Placement Reflection With Memory Service Health And Social Care Essay

Placement Reflection With Memory Service Health And Social Care Essay This essay will include an introduction providing an overview of the placement undertaken and the relevant client group who access the service, a critical evaluation of three assessments that have been used within the service, one being Occupational Therapy specific, a discussion and examples given of how risk is assessed and managed within this practice setting, a discussion of the models of practice used, one intervention plan used with a particular client with an analysis of how the interventions were identified and prioritised, appraisal and justification of other potential intervention strategies, identification and evaluation of the impact of relevant legislation upon service provision within the practice setting, finally an evaluation of own performance as a student Occupational Therapist, and a conclusion. The practice placement setting was a city-wide Memory Service situated in North Yorkshire. The Memory Service is made up of a multi-disciplinary team of mental health professionals, working alongside the Alzheimers Society. The service facilitates early detection, diagnosis, and assessment of needs for older people with a memory problem, as well as giving support to their carers. Group support is also provided. Clients who are referred to the Memory Service are generally older adults who are experiencing early-stages of dementia. This essay will focus on one service-user who has been referred to the service diagnosed with Alzheimers Dementia, we will call him Max. The NHS website defines Alzheimers as being the most common form of dementia, which is a group of symptoms associated with a decline in mental abilities, such as memory and reasoning (NHS.uk, 2010) Max is in the early/forgetfulness stage of dementia (Schneck, Reisberg, Ferris, 1982) This includes mild impairment in memory and language, personality alterations, increased depression and anxiety, although there is no significant deterioration in ADL and is still able to live independently, however, it is apparent that Max is in need of some support. Moniz-Cook Wood (1997) suggest that psychosocial interventions are more effective in the early stages of dementia and memory services have great potential to provide early interventions for the service user. Max is experiencing difficulties in certain areas of his occupational performance, such as cooking/social isolation ASSESSMENT Identify and critically evaluate 3 Axs that are/could be used with the client group. The first step toward intervention is to assess the cognitive level of the client. An example of a standardised assessment is the Mini Mental State Examination 27/30 (MMSE) Folstein et al (1975) but in Memory Service the Addenbrookes cognitive examination (ACE-R) is used. The ACE-R is a brief cognitive test that assesses five cognitive areas: attention/orientation, memory, verbal fluency, language and visuo-spatial abilities. The total score is 100 of which Max scored 85/100. The ACE-R is easy to administer and only takes approximately 15 minutes to complete. The ACE-R results can vary depending on the intelligence of the client and their previous education, and also how literate they are. The Hospital Anxiety and Depression Scale (HAD) was used to find out if Max was anxious or depressed. The results proved that Max was very anxious with him scoring 9/10 anxiety, however only 2/10 for depression which is not significant, therefore this score was discarded. it was highlighted that Max was anxious about beginning social contact again and integrating into the community A kitchen assessment was undertaken with Max and the Occupational Therapist to assess and observe any risks to Maxs well-being. It was highlighted that Max often left pans on the gas cooker and ended up burning them, therefore setting off the smoke alarm, worrying the neighbours. The unstructured observational assessment took place in Maxs kitchen at home which is a familiar environment and in keeping with his daily routine. Max decided to cook scrambled egg on toast as he felt comfortable making this. At the time the Occupational Therapist was also asking Max questions relevant to his daily routine and cooking, therefore also making it an informal interview. Although unstructured assessments cannot provide the reliability that structured assessments can, Kielhofner (2002) mentions several reasons that can justify the use of unstructured assessments, such as, to add to information previously gained through a structured assessment, lack of time, unacceptability of structured assessment by a client, lack of an appropriate structured assessment. The negative points of carrying out a kitchen assessment are that quite often each client has a certain time of the day when they may function a lot better, Jack functions well around midday once he has taken his pain medication for arthritis and he is more able to focus on tasks. The client may also know that they are being assessed and may do things differently to how they would if they were alone. The evidence gathered from these assessments showed the Occupational Therapist that Max is only slightly cognitively impaired and is still able to function relatively well and therefore it is important to support Max as much as we can in his own home. Discuss relevance of risk AX and provide examples of how risk is assessed and managed Risk assessment and management is an important part of professional processes in Occupational Therapy practice. Legislation and policies have been implemented to guide practice such as Alzheimers Society The risk profile section of the Functional Assessment of the Care Environment (FACE) assessment and outcomes system (Clifford, 1999) is used to allow the Occupational Therapist to assess and document any clinical risk that an individual may pose. FACE provides outcome data that enables a patients progress to be followed and also compared with other individuals. The FACE risk profile comprises of a front sheet that summarises a patients contact details, and ratings of risk which are placed on a five-point scale ranging from 0=no apparent risk, through to 4=serious and apparent risk. The second sheet is a checklist of historical and current indicators of risk grouped into categories e.g. clinical symptoms indicative of risk and treatment-related indicators of risk. The third sheet comprises free text boxes where a description of the specific risk factors, both current warning signs and risk history, can be fully describes and individualised for the patient. The fourth sheet comprises r elapse and risk management plan which can be specified and tailored for an individual. Some specific events from Maxs past were documented: Social isolation and exclusion. Max hardly ever left the house apart from to do a weekly shop on a Saturday morning; his wife died two years ago and has since been living alone. Max had very few leisure interests apart from painting, and there was no close family support. As the course of Alzheimers progresses, the global function of individuals with Alzheimers decline. (Kuo, 2009) Max may therefore become increasingly unable to look after himself which could pose a risk in the future i.e. self-neglect? Thom and Blair (1998) describe the role of Occupational Therapy in identifying actual risks to the individual through the use of functional assessment based on observation and interview. (MENTION ABOVE AX) It was observed that Max has limited mobility due to arthritis in his knees, this poses a physical risk of falls. Max is aware of his limited mobility, however does not walk with a stick unless outside as he feels a stick inside is a hindrance. All loose rugs have been removed and the access to Maxs house is flat. He is aware of falls prevention techniques but has requested a pendant alarm from Telecare, as he feels this is appropriate in case he has a fall at home. The furniture is placed so that Max can use this as an aid for walking from the lounge into the kitchen if he feels the need. It was also highlighted that there was a risk operating household appliances safely after the Occupational Therapist carried out a kitchen assessment with Max. It was noted that once Max had started cooking he left the pans on the hob and went off to watch television because he got bored and then consequently forgot about the pan. From the kitchen assessment the Occupational Therapist was able to intervene and reduce the potential risk by suggesting Max engage himself in an activity in the kitchen whilst the food was cooking. Therefore Max could watch over the food but also read a newspaper, or do a jigsaw puzzle to keep himself entertained. Explore application of a model of practice and a therapy approach that were/could be used The Model of Human Occupation (Kielhofner, 1995) is founded on the belief that meaningful occupation is central to