Wednesday, July 31, 2019

Promote Positive Behaviour Essay

In this assignment I am going to explain my understanding about, legislation, frameworks, codes of practice and policies relate to positive behaviour support. Understand the context and use of proactive and reactive strategies. Be able to promote positive Behaviour Be able to Respond Appropriately to Incidents of Challenging Behaviour. People with learning disabilities show behaviours which present a significant challenge for those caring for them. Such behaviours may include aggression, destructive behaviours or self-harm. Individuals with more severe disabilities and those with additional disabilities such as sensory impairment’s and communication disorders are more likely to demonstrate challenging behaviour. Many forms of challenging behaviour are thought of as being functional and adaptive responses to challenging situations, in that they serve as a way of communication with the people with whom they interact (e.g. stopping unwanted attention, attracting attention or attempting to explain they are experiencing pain). Some forms of challenging behaviour may be linked to mental health problems, such as depression. The most important way in the reduction of challenging behaviour is for the individual to have a thorough assessment to find out the function of the behaviour. This is known as a functional behavioural assessment and is used to create an individual’s support plan. Positive behaviour support aims to teach the individual new behaviours and enable them to achieve what they want to achieve. Understand how legislation, frameworks, codes of practice and policies relate to positive behaviour support. In all aspects of my role I am regulated by my company’s policies and government legislation. The human rights act 1998, the disabled person act 1986, disability and discrimination act 1996, Health and safety at work act 1974, the equality act 2010. I have been trained in Mandatory courses, for example protecting vulnerable adults(safeguarding) Strategies for Crisis intervention and pr evention (S.C.I.P) Autism Awareness, and working safely, making sure I understand the legal policies put in place to provide the best care for the people who I support. S.C.I.P focuses on positive techniques and how to deescalate behaviour. Read more:  Essay About Promote Positive Behaviour This allows staff to be consistent in their approach when dealing with challenging behaviour. By following the S.C.I.P policy I am able to  reinforce positive behaviour and good skills in listening and learning as well as helping the individuals that I support feel safe and secure knowing that I am able to deal with their behaviours if they occur. Restrictive interventions are defined as any method which restricts the movement of an individual by physical means, including mechanical means (using straps) physical (holding) chemical restraint (using drugs). For example I support an individual who is prescribed medication (Lorazepam) by his physiatrist, to be used when he starts to become agitated. This is given to the customer as a last resort, when we have explored all other options for example is he in pain? Restrictive interventions should only be used as a matter of urgency to prevent imminent and serious harm to the individual or other people, be used in the best interests of th e person with learning disabilities, and only used alongside other strategies to help people learn to behave in non-challenging ways. Interventions need to be used in a context of a risk assessment. Incidents should be investigated and followed up, ensuring staff and customers get sufficient post-intervention support, risk assessments should be reviewed regularly to identify factors contributing to incidents, and associated action must be taken, to reduce those risks. Planned interventions should be agreed in advance at a multi-disciplinary meeting by relevant professionals working in consultation with the customer, his or her carers, and an independent advocate if appropriate. They should be implemented under the supervision of an identified member of staff who has relevant qualifications, training and experience and recorded in writing, so that the method of intervention and the circumstances when its use has been agreed are clearly understood. Behaviour support plans should be routinely reviewed by having team meetings, support plan reviews and risk assessment reviews. If it is agreed that a customer will require some form of intervention, there must be an up-to-date copy of a written protocol included in the person’s individual support plan and staff should be regularly trained and receive updates regarding an individual’s behaviour support plan because there may be a change in how to support a customer. The use of a restrictive intervention, whether planned or unplanned (emergency) must always be recorded. In the day centre where I work the policy and procedures are to inform the manager on duty who will usually provide support for the customer  involved as well as other customers in the centre, ensuring they are all safe. Offer staff support making sure an independent person checks for injuries and records them. The member of staff involved in using a restrictive intervention should: Record the incident, completing an incident report form, star chart and RIDDOR (Report of suspicious Diseases or Dangerous Occurrences) form. Record the incident in the individual’s logs. Inform carers/ family members. Have a post incident meeting with Manager and the staff involved. Make referrals to specialist services for example Derby City, Proactive S.C.I.P Instructors. Inform the customer’s Social worker/ care manager. Before intervening, the member of staff should ask themselves, is there another way to manage the situation and ensure everyone’s safety? If a person has to use intervention they should do it in the least restrictive way possible to prevent the individual from being hurt and all other options have been explored. A restrictive intervention can feel very intimidating to a vulnerable person who is unable to control themselves. By not exploring other options first, there is a risk that the situation can escalate, causing more damage. For example I support a customer who will be happily smiling, singing and interacting with people, her facial expressions and body language will suddenly change. She will begin to spit, hit out, stand up and try to kick other individuals or damage objects. The individual displayed these behaviours to a member of staff who was supporting her. The member of staff did not explore other options first or follow her behaviour support plan and used a restrictive intervention to deal with her negative behaviour. The situation escalated and the customer became more anxious, damaged property and the staff member became injured. In my opinion if the member of staff had followed the customer’s guidelines and offered calmness, communication and distraction, the incident may not have escalated. We must also use minimum intervention to encourage the customers to trust individuals who are supporting them this helps to form positive relationships with each other and also staff will not be feared. Understand the context and use of proactive and reactive strategies. The difference between proactive and reactive strategies is that proactive  strategies are put into place to avoid any problematic or foreseeable situations and a reactive strategy is a response to a situation that has already happened. In my own work role the reactive strategies that are used are based on the results of an individual’s functional behaviour assessment and the support put into place. Everyone involved in an individual’s care should be involved in creating the behaviour support plan this should include writing a description of the behaviours and working out a reason for the behaviours. Proactive Strategies are used to make sure that the person has got what they need. They also describe ways to teach the person communication and other skills. Examples of proactive strategies that I use include: Teaching the individual skills for example Makaton signs for â€Å"finished† â€Å"Thank you† â€Å"Good† Using communication charts with sig ns, symbols or pictures which also outlines the routine for that day. The environment for example dims the lights, tying hair back to stop the individual from pulling hair. Rewards Routine and Structure Boundaries Giving the individual access to preferred activities Making sure that a person’s cultural and religious needs are being met Reactive strategies are designed to keep the individual and those around them safe. Examples that I use include: I don’t respond to the behaviour, if you ignore the behaviour sometimes it stops as the individual wants a reaction I give the individual reminders I distract the individual, by offering a different activity I give the individual what they want for example a drink or a biscuit Ask the Individual if they are in feeling ill or they are in pain. Remove myself from the situation for example leave the room, making sure I am still supporting the customer from a safe distance. Ask another member of staff if they will assist the customer as sometimes another person can be more productive. The importance of identifying patterns of behaviour or triggers that will result in challenging behaviour is that early warning signs can be spotted and acted upon before the behaviour happens or escalates. Factors that can lead to mood changes include: Body Temperature, is the customer too  hot, too cold. Over sensory stimulation Lack of choice, boredom, Limited communication or understanding Over stimulation through noise A general disruption to a customer’s routine Overcrowding? For example are there too many people in one activity for the customer to be able to cope with. Provocation by other people, for example if a customer is showing signs of disruption they need to be removed from the situation before it escalates. The importance of maintaining a person centred approach when establishing proactive strategies is that challenging behaviours are an individual thing, the causes and triggers differ according to each individual, as do their reactions and degree of severity. I therefore feel it is important when planning strategies for dealing with challenging behaviour that we ensure they are just as individual as the triggers. No two people will respond in the same way to established strategies. In my own experience, a one size fits all approach does not work and does not show the ability to adapt and respond. By responding to customers behaviours in different ways to each other not only shows that we can identify and recognise each individuals strengths and incorporate them into the strategies planned for that individual, it also tells the individual that you are supporting that they have value and worth and no matter how challenging their behaviour may be, there is always something positive to build on. Reinforcing positive behaviour with individuals can improve their behaviour. Positive reinforcement is a powerful and effective way to help shape and change behaviour. Positive reinforcement works by presenting a motivating item to the individual after the desired behaviour is shown, making the behaviour more likely to happen in the future. When I am supporting customers i praise them using speech and Makaton, for example when an individual has washed their hands, put their dirty dinner plates on the trolley, thrown something in the bin, put an item away they have been using in an activity. I use praise â€Å"Thank you†, â€Å"please†, â€Å"well done† which is effective when reinforcing positive behaviour. Using an incentive also works in reinforcing positive behaviour, for example a customer who i  support likes football and cricket. When the customer shows positive behaviour he will get a trip out to the cricket ground to watch a match and have his packed lu nch there, or to the football ground to have a cup of tea and a cake. Using reactive strategies can have an impact on an individual’s wellbeing. For example i support customers who display challenging behaviour’s. A previous manager asked one of my colleagues and me to assist a customer to go out for a walk. The customer is extremely afraid of dogs he will scream and run when he sees one. This is because he was bitten by a dog when he went on holiday to India. Whilst we were out walking, the customer saw a dog in the distance and began to scream and run towards a busy main road. Both my colleague and I ran after the customer shouting â€Å"stop†. When we managed to catch up with the customer we had to restrain the customer using S.C.I.P (strategies for crisis intervention and prevention) because the customer was in danger of running into the road and getting hurt or even killed. The customer was very upset; he was shaking, sweating, crying, and screaming. When we got back into the centre the customer was upset and angry for the rest of the day. He displayed the need for more sensory stimulation by rocking back and forth and flapping his hands. The customer became very vocal and began making loud noises, (which had an effect on other customers) he also began to barge into other people. This in itself is not being proactive as we did not explore other options first or even prepare the customer for going out for a walk. What I feel should have happened is photographs of dogs should have been used and pat dog should have been brought into the centre(as it is a safe environment) on numerous occasions to begin the process of helping the customer to overcome his phobia of dogs. This had an effect on the customer’s wellbeing because he would not get out of bed in the morning and would refuse to come into the centre. He would not eat his food and if he saw a dog through the window he would scream. In my opinion, we put the customer through unnecessary anxiety and stress. Be able to promote positive behaviour. There are a range of factors that may be associated with challenging behaviours these Include: Illness, Pain, Medication, The need for sensory stimulation or sensory overload Seeking interaction, Staff not working consistently, Staff not following customer guidelines, Communication difficulties, Past experiences that have happened to the individual, The environment being too hot or too cold, Boredom Lack of boundaries or goals, Mental and physical health, Bereavement! Phobia The goal of using proactive strategies on mitigating challenging behaviours is to reduce the future probability of the behaviour. It helps if proactive strategies are identified when supporting customers who display challenging behaviours. Risk Assessments means evaluating the consequences and likelihood of challenging behaviour, it identifies measures to help avoid, mitigate or control the risks. The risk assessment should take into account of personal, environmental or situational factors which increase the likelihood of challenging behaviours. To reduce risks associated with challenging behaviour we need to identify the emotional, physical and psychological needs of the customer. Dignity and respect is important and where possible a customer should have choices concerning their care. A strategy for reducing risks also requires communication between staff to form an understanding of an individual’s behaviour and what they need to do to prevent the behaviours. Other services, family/carers should also be involved in discussions and decision making. A crucial part of managing risk is to understand the reasons for the behaviour so that strategies can be put into place for example: What is causing the distress? What are we doing that is leading to the distress? What can we do differently? It is important to highlight praise when supporting customers so that we can reinforce positive behaviour. I feel it is important to offer praise to a  customer I am supporting, immediately after they have demonstrated a skill, this will hopefully learn to make an association between the skill and the reward which means the customer will start to use the skill more often. For example a customer who I support is very impatient and does not like to wait. The individual has to share a toilet with other customers. In the past when another customer is using the toilet, the individual has kicked the toilet door and started pulling on the handle; she would scream and try to attack the other customer when they have come out. In the individuals behaviour support plan it is highlighted how to support the customer if the situation arises. The protocol is, if another customer is using the toilet ask K to wait using speech, Makaton and picture signs explain what is happening and why. Keep reminding K and also use praise.