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An Explication paper on Aunt Hetty on Matrimony
This is an extremely funny piece written by Fanny Fern which has some inherent truth in it. For instance, men are often bored with their wives making them to neglect them. However, presently both women and men can neglect one another or each other on equal measures, but no matter what, women and men will always need each other. In the conclusion of this funny piece, Aunt Hetty makes a plea to girls, to totally shun marriage because of the fact that after their death, their husbands will remarry. However, she also strives to stop herself since irrespective of her warning; at some point in their life, the girls will try marriage (Fanny 49).
Aunt Hetty is trying her best to offer advice to girls; this is because issues to do with marriage and love seem to disgust her and wants girls to be cautious on them. According to Aunty Hetty, “love is a farce; matrimony a humbug; husbands are domestic Napoleons, Alexanders, and Neroes …” (Fanny 47). This indicates her disbelief in these things and is urging young girls to be careful before indulging in them. However, her motive to offer this advice is her unpleasant experience, but she concurs with the fact that at some point many women will always want to try marriage (Fanny 47).
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Aunty Hetty reiterates that after a man wins a woman’s heart; he moves on to conquer other women hearts (Fanny 48). In addition, Aunty Hetty also believes men rarely try to build the home because they envisage that work to be done by women. Therefore, she implies that matrimony should be left alone because it is the hardest thing.
“Remain aloof to any gentleman who gives his attention; until one of us can verify his circumstances” (Fanny 16). Aunty Hetty also advise women to seek knowing men better prior to engaging with them, because they are crafty and will seek to conquer other women’s hearts after they win theirs (Fanny 48).
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Organizing Staff for Success
Introduction
This paper addresses a case study ‘the overhaul of John’s Business- Organizing Staff for Success’. According to the case study, John had worked in a steel fabrication industry in his entire life. He began as a trainee boilermaker, but demonstrated determination and enthusiasm that was absent in the colleagues. He had the desire to start his business, and he did so.
Since the business was booming, he realized that he required more boilermakers to assist with the work he was getting. He employed sixteen tradespeople at the workshop. He soon decided to expand his business in providing labor to nearby mines. John realized that he required office workers to assist since he had two divisions in the business: labor supply and boiler making.
John’s business was prospering and being aware of business literature aimed at keeping, attracting and motivating talented staff, he was aware that business coaching was a technique that successful businesses were using. John usually networked with the community’s business people. During one occasion, he spoke with a business coach and decided that he required the services of one to ensure his team remained productive as was the case initially.
John was informed that coaching is effective when done on-job to assist in management development, and employees are helped to develop individual skills. John therefore, decided on an external coach and being the owner and general manager, john had made several organizational changes in the company (Repenning, 2002, 120).
Specific areas were supervised by different managers. Ted, the workshop’s manager had two supervisors; Dave and Matt. Matt supervised the daily work and organized the team. On the other hand, Dave supervised the off-site work. Craig was the labor hire business manager. Louise was Craig’s assistant manager, and her responsibility was to organize the right tradespeople for specific jobs.
Organizing Staff for Success
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The management team met with John every week, to provide updates in the specific areas, discuss business, and receive instructions. John realized that his motivated and dedicated managers never met their targets. In addition, there were several communication problems although he did not know their extent. John informed the team that a business coach had been employed to work with each of them. This was a chance for managers to work through issues they had been experiencing as well as give response to the coach concerning the systems under implementation.
This was a way through which communication would be improved since the staff would get equipped on how to coach the subordinates (Duncan, 2011, 321). John wanted to initiate a continuous improvement culture in the team. The business coach would report the areas that had problems and strategies that could be used to solve the problems. A management meeting was arranged where the coach briefed the team what the coaching was all about, the benefits and what each session would entail.
At the end of the briefing meeting, the staff was enthusiastic about growing the business and having been involved in the process of decision making. The coaching continued for several months, and the coach reported her insights to john. It was realized that Ted was responsible for all the quoting which was extremely time- consuming and remarkably little would be accomplished until the company secured the job successfully.
Unless Ted was effective with quoting, employees would have nothing to do and would be unable to plan for upcoming jobs appropriately. Moreover, Matt would be frustrated as his responsibility was to organize the daily work. Dave would also be frustrated since he would take the workers to work off-site if they were doing nothing at the workshop. Staffs were usually frustrated since there was a lack of communication between the three supervisors and managers.
Apart from lack of communication, workers were confused about who was in charge of them amongst Dave, Matt and Ted). There was resentment present within the team. Dave and Matt were, ambitious, young and perfect mates away from work. The two often discussed Ted that he did literally nothing since quoting was never done on time although he always said that quoting was his key priority. Ted was open on how much he had to do and even though he dedicated long hours and hard work, productivity was not evident from his efforts.
Organizing Staff for Success
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On the other hand, Craig (responsible of supplying the right mines’ tradespeople, and developing and assisting manage the growth of the overall business) did not have much complains. His notion was that everything was alright. The coach himself was unsure of his roles. His assistant, Louise, did all the labor hire team administration work and actual positions filling. The two got along well, but there was a workload imbalance.
Finally, John was never involved in the daily running of the business as he spent most of his time networking. He had experienced massive prosperity and growth in the recent years, and had earned the rewards. He was however, aware that the business was entering hard times. John’s concern was providing some control, give direction and still keep the staff happy and motivated (Boswell, 2003).
This report is aimed at discussing whether the company’s organizational structure is justified for the size. Secondly, suggestions will be offered on how communication can be improved amongst the staff. Thirdly, it will be assessed whether there is overstaffing, and a new organizational chart will be provided. Fourthly, the benefits of an external coach will be discussed. Finally, contingency plans that can be implemented in the company will be suggested. The report is presented to Denise Tomlin, the course coordinator. Articles and textbooks will be used to gather information.
