latter statement. If knowledge is truly a source of power, how come individuals who do possess knowledge are not powerful? The answer, of course, is that knowledge in itself is not power. In order for knowledge to become a source of power, the individual must be able to aptly apply or exercise his or her knowledge in the form of actions for the purposes of achieving or producing results. As some scholars have put it, â€Å"knowledge is power only if one knows how to use it†.   Truly, if one individual possesses a myriad amount of knowledge but does not know how to translate it into action, then power is not represented. This concept, however, does not stray away from the concept of knowledge as a source of power nor does it emanate from the idea of action as a source of power rather than the mere possession of knowledge. It must be understood that actions are determined by the individual’s mind. If a certain amount of knowledge is absent within the individual’s cognitive processes then the action executed may not produce tremendous results that are reflective of the representation of power. However, if knowledge is indeed present, chances are that actions executed may produce excellent results that would be quite superior to actions that are conducted without knowledge. Simply said, actions augmented by knowledge reflect power on the part of the individual (superiority). In order to make the preceding points more plausible, let us try establishing the concept in a certain field or study. In this instance, let us put the concept of power as knowledge into the workplace – in this case a corporation. Most corporations possess similar theories of organization ranging from the classical theory of organization to the more systematic (systems) theory of organization. And with these models comes a set of different levels, styles or concepts of hierarchy and/or bureaucracy (formal and informal, orthodox or unorthodox). In other words, corporations always try to establish a â€Å"division of power† among its leaders and workers. Now, let us try to apply the concept of knowledge as power in a leader-worker relationship. Leaders of corporations, in all intents and purposes, are the decision-makers of the entire system. Workers, on the other hand, have more of a hands-on approach compared to their respective leaders. As far as the relationship goes, it is the leader who will decide how the workers will act. Now, the question is, is this a simple form of exercising power? Is the authority of the leader over the workers a concrete example of power in the form of knowledge? The answer, of course, is no; it is not a simple form of power illuminated by knowledge – at least not completely. One possible reason why this is so is because the relationship between the two actors reflect two issues as can be inferred from the general concept of power. First, the source of power as reflected from the leader can mostly likely be originating from his or her given authority. In other words, it is the granted authority of the corporation that is providing the leader his or her own personal power and not his or her own possession of knowledge. Second, the worker cannot be subject to inferiority since the worker is aware that his or her job is to simply follow orders. For power to be present, one must be able to persuade or force an individual to do what he or she wishes. Otherwise, if the worker decides not to follow the orders of the leader, then it can be inferred that the worker is expressing power over the leader (charisma or personal ability). But that is another issue. If so, how is knowledge as a source of power reflected in a leader-worker relationship? One possible explanation could be found from the personal histories of both actors. Respective or high positions in most corporations require excellent abilities or practical know-how. As such, no normal individual can just apply or be promoted to such a position if the individual does not possess the necessary skills or abilities that the position requires. Simply said, leaders are on their respective positions simply because they possess the required skills and as a result, are thoroughly capable of fulfilling its functions. Workers, on the other hand, may not possess these prerequisites or capabilities. However, this does not imply that workers are not knowledgeable. This merely implies that workers are yet on the verge of acquiring or developing the necessary knowledge for fulfilling the functions that are required by the position. And where can a worker acquire this necessary knowledge? The answer, definitely, is quite reflective of the answer to the whole problem of where can the idea of knowledge as power be inferred from a leader-worker relationship – from the leader. Indeed, if a worker wishes to achieve the same position as that of his or her own leader, then that worker must first develop knowledge based from his or her work and eventually acquire knowledge from his or her own leader. If recognized (or desired), the leader who possesses the knowledge that is required by the worker can now express or exercise power over the worker in the sense that the leader now has the choice of whether or not to impart his or her own knowledge to the worker. Going back to the previous points, if an individual withholds his or her own knowledge from sharing it to others, then power is gained in the form of an advantage; thus, producing a sense of superiority. As one head of a corporation has put it, â€Å"Knowledge is power and you do not share power.† The worker, however, can try to acquire knowledge of the same context from others and that action might change the idea of power in a leader-worker relationship. However, it is very unlikely that this is to happen for if the worker decides to gather power outside of his or her own corporation that knowledge may well be different from what the corporation may require or need. As mentioned earlier, power is a concept that has been contested my many scholars and philosophers alike for centuries. To suddenly come up with a personal explanation of power in the form of the possession of knowledge is something not new in the world of power.  