Total Environments, Health, and Safety Management Research Paper

Total Environments, Health, and Safety Management - Research Paper Example Employees who are working on the construction site are subjected to a constant change in their nature of work, mix of workers and location of work. In view of most of the people, construction industry has most risky working environment as compared to other industries (Broadbent, 2004). In case of construction industry, the concept of safety culture is relatively a naà ¯ve concept. However, in recent past this concept has gained popularity due to its unique ability of accepting all the psychological, behavioural, perceptional and managerial factors. Multitasking and paying attention to more than one tasks (professional or non professional) at a time result in accidents. While employees are performing their duties without wearing their protective equipments or just talking on their cell phone, they place themselves at risk just only to make themselves comfortable or to save time. In short, in construction industry most of the accidents occur not due to the lack of skill, training and knowledge but are related to relatively poor decision making skills (Cooper and Phillips, 2004). Management, starting from the individuals, who are occupying the highest position in hierarchical order, all the way through the low level management (leaders, superintendents, supervisors etc.), and all the way down to the people working in production area must engage themselves in the combine efforts to systematically reduce or eradicate the chances of being exposed to any of the hazardous condition or situation. An effective and successful safety culture has following elements: By developing and managing the process of safety in a more effective manner, any organization can reduce the chances of injuries, increase the awareness among workers about safety, can increase overall productivity and also raise the morale of the workers. In order to check compliance, the

Structure and symbolism in The Lottery Essay Example for Free

Structure and symbolism in The Lottery Essay In The Lottery, Shirley Jackson relates an unusual story concerning an old ritual within the setting of a small American village. Reading for the first time, most readers will be tremendously shocked by the ending: with an idyllic village atmosphere settled down at the beginning part, the cruel and outrageous ending comes all too suddenly and out of expectation. However, a careful examination can reveal that the shock is not sudden at all; The Lottery actually fuses two stories and themes into one fictional vehicle: the overt, easily discovered story appears in the literal facts, producing an immediate, emotional impact; whereas in the second story which lies beneath the first, the authors careful structure and consistent symbolism work to develop gradually the shock and to present a profound theme: Man is not at the mercy of savagery; he is the victim of unexamined and unchanging traditions which he may easily change if he only realizes their implications. The symbolic overtones which develop in the second story can be sensed as early as the fourth word of the story when the date of June 27th alerts us to the season of summer solstice with all its overtones of ancient ritual (The ancient rituals were traditionally held in summer solstice so as to ask for harvest of autumn. ) Carefully the scene is set-The morning of June 27th was clear and sunny, with the fresh warmth of the full-summer day; the flowers were blossoming profusely and the grass was richly green. The children newly freed from school play boisterously, rolling in the dust. But, ominously, Bobby Martin has already stuffed his pockets with stones and Harry Jones and Dickie Delacroix follow his example, eventually making a great pile of stones in the corner which they guard from the raids of other boys. Thus by the end of just two paragraphs, the author has carefully indicated the season, time of ancient ritual of sacrifice; and the stones, most ancient of sacrifice weapons. Then The men began to gather, talking of the planting and rain-the central issues of the ancient propitiatory rites, and tractors and taxes-those modern additions to the concerns of man. The men are quieter, more aware, and the patriarchal order, the oldest social group of man, is quickly evidenced as women join their husband and call their children to them. When Bobby Martin tries to leaves the group runs laughing to the stones, he is sharply rebuffed by his serious father, who knows that this is no game. All these descriptions clearly show that this is more than the surface idyllic small town life, the symbolic undercurrents prepare us to be drawn step by step towards the ultimate, where everything will fuse.

