Experience of being an overseas trained health professional working in Dissertation

Experience of being an overseas trained health professional working in mental health, Australia - Dissertation Example p.27 Chapter 7: Conclusion and Recommendation †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. p.28 References: †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. p.31 List of Figures: Figure 1: comparison of foreign-trained and foreign born doctors in OECD countries. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.page 13. Abstract Throughout much of the world, there is a shortage of nurses in both medical and psychiatric fields. These shortages will influence the prospects and experiences of medical and mental health professionals seeking to live and work abroad. A literature analysis of current projections on the subject is performed to determine the probable outcomes for nurses migrating to a new country, specifically Australia. A case study analysis using secondary data is obtained and analyzed to develop insights on the cultural differences nurses are likely to experience when attempting to establish themselves in Australia. Declaration: This work contains no material that has been accepted for the award of any o ther degree or diploma in any university or other tertiary institution and, to the best of my knowledge and belief, contains no material previously published or written by any other person, except where due reference has been made in the text. Abbreviations: ACMHN: Australian College for mental health nurses. OECD: Organization for economic cooperation and development. Chapter 1: Introduction Throughout much of the industrialized world, there have been repeated instances of concern over fluctuating shortages in qualified nurses. (Smith, 2008) The worst shortages tend to occur in low income countries, especially sub-Saharan Africa – the continent which, according to the World Health Organization has 36 out of 57 countries with chronic nursing shortages. There are fundamental issues of migration – people voting with their feet. This problem for Africa and certain third world countries represents an opportunity for industrialized countries to address their own nursing iss ues (Martin, 2007). Vigorous debate exists concerning the rights and responsibilities of healthcare personnel regarding migration, and what measures could be employed to address these shortages. (Aiken et al. 2004) There is an ebb and flow to the quantity of qualified nursing personnel based on patterns of career choice, and educational opportunity. One strategy by which hospitals and medical organizations can address this shortfall is through a fundamental mechanism of economic exchange: taking an attractive commodity in question from where it is abundant and relocating it to where it is needed. This is often the source of shortfalls in underdeveloped countries, but a shortage of qualified medical professionals is not limited to one society or continent. Certainly, it is to the advantage of British Commonwealth countries to attract talented nurses from abroad, and measures must be taken to encourage and support them to meet the country's own medical needs. There is no doubt that th e expertise of nursing personnel is an attractive commodity and extraordinary measures are worthwhile if the nursing shortages can be alleviated where they are most serious. There are numerous pitfalls and challenges for foreign nurses, language being among the foremost, (Konno, 2008) but not always for the most obvious reasons. While knowledge of the English language itself is relatively widespread around the globe, there can still be cultural idiosyncrasies that may lead to errors and confusion as a result of the precise language required for the medical profession. For example,

Political Science, Human Trafficking and the CAST Organization Essay

Political Science, Human Trafficking and the CAST Organization - Essay Example Below are stories of victims who were exploited through labour with little or no pay at all. A company in Jordan to work in the United States of America promised Kumar Ramjali from Nepal. However, instead of being taken to United States, he was forcefully taken to Iraq to work for the US army. His passport was seized and was not given permission to leave for over four years2. A 30- year old Bosnian lady named Jana was also a victim of job scam. She went to Slovenia for further studies. On reaching there, she got a female friend who organised for her an accounting job. On the interview day, a woman interviewed her then abruptly two men came into the interview room, which ended the interview. The men forcibly removed her out, she was beaten and raped several times by the men, after which she was taken to a secluded place raped repeatedly and drugged with drugs. Jana escaped from the traffickers after four months and now she is advocating against trafficking3. Most of the victims and experts agree that a lot must be done in providing protection and assistance to those affected by human trafficking. Perpetrators of this violation of human rights should be punished and prosecuted. Coalition to Abolish Slavery and Trafficking (CAST) is an organisation in United States of America that provides services to trafficking victims. They have a client- centred approach in its interconnected activities to empower victims of trafficking in realizing their potential. They provide comprehensive services to trafficking victims, through provision of basic human needs, medical health care and legal services. CAST opened its first shelter in United States in 20044. It conducts policies that are aimed at advancing and protecting human rights of trafficking victims. It achieves these through experience and research of its clients both inside and outside the justice system5. It also provides training programmes to NGOs and IGOs that may

