Case Study K

Case Study K

Betty, a 50-year-old woman, came to this country with her parents when she was 7 years old. The family members worked as migrant farm workers until they had enough money to open a restaurant. Betty married young. She and her husband worked in the family restaurant and eventually bought it from her parents. They raised seven children, all grown and living on their own. Betty and her husband live in a mobile home close to the restaurant. She does not work in the family restaurant anymore because she worries excessively about doing a poor job. Betty no longer goes out if she can help it. She stays at home worrying about how she looks, what people think or say, the weather or road conditions, and many other things that keep her from being social.

Betty does not sleep at night and keeps her husband awake while she roams the house. She often feels on edge or restless. She keeps her clothing and belongings in perfect order while claiming she is doing a poor job of it. She does not prepare large family dinners anymore, though she still cooks the daily meals; one daughter has taken over the family dinners. This daughter has become concerned about Betty being isolated at home and worrying excessively and calls the community mental health center for an appointment for Betty.

After some convincing Betty agrees to go to the community mental health center accompanied by her husband, her children and their spouses, several grandchildren, and a few cousins. When Betty’s name is called and she is told that the nurse is ready to see her, she frowns and says: “What will I say? I don’t know what to say. I think my slip is showing. My hem isn’t straight.” Betty is extremely well groomed and dressed in spite of concerns she has been voicing about her appearance. Betty also mentions that she wants her whole family to go in to see the therapist with her. Before the interview begins, Betty’s daughter was over heard saying that Betty “worries all the time” and although she has always been known to be a worrier, the worrying has become worse over the past six or eight months.

Although Betty wants her entire family to accompany her during the interview, she is told she cannot. This is difficult for Betty, as she repeatedly seeks reassurance from her family members. The husband shares with the therapist that Betty is constantly keeping him awake at night and often will bring up the same things that worry her on a daily basis. The therapist then interviews Betty alone. They notice that Betty casts her eyes downward, speaks in a soft voice, does not smile, and seems restless as she taps her foot on the floor, drums her fingers on the table, and seems on the verge of getting out of her chair. Betty shared that she is often tired and gets tired easily even though she spends most of her time at home, is not able to concentrate and has issues getting housework done around the house. She also shares that a recent worry for her is whether or not her husband loves her anymore and whether she and her husband have enough money, and that she does not have enough energy to attend to her clothing.

There is no convincing Betty that she looks all right. Any attempt to convince her that she need not worry about something in particular leads to a different worry before coming back to the earlier worry. After examining Betty the therapist is unsure of the explanation for her fatigue and difficulty sleeping and asks her if she is currently taking any medication that may be causing side effects. Betty produces her medicine bottles and says she is currently taking only vitamins and a hormone replacement. The therapist concludes that she may be experiencing side effects of fatigue due to her hormone replacement medication and asks her to make an appointment with her primary care provider.

A month later, during a phone call with Betty, the therapist learns, with some probing, that Betty is upset with her husband for loaning all their savings to the daughter and her husband to build a new home, while they continue to live in an older mobile home. Since learning this, Betty has not been able to sleep and has kept herself isolated in her and her husband’s bedroom and has not cooked or cleaned in over two weeks. Betty worries she is not getting better and asks the therapist about taking some herbal medicines containing kava and passaflora that her sister got from a healer; her sister wants to take her to see the healer and have her do a ritual to cure the “evil eye” that was placed on Betty and made her sick. Betty’s daughter can be heard strongly disagreeing with her aunt and the therapist’s assessment, telling Betty that she is not satisfied with her progress and will be contacting another therapist or doctor for a second opinion.

ADDITIONAL THOUGHT QUESTIONS

How common is the diagnosis? Is it common for clients with this disorder to have comorbidity, and should this client be assessed for any other condition?

A lot of people worry on a daily basis. Some people focus their worry on themselves, those that they love and care for or even events that are taking place in the world, but it doesn’t necessarily meet the criteria for a disorder. At what point does someone go from worrying to experiencing worry that is diagnosable?

Adaptive Leadership

Student’s Name:

Professor’s Name:

Course:

Due Date:

Adaptive Leadership

Adaptive leadership requires that leaders work with every member of their organization in the solving of definite and unavoidable problems. In this regard, the accomplishment of adaptive work is highly dependent on compulsory motivation and initiation of support from other members of the organization by leaders. In a broader perspective, leaders must motivate their followers into backing them up in finding solutions for problems in the organization.

In the organization I have chosen; the adaptive challenge experienced in the company is competition. There is very stiff competition in the industry especially from new entrants into the market. The major problem is that at least two other companies have just suddenly risen up and entered the market with new and seemingly better products as customers seem to be flocking towards them.

In this case, my opinion is that this organization needs to consult with every member and stakeholder on the way to regain its market status. Experts could be consulted as well. The questions that arise are: what is the other companies doing that they are not? Do they have better quality products? How can they get back their customers? The most likely issue here is that the quality of products offered by the new entrants could be higher and therefore more appealing to the customers. The prices could also be lower.

This organization should mobilize its employees to help produce better quality products and brainstorm on ways of making their products more attractive and cost effective.

There definitely needs to be a trade-off between efficiency and quality. This organization is focused on being efficient in producing large quantities of goods. The challenge they face now would require them to find a way to manage both as the scale of quality definitely needs to go up.

To sum up, the outcome is expected to be positive if nothing goes wrong. The leadership in the organization is relatively good and therefore this situation should not be so difficult for them to handle. Besides they have the advantage of having customer loyalty which has just been slightly shaken. It is my belief that, in no time, this organization will regain its status quo if it uses appropriate strategies.

Works cited

Heifetz, Ronald A, Alexander Grashow, and Martin Linsky. The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World. Boston, Mass: Harvard Business Press, 2009. Print.

Obolensky, Nick. Complex Adaptive Leadership: Embracing Paradox and Uncertainty. Farnham, England: Gower, 2010. Print.

Case Study of Coaching on Human Resource Management

Case Study of Coaching on Human Resource Management

Student’s Name

Institution Affiliation

Course Name and Code

Professor’s Name

Date

Case Study of Coaching on Human Resource Management

Introduction

As a Human resource manager, I have thought of hiring a coach to enhance the developmental; activities within the executives, mitigating the challenges the managers experience in the delivery of duties. As such, it is necessary to identify and allocate the champion to solve the situation of division within the organization. There exist human resource units consisting of the internal staff within the organization. One is characterized by fifteen years’ experience but has practical coaching on an imitational basis. Another staff member has one year of experience within the company but uses the historical experiences used in conducting the coaching of another organization. Notably, there is Jane, an executive assistant that needs coaching. The staff reported that she talks down to them, cannot conduct resolution of conflicts, and ignores the problems brought to her. However, there is a need to help the situation by providing a coaching mechanism because Jane is an asset to the company’s prosperity. Therefore, the paper discusses the types of research I will conduct as a human resource manager to determine the methods of approaching Jane, the ways of approaching Jane for coaching, the methods of introducing the coaching idea to Jane, and the use of external coaching. Also, the paper examines the criteria I can use if the coaching was unsuccessful and the use of Jane as a champion within the organization.

