Difficulties of Transitioning from Traditional Policing to Community Article

Difficulties of Transitioning from Traditional Policing to Community Policing - Article Example The journal introduces the argument indicating that community policing requires that the police officers have autonomy and discretion in solving community problems as well as forming of partnerships with various agencies. The article begins by posing the greatest challenge in community policing by saying that it is due to the failure to include it in the organization’s mission and vision, organizational structure as well as its goals. This failure that is not recognized by the management has made it difficult to transition. The article also presents a situation where the police do not understand clearly the notion of community policing. This makes it difficult for them to relate it to their role. It further illustrates that the police give a mimic of what they think is community policing. It presents a planning and coordination challenge that faces community policing. It says that in order for community policing to be implemented, a departmental head should plan change well an d carefully construct it. There is also poor coordination of community police officers and the local representatives of the community. Glacomazzi (2012) describes another challenge as the resistance to community policing by the police officers and also having difficulty in public agencies involvement as well as the community. It also says that the average citizen has little knowledge on what community policing entails Benefits of practicing community policing has also been highlighted in the article as reducing fear of crime among others. The major argument that the writer presents in this article is that community policing has been hindered by lack of police in  supporting change by way of the structure in which their organizations are arranged. The notion of community policing has not been implemented by the management due to poor planning and coordination in the police.  Ã‚  

The significance of Garibaldis contribution Essay Example for Free

The significance of Garibaldis contribution Essay Giuseppe Garibaldi was born in Nice, and, although he was a born a French citizen, he regarded himself as Italian. Despite the pressure placed upon him to enter the Church, he joined the Merchant Navy where a chance meeting with Mazzini altered the entire course of his life. One of Mazzinis greatest disciples was Garibaldi, who was inspired with nationalist fervour and patriotic enthusiasm. He quickly converted to share Mazzinis aim of a united Italy, but only an Italy united as a republic. A revolutionary plot in 1833 in Piedmont was introduced to cause mutiny in the army but it failed and Garibaldi was sentenced to death. Execution could not be carried out as Garibaldi left the country prior to the trial. He moved to Brazil and then on to Uruguay where his military ability was first displayed. He fought, defending Uruguay in an Austrian take-over, however, news of the Italian revolutions of 1848 reached him and he decided to return to his homeland. He did this with some out of date weapons and some of his colleagues. Word of his military campaigns in South America had by now reached the Italian States and upon his return, recruits assembled to join Garibaldis legion. Garibaldis contribution in South America had a profound effect on events later on in the fight for unification, as it was due to his military involvement that he came back to Italy a prominent figure. It was only due to his reputation that he was able to recruit so many men. Although Garibaldi was originally drawn to the cause of unification as one of Mazzinis supporters, he saw the powerful Piedmontese state and monarchy as a more realistic way of achieving unification. It was at this point that Garibaldi and his mentor Mazzini parted ways. Mazzini was only interested in a unified Italy as a republic whereas Garibaldi wanted unification by any means possible. This is also where Garibaldi shows contrasts with Cavour who was above all else Piedmontese. February 1849 saw the establishment of the Roman Republic. The Republic itself was short-lived; only lasted four months. Garibaldi played a role in resisting the Catholic countries assisting the Pope however, the defenders  were greatly outnumbered by the powers helping the Pope and the fall of Rome was inevitable. After the fall of the Republic, Garibaldi made an appeal for new recruits to fight the war against the stranger. Although he offered no provisions or promises, almost 5000 men were recruited. Despite this, on their journey to Venetia, 3500 were lost. Garibaldi escaped to Genoa where he was arrested and released on the condition that he leave Italy at once. Upon his release, he travelled to North America where he stayed until 1854. When he returned, Garibaldis significance is clearly visible. A revolt which began in 1860 in Sicily came to the attention of Garibaldi and he set sail for Sicily almost immediately. His unexpected conquests in Sicily and Naples precipitated the unification of most of Italy. When he reached Sicily, Garibaldi was a welcome fighter. His weak army of 1200 now reaching 3000 took Palermo forcing the garrison to return to Naples making Sicily his. In September 1860 Naples fell leaving Garibaldi as Dictator over the Kingdom of Naples. Cavour feared that Garibaldi would not stop and would attempt to take Rome so he advised Victor Emmanuel to take Rome first. When the two forces met, Garibaldi proclaimed Victor Emmanuel the first King of Italy Plebiscites held in the newly acquired land showed immense support for annexation by Piedmont. In 1861, Garibaldis aim of a united Italy came into being; however, it did not include Rome or Venetia. By way of unification under control of Piedmont, the Piedmontese constitution and legal system were extended over the whole country. Though Rome remained to be occupied by France, continuing pressure from Italian liberals came for it to be freed and incorporated into the new Italian Kingdom as the historical capital. Apparently, with the implicit support of Victor Emmanuel, Garibaldi set off with 3000 volunteers to conquer Rome. When Garibaldi reached Palermo, he was greeted by calls of Rome or death and suddenly, Victor Emmanuel disowned the march. Garibaldi and his men were shot at by local troops in Calabria and only 500 remained. The whole operation was a disaster for Garibaldi and an embarrassment for the government. In 1864, the Italian government agreed to protect Rome form attack and to move the Italian capital from Turin to Florence and in return  the French withdrew from Rome. Garibaldi saw this as a betrayal of the cause for unification and decided to make an attempt to recapture Rome. Garibaldi and his men began their march to Rome but he was arrested. Despite this his followers continued on their journey to Rome where they suffered defeat at the hands of the Papal army. Garibaldi attempted to re-join his army and did succeed; however, his planned revolution with the Roman people did not happen. This was the end of Garibaldis contribution to Italian history. Garibaldis contribution to the cause of Italian unity was considerable. He was a brilliant military leader and was determined to achieve unification. He inspired great enthusiasm in his men and made them feel compelled to devote their lives to the cause of unification. Although he encountered many failures such as his journey to Rome, his followers were loyal and determine to try to continue his efforts. His greatest achievement would be his success at conquering Naples and Sicily, as this made Unification inevitable however, he was distressed that Rome did not become part of the unified Italy in his lifetime as he believed Italy should be united with Rome as capital.

The Analysis of Autism Facilitates Neuroanatomical Investigations :: Biology Essays Research Papers

The Analysis of Autism Facilitates Neuroanatomical Investigations Studying the functions of the various structures of the brain is best carried out through analysis of brain defects. For example, individuals with autism exhibit particular behaviors that are not considered normal. Assuming that behavior originates from the brain, then it becomes clear that in order to discover the causes of the abnormal behavior a comparison must be made between and healthy brain and the brain of an autistic person. By finding structural differences such as size and composition, the role that the structures play in the behavior of the autistic can be inferred while also investigating the normal functions of brain structures. There are several differences between a healthy brain and the brain of an autistic person. Dr. Joseph Piven from the University of Iowa noticed a size difference . In the autistic brain, the cerebellum is larger and the corpus callosum is smaller. Another study showed that the amygdala and the hippocampus are different in an autistic brain. In an autistic these structures have densely packed neurons and the neurons are smaller than those in a healthy brain. Also, in the cerebellum there is a noticeable reduction in the number of Purkinje cells. Structure and function can not be separated from one another and changes in one indicate alterations in the other. Because an autistic person has brain defects, a reasonable assumption is made that changes in structure will alter the behavior. An autistic person is characterized by having impaired social interaction, difficulty with communication both verbal and nonverbal, trouble with imagination, and limited activities and interests. By analyzing the abnormal behaviors of the autistic person, the roles that the cerebellum, the corpus callosum, the amygdala, and the hippocampus play in the disease can be inferred. The cerebellum is usually associated with motor movements. Concerning this topic it is interesting to note the research of Dr. Eric Courchesne. He found that the VI and VII lobes of the cerebellum were smaller in autistics than those of a normal brain. This condition is called hypoplasia. The reverse condition, which is what Piven encountered, is called hyperplasia. Courchesne linked the cerebellum with attention shifting . He proposed that the autistic takes longer time to change the focus of his attention. He believed that this condition was caused by lack of development of the cerebellum in utero caused by perhaps oxygen deprivation, infection, toxic exposure, or genetically.

Ishmael Essay -- essays research papers

A review of... Ishmael   Ã‚  Ã‚  Ã‚  Ã‚  In the past few centuries there have been a handful of books written that offer up ideas about humanity that are so completely new to a reader but are so completely convincing that they can force a reader to take a step back and assess all that they know to be true about their life and their purpose. Daniel Quinn has succeeded in creating such a book in Ishmael, a collection of new ideas about man, his evolution, and the â€Å"destiny† that keeps him captive.   Ã‚  Ã‚  Ã‚  Ã‚  When I began reading Ishmael I was amazed by the ideas offered by Quinn. Like in Rambo and the Dalai Lama by Gordon Fellman I was looking at the world not as it must be but as it could be. I was very suprised and excited, that as a member of â€Å"generation X† that tries so hard to create their own destiny, that I had never perceived or questioned â€Å"Mother Culture†.   Ã‚  Ã‚  Ã‚  Ã‚  In the first one hundred pages if Ishamel I found a number of convincing ideas that I believe I will take away with me. The greatest of these being that the technology that we believe will prolong our existence is the same driving force that propells us to extinction. I believe that Quinn illustrated this idea superbly with his narrative of the aeronauts. Man knew that he could fly but he didn’t know all the rules. And instead of leaving it be until he did he was so sure of himself that he made his attempts blindly and came to a much quicker end than if h...

