Global Operations Management of Wal-Mart Essay Example | Topics and Well Written Essays - 1250 words - 2

Global Operations Management of Wal-Mart - Essay Example The paper tells that global supply chain management focuses on the process of planning and optimizing the different international and local processes of procurement, production, and distribution. In order to manage the global or international supply chain in effective and efficient manner, it is required to integrate all supply chain partners in the overall process. Wal-Mart is operating in the industry of international retailing for a couple of years. The company has been in the business of providing different products and goods to the end consumers all over the world. Wal-Mart is known to be one of the largest retail organization in the global industry. Apart from different physical superstores and hypermarkets, Wal-Mart has also entered into the industry or electronic commerce by offering products through online retail stores. Wal-Mart has been able to create the competitive edge in the industry on the basis of considerably low prices. And for this, it has used efficient and effec tive supply chain strategies to increase the responsiveness of the global supply chain and at the same time increase the overall efficiency of the supply chain. Wal-Mart has been able to integrate different stages and partners of the supply chain together with the help of different technological systems like Enterprise Resource Planning (ERP) system. The supply chain of Wal-Mart is more complicated because of the fact that it has to integrate different manufacturers in the whole process. For example, the let's consider the example of a simple detergent provided by the company. Production is about producing and manufacturing different products and goods. In reference to Wal-Mart, the main function of production is handled by different manufacturers and Wal-Mart focuses on the process of making these products

Rethinking Wilderness Essay Example | Topics and Well Written Essays - 1500 words

Rethinking Wilderness - Essay Example nks will hinder the stewardship of wilderness areas in the future will help in showing how Cronon’s â€Å"rethinking of wilderness† can be effectively applied to solve the problems. Naturalness is defined in different ways. It is described as characterizations of nature being apart from humans (Cole, 2012). Cole identifies problems with naturalness. The first challenge is its multiple meanings and hence leads to a different understanding to different peoples. To some people, being natural means lack of human effect, a place with little human influence (Cole, 2012). There are those that believe natural to be freedom from intentional human control while others sees it as a historical fidelity (Cole, 2012). However, the changes of ecosystem currently taking place means one has to be selective when relying on these meanings. Therefore, one has to choose between them to suit the prevailing conditions. The other challenge has been on the reasons for setting wilderness. Currently, there is no unifying reason as to why wilderness areas are set aside. This is because there have been diverse reasons for setting aside such areas. Some of the major reasons for protections include certain valued species, nostalgic landscapes, biological diversity, scenery, ecosystem services, and autonomous nature (Cole, 2012). However, with increasing knowledge, it has been found that it is difficult to achieve all the purpose in one ecosystem. For this reason, some have to be considered at the expense of others. Cronon’s â€Å"rethinking of wilderness† offers a practical solution to the problems of naturalness. The essay argues that the problems can only be solved by realizing that man has always been in existence with the wilderness. Therefore, the notion that Wilderness is the only remaining place that has been free from civilization is unreal. The author notes wilderness has been a product of civilization (Cronon, 1995). As a result, trying to set it apart from the creator will not

Leadership As Construction Of Meaning Philosophy Essay

Leadership As Construction Of Meaning Philosophy Essay As human beings it seems necessary for us to try to put meaning on things to have a better understanding of our world. This process of making sense fulfills our fear (conscious or not) of not controlling our life. Sensemaking is a natural, ongoing and endless process. It implies trying to structure the unknown (Waterman, 1990, p.41) or making something sensible (Weick, 1995, p.16). Sensemaking requires three basics elements: frame, a cue and a relation between these two. Frame of references represents the past moments of the socialization whereas cues are the present moments of experience. The relation between these two must be plausible to extract meaning. Because sensemaking is not just a process as understanding, interpretation or attribution, it requires grasping the seven properties of sensemaking. Indeed, Weick sees sensemaking as a process that is grounded in identity construction, retrospective, enactive of sensible environments, social, ongoing, focused on and by extracted cues, and driven by plausibility rather than accuracy (Weick, 1995, p.17). Identity is a dynamic concept in continual redefinition. In fact, depending on the situation, we adapt our identity. For instance, my identity with my teachers is not the same than the one that I adopt with my friends. As a result, my identity is different according to the different sensemaking of the situation. However, all of those adjustments develop my frame of references. We extract meaning from cues by regarding our frame of references. In this way, sensemaking is a retrospective process: how can I know what I think until I see what I say? (Weick, 1995, p.18). If I take for example the situation where I hear the ambulance siren on the street, I will suppose that there is an accident in the neighborhood. Thus, I understand this stimuli (the siren) by isolating the cue and put off meaning from it. Nevertheless, it is only because I have already experienced it (and so it is on my frame of references) that I can make sense of it. Despite of it, we have to be also conscious that our attention of past events is influenced by what is occurring now, by the new situation and what I am now. This process is reinforced by social interactions. Human being is social so we need a common understanding to interact with each other. Those interactions influence our frame of references because we need a shared meaning to understand each other. One other interesting fact on Weicks theory is the role of interruptions. Since sensemaking is an ongoing process, we always find ourselves in the middle