Change Process Theories

Change Process Theories: A Review Outline Introduction Four types of Organizational Change Theories: Van de Ven and Poole †¢ Dialectical: Kurt Lewin †¢ Evolution: o Lippitt, Watson, and Wesley o Bartlett and Kayser †¢ Teleology: o Edgar Schein o Prochaska and DiClemente †¢ Life Cycle: Ichak Adizes Conclusion Introduction An enduring quest of management scholars is to explain how and why organizations change. The processes of change or sequences of events have been difficult to define, let alone manage. Researchers have borrowed many concepts from many fields of study, including sociology, biology, and physics. Van de Ven and Poole (1995) proposed four categories of organizational change: dialectical, evolution, teleological and life cycle. Dialectical theory is the development of an organization through the conflict, competition, and/or collaboration of internal or external interests, wherein the status quo is changed regardless of the overall benefit or detriment to the organization. Evolutionary theory views organizational change as the cumulative change brought about through the continuous cycle of variation, selection and incorporation, and retention, caused by competition for scarce resources, environmental change or imposed conditions. Teleology is the purposeful development of an organization towards a defined end result or in line with a predetermined collective ideology by means of repetitive sequences of goal definition, implementation, evaluation and modification. Finally, Life Cycle theory is the linear, organic development of an organization from a homogenous, undefined entity to a differentiated, structured entity through accumulated experiences arising from the pressure of external events as mediated by internal logic, rules or programs. Within these four categories, I present six theories of organizational change to illustrate the underlying concepts within each category. Dialectical Theory Kurt Lewin is widely regarded as one of the pioneers in the study of change processes. A social scientist, Lewin postulated that human behavior is based on a relatively stationary equilibrium of two groups of forces. While driving forces facilitate change by pushing in the desired direction, counterforces known as restraining forces immediately sprout to hinder the change. When a significant change in these forces occurs, behavior must also shift to maintain equilibrium. After equilibrium is reached, the new behaviors gradually become the standard for maintaining the status quo. Lewin described this process in his article, Frontiers in Group Dynamics: â€Å"A change toward a higher level of group performance is frequently short lived; after a â€Å"shot in the arm† group life soon returns to the previous level. This indicates that it does not suffice to define the objective of planned change in group performance as the reaching of a different level. Permanency of the new level, or permanency for a desired period, should be included in the objective. A successful change includes, therefore, three aspects: unfreezing (if necessary) the present level, moving to the new level, and freezing group life on the new level† (p 34). The Evolutionary Theories Lippitt, Watson, and Westley expanded on Lewin’s work by introducing the idea of a relationship between the change agent and the ‘client’ or organization to be changed. Lippitt et al. ’s theory proposes seven phases. The first phase focuses on developing a need for change. A client must not only be aware of a problematic situation, but must believe a better state of affairs is possible, and that the change agent (whether a consultant or method) is relevant and available. Phase two is the establishment of a change relationship. As with any human relationship, one of the most delicate yet absolutely crucial elements in forming the change relationship is the first impression. â€Å"Often the client system seems to be seeking assurance that the potential change agent is different enough from the client system to be a real expert and yet enough like it to be horoughly understandable and approachable† (Lippitt et al. p 134). Phases three, four, and five are an elaboration on Lewin’s moving stage, and can be grouped together under the heading: moving toward change. These straightforward phases are (3) Clarification or Diagnosis of the client’s problem (4) Examination of the Alternative Routes and Goals and Establishing Goals and Intention s of Action, and (5) Transformation of Intentions into Actual Change Efforts. Lippitt et al. return to Lewin’s Refreezing stage with phase six: The generalization and stabilization of change. A critical factor in the stabilization of change is the spread of change to neighboring systems. A change is much more likely to be retained if reinforced by colleagues’ usage. The final phase, achieving a terminal relationship, focuses on preventing a dependency on the change agent for support and developing a form of client self-reliance for future problem-solving. Lippitt et al. issue a final caution, noting that the seven phases present are not always sequential, and the phases can overlap or repeat themselves throughout the change process. Bartlett and Kayser (1973) propose that successful change depends on a reactive redistribution of power within the structure of an organization. This power redistribution optimally occurs through a six phase series of stimuli and reactions. Stimulus 1: Pressure on top management takes the form of both internal pressure (such as union strikes, low productivity, high costs or interdepartmental conflict) and external pressure (such as lower sales, stockholder discontent, or a competitor's breakthrough. When these pressures offset one another, e. g. high sales despite employee grumbling, there is little incentive for top management to induce change. However, when internal and external pressures are aligned, Reaction 1: Arousal to take action senior management seeks a consultant or other diagnostic tool to discover the problem. Stimulus 2: Intervention at the top – While long-term managers tend to look for individuals and groups to blame, â€Å"outsiders† tend to see the org anizational structure or processes as equally likely culprits. The â€Å"outsider†, presumably hired and respected for his expert ability to improve organizational practices, is in an ideal position to Reaction 2: Reorient top management to internal problems. In order to Stimulus 3: Diagnose problem areas effectively, top management speaks with multiple levels of the organization. This step largely determines the success of the change. Top menagers who only consult their immediate subordainates gather little to no new data. Managers who conduct a comprehensive hierarchy-spanning feedback search not only acquiremore information but have a positive reinforcing effect on the change to come. By consulting all hierarchy levels, managers achieve employee buy-in, drawing employees to believe that not is management itself willing to change, but actual important problems are being acknowledged and ideas from lower levels are being valued by upper levels (Bartlett and Kaser, 1973, p. 58). In contrast, manager who take a unilateral approach are making changes based on limited viewpoints with little to no employee buy-in. Perhaps even worse is the CEO who delegates the change to a subordinate, who potentially has less information, less clout within the organization, and the lingering uncertainty that top management isn't sincere about the change. Reaction 3: Recognition of specific problems found through the diagnosis process will cause deliberation resulting in the Stimulus 4: Invention of a new solution. Suggestions for solutions can be gathered in phase 3. Barlett and Kayser place particular importance on group collaboration for generating potential solutions. Through this collaboration, there is greater Reaction 4: Commitment to the new courses of action. Stimulus 5: Experimentation with new solutions inevitably produces occasional setbacks and/or outright failure. During this period, the multi-level employee endorsement of change becomes critical as the organization Reaction 5: Reviews the results of the change. While non-effective ‘solutions' are thrown out, effective solutions are propagated and expanded. Ideally, the quietly discarded solutions only briefly demoralize their advocates, while the retained superior solutions have an infectiously positive effect. Finally, this Stimulus 6: Reinforcement from positive results ushers in a full scale Reaction 6: Acceptance of the new practices. Teleological Theories Edgar Schein further defined Lewin's three stage theory, proposing that the Unfreezing stage can be subdivided into three steps: Disconfirmation, Induction of Guilt or â€Å"survival anxiety†, and Creation of Psychological Safety. Disconfirmation is characterized by the dissatisfaction and/or frustration with the current state of affairs. Survival anxiety occurs when the dissatisfiers are accepted as valid and linked to the nonattainment of goals. The primary restraining force at this stage is learning anxiety – having to admit that the current behaviors are â€Å"wrong† and the additional fear that attempting a new process may result in failure and a loss of esteem. The Creation of Psychological Safety step is the addressing and overcoming of this fear. Schein further subdivided Lewin’s theory by splitting the moving process into three phases. The first phase, Cognitive Redefinition is typified by organizational members discovering that the definitions, concepts and other anchors previously relied upon are not absolutes. While the unfreezing stages create motivation for change, the second phase, termed Imitation and Identification with a Role Model, determines whether the change is beneficial or harmful, depending on the role model chosen. However, if there are no attractive role models, the third phase, Scanning of Alternatives and Trial and Error, comes into play. Occasionally, if there is sufficient psychological safety, spontaneous insight into a solution may occur. This spontaneous insight is highly valuable because such insights often take into account both stated and hidden unique obstacles to a change, unlike process consultants who often can only address the stated barriers. With regard to the Refreezing stage, Schein notes that the new behaviors must be at least somewhat compatible with the remaining behaviors or the cycle of