Report Research Paper Example | Topics and Well Written Essays - 250 words

Report - Research Paper Example They employ, train and support local workforce and its families. They have initiatives that allow employees to be active citizens in the community by showing their care for the communities. Moreover, the company advocates for civic engagement, tax contributions and volunteerism among its staffs. According to their website, the Company encourages good deeds via its Disney  VoluntEARS  program. It was initiated on Earth Day in 1995 to supports efforts of global and local non-profits that protect ecosystems, wildlife, and make a helpful impact on the community. Since its inauguration, the kitty has supported over $20 million projects in over 112 nations. Through the film, Disneynature, the company has shared important information and compelling stories that submerge audiences in the natural world. The Disney Worldwide Conservation Fund supports efforts of global and local non-profits organizations that protect ecosystems, wildlife, and make a helpful impact on the community, Disney created a Green Standard agenda in 2008 to reduce their adverse impact on the environment. The program is directed at meetings/events, workplaces, dining and travels. Many more recycling bins have been introduced and hanging ads placed on in the hotel rooms reminding occupants to shut off the lights and water when not in use. These efforts are geared towards being more eco-friendly. The green standard has spread wide showing just how Disney has lobbied for environmental conservation. Volunteerism is a major center of attention for Disney. The company offers free tickets to a million individuals for them to offer a day of volunteer service to a community organization of their choice. ‘’This has encouraged a large number of people in America to commit volunteering in their communities’’2. As it has been indicated, the Disney Company has made massive investment in social responsibility. The three areas, volunteerism, environment and the community

Blues and Jazz Essay Example for Free

Blues and Jazz Essay Blues and Jazz are both very popular genres of music spanning almost a century of culture, aesthetics and spirituality. As the blues and jazz are horribly interrelated, this paper will try to differentiate the two great genres of music. A. What is Blues? Per definition, blues is the name given to both musical form and genre of blues. First coined by the African-American communities in the South of the United States of America by the end of the 19th Century, Blues was inspired by spirituality, work song, field hollers and chants- uncomplicated narrative ballads that rhymes. Its form is defined by the use of specific chord progressions- the most common being the twelve-bar blues chord and the singing is for stimulating purposes at slightly lower pitch than that of the major scale. Blues can be divided in several subgenres ranging from country to urban blues to electric blues to blues rock to punk blues. The term â€Å"the blues† refers to melancholy and sadness. The blues lyrics often refers to depressed mood as it embodies the African laborer, whose hardships and spirit is wed to the songs. B. What is Jazz? In contrast, Jazz sprung from the confluence of African and European music traditions. The African heritage evident in the use of blues notes, improvisation, polyrythms, syncopation and the swung note. The term â€Å"jazz† originated from a West Coast slang term and first used to refer to music in Chicago. Jazz has spawned plenty of genres from New Orleans Dixieland to big-band style swing to bebop to latin jazz to Afro-Cuban and Brazilian jazz to jazz-rock to acid jazz. The spread of jazz cultivated music and aesthetics around the world, hence, giving rise to plenty of unique styles. II. History A. Origin of Blues The Blues was born just after the civil war in North Mississippi. A singer would sing a line, and a guitar would answer. For many years, Blues was recorded only by memory, depicted and told live and in person. It was first made popular by the black composer, W. C. Handy in 1911-1914 The publication of Handy’s â€Å"Memphis Blues† and â€Å"St. Louis Blues† has made Blues popular. By the 1920s, Blues became a national craze. Mamie Smith recorded the first vocal blues song, â€Å"Crazy Blues†. The later 40’s and early 50’s saw the like of Willie Dixon playing what was Mississippi Delta blues backed by bass, drums, piano and occasionally harmonica and so began the popularity of blues on national television. Meanwhile, T-Bone Walker and B. B. King pioneered a style of guitar playing that combined jazz technique with the blues tonality and repertoire. In the 1960’s, bands like the Rolling Stones had picked up the Blues and brought it to young American white men. Rock, since the 1960’s, went through several blues revivals. The latest generation of blues players has drawn a new generation listeners to the blues. B. Origins of Jazz New Orleans is often credited as the birth place of Jazz. African-American music, through the Blues began the improvisation of Jazz. The most influential man is Louis Armstrong, the father of modern jazz. The swing era (1930s-40s) is the most popular and accessible time of Jazz, during this time, Jazz was the most popular music in America. What followed the swing era was one of the most important creative eras since the inception of Jazz. Mid 1940’s to mid 1950’s saw the birth of bebop. Quicker pace and complex harmony were combined with popular melodies to create this kind of subgenre. Jazz in the 1960s was inspired by the avant garde movement. Jazz musicians took the genre to the boundaries of creativity and began to speak out on social issues. The current era of jazz can be deemed to be a combination of the avant garde and neoclassical movement. Through improvisation, current musicians keep pushing jazz to the boundaries of music, experimenting with hip hop and other forms of music. III. Instruments and Musicians A. Instruments/Musicians in Blues Blues uses just about any musical instrument- guitar, piano, harmonica, bass guitar, drums, saxophone, vocals, trumpet, trombone. Different performers use different kinds of instruments. For instance, performers such as Frank Stokes, and Memphis Minnie utilised instruments such as washboard, fiddle, kazoo and mandolin. Musicians who have been famous in Blues include the like of Josh White (1914 or 1915-1969), Sonny Boy Williamson I (1914-1948), Gladys Bentley (1907-1960), T-Bone Walker (1910-1975), Roosevelt Sykes (1906-1983), Memphis Slim (1915-1988), Arnold Moore (1914-2005), Baby Face Leroy Foster (1923-1958), Lenny Kravitz (born 1964). B. Instruments/Musicians in Jazz Just like blues, jazz uses just about any musical instrument- saxophone, trumpet, trombone, clarinet, flute, piano, guitar, double bass, tuba, drums, vocals, vibraphone. Famous jazz musicians include Louis Armstrong (1901–1971), Thelonious Monk (1917–1982), Maynard Ferguson (1928-2006), Herbie Hancock (born 1940), Benny Carter (1907–2003), Glenn Miller (1904–1944), Charles Mingus (1922–1979). IV. Audiences A. Blues Audience The Blues originally was sang by the African-American laborer, to express his emotions on the general hardships in life. However, blues has reached the whole world. All the drama is still there but it is spread for those who can appreciate it. Anyone or everyone can be the audience. B. Jazz Audience Jazz, was spawned by the blues and since its inception, has now gathered millions of audiences around the world. There is no selective audience for this genre, anyone who appreciates jazz music is welcome to be its audience. V. Conclusion Blues is considered as the forerunner of Jazz, given that it started earlier and it actually spawned jazz music. Blues also speaks of traditions and personal experiences (the African-American laborer). Hence, Blues is more of a feel-based kind of music. It is very free, the only purpose is to relay the feelings, expressions of the artist. Jazz, for its part, is considered as dance music and improvisation is at its core. Jazz also incorporates more color, this is tricky for non-musicians and is far more technical in its aspect. Jazz is an exploration on how to make music more colorful, hence jazz spawned a lot of subgenres. When it comes to audience, there is only the matter of appreciation. Anyone who appreciates blues is welcome to blues. The same principle applies to jazz music. Works Cited: History-of-rock. com â€Å"A Short Blues History. † n. d. 27 Jul. 2009 http://www. history-of-rock. com/blues. htm. Unc. edu. â€Å"A (very) brief history of jazz. † n. d. 27 Jul. 2009 http://ils. unc. edu/~jnvicker/inls181/final/histpart2. html. Wikipedia. â€Å"Blues. † n. d. 27 Jul. 2009 http://en. wikipedia. org/wiki/Blues. Wikipedia. â€Å"Jazz. † n. d. 27 Jul. 2009 http://en. wikipedia. org/wiki/Jazz.