our well-being and that human occupation can best be understood as a dynamic system. (Duggan, 2004) This looks at physical and social environments, habituation, skills, and personal causation. As dementia is a progressive disease, the physical environment may become less accessible. Dementia may also cause disorientation, making it harder for the individual to make their way around places they are not familiar with. Occupational Therapists focus on Occupational performance, therefore we are interested in how individuals function on a day-to-day basis with their work, leisure, domestic life, and personal care. We follow a person-centred approach A person-centred and holistic approach.; A holistic approach:leisure, personal care and occupation in relation to the physical, psychological, social, economic spiritual aspects of life, (Reed Sanderson, 1992) Creek, 2002. Kitwood describes: Personhood promotes older people as having the same basic rights to dignity, privacy, choice, independence fulfilment as people of any other age group. Social interaction will help maintain well-being (Kitwood Bredin, 1992), preventing deterioration of mental function. People in a state of well-being are active occupationally engaging by nature (Turner, 2001). . INTERVENTION PLANNING Provide 1 intervention plan which you have implemented and justify this with evidence and clinical reasoning Following Maxs assessment, an occupational strengths and needs list was drawn up for Max and from this an intervention plan was made based on Maxs desired aims, including long-term goals. Goals are targets that the client hopes to reach through involvement in occupational therapy (Creek, 2002, p.129) STRENGTHS NEEDS Insight into condition Socially isolated although Max is very easy to get on with Enjoys drawing/painting-expresses interest in joining a local group Lost wife 2 years ago-feels as though he has lost his role in life Physically functions quite well apart from arthritic knees Burnt Pans Identifies positive qualities: kind, talkative, sense of humour Appears anxious about social involvement Prioritising the plan involved negotiating with Max and other members of the mental health team e.g. community support team, and making sure that Maxs goals were realistic in terms of being achieved within the 6 weeks. Cox (2007) states that symptoms of dementia can significantly disrupt a persons ability to set or meet realistic goals, therefore it is important to make sure each goal is achievable within the six weeks. By prioritising which goals Max wishes to achieve first this highlights the use of a person-centred approach, although risk factors must be taken into consideration e.g. Maxs top priority is to be able to make an evening meal safely and independently without burning pans, this is obviously a potential risk to Max and should be carried out with a member of the mental health team first. To meet the following goals, SMART (specific, manageable, achievable, realistic and time specific) objectives were also established. Long-term goal 1 Max to make some of his historically favourite meals safely and independently. Week 1: Max and the Occupational Therapist will meet on Monday morning at Maxs house, to discuss the risks of cooking with a gas cooker and write these down. Week 2: Max and Occupational Therapist to discuss whether Max would like some reading material in the kitchen to engage Max whilst his meal is cooking, therefore allowing Max to be occupied but also to check his food regularly to prevent burning pans and potential fire hazards. Week 3: Max and Occupational Therapist to walk to the local shop on Monday morning, to gather ingredients for the meal Max has chosen and Occupational Therapist to write down basic instruction for making of the meal. Week 4: Max and Occupational Therapist to make the meal together at 5.30 pm on Tuesday, using the gas cooker and ingredients that were previously bought Due to the nature of dementia, cognitive abilities decrease over time, the environment must be adapted accordingly. People with dementia may be unable to learn new skills; however old skills and habits remain deeply ingrained, and these can be used long into the disease Basic Living skills can be of more purposeful and value to the older person than leisure, PADL skills have been found to be important in the goals of treatment with early onset dementia as they value their independence, dignity privacy (Willard Spackman, 2001) It is important to facilitate plenty of praise and encouragement, through positive reinforcement. It is easier for Max to complete a cooking task when it is broken down into sections, so putting out the ingredients on the worktop in the order they need to go in the pan. Achieving only one or two steps of a task may help to give Max a sense of achievement. Max has a short attention span and finds it hard to remember instructions, so writing down a list of short instructions on how to make his favourite meal will facilitate him in the cooking process. When making the meal for the first time the Occupational Therapist gave tactful verbal reminders and simple instructions to encourage Max. Long-term goal 2 Max will attend creative community based activities and social groups every week for 10 weeks. Max is a friendly and sociable person once he is around people, and he shows a strong interest in art and has many paintings around the house. Aims of the art group: to meet new people and develop social interaction through art work. Week 1: Provide Max with information about his local neighbourhood network, available Memory Service groups, and provide transport information so that Max can attend. Week 2: Accompany Max to attend a local art gallery, and establish a therapeutic relationship with him. Allow Max to socialise with other people at the Art Gallery and start to build up his confidence whilst getting him to talk about his favourite interest. Week 3: Support Max to access the service for the first time; attend a Memory Service lunch club on a Wednesday morning for two hours accompanied by the Occupational Therapist. Week 4: Max to attend a local Memory Service Open Art group for service-users once a week on Monday morning for two hours for 10 weeks. Week 5: Max to continue attending the open art group and aim to achieve a higher level of occupational performance, by grading activities. For an occupation to have any therapeutic benefit it must have purpose, value and meaning to the individual (McLaughlin-Gray, 1998). For Max, this is taking part in Art based activities, in his past he was a strong artist and spent most of his free time outside painting, therefore attending a local art group with similar people with memory loss this is an ideal chance for Max to express his creativity and becoming more socially integrated into the community. It is important that we find out what Max wants to do and what he would enjoy, otherwise there will be little therapeutic benefit. This is an example of Person-centred care: we look for the client to lead us into an understanding of what is good and right for them. Perrin May (2000, p.77) Research is beginning to indicate the value of providing educational and supportive memory groups for people in the early stages of dementia. This can be seen as a cost effective, successful intervention that provides an alternative treatment for people in the early stages of dementia (Knapp, 2006) When looking at the College of Occupational Therapists online dementia clinical forum, there was evidence by Graff et al, 2006, for community based occupational therapy for people with dementia and their caregivers. It found that ten sessions of community occupational therapy over five weeks improved the daily functioning of patients with dementia. Creative activity in groups has also been shown to reduce depression and isolation, offering the power of choice and decisions. Non-verbal therapy methods, such as painting, are able to influence the well-being of the patients positively. (Hannemann,2006) The role of the OT with general goals is in promoting occupation, health well-being taking into consideration that dementia is progressive when making intervention plans (Pedretti, 2001). Analyse how the interventions implemented were identified and prioritised Appraise and justify other potential intervention strategies Another potential intervention strategy was to install Just Checking, a web-based activity monitoring system that provides a chart of daily living activity via the web, allowing the Occupational Therapist to track (via sensors in each room) where the individual has been, for how long, and at what time. A Just Checking system could be used for Max to establish his daily routine and activity levels during the day/night. Max states that he is anxious and sits on the sofa most of the day, Just Checking can monitor what he gets up to on a daily basis for 2-3 weeks and then the Occupational Therapist can be sure that the care