† Well done K for waiting†. K will smile and wait patiently. This has and is working well and has created positive reinforcement as K will now stand away from the door and say â€Å"wait† without being reminded or prompted. It is still important to praise K and not become too complacent because of the risk that K can become challenging again in this situation and regress. It is essential that everyone working with challenging behaviour develop a general understanding of promoting positive behaviour. In my opinion a consistent and proactive approach should be followed rather than reacting negatively to situations. Strategies should be in place that allows us to work positively with individuals and focus on their achievements rather than highlighting their inappropriate behaviour. Staff communicating with each other and sharing ideas and information is vital. In our centre we have daily half hour team briefings where we can discuss the events of the day. The meetings are also used to discuss all customers we have been supporting whether they have had a good day or bad day. Have there been any incidents that have happened, any new information about a customer? Have Colleagues had a good day? We share information and ideas about working with individual customers and share what worked and what didn’t work when dealing with challenging behaviour. I key work a customer who displays challenging behaviour, he will shout, swear, bang his fists on the table, threaten to smash a window and threaten to hit a person. This is usually when he has dropped an item on the floor and been asked to pick it up, or he is not feeling very well, there is too much noise, something has happened at home or on the bus that morning. The  individual has got a behaviour support plan which I ask staff to read and sign which enables everyone to understand his guidelines on how to support him. I have monthly meetings so that we can share ideas, information, what’s working/ not working. Is there any new behaviour or any behaviour that have resurfaced? What can we do better? We discuss activities that the customer appears to like and dislike. It is important for colleagues to support each other when a customer is displaying challenging behaviour. Where possible I ask my colleague if they need any assistance or time out for me to take over, especially if they have been injured by the customer. Blaming the member of staff is not helpful or constructive for example I have witnessed colleagues in the past say â€Å"he doesn’t behave like that when he is supported by me, what they have done to make him like that?† We must all share our experiences, skills, knowledge, thoughts and ideas with each other . How can we promote positive behaviour with our customers if we do not promote it within our staff team? Be able to respond appropriately to incidents of challenging behaviour Challenging behaviour shows there is some need being unfulfilled or a problem with communication. Behaviour is challenging if it causes harm to the individual or others. There are different types of challenging behaviour these include: Spitting, self-harm, aggression (physical, verbal, mental, emotional) destruction (breaking furniture, tearing things up) Shouting, swearing, biting self and others, eating inedible objects, smearing faeces, soiling and urinating in odd places, stripping clothes off, eye poking, hand biting, pulling own hair and others, hitting others and self, Threatening or hitting others with objects, inappropriate sexualised behaviour, destruction of clothing. An appropriate response to challenging behaviour depends on the type of behaviour that is being exhibited by the individual. My opinion on the response to this behaviour should be consistent, fair, so not to cause any further disruption to a group session or the individual, thus calming the situation and the customer using this behaviour. A proactive response is likely to be more effective than one that is merely reactive. When responding to incidents of challenging behaviour it is important to ensure that an individual’s behaviour support plan is followed as no two people are the same. A behaviour support plan describes situations that an individual finds difficult and what others can do to help them cope with distress. They are a  very useful way of encouraging staff supporting the person to respond consistently. The plan should include Strategies to encourage staff to respond to the first signs of distress and resolve issues before they escalate. This helps to ensure that the least restrictive interventions are being used and the strategies being used are in proportion to the level of risk. The behaviour plan should include: Triggers –What can cause the individual distress? In Specific situations, places, activities, changes, sensory issues (noise, touch, smell?) Proactive strategies – How can staff support the person to cope with these triggers? Early warning signs- How do we know the person is becoming distressed? Are the First signs- body language, facial expression, language, behaviours, and tone of voice? What can help the individual calmer at this time? Medium intensity behaviours – What might the individual do at this stage? Are there Specific behaviours and who might be at risk? What should staff do at this time? Things we can do to prevent the situation from getting worse. What can staff do to ensure everyone is safe? High intensity behaviours – What might the individual do at this stage? Are there specific behaviours? How long they may last and who is at risk What should staff do at this time? What can staff do to ensure everyone is safe? Often the best course of action is to withdraw and leave the customer in a safe area to calm down on their own (But this may not be the case for some individuals) When responding to an incident of challenging behaviour it is important to ensure a customer’s dignity and respect are maintained. Try to speak in a calm and clear voice using language that the individual understands this could be in the form of signs and symbols, makaton, photographs. Speak calmly, quietly and as sertively Avoid threatening body postures such as standing in front or above the individual Avoid what may be classed as threatening gestures such as pointing or waving, arms folded across the body. Avoid threatening facial expressions. Avoid shouting or raising your voice. Avoid giving orders or continually repeating requests. Try to disperse any audience. Ask the individual if they would like to go into a quieter area if possible. Consider adopting a posture which reduces your size (sitting, crouching and moving away) Be aware of gender, cultural difference. Avoid belittling and talking to others negatively about the customer. Avoid forcing compliance. Actively listen to the customer and respect their wishes and feelings. Avoid unnecessary physical contact.  Following an incident of challenging behaviour by an individual it should be recorded in their personal file. A detailed written log must be written which should be dated, timed and signed by the member of staff. An incident report form and star chart must be completed. On the star chart we use the A.B.C approach (Antecedent, Behaviour, and Consequence.) Antecedent – What occurs before the behaviour and what may have triggered it. The antecedents are all the relevant things that happened before the behaviour occurred. They can also be considered as triggers for the behaviour such as, things that other people said, emotional state (depressed, tired, anxious.) The environment (is it too hot or noisy cramped, smell, bright lights?) Behaviour –What happens during the behaviour, what does it look like? Consequences – What are the immediate and delayed reactions from everyone involved? Consequences can be pleasant or unpleasant. A pleasant consequence will reinforce the behaviour. (When I yell, everyone gives me what I want)While a negative consequence will discourage behaviour (When I yell everyone ignores me completely) a consistent response from everyone to challenging behaviour can have a very strong effect. Parents/carers are also informed via a customer’s communication book at the end of each day or telephoned. Staff are involved in a team briefing, daily, to be kept informed of any concerns or incidents. In our centre we also have a traffic light system, using laminated cards, they inform people to be cautious or take action. Green- No concerns Amber-Be aware Red- There has been a Serious Incident. A manager is informed whenever the cards are on amber or red. Be able to support individuals and others following an incident of challenging behaviour. I had an incident of challenging behaviour from a male customer who I support on a one to one basis. B is prescribed P.R.N medication by his GP for when necessary, these being Paracetamol for pain and discomfort and Lorazepam for anxiety. B is known to become very agitated and anxious and will slap others very hard without warning. B has his breakfast at the centre each morning when he arrives, as I was preparing his breakfast B became very agitated and anxious slapping me very hard on my arm. After following B’s behaviour support plan and exploring all of the options listed, I asked B if he was in pain offering him Paracetamol if he needed it but he shook his head as a negative. Cooling him down by removing his sweater I offered sensory consisting of a weighted blanket and calm relaxing music. None of the above options worked so B was given Lorazepam as a last resort resulting in B’s behaviour improving over time. I also used the traffic light system, as stated earlier in this assignment. To Support an individual to return to a calm state: Use Reassurance and Praise. Provide whatever support that is needed; give individual some space if that is what they want. Behave in a non-judgemental way, even if you might not feel like that. Don’t discuss the behaviour with the individual at this point, unless they want to. Support the customer to continue to recover and calm down. I key work a male customer and support him to access his choice of activities. S enjoys going outside in the garden to feed the birds. As part of the activity S and myself make a flask of tea, sit in a poly tunnel looking at bird magazines before we venture out to feed them. I was asked to support another customer (M) at the same time, as we were short staffed and to involve him in the activity. I explained to S that M would be joining us. S was not happy with this and became very distressed, he started to swear, bang on the table using his fist and bite on his own arm. The staff that should have been supporting M had changed the routine for that day and decided to support two other customers in taking them out in a car. I tried  to calm the situation down by speaking calmly and quietly to S reassuring him that it was just for that day. S continued to display the same behaviours and would not join in the activity, beginning to cry and shout† I don’t want to do it with M I want you to do it† I continued to reassure S who by this time was threatening to hit me. Another member of staff came to my assistance, supported M whilst I continued to support S. S stopped the behaviour and became very quiet with his head down. When I felt S was calm enough for us to be able to talk about the situation together he began to cry saying he wanted the activity to be just Himself and I. I reassured S, in future, the activity would be himself and either I or another member of staff. I asked S if he still wanted to do the activity, he replied â€Å"NO† When S becomes agitated and upset he will refuse to take part in one of his activities and will realise later on in the day that he has missed out. After the incident S became very withdrawn, appeared sad, would not engage in conversation, sat with his head down and would cry throughout the day. After the incident not only did S show complex feelings both M and I also felt different emotions. M became withdrawn, would not engage in conversation or activities, eat his lunch or enter a room S was in, and a lso wanted to be on his own, appearing anxious and frightened. I asked M if he wanted to talk to me or another member of staff about his feelings but he declined. I had a release of adrenaline my heart was racing; body was shaking, I felt angry frustrated, fearful, tired upset and wanted to cry. I sought help and advice from my immediate manager and explained how the incident had made the two customers and me feel. My manager actively listened and took action by informing staff that a clear plan needs to be put into place when changing activities and when we are short staffed the activity sheet needs to be followed. I feel the situation could and should have been avoided, other customers’ activities were disrupted, their needs were not met they had unnecessary upset which resulted in an individual displaying challenging behaviour. After an incident of challenging the steps that should be taken to check for injuries are: Everyone involved in the incident should be checked thoroughly for injuries by a member of staff (preferably a first aider) who was not involved in the incident. In case of any injuries being noticed, immediate action sh ould be taken to seek the appropriate medical help. Injuries should be recorded and reported using the  centres procedures. An incident report form, body map and dangerous occurrence form should be completed. Parents/ carers should be informed. Be able to review and revise approaches to promoting positive behaviour. Working with others is important if individuals that we support are to receive good, consistent support. Family carers and close friends are important when we are thinking about partnership working. It shows respect and also values other people’s contributions, different people possess different skills which help good support, it can help with problem solving and creative thinking, and partners have different information about a person they can share with others. Working with others to review and examine information which relates to positive behaviour support should include gathering information about incidents from a variety of sources. Information can be gathered from, A.B.C charts (As mentioned earlier in this assignment, promote positive behaviour) in notes from meetings, and debrie fs incident report forms and logs. It is important to promote proactive positive behaviour support and analyse the risk assessment process; whenever there is a review the risk assessment should be revisited and adjusted where necessary. There must be continuous monitoring and review of the individual’s behaviour as sometimes physical interventions or restrictive practices are used in an emergency. To be able to work with others to review the approaches to promoting positive behaviour it is important for managers to check and update policies and organisation practice against current good practice guidelines. Reflection begins when I pause to think back after something unexpected or out of the ordinary has happened. I replay the happenings, incident or event in my head and think about it more. My thoughts begin to change from a sequence of events into a series of questioning thoughts such as; why did it happen that way? And how could I have behaved or done things differently? If I do something that way, what is likely to happen? Reflection helps me to share my ideas with others who are experiencing similar incidents of challenging behaviour which can help improve the promotion of positive behaviour. It also helps you avoid making the same mistake again, for example, as mentioned earlier in this assignment whilst I was supporting B and preparing his breakfast, he hit me. On reflection I questioned why I had taken him in the kitchen with me and should have asked for assistance from another member of staff to prepare his  breakfast. My manager has updated B’s support plan and informed staff that when B has his breakfast prepared the member of staff supporting him must ask colleagues for assistance keeping B out of the kitchen. In my opinion Individuals with the label of challenging behaviour are one of the most vulnerable groups in society. They are often labelled as complex and are at high risk of abuse, neglect and exclusion. Despite some progress in policies and practice that advocate personalisation, the evidence for successful approaches in challenging behaviour is weak. Challenging behaviour is still too often viewed as located within the individual rather than the wider social and physical environment. The appalling events that led to the closure of Winterbourne View hospital in Bristol in 2011 were the latest in a very long line of similar cases that have occurred over many decades. The aim of the winterbourne review was to look into what happened so that lessons can be learned and look into how people with challenging behaviour are supported all over the united kingdom.