Leadership And Change Management At Dominos Pizza Commerce Essay

Leadership And Change Management At Dominos Pizza Commerce Essay Change is part of life. Change come in every things with the passage of time either he is a human being or an organization. To accept these changes things try to adopt different process according to different situations. Similarly in an organisation changing can be small or big as well. For example, hiring a new employee is small change and change in mission or use of new technology is big cause of change. Change should not be done for the sake of change .it is a strategy to accomplish the overall goal. Internal and external triggers are key cause of change and these changes can be planned and unplanned as well. There are some common mistakes while attempting to implement the change. For example, delayed decision making, no proper support of managers, could not understand where business will stand after adopting the change. In addition, for the change organisation follow the process and during this process many conflicts occurred. If something is happening that is indication of resistance. There are many signs of resistance like confusion, denial, immediate criticism, easy agreement, silence and many more. What is change management? Change management is accept, control and manage the situation in the organisation and need to bring change in the organisation has effective management is called change management. Different analysis has to do to see the change and managed by well planned strategy. If any organisation has needed to do change then different valid models are made for effective management of change. Some proactive techniques are used to bring and adjust the change in the external and internal performance of the organisation. There is making some effective strategy to plan step by step change. Change management also keep in eye current and modern issues which can affect the change process. There are some solid reasons when change is required. Change management should have up to date knowledge about the of situation surrounding a issues. Change process: There are many reasons due to change is done. That reason can be internally and can be internally. Change process means journey of source of change to the adopting the change is change process. Why change has done? Which type of changes has done either it is cultural, organisational behaviour, organisation policies. These changes can be related to different department of organisation and every department is related to change process and change process is related to the organisation strategies. Real life examples of the change process: In the recent years, the introduction and modification of the computer dominated the list of changes. It has effected nearly every business, industry and home as well. Change in computer will keep effect on people lives. For examples, nowadays people can buy the thing easily at sitting in home by using the computer through internet. Computer has saved the time and expenses as well. We can buy a thing by clicking a button and can pay at time. Moreover, computer has great impact on industrial area as well. New information technology systems have been installed. It is the best way to access the data. Moreover, working condition also often changes. Many organizations moved or remodelled their facilities. For example shifting of staff or offices to new tall buildings from small quarters which are a great change in working process. Polices, rules and regulations are frequently changed. Continues changes are being made in organizations in order to become more efficient and profitable. For examples, a big insurance company is restructuring its organization around the project management area . They mage centralized area to project mange office where the team of workers stayed until they are assigned to various projects. Foe the starting of the project they need trainings and have to learn methodology of project management. Initiative for the change started in information technology and is expanding rest of the life. History of Dominos Pizza: In USA, Dominos Pizza is second largest franchised chain organisation like its competitors Pizza Hut. Two Brother Tom and James Monagha purchased some property and opened with the mane of Dominicks pizza. After few years Tom had changed the name Dominos Pizza. In late seventies there were 200 franchise of pizza and later on in 1983 it went international and open one thousand franchises and same year in Australia they open new franchise. Organisation of Dominos Pizza grew up very quickly and in many countries it was still a traditional company. The menu of Dominos Pizza was very simple and was offering simple crust means regular pizza. Later on due to competition they added medium and large size otherwise there were no side order, just pizza along with the drink. Deep pan pizza was introduced in 1989 and changed the history. By the market demand, on same years, they opened five thousands stores. For many year, they started the policy about the delivery if the delivery didnt reach in 3 0 minutes then you will get free pizza. In 1993, they did not continue this policy. In 1994 they introduced chicken wings and in 1996 they launched Dominos web site. They also invention the cardboard boxes to keep pizza warm and Heat Wave for the fresh and warm delivery. In 1997 they introduced the new logo as well. They have open many franchises all over the world according to the taste and culture of the different countries. Sources of change in the Dominos Pizza: There are many internal and external sources which has brought change in the dominos pizza and its strategy. They accepted these changes and there are some external reasons which are as follows: Changing in market nature is the source of change in the Dominos Pizza. As the consumers know that their choice is matter in the market whatever they demand it will be considerable. Australia is one of the largest countries and consumers of that country markets want healthy food so Dominos Pizza made healthy menu. With the objective of maintaining the competition, business always run according to the rules and regulation. So Dominos Pizza also influenced by political and legal issues. Employer should have to remember about the nutrition laws and information. There is another source which has affected the operation of the Dominos Pizza which is economic growth and location. There are some internal sources which have impact on the Dominos Pizza. New technology system to keep pizza warm and hot for the longer time it has created change and also online delivery order. New internet based is beneficial for the customers. Dominos made easier for the consumer card payments, driver take wireless card machines for the payment of order. Resistance to change: When changes are made then resistance born. There are many reason of increasing of resistance like due to some confusion in the data, misleading and misusing the data, organisation do not know where have to do change, sometime criticism incurred, employees does not agreed with the new polices. Resistance can be intense because of different reasons like a cognitive of different options, due to deeper emotions and deeply embedded. Resistance to change in Organisational culture of Dominos Pizza: Brandon who had purchased Dominos Pizza for$ 1.1 billion. He tried to create very friendly relationship with employees. First day on the work he explained that change is good. With the passage of time, Dominos Pizza brings changes in cultural sector. Proper wearing uniform and given training to the employees and how to work, given them trainings. Employees of Dominos Pizza were eligible. Organisational culture changing is not a easy thing, manager make out the strategy that how to change in the organisation individually and in the group. Innovation of online ordering is new change in the Dominos Pizza. Competition in the industry has increased in the selection of store manager and gives them training. New computerised system has brought changes in organisational culture as well. Resistance to change in Organisational behaviour of the Dominos Pizza: Due to resistance to change in Dominos Pizza, there are some changes incurred in organisation behaviour of the organisation. Staff issues have increased because new technology is using and employment opportunities are decreasing. With the passage of time new modern technology has taken over the jobs. These are the basic issues and change in the organisational behaviour. There are some problems incurred individually to face the change like managers of store. Resistance to change in organisational policies and power: With the passage of time, there are many changes incurred in polices and rules and regulations which was the cause of resistance to change in dominos. Whenever changes comes in the polices managers have to see the difficulties because he have to handle the store and have direct linkage between the employees. Manger have to try to keep saying to employees to follow new polices these policies can be about food hygienic, delivery, taking orders many other things. After facing these changes, customers who are the basic part of dominos strategy have to face the problem. Some time customers does not understand the about the new polices. Polices has implied on every employee of Dominos Pizza so that is cause of resistance to change. Moreover, main power of Dominos Pizza is their customer so they do not like to lose their customers. If dominos will try to change in culture, organisational behaviour and rules and regulation will directly affect the customers. Basic aim and objective of dominos pizza is to make happy customer. In addition, one more power of dominos is finance which has brought changes many times. Sometimes dominos have to face resistance to change due to finance. Changes come due to loss of revenue, low share market and many other things as well. Strategies to overcome the resistance: Dominos is one of the well know and famous organisation in the world. Its business is expanding day by day at global level. They have experience is the profit margin and have competitive advantage. Dominos pizza have good brand image and have a lot of variety of pizza. In market dominos have leadership quality as well it can competent its competitors like pizza hut, papa johns and many other organisations. There are following steps which are taken by the Dominos Pizza. Dominos pizza aim and objective: To minimize the resistance to change dominos has focus on its aim and objective. Main objective of dominos pizza is to great care of customers. Make customers happy and deliver their orders on the time. Through examine the dominos main objective mangers can control the resistance to change. Achievable goals: Managers can understand about the achievable gaol of the Dominos Pizza. Managers should have to do setting of goal. These goal should be reachable and success able. There is one example of dominos pizza is that in 2006 their goal was to achieve 418 outlet but they had 438. Through this approach Dominos Pizza can reduce the resistance to change. Culture of change: Dominos pizza has to describe their culture to change. Dominos is increasing its growth rate. It has gone international level. Whatever changes will come in the cultural. They should have to explain to their customers. It can be helpful in reduction of strategy. Change models: Kurt lewins has introduced this model. It is very simple to understand and managing the change in any organisation according to this model. His thinking is to bring change as can bring change in ice block. It has given name unfreezing, freezing and refreezing. So, Dominos Pizza should have to accept this approach. Sometime employees cannot work as company demands. Some time customer does not come to but pizza. Step 1: Unfreezing means what problems an organisation is facing? Where it should have to bring changes? There should be proper analysis. Through the survey of market, getting feedback from customers, Dominos Pizza can adopt the change and can reduce the resistance to change. Step2: In this step, freezing, how an organisation can make change? How organisations accept this change? It can be successful by motivating the team and managers. Step 3: In last step refreezing mean if any employee does not want to change the habit. Sometimes organisation does not accept the changes. Unfreezing Freezing Refreezing Sources of conflict within change: Some source which has created change in dominos pizza strategy. These sources were internal and external. Dominos did many changes in it whole journey to the success. This organisation met to resistance to change. These resistance was by organisational culture, behaviour, polices and many other things. There are many approach used to overcome the resistance. After using these approaches and strategies Dominos Pizza faced many conflicts which were changing in the working style of the Dominos Pizza. There is innovation of new technology which has taken over the job of employees. They cannot get working hour more. Online order service, misleading with calculation of sales, misleading the data, misuse of branding. These are the main sources of conflict in the change. When changes come then it creates conflicts between the employees. Due to misleading the calculation there were impact on the sales revue and the ratio analysis of the dominos pizza. Approaches to deal with conflicts: When conflict incurred then there should be some approaches to deal with conflicts. To deal with conflict should have to careful about the main objective and aim. If we forget about the main purpose then there is no befit of running the business. To solve these conflicts Dominos Pizza should have to take some steps which are as follows: Dominos Pizza had to do some promotional activities to keep its image maintain. These activities make customer happy and create more attraction. To reduce the conflicts, Dominos Pizza had to increase the working hours of employees and have to offers some compensation, holiday packages, bonuses. Dominos pizza had to arrange some motivational workshop for the employees like customer service workshop, team work, training of staff. Dominos pizza had offers some new meal deal to the customers to increase the sale and revenue level. Conclusion and Recommendations: At the end, changes come in ever field of organisation. Whenever change needed it comes . For the acceptance to change there are some elements which have to keep in eye. In Dominos Pizza many changes come and due to these changes it has create resistance to change in it. These resistances were in organisational behaviour, organisation cultural, traditional changes, changes in rules and regulation and power. These changes come not individually but it also comes in group of shape. After analysis of Dominos pizza, we came to about the approaches and strategies which had used in the reduction of resistance. After resistance there are some problems and conflict born. Dominos pizza used different techniques like offering the different meal deals, free vouchers to the customers, workshop for the employees and many other things. Dominos pizza is well known and best competitors organisation in the market. It gained high profit and revenue. Bibliography: Paton. R .A and McCalman J (2008) Change Management (3rd Ed) SAGE, London. Tobin. R(1999)overcoming resistance to change (2nd Ed) Kogan Page, UK.