The Type of Research I will Conduct to Determine how to Approach Jane to be Coached

Determining the method of coaching Jane requires comprehensive research to enhance the profitability of coaching. As such, I would conduct numerous types of research to create systematic criteria for enhancing the quality of coaching. The immediate research I would use is the assessment of the competencies of the existing workforce. The assessment of the competencies enhances the observation of the skill mindset of the employees (Wilson, 2014). Also, it acts as a baseline for determining the acceptable behaviors and the competencies that an individual must have within the organization. I identified that the mid-level workers’ skills are lacking in the company. Their competencies are also limited; hence, they need to act swiftly to change the situation (Raza et al., 2018, p.29). Therefore, Jane is characterized by lacking interpersonal skills and disrespecting other workers and subordinates within the organization. The disrespectful behavior makes many workers upset, making them create formal complaints through letter writing against Jane’s behavior. However, Janes’ skills make her an asset to the company and hence need coaching to mould her behavior, thereby becoming an effective leader.

Also, leadership and executive coaching are required to make them influential leaders. Employees will continue to exhibit their effectiveness in the working relationship and interpersonal behaviors. The executive and leadership coaching is provided by certified and trained coaches who observe, asses, listen and personalize the practical approach to individual workers for the leadership development needs. Identifying the necessary competencies characterizes the company management we have identified. The competencies include compassion, listening, organization, team leadership, honesty, loyalty, and fostering integrity (Wilson, 2014, p.2). Notably, executive coaching provides a structured, safe and trustworthy environment to support an individual through one–on–one meetings (Johnson, 2015, p.10). One-on-one meetings with the senior managers within the organization, like the vice president, president and team leaders, enable the leaders to understand the current competencies and their perception by others. It also enhances the identification and clarification of the current goals and the appropriate actions and steps for reaching the specific goals.

Approaching Jane to be Coached After Conducting the Research

I will approach Jane in a quiet office with another human resource management officer by telling her about the workplace concerns that arose in the office. Notably, the managers evaluate the individual worker performance by creating criteria for identifying the weaknesses and the strengths using the feedback generation mechanism (Wilson, 2014, p.2). Also, the employees can ask questions and share feedback with the management. As such, it is our responsibility to bring forth the idea of calling a coach to sensitize the employees on the goals the company needs in the workplace. Furthermore, we must emphasize the negative outcome that defines if we never progress; the case of termination may occur because of a violation of the terms of employment and the codes of conduct.

The Pros and Cons (benefits or detractors) of Having Jane Coached

Having Jane coaches get characterized by many pros. However, there also exist cons which characterize the coaching. Coaching in the company in the leadership setting remains invaluable and hence helps develop an individual across several needs. As such, the benefits of coaching outnumber the detractors of coaching. The reports depict that 80% of people who get coaching increases their confidence75% in work performance, effective communication and relationship (Raza et al., 2018, p.34). Also, 90% of the companies report that they have invested in coaching to improve product quality and quantity. Therefore, coaching provides a mechanism for the personal development of an employee. Employees continue to learn new communication strategies hence improving their confidence. However, the cons of coaching get based on the rare production of sustained confidence because of the induction of the isolation mechanism (Wilson, 2014, p.1). The cost of coaching may not be economical for an individual or the organization to sustain because the coach, who is a professional, needs payment to conduct the duties. Coaching is also consuming time since it involves investment in the employee who takes time to cope with the organization’s standard duties.

Introduction of the Coaching Idea to Jane

I would introduce the idea of coaching to Jane by sensitizing him on the importance of coaching and highlighting the importance of social interaction between an employee and the external coach. Before the actual coaching, I would build a mutual relationship and trust with Jane. The possibility of conducting coaching using an external source requires trust, confidence and the open-mindedness of the one being coached (CIPD, 2008, p.1). Also, I would create an open meeting with Jane to highlight the areas of weaknesses that characterize the work openly with respect. The opening meeting clarifies in a non-evaluator and non-accusatory manner by providing the specific issue and why the coaching meeting was arranged by the management of the company (Johnson, 2015, p.10). Reinstating the coaching on a non-judgmental and friendly mechanism creates an open environment for the appointment of the schedule. Consequently, I would get an agreement with Jane through the verbal mechanism. Avoiding and overlooking the performance due to assumption on the employee undertaking of the significance remains a mistake of the manager and other departmental leaders within the organization. As a result, I must be able to address the issue and its nature by making Jane recognize the consequences of not changing her mind. Doing so requires the specification of the behavior and clarification of the consequences (Raza et al., 2018, p.32). The behaviour specification involves citing examples of the performance issue, clarifying the performance expectations and asking Jane about the issue agreement. Notably, I would identify the consequences of not complying with the issues to jane by probing for getting Jane about the articulation of her understanding associated with the performance issues and asking for the issue agreement. Most importantly, I would explore the alternatives by determining the ways of improving the issues or corrected through encouraging Jane to identify the alternative solutions. Pushing for a specific alternative also needs explanation and not generalization through maximization of the number of choices those employees consider by discussing the advantages and the disadvantages.

I would also introduce the coaching to Jane by explaining the need for the commitment to act. Commitment to act makes Jane the ability to choose the alternative. I will use the verbal commitment from Jane regarding the possible actions to be taken and the generation of the supportive actions of the choice of Jane and praising of the offers. The introduction of coaching also requires the ability of an individual to handle the excuses. As such, I will handle excuses appropriately through the notion of the taken points like the blame games, accusations and encouragement for the behavior examination (Serrat, 2017, p.3). Moreover, I would respond empathetically by supporting Jane’s situation through communication and understanding her feelings about the comment.

The Use of an External or Internal Coach When Jane Accept Coaching

It is productive to hire an external coach for the case of Jane upon accepting coaching because the internal coach is an individual working within the company, like the direct manager. As such, an external coach remains a professionally certified individual hired by the company and outsourced from the external environment. Because Jane is an executive member, it is better to make her comfortable and have better feelings by hiring an individual the extensive coaching experience and training than the managers. The individual should also have spent time coaching others (Serrat, 2017, p.3). Notably, Jane will be able to discuss emerging and secret issues with the external coach that may be hidden from the internal staff members. The external coach is not affected by the company’s politics; hence Jane will become more open to discussing every critical issue that affects her work delivery. Also, Jane will be more adapted to provide sensitive feedback because the coach will apply the principles of maintaining confidentiality and objectivity.