disconfirmation may restart, potentially reversing the progress made, or devolving into an endless cycle of new behaviors. Prochaska et al (1992) developed a change behavior model for the health care field which has gradually been extended to other disciplines. Much like Lewin's model, their model defines the general process of change. Unlike Lewin, Prochaska et al. present their five stages of behavioral change as cyclical in nature rather than as a simple progression. Please see figure 1. Precontemplation (PC) is the stage at which there is no intention to change behavior in the near future. Typically, an external force such as a lawsuit or technological advancement occurs to push an organization into the next stage. Contemplation (C) is the stage where the problem or undesirable behavior is recognized, and serious consideration is given to change the behavior. This stage is characterized by the weighing of current opportunity costs against the actual costs of modifying the problem. Preparation (PP) is a stage that combines intention and initial attempts to change behaviors. The organization intends a full transformation of the indicated ‘problem behaviors' in the very near future. The cessation of undesirable behaviors and embrace of the new behaviors marks the advent of the Action (A) stage. The Maintenance (M) stage is often, and incorrectly, viewed as a static stage. In truth, this stage is the continuation and reinforcement of the new behaviors. This stage becomes particularly pertinent when the initial attitude of ‘new and improved' begins wearing thin and organizational members consciously or subconsciously attempt to return to the ‘old and trusted' methods. This backslide can continue (precontemplation) until the problem is once again addressed (contemplation). Life Cycle Theory In his 1998 book, Adizes presents one of the clearest descriptions and in depth refinements of Life Cycle organizational development models to date. Based on ten sequential stages of development, he addresses the attitudes, issues, and threats at each stage of life. These life stages are categorized into the growing phase, second birth and coming of age, and aging organizations. Please see figure 2 for reference. (In the interest of brevity, a few potential alternative stages have been omitted. ) The Growing Phase begins with the courtship stage where the organization is only an idea in the founder’s mind. At this time, the founder is building inspirational momentum – revving his courage so that when the time comes to make the decision to take the risk, he has the internal commitment to survive the external doubts and hardships. During the courtship stage, this commitment determines whether the idea will result in a healthy organizational child or if it is merely an affair, a momentary infatuation with entrepreneurship. Once the risk has been undertaken, the nature of the organization mutates drastically. At this Infancy stage of the organization, there is an overriding emphasis on doing rather than thinking; thinking of new products may be useful in the future, but sale of current products ensures a future will exist. The organization is incredibly personal, with little hierarchy. Formal procedures are non-existent except for those imposed by outside forces, i. e. laws and government regulation. Like an infant, the organization requires periodic infusion of milk (cash) and the constant tending of its creator. The period of infancy is necessarily short. The energy level required plateaus as brand loyalty builds, suppliers stabilize, and the production problems are no longer a daily crisis: the baby begins sleeping through the night. The infant organization moves into the Go-Go stage. With the idea working, ends meeting, and sales flourishing the founder and the organization become arrogant. The struggle to survive fades to the back of the mind and every opportunity becomes a priority: after all, if one dream came true, why not other dreams as well? The toddler shoves every opportunity into its mouth, without regard for nutritional value. Whereas in the infancy stage there was no hierarchy, the Go-Go stage begins development of a structure. At the beginning of the stage, the responsibilities are shared and many tasks overlap: the organization is organized around the people not the tasks. The CEO risks falling into the Founders Trap: failing to realize the organization has moved beyond a one-man show, that decentralization and delegation have become imperative. The signs of imminent crisis, the arrogance, uncontrolled growth, lack of structure and centralized decision making, are obfuscated by soaring sales, overconfidence from success, and the residual stubbornness of an entrepreneur fighting for his dream. When the crisis hits, the company falters and a second birth occurs. The Second Birth and Coming of Age Phase begins with Adolescence: an awkward period that is more painful and prolonged than infancy. Like a teenager trying to establish independence from his family, the adolescent organization’s characteristic behaviors include conflict and inconsistency. In delegating, the founder must content himself with offering advice instead of taking control: he must allow his organizational child to make mistakes in order to learn from them. Gradually, the organization establishes its sovereignty, with the occasional clash with ‘old management’. This can precipitate a divorce, especially if the founder decides that the organization's goals have become incompatible with his own. The adolescent organization experiences a shift from merely generating more sales, to generating better sales with less overhead and more profit. When the overall structure of the administration stabilizes and leadership roles become institutionalized, the organization moves to the next stage of development: Prime. Prime is the optimum point on the life cycle curve, combining the vision and aggressiveness of a Go-Go with the structure solidified in Adolescence to back it up. This is not to say that a company in its prime has stopped growing, but that growth has become planned and controlled. The challenge of Prime is to continue the momentum, and not become complacent and ride the inertial growth from previous stages. If a Prime organization does not refuel this momentum, organizational vitality will level off, and will enter the stage called Stable, the end of growth and the beginning of decline. The Stable stage is first in the Aging Phase in the organizational life cycle. The organization slowly loses flexibility; the persistent sense of urgency departs and is replaced with a feeling of security in the relatively stable market share acquired over the years. Several changes slip in: the developmental spending budget grows while the product and market research budgets decline, management training is substituted for management development, and there is a power shift to the finance department from engineering, marketing, or research and development. Despite these changes, there is markedly less conflict in the Stable stage. There are no major transitional events in the Aging phase as there were in the Growing phase. Instead, there is a slow process of deterioration. As the organization draws back from personalized attention to each client, it slides into Aristocracy. The organization is often cash rich, leading organizational members to misclassify themselves as in the prime stage. â€Å"Don’t make waves† becomes the company motto, and uniformity of thought, dress, and address becomes the norm. While Bob and Mary may be on a first name basis outside of the office, or behind closed doors, during meetings it is inevitably Mr. Smith and Ms. Jones. Another notable communication change is that focus is placed on how something was said, rather than what is said. Because of the organizational taboo against sparking conflict, consultants are brought in to give voice to the deadly trend of expecting external forces to increase market share without the executives having to admit anything. The consultant reports are often read, but ignored until the advent of Early Bureaucracy. With revenues and profits plummeting and a high turnover of good people, the Early Bureaucracy witch hunt begins. Internal conflict, back stabbing and paranoia obliterate any remaining customer focus. The organization focuses on who caused a problem rather than on what to do about it. The remaining creative individuals jump ship or are fired as though they were the source of the problems. The organization has two options remaining: Bureaucracy or Death. If a company is subsidized or nationalized, it has attached itself to life support: autonomic (administrative) functions are kept moving, but the vital spark from the infancy stage has been extinguished. The organization has become a Bureaucracy; its only purpose is to perpetuate its existence. Eventually, through internal decision making or government reallocation of funds, the organization quietly dies. Conclusion As theories develop, they become more specific and therefore more limited in scope. Scholars examining these theories develop a form of tunnel vision, and can become stymied by unexplainable behavior outside their specialty. Van de Ven and Poole's taxonomy of change theory types helps to reacquaint researchers with the wide variety of possibilities. Further research on the meta-analysis of change theories is indicated. References Adizes, Ichak. (1988). Corporate Lifecycles: How and Why Corporations Grow and Die and What to do About It. Prentice Hall. Englewood Cliffs: New Jersey. Armenakis, Achilles and Bedeian, Arthur. (1999). Organizational Change: A Review of Theory and Research in the 1990s. Journal of Management. 25. 293 – 315. Bartlett, Alton and Kayser, Thomas. (1973). Changing Organizational Behavior. Prentice Hall. Englewood Cliffs: New Jersey Lewin, Kurt. (1947). Frontiers in Group Dynamics. Human Relations. 1. 5-41. Prochaska, James, DiClement, Carlo, and Norcross, John. In Search of How People Change: Applications to Addicitive Behaviors. American Psychologist. 47. 1102 – 1114. Romanelli, Elaine. (1991). The Evolution of New Organizational Forms. Annual Review of Sociology. 17. 79-103. Retrieved November 29, 2006 from JSTOR. http://links. jstor. org/ sici? sici=0360-0572%281991%2917%3C79%3ATEONOF%E2. 0. CO%3B2-M Van de Ven, Andrew. (1995). Explaining Development and Change in Organizations. Academy of Management Review. 20. 510-540.