As demonstrated, power is a really ambiguous term, let alone be defined in terms of knowledge. However, one cannot deny the fact that knowledge is indeed a source of power; for if knowledge is absent, one will not be able to exercise the myriad forms of power over others. In conclusion, if knowledge (in any form) is present within an individual and that that individual’s counterpart possesses a certain amount of ignorance of over the same type of knowledge, then the former is most likely to be more powerful over the latter. Simply put, the possession of knowledge is superiority over those who do not possess knowledge. Works Cited: Caruso, Denise. â€Å"Knowledge is Power only if you know how to use it.† March 2007 The New York Times 21 November 2007, http://www.nytimes.com/2007/03/11/business/yourmoney/11frame.html?_r=1oref=slogin Wimmer, Sandra. â€Å"For Illinois Agency, Knowledge is Power – and Promise.† August 2005 Government Procurement 21 November 2007, http://www.allbusiness.com/government/government-procurement/1162860-1.html Lloyd, Bruce. â€Å"The Paradox of Power.† May 1996 The Futurist 21 November 2007, http://www.allbusiness.com/human-resources/employee-development-leadership/553463-1.html Grant, Beau. â€Å"Knowledge is POWER.† October 2005 Government Procurement 21 November 2007, http://www.allbusiness.com/management/928236-1.html How to cite Knowledge and Power, Essay examples

Case Study on Commercial Law

Question: Mark, Peter and Mary were out on a Saturday night celebrating the successful formation of a new business venture. They went to a special restaurant up in the hills, Hilltop Point, to mark this occasion. After a great night of eating and drinking, they decided to continue their party at Watchout Point, a scenic hilltop spot with a spectacular view of the city. On their way, they stopped at a bottle shop to buy 2 bottles of premium French champagne. When they reached Watchout Point, they parked the car at the car park which was located at the top of the cliff. There was a 2 meter fence to prevent people from going beyond that point as it was not far away from the cliff edge. There were no warning signs but the cliff was very visible. Anyone can very clearly see the cliffs. In fact, the cliff was part of this beautiful scenery which attracted visitors. At first, the trio sat in the car and chatted and drank champagne. As the night progressed Peter, who had too much to drink, got out of the car and dared the others to climb over the fence and walk to the edge of the cliff. While the others were reluctant, Peter climbed over the fence and walked to the edge of the cliff. He lost his balance and fell off the cliff and broke his leg. Peter wishes to sue the Willow Council who is responsible for Watchout Point. What must Peter do to establish a breach of duty by Willow Council? Is Peter likely to succeed in establishing such a breach? Give reasons for your answer. The champagne bottle that the trio purchased had a very special kind of cap. Instead of the usual cork held in place by wire, it had a metal cap and a cork stopper. Mark opened the cap and tried to pour the champagne into a glass. When nothing came out he shook the bottle a little. The cork stopper suddenly ejected and hit Marks nose. He sustained a blood nose and was in pain for 3 weeks. There wasnt any warning anywhere in the bottle about this kind of cap. This sort of cap is very common in France and used by most French wineries. Mark wishes to sue the wine company. Will he succeed? What must he establish? Answer: Issue: The issue that is present in this can be described as being related with the reliability of Willow Council towards John as he suffered injuries after falling off from the edge of the Watchout Point, where they were celebrating their new business venture. As a result, it needs to be decided if Willow Council can be held liable under the law of negligence. Similarly, it also needs to be considered if reasonable steps have not been taken by the Willow Council which could have prevented the people from filing off. Therefore the question is if there is a duty of care on part of the Willow Council towards John. At the same time, another issue is also present in this case which deals with the liability of champagne manufacturer. In this case, the cork stopper hit Mark as he was trying to open the bottle because the bottle had somewhat different type of a cap. Rule: Duty of Care: According to the rule of law that can be applied in the present case, for the purpose of deciding the issue related with Willow Council's liability towards John, it needs to be seen if a duty of care is owed by the Council and if such duty has been breached. At the same time, the law requires that the injuries suffered by John should be the result of such breach of duty and at the same time, the injuries should be the reasonable result of the action or inaction on part of the Council. Generally in this type of cases, the doctrine of duty of care is used to claim compensation. According to the doctrine of duty of care, a party is considered as being liable towards the other party for tort of negligence. In this regard, Lord Atkins provided the neighborhood principle in the famous case of Donoghue v Stevenson. In this case, it was stated by the court that reasonable care needs to be taken by a party and avoid the acts or omissions if it is likely that the neighbor of the party may suffer injury as a result of such acts or omissions (Keenan, 2007). In such cases, an effort is made by the court to consider if reasonable proximity is present between the parties. In the same way, the court is also required to consider it the damage that has been suffered by the other party as a result of the act or omission could have been reasonably foreseen. At the same time, the court also has to consider if such a risk was foreseeable by any other reasonable person under similar circumstances. In the same way, it also needs to be seen if it would be reasonable for the court to impose a duty of care on the defendant in a particular case. The duty of care is a concept that has been discussed in detail by the court in Blyth v Birmingham Waterworks Co.In this case, the court stated that it is required that negligence on the part of the defendant should be decided by using the standard of reasonable person. Therefore it means that the defendant cannot be considered as negligent if all reasonable precautions have been