of complex situations which we try to disentangle by making, then revising, provisional assumptions (Weick, 1995, p.43). Consequently, we need interruptions on our projects to understand. Interruption is a signal that important changes have occurred in the environment (Weick, 1995, p.46). So, it forces and facilitates a time of reflection. A focus on environment is also necessary. In fact, we often forget that we are a part of our environment. Of course our environment influences our sensemaking but there is no single fixed environment. In other words, we also influence our environment by our actions. More than that, we create environment when we try to adapt ourselves to it. It is a mutual influence. To conclude, what is extracted as cues is not pre-given, but is contingent on context, frames of reference and actions. However, sensemaking is not about truth; sensemaking is about the embellishment and elaboration of a single point of reference or extracted cue (Weick, 1995, p.57). We just need something plausible, that makes sense for us. What is necessary in sensemaking is a good story (Weick, 1995, p.61). question 2: Management of meaning Leaders are entrepreneurs of meanings (Popper, 2011). This expression illustrates the main leaders role in the organization; leader must be a sensegiver. Also called the management of meaning, this activity consists in trying to influence followers understandings. Leader must convince his or her followers to embrace a new vision. In order to fulfill this mission, the leader should first provide directions, which could disconfirm the existing understanding. Consequently, the leader has to create a picture, as inspiring as possible, to motivate them. It is necessary that the followers integrate that the current position is wrong or not enough, and that they need to move in another direction. The leader would personify the guide to this desirable future. In spite of it, the leader could also use the bracketing process in order to enhance the followers perception of the organization. This could take the shape of labeling which convey the meaning of competition with other organizations. This strategy will improve the team spirit within the followers. The other solution for the leader could be using symbolic actions. In other words, by the management of meaning the leader legitimate his or her position. However, the main purpose remains to communicate a message to the followers. Those who succeed are the one who frame and define the reality of followers. As a result, those who fail are the one who did not communicate effectively. Several raisons could be mentioned. First of all, the leader and the vision are interrelated. That implies that if something goes wrong, that is the leaders responsibility. Nevertheless, in this particular case, the leader did not fail in sensemaking, just in business decision. So the real failure in management of meaning occurs when followers do not accept to be led by the leader or when they abandon him or her. The main mistake in this situation comes from the communication of the message. Indeed, the leader did not embody correctly the story that she or he relate to his or her followers. Moreover, it could also stem from that the new vision is too much in opposition with the collective frame of references. Consequently, there is no more shared meaning, necessary for a shared action. Indeed, all organizations depend on the existence of shared meanings and interpretations of reality, which facilitate coordi nated action. The actions and symbols of leadership frame and mobilize meaning (Bennis and Nanus, 2004, p.37). In those circumstances, it is quite impossible for the followers to extract the meaning of this new vision. As Bennis and Nanus express: the management of meaning, mastery of communication, is inseparable from effective leadership (2004, p.31). More than that, you lead by voice (Bennis and Nanus, 2004, p.137). If nobody could hear you, nobody will follow you; that is why management of meaning is necessary to lead effectively. question 3: Role of the followers in leadership The relationship between the leader and followers is dynamic. This relation illustrates an implicit contract between these two; the leader assumes all responsibilities if followers accept to be led and the other way round. This contract cannot exist without the mutual consent of both parts. Each of them needs the other to exist; and consequently each of them influences the other. Both are active sensemaker and sensegiver. As a result, leadership comes out as the product constructed by the leader and the followers. Though followers are often underestimated in the leadership, according to this dynamic relationship, they seem to have a role to play. Followership appears as an active role of followers play in shaping the interdependency of leader/followers interactions (Crossman Crossman, 2011). Any leader could exist without followers and no action is possible without followers. The role of leader is, in this way, to influence followers to move into action; but to reach this goal, lead ers need to make sense. This process is called the management of meaning. An essential factor in leadership is the capacity to influence and organize meaning for the members of the organization (Bennis and Nanus, 2004, p.37). As consequence, leaders are responsible to manage meanings into the organization, express it. Since followers have their own frame of references, they will not follow any type of vision. They require finding meaning in the leader vision. In other words, followers influence the way of the leader makes sense and so the leadership. Consequently, the leader has to adapt himself or herself to the collective frame of references; and so fit to followers expectations. To be in harmony with followers expectation, the leader should reflect about the main motivations of the followers to be led. Three principal explanations are formulated: the search for safety, someone responsible of the consequences, and/or someone as a prototypical of the group. As a result, the leader must shape structure to comfort followers, enunciate goals to motivate them and finally take all the responsibility (and so the risk) to fulfill the requirement of safety. In other words, leader has to act as a guide. The only way to embrace this role is to create a picture as inspiring as possible. Leader has to provide a plausible meaning in a complex environment and so he must make sense of an uncertain situation that initially makes no sense (Weick, 2009, p.9). To reach this goal, leader owns several supports as symbols, using cues and bracketing them or fit with the collective frame of references. Those will help him or her to get going the collective