black lung disease :: essays research papers

Black Lung Disease   Ã‚  Ã‚  Ã‚  Ã‚  Every year, almost 1,500 people who have worked in the nation’s coalmines die from black lung disease. That’s equivalent to the Titanic sinking every year, with no ships coming to the rescue. While that disaster which took place so long ago continues to fascinate the nation, black lung victims die an agonizing death in isolated rural communities, away from the spotlight of publicity.  Ã‚  Ã‚  Ã‚  Ã‚   Black lung is the legal term for a man-made, occupational lung disease that is contracted by prolonged breathing of coalmine dust. Some call it miner’s asthma, silicosis, pneumonoultramicroscopicsilicovolcanoconiosis, coal workers' pneumoconiosis, or black lung. However, they are all dust diseases with the same symptoms.   Ã‚  Ã‚  Ã‚  Ã‚  Only the smallest particles of the coal dust make it past the nose, mouth, and throat into the alveoli found deep in the lungs. The alveoli, or air sacs, are responsible for exchanging gases with the blood, and are located at the end of each bronchiole. Microphages, a type of blood cell, gather foreign particles and carry them to where they can either be swallowed or coughed out. If too much dust is inhaled over a long period of time, some dust-laden microphages and particles collect permanently in the lungs causing black lung disease.   Ã‚  Ã‚  Ã‚  Ã‚  The main symptom of the disease is shortness of breath, which gets worse as the disease progresses. In severe cases, the patient may develop cor pulmonale, which is an enlargement and strain on the right side of the heart caused by chronic lung disease. Eventually, this may cause right-sided heart failure. Some patients develop emphysema as a complication of black lung disease. Others develop a severe type of black lung disease in which damage continues to the upper part of the lungs even after exposure to the dust has ended called progressive massive fibrosis.   Ã‚  Ã‚  Ã‚  Ã‚  Black lung disease can be diagnosed by checking a patient’s history for exposure to the coal dust, followed by a chest x-ray to see if the characteristic spots on the lungs are present. A pulmonary function test may help in the diagnosis. However, all coalminer’s should have chest x-rays every four years so the disease can be detected early.   Ã‚  Ã‚  Ã‚  Ã‚  Congress placed strict limits on airborne dust and ordered operators to take periodic air tests inside coalmines in 1969.

Badminton Essay Essay

Self-efficacy and social influences are two guiding principles in the study of sociology of sport. Self-efficacy is an individual’s personal estimate of confidence in his or her capability to accomplish a certain level of performance, whereas social influence occurs when others affect one’s emotions, opinions, behaviors and choices. These sociocultural factors are linked to Figueroa’s framework, which influence my participation in badminton. In this essay, the focus in on self-efficacy and social stigma-related socio-cultural factors, which are constituent elements in the sports socialization process and have influenced my active involvement in Badminton. The purpose of this assignment is to evaluate the impact that sociocultural influences have had on my decision to play on the Moreton Bay College badminton team. Professor Peter Figueroa developed a tool also known as Figueroa’s Framework, which investigates the issues surrounding access, equity and equality in sport and physical activity. It is structured over five different levels: individual, interpersonal, institutional, structural and cultural, these areas are used to investigate the ways in which inequities challenge the area of sport and physical activity. All five levels connect within each other and they all influence the shaping of the overall effect. They show the different functions that reinforce, create, remove and eliminate barriers and inequities within sport and physical activity. The level of Figeuroa’s Framework that affects my participation in badminton the greatest was the interpersonal level and individual level. The interpersonal level of Figueroa’s framework is used to investigate the relationships that affect whether an individual will develop a lifelong association with sport. Most individuals ar e influenced directly or indirectly by the people around them such as parents, peers, siblings, teachers, coaches, or sporting role models. In particular, one barrier that had an impact upon my participation in Badminton is self-efficacy. The theory of self-efficacy â€Å"was developed within the framework of social cognitive theory, which views individuals as proactive agents in the regulation of their cognition, motivation, actions,  and emotions.† When playing badminton I feel vulnerable to this problem of self-efficacy as my self-esteem is affected by my performance because I feel as if I am judged by how well I perform. As I have such high expectations to perform well in badminton, I am very critical and hard on myself. This leads to poor self-efficacy which forces me to believe I do not have the capability for success in Badminton. Someone with high self-efficacy is confident and motivated to work toward a learning goal and someone such as myself with low self-efficacy in badminton is not as motivated, which effects how much effort is put into a particular task. Self-efficacy is based on a social learning theory and is a construct that affects motivation and thus can promote or inhibit learning different skills. Consequently, as Allender et al. (2006) suggests, when an individual has limited confidence in their own ability to perform, enjoyment levels decline and inevitably, participation ceases. Pratt et al. (1999) found that perceived competence and sport ability beliefs had a â€Å"strong and direct impact on enjoyment†. As enjoyment is a precursor to ongoing participation, it is thus evident that self-efficacy is an important factor in my participation in Badminton. A study by McCarthy, Jones and Clark-Carter (2008) investigated the sources of enjoyment reported by youth sport participants and found that positive parental involvement was one of the most frequently reported results by young males and females. This implies that when children in sport perceive parental involvement as positive, they are more likely to enjoy their sporting experience. When we are young, our families influence us more than outsiders do. If your parents played sports, took you to sporting contests, helped you learn basic sport skills, and encouraged you to participate, chances are you gave sports a try. It has been proven that parental influence extends to the parents perception of the sports their children choose to participate in. That is, parents can transmit values through communicating their beliefs, acceptance, and support to their child’s participation in sport. Numerous studies have demonstrated the importance of parental interpretation, often showing th at too much parental feedback causes undue stress in young athletes and can cause them not to participate in certain sports, but the appropriate amounts of encouragement and support can increase enjoyment and longevity of the athletes’ involvement. Parental  interpretation is a powerful mechanism because it communicates expected and valued behaviors. Children internalize parental values and expectations therefore; children try to behave in ways that maximize their acceptance in the social setting. Thus, as my parents communicate that they do not value badminton as an exceptional sport, it is unlikely for me to participate in this sport. Also as my parents are not actively involved, nor intentionally provide sporting experiences for the sport of badminton; it is very unlikely that I was ever exposed to the sporting world of badminton as a child. In conclusion, self-efficacy and social influences are two of the central motives that have influenced my decision to play on the college badminton team. These sociocultural factors target the Interpersonal and Structural level of Figueroa’s framework. The influence of outsiders such as family and peers and my perceived capability at a particular time to perform the specified badminton skills has led me to the decision of not participating in the Moreton Bay College badminton team.