plans and interventions that they put into place are based on objective information, rather than on supposition. They can be confident that the plan more closely meets Maxs needs. It may highlight that Max needs extra support which can be provided by the Community Support Team. It was suggested to Max that he try a dosset box for his daily medication, as it was noted that Max was not always compliant with his medication. However, Max refused this idea as he was happy taking his medication from the packet, and he felt that a dosset box would upset his daily routine. Another suggestion for Max could be for him to keep a diary so he can note down everything that is important like taking medication at a certain time, and attending any necessary appointments. The Occupational Therapist also gave Max some information about a Reminiscence group that is starting in the New Year. On nearly every visit Max would get round to talking about his past or photographs that he had on the wall, so it seemed like a good suggestion for Max to attend this group. When searching the Cochrane Library database, Woods et al (2005) looked at the effects of reminiscence therapy for older people with dementia and their care-givers. The results were statistically significant for cognition (at follow-up), mood (at follow-up) and on a measure of general behavioural function (at the end of the intervention period). The use of reminiscence therapy with people with dementia has been linked with improvements in behaviour, well-being, social interaction, self-care and motivation (Gibson 1994) Although there is little specific evidence for the effectiveness of reminiscence in dementia care (Carr, Jarvis and Moniz-Cook 2009) Max has expressed an interest in joining because he feels as though he would gain some therapeutic benefit being able to talk about past events with people of a similar age and with memory problems. The Cochrane review concluded that there was inconclusive evidence of the efficacy of reminiscence therapy for dementia. However, taking studies together, some significant results were identified, including improvements in mood and cognition, lessening of care giver strain and improved functional ability. No harmful effects were identified. Identify and evaluate the impact of relevant legislation, health and social policy and clinical guidelines upon service provision overall It is important that Occupational Therapists have a clear set of principles to work alongside when working with a person with Dementia. Also it is important to follow the Codes of Ethics and Professional Conduct (COT, 2010) The Mental Capacity Act 2005 (MCA) is underpinned by 5 guiding principles which all staff must follow These are an assumption of capacity supporting people to make their own decisions people have the right to make eccentric or unwise decisions where someone lacks capacity staff must act in the persons best interests where someone lacks capacity any action we take on their behalf must generally be the least restrictive option The National Dementia Strategy for England (DoH, 2009a) is a five-year plan which has three main aims: to ensure better knowledge, to ensure early diagnosis and to develop services. The strategy has put a focus on improving support for this large and growing group of people. It sets out a vision to raise the standards of care for people with dementia and is of great significance to Occupational Therapists working in the Memory Service. Occupational therapists can ensure that both the clients and their carers have a better understanding about the impact of dementia. Occupational Therapists working in the Memory Service get to see clients performing various activities that are directly or indirectly affected by memory and other cognitive functions through observation and assessment and are, therefore, able to identify early signs of cognitive impairments and raise awareness about the functional implications of memory and other cognitive impairments. In the UK, the National Service Framework for Mental Health (DoH, 1999) has been the main guide for how services should be run. It is now being replaced by the New Horizons strategy (DoH, 2009b), which aims to promote good mental health and well-being whilst improving services for people who have mental health problems. Occupational Therapists need Includes early intervention: to improve long-term outcomes, personalised care: ensuring that care is based on individuals needs and wishes, leading to recovery New Horizons sets out an intention across a wide range of agencies to move towards a society where people understand that their mental well-being is as important as their physical health if they are to live their lives to the full. It describes some of the factors that affect well-being and some everyday strategies for preserving and boosting it. It is important that Occupational Therapists specialising in the field of dementia ensure that they have a copy of the National Service Framework for Older People and use it a guide for the minimum level of service provided. EVALUATION Analyse how evaluation of interventions was completed Analyse your own performance as a student OT Having completed this 7 week placement I feel as though I have grown in confidence and learned so around the field of Dementia. I have had the chance to observe and assess many people with different diagnosis of dementia and every single person has been different and unique, with different goals they want to achieve and what they wish to receive out of the service. I have learned that communicating with a person with dementia can be a slow process, it is important to be able to actively listen not only to the service-user but to the carer as well as they provide so much valuable information and they are usually so much involved in the care of the service-user. Reflective practice has been identified as one of the key ways in which we can learn from our experiences. It helps to develop knowledge and skills towards becoming professional practitioners. (Jasper, 2003)  Ã‚   It is important that as a student Occupational Therapist I learn from my experiences on placement in order to understand and develop my practice, this involves consciously thinking about things I am doing, actively listening and making decisions. From what I have observed I can then start the reflective process and describe the experience and analyse it. I used Gibbss reflective cycle (Gibbs, 1988) that consists of six stages of the reflective process and asks cue questions to prompt the memory. CONCLUSION Provide summary of key points Every individual has certain strengths and weaknesses, likes and dislikes, emotions and habits, needs and preferences, and this makes them unique. People with dementia are often denied these things as their disease progresses, therefore it is important to try and maintain as best as possible the individual characteristics that makes up that person. As Occupational Therapists we need to acknowledge the uniqueness of the person and realise that even if they have dementia they are still living their life. Structure and predictability are important aspects of the environment in which people with dementia live. Summarise how the interventions improved or maintained health and well being for the individual Brooker p.44 (2007) states that It is important to and appreciate that all people have a unique history and personality, physical and mental health, and social and economic resources, and that these will affect their response to dementia. There is good evidence that people with dementia can learn, and respond to their environment, and through groups they can experience an improvement in the quality of life. It may not be possible to reverse the effects of dementia, but some of the major difficulties for Dementia sufferers are caused by under-stimulation, withdrawal, depression, and anxiety, and these can be reduced. This can make a real difference to the person. Max has lost his motivation and he was anxious about leaving the house and becoming socially involved again because of his memory deficits and it took some gentle persuasion to get him involved again. However, the Occupational Therapist described to Max what was going to happen, and what he would be doing, and reminded him when to attend the group sessions so he did not need to worry. The Art Group is a closed group, and the same people meet for a number of sessions and they get to know each other and become familiar with the routine of the group. This is good for Max as he is able to make some new friends, return to a familiar environment each week, and start to establish a routine. The leaders of the group get to know the members and are able to plan activities according to each member. Max expressed a strong interest in watercolour painting, and the art group leader was able to accommodate this. The achievement of leisure goals helped Max to sustain his self-esteem and morale.

