Medical Tourism in South India

MEDICAL TOURISM IN SOUTH INDIA – A SWOT PERSPECTIVE OF INDIAN MEDICINE SYSTEM J. Swaminathan AVCCE Health is wealth! (Ayurveda To Yoga) ABSTRACT The Indian Systems of Medicine include Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy is ancient and has the roots in traditional system of medical treatments in tune with the Mother Nature. Medical Tourism is the emerging industry next to the IT boom and India is the second best destination as of now. Especially the Indian Systems of Medicine, in South India can become the leader in medical Tourism Industry. This paper tries to appraise the facts and future possibilities based on a SWOT perspective. Introduction Without sound health we cannot achieve anything in our life, nor enjoy what ever we have. In service sector the concept of Medical Tourism is catching up at lightning speed across the world. The act of traveling to other countries for medical, surgical and other forms of healthcare along with recreation is called Medical Tourism. People from advanced countries, including the United States and Europe, see a benefit in traveling to developing third world countries, like India, Thailand, Philippines, South Africa, and etc. hile combining medical treatments with inexpensive vacation. According to a study conducted by the Confederation of Indian Industry and Mc Kinsey consultants (2004), 1,50,000 foreigners visited India for treatment, with the number rising by 15 percent a year. The number has increased to 2, 72,000 in 2007 and has crossed the 3 lakhs mark in 2008. ASSOCHAM has predi cted that this will grow by 22 to 25% in the coming years. Scope The main demand for medical tourism is generated from millions of Indians who live abroad, though a growing number of foreigners are also keen on speedy and in expensive treatment. They are influenced by two important facts: India now has many world-class private hospitals and the alternative medicines are available in abundance. Foreigners are visiting India for serious medical help as well as rejuvenation therapies and other specific purposes. Medical Tourism has been a popular concept in countries like Malaysia, Thailand, Singapore, Costa Rica, Hungary, India, Israel, Jordan, and Lithuania. South Africa specializes in medical Safaris-visit the country for a safari, with a stock over for plastic surgery. Due to liberalization of our economy and internalization of health care profession, India has entered the industry in only recent times. India’s corporate hospitals are fully equipped with up market and efficiency. The Indian Systems of Medicine also has become a valid reason for them especially in preventive cure and alternative medicines. Medical Tourism is poised to be the next Indian success story after Information Technology. According to recent study of ASSOCHAM, in 2008 the size of industry was estimated Rs 1500 crore and it would grow into Rs. 9500 crores by 2015 with an annual growth rate of 30 %. The Indian government has predicted that India’s $ 17 billion –a-year health care industry would grow by 13% in next four years. Indian Systems of Medicine (ISM) The Indian Systems of Medicine include Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy together characterized under the department of AYUSH in the union health and family welfare ministry. During the ninth plan, with an expenditure of more than Rs. 1,000 crore, a quantum jump in outlays on schemes for development and promotion of AYUSH system of medicine has been achieved during Tenth and Eleventh Plan. Indians are known for their hospitality and warmth. India has an incomparably rich heritage in ancient systems of medicine that make up a veritable treasure house of knowledge for both preventive and curative health care. Around 1000 BC when Indian Systems of Medicine (ISM) were fully documented in Charaka Samhita and Sushruta Samhita. Thus, ISM is considered to be one of the oldest organized systems of medicine for positive health and cure of human sickness. The most important and massive ancient compilation of the school of medicine is known as Charaka Samhita. It contains several chapters dealing at length with internal medicine. About six hundred drugs of plant, animal and mineral origin are described in it. But traditional medicine was ignored when western medical knowledge and procedures were introduced into the country. Once again the same has regained its limelight. Ayurveda : Ayurveda means the â€Å"science of life† in Sanskrit. It is one of oldest and the best documented among the ancient systems of medicine. From the Charaka Samhita (600 B. C) and the Susruta samhita. Yoga & Naturopathy : Yoga is not really a system of medicine. Its objectives are self- realization and spiritual union with all –pervasive divine cosmic power. But certain intermediary practices and yogic attitudes have proved beneficial for reducing stress, preventing many lifestyle-related diseases, and promoting general health and well being. Naturopathy is based on the fundamental principles of airbed. The basic tenet of Naturopathy is to live according to the laws of nature: disease occurs due to the accumulation of toxins in the body, and to cure the ailment, the body is purified with the use of natural methods, dietary regulations and exercise. Unani : The Unani system originated in the fourth and fifth century BC in Greece under the patronage of Hippocrates (460BC-377)and Galen. The system is based on the humoural theory that good health depends on the balance of the four humours: blood, phlegm, yellow bile and black bile. Siddha : Siddha means a â€Å"master† thus the name denoted the mastery of such practices. The most famous of the siddha was Nagarjuna, whose rasatantra forms the basis of this system. The distinctive features of siddha are its reliance on minerals and metallic compounds, and its emphasis on rejuvenation therapies. Homeopathy : The term homeopathy comes from the Greek word ‘ homios’ means like and ‘pathos’ means suffering. Homeopathy works by looking at the symptoms, will take into account the individual’s mental, physical, emotional,and spiritual health before deciding the treatment. Homeopathy is based on the principles that ‘like cures like’. Current State of Affairs The American Medical Association (AMA) has conducted a cost comparison study of health care in different countries. The surgical procedures and the dental treatment procedures have a cost advantage – approximately 1/6th of the cost in USA. Also the waiting period for even a simple surgery is minimum 6 months and specialty treatments are 9-12 months in USA / UK which is almost instant in India. AMA has proved though there are many countries less expensive than USA, India is the least expensive compared to European and Asian countries. Table 1: Summary of Medical care, Medical Manpower facilities available under Indian Systems of Medicine Facilities |Ayurveda |Unani |Siddha |Yoga |Naturopathy |Homeopathy | | | | | | | | | |Total | |Hospitals |2398 |268 |231 |8 |18 |230 |3203 | |Beds |42963 |4489 |2401 |135 |722 |10851 |61561 | |Dispensaries |13914 |1010 |464 |71 |56 |5836 |21351 | |Registered |453661 |46558 |6381 |0 |888 |217850 |725338 | |Practitioners | | | | | | | | Source: Department of Ayush, —- Health & Family welfare, Government of India. The Indian Systems of Medicine is given more importance in southern India. The state like Kerala, Karnataka, Tamil Nadu and other states in India plays a key role in medical tourism. Kerala-The Pioneer State Kerala has pioneered health tourisim in India. Kerala has strongly focused on Ayurveda and its wide array of treatments and medications, good facilities are also available in other traditional forms of medicine as well as in modern medical treatment. Kerala is Capitalizing on its Rich Cultural Heritage and alternate Medical Therapies. Karnataka’s Foray The government of Karnataka has ambitious plans to make Karnataka the top health tourism destination not only in India but internationally. In fact, the government is setting up a Bangalore International Health City Corporation for provision of a wide variety health care products and treatments. Tamil Nadu Tamil Nadu has multi speciality hospitals that offer the best medical treatment at surprisingly low rates. In the state various other forms of medicine, viz, Siddha, Ayurveda, Unani, Nature Therapy and Yoga are also practiced, which the foreigners are inclined to patronize. The Tourism Department is taking steps to promote the â€Å"illness to wellness† concept by developing tourism with health care. Andhra Pradesh The famous Nizamia General Hospital is the one of its kind probably in the whole world to use Unani system of medicine, since 1938 and treating almost 1500 outpatients every day. The state made rejuvenation theraphy , alternative medicine, yoga and traditional healing systems as its main tourist attraction. Maharastra’s Unlimited Potential This state, as a gateway to India, offers tremendous potential to develop medical tourism. The latest addition in Mumbai is the Asian Heart Institute at Bandra-Kurla complex, which offers state-of-the art facilities for all types of heart complications and even preventive cardiological treatment to avoid heart alignments and keep under control a host of heart problems. This institute in collaborating with the Cleveland Institute, U. S. A offers ‘Five Star’ services at reasonable prices. Medical Infrastructure In India, it is estimated that there are 15,000 hospitals, 8,75,000 hospital beds, 5,00,000 doctors, 7,37,000 Nurses, 170 medical colleges, 3, 50,000 retail chemist outlets. Around 18,000 new doctors are added every year. Almost 80,000 additional beds are still required. Given below is a SWOT Analysis of the Indian Systems of Medicine and Medical Tourism Industry in its current state: |STRENGTHS |WEAKNESS | |Quality Service at Affordable Cost |No strong government support / initiative to promote medical | |Vast supply of qualified doctors |tourism | |International Reputation of ospitals and Doctors |Low Coordination between the various players in the industry– | |Diversity of tourism destinations and Experiences |airline operators, hotels and hospitals | |Traditional and Ancient systems of Medicine |Customer Perception as an unhygienic country | | |No proper accreditation and regulation system for hospitals | | |Lack of uniform pricing policies across Hospitals | |OPPORTUN ITIES |THREATS | |Fast-paced life style increases demand for wellness tourism and |†¢ Strong competition from countries like Thailand, Malaysia and | |alternative cures. |Singapore. |Increased demand and Shortage of supply in National Health |†¢ Lack of international accreditation – a major inhibitor. | |Systems in countries like UK, Canada. |†¢ Overseas medical care not covered by insurance providers. | |Demand from countries with underdeveloped healthcare facilities. |†¢ Under – investment in health infrastructure. | |Demand for retirement homes for elderly people especially |†¢ Identifying a real and ideal practitioner is a major problem in| |Japanese. |India. | |Personal touch by the doctors in India. |†¢ Exploitation of tourists | |Traffic system is well developed and easy to go from one country | | |to another country. | |Medicines and labour cost is low as compared to developed | | |countries. | | Role of Government The role of Indian Government for success in medical tourism in Indian Systems of Medicines are †¢ To Regulate functioning of hospitals to build consumers’ trust. †¢ To encourage private investment and FDI in medical infrastructure and policymaking for improving medical tourism. †¢ To provide conducive fiscal policies – providing low interest rate loans, reducing import/excise duty for medical equipment. To Facilitate hassle free visa process and institute visa-on-arrival for patients. The government should 1. Build the ISM Brand Abroad based on – high quality service, value for money and destination diversity. 