taken by the defendant and as a result, the conduct of the defendant is in accordance with the standard of care that would have been followed under similar circumstances by any reasonable person. Test Used to Decide Duty of Care Caparo Industries v Dickman is also a significant case in which the court has provided the tests that can be used to decide the duty of care of the defendant. This test provides that in order to see if the defendant owes a duty of care or not, it needs to be seen if the loss or the injury suffered by the claimant could have been the result of defendant's conduct which was reasonably foreseeable. In the same way, it also needs to be considered if there is a relationship of sufficient proximity present between the parties or in other words, the parties can be considered as neighbors. Another requirement that was mentioned by the court in this case is to see if it will be just and fair to impose liability on the defendant, keeping in mind the circumstances of a particular case. In this regard, the law provides that generally it can be said that a party does not owe a duty of care towards the other party if it had taken reasonable steps with a view to prevent or reduce the harm that the other party may suffer by such conduct. On the other hand, even if a dangerous situation has been created by a person blamelessly, according to the duty of care, such person should take steps be reviewed to ensure that loss or injury is not caused to other persons. An example in this regard can be given of a person who has left his car on the road and has also put the lights of the car off. According to the duty of care present on part of such person, even if there was light on the road, the person owes a duty towards the other persons and drivers present on the road. As a result, if in this case, a car collides with the stationary car, it is possible that the person who has left the car on the road can also be held liable jointly. In this regard, the law also provides that i n case of certain circumstances, it is also possible that a person can be liable for the breach of duty of care in case of pure omissions also (Sappideen et al., 2009). In this regard, the law provides that in case there is a previous relationship present between the parties, a person can be considered as liable for the breach of duty of care. In the same way, such a relationship may also be imposed by a statute. Liability of Manufacturer Regarding the second issue that is present in this case, in Donoghue v Stevenson the Court has stated that tort of negligence has to be considered as an individual tort. The law provides that the plaintiff can take civil action if he or she has suffered loss or injury as a result of the negligence on part of the defendant. However before the decision given by the court in Donoghue v Stevenson, the plaintiff had to establish the presence of a contractual agreement for the purpose of establishing negligence. However in this case, the plaintiff had not purchased the drink and as a result, the contractual relationship was not present between the plaintiff and the defendant. However the court held that the manufacturer of the drink was liable under the thought of negligence. In this way, the law provides that the manufacturers have a duty of care towards the ultimate consumers also. The neighborhood principle that has been provided by Lord Atkins in this case requires that a neighbor can be a person who can be affected directly by the act or omission of the other party. As a result, the other party has to take reasonable care with a view to avoid the acts and omissions that can reasonably be considered as likely to cause injury to the neighbor. Application In the present case, two bottles of champagne were consumed by Peter, Mark and Mary in order to celebrate their new business venture. However, after drinking champagne, Peter got out of the car and also asked others to go towards the edge of the cliff. However, Mark and Mary did not follow him but Peter lost balance and fell from the edge. As a result, he broke his leg. In this case, a two meter high fence has been erected by the Willow Council so that the people can be prevented from going near the edge. But in this regard, it also needs to be noted that the council has not raised any warning signs at this point despite the fact that a large number of people came to the place in order to see its scenic beauty and this fact was well within the knowledge of the Council. On the other hand, so far as the liability of champagne manufacturer is concerned, the law requires that the duty to warn the consumers should be reasonably discharged by the manufacturers. In the present case, the ultimate consumers should have been informed that the bottle contains a special type of a cap and injury may be suffered by a person if the cap is not properly opened. In this regard it needs to be noted that in the present case, there was no warning on the champagne bottle regarding the cap. As a result, while trying to open the bottle, Mark suffered an injury when he was hit by the cork stopper. Conclusion Therefore in the present case it can be said that Willow Council has discharged its duty of care towards Peter and as a result, the Council cannot be considered as liable. The reason is that all the reasonable precautions have been taken by the Council as the Council was well aware that the place was visited by a large number of people due to its scenic beauty. Regarding the second issue that is present in this case, dealing with the liability of champagne manufacturer, it can be said that the manufacturer has breached its duty of care because there was no warning on the bottle regarding the fact that it contained a special type of a cap and if it is not handled properly, a person may suffer injuries. Therefore, Mark can succeed in his action against the wine company. References Keenan (2007) Smith Keenan's English Law (15th edn), Pearson Longman Sappideen, Vines, Grant Watson, 2009, Torts: Commentary and Materials, Lawbook Co, 10th ed, pp. 374-5 Blyth v Birmingham Waterworks Co (1856) 11 Ex 781 Caparo Industries Plc v. Dickman (1990) 2 AC 605 Donoghue v Stevenson (1932) AC 562 Greatlakes Shire Council v. Dederer Anor [2006] NSWCA 101 Wyong Shire Council V. Shirt [1980] HCA 12; 146 CLR 40