Management of pressure ulcers in a high risk patient: a case study

1. Introduction Clinically, pressure ulcers are defined as the lesions that are the result of localized tissue damage or cell death (generally necrosis), developed because of pressure over a bony prominence.More commonly, they are also known as pressure sores or bedsores as they are mainly developed by patients that are bed-bound (Wake, 2010). Approximately, 3 million adults are affected by pressure ulcers and are most common in hospitalized patients (Lyder and Ayello, 2008). However, effective management and care plans against pressure ulcers are still lacking. The role of nursing care is a fundamental aspect to pressure ulcer management, including its prevention and treatment (Wake, 2010). In this case study report, I visited a diabetic patient as a district nurse for insulin administration and provide support by assessing the patient’s risk of developing pressure ulcers due to associated pathological and other risk factors.1.1. Purpose of the studyIn all health care settings, pressure ulce rs remain one of the major issues. More so, pressure sores or pressure ulcers are associated with significant cause for morbidity in the medical community. The main purpose of this patient visit was to provide healthcare support for patients who were at risk of developing pressure ulcer. The healthcare support included the risk minimisation by doing risk assessment, therapeutic interventions, suggestions for lifestyle changes including exercise and dietary habit. All these were targeted with the views of providing timely assessment of pressure ulcers in high risk patients, and suggest therapeutic interventions for timely treatment of the condition.1.2.Patient historyThe patient was 75 years old male, diabetic and paralysed due to recent stroke attack. He was completely bed bound and was on wheelchair. Furthermore, the patient was suffering from cancer of the oesophagus. Since the patient could not mobilize, his family members and carers used to transfer him from the bed to his whe elchair and wheelchair to his bed.1.3. Risk assessments of needs, vulnerabilities and strengths of the patientThe patient was chronically ill and had several complications associated with his conditions. Stroke attack had caused him paralysis and was unable to move. This had put him in significant risk of developing pressure ulcers. The patient was also diabetic. Diabetes causes slow healing of wounds that may lead to ulcer (Guo, et.al. 2010). In this patient, the combination of factors including diabetes and immobility had increased his risk of developing pressure ulcers. Other factors such as old age of the patient, cancer and dietary factors would trigger the development of these pressure sores. Cancer is a chronic disease that may cause severe debilitation and prolonged confinement to bed. Therefore, it is expected that patients with cancer are at significant risk of developing pressure ulcers (Walker, 2001). Diet may have a supporting role in the development of pressure ulcers . Although the role of nutrition in preventing the development of pressure ulcers is still debatable, it is obvious that patients who are malnourished are at risk of developing those (Doley, 2010). Thus, nutrition therapy could be central in minimising the risk of developing pressure ulcers. It was seen that the patient was clearly underweight due to his chronic health conditions. Overall, the following risk factors of the patient were considered while making his assessment. Based on these risk factors, care plans and suggestions were made to minimise the risk in the patient. Sensory factor: This factor was assessed in order to identify how well the patient can process sensory input from the skin, as well as how effectively he can communicate level of sensation. Since the assessment of skin is an important way to identify patient’s risk of developing pressure ulcers, it would ensure the degree of risk of pressure ulcer in this patient and hence, take measures to prevent them before complications arise. Moisture: Moisture is another hallmark of pressure ulcers. Excess skin moisture puts patients at greater risk of developing pressure ulcers. It is common that patients who are confined to bed produce more sweat. Thus, it is required to evaluate what degree the skin is exposed to moisture. Activity Lack of activity is one of major risk factors of developing pressure ulcers in bedbound patients. Continuous friction between the skin and bed mattress may result the development of pressure sores. Measuring the activity is another important parameter to predict the patients’ risk of pressure, irrespective of their degree of mobility. Patients who are unable to move need to be physically turned by healthcare staffs or family members at regular intervals Nutrition As mentioned earlier, although nutrition may not have direct effects on the patient’s risk of developing pressure ulcers, it may be possible that lack of required nutrients may increase its complications. It is thus important to evaluate what constitutes the usual pattern and amount of caloric intake in the patients. After evaluating the above risk factors in the patient, it was concluded that the patient was likely to develop pressure ulcers if timely interventions were not introduced. These would have direct effect in patient’s health. These ulcers influence the risk of bacterial and viral infections, which can become life threatening in chronically ill patients. In addition, there is a high rate of mortality associated with pressure ulcers. Mortality rate is high as 60% is reported in older patients with pressure ulcers within 1 year of hospital discharges (Lyder and Ayello, 2008). The patient in this case study could have weakened immune system due to his old age and illnesses such as cancer and diabetes. In immune-compromised patients, the risk of infections spreading into their blood and other organs of the body are considerably high. This may result blood poisoning and septicaemia. Both these conditions are very fatal and categorised as medical emergencies (Redelings, et.al. 2005). However, despite of several associated risk factors, the patient was provided with proper care and support by his carers and family members. He was regularly taken off from his bed with the support of wheelchair. More so, the patient was on medications to control his blood sugar. He was also supplemented with vitamin to strengthen his immunity. To conclude, patient although was receiving appropriate healthcare service, these were mainly therapeutics which included medications against the chronic illnesses which he had. Patient and family members were lacking suggestions and expert advice in regards to minimising the risk of pressure ulcers. It was also observed that the patient was provided with a normal bed and mattress that would further trigger the risk of developing sores. 