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Translating Military Power into Desired Political Outcomes

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Translating Military Power into Desired Political Outcomes

Three greatest challenges for United States in translating Military Power into Desired Political Outcomes or End States

Introduction

United States today faces a number of challenges in effectively translating military power to the Country’s desired outcomes in politics. However, there are three greater challenges namely:

Unconventional weapons along with proliferation of technology
Proliferation of nuclear
Engaging in fights using asymmetric counterforce

This paper intends to analyze the great challenges that United States as a country face when it comes to translating military power to desired outcomes in politics. In addition, this paper will also look at how the three challenges have led to outcomes of selected conflicts in the United States.

Unconventional weapons along with proliferation of technology

Most countries that engage in war with the United States prefer not to employ the immense conservative armory used by the United States (Kaplan, 2013). Instead, such nations make use of unconventional weapons to attack the United States, since there is a higher likelihood of gaining advantage over United States. Unconventional weapons result from an intelligent use of proliferation of technology.

Such technologies may include: nuclear technology, devices for radiation dispersal, biological technology, cyber warfare use, chemical weapons use, high explosives utilization, an electromagnetic pulse, as well as directed energy. In some cases, when high explosives are used in an innovative way the resultant outcome causes more destruction compared to chemical weapons, biological technology, nuclear technology as well as radiological weapons (Katagiri, 2010). On the other hand, due to globalization in information technology, cyber warfare also has great potential of causing destruction.

Therefore, cyber warfare presents a great challenge to the United States due to the damage it has the potential of causing as well as the accessibility of the weapon. For single attacks, most enemies will prefer to use nuclear weapons. However, the most effective destructive form of weapon directed towards the United States would be biological attacks.

Most of the enemies of United States however, choose to make use of high explosives in attacking the United States which if correctly executed would result in tactical serious consequences as well as strategic consequences (Lake, 2009). To achieve execution of effective attacks on the United States, then rivals of United States may employ a number of techniques.

Rival countries may increase the sentiments of anti- America in different parts of the world. Sentiments of anti- America are spread through showing support to a team that seems dominant in a conflict between two groups. In order to spread the sentiments faster strategic communication is employed which then calls for utilization of the internet (Leffler, & Westad, 2010). This helps United States rivals to gain back up and develop a larger team to fight against the United States.

A clear example of this is the conflict known as Operation New Dawn. In this conflict, the United States engages in war with a group known as Al-Qaida as a war of reducing terror globally. However, Al-Qaida continues to grow its popularity and backing against the United States operations from countries that practice Islamic religion highly. In Arabic translation, Al- Qaida stands for the foundation.

To grow its backing the Al-Qaida group has been spreading its popularity by seeking training grounds through working with different governments globally. Moreover, Al-Qaida helps its host countries in efficiently achieving their broader objectives which in turn buys Al-Qaida more backing for their operations. For instance, the Taliban government established control over most Islamic groups that had been formed with the aim of performing terrorism (Mueller, & Stewart, 2012). Afghanistan provided a suitable ground for training the combined groups.

Recruits were taken from: the host country Afghanistan, neighboring country Pakistan, from Central Asia as well as from differentiated parts of the world including Africa. In addition, Al- Qaida started receiving active sponsorship from Iran. Iran provided support through involving the government ministries. All along Al-Qaida has been persuading Iraq to support them in their activities. Iraq was reluctant which at one point led to Iran supporting attacks on Iraq. However, things took a turn when Iraq was invaded by the United States.

At the time, Islamic groups initiated support on Iraq to fight against the United States. Al-Qaida used this opportunity to show its support to Iraq by fighting against the United States, and forming small sub groups such as Al-Mahdi Army among others (Mulloy, 2011). This act by Al-Qaida made its popularity grow. More countries were now willing to support its activities, which has led to the constant attacks experienced against the United States and its allies.

Proliferation of nuclear

The United States faces a number of challenges in the environment of nuclear security. Most of these challenges develop from nuclear relations that exist between the major countries considered as nuclear powers (Leffler, & Westad, 2010). Among the countries are: Russia, Republic of China, Great Britain and France. However, United States is also considered as one of the nuclear powers.

In addition to the nuclear powers, challenges from nuclear technology directed towards the United States also develop due to establishment of new states for nuclear weapons. Moreover, some states which have no capacity of producing nuclear weapons also seek nuclear weapons and use them against the United States. For instance Iran is believed to advance its efforts in producing nuclear weapons. Iran being an influential country to most countries practicing Islamic religion has led to most of the countries initiating efforts to develop nuclear weapons.

Some of the countries include: Egypt, Saudi Arabia as well as Turkey. It is expected however that, more countries may feel the need to prove their superiority hence start developing nuclear weapons in future (Kaplan, 2013). One of such countries is Brazil. Effects of need for proving superiority may result in nuclear competition. With nuclear competition, the risk of attacks on United States and other European Countries becomes higher.

Notably, when the percentage of states armed with nuclear weapons goes up then states with no capacity of producing nuclear weapons will increase their purchase levels for nuclear weapons. For United States the challenge from proliferation of nuclear emerges from the need to create a military position that will insulate United States from the world of anarchy. The other challenge develops from United States feeling the need to initiate and execute punishment to their enemies who are armed with nuclear weapons.

Recently, China has been developing itself to a major super power in the world. China has achieved its superiority due to its high percentage of expertise with knowledge of advanced technology (Mueller, & Stewart, 2012). Moreover, China has the capacity and sufficiency of resources of developing new technology. In addition, the labor force employed in China is readily available due to China’s high population. China therefore stands at a very good position of producing destructive nuclear weapons. United States then considers China a threat for its security.

Therefore, cold rivalry has developed between China and United States due to the need to prove superiority. China is known to have been producing nuclear weapons. From the silent rivalry existing between United States and China, it is expected that if China was to go to war with Japan over Senkaku Island then United States would enter the war in support of Japan (Katagiri, 2010). Notably, if United States was to consider supporting Japan, then China would fire its nuclear weapons which are believed to have been produced a few years back, and are now placed directed to United States lands and waters.

Engaging in fights using asymmetric counterforce

In terms of asymmetric counterforce United States faces the challenge of forces being attacked directly. When United States forces are attacked the main focus is on command and execution of control. Moreover, support centers for logistics, reconnaissance assets as well as United States fields of intelligence along with the Surveillance fields are at risk (Leffler, & Westad, 2010). In most cases, a situation involving asymmetric counterforce is marred with interruption by United States enemies on logistic lines used by the United States for communication.

The aim of interruption is to cause interference in United States giving support to its forces that have been deployed in the enemies’ territory. Furthermore, various attack attempts are made on the United States waters and lands. Moreover, some enemies use intimidation on allies of the United States to make them withdraw the support they are offering to the United States (Mulloy, 2011).

When the United States forces are subject to attack in a foreign land, it becomes critically hard for the United States government to fully protect a base they consider as critical. In addition, it also becomes hard to project and also sustain United States forces in an environment that is distant and cannot be easily accessed. Most of the attacks directed towards United States make use of space. The challenging part for United States is to have awareness on how the space looks like in terms of security.

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Another challenge is the constant improvement witnessed for cyber crime. Networks are being developed very fast and information revealed and past in a rate that is hard to always monitor. Some of the United States government information gets corrupted by enemies through degrading of networks. United States faces these challenges due to a number of reasons.

Three among them include: first the United States depends on countries that have neither chemical attack protection, biological attack protection nor radiological attack protection for its operations in military (Kaplan, 2013). In such a situation the partners will be subjected to so much loss and suffering which will force them to withdraw unwillingly the support they are offering to the United States. The second reason is because the United States has executed very few changes on its forces since the time the cold war ended.