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Organizational structure and size
Organizational structure refers to the type and degree of vertical differentiation, horizontal differentiation, control and coordination mechanisms, centralization of power and formalization. There is one best way through which an organization can be structured, yet structural attributes vary in organizations. Size refers to the number and capacity of resources, outputs and personnel. Differentiation in an organization increases with size, although at a reducing rate.
On the contrary, the percentage of organizations dealing with administrative overhead reduces with size, resulting to economies of scale. Increased size also means more organizational activities’ structuring and reduced power concentration. Managerial practices for example personal assignments’ flexibility in authority delegation and stress in results, as opposed to procedures are linked to the managed unit size (Jacobides, 2007, 460).
John’s business is a small organization, and a tall or centralized organizational structure is appropriate. John should therefore, be relied on to make significant decisions. However, there are several management layers under the principal decision maker. The centralized structure is the most appropriate since the owner has the responsibility of making business decisions. John feels that some level of control is required in the business because he distrusts his managers’ ability to make decisions.
Owners of small businesses struggle, when allotting managerial duties to managers. However, it is imperative that small businesses that continue to expand and grow have the owners assign decision- making responsibilities (Dubin, 2001, 187). If John uses centralized structure in his business, it will be possible to maintain and create a company culture. A company culture refers to an intangible environment where employees, managers and owners work.
John’s business fits in a formal organization culture which is more stressful as opposed to a friendly and open culture. In many companies, organizational structures evolve as businesses expand and grow. Furthermore, individuals can decide the structure a business will use in its operations.
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Improving communication gaps between staff
Effective communication is extremely significant in every organization. From the case study presented, there is a communication breakdown between John and the staffs, and between Craig, Matt and Dave. However, organizations have varying types of people, with different education levels, personality types, cultures and backgrounds. What makes sense might be nonsense to someone else. Priorities and deadlines may be misinterpreted, and productive ideas can be made ineffective, unproductive and low morale can result in employees.
It is worth noting that the external coach was useful in identifying the communication gaps. John thought there was a communication breakdown but did not know to what extent. Consequently, the worker or device responsible for the breakdown should be assesses (Pugh et al, 1999, 87).
John ought to evaluate interpersonal relationships that exist between employees and communication devices’ calibers. The fact that Ted always says he has a lot to do should be assessed. John should conduct a quick survey to identify how many other employees have the same complaint.
The second thing john should do is gauge feedback and review formal messages to ensure that additional communication is avoided in clarifying principal themes. Grapevine information should not be stifled to avoid misunderstandings and lower productivity.
The third step is to assess the resources required to rectify the problem. Problems that result from acrimonious tension between staffs require a staff meeting or mediation program to disentangle issues. Dave and Matt should be advised to consider all that Ted does and offer a hand where necessary (Child, 2009, 20).
John should organize for training where employees acquire new methods of communication. Staff feedback is crucial in assisting employees’ transit to the new system. Finally, follow ups should be done to ensure that the communication gap is no more. Open communication should be facilitated by welcoming the open- door policy where employees express their concerns without retribution.
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Overstaffing
John’s business is unquestionably overstaffed. It is worth noting that the productivity and efficiency of small businesses heavily depends on maintaining suitable staffing levels and recruiting effectively. Staffing is usually a challenge in all organizations. In my opinion, Ted and Craig should be deployed. Craig should have all he does done by Louise. Dave and Matt are close friends and can therefore, collaborate and handle Ted’s roles.
It is extremely vital that john identifies the company’s needs so as to be able to develop a staffing strategy. This can be achieved through coming up with job descriptions that displays the positions needed to meet different responsibilities. Continual communication can assist john identify staff shortcomings (Braha and Bar-Yam, 1130). Continual feedback is useful in identifying the need for more employees so that work is completed efficiently without straining current employees.
The process of manpower planning enables an organization assess its department’s net worth. A certain department might be reaping enormous profits but understaffed at the same time. In such circumstances, the existing staffs are pressurized to perform. When small businesses are staffed properly, responsibilities and duties are completed in a timely manner.
Organizational chart
Benefits of external coaches
An external coach acts as a source of fresh perspectives in events and people in the organization. This implies that the coach can make connections and notice patterns which the insiders are unaware of. He is a valuable people’s thinking’ sounding boards where he can identify, ask and give feedback from an outsider’s perspective.
Since the coach does not have a manager’s direct responsibilities, he can devote his entire attention to customer’s needs. This results to high- energy and intensive types of coaching that yields significant results within a short period. Long-term term coaching provides a solid individual development foundation (Stone, 2012, 454).
Coaching is usually confidential between the coachee and coach. Hence, employees are more comfortable discussing personal concerns and sensitive information with the coach, as opposed to john. Unspoken problems that interfere with crucial business processes are therefore, resolved.
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External coaches possess extensive coaching training, as opposed to managers. Therefore, John’s company will benefit from a coaching experience wealth and exceedingly developed coaching skills (Stone, 2012, 455).
In addition to core coaching skills, external coaches possess specialist expertise that makes them suitable for particular coaching assignments. These include emotional intelligence, psychology, creativity, presentation skills, meditation, negotiation, sales and leadership.
Contingency plans
As a human resource practitioner, it is particularly vital that an environment is created whereby employees are empowered to think creatively. It is worth noting that contingency plans require the coordination and cooperation of various organizational areas.
One of the contingency plans that can be implemented is collective bargaining breakdown which requires human resource leadership, as well as public relations, purchasing, operations and sales efforts (Child, 2008, 170). Organizations with corporate planning functions can use this to secure cooperation that is organization- wide.
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Conclusion and recommendations
From the foregoing discussion, John’s business hugely benefited from the services of an external coach. The coach was able to identify the communication breakdown that the company had, and offer appropriate remedies. Since John’s company is under the category of a small organization, a tall structure fits the size of the company. It is advisable that John deploys Ted and Craig so as to avoid overstaffing.