action. Indeed, since sense making is social, shared understanding is required to a shared action. To conclude, followers practice an important influence on the leadership. In fact, leader has to convince followers to be led. Consequently, followers appear as the judge of the leadership and allocate the legitimacy of the leader. As a result, leader has to remain in harmony with the collective frame of references in order to provide a common meaning and so to enhance the collective action. Leadership involves just three things a leader, followers and a common goal (Bennis and Thomas, 2007 p.137). qUESTION 4: Leadership as a multi-communicative activity We are living in a complex world where any situations could support a multiplicity of meanings and counter stories. The circumstances are the same in an organizational level. (FACE A) Face to this condition, leaders create meaning out of events and relationships that devastate nonleaders (Bennis and Thomas, 2007, p.17). Leaders are expected to give sense in those situations; we see them as sensegivers. To reach this purpose, leaders have to bracket the experience. In other words, they isolate small piece of experience (called cues) and put off meaning from them. After that, leaders can suggest a meaning. Leaders articulate and define what has previously remained implicit or unsaid; then they focus for new attention (Bennis and Nanus, 2004, p.37). To reach this purpose, leaders own a toolbox to convey effectively this new meaning. The most common tool remains speaking. Most of the great leaders that we know were famous for their ability to speak. In fact, leader and orator are often confused. Linguistic intelligence (Gardner, 1996) appears as a necessary skill. However, master rhetorical speech allows leaders to convince people with words but also with the way of delivering the speech. In fact, in this type of speech, the ton of the voice fit the state of mind of the leader and so attention of the message. The aim is to convey emotions and feeling in order to give life to the leaders vision and so motivate followers in their way. To be as convincing as possible, leaders have to embody the story. That implies relating personal stories, full of example and illustrations. Because they truly believe in what they say, leaders are authentic and so more convincing. They are a prototypical of the group and an exemplification of the message which suppose a strong identification to them. This would increase leaders legitimacy. Leaders could be seen as an actor who embodies perfectly the story. In fact, a lot of comparisons are made between performing leadership and theatre. This tool of performing is often assimilated to drama. In this way, metaphors are required to create stronger meaning. Indeed, metaphors highlight certain interpretations and in the same way hide others. Consequently, theories, building on unspoken metaphors, guide our perception and understanding. Performing also suggests enactment of leaders. Moving, use gestures, screaming but also use the silence is required to create emotions to the audience. Performing is a co-production between leaders and followers; each of them has a special role to play. So, highlight the main points of the message makes the audience react to it. Consequently it will improve the audiences involvement. Finally, using symbols adds power to the message. In fact, the message must be clear and easily understandable in order to touch everyone. Pictures, illustrations and symbols make it more shareable; and collective action is only possible with a shared meaning. All things considered, leadership is a multi-communicative activity. Leaders have choice concerning the way they want to convey their message. However, one important thing needs to be kept in mind: communication leads to community, that is, to understanding, intimacy (Rollo May). question 5: Frames of references both enables our sensemaking but in the same time restricts our sensemaking Frames enables people to locate, perceive, identify and label occurrences in their lives and world. Frames of references are shaped by experiences, values, education, knowledge and interaction with others. Sensemaking is an endless process because of the continuous flow of experiences. Thus, our frame of reference is modified and developed all the time. More you see, more you know express that frames of references enable our sensemaking. In fact, as I have said before, sensemaking is a retrospective cognitive process. More you experience, more developed is your frame of references and so more you put meaning off different situations. In the organizational life, frame of references has several functions. It could act as unwritten rules. It is a way of control because it implies all the shared assumptions about expected norms of organizational behaviour. But it could also be a cognitive structure which shapes theories of action, the appropriate way of doing business. Moreover, frame of reference in the organization could reflect the tradition and consequently bring the vision of the society and its values. All of these aspects of organizational frame of references enable our sensemaking because of a shared meaning. It allows order and to work efficiently within the organization. But, on the other side, frames of references could also restrict our sensemaking. In fact, it directs our attention. The way we percept stimuli appears biased. So, frames of references influence how we bracket cues and how we extract meanings from it. In short, frames of references limit our search for alternatives which constraint our expectation; and so restrict our sensemaking. Plus, our frames of references are more often reinforced than reformed. Indeed, more your frame of references is developed, harder is to question your behaviour and so think differently. Unfortunately, it works exactly the same on an organizational level. That explains why a lot of companies are afraid of taking risks. Risks imply change in the frame of references and so could decrease the legitimacy of the leader if it goes wrong. However, in our complex world, companies have to think different. Nowadays, the aim is not just profit anymore, but more stay competitive. In fact, the competition is harder than ever and crushes the ones who did not adapt themselves quickly. As Porter said: the firms must take out a distinct position from its rivals. Imitation almost ensures a lack of competitive advantage and hence mediocre performances. But, in so many cases, leaders forgot that they could also influence their environment. In short, by thinking different (and so make the difference) companies influence their environment and so their competitors behaviours. As a conclusion, frames of references