2. Interventions and referrals After evaluating the patient’s condition, as a district nurse, I provided the evidence based interventions and referrals to the patient and his family members and carers as preventive approaches of pressure ulcers. Firstly, the patient was provided with a hospital bed with pressure relieving mattresses. This would help minimise the friction between patient’s body and the bed and hence, reduce the risk of pressure ulcers. Moreover, this would provide support surfaces and help in pressure redistribution (Stannard, 2012). Several recommendations for skin care including the use of cold water instead of hot water, use of mild cleansing agents to minimise irritation and dryness of the skin and excessive moisture was suggested. The patient was also advised to avoid low humidity as it may promote scaling and dryness (Lyder and Ayello, 2008). Further suggestion such as avoiding mechanical loading was given. This is considered as one of the most effective preventive measures of p ressure ulcers in hospitalized patients (Lyder and Ayello, 2008). Thus, family members were advised to frequently turn and reposit the patient while in bed. It is essential that patient intake adequate levels of both macro and micronutrients to prevent complications of pressure ulcers. This patient was already supplemented with vitamins and minerals, so no action was taken. However, the patient was suggested to eat diet high in proteins, which are essential for wound-healing and overcome malnutrition. Management of pain is another key aspect in patients with pressure ulcers (Cooper, 2013). Pressure ulcers can be very painful and may require interventions with analgesics (Wake, 2010). However, this patient did not require analgesic treatment as the pain due to pressure ulcers was not very severe. Instead, focus was given on the preventative approaches in minimising the complications associated with pressure ulcers. Finally, the focus was given on the patient/carer education in the management of pressure ulcers. Both patient and carers/family members were made aware about the risk factors of pressure ulcers. Also, they were educated and made aware on the most vulnerable sites of the body that are at risk of developing pressure ulcers. General training was also given on how to take care of skins and methods for pressure reduction. They were told about the severity of the condition and requested to seek medical advice if symptoms of pressure ulcers persist. 3.Critical evaluation and evidence-based examination of outcomes of interventions and referrals The interventions and referrals made for the patient in this case study were evidence based. Risk assessment was made considering the standard pressure ulcer prediction tool, Braden Scale, by observing the six vital signs of pressure ulcers as explained earlier. This tool has allowed for the early prediction of pressure ulcers and thus introduction of early interventions before the complications are developed (Sving, 2014). Classification of pressure ulcers is one of the best ways to predict its outcome. Pressure ulcers are classified into various stages (Lyder and Ayello, 2008). Stage I is determined by the presence of redness in the skin. In case if the redness in the skin is observed, nurses are required to make thorough skin inspection and advice patients about the preventive measures. Stage II is characterized by the loss of skin with the presence of blisters. In stage III loss of skin is quite thick; however, not exposed to muscle or bone tissue. In this stage, there is a high risk of infections, so care should be given in personal hygiene (Sving, 2014). Also, patient should be suggested to include vitamins and minerals in the diet to prevent the possible risk of infection. In stage IV there may be an exposure to bone, tendon and muscle. This condition is considered as potentially dangerous, due to associated risk of life threatening bacterial infections. In many cases, this may also require hospi tal admission to reduce further complications (Lyder and Ayello, 2008; Sving, 2014). To conclude, nurses are required to assess various stages of pressure ulcers and provide treatments and suggestions based on these stages. This is because; different stages of pressure ulcers may require different treatment plans. Some could be minor and may be improved through general suggestions such as encouraging patients to move and involve in physical activities and maintaining healthy diet; whereas some may require therapeutic interventions including the use of antibiotics to treat bacterial infections, dressing and cleaning of the wound and hospital admissions if complications are severe. (Wake, 2010). Ample evidence is now available on the understanding of effective pressure ulcer treatments. Treatment strategies such as use of hospital bed, avoiding mechanical loading, and physical activity are now considered as the standard form of treatments in pressure ulcers. These approaches not only reduce the risk of pressure ulcers, but are also beneficial in lowering its complications. Furthermore, the association of pressure ulcers with other chronic diseases such as cancer, diabetes and stroke are well understood. Thus, much attention is to be given while giving care to the patients who have these conditions. Educating patient and family members on the risk factors and management is another approach to pressure ulcer management as suggested by NICE guidelines (Wake, 2010) However, the available knowledge on the evaluation of risk assessment of pressure seems insufficient. The evidence lacks support and requires further epidemiological research to understand risk factors of pressure ulcers in greater depth. Some of the interventions and their effectiveness including re-positioning and nutrition are still questionable. Further studies on the influence of different turning intervals on the development of pressure ulcers need to be carried out. Similarly, what specific diet is suitable for pressure ulcer patients needs further clarification. Appendix1: Care plan of the patient Risk assessmentCare goalsInterventions and evaluations Patient’s needs and vulnerabilities : old age, bed-bound, chronic diseases including cancer and diabetes, paralysed due to strokeTo identify the patient’s risk of developing pressure ulcersThe patient was provided with hospital bed, cushion for his wheelchair and family members were suggested to move the patient time to time Patient’s strength: on proper medications, carers and family members providing the support, supplemented with vitamins and minerals to boost the immune functionTo build on the patient’s strengths and to meet his needsPatient was provided with full support from the family members. High protein diet was suggested as this may improve would-healing. Signs of complications, such as pain, bacterial and viral infections.To avoid complications associated with infections including blood poisoning and septicaemiaImmune booster such as vitamins and disinfectant creams to avoid infections. References Cooper, K.L. 2013, â€Å"Evidence-based prevention of pressure ulcers in the intensive care unit†, Critical Care Nurse, vol. 33, no. 6, pp. 57-66. Doley, J. 2010, â€Å"Nutrition management of pressure ulcers†, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, vol. 25, no. 1, pp. 50-60. Guo, S and DiPietro, L.A, 2010. Journal of dental research. Factors Affecting Wound Healing, vol. 89, no. 3, 219-229. Lyder, C.H and Ayello, E.A, 2008. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Pressure Ulcers: A Patient Safety Issue. Lyder, C.H, 2003. Clinician’s corner. Pressure Ulcer Prevention and Management, vol. 289, no. 2, pp. 223-226. Lyder, C.H. 2006, â€Å"Assessing risk and preventing pressure ulcers in patients with cancer†, Seminars in oncology nursing, vol. 22, no. 3, pp. 178-184. McInnes, E., Jammali-Blasi, A., Bell-Syer, S., Dumville, J. & Cullum, N. 2012, â€Å"Preventing pressure ulcers–Are pressure-redistributing support surfaces effectiveA Cochrane systematic review and meta-analysis†,International journal of nursing studies, vol. 49, no. 3, pp. 345-359. Redelings, M.D., Lee, N.E. & Sorvillo, F. 2005, â€Å"Pressure ulcers: more lethal than we thought?†, Advances in Skin & Wound Care, vol. 18, no. 7, pp. 367-372. Stannard, D. 2012, â€Å"Support surfaces for pressure ulcer prevention†, Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses / American Society of PeriAnesthesia Nurses, vol. 27, no. 5, pp. 341-342. Stechmiller, J.K. 2010, â€Å"Understanding the role of nutrition and wound healing†, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, vol. 25, no. 1, pp. 61-68. Sving, E., Idvall, E., Hogberg, H. & Gunningberg, L. 2014, â€Å"Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study†, International journal of nursing studies, vol. 51, no. 5, pp. 717-725. Wake, W.T. 2010, â€Å"Pressure ulcers: what clinicians need to know†, The Permanente journal, vol. 14, no. 2, pp. 56-60.