2. Promote Inter-Sectoral Coordination like aligning the activities of various players – Tourism Department, Transport Operators, Hotel Associations, Escorts personnel etc. 3. Information Dissemination using Technology about ISMI and enabling online transactions. 4. Standardization of Services like pricing, hygiene and quality standards. Role o f Private Sector 1. Increased participation in building infrastructure 2. Integrate Horizontally by providing end-to-end healthcare solutions to consumers. 3. Joint Ventures / Alliances: Tie ups with foreign institutions MEDICITIES – A self-sustained healthcare hub with super specialty hospitals of international standards, ancillary facilities, research institutions, health resort, rehabilitation centers and residential apartments may be floated through a public-private partnership. Conclusion : India’s growing economy and the world’s high cost medical treatments are the bright opportunities for promoting Medical Tourism. To gain an competitive advantage over other countries the government may use our unique, ancient and traditional Indian Systems of Medicine as a USP and can participate in developing the needed infrastructure facilities, creating network and connectivity with health, tourism and other related industries, tie-ups with other countries. The sky is open for ISM Medical Tourism.

Discuss the importance of LOYALTY in Millers Essay

Loyalty is one of the big themes in this play and most people are loyal to each other in the neighborhood, because there are quite a few illegal immigrants living there and working at the piers, so everyone trusts everyone else. This shows loyalty between this neighborhood because no one would snitch on anybody else. Because people understand that life is hard back home and they need the money to help their families, because perhaps there isn’t any work to earn the money they need, so they come to a better country hoping they have a better life there. Eddie and Beatrice are happily married, and live together in an apartment with Beatrice’s niece, Catherine. Beatrice as Eddie’s wife is very loyal and loves Eddie, he also loves Beatrice very much, but he is not as loyal to her as she is to him. I can see this on page 24, when Beatrice says to Eddie, â€Å"When am I gonna be a wife again, Eddie? † I think that Beatrice is insecure about how Eddie feels about her and their marriage. It seems that Eddie is paying more attention to Catherine then Beatrice, because he is worried that Rodolfo is taking Catherine for a ride, but he isn’t, Eddie is just getting worried over nothing, but Beatrice thinks that Eddie may think that she is just jealous, but she is just insecure about the way Eddie really feels about Catherine. Beatrice respects Eddie so much, I can see this because when Eddie is telling Beatrice that nobody will go to that wedding until Marco apologizes to him, on page 61 and Beatrice’s response to this was, â€Å"I cant Katie, I cant†¦ She says this because Eddie had already told her before that if she goes to that wedding then she as well not come back. So Beatrice obviously chose her husband and his wishes, rather than go to her nieces wedding. This proves that Beatrice is loyal and would do anything for Eddie. However, Eddie is not so faithful to Beatrice. Evidence of this is on page 47 when Eddie kisses Catherine on the mouth; I can see that she didn’t want Eddie to do that because the text says, ‘he reaches out suddenly, draws her to him, and as she strives to free herself, he kisses her on the mouth! Then suddenly Rodolfo pulls on Eddies arm and says, â€Å"Don’t! Stop that. Have respect for her. † Rodolfo obviously thinks that what Eddie is doing is wrong and he is trying to stop him. Like I mentioned before, Catherine lives in the same apartment as Eddie, and they get along really well, in fact a little to well. Catherine is a 17 year old young woman, she wants to prove to people that she isn’t a little girl anymore, but Eddie is having some trouble believing that. For example on page 5, Catherine comes in wearing her new skirt and shows it of to Eddie. He likes it but he doesn’t want other boys to see her wearing that and so he says to her, â€Å"you’re a baby, you don’t understand these things. † Eddie is saying that she can’t be going out wearing short skirts, high heels and ‘walking wavy’. He is only looking out for Catherine. Beatrice has also realized that Catherine is still acting like a little girl in front Eddie. Beatrice says to Catherine on page 30, â€Å"†¦ like you sit on the bathtub talkin’ to him when he’s shaving, in his underwear. † Beatrice is trying to explain to Catherine that she can’t still be doing that, because Beatrice knows that Catherine is trying to show everyone that she is independent, but Catherine doesn’t seem to understand because Beatrice says to her again on page 30, â€Å"but if you act like a baby, then he be treain’ you like a baby. Like when he comes home sometimes you throw yourself at him like when you was 12 years old! † This shows that Beatrice is really trying to tell Catherine that she has to stop acting like that in front of Eddie, because she isn’t 12 years old anymore, she is nearly 18 years old. This links in quite well with the meaning of this play because; Catherine wants Eddie to have enough faith in her, to let her go to do whatever she wants. Another character who is part of this is, Rodolfo. He and his brother, Marco, are illegal immigrants from Italy. They are Beatrice’s cousins and who have come over to America to work and earn some money to send back home, for their poor families. From the first time Rodolfo met Catherine he really liked her, and as Catherine got to know Rodolfo, she began to like him, a lot. Eddie soon realizes that there is something going on between Catherine and Rodolfo, because they are going out a lot together and coming home late. Eddie feels jealousy towards Rodolfo because he feels like Catherine is never at home anymore and she is always out with Rodolfo. Eddie is obviously jealous of Rodolfo, and he doesn’t really like him as much as he did, this is because Eddie thinks that all Rodolfo wants is his papers so he could stay in America and become an American citizen. This is not true at all, Rodolfo and Catherine are in love and that is why they want to get married. When Eddie found this out he really didn’t know what to do, but he did know that he wasn’t going to attend their wedding! This made Catherine really upset and she felt as thought she had lost her faith in Eddie, because he can’t be happy for her; whoever she would be with. This brings me to a different character in the play, someone who is very trustworthy and loyal. Alfieri is a lawyer and so he knows everyone in the neighborhood and their problems. Everyone always comes to Alfieri because he is a very honest and fair man, who people respect. From the first moment Eddie started to feel ‘bad’ about the whole Catherine and Rodolfo situation, he straight away turned to Alfieri, because Eddie knew he could tell Alfieri anything; even if it’s nothing to do with the law. When Eddie is talking to Alfieri on page 31, Eddie had explained the whole situation to Alfieri asked Eddie if there is a question of law somewhere and he also added, â€Å"Because there is nothing illegal about a girl falling in love with an immigrant. † But Eddie is convinced that all Rodolfo wants is his papers, Alfieri said to Eddie that he doesn’t know that but Eddie is determined for Catherine not to be with Rodolfo. As the conversation draws to an end, Alfieri says to Eddie on page 34, â€Å"†¦ let her go. That’s my advice. You did your job, now it’s her life. † Alfieri is trying to help Eddie saying that there is nothing he can do just wish her luck and let her go. Eddie thanks Alfieri; this shows trust between Eddie and Alfieri because even though Eddie doesn’t like Alfieri’s advice, he still tells him he won’t do anything, because there is nothing he can do. But later on Eddie betrays Alfieri’s trust and he calls the immigration bureau. On page 50 he says, â€Å"I want to report something. Illegal immigrants. Two of them. That’s right. † He also tells them the address and that he is just around the neighborhood. But when they start to question him further, he hangs up. There is also a lot of trust between the neighborhood and people seem to get along quite well. But when Eddie found out that there are two more illegal immigrants living upstairs with Marco and Rodolfo, who are Lipari the butchers nephews, he realizes that he just snitched on them as well as Marco and Rodolfo. Now he is scared because Lipari the butcher’s families are very hot headed and he will be in trouble when Lipari finds out Eddie snitched on them. So when the immigration officers show up on Eddie’s door Beatrice is shocked because she realizes what Eddie had done and she is ashamed with Eddie, because she never thought he would actually do that. The immigration officers start to search the apartment, they found no one, and so they run upstairs. Soon they come back down with Marco, Rodolfo and the two strange immigrants; Catherine follows down, suddenly Marco breaks from the group and dashes into the room and faces Eddie, Marco spits in Eddies face and shouts, â€Å"that one! I accuse that one! † Marco wants the whole neighborhood to know that Eddie was the man who snitched them up and Eddie was the man who snitched them up and Eddie tries to explain himself on page 58 but Lipari turns away with his arm around his wife, and they walk away, Eddie shouts â€Å"for Christ’s sake! I kept them, I gave them the blankets off my bed! † by saying this he is still trying to explain himself to everyone, but they just turn away and walk off, even his close friends, Louis and Mike. Eddie now learns how important trust is and he also realizes that the neighborhood has lost their trust and loyalty in him. In conclusion I have found out that in this play there is a lot of trust and loyalty between; Catherine and Eddie and Rodolfo, Beatrice and Eddie, and Alfieri and Eddie, but in the end there is not so much trust between Eddie and the neighborhood, more like betrayal. In that neighborhood there are quite a few immigrants working on the piers, but people keep it to themselves, because no one wants to snitch. This proves there is trust between everyone in the neighborhood. I think that Miller’s point of this play was to, actually make people realize that life isn’t just all happy endings but there are some issues which need to be talked about, like trust and loyalty in a illegal immigrant environment. I think this quote I got from the back of the book explains my point, â€Å"all the plays that I was trying to write were plays that would grab the audience by the throat and not release them, rather than presenting an emotion which you could observe and walk away. † – Arthur Miler.