South African Public Hospitals Health And Social Care Essay

The words â€Å" crisis † and â€Å" wellness attention † follow each other in sentences so frequently in South Africa that most citizens have grown numb to the association. Clinicians, wellness directors and public wellness experts have been speaking about a crisis in entree to wellness attention for more than half a century, and the coming of democracy has non alleviated the state of affairs. South Africa ‘s inability to adequately react to its many crises is besides the consequence of a national health care system designed to supply intervention instead than bar. The over-dependence on hospital-based attention in South Africa non merely makes the health care system expensive and inefficient, but besides precludes much-needed investings in primary and preventive attention. Health curate Dr Aaron Motsoaledi candidly conceded that the public wellness system faces ‘very serious challenges ‘ ( Philip 2009 ) . In this reappraisal I describe the crisis in child care and its effects for the wellness of kids, characterise the implicit in grounds for the crisis, analyze current intercessions and research some medium and longer term solutions.How terrible is the crisis?It is non surprising that the populace ‘s perceptual experience of wellness services are frequently determined by narratives about the attention offered to kids presented in the media. For case, in one hebdomad in May 2010, two narratives dominated newspaper and media headlines in Gauteng. One was the decease of seven newborn babies and the infection of 16 others as a consequence of a deadly infection ( later identified as a norovirus ) acquired by the babies at the Charlotte Maxexe Johannesburg Academic Hospital. At Natalspruit Hospital in Ekhuruleni, 10 kids likewise succumbed to a nosocomial ( hospital acquired ) infection ( Bodibe 2010 ) . These types of events, with big Numberss of kids geting infections in infirmaries are non uncommon, although merely a fraction grabs the headlines. Outbreaks occur at regular intervals at infirmaries throughout the state. An eruption of Klebsiella infection was responsible for 110 babes deceasing at Mahatma Gandhi Hospital in Durban, harmonizing to the administration â€Å" Voice † that threatened a category action instance against the Department of Health. The national wellness section itself has identified infection control as one of six cardinal countries that needed betterment in the public wellness sector ( Department of Health 2010 ) . Poor wellness attention at several Eastern Cape infirmaries left more than 140 kids dead in one of South Africa ‘s poorest territories within the first three months of 2008 ( Thom 2008 ) . A undertaking squad look intoing these deceases in the Ukhahlamba territory concluded that they were non the consequence to any peculiar disease eruption or exposure to contaminated H2O as ab initio suspected, but instead that the wellness service available was hopelessly faulty. ( Report on childhood deceases, Ukhahlamba District, Eastern Cape ) The Ukhahlamba undertaking squad, comprising of three experient public sector baby doctors, painted a inexorable image of Empilisweni Hospital kids ‘s ward where most of the deceases occurred. Problems identified included: The construction and layout of the physical installation was inappropriate – no nurse ‘s station or work surfaces, no separation of â€Å" clean † and â€Å" dirty † countries and no drama or stimulation installations, The ward and cells were overcrowded and no proviso existed for boarder female parents, who paid R30 to kip on the floor next to their kids, There were grossly unequal services – no O and suction points, excessively few electrical sockets, no basins or showers and excessively few lavatories in the patient ablutions, and an unacceptable ward kitchen, Highly limited clinical equipment, Staffing deployment and rotary motion did non advance effectual attention, with few nurses dedicated to the kids ‘s ward and physicians altering wards every two months, go forthing the ward devoid of experient forces, There were limited policy paperss and no protocols or entree to allow clinical mention stuff or guidelines, Clinical patterns were uneffective or unsafe, peculiarly sing infection control and the readying and distribution of infant provenders and medical specialties, Not a individual infirmary record included inside informations about the prescribing or disposal of infant provenders. Fluid direction was severely documented. Three of the kids appeared to hold died from fluid overload due to inappropriate and unregulated fluid disposal, The bulk of the kids were ne'er weighed, their nutritionary position was non assessed nor their Hiv position established. The undertaking squad ‘s audit of 45 of the deceases revealed that most of the deceases occurred within the first 48 hours of admittance to infirmary and were in babies who were self-referred. The dominant diagnosings were diarrheal disease, pneumonia and malnutrition. The undertaking squad concluded that â€Å" These deceases are more likely the consequence of hapless attention of a vulnerable destitute community with high rates of malnutrition among the babies and hapless use of the available wellness services. † The hapless state of affairs described at Empilisweni Hospital is non alone and similar low conditions can be found at many of the pediatric wards at the 401 infirmaries in the state. While nonsubjective grounds to back up this contention does non be, pediatric practicians in many states and scenes would readily admit the veracity of the claim. The account offered by different probes of inauspicious events happening at public infirmaries countrywide is unusually similar. Uniformly, there is a combination of overcrowded wards, understaffing, overpowering work loads, a dislocation of hygiene and infection control processs, and direction failure with a deficiency of scrutinizing or supervising systems to place and react to jobs at an earlier phase.Increasing kid mortalityWhat is non combative is that South Africa is one of merely 12 states where childhood mortality increased from 1990 to 2006 ( Children ‘s Institute 2010 ) , with a doubling of deceases in kids under the age of five old ages in this period ( from about 56 to 100 deceases per 1000 unrecorded births ) . The 2010 UNICEF State of the World ‘s Children estimates South Africa ‘s under 5 decease rate to be 67 per 1000 for 2008 ( UNICEF 2009 ) . This high rate ranks South Africa 141st out of 193 states. The national statistic besides hides pronounced interprovincial fluctuations ; from about 39 per 1 000 in the Western Cape to 111 per 1 000 in the Free State ( McKerrow 2010 ) . A individual disease – HIV- is mostly responsible for the increased mortality. States with a similar economic profile ( Gross National Income [ GNI ] ) as South Africa such as Brazil and Turkey boast about quadruple lower under 5 mortality rates ( U5MR ) . South Africa ‘s high U5MR is even more confusing when compared to poorer states such as Sri Lanka and Vietnam. These two states ‘ U5MRs are approximately five times lower ( 15 and 14 per 1,000 severally ) despite holding a GNI less than one half to a 3rd of South Africa ‘s ( UNICEF 2009, World Bank 2010 ) . Despite being classified as a high in-between income state, South Africa has high degrees of infective diseases such as diarrhea, pneumonia, HIV, TB and parasitic infections usually found in poorer states. Similarly, there has been small success in cut downing undernutrition in kids – a one-fourth of South Africa ‘s kids are stunted ( short ) . Further, as a consequence of increased urbanization and economic development, the state is besides sing increasing degrees of traumatic hurts and chronic diseases of life style such as fleshiness, diabetes and cardiovascular disease that are more typical of better resourced states. These diseases chiefly affect grownup populations but are progressively being identified in kids. The deterioration in kid wellness has occurred despite important betterment in kids ‘s entree to H2O, sanitation and primary wellness services. About 3000 new clinics have been built or upgraded since 1994, wellness attention is provided for free to kids under 5 old ages and pregnant adult females ( Saloojee 2005 ) , and the kid societal support grant is making 10.5 million kids ( more than half of all kids in the state ) ( Dlamini 2011 ) . These accomplishments have been marred by several defects. Many new clinics and the territory wellness systems are non yet adequately functional because of a deficiency of forces and fundss, hapless disposal, and spread outing demands. Public third wellness attention ( academic infirmary ) services have badly eroded.Characterizing the crisisThe World Health Organization, in 2000, ranked South Africa ‘s wellness attention system as the 57th highest in cost, 73rd in reactivity, 175th in overall public presentation, and 182nd by overall d egree of wellness ( out of 191 member states included in the survey ) ( World Health Organization 2000 ) . What explains this blue evaluation? Despite high national outgo on wellness, inequalities in wellness disbursement, inefficiencies in the wellness system and a deficiency of leading and answerability contribute to South Africa ‘s hapless kid wellness results.Hospitals operate within a dysfunctional wellness systemPoor infirmary attention is but one marker of a dysfunctional wellness system that comprises splodges of independent services instead than a coherent, co-operative attack to presenting wellness attention. Most primary wellness attention services for kids are merely offered during office hours, with some clinics curtailing new patients ‘ entree to services by early afternoon – a waste of available and expensive human resources. Some clinics lack basic diagnostic trials and medicine. Consequently, many infirmary exigency suites are flooded with kids wi th comparatively minor complaints because their health professionals choose non to line up for hours at ill managed local clinics, or prefer accessing wellness services after returning from work. The referral system in which patients are referred from clinics to territory, regional or third infirmaries harmonizing to how serious their wellness jobs are has disintegrated in many parts of the state. Children who require more specialized attention frequently can non acquire it either because they get stuck within a dysfunctional system or because there is no infinite for them at the following degree of attention. Conveyance to secondary and third degree infirmaries is debatable, ensuing in holds or non-arrival, increasing the badness of the disease and intervention costs when the kid does arrive. District infirmary services are the most dysfunctional ( Coovadia 2009 ) , with patients frequently by-passing this degree of attention in scenes where entree to secondary ( regional ) or third attention ( specializer ) services are available. Despite cut-backs in budgets, third attention scenes continue to try to supply ‘first-class ‘ services, which although applaudable, may ensue in over-investigation and intervention, and denial of indispensable attention to kids who reside outside their immediate catchment countries ( because the infirmary is ‘full ‘ ) .Changing wellness environmentSome of the increasing emphasis faced by the public infirmaries may be attributed to the altering wellness environment in which they operate. Two factors are most responsible for the alteration: rapid urbanization and the AIDS epidemic. Urban, township infirmaries are peculiarly affected by the load of increased patient tonss, and hardly get bying with the demand. Although a national strategic program for HIV/AIDS exists, the ability to implement the program is constrained by the tremendous demands on human and financial resources demanded for its execution. The budget allocated to HIV/AIDS has increased from R4.3 billion in 2008 to an estimated R11.4 billion in 2010 ( 13 % of the entire wellness budget ) ( Mukotsanjera 2009 ) . New enterprises aimed at beef uping the HIV/AIDS response, include a national HIV guidance and proving run and the decentalisation of antiretroviral intervention from infirmaries to clinics with nurses now supplying the drugs. About a 3rd of kids at most South African infirmaries are HIV septic. HIV-positive kids are hospitalised more often than HIV-negative kids ( 17 % compared to 4.7 % hospitalised in the 12 months prior to the survey ) ( Shisana 2010 ) . Children with AIDS tend to be sicker and frequently require longer admittances despite enduring from the same spectrum of unwellnesss as ordinary kids. Greater Numberss of patients, higher disease sharp-sightedness degrees and complications, and slower recovery rates all impact on limited resources. High mortality rates take an emotional toll on physicians and nurses. Hospital pediatricss, which has ever been a popular and rewarding pick for freshly qualified physicians because of modern medical specialty ‘s ability to rapidly reconstruct urgently sick kids to wellness has now become much more about chronic attention bringing because of the high figure of HIV infected kids in the wards, many of whom are re-admitted on a regular basis because of perennial infections. In recent old ages, immature physicians have been dissuaded from choosing primary attention subjects, such as pediatricss, and have moved alternatively to prosecuting fortes where contact with patients is limited, such as radiology, for fright of geting HIV from work-related accidents such as needle-stick hurts. The handiness of extremely active antiretroviral ther apy to increasing figure of kids nationally, though still limited to fewer than half of all eligible kids, has the possible to return pediatricss to its old position as a rewarding and fulfilling forte.UnfairnessUnfairnesss and inequalities abound in South African wellness attention disbursement by and large, and specifically sing kids ‘s wellness. Of the R192 billion spent on wellness attention in 2008/09, 58 % was spent in the private sector ( Day 2010 ) . Although this sector merely provides attention to an estimated 15 % of kids, two-thirds of the state ‘s baby doctors service their demands ( Colleges of Medicine of South Africa 2009 ) . Furthermore, of the R90 billion provincial public wellness sector budget, approximately 14 % is spent on cardinal ( third ) infirmary services ( Day 2010 ) , which chiefly benefits kids shacking in urban scenes and wealthier states such as the Western Cape and Gauteng. Similarly, pronounced unfairnesss exist in the figure of wellness professionals available to kids in different states with, for illustration, one baby doctor serving about 8,600 kids in the Western