With lack of changes, the United States puts itself in a situation where getting support is a hard experience since most of the allies of United States will be considered as ineffective at combat. The third reason is because forces of the United States are vulnerable to nuclear attacks that are done in small scale. It is believed that just one nuclear weapon, that has been properly used can cause an entire United States force to surrender (Katagiri, 2010).

For instance, Al-Qaida had easily mastered the weakness of the United States government in 1998. Al-Qaida used interruption to reduce the support that United States was getting from neighboring countries. After causing a division Al- Qaida went ahead and utilized the United States space to carry on with a deadly attack, by bombing the United States embassy in Kenya (Metz, In Martin, & Army War College (U.S.), 2010). On the other hand, China’s has asymmetric counterforce against United States through drawing the support United States was getting from Asia into support for China.

China has achieved with large ensuring large production of products in qualities of high value, middle value and low value. With high production China has been able to raise its economy to a level that is threatening to the United States. Since China has a more stable and ever growing economy, its influence on both the allies and enemies of United States is at a considerable level (Katagiri, 2010). China has the ability of taking away one by one United States support from different countries around the globe.

Recommendations

In order to address these challenges, it is important for the United States to consider installing sensors in bases they would consider as high targets to help in detection of chemical agents or any form of biological weaponry. In addition, United States should consider purchasing and providing to its forces protective equipment for nuclear attacks. Moreover training should be offered on how to use the protective equipment.

In the time of any attack, then the United States government should ensure that it has appropriate equipment for sounding alarm to all people affected. Furthermore, potential victims and real victims should be identified in order to provide first aid services. In addition to this, a system should be established for disseminating information to the world, to help United States sell itself to the world for other nations to understand her and support the policies it has for national security.

It would also be important for United States to have a channel for analyzing public opinion of citizens from foreign countries. Information products should also be made available to all individuals, regardless of whether they are nationals of United States or other countries. In order to cub cyber attacks, the United States government should implement the utilization of websites on the internet for its services.

Information from the United States should be distributed to other nations through the United States embassy radio channel as well as TV. A platform should also be created for coordination of all military force groups of the United States. Therefore, the government of United States should make good use of methods of production utilized by commercial media.

Conclusion

From the paper it comes out clearly that the United States faces a challenge in trying to translate the power it has in military into the outcomes it may desire in politics. The most dangerous forms of challenge are unconventional weapons, proliferation of nuclear weapons and the use of asymmetric counterforce against the United States. Two outcomes have also been discussed that developed as a result of the three challenges.

The first outcome is attacks by the Al-Qaida group. The second outcome is a silent conflict between United States and The Republic of China. However, the paper has presented clearly an analysis showing that most of the enemies of the United States prefer the use of high explosives. In addition, it was also clear that the United States needs to prepare itself better for cyber attacks.

References

Fernando Lujan, “Light Footprints: The Future of American Military Intervention,” Center for New American Security. (ND)

Haley Stauss, “United States’ Strategy in Afghanistan from 2001 to Today,”, Pepperdine Policy Review. (ND)

Kaplan, F. M. (2013). The insurgents: David Petraeus and the plot to change the American way of war. New York: Simon & Schuster.

Katagiri, N. (2010). A Review of: “David H. Ucko. The New Counterinsurgency Era: Transforming the U.S. Military for Modern Wars .”. Terrorism And Political Violence, 22(2), 320-322. http://dx.doi.org/10.1080/09546551003618000

Lake, D. (2009). The Limits of Coercive Airpower: NATO’s “Victory” in Kosovo Revisited. International Security, 34(1), 83-112. http://dx.doi.org/10.1162/isec.2009.34.1.83

Leffler, M. P., & Westad, O. A. (2010). The Cambridge history of the Cold War. Cambridge: Cambridge University Press.

M. Taylor Fravel, “Power Shifts and Escalation: Explaining China’s Use of Forces in Territorial Disputes,” International Security. (ND)

Metz, S., In Martin, J. R., & Army War College (U.S.). (2010). Decision making in Operation Iraqi Freedom: Removing Saddam Hussein by force. Carlisle, PA : Strategic Studies Institute, U.S. Army War College.

Mueller, J. & Stewart, M. (2012). The Terrorism Delusion: America’s Overwrought Response to September 11. International Security, 37(1), 81-110. http://dx.doi.org/10.1162/isec_a_00089

Mulloy, D. (2011). A Review of: “Jeffrey Record. Wanting War: Why the Bush Administration Invaded Iraq. ”. Terrorism And Political Violence, 23(4), 674-675. http://dx.doi.org/10.1080/09546553.2011.598434

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Quality and Safety in Healthcare

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Quality and Safety in Healthcare

Constant improvement of quality and safety is an important aspect in healthcare. Nurses play an important role in improving quality and safety in healthcare. Be as it may, nurses are always in contact with patients during the entire treatment. Their actions, professionalism, and observation of ethical principles determine the level of quality of service and safety within the healthcare system (Simon et al., 2013).

Nurses need to be committed to offering quality services including offering grief support. Emphasis on good care plans to ensure protocol is followed when offering support to patient can improve the quality of care.

I learned that nursing ethics play an important role in improvement of quality and safety of patients. Nurses are guided by professional principles and ethical framework that ensure that patients are treated according to standard protocol put in place. Nurses are required to be caring to patients and communicate effectively to ensure that patient is comfortable throughout while in the hospital. Respecting other healthcare practitioners and building strong and professional relation could also help improve quality of healthcare (Elwyn et al., 2014).

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Nurses can also ensure that healthcare goals of registering desirable patient outcomes is achieved by ensuring that each individual and family takes part in the care process. By engaging patients and families in the process of care, nurses are able to improve patient outcomes and rates of satisfaction. This is achieved through enhancement of the quality of the associations between the patient, the physician as well as the utilization of diagnostic testing, hospitalizations, and referrals.

Improvement of quality of healthcare can be achieved through observing its structure, processes, and outcomes. Structures essentially validates the availability, accessibility and quality of resources such as number of nurses, bed capacity among others. Nurses can help in improving quality of nursing through observing nursing principles and ethics, working through teamwork and involving family in provision of healthcare services.

References

Simon, B. et al (2013, August). Student experience in a student-centered peer instruction classroom. In Proceedings of the ninth annual international ACM conference on International computing education research (pp. 129-136). ACM.

Elwyn, G. et al (2014). Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems. The Annals of Family Medicine, 12(3), 270-275.

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Return on Equity: Financial Statement Interpretation

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Return on Equity: Financial Statement Interpretation

Volkswagen

The German automobile company was created in 1937 under the Volkswagen group of companies and is recognized as one of the top-selling automakers in the entire world. In fact, it is considered to be the second largest automobile manufacturing company in the automotive industry. As such, three of its products are in the top ten of bestselling cars. Better still, the company recorded $244.985 billion in revenues as of 2014. With a workforce of 588,902 employees and $424.982 billion in total assets, the company generated $13.393 billion profits (Morrow, 2016).

The company has focused its primary goal to double its market share in the United States. Through this, the firm would be focusing on its vision of becoming the world’s largest manufacturer of automobiles by the year 2018. In keeping faithful to this vision, they are expanding to bigger markets with the major ones being Germany and China (Morrow, 2016).