Concept Analysis on Acuity Nursing Essay Sample

Concept Analysis on Acuity Nursing Essay Sample Concept Analysis on Acuity Nursing Essay Example Concept Analysis on Acuity Nursing Essay Example The focus of this concept analysis paper is acuity. On the surface, â€Å"acuity† appears to be a precisely defined concept because of its prevalent use in health sciences-related literature. For instance, many authors have acknowledged the rising patient acuity in the course of the last three decades. Moreover, numerous tools have been developed to quantitatively measure patient acuity. Some of these tools include the Revised Easley-Storfjell Patient Classification Instrument, the Can Slyck and Associated Acuity System, the Injury Severity Score, the National Therapeutic Intervention Scoring System, the Acute Physiology, Age, Chronic Health Evaluation instrument, and the Resource Utilization Group Classification System. Despite the existence of several measurement tools for patient acuity, the literature is inconsistent with respect to the definition and measurement of the concept. This concept analysis paper has the main aim of evaluating the definitions of acuity in various disciplines, concepts related to patient acuity, usages of the concept, antecedents of patient acuity, and the consequences of patient acuity. A personal definition of the concept is also provided along with a conceptual model. Before analyzing the concept of acuity, there is the need to have valid measurements, which emphasize on the clarity of the concept being measured. Regardless of the fact that â€Å"acuity† is frequently used, the inconsistent definition and measurement tools of the concept have made it impossible to make a cross-comparison of acuity measurements in diverse settings. In addition, this inconsistency has increased the difficulty of exploring the relationship between acuity and its respective outcomes. As a result, there is the need to perform a concept analysis in order to clarify the meaning and move towards the development of standardized definitions as well as measurements as it relates to acuity. The concept analysis was guided by the Morse’s concept classification method (Morse, 1995). According to Morse (1995), a concept will rarely seem well described and mature, which can be attributed to vast literature covering the concept that provides comprehensive descriptions, clinical empirical evidence as well as quantitative tools used in measuring the concept. However, a closer look reveals inconsistent definitions and several rival implicit theories, which is the case with the concept of patient acuity. The concept clarification method recommended by Morse (1995) encompasses performing a review of literature, and content analysis of literature with respect to the underlying values. In addition, the concept analysis process involves analyzing the attributes of the concept including the consequences and antecedents. A search for the term â€Å"acuity† was performed in the abstract and titles of papers published in the English language in electronic databases and citation indexes such as Google Scholar, PsycINFO, MEDLINE, CINAHL, and PubMed. The Oxford and Merriam-Webster English Dictionaries were also searched. A complementary Internet search using Google was performed. The searches yielded about 100 papers. Only one published report on the topic of concept analysis of patient acuity was found. An inclusion and exclusion criteria was employed in order to filter the papers to remain with relevant resources. Specifically, papers with the term â€Å"acuity† in the abstract or title were incorporated in the concept analysis whereas papers that lacked the term were excluded. The reason for the exclusion of the papers lacking the term â€Å"acuity† in the abstract and title was the possibility that no novel information regarding the concept of acuity could be obtained from these s ources. Definitions of Acuity The Miriam-Webster dictionary defined acuity as â€Å"the ability to understand, hear or see something easily.† In this light, acuity denotes the keenness associated with perception. The Oxford English Dictionary defines acuity as â€Å"keenness or sharpness of hearing, vision or thought.† In literature, there are several definitions of acuity that vary across discipline. For instance, Hebasevich (2012) defined acuity in healthcare settings as the intensity of care needed for a patient determined by a registered need. In this respect, six categories exist that range from minimal care to intensive care. In healthcare settings, when acuity increases, there is the need to allocate more nursing resources in order to guarantee safe care. Hughes (2008) defines patient acuity as the patient requirements for nursing care, which are used in the management of nursing quality, costs and personnel resources. In psychology, acuity has been defined as the sharpness of the mind, which depends on a number of factors including understanding, concentration and focus. An elderly individual with Alzheimer’s Disease is considered to have low mental acuity since he/she is unlikely to remember the events that happened during their youth. In addition, the elderly individual is unlikely to have a precise memory of when and how something occurred. He/she may be slow in understanding relatively simple things like operating a remote control. A person can enhance his/her mental acuity using activities that engage the mind such as mental puzzles. Gorman and Campbell (1995) also defined mental acuity as the sharpness of the mind in terms of understanding, concentration, memory and focus. However, mental acuity is not concerned with intelligence. Mental acuity denotes how well or poorly an individual’s brain is functioning and not his/her ability to undertake complex tasks. A number of factors have irreversible impacts on mental acuity such as the onset of Alzheimer’s disease, encephalitis and prolonged substance abuse. Moreover, some short-term conditions that lessen mental acuity also exist such as high stress and fatigue levels, distractions, external and external interruptions. Table 1 below illustrates the various definitions of acuity as found in the review of literature. Education, Medicine, Psychology, and Nursing Despite the fact that there are some different terminologies and views in the definition of acuity in the various disciplines, a common theme that spans across all the definitions of acuity is that the concept measures something. In all of the definitions, it is evident that acuity denotes the degree to which something being described by the various disciplines manifests itself. For instance, in medicine, acuity denotes the degree to which an illness is severe, or the extent to which an illness requires urgent medical attention. Visual acuity refers to the range to which a person is capable of seeing clearly at a certain distance (Pelosini et al., 2012). In the context of nursing, acuity refers to the aggregate of the nursing services required, which may be in the form of the level of difficulty of the nursing care needs (Buerhaus, 2009), the level of demand for the nursing skills and service (Boudreaux, Friedman, Chansky, Baumann, 2004), the level of patient’s dependence on the nursing staff (Hughes, 2008), the amount of time required to offer nursing care, and the amount of nursing care (Arling, Kane, Mueller, Lewis, 2007). Similarly, in psychology it is evident that acuity denotes the amount of the psychological element being defined; for instance, acuity may denote the severity of the psychological distress, cognition and memory, and sharpness of the mind (Turnage, Kennedy, Smith, Baltzley, Lane, 1992). A similar approach is evident in the definition of acuity in the field of education. From all the definitions, acute represents the smallest degree of whatever is being defined. For instance in medicine, a disease that requires the most urgent medical attention is considered acute. Similarly, a serious psychological distress can be considered acute such as acute depression, implying that it is severe. In mental or intellectual acuity, people with high degrees of sharpness, concentration can be considered to have acute intelligence. Among the various definitions of acuity in the various fields, it is evident that the field of nursing offers the most comprehensive definition of acuity. The definition of acuity in nursing spans focuses on complexity, workload and nursing care needs, which all represent intensity. The nursing care needs represent the amount and concentration of nursing care required – high acuity demands more nursing care and vice versa. Nursing workload with respect to acuity represents the time required in offering the nursing care as well as the level to which a patient relies on nursing staff. Complexity symbolizes the degree of difficulty of the care requirements and the demand for the nursing skills and services. Overall, the definition of nursing is multi-dimensional, as opposed to the definition of acuity in other disciplines, which focus only on a single aspect. Concept Use In order to provide a further clarification of the concept of acuity, it is necessary to examine the different uses and situations involving the usage of the concept. In order to delineate the use of the concept of acuity, it is imperative to establish the attributes associated with the concept. In this respect, the attributes associated with acuity revealed four uses and situations where â€Å"acuity† could be applied, which included patient-related acuity, non-patient related acuity, provider-related acuity, and system-related acuity (Hughes, 2008; Boudreaux, Friedman, Chansky, Baumann, 2004; Cherry, 2003; Chin Muramatsu, 2003). Patient-related acuity emphasizes on the onset of an illness or the timing of the medication intervention such as the treatment of a disease. For instance, high patient acuity could be used when a patient requires urgent medical attention. Patient-related acuity can also be used in differentiating care facilities in terms of those providing long-term care and acute care facilities. Acute care facilities attend to patients with high patient acuity; that is, those requiring urgent medical attention. This is in contrast to long-term care facilities that attend to patients with low acuity. Acute care can also involve the patient receiving active albeit short-term treatment to severe injury. Acute care is in contrast to longer-term care or chronic care. Patient-related acuity can also be used in describing the severity of the illness. An example of the inflammatory acuity, which denotes the extent of the actual inflammatory process, or with respect to a particular illness such as chronic kidney disease or an acute cold. Emergency departments use the term injury acuity for triage purposes. In addition, psychological acuity can be used to represent the severity of a psychological disease such as acute depression. It is evident that in patient-related acuity, the use of acute implies the highest level of severity, requiring urgent attention, and nursing care administered on a short-term basis. This is in contrast with chronic, which represents the need for long-term care. Chronic and acute are on the opposite ends of the patient condition spectrum (Abualrub, 2007). In the context of patient-related acuity, the intensity of nursing care and illness severity can be used in determining the level of patient acuity. It is imperative to note that intensity and severity aspects of acuity are similar, and their uses overlap. Intensity and severity can be utilized interchangeably to refer to the type, duration and amount of nursing care needs required by a particular group of patients. Intensity and severity can also refer to the seriousness of the illness (Abualrub, 2007). The concept of acuity can also be used in non-medical settings to represent keenness or sharpness in various domains including sensation, social intellectual, and coming to a point. With respect to sensation, there are numerous uses of acuity including visual acuity (Pelosini, et al., 2012), tactile acuity, spatial acuity, sensory acuity (Turnage, Kennedy, Smith, Baltzley, Lane, 1992), proprioceptive acuity, perceptual acuity, olfactory acuity, and auditory acuity (Cherry Reed, 2007). Visual acuity is the most commonly used in the non-patient acuity and refers to the clearness and acuteness of one’s vision. Auditory acuity refers to the ability to trace a sound in a given space (Rischbieth, 2006). Essentially, auditory acuity places emphasis on localization acuity. With respect to coming to a point, papers that used this description of the concept of acuity referred to positioning or repositioning of the sense acuity. These papers had the main objective of determining a quantitative error of measure in regards to the positioning of joints in order to relive pain, facilitate a motion range, and come up with diagnostic techniques as well as rehabilitation programs that can be applied to joint-related injuries. In the intellectual domain, intellectual acuity is mostly used when referring to memory and cognition (Cherry, 2003). An example of this could be the strategies that are utilized in helping elderly people maintain their mental capacities and capabilities during aging, and interventions and medicines utilized improving attentiveness and memory among others. Social acuity is used to refer to keenness, sensibility and social awareness with respect to one’s ability to interact with other individuals socially (Salvia, Ysseldyke, Bolt, 20 12; Rischbieth, 2006). Provider-related acuity refers to the intensity of nursing care required for a patient. In this case, intensity represents the care burden that a patient imposes on the nursing staff in regards to surveillance, mental concentration, skills and time in order to satisfy the needs of the patient. The intensity aspect of acuity can be looked at in three ways: in terms of complexity, workload, and care needs (Boudreaux, Friedman, Chansky, Baumann, 2004; Chin Muramatsu, 2003; Pelosini, et al., 2012). Complexity in provider-related acuity refers to the level of difficulty of the medical and nursing care needs of the patient, which involves physicians and nurses’ surveillance, concentration and skill needed to offer care services for patient(s). Workload is an attribute of acuity, whereby high patient acuity requires a high nursing workload. In this respect, high patient acuity is described by a decrease in the period of stay for patients and an escalation in the illness severity (H ughes, 2008). Nursing workload usually denotes a surge in the demand for nursing skills and services, and measures the nursing requirements to satisfy the needs of a patient (Arling, Kane, Mueller, Lewis, 2007; Cherry Reed, 2007). With respect to nursing care needs, it is evident that the severity of the illness often determines the nursing care needs; as a result, there is a close relationship between the intensity and severity aspects of acuity. Seriousness of the illness can be perceived as the amount of nursing resources and care utilized by the patient. Intensity can be looked at in terms of the amount of time needed to offer care to the patient. Some of the measures of nursing intensity could include the nursing intensity weights, and the nursing hours per patient per day (Abualrub, 2007). Other aspects of provider related acuity include the extent to which the patient depends on the nursing staff for their health care needs, which is sometimes referred to as nursing depende ncy. Patient severity could also be used to describe the nursing interventions and the amount and type of nursing care activities (direct and indirect) that are needed for the patient. Other measures of patient severity aspect of provider-related acuity can include patient debility and functional status. With respect to provider-related acuity, based on the review of literature, it can be argued that high acuity requires more nursing care, an increased workload, and complex patient needs; the case is the oppose for low acuity patients. System-related acuity is concerned with the pairing of attributes of acuity with other concepts. The uses of system-related acuity include triage/urgency, classification system and case mix. Urgency/triage are used in emergency medicine settings in ascertaining the severity of illness in order to ensure that the patient is matched with the suitable nursing and medical requirements (Abualrub, 2007; Craig Huber, 2007; Rischbieth, 2006). Classification systems are used in pairing acuity with nursing costs. In this context, acuity denotes the amount of care required. This often involves measuring the patient characteristics in order to ascertain the amount of nursing resources required and determine the nursing assignments. In addition, the classification systems can be used to match and predict staffing needs with respect to the patient needs. Case-mix is also an aspect of system-related acuity and is concerned with the number of patients in a given hospital who can be put in the same group depending on their nursing care needs. The case mix determines the resource utilization needed by a patient grouped in every category (Abualrub, 2007). Patients can also be grouped in accordance with the illness severity and the intensity of care. Acuity measurements can also be utilized in a number of other predictions such as the assignment of patients to nurses or case managers, budgeting, staffing, costs of care, mortality and morbidity (Abualrub, 2007). Antecedents The nursing work environment is continuously evolving, which as a result has increased the demands placed on nurses while at the same time increasing the distance between the nurse and patient, requiring the presence and attention of nurses. There is widespread agreement in the literature that patient acuity is rising, which can be attributed to a number of factors. The first factor is the shortened length of patient stay in hospitals as hospitals embark on reengineering their workflows in order to lessen delays. This reengineering has focuses on nursing care and nurses through various. For instance, a hospital can adopt a screening tool aimed at enabling nurses to recognize patients who may require physical therapy as well as produce early consultation to be undertaken with the physical therapy department. Moreover, other hospitals are modifying their discharge procedures in order to make sure that the discharge takes place early during the day in order to accommodate patients being transferred from emergency