The Luxury of the Bellagio Las Vegas

The Bellagio in Las Vegas is a four star resort that captures the essence of Vegas. It combines elegance with old world charm to provide its guest with one of the most luxurious stays in this colorful city. The rooms are divided into guest rooms, suites and luxury villas. The rooms range from 510-626 square feet.They are modern and well appointed. Each has modern amenities that one would expect at a 4-star establishment. (Bellagio) The suites are characterized by their decorating style and range from 800-4075 square feet. (Bellagio) Their styles appeal to executives and fun-seekers alike.These are truly rooms to be indulged and service should follow accordingly. The villas are designed for guests that seek luxury and the best in life. The Bellagio website describes them as such. â€Å"Each of our 6,500 square foot, two bedroom, five bathroom Villas and 8,000 square foot, three bedroom/seven bathroom Villas feature an in-suite workout facility, a massage room, a private kitchen, a fu ll bar stocked with guests favorite beverages, a duel fireplace, and a gorgeous private terrace and garden with a pool and a whirlpool. † (Bellagio) Obviously these villas are designed for the most exclusive clientele.The hotel itself is known for its beautiful fountains that dance on cue to music several times a day. Additionally, they house botanical gardens, pools and courtyards, art galleries and concierge service. A feature that should not be missed is the lobby ceiling adorned with a blown glass sculpture created by Dale Chihuly. Of course the hotel is known for its gambling floors and Cirque O is now housed within its buildings. Fine dining opportunities are offered in various price levels. This hotel is the embodiment of luxury, convenience and fine living. Training Program for Villa employeesThe Villas require an employee that is versed in excellent service techniques as well as discretion. As this section of the hotel caters to our most exclusive guest, the service m ust mirror their expectations. This is a challenge as these are at times the most demanding of all our guests. There are three groups of employees—floor managers, guest service associates and cleaning personnel. The ongoing training starts with the first day of employment within the division. It is seen as an advantage to work in the Villas because of the high profile of our clientele.Thus most of these employees are promoted from other divisions. They require two weeks of additional training before they are allowed to work with the customers. All require a background check. Training Objectives We employ a program that focuses on consistency, innovative techniques and dedication to upkeep of the reputation of the hotel. (Signature) The first phase is consistency. Each employee must be educated about the hotel’s visions and values. This will inform all their decisions as they need to act in accordance to those expectations. Floor Managers Our first step is to empower th e floor managers.The floor managers should start the day by reviewing their staff’s appearance. Each staff member should be briefed on the guests staying in the Villas and their anticipated needs. The floor manager can do this electronically (as in a daily webpage) or as a face to face meeting. This is the point in the day where the vision of the Bellagio is demonstrated and actualized. It is up to the floor manager to do this accordingly. The floor managers are usually promoted guest service associates. Their two week training session focuses on management techniques and personnel skills.â€Å"Before I can hold my managers accountable for the performance of their staff, I have to make sure they know how to educate their employees. †(Westminster) They are also shown what they are allowed to do. It is the hotel’s goal to solve altercations on that level before they are given to the general management. This is done in an interactive workshop environment and then r einforced with on-line activities and assessments. â€Å"eLearning can effectively deliver the theory behind your service philosophy along with the procedure and policy. † (Duprey) This allows employees to be able to show their advancements both in person and on-line.As well, the online resources provide a point where employees can check their progress and reference prior information. All of the training focuses on hands-on learning and working to resolve real world situations. (Westminster) In particular, floor managers are taken through a series of role-playing activities. The real world aspect of this part of the training is indispensable. Upper management can see exactly how they might solve a problem and assist them in making positive situations. (DeLollis) Once they are trained, they are given the job of training their guest service and cleaning personnel.They are encouraged to share what they learned. They will be taught how to appeal to and train people with many diff erent learning styles and skills. Guest Services and Cleaning Personnel The employees will be assessed in person and on-line. The cleaning personnel will be trained with hand-on modules and will be evaluated based on an on-site observation. They will work in tandem with an experienced cleaner for the first month of their service. Cleanliness is our top priority, so this is a major area of need. Each six months, employees will attend another training session.The purpose of these follow up sessions are to critique their performance, provide them with new information and acknowledge their successes. At this point in their employment, they are offered incentives for retention. Their service is rewarded. For every additional training session they attend or online training they pursue, they will also receive rewards and incentives that lead to promotion and salary increase. Employee Value Each employee, whether manager or cleaner, is valued. Part of the training is to demonstrate this val ue and to show them their importance. This is done through incentives and awards.(Atkinson) We believe the greater the share they have in the overall success of the hotel, the greater effort they will demonstrate. Along with that value, we also seek to challenge the employees. We feel this increases their sense of worth. We challenge them through task achievement, weekly goals, excellence performance levels, and as mentioned additional training incentives. We give the employees space to succeed. â€Å"Today’s workplace can be highly stressful, and the pace is unlikely to slow down. A key challenge is helping people learn in a highly stressful environment.One way that companies can help is by providing learning opportunities that balance challenge and support. † (Atkinson) The bottom line is that we want our employees to feel how important they are to the overall success of the team. We feel that the more training we provide, the more supported they feel. As employees m ake who we are, the Bellagio always provides opportunities for and expects feedback. We seek to create an environment that encourages open discussion and unfettered communication. In that spirit we have weekly meetings where the employees can voice concerns.For more sensitive issues, there is an online journal employees can fill out and floor managers can answer. (Atkinson) We agree with Starwood resorts that although our buildings are beautiful, it is our people that create an unforgettable experience. â€Å"Our guests value the design of our hotels, but what they really remember are the people. Their loyalty was often to a specific employee who had gone out of their way for them. † (DeLollis) Advantages and Disadvantages The employee training program is one with strength but can always be improved. As well, its goal has to be retention otherwise it is extremely expensive and ineffective.The chart divides each section of the training process and assesses its effectiveness. I t also discusses its disadvantages or areas that we can improve. Our hotel is about service people, thus our employee training is about service. Overall our goals are to ensure continuity, offer fresh and interesting training programs and demonstrate the value of our employees. It is absolutely essential that our managers are empowered to make decision. As well, they should be empowered to show their employees appreciation and recognize their growth and development. Working in this section of the hotel is seen as an accomplishment.In order to maintain that mentality, we must focus our training program on what our employees need rather than what we want them to know. Working with the select clientele that the Bellagio attracts requires devotion and knowledge. This can only be developed through a comprehensive training program that consistently communicates value, growth and the image of the hotel. Works Cited Alejandro, C. â€Å"Employee Training, Incentives Boost Conservation Progr ams. † Energy User News 4 October 1982. Atkinson, Tom. â€Å"Helping Hotel Employees Learn—Without Reservation. † Hotel Executive. 2003 Cummins Communications 2 May 2008.Bellagio Las Vegas. 2008. MGM Mirage. 2 May 2008 (www. bellagio. com). De Lollis, Barbara. â€Å"Hotels Train Employees to Think Fast. † USA Today. 2006 USA Today 2 May 2008 (www. usatoday. com). Duprey, Robert. â€Å"Is eLearning On Your Hotel’s Training Menu? † Hotel Online. Hotel Online 2 May 2008 (www. hote-online. com) Hotel and Motel Management. 2008 Questex Media Group. 2 May 2008 (www. hotelmotel. com). â€Å"Lodging Managers. † Bureau of Labor Statistics. 2007 2 May, 2008 (www. bls. gov). Signature World Wide. 2006 Signature Inc. 1 May 2008 (www. signatureworldwide. com). Yahoo Travel. 2008. Yahoo! Inc. 2 May 2008 (travel. yahoo. com).