Braha, D. and Bar-Yam, Y. (2007) The Statistical Mechanics of Complex Product Development: Empirical and Analytical Results. Management Science. Vol. 53, iss. 7, 1127–1145.
Child, J. (2008) Predicting and Understanding Organization Structure. Administrative Science Quarter. Vol. 18, iss. 2, 168-185.
Child, J. (2009) Organizational Structure, Environment and Performance: The Role of Strategic Choice. Sociologa. Vol. 6, iss. 1, 1-22.
Dubin, R. (2001) Management in Britain – Impressions of a Visiting Professor. Journal of Management Studies. Vol. 7, iss. 2, 183-198.
Jacobides, M. G. (2007). The inherent limits of organizational structure and the unfulfilled role of hierarchy: Lessons from a near-war. Organization Science. Vol. 18, iss. 3, 455-477.
Pugh, D. S. et al. (1999) Dimensions of Organization Structure. Administrative Science Quarter. Vol.13, iss. I, 65-105;
Repenning, N. (2002). A Simulation-Based Approach to Understanding the Dynamics of Innovation Implementation. Organization Science. Vol. 13, iss. 2: 109-127.
Stone, R. (2012) Managing Human Resources.3rd Edition. John Wiley & Sons Australia. 454 – 455).
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Company Acquisitions
Issue and Case Analysis: Company Acquisitions
Question 1: Merge the acquired company into your company. The result of this strategy will be one company containing the elements of both companies.
Since 1990s, there has been an accelerated pace of global mergers and company acquisitions as companies use them as a tool for competitiveness and to expand to global markets. A strategic manager must carefully look into both the pre-acquisition phase and the post-acquisition phase to execute a successful acquisition (Lasserre, 2003).
When the value of operational synergies of the companies operating in similar business contexts is expected, the absorption mode is appropriate. This enables necessary consolidation and rationalization necessary, to occur in the soonest time possible. The company is able to evaluate the best business practices to be adopted and find sources of savings by absorbing the competencies and competitive products of the other company (David, 2012).
The challenge in absorption occurs when there’s rationalization by the company being acquired hindering the process due to resistance to change and difference in culture. A SWOT analysis of the new merger would help to identify the areas to strengthen and areas of potential threats that may hinder successful acquisition (Lasserre, 2003).
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Question 2: Operate the acquired company as a separate business entity. The result of this strategy will be two separate companies under one senior management “umbrella” (the senior management team that is responsible for running both companies).
Where the company is allowed to operate as a separate business entity, Preservation Mode, is when very few operational synergies can be gained. This is important when large autonomy of decision making in the acquired business is required. The existing management is kept in place while the parent company learns the ‘rules of the game’ of the new business. The benefits accrued include enlargement of products and markets and also the transfer of new competencies or resources.
The disadvantage is the acquired company could behave opportunistically by ‘siphoning off’ resources of acquirer if there’s ‘weak’ management (Hitt, Ireland & Hoskisson, 2011). A balanced scorecard could be used to measure the acquisition in terms of customers’ opinions and views, financial position and advantages, improvement and value creation through growth and learning among others.
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According to David (2012), research shows twenty percent of all mergers and acquisitions are successful, approximately sixty percent produce disappointing results, and the last twenty percent are clear failures. Continuous evaluation and correction after acquisition is a critical factor to avoid the pitfalls that result in failure of acquisition (Lasserre, 2003).
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Admission Essay Services – Personal Statement – Intent to Transfer
Since when I was a young kid I have always being interested in the management, and preferably being a manager in a hospital. My passion to pursue a degree in Health Management is the main objective I want to transfer from YYY YYY to University of XXX. In order to actualize my dream I have worked hard to lay a good foundation necessary for this career, and for the two years I have been at XXX Dade I have ensured that have selected the essential courses and attained an appropriate GPA which will qualify me for admission to the University of XXX.
This is evident from the fact that I currently hold 45 credits with a GPA of 3.0; credentials I hope will qualify me for admission at the University of XXX to pursue a degree in Health Management.
I have always wished to get a chance for enrollment in the Business school at the University of XXX since my early years of elementary school. This interest was heightened by the success of my four uncles who studied B.Sc. in Engineering at the University of XXX, and are currently holding important key positions in the country. This gave me a good impression of your reputable institution and always had that strong interest to be an alumnnus of the University of XXX.
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I am specifically highly interested to pursue a degree in Health Management major from School of Business at the University of XXX. This has led me to move to XXX in order to render my application for an admission to University of XXX and obtain my preferred degree essential to make me a hospital manager in future.
After looking through the courses offered by the University of XXX for the major of Health Management, I am certain that I will greatly benefit from them as well as the expertise of the professors in the School of Business and learning facilities. I hope to be a crucial asset to my country in the field of hospitals management after obtaining a degree in Health Management from the University of XXX.
Admission Essay Services
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Kohlberg moral development stages
Explain how the concept of justice relates to the field of criminal justice, emphasizing how it should be applied by law enforcement officers. Explain three (3) ways Kohlberg Moral Development stages can be applied to the evaluation of three (3) types of criminals who are at different stages of moral development. Recommend three (3) effective and ethical methods of deterrence for the selected criminals.
(One (1) method for each criminal.) Recommend ways to use ethics to improve decision making in the criminal justice system. Explain why and how the concept of justice is important to the field of criminal justice. Explain Kohlberg’s moral development stages and how they can be applied to issues in criminal justice. Use technology and information resources to research issues in ethics and leadership in criminal justice. Write clearly and concisely about ethics and leadership in criminal justice using proper writing mechanics.The concept of Justice
Definition.
Justice can be defined as a system of laws in a society that bestows every individual his or her natural and legal rights. It encompasses both the concept of equality where everyone is equal before the law and also the concept of equity where one is rewarded on the basis of his efforts.
Kohlberg moral development stages
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Relation between justice and criminal justice.