rooms and surgery. Moreover, other hospitals have embarked on enhancing multidisciplinary rounds in order to make sure that all departments within the hospital have adequate information in a timely manner. It is evident that all of these changes have resulted in novel demands of the nursing staff’s time and has lessened the nurse-time for lower-intensity patients. An increase in throughput results in a high rate of admissions, which increases the demands placed on the nurses’ time. In addition, the durations of patient stay are also being reduced because of the fact that patients are being discharged at a faster rate to post-acute care in home health and skilled nursing facilities. The outcome of faster discharge is an increase in patient acuity in both hospitals and patients placed under post-acute care. Therefore, nursing in post-acute care and hospital care are handling higher acuity patients. According to Lang, Hodge, Olson, Romano, Kravitz (2004), the rising patient acuity and the novel work demands posed by the modified workflow cannot be addressed using higher nursing staffing levels; instead, there is the need to change the manner in which nursing staff use their time. The second factor contributing to patient acuity is an increase in demand for nursing services because of the aging of the population. It is projected that from 2000 through 2020, the population will grow by 18% (Duffield OBrien-Pallas, 2003; Lang, Hodge, Olson, Romano, Kravitz, 2004). In addition, the population growth for the over-65 population will be 54%, which translates to an increase in healthcare needs by this population. Studies have affirmed that the population is aging, and that elderly people comprise a considerable and growing percentage of people being admitted in hospitals and emergency departments. Elderly people usually develop complex health illnesses that are likely to result in chronic diseases. In addition, in hospital settings, elderly patients have reported relatively higher adverse events rates as well as higher chances of becoming deconditioned. According to Duffield OBrien-Pallas (2003), nurses must use all means necessary to avoid prolonging the duration of stay in hospitals for older patients, which requires the use of care models that shun deconditioning while at the same time promoting functioning. In addition, it is imperative to note that an increase in the demand for acute services has increased consistently during the last decades, with older people comprising of the fastest increasing population of those admitted for acute services. Lankshear, Sheldon, Maynard (2005) notes that the increased demand for acute services goes hand in hand with the decrease in the number of available acute hospital beds as well as the increased use of early patient discharge models. The clinical needs and problems of elderly patients are significantly different from the needs and problems presented by younger people (Craig Huber, 2007; Mazzocco, Feigenson, Halberda, 2011). A majority of elderly patients are often admitted with either sub-acute or acute illness that manifests itself ambiguously and is likely to be characterized by functional and mental deterioration. In addition, elderly patients are likely to have multifaceted social needs and several co-morbidities. Studies have shown that elderly have a lesser likelihood of being cleared from acute units. Moreover, when they are admitted, they are more likely to stay in the hospital for longer durations. Elderly patients also have higher rates of readmission (Abualrub, 2007). The healthcare cost pressure has also been associated with the increase in patient acuity. The increase in the use of managed care during the 1990s played a pivotal role in increasing the cost pressure, especially in hospitals employing large numbers of registered nurses. During the 1990s, places with higher enrollments of managed care were characterized by slower employment growth and wage growth for registered nurses when compared to places having lower enrollments. With the spread of managed care, the employment and wage growth for registered nurses fell at the national level in the late 1990s (Hall, Doran, Pink, 2004). This resulted in changes in hospital payment systems in order to lower spending and reduce the duration of patient stay in hospitals. Therefore, registered nurses in hospitals treat patients who are averagely sick although the intensity of their work increased, contributing to patient acuity (Lankshear, Sheldon, Maynard, 2005; Rischbieth, 2006). The nursing work environment and workload have also been linked to patient acuity. As a response to the increasing cost pressure, hospitals embarked on cutting the staffing levels and adopted mandatory overtime policies aimed at ensuring the availability of nurses during unanticipated increases in the number of patients admitted. The outcome has been an increase in nursing workload. In addition, this has resulted in a reduced nurses’ control with respect to weekend and night work. A direct implication of the increased workload could have been an increase in the wages of nurses; however, their wages have actually remained constant, which can be attributed to the increased competition in the healthcare industry. Increased workload contributes to high patient acuity in two ways. First, it reduces the nursing time and resources available to a patient. Second, it contributes to nursing shortage since it discourages people from entering or remaining in the nursing profession. Studie s have affirmed that nurses with higher patient loads (workloads) report higher burnout and dissatisfaction. Consequences Numerous studies have reported a significant relationship between the levels of nursing staffing (patient acuity) and the quality of care for patients in both nursing homes and hospitals. For instance, a study conducted by Unruh (2003) reported that increasing the number of hours of nursing care per day per patient is related to improved health outcomes such as reduced duration of stay; reduced rates of illnesses including cardiac arrest, pneumonia, gastrointestinal bleeding, and urinary tract infections; and reduced mortality associated with complications. Another study by Lankshear, Sheldon, Maynard (2005) revealed that increasing the number of patients per nurse (patient load) increases the probability of patients dying. Specifically, the study reported that, for each patient increased for each nurse, there is a 7% increased chance of death within one month of admission. The researchers also indicated that, for each patient increased per nurse, there is a 7% increase in the proba bility of dying from complications. In the context of nursing homes, studies have also reported a relationship between the quality of care and staffing levels (patient acuity) (Lankshear, Sheldon, Maynard, 2005). Studies have also documented the outcomes associated with increased nursing workload, which is an attribute of patient-related acuity (Hall, Doran, Pink, 2004; Hall, Doran, Pink, 2004; Hughes, 2008). The workload on nurses can be grouped into three categories including the unit, job, and patient levels. At the unit level, the nurse-patient ration is often used in measuring the level of nurse workload. Studies have reported that increased nursing workloads (lower nurse-patient ratio) can negatively affect patient outcomes. As a result, it has been suggested that increasing the number of nursing staff in a unit and reducing the number of patients that are assigned to a single nurse can help in enhancing patient care (Unruh, 2003). Nevertheless, these suggestions are not feasible because of nursing shortages and costs. At the job level, the extent of the nursing workload is determined by the specialty such as operating nurse versus Intensive Care Unit nurse. Studies have reported a re lationship between job-level nursing workload and nursing outcomes like job satisfaction and stress. At the patient level, the extent of the workload depends on the patient’s clinical condition. Several empirical studies have explored relationship between nursing workload and patient outcomes (Duffield OBrien-Pallas, 2003; Hughes, 2008). Increased nurse workload is associated with sub-optimal patient outcomes as well as lessened patient satisfaction (Rothberg, Abraham, Lindenauer, Rose, 2005; Unruh, 2003). The majority of the research studies exploring the effect of nursing workload on patient outcomes have placed an emphasis on the nursing staffing levels – an attribute of patient acuity. For instance, reduced levels of nursing staffing has been associated with increased rates of pneumonia. In this regard, Unruh (2003) reported that increasing the number working hours of nurses by 1 hour per patient day results in an 8.9% increase in the likelihood of surgical patients developing pneumonia. The study also reported that higher pneumonia rates for units that staff fewer nurses. The levels of nursing staffing have also been reported to have an effect on nosocomial infections. In this respect, increasing the number of nursing hours for a patient resulted in a decrease in the rates of urinary tract infection (Hal l, Doran, Pink, 2004). The understaffing of nursing personnel has also been associated with an increase in the prevalence of E cloacae (Rischbieth, 2006). Evidence also suggests that nurse-staffing levels have an effect on mortality and failure to rescue. For instance, increasing the number of hours of registered nurses care per day resulted in reduced rates of failure to rescue. In addition, lower nurse-patient rations have been associated with an increase in the length of stay for admitted patients; specifically, a nurse patient ratio of 1:2 for the case of evening shifts results in a 20% increase in the duration of stay (Duffield OBrien-Pallas, 2003). Moreover, increased working hours are associated with a reduction in the duration of stay (Buerhaus, 2009). Nursing workload does not only affect patient outcomes but nursing hours as well. There is no doubt that nursing workload has an impact on the time available for a nurse allocate for the various tasks. When the workload is high, nurses are unlikely to have adequate time in undertaking tasks having a direct impact on patient outcome. In addition, increased workload for nurses is likely to lessen the time that nurses spend communicating with other physicians, monitoring patients, and make use of safe practices. For instance, nurses may have no time to conform medications. Increased workload for nurses also resulted in decreased motivation and dissatisfaction, which can lead to reduced morale, increased absenteeism, increased organizational turnover, reduced job performance, and poor quality of care. Stress and burnout have also been associated with increased workload for nurses, which can contribute to medical errors because of the reduced attention that nurses put on performing critic al tasks. Nursing workload has also been associated with work-around and violations among nursing staff. Violations comprise of nurses intentionally deviating from established practices that are necessary to guarantee safe operations and improved health outcomes. In this respect, increased nursing workload has been established to increase the difficulty of nurses adhering to guidelines and rules, which in turn can compromise quality of care and patient safety. An example of violation is insufficient hand washing. Moreover, increased nursing workload increases the probability of making errors during decision-making; this is because high workload increases high cognitive workload, which can result in mistakes, lapses or slips. An example of this is nurses forgetting to administer drugs to patients. Rationale for Antecedents, Criteria and Consequences Selection The antecedent healthcare cost pressure was excluded from the table because it has no direct impact on patients. It is evident that the cost pressures on hospitals can be attributed to the competitive nature of the healthcare industry rather than patient-related and nurse-related factors. Nurses and patients are only on the receiving end in the sense that hospitals have to respond to cost pressures by cutting staffing levels, which ultimately affects patients, albeit indirectly. Essentially, because of the cost pressures, hospitals have changed their payment systems in order to cut spending and reduce the duration of patient stay in hospitals. Therefore, registered nurses in hospitals treat patients who are moderately sick although the intensity of their work has increased, contributing to patient acuity. The underlying argument is that, although they indirectly affect patient acuity, they cannot be used in determining the nursing care requirements by patients. In included shortened length of stay, high demand for nurses because of an aging population and nursing workload because they have a direct effect on the amount of nursing care resources allocated to a patient. The criteria intensity of nurse work and clinical condition of the patient were used because they are measures that can be used in determining the staffing levels – an attribute of patient acuity. In addition, the nurse-patient ratio was included as a criterion because it is a measure of the nurse workload – also an attribute of patient acuity. Increased patient acuity was included in the consequences because of the resulting effect associated with increased demand for nurses and shortened length of patient stay. In addition, I synthesized the negative patient outcomes associated with nursing workload as poor health outcomes, and negative nurse outcomes such as poor job satisfaction, low motivation and morale, and increased burnout and stress, which are all linked to higher patient acuity. Personal Definitions of Concept The severity aspect of acuity can be used to refer to the patient’s psychological and physical status, which is the clinical condition of the patient. The intensity aspect of acuity represents the nursing care requirements and needs of the patient, which can be used to refer to the nursing workload for a particular patient or a group of patients. Therefore, the nursing workload depends on the intensity of care needs, which further depends on the illness severity. From this, acuity can be defined as the degree of illness severity and the corresponding workload intensity that required for the patient. It is imperative note that this definition incorporates both patient needs and the corresponding care required from the nurse. The association between intensity and severity aspect of patient acuity can be both non-linear and linear. For instance, Lankshear, Sheldon, Maynard (2005) pointed out that a direct positive relationship exists between patient acuity and the intensity of n ursing care, which suggests that, with an increase in the severity of illness, the nursing care needs increase. Nevertheless, the association between intensity of care and illness severity can also be influenced by the treatment goals. For instance, the nursing care requirements for a patient who have undergone a bone marrow transplant is likely to increase with respect to illness severity in instances where the treatment plan draws upon curative care when compared to a treatment plan that draws upon palliative care (Arling, Kane, Mueller, Lewis, 2007). The association between intensity of care and illness severity is linear to a degree to which the patient decides to decline further treatment. At this point, the nursing care requirements are significantly reduced whereas the severity of the illness remains high. In the same light, patients needing long-term care may need complex interventions and therapies despite the fact that their illness severity is relatively stable relative to a patient that requires short-term care (high acuity patient) (Rothberg, Abraham, Lindenauer, Rose, 2005). In order to further clarify the concept of acuity, it is imperative to develop an operational definition that can be used in measuring acuity. In this regard, two attributes of acuity can be measured including provider-related and patient-related acuity. Provider-related acuity focuses on the measures intensity, which can be measured using nursing care needs in terms of amount, nursing care needs in terms of time, workload and complexity of care. The nursing care needs measured in terms of the amount, can be assessed by counting data about the number of tasks/activities accomplished for a single patient within 24 hours (Buerhaus, 2009). Nursing Intensity Weights can also be used in assessing the nursing care needs, which is based on a scale that ranges from 1 to 5 based on the nursing care requirements with higher scores indicating higher requirements (Abualrub, 2007). The nursing care needs in terms of time can be measured using the nursing hours per patient day (HPPD) and the minut es needed for particular indirect and direct care activities. Workload can be determined by using count data relating to nursing needs indicators. The care complexity is a categorical variable that depends on primary diagnosis, needs of the patient, and the case manager activities. Patient-related acuity can be measured using the Acute Physiology, Age, Chronic, Health Evaluation (APACHE), which is a weighted score relating to the patient physiological status including chronic health and age (Craig Huber, 2007). Conceptual Framework This concept analysis of acuity has a number of implications for nursing research and practices. For nursing researchers, it is imperative to distinguish the acuity attribute that is being researched between severity (patient-related acuity) and intensity (provider-related). With respect to practices, it is evident that there are no consistent tool that is being used in measuring acuity, especially when measuring provider-related acuity. This is because the developers of these tools were not precise regarding the acuity attribute being measured. Therefore, these tools used in measuring acuity were not helpful in clinical situations. It is imperative to develop the tools for measuring acuity by drawing upon sound conceptual framework in order to affirm their relevance as well as validity for a specific patient population. From this concept analysis paper, I have discovered that patient acuity is a multifaceted concept that should be analyzed from both the provider and patient perspect ive, after which the two perspectives should be reconciled in order to match the patient requirements with the amount of nursing care provided in terms of amount and time.