Use of Jane as a Champion of Spearheading Coaching Culture After Success of Coaching

In the situation where coaching is successful in the condition of Jane, I would use Jane as a champion for the caching culture because Jane is an ideal employee in a company and hence can easily crate work motivation and the ability of the employees to follow suit. Also, Jane’s dedication and feedback about the company enable the company to change its management policies. Her lashing out at employees was because of overworking and the need to do more tasks which is above her handling ability (Raza et al., 2018, p.40). The situation of Jane continues to depict the depression which characterized her move after the divorce. Sometimes, the employees could have gossiped about her divorce issues, making her create negative remarks due to pressure, stress and depression. As such, the company has edited the codes of conduct for hiring social workers for the attainment of the mental well-being of the employees. Even though the investment might become expensive for the company, the company has also learnt the criteria for handling the stressors within the working environment (Serrat, 2017, p.3). However, the expense of the coaching seems to be non-economical, but the management had highlighted negative things within the organization that the managers would not have known when the internal coach was applied. As such, there is a need to ensure that all the employees work in an environment that will promote positive changes. The environment should also have the opportunities to exploit and report company challenges. The management should also use rewards to motivate the employees’ hard work, creating a creative and innovative environment for the mutual benefit of the managers and employees.

The Alternative Means to Help Jane be Successful in the Organization Apart from Coaching

The alternative approach to helping Jane succeed in the organization is to foster internal communication within the company. Internal communication involves the use of official communication like guidelines, memos, procedures and policies, and unofficial communication w2hic h is generated by the manager between the staff involving the exchange of ideas. Notably, communication within the organization will provide the needed information at a particular moment and time. It also lets all employees know anything that concerns them (Serrat, 2017, p. 3). Other importance of communication within the company for the mitigation of the challenges is the suggestion of new ideas, understanding of the overall situation of the organization, and the maintenance of the shared vision. The communication should not be one-sided hence creating the emphasis on the audience.

Moreover, communication improves effectiveness and allows the entire organization to respond quickly to changing emergencies. Effective communication has also triggered problem-solving by creating openness within the company (CIPD, 2008, p.1). The methodology of enhancing communication within the company involves making all the employees, including Jane o practice the criteria of delivering the messages. Also, Jane and her colleagues should practice treating everyone similarly regardless of the position and the job within the organization.

Conclusion

Overall, Jane was experiencing issues which required urgent attention for the effective operation of all the departments. She was assigned a role in the organization. Several internal and external issues characterized the challenges. The internal issues include the workmate’s move to blackmail her divorce situation, while the external forces are the work pressure and lack of adequate technical know-how to complete the job. As such, coaching was the only asset the company could employ to enable Jane to conduct her daily task. Therefore, I would advise the company to encourage changes and avoid overcoming obstacles.

References

CIPD. (2008). Coaching and Buying Coaching Services. Retrieved from: https://www.portfolio-info.co.uk/files/file/CIPD%20coaching_buying_services.pdfJohnson, M. (2015). Engaging a multigenerational and multicultural workforce: One style does not suit all. Plans & trusts, 33(5), 10-15. Retrieved from EBSCO Multi-search database.

Raza, B., Ali, M., Ahmed, S., & Ahmad, J. (2018). The mediation and moderation model impacts managerial coaching on organizational citizenship behavior. International Journal of Organizational Leadership, pp. 7, 27–46. https://ijol.cikd.ca/article_60360_b5930dae0306fc69e33c7e9a5bbe1256.pdfSerrat O. (2017). Coaching and Mentoring. In: Knowledge Solutions. Springer, Singapore. Retrieved from: https://link.springer.com/chapter/10.1007/978-981-10-0983-9_101Wilson, C. (2014). Performance coaching: A complete guide to best practice coaching and training (2). London: Kogan Page.

ADD, suffering from this problem of wondering

ADD

Have you ever had a conversation with a person and you can see that their interest seems to be drifting to somewhere else? There are many young people as well was adults who are members of a group whom suffer from this problem of wondering. They suffer from what is called ADHD or Attention Deficit Hyperactivity Disorder. Along with ADHD, is the disorder of ADD or Attention Deficit Disorder? Both are similar and can have an enormous impact on a child’s life.

According to Encyclopedia.com, ADHD and ADD is a “chronic, neurologically based syndrome characterized by any or all of three types of behavior: hyperactivity, distractibility, and impulsively. Unlike similar behaviors caused by emotional problems or anxiety, ADHD does not fluctuate with emotional states. Often diagnosed when a child begins school, ADHD is usually accompanied by learning difficulties and social inappropriateness. Treatment may include medication such as methylphenidate hydrochloride (Ritalin), which corrects neurochemical imbalances in the brain; sugar intake is no longer considered to be a factor. Also behavioral modifications therapy a way of teaching people the organizational techniques and coping strategies, which is one of the most effective ways to curb symptoms. Symptoms may decrease after adolescence, although adults can also have ADHD and ADD as well.” The most recent news about medications is that the first Lady and U.S Senate candidate Hillary C!

linton responded to recent studies that show a doubling or possible tripling of the number of children under age four taking Ritalin, a drug that is believed to increase a child’s alertness by stimulating the central nervous system. Clinton has called for a plan that would create

new government warning labels for such drugs, a national study of their use and a fall conference on children’s mental health.

Attention Deficit Hyperactivity Disorder is a learning disorder in which psychiatrists have been looking into since the 1940’s. Serious studies were not started until the 1980’s and then “within the past several years, medical researchers have begun to clarify its symptoms and causes and have found that it may have a genetic underpinning. Today’s view of the basis of the condition is strikingly different from that of just a few years ago. We are finding that ADHD and ADD is not a disorder of

attention, as had long been assumed, rather it arises as a developmental failure in the brain circuitry that underlies inhibition and self-control. This loss of self-control in turn impairs other important brain functions crucial for maintaining attention, including the ability to defer immediate rewards for later, greater gain.” (Barkley).Young children are most often diagnosed with ADHD in there early years of development. Russell A. Barkley is a doctor who diagnosed his young patient Keith with ADHD. Here is how Keith was acting before Russell Barkley saw him. “As I watched five-year-old Keith in the waiting room of my office, I could see why his parents said he was having such a tough time in kindergarten. He hopped from chair to chair, swinging his arms and legs restlessly, and then began to fiddle with the light switches, turning the lights on and off again to everyone’s annoyance-all the while talking nonstop. When his mother encouraged him to join a group of other children busy in the playroom, Keith butted into a game that was already in progress and took over, causing the other children to complain

of his bossiness and drift away to other activities. Even when Keith had the toys to himself, he fidgeted aimlessly with them and seemed unable to entertain himself quietly.

Once I examined him more fully, my initial suspicions were confirmed: Keith had attention-deficit hyperactivity disorder (ADHD).” There are no known cures for ADHD. There are ways to help control it to a confinable disorder. CHADD is an organization that tries to help those children and adults with ADHD. It is a national non-profit organization that was founded in 1987 by a group of concerned parents. CHADD works to improve the lives of the people who live with a person suffering with ADHD and ADD through education, advocacy and support.