Tuesday, July 30, 2019

Summary and critique of Stanley Milgram

The experiment on â€Å"Behavioral Study of Obedience† was conducted by Stanley Milgram in July 1961. It was barely three months after Adolf Eichmann had been tried over the criminal activities committed during the Nazi war. The research was designed to address the questions about the peoples who were the masterminds of the infamous Nazi torturing ordeal that were responsible for the deaths of millions of the innocent people. It was intended to find out the people who would prefer to be submissive to the authority at the expense of human life. The experiment also sought to measure the willingness of individuals to obey an authority figure who instructs them to do certain things that are against their personal conscience. The question that the researchers were asking was, â€Å"Could it be that Eichmann and his million accomplices in the Holocaust were just following orders? Could we call them all accomplices?† The hypothesis was that there was likelihood that that during the Nazi war it might have been that Adolf Eichmann and his accomplices were just being submissive to the orders from higher authority (against their will) to murder the innocent people. The research question was very instrumental in helping to unveil how one can alter another person’s behavior, beliefs and mind-set. Before giving the results of the experiment the researcher predicted that only a negligible number of the participants would obey the orders and persist on to administer maximum shock. The range was 0 – 3%. That meant that out of 100 participants only 3 would administer the 450 volt shock. Method The people who participate in the experiment (subjects) were drawn from different social status background within New Haven area. They comprised people from a wide range occupation with characteristic characters include clerical officers, teachers, salespersons, engineers and drudges. The group was a representative of all educational levels; from elementary school to doctorate and other professional degrees and aged between 20 – 50 years in their right state of mind (Milgram, S., 1963). The dependable variable in this experiment was the maximum shock that the subject, S, was willing to administer to the victim L up to that point when he resist to follow the instructions given to him by the experimenter. The independent variables were the learner (an experimental confederate) and the experimenter’s orders. There were two participants in each case. They were; a naà ¯ve subject who played the role of a â€Å"teacher† and was provided with a 450 volt electric shock generator and the second one a confederate who played the role of a â€Å"learner.† The task of the â€Å"teacher† was to read to the â€Å"learner† a list of word pairs. The â€Å"learner† on the other hand was to respond correctly to these pairs of words by pressing the button as an indicator of his response. In case of a wrong answer the â€Å"teacher† was to administer an electric shock to the â€Å"learner†. For each subsequent wrong answer, the â€Å"teacher† would increase the voltage. Even though the subject believed that the learner was receiving the actual shock, the learner, being in a separate room, sets up a tape recorder which had been incorporated to the electric shock generator. This tape played sounds which had been pre-recorded to march each shock level. The presupposed victim (â€Å"learner†) would start to bang the wall separating him from the subject at given numbers of voltage increase. He would continue banging on the wall and complaining of heart condition until all the responses from him ceased. The data collected was based on how much electric shock the subjects were willing to inflict on the victim. This was to indicate their level of obedience and to see their willingness to obey the orders; if it they were doing it deliberately or did it against their will. Results Eventually it was discovered that out of the 40 participants 14 subjects showed explicit signs of nervous laughter and smiling which were inapt and weird. Three of the subjects developed irrepressible convulsions. According to the results obtained, it is evident that while responding to the demands prompted by the appraisals, 40 themes exceed the projected break-off point. None of them administered the electric shock below 300 volts, a point when the victim starts to kick the wall and provided no answers to the teacher’s questions. 5 of them stops at the 300 volt level; 4 of them proceeds to 315 volt level; 2 breaks of at 330 volt level; 3 others drop off at 345, 360 and 375 volts respectively. These 14 subjects were defiant to the experimenter’s instructions. They were recurrently in a frantic and enraged condition. However 26 of the 40 subjects were obedient enough to proceed on to punish the victim till they attain the shock of 450 volts. But they do this against their will. They could be observed to be in consternation once the experiment was brought to a halt. Discussion The results obtained imply that there are people who, despite receiving orders from authority, would choose to defy and stick to what they believe is morally acceptable. In this case the 14 subjects held this belief and would not inflict pain on another person against his/her will. It was however observed that some people would choose to act against their conscience and submit to authority even if what they are ordered to do is against moral principles. This what the 26 subjects did; despite expressing some signs of displeasure in shocking an innocent person, they still go on to obey the commands to the end. This implies that obedience to authority can cause harmless and non-hostile individuals to turn inhuman. The results seems to be in contrast to those predicted in the questionnaire where only 3 out of 100 respondents said they would proceed to administer electric shock to their victim up to the most maximum and risky shock of 450 volts. In this case however, the figure was surprisingly high; 26 out of 40. It had also been expected that a subjected would basically terminate or proceed as dictated by his conscience. However the subjects exhibited tension and emotional strain in their response to the commands. Critique The experiment was well conducted and its objective was attained. The volunteers were got through a New Have (Connecticut) daily newspaper advert and direct mail to some informing them take part in the study of reminiscence as well as the learning designate conducted in a laboratory at Yale University. The real purpose of the experiment was hidden from the subjects until the experiment was over; they knew that the experiment was a study of memory and learning yet it was about study of obedience to authority. Another thing was that the entire volunteers were to play the role of the teacher while that of the student was played by an experimental confederate. In addition, the generator that the teacher used was just but of 45 volts sample shock with the generator not wired to shock the learner. Lastly, the kicking of the wall by the learner, screams and his rejection to proceed and the commands/orders of the experimenter to the teacher were all skillfully fabricated. These indicate the researchers’ thoroughness in the design of the experiment to answer their specific research question. Most importantly, at the end of the experiment subjects underwent some procedures to assist them go back to normal well being. The researchers did not however deal with any feasible alternative explanation for their results. This might be attributes to the fact that they expected the subjects to show some level of obedience. Also, the subjects might have been expected to act accordingly and participate fully to make the research successfully bearing in mind that the real objective of the experiment was hidden from them. It should be stated here that there are some people who will not, at any cost, accept to administer any level of electric shock to another person. The research was also not well represented in terms of gender or the researchers did not specify the sex of the participants. This raises the question about the criteria that was used in selecting the subjects. But all in all the experiment was quite essential as it the positive and the negative nature of human beings. Reference: Milgram. S. (1969); Study on behavioral obedience, Journal of Abnormal and social psychology; 371-378. http://www.wadsworth.com/psychology_d/templates/student_resources/0155060678_rathus/ps/index.html

