Effects of Behavioral Interventions on Disruptive Behavior and Affect in Demented Nursing Home Residents Essay

Behavioral interventions might ameliorate them and have a positive effect on residents’ mood (affect). Objectives: This study tested two interventions—an activities of daily living and a psychosocial activity intervention—and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia. Methods: The study had three treatment groups (activities of daily living, psychosocial activity, and a combination) and two control groups (placebo and no intervention). Nursing assistants hired specifically for this study enacted the interventions under the direction of a master’s prepared gerontological clinical nurse specialist. Nursing assistants employed at the nursing homes recorded the occurrence of disruptive behaviors. Raters analyzed videotapes filmed during the study to determine the interventions’ influence on affect. Results: Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups. Conclusions: The treatments did not specifically address the factors that may have been triggering disruptive behaviors. Interventions much more precisely designed than those employed in this study require development to quell disruptive behaviors. Nontargeted interventions might increase positive affect. Treatments that produce even a brief improvement in affect indicate improved quality of mental health as mandated by federal law. Key Words: affect †¢ Alzheimer’s disease †¢ behavior therapy †¢ dementia †¢ nursing homes Nursing Research July/August 2002 Vol 51, No 4 proximately 1. 3 million older Americans live in nursing homes today (Magaziner et al. , 2000). By 2030, with the aging of the population, the estimated demand for long-term care is expected to more than double (Feder, Komisar, & Niefeld, 2000). Thus, nursing home expenditures could grow from $69 billion in 2000 to $330 billion in 2030 (Shactman & Altman, 2000). About half of new nursing home r esidents have dementia (Magaziner et al. , 2000). The disease has an impact on four major categories of functioning in persons with dementia. These are disruptive behavior (DB), affect, functional status, and cognition (Cohen-Mansfield, 2000). This article will focus on the first two categories. Disruptive behavior has received much more attention than affect has (Lawton, 1997), perhaps for three reasons. First, more than half (53. 7%) of nursing home residents display DB with aggression (34. 3%) occurring the most often (Jackson, Spector, & Rabins, 1997). Second, DB threatens the wellbeing of the resident and others in the environment. Consequences include: (a) stress experienced by other resiCornelia K. Beck, PhD, RN, is Professor, Colleges of Medicine and Nursing, University of Arkansas for Medical Sciences. Theresa S. Vogelpohl, MNSc, RN, is President, ElderCare Decisions. Joyce H. Rasin, PhD, RN, is Associate Professor, School of Nursing, University of North Carolina. Johannah Topps Uriri, PhD(c), RN, is Clinical Assistant Professor, College of Nursing, University of Arkansas for Medical Sciences. Patricia O’Sullivan, EdD, is Associate Professor, Office of Educational Development, University of Arkansas for Medical Sciences. Robert Walls, PhD, is Professor Emeritus, University of Arkansas for Medical Sciences. Regina Phillips, PhD(c), RN, is Assistant Professor, Nursing Villa Julie College. Beverly Baldwin, PhD, RN, deceased, was Sonya Ziporkin Gershowitz Professor of Gerontological Nursing, University of Maryland. A Note to Readers: This article employs a number of acronyms. Refer to Table 1 to facilitate reading. 219 220 Effects of Behavioral Interventions Nursing Research July/August 2002 Vol 51, No 4 TABLE 1. Acronyms Term Activities of daily living Analysis of variance Apparent affect rating scale Arkansas Combined Disruptive behavior(s) Disruptive behavior scale Licensed practical nurse(s) Maryland Mini mental status exam Negative visual analogue scale Nursing home nursing assistant(s) Observable displays of affect scale Positive visual analogue scale Project nursing assistant(s) Psychosocial activity Research assistant(s) Acronym ADL ANOVA AARS AR CB DB DBS LPN MD MMSE NVAS NHNA ODAS PVAS PNA PSA RA decreases in targeted behaviors (Gerdner, 2000; Matteson, Linton, Cleary, Barnes, & Lichtenstein, 1997). However, others reported nonsignificant reductions (Teri et al. , 2000), no change (Churchill, Safaoui, McCabe, & Baun, 1999), or increased behavioral symptoms (Mather, Nemecek, & Oliver, 1997). These studies used nursing home staffs to collect data, had sample sizes below 100, and measured an array of DB with different assessments. Only in the last decade have researchers investigated affect. Compared to studies to reduce DB, far fewer studies have measured interventions using affect as an outcome measure. Studies reported positive outcomes on affect from such interventions as simulated presence therapy (Camberg et al. , 1999), Montessori-based activities (Orsulic-Jeras, Judge, & Camp, 2000), advanced practice nursing (Ryden et al. , 2000), music (Ragneskog, Brane, Karlsson, & Kihlgren, 1996), rocking chair therapy (Watson, Wells, & Cox, 1998), and pet therapy (Churchill et al. , 1999). The studies on affect used global measures that relied on observer interpretation, which could have compromised objectivity. Theoretical Bases A number of conceptual frameworks have guided intervention research on persons with cognitive impairment (Garand et al. , 2000). The theoretical basis for this study was that individuals have basic psychosocial needs, which, when met, reduce DB (Algase et al. , 1996) (Table 2). The interventions, one focusing on activities of daily living (ADL) and the other focusing on psychosocial activity (PSA), and a combination (CB) of the two, were developed to meet most of the basic psychosocial needs that Boettcher (1983) identified. These included territoriality, privacy and freedom from unwanted physical intrusion; communication, opportunity to talk openly with others; self-esteem, respect from others and freedom from insult or shaming; safety and security, protection from harm; autonomy, control over one’s life; personal identity, access to personal items and identifying material, and cognitive understanding, awareness of surroundings and mental clarity. The section on study groups specifies which interventions were designed to meet which needs. Positive affect usually accompanies interventions that meet basic psychosocial needs (Lawton, Van Haitsma, & Klapper, 1996). Several researchers and clinicians have suggested that displays of affect may offer a window for revealing demented residents’ needs, preferences, aversions (Lawton, 1994), and responses to daily events (Hurley, Volicer, Mahoney, & Volicer, 1993). The study reported here dents and staff; (b) increased falls and injury; (c) economic costs, such as property damage and staff burn-out, absenteeism, and turnover; (d) emotional deprivation such as social isolation of the resident; and (e) use of physical or pharmacologic restraints (Beck, Heithoff, et al. 1997). Third, before the Nursing Home Reform Act (Omnibus Budget Reconciliation Act, 1987), nursing homes routinely applied physical and chemical restraints to control DB with only moderate results (Garand, Buckwalter, & Hall, 2000). However, the Act mandated that residents have the right to be free from restraints imposed for discipline or convenience and not required to treat the residents’ medical symptoms. Thus, research ers have tested a wide range of behavioral interventions to reduce DB and replace restraints. The Act (1987) also stipulated that all residents are entitled to an environment that improves or maintains the quality of mental health. Interventions that promote positive mood or affect fulfill this entitlement. Therefore, this article will report the effects of an intervention to increase functional status in activities of daily living (Beck, Heacock, et al. , 1997), a psychosocial intervention, and a combination of both on reducing DB and improving affect of nursing home residents with dementia. TABLE 2. Basic Psychosocial Needs Relevant Literature Literature suggests that behavioral interventions offer promise in managing DB. A wide range of modalities and approaches have been tested: (a) sensory stimulation (e. g. , music); (b) physical environment changes (e. g. , walled garden); (c) psychosocial measures (e. g. , pet therapy); and (d) multimodal strategies. Many studies found significant Territoriality Communication Self-esteem Safety and security Autonomy Personal identity Cognitive understanding Nursing Research July/August 2002 Vol 51, No 4 Effects of Behavioral Interventions 221 adopted the inference by Lawton et al. (1996) that frequent displays of positive affect when basic psychosocial needs are met might indicate improved emotional wellbeing. is leg continually and without apparent reason needs redirection. This intervention lasted 45–60 minutes a day during various ADL. PSA Intervention. A PNA also conducted the PSA intervention, which involved 25 standardized modules designed to meet the psychosocial needs for communication, selfesteem, safety and security, personal identity, and cogni tive understanding through engagement in meaningful activity while respecting the individual’s unique cognitive and physical