“Today, children and adults with ADHD and ADD have CHADD, the national organization with over 32,000 members and more than 500 chapters nationwide, to provide that support and information. Thanks in large part to the efforts of CHADD, AD/HD is now recognized as a treatable, yet potentially serious disorder, that affects up to 2.6 million school-aged children between the ages of 5 and 18, and an estimated 2-5 million adults. Today, children with ADHD can receive special education services or accommodations within the regular classroom when needed, and adults with ADHD may be eligible for accommodations in the workplace under the Americans with Disabilities Act of 1990 guidelines issued by the Equal Employment Opportunity Commission in 1997.” (CHADD.com). “CHADD is a success story, inspired by the desire of countless parents to see their children with ADHD succeed. From one parent support group in

Florida, the organization grew dramatically from year to year to its present status as the leading non-profit national organization for children and adults with ADD. CHADD’s first annual conference in 1989 attracted 300 attendees. The fourth annual conference, held in Chicago in 1992, drew over 2,500 people. Despite the growth in size and

reputation, CHADD has not lost the passion and commitment of its founders. The organization still relies heavily on dedicated volunteers around the country who offer their support and encouragement to all those living with or affected by ADD.” (CHADD.com.).

Even though there is no cure for ADD and ADHD there are ways in coping with

the destructive disorder. I had the privilege to go see a speaker by the name Michael

Asher, an East Brunswick psychologist at The Middlesex County Educational Service

Commission on March twenty-eighth. This seminar was so informative he disguised

behavioral management for students with ADD and ADHD, how to properly diagnosis,

and important facts. He said there are four ways to detect ADD and ADHD. First,

extensive history has to be taken because there are serious genetic connections.

Secondly, questionnaires are sent to people who are involved in that child’s life. Thirdly,

you must observe that child in a classroom environment. Finally, a CPT test, which is

continuous performance test to measure audio and visual difficulties. Important decisions in that child’s life such as college and the background of the disorder was also touched on. Recently they discover that a disorder is a defect in the brain but it also is caused by the lack of glucose, which causes the abnormalities in the structure and function of an

ADD or ADHD brain. He also stressed that there is no cure, but studies do show that the disorder decrease as the child approaches adolescences. When deciding to send them to college wait until age twenty, they are more mature then. We have to remember a child of nine with ADD or ADHD will behave like a six year old socially and emotionally. A child might be fine cognitively but not emotionally. He was so right when he talked about teacher having to help with children with this disorder because they need extra time and attention. He also said not to single out these children but to make them feel like everyone else. He suggested sending ADD and ADHD to camps such as W.I.S.E. and Stepping Stone Day Camp. These are camps to help them socially and to help them to focus on developing social-emotional skills through group training, individual attention, recreational activities, and academic instruction. This past summer, I had the opportunity to be around children with ADHD !and ADD. I was a counselor at a day camp. I was with some of these kids from 7:30 am to 4:30 pm. To watch the behavior of some of these children with ADHD and ADD was remarkable. They, at the most, could sit down at one activity for 10-15 minutes, before they where bored. Whether they were boys or girls they were always on the go. I could see how they were affected by the disorder most when it was time to sit and listen to someone. Children with ADHD and ADD cannot sit still for a long time. When it came time for the camp talent show these children where usually standing the back of the group fighting with one another. In a camp setting like the one I was in over, the summer it was very common to have more then one child in a group with ADHD or ADD. One of the members of the staff I worked

with, my friend Josh, had a group of 3rd grade boys of which half the group was hyperactive. This was the group that was always in trouble usually for their behavior. They were uncontrollable and not even the director talking to them helped. When this

group walked around camp, they were never in any order and you always knew they were approaching without even seeing them. Now Josh and his co-counselor Andrew tried everything in their power they could think of to get these boys in line, but nothing worked. The boys always played the game, monkey see monkey do. If they saw one of the boys in the group acting up then they all started to act up. This type of behavior

happened not only in Josh and Andrew’s group, but also in many other groups throughout the camp. Camp is a social setting where they do things for enjoyment, I cannot imagine working with them on an academic lever.

My mom, on the other hand, has to teach these children everyday. Many of them take medication before they leave the house for a first dose, and then have to go to the medical center to get another one or two times during the course of the day to take another dosage. As the medication wears off the student becomes agitated, disruptive, antsy, and can no longer focus on what is being taught. Often they become the class clowns for attention and to steer focus off of the academic setting. For the next twenty- thirty minutes after the child goes for his medicine he becomes completely lethargic. You would not know it was the same child. Thus during an academic setting of eight

hours, they are really only attentive about half the time. That is why most of those students take untimed tests. According to Adam Rogers of Newsweek, “Even in a

classroom of 30 preteens, it’s not hard to spot the one with problems. He’s staring out the window instead of listening, or tearing around the room instead of finishing that art project.”

After reading, going to seminars, gathering information, and speaking with actual teachers I can fully understand the disorder. I had no idea how serious and complicated it all really is. It is a whole different lifestyle because people lose jobs because of the disorder, they are impulsive and impatient, they have frequent mood swings and short tempers and relationship are restrained. It doesn’t just affect their academic life it affects relationship with others, their career, and other everyday life experiences. It’s not something that will just go away, there is no cure. One thing is certain: ADD and ADHD, if left untreated, can block people from leading healthy and productive lives by sabotaging their self-confidence and blocking their willingness to succeed. I think that there are several issues and arguments to be made with ADD and ADHD. Doctors are prescribing Ritalin at the drop of a hat. It is a very serious drug and should be carefully looked into before pres!

cribing a drug like Ritalin. Two million out of the five million living with the disorder were diagnosed as a child. No one really knows how serious this disorder really is. It causes great depression, social difficulties and character problems. It’s not just a learning disability it is a serious disorder. After seeing what it is like for

these children through camps, and interacting with these children it is very hard on them. After watching an ADD child sit on the side as everyone else plays is very disturbing.

And why does he sit on the side, one of the other boys called him a “freak.” Not only is it hard for me to understand trying to explain that to a seven-year-old kid, who just wants to be like the other children. The toughest part for ADD and ADHD children is being singled out from the other kids. They have to sit right next to the teacher’s desk because they don’t pay attention or they won’t stop walking around the room. Learning more about the disorder had helped me understand more about the disorder and has helped me understand how to deal with it and to make an environment more comfortable for kids who have the disorder.

Attention Deficit Hyperactivity Disorder and Attention Deficit Disorder are something that everyone comes in contact with at some point in his or her life. It is a disorder everyone should feel comfortable with incase they come in contact with it. Fortunately, as more and more children are being diagnosed with it, there is a larger turnout from society to help them. No one wants to see a child struggle through school and life because of a disorder they cannot control.

Bibliography:

Barbosa, Brenda. Homes News Tribune: “No cure for ADHD but coping with the

Destructive disorder is a must.” April 3, 2000. pg 3.

Green, Ross. Explosive Child. Chicago Publisher Company, 1999.

World Wide Web. Website: www.http:/ Chadd.org. 1999.

World Wide Web. Website: www.http:/ HHS.gov.1998.

World Wide Web. Website: www.http:/ NIMH.NIH.GOV.1999.

Mr. Boulal Fear of Pearl Business Today

Mr. Boulal Fear of Pearl Business Today

Name

Affiliation

The dangers that Mr.Boulal is afraid of this days is the value that comes with the pearl business. The business is very risk this days since it come with various concerns not only to the environmental issues but also the scarcity of the pearls has resulted in less supply and higher demands of the products.