Monday, July 29, 2019

Austrian and Post-Keynesian theories of the competitive process

Austrian and Post-Keynesian theories of the competitive process The Austrian School is a heterodox school of economic thought that emphasizes the spontaneous organizing power of the price mechanism, which was influential in the late 19th and early 20th century (Boettke, 2008). After the 1870s, Marxism spread rapidly in the ranks of workers, and the economic theories that defended for the capitalists went bankrupt. The Austrian economics based on three core concepts: entrepreneurship, subjectivism and market process, which became popular after that. The Post-Keynesian school of thought was developed in the debate with the neoclassical synthesis. After The General Theory of Keynes was published, some different points of view on the practical problems arose in the followers of Keynes, and gradually formed two opposing schools of thought: neoclassical and the Post Keynesian School. The theoretical foundation of Post Keynesian economics is the principle of effective demand, that demand matters in the long as well as the short run, so that a competiti ve market economy has no natural or automatic tendency towards full employment (Arestis, 1996). The objective of this paper is comparing and contrasting Austrian and Post-Keynesian theories of the competitive process. The similarities and differences between these two theories will be stated orderly. Although Austrian and Post-Keynesian theories are two different schools of thought, they still have some degree of similarities. First, they both advocate uncertainty. Next, they both cannot be regarded as profit maximizers. Last, the competitive process is seen as a dynamic process by both theories. First of all, for the Austrian approach uncertainty is pervasive. One of the Austrian’s core concepts is entrepreneurship. Austrian school thinks that the community is a collection of individuals. Individual’s economic activity is a microcosm of the national economy. Through the interpretation of individual economic activities, reasoning illustrates the complexities of real ec onomic phenomena. Entrepreneur is the individual here in the real economy. They are all different in each other. Therefore entrepreneurs in particular always face fundamental uncertainty. Kirzner (1973) emphasized the uncertainty present in all human decision-making, has primarily focused on the entrepreneurial market process. For the Post-Keynesian approach firms’ pricing behaviour is determined by a ‘mark-up’ rule. This behavioural approach to pricing is partly in response to the imprecision of price setting in conditions of uncertainty. Uncertainty is the fundamental element of Keynes’ theory, and Post-Keynesian followed and developed it. In the Post-Keynesian theory of agency, agents are non-optimisers due to fundamental uncertainty. According to Fernando Ferarri Filho (2001), in a context in which time is historical, economic agents do not decide future actions on the basis of statistical series analyses or beliefs justified by experience. To the cont rary, decision-making is classified as an environment of true uncertainty. They are not the rational calculators of standard theory. This suggests some overlap with Austrian theory. Second, in Austrian’s term, entrepreneurs display purposeful pursuit of profit in the competitive process, which provides market order. It cannot be regarded as profit maximizers due to fundamental uncertainty. However profit is still therefore important in motivating agents. Neoclassical theory assume that manufacturers pursuit profit maximization, but we all know there is another voice in society requiring manufacturers to take social responsibility. Social responsibility will increase the company’s operating costs, which is not conducive to their competition in the market. So, non-profit-maximizing firms will be sustained by the loss of profits and investment capacity and continuous losses, and finally be forced out of the market. Austrian school advocates idealism and they do not believ e that firms select the behaviour of pursuit profit maximization. In post-Keynesian economics, firms are not assumed to maximize profits as well, as is clear in Lavoie (1992, p.105), â€Å"The standard critique of the neoclassical theory of the firm is that profit maximization is not possible because of the lack of pertinent knowledge due to an uncertain environment. Profit maximization is then replaced by profit satisfying. Firms are assumed to set themselves threshold levels of profits; that is, minimum levels of profits or of rates of return.† Furthermore, the firm’s overall objective is the pursuit of ‘power’. This involves attempting to control its environment. To become powerful, firms must be big; to become big, firms must grow. Growth is the subjective and profits are the means to realize this objective. However, maximizing growth does not equal to maximizing profits. Firms maximize the rate of growth, subject to various finance and expansion const raints.

Case study Example | Topics and Well Written Essays - 500 words - 17

Case Study Example She has no time to socialize and communicate inspite of having an assistant. She was not very accessible and the communication took time because of her delayed response to e-mails or messages and handover with the assistant. Studying the organizational behavior of Julie, it can be observed that she seems to have a good relationship with everyone in the university. She received good appraisals from her manager Pat Griffiths. She also received positive reviews from other faculty members. However, the surrounding environment has played a role in these relationships. Julie had several opportunities to interact with her colleagues and faculty members in informal gatherings which she did not do with Susan. Hence, there was a friendly emotional climate between Julie and other faculty members which was absent in case of Susan. This may have led to cognitive dissonance changing her attitude towards Susan. All full time faculty members Julie works with, apart from Susan, are men. Therefore, there is a high probability of gender dynamics creeping in. Also, her manager is a man. Men could have a favorable gender bias while evaluating or appraising women. Susan is a woman and is bound to have a different kind of relationship with Julie. Mental ability could also have an impact on the conflict between Julie and Susan. As confessed by Julie herself, she has been doing a lot of easy and normal work while the work given by Susan needed greater effort. Julie may not have the ability to handle such work due to her education or experience in the past which impacts her productivity. Studying the organizational behaviour of Susan, she seems to be highly occupied with work. Her work habits seem to be a result of her neurotic personality. Susan’s personality traits are that of an introvert which are quite opposite to that of Julie. In addition, Susan’s communication through Internet or messages has been ineffective. While Julie’s inability may be