Enders Game Essay Example

Enders Game Essay Example Enders Game Essay Enders Game Essay Essay Topic: Enders Game The basic tool for the use of world is the use of words. If you can command the significance of words. you can command the people who must utilize the words. -Philip K. Dick In the fresh Enders Game the writer Orson Scott Card shows us a complete different universe than we are used to. Set into the hereafter. the universe has merely recovered from a desolation foreign war that was won by a good luck of fortune by our soldiers. Although this clip we will strike back. in readying for the approaching Bugger war the universes smartest kids get drafted to fall in the conflict school plan set in infinite to larn combat signifier an early age. One of these childs happened to be Andrew Ender Wiggin. the six twelvemonth old was stripped of his childhood. taken away from his household and sent to conflict school. All his life Ender has utmost force per unit area on him because six twelvemonth old Ender was meant to salvage the universe. Throughout the fresh Orson Scott Card blurs the thin line between visual aspect and world. through the construct of games two different illustrations of this are Enders corsets at Battle School and so once more at Command School. t hroughout both Ender was invariably played and manipulated for the greater good . While at Battle School Ender was objected to isolation. due to the green-eyed monster of the other kids. Ender grew accustomed to the ill will and tried to non allow it trouble oneself him every bit much as he could. In the private survey clip given to the kid soldiers they were free to make what they wished. Not holding many friends and non happening the surveies excessively disputing Ender would play the games on the Battles School’s plan. Ender rapidly became engorged in a function drama game called the Giants Drink. This game was deemed impossible but Ender became obsessed with it and reached degrees no 1 had of all time seen earlier. Ender could non stand to lose at anything so he went to any extreme needed to further him in the game. Ender was to ever retrieve the inside informations of this game. because to finish the degree clip and clip once more Ender had to play maliciously and wickedly. he had to play as a liquidator and a deceiver all the qualities reminding him of his brother. Peter who Ender despised and wished to neer turn into. Subsequently on into the fresh Ender is told to seek for new planets to colonise. While on his mission to happen new planets to populate Ender lurchs upon a works that seemed to experience a small excessively familiar holding an eldritch resemblance to the landscape and construction of the works of his childhood base on balls clip game. The Giants Drink. Merely to detect this planet was created for him as a agency of communicating by the Buggers . He had played here excessively many times as a kid non to cognize this topographic point. But it was non possible. The computing machine in the Battle School could non hold perchance seen this place A game signifier his yesteryear. what he though was mere pulp of pels and artworks turned out to go a world. Orson Scott Card made us believe throughout the novel that The Giants Drink was merely a game. Whereas it was really ever a secret topographic point merely Ender had of all time visited. doing it perfect to utilize as a secret agency of communicating. Orson Scott Card pushed us beyond what we thought was quite undistinguished and made it more or less one of the most of import event to take topographic point in the novel. By non lodging to convention and traveling above and beyond doing us believe more about how what was merely a game turned into world. Furthermore while at Battle School all the solider had to take part in Battles once more each other. These Battles were frequently the high spots of these children’s yearss. when Ender became a commanding officer and got his ain ground forces to develop for these make-believe Battles. He rapidly learned that he was neer traveling to be treated just and that all odd will ever be stacked against him ever seeking to get the better of him. Time and clip once more Ender won the Battles he took portion it. holding a perfect win run. This infuriated many and Ender made many enemies. even the instructors seemed to be against Ender give him multiple conflicts a twenty-four hours and besides giving him two ground forcess as oppositions alternatively of the usual 1. All his life Ender was isolated and treated below the belt so none of this was new to Ender. Whatever state of affairs was thrown at him Ender came out at top because of his intelligence. natural born leading and longing to win. Although these conflicts seemed to be merely a game to rupture apart the kids the accomplishments learned in this game could be the difference between life and decease. one time once more confounding us about what is the semblance in it all. Ender graduated through the Battle School plan faster than anyone and got transferred to the following measure. Command School. The first small piece in Command School was spent in complete isolation. it was more awful than Battle School which Ender idea was non possible one time once more merely being left with the company of the games they offered. After a twelvemonth of complete privacy Ender meet with his wise man. instructor. friend and enemy Mazer Rackmen. the adult male who was responsible for salvaging the human race from the 2nd Bugger invasion. Mazer was the lone individual Ender of all time got a opportunity to be with. Together they went through anything and everything that could perchance be an assistance to Ender when the Buggers onslaught. Mazer got Ender to play the simulator games once more but now in a complete different manner. it was no longer a one adult male game. Ender verses The Computer but now it was Ender Commanding different squadron leaders. The leaders which turned out to be the little group of friends Ender had accumulated over his stay at the Battle School. Together they worked surprisingly. utilizing Enders intelligence and great leading accomplishments. With Enders despair to ever win they ever came out of conflicts winning. he may hold lost his friends in the procedure of going this astonishing leader but he gained their complete esteem and regard. Closer to the terminal of this novel. Mazer gives Ender his concluding scrutiny. being ill of it all Ender merely wanted to stop it every bit shortly as he could. Not into it at all Ender plays half-heartedly in the bigining. when being faced with his challenge Ender steps it up cognizing he was one time once more put for failure. Not desiring the instructors to hold the satisfaction of One Uping Ender he plays in a manner he hates. as a darnel but it seems to once once more be the lone manner to win in these games. After crushing his concluding examiniation Ender finds out all of the simulations he played with his squadron leaders were non games but they were they existent Bugger war which Ender had fought and won without even cognizing what her was making. You made the difficult pick. male child. All or nil. End them or stop is. But heaven knows there was no other manner you could hold making it. Congratulations. You beat them. and it’s all over. Real. Not a game. Enders head was excessively tired to get by with it all. Absent mindedly Ender has annihilated a whole species. doing him a liquidator. Thinking he was playing a game Ender had fought a galactic war. Once once more Orson Scott Card hazes the thin line between your visual aspects and your worlds. What Ender thought was a game was a life or decease state of affairs. If Ender would hold listened to his bosom and lose the last game. he could hold saved an intelligent species. but we neer know our results until our determinations have been played out and it is excessively late to alter our head. Orson Scott Card highlighted the fact that every small thing in someone’s life makes a immense impact. As insignificant as it may look everything has a intent. If Ender had non played these games to win the Buggers could really good be alive and non cognizing their purposes. allowing them unrecorded was excessively large a hazard. All throughout his life Ender had been played with. an object of changeless use and head games. Battle and Command School were no different than Earth in this facet. On Earth Ender was bullied and pull strings into making what he wants by Enders evil older brother Peter. piece at Battle School. Colonel Graff the caput decision maker neer failed to lie to Ender. merely tell him half the truth and to boot pull strings him. When Ender got to his last preparation plan Command School Ender was manipulated and lied to in a manner he could non even get down to conceive of Of class we tricked you into it. That’s the whole point. At the terminal Colonel Graff even admits that all the use. prevarications and ill will towards Ender was a portion of his and Mazer Rackmens program. Ender holding been lied to and convey back to his homicidal side. the portion of him he hated the most. Ender was ferocious and could non bear to look at anyone and went back to his room. Orson Scott Cards showed us that it’s better to non swear anyone. What you think is truly go oning might merely non truly be go oning and that you should ever maintain a cheque on your world verses your semblances. Throughout the fresh Orson Scott Card blurs the thin line between visual aspect and world. through the construct of games . At times it is rather hard to hold on your visual aspects verses your worlds because you get excessively caught up in the small things that you forget to halt and look at the bigger image. Merely if you look at your life from a impersonal position will you be able to state what is truly go oning and what is a fragment of your imaginativeness. Orson Scott Card illustrated this point surprisingly throughout this novel.