Journal Essay Example | Topics and Well Written Essays - 1000 words - 1

Journal - Essay Example We also learnt about the audience of the story. The people who read stories and listen to stories are the audience. We learnt that good compositions are about things that the audience knows. Week Three During this week, I learnt about analysis. Analysis is looking for facts and issues that are presented in the composition. Analyses are important because they help us to understand the issues that the composition is writing about. This lesson was important because it helped me to get good skills of analyzing compositions and other writing in English. Week Four This week was important because I was tested on the skills of how to analyze something that I had read. It was an important week in the classroom. In this week I was able to write a paper from the article called â€Å"The Responsibility of Intellectuals, Redux.† I was interested in this article because I read it and understood what it was about. It was the first assignment of analyzing an article that was written in Englis h language. I was an important test which helped me to sharpen my analytical skills. During this week, I gained skills of analysis and summary. I was able to read articles written in English and then summarize them in my own words. It was an important task that helped my process of learning, reading, and writing. Week Five This week was important because I was taught about ethos, logos, and pathos. ... Ethos are the symbols which writers use when they want to explain something in their writing. Pathos are the things that writers use to convince the readers. Pathos use emotions to make meaning out of the various issues that writers use in their writings and articles. Many times, the use of these ethos and logos are brought about through articles and stories. I also learnt about logos. Logos are used when writers want to use facts and logic in in their articles and other writings. These week helped me to understand the way different writers use different methods for making meaning from various sources. I can also use ethos, logos and pathos to write stories and make meaning from them. Week Six During this week, I was able to learn about poetry. We learnt about poems and the way of reading and writing poems. We were taught the way the language used in poetry is different from the language that is used in other forms of writing. Usually, the writing process is important because it help s people to understand the use of language very well. I was able to write some poems and to read others. I was also able to analyze some poems that are generally brought within the element of writing. Week Seven During this week I was able to try and write about the things that I was taught in class. It was a week that helped me to practice my new skills. Week Eight This week was important because it helped me to understand poetry and the styles used in writing of poems. I was able to read about tone by looking at the words that were used in writing of the poem. I have developed the skills of writing about the things used in poems in ways that are creative and which respond to the challenges of everyday life. Week Nine During this week I was now able to practice

Is the USA PATRIOT Act an effective deterrent to terrorism Why, why Essay

Is the USA PATRIOT Act an effective deterrent to terrorism Why, why not What are your suggestions for combating terrorism - Essay Example The Patriot Act freed up international intelligence agencies so that they could share information in order to fight terrorism worldwide. Senator Kay Bailey Hutchison stated, â€Å"The Patriot Act has enabled our law enforcement much more capability to capture terrorism than we ever had before† (Ynn, 2004). The Patriot Act has helped the government track a lot of the money that was being laundered to fund terrorist organizations. A lot more has to be done in order to improve our chances in the fight against terrorism. A strategy that could be used to attack terrorism is to improve the diplomacy efforts worldwide. The UN could formulate a special terrorism task force to oversee the efforts of the different intelligence agencies across the world. The agency’s budget would be funded by all the UN allies. The develop nations would have to contribute more money than the developing nations. The Patriot Act help unite the intelligence community, but the efforts of these agencie s are still fragmented. There is a lack of a united front against terrorism. The current war on the Middle East is hurting the image of the war of terrorism because people feel that the war is driven by the desire of the US and its allies to control the petroleum in the Middle East. A new effort lead by the UN would provide legitimacy to the war on terrorism. References Ynn.com (2004). Hutchison says Patriot Act effective in fighting terrorism. YNN.