Cape, but 200,000 kids in Limpopo ( Colleges of Medicine of South Africa 2009 ) . This differential exists among most classs of wellness professionals. The current wellness system claims to supply cosmopolitan coverage to kids. Yet, from a resourcing, service bringing and quality position, the handiness and degree of service is unjust with many patients and communities sing significant trouble in accessing the public wellness system. Rural and black communities remain most deprived. Apartheid age derived functions continue in present twenty-four hours wellness attention. Therefore, for case, while the once whites merely Charlotte Maxexe Johannesburg Academic Hospital now chiefly serves a black urban population, its resources including ward installations, staff-patient ratios and overall budget still demo a clear positive prejudice when compared to the resources available to the Chris Hani Baragwanath Hospital located in Soweto ( a former ‘black ‘ infirmary ) ( von Holdt 2007 ) . Nationally, the most stressed infirmaries are those with the lowest resources per bed. The least stressed infirmaries continue to be those with old reputes as high-quality establishments ( largely antecedently â€Å" whites merely † infirmaries ) that provide them with a sort of ‘social capital ‘ ( von Holdt 2007 ) .Management capacity crisisThe conflict for the control of infirmariesSouth Africa has embraced the construct of wellness services delivered wit hin a three-tiered national wellness system framework – national, provincial and territory. States are charged with the duty of supplying secondary or third infirmary services, with territory services holding duty for territory infirmaries and clinics. Existing legislative assembly allows hospital main executive officers ( CEOs ) considerable powers in the running of their ain infirmaries. However, there is a dysfunctional relationship between infirmaries and provincial caput offices, which frequently assume autocratic and bureaucratic control over strategic, operational and elaborate procedures at infirmaries but are unable to present on these. There is a bleary and equivocal venue of power and decision-making authorization between infirmaries and caput offices ( von Holdt 2007 ) . Hospital directors are disempowered, can non take full answerability for their establishments and are largely unable to make up one's mind on affairs such as staff Numberss and assignments, pulling up their ain budgets or playing any function in the procurance of goods and services. The structural relationship between state and establishment is a disincentive for managerial invention, giving rise to a infirmary direction civilization in which disposal of regulations and ordinances is more of import than pull offing people and operations or work outing jobs, and where incompetency is easy tolerated. Hospital directors ‘ deficiency of control undermines direction answerability and promotes subservience to the cardinal authorization. The function of provincial wellness sections should truly be about commanding policy sing preparation, occupation scaling and answerability.Silos of directionMost South African infirmaries have basically the same direction construction where authorization is fragmented into separate and parallel silos. Therefore, physicians are managed within a silo of clinicians, nurses within a nursing silo, and support staff by a mesh of separate silos for cleaners, porters, clerks, etc. The senior directors in the establishments have broad do mains of duty but with small authorization to do determinations or implement them ( von Holdt 2007 ) . As an illustration, a clinical section such as pediatricss is headed by a senior or chief pediatric specializer who has no control over the nurses in the pediatric section. In the wards, nursing directors are responsible for effectual ward operation, but have small control over ward support staff such as cleaners or clerks. A senior clinical executive ( overseer ) has duty for the paediatric ( and other ) sections, but can exert small significant authorization over it because power prevarications within each of the silos ( physicians, nurses, support workers ) . As a consequence, the clinical executive has to try to negociate with all parties. Doctors and nurses do non find budgets, or proctor and control costs. In kernel, those responsible for utilizing resources have no influence on their budgetary allotment, while those responsible for the budget presume no duty for the services that the budget supports. Most clinical caputs have no thought what their budgets are and costs are non disaggregated within the establishment to single units or wards. Therefore, what should be managed as an incorporate operational unit ( for illustration, a ward or clinical section ) operates alternatively in a disconnected manner with small clear answerability. In this circumstance all parties are disempowered, and relationships oscillate between diplomatic negotiations, persuasion, dialogue, angry confrontation, ailment and backdown. In the procedure few jobs are definitively resolved, with negative effects for patient attention. Where institutional emphasis is high, the disconnected silo constructions generate the mistake lines along which struggle and managerial failure manifest ( von Holdt 2007 ) .Fiscal crisisInsufficient outgo on wellness, infirmaries and kid wellnessBetween 1998 and 2006, South African one-year public per capita wellness outgo remained virtually changeless in existent footings ( i.e. accounting for rising prices ) , although disbursement in the public sector increased by 16.7 % yearly between 2006 and 2009 ( National Treasury 2009 ) . However, the little additions in outgo have non kept gait with population growing, or the greatly increased load of disease ( Cullinan 2009 ) . In 2009 the state spent 8.9 % of the gross national merchandise ( GDP ) on wellness ( Day 2010 ) , and easy met the World Health Organisation ‘s ( WHO ) informal recommendation that alleged developing states spend at least 5 % of their GDP on wellness ( World Health Organization 2003 ) . However merely 3.7 % of GDP was spent in the populace sector, with 5.2 % of GDP expended in the private sector ( Day 2010 ) . In per capita footings R9605 was spent per private medical strategy donee in 2009, while the public sector spent R2206 per uninsured individual ( Day 2010 ) . Although the wellness of female parents and kids has been a precedence in authorities policy since 1994, including in the latest 10 Point Plan for Health ( Department of Health 2010 ) , it has non translated into motions in financial and resource allotment. Children comprise about 40 % of the population ( Statistics South Africa 2009 ) , but it is improbable that a similar proportion of the wellness budget is spent on kid wellness. No dependable informations exist, as authorities departmental budgets do non specifically represented outgo on kids, easy leting this constituency to be short-changed or ignored.Poor financial subjectA deficiency of answerability extends throughout the wellness service, and includes the deficiency of financial subject. Provincial sections of wellness jointly overspent their budgets by more than R7.5bn in 2009/10 ( Engelbrecht 2010 ) . Provincial sections often fail to budget adequately, ensuing in the freeze of stations and the limitation of basic service proviso ( e.g. everyday kid immunization services were earnestly disrupted in the Free State state in 2009 [ Kok D 2009 ] ) . Every twelvemonth, budgetary undiscipline consequences in critical deficits of drugs, nutrient supplies and equipment in many states, peculiarly during the last fiscal one-fourth from January to March, and during April when new budgetary allotments are being released. â€Å" Stock-outs † of pharmaceutical agents, medical supplies such as germicides or baseball mitts or radiological stuff, and nutrient or baby expression, may rag staff but may hold lay waste toing effects for patients, including decease. Most of these â€Å" stock-outs † are the consequence of providers ending contracts because of failure of payment of histories. In Gauteng, medical providers are presently owed more than half a billion rand by the Auckland Park Medical Supplies Depot, the cardinal unit from which medical specialties are distributed to provincial infirmaries and clinics. The largest sums owed by the terminal are to two pharmaceutical companies ( some R130 million ) ( Bateman 2011 ) . A recent embarrassing happening is the return of R813 million to Treasury at the terminal of the past fiscal twelvemonth by the wellness section because of unexpended financess ( Bateman 2011 ) . Most of the money was budgeted to resuscitate collapsed and unfinished substructure at infirmaries. This map belongs to the Department of Public Works, and infirmaries have small influence on the operation of this separate section – a farther illustration of disconnected services. Treasury has however allocated financess for the resurgence or building of five academic infirmaries by 2015, chiefly through public private partnerships. These are Chris Hani Baragwanath in Soweto, Dr George Mukhari in Pretoria, King Edward VIII in Durban and Nelson Mandela in Mthatha, every bit good as a new third infirmary for Limpopo. Provincial wellness sections are get downing to demo modest success in rooting out fraud and corruptness, but their attempts have revealed widespread victimizing bing taxpayers one million millions of rands, much of it deeply systemic ( Bateman 2011 ) . The majority of endemic corruptness involves dishonorable service suppliers with links to identify wellness section functionaries, plundering via shade and multiple payments loaded onto payment systems. In the Eastern Cape an external audit of ‘anomalies ‘ in four wellness section provider databases revealed R35 million in extra or multiple payments in 2010 ( Bateman 2011 ) . Some 107 providers had the same bank history figure, 4 496 had the same physical reference and 165 providers shared the same telephone figure. Less sophisticated fraud involved the bribing of territory ambulance service managers to transport private patients. Larceny of equipment, medicine and nutrient is permeant, worsening bing constrictions in supply concatenation direction. Almost R120 000 worth of infant expression destined for malnourished babes or babies of HIV-positive female parents was stolen in the Eastern Cape in 2010 for which three foreign national business communities and four wellness section functionaries were arrested. Eight nurses at Mthatha ‘s Nelson Mandela Academic Hospital were arrested for allegedly stealing R200 000 worth of medical specialties ( Bateman 2011 ) . In KwaZulu-Natal, a study to the finance portfolio commission revealed 24 ‘high precedence ‘ instances affecting abnormalities, supply concatenation and human resource misdirection, overtime fraud, corruptness, nepotism, misconduct and carelessness, amounting to about R1 billion. Among others, the former wellness MEC, Peggy Nkonyeni faced charges of irregular stamp awards amounting to several million rands ( Bateman 2011 ) . Ten wellness section functionaries in Mpumalanga, including its main fiscal officer, appeared before a disciplinary court on charges of corruptness. Three separate investigations uncovered monolithic fraud and corruptness in the section, including abnormalities with stamp processs and the purchasing of unneeded infirmary equipment. Perversely, Sibongile Manana, the wellness MEC, was removed from her station by the provincial Premier, and given the Sports, Recreation, Arts and Culture portfolio. The Premier justified this determination by claiming that the reshuffle of his executive council was to rectify ‘instances of misdirection and wrongdoing ‘ uncovered by a series of forensic audits ( Bateman 2011 ) .Human resources crisisStaff deficitsStaff deficits are a critical job in most public infirmaries, and are the consequence of underfunding every bit good as a national deficit of professional accomplishments. About 43 % of wellness stations in the populace sector countryw ide are vacant, and more concerning appear to be increasing ( up from 33 % in 2009 and 27 % in 2005 ) ( Lloyd 2010 ) . Some establishments are running with less than half the staff they need, with more than two-thirds of professional nurse stations and over 80 % of medical practician stations in Limpopo unfilled ( Lloyd 2010 ) . Deficits of support workers such as cleaners and porters exacerbate the job, since nurses and physicians end up executing unskilled but indispensable maps. Deficits of nurses in peculiar are bring forthing a health care crisis in South African public infirmaries ( von Holdt 2007 ) . Nurses have a broad range of pattern, and bear the brunt of increased patient-loads, staff deficits and direction failures. Ironically, a figure of nursing colleges were closed down in the late ninetiess as portion of authorities ‘s cost-cutting steps while authorities made it really hard for foreign physicians to pattern in the state. The state of affairs is now being addressed with acknowledgment of the demand for both more nurses and physicians to be trained. However, the constricted resources available bound a speedy or meaningful response and considerable investing in new installations and trainers is required over the following decennary to turn to the current shortage. Throughout the state, physicians and nurses invariably make determinations about which patients to salvage and which to keep back intervention from based on available staff and physical resources, instead than medical standards. Because of the force per unit area on beds, kids are sometimes denied admittance to infirmaries, non referred suitably or discharged prematurely, therefore confronting the danger of impairment, backsliding or decease.Conditionss of serviceUnderstaffing and vacant professional stations and are the consequence of a figure of factors, and vary in different locations. They include failure to set up new stations despite the increased demand for services, ‘frozen stations ‘ because of deficient support being available and deficiency of appropriately qualified staff. This deficiency may be because of â€Å" pull † or â€Å" push † factors. â€Å" Pull † factors attract staff off from the public service and include out-migration and m otion to the more moneymaking private sector. â€Å" Push † factors such as hapless wages, the inability of infirmaries to fulfill the simple animal amenitiess of staff, peculiarly in rural or township scenes, and a blazing discourtesy by hospital decision makers of the professional position of staff induce staff to go forth the public service. The high decease rate of wellness workers from AIDS has farther exacerbated the