How you relate to a fictional character essays

How you relate to a fictional character essays Many fictional characters are based on fantasies of what we want or wish we were like. Some have great powers, while others are just rich or famous. It is this wish of wanting what we do not have, or cannot be, that brings about some of the greatest heroes in our imagination. Many younger generations look towards television, and one of the most popular among boys is Goku, the main character in the hit anime Dragonball Z. Goku is the main character, and hero of the hit anime television show Dragonball Z. In the show, he is the most powerful fighter on Earth and the first being to become a Super Saiyan in over one thousand years. When other Saiyans arrive, Goku learns of his mysterious past. He learns that he is a Saiyan formerly named Kakarot. Goku was sent to Earth as a baby to grow up and destroy the planet, but a head injury scrambled Gokus natural thought processes. Instead of growing up to become a destructive destroyer of worlds, he became pure of heart, fighting for the good of the Earth. Goku had one of the largest families in the entire series. Mostly everyone who belonged to it were great fighters, or at least known by many great fighters. His father was a Saiyan named Bardock, and was great fighter. He was also the man who found out that Frieza planed to destroy the planet Vegeta, which is the Saiyan home world. He sent Goku away at first, but soon after, he regretted the decision, and wanted to meet with Goku again, but was killed by Frieza. Throughout his life, Goku did a lot of training, and this was the secret to his incredible strength. Whenever his friends or family were in any harm or danger, he would train his body even harder, pushing himself to his limits, gaining new levels of power. He didnt become a great fighter on his own though. Many people took Goku under their wing, and trained him to be adept in the martial arts. When Goku was a young boy, his Grandfather Gohan trained him. When he had...

Bullying in the united states of america Research Paper

Bullying in the united states of america - Research Paper Example (Salamone & Pesce 2010). The list actually contained a growing number of victims and these names mentioned here were just part of many cases of bullying that occur in American schools today. These incidents should serve as a wake up call to policymakers, school administrators and the society itself in order for them to pay attention, take necessary and immediate steps to address the problem. The number of innocent lives that are being claimed by this national epidemic should not be permitted to grow even further, especially given the fact that we can do something about it. Why is Bullying Dangerous? In order to understand why bullying must be stopped once and for all, everyone should be aware of what it is. This is crucial because there might still be people out there who scoff at these incidents and regard them as some minor teasing or school scuffles that are naturally part of growing up. The number of interest groups and scholarly work on bullying has resulted to several depiction s of bullying. For example, Robert Thomas (2006) explained that it is the act of tormenting a person in a way he detests. (p. 135) JaredStory.com a cause-oriented website founded by the mother of a bully's victim went as far as calling it a smaller scale terrorism because the bully uses intimidation and terror to threaten, harass and assault a weaker individual. (2011) Then, Fried and Sosland (2009) cited taunting, ostracizing and ridiculing beyond endurance as bullying and pointed to the emergence of the word/concept called bullycide that came to refer to young people who commit suicide because of bullying. (p. 14) The sheer number of explanations does not represent differences or some semblance of debate with regards to bullying. The case is that each has his or her own version to this phenomenon, which is fundamentally about a consistent assault - physical, psychological, oral - on a weaker individual by a stronger bully. In a study undertaken by Bradley (2007), it was found that : 1) one-third of middle school students have felt unsafe at school due to bullying; and, 2) at least 10% of high school students who dropped out of school cited fear of bullying as the cause. (p. 1) Hernandez (2006) also shared grim statistics in his own research, stating, â€Å"nearly 30% of American school children have been involved in some aspect of bullying,† with 13% self-reported of being bullies, 10.6% reported being bullied, and 6.3% reported being both a victim and a bully. (p. 61) The statistics as represented by the works of Bradley and Hernandez is feared to be far from accurate because it is believed that many incidence of bullying go unreported. A very disturbing development today is the emergence of the so-called cyberbullying, â€Å"the use of information and communication technologies to support deliberate, repeated, and hostile behavior by an individual or group that is intended to harm others.† (Evans 2007, p. 14) This type of bullying is increasin gly becoming significant because it tends to magnify the effects of aggression tenfold. Due to the technological and communication advancements today, many tools are now available to students that enable them to bully individuals at a rate, degree and frequency that has never seen before. Access to mobile phones, the Internet, including its many social networking web sites are conveniently offering very potent means to hurt, harass and humiliate an

Marketing plan for assisted living facilty Research Paper

Marketing plan for assisted living facilty - Research Paper Example This can be accomplished through utilizing various expert marketing tips and consolidating present day tools that exploit todays innovation and assets to market the facilities. The Assisted Living Facility (ALF) will strive to provide these individuals with the up to date comprehensive services with regular supervision and assistance from a wide range of health care providers to ensure they enjoy proper health as well as to guarantee them their safety and well being. This marketing plan targets to improve the volume of admission of new clients as well as to avoid transfers for the current clients at the facility. Development in assisted living industry has been driven in expansive part by customer demand. Individuals who need help with performing ordinary tasks like bathing, taking their meals, or putting on their clothing prefer to acquire the services in settings that resemble homes and not institutions. The business sector for assisted living has advanced over the previous decade as facilities now serve a more handicapped occupant population with complex demand for services, conceivably inferring that helped living could be a more suitable nursing home option than it at first was (Marsden, 2005). The ASL will provide throughout the clock supervision and care for the clients. This will ensure that the clients are well served when there is need regardless of the time of the day. Clients will be provided assistance in eating, bathing, dressing and taking medication. The program of the facility will also include a health and exercise program (Yee-Melichar, Boyle & Flores, 2010). This will make the clients to be physically fit. Clients who will need to be transported to medical hospitals will be offered transportation services by the ASL facility. Assisted Living facilities continue to provide people with disability and elderly citizens with necessary services with full time

Migration Geography Research Paper Example | Topics and Well Written Essays - 1000 words