Justice brings about rule of law in the society (Colleen, 2008). The law enforcement officers are allowed to investigate a suspect of wrongdoing and then make an arrest. These officers are allowed to use force in effecting public and social order and if a suspect is dangerous they are allowed to use legal means of coercion to arrest him. This means a suspect can be denied some of his rights in an effort to protect the whole society. The police are empowered to enforce all aspects of criminal law on the basis of their mission and jurisdiction.
Evaluation of three types of criminals using Kohlberg’s stages of moral development.
The pre-social criminal easily gives in to his mind’s strong impulses to commit an act. The criminal is in the pre conventional stage of development and is not bothered by the consequences of his actions (Cherry, 2002). This behavior is most prevalent in children who have not yet internalized the requirements and moral standards that one is supposed to uphold in society.
The anti social criminal acts in pursuit of what is in his best interest. The criminal is in the conventional stage of moral development and knows very well that his actions are in contravention to society morals and norms. The criminal has a harsh super ego to attain his intentions regardless of the consequences.
The asocial criminal is not loyal to any ideals of the society. He is in the post conventional stage of moral development and considers that individuals are separate entities from the society. Their own perspective must take precedence over the society’s perspectives.
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Deterrence methods for the three types of criminals.
The pre- social criminal should be empowered through training so as he can access his needs through legal means. The societal norms and practices should be inculcated in him through advice and follow up.
The anti social criminal should be deterred through environmental designs that predispose all violent acts. Such measures include installation of surveillance devices and territorial reinforcements.
The asocial criminal can be deterred through being disciplined through the criminal laws that are applicable in a society. This is mainly through sentences in courts of law.
Kohlberg’s stages of moral development help the criminal justice system identify the intention behind the commitment of various types of crimes (Baker, 2011). There are those who commit crime out of necessity as portrayed in the Heinz dilemma. There are others who commit crimes to satisfy their ego and are not aware of the underlying consequences. This is mainly prevalent in juvenile crimes that are committed by children.
They do not know fully what is expected of them by the society. There are others who commit crimes because they take it as their right. They do not mind what the society will think of them. They commit crimes to satisfy their satiable thirst to achieve their goals. Such crimes are mainly committed by mass murderers who are only out to achieve their wishes no matter how heinous.
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What is love
What is love?. Love can be said to be a strong emotion of affection towards somebody else. It brings about personal attachment between two or more people. Love is usually demonstrated through acts of compassion and personal kindness as demonstrated by Madame Rosa who adopts Momo who is an orphaned young boy. She gives him accommodation and takes care of his needs. Madame Rosa treats Momo as one of her own. Momo also comes to the aid of his foster mother especially when she grows old and is unable to attend to her daily routine.
He supports her even when she is unable to walk like when he supports her when climbing the stairs. This unselfish and benevolent concern for one another in times of need and happiness is the true manifestation of love. Love goes beyond the physical appearance of a person. It means being concerned with somebody’s welfare and well being. This is as demonstrated by Madame Rosa when he adopts Momo.
If she had not done so, the young boy could have been exposed to the many dangers that face street children of being prone to all manner of evils like drug addiction, diseases, theft and even death. The way Madame Rosa identifies with the boy and rescues him from the vulnerability of street life shows great compassion and affection. The assertion by Madame Rosa that “I’ve never really loved anybody else” (Gary 152) demonstrates how her heart and spirit had embraced this young boy to a point that they were inseparable.
What is love
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It shows that psychologically, Madame Rosa felt at home and at ease when living with this boy even though they had no blood relationship. The boy felt great affection towards this woman who shows him the motherly love that he had not experienced. This act of concern makes the boy treasure the woman so much that the bond between the two can be said to be inexplicably strong.
Madame Rosa depicts the care being accorded her by the boy in great stride. She knows that since she has grown old, nobody is really interested in her. She therefore knows that Momo, is her everything from providing her support to doing almost all the domestic chores in the house. This scenario reminds Madame Rosa of her glorious days and also reminds her of the current status where she is old and unable to attend to all her needs. She is not worried because she knows that there is somebody who will unwaveringly attend to all her needs.
The impeccable thing is that this boy is at peace to reciprocate what the woman did to him when he was also in need. This is also depicted in the poem ‘When you are old’ where it says “But one man loved the pilgrim soul in you,” (http://www.poetryfoundation.org/poem/172055 ). Love is therefore demonstrated as the acts of kindness and compassion to somebody regardless of whether you know him or her.
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Such acts of kindness will are reciprocated when one may also be in need. God is known to reward all acts of kindness and passionate love for others in many ways and this underscores the notion that each one of us should treat others like their own. This will make us find solace and the grace in life since our ways will be atoned with God’s grace. This is as depicted by Shakespeare when he says our good acts in life will make us not “look at myself, cursing my fate” (http://shakespeare-online.com/sonnets/29detail.html )
Works cited
Gary, R. The life Before Us. New York. New Directions Publications Corp., 1986
Yeats, W. “When You Are Old” Web. Accessed on 14th August 2012
Shakespeare, W. “Sonnet-29” Web. Accessed on 14 August 2012
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Why people attend college
Each year, hundreds of thousands of students join colleges and institutions of higher learning to pursue college education, according to the U.S. Bureau of Labor Statistics, (1) “in the year 2011, about 68.3 % of 2011 high school graduates were enrolled in colleges or universities”. These figures point out to a high number of people seeking college education. It is worth noting that, there were other college admissions outside high school graduates.
The three major reasons why people attend college are; to attain success because a college degree is a requirement by most employers, secondly it is because attending college is what everyone else is doing and perhaps chances are that the student wants to just join his or her peers and finally the third reason is the desire to gain knowledge on a given skill and build on one’s talent. The three reasons are discussed in the next paragraphs.
Nothing is more important to an ambitious student than ending up in their dream job since this is considered by many as attaining success. Success for most students depends on what course they study and employers look for just that. Even the most independent-minded student acknowledges the relevance of a college degree in the current job environment.