The Cold War Between Communism And Communism - 1721 Words

The Cold War The conflict in ideologies between capitalism and communism resulted in one of the greatest conflicts of the twentieth century. The belief that freedom and democracy would die under communist rule caused the United States to start a conflict that would last for decades. The decisions made by the United States in W.W.II caused tensions to rise between the U. S. and the Soviet Union. Fear of Communism in capitalist nations, caused the United states government to use propaganda to raise Cold War anxieties. Furthermore, the American media influenced the attitudes of Americans, making a hatred of communism spread though the nation. Thus, the United States caused the conflict known as the Cold War, through its political policy and propaganda. The political relations going on in Europe during and directly after World War II had an enormous effect on laying the foundation for the Cold War. War time conferences such as Yalta and Terhran harshened the relationship between the communists and th e capitalists. At the end of W.W.II American policy towards the Soviets changed drastically. The change in president in 1945 caused relations with Russia to worsen. Furthermore, other political contributions to the Cold War entailed the Truman Doctrine and the Marshall Plan. The division of Europe between the west and east drew physical borders which outlined that the war of misinformation that had began. Also treaties of the post war world further separated the two super powersShow MoreRelatedThe Cold War Between Communism And Communism1382 Words   |  6 Pagesdemocracy and capitalism. However, Soviet Union, which was the only power that could rival the United States, claimed that communism could make the world more organized and ordered. Both countries hoped to expend their influences around the world, and their confliction generally turned to be a cold war, in other words, a battle between Capitalism and Communism. The cold war coincided with the civil rights movement in the U nited States and had a strong influence on Africa-Americans’ action of pursuingRead MoreThe Cold War : A Battle Between Capitalism And Communism1435 Words   |  6 PagesThe Cold War: A Battle Between Capitalism and Communism The Cold War began not very long after the end of World War II in 1945. Despite the fact that, the Soviet Union was an essential part of the Allied Powers, there was certainly a great amount of distrust between the Soviet Union and what remains of the Allies, specifically the United States. The Allies were worried about Stalin s ruthless leadership and also the spread of communism. The Cold War was a long stretch of tension between the US andRead MoreCommunism : A Great Evil1011 Words   |  5 PagesCommunism is a lot like a bad relationship. It looked good on paper. In regards to the world’s most feared form of government, two things have been historically recurring. First, communism falls when those in power fall victim to the vice of greed. And second, most important to the US-centric concerns of The West, the United States shows a consistent opposition to the ideals of communism. The most notable example of America’s great fear of the perceived evils of communism c an be seen during the 1950sRead MoreThe Cold War Was Inevitable Or Not?1624 Words   |  7 PagesIntroduction To gain a full understanding of the Cold War, the knowledge of the why it started, an in depth analysis of what both sides contributed to make the Cold War what was and knowing whether the Cold War was inevitable or not is necessary. There were many different actions that both of the two major superpowers, the US and the USSR took that started the Cold War. I believe that the Cold War was inevitable because of the difference in ideologies between the US and the USSR, and the large threat theRead MoreThe Cold War : Communism And Capitalism997 Words   |  4 Pages The Cold War When the cold war began, no one thought that it would last as long as it did. Many people thought the war was caused by fighting, and there were some people that thought it was caused by the conflicts of communism and capitalism, so who was right? Well we only know what we read in our history books which says that it was caused by the conflicts of communism and capitalism. Was this the real reason for the cold war? In my essay I will give details about the cold war and tell whyRead MoreThe War Of The Cold War1644 Words   |  7 PagesThe Cold War was a state of political and military tension stemming from World War II fought primarily between the United States and the Soviet Union. Although the start and end dates of the Cold War are frequently disputed over, it is generally accepted that the conflict started at the conclusion of the Second World War and stemmed from the social climate and lingering tensions in Europe and the increasing power struggles between the Soviet Union and the United States. Along with economic separationRead MoreEssay on The Failure of Communism1655 Words   |  7 PagesThe failure of communism Communist had a long history during the 20th century, and communism was very influential. Almost all of Asia and East Europe became Communist. From the start of the theory then many civil wars in Russia affected the whole world. Communist defined the idea of itself in many different ways, it helps many nations came together formed a party fought wars, but it also made many countries became really poor, and the economy in most of the countries got pushed back about 10 yearsRead MoreThe War Of The Cold War Essay1075 Words   |  5 PagesDuring World War II, the United States, Britain, and Russia all worked together to take down Hitler. Although after the war, the coordination between the U.S. and Russia became extremely tense which inevitably lead to the Cold War. The U.S. was worried that Russia would spread communism after World War II. Russia was concerned with the U.S. arms increase and intervention in international affairs. The distrust between the two nations resulted in the Col d war which lasted until 1991. In 1946, WinstonRead MoreWas Korea a Turning Point in the Civil War?716 Words   |  3 Pagesthe Korean War a turning point in the Civil War? The Korean War was thus a turning point in the development of the Cold War in that it marked a shift in the focal point in the development of tensions, from Europe to East Asia, with many indirect conflicts being largely confined to Europe. The Korean War was the first time that communism and capitalism were to fight against each other. It was hence a turning point in the development of the Cold War — instead of tensions developing between the two countriesRead MoreThe Battle Of The Cold War1450 Words   |  6 Pagesideologies between communism and capitalism lead to one of the greatest conflicts of the twentieth century. The concept that freedom and democracy would not survive under communist rule triggered a battle that could endure for decades. American media significantly impacted the attitudes of Americans, creating a hatred of communism to spread throughout the nation. The political relations in Europe, during and directly after World War II, played a large part in l aying the foundation for the Cold War. Wartime

Taking Online College Courses to Earn a Degree

Online college courses can help you earn a degree, improve your resume, or develop a new skill just for fun. If you’re  interested in starting online college courses, this article will help you get started. Taking Online College Courses That Lead to a Degree A growing number of students are taking online college courses to earn their degrees. Some students earn entire degrees online, some transfer traditional college credits to an online program, and some transfer credits from their online college courses to a traditional school. Online college courses are convenient and many can be taken asynchronously, making it possible to be enrolled in a course and engaged in discussions even though you do not need to log on to a website at a specific time. Online college courses in thought-heavy topics (such as English, humanities, math, etc.) tend to be more common than online college courses covering action-specific subjects. If you are interested in taking online college courses that lead to a degree, make sure that the school you’re choosing is properly accredited. Keep in mind that many traditional and online colleges do not easily accept credit transfers. If your plan includes transferring schools at some point, talk to counselors at both schools to make sure that your online college course credits will be approved.   Taking Online College Courses for Professional Development Even if you don’t want to earn an entire degree through the internet, you can take online college courses to improve your resume and develop skills that are valued in the workplace. You may choose to take online college courses ala carte. Or, you may enroll in an online professional development program. Many programs like the  Ã¢â‚¬â€¹Stanford Center for Professional Development allow students to take a sequence of shorter online college courses leading to a professional certificate in a subject like project management, computer security, information technology, or sustainable energy. Check with your workplace or experts in your field to see how a particular online college course will be received in your industry. For example, some computer certification courses that are highly coveted for secretarial work would be considered unnecessary for those employed in a managerial position. Many students are able to take online college courses for free by asking their employers to cover the cost of their tuition. Tuition reimbursement programs are designed for employees that complete coursework or earn degrees related to their position or a position they may qualify for. Even if your employer doesn’t have a formal tuition assistance program in place, he or she may be willing to work with you to subsidize coursework that will help you do better at your job. Taking Online College Courses for Personal Enrichment Online college courses aren’t all about profit and degrees. Many students enroll in online college courses just to learn a skill they are interested in or explore a subject they are curious about. Some schools will allow students to take a class pass/fail so that students do not need to concern themselves with receiving grades. As an alternative to taking online college courses through formal enrollment, you may want to explore many of the free online classes that are now available. Dozens of traditional colleges make their course lectures, assignments, and reading guides openly available to the public as open courseware. By taking free online college courses, you won’t have access to an instructor to help you through the content. Nor will you receive graded feedback. However, you will be able to work at your own pace and learn without paying a dime. There is coursework available on just about every subject, from math to anthropology. Another option is to take advantage of the many free online courses offered outside of the education system altogether. While these aren’t technically â€Å"college† classes, many independent organizations and individuals offer in-depth instruction on a wide variety of topics. For example, Khan Academy provides down-to-earth video lectures on dozens of math topics. Many virtual learners have found these resources easier to understand more than when taking many traditional courses.