abilities (Baldwin, Magsamen, Griggs, & Kent, 1992). The intervention was chosen because it: (a) provided a systematic plan for the PNA to address some of the participant’s basic psychosocial needs; and (b) represented clinical interventions that many long-term care facilities routinely used, but had not been formalized into a research protocol or systematically tested. Each module contained five psychosocial areas of content (expression of feelings, expression of thoughts, memory/recall, recreation, and education) and stimulated five sensory modalities (verbal, visual, auditory, tactile, and gustatory/olfactory). For instance, Activity Module I involved life review, communicating ideas visually (identifying and making drawings), clapping to different rhythms, massaging one’s face, and eating a snack. Initially, many participants tolerated less than 15 minutes of the activity but eventually habituated and participated 30 minutes. CB Intervention. This treatment consisted of both the ADL and PSA interventions and lasted 90 minutes daily. Placebo Control. This involved a one-to-one interaction between the participant and PNA. It controlled for the effect of the personal attention that the PNA provided to the three treatment groups. The PNA asked the participant to choose the activity, such as holding a conversation or manicuring nails. It lasted 30 minutes a day. No Intervention Control. This condition consisted of routine care from a NHNA with no scheduled contact between participants and the PNA. Instruments: Disruptive Behavior Scale. The 45-item disruptive behavior scale (DBS), designed to construct scores based on the occurrence and severity of behaviors, assessed the effect of the interventions on DB (Beck, Heithoff et al. 1997). Gerontological experts (n 29) established content validity, and interrater reliability tests yielded an interclass correlation coefficient of . 80 (p . 001). Geropsychiatricnursing experts weighted the behaviors using a Q-sort to improve the scale’s capacity to predict perceived patient disruptiveness. Factor analysis identified four factors (Beck et al. , 1998). Two corresponded to two—physically aggressive and physically nonaggressive—of the three categories from the factor analysis of the Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, Marx, & Rosenthal, 1989). The third category of the Inventory was verbally agitated; in contrast, the factor analysis of the DBS produced a third and fourth category—vocally agitated and vocally aggressive. To obtain a score for the DBS, a trained individual completed a DBS form for every hour of a shift by check- Methods The primary aim was to conduct a randomized trial of the ADL and PSA interventions individually and in combination (CB) for their effect on DB and affect on a large sample of nursing home residents. The experimental design consisted of three treatment groups (ADL, PSA, and Combined) and two control groups (placebo and no intervention). Individual residents were assigned to one of the five groups at each of seven sites in Arkansas and Maryland, which controlled for site differences. To demonstrate the practicability of the interventions and assure adherence to the treatment protocols, certified nursing assistants were hired and trained as project nursing assistants (PNA). They implemented the interventions Monday–Friday for 12 weeks. Afterward, one-month and two-month follow-up periods occurred. Nursing assistants employed by the nursing homes (NHNA) recorded DB. To measure affect, raters were hired for the study to analyze videotapes filmed during intervention. Research Subjects: The sample initially consisted of 179 participants. The study design allowed for the detection of an improvement in DB scores on the Disruptive Behavior Scale (DBS) (Beck, Heithoff et al. , 1997) across time of at least 1. 6 units with a power of 80%. This power calculation assumed that the repeated measures would be correlated with one another at 0. 60. Inclusion criteria were age 65; a dementia diagnosis; a Mini Mental Status Exam (MMSE) (Folstein, Folstein, & McHugh, 1975) score of 20; and a report of DB in the previous two weeks. To form a more homogeneous group for generalizing findings, exclusion criteria were a physical disability that severely limited ADL; a psychiatric diagnosis; and a progressive or recurring medical, metabolic, or neurological condition that might interfere with cognition or behavior. Study Groups: ADL Intervention. A PNA used the ADL intervention during bathing, grooming, dressing, and the noon meal based on successful protocols that improved functional status in dressing (Beck, Heacock et al. , 1997). It attempted to meet residents’ psychosocial needs for territoriality, communication, autonomy, and self-esteem to promote their sense of safety and security. The intervention also tried to respect participants’ cognitive and physical abilities by prescribing three types of strategies specific to the individual participant. First, strategies to complete an ADL address specific cognitive deficits. For example, the person with ideomotor apraxia needs touch or physical guidance to start movements. Second, standard strategies are behaviors and communication techniques that work for almost everyone with dementia. For example, the caregiver gives a series of one-step commands to guide the resident to put on her shoe. Third, problem-oriented strategies address particular disabilities such as fine motor impairment, physical limitations, or perseveration. For example, a subject who rubs his hand back and forth on 222 Effects of Behavioral Interventions ing the behaviors that occurred. The score for a behavior was the frequency (0–8) times the weight. The item scores were summed to obtain each of the four subscale scores. Mini Mental Status Exam. The Mini Mental Status Exam (MMSE) (Folstein et al. 1975) provided a global evaluation of participants’ cognitive statuses for screening subjects for the study. Test-retest reliability of the MMSE is . 82 or better (Folstein et al. ). Cognition is assessed in seven areas, and scores lower than 24 out of 30 indicate dementia. Nursing Research July/August 2002 Vol 51, No 4 Observable Displays of Affect Scale. The Observable Displays of Affect Scale (ODAS) (Vogelpohl & Beck, 1997), designed to rate videotaped data, contains 41 behaviors categorized into six subscales of positive and negative facial displays, vocalizations, and body movement/posture. Raters indicate presence/absence of each behavior during five 2-minute intervals from a 10minute videotape. Scores range from 0–5 for each item. The range of scores for each scale is: facial positive (0–20), Aggression during bathing facial negative (0–20), vocal positive (0–45), vocal negative (0–50), body could stem from physical positive (0–30), and body negative discomfort or rough (0–40). Interrater reliabilities (Kappa handling coefficients) for the ODAS range from . 68–1. 00, and intrarater reliability is . 97–1. 00. Ten gerontological nursing experts established content validity (Vogelpohl & Beck). Apparent Affect Rating Scale. The Apparent Affect Rating Scale (AARS) (Lawton et al. , 1996) is designed for direct observation of persons with dementia and contains six affective states: pleasure, anger, anxiety/fear, sadness, interest, and contentment. (In later work, Lawton, Van Haitsma, Perkinson, & Ruckdeschel [1999] deleted contentment). Each item has a noninclusive list of behaviors that might signal the presence of the affect from which observers infer the affect. The observer assigns a score of 1 to 5 to measure the duration of the behavior. Visual Analogue Scales. The Positive Visual Analogue Scale (PVAS) and Negative Visual Analogue Scale (NVAS) (Lee & Kieckhefer, 1989; Wewers & Lowe, 1990) are two 10centimeter lines on separate pages for rating positive and negative affect. The PVAS has end anchors of â€Å"no positive affect† and â€Å"a great deal of positive affect. † The NVAS has end anchors of â€Å"no negative affect† and â€Å"a great deal of negative affect. † Scores range from 0 to 100. Procedure: The study consisted of six phases: (a) preliminary activities, (b) a three-week normalization/desensitization period, (c) a 12-week intervention period, (d) a onemonth follow-up period, (e) a two-month follow-up period, and f) a videotape analysis. Preliminary Activities. The institutional review boards at the University of Arkansas for Medical Sciences and the Univer- sity of Maryland approved the research. Each nursing home identified residents with dementia and sent letters informing persons responsible for the residents that researchers would be contacting them. Responsible persons could return a signed form if they did not want to participate. Willing responsible persons received a telephone call explaining the study followed by a mailed written description along with two consent forms. Those willing kept one consent form for their records and signed and mailed back the other. Screening involved a review of the residents’ charts, recording their diagnoses, and interviews with the staff to find evidence of DB during the previous two weeks. Each resident took the MMSE to meet inclusion criteria. Within each home, female residents who passed these screens were randomized to one of the five groups by a drawing, but males were assigned