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Explain Gandhi's contention that external independence (swaraj) depends upon internal swaraj. Do you think his reasoning is correct why or why not - Essay Example All citizens should enjoy the fruits of their labor and enjoy their human rights and freedoms (Singh 14). Gandhi’s thinking contention that external independence will depend on internal swaraj is correct. First and foremost, self-government ability should depend on internal strengths and ability to resist all odds. Political self-government which is not sustainable is not worth its name and thus external swaraj will be attained by attaining internal swaraj. According to Gandhi, internal swaraj forms the basis of civilization and internal strengths can only be maintained when the masses remain patriotic in achieving the national goals and good which are above any personal considerations such as personal profit. Gandhi is correct to assert that swaraj is an inclusive government but the majority should refrain from selfish and immoral acts since this can only spell anarchy. Internal swaraj is not based on any race or religious affiliations, or controlled by the moneyed men thus all citizens are able to unity and resist external pressures of colonization and achieve external independ ence (Parel 77). Gandhi’s thinking is correct since he clearly asserts that Indian swaraj is not based on any major community such as Hindus but rule of all people thus ensuring justice to all the citizens. Gandhi is correct since civilization should ensure public resources are safeguarded by ensuring morality in all public affairs, private undertaking and public undertakings. Internal swaraj will eliminate all violent acts and unify all the citizens in resisting the heaviest external odds and external control of their nation’s affairs. According to Gandhi, all citizens are entitled to amenities that are enjoyed by moneyed men but they are not necessary for happiness thus self-government should guarantee this amenities to all citizens. Through internal swaraj, Gandhi demonstrates that Indians can attain a healthy and dignified independence and nationalism spirit

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Philadelphia Art Museum Experience - Research Paper Example Once you have battled the line in, the first thing that strikes you immediately upon entering the main foyer is the beautiful statue of Diana reflecting majestically off of the highly polished sweeping marble staircases that lead to the many wings of the museum. Classical influence is clearly obvious in the aesthetic feel, but Diana’s long, lean physique and athletic build mark her as a creation of a more modern age. Augustus Saint-Gauden fashioned â€Å"Diana† out of copper sheets in 1894. Originally, the goddess was gilded, and wore draperies that floated on the wind. She was the highest point in New York City, when she served her original purpose as the weathervane of the second Madison Square Garden building in New York City. The first NYC statue to be lit by electricity at night, â€Å"Diana† was a city landmark until 1925, when the structure was demolished, and the sculpture acquired by the Philadelphia Art Museum. (Saint-Gaudens, 1894) When which artworks I would like to focus on, at first it seemed rather difficult. Art, by its very nature, is subject in evaluation to individual preference. The core of individual preference is that which you think is good. Since what you think is good is automatically going to be whatever it is you like, and conversely, whatever you like will automatically be deemed by you to be â€Å"Good Art†. Since â€Å"Good Art† is inherently subject to the lens of individual preference, and what a person prefers will automatically be that which they enjoy, then consequently â€Å"Good Art† will always lean inherently toward things that will be in line with your personal preferences. Since the definition of â€Å"Good Art† is to be accepted as something that you like, and would likely enjoy owning as a result, if the Philadelphia Art Museum were my personal IKEA, these are the items that I would like to take home.

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Genetic Engineering - Research Paper Example Nature has the inherent ability to produce a new combination of genes through the process of natural sexual reproduction. However the number of combinations that can be produced is small due to limitations in sexual reproduction mechanism. Through the process of genetic engineering innumerable genes can be shuffled from a variety of organisms and used for the production of novel and economically viable traits (Genetic Engineering). This process was initially developed for the production of genetically modified foods that had resistance against pesticides and which provided higher yields. Genetic engineering allows for bulk production of substances which could be an economically viable option in cases where conventional process required to produce the same compound are expensive. This technology is now being widely used for the commercial production of enzymes, antibodies, crops, drugs and vaccines. In addition, several genetically modified organisms such as insects, bacteria, plants, livestock, fishes and animals are also being produced through this process that is not otherwise possible through natural means (Epstein; Abbas, Lasekan and Khalil). Though the technology has ushered in the production of organisms, crops and drugs with unique properties major interest groups within the society believe that genetic engineering is a threat to mankind as there are several grave consequences associated with the development. One of the main concerns is the ability of this technology to disrupt the natural ecosystems and the environment. All the genetically modified organisms such as plants, animals and microbes would further reproduce and mutate to give rise to ne life forms and all of these could cause irreversible changes to the natural ecosystems and environment (Epstein). Most of the genetic engineering work is carried out through the use of recombinant DNA (rDNA) technology that employs vectors such as plasmids or viruses to transfer the

Study guide for an exam Essay Example | Topics and Well Written Essays - 1250 words

Study guide for an exam - Essay Example The current global footprint is exceeding the potential of the planet to sustain itself. However, with time, there will be a number of issues, which might help to bring the global footprint down and make the existence of humans on the planet sustainable. According to Wackernagel and William (32), sustainable developemt is the kind of developent, which meets the needs of today’s popualtion without compromising the needs of future generations. The first is the fact that technology is increasing the ability for the planet to sustain itself. Technology will help in producing manufacturing systems, which, in turn, produce less waste for the same level of production. At the same time, technology can be used to develop ways for the planet to help refresh its resources faster as artificial genetic modification of plants will make it easier for plants to grow faster. The second important fact is that people will get more aware about the issue of sustainability, and this may help in mak ing sure that people and societies can start living in a more sustainable way. This will, however, depend on how aggressively the campaign for sustainability is going to be accomplished. Section II Q 3: Tragedy of the Commons Tragedy of the Commons refers to the overuse and sometimes abuse of a common resource by different individuals who act independently in their exploitation of a natural resource. A good example of a common, which is being depleted by different parties, is the oceans. Different countries are depleting the oceans in a number of ways, without knowing that they are doing it. Nations such as China, the USA, European Union countries and other big nations are depleting the oceans at quite an intense pace. The oceans and seas are all interconnected and when depletion happens in one area, the effect is being felt in many other areas. For instance, overfishing is becoming a major problem as fish reserves are being depleted around the world. There is a reason why depleting fish reserves in one area of the planet affects any other area. First of all, most fish and marine animals, such as whales, sharks etc., always travel for long distances, and this means that when these fish and mammals are depleted in one area, the rest of the fauna will still be affected. In this regard, it becomes clear that seas and oceans are one of the commons, which are being affected by different nations of the world, thus, depleting the resources. Another way in which the seas are depleted is by the rising the number of cruise ships, which are increasingly overburdening the seas with waste that is hard for the seas to absorb or assimilate. The main issue with this is the fact that these cruise ships are causing massive deaths in the seas because they produce a lot of waste as they keep going. The USA, Canada and China are leading this type of pollution with their increasing number of cruise ships that take to the open sea for long periods of time, thus, spilling a lot of wa ste into the water. The waste produced by these nations has led to disasters in the marine life with many marine animals being reported as dying or having serious health issues caused by these wastes produced. Q4: Triple bottom-line Triple bottom-line is a concept of accounting, which argues that firms should look at various issues when

Promotional Effectiveness of an Advertisement Essay Example for Free