‘Mirror’ & double-layered poem Essay Example for Free

‘Mirror’ double-layered poem Essay ‘Mirror’ is a double-layered poem: The mirror, personified and equipped with senses, sees and depicts its world in the most honest terms; then we see our own world from the mirror’s perspective—how raw and tormenting it is. Why the author chooses to personify a mirror as the poem’s narrator is firstly because it is an object most closely associated with a woman who seeks to see â€Å"what she really is† (11). When she is young, the mirror cheerfully reflects and praises her youthful beauty, letting her contemplate on her own appearance. When she is old, it cruelly reminds her of time’s meddling in her fading beauty and how life has passed and left her behind. Secondly, the mirror reflects the world just as it is—it cannot lie to us—and faithfully shows us all signs of aging, sorrow, pain and sickness that appear in our face. The theme of the poem is the effects of time reflected in the mirror, how it â€Å"has drowned a young girl† and makes a woman become â€Å"an old woman†. Adverbs depicting the motion of time are employed throughout the poem: â€Å"most of the time† (6), â€Å"so long† (7), â€Å"over and over† (9), â€Å"Now† (10), â€Å"Each morning† (16), â€Å"day after day† (18). The irony is deliberated in the difference between the mirror’s reflection and cognition of changes in the outside world. The woman who looks at the mirror is sad because her beauty and youthfulness are fading while her tears and agitation are considered â€Å"rewards† by the mirror. In the first stanza, the mirror simply tries to define its existence and introduce the reader to its world using its own language register. In the opening line, the mirror describes its appearance and unique quality, â€Å"I am silver and exact. I have no preconception. †(1). The word ‘swallow’ demonstrates Plath’s sensitivities and playfulness in her personification and imagery: everything is instantly reflected inside the mirror as if the mirror has devoured them. Next, mirror immediately explains its ‘non-discriminatory’ behaviours as being truthful rather than cruel. In the last four lines of stanza 1, the mirror honestly describes its bounded world. Ironically, even though the mirror reflects everything truthfully and exactly with no preconceptions or prejudice, it seems to live in self-created illusions, that the opposite wall is â€Å"a part of my heart†. Line 8 presents the mirror with human characteristics, not â€Å"the eye of a little god, four-cornered† as it describes itself. Nevertheless, its world constantly collides with the world outside it—our world: â€Å"it flickers. //Faces and darkness separate us over and over. † In the first stanza, the use of caesura in most of the sentences interrupts the flow of the poem but gives the mirror its own tone: emphatic and meditative. The enjambment between line 2 and 3 as well as between line 7 and 8 allow the mirror to reflect on itself naturally and coherently. In stanza 2, the mirror ironically creates another illusion, â€Å"Now I am a lake† (10), which is in contrast with its claim to be â€Å"only truthful†. It proudly demonstrates its usefulness in helping a woman to see â€Å"what she really is†. The images of the â€Å"candles† and â€Å"moon† (12) may symbolize fragility, inconstancy and instability which contrast with how faithfully it serves the woman (13). The connection between the mirror and the woman strengthens by day: it is important to her and she brightens its existence. Nevertheless, its unintended cruelty is shown in its being â€Å"only truthful† (4). The simile ‘like a terrible fish’ is consistent with the mirror’s illusion that it is a lake but it shows Plath’s grotesque and tormenting view of aging—as a destructive and dehumanizing process. The poem is structured as narrative prose poetry, with the use of caesura to create an emphatic tone, to present the mirror as a misunderstood, proud and honest object. The mirror exactly and dutifully reflects what appears before it and considers the changes shown in it others’ doing and completely out of its power: â€Å"she drowned a young girl, and in me an old woman//Rises toward her day after day† (17-18).

Effectiveness Of Motivational Strategy In Habib Bank

Effectiveness Of Motivational Strategy In Habib Bank In this modernized world where globalization is fast crating an effect, the workplace realities of the ancient organizations no longer exists (Roberts, 2003). It has become past and needs to be revised very carefully before any aspect of it can be implemented nowadays. It has become increasingly important for the organizations to introduce new methods and meet the new motivational needs of the employees. The reality of workplace, the changing work environment has increased the end for the managers to reconsider the methodologies of developing durable and strong relationship between the employees and organization that ultimately leads to the achievement of the organizations goals and objectives. A thorough and complete understanding of the employees motivational need has became important for the management in order to accomplish what employees expect from the organization in order to return what organization expect from them ( Beer et al, 1984).. Therefore it becomes clear from the re searches that a motivated work-force is an instrument of success for full filling the needs of a rapidly changing work environment for both, the employees and the organization. It also becomes clear that a well- motivated workforce will eventually lead to the organization achieving its goals and objectives in a better an efficient manner. To serve this purpose ob building a strong bond between the management and workforce, the role of the top management is very crucial in this respect. According to Carnige (1985), human capital is capable of playing a pivotal role compared to financial capital, in the effectiveness of the organization. In modern times people are believed to me a source of competitive advantage and carry more importance in leading a company towards