Based on the security concerns, it is worth to note that the Mr. boulal as well as those were in business previous know that due to the low supply of the pearls, it has increased in demand hence the value and the price of the same. Individual are killing each as a result of this hence why the diver fears the business today.

The other issue that the diver considers a great danger is environmental protection. The government through its agencies are protecting the pearl business to control exhaustion of the same. The penalty to such is high hence the cause of alarm and fear to the diver.

This can be consider that Mr. Boulal is one of the divers that not only value the pearl business even today, but he also value protection of the same.

Morale in an organisation

Name

Professor

Course

Date

Morale in the Organization

Recent research carried out by experts in management of health care personnel’s shows, that today more than ever, the sector is facing a growing number of challenges that can potentially limit its ability to curb the growing demand in the industry. The major challenges in the healthcare sector include: financial inadequacy, growing competition in the industry, shortage of skilled and experienced staff, staff and patient safety concerns and by extension an increased rate of consumption of healthcare related services. (Rowland pg400 2012).

For a healthcare organization to overcome these challenges, those responsible for management of healthcare facilities ought to learn creative ways and strategies to improve and maintain high performance of staff. With that in mind it is clear that maintaining and improving staff morale is a key factor in ensuring organization success.

Healthcare environment is often characterized with a lot of activities and stress, the leaders are therefore expected to be focused in maintaining high levels of healthcare in their institutions and their staff should remain motivated and enriched by what they do within the organization. To accomplish all these concepts can be challenging to the healthcare managers. In doing these team spirit must be cultivated among the staff members.

In order to keep up an effective team work, the team leader should be in a position to understand the needs and preference of each staff so as to come up with an average team work plan. It has also been noticed that there are numerous reason why it is important to maintain a positive work environment; majorly it makes employees feel free with each other and most importantly feel valued in the work place (Rowland pg45 2012). Finally employees should be in a position to recognize the importance of their work in order get the objectives of morale boosting services offered in the healthcare institutions (Rowland pg458 2012).

References

Rowland, H. S., & Rowland, B. L. (2012). Nursing administration handbook. Gaithersburg, Md: Aspen Publishers.

morality and environment. Application of morality in environmental issues

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Tutor

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Date

Group A: Environmental Topics

Application of morality in environmental issues

The importance of environmental conservation cannot be gainsaid as far as sustenance of human beings is concerned. For many people, conservation is a moral issue, or rather, quite a large number of moral issues are applicable to it. Morality concerns itself with actions that are deemed acceptable or faulty when put against secular or religious principles. It is noteworthy that such principles include implicit or explicit responsibility of environmental custodianship, especially compassion towards all species. Every form of life on the surface of the earth needs certain conditions so as to enhance the continuation of its species. However, in the existence process, all life persistently modifies its environment. Studies show that, a long time ago, numerous species were rendered extinct by the excretion of oxygen into the atmosphere by organisms known as cyanobacteria (Fllatau 45). While this may be imply a natural process, it underlines the notion that the surface of the earth and every living thing is affected significantly and continuously by the operations of the inhabitants. Human beings have not been left behind as far as shaping life on planet earth is concerned. Their impact has been compounded by modern technologies. There are scholars who opine that these activities will lead to human beings’ extinction. Nevertheless, some moral issues emerge from the issue of the impact of human activity on the environment.

One of the key moral issues is the human being’s welfare, as well as that of the sentient organisms. The simple fact that the actions of a human being affect the welfare of other organisms makes environmental conservation a moral issue. Of course, questions have been raised as to how human welfare may be justified as a moral objective when it is not tantamount to affluence. It is noteworthy, however, that the process of evolution has never respected any species. In essence, unless species are sufficiently equipped to withstand modification of their environment, they would be wiped out. Studies show that humanity came as a result of evolutionary processes where some species were eliminated from the face of the earth leading to the emergence of human beings. The extinction of these species resulted from their activities, which affected the environmental balance. In essence, it would be proper to expect that human beings will modify the environment to their own extinction. There are common thoughts to the effect that human beings will emerge in enhanced forms. However, the intelligence and emotions of human beings may hinder their capacity to evolve (Gillroy and Bowersox 67).

Everyone would agree that the prevention of severe harm or destruction of humanity is a crucial moral consideration. It would not be far-off to regard prudence as more morally preferable than decadence (Fllatau 78).

In applying morality to environmental conservation, it is noteworthy that the continuation of the earth as a planet depends on the other components of the universe. The universe carves out its own consequences, sometimes to the detriment of some species. Having in mind that the condition of the universe is of utmost importance to the wellbeing and existence of all species, its operation in a manner that is conducive to the human being’s continued existence is a moral issue (Gillroy and Bowersox 89).

In addition, the welfare of other species is a moral issue thanks to the interdependence that exists between human beings and other species. In addition, many people justify the welfare of other species due to their ability to have emotions and feel pain. In essence, they have a right to be treated in a fair and human manner and be able to gratify their innate urges and feelings. In essence, if these animals are treated in an inhuman manner, it would be a moral issue. This includes endangering their environment in a manner that threatens their existence.

Quite a large number of people feel that they have a God-given right to run over other living things. This is justified as the natural order, in which case the actions of human beings are explained as part of this natural order. Unfortunately, this explanation is also given in the case of fellow human beings who are or a relatively lower status. However, it is imperative that human beings acknowledge that every living thing is charged with a responsibility in maintaining the balance of the universe. However, it is imperative that people use common sense, as well as judgment to determine the aspects of the environment that they should protect (Gillroy and Bowersox 98).

In conclusion, morality is intertwined in all aspects that pertain to the environment. This is because it determines what an individual considers wrong according to secular or religious principles. The moral nature emanates from the fact that every living thing would be affected by the actions of human beings. In essence, human beings have a moral obligation not to deprive them of the only planet they know. In addition, irrespective of the lowly nature of some species, it is noteworthy that they play a significant or key role in enhancing the balance of the universe. However, it is imperative that human beings determine which species to save depending on their usefulness to them.

Economic Development and National Sovereignty Topics

Globalization is a threat to the sovereignty of poor countries

Issues pertaining to national sovereignty and self-determination have been controversial since time immemorial. It refers to the quality of having an independent and supreme authority over a certain geographical area. The importance of this concept lies in its interconnectedness to a country’s ability to offer its citizens the best as far as meeting their interests is concerned. In the recent times, debate has been raging as to the effect of globalization on the sovereignty of nations, and especially poor nations. Theories suggest that when a country surrenders some of its sovereignty and submits to the global rules, that country stands to gain as global commerce will be unshackled from the unpleasant national interventions. Unfortunately, this has not been actualized in real life. What has been experienced is a split of countries into warring factions that accuse each other of foul faith. It is noteworthy that, quite a large number of governments and countries have doubts as far as being integrated into the global economy while retaining their national sovereignty is concerned (Streeten 78). This is exhibited by the failure of governments to conclude a number of multilateral agreements. Are poor countries right to take globalization with a pinch of salt? In my opinion, globalization or liberalization will do more harm than fair to poor nations.