Sunday, July 28, 2019

International Human Resources Management Strategies Essay

International Human Resources Management Strategies - Essay Example Some companies tend to lack the knowledge that globalization is closing the gap on how we relate to others. This paper on International HRM aims to assess various key issues associated with the management of human resources in a global environment, such as the key strategies or challenges faced by companies operating in international locations; the most effective approach recommended for global companies to operate successfully in an international environment; etc. For the purpose of this study, Nike Inc., is chosen for discussion and analysis. International HRM strategies: Nike Inc. Nike Inc., is an international footwear, sportswear and equipment supplier headquartered in Washington, U.S.A, and having branches all over the globe. The company truly reflects the characteristics of a truly global multinational brand, due to its successful operations in international markets. Nike’s international HRM strategies involve introduction of market driven policies aimed at profit maxim ization. Led by visionary Phil Knight, Nike Inc.'s phenomenal success in international markets was achieved by outsourcing majority of its manufacturing operations to low-wage countries such as Indonesia, Vietnam and China. The company received flak for its outrageous HRM policies whereby young children and other workers in the Nike factories were made to work for long durations in unsafe work environments, raising alarm in the international community (Aswathappa & Dash, 2007). However, ever since the company has focused on improving its working conditions and rewired its approach to human resource management by introducing polices focusing on an integrated and multi-disciplinary team to support and monitor its outsourcing operations. The company today focuses on worker safety and sustainable business as its core business strategy and vision (Nike Inc., 2012). Global challenges of IHRM: A significant number of organizations have internationalized their operations over the past coupl e of decades. This new trend has given rise to global challenges with regard to the management of human resources across international borders. The key challenges faced by managers today, with regard to International HRM include aligning its resources and work practices with those of the host nations; increasing risk of global terrorism; change in patterns of hiring and staffing; ethical and CSR challenges; strategic challenges etc (Dowling, Festing, and Engle, 2008). However one of the most pressing issues faced by multinational companies today is to monitor and supervise the code of conduct and HRM practices in the host countries. Various multinational companies such as Nike, Benetton, Levi Strauss, Reebok, Adidas etc., among many others have faced severe criticism in their home country for their unethical work practices. These companies have been accused of child labor and violation of human rights thus resulting in a serious negative impact on its brand image. Similar challenges were faced by companies like Google for its questionable ethical practices in China; Coca Cola for its CSR practices; Allure Cruise Lines' strategic challenges etc (Dowling, Festing and Engle, 2008; Deresky, 2007). Some of the other key challenges faced by the multinational related to international HRM include those associated with ethnocentric, polycentric, geocentric and/ or region centric approaches. Ethnocentricity refers to

Saturday, July 27, 2019

Human Resources Management Essay Example | Topics and Well Written Essays - 500 words - 1

Human Resources Management - Essay Example Due to the diverse nature of the roles played by the human resources department of any organizations the unit could consist of several individuals based on their career roles. Recruiting and placement manager are in charge of sourcing for the right candidates to serve in the organization (Mathis & Jackson, 2008). This is mainly done through advertising for available positions, conducting the selection process through interviewing and making an employment decision based on the evaluation of shortlisted candidates (Mathis & Jackson, 2008). A development and training specialist are in charge of orientation for new employees in the roles, they are expected to play in the organization. They also analyze employee performance to identify any deficits. The feedback obtained in applied in planning, coordinating and conducting training for capacity building (Mathis & Jackson, 2008). A career as a compensation and benefits specialist involves providing legal information to employees and the company on labor organization regulations in terms of employee remunerations, benefits offered, and compensations recommended. They are in charge of wages and salaries administration. Strategic planning based on company performance and growth projections is done to evaluate the ability of available resources to sustain the set targets. Health, safety and security specialist ensures that the HR department is informed of current employee working conditions in the organization and possible improvement to create an environment that motivate opt imal productivity (Mathis & Jackson, 2008). For effective performance of the HR department, a strategic plan is essential since it links the HR management to the organization overall strategic planning (Armstrong, 2011). It guides future decisions in integrating HR strategies towards meeting the organization mission and vision while sustaining the needs of employees and other stakeholders (Armstrong, 2011). This plan ensures

Friday, July 26, 2019

Issues in sports 1 Essay Example | Topics and Well Written Essays - 500 words

Issues in sports 1 - Essay Example The women players or athletics are under many constraints related to economical, financial, social and political issues. Most of the conservative countries are not permitting women to participate in any sports event. The social and political rules and regulations are against the women. Some countries are not providing enough financial assistance to the women team or women athletics but they are very much interested in putting more money for the men’s team or athletics. According to Kirsch, â€Å"In todays world female athletes are learning the hard way that even if they train harder than their male counterparts and out-perform them they will still not receive the same recognition or money that the guys make†. (Kirsch) Recently, some countries are giving importance to their women players and athletics. United Nations, China and some other developed and developing countries are trying to remove this discrimination through proper implementation of new policies, which help women players to come out from those constraints. The United Nations Millennium Development Goals (MDGs) introduced innovative ideas to solve this discrimination problem. This was a great achievement for women athletics and players. It was implemented to create gender equality in sports. In 2002, the United Nations Inter-Agency Task Force on Sport for Development took initiatives to give more importance on this discrimination issue in sports. They suggested some steps by which they can create gender equality. The steps are as followed, Drug abuse by athletes and sports persons is an international issue in sports. For instance East German succeeded in sports during the 1970s and 80s fighting back the United States and even Soviet Union with the help of intake of several performance enhancing medicines. This was meant to prove their power in sports against the west. Swimmers like Kornelia Ender, Barbara Krause and Carol Mitschke were the victims of the doping schemes. During 1989

Thursday, July 25, 2019

History Essay Example | Topics and Well Written Essays - 1750 words - 3

History - Essay Example The insufficient labor supply in America should actually be solved by considering immigration for people with different skills from other places to foster technology and development. The immigration system in America involves state, labor and justice federal departments. The labor department certifies that the immigrant’s employment shall not be of negative effect to the working conditions, salaries and employment in America. The justice department implements the laws in regards to the immigrants in America. The state department is responsible for distribution of applications to people in search for employment in the US. This also involves administering the immigration law. After immigration, most immigrants seek naturalization, after working in the US for over five years. Over the years, many immigrants have been granted legal status, but recently barriers have been put because of the rising numbers of immigrants. The immigration controversy brings out the conflict between the desires for growth and that for stability. In both cases, the proponents and opponents have their arguments based on the cultural and economic aspects, or status. The recent increase in the number of immigrants is the main reason for the immigration controversy in America. The origins of immigrants also pay a major role in their behavior and this adds to the existing controversy. The massive increase in the immigrants is a threat to the English-speaking heritage, because of the numerous ethic groups changing the ethnic composition of the population. Immigration controversy has been agitated by people especially leaders, who view immigration as a threat to the American culture and the English language. Religion has also been one of the major issues addressed along with the anti-immigration forces. The economic impact caused by immigration is one of the arguments brought forward against immigration in

Wednesday, July 24, 2019

Analytical report on the international marketing strategy of BreadTalk Term Paper

Analytical report on the international marketing strategy of BreadTalk in Singapore entering United Kingdom - Term Paper Example The company sells a wide range of products that include bread, buns, cakes and pastries. During the early years after inception, the company’s operations were centralised and the baking process right from the preparation of dough to the final process of topping of each objects of bakery was done at individual retail stores (BreadTalk Group Ltd, 2013). However, as the company continued to grow, and the plan of establishing franchisees was conceptualised, the company created a single central kitchen and shifted its headquarters to KA FoodLink, on September of 2001. Moreover, the company acquired more space and current machinery in 2002 to expand its production capacity. Currently, the company has about 746 retail outlets with over 7000 workers throughout Singapore, Hong Kong, Middle Ease and China. Our vision is, â€Å"establishing BreadTalk as a  brand and enterprise known for its innovative, trend setting and delightful bread and pastries†, which we believe we can achieve through franchising by opening new outlets both in the existing and new markets e.g. the current one being the United Kingdom. Our mission statement is â€Å"leading a new lifestyle culture with new innovative changes and creative differentiation to craft products with passion and vibrancy†. Thus, this mission statement implies that as a company we want we want to employ a mix of strategies to create a new culture at the company that embodies the production of quality vibrant crafted products that are better and bring satisfaction to the consumers than those of consumers. At BreadTalk we are happy with our financial performance given that we have already surpassed the half-way point of S$1billion revenue mark towards our 2016 target (Iesingapore.Gov, n.d.). The excellent performance has been attributed to our current strategies and accelerated growth. Firstly, since inception we have use the franchising strategy to venture into new markets. For instance as at 2009 December we

Tuesday, July 23, 2019

1880-1929 Essay Example | Topics and Well Written Essays - 250 words

1880-1929 - Essay Example This migration fuelled economic activities thus leading to urbanization. This progressive era saw the 15th and 16th Amendments being passed that served to free the black American community from chains of slavery and discrimination. It is also these amendments that gave the black men opportunity to participate in electoral voting. However, women had to wait until 1920 before they earned their rights to participate in electoral processes. The progressive legislations were clearly a product of grassroots pressure from abolitionists and women rights movements. Women suffrage movements had by 19th century gained momentum and little could have been done to tone their demands down. All they wanted was their rights just as the African Americans demanded for them. After the war, it was evident that most blacks were still being victims of segregation as most of their basic freedoms were curtailed. Secondly, the industrialization has just taken its roots and most of the workers felt they were working under deplorable conditions. Statistics gathered in the same period revealed that most employees had succumbed to death due to injuries or illnesses relating to their workplaces. Labor movements soon shaped up and calls for the end of child labor, improved working conditions, and better pay became the order of the