success, rather than finance. What is actually motivation and how and why does it matter? In business terms, motivation is the desire of a firm to see a job done well and quickly. The highly motivated workforce becomes an instrument for the business to achieve its goals and objectives as cost effectively as may be possible. Motivated worker also try to reach their own personal objectives. The employers should be well aware of what these are .This is because the greatest motivation will develop if workers feel that working towards the business objectives is ultimately helping them achieve their own goals. A milestone in a success of an organization is fulfilling the continually changing needs of employees and the organization. A heavy responsibility rests on the shoulder of the management to develop durable and strong relationships between them. Companies expect workers to follow the rules according to the terms and conditions set for them. Employees in return expect fir pay, good working conditions, secure career, fair treatment, involvement in decisions and power. These expectations of both groups vary from company to company. For any business to deal with these expectations successfully a complete understanding of the employee motivation becomes necessary. (Beer et al, 1984 from pdf file motivation pak bank). It is usually that it is the organization and not managers that fail to hold managers responsible for creating motivation among the people. They fail to understand the role of motivation and its connection to job performance. One of the biggest challenges for HR is to persuade line managers to develop and manage people. These line managers should be able to build string and personal relationship with the employees through effective communication. There is a need for the line mangers to understand the nature of the employee and his subordinates and should be able to deal with the problems of workers effectively. A thorough understanding of the needs of the subordinates will eventually let the managers know what the employee aims for and what are their goals and objectives. They can then decide how to develop and implement strategies that will achieve the objectives of the company while letting the employees achieve their personal goals. Staff that is unmotivated will be reluctant to do their jobs quickly and efficiently and will only provide the minimal of what is required of them from the organization. It is important to know how well motivated staff will alter the levels of productivity and performance within a company, thus affecting the competitiveness of the business. A well motivated staff is not only able to increase productivity and performance but is also prepared to accept responsibility, willingly and happily. There is low labor turnover which reduces the business cost of hiring and training new labor. With a highly motivate staff, a business also benefits from low absenteeism rate and employees participate on making suggestions for improvements. (Peter) Theories of motivation and their significance in today world: There are many theories of well known theorists that deal with the factors that affect motivation. F. W Taylor- theory of scientific management. F.W Taylor proposed a theory of scientific management that emphasized that money is the motivating factor that affects the employees to the most. Scientific management defines a method of establishing an idea after studying, analyzing and recording performance at work, then altering working conditions and recording performance. This is the approach that Taylor used to establish his idea. This method of scientific management is still used in the companies today. Taylors theory was based upon the notion of economic man and he believed that when wages are based on output, it increases workers productivity. He maintained his belief that a fair days pay for fair days work is what motivated staff to do better. But critics also say that money moves the workers to work, not motivate them. The other renowned theory of theorist is the Elton mayo Hawthorne affect. He carried out some experiments with a group of line workers. Changes in rest periods, canteen food, assembly bench lay out were made at a particular interval. Before every major change, the upcoming change was discussed with the workers. At the end of the experiment when working conditions were returned to the original, it was noticed that the output rose far above the level before the experiment. He drew some conclusions from his work that is as follows: Alterations in financial rewards or changes in working conditions have little or no effect on a workers productivity When management consult with workers before any major changes are made that affects them, motivation is improved When some control over their own working lives is given to workers, there is improved motivation Groups can establish their own targets and goals, and these can be greatly influenced by the informal leaders of the group. Taylors approach is important but not widely held today. Many workers, now a days seek for a respectable job rather than a one which is not valued but is being paid. Workers who have money as their basic need still moves towards a job offering a handsome wage/salary but they are unable to be motivated and still continue the job for money. This reduces job performance and productivity is affected. Maslow- hierarchy of needs One of another major theorist that takes a good position among the motivation theorist is Maslow. He extensively wrote on the subject concepts of the hierarchy of needs. He became a leader of the humanistic school of psychology and looked at the needs of human beings arranged like a hierarchy. The Maslow theory consists of two parts. The first one concerns the classification of the needs and the second part relates theses needs with each other. Maslow arranged the needs in a pyramid. Maslow proposed a hierarchy of needs that workers have. He suggested that these have to be fulfilled step by step. He identified and classified the basic needs that a human being