Criminal Sentencing Essay

A basic question in criminal sentencing is â€Å"What are the purposes of criminal sentencing?†Ã‚   Scholars, too, reflect on the purposes of punishment. There are commonly four identified purposes: Retribution. The oldest but considered the most important purpose for sentencing is retribution, that is, inflicting on an offender suffering comparable to that caused by the offense. An act of social vengeance, retribution is grounded in a view of society as a system of moral balance.   When criminality upsets this balance, punishment exacted in comparable measure restores the moral order, as suggested in the biblical dictum â€Å"An eye for an eye.† While contemporary critics of retribution sometimes charge that this policy lacks the force to reform the offender, it still remains a strong justification for punishment. A second purpose for sentencing, deterrence amounts to the attempt to discourage criminality through punishment.   Initially, deterrence arose as the banner of reformers seeking to end what they saw as excessive punishments based on retribution.   Critics asked, â€Å"Why put someone to death for stealing if that crime could be discouraged with a prison sentence?†Ã‚   As the concept of deterrence in sentencing gained widespread acceptance, execution and physical mutilation of criminals were gradually replaced by milder forms of punishment such as imprisonment.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There are two types of deterrence, specific deterrence demonstrates to the   individual offender that crime does not pay while in general deterrence, the  punishment of one person serves as an example to others. Rehabilitation. The third purpose for sentencing, rehabilitation, involves reforming the offender to preclude subsequent offenses.   It resembles deterrence by motivating the offender to conform.   But rehabilitation emphasizes constructive improvement while deterrence and retribution make the offender suffer.   In addition, while retribution demands that the punishment fit the crime, rehabilitation focuses on the distinctive problems of each offender.   Thus identical offenses would call for similar acts of retribution but different programs of rehabilitation. Social protection. A final purpose for sentencing is social protection, or rendering an offender incapable of further offenses either temporarily through incarceration or permanently by execution. Like deterrence, social protection is a rational approach to punishment and seeks to protect society from crime.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚   The different forms of sentencing used in different jurisdictions include institutional sanctions—time to be served in prison or jail; and noninstitutional sanctions—fines and forfeiture of the proceeds of crime, and service of the sentence in the community in the form of probation or parole. Recently the arsenal of punishments has been considerably enlarged by the creation of mixed sanctions and alternatives to either institutional or noninstitutional sanctions. The following are the variety of options for sentencing: Death penalty. In thirty-six states (as well as the federal courts), courts may impose a sentence of death for any offense designated a capital crime, for example, first-degree murder. Incarceration. The defendant may be sentenced to serve a term in a local jail, state prison, or federal prison. Probation. The defendant may be sentenced to a period of probationary supervision   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   within the community. Split sentence. A judge may split the sentence between a period of incarceration and a period of probation. Restitution. An offender may be required to provide financial reimbursement to cover the cost of a victim’s losses. Community service. An offender may be required to spend a period of time performing public service work. Fine. An offender may be required to pay a certain sum of money as a penalty and/or as an alternative to or in conjunction with incarceration. This leads us to the next question, â€Å"What are some reforms that have been proposed? A recent reform growing out of the victims’ rights movement in the sentencing process is the consideration of statements by the victim, known as â€Å"victim impact statements† (VIS). Twenty-six states have mandated the use of VIS in criminal cases, while another twenty-two states have adopted so-called â€Å"victim bills of rights† that include recognition of the right of a victim to present a VIS. In the VIS, the victim provides a statement about the extent of economic, physical, or psychological harm suffered as a result of the victimization. The victim also can make a recommendation about the type of sentence an offender should receive. Usually the VIS is incorporated into the pre-sentence investigation report written by the probation officer. Research has revealed that a judge’s choice of a sentence is influenced much more by legal considerations than by victim preferences in cases where VIS has been presented (McGarrell, 1999). The third reform proposal is â€Å"restorative justice.† Restorative justice has been a feature of justice systems for a long time, though it was little used until a group of criminologists in the United States and the Commonwealth countries brought the idea back to life. The term restorative justice was virtually unknown a decade ago, and it is still in search of a commonly accepted meaning. Yet, the literature related to this subject has grown rapidly, so that we venture to define it in terms offered by Howard Zehr, published in a symposium of The Justice Professional, entitled â€Å"Criminology as Peacemaking.† Zehr provides contrasting paradigms between the traditional, retributive sense of justice and the newly emerging (or reemerging) restorative sense of justice.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   If the proposed reform of restorative justice were adopted, where would that leave us with respect to the traditional â€Å"aims† or â€Å"justifications† of criminal justice? As to retribution (or just desserts), we would still be limited to never imposing an obligation (sanction) that outweighs the harm done. As to incapacitation, even the staunchest advocates of restorative justice recognize that some offenders are far too dangerous to be returned to the community and that their separation from the community is necessary. But the prison population could be vastly reduced. As to resocialization or rehabilitation, the very idea is built into restorative justice, which aims at   Ã‚  restoring the community. Some of the current issues in federal sentencing according to the U.S. Sentencing Commission at https://www.ussc.gov. are the following: The issue on the amendment pertaining to offenses involving cocaine base (â€Å"crack†) and the amendment pertaining to certain criminal history rules, see 72 FR 28558 (May   21, 2007); 72 FR 51882 (September 11, 2007), should be applied retroactively to previously sentenced defendants. The issue of the Judicial Conference of the United States, the and the United States Sentencing Commission has decided to establish a standing victim’s advisory group pursuant to   28 U.S.C.  § 995 and Rule 5.4 of the Commission’s Rules of Practice and Procedure. It was stated that the purpose of the advisory group is (1) to assist the Commission in carrying out its statutory responsibilities under 28 U.S.C.  § 994(o); (2) to provide the Commission its views on the Commission’s activities as they relate to victims of crime; (3) to   disseminate information regarding sentencing issues to organizations represented by the   Ã‚  advisory group and to other victims of crime and victims advocacy groups, as appropriate; and (4) to perform any other functions related to victims of crime as the Commission requests. The victims’ advisory group will consist of not more than 9 members, each of whom may serve not more than two consecutive 3-year terms. The issue on New York’s Rockefeller laws to curb the drug trade – which directly contributed to a dramatic increase in the state’s prison population costing the state millions of dollars, but failing to impact drug trafficking. According to a New York   Times editorial, â€Å"New York has made incremental changes to the Rockefeller laws in recent years, but has stopped short of restoring judicial discretion.† A governor-appointed commission charged with studying state sentencing practices, however, has produced a report calling for the end of â€Å"indeterminate sentencing† – the process by which a judge imposes a minimum and a maximum sentence and the Parole Board decides when to release an offender. It further suggests that nonviolent offenders be considered for community-based treatment instead of prison. Finally, Gov. Elliot Spitzer’s commission recommends restoring prison-based educational and training programs as a means of helping to lower recidivism rates. The website of the Sentencing Project at http://www.sentencingproject.org. mission is to promote reforms in sentencing law and practice, and alternatives to incarceration through their advocacy and research. Moreover, the Sentencing Project provides defense lawyers with sentencing advocacy training and to reduce the reliance on incarceration. Hence, the Sentencing Project has become the leader in the effort to bring national attention to disturbing trends and inequities in the criminal justice system with a successful formula that includes the publication of groundbreaking research, aggressive media campaigns and strategic advocacy for policy reform. As a result of The Sentencing Project’s research, publications and advocacy, many people know that this country is the world’s leader in incarceration, that one in three young black men is under control of the criminal justice system, that five million Americans can’t vote because of felony convictions, and that thousands of women and children have lost welfare, education and housing benefits as the result of convictions for minor drug offenses.   Thus, the Sentencing Project is dedicated to changing the way Americans think about crime and punishment which coincide with the interests of the National Association of Sentencing Advocates. References   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   McGarrell, E.F. Restorative Justice Conferences.   Indianapolis, IN: Hudson Institute, 1999; Edmund F. McGarrell, â€Å"Cutting Crime through Police-Citizen Cooperation,† American Outlook, Spring 1998, pp. 65–67. The Sentencing Project at http://www.sentencingproject.org. U.S. Sentencing Commission Available at https://www.ussc.gov. Zehr, H.   Ã¢â‚¬Å"Justice as Restoration, Justice as Respect,†The Justice Professional 11,   Ã‚  Ã‚   nos. 1–2 (1998), pp. 71–87.