Ford Motor Company: Challenges and Opportunities

Ford Motor Company: Challenges and Opportunities The purpose of the following report is to identify the most significant problems facing the Ford Motor Corporation and recommend a course of action that most adequately resolves the challenges of todays marketplace. It begins by outlining three of the major challenges facing the Ford Motor Company: Fords current business plan is not as financially and environmentally sustainable as it could be. Global economic markets are performing far worse than Ford had expected in prior planning. Fords market share in developing foreign markets is lower than desired. The report recommends that Ford should focus on creating a more financially and environmentally sustainable business model by developing energy efficient and environmentally sustainable automobile models in every vehicle class. These models should be developed without significant increases in consumer cost or decreases in overall performance. This is to be accomplished by revamping Fords research and development program. Some potentially promising areas of research include hybrid electric vehicles, natural gas vehicles, and electric vehicles. Ford has the opportunity to make the most progress by focusing on hybrid vehicle research and development. This is to be done by redirecting other RD expenditures and efforts, scaling back production to free up additional funds, initiating a new public relations campaign to inform consumers about the new sustainable Ford plan, and creating partnerships with leading technology and engineering firms. The report then presents an ethical screen outlining the moral considerations this course of action entails. While the creation of a more sustainable business model builds upon Fords ethical commitments, the loss of jobs resulting from proposed production and retail facility closures conflicts with these principles. And while a course of action that brings about greater job losses to Ford employees is less than ideal, it arises from market conditions. Lack of action may result in even greater job losses on a long-term scale. In this way, the recommended course of action resonates with the ethical commitments outlined in Fords Mission Statement. A feasibility report discusses Fords ability to achieve these goals. As of 2007, the Ford Motor Company maintained the second highest RD budget in the world, with a hybrid vehicle program already well underway. In the year 2000, Ford unveiled the first U.S. made hybrid-vehicle, an accomplishment that sets Ford apart from its U.S. competitors. This report concludes that Ford possesses adequate resources and abilities to reach these new goals. A cost-benefit analysis then weighs potential losses against gains that may arise from this plan. The proposed course of action is high-risk is cost-intensive, however the potential benefits of increased income outweigh the expenditures Ford stands to lose while pursuing this goal and the equally high-risk option of failing to act on this pressing challenge and opportunity. Finally, the report outlines a preliminary budget, timeline, and a step-by-step course of action. Overall, the proposed plan is intended to cost Ford little in terms of net expenditure, and should be completed in its entirely by the year 2015. Position The Ford Motor Company is one of the largest automotive manufactures in the world (OICA). Founded in 1903 by Henry Ford, Ford Motor Company is currently one of Americas Big Three auto manufacturers, along with Chrysler and General Motors (Datamonitor 13). As of 2009, Fords net worth in assets was $222.977 billion (Ford 67). Fords market capitalization in 2006 was reported at just over $13 billion (Kiley), and the companys total equity as of 2009 stands at negative $17.311 billion (Ford 67). Debt notwithstanding, Ford stands apart from Chrysler and GM as the only Big Three manufacturer to not seek bankruptcy or government bailout since the onset of the current financial recession. Ford has incorporated Lincoln Mercury, Volvo, Aston Martin and one-third of Mazda into its brand roster. Fords Mission Statement is titled the One Ford Mission. It is divided into three parts One Team, One Plan, One Goal and is included in this reports Appendix on page 17. Ford strives to be one of the leading automotive manufacturers in the world, and to sustain this position for generations to come. Furthermore, Ford strives to provide its consumers with an affordable, ethical, and quality product. There are a number of key stakeholders that rely on the Ford brand, including financial investors, consumers, and large companies and government organizations that depend on Ford to maintain reliable fleets of vehicles (Datamonitor 14). Challenges to Ford While the Ford Motor Companys influence on the automotive industry is undeniable, a wide variety of challenges are preventing Ford from capitalizing on the opportunities presented by todays shifting economic and social landscapes. Three of these challenges will be outlined in the following section. They are listed in order of priority. Fords current automobile models are not as energy efficient, environmentally friendly, and sustainable as they could be. William Clay Ford Jr. echoes the sentiments of Ford Motor Companys Mission Statement in a recent interview: For us, sustainability is not just about the environment if you dont have a sustainable business model, none of the rest matters (Bonini and Kaas). Ford prides itself as a company built both on innovation as well as ethical responsibility. Yet Ford trails significantly behind Toyota in terms of hybrid technology and GM in terms of larger-class hybrid