For such a student, he or she will attend college so as to increase their chances of being successful in their future endeavors. There is a significant number of students whose main aim of going to college is to attain the right papers for securing their future jobs.
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Another reason why people attend college is because it is trendy, most people will think lowly of anyone who does not have college education. Therefore because it is what everyone does and perhaps the chance is there and the student has a guardian or another source of financing, so he or she just attends the college because the chance is available. Such people do not necessarily perform poorer than those in the category explained above; it is just that they join college with a different kind of motive.
Perhaps the third major reason why people attend college is the desire to gain knowledge on a given skill and build on ones talent; there are some skills which can only be trained adequately in colleges. This could be because of some training facilities required. In addition, such skills have to be passed on by qualified professionals who can only offer such services in colleges and this is possible in colleges.
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The above mentioned three reasons are the common reasons on why people attend college. Evidently after college a lot of the success or failure witnessed amongst people in life after college hardly depends on what caused the person attends college.
Often it is hard to pick out for example from an organizational or workplace set up, the different types of people based on the above categorization. In most cases, one may succeed or fail in life after college irrespective of their reason for joining college. It is worth noting that other factors besides reason for attending college can determine the outcome of one’s college life.
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Neonatal Resuscitation
Introduction
Is there a thing that is as defenseless and precious as a baby who is newly born? I agree with the fact that thousands of babies in the United States are premature before their small bodies can sustain life. The normal time needed for a fetus to be fully developed in to a normal baby is usually thirty six to forty weeks. Premature infants therefore, are those born before the thirty sixth week.
Infants born before the twenty sixth gestation week have anatomically underdeveloped lungs and, they cannot physiologically support ventilation. I appreciate that there has been giant leaps forward within the last decades which has enabled us all but the most premature and smallest infants.
Currently, analyzing the Millennium Development Goals on Neonatal resuscitation in the developing world indicates that there is an impressive progress in child health. However, there is barely any notable achievement as far as neonatal health is concerned. Neonatal deaths’ proportion (death within the initial twenty eight days) is anticipated to increase as a result of the reduction in postneonatal deaths burden.
The World Health Statistics shows that the health-related MDGs indicate that approximately thirty seven percent of the under-five mortality is usually within the neonatal period. Most deaths occur during the first week (early neonatal period). More than one million neonates lose their life within the first twenty four hours as a result of poor quality care, globally and annually.
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Continuum of Care
The key principle in developing strategies aimed at addressing (NHC) Neonatal Health Care revolves within the continuum of care. Throughout the lifecycle, including childhood, childbirth, pregnancy and adolescence, the care need to be offered as a seamless continuum spanning the health center, community and home, globally and locally (Atkins and Murphy, 1994, 50). Therefore, decreasing child mortality depends entirely on managing neonatal mortality or otherwise, tackling Neonatal Health Care.
Personal Experience
I am a RRT (Registered Respiratory Therapist) and have worked in NICU (Neonatal Intensive Care Unit). Additionally, I have visited many other units as part of the duties as a Respiratory Care nurse. I have experienced the procedures and tests, the angst and waiting as well as the sensitive roller coaster of emotions that both parents and child endure. In case the infant is developed adequately and is strong enough for survival, there is anxiety concerning the quality of life for the child and the family that has to cater for the child’s specific needs.
Is the cost measurable in terms of real dollars and emotionally? Mezirow (1990) argues the mortality and morbidity rates in particularly low birth weight children is remarkably high; it is in fact, so high that the sole ethical choice is to leave them die a painless and natural death. Infants that are born before the twenty fourth gestation week need not be resuscitated for financial, medical and ethical reasons.
Medical ethic principles are justice, beneficence, non-maleficence and respect for autonomy. These principles act as the guideline for health care professionals when dealing with all their patients. There is no exception. Respect for autonomy recognizes “the patient has the capacity to act intentionally, with understanding, and without controlling influences that would mitigate against a free and voluntary act” (Lim et al, 2000, 492).
In the case of neonates, the biological parents have the responsibility of making the child’s health care decisions, as far as ethics in medicine is concerned. The non-maleficence principle implies that healthcare professionals should not create needless injury or harm intentionally to the patient, either with omission or commission acts. All procedures ad tests should have their benefits weighed. Beneficence can be defined as “the duty of health care providers to be of a benefit to the patient, as well as to take positive steps to prevent and to remove harm from the patient”.
In respect to the justice principle, each patient should be given what is rightfully theirs. Equal persons should be given equal treatment (Speck, 1985, 93). Moreover, patients need to be treated with honesty and dignity, and together with their families, the healthcare community’s total disclosure is necessary so that they are able to make informed decisions. Even if, a health care professional does not agree with the decision made, it is necessary to treat the patient with dignity; the choice should be respected.
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My Critical Experience
From my many years of practice as a nurse, I choose this critical experience since it was tremendously emotional and had a profound impact on me until today. Douglas was delivered at twenty five weeks of gestation with a weight of five hundred and fifty grams. He was born spontaneously preterm in vertex presentation. His primigravida single mother, Annette, had pre-eclampsia which led to the preterm birth.
Annette was given a dose of steroids thereby delivering Douglas within the next hour. Using antenatal steroids is considered as critical intervention in anticipation of prematurity which improves preterm babies outcome (Teasdale, 2000, 581).
At birth, Douglas’ condition was critical and therefore, the need for resuscitation. As mentioned earlier, surfactant treatment is administered to preterm infants having respiratory distress since they lack a protein referred to as surfactant which prevents the lung’s small air sacs from collapsing. Douglas was therefore given surfactant treatment together with a breathing mechanical ventilator aid so that his lungs could remain expanded.