Promotional Effectiveness of an Advertisement Essay This paper will examine the effectiveness of an advertisement for Giorgio Armani’s fragrance for men found in Men’s Health magazine. Focusing on the specifics of the ad, analysis will be done to depict the ins and outs of how the advertisement is conveying its message to the reader. To understand how marketers exploit their products to the consumers, the dynamics of an ad can be studied. Assessing the advertisement on a few important characteristics such as how the product is differentiated from the competitors, is there a need for redesign to obtain a more universal appeal, or are there any triggers which might evoke some negative emotions towards the product. The ad is a full page, double sided ad in the magazine. This is one of many fragrance promotions which are found throughout the magazine. To assess the characteristics of the ad, a number of questions can be asked to depict if there is room from improvement to effectively relay the marketer’s promotion. Promotional Effectiveness of an Advertisement Assessing the characteristics of an advertisement can lead to an understanding of how marketers promote their products to the consumer in effective or not so effective ways. Thumbing through Men’s Health magazine there are numerous ads. In fact, there seems to be an ad on every other page screaming out at the reader. To differentiate their product from other competitors, marketers have the task of effectively appealing to a universal customer without sacrificing the effectiveness of the target segment. In some cases there is a glaring need for a possible redesign or some other way to improve the advertisement. The strategies used by marketers to promote the Giorgio Armani’s fragrance can be assessed through a number of questions focusing on the effectiveness of the advertisement. According to Mullins and Walker Jr. (2010), identifying and having a clear understanding of the target market is essential for the planning and implementation of an effective promotional program (p. 368). By asking whether or not the ad effectively communicates the products benefits is a basic start and exactly what marketers want to relay to the reader. The target market is men who are reading through Men’s Health who come across this ad to see a young, attractive looking man in black and white photo with the fragrance bottle in the corner. On the other side a clear, bright picture of a wave crashing with a bottle of the fragrance in front of the wave. The marketers want the reader to see the benefits of being in the elite class of young, sleek looking men who wear the Armani fragrance. Marketers push a message of distinguished men wear our product. The wave gives the reader a feeling of clean, cool, and refreshing emotions and benefits from wearing the fragrance. Marketers use these pictures to convey the message of the products benefits. For marketers, differentiating from the competition is an important factor in promoting a product. In a magazine specifically for men, marketers of all big name brands take out full page ads to promote their individual product. Mullins and Walker Jr. (2010), mention that print media is much different than broadcast media because the reader selects the advertisement they want to read and take as much time as they want to read it (p. 354). With the Armani ad, there is a simple shot of a young man starring at the camera and a bottle in the corner. The back side has a flip up part to sample the fragrance. Thumbing through the rest of the magazine there are nine other, full paged fragrance ads located in the front of the magazine and most have a flip up sample on the back. All of them have a young attractive man looking at the camera in some similar variations of the Armani ad. Of course the fragrances all have their unique smell and that is a matter of taste in the consumer’s mind, but esthetically, the ad is not different at all. Improvements to better their uniqueness and elite class could be made. The market segment targeted in the ad is based on the person who is most likely to pick up a Men’s Health magazine, men. This might mean young or old but typically a young man in his twenties, thirties, forties, and maybe fifties. Marketers for Armani already have an advantage in knowing who are most likely to be the readers of Men’s Health and can narrow down their strategies to direct them towards the appropriate market segment. The ad is basically designed to have a universal appeal without sacrificing its effectiveness at the targeted segment and there really is not enough visual or literate information on the advertisement to trigger any real negative emotions towards the product, however, there could be room for improvement in some marketing strategies to improve the advertisement. The advertisement for Armani’s fragrance is clearly based around the sample of the fragrance on the back side which serves as the hook to get men craving that smell. There is not much that a marketer can do if the consumer does not enjoy the smell of the fragrance. However, to differentiate the product from the competitors’ products, a possible change in the typical shot of a man starring into the camera could improve the advertisement by creating interest in the uniqueness of the ad. The ad is in black and white which is different than the rest, but a change in the esthetics of the ad might separate Armani from the completion. An article in the Journal of American Academy of Business (2011) describes the importance of evaluating the marketing strategy. Possible improvements can be made in the advertisement for Armani by evaluating how effective there ad is with selling their product. Selecting and placing more importance on the pricing strategy might improve the effectiveness of the ad. The company could run a bundle deal with the different sized bottles. If the market segment is men, an attractive woman might get readers to stop more often. Celebrities always seem to push products well so maybe an endorsement could help. In the end, setting a clear and measurable objective can only be effective if it is evaluated right. Marketing managers for Armani face strategic decisions about how they can create a need and want for their fragrance. In the medium of print, marketers can narrow down their targeted market to exploit their product further and analyze what gets readers to select their promotional advertisement to read. Communicating the benefits, differentiating the product form competitors, identifying the market segment targeted, and analyzing the appeal of the product are ways to analyze the effectiveness of the promotion and find room for improvement if any. The Armani advertisement conveys a clear benefit through the use of their product by appealing to a targeted segment, but could use improvements in differentiating their strategies from the competition.

My Personal and Professional Development Plan Essay Example for Free

My Personal and Professional Development Plan Essay It is a journey of the self to contemplate all the happenings going on around. I can say that I have reached the middle of the road with regard to my journey in life. I am now entering a new phase of my life. My graduation is almost near. I have to face the new world in order for me to continue my journey on this earth. I remember when I first entered this university. I do not have friends before; I also remember the times when I am longing for my parents. I miss them so much but because of my determination to study here, I managed to cope up with my new environment. I remember how I felt whenever I’m alone. I also remember the hard times during my first day here. The way of life, the attitudes of the students and of course, the expectations from my instructors and professors gave me some intense feeling of being new to this university. But as days passed I learned how to mingle with them and cope with my new environment. Now, the time is near to end my journey in this stage of my life. My journey in college is coming to an end. I am so excited to face a new period in my life. As I move on to my journey, I want to spend time with my family and catch up with my friends. I want to go out on a vacation where I can loosen up a bit. I am planning to go to a place where I can relax and think of nothing but myself. By the time I graduate, I will visit my family back in Brazil and I will visit all the places that Ive been. This will give me time to think about my future; on what path would I take. I will also visit my old friends to reconnect with them, and try to enjoy my vacation there. By the time I go back to work, I will see to it that I will be promoted after five months. I will instill in mind that I need to be promoted, this is my way in motivating myself to achieve what I have planned. I will also enroll in a university to get a Master’s degree. I plan to get a management degree because I want to have a managerial position in my workplace. We know for a fact that having a greater education gives you a chance to compete in the market that is, having a higher position in a company. I believe that the adult tasks, unique to each period and era of the adult life are intertwined with the issues and problems inherited from our childhood, and are mediated by dynamic pressure from socioeconomic and historical aspects of life from within the cultures and societies where we live. Helping put our adult lives back in balance with our inner resources, and understanding the contradictions and conflicts built into our life patterns between who we are and who we want to be, between what we love and what we must do, between our often clashing commitments this is often the task that underlies the resolution of psychological symptoms and suffering. With these challenges in life, an individual learn to know himself/herself better and try to do something about it. Each and every one of us has experienced this kind of situation and we try to solve it as soon as the problem arises. Going back to my previous papers I mentioned that I have been into sorrow but I think of positive thoughts to divert my attention and see to it that these challenges in my life will help me grow. I am grateful for the incidents in my life that I have experienced. It made me who I am a stronger woman. Forgetting and learning from your experiences, makes you more knowledgeable about realities of life. As human being, we have differences and similarities. Thus, according to Levinson, â€Å"human life cycle is universal, yet each life is different†; that both sexes have developmental histories to some extent unique to their own gender, but the overall pattern in the adult development. This follows the same structure of eras and alternating periods. Adult Development Theory helps us see more of our connectedness to the rest of life, primarily through our experience of living within the limits of a relatively invariant, species-specific life cycle, containing nevertheless within it, the creative potential of individual variability (Kitrrell, 1998). My plan in achieving my goals: personal and professional I mentioned earlier that I first planned to graduate for me to get a decent job. In order for me to get a high grades I would have to keep in mind that nothing is more important than finishing all the requirements needed for me to graduate. One of my mottos this school year was to graduate and find a job that will help me enhance my knowledge about my course. And time is near for me to accomplish my goal with regard to my education. One of my personal goals is to develop my profession and apply the knowledge that I have learned during my stay here at the University. I want to help others in building their own dreams. I want to have smooth relationships with my co-workers. I want them to know me better. In helping them with their tasks, they will also help me with mine. thus, my growth with regard to personal and professional life go hand in hand, that is, i can develop my relationship with others by making them my friends and at the same time, they help me enhance my professional growthmaking good at my job. Doing your job is not good enough to say that you are growing professionally. An individual needs a harmonious relationship with people surrounding him/her to understand and do his/her work better. In it, the individual will not have any conflicts with his/her co-workers. S/he will be happy and enjoys his/her tasks in the office. Adjustment is the key in making a harmonious relationship with others. It is very important in work and also with personal life, rather than likability, meaning it is more important to interact within your co-workers than to impress them. If a person wants to impress others, s/he must communicate will with others s/he must mingle with them. In this way, s/he will be understood by them and they may help him/her in his/her endeavor in work. Being friends with your co-workers makes your work load more fun and you will not feel the pressure in doing your assigned tasks. So, I