Truth Essay Essay Example for Free

Truth Essay Essay How should truth be defined based on the knowledge one would have? There are endless theories that try to answer this question. Unfortunately, every theory has its contest. Would we even know if a theory was the truth? That is not even possible. We could never prove whether a theory was actually truth. It creates a loop. We would have to know what is and isn’t truth to prove what is actually true. Is truth relative, or is it absolute? How would we know? Winkin made a statement about the Dutroux Commission, which was a court case in which a Belgian man named Marc Dutroux was found guilty of murder after he kidnapped, imprisoned and repeatedly raped six girls and murdered four of them, which states â€Å". . . the Commission is based on a sort of presupposition that there exists, not a truth, but the truth. . . † However, as he talked on he stated that he believed that both Officer Lesage, who said he send Judge Doutrewe a file on Dutroux, and that Doutrewe, who denied ever receiving the file, were both telling the truth. He implied that truth is in relation to one person is not necessarily true in relation to another person. What is true depends on who is making the statement. On another hand, the most popular theory of truth is the correspondence theory. The correspondence theory states that truth is a correspondence between a proposal or idea and some fact in the real world. This theory assumes that there actually is a real world whose existence does not depend on our own thought, beliefs and perceptions. It assumes that the real world exists and has always existed whether or not we were around to believe it or not. However, this theory is contested. It can be â€Å"wrongly assumed† that we can determine whether our beliefs correspond to an external realty or just our response to the external world through our senses. Perhaps the problem with this is that we cannot define the fact that the statement is suppose to correspond without using the true statement as proof. However, in tune with the correspondence theory, coherence theory states that a belief is true if it is coherent with other beliefs that we regard as true. However, I personally believe that truth is not defined this way at all. You can get a 3 billion people to believe that the sun is a giant llama wizard and the stars are his minions and it would not make it anymore true and would probably be proven false eventually. This relates to when people thought the earth was flat or that the sun orbited it. It is clear, with the faults in the correspondence and the coherence theory, more possibilities have been suggested. Possibilities such being that a belief is true if it works or is useful, like the pragmatic theory. This â€Å"Pragmatic Theory† holds that there is no actual absolute truth. A statement is true if it is useful to believe. It is only true if it is beneficial to us or necessary to survival, if it passes the test of science. However, the flaw I see in this theory is that the wonder that, what if what is beneficial to the human race is not able to pass the test of science? Why would it need to? If it is useful and we believe it why should it have to pass the test of science? Not to mention that if everyone just suddenly believes it, it doesn’t necessarily make it true all of the sudden. I side with Winkin. He defines that there are many truth depending on whom you are and who is talking. I tend to agree with that. This would mean there just may be an actual and absolute truth but we would never know for sure. This way truth is both relative and absolute. I may believe the relative truth and another may believe that which is absolute. It is also possible that everyone believes a relative truth and the absolute is hidden. It would be impossible to prove what is true and what would not be if we all believed something different to be true. However, that is small scale. There are seven billion people on the planet. Everyone one the whole planet could believe that, bringing the sun back to the spotlight, the earth is currently orbiting the sun. However, we could all believe it and have the science, as we would believe, to back up the theory but it may not be true at all. Truth can be both relative and absolute.

Monday, July 22, 2019

Prevalence of Racism within Police Departments Essay Example for Free

Prevalence of Racism within Police Departments Essay Abstract   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Racism is always associated with the occurrence of Police Brutality in the country. Police violence’s had been reported from different states in the country. According to some notable information, race is an instrument in treating criminals or violators. This implies that Black and Whites are fostering a biased attitude in their counter-part race. Black would treat black Americans favorably than whites and vice versa.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   On the other hand, it was determined that cases of police brutality are also highly probable to those people with low connections in police departments. People are averring that Policemen are engaged with Abused Power which including fond of terrorizing and exploiting apprehenders.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Perhaps, America can never be free from Racism but Policemen can always be away from cases of Brutality. Prevalence of Racism within Police Departments   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   All nations in the world are in influence of Racism. Compared to other countries, racism is well identified issue in the United States of America. In the study conducted by the United Nations Organization, racism was also considered as the roots or catalyst of other discrimination and exploitation issues such as slavery, crimes and even police brutality against minorities. The issue regarding police brutality is in great concern as the numbers of victims are greatly increasing in the state.   (Snah, 2004)This paper aims to study the role of racism in the incidence or occurrence of police brutality. Also it sought to find out some cases of police brutality. Incidence of Police brutality   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Cases of police brutality had been reported across the country. In the New York City alone, 500 cases occurred per month (Gregg, 1999). In 1999, the Chicago Police Department faced the charges of racism after the incidence of different deadly encounters of Black Americans and police. The department was in controversy as an incident happened regarding a university student football player Robert Russ. He was suspected of grabbing the gun and disrespecting a police officer while in confrontation in the street. He was shot out in his car aimlessly. According to some witnesses, the policemen in the said department are abusing their power in treating every suspected violator.   (Johnson, 1999) The bottom line in this incident is most victims are black Americans while apprehenders are white Americans. On the other states, New York Police Department was also in intrigue with the incident called the â€Å"savage brutality†. An immigrant from Guinea named Amadou Diallo died after being rained of forty one shots by four policemen. (Jones, 1998) This event is an absolute proof were policemen are not following the â€Å"zero-tolerance† policy where they tend to react violently to the criminal notoriously; not upholding the rights of the criminal.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   It can be considered that police brutality is in everyday occurrence. Also, the event is highly probable or possible in which different races or culture mixes. They are highly victimized because these people have lesser security or higher connections, in which police officers are confident of terrorizing and intimidating therm. Different races like Blacks, immigrants like Latinos and Asians are harassed, exploited, assaulted and in worst case-killed. This incident implies that American policeman are not equable, they do unequal treatments. Race had been their instrument or basis in giving their service as crime-busters and peace keepers. It’s an implication of prevalence of racism and police brutality where both races are fostering a condescending attitude toward their counterpart race. Narrowing Down   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Primarily, Racism triggered the occurrence of police brutality in the country. Police brutality in one way or another had stained the over-all integrity of Policeman as the defenders of Democratic and Republic people. With different cases or evidences of police brutality, we can certainly deduce that the police system is instituted basically to protect upper class people from poor people, serve and promote their own race and consider other races as conspiracy against them. In short, they are not equable.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The image portray by the police is very different from their sole purpose. It’s never late to renew the image of policeman in the country. It’s true that the country is divided and being separated by different principles. Races continue to develop gap with in each other.   However, the resemblance that keeps us one is our ability to accept the challenge of Racism. We can always foster a good camaraderie with all people in the word. In this simple way, in some how, we can make a better America and have the best Policemen in the universe, where Police brutality will never be experienced again and policemen will be associated to goodness. References Gress, T. (1998, July 4). Everyones Problem: Police Brutalty and Race. Retrieved August 12,    2008, from http://www.socialissuesletters.com.html Johnson, D. (1999, July 19). Police Racism Charges Defy a Pattern. Retrieved Augut 12, 2008,   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   from New York Times Press:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   http://querry.nytimes.com/gst/fullpage.html?res=9B02E4DE123BF93AA257 Jones, A. (1998, 9 July). US Police Brutality. Retrieved August 11, 2008, from Socialism Today:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   http://www.socialismtoday.org/38/nypd38.html Snah, A. (2004, December 20). Racism in North America. Retrieved August 13, 2008, from   Ã‚  Ã‚  Ã‚  Ã‚   Global Issues:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   http://www.globalissues.or/article/165/racism/NorthAmerica