The boy’s condition improved, and he was successfully transferred to CPAP (Continuous Positive Airway Pressure). This was aimed at delivering pressurized air to his lings via small tubes in the nose to help in breathing. Douglas developed bleeding in the brain (intracranial bleed) of grade III on the second day. Intracranial bleed is prevalent during the first 3 days of life and an ultrasound examination diagnoses it. Mild intracranial bleeds resolve themselves and no of few lasting problems (Miles, 1989, 71).
More severe bleeds cause the brain ventricles to expand rapidly, causing brain pressure which brings about permanent brain damage. The results are neuro developmental delay or cerebral palsy. Douglas also had PDA (Patent Ductus Arteriosus), a common heart problem in premature babies. This however did not need treatment as it was small.
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Irrespective of the boy’s critical condition during the first week in life, there was an improvement in his general condition. Naso-gastric tube feeds started being used, and intravenous fluids stopped (Shields-Poe and Pinelli, 1997, 32). While still an inpatient at the hospital, Annette visited Douglas for 2 days during which she was updated of his critical condition. Annette did not bond with her son comfortably, although the nurses encouraged her to.
She gave excuses so that she could not express milk and therefore Douglas was fed with donor breast milk. On the 3rd day, she was discharged, and she visited only once every week. However, she called nurses most of the times to enquire about his progress. Annette’s behavior was brought to the attention of a social worker, and it was reviewed. When I was delegated to look after Douglas, I met the mother once during which I spoke with her and encouraged her to hold and touch the baby which she did.
On the 22nd day after birth, the CPAP was working for Douglas; he could tolerate the feeds and was adding weight. For the six days I took care of him, his general condition was satisfactory. Annette called at nights to check on Douglas’ condition. I informed her he was stable with a 30 grams weight gain. She was enthralled and promised to come the following day.
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On my seventh night duty, on the twenty eight days after birth, I was surprised to meet Douglas re-intubated and on Nitric oxide high frequency mode ventilator. Douglas has developed PPHN (Persistent Pulmonary Hypertension), stopped breathing and was cyanotic. According to Wood (2009), preterm PPHN is linked to high risk adverse neurodevelopmental and health outcomes. To date, it is among the most complicated conditions experienced in NICU.
His critical condition made him be supported using various intravenous infusions, among them morphine to manage pain. Annette had visited at day time and cuddled her baby. She also has a social talk with the in-charge nurse and she was to come during the evening and stay overnight with her son. Unfortunately, Douglas succumbed to cyanotic attack after she left. She was updated of this on her way back to the hospital. On arrival, Annette and the friend she had come with were confused to see the extreme technical situation surrounding the boy.
I offered a drink and a chair to Annette. The serving consultant counseled her and recommended the life support to be withdrawn since Douglas IVH was at grade IV. Annette was unable to decide on the care withdrawal. She begged to leave and come back with her mother the following morning to discuss the situation further and come up with a decision. She immediately left.
At NICU, 4 nurses are delegated with the responsibility of receiving admissions from the theatre and labor ward and taking care of sick babies. We were 3 three nurses that night as a result of staff shortage. An emergency came from the clinical nurse manager from the labor room. One of the nurses rushed to the labor room and brought back twenty eight weeks preterm Mark who was intubated. He required medications and infusions and since his condition was grave, attention was focused to him.
After Mark settled, I was beside Douglas when I realized that his heart rate had gone down to 120 per minute from the usual 160 per minute. The consultant agreed with me that nothing more could be done. The morphine infusion had to be increased to manage pain (Reid, 1993, 307). I called Annette as they were driving home with the friend to inform her of the development. She confirmed that she would come back the following with her mother as earlier agreed.
I touched Douglas’s hand soothingly and wished Annette was there to console and hold him. Suddenly, the nurse attending to Mark called out for drugs as Mark had developed cardiac arrest. We worked to resuscitate Mark but I could see that Douglas was also going in to an arrest since there was continuous drop in the heart rate. Mark was the priority at the moment but I wished I could go over to Douglas and console him.
His monitor stopped indicating vital signs. Mark died shortly after Douglas. We did all we could have done to save the two lives but as with hundreds of other babies, we were unsuccessful. The social worker had to follow Annette to provide further care.
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The Care of Premature Newborns
“Good ethics begin with compelling facts” is a guiding principle when dealing with ethical care for premature newborns. So as to make a profound decision, the first thing is the qualified obstetrician to assess and gather all the necessary information utilizing all the available resources. Consequently, the parents need to be informed in a way that they can understand (respect for autonomy).
“It should be emphasized that there is some uncertainty with any predictive process, because every infant is unique. The prognosis for the fetus may change after birth, when a more accurate assessment of the gestational age and actual condition can be made” (Daly et al, 2004, 2).After the fetal weight and gestational age are determined; the parents should be presented with the facts and counseled on the child’s possible outcomes.
It is imperative that the health care team and physician address the process of decision making as a team, together with the parents. Moreover, the parent’s belief system and desires as well as the child’s needs should be kept at the forefront. The Journal Pediatrics have categorized the treatment decisions and summarized them on prognosis basis as:
1. In case there is a high likelihood of early death and survival would encompass high risk of morbidity that is unacceptably severe: intensive care not indicated.
2. In case there is a likelihood of survival and the risk of inadmissibly severe morbidity is small: indicate intensive care.
3. In cases that fall within the mentioned categories and there is uncertain prognosis and likely extraordinarily poor, and survival encompasses diminished child’s quality of life, parental desires determine the approach for treatment. (Carkhuff, 1996, 211).
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During the last few decades, there has been an improvement in the prognosis for tremendously premature infants. However, many of the exceptionally small and extremely premature infants die or possess a morbidity rate that is unacceptably high. In this population, the medical complications are usually profound and complicated. Some complications result from the birth event and others are congenital defects. Majority of the morbidities are linked to immature lung development.