has. The pyramid starts from physical needs that occupy the lowest level of hierarchy. The top level becomes the self actualization with three levels of needs in between. Maslow suggested that once a worker achieves the lower level of need, he strives for the next level. Management should be aware on what level their employees a re, and moving them trio next level, thus keeping him motivated for his job. The sequence of the Maslows pyramid is as follows: Physiological needs: these are the strongest needs. This is because if a person is deprived, the physiological needs would come first to fulfill his satisfaction. The physiological needs consist of needs like oxygen, clothing, food and shelter. These needs are the priority before any other class of need. Safety needs: this class of needs includes job security accompanied with a secured working environment. A sense of job security is essential for an employee to stay motivated towards his work with the addition of a hygiene environment with safe equipments if required. Love and belonging: the need of belonging and affection is necessary to overcome the feeling of loneliness. To overcome this, team work should be encouraged within an organization along with other social activities that instill in an employee a feeling of belonging and being a part of the organization. Esteem needs: this class of need is defined by the receipt of recognition of what the employee has achieved at work. There are chances that a worker may feel worthless and in valuable if he is not appreciated. This level of need can be achieved by the announcement of achievements publicly at events. Self actualization: this is the top level of the hierarchy. Very few workers have the potential to reach this level. This class defines need as to be given added responsibility with new challenges and promotions in his career. This theory has its own complications. Maslow did not suggest any criteria to measure which level of need has actually been satisfied. Each kevel is dependent upon the level below. The whole system might collapse if a level goes missing in between. It is also hard to say that a particular level is achieved of an employee and now the next level must be targeted. Adam- equity theory Another theory of motivation, widely recognized is the Adams equity theory of motivation. Adam proposed a very simple theory that suggested that employees balance their inputs against their out. The input is not only in the form of time that is put into work measured against the financial reward that is received as output but input also includes all the factors affecting working conditions and the worker at work. Similarly, output also includes the response, the recognition and the praise or the negative attitude experienced as a result of the job being done. The attitudes that lead to positive outcomes is repeated and attitude that lead to negative outcomes is avoided. It becomes difficult for the managers to know exactly what the employee perceives of the output against their input. Moreover inputs of the work and out puts of the work cannot be measured literally in order to calculate and balance both against each other. Herzberg- two factor theory But here our major focus would be on the Herzberg motivational theory that we desire to implement on our project. Herzberg (1923-2000) proposed a theory recognized by the world as the two factor theory. Herzberg, despite basing his research on just 200 professional workers, Herzbergs two factor theory and his conclusions has left the greatest impact on motivational practices. A survey was conducted through interviews and questionnaires that aim to know the following things: Identification of these factors that lead the workers to think very positively about their work and those factors that led them to think very negatively about their job. His conclusions reveled the following: Advancement, work itself, responsibility, achievement and the recognition for achievement were the factors relating to job satisfaction. Administration and company policy, salary, supervision, relationship with others and working conditions were these factors that lead to job dissatisfaction. These factors were termed as hygiene factors by Herzberg. Conclusions of Herzbergs work. Herzbergs two factor theory carried the hygiene factors and the motivators. Hygiene factors included working conditions, pay rates etc. these hygiene factors can eb improved in order to remove dissatisfaction from the jab but they will not help creating a motivated albor for ce. Herzberg argued that it was readily possible to move someone to do a job by paying him but it will not actually motivate him for doing the job. Similarly, he proposed that motivators, that are principles of job enrichment (encouragement, added responsibility, recognition), need to be in place to motivate the labor force to perform a task. These principles of job enrichment include Offering complete units of work: a typical mass production method only allows workers to assemble small units of a finished product. This is not motivating as the repetitive and small, invaluable task is not interesting. It also prevents workers to receive the appreciation and the importance what they are contributing to the production process. When workers are offered the complete tasks, it gives them the motivation to do a job effectively. It bears in them feeling of achievement of producing the goods themselves. Herzberg puts this idea as if u want your employees to perform a good job, offer them a good job. Feed back on performance: this communication enables workers to feel recognized and they are motivated to achieve more. A range of tasks: a range of tasks, when offered to workers is challenging and makes it interesting as their first experience if given them the first time. This provides the employees the opportunity to explore their abilities and provide incentive for the business to achieve the full potential of the workers. Analysis and evaluation of Herzberg work: As we will be implementing Herzbergs approach to her