Sunday, July 21, 2019

Socio-Economic Status Impact on Health Care Access in NZ

Socio-Economic Status Impact on Health Care Access in NZ This review aims to analyse the effect of several key factors such as socio-economic status in connection with health care access of people. The literature study of this topic is important to us as health care providers in order to promote the rights and equality among Maori and non-Maori clients. Factors such as education, employment status, and housing may greatly affect one’s health. Like for instance, if a home is located in a community where health care facilities are immediate, then, services can be easily accessible to the public. However, if a person lives in a remote community where access to hospitals are limited, it will of course be difficult for him to manage certain illnesses and emergency cases since doctors and nurses are far from the place. Some people may also feel lazy to pay visits to clinics for some check-ups if it will be far from their homes. Poor quality houses may also cause deterioration of one’s health if it is not properly insulated as exposure to extreme cold climate may be a precursor for illnesses such as flu and fever. Mold build-ups in low quality shelters is also a risk factor in diseases. Pneumonia and other respiratory illnesses commonly affect indviduals, particularly young children, in poorly insulated and moldy homes in New Zealand. For this reason, th e New Zealand government is taking its actions to prevent health deterioration affected by housing. According to a report, Housing new Zealand(2013) is responsible for providing warm, dry homes for people in need, and ensuring those homes are the right size and where we need them[1] (Housing New Zealand, 2013). Education plays an important role in using nursing services. A person can receive efficient nursing services from a health care provider if he is equipped with adequate knowledge of his or her rights and responsibilities. A certain client can be proactive with his treatment routine because he knows he has the right to decline or suggest any alternative medications which may be beneficial for him. Say for example, if he wishes to consume any medicinal herbs as a substitute or supplement, then he may do suggest it to his physician for approval. Employment status can also be associated with nursing services in terms of economic state. Salaries of em ployees affect their access to services because of affordability. Workers with higher salaries tend to have more funds for their health check-ups and medications than those who are within the minimum wages. But still, the government subsidised hospitalisations and medication for New Zealand citizens and residents. Victims of road accidents are also given with free medical assistance and hospitalisation as well. According to Pollock, Under the Social Security Act 1938, public hospitals became free in 1939 and prescription medicines in 1941. [2] (Pollock, K., 2013) The Accident Compensation Corporation (ACC)states that: Everyone in New Zealand is eligible for comprehensive injury cover: no matter what you’re doing or where you are when you’re injured – driving, playing sport, at home, at work no matter how the injury happened, even if you did something yourself to contribute to it no matter what age you are or whether you’re working – you might be retired, a child, on a benefit or studying. What injuries am I covered for? Wounds, lacerations, sprains, strains, fractures, dislocations and work-related injuries such as hearing loss may all be covered. Most physical injuries are covered if they’re caused by: an accident a condition that comes on gradually because of your work (gradual process) medical treatment sexual assault or abuse.[3] (The Accident Compensation Corporation, 2014). However, there are some considerations that must be taken prior to approval of these benefits. That is,the ACC must be satisfied with the present conditions of the clients taking their claims. An accident victim must be physically injured, obtained mental injury as a result of physical injury. Injuries related to work or any traumatic accidents, damages of prosthesis, and death because of the accident. There is a specific definition of ‘injury’ in the Accident Compensation (AC) Act 2001, which is the law that ACC must apply when considering applications for claims and assistance. Gender is also an element that affects health because generally, women are the ones who bear children and this situation puts their lives at risk. Cook stated that before European contact to New Zealand, â€Å"Rates of maternal mortality in 19th- and early 20th-century MÄ ori communities are unknown, as the first figures were not collected until 1920. In that year nearly 23 MÄ ori women died for every 1,000 live births. (The rate amongstPÄ kehÄ women was 6.5 per 1,000 live births.) This figure, high as it is, was probably an underestimate: MÄ ori deaths were not reliably reported until after the Second World War. MÄ ori women’s access to medical help was limited by a number of factors: the loss oftohungaand traditional medical knowledge through population decline the scarcity of hospitals and doctors in the rural areas where most MÄ ori lived the refusal of some hospitals to admit MÄ ori the reluctance of some doctors to treat MÄ ori MÄ ori women’s reluctance to be examined by male doctors (almost invariably PÄ kehÄ ).†[4] ( Cook, M.,2012). Women also play a big role in the health care industry. Most health care providers and nurses are female as more women prefer such job roles than males. According to The Nursing Council of New Zealand, â€Å"The nursing workforce is overwhelmingly female, with only 7.4% of nurses being male (essentially unchanged from 2010 report figures of 7.2%). The male workforce is younger than the female workforce, with 38% aged under 40 compared with 31% of female nurses. The average age of the nursing workforce is 45.6, with the average age of male nurses being 43.4 and the average age of female nurses being 45.7.†[5] (The Nursing Council of New Zealand, 2011). One’s social status is relevant in the promotion of well-being. That is, if a person has a good standing in the community where he or she dwells, there is a higher chance of self-esteem and optimum mental health may be achieved at this point. It is because how a person feels from the inside radiates towards his personality and how he reacts with people around him. A good social status may also result from a decent employment status. In addition, a supportive community can also promote each other’s well-being. Those who are socially isolated are at higher risk of health deterioration because of lack of social support from the neighbourhood. For example, people with disabilities may cope better in a disable friendly places, such as presence of handrails and ramps, which are supported by the government and its people. A good relationship with the community and family also creates a friendly atmosphere and happiness in each other. These positive vibes are also key factors i n promoting healthy individuals. As what Griffiths mentioned, â€Å"People with strong family, cultural and community ties have better health than people who are socially isolated. Social cohesion or ‘connectedness’ is related to the health of individuals and communities. Single parent families, people with mental illness, people with disabilities, people living alone and older people are particularly vulnerable to social isolation. There are generally high levels of access to telephones and motor vehicles in New Zealand but access for some groups is poor. Features of New Zealand society that may tend to reduce social connectedness are unemployment, frequent change of residence (high mobility), and an increase in single parent and one person households over the past decade.†[6] ( Griffiths, 1998) Summing it up, good communication is a relavant factor in health improvemnt because interaction with other people limits the bounadries, and creates a channel to divert any confusions or uncertainties in life. In adddttion, reaching out benefits everyone especially in times of needs and other unexpected life circumstances. This concept is similar to the saying that â€Å"No man is an island.† or â€Å"No man can live alone by himself.† Maori people’s access to health care is different from that of non-Maoris. This is because of several factors such as inaccessibility to health care facilities of the indigineous native people. Cultural safety is also an element because some individuals may prefer utilizing the tradional way of treating illnesses rather than seeing a general physician for consultation. And in line with this idea, it will be difficult to contest them in their beliefs because doing so will result to violation their right to self-determination or them beig in-charge of their own well-being. Non-Maoris, on the other hand, are well accustomed to modern lifestyle as compared with Maori group. This is the reason why more non-Maori people regularly pay visit to clinics and other health care facilities if they have some concerns regarding their health issues. Moreover, non-Maori, especially the Kiwi people are the ones who introduced the modern health care system in New Zealand. So, most likely, they a re the ones who will patronize more that particular type of system. The legitimacy of differences in culture and respect for the rights of others can be materialized or be actualized in the priniciple of Tino rangatiratanga. As mentioned before, the principle of Tino rangatiratanga focuses on a Maori’s right to self-determination. It means that despite the introduction of new government and health care delivery system in New Zealand, these indigenous people can still have the right to choose their preference especially in health care, and whatever culture or values they possess or believe in to can still be preserved. In this context, equality among each individal can be evident. Power relationship can be defined as ann unequal quality of relationship between a client and a health care provider. This is comprised of a higher authority, or the health care provider who is much superior to the client. This is due to the fact that health care professionals tend to possess more knowledge than his or her client in the sense of giving care or treatment. However, instances that there may be biases in this scenario if a client is submissive to whatever the health care professional tells him. Like if the client is not given the privilege to speak out what is on his mind and the choices or preferences he or she wishes to have. In my belief, imbalances in health care relationships can be resolved if proper education is provided to every individual especially to Maori people. Since they have diverse cultural beliefs and that is, very different from the modern approach, it is very important to orient them properly prior to imposing new treatments and medical interventions to them. An equitable, efficient and efffective health service delivery can be achieved as well if every health care professional can be compassionate and understading of each client’s needs and cultur. One must always keep in mind that health services is not just about the physical aspect, but, rather, it must be hollistically done. Emotional and cultural aspects must be identified and given importance as well. To summarize this review, there is still some inequalities in health service with Maori and non-Maori people as evident in several readings published. As members of one community, it is important that each must take part in improving this issue in the society. Especially as part of the health care team, it is my responsiblity to materialize whatever learnings I gained in reviewing this literature. Through this task, I was also able to identify the markers that affects the well-being and access of every individual to health care. And the knowledge of these factors can help us in our roles in the community. Yet, despite of the issues present, it is still evident that New Zealand is indeed one of the coutries to have ann excellent health care system in the world because it took an effort to provide subsidy for medical and hospitalistion for its citizens. [1] Housing New Zealand. (2013). 2012-2013 Annual Report (Focused. Homes for people, reshaping our houses). Wellington. Retrieved from http://www.hnzc.co.nz/our-publications/annual-report/2012-13-annual-report/annual-report-2012-13 [2] Pollock, K. (2013) Health and society Health services, Te Ara the Encyclopedia of New Zealand. Retrieved from http://www.TeAra.govt.nz/en/health-and-society/page-4 [3] The Accident Compensation Corporation. (2014). Am I covered?. Retrieved from http://www.acc.co.nz/making-a-claim/am-i-covered/index.htm [4] Cook, M. (2012). Women’s health MÄ ori women’s health, pre-colonial times to 1940s. Te Ara the Encyclopedia of New Zealand. Retrieved from http://www.TeAra.govt.nz/en/womens-health/page-2 [5] The Nursing Council of New Zealand. (2011). The New Zealand Nursing Workforce. Retrieved from http://www.nursingcouncil.org.nz [6] National Health Committee. (1998). The Social, Cultural and Economic Determinants of Health in New Zealand: Action to Improve Health (A Report from the National Advisory Committee on Health and Disability). Wellington: Griffiths, G. Retrieved from http://nhc.health.govt.nz/system/files/documents/publications/det-health.pdf

Saturday, July 20, 2019

Physics and the Speed of Sound :: physics sound

The Speed of "Sound": is actually the speed of transmission of a small disturbance through a medium. The speed of sound (a) is equal to the square root of the ratio of specific heats (g) times the gas constant (R) times the absolute temperature (T). a = sqrt [g * R * T] Sonic Boom Sound generated by airflow has been around and reasearched for a long time. The increased use of fluid machines and engines has led to an increasing level of noise generation, and hence to an increasing interest in this area of research. A sonic boom is a loud noise caused by an aircraft travelling faster than the speed of sound which is mach one.. The sound propagates along the figure which is called the mach cone. The boom is due to a combination of volume and lift. While the boom due to volume can be virtually eliminated (Busemann, 1935), the boom due to lift can only be minimized. The minimum sonic boom generally does not correspond to the best aircraft. There is among others: sonic boom minimization at given drag; minimization at given volume, etc. (Seebass, 1998). Because the shock energy is nearly conserved as the shock radiates, its strength decays only slightly with the distance from the aircraft. Minimization is not straightforward, because it is constrained by structural, aerodynamic and design parameters, and not least by the variation of the thermo-dynamic properties of the atmosphere. The Speed of Sound, source: Air & Space/Smithsonian. The speed of sound varies with temperature. At sea level Mach 1 is around 742 mph. It decreases with altitude until it reaches about 661 mph at 36,000 feet, then remains at that speed in a band of steady temperature up to 60,000 feet. Because of the variation, it is possible for an airplane flying supersonic at high altitude to be slower than a subsonic flight at sea level.