Return on Equity

Return on equity checks the return on the shareholders’ equity. In simpler terms, it measures the firm’s efficiency in earning profits from every unit of the shareholder’s equity. This means that a company needs to invest funds in an appropriate manner for them to get growth in their earnings. It is essential to note that measuring consistent margins in earnings per share does not sufficiently explain the performance. Therefore, Return on equity serves to be the best profitability ratio in measuring efficiency in performance. In this case, Volkswagen’s Return on equity ROE using the Du Point analysis for the last two years would be;

ROE using the DuPont method = (net income/revenue) * (income/assets) * (assets/equity)

ROE = (RNOA) + Return on debt

2015 = -1.67

2016; (10271.714922/227011) * (227011/429031.72385) * (429031.72385/97714.633) = 10.51

High return on equity mean that firms are not capital intensive. However, even if there are high returns with leverage in 2016, there is still a solid balance sheet. This means that the firm has utilized little of its capital this year on income-generating investing as opposed to 2015. All in all, it is critical to invest in firms with high Return on equity as they fluctuate due to company earnings or cycles when looking at long-term investments. For that reason, investors should look at investing in this year’s company ventures for them to get high returns.

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Microsoft

Microsoft is an American technology company that deals with the manufacture and distribution of computer software, electronics, as well as services. It is also recognized as the world’s largest software company and the most valuable. Founded in 1975, the company had its headquarters in Washington and recorded a revenue of $93.58 billion by 2015. It is also noted that the company has produced billionaires and millionaires from its 118,584 employees. More so, the firm is known to register high profits with a net income of $12.19 in 2015. As such, the company continues to grow to be a major player in the computer and electronics industry.

Return on Equity

ROE using the DuPont method = (net income/revenue) * (revenues/assets) * (assets/equity)

(Net profit margin) * (Asset turnover) * (Leverage)

2014; (25.42%) * (0.50) * (1.92) = 24.59%

2015; (13.03%) * (0.53%) * (2.20) = 15.23%

As stated earlier, firms that have registered high ROE often generate more cash rather than investing it. Even though, higher Return on equity show that the company is making good use of their equity in making more income, they are not exhausting their full potential in investments. In this case, Microsoft’s 2015’s Return on equity is lower than in 2014 by 9.36%. This means that they have been investing more rather than making profits. As a result, their balance sheet is not rigid since cash is always flowing in and out of investments. Better still, the higher rates of ROE show that the company is making good use of efficiency in utilizing their capital or shareholders’ equity in generating more income.

Walmart

In the same sense as Microsoft, Walmart is an American company but classified under the retail industry where it manages hypermarkets, departmental stores, and groceries. The firm has grown to establish 11,543 stores in 28 countries with its main operations being in the United States and Canada. The company has a registered revenue of $482.13 billion by 2016 thereby being recognized as the world’s largest firm by revenue. The family-owned business is also the most valuable enterprise through its attractive market value.

Being the biggest grocery retailer in the United States, its net income adds up to $14.694 billion even though it has employed 2.2 million people in all its global branches. However, it struggles to get a bigger market share by venturing into the growing and emerging Chinese and another Asian market. Also, they set low prices for their products in order to get a large customer base. Additionally, since the business is the biggest private employer in the United States, its turnover rate significantly affects the unemployment rates. In the same regard, they have faced numerous charges ranging from lawsuits to labor strikes.

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Return on Equity

ROE using the DuPont method = (net income/revenue) * (income/assets) * (assets/equity)

(Net profit margin) * (Asset turnover) * (Leverage)

2016; (3.07%) * (2.40%) * (2.48%) = 18.24%

2015; (3.39%) * (2.37%) * (2.50%) = 20.10%

Businesses that have higher returns on equity are focused on protecting their net income in facing the competition. This is so since they generate more income with little need of reinvesting it yet they have the ability to increase their business value. Still, higher Return on equity means having good business value since the stock prices will appreciate in a bid to trade with the firm’s growing value.

But, is having more shares worthwhile than investing the gained income? In the above recordings, it is clear that Walmart is making god use of their shareholders’ equity in generating more income for the business. However, the generated income is to place the company at the top of their rivals and in the stock market. Fortunately, the Return on equity decreased from 20.10% in 2015 to 18.24% in 2016 due to further reinvestment of their gained earnings.

From the above statistics, it is clear that both Microsoft and Walmart understand the importance of reinvesting their income in profitable ventures rather than having a solid balance sheet. On the other hand, Volkswagen is increasing their Return on equity perhaps to recapture their market position. The firm might also have decided not to reinvest their earnings probably to increase their value and better trading stocks in the stock market.

Company Analysis

Current Ratio

The current ratio measures a organization’s ability to offset its short-term debts or meeting its obligations. It gives the efficiency of a company’s operations to turn the product into cash. This is understood through the fact that businesses that are unable to pay their short-term debts often have liquidity problems.

It is given as; Total current liabilities/total current liabilities

For the first quarter in 2016;

Volkswagen – 179895.323/177672.61 = 1.01

Walmart – 59097/70282 = 0.84

Microsoft – 128421/44354 = 2.90

(Financials are given in millions)

The higher the ratio is, the more likely a company is able to pay its short-term debt. Therefore, a current ratio that is under 1 means that the establishment is having difficulties in paying off its obligations. Even though this is an indication the firm is not in good financial vigor, it does not inevitably mean that they will go broke (Christensen, Baker & Cottrell, 2014).

This means that Walmart’s first quarter performance is not good since they are having difficulties paying off their short-term debt. However, if the company has satisfying long-term projections, it may be able to borrow and pay off its obligations. In the same sense, Microsoft proves to be most efficient in paying off its short-term liabilities compared to the rest.

Quick Ratio

Though almost similar to current ratios, quick ratios show the practice’s ability to meet its short-term debt through its most liquid assets such as cash. As a result, inventories are excluded since they are less liquid.

For that reason, it is given through;

(Total current assets – portfolio)/ total current liabilities

For the first quarter in 2016;

Volkswagen – (179895.322 – 39936.526)/ 177672.606 = 0.79

Walmart – (59097 – 44513)/ 70282 = 0.21

Microsoft – (128421 – 2450)/ 44354 = 2.84

(Financials are given in millions)

Generally, a low quick ratio is an indication that a company is over-leveraged or is finding it hard to increase its sales, pay bills or is collecting their income slowly. From the other perspective, a higher quick ratio shows that a business is able to meet its financial obligations (Christensen, Baker & Cottrell, 2014). As such, they often have a faster inventory with fast conversion cash cycles. In this regard, Both Volkswagen and Walmart and struggling to meet their financial obligations. They cannot fully pay their current debt. Conversely, Microsoft shows good financial strength in its short term.

Net Profit Margin

Net margin is often used in assessing a company’s profitability and value estimation but is not entirely reliable. This is so because they can be easily manipulated by changing the methods of depreciation or altering the standard accounting practices. They are given through;

Net profit margin – net income/revenue

For the first quarter in 2016;

Volkswagen – 2630.290/56752.784 = 4.63

Walmart – 3079/115904 = 2.66

Microsoft – 3756/20531 = 18.29

(Financials are given in millions)

In this case, Microsoft company is the most profitable firm in the sense has it has the highest net profit margin with Walmart having the least profit margin. Microsoft is, therefore, ranked as having a net margin higher than 79% of the companies in the global software and infrastructure industry. In the same regard, Walmart was 68% higher in the retail industry while Volkswagen was 83% higher in net margins in the automotive industry.

Asset Utilization

Asset utilization involves the calculation of returns on Assets which measures the efficiency in which a firm uses their assets to generate income (Christensen, Baker & Cottrell, 2014). In short, it shows how well a company uses what it has to generate income. Therefore, it is given by;

Asset utilization – (net income/revenue) * (revenue/average total assets)

For the first quarter in 2016;

Volkswagen – (10521.1581/227011.136) * (227011.136/429031.724)= 2.45

Walmart – (12316/463616) * (463616/199143) = 6.18

Microsoft – (15024/82124) * (82124/180983) = 8.30

Similar to the return on equity, asset utilization can be affected by dynamic business cycles. Due to this, the ratio becomes crucial when looked at in the long-term perspective. Due the many factors such as stock buyback, may make the ROA not reflect the specific earning authority of the assets. ROA and ROE should not be used in the comparison of firms that are in different industries (Christensen, Baker & Cottrell, 2014). Microsoft’s ROA is higher than the rest of the companies even though they are in different industries.