There are two areas that show the negative effects of globalization as far as economic relations are concerned. These are trade and finance. While there are theorists who argue that it is OK for countries to open their economies to allow the benefits of investment to flow into their economies, evidence calls for caution. There has been no quantitatively significant proof that financial liberalization enhances economic growth. In fact, researchers admit that liberalization of capital account heightens the vulnerability of poor countries and increases risks by magnifying the impact of shocks. These shocks are transmitted extremely fast across national borders thanks to globalization (Streeten 89).

In addition, there exists a hot debate as to whether liberalization is appropriate for trade. Studies have shown that countries that have become globalized have enjoyed fast, economic growth. However, this reasoning has fundamental flaws. It is noteworthy that most of these reports quote the tremendous growth that China has had. However, China is one of the world’s least open economies. In fact, it has always maintained a high degree of national sovereignty. Studies have shown that globalization has had adverse effects on poor countries. According to the World Bank Report 2003, the share that poor countries enjoyed as far as the world trade is concerned declined during the liberalizations period. Anyone would acknowledge that the decline in the share of world trade owned by poor countries is not in the best interests of the citizens of poor countries. In essence, it means that poor countries would be losing their sovereignty to developed countries as far as self-determinism in trade is concerned. The question that emerges from these studies is, “who is benefiting from globalization?” Evidently, developed countries stand to gain from the failings of poor countries in which case they would have the capacity to threaten their sovereignty. After all, economic power is everything as far as national sovereignty is concerned (Streeten 95).

Individuals who support globalization would argue that as much as financial and trade liberalization may not enhance the growth and capital access capacity of a country, it comes with some advantages. They would argue that globalization locks governments into policies that are market-oriented in their home economies. This, therefore, hinders distortion of policies by distinct interests. Unfortunately, they are still unable to provide factual and country-specific evidence to ascertain these claims (Karliner 89).

It is noteworthy that, evidence pertaining to financial and trade liberalization does not in any way suggest that liberalization or globalization is entirely laden with negative effects in all countries. Instead, it underlines the importance of managing globalization in a different manner so that all countries can benefit. It is imperative that before governments or countries surrender their sovereignty or national autonomy, they ascertain the effectiveness of the global institutions and rules that are replacing the national policies. In addition, they should ensure that the institutions and rules work to enhance fair distribution of the benefits that accrue to globalization, as well as the costs pertaining to new vulnerabilities. This is essentially the only way for these countries to safeguard their sovereignty in the face of globalization and ensure that liberalization is still in the best interests of their citizens (Karliner 8).

In conclusion, globalization has a bearing on the autonomy of a country or its national sovereignty. As much as it has been said to enhance economic growth of poor countries, it not only threatens the autonomy of poor countries but also their share in the world market. It is noteworthy that the rules governing international finance and trade heavily reflect the vested and peculiar interests of industrialized countries (Karliner 68). In essence, globalization is a threat to the autonomy and national sovereignty of poor countries. It should, therefore, be adopted only in cases here it allows for fair distribution of the benefits and costs of globalization.

Works cited

Karliner, Joshua. 1997. The corporate planet: ecology and politics in the age of globalization. Chicago: Sierra Club Books.1997. Print

Streeten, Paul. “Globalization: Threat or Opportunity”. New York: John Wiley & Sons. (1999). Print

Flattau, Edward. Green Morality. New York: Way Things Are Publications, 2010. Print

Gillroy, John Martin and Bowersox, Joe, The Moral Austerity of Environmental Decision Making: Sustainability, Democracy, and Normative Argument in Policy and Law. London: Duke University Press, 2002. Print

MOVIE REVIEW. Death of a Salesman a play by Arthur Miller 1949

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Lecturer

Course

Date

“Death of a Salesman”

Introduction

“Death of a Salesman” is a play that was written by Arthur Miller 1949. It was awarded The Tony Award for Best Play and Pulitzer Prize for Drama. It uses Willy, a disillusioned salesman, his conscious and caring wife, Linda and their two sons Happy and Biff as the protagonists. They help us to understand the turbulent life in this family which is involved in a constant disagreement. Willy does not get happiness from his job as a salesman, a job he gets sacked from even after serving for a very long time.

He is not pleased with his sons whom he blames for not making him proud. Biff, his older son, fails the math class and drops out of college. His father’s efforts to lure him to venture into business later fail when he instead opts for farming. On the other hand, his younger brother, Happy, a womanizer, is loathed by Linda for his cheap lifestyle is a family arbiter. As events unfold, such a scenario, places Willy into a constant rivalry within and out of his household. Eventually, he opts to commit suicide at least to make his older son happier. However, this does not happen since Biff turns down the insurance compensation.

Conflict

The above synopsis indicates that conflict is one of the major themes of this play. In deed, there is a constant rivalry. Willy, the “weak, low” man, disagrees with all the people within his reach: his wife, Linda; sons, Biff and Happy; neighbor, Charlie and his boss, Howard.

To begin with, Willy and Linda disagree in many occasions. First, Willy is unfaithful in his marriage. He is involved in an extra marital love affair with Ms. Francis, whom he had been with, in a hotel, during the time, when his son was still a promising student in the Summer School. In fact, this is the reason why Biff loses hopes in studies and finally drops out of school as was narrated by Bernard. He says, “I am a failure!” Meaning there was a misunderstanding. Moreover, Willy turns down Linda’s offer of pleading to his boss to transfer him to their home town. Willy refused to buy this idea, however, good it was. Whereas Linda believed that it would prevent him from travelling that might cause him a tragic road accident.

Besides, there is a disagreement between Willy and his two sons. First, he is not happy with Biff’s decision to drop out of school. Later, he refuses to pursue a business career proposed by his father. Instead, he opts to try his hand in farming because that is what he likes most. The failing to fulfill Willy’s expectations of him, constantly puts them in a rivalry. In his opinion, Biff would have to be as successful just like his friend Bernard who has become a lawyer and a responsible husband. On the other hand, Biff blames his father’s promiscuity to be the sole cause for his failure. While in the restaurant Willy gets annoyed with his sons when they decide to abandon him. Instead, they enjoy the company of prostitutes. This incident infuriates Linda to the extent that she rebukes her two sons. She felt that it was so stupid of the boys to show such an irresponsible conduct.

Finally, Willy is in a disagreement with his neighbor and employer. Even though Charlie is a good friend who often helps him in case of difficulty, Willy frequently turns down his offers. In fact, he even refused to be employed by Charlie when he lost his job. This is because, he is jealous of his son, Bernard’s success. He is threatened at his success because he was expecting him to be equal to his sons. When he goes to Howard to discuss better working terms, Willy gets sacked when he is told, “You will no longer represent this company!” This is so unfair because his long time dedicated service finally gets unrewarded. This enmity continued even after his death. Otherwise, he would be accorded a colorful burial.