are essential and necessary for order and clarity in any type of organizations. They represent shared, relatively coherently interrelated set of emotionally charged beliefs, values, and norms that bind some people together and help them to make sense of their worlds. Frames of references enable our sensemaking but, on the same time, can restrict it. To avoid it, we have to learn thinking outside the boundaries. We have to keep in mind the Albert Einsteins quote: Insanity: doing the same thing over and over again and expecting different results. question 6: Clintons Human Rights Day Speech Rhetoric in the most general sense, is the energy inherent in emotion and thought, transmitted through a system of signs, including language, to others to influence their decisions or actions (Kennedy, 1991, p.7). Based on this concept, I will proceed to a rhetorical analysis of Hilary Clintons Human Rights Day Speech. Nevertheless, I want draw attention in the fact that it is a personal analysis. In fact, because of my own frame of references, I have particular expectations and interpretation of this speech and its subject; and it must bias the meaning that I could extract from it. I have also to take into account that is a celebrative speech. The point of it is to celebrate a special event, so it will influence the style of arrangement. However, Hilary Clinton has decided that is a good occasion to go over a simple celebration and argue also for the LGBT rights. In fact, just the first part of her speech is about celebration. Generally speaking, this speech is well written and arranged. In fact, it follows the fundamental aspects of rhetoric with differentiate parts as the exordium, the narratio, the probation, the refutation and the peroratio. Moreover, she decides to appeal to the audience by using pathos which awakening the emotions of the audience by employing the violence vocabulary and the protection and progress vocabulary. Hence, her speech is based on opposition. First of all, I could observe the introduction (or exordium) at the beginning of the speech. This part must be shortly and create sympathy to the audience. Here Hilary Clinton expresses it by some salutations as good evening and with humbleness deep honor and pleasure. She also explains the reason of her speech: the anniversary of one of the great accomplishment of the last century. It is a direct introduction since it is not a sensitive subject to talk about, just a celebrative speech. Consequently she has no need to present the subject in a more subtle way, nor introduce herself because she is already known by the audience. Secondly, her statement of facts (or narratio), remains the background of the speech as a story chronologically ordered and strongly based on the WWII. She also employs some metaphors as step by step or barriers and some illustrations full of details to make it spirited. This war is the collective symbol of a real trauma concerning the Human Rights, so she uses it to arouse the interest of the audience and emphasize the importance of the subject. Furthermore, everybody recognizes how terrible some people were treated during this period and sees it as a violation of Human Rights. Thirdly, there is the opinion and proof (probatio). I find it interesting how she changes her way of speaking. Indeed, I can see that she speaks more directly because she now uses I and no more speaks about the past (the word now is often used). She is no more subtle and she expresses clearly her point. From now on, the vocabulary used is stronger and the ton more convincing. She also uses a lot of comparison which is a good way to bring out arguments. She adopts an inclusionary vision, in other words she wants to demonstrate that everyone should join the movement: this challenge applies to all of us. I have noticed some particularities in her probatio. First, she divides it with five strong arguments, clearly identifiable thanks to catchphrases as the first issue, the third or a fifth. But the most surprising point is that she mixes the probatio and the refutatio (refutation). Though it does not disturb the general comprehension, some extracts of the refutatio are too much accusing according to me and can reverse the expected effect of it because it goes against her request of tolerance, in some extent. Another important aspect of this part is situated at the end of this part. The last three paragraphs of the probatio are addressed to a certain part of the audience: to the leaders, to people of all nations and to LGBT men and women. In each paragraph, Hilary Clinton acts as a real leader and gives special directions. The point of that is to show that everyone has a particular role to play in this fight. None the less, I find it regrettable that she seems to reduce the implication of the LGBT population. In the last paragraph of her probatio, Hilary Clinton tries to comfort them with people around the globe are working hard to support you and to bring an end to the injustices and dangers you face. However it is unfortunate that she does not motivate them as she motivated the other parts of the population. Because of that, the LGBT must feel considered as powerless although it is mainly their fight, even if they need help from the others. Finally the conclusion (or peroratio) is one of the most important parts of a rhetorical speech. It is the occasion to sum up the arguments and request the audience to do something. As it is the crescendo of the speech, the way of speaking must be more dramatic. Hilary Clinton does not respect totally this aspect of the peroratio. One the one hand, she asks the audience for acting in favor of Human Rights and do not stay immobile. Plus, the fact that she employs us during the latest sentences highlights that it is a collective fight, and that team spirit is required. But on the other hand, the explanation of the implementation of current policies disturbs the rest of her speech. She requests for fight but also explains that a lot of policies adopted, as the situation is almost fixed now. To my personal point of view, this part of the speech would be more effective on the narratio, just after the background history. She could express after it that a lot of progress should be necessary to a full achievement. Moreover, her way of speaking appears a little confusing. In fact, she is now using an exclusionary vision by repeating several time right side as if there existed a wrong side on this fight. This change of vision obscures her message and what she expects from the audience. Essay: Based on the description of the two leaders as persons and their leadership, what I have learned myself that I would like to bring with me in my following career as a potential leader?