National Health Service in the United Kingdom Essay

The National Health Service (NHS) was formed in the UK on July 5 1949. Its formation was part of the nationalization drive that epitomized post World War II UK which witnessed the establishment of the welfare state and the drive towards production of goods and services for public use instead of profit for private investors and owners. (Yergin and Stanislaw, 1998)[1] Thus reflecting the political economic philosophy of the time, the establishment of a free for all health delivery system within a country outside the Eastern socialist/communist block of nations was quite extraordinary as other systems of health care in most western economies had adopted the insurance system – i.e. pay for health care when healthy and use the care when ill.   Prior to the nationalization of health care under the NHS, health care providers like voluntary hospitals, municipal hospitals (that also provided mental health services), entrepreneurial cottage hospitals and specialist hospitals were already in existence. Local authorities also had departments responsible for health care services like midwifery and child welfare and also had authority to provide health care under the Poor Law. The NHS thus did not commence on a clean slate as these already existing health care establishments were inherited under the NHS. Also, health care for workers was covered under the Lloyd George’s National Insurance Act of 1911, though this did not extend to the families of workers. (Rivett, 1998)[2] Though the role of the general practitioner (GP) had been envisaged as crucial in providing non-specialised primary health care covering areas and activities like home visits and attending to patients in GP surgeries, prenatal and antenatal care, child welfare, venereal diseases, and industrial medicine, the reality of pre-NHS health care in the UK was very far from the realization of these ideals. According to Rivett (n.d.) the NHS in the UK was founded on the following principles: â€Å"The service was financed almost 100% from central taxation.   The rich therefore paid more than the poor for comparable benefits †¦ Everyone was eligible for care, even people temporarily resident or visiting the country.   Anybody could be referred to any hospital, local or more distant. Care was entirely free at the point of use, although prescription charges and dental charges were subsequently introduced Organisation was based upon 14 Regional Hospital Boards that funded and oversaw local hospital management committees.   The teaching hospitals were directly responsible to the Ministry of Health for they served the nation, not the locality.†[3] The NHS has three main interacting parties who have diverse stakes, responsibilities, and expectations in the running of the health service – those who need health care, the skilled personnel who deliver health care, and those responsible for raising money and ensuring that the money is spent properly on the NHS. (Rivett 1998)[4] Undoubtedly, the formation of the NHS has had an immense impact on health care delivery in the UK. For instance, life expectancy for females has risen from 71 years in the pre-NHS era to 80 years under the NHS. Life expectancy for males has also risen from 66 years in the pre-NHS era to 75 years under the NHS. Infant mortality rate (i.e. babies under 1 year old) has decreased from 34 per thousand to six per thousand. (Secretary of State for Health, 2000)[5] In spite of the altruistic principles upon which the NHS was founded, it has faced significant challenges of which finance is perhaps one of the most paramount. Rosenberg (1987) has for instance argued that the â€Å"implementation of developments has often been slower in the UK than in other countries. Partly this has been due to innate conservatism, but mainly it has been the result of financial restrictions.†[6] The former prime minister of the UK, Tony Blair, summarized the problems faced by the NHS as follows: â€Å"†¦ the NHS retains, in its essential values, huge public support. But over twenty years, it has struggled. Its funding has not kept pace with the healthcare systems of comparable countries. Its systems of working are often little changed from the time it was founded, when in the meantime virtually every other service we can think of has changed fundamentally. So urgent was the need for extra money for the NHS that many of the failures of the system were masked or considered secondary.†[7] Despite the apparent inability of the public purse to fund a free for all health delivery system under the NHS, government policy in the UK is firmly set against any form of payment of healthcare by workers as done in other western countries like France and Germany. Leaving healthcare in the hands of the market as in the United States has also been decidedly kicked against. (Secretary of State for Health, 2000) The UK government’s stance may be seen more as a decision of political expediency rather than an economic one, as the issue of free healthcare is a highly charged political debate that is top on the agenda not only of the ruling Labor government but also of the opposition Conservative Party. (BBC News 2004) On both sides of the political divide, it is highly improbable that privatisation of healthcare would be an option. Consequently, the future of the NHS, it appears, would not be based on the recommendations of health professionals and administrators, but rather the manifestos of political parties.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Though inadequate public funding has been the pivotal problem faced by the NHS, it is bedevilled with other problems that affect the ability of the system to deliver a proper service for the demands of the 21st century.   One such problem is the waiting times for care in accident and emergencies (A&E), GP surgery appointments and operations. In 2000, it was expected that by 2005 patients would have a maximum of 48 hours waiting time for a GP appointment, three months maximum for an outpatients appointment, six months maximum for an operation and the halving of A&E waiting times. (Secretary of State for Health, 2000) By 2007 however, these targets were far from a reality. A 2004 survey found that patients in England and Scotland had to wait for up to eight months for a cataract operation, eleven months for a hip operation, twelve months for a knee replacement, five months to repair a slipped disc, and five months for a hernia repair. (BBC News, 2004) Injection of more funds in health care in the NHS has been viewed by some health care professionals as inadequate to solve the problems of waiting times. A senior surgeon in the NHS is reported to have said that: â€Å"The government is increasing capacity by investing money but I’m concerned as a surgeon that the arrangements are not in the patient’s best interest. The individual patient may get their operation done quicker by the NHS funding treatment in the private sector but it will be with a different surgeon from the one they saw in the clinic.†[8] Though by December 2007, there had been significant reductions in the waiting times for inpatient and outpatient appointments, the problem delays in the NHS continues to persist. For example, 91.3% of patients in England waited for under 13 weeks for an inpatient appointment and 8.3% waited for over 13 weeks for an inpatient appointment. Also, 95.6% of patients waited for under 8 weeks for an outpatients appointment by December 2007. (Department of Health, 2008)[9] Evidently, lack of requisite skilled health workers has had an immense impact on the problems of long waiting times in the NHS. Funding the NHS from the public purse however presents problems of recruitment as remuneration has not been enticing enough for health care professionals and for potential training of needed skilled professionals from the communities. As stated earlier, the nationalization drive in post World War II UK precipitated the establishment of the NHS. Thus, centralized administration at the national level is a typical hallmark of the NHS. Over centralization has been identified as one of the major problems facing the management of the 21st century NHS. (Secretary of State for Health, 2000) Administration of a health service built for the population and health needs of the mid-20th century UK is still used for the needs of a country that has witnessed seismic growth in its population and especially in the size of its immigrant populations. Consequently, the organizational growth and modernization of the NHS has not kept pace with both population growth and modern organizational and administrative principles. The NHS today could be seen as a colossal, amorphous entity that that seriously needs a structural overhaul. The Secretary of State for Health (2000) also identifies the following as problematic within the current constitution of the NHS – â€Å"a lack of national standards†, â€Å"old-fashioned demarcations between staff and barriers between services† and â€Å"a lack of clear incentives and levers to improve performance†. (p.10) Thus the need overhaul the organizational structure of the NHS should affect the staff incentives and performance levels and effective communication and networking between the different health services within the NHS. Bibliography and References: BBC News, May 27 2004. ‘NHS Waiting Time Underestimated’. Retrieved February 14 2008 from http://news.bbc.co.uk/2/hi/health/3749801.stm Department of Health. February 1 2008, ‘Statistical Press Notice: NHS Inpatient and Outpatient Waiting Times Figures’. Government News Network, Retrieved February 14 2008 from http://www.gnn.gov.uk/environment/fullDetail.asp?ReleaseID=349539&NewsAreaID=2&NavigatedFromDepartment=True Rivett, G. (1998). From Cradle to Grave: Fifty Years of the NHS. London: King’s Fund Publishing Rivett, Geoffrey (n.d.) ‘National Health Service History’ http://www.nhshistory.net/shorthistory.htm Secretary of State for Health (2000). The NHS Plan: A Plan for Investment, A Plan for Reform. London: HMSO (Cm 4818-I) Rosenberg, C. (1987) The Care of Strangers: The Rise of America’s Hospital System. New York: Basic Books Timmins, N. (1995) The Five Giants: A Biography of the Welfare State. London: HarperCollins Yergin, D. and Stanislaw, J. (1998) The Commanding Heights: The Battle for the World’s Economy. New York: Touchstone [1] Yergin, D. and Stanislaw, J. (1998) The Commanding Heights: The Battle for the World’s Economy. New York: Touchstone [2] Rivett, G. (1998). From Cradle to Grave: Fifty Years of the NHS. London: King’s Fund Publishing [3] Rivett, G. (n.d.) ‘National Health Service History’. Retrieved February 14 2008 from http://www.nhshistory.net/shorthistory.htm [4] Rivett, G. (1998). From Cradle to Grave: Fifty Years of the NHS. London: King’s Fund Publishing [5] Secretary of State for Health (2000). The NHS Plan: A Plan for Investment, A Plan for Reform. London: HMSO (Cm 4818-I) [6] Rosenberg, C. (1987) The Care of Strangers: The Rise of America’s Hospital System. New York: Basic Books, p.7. [7] Secretary of State for Health (2000) op cit p.8 [8] BBC News, May 27 2004. ‘NHS Waiting Time Underestimated’. Retrieved February 14 2008 from http://news.bbc.co.uk/2/hi/health/3749801.stm [9] Department of Health. February 1 2008, ‘Statistical Press Notice: NHS Inpatient and Outpatient Waiting Times Figures’. Government News Network, Retrieved February 14 2008 from http://www.gnn.gov.uk/environment/fullDetail.asp?ReleaseID=349539&NewsAreaID=2&NavigatedFromDepartment=True