research, an analysis and evaluation of its work becomes necessary. Team working and delegation of complete tasks with much less close supervision is becoming increasingly popular in todays industrial world. Organization ensure effective communication is present between management and the workforce and this two way effective communication itself becomes a motivating factor. There is little doubt that that the increasing trend towards Herzberg approach is fast becoming popular, but many researchers who have used Herzbergs methods still argue and theory experimenting failed to arrive at such a clear cut conclusion. This wouldnt be wrong to hold Herzberg responsible for this evolution and this change would have been slower without the theories put forward by the Herzberg. Herzberg identified five main factors that resulted in job satisfaction. These factors can easily be identified in an organization and can be used for evaluation. The five main factors include achievement, recognition for achievement, responsibility, nature of work itself and advancement. These are the factors which can easily be identified if they exist in an organization. Similarly Herzberg gave five main factors that resulted in job dissatisfaction. These are termed as companys administration and policy, salary, supervision working conditions and relationships. This factor can easily be searched for in an organization to determine the effects of motivation. Service sector throughout the world is greatly dependent upon the human resource. Be it Habib bank ltd in Pakistan or RBS in Scotland, the banking sector and its success mainly depends upon the level of skilled, capable and most important motivated workforce. A motivated workforce does not only increase the performance at work but increased performance and satisfactory interaction among the clients and colleagues leads to high productivity. This in turn creates satisfied customers which forms the basis of success for any organization. Significance of motivation for commercial banks: Commercial banks are structures that are maintained and developed my human resources that ensure the delivery of a good service. The process that ensures the delivery of a good eservice is affected by the individual motivation of labor force whether skilled, unskilled, professional or unprofessional. The increased growth of service industry, commercial banks are struggling foe workers possessing the ability of providing quality service. And their labor is the best source if providing best services to their customers. Excellent services being offered and provided by the employees is able to create a positive perception among the eyes of the banking consumers. ( pdf file motivation pak bank petcharak 2004) Commercial banks play a vital role in the world wide economy. Research concludes that today it is becoming challenging for management in Pakistan to motivate their employees, especially those employed at commercial banks, to provide a quality service with increasing competitive market in the specified sector, i.e. commercial banks. The tough competition is making difficult to provide best of services to its clientele, thus satisfying their needs effectively. Theoretical frame work. Our research aims to find out the effectiveness of motivation strategies at HBL. To measure the effectiveness, the first step is to find out the variables that are creating motivation within the employees at HBL. Once the variables are identified a sample of 75 respondents will be selected from various departments of various posts, qualification and experience. These sample size is selected to determine the research question and research objective. The questionnaire will carry pout the research and will obtain the result that will identify the factors that create little or no, and high motivation among the employees. These factors when identifies will be classified under the motivators and the hygiene factors. These motivators and hygiene factors must be forming a part of the motivational strategy of the management at HBL that will effective or ineffective in creating motivation. The highly effective and the little effective will then be measured against the performance level of the workers when implemented. According to the results, those strategies will be labeled as successful or unsuccessful. For the unsuccessful strategies recommendations will be made . Research conducted through a questionnaire Identification of the factors affecting the level of motivation Identification of factors creating job satisfaction and job dissatisfaction Classifying them into hygiene factors and motivators Result on motivation result on motivation when When hygiene factors motivators implemented. implemented. Measure the effect Measure the effect on work On work performance performance. Employee motivation and work performance: Improving the work performance has always been and will continue to be the major concern of all businesses. It is the performance of work that creates satisfied managers and/or dissatisfied managers. The work performance has always been an important issue for the businesses as their success and failure depends upon the performance displays by their workforce. A manager when pays the employee, expects to return the worth of what is paid to him. In case of failure to do so, many workplace issues are created that managers then need to deal with. It is not always possible for managers to repay the accurately the input employee has put into work. This is because there exist no method to measure the input against the output wh9ich the employee receives or perceives. Failure to come up to the expectation results in demotivation. Is also seen, as described by the expectancy theory that workers expect according to what they see around. Now it becomes difficult for managers to know how they pe rceive their work output and it is compared to whose job. The performance at work is not only dependent upon the skills and abilities the worker possesses but there are many factors that exist which creates and leave an impact upon