vehicles (Carr-Ruffino and Acheson 21). With no hybrid or alternative energy models of its own in several vehicle classes, Ford has much ground to cover in becoming a leader in environmental sustainability. Global economic markets are performing far worse than Ford had expected in prior planning. This poor planning has resulted in a $34.3 billion debt that strains Fords already tight budget (Ford 28). Compounding these problems, consumer confidence is, in turn, exasperatingly low (Datamonitor 9) with most consumers unwilling to make large purchases until markets improve. While government incentives such as the so-called cash-for-clunkers legislation and tax-credits for hybrid vehicle owners have helped American auto manufacturers weather unusually low sales figures, these fixes are temporary (U.S. Department of Energy). Fords market share in developing foreign markets is lower than desired. While Ford posted a 1.1% gain in domestic market shares this year (16.1% up from 15.0% at the close of 2008), the company remains fourth in total global sales behind Toyota, GM, and Volkswagen (OICA) and possesses only 2.0% of all automotive sales in the companys South Asia Africa sector, which includes the rapidly emerging markets of China and India (Ford 19). While Ford ultimately must address all of these challenges to remain competitive and fulfill its Mission Statement, the remainder of this report will focus on how Ford can create more energy efficient, environmentally friendly, and sustainable automobiles. In so doing, Ford stands to develop consumer acquisitions and brand loyalty by addressing rapidly changing needs of consumers and other stakeholders. Consumer Needs Research is showing that more and more consumers do not want to own cars that are not fuel-efficient. This is due to financial as well as ethical considerations (Prickett 29). Rising gas prices are increasing the importance of fuel-efficiency for consumers (Bonini and Kaas) and governments are willing to offer incentives to consumers in exchange for their purchases of more fuel-efficient vehicles. As the U.S. economy is based largely on fossil fuel usage and as increasing scarcity is beginning to characterize fossil fuel sources worldwide there is social interest vested in increasing overall reliance on sustainable energy sources. To remain competitive, Ford must not only acknowledge this future, but embrace it. Domestic and global auto-manufacturers stand to gain a competitive edge if Ford does not act on this changing consumer need quickly. More and more hybrid models emerge every year, with GM leading the way in larger hybrid vehicle models (Carr-Ruffino and Acheson). Chinas government and domestic auto-manufacturers have made it clear that they intend to make China the next center of hybrid and light vehicle construction (Gallagher). The clock is ticking and Fords window of opportunity is closing. Sustainability at Ford Ford must work to create sustainable models in all vehicle classes. These models must compare to conventional counterparts in terms of ticket price. On top of this, Ford must ensure that public infrastructure can adequately support these innovations so that consumers are not burdened with new operating complications, costs, or maintenance issues. Potentially promising areas of development include hybrid vehicles, natural gas vehicles, and electric vehicles (Bonini and Kaas). Hybrid vehicles present the least complicated fix in terms of infrastructure and consumer familiarity compared to other alternative fuel types. And while all options must be explored, Fords first step is to focus on developing and expanding its hybrid program. Fords hybrid program is already well underway, and would require less allocation of resources to build upon in comparison with other areas of research and development. Revamping Fords hybrid program will require significant financial commitments. In markets that already leave little breathing room for addition expenditure, this report recommends that Ford funnel all research and development funds into innovating Fords hybrid program. Ford must also develop cooperative RD facilities with leading energy firms, government research groups, and NGOs to save on costs and consolidate resources and knowledge. In addition, Ford should continue scaling back production to meet the lower demands of recession markets (Canis and Platzer) and redirect most of these savings into an expanded RD program. By making these changes in tandem with a massive PR campaign, Ford stands to gain considerable market shares both domestically and abroad (Byron). And while this recommendation is high-risk, the history of the Ford Motor Company demonstrates that Ford functions best when setting itself apart from competitors and taking risks. The Ford Motor Company was build on big thinking and technological innovation (Wren and Greenwood 73), and it is through these methods that Ford will overcome the most pressing challenges of todays market. Benefits to Sustainability Ethical screen. The notion of a more environmentally friendly Ford Motor Company is not only ethically compatible with Fords Mission Statement, it reaffirms and builds upon it. At the same time, there are consequences to this course of action that contain further ethical considerations. Due to the proposed closing of several production and retail facilities, a number of Ford employees stand to lose their jobs. This move is extremely unwelcome in a nation with an unemployment rate already averaging 9.7% (Bureau of Labor Statistics). Ford stands to suffer from bad publicity and to potentially contradict the ethical commitments outlined in its mission statement. This course of