Fetuses produce surfactant, an essential proper lung function protein, at the age of thirty two weeks. Surfactant deficiency is treated by medical science by refining and producing porcine and bovine surfactant. However, this is usually not as effective compared to native surfactant. There is the instantaneous complication of reduced delivery of oxygen to the brain, organs and blood. Besides this, the long term complication is anoxia, brain injury as a result of inadequate oxygen supply to the brain. High morbidity rates attract the greatest categories of complications.
Majority of the morbidities bring about profound and severe disabilities, and cause early demise (Murphy et al, 2003, 227). The mortality rate of neonates in this group is relatively high, and the severe to moderate morbidity rate is more than fifty percent. It is worth noting that the statistics for very small and very premature neonates indicate a one hundred percent mortality rate. These children possess physical limitations and abnormalities that they have to bear with for their entire lives and which their families need to provide care. The outstanding care is extremely expensive and emotionally exhausting.
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Reflect on the cost of offering care to late preterm vs a term infant. Late preterm have far much less complications as well as complicated medical needs as opposed to Extremely Low Birth Weight (ELBW) neonates, and yet the cost of caring for them during their 1st year of life is astoundingly vast. The cost for taking care of a premature infant who is late term is three times more the cost for term infants.
Extremely Low Birth Weight neonates’ cost is six times a term infant’s cost, if the infant survives. At a national level, the cost for ELBW’s care is staggering. United States spends 5.8 billion dollars annually (Raeside, 2000, 98). This represents forty seven percent of all infant hospitalization costs and twenty seven of all pediatric stays. 65, 600 dollars is the average cost, where the least viable consume most of the resources.
The figures refer to the initial hospital stay costs. This is the first care as far as caring for children with profound or severe disabilities are concerned. Is this burden fair to the society? These are some of the prevailing questions in the light of the discussion on medicine socialization and healthcare coverage. What is the belief of the society on the value of life? Can a baby’s existence be replaced with the dollar value?
Considering that resources are infinite, should they be used on the few neonates and leave the majority to share the smaller percentage? (Schmieding, 1999, 636). What if it is my child is among those that require disproportionate resources and care to survive? What if my child is among those being given a normal care level since there are few providers as majority of the providers are focused on ELBW who need the highest care level? The answer to these questions will vary depending on the role of a person; a parent, health care consumer or a provider.
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Figure 1: Grave Neonatal Morbidities in < 750 g Birth Weight Infants in the National Institute of Child Health and Human Development Neonatal Centers, 1995-1996
Condition
Frequency of Morbidities (%)
Range
Respiratory Distress Syndrome
78
54-97
Oxygen required at twenty eight days after birth
81
64-92
Chronic Lung Disease
52
8-86
Necrotizing Enterocolitis
14
9-38
Septicemia
48
30-64
Grade 3 intraventricular hemorrhage
13
6-29
Grade 4 intraventricular hemorrhage
13
3-26
Periventricular Leukomalacia
7
2-30
Growth failure
100
92-100
This data is for infants who are alive at twenty days (Cotton, 2001, 515).
Conclusion
Preterm neonates require extensive care to ensure their survival. Major challenges that make this goal ineffective include inadequate nurses and medication. More than often, care has to shift to neonates who require immediate attention. It is sue to these reasons that neonate mortality is still high although there has been an improvement in child care as per the MDGs. It takes a lot of courage to work as a nurse and especially when emphatic with the mother to the neonate infant.
Bibliography
Atkins, S. and Murphy, K. (1994) “Reflective Practice.” Journal of Nursing Standard, Vol. 8, iss. 39, 49-56.
Carkhuff, M. H. (1996) “Reflective learning: work groups as learning groups.” Journal of Continuing Education in Nursing, Vol. 27, iss. 5, 209–214.
Cotton, A. H. (2001) “Private thoughts in public spheres: issues in reflection and reflective practices in nursing.” Journal of Advanced Nursing, Vol. 364, iss. 4, 512-519.
Lim, J. J., Childs. J. and Gonsalves, K. (2000) “Critical incident stress management.” The Journal of American association of occupational health nursing, Vol. 48, iss. 10, 487–497.
Mezirow, J. (1990) Fostering critical reflection in adulthood: a guide to transformative and emancipatory learning. Jossey-Bass.
Miles, M. S. (1989) “Parents of chronically ill premature infants: sources of stress.”Journal of Critical Care Nursing Quarterly, Vol. 12, iss. 3, 69-74.
Raeside, L (2000) “Caring for dying babies: perceptions of neonatal nurses.” Journal of Neonatal Nursing,Vol. 6, iss. 93-99.
Reid, B. (1993) “But we’re doing it already”, Exploring a response to the concept of reflective practice in order to improve its facilitation.” Journal of Nurse Education Today, Vol. 13, iss. 4, 305-309.
Schmieding, N. J. (1999) “Reflective inquiry framework for nurse administrators.” Journal of Advanced Nursing, Vol. 30, iss. 3, 631–639.
Shields-Poe, D. and Pinelli, J. (1997) “Variables associated with parental stress in neonatal intensive care units.”Journal of Neonatal Network, Vol. 16, iss. 1, 29-37.
Speck, P. (1985) “Counselling on death and dying.”British Journal of Guidance and Counselling, Vol. 13, iss. 1, 89-97.
Teasdale, K. (2000) “Practical approaches to clinical supervision.”The journal of Professional Nurse,Vol. 15, iss. 9, 579–582.
Wood, J. T. (2009) Interpersonal Communication: Everyday Encounters. Cengage learning.
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Transactions cost economics
Firm v market, transactions cost economics (TCE), make-or-buy dilemma, vertical boundaries of the firm, vertical chain.
Firms are important when contracts are incomplete, and firms make large specific investments. Firms are complex, a nexus of contracts where management take the view that vertical integration is useful for assuring input supply in an uncertain world. However coordination can be a problem in vertical chains yet management need to obtain economies of scale and size in production in order to be profitable. A critical task for management is to define the boundaries of the firm by determining what to make and what to buy.