the performance of the employee. A well-motivated employee results in well performed job and an unsatisfied employee who is unmotivated towards his job naturally results in a poor job performance. But the question what motivates man to perform better has many answers. There are many motivational factors as discussed above that leaves an impact upon the motivation of the employees. When discussing and implementing the Herzberg theory, we see the hygiene factors create job satisfaction and not motivation but the motivators when placed creates motivation that results in a high performance of the job. For instance providing hygiene conditions at work place will not create motivation for the worker to perform the job but the satisfactory working conditions will make the employee continue the job a and not create a desire to do the job. Therefore a hygiene working environment will have no effect upon the performance of the job. But, if on the other hand, a worker is praised for his achievements and efforts, he will be happy and will be eager to achieve more, thus increasing his job performance. Increasing job performance includes increased productivity, putting in extra effort in the job and probably low absenteeism with happy workers who look at the golas and objectives of the company through which they can not only achieve their personal objective but companies goals become their goals and business objectives as their objectives. When performance at work is increased in any of the forms mentioned above, the company benefits from it. For a manufacturing business increased quality and quantity of it products will attract consumers which will benefit the company. In the service sector, a motivated staff will result in a cooperative and positive attitude and interactions with the customers and colleagues which will create thousands of satisfied customers. Customer service being very important in the service sector is completely dependent upon the attitude and behavior of the employees which is directly proportional to their motivation level. This motivation level is depended upon many factors like motivators described by Herzberg and others as described by many of the other renowned theorists. Linkage between objectives and questions with the theories and concept Research question/objectives Theories and concepts

Effect Of Pharmacist and Nurse on Improving Blood Pressure

Effect Of Pharmacist and Nurse on Improving Blood Pressure Afzal Hussain Problem and Purpose In this paper, I will be critically analyzing the article â€Å"A Randomized Trial of the Effect  Of Community Pharmacist and Nurse Care on Improving Blood Pressure Management  in Patients With Diabetes Mellitus- Study of Cardiovascular Risk Intervention by Pharmacists–Hypertension (SCRIP-HTN) by Donna L. Maclean ; Finlay A. McAlister; Jeffery A. Johnson, Kathryn M. King; Mark J. Makowsky ; Charlotte A. Jones and Ross T. Tsuyuki. This article outlines a quantitative experimental design involving two sample groups (experimental and Control). According to Sullivan-Bolyai, Bova, Singh (2013), experimental designs are particularly suitable for testing cause and effect relationships because they help eliminate potential alternative explanation (threats to validity) for the findings (p. 217). The authors articulate their recognition of the fact that interventions are key markers to identify and observe blood pressure (BP) control in diabetic patients. The authors also recognize the fact that there is a need for a new model of care to improve BP control, particularly with significant challenges in accessing primary care physicians attributing to labor shortages in the health scare system. In addition, the authors used manipulation by introducing the intervention, then by comparing the standard and usual care among the control group and experimental groups. This resulted in the manipulation variable being the difference of care among patients with blood pressure and diabetes. One intervention delivered to the group based on the manipulated variable of difference of care is evident through the interventions made by the pharmacist-nurse teams at various pharmacy sites, which included cardiovascular risk reduction counselling, education brochure on hypertension, lifestyle strategies, effect of diabetes on high BP, and referral to the patient’s primary care physician for further BP and cardiovascular assessment (McLean, McAlister , Johnson, King, Makowsky, Jones, and Tsuyuki, 2008, p. 2356). The control group received the standard and usual treatment compared to the experimental intervention group. Furthermore, blood pressure wallet card, educational pamphlet on diabetes and physician care were received by the control group. (McLean et al., 2008, p. 2355).The authors used randomization to categorize the research participants into two groups- experimental intervention and control which is set to receive the standard treatment of care. Mclean et al (2008) states, â€Å" Randomization was at the level of the patient ( stratified by pharmacy and using a variable block design), it was performed centrally to preserve allocation concealment using a computer generated sequence over a secure internet service at the Epidemiology Coordinating and Research (EPICORE) centre,(p. 2356). The authors propose a practical necessity for this research problem to be explored and be further researched. The purpose of the research was to explore whether pharmacist or nurses can professionally contribute to improving the BP control of patients with diabetes and implement preventative care measures due to ongoing lack of physicians, pharmacist and nurses, it is clear that the research is also significant. It is based on changing the attitude of health care professionals to meet current outcomes, outcomes which seem to be on par with those of the current health care system in Canada. Sample Size, Design and Collection Methods The sample for this study was appropriately assembled for a quantitative study. The study sample is easily identified when reading the article, included