Financial leverage

Financial leverage is recognized as the ability of an enterprise to use its debt in acquiring assets. It is also commonly known as trading on equity. It is given through;

Financial leverage – average of the total assets/average of the total equity

For the first quarter in 2016;

Volkswagen – 429031.724 / 97714.633 = 4.391

Walmart – 199143/77864.5 = 2.558

Microsoft – 180983.5/75793 = 2.388

When the value of assets falls, the financial leverage may fail to be beneficial. They do not guarantee the success of any business (Christensen, Baker & Cottrell, 2014). Volkswagen is, therefore, risking due to its high financial leverage in the event of having a decline in sales. From the above recordings, Microsoft is taking less risky investments of using debt to acquire assets as opposed to Walmart and Volkswagen.

Conclusion

Comparing companies in different industries is not always easy due to the variety of factors that involve the various operations that are undertaken. As stated above, ROE and ROA will not be useful when comparing the companies since they are from various industries (Christensen, Baker & Cottrell, 2014). In the same regard, manufacturing companies will have different accounting methods.

The allocation of resources and elements will be different. The service industry often has little overhead costs that lead to higher revenues that are converted to profit. On the other hand, manufacturing companies have higher revenues due to the variety of products and the costs. It is also to note that the difference in accounting is due to the standards applied. Inventory costs in IFRS are not allowed as opposed to GAAP standards.

Similarly, write-downs are reversed under the IFRS while it is not allowed in under GAAP. The IFRS are based on principles while the U.S. GAAP focus on rules. Therefore, IFRS better present economic transactions. However, all companies have shown efficiency in using their working capital even though they are done in different degrees (Christensen, Baker & Cottrell, 2014). All in all, Microsoft proves to be most efficient and having more financial strength.

References

Christensen, T. E., Baker, R. E., & Cottrell, D. M. (2014). Advanced Financial Accounting. The McGraw-Hill Companies, Inc.

http://www.gurufocus.com/term/ROE/MSFT/Return-on-Equity/Microsoft-Corp

http://www.gurufocus.com/term/ROE/VLKAY/Return-on-Equity/Volkswagen-AG

http://www.gurufocus.com/term/ROE/WMT/Return-on-Equity/Wal-Mart-Stores-Inc

Hurd, J., Lawman, M., Salkowski, Z., Sampson, H., & Stellato, A. (2014). Wal-Mart Case Study.

Morrow, R. (2016). Corporate Social Responsibility and Corporate Financial Performance: An Empirical Analysis. Available at SSRN.

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Data Security: Analysis of Effect of Cloud Computing

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Data Security: Analysis of Effect of Cloud Computing

Cloud Computing: Security, New Opportunities and Challenges

Section 1: Topic Endorsements

Cloud computing has been a very successful invention. It has created new opportunities for businesses in terms of storage spaces, access to software and other facilities. Additionally, many businesses have stated that they feel that their data is more secure if it is held in a cloud (Pearson and Yee, 2013). However, just as many businesses and experts have stated that cloud computing exposes data and makes businesses vulnerable in terms of data security (Ali, Khan and Vasilakos, 2015).

For computer scientists, understanding security issues as they relate to cloud computing is important for several reasons (Ali et al., 2015). The first and most important is the fact that in the future, any establishment will likely, partly or entirely, depend on cloud computing for storage of data (Mahmood, 2014). As a computer specialist, a computer scientist will be relied upon to monitor data, ensure security and make necessary adjustments where they are required (Verma and Kaushal, 2011).

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Section 2: Research Overview

The research literature on cloud computing indicates that we know cloud computing, even though safer than botnets, has created unexpected side channels because it is a shared resource (Verma and Kaushal, 2011). We also know that security incidences related to data computing are not unique, just different (Flinn, 2012). However, we do not know exact ways on how to improve data security within oud computing. However, several measures such as passwords, can be used to improve security (Pearson and Yee, 2013).

Cloud computing means that the devices used to provide required computing services do not belong to the end users (Krutz and Vines, 2010). As a result, users do not have control over how these devices are operated or who has access to them (Zhu, Hill and Trovati, 2015). Research regarding cloud computing has been extensive over the last decade as the service has continued to become more common among businesses and individuals. With each security development made, new ways to breach security come up as well (Samani, Honan, Reavis, Jirasek and CSA, 2015).

The basic research question is whether cloud computing has led to the increase or decrease of data security in enterprises, since it has become a business necessity (Nepal, Pathan and SpringerLink, 2014). The purpose of the study is to provide insight on cloud computing and how best to ensure data security. The methodology suggested for this research is equation methodology. Similarly, Moustakas- transcendental phenemonology is the suggested research model. With this in mind, the dissertation title becomes; Cloud Computing: Security, New opportunities and challenges (Schwarzkopf, Schmidt, Strack, Martin and Freisleben, 2012).

References

Ali, M., Khan, S. U., & Vasilakos, A. V. (June 01, 2015). Security in cloud computing: Opportunities and challenges. Information Sciences, 305, 1, 357-383.

Flinn, J. (2012). Cyber foraging: Bridging mobile and cloud computing. San Rafael, Calif.: Morgan & Claypool.

Samani, R., Honan, B., Reavis, J., In Jirasek, V., & CSA (Organization),. (2015). CSA guide to cloud computing: Implementing cloud privacy and security. Waltham, MA: Syngress

Krutz, R. L., & Vines, R. D. (2010). Cloud security: A comprehensive guide to secure cloud computing. Indianapolis, Ind: Wiley Pub.

In Zhu, S. Y., In Hill, R., & In Trovati, M. (2015). Guide to security assurance for cloud computing.

In Mahmood, Z. (2014). Cloud computing: Challenges, limitations and R & D solutions.

Pearson, S., & Yee, G. (2013). Privacy and security for cloud computing. London: Springer.

In Nepal, S., In Pathan, M., & SpringerLink (Online service). (2014). Security, Privacy and Trust in Cloud Systems. Berlin, Heidelberg: Springer Berlin Heidelberg.

Verma, A., & Kaushal, S. (January 01, 2011). Cloud Computing Security Issues and Challenges: A Survey.

Schwarzkopf, Roland, Schmidt, Matthias, Strack, Christian, Martin, Simon, & Freisleben, Bernd. (2012). Increasing virtual machine security in cloud environments. (BioMed Central Ltd.) BioMed Central Ltd.

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Gynecologic Condition Case Study

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Overview of the case study

The case study of a 42 year of African American female during her routine gynecologic examination reports of bleeding between her periods for some months. She has three children, is sexually active with one partner. Her examination indicates that she has irregular intrauterine mass, 4cm in diameter that is not painful on touch.

Diagnosis, treatment and management of the Gynecologic Condition

The patient is experiencing abnormal uterine bleeding due her history of pregnancy. Uterine bleeding is a common occurrence. When assessing patient with the common gynecologic conditions it is important to question the patient pregnancy status, her reproductive status to understand the source of bleeding (Lethaby et al, 2015).

Irregular intrauterine non-tender mass about 4 cm in diameter is a sign of abdominal or pelvic mass that can occur at any age. A woman experiencing intrauterine non- tender mass might complain of various symptoms, but there are a number of possible causes of pelvic mass. In evaluating the patient, the first step includes getting a good medical history of the patient regarding the pain, any family history of such similar problem and also knowing if the patient has regular periods or not or the history of pregnancy (Singh et al., 2013).