action, however, is necessitated by recession markets and does not represent the ultimate intentions of the Ford Motor Company. The strategy of creating a more sustainable Ford is intended to protect the job security of all Ford employees on a long-term basis (i.e. the creation of a more sustainable business model). It is the conclusion of this report, therefore, that this course of action complies with and upholds the ethical commitments outlined in Fords mission statement. Feasibility analysis. In terms of pure research, hybrid technology is fairly well understood and is already utilized by the Ford Motor Company. Focus must be placed on improving hybrid efficiency, performance, and reliability, as well as maintaining affordable costs to consumers. Furthermore, Fords RD facilities are top-notch and already working to develop Fords hybrid program. As of 2007, Ford had the second-largest research and development budget in the world at approximately $8 billion annually (Vijayenthiran). Additionally, Ford was the first auto-manufacturer to offer a U.S.-made hybrid vehicle (in the year 2000) (Carr-Ruffino and Acheson). Based on this information, it is entirely feasible that Ford can produce additional landmark models in the near future provided that adequate resources and proper strategies are applied towards revamping its current hybrid RD program. Cost-Benefit Analysis. There are a number of initial costs that Ford must account for in order to properly execute this course of action. Costs must be covered immediately and will rely on the success of several preliminary budget-saving steps. That said, the total price of developing hybrid models for all vehicle classes is intended to be accounted for through internal budget recoveries; reductions in production costs are meant to reduce the need for increased net spending. The potential benefits of these investments far outweigh initial costs, but are long-term and may not bring significant returns until the entirety of the plan is completed. And while this proposal is financially risky, the current problems facing the Ford Motor Company its potential inability to respond to the challenges and opportunities of a changing marketplace are dire enough that the competitiveness of the company itself is at risk. In this sense, these costs should not only be considered investments, but preventative measures. Costs: public relations campaign: $300 million annually includes costs due to advertising in print, television, radio, and internet media, partnerships with non-profit organizations, market research, and product promotions; revamped RD facilities: $700 million annually includes costs due to equipment, larger research/design staff, new/upgraded facilities, fair-use of patents and other legal expenses, materials, and partnerships with technology firms, government research groups, and NGOs. Total costs: approximately $1 billion annually for the next five years. Monetary benefits: A report from 2009 estimates that by 2015 the global hybrid vehicle market will have risen by 31.3% and be valued at around $67.7 billion (Global Markets Direct). In 2009 the U.S. market comprised 47.5% of all hybrid vehicles sold worldwide (or a predicted $32.16 billion annually in 2015, if the U.S. market share remains the same). Of these 2009 sales, Toyota has currently sequestered the highest market share of 72% percent (R.L Polk Co.). If Ford succeeds in obtaining the highest U.S. market share in prospected hybrid sales by 2015 and if this market share is roughly the same as Toyotas first-ranked share in 2009 Ford could earn up to $23.15 billion in hybrid vehicle sales in 2015 in the U.S. alone (72% of $32.16 billion). While this estimate is extremely rough and represents a very high performance in terms of Fords future hybrid sales, it illustrates the potential monetary benefits that may result from focusing on hybrid development over the next several year s. Other benefits: Financial and environmental sustainability should be considered tremendous benefits in their own right. It is through both that Ford ensures future competitiveness and remains true to its Mission Statement. Recommendations for Ford This report recommends the following steps to achieve success in its goal of creating a more sustainable Ford Motor Company. First, Ford must begin a PR campaign focused on educating consumers about the current status of the automotive industry and to raise awareness about the future Ford is helping to build. The campaign should focus both on consumers who, in general, already look favorably on hybrid vehicles, as well as those who may be skeptical about hybrid performance, cost, and feasibility on a larger scale. Ford must use this campaign to unveil to consumers its five-year plan to create a more sustainable Ford. This should begin immediately and be fully operational after a transition period of no more than four full quarters. Ford should continue this campaign until the Ford brand is synonymous with sustainability. A total of around $300 million per year (from an estimated $1 billion gleaned annually from facility closures) will be allocated towards the development and maintena nce of this new PR campaign. Market research teams will evaluate the success of this campaign twice per quarter. The PR campaign will be considered a success once the Ford brand is recognized above all global competitors as the leader in sustainability and hybrid vehicle production. Second, Ford must begin to significantly scale back production. This should be completed within the next four quarters. While the PR campaign should begin immediately, it may take several months for Ford to assess which production