Transaction Cost Economics and Vertical Boundaries of a Firm
Introduction
The conditions under which businesses are being done are dramatically changing, with the continuous infrastructure improvement marked by communications, transportation and technologies, as well as revolutionizing the environment of business operations and stakeholders of business institutions as well as the interactions with suppliers, competitors, customers and other stakeholders (Williamson, 2002).
Therefore, given the above changes in infrastructure, vertical integration turns out to be a logical option for firms due to the tremendous increase in market size and the demand of product thereby allowing high-volume production. Hence, with the continuous telecommunications technologies and production advancements, one of the most significant firm’s strategic decisions is defining their boundaries under the circumstances which they consider using market rather than using internal organization in coordinating exchange (Milgrom & Roberts, 1992).
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This essay provides a keen examination of the key characteristics of Transaction Cost Economics (TCE), as well as analyzing the role that co-ordination plays in a vertical chain with the use of the issue tree. The essay has two parts where the first part starts by describing the TCE followed by the reviewing of the assumptions and the role of TCE. The second part provides a discussion of the role played by co-ordination in a vertical chain while the final part provides a conclusion of the essay.
The key characteristics of transaction cost
Milgrom & Roberts (1992) defines transaction cost economics as the search, bargain, monitoring, enforcing as well as other cost not in direct relation to production of both services and goods. The use of the principle of TCE has been extensive and managers utilize it to determine the goods and services’ which are needed in a production process for make-or-buy decisions. Williamson (1981) states the assumptions of TCE as bounder rationality which referring to the rate as well as storage limits on the individual’s capacities for retrieving, storing and processing information without errors.
However, the key characteristics of TCE would be discussed in terms of relationship specific assets, as well as the concept of fundamental transformation of rent, hold-up and quasi-rent (Milgrom & Roberts, 1992). Moreover, relationship specific assets are a set of investments or assets which are made towards supporting a given transaction particularly for improving efficiency of the given transaction whose redeployment to another transaction is not possible without incurring cost or affecting the asset productivity. Besanko, Dranove, Shanley & Schaefer (2010) described the key characteristics of CTE as well as the relationship specific asset which takes four forms discussed below:
1. Site specificity: These investments in assets can be referred to as the located side-by -side with the aim of taking advantage of efficiency in processing while making it economical to transport as well as minimizing inventory cost. Willamson (1981) provides an example of location of this as successive stations in check-by-jowl relation to each other in the attempts of economizing of the transportation and inventory expenses.
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2. Physical Asset Specificity: Assets that are particularly tailored to a specific transaction in both physical properties and engineering. Willamson (1981) gives an example of a situation whereby specialized or unique resources are needed in a component.
3. Dedicated Assets: this is a situation whereby an investment is not necessarily profitable, in equipment and plant induced by a contract or promise of a buyer.
4. Human Asset Specificity: a set of know-how, skills as well as information acquired by a group of workers or workers who have valuable significance inside a particular transaction relationship compared to when it is outside of it. Milgrom & Roberts (1992) states that, this is likely to occur through a process of learning or by doing. Moreover, Besanko, Dranove, Shanley & Schaefer (2010) brings the fundamental transformation associated concepts of assets specific relationship as rent, holdup and quasi-rent problems.
The vertical boundaries of a firm and the role of coordination
Generally, the flow of goods occurs along a vertical chain, that is, from the component parts and raw materials to manufacturing through distribution and finally retailing. Williamson (2002) observed that, in making decisions on firm boundaries, managers and entrepreneurs weigh the internal production benefits against the risks and costs of using markets.
For instance, in the oil and gas industry, the vertical chain of petroleum products is from crude oil which is the raw material being explored and produced, to storage and/or transportation through vessels and pipelines to a refineries for processing to various other petroleum products such as diesel, petrol, aviation fuel and other associated products. This also involves later storage and distribution of the finished petroleum products to various channels for retailing.
Irrespective of the position of a firm along the vertical chain, it has to define boundaries of the firm as well as the firm as a pool of experience, abilities and knowledge in addition to undertaking stages in which the application of the existing capabilities occur. In the attempts to resolve the associated make-or-buy decisions, there must be a comparison of the benefits as well as cost of using the market compared to performing the activities in house by the firm.
Besanko, Dranove, Shanley & Schaefer (2010) reiterates that a firm uses the market mainly due to the fact that the market firm are in most cases very efficient because of the exploitation of the learning curve and economics of scale as well as eliminating bureaucracy, and vertical integration of a firm makes links with products in adjacent stages that are within the value chain as well as internalizing exchanges taking place in open market.
Milgrom & Roberts (1992) states the cost incurred as a result of the use of the market as well as the reasons which makes the firm to embrace vertical integration such as the poor coordination cost between the vertical chain steps, asymmetric information and transaction cost.
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Coordination is the management of the business activities dependencies (Besanko, Dranove, Shanley & Schaefer, 2010), and thereby make it a core aspect of the market utilization within the vertical chain. This implies that in coordination a set of two or more actors are involved in performing economic activities or exchanges in order to ensure goals are achieved within the vertical chain (Williamson, 2002).
Using the issue tree in Figure 5.4 pp144 Besanko as guide for the critical role played by coordination in the vertical chain and how firms make or buy decision; the use of the market firm as well as vertically integration are very essential. Therefore, this implies that coordination arises in using the market, and the following of the issue tree would be achieved in using the market.
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Conclusion
In this essay there has been identification of the key characteristics of TCE in terms of its relation asset specific as well as evaluating the assumptions of bounder opportunism and rationality. The discussion of the vertical chain as well as the essential role that coordination plays, have also been discussed in the essay.
References
Besanko, D., Dranove, D., Shanley, M. & Schaefer, S. (2010). Economics of strategy, 5th ed. Hoboken, NJ: John Wiley& Sons.
Milgrom, P., & Roberts, J. (1992). Economics, Organization and Management. Englewood Cliffs, NJ: Prentice-Hall.