to the five groups to ensure even distribution of their small number. Simultaneously, research staff members were hired and trained. Normalization/Desensitization. For the next three weeks, each PNA accompanied a NHNA to learn the routines of the facility but did not help care for potential study participants. A videotape technician placed a camera that was not running in the dining and shower rooms to desensitize residents and staff to its presence. In addition, nursing home staffs participated in two-hour training sessions on the DBS. Throughout the study, a gerontological clinical nurse specialist trained any new NHNA and retrained if behaviors reported on the DBS differed from those she observed during randomized checks. Intervention. During the 12-week intervention period, the first three weeks were considered baseline and the last two weeks postintervention. The PNA administered the treatment/s or placebo five days a week. Every day, they asked participants to give their assent and espected any dissents. During weeks 11–12 (postintervention), the PNA prepared the participants for their departure by telling them that they were leaving soon. To facilitate data collection, a separate form of the DBS for each of the three eight-hour daily shifts was developed. Eight one-hour blocks accompanied each item of the scale. The NHNA placed a check mark in the block that corresponded to the hour when the NHNA observed the behavi or. The NHNA completed the DBS on all participants during or at the end of a shift. In addition, a technician videotaped participants in the treatment and placebo groups every other week during an interaction with the PNA and no intervention group monthly during an ADL. The technician monitored positioning and operation of the camera from outside the room or behind a curtain to respect the participants’ privacy. One-Month and Two-Month Follow-up. One month and two months after the research team left the nursing home, Nursing Research July/August 2002 Vol 51, No 4 Effects of Behavioral Interventions 223 esearch assistants (RA) retrained nursing home staffs on the DBS. The NHNA then collected DB data on their shifts Monday–Friday for one week. tervention, week 16 as one-month follow-up, and week 20 as two-month follow-up. Participants with fewer than six observations at any time period were omitted. For each period, a total DBS score represented an averVideotape Analysis. The videotapes ranged in length from age of the participant’s data for the t hree shifts of each day less than five minutes to 40 minutes, depending on the across the five days of the observation week. Therefore, activity and the participant’s willingness to cooperate with total DBS scores were obtained for baseline (M of weeks the treatment (baseline and control participants’ tapes 1–3), intervention (M of weeks 4–10), postintervention (M tended to be shorter). To standardize the opportunity for of weeks 11–12), first follow-up (M of week 16), and secbehaviors to occur, an editor took 10-minute segments ond follow-up (M of week 20). The same procedure from the middle of baseline and final treatment eek tapes yielded subscale scores for physically aggressive, physically and randomized them onto videotapes for rating. Because nonaggressive, vocally aggressive, and vocally agitated videotaping occurred to ensure appropriate implementabehaviors for each of the five time periods. tion of interventions, the treatment groups had more A repeated measures analysis of variance (ANOVA) usable videotapes than the control groups did. consisted of two between- subjects and one within-subjects A master’s prepared gerontological factors. The between-subjects factors nurse specialist intensively trained six were intervention group and state (AR raters on the Observer III Software or MD) to account for regional differSystem (Noldus Information Technolences in scoring DB, and the withinogy, 1993) for direct data entry and subjects factor represented DBS scores the affect rating scales. The raters for the five different time periods. Each reached . 80 agreement with the speanalysis allowed for testing by intervencialist on practice tapes before they tion group, time period, and state. The Screaming may started rating the study videotapes. nalysis of the interaction effect of She monitored reliability for each tape intervention group by time period express pain or monthly, retrained as needed, and rantested the hypothesis that the intervenself-stimulation domized the sequence of rating the tions would decrease DB across time in scales. The raters entered the ODAS treatment conditions as compared to and AARS data directly into a comcontrol conditions. The analysis was puter using the Observer. The system repeated five times, once for each suballowed raters to watch videos repeatscale of the DBS and once for the total edly in actual time and slow action to score. Level of significance was set at document behaviors objectively and 0. 05. The researchers believed that the precisely. The raters indicated their small group sizes justified the liberal perception of the participants’ positive and negative level of significance. For the videotape analysis, analyses of affect by placing a vertical mark at some point between covariance occurred for the 14 variables observed from the the two end anchors of the PVAS and NVAS. They videotapes during intervention. The baseline score served marked neutral affect as negative. s a covariate for the final score. While a multivariate analysis would have been desirable, it would have had Intervention Integrity: The PNA and video camera techniinsufficient power with this number of variables and subcian underwent two weeks of intensive training on general jects. The 14 univariate analyses do inflate the Type I error aging topics, stress management, information on dementia, rate. and confidentiality/privacy issues. Training also involved instruction on the study interventions, DBS, and research Results protocols. Of the 179 initial participants, 36 did not finish; the greatA gerontological clinical nurse specialist viewed treatest attrition occurred in the no intervention control group. ment and placebo videotapes biweekly in a private office to Attrition resulted from death (39%), withdrawal of fammonitor PNA compliance with research protocols, provide ily’s consent or at nursing home staff’s request (26%), discorrective feedback to PNA, and help PNA recognize and charge (18%), and change in health status/medications meet participants’ needs as they changed during treatment. hat did not meet inclusion criteria (17%). This left 143 The possibility for contamination appeared to be low participants: 29 in the ADL, 30 in PSA, 30 in CB, 30 in the because NHNA were unlikely to change their care practices placebo, and 24 in the no intervention, but 16 with incomand had little opportunity to observe PNA. Further, NHNA plete data were dropped. Table 3 gives the demographic were b linded to the hypothesis of the study, the nature of the statistics for the 127 participants with complete data. No interventions, and the participants’ group assignments, statistically significant demographic differences emerged although they probably could identify the no intervention among the five groups. In short, this sample primarily conparticipants. sisted of elderly, white females with severe cognitive impairment. Analysis: Reviewers checked for completeness of all data. For the videotape analysis, the final number was 84 The researchers designated intervention weeks 1–3 as baseparticipants with 168 videotape segments. Most were line, weeks 4–10 as intervention, weeks 11–12 as postin- 224 Effects of Behavioral Interventions Nursing Research July/August 2002 Vol 51, No 4 TABLE 3. Description of the Sample by Intervention Group No Intervention 19 89. 5 78. 9 84. 2 86. 47 (6. 37) 11. 47 (6. 43) ADL Number in group Percent female Percent white Percent widowed Mean age (SD) M MMSE (SD) 28 78. 6 82. 1 64. 3 82. 29 (8. 40) 11. 44 (7. 69) PSA 29 82. 1 85. 7 66. 7 82. 18 (7. 64) 10. 65 (6. 76) CB 22 81. 8 77. 3 77. 3 82. 82 (9. 81) 7. 91 (5. 41) Placebo 29 75. 9 86. 2 75. 9 86. 45 (6. 92) 11. 11 (6. 39) Total 127 81. 0 82. 5 72. 8 83. 64 (7. 97) 10. 55 (6. 64) Note. ADL = activities of daily living; PSA = psychosocial activity; CB = combination. emale (79%) and widowed (69%) with a mean age of 83 (SD 7. 44). Participants had a mean score of 10 (SD 6. 34) on the MMSE, indicating moderate to severe cognitive impairment. Table 4 displays the means and standard deviations for the DBS overall and the four subscales across the five time periods for the five groups. No significant differences emerged for the interventi on-by-time interaction for any of the dependent variables. Thus, the results failed to support the hypothesis that the interventions would decrease DB across time in treatment groups as compared to control groups (statistical analysis tables on Website at: http://sonweb. nc. edu/nursing-research-editor). However, the main effect of state was significant in three analyses. Arkansas recorded significantly more behaviors than Maryland did for the dependent variables of physically nonaggressive (p . 001), vocally agitated (p . 001), and overall DBS (p . 002). Further, the main effect of time was significant for overall DBS (p . 