must adjust to the people in my workplace and in the society that I belong. I will see to it that I will not have any conflict with them. I will befriend them to help me cope with the new environment that I enter. I will share my thoughts to them for them to understand me better and try to use it as an instrument in accepting me as part of their company. I also want promotion, so I am planning to have a higher education, I will enroll for masteral and at the same time do good in my work. I will attend conferences if necessary to help me gain more credentials for the promotion that I want. I just want to achieve this in my first two years of work. After attending masterals, I plan to have my PhD to have a higher position in my recent workplace or maybe I can have a career move where I can improve my ability and skills with regard to what I have studied. But before I achieve these goals, I will develop a clear and highly specific career goals and objectives for myself. I believe in the goodness and attainability of my goals I being accountable for the consequences that may occur. I will strive towards reaching my goals and dreams one day at a time. I see my career as a vehicle that will help me take my goals. I will commit myself emotionally and psychologically to turn my dreams into reality. But first, I need to focus on what I want to do, that is, to have a vacation for myself. I will plan my goals base on its attainabilityshort- and long-term goals. Second, I need to eliminate excuses for not moving forward toward my goals. I will put my career plan that maps out specific moves I can make toward my goals on a daily basis. From what I have found on my assessments, I now develop an awareness of what I want to do. Two years from now, I want to finish my Master’s degree. Five years from now, I want to have a child and have a beautiful family of my own. And ten years from now I want to have a top position in a company and make a name in the business industry. My ideal job would enable me to grow personally and professionally. This job will help me enhance my ability and skills in communicating with others. As I graduate from this university, I will step-up for more formal education in order for me to attain my goal. We all know that having a higher education will give you a chance to compete on the job market. This way, I can improve my personality. Having a good job is not enough. I want to get more than what I have. At my recent job, I will try my best to do my job for me to be promoted. Being a CSR, I won’t try arguing with unhappy customers. If I can’t handle them, I better call my manager. I also want to receive feedback about my performance at work once a week. I will use these feedbacks to improve my work, and to be more efficient employee. I will use my resources to my advantage. Performance is a very important factor for every individual. It is created to assess individual action with regard to how s/he conducted his/her own acts. Interacting with others help someone assess his/her action on how and what should s/he do to act accordingly, that is, behaving in a manner where s/he is supposed to act. Each and every one of us is expected to act in every situation we encounter. An individual could maintain an ideal role within the situation. As a student, I must study hard and do all my assignments to conform to the rules and regulations of the school. I must act as a student in order for me to perform my role as a student. By doing this, I learned how to assess my work according to the standards of the University. The road to success Happiness is connected to personal effectiveness wherein you feel contentment within yourself. For me, personal effectiveness is doing what you want, getting yourself from where you are to where you want to be, that is, achieving what you want in life. Thus, it takes a lot of effort to say that an individual is successful in doing the things that s/he wants. Defining personal effectiveness is the same as how we define success. We individuals seek success being intertwined with happiness. We can say that success is having the things that you wantearning money for yourself and your family, getting the highest paying job in town, having all the things that the world offers, and the likes. We define success with regard to tangible and intangible factors the materials that we use in determining success and the feeling that we feel inside in getting that success. As I mentioned in my previous paper, I defined happiness as a pleasurable satisfaction, a state of well-being and contentmentbeing happy of what you have. Regret is a way of depressing yourself of not getting what you want or doing what you should have done. Seeing my mistakes and my weaknesses enables me to improve my worth as an individual. This made me more effective citizen, student, daughter, friend and a partner. And I try to live one day at a time in order for me to achieve my goals in life. In this way, I can avoid myself of feeling too overwhelmed with my limits and emotions. I will be entering a new page in my life, as I go on with this great transition, I realized that my experiences and the people around me have a great impact of who I am today and what will I be tomorrow. My future depends on how I plan to go on with my lifemy future! I can say that I am contented of what I have right now but I am not satisfied of where I am today. I want to explore more of my world. I want to excel from my job and I plan to have a very good life, that is, being successful and all the people around me are happy with what they have, especially my family. Prior to graduation, I plan to have good, if not better grades. I want to make it better for me to land a job that will help me earn enough money that is salary that will enhance my way of living. I don’t want to have a failing mark. This will reflect my personality as individual. Failing mark means I didn’t do my best to pass my course. In order for me to achieve this, I will read all my reading assignments and complete all the requirements that are needed to be submitted. I will see to it that I will pass my entire exam. I will love and enjoy my course and look at every single test as a challenge in making me more responsible individual. Taking responsibility in all your actions make an individual is more assertive of what s/he wants to achieve. My family is very important to my life, I want them to be happy with their own life and be successful with their chosen field. I want my mother to be more understanding and I will see to it that she is happy right now. I want her to feel that we, her children love her very much. I want my family to be complete and witness my graduation. I want to share my achievement with them. They are my strength and joy. Without them, I cannot overcome all the obstacles that came my way. They are the one whom I run to whenever I have a problem. They gave me good advices on how to handle my problems. Even though they are not with me, they are always here in my heart. Daniel Levinson’s theory of adult development Adult development theory presents a vivid understanding of life cycle. Daniel Levinson worked out his theories of adult development in two landmark studies, Seasons of a Man’s Life and Seasons of a Woman’s Life. He argues essentially that the adult portion of the human life span is divided into three eras: early, middle, and late adulthood. Each of these broad eras are themselves divided between entry or initial stages and ending or more-or-less stable stages. Think of the difference and quality of the life structure and goals of a 24 year old as compared with a 34 year old, and you will get a sense of the internal changes that occur within otherwise specific eras, i. e. , both a 24 year old and a 34 year old would be considered young adults within the Levinsonian perspective. The divisions between the life eras are marked by significant transitional periods that can last for some years. Life during these shifts can be seen as rocky or smooth, noisy or quiet, but the quality and significance of one’s life commitments often change between the beginning and end of such periods. I chose this theory to plan my future because it enables me to think of the differences and similarities of characteristics between the two sexes and also to compare the experience of the adulthood with the late-adulthood stage and the other stages of life as discussed by Levinson. This theory reflects essential changes that adults undergo. Thus, it provides a clearer view of what reality is. This theory can be applied in planning on with your life. It will make you aware of the things that you don’t bother to know. This will help you analyze your work and performances as part of the society. This will enhance your knowledge about your role in the society. This will enable you to view things in a broader way, i. e. , having a positive outlook in life in entering the new phase of your life. This theory also presents a good foundation for understanding goal setting of individuals entering into particular adult stages (Minter Samuel, 1998). If you know your goals, probably you will know where you are heading to. This perspective on adult development is important for us, adults to understand. This will enable us to resolve important transitional issues during the vital periods in our lives. Thus, each transitional period is needed so that changes in individuation and relationships are attained by concerned individuals (Wheeler-Scruggs, 2008). This model is created to promote individuation and build relationships among individuals that they may use in getting what they want in life. These changes bring greater sense of autonomy and give a greater expression and achievement of one’s self-potential (Wheeler-Scruggs, 2008). Thus, individuals go through the various stages and transitions in order for them to become more self-reliant. Its nature is focused on building characteristics that would help the individual attain his/her personal and professional goals. It is also used to create rapport with each and every individual concerned. This would help the individuals reach their goals. Building rapport is very important in making your goals attainable. If you communicate well with other, they will help you achieve your goals by giving you information that you need. For instance, as a CSR I need to build rapport to the customers for them to give a positive feedback in which they will be nice to me thus, making my work easy. And with regard to my co-workers, I need to build rapport for them to help me in my job, giving some advices if I experience some difficulties in my job. Thus, this will help each and every one to improve their work and at the same time develop personal relationships. As I have mentioned earlier, we need each other in order for us to grow. With the help of others, we will achieve the set goals we planned for ourselves. As I assess my performance, I see my potentials to be growing. These potentials include my leadership ability and interpersonal skills which I can use in communicating at work. I will try to develop my weaknesses into strengths for me to improve myself, personally and professionally. This will also be of help to us in communicating with each other. Every student must know that they need their teachers for them to gain knowledge and improve their way of thinking. The