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Physical examination of the gynecologic conditions needs to include a palpation of the abdomen to detect a palpable mass, abdominal pain, and CVA tenderness. Pelvic exam needs determine cervix compression or uterine enlargement and also tenderness associated with vaginal lesion. Further examination can be done through ultrasound or CAT scan (Chaudhuri et al., 2014).

If the ultrasound suggests an abdominal mass the patient needs to seek for further advice from a gastroenterologist or general surgeon. Treatment for abdominal, uterine bleeding includes mediation like prostaglandin inhibitors (Kokaine et al, 2014). Surgery may be recommended or change in contraception. Some of the suggestion for managing abnormal uterine bleeding including taking iron supplements t and eating a balanced diet. Patients need to avoid drugs like aspirin that might contribute to excessive bleeding.

References

Chaudhuri, S., Datta, S., Paul, P. C., Mukherjee, S., & Malo, S. (2014). Cytologically Diagnosed Ovarian Carcinoma Turned Out To Be a Case of Chronic Ectopic Pregnancy. Journal of Interdisciplinary Histopathology, 2(2), 116-120

Kokaine, L., Lemanis, A., Sapovalovs, S., Abolins, A., & Balodis, A. (2014). Torsion of Arteriovenous Malformation–A Rare Case of Acute Abdomen. American Journal of Medical Case Reports, 2(11), 229-231.

Lethaby, A., Hussain, M., Rishworth, J. R., & Rees, M. C. (2015). Progesterone or progestogen‐releasing intrauterine systems for heavy menstrual bleeding. The Cochrane Library.

Singh, S., Best, C., Dunn, S., Leyland, N., Wolfman, W. L., Wolfman, W. & Marcoux, V. (2013). Abnormal uterine bleeding in pre-menopausal women. Journal of Obstetrics and Gynaecology Canada, 35(5), 473-475.

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Health Promotion to Pregnant Women

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Health Promotion to Pregnant Women

Introduction

All expectant women should ensure that they stay healthy during pregnancy since most of what they consume is shared with the foetus. Some of the things women take are good for the baby while others can be harmful. To educate a group of first-time teenage mothers, I will use posters to inform them about the following important information.

First, I will emphasize on the need for pregnant women to maintain a balanced diet. Most meals should include starch –based foods such as cereals, rice, fruits as well as vegetables. Women should also eat a lot of fiber and proteins. Weight monitoring is also of great importance although it has been found out that a weight increase of between 11 to 16kg during pregnancy is normal.

Pregnant women also need an extra 200 calories especially in their last month of pregnancy. Rauh et al. (2013) support the idea that folic acid supplements are ideal during pregnancy and should be taken up to the end of the 12th week of pregnancy since they aid in avoiding anemia, a common condition among pregnant women.

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Tobacco smoke contains harmful chemicals that pass through our bloodstream and goes into the growing foetus’ blood. Therefore, the pregnant woman should be counseled to stop smoking and avoid risks such as ectopic pregnancy, miscarriage, and premature labor (Piano & Phillips, 2013).

Additionally, during pregnancy women should avoid drinking alcohol because it slows down growth and causes serious problems in future. Pregnant women should also avoid pets which at times may carry germs that can be passed to the unborn baby. For instance, toxoplasma is bacteria commonly found in cats, therefore, I will educate women to wash their hands after handling cats.

This will aid in minimizing the effects of these germs. Using any illicit drugs when pregnant can have a detrimental effect on the unborn baby. Illicit drugs in most cases cause birth defects or miscarriage. Drug use can also affect the baby central nervous system according to Simkin et al. (2016).

Conclusion

Pregnant women should seek advice to get more information on how to stay healthy during pregnancy and after giving birth. Lifestyle adjustments will enable both the mother and the baby to stay healthy.

References

Piano, M. R., & Phillips, S. A. (2013). 20 Things You Didn’t Know About Alcohol. Journal of Cardiovascular Nursing, 28(4), 318-319.

Rauh, K., Gabriel, E., Kerschbaum, E., Schuster, T., von Kries, R., Amann-Gassner, U., & Hauner, H. (2013). Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial. BMC pregnancy and childbirth, 13(1), 1.

Simkin, P., Whalley, J., Keppler, A., Durham, J., & Bolding, A. (2016). Pregnancy, childbirth and the newborn: The complete guide. Simon and Schuster.

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Parole: Moral Dilemma in Criminal Justice Case Study

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Moral Dilemma in Criminal Justice

Case 1: The Parole Board

Critical dilemmas require critical decisions to minimize the risks that come with every cause of action. For this case, there is no guarantee that the release of prisoners on the federal process beyond the parole board control will serve its purpose without inflicting breaches in the security of the community. The alternative is therefore to take the less risky route of releasing the inmates by broadening the parole eligibility criteria.

As much as this is ethically wrong, it is a morally acceptable option. This is because prison overcrowding poses many risks health wise and it compromises the safety level in these facilities. For instance, many communicable diseases such as tuberculosis can spread uncontrollably in overcrowded populations. It also becomes impossible for the workforce available to keep law and order in such situations.

According to Pollock (2014), the purpose of prisons is to rehabilitate inmates to make them better people as they go back to the society. It is, therefore, essential to safeguard them from such incidences as well as respect their human rights (Bachman & Schutt, 2013). The moral question in this case Robert is faced with the moral question of the safety standards in the prison and at the same time he had to consider the probability of the inmates reoffending as evidenced by the assessment results.

The motivator to actors’ response is the fact that by releasing prisoners under the parole board control this department will have full control over them as opposed to the federal process. This is important because it only allows the release of low- and medium-level offenders to the community correction programs (Pollock, 2014). This ensures that these offenders re-enters the community in a well-regulated and managed procedure. Since it deals with inmates who are completing their term, the program acts as a last chance to the prisoners before incarceration.

The consequence of broadening the parole system will be the risk of releasing violent convicts who might disregard their agreement resulting to their return in prison and hence accelerate the overcrowding issue. From the results of assessment, it is evident that the parole system does not provide the right punishment for the prisoners since it has been found out that the prisoners are likely to offend again if they are subjected to the parole system. As such it is the obligation of Robert to decide on the corrective measure of dealing with the issue at hand.

Subsequently, he is supposed to give the correct information to the governor who will execute the plan (Bachman & Schutt, 2013). The federal system is, however, riskier as the released inmates are difficult to monitor and can, therefore, lead to increased crime in the community. This will lead the probationers back to prison, and therefore the overcrowding problem will not have been solved (Pollock, 2014). On the other hand, all the prisoners cannot be held in the same prisoners since as the situation is the prisoners are already overcrowded. This could bring other problems in the picture most importantly the health and the safety standards in the prison.

Considering the risk assessment of both options, it is clear that none would help unravel the problem at hand efficiently. Robert should ask the governor to consider expansion of prison facilities to accommodate more inmates. This will be both ethically and morally considerate because it will ensure prisoners are taken care of without disregarding neither their security nor that of the community. This proves to be the only conceivable way of solving this problem because, the probation and parole officers would experience diverse caseloads with the large numbers of inmates, therefore, limiting their capacities of supervising them (Pollock, 2014).

It is considered the only undisputable way of protecting convicts from the numerous risks that they face in overcrowded prisons without comprising on public safety. Proper prison conditions will also ensure that the lawbreakers will come out as helpful people due to the various correction programs offered to them. Overcrowding will only make the wardens anticipate releasing them without considering whether they have reformed or not so long as they have served their jail term.