Case Study Example

Case Study Example

Scenario:

Joe is in his 80s and has been receiving outpatient chemotherapy for cancer. He fell in his apartment and broke his hip, so he ended up in the hospital for 2 weeks. Towards the end of his stay, he began experiencing a fever and rapid heart rate. He had stomach pain and terrible watery diarrhea many times throughout the day. He became severely dehydrated. It was hard for him to manage the nausea. His doctor took a stool sample and noticed an anaerobic Gram positive bacteria.

This case is an 80-year-old cancer patient, named Joe, who acquired an in-hospital infection while being treated for a hip fracture secondary to cancer. Joe is currently undergoing cancer treatment with chemotherapeutic drugs. Hospital acquired infections are a serious matter within our healthcare system; so much so that in 2014 the CDC did a study and determined that about 4% of hospitalized patient’s suffered from a hospital acquired infection (Monegro et al., 2020). To put that number into perspective we look at local, nationally ranked Johns Hopkins Hospital. Johns Hopkins has roughly 107,000 inpatient admissions annually, using the 4% number mentioned previously, that equates to 4,280 patients in one hospital system in one year that suffered from a hospital acquired infection (Fast Facts: Johns Hopkins Medicine, 2020).

Based on the information provided in this case study I have determined that Joe is suffering from a common hospital acquired infection, Clostridium difficile. Joe’s compromised immune system, his abdominal pain, fever and watery stool are all classical indicators of a Clostridium difficile infection. Clostridium difficile (C. difficile) is a spore-forming, gram positive anaerobic bacillus (Clinical C. Diff Q & A, 2020). C. difficile is a common cause of antibiotic associated diarrhea and currently accounts for 15-25% of all episodes of antibiotic associated diarrhea (Clinical C. Diff Q & A, 2020). C. difficile is often caused by specific antibiotics that wipe out the “good bacteria” within a patient’s GI tract, other patients at risk are those with compromised immune systems (Clinical C. Diff Q & A, 2020).

C. difficile has some key characteristics that make it easy to spread within a hospital environment; for one, it has a protective outer coating that potentially allows it to live for months if not years on surfaces and in the soil (Prevent the Spread of C. Diff (Deadly Diarrhea)., 2019). Second, C. difficile requires the use of soap and water to prevent the spread of germs, with the increase in usage of alchol based hand sanitizers like Purell in the hospital environment, which is not effective at killing C. difficile, it is easier for hospital staff to unintentionally spread the disease (Prevent the Spread of C. Diff (Deadly Diarrhea)., 2019). Third, C. difficile requires cleaning beyond the traditional norm within the hospital environment, a bleach solution is required in order to kill C. difficile spores, this is a higher level of cleaning than is what is typically used for most room turnovers within a hospital environment (Prevent the Spread of C. Diff (Deadly Diarrhea)., 2019). Finally, it is important to note that various studies have shown that C. difficile has been present in anywhere from 2%-15% of the healthcare workers sampled, while this is a relatively low number, it could provide a substantial source of potential infection to the immunocompromised patient’s that C. difficile infects so readily (Prevalence of Clostridium Difficile Colonization among Healthcare Workers, 2013). C. difficile is shed through GI tract and out of the body through feces and can be transferred with any surface contact of infected materials (Clinical C. Diff Q & A, 2020). In the hospital setting modes of transmission could include any number of items: hospital beds, rectal thermometers, sheets, toilets or hospital employees’ hands just to name a few. While surface contact is the most common mode of transmission, a 2010 study suggests that C. difficile is also transmittible through the air and notes that individual rooms are the safest option for preventing the spread of C. difficile (Adalja, 2019).

Despite its virulence, C. difficile generally responds well to treatments. About 20% of patients who acquire C. difficile will see it resolve with just the discontinuation of the antibiotics they were previously prescribed (Clinical C. Diff Q & A, 2020). The remaining patients will often see improvement with a change to a more appropriate antibiotic, usually Vancomycin for Fidaxomicin (Clinical C. Diff Q & A, 2020). Other treatments will include replacement of fluids to prevent the dehydration that is commonly associated with diarrhea. It is important to treat C. difficile early as it can lead to serious conditions such as dehydration, sepsis, toxic megacolon and in rare cases death (Clostridium Difficile: Epidemiology, Diagnostic and Therapeutic Possibilities—a Systematic Review, 2013).

If left untreated, C. difficile can cause a number of different symptoms, the most common of which are watery diarrhea, fever, loss of appetite, abdominal pain or tenderness and nausea (Clinical C. Diff Q & A, 2020). While those symptoms might sound minor, in totality they can ultimately lead to dehydration, a perforated colon (which is a life threatening condition that will require surgery) or a very serious condition called sepsis which is characterized by high fever, high heart rate and severe low blood pressure which can ultimately be fatal.

According to the Cleveland Clinic, with treatment, the prognosis for C. difficile is usually positive, they state that with proper antibiotics the fever will subside within two days and the diarrhea within two to four days (C. Diff (Clostridioides Difficile) Infection Outlook / Prognosis, n.d.). They do report that 10-20% of patients may see a re-emergence of symptoms within one to two weeks (C. Diff (Clostridioides Difficile) Infection Outlook / Prognosis, n.d.). More serious complications like a perforated colon, dehydration or sepsis could require longer hospital stays to treat appropriately.

In conclusion, our patient Joe, is suffering from a Clostridium difficile infection acquired during his hospital stay for his broken hip. His immunocompromised system, caused by his cancer treatments, places him at an increased risk for hospital acquired infections. With quick identification and rapid treatment with appropriate antibiotics, Joe has a good chance of overcoming his C. difficile infection and getting discharged to rehab to continue healing from his hip fracture.

Works Cited

Adalja, A. A. (2019, January 29). Airborne Spread of Clostridium difficile | 05-14-2010 | CBN article. Clinicians’ Biosecurity News | Johns Hopkins Center for Health Security. https://www.centerforhealthsecurity.org/cbn/2010/cbnreport_05142010.htmlThis source is a world-renowned hospital that is consistently ranked as a “top hospital” within the United States.

C. diff (Clostridioides difficile) Infection Outlook / Prognosis. (n.d.). Cleveland Clinic. Retrieved November 8, 2020, from https://my.clevelandclinic.org/health/diseases/15548-c-diff-clostridioides-difficile-infection/outlook–prognosisThis source is a world-renowned hospital that is consistently ranked as a “top hospital” within the United States.

Clinical C. diff Q & A. (2020, March 27). Centers for Disease Control and Prevention. https://www.cdc.gov/cdiff/clinicians/faq.html#anchor_1529601781962This source is a federal government agency.

Clostridium difficile: epidemiology, diagnostic and therapeutic possibilities—a systematic review. (2013, November 1). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950610/This source is a peer reviewed medical journal.

Fast Facts: Johns Hopkins Medicine. (2020, January 1). [Graph]. Hopkins Medicine. https://www.hopkinsmedicine.org/about/_downloads/JHM-Fast-Facts.pdfThis source is a world-renowned hospital that is consistently ranked as a “top hospital” within the United States.