and retail facilities are most extraneous. Qualified workers can be transferred to different positions at RD facilities and public relations departments (Ford will begin recruiting internally). This step will be considered successful once Ford has reduced its production costs by a goal of around $1 billion annually. Managers will monitor the progress of facility closures with goals set at reducing operating costs by about $250 million annually per quarter for the next four quarters. Third, Ford must immediately direct newly acquired funds towards revamping its RD program and focusing this program upon the development of hybrid technologies. This should be completed within the next four quarters and will utilize an additional $700 million annually (gleaned from the estimated $1 billion in reduced annual operating expenses). Achievement teams will assess the growth of Fords hybrid RD program twice per quarter, ensuring that a gain of at least $175 million in addition annual RD funds are available at the end of each quarter. Fourth, Ford must begin to develop relationships and partnerships with leading energy firms. By creating cooperative RD facilities where research tasks, budgets and innovations are shared Ford stands to make significant strides at lower costs and accelerated rates. By sequestering their cooperation early on, Ford stands to gain a competitive edge against competitors. Ford must gain cooperative relationships with the majority of leading energy and engineering firms such as General Electric and Lockheed Martin as well as non-government organizations and federal research groups like the EPAs National Vehicle and Fuel Emissions Laboratory (NVFEL) in Ann Arbor, Michigan (U.S. Environmental Protection Agency). Costs and evaluations will be incorporated into expanded RD departments. Fifth, Ford must unveil several new models of hybrid vehicles in all vehicle class types. This should be accomplished completely by 2015, followed by the eventual discontinuation or transformation of existing conventional-engine-models in years to follow. Hybrid models should cost no more than current conventional counterparts, and perform comparatively. Vehicle design budgets will be incorporated into expanded RD departments. The challenges facing the Ford Motor Company are great, but will be overcome through innovation and an increased dedication towards environmental and financial sustainability. Ford has repeatedly acted as a revolutionary force throughout history, and it is only through equally radical revolutions and innovations that Ford can help usher a new era in the global automotive industry.

Elmer Gantry Essay -- Essays Papers

Elmer Gantry The majority of all books are trash. Sinclair Lewis’ Elmer Gantry is a great book because it has credibility, a timeless theme, and it has the necessary action. Any book that can do that is a great book. The credibility of Elmer Gantry is something that will keep this book eternally great. Although the actual time period is dated, the plot is not dated. Most people can relate to the different characters in the book. Elmer is a pompous football player who thinks that he is higher than any religion. However, people try, and successfully convert him. He attempts to please two masters at first: his vices and God. He eventually makes the decision to live by God, but of course he will occasionally fool around with his old vices, especially adultery. Most people know someone who is like this and still somehow succeeds although he shouldn’t have. Although Elmer is more extreme than the people the reader is likely to know, he is still a very credible characters. Another thing th at makes this a timeless novel is that it has the needed action to attract the reader who only wants entertainment. Elmer often gets into fights that will keep the reader in the edge of their seat. He will face odds that most would run away from, but also has times when he backs down from a fight, such as when Brother Naylor and Brother Bains confront him about â€Å"fooling around† with Lulu. It also has enough opportunities for the modern person to think about sex although it doesn’t graphical... Elmer Gantry Essay -- Essays Papers Elmer Gantry The majority of all books are trash. Sinclair Lewis’ Elmer Gantry is a great book because it has credibility, a timeless theme, and it has the necessary action. Any book that can do that is a great book. The credibility of Elmer Gantry is something that will keep this book eternally great. Although the actual time period is dated, the plot is not dated. Most people can relate to the different characters in the book. Elmer is a pompous football player who thinks that he is higher than any religion. However, people try, and successfully convert him. He attempts to please two masters at first: his vices and God. He eventually makes the decision to live by God, but of course he will occasionally fool around with his old vices, especially adultery. Most people know someone who is like this and still somehow succeeds although he shouldn’t have. Although Elmer is more extreme than the people the reader is likely to know, he is still a very credible characters. Another thing th at makes this a timeless novel is that it has the needed action to attract the reader who only wants entertainment. Elmer often gets into fights that will keep the reader in the edge of their seat. He will face odds that most would run away from, but also has times when he backs down from a fight, such as when Brother Naylor and Brother Bains confront him about â€Å"fooling around† with Lulu. It also has enough opportunities for the modern person to think about sex although it doesn’t graphical...