002) and the four subscales of physically aggressive (p . 001), physically nonaggressive (p . 027), vocally aggressive (p . 021), and vocally agitated behaviors (p . 008). The significance resulted from increased DB after the PNA had left the home (generally from intervention or postintervention to first follow-up). For the videotape analysis, the hypothesis stated that treatment groups, compared with control groups, would display more indicators of positive affect and fewer indicators of negative affect following behavioral interventions. In general, neither the positive nor the negative affect scores were particularly high, indicating that this sample had relatively flat affect. Results from the analysis of covariance tests supported increased positive affect but not decreased negative affect. Compared to the control groups, the treatment groups had significantly more positive facial expressions (p . 001) and positive body posture/movements (p . 001), but not more positive verbal displays on the ODAS. The treatment groups displayed significantly more contentment (p . 037) and interest (p . 028) than the control groups did on the AARS. For the negative affects on the AARS, the treatment groups had a shorter duration of sad behaviors (p . 007) than the control groups did. Comparison of VAS scales likewise showed that the treatment groups displayed more positive affect (p . 012). Discussion In contrast to other studies (e. . , Hoeffer et al. , 1997; Kim & Buschmann. , 1999; Whall et al. , 1997), this study found no treatment effect on DB. The interventions were a synthesis of approaches believed to globally address â€Å"triggers† of DB and meet psychosocial needs (Boettcher, 1983). They did not address the specific factors that might have been triggering the particula r behavior (Algase et al. , 1996). Such triggers include under/over stimulation, unfamiliar or impersonal caregivers, and particular individual unmet psychosocial needs. For example, aggression during bathing could stem from physical discomfort or rough handling (Whall et al. 1997). Interventions much more individually designed require development. Increasing DB across all groups was reflected in the DBS scores at 1-month follow-up. Two factors may explain this increase. First, the PNA had warned participants that they would be leaving. Second, the ADL and CB participants no longer received care from the familiar PNA, and PSA, CB, and placebo participants no longer had a daily activity or visit. The increased stress and time constraints for NHNA as they resumed caregiving of the ADL and CB participants may explain the heightened DB in the control groups. Such changes may trigger increased behavioral symptoms in persons with dementia (Hall, Gerdner, Zwygart-Stauffacher, & Buckwalter, 1995). Two measurement issues may have affected outcomes. First, observers view behaviors differently (Whall et al. , 1997) and come to expect particular behaviors from certain residents (Hillman, Skoloda, Zander, & Stricker, 1999). If the NHNA were accustomed to a participant’s DB pattern, such as persistent screaming, they may have overlooked decreases in that behavior. Initial training and retraining of raters occurred as needed; however, some Nursing Research July/August 2002 Vol 51, No 4 Effects of Behavioral Interventions 225 TABLE 4. Weighted Scores for Disruptive Behavior by Intervention Group and Time Period No Intervention (n = 19) Mean (SD) 408. 71 (427. 24) 303. 69 (408. 44) 281. 97 (410. 85) 418. 31 (630. 58) 292. 85 (405. 15) 114. 66 (202. 89) 90. 85 (182. 70) 77. 98 (173. 15) 130. 92 (257. 12) 128. 20 (195. 67) 191. 97 (157. 75) 117. 11 (112. 30) 118. 23 (137. 08) 154. 46 (225. 05) 100. 45 (153. 30) 55. 16 (74. 70) 42. 89 (54. 54) 33. 26 (47. 06) 64. 72 (77. 89) 28. 09 (37. 02) (continues) DB Category Time Period DBS total Baseline ADL (n = 28) Mean (SD) 172. 51 (191. 47) 182. 45 (181. 3) 164. 56 (154. 95) 207. 22 (205. 58) 190. 70 (291. 06) 20. 67 (30. 52) 32. 59 (51. 29) 15. 02 (26. 10) 44. 18 (100. 62) 21. 45 (36. 47) 95. 50 (105. 28) 87. 58 (87. 58) 85. 04 (89. 60) 88. 81 (85. 69) 148. 75 (187. 28) 22. 85 (32. 10) 28. 37 (32. 50) 21. 15 (26. 54) 30. 72 (48. 95) 18. 28 (24. 55) PSA (n = 29) Mean (SD) 348. 02 (467. 50) 306. 81 (393. 03) 303. 24 (367. 54) 373. 17 (533. 05) 300. 20 (366. 42) 85. 87 (199. 01) 83. 94 (167. 53) 82. 82 (166. 93) 113. 49 (235. 71) 81. 30 (151. 85) 162. 41 (206. 65) 130. 82 (142. 72) 133. 92 (145. 97) 141. 47 (188. 99) 164. 92 (223. 63) 49. 64 (93. 15) 43. 80 (64. 6) 37. 90 (53. 43) 54. 47 (90. 33) 40. 26 (45. 26) CB (n = 22) Mean (SD) 287. 66 (373. 73) 300. 84 (379. 33) 286. 21 (365. 78) 374. 10 (510. 10) 312. 83 (433. 18) 68. 84 (126. 18) 67. 14 (137. 79) 61. 04 (127. 78) 92. 68 (205. 52) 60. 40 (131. 54) 136. 67 (189. 03) 124. 64 (164. 49) 125. 99 (157. 78) 159. 97 (202. 75) 146. 53 (201. 83) 34. 49 (55. 91) 40. 73 (52. 60) 31. 18 (33. 85) 36. 95 (42. 70) 32. 82 (51. 32) Placebo (n = 29) Mean (SD) 325. 96 (337. 14) 337. 60 (328. 94) 336. 80 (366. 55) 389. 92 (434. 43) 319. 15 (384. 59) 49. 26 (90. 24) 62. 10 (112. 71) 59. 67 (106. 37) 76. 79 (165. 45) 48. 25 (101. 4) 167. 01 (177. 80) 164. 62 (161. 48) 175. 36 (189. 80) 201. 68 (212. 06) 87. 67 (127. 38) 47. 20 (79. 70) 39. 55 (57. 74) 32. 69 (55. 77) 29 . 30 (47. 60) 30. 18 (52. 85) Intervention Postintervention 1 month follow-up 2 month follow-up Physically aggressive Baseline Intervention Postintervention 1 month follow-up 2 month follow-up Physically nonaggressive Baseline Intervention Postintervention 1 month follow-up 2 month follow-up Vocally aggressive Baseline Intervention Postintervention 1 month follow-up 2 month follow-up 226 Effects of Behavioral Interventions Nursing Research July/August 2002 Vol 51, No 4 TABLE 4. Weighted Scores for Disruptive Behavior by Intervention Group and Time Period (Continued) NoIntervention (n = 19) Mean (SD) 47. 65 (97. 22) 68. 32 (103. 13) 68. 01 (116. 62) 84. 50 (112. 48) 73. 07 (117. 12) DB Category Time Period Vocally agitated Baseline ADL (n = 28) Mean (SD) 33. 49 (84. 39) 33. 91 (62. 52) 43. 17 (72. 10) 43. 48 (64. 39) 50. 53 (117. 95) PSA (n = 29) Mean (SD) 46. 92 (98. 70) 52. 84 (96. 03) 52. 50 (90. 78) 68. 22 (98. 89) 48. 89 (92. 33) CB (n = 22) Mean (SD) 62. 49 (98. 97) 70. 43 (110. 85) 69. 08 (107. 29) 82. 14 (118. 97) 75. 80 (129. 67) Placebo (n = 29) Mean (SD) 50. 0 (92. 05) 48. 25 (81. 63) 48. 59 (72. 20) 63. 74 (95. 30) 54. 11 (80. 61) Intervention Postintervention 1 month follow-up 2 month follow-up Note. Scores were created by assigning each behavior with a severity weight prior to summing and then averaging across day and then week(s). DBS = disruptive behaviors; ADL = activities of daily living intervention; PSA = psychocial activity inte rvention; CB = combination of the two interventions. NHNA appeared to continue to consider participants’ behaviors, such as repetitive questioning, to be personality characteristics or attention-seeking efforts rather than DB. Thus, they may have under-reported behaviors. Further, staff may prefer withdrawn behaviors, such as isolating self and muteness (Camberg et al. , 1999), and view them as nonproblematic. Second, categorizing a behavior as disruptive without understanding its meaning to the person with dementia may be conceptually flawed. For example, screaming may express pain or self-stimulation. Two design features may explain differences between the findings of this study and others. First, this study had both placebo and no intervention control conditions. Just a few other studies randomized subjects to treatment or control groups or included two control groups (e. g. , Camberg et al. , 1999). In most studies, control conditions preceded or followed treatment conditions (e. g. , Clark, Lipe, & Bilbrey, 1998). In both designs, subjects served as their own controls, which limits examination of simultaneous intra- and extra-personal events that might affect DB frequency. Second, many control groups came from separate units or different nursing homes (e. g. , Matteson et al. , 1997), which makes it difficult to control for differences in environment, staff relationships, and personalities. This study occurred at seven sites in two different geographical areas, but at each site, the randomization of female participants distributed the groups across all nursing units to control for environmental and staff characteristics. Acknowledged limitations include the following. First, in spite of the large overall sample, the group sizes were small (range 19–30) with the greatest loss in the no inter- vention group. Larger groups might have provided more definitive findings on the relationship between behavioral interventions and DB frequency as Rovner et al. (1996) did (treatment group 42; control group 39). Second, NHNA served as data collectors because using independent observers would have been cost-prohibitive. These results suggest that future intervention research should consider the individual characteristics of the person with dementia (Maslow, 1996) and the triggers of the behavior (Algase et al. , 1996). Studies that have individualized interventions have demonstrated decreased DB (Gerdner, 2000; Hoeffer et al. , 1997). Researchers need to continue to refine methods for identifying what works for whom (Forbes, 1998) to minimize the prevalent trial-anderror approach to DB management.