teachers may help their students in developing their potentials and skills which they will use in communicating with others, most especially with regard to their work. Conclusion After planning all my walks in life, I would like to slowly acquire my goal. I will stick to my plan. As I have said earlier, I want to achieve my goal one step at a time. I believe that all my plans are reachable. I divided my plans into two: long-term goal and short-term goal. I would focus first on short-term goal: to be promoted in my work, to have a vacation with my family in Brazil, to visit my friends, to extend my family by having a new French bulldog in my house, and to graduate; and then work on to my long-term goals: having a good life with my own family and for my mom to be happy with what we, her children have achieved in life, and be one of the best Psychologist in town. This assignment enables me to reflect on how I manage my life after graduation. I have learned that in order to succeed in life, an individual must look at all the aspects of life before planning his/her future, that is, reflecting on the experiences s/he had and planning the future. Thus, development means assessing your own life and making all the necessary steps to achieve my goals. I learned that in order to achieve your dreams, you must decide to for Utopia, which means going beyond the reach of the society until we overcome the obstacles that stand in our way. These obstacles include negativism, fear, depression, and the problems they create discouragement, economic stagnation, crime, drug dependency, family distrust, etc. At this moment in my life, I can say that I have achieved something for myselfovercoming the obstacles that came my way. This helped me have a positive outlook in life. Thus, I will prioritize myself, of what I want to do and where I want to go. Through this process I will know that I will be a successful psychologist someday. References Kitrrell, D. (1998). A Comparison of the Evolution of Men’s and Women’s Dreams in Daniel Levinson’s Theory of Adult Development. Journal of Adult Development, 5(2), 105-115. Minter, L. E. Samuel, C. A. (1998). The Impact of ‘the Dream’ on Women’s Experience of the Midlife Transition. Journal of Adult Development, 5(1), 31-43. Wheeler-Scruggs, K. S. (2008). Do Lesbians Differ from Heterosexual Men and Women in Levinsonian Phases of Adult Development? Journal of Counseling Development, 86(1), 39-46.

Skills Development for Child Nursing Course

Skills Development for Child Nursing Course Provide an in-depth reflective account that demonstrates how learning, during the three years of the child nursing course, has been achieved in relation to two areas of your practice which has informed and enhanced your development towards qualification as a Childrens Nurse. Introduction Reflection is a vital component of the development of nursing competence and reflexive nursing practice. Although reflection functions on many levels, including the personal level, in allowing student nurses to review experiences and incorporate them into their internal schema, one of the most important levels of reflection is the process of asking questions about practice, and through asking those questions learning about the self in practice, and the role of the nurse (Bowden, 2003). Reflection is an important aspect of developing competence in practice, as well as developing practice itself (Durgahee, 1998; Gustafsson and Fagerberg, 2004). Some authors view the ability of the nurse to reflect on practice and in practice as a fundamental component of providing truly holistic and client centred care (Gustafsson and Fagerberg, 2004), while others view reflection as a self-limited, flawed and biased practice which is of little or no use to developing nursing professionalism (Jones, 19 95). I believe that reflection, if properly used and structured, provides powerful insight into the self, into practice, and into the ways in which competence and practice develop over time and through experiential learning. Therefore, I have concluded that to make reflection effective and useful, it is important to use a reflective model, such as that of Gibbs (1988), which I have chosen for this essay. Although there are limitations to Gibbs’ (1988) model, particularly in applying it to the requirements of this essay, it provides clear guidance and useful questions to ask about the experiences that contribute to the reflective process. I have adapted this cycle to suit the processes and analyses of this essay, and so, while two cycles of reflection are outlined below, the conclusions are developed collectively. For the purposes of this essay, the final stage of the cycle is to be found within the Appendix (see Appendix 1), and thus the Action Plan is adapted to become the P ersonal Development Plan. The purpose of this essay is to engage in an in-depth, detailed process of reflection on two areas of practice and learning that have been important to me through my studies in the three year child nursing course. Using a reflective cycle to guide and direct the reflective process, I will explore the process of professional development, towards competence and expertise, in relation to Benner’s (1984) stages of development, examining the nature of competence in each designated area of practice. The first chosen area of practice is the skill of managing an intravenous infusion, because the use of intravenous infusions and the provision of intravenous medications is an important component of many clinical paediatric nursing scenarios, and the management of intravenous access and infusions is particularly problematic when nursing children. The other area of practice and nursing professionalism chosen is communication, with a particular focus on the development of communication skills with staff, in relation to the nursing handover within the acute hospital environment, and the development of communication skills with patients, using the example of providing health education and promotion for a patient with Type 1 diabetes. I have chosen to focus on specific examples of communication skills in practice because these relate strongly to my own experiences, and also allow for a deeper and more critical analysis of practice and my own development. This will also allow for a more co ncrete development of a personal development plan to encompass identified development needs and actions to achieve these during the first six months of practice as a Registered Children’s Nurse. The focus on critical analysis allows for the development of a skill of great value for my professional practice, deconstructing practice and reviewing it in the the light of other knowledge (Burns and Bulman, 2000). However, because of the complex nature of practice, and the reflective processes which question feelings and thoughts as well as actions, the reflective process is complex (Wilkinson, 1999). Thus, although there are two issues being reflected upon, they are drawn together in one discursive thread which signposts the learning and development, the acquisition of professional understanding, which signifies the transition from novice to competent practitioner. Discussion 1. Clinical Skill Development: Intravenous Infusion and Medication Management in Children’s Nursing Practice. Description: What Happened. During the three years of nurse training, the development of the skill of managing intravenous infusions, either of hydration solutions or of medications, was one which I developed almost from the beginning, when it was taught as a clinical skill in the university setting. The typical approach to teaching clinical skills was to provide the students with a lecture on the relevant theory, complemented by a practical skills session to apply the knowledge in a simulated environment, utilising mannequins. Every acute ward area of my clinical practice involved the care of patients with intravenous infusions, which included caring for children while the intravenous cannula was inserted, and then monitoring and care of the intravenous cannula site, and of the infusion itself. This skill was therefore not only a basic skill for nursing competence throughout my training, but also an important opportunity to promote health, prevent infection, and was fundamental to other aspects of care and tre atment. Over the three years, I first learned how to set up an intravenous infusion, safely and in a sterile manner, how to check the infusion, and how to check the infusion rate manually (ie, without the use of an infusion pump, although infusion pumps are standard best practice in children’s nursing). During clinical practice, I learned how to support a child during the cannula insertion, monitor the site, check the infusion and infusion rate, set up and check different types of infusion pumps, and how to change the IV line (which must be changed regularly). I also learned complementary skills such as drug and dosage calculations for infusions, and fluid balance calculations, both of which required numeracy skills Feelings: what were you thinking and feeling? Throughout my training, management of intravenous infusions was stressful, but in particular, the associated aspects of care were challenging. Supporting children who have intravenous infusions is problematic, particularly as the experience is often painful and distressing for them. Carrying out drug calculations was terrifying at the beginning of my training, and even by the end, despite increased competence and confidence, I would still have more than one colleague check calculations and dosage rates, and check infusion rates on pumps, to ensure I had made the correct calculations. I felt very lacking in confidence in this area. I also felt that while I focused on safety aspects of IVI use, including risk management and prevention of infection via the IV site, other colleagues did not seem to pay so much attention to this aspect of care. Evaluation: What was good and bad about the experience? It was good that I identified important aspects of this clinical skill, and the complexities of practice surrounding it. What was not so good was the lack of transparency in colleague’s practice, particularly in my earlier clinical placements. Analysis: What sense can you make of the situation? I became aware during my reflection on this element of my learning that it was very much something which became assimilated into the almost intuitive elements of nursing competence (Benner, 1984). This was because apart from the elements of the process which had been identified as distressing for the child, such as cannula insertion and removal, managing the IVI had become ‘second nature’, and checking the line, site and rate of the pump were activities that the qualified nurse carried out without any overt signifying of the action, as part of her interactions around the patient/bedside. Thus, making this overt was almost counter-intuitive. Certainly, it appeared to me that many staff did not record these observations every time they were made, and that they did not always communicate these observations to others, including me, as a student. As a student, a learner, I was required to take more time over such observations, to note their significance, and to evaluate their place within my nursing work. I was required to develop specific skills around the use of IV infusions