Case 2: The Warden

In this case, William is facing a dilemma on whether to compromise on the inmates’ expenditure by cutting the health and food expenses to afford over time officers as well as replacement pay employees. This will, in turn, assist in eradicating the looming danger of understaffing which could lead to several other problems. By cutting on the food and medical budget, he will be able to pay the officers’ overtime as well as increase workforce to control the increasing population in the prisons (Bachman & Schutt, 2013).

It will also motivate the personnel, and they will enhance security and normality in the facility. As much as this may seem like the best alternative Robert has to think critically because denying the prisoners their rights to food and medical care is immoral and will result in severe consequences which might be fatal (Pollock, 2014). The motivational factor for this option is the need to maintain the workforce meant to prevent the triggers that can cause the employees to quit or fail to report on duty as required.

In my opinion, this is the best pronouncement that warden could implement to handle the ethical dilemma. Although this alternative will achieve the goal of maintaining the employees it will compromise on the safety of the prisoners. More so it might result in deaths of the lawbreakers emanating from the tremendous infections that are present in those facilities and are aggravated by the increasing populations.

The prisoners might also become rebellious, and this can trigger them to go on strike or even attack the prison wardens worsening the situation. Also, depriving the inmates of their medical rights will lead to increased epidemics that may further cost the facility a lot of money on treatment (Cole, Smith & DeJong, 2015). On the other hand, by not taking this option, the workers feel insecure and unappreciated, and this will prompt them to quit their jobs or fail to undertake their responsibilities.

They will also be overworked, and this will reduce their effectiveness when performing their duties. These workers will also become reluctant; this will compromise the safety of the facility and with the increasing population, it will be difficult for the limited workers to manage and control the inmates.

William should consider utilizing other amenities such as community supervision programs to decongest the prisons. These programs will take care of the prisoners who are completing their jail terms as well as those with minor offenses (Pollock, 2014). Prisoners with drug abuse and mental health problems should be taken to other rehabilitation centers that fit their needs best. This is because staying will only alleviate their conditions because drugs are also present in prison with inadequate labor it is impossible to keep track of such occurrences (Pollock, 2014).

Community supervision will incorporate prisoners in more useful activities including counseling, life skills training and educational based programs. This will not only help in the reforming of these lawbreakers but will also equip them with the much-needed self-development capabilities. Specialized courts should also be utilized to ensure the inmates placed under parole are complying with the community correction programs (Pollock, 2014).

The ethical basis for this decision is to ensure everybody in this situation is suited by the final decision that is made. The decision should entail the well-being of the prisoners and at the same time ensure that the prison is appropriately staffed. By utilization of other facilities, the overcrowding problem will be solved without compromising on the safety of the workers or cutting the food and health budget for the inmates. This will ensure that the personnel will feel secure in their working environments and will, therefore, be able to manage the remaining number of inmates.

It is, therefore, the duty of the warden to ensure that proper measures are established and implemented. Regarding drug and alcohol dependency, addicts recover better and faster when placed under specialized programs as opposed to incarceration. Therefore the warden should make plans to ensure that other institutions are engaged in taking care of the high inflow of the criminal offenders. It is therefore in the interest of all individuals to ensure that community supervision strategies are specifically used to ensure that all the lawbreakers are punished properly.

Therefore in the meeting it will be appropriate that William responds in respect to alternative strategies of handling the increased rate of prisoner’s inflow. Designation of some of the prisoners particularly the petty offenders to community based work release is one of the most effective strategies that would ensure that the facilities are not overcrowded. On the other hand, the problem of understaffing will be automatically addressed if overcrowding is addressed (Pollock, 2014). This is because it will be easier to cut down the costs in the prison when it is not overcrowded.

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Case 3: The District Attorney

The moral question that faces Martha is the question of being supportive of the governor or stand with her campaign platform of plea bargaining and reduced sentences for convicts. It would seem morally right to make good of her words during her campaign, but this option will compromise the security in the community as well as her relationship with the mayor (Maxfield & Babbie, 2014).

This brings about the dilemma since the district understands that the criminal records suggest that majority of the arrests are from the drug culture. It would be, therefore, unethical since a district attorney should be more concerned about the people’s security rather keeping her word to the convicts. However, she will appear like a traitor, and this is not a good picture to her future campaigns. Martha should be critical in her decision making for her to make the most out of this dilemma.

Martha is motivated by the fact that she will need the mayor and the community in her future campaigns for it to be a success. By deciding to support the mayor she will be assured of a smooth relationship between her and the police chief which will play a major role in the success of her campaigns. She will also secure support from the mayor and other stakeholders in law keeping during her future campaigns (Pollock, 2014). Apart from that, it is seemingly morally wrong to go easy on gun-toting drug merchants by reducing their sentences or plea-bargaining.

This is because such an action will be seen as collaboration with the wrongdoers which will imply that the district attorney is collaborating with the wrongdoers which can be likened to blackmail (Cole, Smith & DeJong, 2015). However, by going back in her words, she might as well forget future support from the community as this will portray her as a betrayer. She will, therefore, reduce her chances of remaining attorney general if the community loses faith in her. Also, it is morally wrong to deny the prisoners a fair trial by supporting the governor to exercise aggressive arrest of the drug felons (Braswell, McCarthy & McCarthy, 2014).

According to the analysis of both options, Martha should ensure that the arrestees face the law and are responsible for their offenses. This should, however, be done in that makes them face a fair trial and a sentence that matches the crimes committed by each (Cullen, & Chouhy, 2016). She should ask her staff to convict the lawbreakers each according to his/her crimes and not by treating and judging them as a group.

She should also ask the mayor and the chief police to introduce new sentences for the drug dealers especially those who do not involve murder or other serious crimes (Banks, 2016). These sentences can incorporate life training skills that will help the prisoners with alternative means of livelihood. This will reduce the art of drug hawking without necessarily being tough on the convicts. Subsequently, if she considers the morally right course of action, then it is most likely that she will get the support that she aspires to get.

This option also ensures that the convicts will be equipped differently as they go back to the community. Otherwise convicting the drug felons harshly will only result in bitter inmates who will be back to drug dealing as soon as they finish their jail terms. Also, by grouping the arrestees according to the level of their crimes, it will help the prosecutors determine the best sentence for each of them (Pollock, 2014).

This will result in long term cleaning of the streets in one way instead of convict and release style. The community’s security and the inmate’s interests will be met without compromising Martha’s ethical and moral responsibilities. It will, therefore, be a win-win situation for both her and the mayor (Pollock, 2014). This will ensure that she will have future support from the mayor, the police, and the entire community.

Case 4: The Officer

The moral and ethical aspect, in this case, is that Linda cannot decide on whether first to arrest the suspect or honor the dispatchers call and act as back up. It is immoral for her to let the suspect go despite the fact she has the evidence that the suspect is a drug dealer (Cole, Smith & DeJong, 2015). Although there have been several complaints regarding the fact that the police in the area have been engaging in making minor arrests, the officer happens to encounter such a case.

Coincidentally the officer happens to be in the middle of making an arrest regarding drugs when she receives the call to attend to a burglary in progress. However, it is also her responsibility to assist officers in patrol especially in times of emergency such as this one (Banks, 2016). Linda should, therefore, be critical to the most prudent decision for this dilemma. She should make a move that will benefit the interests of the community’s security as well as the nature of her job.

The fact that Linda might lose her job for handling a ‘petty drug case’ instead of serving as backup for the progressing burglary is the motivator for her course of decision. The easier route is letting loose the suspect and declare herself available for the backup (Albanese, 2015). By so doing she will secure her job and avoid the griping that comes with her colleagues about her not being available for this call of duty (Banks, 2016).