Motivational Techniques

Motivationals methods in Switzerland MOTIVATIONAL METHODS THAT ARE MOST EFFECTIVE IN EMPLOYEE MOTIVATION Robert Gordon University – Business and Hotel Management School BA Hotel and Hospitality Management Course BS 3149 Research Methods for Business Students Module coordinator: Ms Heather Robinson Submission date: 9th April 2013 Student ID No. : 1219453 Word Count: 2008 1. TOPIC: Motivational methods that are most effective in hospitality employee motivation 2. QUESTION: What are the most successful methods to motivate restaurant employees in Switzerland? . ARTICLES ANKLI, R. E. , PALLIAM, R. , (2012). Enabling a motivated workforce: exploring the sources of motivation. Development and Learning in Organizations, 26(2), pp. 7 – 10 BASSETT-JONES, N. , LLOYD, G. C. , (2005). Does Herzberg's motivation theory have staying power?. Journal of Management Development, 24(10), pp. 929 – 943 ESKILDSEN, J. K. , KRISTENSEN, K. , and WESTLUND, A. H. , (2004). Work motivation and job satisfaction in the Nordic countries. Employee Relations, 26(2), pp. 122 – 136 LEE-ROSS, D. , (2005).Perceived job characteristics and internal work motivation: An exploratory cross-cultural analysis of the motivational antecedents of hotel workers in Mauritius and Australia. Journal of Management Development, 24(3), 253 – 266. STAMOV-ROSSNAGEL, C. , and HERTEL, G. , (2010). Older workers' motivation: against the myth of general decline. Management Decision, 48(6), 894 – 906. WHEELER, A. R. , BUCKLEY, M. R. , (2001). Examining the motivation process of temporary employees: A holistic model and research framework.Journal of Managerial Psychology, 16(5), pp. 339 – 354. OTHER SOURCES HERZBERG, F. , MAUSNER, B. , and SNYDERMAN, B. B. , 1959. Motivation to work. New York: Transaction Publishers. 4. RATIONALE The researcher believes that the topic selected is very significant for the restaurant and hospitality industry today and plays a key role in maxi mizing profit as motivating the workforce would further help in better service, food quality and even ability to retain customers up to a certain degree.According to Stamov-Rossnagel and Hertel (2010), the motivational factors depends on quite a wide range of possibilities, however one of them include the work environment, peers and the need to compete with the attainments of another worker in the same entity. These workers are motivated when they have the proper equipment desired for performing a specific task and are regularly updated with the latest equipment which would aid them in their tasks at work.When these workers feel that they are being monitored and are cared for by providing the equipment, proper working conditions, they inevitably feel the urge to perform better and are motivated. However, occasionally, the range of tasks in a job may not be as motivating as the particular task that the worker is interested in. Monitoring these tasks which motivate a worker should be specifically assigned to them to improve productivity. Managers should limit and avoid the use of any sort of cultural or ethical background about an employee while trying to judge the work or motivating him (Lee-Ross, 2005).Various western companies observed and practiced the approach of participative leadership and style of work which involved the decisions and views of every worker, which would indirectly rise their esteem and motivate them. Deference and responsibility are two highly important motivators. Individuals also have personal goals and if they are similar to those of the enterprise, then motivation is a very simple process. However, identifying the aims and goals of employees is mandatory to link it in a way to that of the organization and excel in revenues and market productivity.These individuals could bring up several innovative techniques and ideas, especially when they are at the prime of motivation level. Hence, the goals and aims of individuals matter largely in an enterprise for it to accelerate in the market. Temporary employees are a very common trend in today’s era where enormous multinational and private companies employee them specifically for reducing cost and being able to manipulate the schedule of the part time or temporary employees (Wheeler and Buckley, 2001).However, many private companies employee temporary employees and are expecting them to be motivated for the job. The full time workers also lose interest in explaining the part time workers about the work flow and the importance of following a systematic approach to every method and hence, the temporary workers do not feel the urge to perform better and accelerate in their position. The temporary workers are kept apart from the important decisions being taken in the organization and are isolated, especially in MNC’s such as McDonald’s Burger King and other various different fast food restaurants.However, this also implies to certain other casual restau rants which employs interns and other part time workers who as well are not motivated enough to put their efforts into the enterprise. The researcher explored the literature and identified the following few advantages of motivating people: 1. Creates an enthusiastic workforce 2. Enables the opportunity to resolve any confrontation within minutes and boost staff morale 3. Increases revenue of the restaurant . Eliminates the necessity of monitoring staff According to Eskildsen, Kristensen, and Westlund, (2004) women are more satisfied than men regarding job satisfaction, employees with higher level of education need not necessarily be more satisfied, but at time could even result to be the contrary. However, education level does not have an impact on intrinsic factors, whereas managerial positioned workers are more satisfied with their jobs.The Herzberg theory states that the motivational factors are divided into two main parts, the first known as the hygiene factors which are related to salary, working conditions and team work while the latter is related to motivational means (Bassett-Jones and Lloyd, 2005). Motivational means are based solely on 3 major factors, ability to exercise, opportunity to practice and feedback to self. These are explained in the book by Herzberg, Mausner and Snyderman (1959) which describe the hygiene factors offered by the employer simply as ‘KITA’ or kick in the ass, which does not motivate one but rather threatens them to work harder in a way.If one possess the ability to perform or has a skill such as communication, service, cooking etc. he/she will be aiming to achieve better goals in life. However, if the person does not have the equipment and other necessary means to practice his skills, he will not be able to perform to the best and would not be motivated. This later includes a feedback, which may not always come from a higher authority but even from self helps. These are the 3 basic necessities for motivation and is related to every industry. 5. AIMS: The aim of this research paper is to analyse the best method(s) for motivating restaurant employees in Switzerland. . OBJECTIVES: To review past and current methods of employee motivation To examine the difference between employee motivation methods in different restaurants in Switzerland To evaluate the most used methods applied by employers and their effectiveness 7. METHODOLOGY The researcher was enthusiastic about collecting primary data and is looking forth to setup a network for communicating between several restaurants in Switzerland regarding the motivational techniques widely used within the restaurant for backing up employees for further work.The research philosophy surfaced as realism as the methods and techniques are applicable in the practical life and need to be reviewed once again for a more clear vision. Deductive approach was the best suited style for this kind of research where the researcher evaluated different concepts and theories set ahead of him by different philosophers and psychologists studying the area of motivation of employees in any type of an industry and a mixture of both qualitative and quantitative analysis were both necessary in such a project.Qualitative analysis hung on the literature and journal articles and will also include the surveys spread throughout certain restaurants in Switzerland, and the researcher would later interview and question the owner of a famous Indian restaurant in Zurich, Switzerland which is known for motivating its employees to a very high degree and enabling them to monitor and manage a restaurant solo.The researcher will distribute a questionnaire amongst 30 different employees of several restaurants in Luzern and in Zurich and also to 3-5 different restaurant managers for feedback regarding the motivational methods and techniques abundant in the vicinity. The sampling technique is non-probability, purposive method and focuses on only a niche of the populati on. Calculating the results from both the employer and employee would enlarge the scope of research and present forward a more ransparent knowledge of motivational means applied. The Fredrick Herzberg theory of motivational and hygienic factors are quite relevant to this focus topic and go hand in hand with the ideas of the researcher. The practical world believes in money being a very heavy motivator and as well as job security, working conditions and benefits. The researcher claims it to be false and would like to prove it on paper. 8. DRAFT QUESTIONS My name is Ankit Sharma and I am a student of Business and Hotel Management School in Luzern, Switzerland.This research survey will give me concrete evidence towards my project, ‘What are the most successful methods to motivate restaurant employees in Switzerland’ and aid me in my Research and Methodology class. The questions will be regarding the factors that will motivate the employees in a restaurant oriented job and the answers will be kept anonymous and confidential and used only for research purposes. Questionnaire 1 What are the factors that motivate you to work? Name: Age: Sex:Nationality: American African European Asian Other 1) From a scale of 1 to 4, 1 being very satisfied, how satisfied are you with your job? a. 1 b. 2 c. 3 d. 4 2) What is the first feature you look at when accepting a job? a. Pay b. Work hours c. Type of job d. Location 3) Your average daily work hours ranges from: a. 6-7 b. 7-8 c. 8-10 d. 10+ 4) Which of the following factors motivate you? a. Money b. Special benefits c. New challenges daily d. Job security 5) What is your average monthly income? a.