Music and Color which ones positively affect men and women, which ones Essay

Music and Color which ones positively affect men and women, which ones negatively affect them - Essay Example However, there are currently no books on this topic, and educators and parents are often forced to rely on news reports and websites that sometimes present the information in a biased and sketchy fashion. As a result, there is a great deal of confusion about the benefits of music listening and instruction. Music has been touted to cure backache, asthma, obesity, writer’s block, alcoholism, schizophrenia, prejudice, heart disease, drug addiction, headaches, and AIDS. Claims have been made that music makes bread rise better and improves the taste of beer. In Florida it’s now the law that all childcare facilities receiving state aid include at least half an hour of music exposure every day. The governors of both Tennessee and Georgia give newborns in their states classical music CDs. An Indiana obstetrician even markets a device that administers music in-utero. Clearly, most of these claims are unsubstantiated, despite the (usually) good intentions of their supporters. Unf ortunately, the exaggerated claims that have often accompanied the research have caused some academicians to be skeptical of any research suggesting the benefits of music. Although music is important in its own right, a book that systematically reviews what is known about the power of music to influence non-musical domains is necessary for scientists and laypeople alike’.(Sabattical , 2 ) ‘Color conveys meanings in two primary ways - natural associations and psychological symbolism. No, it’s not mind control. The truth of the matter is that people are comfortable when colors remind them of similar things. For example, a soft shade of blue triggers associations with the sky and a psychological sense of calm. Successful design requires an awareness of how and why colors communicate meaning. The source of these meanings can be quite conspicuous, such as those found in nature — red is the color of blazing fire

The interaction of individual agency Essay Example | Topics and Well Written Essays - 750 words

The interaction of individual agency - Essay Example The structure of tennis (tournaments) consists of the four Grand Slam tournaments — the Australian Open, the French Open, the US open And the Wimbledon, and the Davis Cup (for men) and the Fed Cup (women). (University of Texas: Introduction to Tennis - website) The Agencies in the game of tennis are the governing bodies, the clubs and educational institutions where tennis is encouraged and played and also advertising sponsors and media, which have a marked influence on the fortunes of the game. The individuals involved in the game are the players, the coaches, the members of administrative bodies that govern the game, its patrons, the persons in decision-making positions in educational institutions, companies that sponsor the game and in the media; and most important of all — the individuals that comprise the audience. How is the role of a tennis coach affected by the interactions among its various agencies, and those between the agencies and the overall structure of th e game? I propose to look at the question mainly from my own experience as a tennis coach for the past fourteen years, and shall also refer to the findings of a research study done for the Scottish Sports Council (Lyle, Allison & Taylor 1997) Individuals are attracted to coaching to prolong an involvement with the game and to help others —mostly younger persons — and to a limited extent, the top performers in the game (those who coach top performers are less in number.) Wanting to put something back into the sport motivates many to become coaches. Although in most sports financial reward is not a motivating factor for taking up coaching, in tennis this reason seems to be of greater importance, with 38% of the respondents stating this.

Significance of effective leadership within the 21st century business Assignment

Significance of effective leadership within the 21st century business context - Assignment Example Significance of effective leadership within the 21st century business context It is in this context that various challenges and shortcomings are witnessed in relation to the strategies developed for effective organizational management which further requires greater degree of rationality among the leaders. An illustration of a practical scenario shall be quite helpful to describe the significance and criticality of effective leadership within the 21st century business context. With this concern, this discussion will intend to describe, analyze and subsequently understand the effectiveness of leadership in Ford Motor Company. Notably, the company had to witness serious obstacles recently before the occurrence of 2008 economic crisis when the strategies implemented by the Corporate Executive Officer (CEO) Mr. Alan Mulally proved to be quite helpful in redirecting the organization towards a healthier growth. However, the current situation is also not without any challenges for the company which indicates towards the necessity to reconsider the business strategies practiced by the company. Ford is renowned as one of the leading brands in the international automotive industry which is engaged with manufacturing and distributing a wide range of automobiles and accessories. Ford is universally well-known having its manufacturing and distributing branches located all over the world. There are currently altogether nearly 90 manufacturing and distributing plants located in globally. ... Ford also relates with the financial services industry being associated with rendering loan and vehicle insurance facilities to its customers worldwide. Working in such versatile environment, Ford was able to successfully secure a leadership position within the global automotive industry obtaining sustainable profits over the years. However, it had to witness severe crisis situation during the early decade of the 21st century, incurring a record debt in its history depicting a position of financial instability and limited sustainability. Contextually, to rule the market once again and to regain its sustainability, Ford had to overcome number of challenges over the recent decades. In order to overcome such a crisis situation, Ford had to consider drastic changes in its operations being largely focused on its consumer needs and wants. It was during this period, that the organization witnessed a leadership change, where the then newly recruited Corporate Executive Officer (CEO) Mr. Alan Mulally implemented drastic financial and managerial strategies which ultimately assisted the organization to recover from the situation. This particular scenario can be regarded as quite illustrative too reflect upon the significance of organizational leadership to secure competitiveness, sustainability and growth of the company in today’s 21st century context (Hitt, Ireland & Hoskisson, 2009). Being a global and hugely diversified organization, Ford has a large number of primary stakeholders which include customers, suppliers, dealers, employees’ communities and investors or shareholders. Ford has been significantly focused on its brand recognition and reputation amid its stakeholders. For instance, the