She will also save time and spare the already clogged up system. After all, it is also impossible for her to arrest the suspect without the help of the contraband. As much this seems like the right thing to do, it is unethical for Linda to leave a drug dealer suspect for whom she has evidence. This will compromise on the community’s security because drug dealing comes with many other crimes (Bazemore & Boba, 2007).

It will also encourage other culprits resulting to drug-dealer laden streets, which might be uncontrollable or cost the law keepers a lot of money to control. Letting the suspect go would also indicate that such a crime is not as important and therefore would encourage other drug peddlers (Bazemore & Boba, 2007).

Putting all these factors into considerations, Linda should truthfully tell the dispatcher that she is unavailable. Being a backup for the progressing burglary is essential but arresting and charging the suspect is equally important (Banks, 2016). She should also ask for a backup to help her arrest this suspect instead of risking her life trying to arrest this man alone. Disregarding the fact that there have been complaints regarding the situation at hand attending to it would be the appropriate course of action rather than setting free a probable convict (Albanese, 2015).

As much this will put her at risk, it is the moral and ethical thing to do. Since she has evidence that the suspect is indeed a drug dealer, it will not take her long to convict this suspect. This will therefore not be one of those cases that clog up the system. Furthermore, the evidence that she already has at hand could be used to build a case for the suspect, and the only remaining step would be to take him to the station. This is because the only thing she needs is to identify the suspect to be able to charge him.

It would be advisable that other officers especially those who are off duty should be utilized in such a case to act as the backup. She should also let her sergeant see the dangers posed by such drug dealers especially if they are left uncontrolled (Braswell, McCarthy, & McCarthy, 2014). This cause of action might result in Linda losing her job, but it is important to protect the people and save the law keepers time and money in the future instead of staying employed and only serving out of obligation.

References

Albanese, J. S. (2015). Professional ethics in criminal justice: Being ethical when no one is Looking. Pearson.

Bachman, R., & Schutt, R. K. (2013). The practice of research in criminology and criminal justice. Sage.

Banks, C. (2016). Criminal justice ethics: Theory and practice. Sage Publications.

Bazemore, G., & Boba, R. (2007). “Doing Good” to “Make Good”: Community Theory for Practice in a Restorative Justice Civic Engagement Reentry Model. Journal of Offender Rehabilitation, 46(1-2), 25-56.

Braswell, M. C., McCarthy, B. R., & McCarthy, B. J. (2014). Justice, crime, and ethics. Routledge.

Castellano, U. (2007). Becoming a nonexpert and other strategies for managing fieldwork Dilemmas in the criminal justice system. Journal of Contemporary Ethnography, 36(6), 704-730.

Cole, G. F., Smith, C. E., & DeJong, C. (2015). The American system of criminal justice. Nelson Education.

Cullen, F. T., & Chouhy, C. (2016). The role of theory, ideology, and ethics in criminal justice policy. Advancing Criminology and Criminal Justice Policy, 40.

Finkel, N. J., Harre, R., & Lopez, J. L. R. (2001). Commonsense morality across cultures: Notions of fairness, justice, honor and equity. Discourse Studies, 3(1), 5-27.

Maxfield, M. G., & Babbie, E. R. (2014). Research methods for criminal justice and criminology. Nelson Education.

Pollock, J. M. (2014). Ethical dilemmas and decisions in criminal justice. Nelson Education.

Williams, C. R., & Arrigo, B. A. (2011). Ethics, crime, and criminal justice. Pearson Higher Ed.

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Application of Systems Theory

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Application of Systems Theory

Description of System

Health care systems may be established in different settings, making it vary the elements it is composed of. A number of challenges may be experienced depending on the nature of the environment of a health care system. Home care is one kind of the systems of nursing care, where patients receive support and care from their homes or where care is delivered within a community locale.

Considering the elements forming a home based care system, it is predictable that nurses and other health practitioners are bound to experience challenges in their daily work. Among the many issues that home health care faces, communication hitches are the most common. Open system theory can be used to analyze a home based care unit so as to describe the challenges it experiences.

In this case, home-based care may be taken as a nursing production unit. Basing on the Systems theory, a number of elements should interact to form the whole. There should be inputs to feed the system while outputs are as a result of operations and transformations that inputs are subjected to. This nursing production unit is kept in motion by throughput and feedback processes.

Therefore, basing on Systems theory, home care as a unit is made complete by inputs, outputs, throughput, and feedback processes. A thorough appraisal of this components can play a big role in determining potential sources of issues affecting home-based care, and therefore, it helps in formulating necessary solutions.

Inputs

In a home care system, some of the important factors that contribute to inputs include a number of energic sources like information, resources, nurse characteristics and the features of care receivers.

Characteristics of care receivers: In a home-based care, young or old age is an important feature of those who benefit from this kind of nursing production. Basically, the aged and the young forms this group as they may experience access challenges to health facilities. Chronic health conditions are predominant in this system, where patients have developed conditions that are ever recurring.

More than 80 percent of adults, who are over sixty-five years of age suffer from at least one long-term condition, while 50 percent of the same category of adults suffer from two or more chronic diseases (Brennan-Cook, & Molloy, 2016). This indicates that caregivers have a huge workload of addressing the large number of the elderly, who develop complex conditions and other comorbidities day after day.

Old age is yet another factor that makes health conditions to persist over a long period. Language and speech of these group of persons are troublesome in most cases. As Brennan-Cook & Molloy (2016) states, older people undergo a number of natural physiological changes that interfere with their communication abilities. Old age, as a characteristic of the nursing care recipients in the home care system, is the most significant issue. Health care recipients in this system may be resilient and conservative which affects care delivery.

Characteristics of caregivers: In a home care system, nurses and other care deliverers need to have a high level of competency to meet demands. Nurses form part of the inputs of the system, feeding the system in the sense that they provide care and services needed by home care recipients. Community or home care nurses should be well experienced and conversant with chronic conditions in this setting. They also need to have high levels of expertise so that they can handle a diverse nature of complex conditions and comorbidities.

Other Inputs: There are quite a number of specialized fiscal resources that are needed to deliver care in this system. Communication technologies, support and self-medications devices can play a significant role as inputs.

Throughput

In a home care setting, this entails factors such as care delivery happening in a local and informal setting which relies a lot on a close relationship established between caregivers and recipients. This will involve the type and quality of operations and services that a health care team offers to patients. Services that can be offered to receivers of home care includes medications, counseling, and educational services.

Outputs

If effective service delivery has been achieved, home-based care can result in noticeable changes in patient outcomes. Safety of both patients and care providers is guaranteed from good interactions of the system’s elements. Improved quality of life, reduced severity of chronic infections and a lowered number of comorbidities among the elderly are some of the expected patient outcomes.

Negative Feedback

Persistence of conditions, reluctance to comply with caregivers and other poor patient outcomes are good measures of performance of the home care system. They are vital for system’s self-evaluation, which triggers positive change.

Communication Problems in Home Care

As identified earlier, communication plays a vital role in defining outcomes from a home care system. In all the elements, especially inputs, ineffective communication causes poor performance of the whole system. Healthcare receivers have a likely disability in their communication because of their physiological changes. Old age tempers with speech and hearing, which makes their relationship with caregivers demanding.

Communication challenges that recipients have require that nurses and other health practitioners have great expertise so as to compensate for the weaknesses in one element of the system for its maintenance. Despite that patient’s characteristics may hinder communication, it is the responsibilities of nurses to devise ways of enhancing effective interactions. Technical and professional nursing language may be a hindrance to a good patient-nurse relationship. Throughput and negative feedback may face interference as they rely on effective communication.