and the management of whatever medication or fluid was being infused. This was a protracted learning process, which developed throughout the three years. I learned the importance of this for my practice. â€Å"Possible complications associated with short peripheral venous access include infiltration of infused fluids (nonvesicants) into the surrounding tissue, extravasation of vesicant medications or blood into the surrounding tissue, and phlebitis† (Hinkle and Hadaway, 2006 p 122). The clinical skill here also, therefore, included the component of determining when such complications had occurred. I also had to learn to observe for infusion reactions, which could range from mild to severe (Hinkle and Hadaway, 2006). Competency can be viewed as behaviours which are achieved or approved of in relation to the completion of a task, and competency is described in relation to that task (Gonczi, 1993). However, developing competence in IVI management is much more than simple task proficiency, and this may be true of much of professional competence in nursing (Preston and Walker, 1993). Not only does it appear that no single clinical requirement can be reduced to single task, but also, competence in that task may be affected by other contextual factors, including the presence of others, and how their contribution or lack of it can affect performance of clinical actions (Ashworth and Saxton, 1990). If we view competence as the ability to manage any situation holistically, making use of collaboration with colleagues (Meretoja et al, 2002), then even this process of reflecting on a clinical skill is very limiting, because the skill alone does not signify the whole of the learning process associated with th at area of practice throughout my training. One of the important elements of learning around this particular skill, however, was the gradual recognition of my own competence, which was signified most clearly when I no longer become ‘overt’ about assessing the IVI and monitoring it, but carried out this activity as part of my practice, almost automatically. Here, the skill had many facets, but this kind of ease was never achieved with the drug/dosage/infusion rate calculations. Numeracy competence is important for nurses, and nurses are required to demonstrate acceptable levels of numeracy in order to qualify (Bath et al, 1993). However, this was an area I struggled with, not because I had ever considered I had difficulties with numeracy, but because applying numeracy to clinical situations seemed to make drug calculations much harder. Over time, I found that if I visualised the calculations myself first, and wrote them out longhand, then checked them with a calculator, I usually reached the right conclusion, which showed that my own learning style influenced my ability to come to the right answer(Bath et al, 1993; Galligan, 2001). Hinchliff (2004) descrives Bloom’s (1972) learning domains, and this learning experience, throughout the three years, involved all three areas: cognitive, psychomotor, and affective. In relation to the cognitive domain, I learned knowledge to underpin practice, consolidated this knowledge over time. In relation to psychomotor skills, these were about the practical ability to carry out necessary procedures and actions, including running fluids through an IV line, identifying, choosing, priming and setting up the correct line for the correct infusion pump, and the skills around removal of the cannula and dressing of the cannula after insertion, along with changing an IV bag. The affective domain refers to the attitude formation, which can be seen above to be about a positive attitude but an internalisation of much of the knowledge and practice to the point that aspects of these procedures became almost innate. It became apparent that this clinical skill could not be viewed in isolation, and also incorporated a great deal of discussion with the family and the patient, and in the case of most children, informing them of the need to take care of the IV line, and educating them about infection control, thus engaging them in their own care and in their own health promotion (Long et al, 2008). Prevention of trauma to the IV cannula or site, and ensuring maintenance of patency of the cannula and line, are important in minimising the amount of times the cannula needs to be resited, which is desirable because of how distressing this procedure is for most babies and children (Thomas, 2007). I became aware of this after viewing resiting of cannulae in a number of patients, most often due to either traumatic accidental removal. 2. Professional Skill Development: Communication in Practice: The Nursing Handover. What Happened During the three years of training, communication was identified as a professional skill, and it soon became apparent that this skill formed the basis of the majority of nursing actions and roles. Because of the complexity of communication in nursing practice, during this reflection I chose to focus on one aspect, that of providing handover for a designated patient, or group of patients, under my care, to the nurse taking over care. Engaging in this activity was a significant aspect of my development. Initially, in the first clinical placements, I observed this taking place, but did not really understand all the components of the process. Over time, I was encouraged by mentors to provide the handover report myself, and I found this demanded communication and information processing skills perhaps unique to the process and to the situation. I discovered that I needed to know the terminology and abbreviations used, the format of the report, and to remember the patient information and pr ovide a comprehensive report that did not omit important elements of care. During the initial experiences of this, I did miss out elements of care, but was always supported by a mentor who could augment my limited report and ensure patient needs were communicated. However, by the end of my clinical experiences I was expected to provide reports myself, and I did so, but became increasingly aware of the limitations of this form of communication, and of how it had become ritualised in practice (Strange, 1996). Understanding the nature of this element of communication became an important element of my learning, perhaps because I had found it so difficulty initially Feelings: what were you thinking and feeling? During successive experiences of handover, I came to a growing realisation that the format and nature of the handover report was not only extremely ritualised (Strange, 1996), but also constituted a unique form of communication, with certain expected behaviours and standardised formats. However, I started to feel, quite early on, that information was not necessarily being fully communicated, and I found myself increasingly frustrated with the process, because instead of providing a comprehensive report, it was more a kind of focused tick list of tasks, which did not really relate to my concept of holistic approaches to nursing care. I found myself learning how to give a ‘proper’ handover but wishing I could give a ‘good’ handover. Evaluation: What was good and bad about the experience? The good aspects of this experience were the fact that I was able to identify what was happening, and able to realise that I was frustrated with the process of handover, and the way it had become habitual. This prompted me to explore the evidence base surrounding this important aspect of nursing communication, which then enhanced my understanding. However, to cite what was bad about the experience, I must focus on the limitations of the process, because it made me feel that the handovers were, quite often, inadequate, and very limited, reducing patients to a list of problems and actions. Having said this, it also became apparent that handovers conducted at the patient’s bedside were an entirely different entity, and that communicating at the bedside included the patient and their family in the handover, and made them much more holistic and comprehensive. But it may not be appropriate to do this in all situations. Analysis: What sense can you make of the situation? Developing professional skills is part of the complex acquisition of nursing competence, and this process can be viewed as an apprenticeship of sorts (Benner, 1984). Much of the professional competence that is assessed during nurse training is related to the standards set out by the Nursing and Midwifery Council (NMC, 2004), and are realised through a process of learning, negotiation and assessment which predominantly occurs through clinical practice. While a lot of this learning is directed and planned, development is through experiential processes, as in this case, in the development of the required verbal communication skills for providing ‘handover’ report. This emerged as a significant area of practice for me, particularly in relation to responsibility and autonomy after the transition from student nurse to staff nurse, because of the different expectations of the latter role. While in relation to performance, clinical skill and professional skill, the senior studen t nurse and the newly qualified staff nurse are similar, in relation to role and responsibility, and expectation, there is a sudden shift and competence takes on new meaning for the newly qualified nurse (Wade, 1999). Thus, I can see that my concerns about the nursing handover, and my ability to provide an appropriate, comprehensive report, were very clearly linked to this notion of responsibility, because a poor handover could impact on patient care (Sexton et al, 2004). The nursing handover report is a process which involved the communication of key information about patients on the ward, care plans, actions and imminent needs, and about the stage of their care journey (McKenna, 1997). It usually occurs as a communication between nurses at the point of shift change (McKenna, 1997), but it can also take place when a patient is transferred from one clinical area to another. According to Hopkinson (2003) the nursing handover is an important and significant activity in the hospital setting, relating to the proper management of care and the provision of continuity of care (Kerr, 2002). Although handovers have the same basic function, I have observed that they can vary from ward to ward, but that within each location, they seem to have a certain format or shape. While in some areas tape recorded handovers are used, in others, the staff provide a handover at each bedside. More commonly, handover occurs in a designated room (to ensure confidentiality), and may then in some circumstances be followed by a ward round to introduce the next shift to the patients and their family. It is important to include the family in this communication, because most sick children are accompanied by a parent or carer during their stay in hospital, for a large proportion of the time. The nurse may either hand over the care of one patient, a group of patients, or the entire ward, if they have been the nurse in charge of the ward for that shift. This requires that the nurse providing the report must have a thorough and comprehensive knowledge of the patients, their needs and diagnoses, trea tments, and any pending results or procedures. Not only is it a process of communicating this information, it is also the time when colleagues might