Add Math Essay 2 Essays

Add Math Essay 2 Essays Add Math Essay 2 Essay Add Math Essay 2 Essay Additional Mathematics Project Work 2 Written By : Nurul Hazira Syaza Abas I/C : 940602-01-6676 Angka Giliran : School : SMK Kangkar Pulai Copyright 2011  ©. Hazira Syaza, All Right Reserve Numb| Title| Page| 1| Acknowledge| 1| 2| Objective| 2| 3| Introduction Part I| 3| 4| Mathematics In Cake Baking And Cake Decorating| 4 5| 5| Part II| 6 14| 6| Part III| 15 17| 7| Further Exploration| 18 21| 8| Reflection| 22 23| 9| Conclusion| 24| 10| Reference| 25| Table. of. Content Copyright 2011  ©. Hazira Syaza, All Right Reserve Acknowledge First of all, I would like to say Alhamdulillah, for giving me the strength and health to do this project work. Not forgotten my parents for providing everything, such as money, to buy anything that are related to this project work and their advise, which is the most needed for this project. Internet, books, computers and all that. They also supported me and encouraged me to complete this task so that I will not procrastinate in doing it. Then I would like to thank my teacher, Puan Andek for guiding me and my friends throughout this project. We had some difficulties in doing this task, but he taught us patiently until we knew what to do. He tried and tried to teach us until we understand what we supposed to do with the project work. Last but not least, my friends who were doing this project with me and sharing our ideas. They were helpful that when we combined and discussed together, we had this task done. Copyright 2011  ©. Hazira Syaza, All Right Reserve 1 Objective The aims of carrying out this project work are: * To apply and adapt a variety of problem-solving strategies to solve problems * To improve thinking skills * To promote effective mathematical communication To develop mathematical knowledge through problem solving in a way that increases students’ interest and confidence * To use the language of mathematics to express mathematical ideas precisely * To provide learning environment that stimulates and enhances effective learning * To develop positive attitude towards mathematics Copyright 2011  ©. H azira Syaza, All Right Reserve 2 Introduction Part 1 Cakes come in a variety of forms and flavours and are among favourite desserts served during special occasions such as birthday parties, Hari Raya, weddings and others. Cakes are treasured not only because of their onderful taste but also in the art of cake baking and cake decorating Baking a cake offers a tasty way to practice math skills, such as fractions and ratios, in a real-world context. Many steps of baking a cake, such as counting ingredients and setting the oven timer, provide basic math practice for young children. Older children and teenagers can use more sophisticated math to solve baking dilemmas, such as how to make a cake recipe larger or smaller or how to determine what size slices you should cut. Practicing math while baking not only improves your math skills, it helps you become a more flexible and resourceful baker. Copyright 2011  ©. Hazira Syaza, All Right Reserve 3 MATHEMATICS IN CAKE BAKING AND CAKE DECORATING GEOMETRY To determine suitable dimensions for the cake, to assist in designing and decorating cakes that comes in many attractive shapes and designs, to estimate volume of cake to be produced When making a batch of cake batter, you end up with a certain volume, determined by the recipe. The baker must then choose the appropriate size and shape of pan to achieve the desired result. If the pan is too big, the cake becomes too short. If the pan is too small, the cake becomes too tall. This leads into the next situation. The ratio of the surface area to the volume determines how much crust a baked good will have. The more surface area there is, compared to the volume, the faster the item will bake, and the less inside there will be. For a very large, thick item, it will take a long time for the heat to penetrate to the center. To avoid having a rock-hard outside in this case, the baker will have to lower the temperature a little bit and bake for a longer time. We mix ingredients in round bowls because cubes would have corners where unmixed ingredients would accumulate, and we would have a hard time scraping them into the batter. Calculus (DIFFERENTIATION) To determine minimum or maximum amount of ingredients for cake-baking, to estimate min. or max. amount of cream needed for decorating, to estimate min. or max. Size of cake produced. Copyright 2011  ©. Hazira Syaza, All Right Reserve 4 PROGRESSION To determine total weight/volume of multi-storey cakes with proportional dimensions, to estimate total ingredients needed for cake-baking, to estimate total amount of cream for decoration. For example when we make a cake with many layers, we must fix the difference of diameter of the two layers. So we can say that it used arithmetic progression. When the diameter of the first layer of the cake is 8? nd the diameter of second layer of the cake is 6? , then the diameter of the third layer should be 4?. In this case, we use arithmetic progression where the difference of the diameter is constant that is 2. When the diameter decreases, the weight also decreases. That is the way how the cake is balance to prevent it from smooch. We can also use ratio, because when we prepare the ingredient for each layer of the cake, we need to decrease its ratio from lower layer to upper layer. When we cut the cake, we can use fraction to devide the cake according to the total people that will eat the cake. Copyright 2011  ©. Hazira Syaza, All Right Reserve 5 Part 11 Best Bakery shop received an order from your school to bake a 5 kg of round cake as shown in Diagram 1 for the Teachers’ Day celebration. 1) If a kilogram of cake has a volume of 38000cm3, and the height of the cake is to be 7. 0 cm, the diameter of the baking tray to be used to fit the 5 kg cake ordered by your school 3800 is Volume of 5kg cake = Base area of cake x Height of cake 3800 x 5 = (3. 142)( d/2)? x 7 1900/7 (3. 142) = ( d/2)? 863. 872 = (d/2 )? d/2 = 29. 392 d d = 58. 784 cm Copyright 2011  ©. Hazira Syaza, All Right Reserve 2) The inner dimensions of oven: 80cm length, 60cm width, 45cm height a) The formula that formed for d in terms of h by using the formula for volume of cake, V = 19000 is: 19000 = (3. 142)(d/2)(d/2)   ? h 1900/(3. 142)2 = d   ? /4 24188. 415/h = d   ? d = 155. 53/ h Copyright 2011  ©. Hazira Syaza, All Right Reserve 7 Height,h| Diameter,d| 1. 0| 155. 53| 2. 0| 109. 98| 3. 0| 89. 79| 4. 0| 77. 76| 5. 0| 69. 55| 6. 0| 63. 49| 7. 0| 58. 78| 8. 0| 54. 99| 9. 0| 51. 84| 10. 0| 49. 18| Table 1 b) i) h 7cm is NOT suitable, because the resulting diameter produced is too large to fit into the oven. Furthermore, the cake would be too short and too wide, making it less attractive. b) ii) The most suitable dimensions (h and d) for the cake is h = 8cm, d = 54. 99cm, because it can fit into the oven, and the size is suitable for easy handling. c) i) The same formula in 2(a) is used, that is 19000 = (3. 142)( )? h. The same process is also used, that is, make d the subject. An equation which is suitable and relevant for the graph: Copyright 2011  ©. Hazira Syaza, All Right Reserve 8 1900= (3. 1420(d/2)   ? h 119000/(3. 142)h = d   ? /4 24188. 415/h = d   ? d = 155. 53/ vh d = 155. 53h(1-/? ) log d = log 155. 3h(-1/? ) log d = (-1/? )log h + log 155. 53 Table of log d = (-1/? )log h + log 155. 53 Height,h| Diameter,d| Log h| Log d| 1. 0| 155. 53| 0. 00| 2. 19| 2. 0| 109. 98| 0. 30| 2. 04| 3. 0| 89. 79| 0. 48| 1. 95| 4. 0| 77. 76| 0. 60| 1. 89| 5. 0| 69. 55| 0. 70| 1. 84| 6. 0| 63. 49| 0. 78| 1. 80| 7. 0| 58. 78| 0. 85| 1. 77| 8. 0| 54. 99| 0. 90| 1. 74| 9. 0| 51. 84| 0. 95| 1. 71| 10. 0| 49. 18| 1. 0| 1. 69| Table 2 Copyright 2011  ©. Hazira Syaza, All Right Reserve 9 Graph of log d against log h Copyright 2011  ©. Hazira Syaza, All Right Reserve 10 ii) Based on the graph: a) d when h = 10. 5cm h = 10. 5cm, log h = 1. 21, log d = 1. 680, d = 47. 86cm b) h when d = 42cm d = 42cm, log d = 1. 623, log h = 1. 140, h = 13. 80cm 3) The cake with fresh cream, with uniform thickness 1cm is decorated a) The amount of fresh cream needed to decorate the cake, using the dimensions Ive suggested in 2(b)(ii) My answer in 2(b)(ii) ==; h = 8cm, d = 54. 99cm Amount of fresh cream = volume of fresh cream needed (area x height) Amount of fresh cream = volume of cream at the top surface + volume of cream at the side surface The bottom surface area of cake is not counted, because were decorating the visible part of the cake only (top and sides). Obviously, we dont decorate the bottom part of the cake Volume of cream at the top surface = Area of top surface x Height of cream = (3. 142)(54. 99/2) ? )x 1 = 2375 cm? Volume of cream at the side surface = Area of side surface x Height of cream = (Circumference of cake x Height of cake) x Height of cream = 2(3. 142)( 54. 99/2)(8) x 1 = 1382. 23 cm? Therefore, amount of fresh cream = 2375 + 1382. 23 = 3757. 23 cm? Copyright 2011  ©. Hazira Syaza, All Right Reserve 11 c) Three other shapes (the shape of the base of the cake) for the cake with same height which is depends on the 2(b)(ii) and volume 19000cm? The volume of top surface is always the same for all shapes (since height is same), My answer (with h = 8cm, and volume of cream on top surface =1900/8 = 2375 cm? ) 19000 = base area x height base area = 1900/8 length x width = 2375 By trial and improvement, 2375 = 50 x 47. 5 (length = 50, width = 47. 5, height = 8) Therefore, volume of cream = 2(Area of left and right side surface)(Height of cream) + 2(Area of front and back side surface)(Height of cream) + volume of top surface = 2(50 x 8)(1) + 2(47. 5 x 8)(1) + 2375 = 3935 cm? Copyright 2011  ©. Hazira Syaza, All Right Reserve 12 Triangle-shaped base 19000 = base area x height base area = 1900/8 base area = 2375 x length x width = 2375 length x width = 4750 By trial and improvement, 4750 = 95 x 50 (length = 95, width = 50) Slant length of triangle = v (95? + 25? )= 98. 23 Therefore, amount of cream = Area of rectangular front side surface(Height of cream) + 2(Area of slant rectangular left/right side surface)(Height of cream) + Volume of top surface = (50 x 8)(1) + 2(98. 23 x 8)(1) + 2375 = 4346. 68 cm? Copyright 2011  ©. Hazira Syaza, All Right Reserve 13 3 – Pentagon Shaped Base 19000 = base area x height ase area = 2375 = area of 5 similar isosceles triangles in a pentagon therefore: 2375 = 5(length x width) 475 = length x width By trial and improvement, 475 = 25 x 19 (length = 25, width = 19) Therefore, amount of cream = 5(area of one rectangular side surface)(height of cream) + vol. of top surface = 5(19 x 8) + 2375 = 3135 cm? c) Based on the values above, the shape that require the least amount of fresh cream to be used is: Pentagon-shaped cake, since it requires only 3135 cm? of cream to be used. Copyright 2011  ©. Hazira Syaza, All Right Reserve 14 Part III When theres minimum? or maximum? well, theres differentiation and quadratic functions. The minimum height, h and its corresponding minimum diameter, d is calculated by using the differentiation and function. Method 1: Differentiation Two equations for this method: the formula for volume of cake (as in 2(a)), and the formula for amount (volume) of cream to be used for the round cake (as in 3(a)). 19000 = (3. 142)r? h (1) V = (3. 142)r? + 2(3. 142)rh (2) From (1): h =19000/(3. 142)r? (3) Sub. (3)into (2): V=(3. 142)r? +2(3. 142)r(19000/(3. 142)r? ) V=(3. 142)r? +(38000/r) V=(3. 142)r? +38000r-1 (dV/dr)=2(3. 142)r-(38000/r? ) 0=2(3. 142)r-(38000/r? minimun value therefore dv/dr=0 38000/r? =2(3. 142)r 38000/2(3. 142)=r^3 6047. 104=r^3 R=18. 22 Sub. r = 18. 22 into (3) H=19000/(3. 142)(18. 22) Therefore,h = 18. 22cm,d=2r=2(18. 22)=36. 44cm Copyright 2011  ©. Hazira Syaza, All Right Reserve 15 Method 2 : Quadratic Functions Two same equations as in Method 1,but only the formula for amount of cream is the main equation used as the quadratic functions. Let f(r)=volume of cream,r = radius of round cake: 19000 = (3. 142)r ? h (1) F(r)=(3. 142)r ? +2(3. 142)hr (2) From (2): F(r) = (3. 142)(r ? +2hr) factorize (3. 142) = (3. 142)[(r+2h/2) ? (2h/2) ? ] completing square,with a =(3. 142),b=2h and c=0 = (3. 142)[(r+h) ? -h ? ] = (3. 142)(r+h) ? -(3. 142)h ? (a=(3. 142)(positive indicates min. value),min. value = f(r)=-(3. 142)h ? ,corresponding value of x = r = -h) Sub. r =-h into (1): 19000=(3. 142)(h) ? h h^3=6047. 104 h=18. 22 Sub. h=188. 22 into (1) 19000=(3. 142)r ? (18. 22) r ? =331. 894 r=18. 22) therefore,h=18. 22cm,d=2r=2(18. 22)=36. 44cm Copyright 2011  ©. Hazira Syaza, All Right Reserve 16 I would choose not to bake a cake with such dimensions because its dimensions are not suitable (the height is too high) and therefore less attractive. Furthermore, such cakes are difficult to handle easily. Copyright 2011  ©. Hazira Syaza, All Right Reserve 17 Futher Exploration Copyright 2011  ©. Hazira Syaza, All Right Reserve 18 Best Bakery received an order to bake a multi-storey cake for Merdeka Day celebration, as shown in Diagram 2. The height of each cake is 6. 0 cm and the radius of the largest cake is 31. 0 cm. The radius of the second cake is 10% less than the radius of the first cake, the radius of the third cake is 10% less than the radius of the second cake and so on. Given: height, h of each cake = 6cm radius of largest cake = 31cm adius of 2nd cake = 10% smaller than 1st cake radius of 3rd cake = 10% smaller than 2nd cake 31, 27. 9, 25. 11, 22. 599,†¦ a = 31, r = 9/10 V = (3. 142)r? h, a) By using the formula for volume V = (3. 142)r? h, with h = 6 to get the volume of cakes. Volume of 1st, 2nd, 3rd, and 4th cakes: Copyright 2011  ©. Hazira Syaza, All Right Reserve 19 Radius of 1st cake = 31, volume of 1s t cake = (3. 142)(31)? (6) = 18116. 772 Radius of 2nd cake = 27. 9, 9, volume of 2nd cake = (3. 142)(27. 9)? (6) 14674. 585 Radius of 3rd cake = 25. 11, Radius of 4th cake = 22. 59 volume of 3rd cake = (3. 42)(25. 11)? (6) 11886. 414 , volume of 4th cake = (3. 142)(22. 599)? (6) 9627. 995 The volumes form number pattern: 18116. 772, 14674. 585, 11886. 414, 9627. 995,†¦ (it is a geometric progression with first term, a = 18116. 772 and ratio, r = T2/T1 = T3 /T2 = †¦ = 0. 81) b) The total mass of all the cakes should not exceed 15 kg ( total mass ; 15 kg, change to volume: total volume ; 57000 cm? ), so the maximum number of cakes that needs to be baked is Copyright 2011  ©. Hazira Syaza, All Right Reserve 20 Sn =(a(1-rn))/(1-r) Sn = 57000, a = 18116. 772 and r = 0. 81 57000 =(18116. 22(1-(0. 81)n))/(1-0. 81) 1 0. 81n = 0. 59779 0. 40221 = 0. 81n og0. 81 0. 40221 = n n=log0. 40221/log0. 81 n = 4. 322 therefore, n ~ 4 Verifying the answer: When n = 5: S5 = (18116. 772(1 ( 0. 81)5)) / (1 0. 81) = 62104. 443 ; 57000 (Sn ; 57000, n = 5 is not suitable) When n = 4: S4 = (18116. 772(1- (0. 81)4)) / (1 -0. 81) = 54305. 767 ; 57000 (Sn ; 57000, n = 4 is suitable) Copyright 2011  ©. Hazira Syaza, All Right Reserve 21 Reflection Copyright 2011  ©. Hazira Syaza, All Right Reserve 22 TEAM IS IMPORTANT! BE HELPFUL ALWAYS READY TO LEARN NEW THINGS BE A HARDWORKING STUDENT Copyright 2011  ©. Hazira Syaza, All Right Reserve 23 CONCLUSION * Geometry is the study of angles and triangles, perimeter, area and volume. It differs from algebra in that one develops a logical structure where mathematical relationships are proved and applied. * An arithmetic progression (AP) or arithmetic sequence is a sequence of numbers such that the difference of any two successive members of the sequence is a constant * A geometric progression, also known as a geometric sequence, is a sequence of numbers where each term after the first is found by multiplying he previous one by a fixed non-zero number called the common ratio * Differentiation is essentially the process of finding an equation which will give you the gradient (slope, rise over run, etc. ) at any point along the curve. Say you have y = x^2. The equation y = 2x will give you the gradient of y at any point along that curve. Copyright 2011  ©. Hazira Syaza, All Right Reserve 24 REFERENC E * Wikipedia * one-school. net/ * Additional Mathematics text book form 4 and form 5 Copyright 2011  ©. Hazira Syaza, All Right Reserve 25