Communist Controversy over Film Salt of the Earth Essay -- Politics Mc

Communist Controversy over Film Salt of the Earth Salt of the Earth was released in 1954, during the anticommunist McCarthy era by a collection of blacklisted individuals, including screenwriter Michael Wilson, producer Paul Jarrico, and Hollywood 10 director Herbert J. Biberman. Salt is based on the Empire Zinc strike of Local 890 in Bayard County, New Mexico that took place from 1950-1952. In many ways, Salt of the Earth resembles the archetypal American dream by presenting the triumph of ordinary, working class Americans over the forces of discrimination, inequality, and injustice. Salt enjoyed widespread acclaim in Europe, and won prestigious awards in Czechoslovakia and France. Yet in the United States, its production encountered violent opposition from agencies such as the Screen Actors Guild, the American Federation of Labor and the Federal Bureau of Investigation. What particular element of Salt made it seem so threatening and subversive? According to film critic Pauline Kael Salt was nothing more than "shrewd propaganda for the urgent business of the USSR." (Kael, 331-332) She unhesitatingly asserts that Salt is "as clear a piece of communist propaganda as we have had in many years" (Kael 331-332). In short, Kael argues that Salt is fundamentally subversive, threatening and un-American. Yet what does it mean to be subversive in the context of the McCarthy era? The Oxford English Dictionary defines the noun subversive as wishing to "overthrow a regime" (OED). Kael’s argument seems to be congruous to this definition. Does Salt of the Earth intend to overthrow the existing political order and replace it with a communist form of government? Several scholars have responded to Kael’s communist reading of Salt. Lorence... ...d English Dictionary. Accessed 2. June.2003 9. Rosseau, Jean-Jacques. The Social Contract. Liberty, Equality, Fraternity: Exploring the French Revolution. Hunt, Lynn & Censer, Jack. University Park, Pennsylvania: The Pennsylvania State University Press (2001) 10. Rosenfelt, Deborah S. Salt of the Earth: commentary by Deborah Silverton Rosenfelt and Screenplay by Michael Wilson New York: The Feminist Press, (1978) 11. Salt of the Earth. Dir. Herbert J. Bibberman. Produced by Paul Jarrico. Screenplay by Michael Wilson. Video recording. Independent Productions Corporation and the International Union of Mine. (1954) 12. Wilson, Michael. Salt of the Earth: commentary by Deborah Silverton Rosenfelt and Screenplay by Michael Wilson. (The Screenplay) New York: The Feminist Press, (1978)

The French and Russian Revolutions: Similar? Or Different?

The French Revolution and the Russian Revolution were the same in many ways, but were also different in just as many ways. A king who believed in absolutism, just as France was before the revolution, led Russia; the kings didn't accurately represent their people, nor were they close to them; the middle class (bourgeoisie, in France, Duma, in Russia) wanted recognition; and in both cases, the royal families were executed. There were even more comparisons to the two Revolutions. Both Louis XVI and Nicholas II were absolute rulers. Neither of them wanted to be king. Louis simply wanted a quiet life where he could be tucked in and eat to his delight. He wanted nothing to do with the problems that arose in his reign. It was also his indifference to the crown that caused those problems. Tsar Nicholas also felt that way. Both kings followed their ancestors' rulings. The Bourbons and Romanovs had always ruled their country with a firm, absolute hand. Though they were relatively kind, gentle men, their people did not see it that way. They saw them as uncaring towards their countries and wanted a new monarchy – but without a monarch. They wanted a fair government. France's Revolution followed America's Revolution, their desire for a free, fair Constitution strong. The problems that arose and caused the French and Russian Revolution were many. In both cases, however, it was the starvation and the bitter winter that had taken its toll on the people. A bread riot began in both cases. In the French Revolution, the women marched to Versailles and chased after Marie Antoinette, fixed upon killing her. They then forced the royal family into the Tuilleries Palace in Paris so they could keep a good eye on them. In the Russian Revolution, the women were calmer and simply paraded down the streets on International Women's Day, merely wanting some bread to sate their hunger. Unlike in the French Revolution, soldiers were ordered to shoot at the people in the â€Å"parade. † They disobeyed and instead shot their officers and joined the â€Å"parade. † The middle-class, which had hardly existed in Russia until socialism was introduced, was also a major factor in both Revolutions. In the French Revolution, the middle-class – or bourgeoisie – was practically ignored by Louis XVI, who only gave recognition to the aristocracy. As for Tsar Nicholas, he refused to acknowledge the middle-class, whom was called the Duma. The aristocracy enjoyed their place in society and had no problems with the way things were. The Duma, on the other hand, was disgusted with the way Tsar Nicholas ruled. Their discontent, along with the poor people's, were one of the uprisings that led to the Revolution of 1917. This, too, happened in the French Revolution. The bourgeoisie planned and organized until striking at the monarch and setting up their own government. The Duma had set up what was called the Provisional Government on March 12, 1917, which â€Å"established equality before law; freedom of religion, speech, and assembly; the right of unions to organize and strike; and the rest of the classic liberal program. † The government in which the bourgeoisie had set up was identical. The Provisional Government lasted only a short time before Vladimir Lenin, an extreme socialist, overthrew it, giving this proclamation: â€Å"To the Citizens of Russia! The Provisional Government has been deposed. State power has passed into the hands of the organ of the Petrogad Soviet of Workers' and Soldiers' Deputies – the Revolutionary Military Committee, which heads the Petrogad proletariat and the garrison. The cause for which the people had fought, namely, the immediate offer of a democratic peace, the abolition of landlord property-rights over the land, workers' control over production, and the establishment of Soviet power – this cause has been secured. Long live the revolution of workers, soldiers, and peasants! † Conclusively, though the French Revolution and Russian Revolution had many similarities, it also had many differences. Both Revolutions ended in both happiness and sadness. There were two sides to each of the Revolutions. To this day, many see Tsar Nicholas and Louis XVI as men that had ended in a position they were not destined for and paid with their life and their family's for that.