a description of the demographic characteristics and the size of the sample. Also included were any sampling bias, drop outs or loss of patients to follow up. In doing so, an adjustment of 85 to 110 per group were added. (McLean et al., 2008, p. 2357). Its purpose was to test the efficacy of community-based interventions through a pharmacist and nurse team approach on reduction of cardiovascular events in diabetes mellitus patients. This was achieved by measuring the BP which has been linked to comorbidities such as cardiovascular disease, and to BP measurement changes used as an indicator of health. This sampling was appropriate to the study as the sample were to represent diabetic patients. Mclean et al (2013) states, â€Å" All adult diabetic patients with BP higher than 130/80 mm Hg on 2 screening visits separated by 2 weeks wer e identified in participating pharmacies. Diabetes was identified by community pharmacists through the use of diabetes indicator medications in each pharmacy’s prescription database. (p. 2356). In this study, Mclean et al (2008) used a randomized controlled trial (RCT) in 14 community Pharmacies in Edmonton, Alberta as a method of data collection (McLean et al., 2008, p. 2355). Participants were identified and manipulated by pharmacists and nurses who were trained using a combination of an online learning program and a case-based learning session – both based on the Canadian Hypertension Education Program (CHEP) guidelines†. Also the use of a commercial BP monitor set at an average of 5 measurements of BP taken 1 minute was used to measure participants BP (McLean et al., 2008, p. 2356). Data analysis procedures were appropriate to the research study because â€Å"all analyses were conducted using a commercially available software program† (McLean et al., 2008, p. 2357). Threats to Internal and External Validity specifically the authors use of instrumentation and selection could possibly have introduced problems of internal validity in the research. This threat was discussed by ensuring that both groups (control and experimental) BP were measured with the same BP device, which has 6 readings, discard the first test and further takes an additional 5 measures . Mclean et al (2008) found that, â€Å"It is possible that the more frequent contact with the pharmacist –nurse team reduced the anxiety of patients and any â€Å"white coat effect† on their BP measurement†. (p.2359). Furthermore, the screening modules used by the researchers to collect the data were conducted by pharmacists and nurses well versed in their profession. Selection bias was another threat predisposing the sampling design to internal validity. The authors in their findings found that patients eligible for selection presented with lower BP, this can be caused by the researchers utilizing a convenience sample instead of a random sample. Also, selection bias may have been an essential part of the end results due to the fact that patients who are eager to monitor and control their BP are more likely to agree to participate in the trial, also that more than 80% of trial participants were aware that hypertension is a risk factor for cardiovascular disease (McLean et al., 2008, p. 2358). The external validity of the study was weakened by the sampling design. The authors failed to take into consideration non English speaking people, whose cultural differences and beliefs could influence the study, and who may lack health literacy to read and identify medical abbreviations and symbols. Maclean et al (2008) states, â€Å"pharmacists and nurses who participated may be different from those who did not participate, an investigator vol unteer bias that may limit generalizability of the program† (McLean et al., 2008, p. 2359). Limitations of the Design One major limitation of the design identified by the authors is regarding the interventions implemented in regards to the in person contact time between patients and the pharmacist-nurse team, which can be further be evaluated by future studies on whether less intensive interventions are The researchers identified a potential limitation regarding that the intervention involved substantial in-person contact time between patients and study personnel, and that future studies will need to determine whether less intensive interventions are productive in controlling BP in diabetic patients (McLean et al., 2008, p. 2359 Generalization of Findings The research findings can be generally be applied to larger populations, the authors acknowledge the fact that their research intervention was extremely efficacious, resulting in a 24.1 mm Hg greater reduction in systolic BP (McLean et al., 2008, p. 2358) They recommend a new model of care to improve BP control. In addition, by utilizing an experimental research design in which a cause and effect relationship can be analyzed and measured, the researchers were able to provide coherent evidence and correlation that community pharmacists and nurses through a collaborative effort with primary care physicians could have a huge impact on hypertension management in patients with diabetes mellitus and BP control within the community (McLean et al., 2008, p. 2360) References LoBiondo-Wood, G., Singh, M.D., (2013). Introduction to quantitative research. In C. Cameron, M. D. Singh (Eds.), Nursing research in Canada: Methods and critical appraisal for evidence-based practice (3rd ed.) (pp. 198-215). Toronto: Elsevier Canada McLean, D. L., McAlister, F. A., Johnson, J.A., King, K.M., Makowsky, M.J., Jones, C.A., Tsuyuki, R.T. (2008). A randomized trial of the effect of community pharmacist and nurse care on improving blood pressure management in patients with diabetes mellitus. Archives of Internal Medicine, 168(21), 2355-2361 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19029501 Sullivan-Bolyai, S., Bova, C., Singh, M.D. (2013). Experimental and quasiexperimental designs. In C. Cameron, M. D. Singh (Eds.), Nursing research in Canada: Methods and critical appraisal for evidence-based practice (3rd ed.) (pp. 216-233). Toronto: Elsevier Canada