Nursing Reflective Essay using Driscoll’s reflective cycle The WritePass Journal

Nursing Reflective Essay using Driscoll’s reflective cycle Introduction: Nursing Reflective Essay using Driscoll’s reflective cycle Introduction:ReferenceRelated Introduction: In this reflective account essay, I will be describing nursing skills that I undertook during my practice placement, using Driscoll’s (2000) reflective cycle, a recognised framework for reflection to demonstrate my ability to reflect on different nursing skill.  Ã‚   According to Driscoll’s (2000), there are three processes when reflecting on one’s practice. They are: What (what happened), so what (what were you feeling, what was good/bad about the experience and Now what (if it happens again what you would do differently). The application of Driscoll’s reflective cycle will enable me link theory to practice. As outlined, in the Nursing and Midwifery Council (NMC, 2004), the practice of reflection will allow me to explore, through experience, area for development in providing the necessary quality of care (Taylor, 2006). Reflection is a significant part of attaining knowledge and understanding, to reflect on experiences which could be positive or negative allowing for self criticism (Bulman and Schutz, 2004). My 1st skill will explores how communication can be enhanced for clients with communication impairments which I raised in one of the multidisciplinary team meeting (MDT). I will be   drawing from knowledge and experience gained from that meeting which involve social workers, speech language therapist, adult nurse, mental health nurse and a carer experience. Names have been changed to maintain confidentiality (NMC, 2007) 1st skill: I discover the level at which nurses and support worker communicate with service user are not up to standard simply because they have an impairment see Appendix 1 This now lead me to carry out a research on this issues which I discover that it has been estimated that there are 2.5 million people in the UK with communication impairment (Communications Forum, 2008).   It is estimated that 50% to 90% of people with intellectual disabilities have communication difficulties and about 60% of people with intellectual disabilities have some skills in symbolic communication using pictures, signs or symbols (Fraser Kerr, 2003). The World Health Organization’s classification of impairment, disability and handicap relating   to communication disorders are impairment which disruption the normal language-processing or speech production system e.g. difficulty with finding the right words or with reading sentences, reduced spelling ability and reduced ability to pronounce words clearly (World Health Organization, 2001). Communication is ‘a process that involves a meaningful exchange between at least two people to convey facts, needs, opinions, thoughts, feelings and other information through both verbal and non-verbal means, including face to face exchanges and the written word’. (DH, 2003) Communication is a two-way process, involving at least two people who alternate in sending and receiving messages (Ferris-Taylor, 2007).   When the message is received, it is interpreted and normally a response is given. In some people there may be a delay in response time as result of communication impairment. This was the problem encountered by Mr Kee whilst I felt frustrated sometimes as I felt nurses/support workers were not patient enough with him. I propose both verbal and non verbal communication is important when dealing with Mr Kee as it is important to ensure the message put across is clear. There is a need to devise a strategy to communicate that would promote empowerment, building on existing strengths so as not to reinforce a sense of helplessness and power imbalance. Studies have showed that by using verbal and non verbal communication techniques appropriately can help us nurses/carers and families to communicate and enhance the communication experience for Mr Kee.   For example we should   create conducive environment,   listen carefully to what he is trying to say, observing his body language, using positive body language to convey warmth and reassurance, speaking slowly, using short and simple words,   give Mr Kee opportunities to talk in indirect ways and to express himself, I tried emphasis the need for us nurses/support worker to be creative, adaptable and skilful to avoid disempowering Mr Kee because of his communication impairment (Allan 2001, Feil DeKlerk-Rubin 2002 and Alzheimer’s Association 2005). ‘One of the ways in which people with dementia are disempowered in communication is that of being continually outpaced, having others speak, move and act more quickly that they are able to understand or match’ (Killick and Allan, 2001, pp. 60–1) The MDT experience has emphasised the importance of interprofessional working together as it encourages holistic care to be delivered.   The learning gained from this experience will impact my future practice in various areas which include communication and empathy. I am mindful of the challenges faced by Mr Kee and this has increased my knowledge in clinical practice where I have observed that mental illness can impair patient’s ability to communication, for example dementia, schizophrenia, depression and psychosis cause’s cognitive impairment which can interferes with a persons ability to think clearly, to distinguish reality from fantasy, to manage emotions, make decisions, and relate to others, which often hinders the development of a therapeutic relationship. I have learnt a lot about The Mental Capacity Act, 2005 provides guidance as to what factors should be taken into consideration when making a decision in someone’s best interest. As a qualified nurse my role would be to ensure decisions are made on behalf of the service user after much consultation with the service user as communication advocacy is universally considered a moral obligation in nursing practice as it is the crucial foundation of nursing (McDonald, 2007) Effective advocacy can transform the lives of people with learning disabilities enabling them to express their wishes and make real choices. In Mental health nursing, empowerment usually means the intent to ensure that conditions are such that the individual can act as a self advocate (Webb, 2008)] This experience has highlighted the difficulties that may be encountered in communicating and gaining valid consent which I will be aware of in future practice. In conclusion steps towards better health care can be made by providing encouragement and support to improve communication between nurses/support workers and carers with communication disabilities [Godsell and Scarborough, 2006]. In order to battle any restriction for Mr Kee to access good health care and prevented anything against his wellbeing. Introduction In this reflective account essay, I will be describing nursing skills that I undertook during my practice placement, using Driscoll’s (2000) reflective cycle, a recognised framework for reflection to demonstrate my ability to reflect on different nursing skill.  Ã‚   According to Driscoll’s (2000), there are three processes when reflecting on one’s practice. They are: What (what happened), so what (what were you feeling, what was good/bad about the experience and Now what (if it happens again what you would do differently). The application of Driscoll’s reflective cycle will enable me link theory to practice. This 2nd skill will define the concept of dignity and its important in relation to Mr   Moses, an elderly patient, has difficulty hearing, frail, require assistant to walk, his trouser and shoes wet with urine and the smell of faeces. Actions and support according to the Code of Professional Conduct (Nursing and Midwifery Council (NMC, 2008) as suggested to be used in rendering care to Mr Moses. Also, the Nursing actions that will promote and maintain Mr Moses dignity during his care will be described. 2nd Skill The way Mr Moses was treated by the staff gave me concern see appendix 2 This now gave me an interest into this topic as to acquit myself before escalating the matter. I was involved in the care for Mr Moses who has diagnosed with dementia. Dementia is a chronic lifelong condition that causes memory loss, communication problems, incontinence and neglect of personal hygiene (Prime, 1994 p, 301). Mr Moses neglect of his personal hygiene was profound due to his incontinence condition Dignity   mean â€Å"Being treated like I was somebody† (Help the Aged, 2001).Relating dignity in the care Mr Moses, dignity will be define as care given to Mr Moses that will uphold, promote and not degrade his self respect despite his present situation (being wet with urine and smell of faeces), frail or his age (SCIE, 2006). Mr Moses despite his present circumstance should feel value before, during and after his care (Nursing Standard, 2007). The concept of dignity has to do with privacy, respect, autonomy, identity and self worth thereby making life worth living for them (SCIE, 2006). However, each patient needs is unique, the level of these concept will varies on individual service user, such as the privacy that other service user need will be different from what Mr Moses require at the time of His care. When dignity is not present during his care, Mr Moses will feel devalued, lacking control, comfort and feel embarrass and ashamed (RCN, 2008). Things that emerged in my observation for Mr Moses to be provided with care in a dignified way involves, delivery Mr Moses personal care in a way that maintain his dignity, having support from team members and an up to date training in delivering care, and supportive ward environment (NHS evidence, 2007). I did raise some issues with my mentor that was missing when attending to Mr Moses which includes: Respect, Privacy, Self-esteem (self-worth, identity and a sense of oneself) and Autonomy (SCIE, 2006). Respect is a summary of courtesy, good communication and taking time (SCIE. 2006). It is the objective, unbiased consideration and regard for the right, values, beliefs and property of all people (Wikipedia, 2006).Mr Moses being   particularly vulnerable because he   solely dependent on staff to provide his personal care because of his age , frail and needing assistant to walk (Help the Aged, 2006)   should be treated as an individual. He should not be discriminated. Emphasised should be on Procedures during care should be explained to Mr Moses and his care should be person centre rather than task-oriented (Calnan et al, 2005). The dignity of Mr Len must be respected and protected as a person who is born free, equal in dignity and has basic human right (Amnesty international, 1999).Health service will need to recognise the specific needs of older people in caring for them, demonstrating respect for Mr Len autonomy, privacy during Mr Len care and avoiding poor practice that will deify Mr Moses dignity, such as: allowing him to remain wet and soiled or scolding him   (Age Concern, 2008). The NMC (2008) code of conduct state that the care of Mr Moses should be the nurse first concern, respecting Mr Moses dignity and treating him as an individual. Mr Moses will be approached in a dignified manner, he should be given choice to decide whether or where he want his care to be carried out, demonstrating appropriate communication, sensitivity and interpersonal skill during interaction. Dignity is defy when there is a negative interaction between staff and Mr Moses when freedom to make decision is taken from him (BMJ, 2001). Mr Moses appearance is essential to his self respect; Mr Moses will require support in changing his wet cloth. Mr Moses should not be neglected based on his appearance rather supported to maintain the standard he is used to (SCIE, 2006). The NMC (2004), also instruct nurse to promote and protect the interest and dignity of service users irrespective of gender, age, race, ability sexuality, economic status, lifestyle, culture and religion or political beliefs. Mr Moses being an elderly man will not be problematic, because according to the code, care should be delivered, his culture preference , such as preferring a male staff to assist with his care . Treating Mr Moses fairly without discrimination is part of the Code, Mr Moses should not be discriminated against because he smells of faeces and trouser wet with urine Quot   but should be respected while attending to his needs. Privacy is closely related to respect (SCIE, 2006). Mr Moses care should be deliver in a private area, ensuring Mr Moses receive care in a dignified way that does not humiliate him: Discussion about Mr Moses condition should be discussed with him where others are unable to hear and curtain or doors are closed during Mr Moses care (Woolhead et al, 2004). Not giving Mr Moses the privacy that he needs makes feel that he was treated as incontinent because he was wet of urine and smell of faeces( which was stated in Mr Moses case not at the end of that shift â€Å"incontinent of urine and faeces). Incontinence is not uncommon; it may be cause by various reasons. It affects all age group (Godfrey and Hogg, 2002). Incontinent is defined to be an involuntary or inappropriate passing of urine or faeces thereby having impact on social functions or hygiene of client (DOH, 2000). There are various types of incontinent such as: stress incontinent (this can occur when coughing, or during physical activities), urge incontinent (overactive bladder), reflex incontinent (incontinent without warning) and mixed incontinent (both urge and stress incontinent) (Chris, 2007). Mr Moses may have be a victim of any of the above. In conclusion my knowledge about the concept of dignity and its importance to health care and the benefit to service users increased. NMC has made dignity clearer to understand by including dignity among its codes. This easy has also clarified that dignity has different meaning to various people. Introduction In this reflective account essay, I will be describing nursing skills that I undertook during my practice placement, using Driscoll’s (2000) reflective cycle, a recognised framework for reflection to demonstrate my ability to reflect on different nursing skill.  Ã‚   According to Driscoll’s (2000), there are three processes when reflecting on one’s practice. They are: What (what happened), so what (what were you feeling, what was good/bad about the experience and Now what (if it happens again what you would do differently). The application of Driscoll’s reflective cycle will enable me link theory to practice. This 3rd Skill will look at the assessment I did. One week into my placement at the community I was told by my mentor that I will be carrying out an assessment for a new patient that was referred to our service. To prepare for this I started to read the assessment note of other patient and doing research on the best method to get information from the patient. Barker (2004) defines mental health nursing assessment as ‘the decision making process, based upon the collection of relevant information, using a formal set of ethical criteria that contributes to an overall evaluation of a person and his circumstances’. Assessment is a continuous process which includes collecting information in a systematic way from a variety of sources. Assessment can be describe as a two stage process of gathering information and drawing inferences from the available data and decisions made regarding a person’s need of care. (Norman and Ryrie, 2007).   The purpose of assessment include judging and understanding levels of need, planning programmes of care and observing progress over time, planning service provision and conducting research (Gamble and Brennan, 2006) Meaningful and accurate assessment is essential if a person’s needs are highly complex so as to streamline the service user care requirement (DOH 2004). Assessment of person’s strengths and needs in social functioning is a fundamental stage in developing planned care that is familiar to practitioners. Making an accurate assessment of social functioning provides valuable information about the range of activities that a person can undertake on his or her own as well as those activities where a person requires support (Godsell and Scarborough, 2006) During our (Mentor and I) brainstorm to identify the main communication needs of the new service user based on the referral letter/note that I need to use the open question as this will give the patient the opportunity of expressing himself as supported by crouch and Meurier (2005). I observed differences in perception of needs between disciplines. This was beneficial to the group as it enabled us to achieve a holistic view of possible needs. Reference Age Concern.(2008). Help with continence. England. www.ageconcern.org.uk. Help Centre assessed on the 13/05/2011 @ 18:23. Amnesty international (1999).Universal Declaration of Human Rights. Amnesty International UK, London. Barker, P.J. (2004) Assessment in Psychiatric and Mental Health Nursing: In search of the whole person. 2nd edition. Cheltenham: Nelson Thornes. British Journal of Community Nursing (2001). Maintaining the dignity and   autonomy of older people in the healthcare setting. Downloaded from bmj.com on 12 April 2011 doi:10.1136/bmj.322.7287.668 BMJ 2001;322;668-670 Kate Lothian and Ian Philp Calnan, M, Woolhead, G, Dieppe, P. Tadd, W. (2005) Views on dignity in providing health care for older people. Nursing Times, 101, 38-41. Chris brooker, Anne Waugh   (2007). foundation. In foundations of nursing practice. fundamentals of holistic care (p. 92). Philadelphia: mosby elsevier. Communication Forum (2008)   www.communicationforum.org.uk accessed on the   15 April 2011 @ 16:03 Department of Health (2000). Good Practice IN Continence Services. DH, London Department of Health (2003) Essence of Care: National patient-focused benchmarking for health care practitioners. London: DH. Fraser, W Kerr, M.   (2003). Seminars in psychiatry of learning disabilities. 2nd ed. London: The Royal College of Psychiatrists. Ferris-Taylor, R. (2007) Communication. In: Gates, B. (Ed) Learning Disabilities: Toward Inclusion. 5th edition. Edinburgh: Churchill Livingstone. Gamble C and Brennan, G. (2006) Assessments: a rationale for choosing and using. In:   Gamble, C and Brennan, G (Eds) Working with Serious Mental illness: A manual for clinical practice. 2nd Edition.   London: Elsevier Limited. Godfrey H, Hogg A (2007).   Links between social isolation and incontinence. Continence –UK. 1(3): 51-8. Godsell, M. and Scarborough, K. (2006) Improving communication for people with learning disabilities. Nursing Standard 20(30) 12 April : 58-65 Help The Aged.(2006). Measuring Dignity in Care for Older People. Picker Institute Europe. MacDonald, H. (2007) Relational ethics and advocacy in nursing: literature review. Journal of Advanced Nursing 57(2): 119-126 Nursing and Midwifery Council (2004) Code of professional conduct: standard for conduct, performance and ethics. NMC, London. Nursing and Midwifery Council (2007) Code of professional conduct: standards for conduct, performance and ethics.NMC London. Nursing and Midwifery Council (2008) Code of professional conduct: standards for conduct, performance and ethics. NMC London. NS401 Matiti M et al (2007). Promoting patient dignity in healthcare settings. Nursing   Standard. 21,45,46-52. Date of acceptance: June 15 2007. NHS Evidence (2007). Caring for Dignity: A national report on dignity in care for older people while in hospital. Healthcare   Commission. Nursing and Midwifery Council (2008). The NMC Code Of Professional Conduct: Standard of conduct, performance and ethics for nurses and midwives. NMC, London Royal College of Nursing (2008). Defending Dignity: Opportunities and Challenges for Nursing. RCN, London. Social Care Institute for Excellence (2006). Dignity in care. Great British. Steven Richards, A. F. (2007). Working with THE MENTAL CAPACITY ACT 2005. Hampshire: Matrix Training Associates Ltd. Webb, J. U. (2008) The application of ethical reasoning in mental health nursing. In: Dooher, J. (ed) Fundamental aspects of mental health nursing. London. Quay Books. Woolhead, G, Calnan, M, Dieppe, P. Tadd, W (2004) Dignity in older age- what do older people in the United Kingdom thinks? Age and Ageing, 33, 165-169.