ask questions about care, and therefore also serves to demonstrate what the nurse has achieved, or not achieved, during the preceding time period, and tests the nurse’s knowledge of the patients. Yet some evidence suggests that handovers are limited and undermined by forumulaic approaches to providing the information, by incomplete communication, use of cryptic terminology, jargon and abbreviation, and can require that nurses have ‘socialized knowledge’ in order to understand them (Payne et al, 2000). Thus, it can be difficult for the student, or even the newly qualified staff nurse, to fully understand this communication because they perhaps are not fully socialised into the clinical area. Terminology and units of language may acquire different significance in specific areas of practice (Payne et al, 2000). Another identified limitation is the tendency to prioritise biomedical and physical aspects of care, reducing the patient to their disease and its treatment (Payne et al, 2000). The handover forms the initial part of the process of care planning for the nursing staff taking over care, although this is supplemented by a thorough examination of the patient records, and discussion with the patient and family. Having observed and participated in such processes, it is understandable that this communicative act developed some significance for me in relation to professional development, particularly in relation to future practice as a qualified staff nurse. Competence takes on new meaning at this transition (Amos, 2001; Ashworth and Saxton, 1990), because it signifies the point when I have to become responsible and accountable for my own actions, with no one else to cover any inadequacies or mistakes (Gerrish, 2000). Because it is viewed as a fundamental component of good quality nursing care (Pothier et al, 2005), ‘getting it right’ is understandably important. Handover can be viewed as a communicative act from a number of perspectives. It provides a forum for discussion, debate and questioning, as well as expressing one’s views and feelings about a particular case or cases (Hopkinson, 2002), which to me suggests that it is more than simply the presenting of information, but is also a form of self-expression for the nurse. However, it’s main purpose is to provide the information that nurses will then use to formulate their plans for care and their prioritisation of their workload for that shift (Hopkinson, 2002). For example, in one handover a colleague did not inform staff that a chest X-ray had been carried out, which meant that the next shift ordered another chest-X ray with resultant delays and confusion. Providing a good quality handover may be more significant than ever in the current clinical paediatric nursing environment, where every aspect of healthcare appears to have become more complex, requiring more multiprofessional input and collaboration, and in which patients are subject to complex and multifactorial assessments (Pothier et al, 2005). There is some evidence to suggest, however, that important patient information can be lost during the shift handover (Pothier et al, 2005), which reinforces my own conclusions about this communication. This may not, however, be due to simple acts of omission, but also due to the culture of ward areas and the ways in which nurses behave and exercise power, albeit a small degree of power, over the information they possess (Hardey et al, 2000). Some research suggests that the handover process is where tensions an institutionally-derived conflicts and drivers for nurses can become evident (Parker et al, 1992). It would seem that it is more tha n a simple process of dialogic communication (Kerr, 2002), but also serves a range of other functions, including social and protective functions (Strange, 1996). To me, this knowledge and understanding of the deeper and wider aspects of communication, of what is being communicated, how and why, during this process, signifies the journey of learning and development as a student nurse. Initially, I was the novice, viewing this process as a mere interchange of key information. Gradually, however, I developed an intuitive knowledge of the handover and its communicative role, intuition based on experience and on the processing of a range of cues and sources of information (Benner, 1984), leading to a degree of awareness that the handover signified more than simply an exchange of facts. It demonstrates competence in communication, but in adherence to cultural roles and expectations, and the ability to mange the competing demands and tensions of the nursing role (Kerr, 2002). Thus it empha sises a shared valued system amongst the nurses within the given context (Lally, 1999), which in some ways can demonstrate competence and acceptance, of me by qualified colleagues, signifying I have achieved nurse status, but also which can mean an enforced compliance with local behaviours and expectations which may be at odds with my own philosophy and principles of professionalism. Therefore, I realised that the communication skills of the nursing handover are both verbal and personal, involving managing myself, managing information, and managing the work environment and my colleagues (Lathlean and Corner, 1991). Achieving competence in the effective verbal communication skills associated with the handover is problematic, because from all that I have learned through my education, and my exposure to the ideals of professional nursing, the handover should be a detailed, comprehensive communication delivered without jargon or abbreviations, and which is inclusive of the patient and their carers. However, the conventions of the handover in different areas may oppose this. This is an area of development identified as important for my personal development plan. Conclusions The first conclusion I draw from this reflection is that it is impossible to see any area of nursing competence, or any clinical skill, as a discrete entity or area of practice. Every skill and professional role is inextricably linked with others, with aspects of practice, with other skills, demonstrating the complexity of practice and of the learning and development processes which lead me towards expertise and confidence, as well as basic competence. As I have demonstrated above, managing an intravenous infusion involved a range of skills and actions, including numeracy calculations, risk management and prevention, health promotion, patient support and education, care planning, and communication. Thus, it becomes evident that what may be identified as a discrete clinical skill intersects with multiple areas of practice and competence. This perhaps reflects holistic models of nursing, because it demonstrates that the nurse cannot deconstruct practice to such an extent as to make it fully task oriented, due to these intersections and the interconnectivity of different tasks. It would appear, from my reflections, that the ideals of ‘holism’ which are expounded in relation to nursing ideologies and philosophies can be viewed on the ‘micro’ level in practice, as well as the ‘macro’ level of the nursing philosophy. Every part of clinical practice is an element of a complex, yet connected, ’whole’, and therefore, competence in every part of practice is important in order to provide optimal standards of care in every respect. This is an important realisation for me, and one which I believe to be appropriate for this stage of my development. It might be that coming to this realisation earlier on in my professional development journey would have been too overwhelming. Coming to this realisation now, when I can signpost my own learning, development and competence, is more motivating than challenging, because it underl ines my commitment to providing the best possible care that I can, which in turn must be based on ongoing professional development, diligence and a focus on the patient’s needs. The second conclusion I draw from my reflective processes is that while a reflective cycle can guide reflection, it cannot provide the answers to the questions that are raised. The value of reflection lies in the ability to take those questions, answer them honestly, and to seek out the knowledge and information required to explore those answers in relation to practice as well as in relation to the self. As with my previous point, the process of professional development has led me to understand my role as one aspect of a greater whole, a complex network of professionals and roles, where roles and activities may overlap, but where the competence of each individual contributes to the whole, and where, if one component is missing, or lacking in some way, the whole is affected. If my communication skills are insufficient, this affects the work of others, their ability to meet patients’s needs, which impacts, sometimes significantly, on patient wellbeing and the patient experience. For children, who are perhaps the most vulnerable patient group, the impact is likely to be greatest. Therefore, reflection is no mere academic exercise, it is the means by which I can remind myself of my place within this network, and value my contributions whilst also appreciating the responsibility of my future position. Again, this is a motivation to provide excellence in practice, to ensure the continued quality of the whole. While the development of nursing expertise is viewed as a foundation to professionalism (Hodkinson and Issit, 2004), I would argue that expertise is still poorly defined because in nursing it is very complex, and the intersections of various domains of practice are blurred, such that, for example, clinical skills are inseparable from other skills. Personal effectiveness in the nursing role may be more important in terms of professional development (Hodkinson and Isset, 2004). There are implications of this, however, for my role as a newly qualified staff nurse, because the change in expectations (on my own part and on others’), may lead to challenging transitions and some degree of reality shock (Evans, 2001). My reflections here have identified the fact that the socio-occupational integration into my qualified role is probably the most problematic (Evans, 2001). However, it is apparent that having engaged in a good degree of reflective practice throughout my training, I have developed the skills to be able to analyse and reflect upon experiences and situations, and to take this reflection further, by applying theory and evidence to my own practice. This requires not only a great degree of professionalism, but a commitment to ongoing professional development, preparing myself for the transition (Yonge, 2002), and continuing to view my working life as a continual process of learning and development. References Agnew, T (2005) Words of wisdom. Nursing Standard 20(6),pp24-26 Amos, D. (2001) An evaluation of staff nurse role transition. Nursing Standard 16 (3) 36-41 Andrews, M., Gidman, J. and Humphreys, A. (1998) Reflection: does it enhance professional nursing practice?. British Journal of Nursing 7(7) 413-7. Ashworth, P. and Saxton, J. (1990).On competence. Journal of Further and Higher Education, 14, 3-25. Bath, J.B., Blais, K. (1993). Learning style as a predictor of drug dosage calculation ability. Nursing Educator 18(1), 33-36. Beaney, A.M., Black, A., Dobson, C.R. et al (2005) Development and application of a ris