The First Jump Essay -- Personal Narrative Sky Diving Essays

The First Jump My first jump out of an airplane on December 17, 1999 was the most exciting experience of my life. I had been anticipating this day since some point when I was a little kid and saw a skydiver on TV for the first time, at which time I promised myself that I would let nothing stop me from jumping out of a plane sometime before I die. It was the first time I had been in a small airplane since I was a young child. From shortly after I was born until I was seven years old, I had flown in my father's Cessna 150 countless times, so I have always felt comfortable flying in airplanes, but I always had a small fear of heights; the kind of heights where there is nothing around you to keep you from falling off. The aircraft that we were to jump out of was a Cessna 182- a commonly used five-person, high-wing, single engine airplane. The interior of this particular plane was not much to speak of. All of the upholstery had been removed, as were all the seats (except for the pilot's seat, of course). That was okay though. This plane is used for skydiving, not first-class passenger transportation. As we were climbing to 3,500 feet, I was experiencing the most exciting yet nervous point in my life. I had been looking forward to this day for a long time and there I was sitting in the back of that small aircraft, waiting to take the plunge of my life while nervously taking turns looking at the little needle on my wrist altimeter and glancing out the window, looking at everything on the ground getting smaller, anxiously reviewing the jump routine over and over in my head, â€Å"arch one-thousand, look one-thousand, reach one-thousand, pull one-thousand.† Since this was going to be a static-line jump, there was not a real ripcord to pull because the canopy would deploy automatically, but we were equipped with a dummy ripcord so that we would learn the proper free-fall technique. At about three-thousand three-hundred feet, the jumpmaster hollered â€Å"one minute to jump,† and opened the cabin door. It was me and two other beginners on board, Jennifer and Susan. Since Jennifer was the first to go, she was already sitting by the door, facing aft of the aircraft. When the door flung open and the air came rushing in, Jennifer took a quick glance at the ground and her eyes grew huge. At this time, I was going over the exit routine in my head. â€Å"Wait for the ju... ...went out the window and was replaced with "oh shit, oh shit, oh shit!" Instead of arching my back with my arms and legs spread out like I was supposed to do, I instinctively tried to "swim" back to the aircraft. With my arms and legs flailing all over the place, I flipped and flopped through the thin air until my chute opened about five seconds after leaving the airplane. The momentum of my spinning body caused my lines to twist when my canopy deployed. Not a big deal. They taught us how to deal with this during ground instruction. I pulled my lines apart and kicked my way out of it. Having successfully left the plane with my chute open and my lines untwisted, I breathed the biggest sigh of relief that I had ever breathed in my entire life. The ride down was extraordinary. The only problem was that I had gotten so caught up in the moment that I had pretty much forgotten to steer the chute toward the airport until I was about two-hundred feet above the ground. Luckily, I barely made it back into the airport, but landed in some mud about three-hundred yards from the X that I was supposed to be aiming for. Oh, well. I knew that next time, I'd make it a lot closer to that X.

Friday, July 19, 2019

Rain Forest :: essays research papers

Long ago, the Earth had a green belt of rain forests around its middle that covered almost twelve percent of the earth's land surface.(Miller & Berry 3) Today, the rain forest covers two percent of the earth's land surface and it is declining rapidly. The following will be a description of the rain forest, factors in its destruction, and if there are any answers to slow or halt the process. "Today, as we enter the last decade of the twentieth century, we have reached a turning point; we can no longer use the excuse of ignorance."(Hammond 2) People need to try harder to stop rain forest depletion. There are two major areas on earth where rain forests are located. One of these areas is called "The Old World Tropics," which includes Africa and Asia. In Africa, the rain forests are primarily located around the Zaire river. The other area in which rain forests are located is called "The New World Tropics," which contains Central and South America. The New World tropics are in lower altitudes as opposed to the Old World tropics, which are at higher altitudes. Rain forests are located around the equator. This location of the rain forests makes them warm and humid all year round. There are never cold winters in the rain forests. During winter in the rain forests, people comfortably are able to wear T-shirts and shorts. The rain forest has a rainy season which usually lasts most of the year. "The rain forests of the world are home to more than half of the animal species that live on earth."(CSIRO 1) Many of these creatures are some of the most beautiful and odd creatures in the world, Such as the large rodent Capybara, the Anteater, and many different colorful exotic birds. There are many beautiful creatures living in our Earth's rain forests. Many people are ignorant to the effects of rain forest depletion on our environment, and this ignorance is a major cause in the beginning of the destruction of the rain forests. "Eu ropean settlers exploited the rain forests for timber and cleared them for agricultural purposes."(Parish 4) "The name scrub, which was originally applied to the rain forest by European settlers, became a term for land seen as useless until subject to ax, fire, and plough."(Parish 4) People did not think of the affects on the environment because the little knowledge that was known about the affects was not very widespread.

Thursday, July 18, 2019

Insurance and Payment Expectations

HEALTHCARE PAYMENT EXPECTATIONS Unit 1 Individual Project Tina Nguyen HLTH420 – Healthcare Finance November 7, 2012 Abstract This research paper will explain the payment expectations of government, commercial, and liability insurances, as well as self-pay/cash pay patients. An in depth explanation of how they differ, such as rules, will be made. This report will help readers understand the different types of programs in bill collecting, and account and project financial expectations. Healthcare Payment Expectations Payment expectations are the reimbursement of the services given to patients.There are many alternatives to how healthcare organizations collect their payments or revenues. They can be handled through cash transactions or through various types of insurances, such as government-assisted, commercial, and liability insurances. Some of the health insurances that are government-assisted are Medicare, CHIP, and Medicaid. Government-assisted insurances, such as Medicare an d Medicaid, are provided for low income families and adults over the age of 65 or even those under 65 that has certain disabilities (USA. gov, 2012).Medicaid’s health coverage will vary by states, as they will set their own rules and guidelines. In order to be granted for these government health insurances, an individual must meet certain criteria to be eligible, depending on which program it is catered for (New Horizons Un-Limited Inc. , 2011). Payment expectations of government-assisted health insurances, such as Medicaid, are reimbursed through co-pays, and premiums (â€Å"Medicaid Payment Expectations, â€Å" n. d. ). As mentioned before, payment expectations will vary by state but should not be much different.Co-pays are the rate at how much is to be paid for the services or a prescription a patient will be receiving (â€Å"Medicaid Payment Expectations,† n. d. ). Co-pay rates are rates that are agreed upon by the Medicaid program and type an individual has. Pre miums are out of pocket expenses that need to be paid by the individual to maintain and retain medical benefits (â€Å"Medicaid Payment Expectations,† n. d. ). Premiums are a monthly expense and it also depends on each individual and will vary by state.If premiums are not paid in a timely manner, that can be considered as a non-payment and there may be a possibility that an individual may lose their insurance coverage. If that was to occur, the individual would need to reapply. Commercial health insurances are health insurances that cover medical and health expenses for those that are already insured. For example, since commercial health insurances is for profit and is not offered through a government entity, these health insurances are usually offered through group insurances (â€Å"What Is Commercial Health,† n. . ). In many instances, commercial health insurances will be offered through the individual’s employer. Typically, these insurances will have a monthl y or even a bi-weekly premium that will be deducted from an employee’s paycheck. Depending on how the commercial health insurance is planned, employees will usually see a payment of the entire monthly premium or a percentage of it in their paycheck. Liability insurance is also known as medical malpractice insurance.Liability health insurance helps protect the insurer from lawsuits and mistakes that can or will arise from the workplace. Liability insurance can be purchased through many types of companies, such as insured insurance companies, risk purchasing and risk retention groups, and etc (Texas Department of Insurance, 2012). Payment expectations are that liability insurance information must be provided at the time of registration in order for a claim to be filed.Depending on the responsible party of paying that claim, it can either be the insured or the insurance company; it varies with each plan per individual. Self-pay or cash pay patients are usually those patients tha t does not have medical insurance or those who just prefer not dealing with the hassles of Medicare or insurance reimbursement or claims, will pay an out of pocket expense for the medical services they seek and get. Medical doctors and clinicians view these patients as more compliant and motivated to doctor’s orders (Carter, 2011).Without any insurance help, self-pay patients would usually get a discount percentage due to the high cost of medical services. Self-pay or cash patients will have to pay the full amount or partial before or after the service, and if a balance remains would need to pay in the next couple of months depending on the payment plan. All of these components of payment expectations of different insurances would need to familiarize with by medical business professionals in order for efficient billing, collecting, accounting, and the projection of financial expectations to occur.All health insurances, it doesn’t matter what type of insurance, has to f ollow basic standards of regulations of the service and product, but each state and health facility has its own discretion in how to price their services and also deciding how much a patient is responsible for their balance. There is much that needs to be considered if the payer mix is the basic determinant of the healthcare organization’s financial projections. Payer mix is a medical term of the percentage of revenues that comes into the organizations is from private to government insurances to self-pay patients (Wall, 2010).Unfortunately, revenues from government insurances, such as Medicare and Medicaid, are considered losses to healthcare organizations due to these government insurances pay less to hospitals and healthcare organizations than what they charge patients for services. Through this knowledge, healthcare organizations need to be aware of areas like this in order to compensate for what is lacking. | References Carter, J. (2011, November 7). How Self-Pay Patients Have Made Me a More Effective Clinician. Retrieved from