Managing Conflict Essay

Managing conflict Medicolegal issues We live in an increasingly demanding and vociferous society and incidents of conflict and aggression are sadly commonplace. Kate Taylor, Clinical Risk Manager at the Medical Protection Society offers advice on how to deal with the problem Working in general practice is busy and demanding, with increased workloads, stretched time and some patients having greater expectations of care. At times, when expectations are not met, we can find ourselves in conflict with patients – and in some situations this can turn to aggression. As nurses, how should we deal with potentially difficult situations? This article aims to increase our understanding of conflict and provide strategies to deal with it effectively. It also includes practical tips to reduce risks associated with managing conflict and aggression. DEFINITIONS Conflict means different things to different people. The Health and Safety Executive defines workplace violence as ‘any incident where staff are abused, threatened or assaulted in circumstances relating to their work, involving an explicit or implicit challenge to their safety, well-being or  health’.1 Non-physical violence can be defined as the ‘use of inappropriate words or behaviour causing distress and/or constituting harassment.'[ 2] The scale of the problem There is limited documentation relating to violence against nurses working in general practice. However, a recent survey carried out by the British Medical Association, to which 20% of doctors responded, found:[ 3] * Violence is a problem in the workplace for half of doctors (same for GPs and hospital doctors). * 1 in 3 respondents had experienced some form of violence in the workplace in the last year (same for hospital doctors and GPs). * 1 in 5 doctors reported an increase in violence in the past year, but the level remained constant for the majority. * Among doctors who reported some experience of violence, most had been the victim of verbal abuse in the past year while more than half had received a threat, and a third had been physically assaulted. Most injuries were minor, but 5% were serious. In April 2011, NHS Protect was set up. It is responsible for leading on work to protect NHS staff and resources from crime in England.[ 4] According to its statistics, physical assault against NHS staff is steadily increasing. However, these statistics do not capture the incidents where staff have been subjected to non-physical violence. In general practice, members of staff are more likely to be subjected to non-physical violence. Imagine working as a practice nurse and an unhappy patient threatens you, telling you ‘I know where you live?’ We cannot underestimate the impact that such non-physical violence can have on individuals. CONTRIBUTORY FACTORS Circumstances * Members of the general practice team are particularly vulnerable as they often consult with patients alone. Doctors and practice nurses often work in small numbers. * Home visits are usually carried out alone. System and Organisational Problems * Delays, restrictions and mistakes such as lost prescriptions or delays in test results * Lack of appointments * Patient disappointment often results from unmet expectations, whether  realistic or unrealistic. Environment * Waiting room (heating, lighting, noise and seating) * Cramped consulting rooms without easy exit for health professionals * Lack of privacy * Availability of potential weapons. Patient Factors * Increased expectations and the difficulties in meeting these demands. Dissatisfaction with the care provided is perceived as the most common cause of aggression and violence * Strong patient emotions e.g. uncertainty, frustration, stress and anxiety. Anger is often secondary to emotions such as anxiety or grief * An underlying medical condition such as hypoglycaemia or psychotic illness * Physical symptoms including pain, headache or over-tiredness * Mental health problems such as * Personal problems e.g. financial, relationship, stress at work * Drugs and alcohol. Staff Factors * Under pressure staff-working in noisy cramped rooms, unable to trace or contact staff * In adequate staff numbers * Escalating the situation by confrontation, over-reacting, poor ccmmunication, inconsistencies in handling patients, patronising behaviour, ignoring a situation or falling to apologise. COMMUNICATION SKILLS Good communication with patients is likely to reduce the risk of conflict and violence. As nurses, how we communicate with our patients can have an impact on how difficult situations develop. We need to think about what we say and how we say it. We should rely on our strong communication skills to determine with our patients what they can expect from the services we provide. A study by American psychologist, Albert Mehrabian, determined that non-verbal communication represents over 50% of an interaction.