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Reflective Portfolio 05205 Essay Example | Topics and Well Written Essays - 2000 words

Reflective Portfolio 05205 - Essay Example However the participation of the company in the global market also depends on the comparative advantage of the firms that is the firms can export goods in which the firm specialises as well it needs to consider the cultural as well as the political issues of the trading partners. The entrepreneurs within a market focus on technological progress. Through internalisation a new product can be known that the firm may produce and then export the goods to other countries. (Ethier, 2005; Hoekstra and Hung, 2005). The products produced by the firms also depend on the demands of the customers and the entrepreneurs apply various strategies related to internalisation in order to increase the production capacity of the firms. International trade links the home and the host countries through the export and the import of goods that take place. The main factors that play a key role in promoting the globalisation within the economy are the technological innovation that brings in a change within the economy, economic and political changes that take place. The technological innovation within the economy enhances the transportation and communication process at low costs. A large investment in the road infrastructure allowed greater share of trade to be conducted by trucks movi ng between North America and Western Europe (Lane and Milesi-Ferretti, 2008). The shifting of the coal miners towards oil and gas industry is also considered as an important element of Globalisation. The currencies were convertible and the balance of payment restrictions was eliminated. The birth of the Euro Dollar market in the global economy was a move towards the availability of the international liquidity and the cross border trade relations that was set up in Western Europe (Chen, 2006). The organizations are expected to carry out the exchange of goods so as to promote

Research paper of Afro-American Music Example | Topics and Well Written Essays - 750 words

Of Afro-American Music - Research Paper Example He started to sing about his freedom which was given to him after the proclamation of independence. Blues music rose from this period. During the earlier days blues was called folk-blues. Many blues singers got jobs in entertainment groups and troupes and shows. Later on country music gained popularity which resulted in blues singers integrating country music into their singing which later on developed into a country oriented blues style (Ruehl) Jazz music started its motion in New Orleans. Improvisation is the most defining feature of this type of music. Born in the south of America this music recognizes the pain of lost love, injustice, and gives expression to the victory of surviving a broken heart as well as facing down hardships. It was the great musical tradition of New Orleans that blended folk, African drumming, church music, ragtime, blues etc, jazz music was born (History of jazz ). Jazz and blues music have lots of similarities together. In fact both are tangled and it is very difficult to separate them. Both of the music has emerged from the southern part of America. It was very much popular with the Afro-American population of that region. The musical forms of both jazz and blues are as a result of the collision of traditionally African rhythms and with that of European classical and folk music. Both jazz and blues are beloved and uniquely American forms of music. The actual origins of both jazz and blues cannot be located precisely. They are quite shrouded. This is because these types of music were generated out of poverty and the persons who developed them did not know that the music would get popular in the future. But both these music forms can be related to African-American spirituals and with that of songs sung by slaves at work places. These music contained early blends of European -African music. .Both jazz and blues music were once considered music of the devil. These types of

The policies of a Government Essay Example | Topics and Well Written Essays - 2000 words

The policies of a Government - Essay Example United Kingdom has seen the development of these organizations at a massive scale, with the number extending into thousands while the number of political parties remains small. The public has immensely supported the petitioning of the State to succumb to significant issues, and thus the membership of these groups has increased greatly (History Learning, 2010) The issue under consideration is an environmental factor, which has been drawing the attention of billions around the globe; it is an ecocatastrophe that everyone faces, irrespective of cast, creed, gender, status or nationality. This environmental factor is the phenomenon of Global Climate Change, which has been highlighted in political and economic debates, and Greenpeace International is one of the first pressure groups that promote this issue on a world-wide scale (IPCC, 2007). The slogan holds an energy within itself, and provokes the desire to act immediately; Greenpeace has effectively used the terminology which strikes t he emotions of the people, such as Fragile Earth and needs. It focuses on creating awareness and realization that the world is heading towards a disaster, and brings this issue on main scale, by confronting the government policies and large corporations which have led to this environmental degradation, such as forcing Timberland (a major shoe manufacturing company) to sort out their supply chain.The energy system of UK has become antique, and need up gradation to be conducive enough for contemporary times, and thus Greenpeace has proposed.