accomplishments crisis. The Occupational Specific Dispensation was a step introduced to specifically turn to the hapless wages paid to nurses and physicians. Although the intercession has been successful in retaining some staff in public sector infirmaries and even luring private sector nurses and physicians back, this fiscal inducement was deficient to forestall national work stoppages by both physicians in 2009 and the full wellness sector in 2010. Much of the dissent and sadness related to conditions of service, instead than the declared difference about the size of the one-year addition of the wage bundle. The long and bruising six-week work stoppage was a sad indictment of the hapless degrees of professionalism of wellness workers, with wards full of newborn and immature babies in many infirmaries being abandoned immediately and wholly with no interim programs for their eating or attention. This necessitated exigency emptyings or alternate agreements by practicians who were willing to put their small p atients ‘ demands above those of the work stoppage action, and by concerned members of the populace. Undoubtedly, many 100s of kids ‘s lives were lost during this industrial action but the inside informations of these deceases and any attendant punitory action has been handily ignored in an effort to pacify further work stoppage action by the responsible parties.Aberrant staff behaviorAbsenteeism among wellness workers is prevailing, even at good run establishments such Durban ‘s Addington Hospital ( Cullinan 2006 ) . This is largely due to emphasize, but nurses â€Å" moonlighting † in private infirmaries to supplement their province wages is besides a factor. At infirmaries where direction was weak, such as Cecilia Makiwane Hospital in East London or Prince Mshiyeni in Durban, nurses besides turned up late, left early, and frequently ignored patient attention such as regular monitoring of critical marks ( Cullinan 2006 ) . Hospital directors ‘ abilit y to take disciplinary action is badly limited by the centralized nature of provincial wellness bureaucratisms. In many states, the provincial caput of wellness is the lone individual able to disregard staff. Hospitalised kids are the most vulnerable, since they can non demand services or recommend for their ain demands. Therefore lost provenders, failure to have prescribed medicine timeously or missed doses, inattention to supervising critical marks and holds in reacting to sudden clinical impairment are day-to-day happenings in kids ‘s wards countrywide.Service bringing crisisInadequate patient attentionThere is a crisis of caring at infirmary throughout the state. Evidence of hapless service bringing at infirmaries is disputed, ignored, and largely tolerated by readily accepting the alibi of low staff morale, staff or resource deficits and ‘no money ‘ ( Saloojee 2010 ) . The caring ethos that characterises the wellness profession has eroded to the grade that most patients are thankful for any Acts of the Apostless of kindness directed to them. Many patients can tell how their most basic demands, such as aid with eating, toileting or trouble control, have been ignored by wellness staff even in state of affairss where wards have been quiet and adequately staffed. Despite the well-known Batu Pele ( People First ) principles being conspicuously displayed in wellness Centres, few appear to be committed to their execution. The effects of this deficiency of lovingness and answerability are predictable and inevitable for kids – higher morbidity and decease. The grounds for unequal paediatric attention is good documented and significant. The Salvaging Children 2005-7 study reviewed 8060 child deceases at 51 infirmaries in all nine states of South Africa ( Stephen 2009 ) . The sites represented different degrees of paediatric health care functioning rural, peri-urban and urban populations. Almost one out of three deceases was considered evitable. For each kid who died during this clip there were, on norm, more than two happenings of substandard attention, one of which 1 could be attributed to clinical forces. One-third of deceases occurred during the first 24 hours in infirmary, which reflects jobs with initial appraisal and exigency attention of kids on admittance. Nevertheless, the reappraisal identified jobs in all countries of clinical attention: appraisal, direction and monitoring. In the wards, staff deficits increased increasingly during the three old ages under reappraisal. Merely 14 of 380 public sector infirmaries run into and keep criterions set by the internationally accredited not-for-profit quality betterment and accreditation organic structure, the Council for Health Service Accreditation of South Africa ( COHSASA ) ( Bateman 2007 ) . This administration has pioneered a quality betterment programme to help and promote infirmaries to work towards accomplishing significant conformity with the quality criterions, taking finally to accreditation. While many ( 243 ) infirmaries have been supported in accomplishing accreditation over the past decennary, merely 32 achieved accreditation position. Some ( 36 ) made deficient advancement or withdrew from the programme, while others ( 17 ) achieved accreditation but later ‘backslid ‘ as a consequence of non keeping criterions.Lack of answerabilityA deficiency of answerability at all degrees of the wellness system may be the best account for why awkward public presentation has been tolerated for so long. Accountability requires public functionaries to be answerable for specific actions, activities or determinations to the populace ( from whom they derive their authorization ) . Accountability besides means set uping standards to mensurate public presentation, every bit good as inadvertence mechanisms to guarantee that criterions are met. Concentrating on answerability is hence of import for advancing capacity development and public presentation. In the absence of any provincial or territory degree monitoring of deceases or quality of attention, the hapless or negligent public presentation of some wellness establishments continues unbridled. A ‘culture of averageness ‘ dominates. Merely the occasional patient or job attracts media attending, normally because of a catastrophe sufficient to raise major concern from wellness governments, who normally act to penalize the ‘guilty party ‘ instead than to rectify or turn to the implicit in causes and jobs built-in in the system. A disturbing but of import set of contemplations on the public presentation of the wellness sector was provided by the amalgamate national and single provincial studies of the Integrated Support Teams commissioned by the so Minister of Health, Barbara Hogan ( Barron 2009 ) . Despite being ready in May 2009, the studies were merely available publically after being leaked in late 2010. The amalgamate study was scathing approximately many issues observing a deficiency of: national guidelines, norms and criterions, alliance between planning, execution and monitoring and rating, managerial answerability for the attainment of service related marks, an sanctioned policy and overarching model, and lucidity sing functions and duties ( e.g. between monitoring and rating, strategic planning and programme divisions [ e.g. HIV, TB, Maternal and Child Health ] ) . The national wellness section has been loath to set up clear norms and criterions for a figure of cardinal countries such as human resources ( e.g. figure of nurses per pediatric bed ) , equipment or budgets. This is likely related to a fright of the existent possibility of a tribunal challenge if it is found desiring in its ain criterions. The effect is a farther deficiency of answerability as no 1 can be held accountable for non presenting to a criterion that does non be. This state of affairs is now being addressed through the constitution of an Office of Health Standards conformity at the national degree.SolutionsFrom the description presented, it should be clear that a solution to the wellness crisis in general, and for hospital attention of kids in peculiar, is complex, multi-layered, requires the intercession of multiple histrions and activities, demands new and reallocated resources and will necessarily be a long-run procedure. Many wellness professionals desperation, non cog nizing how to act upon or consequence alteration in such a complicated and dysfunctional system, and prefer to make nil, trusting alternatively that some Jesus ( such as the Minister of Health ) will repair everything. The wellness curate himself recognises the demand to â€Å" pass the whole wellness system † and considered the wellness attention system unsustainable, â€Å" highly expensive † , healing and â€Å" hospicentric † ( The Star 2011 ) . Despite there being no quick holes, a figure of short- and medium-term solutions could significantly better the state of affairs. The limited range of this paper prevents an in-depth geographic expedition of these thoughts, but many should be obvious based on the item presented earlier. However, even obvious solutions can be impossible to implement in some environments. I summarise some of the cardinal intercessions required below. A major hindrance to adequate attention at province infirmaries is managerial disempowerment. Considerable investing in direction capacity and systems is required to get the better of current direction palsy, and optimise scarce fiscal and human resource use. A restructuring of the relationship between provincial caput offices and public infirmaries is a precedence, as is the empowering of hospital direction and augmentation of their competences. There is acknowledgment and understanding at the highest degrees, including the Presidency, about the demand for this. In his 2011 State of the Nation Address, Jacob Zuma, emphasised the demand for assignment of appropriate and qualified wellness forces. Provincial caput offices should release their chokehold on infirmaries and an insisting on micro direction and dressed ore alternatively on policy, scheme and monitoring of direction public presentation. Hospital directors should hold the authorization to run their ain infirmaries and be held accountable for this without undue intervention from caput offices, harmonizing to hold concern, budget and public presentation programs. Hospital organizational constructions should be based on clear operational units. A unit such as pediatricss should hold clear lines of authorization and answerability and silo maps should be disintegrated. An every bit crippling precedence is the deficiency of competent staff. In footings of supply, nurses preparation colleges are being reopened and medical schools being encouraged to increase admittance Numberss, with a clear penchant for pupils arising from rural or distant scenes since they are more likely to return at that place on finishing their preparation. The Occupational Specific Dispensation has made public sector wages much more attractive and competitory. A more hard job to get the better of is the inability of infirmary and provincial decision makers to appreciate the demand to handle wellness professionals as valuable assets whose demands need to be respected instead than sing them as easy dispensable trade goods. Task shifting, where undertakings that can be performed by less trained staff with specific accomplishments are allowed to pull off some conditions within their competence, is acknowledged to be a utile manner to cover with the accomplishments shortage. Better service bringing can be promoted through the coevals of norms and criterions, and the application of these including monitoring of conformity. Widening the Child Healthcare Identification Programme ( CHIP ) system of scrutinizing of deceases to all infirmaries in the state offers another mechanism for quality control, even though this attack merely scrutinises events in those kids with the worst results, i.e. decease. Measures and processs that extract answerability from wellness professionals, directors and decision makers are urgently needed, but few have succeeded to day of the month. Civil society has been outstanding in advancing action for HIV and AIDS and could play a more powerful function for the wider wellness docket in South Africa. A provincial administration policy is required which makes proviso for the creative activity of a cell of senior regional clinicians to supervise the map of the assorted major fortes throughout the state. Therefore, the regional baby doctor, for case, would be required to supervise the development and execution of norms and criterions for the physical substructure and equipment of kids in all infirmaries in his/her part. This person would be tasked to turn to issues of unfairness, every bit good as better synchronism between clinics and infirmaries and take constrictions in the referral system. A specific demand for pediatricss is a committedness to greater resource allotment for kids ‘s wellness. A recent exercising conducted in Gauteng estimated that an extra ( fringy ) investing of merely R4 billion over five old ages ( or R70 per capita ) in kid wellness could salvage the lives of 14,283 kids and cut down the U5MR by 50 % , about run intoing the provincial Millennium Development Goal mark for 2015. This extra investing would necessitate less than 5 % of the current provincial wellness budget ( Gauteng Department of Health 2009 ) . Not all of this needs to be ‘new ‘ money – much, but non all, of the money could be obtained through cut downing present inefficiencies. The authorities will present a new National Health Insurance in 2012. Detailss of this are still sketchy soon and its impact on child care at infirmaries is hard to foretell. It is chiefly a wellness attention financing mechanism, raising financess from taxpayers and users of the private wellness sector to buy wellness attention benefits for the broader population. The Minister of Health has claimed that the NHI would present ‘universal coverage and better health care in one united health care system ‘ ( The Times 2009 ) . Sceptics argue that it can and will make little to turn to the built-in defects in the wellness bringing system outlined in this paper. Many of the recommendations made in this subdivision are non new and good recognised and some have been accepted by wellness sections antecedently. However, there is limited grounds of their execution and even less grounds of their successful execution. However, islands of excellence remain in the public wellness service, many making this is the face of the same fiscal and logistical restraints as everybody else. The challenge is placing how to acquire everybody else to emulate these success narratives and retroflex their consequences. Children ‘s lives depend on making this quickly.