[ 5] Being aware of your own body language can be the first step to understanding how it is perceived by our patients. Listening and empathising with patients are essential skills for nurses-so how do we ensure our patients know we are listening? * Give the patient your undivided attention * Don’t trivialise the patient’s issue * How is the patient feeling – are they angry, afraid, frustrated? Respond to the emotion as well as the words * Allow the patient to finish what they are saying * Ask questions, paraphrase and reflect to ensure you understand the message. CHALLENGING INTERACTIONS Challenging interactions with patients can be a significant cause of stress for nurses, yet the nature of most clinical jobs makes these encounters unavoidable. It can be difficult to communicate your point of view effectively for fear of generating conflict, which can lead to frustration and dissatisfaction, and may affect your ability to give good care. It is vital to build a trusting relationship with the patient in these circumstances; ensure you listen attentively, empathise and avoid confrontation. Maintain eye contact and try to establish a shared understanding of the patient’s problem. Having acknowledged their perspective, respectfully inform them of your position. Then work on achieving a mutually agreeable solution or way forward rather than focussing on points of disagreement, which can otherwise degenerate into an argument. Then help and support the patient to achieve the agreed solution. After challenging interactions that have required you to state your position, ensure there is effective communication with other members of the practice clinical team, along with a clear record of the discussions held. This will ensure consistency should the patient approach a different clinician seeking to re-negotiate an alternative plan or outcome. PRACTICAL TIPS Practices should consider: * Providing a side room or separate area to deal with upset/aggressive patients or those who need more privacy. * Providing good temperature and ventilation control, adequate seating and clear signage * Providing calming measures to reduce frustration, anxiety or boredom such as distractions in waiting room e.g. toys for children, magazines for adults * Adding an agreed marker to the summary of a patient’s record who has a history of violence (and ensure it is factually accurate) * Having a protocol for involving the police and removing patients from the list * Using CCTV * Ensuring all practice staff have access to panic alarms * Providing locks for all areas where patient access is restricted CONCLUSION We can and will experience conflict in general practice due to the sheer volume of patient contacts that occur every day. The key to managing a conflict situation is to try to de-escalate it as much as possible.confidentiality is central to the trust between nurses and their patients – think how easy it may be to breach confidentiality when you have a situation with an aggressive patient. The Nursing and Midwifery Council Code of conduct clearly states ‘you must respect people’s right to confidentiality’.[ 6] As a last resort you can remove a patient from the practice list. However, this can be seen as an emotive issue, risking criticism from bodies such as the Parliamentary and Health Service Ombudsman, the GMC and the media. You can find useful information on how to go about it in the MPS factsheet, Removing patients from the practice list (September 2013).[ 7] http://www.medicalprotection.org/ uk/england-factsheets/removing-patients-from-the-practice-list. CASE STUDY Nurse E is about to start her clinic when she notices Mrs S on the list of patients for the day. Her heart sinks. Mrs S often presents with one or more complaints, talks nonstop and does not listen to advice provided. She knows from experience that interactions with Mrs S will be challenging. Mrs S is called in 20 minutes later than her planned appointment and she lets Nurse E know that she is not happy. Nurse E admits that her clinic is running late but tells Mrs S that she had an unavoidable emergency. She proceeds to take Mrs S’s blood pressure and other vital signs. Mrs S then asks Nurse E for a prescription for antibiotics as she is going on holiday and wants them ‘just in case her chest flares up’ while away. Nurse E advises her that she will need to make an appointment to see the GP. Mrs S, now increasingly unhappy, begins to raise her voice and bang her fist on the desk, demanding a prescription before she leaves. Nurse E, staying calm, advises Mrs S that she is unable to give her a prescription as she doesn’t have any active symptoms. Mrs S storms out of the consultation room pushing past Nurse E. Understandably upset, Nurse E calls the practice manager to report the incident. How could this situation have been dealt with better? * Apologise when mistakes occur or when clinics are running late. Some practices ask reception staff to inform patients when they are checking in if clinicians are behind schedule * Ensure patients are well informed about how systems at the practice work to try to reduce unrealistic expectations * Acknowledge the patient’s emotions and allow them to express them, which can take time. Ask the patient to tell you about their concerns. Listen actively using comments such as ‘I see’, or ‘go on?’, and nodding your head. Summarise their experiences, feelings and concerns back to them * Work with the patient to resolve the situation. Agree a plan for dealing with their concerns and moving forward. * Try to offer an alternative solution to demonstrate that you are keen to help them. For example, ‘I’m sorry Mrs S, but I am unable to give you a