Transformational Leadership Paper Essay Example for Free

Transformational Leadership Paper Essay Abstract The purpose of this paper is to identify the the role a transformational leader can play in order to minimize the volatility that a change or transformation brings about in an organization. The paper discusses the two most common leadership styles, transactional and transformational leadership, and their differences. The qualities and traits of a transformational leader have been discussed. Most importantly this paper tries to associate the qualities of emotional intelligence to a transformational leadership style, and how the two feed into one another. Introduction Today the world has become a global village and markets have expanded to the extent that now firms are competing on a global level. This on one has provided firms with a massive opportunity and on the other hand it also demands more hard-work and effort from the workers. The challenge therefore is how to tackle the ever-changing work-environment. When one speaks of the dynamic work environment one has to realize the importance of Good Leadership in such a scenario. So, the leaders of todays companies have a lot to care about and a lot of responsibilities to take care of. Therefore, it is totally up to the leadership to make most of the human skills at hand and motivate them in order to make sure that they adapt quickly and easily to the work environment and thus maximize efficiency. Leaders broadly may be categorized into two groups, transactional leaders and transformational leaders. Transactional leaders are the kind of leaders whoguide or motivate their followers in the direction of established goals by clarifying role and task requirements (Robbins and Judge, 2005). The other type of leaders inspire followers to transcend their own self interest for the good of the organization. They are able to have a profound and extra-ordinary effect on their followers, these are transformational leaders (Robbins and Judge, 2005). Transformational leaders are are charismatic in nature and have the ability to provide individualized consideration and intellectual simulation (Robbins and Judge, 2005). Transformational leaders pay attention to the concerns and development needs of individualized followers; they change followers’ awareness of issues by helping them to look at old problems in new ways, and are therefore able to excite, arouse and inspire followers to put in extra effort to achieve group goals (Robbins and Judge, 2005). Analysis Leadership at the top is never easy for even the most experienced people. For someone taking on the job of CEO for the first time, mastering the new skills and sorting out the uncertainties that go with the position can be an overwhelming challenge. The fact is that for most of the CEOs especially the freshly appointed ones it is exceedingly difficult to familiarize themselves with the responsibilities and the risks that are associated with the job, and usually it requires some time and experience before they can deliver. The Centre for Creative Leadership has estimated that 40% of new CEOs fail in their first 18 months (Dan Ciampa 2005). What’s more, the churn rate is on the rise: In a 2002 study, the centre found that the number of CEOs leaving their jobs had increased 10% since 2001 (Dan Ciampa 2005). As a recent report from the outplacement firm Challenger, Gray Christmas points out, â€Å"The biggest challenge looming over corporate America [is] finding replacement CEOs.†(Dan Ciampa 2005) Take Coca Cola for an example, when the company lost its CEO Robert Goizueta in 1997, the two subsequent CEOs suffered in his shadow, as people expected them to perform the same way Goizueta did, however, leading as suggested earlier is the toughest job amongst all. Goizueta had guided Coke through its glorious years of the 1980s and the most of 1990s, leading it to perennially unrealistic expectations by shareholders. This is why change management is regarded as a tough job, because changes can occur in the external macro-environment and at the same time in the internal environment, as incase of Coke, whose CEO Robert Goizeuta died of cancer. And since then Coke has never been able to make up for the loss, and Pepsi has gained a significant market share since then. Jack Welch is probably the first name that comes to mind when we speak of transformational leaders. Richard Branson of the Virgin group is another very famous transformational leader (Robbins and Judge, 2005). When we speak of transactional and transformational leaders, they shouldn’t be considered or viewed as opposing approaches to getting things done. Transformational leadership is built on top of transactional leadership, as it produces levels of follower effort and performance that go beyond what would   with a transactional approach alone (Kotter, 1995). A transcational leader believes in exchange of rewards for effort as a major source of intrinsic and extrinsic motivation. He rewards good performance, and recognizes accomplishments. He tries to identify deviations from rules and standards, and subsequently reverts to corrective measures, and intervenes only if he believes that the standards have not been met. Transactional leaders usually abdicate responsibilties to others empowering them but also avoiding to go throw the challenging phase of decision-making. Trasformational leaders, on the other hand, are charismatic by nature, i.e. they provide vision and sense of mission, instills pride, gains respect and trust of his followers (Kotter, 1995). But, transformational leadership is more than just charisma. Because all charismatic leaders would want is to make sure their followers share the same viewpoint on things as they do, whereas transformational leaders will try to instill in followers the ability to question views, views established by the leaders themselves. Transformational leaders act as a source of inspiration to their followers, communicating high expectations, using symbols to focus efforts, expressing important purposes in simple ways. Transformational leaders also promote intelligence, rationality and careful problem solving skills (Robbins and Judge, 2005). But the most obvious and impotant trait of a transformational leader is that they offer individualized considerations to their followers, giving them personal attention, treating them all individually, coaching and advising them on a one to one basis. The evidence supporting the superiority of transformational leadership over the transactional variety is overwhelmingly impressive. For instance, a number of studies were conducted with American, German and Canadian military officers, belonging to different ranks, and the eventual verdict was that transformational leaders were evaluated as more effective than their transactional counterparts. Similarly, managers at Federal Express who were rated by their followers as exhibiting more transformational leadership were evaluated by their immediate supervisors as higher performers and more promotable. Much has been written about leadership and the qualities that fuel leadership such as intelligence, passion, toughness, determination, ethics, credibility, integrity, vision, etc. Often left off are the lists softer and more personal qualities, but recent studies have proven that they are equally important. Researchers have proposed a new term called Emotional Intelligence, and it may well help differentiate the outstanding leaders from the merely adequate ones. Emotional intelligence is one of the major aspects of transformational leadership. This may be because, effective transformational leaders rely on the expression of feelings to help convey a message; therefore, they possess a higher level of emotional intelligence. Emotional intelligence helps leaders manage the mood of their organizations which is an integral part of the transformation process (Satterlee, 2007). Emotional intelligence is what makes transformational leaders self-aware and empathetic to a greater extent. They can read and regulate their own emotions while intuitively grasping how others feel and gauging their organization’s emotional state. According to Daniel Goleman, who conducted a lot of research on Emotional Intelligence, there are five main components to emotional intelligence. Self-awareness is the trait where emotional intelligence actually begins (Goleman, 1998). Transformational leaders with a greater degree of self-awareness are never hesitant to talk about and discuss their weaknesses and it is this attitude that later brings upon a positive change in them as they are able to improve upon such weaknesses with time. This helps a leader in bringing about a transformation as he is someone who knows his limitations and he knows when and where he can actually stand-up and deliver for the rest of the workforce and be a motivator for them, i.e. when can he lead by example. Thus he knows which tasks and changes can actually be brought about in an organization and which ones cannot. The second trait is self-regulation, and that leaders with this trait can control their emotions and impulses better and channel them for good purposes (Goleman, 1998). This brings about an openness to change and transformation in their attitude and behavior, and increases their trustworthiness and integrity, and also helps them remain comfortable in ambiguous situations and scenario. And this is what subordinates try to see in their leaders, especially in times of change and transformation. Motivation is perhaps the most important trait and the most obvious one that a leader is judged upon. It’s the motivational abilities of a leader that gives the sub-ordinates the notion that the leader has a strong drive to achieve. It portrays the optimism of the leader towards the followers, such that they know their leader would still be optimistic when facing failure, so it has to do more with the mind than anything else. It is the positivity of the mind, it emanates from the mind of the leader and leads its way to the minds of the followers (Michael Roberto and David Garvin 2005). Empathy is the ability to understand the emotional makeup of other people. Empathy is the trait that enables a leader to be an expert in building and maintaining talent, something that is critical to the process of transformation. It enables him to treat people according to their emotional reactions. This is why he can be successful in getting the most out of the talented people that work under him, making him a better man manager. He is able to manage and lead people from various different backgrounds and cultures, belonging to various social and economic classes, i.e. it increases the cross-cultural sensitivity of the leader himself. With the businesses and economies globalizing, leaders have to lead and manage people belonging to different cultures which is the major reason why change management in such a scenario is very difficult, however, if only a leader can empathize with his followers, it makes the job half as difficult as before. The last trait that comes under emotional intelligence is the social skills of the leader. Transformational leaders need to be proficient in managing relationships and constructing networks that lead to effectiveness in change management ans transformation. Such a leader is able to find common ground between individuals and situations and scenarios and is able to build rapport. It also improves his persuasiveness and the ability to build and lead teams. A transformational leader combines emotional intelligence with the courage to raise the tough questions, challenge people’s assumptions about strategy and operations and risk losing their goodwill, i.e. he does not care about pleasing individuals but rather believes in the greater good of the company. A leader gets into trouble when there’s dissonance between the inside and outside what today we’d call a â€Å"disconnect.† (Mayer 2004) If a single theme runs through this issue, it’s the importance of keeping the two aligned. Every leader ought to want a more supple emotional intelligence, and â€Å"Leading by Feel† is a great place to begin (Mayer 2004). Another important tool in ensuring effective transformation is collaboration and good communication, which is essential and plays a vital role in process. All processes, practices and functionalities give more values to customer, goals and performance for achievement of goals. There should be internal solutions. Horizontal, Vertical and multi directional interaction must be carried out before change in organization. For a transformational leader, it is important to study the present culture of the organization and to know where one is. It is also necessary for a him to identify employees who want change and those who are not happy with the process of transformation. Take examples from existing model that has effectively implemented change and also communicate with them regarding their experience with transformation. The process has to be subtle and gradual, and a transformational approach would not demand immediate and complete change in the existing culture. Transformational approach to leadership also encourages one to seek advice from people about ways to implement change and methods to solve the problems while transformation. A clear vision definitely accelerates the transformation process. References Ciampa, Dan (2005). Almost Ready: How Leaders Move Up. Harvard Business Review. Goleman, Daniel (1998).What makes a Leader?. Harvard Business Review. Mayer, John (2004). Leading by Feel. Harvard Business Review. Kotter, John P. (1995). Leading Change: Why Transformation Efforts Fail. Harvard Business Review Leadership As A Boss In The Workplace. Retrieved July 29, 2008, from Manager Newz Web site: http://www.managernewz.com/managernewz-21-20070125LeadershipasaBossintheWorkplace.html Roberto, Michael and Garvin, David (2005). Change through Persuasion. Harvard Business Review. Robbins, Stephen P.   and Judge, Timothy A. (2005). Organizational Behavior, Twelfth edition: Pearsons Publishers Satterlee, Anita (2007). Essential of Management: Core principles, concepts, and strategies. Synergistics Inc.