Monegro, A. F., Muppidi, V., & Regunath, H. (2020, September 3). Hospital Acquired Infections. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/books/NBK441857/This source is a peer reviewed medical journal.

Prevalence of Clostridium difficile colonization among healthcare workers. (2013, October 4). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850636/This source is a peer reviewed medical journal.

Prevent the spread of C. diff (deadly diarrhea). (2019, November 4). Centers for Disease Control and Prevention. https://www.cdc.gov/cdiff/prevent.htmlThis source is a federal government agency.

Acute Impaired Tissue Perfusion

Acute Impaired Tissue Perfusion

Introduction

The ability of blood to circulate unimpeded throughout the body is what is known as perfusion, it involves the process of hemoglobin in the blood binding with oxygen through respiration in the lungs, in cases where the process is unable to be complete a perfusion state is said to exist. This deficiency can be identified through the diagnosis of the inadequate tissue perfusion symptoms and signs of organ failure, mainly due to lack or inadequate circulation of oxygenated blood through body organs or system. It is with this above understanding of its importance that this article seeks to address its effects on patients with acute impaired tissue perfusion, characteristic, other related factors, outcomes in both patient and caregiver diagnosis, relevant interventions and rationales and the family and patient teachings.

The perfusion within the ineffective tissues can occur in various body systems like the peripheral, cerebral, renal, gastrointestinal, and cardiopulmonary. It can be described as a condition that exhibits a reduction in the blood flow which results in the capillary tissues failure to nourish, since it causes less nutrition and oxygenation at the cellular level. There are divergent effects on a patient if the condition persists mainly if it is an acute condition can turn tragic and cause tissue or organ damage or even death, if it is a mild condition it will have no or few effects on the patient (Maylor ME, 2005).

The main defining characteristics for diagnosing the condition include peripheral issues such as clammy skin, absent or absent peripheral pulses, edema, numbness or pain, cerebral issues like seizures, lethargy, restlessness, confusion decrease to light reaction, and cardiopulmonary effects such as angina or hypertension. The renal system can also have impacts like hematuria and blood pressure change or problems in the gastrointestinal like abdominal pain, nausea or absent or decreased bowel sounds.

Indicators of tissue perfusion on patient would include symptoms of possible impaired blood clotting capabilities and blood flow, and decreased tissue perfusion. Also by monitoring and comparing the patients pulse to ensure that it is steady. Other indicators could be identified through performing therapeutic interventions that have diagnostic testing characteristics like vasodilator therapy and angiograms indicators like heparinization or embolectomy. It can also be done by performing a possible cardiac output test like by using an anti-embolism device or raising an affected limb as necessary. Other specific interventions would include administration of oxygen, range of motion exercises or often change of body positions (Gardiner SM et, al, 1990).

Other related factors that also lead to perfusion of tissues would include mismatch of blood flow with ventilation, Hypovolemia, venous flow interruption, hypoventilation, altered affinity of hemoglobin for oxygen, interruption of arterial flow, impaired transport of oxygen across capillary membrane or alveolar, enzyme poisoning; hypervolemia, decreased hemoglobin concentration in blood, exchange problems, mechanical reduction of arterial blood or venous flow (Kupper N, et.al, 2011).

The care givers expected outcomes would include improvement in the Urinary Elimination, Circulation Status, Fluid Balance, Cardiac Pump Effectiveness: cardiac and Tissue Perfusion, Tissue Perfusion: Peripheral and Tissue Perfusion: Cerebral. On the other hand the expected client outcome would include them demonstrating an adequate and efficient perfusion in their tissues as demonstrated by them having dry and warm skins, an absence in respiratory distress, palpable peripheral pulses, verbalized treatment regimen knowledge, adequate urinary output, recognize change in lifestyle that would encourage tissue perfusion, include appropriate medication and exercise and their possible actions and side effects.

Patients who exhibit acute cerebral perfusion symptoms would include them showing signs of orthostatic hypertension which causes them to experience dizziness while getting up; the interventions would include teaching them on remedies of addressing the dizziness like rising slowly, while seated they flex their feet upwards, they set for a while before standing, trying to have someone present while trying to stand and sitting immediately they start feeling dizzy. The rational for emphasizing on addressing this condition would be that it leads to a decrease in the cerebral perfusion fusions or stroke which if addressed early can be treated.

It can also be diagnosed by monitoring the neurological status, mainly by performing an examination of the neurological functions, or in cases where symptoms of a (CVA) cerebrovascular accident are present like in hemiplegia, hemiparesis or dysphasia. Feeling the temperature and skin color for signs of mottling, skin pallor, absent of pulse, cold skins or cool temperature could signify obstruction within the arteries, which would signify urgency for immediate intervention (Makhsous, M et.al, 2007).

The main lessons for the family and the client would be them being taught on importance and ways of avoiding getting exposed to cold conditions in any kind of weather condition by stressing on their dressing. They will have a better understanding of proper foot care and the need to inspect and wash their feet daily since they will be aware of its relevance to a diabetic patient and as such implement the recommended special insoles, padded socks and jogging shoes. The diabetic client will be more knowledgeable on the relevance of undertaking a comprehensive foot examination annually that comprises of a Semmes-Weinstein monofilaments sensation assessment where they will be referred to a footwear professional for therapeutic inserts and shoes fitting, in which the incurred costs are covered by the Medicare (Wipke-Tevis D,et.al,2004).

In patients with arterial disease they are taught on the importance of following proper weight loss programs, not smoking, controlling hypertension and hyperlipidemia, careful control of their diabetic conditions and stress reduction. For the patients with venous disease, they are taught on the relevance of maintaining the recommended procedures of elevating their legs at intervals, wearing support hose and watching for skin breakdown on their legs as stipulated by the physician. The client/family are also taught on ways of recognizing symptoms/signs that the physician should be notified about example presence of a new foot lesion, change in skin temperature or abnormal sensation.

Reference

Maylor ME.(2005) Signs and symptoms of hypothetical wound assessment by nurses. Br J Nurs (6):S14-20.

Makhsous, M, Priebe, M, Rowles D, Zeigler M, Chen D, Lin F. (2007)“Measuring Tissue Perfusion During Pressure Relief Maneuvers: Insights into Preventing Pressure Ulcers.” Journal of Spinal Cord Medicine, (5): 63-73.

Kupper N , Mitchell D , et al:(2011) Nursing management: inflam-matory and structural heart disorders . In Lewis S , editor: Medical-surgical nursing: assessment and management of clinical problems, ed 8 , St Louis , Mosby/Elsevier , p

Wipke-Tevis D , Rich K , et al: (2004)Nursing management: vascular disorders . In Lewis S , editor: Medical-surgical nursing: assess-ment and management of clinical problems, ed 8 , St Louis ,Elsevier , pp 866 –

Gardiner SM, Sompton AM, Bennett T, Palmer RMJ, Moncada S (1990) Control of regional blood flow by endothelium-derived nitric oxide. Hypertension 15:486–492