A Midsummer Nights Dream Essay - 1482 Words

A Midsummer Night’s Dream: by William Shakespeare William Shakespeare was born in April 1564. He had married at the age of eighteen to a twenty-six year old woman named Anne Hathaway in 1582. He had a daughter named Susanna and twins, Judith and Hamnet. Hamnet, his only son, died at age eleven. Shakespeare died in April 1616. Despite the fact that Shakespeare wrote some thirty-seven plays, owned part of his theatrical company, acted in plays, and retired a relatively wealthy man in the city of his birth, there is much we do not know about him (Jacobus, 167-169). One of the plays that Shakespeare wrote was A Midsummer Night’s Dream. A Midsummer Night’s Dream (1595-1596) is an early comedy and one of Shakespeare’s most beloved†¦show more content†¦The purpose of this essay is to reassess A Midsummer Night’s Dream as a dual-locale comedy, its meaning essentially linked to the dialectical relationship of Theseus’ court to the wood outside Athens. Such a reading brings together Renaissance attitudes to the revivification of classical mythology in the context of Christian neo-platonic doctrine, reinforces our expectations concerning the Shakespearean love ethic which, in the world of the comedies, ideally â€Å"looks not with the eyes but with the mind,† and attains contemporary pungency via its basis in beliefs concerning the power of witchcraft (Ormerod, 39-52). Puck plays a very important role in the play. The philologists long ago discovered the devilish origin of Puck. Puck is simply one of the names for the devil. His name was invoked to frighten women and children, together with the ogre and the incubus (Kott, 107). Puck was supposed to put a spell on Demetrius while he was sleep with love-juice so when he woke up he would fall in love with Helena. It didn’t quite work out that way. Puck had put the love-juice on the wrong person instead. He had cast theShow MoreRelatedA Midsummer Nights Dream772 Words   |  4 Pages In A Midsummer Nights Dream, one of the masterpieces of William Shakespeare, Shakespeare explores various aspects of love and friendship. With the help of the main characters such as Lysander, Demetrious Helena and Hermia, he endeavors that the path of love is full of obstacles, however, if one is committed and faithful, he/she can defy those obstacles leading him/her to success. As Lysander says â€Å"The course of true love never did run smooth†, the love stories presented in the playRead MoreMidsummer Nights Dream1886 Words   |  8 Pagesleads the troupe and plays Prologue Nick Bottom – weaver, plays Pyramus Francis Flute – bellows-mender, plays Thisbe Robin Starveling – tailor, plays Moonshine Tom Snout – tinker, plays Wall Snug – joiner, plays Lion Play Summary A Midsummer Nights Dream opens with Theseus and Hippolyta planning their wedding, which takes place in four days. Theseus is upset because time is moving so slowly, but Hippolyta assures him the four days will quickly pass. Their relationship has not always been soRead MoreUnreality in A Midsummer Nights Dream1693 Words   |  7 PagesUnreality in A Midsummer Nights Dream Shakespeares A Midsummer Nights Dream is a play that encompasses three worlds: the romantic world of the aristocratic lovers, the workday world of the rude mechanicals, and the fairy world of Titania and Oberon. And while all three worlds tangle and intertwine during the course of the play, it is the fairy world that has the greatest impact, for both the lovers and the mechanicals are changed by their brush with the children of Pan. For those whoseRead MoreMidsummer Nights Dream Essay1041 Words   |  5 PagesWilliam Shakespeare’s play A Midsummer Night’s Dream utilizes the technique of multiple characters playing leading roles. The fairy character Puck stands out as a dominant and leading role in the play. Puck is the best fit for the role of the protagonist because he is mischievous and therefore, has the ability to change the outcome of the play through his schemes and actions. As the protagonist, Puck is responsible for creating the major conflict that occurs between the four lovers throughout theRead MoreLove in A Midsummer Night’s Dream1043 Words   |  5 PagesLove in A Midsummer Night’s Dream Throughout the events which unfold in A Midsummer Night’s Dream, Shakespeare delivers several messages on love. Through this play, one of the significant ideas he suggests is that love is blind, often defying logic and overriding other emotions and priorities. Helena loves Demetrius unconditionally and pursues him despite knowing that he loathes her; conflict arises between Helena and Hermia, childhood best friends, over Demetrius and Lysander; and becauseRead MoreMetatheatre in a Midsummer Nights Dream1805 Words   |  8 PagesMETATHEATRE IN A MIDSUMMER NIGHT’S DREAM (SHAKESPEARE). The term metatheatre is used to refer to any instance in which a play draws attention to itself as a play, rather than pretending to be a representation of â€Å"reality.† Various uses of metatheatrical devices can be found in the works of William Shakespeare. One of Shakespeare’s favorite such devices is the â€Å"play-within-a-play.† With this device, the theatre audience finds itself watching an audience (on stage) watching a playRead MoreA Midsummer Nights Dream Essay1790 Words   |  8 Pagesâ€Å"A Midsummer Night’s Dream† Essay â€Å"A Midsummer Night’s Dream†, one of Shakespeare’s most beloved comedies, is generally thought of as a comical romance. A very important factor that makes the whole play a comedy, is magic, which is used to affect the lives of four Athenians: Hermia, Lysander, Helena and Demetrius. Bottom, also a simple human, falls victim of the fairies’ mischievous magic. The magic reaches these characters by Puck, a naughty fairy, and Oberon, the king of fairies. PuckRead MoreA Midsummer Nights Dream and Scene1024 Words   |  5 PagesA Midsummer Night’s Dream Study Questions ACT I, SCENE I - Due Date ____________________ 1. How is Hippolyta’s reasoning concerning how quickly the next four days will pass different from that of Theseus? 2. Why has Egeus brought his daughter and her two suitors to Theseus? What does Egeus expect him to do? 3. What was the proper role for women/daughters in Athenian society according to Egeus and Theseus? 4. What is Theseus’s ruling concerning Hermia? 5. How does Lysander’s comment about Demetrius’sRead MoreA Midsummer Nights Dream1121 Words   |  5 Pagesarranged by parents for financial support. Shakespeare, however, wrote about couples who choose each other and love in preference to money and social status. They prove their love through crazy antics and tender loving words. In A Midsummer Nights Dream right from the begining we see the romance and drama unfold with the characters Lysander and Hermia, both madly in love but both threatened during the pursuit of their love. Hermia is told by her father not to marry Lysander but to marry DemetriusRead MoreThe Power of Magic in A Midsummer Night’s Dream1475 Words   |  6 Pages In William Shakespeare’s book, A Midsummer Night’s Dream, magic is a powerful and useful tool for the characters that have the capability to use it. Some of the characters abuse the power of magic, while others are more responsible in how they use it. Oberon is one the characters that abuses the power of magic. Oberon’s magic has an immense impact on the plot of A Midsummer Night’s Dream. More specifically, Oberon’s magic affects his own life, the lives of other characters, and all the characters

Management Competencies Free Essays