Public Health Expenditure And Health

Public Health Expenditure And Health Using a utility maximization approach as developed by Grossman, the results revealed that health expenditure does not affect health outcomes in Kenya. The factors that affect health outcomes include: distance to nearest health facility (5km or more) and other household income. This implies that increasing public health expenditure does not lead to reduced maternal mortality rates. Since the other determinants (access to medical facility and other household income) significantly affect the health outcomes, the government needs to put measures in place to ensure that women can easily access health facilities and sensitize them to ensure that they deliver in health facilities and attend antenatal care. This study did not include some important variables that affect maternal mortality rates like the impact of cultural practices such as female genital mutilation (FGM), preference of certain types of health care providers (including traditional and herbal medicine) and earlier marriages. Therefore we suggest that in future, studies in this field should give attention to these variables. CHAPTER ONE: INTRODUCTION 1.1 Background information Health is the extent to which an individual or group is able to cope with the interpersonal, social, biological, and physical environments (World Bank, 2004). Health is therefore a resource for everyday life, not the objective of living. It is a positive concept embracing social and personal resources as well as physical and psychological capacities. Health financing is a key input in the provision of quality healthcare. Governments have always had a prominent role in overcoming public health risks and this is a major area of concern in less developed countries like Kenya (Scott, 2001). The provision of good health satisfies one of the basic human needs and contributes significantly to maintaining and enhancing the productivity of the people (Owino, 1997). Public expenditure on health services therefore is a key investment in human capital and plays a catalytic role in the growth of the economy by enabling people to achieve their full potential and lead productive lives. In recognition of the importance of human health, one of the Kenya governments major goals since independence has been to achieve adequate and good-quality health care for all citizens (GOK, 1965). To address health outcomes in developing countries such as Kenya, UNICEF advocates for increased public expenditure on health (UNICEF, 2006). Therefore, many countries in developing countries have increased their health expenditure over time. For example, to achieve better health outcomes, Kenya has increased its health expenditure from Kshs. 11.9 billion in 2000 to Kshs. 20 billion in 2004 representing a 30% increase as shown in Figure 1.1 (GOK, 2007). But more resources alone may not necessarily lead to better health outcomes because health care expenditure is only one of the many factors that contribute to health outcomes, considering the fact that these resources may be channeled to various projects that may not directly influence health outcomes. The link between government health expenditures and health outcomes may therefore not necessarily be present. First, an increase in public health expenditures may result in a decrease in private health expenditures; a household may dive rt its funds towards other uses once the government increases its provision of basic health care. Second, the incremental government expenditures may be employed on the intensive rather than the extensive margin. An example of intensive expenditures would be if expensive and low productivity inputs are bought with marginal funds in which case the impact of these expenditures on health outcomes may be small. Third, even if extra funds are applied extensively to health care (e.g. more staff at hospitals, adequate stocking of medications), but complementary services, both inside and outside the health sector, are not there (e.g. lack of roads or transportation to hospitals and clinics, subsidized prices for medication, etc.) the impact of extra government health expenditures may be little or none (Wagstaff, 2002a). In addition to health expenditure, Kenya also joined hands with other one hundred and eighty eight countries in a global effort to improve health outcome and reaffirmed its commitment to the united Nations Millennium Development goals (MDGs). Three of these millennium development goals are directly related to health. These are to (i) reduce child mortality, (ii) Improve maternal health and (iii) combat HIV/AIDS, malaria and other diseases. Despite these global and local interventions in health, performance of Kenyas health sector in terms of maternal mortality has remained as high as four hundred and eighty eight maternal deaths per 100,000 live births in 2008/9, an increase from four hundred and fourteen per 100,000 live births in 2003, five hundred and ninety per 100,000 in 1998 (KDHS, 2008-09). Figure 1.2. Most maternal deaths are due to causes directly related to pregnancy and childbirth, unsafe abortion and obstetric complications such as severe bleeding, infection, hypertensive disorders, and obstructed labor (KDHS, 2008-09). Improving maternal health being one of the eight Millennium Development Goals (MDGs) adopted at the 2000 Millennium Summit, and with only three years left until the 2015 deadline to achieve the MDGs, closer examination of maternal mortality levels is needed to inform planning of reproductive health programmes and to guide advocacy efforts and research at the national level. These estimates a re also needed at the international level, to inform decision-making concerning funding support for the achievement of this goal. Therefore this study focuses on the relationship between health expenditure and health outcomes in Kenya more particularly, how public health expenditure impacts on maternal mortality rates and other determinants of health outcomes. Figure 1.1 Public Health expenditure trends in Kenya Source: Kenya Demographic Health Survey 2008/09 Figure 1.2 Trends in maternal mortality: 1990-2008 Source: Kenya Demographic Health Survey 2008/09 1.1.2 Public Health expenditure in Kenya Adequate resources are critical to sustainable provision of health services. The government remains the major financier of health care, meeting nearly half of the national health recurrent expenditure. The Kenya policy framework of 1994 identified several methods of health services financing, including taxation, user fees, donor funds, and health insurance. These methods have evolved into important mechanisms for funding health services in the country. The GOK funds the health sector through budgetary allocations to the MOH. However, tax revenues are unreliable sources of health finance, because of macroeconomic conditions such as poor growth, national debt, and inflation, which often affect health allocations. The government therefore works closely with development partners to raise money for the health sector. Donor contributions to the health sector have been on the increase, rising from eight percent of the health budget in 1994-95 to sixteen percent in the fiscal 2001/2002. In some years, donor contributions accounted for over ninety percent of the development budget of the MOH (Ministry of Health, 2006). According to the 2001-2002 national health accounts (NHA), as cited by Wamai (2009) Kenya spends 5.1% of its GDP on health. He cited that the health budget had grown significantly from Ksh15.2 billion in Fiscal 2001/02 to Ksh34.4 billion in Fiscal 2008/09. He added that the proportion of overall government expenditure that the government spent on health declined over the same period from 9% to 7.9% in Fiscal 2006/07. In 1992 a cost-sharing system was introduced to leverage more resources for health services (Collins et al, 1996). Revenue from the cost-sharing system increased exponentially from Ksh60 million in Fiscal 1992/93 to over Ksh1, 468 million in Fiscal 2005/06. However, the revenues overall share of total health expenditure for Fiscal 2005/06 was just 6.4% of the MOHs total spending (MOH, 2007). Figure 1.3: Overview of Kenyas health budget, FY2002 2008 ( US$ million) Source: Health Policy Initiative analysis of Ministry of medical services, 2008 Figure 1.4: Absolute value of Total Health Expenditure (THE) by financing source 2001-2010 Source: Kenya National Health Accounts 2009/10 Reviews of public expenditures and budgets in Kenya show that total health spending constitutes about eight percent of the total government expenditure and that recurrent expenditures have been consistently higher than the development expenditures, both in absolute terms, and as a percentage of the GDP. Government financing of health expenditure is about sixty percent of what is required to provide minimum health services, implying that healthcare delivery in Kenya is under-funded (KHDR, 1999). This is accentuated by inefficiency of the system, including lack of cost-effectiveness in service delivery. However, preliminary information from Kenyas national health accounts shows that the financial contributions of households (out of pocket expenses) exceed those of the government. (Collins et al. 1996) The per capita expenditure therefore falls short of the Government of Kenyas commitment to spend fifteen percent of its total budget on health, as agreed in the Abuja Declaration. The under-financing of the health sector has thus reduced its ability to ensure an adequate level of service provision to the population (Collins et al. 1996). The national health concern therefore is the extent to which additional health expenditure on specific care programmes like maternal health will promote /increase benefits of the patients through improved outcomes in health (decline in maternal mortality rates). 1.1.3 Maternal healthcare in Kenya Improving maternal health is one of the eight Millennium Development Goals (MDGs) adopted at the 2000 Millennium Summit. The two targets for assessing progress in improving maternal health are reducing the maternal mortality ratio (MMR) by three quarters between 1990 and 2015, and achieving universal access to reproductive health by 2015. With only three years left until the 2015 deadline to achieve the MDGs, closer examination of maternal mortality levels is needed to inform planning of reproductive health programmes and to guide advocacy efforts and research at the national level. These estimates are also needed at the international level, to inform decision-making concerning funding support for the achievement of this goal. Good maternal health is crucial for the welfare of the whole household, especially children who are dependent on their mothers to provide food and care. Prevention of the death of a mother is the single most important intervention for the health of a child. Women are intensely vulnerable to the effects of costs incurred during childbirth. User fees can be especially high for emergency or technological procedures such as caesarean section, sometimes reaching catastrophic amounts, which push families into poverty (Graham and Newell, 1999). Many women often leave the hospital before they are well enough for discharge because they cannot pay for the care they have received. User charges add to the costs of transport and companion time, which can be substantial for those living far from facilities. The time spent looking for cash can also delay access to emergency life-saving care in facilities (Kunst and Houweling, 2001). In sub-Saharan Africa, one in sixteen women die in pregnancy or childbirth (WHO, 2001). An estimated ten to twenty million women develop physical or mental disabilities every year as a result of complications or poor management (Ashford, 2006). The long-term consequences are not only physical, but are also psychological, social, and economic. Despite the commitment expressed with the Millennium initiative, maternal health has not been given financial priority internationally. Safe motherhood programmes compete for funding with other priorities such as tuberculosis, malaria and HIV/AIDS. 1.2 Statement of the problem In Kenya, as in most Sub-Saharan African countries, health care expenditure has steadily increased over time, therefore making its containment a major issue for successive governments. The existence of a large public deficit and the need to reduce it drastically to comply with the requirements of the AU has added importance to controlling health care expenditure. Financing health care has remained a challenge to the Government of Kenya for a long time. There seems to be very low investment in health by the government, and inappropriate allocation of resources within the government health budget. In Kenya, health is a basic human right and therefore the health situation in Kenya remains a significant concern for the policy makers. The cost of health care, especially maternal health is a heavy burden on households. While health financing has undergone numerous reforms, more changes are needed to ease the burden of maternal health care costs on households in a bid to increase utilization and subsequently improve the health status of the population. In Kenya, like in most developing countries, maternal health care program encompass a medical condition that is regularly associated with death. The maternal mortality rates are very high. The major concern in this study is therefore the change in patient improvement due to additional expenditure on maternal health care (reduced maternal mortality rates). It analyzes whether increasing health care expenditure towards maternal health care program will reduce the maternal mortality rates. 