prescription. However, if you wish to make an appointment with one of the GPs you can discuss this with them’ * Consider the layout of the consulting rooms and reception area to ensure you can leave the room if the situation escalates. Aggression in healthcare settings is becoming all too common REFERENCES 1. Health and Safety Executive: work related violence www.hsegov.uk/violence 2. NHS Business Services(2012) Not part of my job http://www.nhsbsa.nhs.uk/Documents/ SecurityManagement/NP0J1 .pdf 3. British Medical Association (2008). Violence in the workplace. The experience of doctors in the UK. http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/ PDFviolence08/$FILE/Violence.pdf 4. NHS Protect 2013 http://www.nhsbsa.nhs.uk/Protect.aspx 5. Mehrabian, A(1971) Silent messages Belmont, CA:Wadsworth 6. NMC(2011)The code: Standards of conduct, performance and ethics for nurses and midwives http://www.nmc-uk.org/Documents/Standards/ nmc TheCodeStandardsofConduct PerformanceAndEthicsForNursesAndMidwives%5FLargePrintVersion.PDF 7. MPS Factsheet removing patients from practices list September 2013 http://www.medicalprotection.org/uk/england-factsheets/removing-patients-from-the-practice-list ~~~~~~~~

Bad Survey Questions

EXAMPLES OF BAD QUESTIONS & SUGGESTIONS OF HOW TO FIX THEM! Double Barreled question: Please indicate how much you agree or disagree with each of the following statements about the childcare program. Incorrect: I feel welcomed by staff and other youth at the center Correction: I feel welcomed by staff at the center I feel welcomed by other youth at the center Biased/leading question Incorrect: Community organizing is hard. Do leadership trainings help you feel prepared for community organizing? Much more prepared Slightly more prepared Somewhat more prepared Not more preparedCorrect: The leadership trainings prepare me for community organizing. Strongly agree Double Negative Incorrect Does it seem possible or does it seem impossible to you that the Nazi extermination of the Jews never happened? (22%) Very possible Impossible Correct Do you doubt that the Holocaust actually happened or not? (9%) Very possible Impossible Possible Very impossible Possible Very impossible Agree Disagree Strongly disagree EVALUATING SURVEYS The following are additional examples of bad survey questions. As a group, apply our class discussion, evaluating each question and its response choices to identify one error in each question (ie. ouble barreled). Explain the problem that your group identifies in each question and propose an alternative that solves the problem. 1. More people have attended the movie, Gone with the Wind, than any other motion picture produced this century. Have you seen this movie? Yes No 2. In your opinion, how would you rate the speed and accuracy of your work? Excellent Good Fair Poor 3. Did you first hear about the bombing: ______ from a friend or relative ______ from your spouse ______ from a newspaper ______ at work ______ from the television or radio or other electronic media 4.How do you feel about the following statement? We should not reduce military spending. Strongly agree Agree Disagree Strongly disagree 5. People grow up in all different types of fam ilies. What type of family did you grow up in? ______Mom as single parent ______Dad as a single parent ______Both Mom and Dad 6. Where do you get most or all of your information about current events in the nation and the world? __radio __Newspapers __Magazines __internet 7. Higher than single-family density is acceptable in order to make housing affordable. Strongly Undecided Disagree Strongly Disagree Agree Agree 1 2 3 4 5CORRECTING SURVEYS The following are some suggestions of how to fix the problems of the survey questions found on the prior page. 1. Problem: Biased/Leading Solution: Have you seen the movie Gone with the Wind? Yes No 2. Problem: Double Barreled Solution: In your opinion, how would you rate the speed of your work? Excellent Good Fair Poor In your opinion, how would you rate the accuracy of your work? Excellent Good Fair Poor 3. Problem: Categories are not Mutually exclusive Solution: Did you first hear about the bombing: ____ from a friend ____ from a relative ___ _ from a media source 4.Problem: Double Negative Solution: How do you feel about the following statement? We should reduce military spending. Strongly agree Agree Disagree Strongly Disagree 5. Problem: Categories are not Exhaustive Solution: People grow up in all types of families. What type of family did you grow up in? ____two biological parents ____one biological parent & a step parent ____ mom as a single parent ____ dad as a single parent ____ with a relative other than my biological parents ____ in foster care ____ with adoptive parent(s) 6.Problem: Double Barreled Solution: Which media source do you rely on most to get information about current events involving the nation? ___radio ___ Newspapers __Magazines ___ Internet Which media source do you rely on most to get information about current events involving the world? ___radio ___ Newspapers __Magazines ___ Internet 7. Problem: Ambiguous Solution: In order to make housing affordable, is it acceptable to build housing whose b uildings hold more than one family? Strongly agree Agree Undecided Disagree Strongly Disagree