Management Competencies – Experience of a Healthcare Manager Context Health care organisations in New Zealand today face similar challenges to those in other highly developed countries (1, 2). With growing aging populations and increasing burden of chronic illnesses the demand for publically funded health and disabilities services continues to grow significantly (1). This increase in need coupled with the advancements in technology has driven the costs of providing publically funded healthcare services to unsustainable high levels (1, 2). We will write a custom essay sample on Management Competencies or any similar topic only for you Order Now Public spending on healthcare has continued to rise at the rate of 6% per year over the last decade with 21% of share of public spending being on health in 2010 (2, 3). In a background of the global economic crisis, District Health Boards (DHBs) who are charged with the provision of publically funded health and disability services are increasingly having to re-engineer their systems and services to provide value in financially constraint environments (2). While this at a systems level may mean taking a â€Å"whole of systems† approach with integrated service models (2), at the unit-specific services level it also includes focused attention on productivity, quality, waste reduction and safety. Key Competencies of the Service Manager Management competence is an important determinant of healthcare organisational performance (5). Competence is an individual’s knowledge, skills and behaviours relevant to their practice and performance (6, 7). Evidence from the Management Matter Research Project indicates that â€Å"higher management practice in hospitals is strongly correlated with hospitals’ quality of patient care and productivity outcomes† (8). It reported that improved management practice in hospitals were related to better clinical outcomes, increased patient satisfaction and better financial performance (8). The management role focused in this case is the service manager, a middle management role responsible for the strategic development and deliverables of the health service. The role is also accountable for the operational budget and management of staff. This paper explores the experience of the service manager challenged with transforming the health service from a dysfunctional average performing unit to a high performing, progressive and highly respected and valued service. It discusses the competencies of effective management with some reflection by the health service manager on the management approach utilised. Given the challenges of improving performance and developing a highly functional team, the service manager utilised the influential model of leadership style over the traditional reactive and transactional style as the predominant style of management (9, 10). This included engaging the workforce in developing a common vision for the service with clear objectives (11). In order to ensure the service goals were aligned with the organisational goals, an important characteristic of the service manager during this process was having a good understanding of the changing healthcare environment and the organisational priorities (11, 12, 13). Critical to achieving change and success was also his ability to work with staff to collectively determine and communicate the â€Å"Why†, â€Å"What†, â€Å"How†, â€Å"Who† and â€Å"When† elements of managing change. Regular reinforcement of both the positive and negative implications of the situation as well as setting mutually agreed expectations were also important to achieving change (11). This transformational style of management was also instrumental in gaining confidence and trust of staff in order to manage the workforce culture issues of mistrust, low morale and dissatisfaction largely resultant from historical experiences. The evidence for efficacy of this style and the associated competencies has been demonstrated by 2 studies reporting that transformational leader behaviour has significant positive impact on employee satisfaction and psychological well-being (14, 15). Additional leader/manager behaviours required and demonstrated by the service manager were those that focused on individualised consideration including; creating close working relationships which encourage mutual respect, empowering and including employees in decision making, creating opportunities for employee development through coaching and mentoring and team building (16). The benefits of these behaviours are evidenced in other leadership theories including behavioural (consideration behaviours) approach and leader-member exchange theory (11, 14, 17, 18, 19). Followership and early recognition of the relationship dynamics of a team are also key elements to effective management. Working closely with followers and those with team influential ability is useful when change is likely to be difficult or experience high levels of resistance (11). The use of a collective approach to resolving a problem and delegating the ownership of solution creation to a staff member with high peer influential ability results in achievement of objectives. The ability of the service manager to move appropriately between directive and participatory type management styles was also important in certain situations (11, 19). This was particularly useful for implementing workplace behavioural expectations like punctuality and managing disrespectful behaviours. A key competency for healthcare manager effectiveness relevant to the management style illustrated above is emotional intelligence (EI) (20). Essentially, this competency recognises the â€Å"importance of highly developed interpersonal skills and the ability to get along with others† to be effective at influencing and negotiating (20). The key attributes of a manager with high EI include self-awareness, self regulation, self motivation, social awareness and social skills (20). A summary of the key management competencies relevant to the management style described here is illustrated by the matrix diagram below (Figure 1) (12, 13). In summary, management styles in healthcare that are based upon the principles of transformational and behavioural leadership and utilise the respective competencies are likely to be more successful. Furthermore, while there are specific skills, behaviours and knowledge that describe the key competency domains, their use in practice is interrelated (see Figure 1) and often context-specific. [pic] References 1. The Global Health Policy Summit 2012. Report of the inaugural meeting 1 August 2012. Institute of Global Health Innovation. London: Imperial College London (UK); 2012. https://workspace. imperial. ac. k/global-health-innovation/Public/GHPS_2012_Summit_Report. pdfs 2. Mays N. Reorienting the New Zealand healthcare system to meet the challenge of long term conditions in a fiscally constraint environment. Jan 2013 (revised version). Paper prepared for New Zealand Treasury Long-term Fiscal External Panel, November 2012, and Chair of Public Finance, Victoria University of Wellington and New Zealand Treasury conference, Affording our Future, Wellington, 10-11 December. http://www. victoria. ac. nz/sacl/about/cpf/publications/pdfs/Nick-Mays-Revised-Conference-Paper-Jan-2013-website-version. pdf 3. Ministry of Health. Health Expenditure trends in New Zealand 2000-2010. Aug 2012. http://www. health. govt. nz/publication/health-expenditure-trends-new-zealand-2000-2010 4. 5. Fine, D. Establishing Competencies for Healthcare Managers. Healthcare Executive. 2002; 172(2): 66-67. (Cited by: Shewchuk R M. O’Connor S, Fine D. Building an Understanding of the Competencies Needed for Health Administration Practice. Journal of Health Care Management. 2005; 50(1):32-47). 6. Filerman GL. Closing the management competence gap. Hum Resource Health. 2003; 1: 7. (Cited by: Santric MM, Bjegovic-Mikanovic VM, Terzic-Supic ZJ, Vasic V. Competencies gap of management teams in primary health care. Euro J Pub Health. 2010; 21(2): 247-253). 7. Parry SB. Just what is a competency? And why should you care? Training. 1998: 58-64. (Cited by: Santric MM, Bjegovic-Mikanovic VM, Terzic-Supic ZJ, Vasic V. Competencies gap of management teams in primary health care. Euro J Pub Health. 2010; 21(2): 247-253). 8. Dorgan S, Layton D, Bloom N, Homkes R, Sadu R, Van Reenen J. Management matters. Why good practice really matters. Healthcare Management Survey. McKinsey Company. London School of Economics and Political Science. 2010: 1-28. ttp://cep. lse. ac. uk/textonly/_new/research/productivity/management/PDF/Management_in_Healthcare_Report. pdf 9. Rubin RS, Munz DC, Bommer WH. Leading form within: The effects of emotion recognition and personality on transformational leadership behaviour. Academy of Management Journal. 2005; 48: 845-858. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing st ress at work. Identifying and developing the management behaviours necessary to implement the HSE management standards. Phase 2. 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf ) 10. Bass BM.. Two decades of research and development in transformational leadership. European Journal of Work and Organizational Psychology. 1999; 8: 9-32. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work. Identifying and developing the management behaviours necessary to implement the HSE management standards. Phase 2. 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf ) 11. Banaszak-Holl J, Nembhard I, Taylor L, Bradley E . Leadership and Management: A Framework for Action. Chapter 2. In: Burns LB, Bradley EH, Weiner BJ (editors). Shortell and Kaluzny’s Health Care Management Organisation Design and Behaviour. New York: Delmar Cenage; 2012. p. 33-62. 12. Stefl M. Common competencies for all healthcare managers: The Healthcare Leadership Alliance Model. J Healthcare Management. 2008; 53(6): 360-73. 13. Anderson P, Pulich M. Managerial competencies necessary in today’s dynamic health care environment. Health Care Manager. 2002; 21(2): 1–11. 14. Sosik JJ, Godshalk VM.. Leadership styles, mentoring functions received, and job related stress: A conceptual model and preliminary study. Journal of Organizational Behaviour. 