1.3 Objectives of the study The broad objective of this study is to analyze the relationship between health care expenditure and maternal health outcomes in Kenya. The specific objectives of this study are: To identify the determinants of maternal health in Kenya. To investigate the relationship between government expenditure on maternal health care and maternal health outcomes To make policy recommendations based on study findings 1.4 Significance of the study A key factor that has contributed to the declining health outcomes has been the decline in annual real per capita government budget to the health sector. As noted earlier, the actual expenditures fall below budgetary allocations. With respect to this, policy makers are highly interested in the relationship between expenditure on public health and the resultant health outcomes/benefits. The issue is whether extra spending on maternal health leads to better maternal health outcomes. From a policy perspective, this study can help set priorities on resource allocations across specific program of care. For instance it can help the government to know whether additional expenditure on maternal health care will reduce maternal mortality rates in the country. The government is able to set its priorities right whether to invest more on these specific care programme or to reduce its expenditure given the severe budgetary constraints. It also gives policy makers some guidance on appropriate cost containment measures that will help improve health system performance in Kenya. It is also very useful at the international level, to inform decision-making concerning funding support for the achievement of the fifth millennium development goal. This study also adds to the existing literature on the relationship between health care expenditure and health outcomes, determinants of health outcomes and how health outcomes can be improved. CHAPTER TWO: LITERATURE REVIEW 2.1 THEORETICAL FRAMEWORK Healthcare is an intermediate good that has no intrinsic value in itself but has value in its contribution (along with other inputs such as environmental and social factors) towards production of health itself. Health, or in general, health status, refers to measures of the physical and emotional well-being of an individual or a defined population. The quantity of healthcare product produced by a healthcare firm is referred to as its output. The ultimate output of the health sector is health. Healthcare therefore can be viewed as any other good or service in which each individual maximizes utility subject to a budget constraint. The basic economic theory of production provides a basis on the linkage of health expenditure and health outcomes. The theory suggests that there are many ways inputs can be used in various proportions to produce outputs (Wolfe, 2002). Inputs refer to the resources needed to carry out a process or provide a service. Inputs required in healthcare are usually financial, physical structures such as buildings, supplies and equipment, personnel, and clients while output refers to the direct result of the interaction of inputs and processes in the system; the types and quantities of goods and services produced by an activity, project or program. The use of inputs in healthcare leads to outcomes. (Cremieux et al. 1999). Health production theory highlights the manner in which health care as an input is related to health as an output. In this theory, health is the output measured in terms of improved health status such as reduced mortality, morbidity or achieving health related millennium development goals while inputs consist of the number of trained health professionals, the number of school years completed, residential place, the proportion of GDP spent on health and the government health expenditure in the health sector (Desai, 1998). Health production theory utilizes the health production function which is the change in health status affected as an approximate matter by changes in the consumption of various health services effective in improving health. The production function summarizes the relationship between inputs and outputs with health status being the dependent variable (function of healthcare) dependent on populations social and environmental factors, policy variables and country specific effects inclusive of biological endowment, and lifestyle. Many studies on this subject have adopted Grossmans (1972) model of health production which views each individual as both a producer and a consumer of health. It regards health as a commodity which the individual will wish to consume and maximize, subject to his/her budget constraints, in conjunction with a number of endogenous and exogenous variables which have an impact on individuals health. Within this model, income and educational level play an important role as explanatory variables. In Grossmans model, he regards health care as both a consumption good that provides direct satisfaction and utility, and as an investment good, it provides satisfaction to individuals indirectly through reduction in sick days, increased wages and increased productivity. In this case, health can be viewed as a stock which degrades over time if there are no investments in the individual health, and that health is taken as a sort of capital. Investing in health may seem costly as individuals must trade off resources and time that may be devoted to health, unlike other goals. These factors are also used in determining the optimal level of health that is needed by an individual. The model therefore makes predictions on the likely effects of health care price changes and other goods, outcomes in labor market such as technological changes, wages and employment. In the Grossman model, at the optimal level, health investment occurs where the marginal cost of health capital is equal to the marginal benefit. Over time, health is likely to depreciate at a certain rate which may be denoted by ÃŽÂ ´. The consumer faces an interest rate which may also be denoted by r. By adding these variables, the health capital marginal cost can be calculated as under: ÃŽÂ ´ In this case the health capital marginal benefit is the rate of return from this capital in both non market and market sectors. In this model, the health stock at optimal level can be caused by factors such as education, wages and age. The theory further advocates that investing in health should be combined with other factors which are crucial in order to produce new health, which in the long run may offset the process of deterioration in the stock of health. Medical scientists could argue that only effective medical care should be universally available (OHE, 1979). The government therefore may resort to explicit rationing which is not only to set limits on total expenditure for care, but also to develop mechanisms to arrive at more rational decisions as to relative investments in different disease specific programmes, and the establishment of certain minimal uniform standards. This rationing does not guarantee mothers to equal access to appropriate maternal/medical care. Treatment is still within the postulate that the doctor will do his best with the resources available to him but there is no such constraint on those resources as government decides (OHE, 1979). This study looks at maternal health as the output of an aggregate production which utilizes variables such as public health expenditure, access to government medical services and household incomes as the inputs. The assumption is that for reasons associated with diminishing returns and the adverse effects of certain variables after an initial positive outcome, the relationship is expected to be nonlinear (Nixon and Ulman, 2006). 2.2 EMPIRICAL LITERATURE Health status are commonly measured using four major indicators, maternal mortality, mortality rate in infants, mortality rate for under five and life expectancy at birth (Akinkugbe et al. 2009); (Gupta et al. 1999); (Wang,2002); (Imam et al. 2003). Other measures of health outcomes/status used include preference of cancer or circulatory diseases, disability adjusted life years, quality adjusted life years, fertility indicators and achievement of other health related millennium development goals. Similarly, government health expenditure, GDP per capita, female literacy, number of physicians, immunization coverage, urbanization and calorie intake among others are some of the most used explanatory variables (Wolfe, 1986); (Wang, 2002); (Or, 2000b); (Caldwell, 1990) and (Filmer et al. 1999). Most studies have used cross-sectional analysis (Bokhari et al.2007); (Imam et al. 2003); (Anyanwu et al. 2008); (Gani et al. 2009); (Wang, 2002); (Nixon and Ulman, 2006) and (Martin et al. 2009). Some have used panel data (Gupta et al. 1999) and (Or, 2000b), while Akinkugbe et al. (2009) used time series analysis to estimate the relationship between the public health expenditure and health outcomes. To solve the problem of autocorrelation in cross sectional analysis, heteroskedasticity test was done, corrected standard errors for panel data analysis while augmented Dickey Fuller tests were used to test for stationarity in all studies using time series data. All studies reviewed used health expenditure as one of the explanatory variables except Wang, (2002) who looked at it in a different perspective. According to him, demand for electricity, access to piped water and sanitation and female education increases health expenditure but it does not increase public health expenditure in improving health outcomes. Most studies indicated that public spending contributes significantly to health status improvements (Filmer et al. 1999); (Abel Smith, 1963); (Kiymaz et al. 2006); (Ester et al. 2011); (Gakunju, 2003); (Bokhari et al.2006); (Anyanwu et al. 2005); (Cremieux et al. 1999); (Nixon and Ulman, 2006) and (Blendon et al. 2006). For example, Filmer et al. (1999) used data from the early 1990s and estimated multivariate regression model of child mortality on per capita income, government health expenditure and other controls. They found that there was significant correlation between child mortality and income per capita. Some studies however indicated that public health expenditure alone as a determinant of health is inadequate (Ogbu and Gallagher, 1992); (Castrol-leal et al. 1999); (Gupta et al. 2003); (Anderson and Frogner, 2005); (Hitris and Posnet, 1992); (Caldwell, 1986); (Dor et al. 2007) and (Cochrane et al. 1978). In estimations, different methods were used by different authors. Generally two main methods were used: generalized least squares and the ordinary least squares. However, other methods have also been used. For example, Bokhari et al. (2006) and Gupta et al. (1999) used two stage least squares because of the instrumental variables used to address the problem of reverse causality and measurement errors in the variables. Anyanwu et al. (2005) used Robust Ordinary Least Squares as the baseline specification and robust two stage least squares to control for endogeneity and reverse causality. Bhalotra (2007) used the linear probability model. Particularly, Flippi et al (2006) took a broader perspective on maternal health and drew attention to the economic and social vulnerability of pregnant women. They called for action to reduce maternal mortality rates by channeling more resources towards maternal healthcare, improving on human resources and information. They used maternal mortality ratio (by cause) as the major indicator and recommended that research is needed on how to finance health services and ensure equitable access to generate more evidence. While examining the association of the socio-demographic characteristics of women and the unobserved hospital factors in Kenya, Magadi et al. (2001) used multilevel logistic regression. The results showed that the probability of maternal mortality depends on both observed factors that are associated with a particular woman and unobserved factors peculiar to the admitting hospital. The individual characteristics observed to have a significant association with maternal mortality include maternal age, antenatal clinic attendance and educational attainment. The hospital variation was observed to be stronger for women with least favorable socio-demographic characteristics. For example, the risk of maternal death at high-risk hospitals for women aged thirty five years and above, who had low levels of education, and did not attend antenatal care is about two hundred and eighty deaths per a thousand admissions. The risk for similar women at low-risk hospitals is about four deaths per a thous and admissions. In a study carried out on health care services and sources of revenue in six countries from Western Europe and North America, Abel Smith (1963) found that health care expenditure was associated with reduced life expectancy and increased mortality rates. In a similar study carried out in the year 1967 involving twenty nine countries he found that the level of national income was associated with improved health status and that the demand for healthcare increased in countries with declining mortality. Abel Smiths studies laid down foundation for the development of methodologies for tracking health expenditures in both private and public sectors. While investigating the factors that are associated with infant mortality in Sub-Saharan Africa, Ester et al. (2011) carried out an ecological multi-group study using a bi-variate and multi-variate analysis with infant mortality rate as the dependent variable. They used a linear regression model between infant mortality rate and the correlated indicators (social security expenditure and government expenditure per-capita on health). This study revealed, in the multi-variate analysis, three factors associated with the IMR: a higher social security expenditure on health as a percentage of the general government expenditure on health, a higher per-capita government expenditure on health and a higher number of children under five years of age with diarrhea receiving oral dehydration therapy indicated a lower IMR. During the examination of the effectiveness of public social spending on education and health care in several African countries, Castro-Leal et al. (1999) reviewed the benefit incidence of government spending in Cote divoire, Guinea, Kenya, Madagascar, South Africa and Tanzania. Their study found that public expenditures on health were not sufficient especially on the poor to reduce mortality rates. On the other hand, Gupta et al. (2003) used cross-country data for over seventy developing countries to assess the relationship between public spending on health care and the health status of the poor. Their findings confirmed that the poor have significantly worse health status than the rich. The results however suggested that increased public spending alone will not be sufficient to significantly improve health status. Another study carried out on the health effects of per capita income and public expenditure on social services in Kenya, proved that per capita income had been very influential in determining health status. The study found that expenditures on education and health care improved health status at a great margin. It further established that per capita income was significantly linked to the levels of mortalities, and that some of the negative trends in health status could have been attributed to unfavorable growth and insufficient social spending on health (Manyala, 2000). In his findings income elasticities were all statistically significant, current income had the expected effect on life expectancy but not on infant mortality. He further found that if mothers are malnourished and are in poor state of health, their infant will inherit part of this poor health, and therefore will be at greater risk of mortality relative to infants of healthy mother. A comparative study by Wagstaff (2002a) that focused on forty two developing countries used child mortality due to malnutrition and diarrhea as the health outcomes/indicators. Wagstaff (2002b) treated government health expenditure as an exogenous variable and found that it did have a statistically significant (negative) coefficient. The study used a simple stylized theoretical model rationalizing the health-income relationship and found that public spending on health care had a larger impact on child mortality among the poor than among the non-poor population. In his study on health and schooling investments in Africa, Schultz (1999) found that health status rose with increased public spending on health services. He also argued that the health status will tend to decline with a rise in relative prices of health inputs such as salaries of medical personnel, cost of drugs and other medical supplies, relative to prices of nutrients that help fight infections and disease. He also found that levels of education were correlated with lower mortality rates. The relationship between mothers education and mortality rate was stronger than the fathers. He recommended that an additional year of schooling to the mother especially in low-income countries was associated with a five to ten percent reduction in mortality rates. On his analysis of the factors determining health status in Kenya, Gakunju (2003) found that government expenditure on public health was noteworthy in shaping individual health status. He also found that government health expenditure influences health status with over a long time. This actually implies that the government investment and spending in the health sector have had a major effect on the health of the people. He also acknowledged a number of factors as being important in resolving the health problem Kenya such as: Per capita income, individual access to doctors, HIV/AIDs prevalence, literacy level for women, Child immunization coverage and spending/investment by the government in the health sector. His study majorly used the central government e