State and local week 3 Essay Example | Topics and Well Written Essays - 250 words

State and local week 3 - Essay Example As well, as limits the age contribution of up to 25 dollars. Chapter 55 section 7A elaborates further on the individual’s contribution to candidates, as well as penalties and event expenditure controls. The state offers partial financing to the matching grants program. The state also set electronic disclosures requirements for the candidate and committees of all contributions. Regulation of the campaign financing is an area where the state could consider putting the requirements for donor disclosure. Additionally, change the very public financing for campaigns is paramount. Having a preliminary vote for approval of a party or candidate, for example, enroll 5% of the state members to the party can also help. The state could also drop the campaign finance. It could also eliminate or review disclosure exemptions for donations as it will help detect fraudulent schemes. Reforming the federal elections commission will also serve to change the

The Cherokee People Research Paper Example | Topics and Well Written Essays - 1500 words

The Cherokee People - Research Paper Example Although a great deal of emphasis has been placed upon the interaction between Europeans and Native Americans, the reality of the fact is that rather than approaching this issue from the split standpoint of understanding that two separate entities existed at each and every juncture, a far more effective means of interpretation has to do with the melding of culture and the means through which unique dynamics in the Cherokee experience came to be evidenced as a result of the process of acculturation. Firstly, it must be understood that the geographic representation of the Cherokee people was mainly concentric within the now modern states of Georgia, South Carolina, North Carolina, and Tennessee. As a function of this level of geographic representation, the Cherokee people have oftentimes been referred to as those who lived in the mountains by contemporary Indian tribes. Interestingly, whereas many other Native American tribes were defined as nomadic, the Cherokee people could be define d as â€Å"semi-nomadic† (Emerald, 2012, p. 44). This is due primarily to the fact that individual branches of the tribe tended to inhabit specific regions, and cultivate crops. These crops included but were not limited to squash, beans, sunflowers, and different types of corn. So great was the emphasis upon agriculture that the Cherokee put forward that the introduction of a specific hybrid of corn was developed as a result of their agricultural endeavors. To specific theories exist with regards to the ultimate origin of the Cherokee tribe. Due to the fact that the Cherokees native-language was determined by linguists and anthropologists as uniquely Iroquoian, the most prominent theory suggests that the Cherokee tribe migrated from the Great Lakes region approximately 500 to 700 years prior to first contact with the Europeans (Chambers, 2013, p. 26). The ultimate purpose for this migration is little known; however, myths and legends exist with regards to the fact that other Iroquois nations banished this particular group of individuals from the Great Lakes regions. The subsequent removal and forced exodus led this tribe to inhabit a region that few other native peoples wanted; namely the Appalachian mountain range. A secondary theory that exists with regards the origin of the Cherokee people posits the belief that this particular tribe of Native Americans was an offshoot of the mound building Native Americans that inhabited parts of Mississippi. However, further ethnological and anthropological work, as well as a great deal of archaeological analysis has revealed the fact that this particular theory does not have a high level of evidence to support it. Moreover, the secondary theory promotes an understanding that the Cherokee people had been living within the region of the southeastern states for a period of over 1000 years; a fact that no direct archaeological evidence that is thus far been uncovered and/or analyzed denotes (Blackburn, 2013, p. 16). T he first contact with Europeans was with an expedition led by Hernando De Soto. As such, like so many of the contacts initially made with Europeans, relations were friendly and ultimately somewhat profitable to both sides (Greg & Wishart, 2012, p. 11). The Native Americans received traded goods in exchange for raw material, guidance, and

Character and Setting in Emma Essay Example | Topics and Well Written Essays - 1000 words

Character and Setting in Emma - Essay Example Jane Austin’s novel concentrates on human relationship revolving around the main character Emma and the importance of Highbury setting to the characterization of the Heroine. Relationship between Emma and Harriet With the witty and charming heroin Emma, Jane Austen’s work was flawless with exploration of human relationship. The major subject of Jane Austen’s Emma revolves around the natural power of human relationship. Austen in this novel compares the healthy and unhealthy relationship between Emma and Harriet. The relationship between Emma and Harriet was an epitome of unhealthy relationship where the teacher Emma exploited, manipulated and neglected her student Harriet. Emma took Harriet under her wings and wanted to teach how to adjust with her choices of acquaintances. Emma was more concerned about her own desires rather being concerned about what would be best for Harriet. Chapter seven of the novel lays special reinforcement to the relationship between Emm a and Harriet Smith. Harriet depend upon the decision and suggestion of Emma whether to marry or reject Robert Martin. Though she had some opinion and decisions of her own but could not go by them since Emma’s opinion was more important. This shows how much important role Emma plays in the life of Harriet. They had friendship but between unequal. When Emma advised her to reject Robert Martin, Harriet was disappointed and said â€Å"You think I ought to refuse him, then† (Austen, 44) but did not have the courage to go against Emma’s decision. This clearly reveals that Harriet was totally dependent on Emma’s decision and trusted her blindly. ... Elton developed theme like reason versus thoughts, social responsibility versus selfishness and arrogance. Settings The Novel of Jane Austin, Emma has its setting in a provincial community, which involved the gentry of the region. She chose a small tiny town named Highbury where everybody knew everything about anyone staying over there. This revealed that everyone was aware of the peculiarities and odd habits of each individual in the town. One was unaware of the local’s geography. The closeness of the town Highbury to its estates â€Å"Hartfield, Donwell Abbey and Randalls† were clearly revealed in the novel as the fact that London was sixteen miles away. However the description of the physical aspects of the town was not given except that of the Donwell, which was given with a purpose to portray Emma’s reaction. The presence of â€Å"Richmond road† can be felt from the description that Harriet met the gypsies on the Richmond Road but no other details wer e found. The presence of an embankment over where the companions scuttles was also derived from the description. Emma and Mr. Woodhouse’s house was the geographical center around which the whole novel revolved. The drawing room or something equivalent was the primary setting of the novel. The scene of Box Hill or even the shrubbery walk where George proposed Emma was simply an open-air drawing room. The novel mainly concentrated on the social involvement and human relations. It did not give any clear description of the vegetation or terrain or any connection that leads to the description of the geography of the place. Instead the novel had an evident presence of the description of drawing and dining rooms, rooms for dancing and scenes of carriage and equipment of