Critical Evaluation of International Essay

A review of literature on international HRM reveals three different approaches (Dowling et al. , 1999, p. 2): Comparative, Cross-cultural and multi-national. Firstly, according to Adler (1997), the early approaches to researching international HRM focused on cross-cultural differences and examination of human behaviour from an international perspective. Certainly, research on cross-cultural organizational behaviour has become a conduit for the understanding of the dynamics of multicultural domestic and international workplaces within the advent of globalisation. There are different levels of analysis within cross-national HRM, national factors, contingent factors and organisational level. Cross-national HRM researchers claim that it is at the levels of national factors and contigent variables that they can make useful contributions through the examination of the impacts of such determinants of HRM policies and practices (Boxall, 1995; Brewster et al, 1996). However, other researchers (Budhwar and Sparrow, 1997; Jackson and Schuler, 1995) argue that national factors and contingent variables are not enough in themselves to provide an understanding of the context-specific nature of HRM practices. It is important therefore, to consider analysis of the impact of organisational-level strategies (Budhwar and Sparrow, 1997). Secondly, the comparative approach focuses on similarities and differences in HRM practices within an international context. Undeniably, Budhwar & Sparrow (2002) note that the increase in globalisation of business transactions, the emergence of new markets such as the BRIC countries (Brazil, Russia, India and China) as well as hyper competition among organisations at equally the domestic and international level have been associated with an increased significance and need for comparative human resource management (HRM) studies. As a result, there has been a growing number of studies addressing the configuration of HRM in different national contexts (Budhwar & Sparrow, 2002). According to Rechie, Lee and Quintanilla (2009) one of the most significant role of comparative HRM research is to provide managers, principally those working in multinational firms, with specific guidelines concerning how to design and implement an effective HRM system taking into consideration cultural differences especially when their business operation enters into different cultural contexts for example western multinationals seeking to do business in China. This notion of being responsive to the context and standardisation of HRM policies and practices has generated controversial but nonetheless critical topics of discussion in comparative HRM, such as the debate on localization versus standardization, and the process of transferring HRM policies and practices across nations (Rechie et al, 2009). The thirdly, multinational approach, tends to focus on HRM practices in multinational organisations. The HRM extant literature reveals that there are two distinct schools of thought as regards approaches to managing people within MNCs: (i) convergence and (ii) divergence. According to Brewster et al. , (2007), the convergence approach is said to be one of the most dominant strands in international management research. On the one hand, the convergence approach has three main assumptions: firstly, the ultimate aim in all organisations is to improve performance through high-performance work systems (Brewster, 2001). Secondly, the universal aim of performance improvement can be achieved by using sound and effective management philosophies that hold true despite of differences among national environments (Girgin, 2005). Thirdly, proponents of the convergence approach argue that if local practices are different from these principles, they are expected to be replaced with ‘the one best way’, converging mainly on the American model as the leading industrial economy (Dowling et al. , 1999). According to Girgin (2005) the concept of convergence towards the one best way practice has been encouraged and/or supported by the forces of globalisation, which has led to the opening of world markets, deregulation, regional integration and improvements in communication technologies. Although HRM as a field of practice was developed in America, the principles and practices designed for America may not hold for other parts of the world. Barlett and Ghoshal (1989), say that, the main suggestion of the globalisation argument is that nationality factors in the operation of national systems and of companies are no longer influential or important as international companies become ‘trans-national’ which converge to a new ‘best model’. Yes, the IHRM literature shows that because multinational corporations are embedded in their home institutional environments, they may attempt to transfer ‘home’ practices to their foreign operations in different cultural environments (Edwards et al. , 1999). However, the study of HRM practices in Europe (see Brewster et al 2007) suggest that national differences are significant in the determination of HRM practices. On the other hand, the divergence approach or contextual paradigm searches for contextually unique practices and approaches to management, it does not search for evidence of similarities (Brewster, 2001). Within the IHRM literature, the focal point of the divergence standpoint is the dissimilarity of policies and applications across different national and regional contexts and tries to understand the particularities of the context with a view to interpret why and how such differences have emerged in these settings (Brewster, 2005). Within the divergence school of thought, there are two distinct approaches to managing human resources in multinational organisations: (i) the culturalist and (ii) the institutionalist perspectives. Based mainly on Hofstede’s (1980) value-based behavioural dimensions and concepts of national culture which have made an attempt to explain the influence of culture upon Multinationals’ behaviour, the culturalist approach has found widespread acceptance in the IHRM literature. Hofstede (1980) came to a conclusion that culture was the main determinant of the variations in work-related values, attitudes and behaviours among employees and managers within the same organisation, and of the same profession, age, or gender. Hofstede found that there were four dimensions that explained the differences in work-related values and behaviours: (i) Individualism and collectivism, (ii) Uncertainty avoidance, (iii) Power distance and (iv) Masculinity and femininity According to Girgin (2005), the culturalist approach endeavours to build an understanding of differences in work organisations, managerial behaviour and human resource practices based on attributes of national cultural distinctiveness in terms of values, ideas and beliefs shared by people in a given society. Under the divergence school of thought, the institutionalist perspective is the second. The main argument of the institutionalist perspective is that national institutional contexts (for example, government systems, training and development systems) play a major role in determining structures and strategies of organisations (Girgin, 2005). According to Girgin (2005), those who support the Institutionalist perspective stress the pressures on companies to acquire and maintain legitimacy in relation to the environment and the way that interlocking practices can bring benefits in particular systemic contexts. This perspective presents itself as a more comprehensive framework for the comparative study of different national systems (Girgin, 2005). For example, despite the knowledge of the influence of culture on organisational behaviour, HR practitioners cannot simply measure cultural values across their operations and predict behaviour, due cognisance must be given to various institutional contexts. As noted by Dewettinck and Remue (2011) certain practices are shared across or within particular contexts; some are distinctive of certain countries; some are unique to certain sectors or sections of an organization or even individuals. Without doubt, while each of the above approaches sharpens the focus on some aspects of HRM, it is possible that solely focusing on one aspect may unavoidably, hinder capturing the positive aspects from other perspectives(Mayrhofer and Brewster, 2005). Indeed what appears to be more significant in researching international HRM is the context. According to Dewettinck and Remue (2011) the notion of context and/or focus on contextual factors has been reflected in the cross-cultural embedment of many international HRM studies (Brewster, Mayrhoferand Morley, 2004), in addition, the Globe project which was focused on leadership also reveals that context is important (House and Javidan, 2004). For example, a recent study by Hartmann et al. (2010) of western multinationals operating in China shows that these organisations implement relatively unchanged HRM practices from their home country in their Chinese subsidiaries. The study of Hartmann et al. , reveals that consideration of contextual factors is important in the understanding of HRM practices and the management of people in an international context. As a matter of fact, results of Hartmann et al. ’s study indicate that, although the Chinese subsidiaries of Western multinationals were able to implement unchanged HRM practices such as talent management from their headquarters, the practices were not successfully internalised. This demonstrates the significance of national cultures and being responsive to local needs in implementing HRM practices. The example above actually shows that context is an important aspect in researching international HRM regardless of the approach taken. In conclusion, there is indeed something to be learnt from each of the perspectives. Each of the perspectives do make considerable contribution to the understanding of international HRM.

Critical and Creative Thinking in Society Short Essay Essay

The situation that comes to mind of public interest is the rioting and looting going on in Ferguson, Missouri. We understand everyone in the community is upset about the shooting but you also have to remember that this has not been the only shooting over the years dealing with an African America male, and look how a few bad people can change the message that your organization or group is really trying to get across. We believe the purpose of the protest was to bring awareness to the issue at hand but now it has turn into something else now. Free will is the ability to do whatever you want at any time, truth is something that is justify a fact that has happen, and knowledge is the research and experience you have on different subjects. Opinion is something every individual has about every situation. Critical thinking process hindrances are self-deception, resistance to change, and stereotyping there are a few ways to deal with this issue whether in business or everyday life. One is to make change easy, and simple people are most likely to get on board if you do that. Self- deception just be honest with yourself, and others being in business not tell shareholder the truth could back fire on you. We believe this last one is probably the hardest stereotyping because of everyone’s up bring but we believe if you look at the facts and take way stigma of what you have heard most the time you will see that the stereotype was wrong. An advertisement that perceives to make you jump higher and play better basketball is the Michael Jordon Nike advertisement, but the reality of it is that you have to have some skills to play like Mike. Reference Ruggiero, V. R. (2012). The Art of Thinking, A Guide to Critical and Creative Though (10th ed.). Upper Saddle River, NJ: Pearson Education,Inc.

Whren vs. United States. June 10, 1993 Essay Example | Topics and Well Written Essays - 750 words