Evidence-based Interventions for a Patient Suffering from Dementia

Introduction Evidence-based practice has been promoted in all healthcare levels in the NHS (Department of Health, 2012). This is done to ensure that interventions are supported by current evidence in healthcare and have been found to be effective for most patients (Pearson et al., 2009). The use of evidence-based practice is rooted in the belief that patients should only receive quality care (Pearson et al., 2009). The same approach is used when caring for patients with mental health conditions. In the policy, No Health without Mental Health (Department of Health, 2012), the NHS has emphasised that patients suffering from mental health conditions should receive quality and evidence-based care. This brief aims to critically discuss the case of an 80-year old woman who is suffering from dementia and the different forms of interventions that could be applied to the case. Consistent with the Nursing and Midwifery Council’s (NMC, 2008) code of conduct, a pseudonym will be used to hide the identity of the patient. This brief discusses the purpose of evidence-based practice in managing patients with a progressive condition such as dementia. An investigation on the different forms of evidence-based interventions and their potential impact for promoting inclusion would also be presented. A discussion on interventions as means to develop a shared understanding of the patient’s needs would also be done. Legal, ethical and socio-political factors that influence the intervention process would also be explored. Finally, the last part discusses my role as a nurse in the intervention process. Using Evidence-based Interventions for Patients with Dementia The Nursing and Midwifery Council’s (NMC, 2008) Code of Conduct has stressed the importance of delivering quality evidence-based care that is patient-centred. Fitzpatrick (2007a) emphasised that the past model of evidence-based intervention relies only on current evidence from literature to support clinical decisions. Current studies that are of high quality are often used to inform current practices. Fitzpatrick (2007b; 2007c) exmphasised that nurses and other healthcare professionals should have the skills to critically assess the quality of a study and determine whether the findings are applicable to one’s current and future practice. Evaluating the strength of the evidence presented in a research study would require understanding of the search process and whether themes or findings from the study are credible or trustworthy (Polit and Beck, 2010). In recent years, this definition has included best practices, personal experiences of healthcare professional on providi ng care, experiences of colleagues, opinions of experts and current guidelines on a health condition (Fitzpatrick, 2007a; 2007b, 2007c; Greenhalgh, 2010). This new definition embraces other sources of evidence that could be used to help healthcare practitioners and patients make decisions regarding their care. Greenhalgh (2010) specifically points out that while there is reliance on good evidence from published studies, including the experiences of nurses, expert opinion and best practices to aid decision-making would ensure that patients receive quality care. Communicating evidence from published literature is also essential in helping patients decide on the best form of intervention. Morrisey and Calighan (2011) emphasises that effective communication is needed to convey findings of a study in a manner that is understandable to the patient. Successful use of evidence depends first on the quality of relationship between the healthcare providers and the patients (Croker et al., 2013. Kizer (2002) argued that for better care, the relationship between the healthcare professionals and the patients should be strengthened first. Kizer (2002) observe that, â€Å"this intimate relationship is the medium by which information, feelings, fears, concerns, and hopes are exchanged between caregiver and patient† (p. 117). In the UK, The National Institute for Health and Clinical Excellence (NICE, 2006) and the National Collaborating Centre for Mental Health (2007) have provided evidence-based guidelines on how to care for patients with dementia. These guidelines along with current literature, my own and my colleagues’ experiences, expert opinion and the experiences of my patient and her carers will form evidence on the best form of interventions for the patient. My patient’s name is Laura (not her real name). She is 80 years old with dementia, a condition that is progressive and characterized by deterioration of mental state, aggressive behaviour and agitation (Department of Health, 2009). A psychiatric consultant oversees the management of her condition. She has been receiving medications for her dementia but her GP and psychiatrist are discussing alternative drugs to reduce her anxiety level and regulate her sleeping patterns. She is diagnosed with type 2 diabetes and is mobilised with a frame following a broken hip. While she is still lucid and can communicate clearly, it is a challenge to care for her during nighttime when she becomes more anxious and shows signs of confusion. Patients with dementia suffer from progressive cognitive impairments (Department of Health, 2009) that could have an impact on how they receive information from their healthcare professionals and carers and in their adherence to medications. In the case of my patient, she is now showing signs of advanced dementia (NICE, 2006). This could be a challenge since her ability to refuse treatment or engage in healthcare decisions is severely reduced (Department for Constitutional Affairs, 2007). In the UK, the Mental Health Act 2007 (UK Legislation, 2007) and the Mental Capacity Act (Department for Constitutional Affairs, 2007) serve as guides on how to care for patients with mental health conditions such as dementia. These acts serve to protect the rights of the patient by locating a representative of the patient who could decide on her behalf. Hence, any interventions introduced for the patient should be agreed by the patient’s immediate family members or appointed guardian (Depart ment for Constitutional Affair, 2007). Since dementia is a progressive condition that could eventually lead to palliative care, the nurses have to ensure that the patient receives appropriate support during the trajectory of the condition. In my patient’s case, she needs immediate interventions for anxiety and sleep disturbance. She is also currently taking medications for her type 2 diabetes. The NICE (2006) guideline has stated the use of psychological intervention for patients with dementia. These include cognitive behavioural therapy, which will include the patient’s carers, animal-assisted therapy, reminiscence therapy, multisensory