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Solutions to Communication Issues

Outcome

Improved patient outcomes of the elderly people, facing communication challenges as a result of natural physiological changes that interferes with listening and hearing.

Goals/Objectives

To ensure that all the elderly persons receiving home care achieve the best outcomes from their interactions with nurses by adequately training them so that they are equipped with better communications strategies and ability.
To better patient-nurse relationship by eliminating communication barriers through regular training of both nurses and care recipients, and through an incorporation of helpful technologies.

Policies

All nurses and students should be adequately trained, and must have a certificate showing that they can effectively communicate in a home care system before they get licensed to work in the care system.
Educative sessions and training, for both patients and nurses, should be carried out at least once a year, with the purpose of ensuring a positive patient-nurse communication relationship.

Professional Standards

Nurses should be in a position of playing a vital role in ensuring effective communication in whatever interaction they have. They should have excellent skills in processing, recording, assessing and reporting various types of information.

How Resolutions will uphold visions, values, and Mission

The recommended resolutions can help achieve the visions and the missions and values that the organization advocates. Some of the values and visions upheld by the system include resilience, discipline, honesty, advocacy, satisfaction, among others. Promoting training and education of nurses on matters of effective communication can help to achieve this. Effective communication is crucial for advocacy and in edifying the importance of the system’s value.

Given that the system has a mission of bettering the community life, effective communication policies will help in getting feedback, improving patient-nurse interactions among other practices, all of which have a potential of improving the quality of life.

References

Brennan-Cook, J., & Molloy, M. A. (2016). Utilizing Trigger Films to Enhance Communication Skills of Home Care Clinicians. Home Healthcare Now, 34(7), 376-380. Retrieved from. DOI: 10.1097/NHH.0000000000000409.

Johansson, C., D. Miller, V., & Hamrin, S. (2014). Conceptualizing communicative leadership: A framework for analyzing and developing leaders’ communication competence. Corporate Communications: An International Journal, 19(2), 147-165. Retrieved from http://www.emeraldinsight.com/doi/pdfplus/10.1108/CCIJ-02-2013-0007.

Meyer, R. M., & O’Brien‐Pallas, L. L. (2010). Nursing services delivery theory: an open system approach. Journal of advanced nursing, 66(12), 2828-2838. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2010.05449.x/pdf.

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The spiritual assessment tool

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The spiritual assessment tool

Spiritual Needs Assessment

The spiritual assessment tool is part of a holistic approach to addressing the needs of the patients. Ideally, the personal beliefs of a patient can play a vital role in incorporating coping strategies and limiting the negative implications of depression. Currently, healthcare plans implement psychosocial resources in addressing the needs of patients. Mainly, oncology patients tend to spend an extended time with the nurses and doctors; therefore, there is a need to ensure that their accommodation is as comfortable as possible (McSherry & Ross, 2010).

The spiritual assessment tool can be customized depending on attributes such as age, gender, and ethnicity. Analyzing the implications of the instrument will ultimately enable doctors and nurses to improve care management. The following questions were developed and the conversation between the interviewer and the patient documented. Furthermore, the patient was an adult male cancer patient in the late twenties, of African American ethnicity.

Part I: The Interview

Interviewer: Are there any spiritual beliefs that help you to interpret the role and meaning of life?

Patient: Yes there are. I believe that every man has a part to play in balancing earth’s ecosystem. Some people have minor roles, and others have major ones; however, each is equally important. God’s will is that people share the gifts they have with each other and with their environment.

Interviewer: Does your family have a religious background?

Patient: My father is of the Catholic faith. My mother is a Christian, a Protestant. I never really understood what she is protesting about

Interviewer: Do you have any personal religious convictions?

Patient: Yes I do. I believe the blood of Jesus can save lives and souls. Of course, I don’t mean a literal approach, but I am convinced that my life is spent well if I live reflecting on the teaching of the Bible.

Interviewer: Do you believe that aspects of your spiritual life have physical manifestations on your health?

Patient: Yes. The devil came to steal, kill and destroy. Naturally, that implies harm on my physical body. However, I can face adversity because I know I am not alone. Jesus hears my prayers and will deliver me from this affliction one way or another.

Interviewer: Are there any specific attributes about spirituality that provide an anchor in times of distress?

Patient: Christianity is about submitting to a higher purpose. God has good plans for me, therefore, if harm comes my way it is all part of God’s plan. Maybe the Lord wants to display his strength, and I just have to trust him, or my pain is somehow supposed to be a testimony for someone else who is suffering. The Lord works in mysterious ways.

Interviewer: Are there any resources from your spiritual history that you would prefer to be incorporated in your treatment plan?

Patient: Yes. Kindly notify my family to bring my Bible and study book. Also, I would prefer to connect with my local church ministry through social media, television, or radio. There is a prayer and fasting revival that is to begin next week, and I would not want to miss it despite the pain.

Interviewer: Are you concerned about any medical procedures that may assist or interfere with your spiritual convictions regarding your treatment?

Patient: Please do not give me any medicinal marijuana. I am not supposed to consume any hallucinogenic substance. Also, I would have to skip lunch starting from next week since that is when the prayer and fasting revival begins.

Part II: Analysis

The spiritual assessment tool provided crucial insight on the patient’s current mental state. Mainly, the patient’s spirituality seemed to offer effective coping strategies since there were minimal signs of depression. The patient was very cooperative and open about his spiritual preferences and how they manifest in medical perspectives. However, in future, some of the questions will be modified to prevent introducing aspects that interfere with the treatment process.

Especially, the question reflecting on the spiritual resources that can be implemented in the treatment plan tends to invoke a controversial response; therefore, it will be modified as a suggestion as opposed to the indication that the resources can indeed be incorporated despite their negative influence on health dynamics.

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The patient answered all the questions asked. However, he appeared to have a limited attention span which may be affected by pain associated with his condition. As such, his response was very slow. Interactive communication strategies that sustain active engagement can be used in future in anticipation of challenges when the patients are required to respond (Katz, 2015). Additionally, a more open approach should be applied on a general basis since some patients may not have any spiritual affiliations. For instance, the first question can suggest to the patient that he or she has the right to refuse involvement in the conversation by incorporating terms like ‘May I ask about your religious orientation?’

The spiritual exercise facilitated a healthy interaction between the interviewer and the patient, enabling documentation of attitudes towards the current condition. Therefore, physicians and nurses can anticipate certain reactions from the patient during the treatment program. For instance, suggestions of medicinal marijuana to minimize pain and strain due to chemotherapy should not be made to ensure that the patient does not lose confidence in the treatment.

The illness had a consistent implication on the patient’s spiritual needs. The interviewee believed that Jesus would aid him in his times of need; therefore, more pain or distress required additional religious influence as an anchor. The spiritual assessment tool identifies holistic resources that should improve the patient’s experience. In scenarios whereby the interviewee does not have any religious or spiritual convictions, the physician can focus on whether the patient believes he or she has some purpose in life.

In conclusion, the spiritual assessment tool enables patients, nurses, and doctors to develop effective communication strategies. The nurses can monitor changes in behavior and offer timely intervention to prevent cases of depression (Christ, Messner & Behar, 2015). Ultimately, a patient’s psychological and social orientation should provide a support system that should be applied in the treatment strategy. Additionally, since the placebo effect proves the physiological benefits of belief, the benefits of the spiritual assessment tool should be prioritized.

References

Christ, G. H., Messner, C., & Behar, L. C. (2015). Handbook of oncology social work: Psychosocial care for people with cancer.

Katz, A. (2015). Meeting the need for psychosocial care in young adults with cancer.

McSherry, W., & Ross, L. (2010). Spiritual assessment in healthcare practice. Keswick, England: M & K.

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