How do changing approaches to geography affect the knowlege produced Essay

How do changing approaches to geography affect the knowlege produced about development in the global south over time - Essay Example observed that while some of the countries or the land areas have attained much higher degree of knowledge, many of the areas are still in the dark and just have commenced to get the light of the modern education system. The area that is broadly classified as the ‘Global South’ had been under prolonged ‘darkness’ with regards to education and knowledge. The citizens of the area were never treated at par with their counterparts of the other parts of the world, till recently. The development of the global south has been basically characterized by the globalization and the modernization. It has been because of globalization, the citizens of those backward areas could get the ray of hope as it had all the attributes of being huge market. The way the Chinese firms entered into the Nigerian textile industry is a perfect example of such effects of globalization. Without much advantages of the modern knowledge, Nigeria turned out to be the dumping ground of the inferior quality Chinese goods which ultimately destroyed the indigenous industry of the land (Akinrinade & Ogen, 2008). Though such acts of globalization had certain de-merits for those nations but with time the light of knowledge could be accessed in those backward countries too. The various types of knowledge used in those economies of Global South include ontology and epistemology. Ontology is that branch of philosophy that studies the reality along with categories of being and their relations. Epistemology, on the other hand, is a much broader term and provides due emphasis on the different facets of acquired knowledge. The epistemology, as the experts suggest, is also a branch of philosophy that takes in to purview the various features, scopes and limitations of the knowledge. The four basic attributes of the epistemology include the definition of knowledge, the way of acquiring such knowledge, knowledge of the people and the certainty of knowing what people know (Encyclopedia of Philosophy,

Business and Society Research Paper Example | Topics and Well Written Essays - 1000 words

Business and Society - Research Paper Example From then on, strategies should be developed in order to incorporate their participation in forming a coalition which can divine special assistance to the company in its entirety. Stakeholder analysis is particularly important because of the increasing interconnectivity nature of the world. Not one corporation is fully in monopoly of one particular business because there are many other entities involved, all with their own interests and motives. In order to be successful as CEO, it is imperative to be able to identify the key stakeholders and take advantage of the scenario. Stakeholders have varying interests which are dependent on their roles and relationship to the company. In identifying these roles, only then can a better understanding be founded on how to best manage them. There are two kinds of stakeholders; the primary and the secondary stakeholders. By definition, the primary stakeholders, also known as the market stakeholders, are the ones directly benefitting and/or affected by the performance of the corporation or a particular business activity (Akpinar, p. 52). These may include customers, employees, stockholders, creditors, suppliers, and basically anyone with financial and functional interest to the operation or business situation. The secondary stakeholders, who are also referred as non-market stakeholders, are individuals or groups which are not directly affected by the results or consequences of the company but still hold interest to the corporation. Such as these are the money-lending institutions, government agencies, the media, competitors, or even the general public. Secondary stakeholders are also important not only since they can also be primary stakeholders, too, but also because they influence the empowerment or the limitation of the capacity of the operations of the corporation. Like dominos, many individuals, groups, and other organizations are affected and involved with the actions of a company. Problems facing the

Diversity in America Essay Example for Free

Diversity in America Essay In an ideal world, humanity would understand that all mankind is created equally; that the underlying truth of each of us is goodness, and that through awareness, conscious choice and the willingness to create positive change, we could live in a world where diversity is celebrated. We would leave behind the substantial racist and oppressing patterns that exits in this world, specifically in the United States of America. It is said that the U. S. is a melting pot of cultures, and that we are a country of immigrants existing together as a new culture, living under the values of a democracy based on freedom, liberty and the pursuit of happiness. Yet this policy is completely disregarding the fact that as immigrants, we brutally committed genocide to the Native Americans. The dominant race in the U. S. A. is made up of white Euro-centric people, and looking at the patterns that exist in this culture is important to examine the history, the ways in which racism is alive and how and who is affected. We all must look at how, as an individual and within a community, we can work towards positive change, healing and understanding. As a society, we have committed and perpetuated the oppression of different cultures specifically the Native Americans, the Native Africans and the many immigrants from different countries. In the early history of the U. S. government, it is clear that there was a systematic method that aimed to remove the Native Americans from the land that was desired by the colonists, with the malicious intention to commit genocide. The first example of the patterns of racism that were established is seen in the fabrication of stereotypes onto the Native Americans. It was said that the Natives were â€Å"barbarians† and that they would rape and murder women and children and that they â€Å"served the devil† (Tataki, 1993, p. 41). The whites held the belief that the Natives were occupying land that the colonists felt entitled to. â€Å"White people also justified the genocide by saying that Native Americans died from diseases they were biologically unable to resist† (Kivel, 2002, p.126). It is a known fact that smallpox were given to the Natives as a way to kill them. Multiple examples exist throughout the history of the whites murdering, raping and unjustly exploiting almost every aspect of the Native’s culture. After committing such horrendous violations we are left with the inability to change all that has occurred and a great sadness that produces guilt, blame and anger that often stagnates a healing process and increases denial and avoidance. The Native American population has almost completely been destroyed. â€Å"At the time Columbus arrived in the West Indies there were approximately fifteen million indigenous people†¦ today†¦ the population of native Americans in the United States is around three million according to U. S. government census figures† (Kivel, 2002, p. 124) and the remaining Natives in America are mostly confined to reservations. This small fraction of designated land is no longer their original sacred land but it is being raped for natural resources. White settlers not only committed genocide but they also enslaved the Native Americans. This pattern of entitlement and abuse was continued with the legal capturing and enslavement of people of African decent with as much violence and oppression. The history of slavery in the United States that occurred through 1619 to 1865 began soon after the English colonists first settled in Virginia and lasted until the passage of the thirteenth Amendment to the U. S. Constitution. â€Å"Over the next twenty five years Virginia passed a series of laws that legalized slavery, producing a radically subordinate and stigmatized class below that of all whites† (Kivel, 2002, p.130). Although technically slavery was abolished in1865, a linage of abuse and inhumane treatment was installed and has been carried into this day and age providing a challenge to accept and comprehend the past. In an attempt in understanding black oppression, there are aspects that demonstrate this injustice. They are institutional racism, racist knowledge and power relations that are played out in our culture and in no way have anything to do biology. Individuals and societies have created and used race as a means to oppress and overpower other groups of people. Racial oppression is when a group of people dominates another for their own benefit disregarding justice and respect through the use of violence and defining and discriminating racial differences. This dominant group receives various benefits although in the larger picture all sides loose for the continuation of a pattern of pain and injustice is insured through these actions. African-Americans are a case of this racial oppression. They were turned into slaves because of the color of their skin. It is shocking that it did not start this way and that through the power of the U. S.government slavery laws were passed that enabled the white masters to turn the blacks into slaves. This is an example of the institutional racism used to enslave the blacks. Because of this occurrence, we, as a society, must break down the residual stereotypes that have instilled fear, pain and disconnection between the races, and to change the model that exists even at this point in time. Another example of racism in the U. S. is seen in the treatment of immigrants. This subject is personal, for on my father’s side of my family I am part of the first generation born in American. My father’s parents immigrated to the U. S. , to escape the holocaust and I am sure shared the dreams of the majority of different immigrants who traveled to the â€Å"land of opportunity,† escaping places of war and economic devastation to begin and pursue a new and better life. Through the duration of attending a class studying the diversity in America I have gained painful yet poignant knowledge of the racism that is still perpetrated upon immigrants, specifically on Jewish people. I have recently learned that groups of neo-Nazis congregate and commit acts of violence against Jewish people and immigrating races. This is terrifying to me and feels unacceptable while we live under a constitution that allows personal expression but does not permit such distinct racist and violent behavior. I am grateful and saddened that because I was raised in a protected and privileged community I have rarely experienced oppression and hateful discrimination when it so readily exists in our culture. In the past few months I find myself cycling through heartbreak, anger and disbelief of the injustice that has and still occurs, and then to a yearning for healing and equality for all. I remain in a space of wonderment, questioning the fact that although laws have been installed to prevent the acts of racism, fear, ignorance and violence is bubbling hot under the surface of our society, and we are a long way from a complete shift in humanity that I crave. I do believe there is hope. I believe that in gaining the truth of the past and diminishing ignorance of the harm that was and still is being done we open a door that may aid in the battles that are still being fought. Although the brutality of racism is alive, the potential to fight for the rights of all the people who live upon this American soil is possible, but the truth of the history and the attainment of awareness must be brought to fruition. Reference List Kivel, Paul, (2002). Uprooting racism: How White People Can Work For Racial Justice. Gabriola Island, BC VOR 1X0, Canada: New Society Publishers. Takaki, Ronald, (1993). A Different Mirror: A History of Multicultural America. New York, NY: Time Warner Book Group.