stimulation and exercise. Evidence-based Interventions and Potential Impact for Promoting Inclusion A number of studies (Casartelli et al., 2013; Monaghan et al., 2012; Ewen et al., 2012) have shown that exercise could improve the mobility of patients following hip surgery. Most of these studies use the randomised controlled trial study design, which ranks high in the hierarchy of evidence (Greenhalgh, 2010). This type of design reduces selection bias of the participants and increases the credibility of the findings of the study (Polit and Beck, 2010). The NICE (2013) guideline for fall also supports exercise intervention for improving patient’s mobility. My patient Laura is using a frame to aid her walking following a fall and an exercise intervention would improve her mobility. Considering that Laura is also suffering from anxiety, I counseled with the carer that we might consider an exercise intervention to both manage anxiety and improve mobility of the patient. This was well-received by the carer who expressed that they could help the patient with a structured walking e xercise. Meanwhile, cognitive behavioural therapy (Kurz et al., 2012; Hopper et al., 2013) has also been shown to be effective in reducing anxiety amongst patients and in regulating sleep behaviour. This form of intervention was also introduced to Laura and her carer. A programme was created where she would receive CBT on a weekly basis. It should be noted that the psychiatrist and the GP in the healthcare team are considering on alternative pharmacologic therapy to regulate sleeping behaviour and anxiety of the patient. While this might have a positive effect on the patient, it should be noted that medications for anxiety have side effects. For instance, the acetylcholinesterase inhibitors such as rivastigmine, galantamine and donepezil are known to have side effects on the cognition of patients (Porsteinsson et al., 2013; Moncrieff and Cohen, 2009). As a nurse and part of the team, I suggested to the team to consider the effects of pharmacologic interventions on the patient. Further, the NICE (2006) guideline also states that only specialists, that include GPs specialising in elderly care or psychiatrists, should initiate pharmacologic interventions. This guideline also emphasises that the Mini Mental State Examination (MMSE) score of the patient should be between 10 to 20 points. In Laura’s case, she is pro gressing from moderately severe dementia to its severe form. Introducing pharmacologic interventions might only worsen the cognitive state of Laura. Meanwhile, there is strong evidence from a systematic review (Filan and Llewellyn-Jones, 2006) on the effectiveness of animal-assisted therapy in reducing psychological and behavioural symptoms of dementia. A systematic review also ranks as high as randomised controlled trials in the hierarchy of evidence (Greenhalgh, 2010). Findings of Filan and Llewellyn-Jones (2006) also reveal that it can promote social behaviour amongst patients. This form of therapy was initially considered in Laura’s case due to its possible effects on the sleep behaviour of the patient. However, current evidence is still unclear on whether the effects could be sustained for prolonged periods. In application to my patient’s case, the use of animal-assisted therapy might be difficult to carry out since the patient has to depend on a carer for her daily needs. However, our team decided on using music therapy for the patient. Similar to animal-assisted therapy, there is also strong evidence on the e ffectiveness of music therapy in managing anxiety, depression and aggression amongst patients with dementia (Sakamoto et al., 2013; Wall and Duffy, 2010). Importantly, cognitive behavioural and music therapies and exercise interventions all promote inclusion of the patient in the care process (Repper and Perkins, 2003). In cognitive behavioural therapy, the patient and her carer receive support on how to manage anxiety and sleeping behaviour. Since carers are highly involved during CBT, there is a higher chance that the intervention would be successful (Hopper et al., 2013). It has been shown that carers of patients with chronic conditions such as dementia are also at risk of developing depression and anxiety (Department of Health, 2009). Smith et al. (2007) explain that this might be due to the realisation that the patient would not recover from the illness. Further, these carers have to prepare themselves for the patient’s end-of-life care. All these realisations could influence the carer’s own mental health (Smith et al., 2007). Hence, it is important that interventions are not only holistic for the patient, but should also include the carers in the process. Hence, implementing CBT would promote inclusion in practice (Wright and Stickley, 2013). The patient in my care is also suffering from type 2 diabetes. Pharmacologic interventions would include metformin and insulin therapy (NICE, 2008). Non-pharmacologic interventions include exercise, behavioural modification and diet. This presents a complex problem for Laura since it has been shown that elderly patients are also at greatest risk of malnutrition due to the aging process (Department of Health, 2009). Patients with dementia could experience feeding behavioural problems. When patients are admitted in hospitals, the new environment and lack of social interaction with peers could act as triggers in behavioural problems (Department of Health, 2009). Since patients might lack the cognitive ability to express themselves, this might present as aggressive behaviour (NICE, 2006). Hence, ensuring that Laura receives appropriate nutrition during her hospital stay could be influenced by changes in her behaviour. It is important that patients with type 2 diabetes do not only receive pharmacologic interventions but should also have sufficient diet. This is seen as a challenge in Laura’s case since she could experience feeding problems due to loss in cognitive abilities. For instance, she might be reminded on how to chew food or why she needs to eat (Department of Health, 2009). In patients with severe forms, the main aim of feeding is now focused on comfort feeding rather than allowing patients to eat the proper amount of food (Department of Health, 2009). Hence, managing Laura’s type 2 diabetes through proper feeding would be an added challenge to her care. Legal, Ethical and Socio-Political Factors that Influence the Intervention Process Decisions on the care and interventions received by the patient are influenced by several factors. First, the Mental Health Act 2007 (UK Legislation, 2007) states that patients with mental health condition could seek voluntary admission to hospitals and leave whenever they want. This Act also states that patients could only be forced to receive treatment in hospital settings