American Colege of Rheumatology Management

Old age is a phase in life that is quite sensitive; elderly people require comfort and care to enable them lead healthy lives without the unnecessary anxiety and worries. (AgeUK, 2015). Old age, adulthood, adolescence, childhood, and birth are the critical stages in every person's life. Each stage is characterized by its own challenges and issues. As one proceeds from one stage to another, it reaches a point when physical strength deteriorates and so too the mental stability (Bragen, 2013). As age progresses, several medical issues occur the most common being osteoarthritis, dementia, diabetes, cardiovascular diseases, visual impairment, kidney infections, and other geriatric medical conditions. Besides disease, other issues are interlinked with old age. A major concern among the elderly is loneliness and depression. As one ages, the relationships that one had begin to sever; children grow up and move out, souses die, friends and family move away and soon an elderly person finds that they are all alone. Depression begins to manifest even as the elderly person starts to visualize a different life from what they have been accustomed too (Mental Health America, 2017). In this paper, the patient, Barbara Green is an 89 year old widow who has reported at the health center with multiple complaints.   The patient complains of swollen feet and enlarged joints; painful joint pains in the knees, fingers, hip, and back; joint stiffness, minimal joint movement; visual impairment; constipation; weight loss; and dizziness that occur on and off (Levett-Jones, 2013). The decrease in physical functionality has caused her to cut off socializing with her friends at the German Association, her eating habits have deteriorated; and her house keeping has reduced causing her to live in poor condition. The physical conditions that the patient in this case has complained about and which are geriatric in nature include constipation, the visual impairment, and stiff painful joint   (Siamak, 2016, Levett-Jones, 2013). The risk factors associated with constipation include use of multiple pharmacological drugs, poor diet that is deficient in roughage and fluids; and reduced amount of physical activity (Hunter, 2016). In addition, the fact that Barbara has a visual impairment renders her at risk of physical injury. The visual impairment is most likely caused by macular degeneration (WebMd, 2016) a condition that is common among the elderly and also among the Caucasian community (Haddrill, 2016). In addition, reduced amount of activity as well as poor eating habits have been known to exacerbate the condition among the elderly (WebMd, 2016). In this scenario, the three major illnesses that will be addressed are Osteoarthritis/Rheumatoid arthritis, Constipation, and Macular degeneration. Although Barbara is currently living a solitude life, the underlying reason behind it is not depression, rather it is as a result of reduced activity resulting from joint pain (Hunter, 2016). The inactivity has resulted in the patient developing constipation (also caused by her prescribed medication) and exacerbated macular degeneration (also caused by age) (Hunter , 2016). Based on the presentation of facts and by utilizing clinical reasoning, the optimal patient outcomes will be achieved when Barbara is able to manage her pain   (Bullock, & Hales 2013) which will in turn help her achieve her ADLs, eat healthier, become more active, and resume her normal life and restore severed relations with her German Association friends as well as her family. Eating healthier will reduce incidences of constipation and   will slow down macular deg eneration. To manage her pain, Barbara will need to adhere to her medication regimen. Barbara reported that she lives alone in a one-storey building. She said that she experiences joint pain especially on the hip and knees which could result in limited movement. Although she did not mention it, it is probable that her housekeeping as well as other ADLs is below par because of the physical pain in her joints. It is also possible that she has resulted in eating poorly because of her inability to make healthier food purchases at the grocery due to her reduced mobility caused by her painful joints. Other than not being able to go to the grocery, her weight loss could be attributed to depression as she reported that she no longer visits with her friends at the German Association and that she is widowed. Visual impairment is caused by macular degeneration in older patients. Macular degeneration occurs when the retinal macular wears out from ageing which causes one to lose central vision (WebMd, 2016). However, a patient is able to see using the peripheral vision. Macular degeneration can either be dry or wet with the most common being the dry macular degeneration among the elderly. (WebMd, 2016) Constipation is a common occurrence among the elderly. There is a distinction between hospital environment constipation and that which is influenced by other external environments. The occurrence of constipation among the elderly increases with age, the older one gets the more incidences one experiences (Gandell, Straus, & Bundookwala et al., 2013). In addition, constipation can be as a result of drug interactions in the body (Hunter, 2016). Barbra is currently prescribed on slow release Paracetamol which causes slow bowel movement. Another common medical condition among the elderly is Rheumatoid arthritis and/or osteoarthritis (Hunter, 2016). The medical condition is as a result of bone cartilage wearing out with age which causes joints to rub off against each other. The friction between the joints causes stiffness, mild to acute pain, as well as development of swollen nodes (Udell, 2017). Assessment of the patient showed blurred vision and a centralized blind spot in the visual filed. In addition, Hydroxychloroquine can also cause impaired vision ((Tiziani, 2014). The patient has visual impairment and is at risk of injury from poor vision. The patient may also experience challenges in her ADLs because of minimal vision. To manage the condition, the patient will be advised to wear sunglasses and avoid direct light or sunlight once she has undergone photodynamic therapy (Arnold J, Heriot W , 2007; WebMd, 2016). The patient will be required to give details on the time of day and frequency of constipation. Symptoms to look out for include confusion, diarrhea, nausea, urinary retention, loss of appetite, and abdominal pain (Mandal, 2016). The patient is already on multiple drugs which predisposes her to constipation.(Hunter, 2016). The limited physical activity that is caused by her painful joints is another risk factor that contributes to the patient's constipated condition. The patient will be advised on increasing her fluid and roughage intake (Orenstein, 2016). In addition, she will be advised to adhere to her pain management medication for her joint aches. Once she is able to manage her joint pain, the patient will be able to increase her physical activity which will help ease the constipation that she is experiencing. Assessment of the patient shows joint swelling and deformity with Heberden and Bouchad nodes in the distal and proximal joints respectively. The pain in the joints intensifies with physical activity such as walking, exercising or basic ADLs. Patient also indicated that the pain intensifies during the night when the room temperatures are low, and upon getting up after sitting or lying down. The diagnosis is chronic pain that results from joint deterioration. Evaluation using x-rays shows joint narrowing and sclerosis in the knee, hip, and finger joints. The synovial fluid analysis showed the occurrence of both rheumatoid arthritis and osteoarthritis in the affected joints. The patient will be advised to manage the pain through strict adherence to medication. She will also be advised to avoid strenuous activities that can trigger painful joint episodes. Heat application will be done on the affected joints. A terry clothe will be placed under the patient's neck to relieve any pain on the cervical area as she sleeps. Simple exercises will be taught to the patient that will help reduce joint stiffness. The patient will also be advised to wear foot pain relieving shoes and support. In addition, calcium supplements will be included in her medication. The four main goals that need to be met with regard to taking care of Barbara include: The first issue that needs to be resolved is medication non-adherence. The first step is o have a conversation with the patient and educate her on the need to stick to her medication regimen, the health benefits she stands to gain from her medications, any side effects she should be on the look-out for, and how to use a medicine chart (Jimy, & Jose, 2011). Barbara's medication will be packaged in different colored bottles and placed in easy to reach areas. This will allow Barbra to be engaged in her own therapy. As she is suffering from visual impairment, placing the medications in places she uses often will help her in adherence. For the drugs that are to be taken before she sleeps, the bottles will be placed on her nightstand. Those that need to be taken in the morning will be placed in the toothbrush stand and those that need to be taken during or after meals will be placed on top of her refrigerator. A medication chart will also be created to enable the patient take her medicines at the right time (Jimmy et al., 2011) Tracy will be informed on the action plan so that she is able to discuss with Barbara about her daily goals when she calls her. Barbara will be required to purchase a water bottle and advised to fill it with water which she will be expected to drink during the course of the day. A meal plan will be drafted by the healthcare nutritionist to help Barbra make healthier meal choices and also enable her regain her weight. After three weeks: Barbara has gained weight of 1-2kgs The patient has rejoined her friends in the regular meetings at the German association As people become older, I not excluded, the things that we value become lesser and we are left with that which is most precious. The key is to expand our horizons, value more relationships, and more variety in what makes our lives rosier. When a person spends his early years establishing and strengthening many good relationships, it pays off in the sunset years as such a person will always have people around them to laugh, share, and confide in. In addition to people investment, health investment is critical. I have resolved to live healthier now so that I do not have to struggle with some of the geriatric conditions n the future. For the overall wellness and enhanced productivity, Barbra's care will include taking care of her physical needs through pain management and medication adherence; healthier eating and consumption of daily fluids; and regular mild exercises. For her socio-psychological health, Barbra will be able to socialize with her friends and family and get out more as she makes visits to the grocery store. Health eating and exercising will improve her mental health and decrease chances of depression occurring AgeUK. (2015). Protecting yourself and others from abuse. Retrieved 03 09, 2017, from https://www.ageuk.org.uk/health-wellbeing/relationships-and-family/protecting-yourself/what-is-elder-abuse/ Bragen, J. (2013). The Berkley Daily Planet. Retrieved 03 09, 2017, from https://www.berkeleydailyplanet.com/issue/2013-01-03/article/40630 Bullock, S & Hales, M. (2013). Principles of Pathophysiology. NSW: Pearson Australia. Gandell, D; Straus, S; & Bundookwala et al., (2013). Treatment of constipation in older people. CMAJ , 663-670. Haddrill, M. (2016). What Is Age-Related Macular Degeneration? Retrieved 04 09, 2017, from All About Vision: https://www.allaboutvision.com/conditions/amd.htm Hunter, S. (2016). Miller's Nursing for wellness in older adults. North Ryde: Lippincott, Williams and Wilkins. Jimmy, B & Jose, J. (2011). Patient Medication Adherance: Measures in Daily Practice. Oman Medical Journal , 155-159. Levett-Jones. (2013). Clinical reasoning: Learning to think like a nurse. NSW: Pearson. Mandal, A. (2016). Constipation in the Elderly. Retrieved 04 09, 2017, from News Medical : https://www.news-medical.net/health/Constipation-in-the-Elderly.aspx Mental Health America (2017). Depression In Older Adults: More Facts. Retrieved 04 09, 2017, from Mental Health America: https://www.mentalhealthamerica.net/conditions/depression-older-adults-more-facts Orenstein, B. (2016). How Fiber Helps Ease Constipation. Retrieved 04 09, 2017, from Everyday heakth.com: https://www.everydayhealth.com/digestive-health/fiber-and-constipation.aspx Siamak, N. (2016). Senior Health. Retrieved 04 09, 2017, from eMedicine: https://www.emedicinehealth.com/senior_health/article_em.htm Tiziani, A. (2014). Havard Nursing Guide to Drugs. (9th ed.). Chatswood.NSW; Mosby Elsevier. Udell, J. (2017). Osteoarthritis. Retrieved 04 09, 2017, from American Colege of Rheumatology: https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteoarthritis WebMd. (2016). Age-Related Macular Degeneration Overview. Retrieved 04 09, 2017, from WebMd: https://www.webmd.com/eye-health/macular-degeneration/age-related-macular-degeneration-overview#1