Migration Geography - Research Paper Example Push/pull factors to the factors driving Latin American immigration to the U.S. today This section compares and contrasts between the push/pull factors to the factors driving Latin American immigration (both documented and undocumented) to the U.S. today. Push factors basically involve the motives for emigrating from one’s country of origin. With economic migration (usually labor migration), wage rate differentials are quite prominent. It is notable that Latin Americans might choose to migrate from their country to another country, especially the United States due to higher wages that what they can get in their native country, as long as the costs of such migration are not too high. In the 19th century, the economic expansion of the United States led to a huge rise in the flow of immigrants, and approximately one fifth of the population was foreign-born as against the present values of about ten percent. This makes up a significant part of the labor force. There are also some non-economic push factors like oppression, persecution (both religious and otherwise), war, genocide and frequent abuse. In some cases, migration occurs due to personal reasons, or as a result of wanting to be with family relatives or a partner. In some cases, people may migrate from their country to another country due to a form of ‘transferred patriotism’. Migration may also result for the wish to avoid arrest, and this is seen to be a personal motivation. Migration of this kind illegal, especially if the crime in question is internationally recognized. Thus, criminals may then try to hide their identity or seek other loopholes in an attempt to avoid detection. (Immigration and Naturalization Service. 2001) One major force pushing Latin American immigrants into the United States is the difference between the aspirations of these Latin Americans and the scant opportunities in their countries of origin, as against the belief that absolute poverty is the main reason for migration. â€Å"Barriers to immigration come not only in legal form; natural and social barriers to immigration can also be very powerful.† (Barnard, Alexander, 2007). In most cases, when these immigrants leave their country, they also leave everything familiar to them behind, including their culture, families and friends. The Census of 2010 indicated that there were about 50.5 million Latin Americans in the United Sates, making up about 16 percent of the total population. Historically, there have been periods of shared interests in which migratory flows have been promoted. Immigration legislation in the United States is now more restrictive than in previous decades, and this is due to a growing concern in the United States about the high level immigration from Latin American countries. (Durand, Jorge, Douglass Massey, Rene Zenteno, 2001). United States immigration policy as it concerns undocumented migration from Latin America Latin American migration into the United States of America represents a major area of contention in bilateral relations between Latin American countries and the United States. In spite of United States immigration laws that many perceive to be very restrictive, Latin American countries have remained the highest producers of legal and illegal migrants into the United States. Initially, the United States encouraged migration from

Foundations of Business Law Essay Example | Topics and Well Written Essays - 1250 words

Foundations of Business Law - Essay Example By virtue of a valid sale and waiver of all her rights to the enterprise, Roxanne has transferred all said rights and interests to the property, which also includes liabilities and future litigation, such as the present case against her former business enterprise and its new owner, Sting. If Sting, also signified that it was Roxanne who owned the business through his conduct, Roxanne cannot be still held liable as there was fraud and misrepresentation employed by the former. Conversely, if there was indeed a valid, legal transfer of the rights to the business to Sting, he shall be the one solely liable to pay the obligation of $40,000 to Lumieres Sound and Lighting System. If Lumieres Sound and Lighting System cannot recover from Sting by virtue of his disappearance, the former cannot recover from Roxanne, as she has no knowledge whatsoever of the obligation and therefore, no obligation to pay the debt created by the new owner Sting. Moreover, since the parties were entering a contra ct which amounted to a significant amount of money, namely: $40,000.00, it was incumbent upon Lumieres Sound and Lighting System to verify the identity of the business proprietor they were contracting with, and look into all the considerations such as the financial capability of the other party to pay, among several other factors. It cannot take refuge in the fact that they had been â€Å"a regular supplier to Mogadon in the past, and was not aware of the change of ownership.† In all their financial dealings, a supplier must always exercise diligence and due care by assessing their client’s profile and identity. If there was only an actual transfer of the rights to the property, where legally, Roxanne was still the owner of the business enterprise, she is still liable for all the acts and obligations despite the actual ownership of Sting. Under the law, she still has rights and interests to the business enterprise, and would ultimately be liable for litigation and brea ch of contract, as Sting can only be considered as an agent acting in her behalf. Hence, in the absence of Sting, Roxanne can be held liable. Lastly, although there was an actual transfer of rights and ownership of the business by virtue of the sale between Roxanne and Sting, it was incumbent upon Roxanne to have advised Sting to stop the use of the old business signs, advertising, materials and stationary, and letterhead of Mogadon Music, and informed her former contacts and suppliers of the change of ownership of her former business enterprise. Question 2 To effectively ascertain whether or not Sally has a valid claim and cause of action under the law against Great Eastern Railway, an analysis of the facts and circumstances surrounding the case is proper. The facts of the case are clear and undisputed. There was a valid freight contact entered into by the parties. The issue and question in this case is whether or not Great Eastern Railway, under the stipulations of the contract en tered into by the parties, and through the acts or omissions of its employees, is liable for damages under the provisions and instances set forth by law and jurisprudence. The case at bar merits a situation of breach of contract. Defined in general terms, a breach of contract of a contractual obligation is any failure or departure from the agreed  terms and conditions of a contract, Accordingly, where a breach has been caused where one of the parties to the

Economic Externalities And Market Failure Essay

Economic Externalities And Market Failure - Essay Example It can then, in turn, have either a positive or a negative effect on a third party individual who is not directly involved with the buyer or the seller of the transaction at hand.These costs (or benefits) are not included in the cost curve faced by the decision makers. For example, if I plant trees around my neighborhood, not only will I enjoy the benefits of having a street that is cooler and has more shade, but so will my neighbors, even though they did not have any part whatsoever to play in planting the trees. This is an instance of a positive externality. There are several instances that provide absolute evidence that the market economy is plowed with enough imperfections and that it is unable to achieve economic efficiency. Economic efficiency is both productive and allocative efficiency. Productive efficiency is achieved when goods are made with the least possible amount of scarce resources, in other words, goods are made at the lowest possible cost. Allocative efficiency is a chieved when the right amount of scarce resources are allocated towards the production of the right kind of products., i.e., when a combination of goods that leads to the maximum satisfaction of unlimited wants is produced, allocative efficiency is achieved. Therefore, the market fails to choose the right goods and services and is unable to produce them well enough. Market failure is a concept pertained to economic theory, whereby the allocation of goods and services by a free market is not very efficient.

Ergonomic Review of Workstations Essay Example | Topics and Well Written Essays - 500 words

Ergonomic Review of Workstations - Essay Example This can be done by making the following adjustments to the work environment: 1. Using ergonomically designed furniture which allows for the adjustment of both the chairs and the desk on which the typing console is placed. The furniture should be adaptable for multiple users of varying body types. 4. Strategically placing the keyboard in positions which facilitate ease in reach as well as to restrict range of motion in order to prevent awkward movement which can result in harm (Legg, Mackie & Milicich, 2002). In addition to examining postural flexibility, I would examine whether the Executive Assistants are visually comfortable. In so doing, I would ensure that the monitors are placed in an optimal position to facilitate ease in seeing the computer monitors. This would go a long way in preventing eye strain. In this vein, I would also make accommodations for the height of the monitors which are utilized for most of the day. In so doing, they should be placed at eye level as a means of relieving the pressure which may be placed on the neck muscles and ensuring that the head is held flat. Another component of visual comfort is the distance between the eyes and the screen.

Foundations of Business Law Essay Example | Topics and Well Written Essays - 1250 words

Foundations of Business Law - Essay Example By virtue of a valid sale and waiver of all her rights to the enterprise, Roxanne has transferred all said rights and interests to the property, which also includes liabilities and future litigation, such as the present case against her former business enterprise and its new owner, Sting. If Sting, also signified that it was Roxanne who owned the business through his conduct, Roxanne cannot be still held liable as there was fraud and misrepresentation employed by the former. Conversely, if there was indeed a valid, legal transfer of the rights to the business to Sting, he shall be the one solely liable to pay the obligation of $40,000 to Lumieres Sound and Lighting System. If Lumieres Sound and Lighting System cannot recover from Sting by virtue of his disappearance, the former cannot recover from Roxanne, as she has no knowledge whatsoever of the obligation and therefore, no obligation to pay the debt created by the new owner Sting. Moreover, since the parties were entering a contra ct which amounted to a significant amount of money, namely: $40,000.00, it was incumbent upon Lumieres Sound and Lighting System to verify the identity of the business proprietor they were contracting with, and look into all the considerations such as the financial capability of the other party to pay, among several other factors. It cannot take refuge in the fact that they had been â€Å"a regular supplier to Mogadon in the past, and was not aware of the change of ownership.† In all their financial dealings, a supplier must always exercise diligence and due care by assessing their client’s profile and identity. If there was only an actual transfer of the rights to the property, where legally, Roxanne was still the owner of the business enterprise, she is still liable for all the acts and obligations despite the actual ownership of Sting. Under the law, she still has rights and interests to the business enterprise, and would ultimately be liable for litigation and brea ch of contract, as Sting can only be considered as an agent acting in her behalf. Hence, in the absence of Sting, Roxanne can be held liable. Lastly, although there was an actual transfer of rights and ownership of the business by virtue of the sale between Roxanne and Sting, it was incumbent upon Roxanne to have advised Sting to stop the use of the old business signs, advertising, materials and stationary, and letterhead of Mogadon Music, and informed her former contacts and suppliers of the change of ownership of her former business enterprise. Question 2 To effectively ascertain whether or not Sally has a valid claim and cause of action under the law against Great Eastern Railway, an analysis of the facts and circumstances surrounding the case is proper. The facts of the case are clear and undisputed. There was a valid freight contact entered into by the parties. The issue and question in this case is whether or not Great Eastern Railway, under the stipulations of the contract en tered into by the parties, and through the acts or omissions of its employees, is liable for damages under the provisions and instances set forth by law and jurisprudence. The case at bar merits a situation of breach of contract. Defined in general terms, a breach of contract of a contractual obligation is any failure or departure from the agreed  terms and conditions of a contract, Accordingly, where a breach has been caused where one of the parties to the