000; 21: 365-390. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work. Identifying and developing the management behaviours necessary to implement the HSE management standards. Phase 2. 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf ). 15. AlimoMetcalfe B, AlbanMetcalfe RJ. The development of a new transformationa l leadership questionnaire. The Journal of Occupational Organizational Psychology. 2001: 74: 1-27. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work. Identifying and developing the management behaviours necessary to implement the HSE management standards. Phase 2. 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf ). 16. Shewchuk RM, O’Connor S, Fine D. Building an Understanding of the Competencies Needed for Health Administration Practice. Journal of Health Care Management. 2005; 50(1):32-47. 17. Gerstner CR, Day DV. Meta-analytic review of leader-member exchange theory: correlates and construct issues. Journal of Applied Psychology. 1997: 82; 827-844. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work. Identifying and developing the management behaviours necessary to implement the HSE management standards. Phase 2. 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf ). 18. Graen GB, UhlBien M. Relationship based approach to leadership: Development of leader-member exchange theory of leadership over 25 years: Applying a multi domain perspective. Leadership Quarterly. 1995; 6: 219-247. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work. Identifying and developing the management behaviours necessary to implement the HSE management standards. Phase 2: 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf). 19. Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work. Identifying and developing the management behaviours necessary to implement the HSE management standards. Phase 2. 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf ) 20. Freshman B, Rubino L. Emotional Intelligence: A core competency for health care administrators. Health Care Manager 2002 20(4): 1- 9. ———————– Figure 1: Key Management Competencies for a HealthCare Manager How to cite Management Competencies, Papers

Bean Trees Essay free essay sample

Most authors convey an important message or idea throughout their novels to give a greater understanding to their readers. In Barbara Kingfishers novel, The Bean Trees, a strong idea that was developed was the possibility of new beginnings. The Bean Trees is the story of the protagonist Taylor Greer, who starts off on a journey from her home town of Kentucky to Arizona. Along the way she she Is given an abandoned child which is the start to her learning about motherhood, becoming a women, the power of friendships and also learns to be capable.The Idea of new singings Is the ability for characters to start over and leave their past behind them. It was mainly developed through Taylor, Turtle, and also a Guatemalan couple Stefan and Separates. The first person who helped develop this Idea Is Taylor. At the beginning of the story Taylor was called Marietta before she decided that she wanted to have a clean break because she had never been crazy about the names which she had been called previously. We will write a custom essay sample on Bean Trees Essay or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page I didnt have any special name In mind, but lust wanted a change this fitted into the theme of new beginnings because she was palpable of leaving behind her old life and things that surrounded her name and had the opportunity to have the chance to create a new destiny for herself. As well as giving herself another chance to start her life and live it the way that she wanted through the changing of her name she also left her home town, house, friends, and mother all in search of somewhere new to live her life. She used chance to decide where she was going to stop with the use of her car.Wherever it ran out of fuel or something happened to it, she would stop there. With the ambition of leaving her old Kentucky life behind her, she started a Journey which led her to Oklahoma. This just happened to be the place where she was given an abandoned child. This was another new beginning for Taylor. Can you talk?. .. What am I supposed to do with you tonight? What do you eat?.. . This series of questions that Taylor asked the abandoned child showed that she had absolutely no idea what she was doing and still had to learn the first steps of becoming a mother.It was a new beginning for her to take on responsibility for someone else. She had to grow, learn and understand in order to take care of the child that she had suddenly gained to take on her journey. She may not have understood what to do or how to do it, or even truly wanted this new beginning, but all in all she was given the chance. Kingfisher suggests through the use of Taylor that often life presents us with unexpected occurrences, but If grasped correctly can lead to a possible great change, and therefore future.Through the use of Taylor as a character Kingfisher helps to show us that around the corner, In every situation, If something as small as a car Journey, can lead to amazing opportunities to start afresh In our lives. Turtle Is another character that helps develop Kingfishers Idea of new beginnings. Turtle Is an abandoned 3 year old Indian child, who was abused when she was younger. After her mother died she was left to an unexpected Taylor who was just someone passing through the town, but turned into the receiver off child who she had no clue what to do with.On later inspection of the child which she named Turtle she noticed that her body was covered in ;bruises and worse as Taylor said. When Taylor realized that turtle was a could not imagine. Through this you can picture Just how horrible the life this young child must have had. However this was the end of her bad story and the beginning to a new one. Just like Taylor she is given a new name, but also a new mother, new friends, and a new chance. With the opportunity Turtle is now able to grow. Turtle had managed to get through her whole life without a book, I suppose, and then she had two of them bought for her in one day. This quote shows the beginning if Turtles chance of recovery. She was a 3 year old stuck in an 18 month old body. She was a child with a horrible past, but a chance to start over. The development of Turtle made you understand that the majority of people are at some point given the ability to have a new beginning, no matter how terrible their life was before hand. Stefan and Separates are a Guatemalan couple who are also given the opportunity to have a new beginning and therefore helped develop the idea of new beginnings. Stefan and Separates are people who are illegally living in Tucson. Separates and Stefan live in Mattes sanctuary that she has set up for people like them. After becoming good friends with Taylor they decide that they need to move on from Tucson and instantly running from the law. With Taylor and Turtle they set off to go to a safe house in Oklahoma. They were considered illegal and needed to be taken out of the country. However there should not be people Judged as legal or illegal. There is only a difference between people who are good or bad. Because of this they are taken to a safe house where they are unlikely to be taken away. Instead of focusing on the negative once at the church Stefan says dont think of us stuck here forever. Think of us back in Guatemala with our families. His optimism in their new ability to have a lean break and go back to their home country showed the idea of new beginnings in a different light. It'[s not always physically being somewhere that gives people their new beginnings.Sometimes it is Just a chance that makes believing in what was, or what could be, possible again. This is how Stefan and Separates helped doodle new beginnings as an idea in the novel. In conclusion, everyone has a chance at a new beginning, whether big or small. Three different sets of characters showed this throughout the novel The Bean Trees. Taylor helped the idea become present in the Tory as well as develop in as not only the physical actions that allow the new beginning to happen, but also a state of mind.Turtle developed the idea so that it showed the readers that Just because someones life starts out badly, it doesnt mean their opportunity to have a new beginning wont come along. Stefan and Separates developed the idea so that you realized sometimes all that you need is faith to have the chance at a new beginning. In the end new beginnings was an idea that many characters showed their their own stories and therefore developed into their own way of showing the idea and allowing readers to understand it.