Body Art Research Proposal Example | Topics and Well Written Essays - 1750 words

Body Art - Research Proposal Example As discussed, the research question to be addressed in the course of this research is, "Is Body Art Important in Forming Young People Identities In Britain". This question has been chosen because it is of interest to me personally, in terms of the art itself, but also in terms of understanding the motivations behind altering one's body through body art. The phenomena of body art is becoming increasingly popular in Western societies, and the reasons behind this increasing popularity are of interest to me, sociologically speaking; I am interested in knowing why body art is increasing in popularity and why people participate in body art, in terms of their personal histories and perspectives. The widespread nature, and long history, of body art suggests that the human body has been, and is, a canvas for the expression of cultural ideas. Body art is something universal, that is documented across all of recorded time, and as such, the reasons behind it's use and incorporation are of fundamental interest in the understanding of cultural politics and issues of self acknowledgement and representation. This section will show what other research has been done, and will present gaps in the research that this current research proposal will address. A brief background and history of body art will be presented, which will introduce the work of other theorists, in terms of what they say about the links between the body and modernity, and the links between body and identity, for example. Body art is essentially art that is put on, or consists of, the human body (Brain, 1979). There are many forms of body art, including: tattoos, piercings, henna painting, branding, scarification, body painting or other, less invasive, less permanent, types of body art, for example, corseting. Many academics include other forms of body modification, such as plastic surgery, under the umbrella of body art, but this is the subject of much discussion. Others include extreme performance under the umbrella of body art, for example, mutilation on stage, or sadomasochism, or pushing the body to it's physical limits (for example, the work of Oppenheimer), but again, the inclusion of these categories of body modification under the umbrella of body art is subject to much debate. Body art has been around for centuries, with tattooed Mummies being common from the age of the Egyptians, to henna painting in India, which is centuries old. The inhabitants of the islands of the Pacific have some of the most magnificent tattooing in the world, which is known to have been practiced by them for centuries. Many other cultures, from Africa to Australia, to the Pacific islands, are known to have participated in body modification (neck stretching, ear ornamentation) for centuries. The widespread nature, and long history, of body art suggests that the human body has been, and is, a canvas for the expression of cultural ideas. Body art is something universal, across all of recorded time, and as such, the reasons behind it's use and incorporation are of fundamental interest in the understanding of cultural politics and issues of self acknowledgement and representation. The increasing trend for body art amongst Western

Reflection of this course Essay Example | Topics and Well Written Essays - 1000 words

Reflection of this course - Essay Example Tentatively, it has given me the chance to have a critical outlook and view when pursuing facts and principles or ideas in my world. Secondly, I also enjoyed and took a lot of care and interest in the learning objective which required us to produce research materials for specific audiences. I find this issue to be of high relevance especially after being tasked with the privilege of doing annotated bibliography. I am of the humble and respectful opinion that I did well in composing the annotated bibliography of the source required of me. For instance, I did well in pin-pointing with an utmost precision the exact and intended destination of the academic materials that I considered. I also enjoyed the learning objective of using the print and digital media to speak to different people or audiences. I was guided and greatly helped to know that media is not just a form of passage of information and communication, but it is also a tool for contacting different people in diverse ways. It is to say that the objective was to introduce me to the field of knowing and treating people or relating to people differently by use of the different media tools and sources. Subsequently, it was an objective to integrate evidence from reading and then synchronize them with my own ideas and ideals in order to produce masterpiece and quality works. I am of the respectful view that I did that when I was composing the annotated bibliographies, I had the benefit of inculcating my knowledge with the clinical or academic knowledge present. I believe I excelled accordingly in those learning objectives which was attested when I gave my arguments while composing the annotated bibliography. On the contrary, there are goals that I would wish to put in more effort and energy so as to realize the best or maximum results. For instance, the goal of being able to read and think critically about the diverse cultural and social perceptions from the texts we read would have to be considered and

Notes on Nursing Essay Example | Topics and Well Written Essays - 750 words

Notes on Nursing - Essay Example Florence Nightingale addresses fundamental issues concerning personal cleanliness by looking at three major issues including poisoning by the skin, ventilation and skin cleanliness, steaming and rubbing the skin. Poisoning by the skin is a crucial ideology because sick people usually relieve themselves through the skin (Nightingale, 2010). A nurse should always understand that the excretion process leaves dirt and infectious particles on the body. As a result, it is necessary to practice high levels of hygiene. It is also important to note that the sick usually feel relieved after cleaning. Consequently, it appears that vital powers have been removed from the patient’s body that empowers them to go through life processes easily. One of the strategies that can be used during the cleaning process is removing dirt using hot water and soap (Nightingale, 2010). It is also important to wash the skin using a large amount of water. The water makes the skin softer. The first rule in the nursing field is keeping the air pure just like the external environment while reducing the chances of chills. It is important for a nurse to ensure that the source of the air is clean. For example, Nightingale indicates that people usually allow air into a patient’s room without thinking about its sources. For example, the air may be coming from other wards, environment next to a sewer or hallways (Nightingale, 2010). Nightingale indicates that with the availability of windows, patients in bed are likely to get fresh air. It is crucial to note that such fresh air do not cause colds. It is also important to limit dependence on fumigations and disinfectants in order to purify the air in a patient’s room. The disinfectants are already mixed with other chemicals that are unlikely to ventilate a patient’s room. It is also important to abolish slope pails in a patient’s room because they limit the chances of maintaining a

Multicultural Mall Essay Example | Topics and Well Written Essays - 250 words

Multicultural Mall - Essay Example In relation to this, their attitude could also be an additional criterion to know how effective the proposal is. If the community gets actively involved, not only patronizing the business but sharing their skills and talents as well as investing in the venture, then it is a sign that the people agree with the project’s establishment. Moreover, the number of people participating will also tell how successful the business is. If there are only a few who are interested in the business, it means that the business could either stagnate or fall. However, when there are numerous people participating, it shows that there are many who are interested in the business. The reason why this is important is because in business, it is known that the people are the ones who will bring the money in. The more prospective customers entering the multicultural mall mean more profit for the businessmen. Moreover, when more tourists are attracted to the place, it implies the success of the enterprise . Lastly, with the convenience of online shopping nowadays, inquiries , requests and patronage tells how well the business is