Whren vs. United States. June 10, 1993 - Essay Example As the police officers in an unmarked car made their first pass, they noticed that the Whren and Brown were in a dark colored Pathfinder truck with temporary license plates, and the driver, Brown kept looked downward to the lap of Whren in the passenger seat. The police officers then made a U-turn towards the Pathfinder, when all of a sudden the Pathfinder suddenly turned right without signaling, and sped off at what the officers describe an "unreasonable speed." Thus the police officers continued pursuit, and in a short while caught up with Whren and Brown at a stop light. The officers identified themselves and as the approached the driver side window, saw that the Whren had in his hands two large plastic bags of crack cocaine. They were subsequently arrested and charged with federal drug charges. At the pretrial suppression hearing, Whren and Brown filed a motion to suppress the evidence on the ground of an illegal search and seizure surrounding the circumstances of the case. They alleged that the police officers used the traffic violation as a pretext for stopping the truck due to the lack of any reasonable suspicion or probable cause to stop them on suspicion of drug dealing. Court Decisions: The District Trial Court denied the motion and conducted trial, resulting in the conviction of Whren and Brown. On appeal to the Court of Appeals their conviction was affirmed. Thus, Whren and Brown brought this case to the Supreme Court on certiorari. Issue: Whether or not the police officers conducted an unlawful search and seizure in this case. Whether or not the police officers violated the Fourth Amendment of the Constitution proscribing unlawful searches and seizures. Ruling: No on both issues. In a unanimous decision the Supreme Court held that as long as police officers have reasonable cause to believe that there had occurred a traffic violation, they may stop any vehicle. In the case at bar, the police officers had reasonable cause to stop Whren and Brown on the basis of a traffic violation because they had made a turn without signaling and sped away from a stop sign at an unreasonable speed. Hence, an actual traffic violation was committed by Whren and Brown, and the resulting search and seizure of the Pathfinder was reasonable, regardless of what other personal motivations the officers might have had for stopping the vehicle. Also, the Supreme Court discarded the allegations of Whren and Brown that they had suffered from anxiety, confusion, and haste which they experienced from the stop and search procedure outweighed the government's interest in traffic safety. Indeed, while the Fourth Amendment requires a balancing test between the benefits derived from a search-and-seizure and the harm it may cause to the person, this test only applies to unusually harmful searches and seizures. In the case at bar there was nothing unusually harmful about this traffic stop. Personal Opinion: With reference to the case at bar, I am in total concurrence with the manner in which the legal and procedural issues were resolved by the Supreme Court. The Constitutional right against unreasonable searches and seizures embodied in the Fourth Amendment has to be taken in accordance with the underlying circumstances in the case. The evil sought to be prohibited is that of abuse on the part of the arresting officer, in making any search or seizure of a individual's person, house, papers and effects. Indeed, a number of Constitutional doctrines have already held that the applicable case law. Delaware vs. Prouse, United States vs. Martinez Fuerte and United States vs. Brignoni Ponce were all mentioned

Westward Migration in 1800s Essay Example | Topics and Well Written Essays - 500 words

Westward Migration in 1800s - Essay Example John O'Sullivan, it is considered by the United States to be a divine mission to spread and possess the whole continent for the development of liberty and self-government to which the United States is known to. Philosophically speaking, this is true. Indeed many American authorities had a strong belief that their country's freedom and ambitions are very ideal and perfect that it should be shared to other countries beyond their jurisdiction. This was actually promoted by the Young America movement headed by Franklin Pierce. Realistically speaking however, this was not the case. The otherwise divine mission became an excuse, a moral justification that inspired the origin of imperialism in forcefully occupying the lands of those who previously live in peace and abundance. Most leaders and politicians promoted territorial expansion towards the west because of the desire to acquire new lands. Acquisition of more lands does not only connote more power; it represents additional source of income and wealth. During that time, the United States were already in the process of producing goods that require raw materials. These raw materials however could not be found therein as it has not much natural resources sufficient to provide its needs.

Art Management-festival comparison Literature review

Art Management-festival comparison - Literature review Example Additionally the works of the extremely powerful artists of those eras, like Gyula Kaesz and Lajos Kozma, the show displays the furniture of such, all but forgotten presently, which was once very admired, designers as Gyà ¶rgy Frà ¤nkel, Zsuzsa Kovà ¡cs, Pà ¡l Và ¡gà ³, Gyà ¶rgy Kà ³rà ³dy and Kà ¡roly Nagy, as well as those equipments that make a living space a residence, like textiles, lighting fittings and ornaments. Music Festivals are specially organized events oriented towards the culture of not only domestic people, but also for international visitors. It is also focused towards the leisure time of both the general and business to business customers. Music Festivals are known as culturally oriented tourism (Koutoulas, N.d.). Although cultural tourism shows a little favoritism towards the â€Å"elite† culture and associated people, much of the contemporary culture revolves around â€Å"folk† culture (Walle, 1998). A cultural tourism event attracts not only large diversified customers, but it also attracts potentially lucrative sponsors and in turn, the sponsors can also communicate to a large number of target audiences (Walle, 1998). Music festivals can be understood as a result derived from the increasing demand of culture along with increased availability of time for leisure and holidays (Frey, 1994). It was observed that number of foreign visitors in Finland was increased in the year of 1980-1990. It is from that time, Kuhmo Chamber Music Festival, based in Finland, went into the pre-internationalization process. After 1990s, it is observed that after the sudden increase in the year 1990s following by the deep recession, consumers’ willingness to join music festivals had also been changed (Tikkanen, 2008, pp.127-133). From the year of establishment in the year 1970 to 1975, it was known as â€Å"Local Chamber Music Festival†. At that time, due to scarce financial and labor resources, voluntary

Discuss the specific factors within the current external environment Essay

Discuss the specific factors within the current external environment that must be considered prior to the development of a new - Essay Example Teenagers drink and behave that way because of youngsters’ culture that is influenced by peer pressure. This behaviour is extended in order to get someone to act in a similar way, and often, teenagers drink because everybody else is doing it. Peer pressure encourages teenagers to change their behaviour either on a negative and positive way (Wise Geek). It may be dangerous to children, especially the younger or insecure children. In group gatherings of teenagers, they may be encouraged to take dangerous actions simply because everybody else is drinking alcohol. Another external environment that is a very important consideration is the competitive condition in the market. This requires an analysis of the competitive environment that the business will operate. Some businesses may offer similar products that the company is contemplating on doing. Thus, it becomes necessary that an analysis consist of study of the strengths and weaknesses of the soft drink industry in UK, as well a s the company’s own strengths and weaknesses; a study of the demographics and desires of marketplace customers, and barriers that can impede the introduction the new soft drink (Competitive analysis). First, it is important to discover the magnitude of competition in the soft drinks manufacturer in the market. Then, there is need to consider the chances of the new soft drinks on how it will compare and compete in this market. Second, what are the taste preferences of the teenagers when it comes to soft drinks? For instance, competition in the industry includes giants such as Coke and Pepsi. The study should look into reasons why companies like Coke and Pepsi succeed, or why others failed. For example, why did Pepsi â€Å"BLUE† fail in the market when it was introduced in 2004? It is worth looking into what are the motivational factors that encourage people to buy a product. Let us look at Pepsi â€Å"Blue† again. Pepsi spent a lot of money in its development, ad vertisements and promotions, but after a while, it lacked the needed luster to remain in the market (PepsiCo – bolt from the â€Å"Blue†) Technological factors are also vital consideration for development of new soft drinks in the market. We all know that technology is fast changing and this likewise change the production process and product innovations. The relevant factor here is the product presentation or packaging, its appeal and process needed. In the ready to drink category of the new soft drink, what is the most appropriate for the 11-15 teenage market; will it come in an aluminium can, tetra-packs or in bottles. Comes next is the appropriate theme in the brand labels to create an appeal. For instance, Mountain Dew became a popular drink when it turned into aluminium cans, and used eye appealing labels as well as durability, fast chilling capability and recyclability (Shelf Impact, 2008) Economic environment becomes an important factor of analysis because these are the taxation, government spending, general demand,

Request For Proposal Assignment Example | Topics and Well Written Essays - 750 words

Request For Proposal - Assignment Example The identified company goes by the name Go Daddy taking the package on unlimited hosting space. Workers at the information technology department will be trained on ways of updating the website (Stephen, 2010). Our Company has worked with a number of nongovernmental organizations. Their websites are up and running while positive recommendations have been provided by the companies. The listings of the websites are the: The above websites were fully implemented by our company from design to provision of hosting services. The profile holds a mixture of nongovernmental, corporate and governmental websites. This makes our company to have wide experience in dealing with the wide global diverse clientele. Dealing with these clients leaves us being the best company of developing the European Union Website (Lydia, 2003). Our company has been in the business for 10 years specializing in design and implementation of web based systems. The company has grown from five employers to 50 employees in a period of two years. The number working in web site design is 30 people among the hundred workers within the company. Upon receiving this job we will dedicate ten of our best designer which will add to 10% of the company workforce to ensure timely delivery of the website. Our company is located in San Francisco city street 234 Zip 20300. The telephone number that can be used to contact us is 0100-2033-5567. The lines are open 24 hours a day for clients to make any enquiries (Dennis, 2007). The company will employ the prototype model in delivering the project to ensure its reliability and usability. The prototyping model will allow development of the first release of the website which is delivered to users to elicit their opinion on the website. Their opinion will be taken and included in the next release of the software which will be a half finished website with some of the functionalities fully working. The final prototype will