if they are detained under this Act. Laura and her carer could refuse treatment or interventions at any point of her care and my team and I would respect her decision. Observance of this provision under the Mental Health Act would also be consistent with patient-centred care where patients are empowered to act for own benefit and to choose appropriate interventions. Apart from the legal aspects that influence the delivery of interventions, ethical issues should also be observed. In the ethics principle of beneficence, nurses and ot her healthcare practitioners should ensure that the interventions would be beneficial to the patient (Beauchamp and Childress, 2001). In Laura’s case, all the interventions cited previously have been shown to be beneficial to the patient. Only the pharmacologic interventions are associated with adverse and side effects for the patient (Popp and Arlt, 2011). Hence, as a nurse, I lobbied for inclusion of non-pharmacologic interventions instead of reliance on anticholinergic drugs to control the patient’s behaviour. In addition to beneficence, Beauchamp and Childress (2001) also add the ethics principles of autonomy, non-maleficence and justice. In Laura’s case, her autonomy would be respected. Allowing patients to participate in the decision-making process is crucial. However, patients with dementia suffer from cognitive impairments that could influence their decision-making ability (Wright et al., 2009). In accordance with the Mental Capacity Act 2005 (Department for Constitutional Affairs, 2007), the carers of Laura could be appointed to act on her behalf. In non-maleficence, the main aim of the interventions is to promote the health of the patient. There are no known side effects of the psychosocial and exercise interventions. Justice will be observed if Laura receives tailored-interventions that would address her needs. It is important that regardless of the patient’s background, religion, race, gender, ethnicity, she should receive healthcare interventions fit for her needs. This ethics principle is observed since a healthcare team has been addressing Laura’s healthcare needs. While all interventions are patient-centred, socio-political issues that could influence the interventions include the recent changes in the NHS structure where local health boards are primarily responsible for allocating funds to healthcare services (Department for Constitutional Affairs, 2007). Hence, if dementia care is not a priority in the local health board, health programmes for dementia might not receive sufficient funding. This could pose considerable problems for the elderly who are dependent on the NHS for their care. Laura has been receiving sufficient support for her mental health condition. This demonstrates that dementia care remains a priority in my area of care. A survey of the support system in my community reveals that support groups for carers are available. This is essential since supporting carers is also a priority in the NHS (National Collaborating Centre for Mental Health, 2007). Role of the Nurse in the Intervention Process On reflection of the case, I have a role to coordinate care with other team members and to ensure that the patient receives patient-centered care. As a nurse, I have to adhere to the NMC’s (2008) code of conduct and observe patient safety. Recognising that dementia is a progressive condition, I should also focus on interventions that not only addresses the current behavioural problems of the patient but also on preparing the carer and Laura’s family members on palliative care. The NICE (2006) guideline has stated that nurses have an important role in preparing patients of dementia and their family members on end-of-life care. This could be a highly stressful stage in the patient’s disease trajectory or could be one of acceptance and peace for the family. As a nurse, I have to ensure that interventions are appropriate to the stage of dementia that the patient is experiencing. Since nursing is a continuing process, I have to inform the family members that the patie nt will increasingly lose her cognitive abilities and would have difficulty feeding in the last stages of the condition (National Collaborating Centre for Mental Health, 2007). I have to ensure that the patient receives both spiritual and physical support at this stage. Evidence-based care is crucial in ensuring that patients receive the appropriate intervention. In my role as a nurse, I have to ensure that interventions are acceptable to the patient. I should also consider the preferences of the patient, their past experiences and their own perceptions on how to best manage their condition. Since I would be caring for a patient with declining cognitive abilities, I should ensure that her dignity would be maintained (Baillie and Gallagher, 2011). As part of my future learning development, I will attend courses on how to conduct end-of-life care for patients with dementia. Through Laura, I realised that a patient’s dignity should always be observed. It is recommended that in my future and present practice, I will continue to rely on literature on the best form of interventions of my patient. I will also consult with my colleagues, seek expert opinion and the patient’s experiences on how to choose and deliver interventions. Conclusion Evidence-based practice is important in helping patients achieve quality care. In this case, Laura is an 80-year old patient with dementia. She exhibits the moderate form of the condition but is beginning to show signs of advance dementia. As her nurse, I have the duty to observe ethics in healthcare and to seek for interventions that are evidence-based. However, I also realised that other factors also influence the delivery of interventions. These include socio-political, legal and ethical factors. As a nurse, I have to protect the patient’s rights, act as her advocate and ensure her safety during the trajectory of the condition. For future practice, I will continue to practice evidence-based practice. I will also encourage others in the mental health profession to always consider the patient’s preferences when caring for patients with dementia. When patients are unable to decide for their own care, the carer of the patient could act on her behalf. Finally, as a mental health nurse, I should constantly update myself with the best form of interventions for patients with dementia. This will ensure that my patients will receive evidence-based interventions. References Baillie, L. & Gallagher, A. (2011). ‘Respecting dignity in care in diverse care settings: Strategies of UK nurses’. International Journal of Nursing Practice, 17, pp. 336-341. Beauchamp, T. & Childress, J. (2001). Principles of biomedical ethics. 5th ed. Oxford: Oxford University Press. 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