Argument Analysis Essay Example | Topics and Well Written Essays - 750 words - 1

Argument Analysis - Essay Example In order to build an excellent and convincing argumentative essay it is necessary for the writer to take in account various aspects that are involved in the construction of a good essay. This includes the tone, style of writing, use of statistical data and the art of building an essay on the basis of the data collected, targeting and securing an audience for his essay etc. similarly the author of this article is also observed to be using such techniques as a result of which his essay provides the readers with a lot of a variety of aspects to be explored. The approach used in depicting this essay is explicit because the article deals with a critical topic that can have hazardous affects if remedies are not taken. This essay reflects the writers concern for his environment as well as the health of his fellow beings because he tries to convince the readers about the adverse effects of using fossil fuels in contrast to the benefits of nuclear power plant. ... Yet at the same time analogies and facts are used to compare and contrast the state of his country with other governments without confining the comparison to a particular country. As mentioned in the article, ‘other governments are enthusiastically embracing nuclear power as a way to lessen their greenhouse emissions and their dependence on imported oil. Hence the writer’s point of view depicted in this article is not only acceptable but also gives the readers food for thought and consequently results in convincing them. The article very tactfully states all the pros and cons of starting a new power plant. The essay strategically first talks about the importance and the benefits of nuclear power plants and gradually moves towards the amount of risk and finance involved in this essay. So this gradual descend from the glory to the risk is a good strategy on the writer’s part. As states, ‘†¦with advanced designs, new construction techniques and strong over sight should be even safer†¦ The tab for a new reactor can run as high as $7 billion to $8 billion, and overruns can add more. There is a long lead time before a plant starts selling power and paying returns. The target audience of the writer appears to be the investors of the private sector as well as the government officials who are responsible for providing assistance to the citizens of the country in beginning a new venture. The tone of the essay is formal since the target audience is also the group of investors and the government officials. The use of formal tone helps in enhancing the over all impact of this article on the readers since the purpose of this article is to attract the citizens of

Dr. Stones Feats of Survival in the Film Gravity Essay

Dr. Stones Feats of Survival in the Film Gravity - Essay Example Accompanying her is the veteran Astronaut Matt Kowalsky, who is commanding his final expedition. However, during their spacewalk, a most unfortunate thing happens: a debris from a satellite crashes into the space shuttle, Explorer, destroying most of it and therefore leaving them stranded in space with limited air. As the debris continues to hit other satellite, a chain reaction of destruction is caused such that the satellites necessary for the two astronauts to communicate with mission control in Houston are also destroyed. Even though the two astronauts do not receive any messages from the Mission Control in Houston, both Kowalsky and Stone continue to transmit-though â€Å"in the blind â€Å"to Mission Control, in the hopes that somehow Mission Control can hear them. According to Pomerantz, Fearfully, Stone tumbles out of control after separating from the shuttle’s cargo bay arm. Kowalsky who is wearing a thruster pack as part of his spacesuit navigates to Stone and retrieves her. The two tethers together and find their way back to the Explorer, where to their utter dismay discover that the shuttle has been damaged beyond repair, and further, the rest of the crew is dead. They then decide to use the thruster pack to make their way to the ISS, which is nearby in orbit. Kowalsky sets the timer on his suit for 90 minutes, in estimation that the debris which destroyed the explorer will orbit the Earth and come back around in that amount of time. Kowalsky, ever calm and efficient in the crisis reassures Stone that they will both make it back to Earth safely. En route to the ISS, they discuss Stone’s life back home and the death of her daughter in a schoolyard accident. As they approach ISS, it is clear that the crew has evacuated due to the debris field causing damage.  

Do some brief research on the topic of resisting change. What Paper

Do some brief on the topic of resisting change. What determines whether or not people resist change - Research Paper Example Researchers have observed many types of resistance. Employees avoid doing tasks or postponement of tasks, resignation and underproduction are the most common outcomes recognized by researchers. Another study unveils few other indicators that show resistance for change in the organization, which include increased absenteeism, impatience and frustration (Todnem, 2005). These indicators and reactions of employees are reflective of the resistance to change. In order to manage the change effectively and to avoid these negative after effects of change in the organization, mangers must understand the reasons behind the resistance. Employees do resist change and their negative responses are caused by few rational reasons. One reason behind the resistance of change by employees is uncertainty about the effects of change being implemented in the organization. Uncertainty about job performance is another reason that triggers employees to resist change because they are unaware of the tasks, which will be given to them after change and they have fear of not having the required skills. Another reason behind this resistance is no involvement of employee in the change process, which creates the fear of abrupt change in the mind of employees and they think they are not the part of the organization. To cope with these consequences, management must be proactive, enable employee participation, and make them aware of the effects of the change in the organization (Todnem,

Influence of Advertisement on Brand Preference Essay Example for Free

Influence of Advertisement on Brand Preference Essay Vithya Vivekananthan, Faculty of Commerce and Management, Eastern University, Vantharumoolai, Sri Lanka [emailprotected] com ABSTRACT Measuring the influence of Advertisement in Consumer Brand Preference is very essential for every marketer. If advertisement does not create any positive change in consumers’ brand preference, all the resources such as money, time and efforts spent on advertisement will go in vain. Most of the marketers use Advertisement as a tool to attract substantially new customers and to retain the existing customers. This research studies about the â€Å"Influence of Advertisement in Consumer Brand Preference in the Soft Drink Market†, which is one of the most competitive markets in Batticaloa. Every Brand in this market use Advertisement as a major weapon to overcome the fierce Competition. There are numerous Advertisements of different Soft drink brands exposed in Television. But, the main thing here is, the marketer want to identify that, do all these advertisements positively influencing the consumers’ brand preference. In order to study the influence of Advertisement in Consumer Brand Preference, three main variables are considered with appropriate dimensions. They are; Information, Communication and Comprehension. The structured questionnaire was used to collect primary data from 200 respondents. The study found that all three variables indicate high influence of Advertisement in consumer brand preference. Even though it has high influence in overall view, the advertiser wants to consider the indicators, which have low and moderate influence in their future developments of the Advertisements to maintain its position in the market in the long-run. Eventually, this study recommends some actions for improving the influence of Advertisement in consumer brand preference. 2 Introduction The importance of sales on business survival and the connection between customers and sales, it is expedient for organizations to engage in programmes that can influence consumers’ decision to purchase its products. This is where advertising and brand management are relevant. Advertising is a subset of promotion mix which is one of the Four ’P’s in the marketing mix i. e. product, price, place and promotion. As a promotional strategy, advertising serve as a major tool in creating product awareness and condition the mind of a potential consumer to take eventual purchase decision. Marketers’ survival depends on consumer satisfaction. Consumer satisfaction depends on their perception and brand preference of the particular brand. In brand preference, advertising plays a major role. Nearly everyone in the modern world influence to some degree by advertising. Organizations in both public and private sectors have learned that the ability to communicate effectively and efficiently with their target audiences is important to their success. In today’s world, there are a myriad of media outlets-print, radio, and television are competing for consumers’ attention. There are number of creative and attractive advertisements we can see and hear in television, Radio, newspapers and in magazines. Within these media, television advertisements are more attractive and interestingly watched by mass audience. It has often been said that television is the ideal advertising medium where the consumer spends the most attentive time. However, the main thing here is, the marketer want to identify the influence of advertising in consumers brand preference. Nowadays soft drinks have become essential part in lifestyle of the people in the society. There are number of soft drink brands are available in the market. In those brands, some brands are very famous not only in Sri Lanka but also globally. For the research purpose Coca-cola, Fanta, Elephant, and Ole are selected. These are the most preferred brand of the consumers in Sri Lanka. For these brands, different advertisements are available in Television. Some brands’ advertisements are more attractive than others are and some are new creative advertisements. There is no any television advertisement regarding Pepsi during the research period. Therefore, Pepsi was not take into consideration. 3 It is very hard to find people who never consume any brand of soft drink. Everyone in the society prefers a particular brand. We can see frequent advertisements for Soft drinks in Television. Companies spend much on their advertisements to attract more customers. So it is very important to study its’ influence in consumer brand preference. Problem statement There are numerous advertisements in Medias; television, radio, newspapers and magazines but, the important question for a marketer is â€Å"do all these advertisements positively influence the consumers’ brand preference? If advertisement is not create any positive change in consumers’ brand preference, all the resources such as money, time and efforts spent on advertisement will go in vain.

The Yellow Wallpaper Essay Essay Example for Free

The Yellow Wallpaper Essay Essay â€Å"The Yellow Wallpaper† is a chilling tale of a woman forced to insanity, yet her mental state is a double edged sword. What brings her down is, in the end, her savior. The doctors in the narrator’s life give her the worst advice possible for the outcome they desire. She is forced to do nothing, and instead of pulling her back to normality, the dreariness pushes her further and further away. Left with nothing to occupy her mind, her mind occupies itself. In the beginning of the story, the woman is quite lucid in the usual sense. Due to a lack of understanding of depression, she is forced to hide the things she loves. She focuses her attention on all she has left, her mental state. However, since she is told that there is nothing wrong she does not analyze it directly, but instead watches her life play out in the metaphor created by the horrid yellow wallpaper. As the story progresses, you watch as the lady loses her touch with reality, focusing more and more on the yellow wallpaper. She pays attention every inch of it, noticing the ever watching eyes and the twists that keep what she believes to be a creeping woman trapped behind. She stops complaining of boredom, and instead analyses the paper most intently. I believe when the narrator begins to see the creeping, humiliated woman outside is the beginning of her liberation. It shows that the woman is free, at least part of the time. This is also around the time when the narrator noti ces the streak running around the room. While this could of been there before, one would think she would of noticed it previously. This indicates she created it herself, in her moments of freedom. During this part of the story she was only liberated part of the time though, as John was still there to watch her at night. The creeping woman she sees also hides herself when someone is coming. As the moon peeks through the windows, the narrator watches the woman in the wallpaper. She is no longer creeping and hiding, as the narrator is forced to also do by day, but shaking the â€Å"bars† of her prison, meanwhile the narrator is wishing John would take another room so that she could escape him. By the end of the story, she has completely forgotten about her wishes to have some kind of entertainment. As her husband is gone and she is able to trick Jennie into  leaving her alone, the narrator manages to free the woman behind the wallpaper from it’s entangling grasp. Thus, she also frees herself from the controlling grasp of her husband. She is free to do as she pleases, which at the moment is creep around the room in the most unusual fashion. However, she seems to really be enjoying herself. Not only that, but she doesn’t even want to leave her room. When John returns, he sees that he is no longer in control what so ever, and faints. While he is kind of cumbersome and in the way, as the narrator now has to crawl over him to complete her circuit, this shows how completely she has triumphed. Society may find her actions disconcerting, but it is the very same society that pushed her away into isolation in the first place. Crawling over her husband’s inert body merely emphasizes the point that she has finally completely overcome him. She finally get’s her way.