Human development Essay Example | Topics and Well Written Essays - 750 words - 2

Human development - Essay Example Skinner’s theory of learning is based on the premise that learning is a function of change in overt behavior. Changes occur due to the response to the external stimuli. This reinforcement theory relies on the assumption that behavior is a function of its consequences (Dunn, 2002). The learner will repeat the behavior if positive reinforcement follows the behavior. Positive reinforcement refers to some verbal recognition or appreciation or rewards like certificates or promotion to a higher level. Negative reinforcement can also strengthen the behavior but punishment can weaken the behavior. This is because the negative condition has been experienced as a consequence of the behavior and teaches the individual not to repeat the behavior. Punishment can help to eliminate behavior and is used in daily life but it works only for a short period. Bandura’s theory states that to learn anything you have to pay attention to it. Anything that dampens the attention will consequently reduce the learning process (Boeree, 1998). For instance, sleep and lethargy can dampen attention and consequrntly learning. Bandura experimented with models and summarized that if the model is attractive colorful appears like us we would pay more attention. After paying attention, it is important to retain what has been paid attention to. This means retaining the mental image or verbal description of the model. When it is stored the same image can be brought up at will whenever necessary. The third step involves translation or reproducing the images into actual behavior. This implies an individual must have the ability to reproduce. This way the ability to imitate improves with practice. In fact the abilities improve even when one just imagines imitating. The act of imitating comes only through some form of motivation. This reinforcement can b e some past reinforcement, promised reinforcement or vicarious reinforcement. The main difference between Bandura and Skinner lies in their

Latin America and the Church Essay Example for Free

Latin America and the Church Essay The Catholic Church has been regarded as one of the most powerful institutions in the world. The beginnings of its authority can be rooted in the European continent wherein the development of the Catholic religious belief took place. Nevertheless, the numerous changes that happened in the world paved the way for the Catholic Church to extend their influence. At present, Europe is no longer regarded as the center of the Roman Catholic Church in terms of the number of people who adhere to this faith because the Latin American region has long been the most Catholic continent in the world. As a result, Catholic doctrines and beliefs play a very important role in the development of the Latin American continent. The influence of the Catholic Church goes beyond the mere spiritual well being of the people because it also has a huge impact in the areas of their life. The influential role of the Catholic Church is clearly observable in the cultural, social, and even political areas of the society. Being the case, it can be said that the Catholic Church has a substantial and advantageous contribution to the Latin American society. The Catholic Church has appositive influence in the Latin American region, which can be proven by four important points. First, much of the culture of the countries within Latin America is derive from the Catholic Church. Catholicism started in Latin America during the 1500’s. The Iberian monarchs are the one responsible in propagating the Catholic faith in the Latin American region through the holy crusade that they waged in their new dominion. One of the main objectives of the Iberian monarchs in converting the Latin American people into becoming Catholics is for the Church to have a comprehensive in the society. This is related to their belief that every area of an individual’s life is related to his or her salvation. Thus, the Church established connection to every sector of the society and every part of an individual’s life. As a result, the distinction between the sacred or the secular is observable in Latin America wherein the Church plays an active role in the various areas of community life. This kind of adage is clearly exemplified in the family dynamics of most Latin American countries such as: Brazil, Chile, and Cuba. Due to the teachings of the Catholic Church, the Iberian monarchs were able to instill the value of close-family ties in Latin America. As a result, the family as the basic unit of society is given due importance. This makes the people very family oriented, which almost every individual acquires and later on pass to the succeeding generations. Moreover, the family structure in Latin America is mostly patriarchal because of the authoritative society that the Christendom has propagated (Patterson 18). It gives importance to the fact that the father is the head of the family. Having such role entails that he is the main decision-maker in the household. The male dominion or superiority is not merely confined within the four corners of their houses but rather it is also seen in work-related opportunities. Men still have control of many occupational areas especially in terms of job that are regarded to be the domain of men like politics. However, the changes in time that the Catholic Church sometimes adheres to have also revolutionized the political dynamics of Latin America. In the call of the Church for greater equality in the society, they have also supported women empowerment in terms of giving them more opportunity to develop their skills and participate in the society. This could be proven by the case of Chile wherein the country elected its first female president. President Michelle Bachelet holds the highest position in Chilean politics. This only goes to show that the Catholic Church has a substantial influence in the culture of Latin America especially with regards to its family values. Second, The Catholic Church heavily influences the social fields in Latin America especially in the realm of education. The mission of the Catholic Church that came together with the Iberian invasion of the region is focused on the creation of highly selective and academic educational foundations. The colonial territories were controlled and administered in towns and cities. The central features of these places are the schools, seminaries, and universities. During the nineteenth century, the formative influence that plays a vital role in the educational system of Latin America was that of Napoleonic France. This kind of education is characterized by hierarchical responsibility that includes national to regional to local scale of territorial administration. Each of these levels also extended in both the urban and rural sectors (Brock and Lawlor 2-3). The influence of the Catholic Church in the educational system is seen in Brazil’s public life. The Brazilian Catholic Church took part in implementing a conservative program in order to strengthen it internal hierarchy by means of providing education and other social services. In the same manner, Catholicism also has a huge impact in the educational institution of Cuba. Despite the fact that Cuba is regarded as a Communist state, which means that the government has the main and greater responsibility in making decisions and distributing the resources of the country, the Catholic Church still manage to influence the country’s education. In Cuba, the government delivers the vast majority of social services. Nevertheless, the emergence of other actors also exists and one of the most notable is the Catholic Church. This is clearly exemplified by the Caritas Cubana, a non-governmental organization that is affiliated with the Catholic Church. Caritas Cubana provides social services and distributes medications. Some of their programs are funded through the help of international non-governmental organizations. The services that they render are providing academic support for the children and others (Uriarte 62). Third, the Church is a highly structured organization in a region that is experiencing low and slow development. The Catholic Church is recognized as one of the strongest institution that is established in the world. The network of churches that adhere to the doctrines and teaching of the Roman Catholic is observable in various parts of the world and this also includes the Latin American region. The important role that the Church has in this part of the South American continent can be rooted from the very organizational strength of the Catholic Church. In relation to this, the reality that most countries in Latin America experienced and are still facing political instability make the influence of the Catholic Church greater than ever. This is mentality is due to the sentiment of the people wherein they need a strong governing body that they can hold into in times of hardships and trials. The Catholic Church emerged as the stable organization that most people can believe and lean on. The weaknesses and shortcomings of the most Latin American government to address the pressing problems of the people like threats to peace and order as well as the sustenance of basic needs like food, shelter, education and public health care. Being the case, the Catholic Church takes a bolder role in giving hope to the people especially those who are living in dire poverty. The political turmoil in the Latin American region is observable in countries like Brazil, Chile, and Cuba. In the case of Brazil, its weak government during the 1960s caused a coup d’etat and the establishment of a totalitarian state in the country. However, there was significant resistance to the ouster of the civilian government that attributed to the major split of the Brazilian Communist Party. Due to this, a number of small urban and rural guerilla groups were formed, which aim to provoke the government by creating a domestic atmosphere of repression that will force the people to rebel (Train, 1994). In the same manner, Chile also has its own set of political problems that is very evident during the Pinochet regime. Augusto Pinochet was able to obtain the seat of power in Chile through a military junta. Most of the citizens supported the coup because they want to overthrow the administration of Salvador Allende. Many people believed that the army would bring back order and then call elections. However, General Pinochet disabused them as he asserted that in order to eliminate communism democracy must be ended. He unleashed violence that has no precedent in Chile (â€Å"Augusto Pinochet†). Cuba also has its political concerns especially those that the country experience under the authority of Fidel Castro. During those times, Cuba was regarded as an isolationist country that is against its close neighbor, the United States. The situation of the country was further worsened by U. S. political and diplomatic hostility (Falcoff). In these instances, the people turn toward the Catholic Church instead of their government because the Church clearly shows organization and stability as compared with the government that usually changes political leaders due to civil unrest. Fourth, the influence of the Catholic Church has extended up to point of being politically active. The Catholic Church has the power to create popular movements because they have a huge influence in motivating the people to participate. The Church can promote the political mobilization of the poor and marginalized people society. In line with this, poor and marginalized parishioners in Latin American sometime require the help and support of their religious leaders in order to change their political an economic condition. The responsibilities as well as the reputation that the Catholic Church has in the society have prompted them to become politically active. The Church involvement in politics is not simply confined in giving advices or their stand on certain issues but rather they also established their own political parties. This is proven in the case of Brazil wherein it has Christian democratic parties that support traditional Catholic principles like hierarchy, paternalism, and corporate identity (Trejo). The Catholic Church indeed has a positive influence in the Latin American region. This is proven by the four major tenets that are discuss above that the Catholic Church contribute to the development of Latin America’s culture, social fields, citizen’s strength amidst political turmoil, and greater political participation. These only show that an individual’s religious belief has a huge role in the development of the other aspects of his or her life as well as the evolution of the society as a whole. Works Cited â€Å"Augusto Pinochet. † 2007. The Economist Newspaper and The Economist Group. 30 July 2009 http://www. economist. com/obituary/PrinterFirendly. cfm? story_id=8406905. Brock, Colin. , Lawlor, Hugh. Education in Latin America. New York: Routledge, 1985. Falcoff, Mark. â€Å"Cuba’s Future – or Futures. † 21 December 2004. American Experience. 09 March 2009. http://www. pbs. org/wgbh/amex/castro/sf viewsfalcoll. html. Patterson, Eric. Latin America’s Neo-reformation: Religion’s influence in Contemporary Politics. New York: Routledge, 2005. Train, Brian. â€Å"Urban Guerillas in Brazil. † 1994. MIT Western Hemisphere Project. 18 July 2007 http://web. mit. edu/hemisphere/events/mnm03-1m/brazil-train. shtml. Trejo, Guillermo. â€Å"Religious Competition and Popular Mobilization: Evidence from Mexico’s Regions. † 2006. 08 March 2009 http://cas. uchicago. edu /workshops/cpolit/papers/trejo. doc. Uriarte, Miren. Cuba Social Policy at the Crossroads: Maintaining Priorities, Transforming Practice. † Oxfam American Report. Boston: Oxfam America, 2002.

Use of ethical behavior will pay off in the long-run

Use of ethical behavior will pay off in the long-run Ethical behavior is morally accepted as being good and right in a particular situation. The society-at-large is always demanding high ethical and moral standards from organizations. Unethical behavior is always seen as a virus working on the society and eating it up. In a business organization, the top level managers have a big part to play when it comes to ethical issues. How they react when it comes to ethical dilemmas makes a big difference as to how the other employees of that organization will face the same situation. A big example is what Johnson Johnson Company executives did when the Tylenol poisoning took place. They pulled out all the stocks out of the market even thou it cost them millions of dollars, because the management knew it was the ethical thing to do. It uplifted their image amongst its customer base rather than downgrading it since the customers could see that the company had their best interests at heart. That particular reaction set a big example for other org anizations throughout the world to follow. When it comes to ethical behavior in the long run, I believe it will pay off for any organization. In todays intense business environment its more important than ever to have strong ethical programs in place. In a survey conducted by the ethics resource centre on more than 4,000 employees, one third had witnessed ethical misconduct in the past year (Flynn, 1995). Ethical standards depict behaviors morally accepted as good and right as opposed to bad or wrong in a particular setting it is particularly crucial for the business for a number of reasons. For example, murder and robbery are not only illegal but are universally regarded as wrong, while dishonesty , while not necessarily illegal, is usually thought to be immoral. They are created and adopted by people who are interested primarily in ensuring there are guidelines for behavior for the group members. For example, doctors and lawyers have ethical codes of practice which they sear to uphold as part of their professional practice. Ethics in the society carries a lot of value, so I believe that ethical behavior is what all working professionals should aim to have. However its not just the ethical attributes that the employees and organizations should have, but also the behavior they put forward with regards to those ethical issues is also important. To build a good career one should live there life by rules of ethics in order to safeguard themselves and also society as a whole. Most business experts suggest that establishing a code of conduct can help the company to behave ethically. A code of conduct is a formal document stating the principles and the ethical rules it expects the employees to follow in the organization. Ethical standards protect the business from scandals and prevent them in the future. Ethical statements imply the employees, business associates, and the larger community a framework of the companys operating principles (rules and regulations) which needs to be followed, why the company exists, what the company believes in, and how it goes about to comply with its professed beliefs. In addition, reviewing the standard operating procedures and performance measurements will ensure the business owners and managers that it is well structured and does not encourage unethical behavior. Studies has shown that organizations are now increasingly take account of ethical considerations, there has been a shift from traditional profit and free market bu siness approach to ethical approach, in favor of consumer interests. Practicing ethical behavior can develop the business to great heights. High ethical behaviors will set high standards and put the work practices of the organization to high levels. It will develop a discipline which will help your business to succeed. It will also build teamwork amongst employees. They will show respect for the organization, its culture and top level management. It will build trust and confidence among colleagues. Also organizations which practice ethical standards can attract good short and long term investment. Investors will definitely see it more viable to associate itself which businesses who put ethical issues to high regards hence uplifting the investors image in the society and the business environment. Most investors believe that it is important for companies to consider ethical and social issues alongside financial issues in order for them to be sustainable and remain competitive in the long run. Ethical investors are essentially concerned with how profit is made and looks to maximize profit at the same time trying to minimize and avoid negative social effects. On the positive side, the public will begin to recognize and to honor individual companies for their contributions to solving most obdurate problems. This puts companies in a very strong situation since all the stake holders like shareholders, government, employees, suppliers and local communities benefit Ethical investments is one way of responding to issues of social responsibility in business decisions and activities and avoiding being self serving. Socially responsible factors in areas of public concern include the environment, sustainability, and globalization. Behaving ethically also improves the quality of work life and enhances the role of every employer in creating an environment where employee pride blossoms and theft losses disappear. There is reduced corruption when employees are treated with fairness and are valued as individuals, as they take pride in their organization. Positive results are achieved when employees are given a basis for trust and respect to live by. If employees believe all are held to similar high standards, they likely will feel better about themselves, their colleagues, their organization and behave ethically when dealing with customers and business associates. Research over the years have proved that consumers are used to buying products from companies that have public recognition, a company record or being promoted. Enhancing customer loyalty to the brand is probably the single most powerful incentive for convincing companies to adopt ethics as a way of life. Another advantage of behaving ethically is that it promotes better staff retention and attraction; good organizations cannot function without good people. Ethical organizations have increased commitment by employees as good employees want to work with responsible and ethical employers. When a company fails to be a good employer they lose good staff and it reduces the possibility of attracting good new-comers. Many business want employees to behave ethically because such a reputation is good for business which in turn can mean larger profits. How one behaves in the workplace helps them in building a good reputation and praises over the years to come. Similarly, encouraging employees to act ethically can save money by reducing employee theft, down time and lawsuits. It is noticed that that when employees dont show respect for the company and colleagues, it encourage many forms of theft such unnecessary phone calls on company account and taking office supplies home. It is important that employees have a clear understanding of their organizations ethical standards and a feeling of management support for acting within those standards. Teaching ethics to an employee is not always effective. Management must set examples by their personal alignment with ethical standards and principles. Thus, Managers have to always keep in mind that leading by example is the first step in developing a culture of ethical behavior in the organization. PART TWO; Q2) Within the business context, businesses are expected to have good ethical values and act socially responsible. The problem is that the ethics of a business is a mixture of the individual sets of ethics. This is why it is important to have good individuals as employees. it is also equally important that when you go to work somewhere that you feel like you share the values of those you work with. Ethic is not just talking about the right thing. It is doing what is the right in every decision that is made. Based on the above observation discuss the impact on society that ethical leaders can make As the world business platform is growing rapidly, more business leaders and are now waking up to the reality of social responsibility and good organizational ethics. The opinion of the society is re-shaping expectations and standards on how leaders should perform with regards to the general public. Injustice around the world is becoming more visible and less acceptable and behavior of leaders is becoming more transparent every day. Leaders now have real incentives when they do the right thing, but they do have disincentives for doing things that are unacceptable in todays world. Leaders show ethical behaviors when they do what is morally right, and good, and when they help to elevate followers moral awareness. Ethical leaders must generate the right conditions and organizational culture for the development of ethical behavior amongst society members. Every community has leaders to look after its interests and protects its rights. However in todays world, many people do not have faith in leaders and hold them responsible for many of their problems. Ethical leaders should be people-oriented and always aware of how their decisions affect others. They serve the society with compassionate interests. This becomes the only way ethical leaders are able to motivate followers and put needs and interest of group before their own. When these leaders act ethically than the people in the society will follow them. The respect and trust the people put in their leaders will lead them to follow the same values that the leaders do. The leaders have a big responsibility on their shoulders when it comes to guiding the society to follow these ethical principles. They act as role models for the society. What they do in their day to day life becomes the corner stone for the followers. Leaders also play an important role in social responsibility.   The keys issues involved are the health and safety of every employee. Great leadership includes establishing health and safety as a value and affirming that safety by allowing employees adequate time to prepare for evacuation. Organizations blossom when leaders take responsibility to ensure that works are performed ethically. Ethical behavior should start at the top level management, so that employees also ensure ethical standards are maintained. However if leaders want to be more effective than they need to have good employees working for them in the first place. These employees should be able to carry on the leaders values and follow the same principles when the leader is not around. They should be people who can be trusted enough to be given such a big responsibility. They should be able to promote right actions to inspire the performance of individuals and the culture as a whole.  They Leaders contribute to the success of the society and influence the choices made by the members and businesses in carrying out day-to-day activities. To conclude, every society needs leaders who take personal responsibility for their decisions. People should be able to trust their leaders and see the difference between good and bad.