Concept Of Service Quality in Call Centre Industry

Concept Of Service Quality in Call Centre Industry This chapter of dissertation consists of literature review, which is collected from several journals, articles and books. I have divided it into two parts. First part defines the concept of service quality, its importance and then will exemplify how different researchers have measured service quality by dividing it into different dimensions. This part further reviews role of call centers, how call centers are managed and what role call center employees play in delivering quality services. Second part of literature review considers theories from literature such as, Total quality management (TQM), six sigma, investor in People (IIP) and Continuous Performance Improvement, in order to measure quality management system of call centers. 1.2 Service Quality: According to Berry et al.(1988 cited in Amy and Amrik, 2003) service quality has become a significant differentiator and the most powerful competitive weapon which many leading service organizations possess. Further cronin and taylor, (1992 cited in Agens K,Y law, 2003) state that by improving service quality, service providing firm can differentiate itself from its rival firms and thus occupy strong positioning in the relevant market.. Lee et al. (2003) said, now days leading service firms consider service quality as the most sustainable basis for: Differentiation ( Zeithaml and Bitner, 1996); Leveraging customer satisfaction and value (parasuraman, 1997); Driving market share and profitability (Buzzel and Gale, 1987); and Developing strategy (gronroos, 2000). Service quality can be defined as the perceived judgment, which customer develop by comparing their expectation about services with the services they actually perceived to receive ( Gronroos, 1984 cited in Amy and Amrik , 2003). Bolton and Drew (1991a) and Parasuraman at el.(1988a) argued that although evaluation of service quality will help customers to form an attitude towards service provider, customer satisfaction is not obvious and satisfaction level is based on how well the delivered service meet customers expectation.(cited in Agnes K.Y, 2002). Service quality is dependent on two variables perceived services: service customer actually receives form organization and expected services: which comes from the customers previous experience or overall perception of the service( Gronroose, 1984cited in amy amirk, 2003) When expected service is higher than perceived service, service is said to be of low quality and when service expected is less than perceived service, overall service quality is considered to be high. Quality is s subjective concept and it is difficult for the customer to evaluate service quality than product quality (Parasuraman et al., 1985). Author further suggests that there are three main features of services: intangibility, Heterogeneity and Inseparability, which construct service quality an elusive and abstract concept. There are five main determinants that customer consider to evaluate service quality such as reliability, responsiveness, empathy, tangible and assurance. Customers perception and evaluation of quality can be different due to different needs and wants, it could be satisfactory for one customer while other may experience it in different way (Venetis and Ghauri, 2004) 1.2.1 Importance of service quality: In todays highly competitive business world- where customers needs and wants are highly influenced by global competition and where customer has large number of firms to satisfy their needs, organizations are forced to change their focus from profit maximization to maximize profit through customer satisfaction( nithin seth and S G deshmukh, 2004). Author further state that subject of service quality is of great importance; because it has strong impact on business performance, lower costs, profitability, customer satisfaction and customer loyalty. In other words service quality is the main driver of firms marketing and financial performance. An extensive research from services marketing, services management and organizational psychology has proved that an improved service quality can help organization in attracting, satisfying and retaining customers( Heskett et al., 1997; Schneider et al., 1998 cited in Alison M Dean, 2002). Firms that fail to provide quality services not only loose their customers to its competitors but it also resulted as declining of profit and finally firms withdraw from competition. In service marketing, terms service quality and customer satisfaction are used interchangeably. Rust and Oliver, (1994) said service quality is the one dimension on which customer satisfaction is based. In fact service quality is considered as antecedent to satisfaction (Agens K.y ). According to Iacobucci et al., (1995) Service quality is concerned with the firms service delivery, while satisfaction is the post consumption experience which reflects customers overall experience and perception with firms service (cited in Eugene sivadas,2000). Zeithaml at el. (1996, cited in Eugene sivadas, 2000) suggest that customers relationship with the firm is strengthened, when that customer has favourable attitude towards a firms service quality and relationship is weakened when customers attitude represent his dissatisfaction with firms services quality. He further argued that positive attitude towards firms service quality will lead customer to develop favourable behavioural intentions such as preferring company over its competitors, making repurchases and recommending firms service and product to others. According to Agens K.Y(), loyalty comes from customers repurchase behaviour. It is satisfaction with the services that construct brand loyalty and encourages customer for repeat purchases. Zeithaml,(1996, cited in Amy wong) suggests that loyalty is the main determinant that service organization are using to measure their long term success and by maintaining superior service quality, firms are retaining and expanding their loyal customer base. Johnston, (1995 cited in amy wong) further argued that firms service quality has strong impact on customer loyalty, therefore in order to measure, control, and improve service quality from customer perspective, management should identify what factors of service quality influence customer loyalty. Customers loyalty is important for firms profitability, as loyal customers are ready to pay premium price (Gronroose, 2000). Similar to satisfaction, loyalty is also comes from high service quality. Customer satisfaction is often viewed as mediator that link service quality with service loyalty (Agens.K.Y). 1.2.2 Measures and dimensions of service quality: Today, whether it is developed country or developing country their economic conditions are largely influenced by globalisation and liberalization. Due to rapid change in needs and wants, firms are forced to develop constant standards for measuring the quality of services offering. Measuring service quality on regular basis will help firm to evaluate and analyse the needs and requirements of customers. These measures will also facilitate firm to provide services quality that encounters customer expectations, by improving both aspect of service quality: WHAT (technical quality) service should be delivered and HOW (functional quality) service should be delivered. In order to measure service quality numerous researchers have suggested different models. GI, DU Kang, (2006) said, many of scholars agreed that service quality is based on multiple dimensions (Gronroos, 1982, 1990; Parasuraman et al., 1985), but there is no consensus on the exact nature and content of these dimensions (Brady and cronin, 2001). Lehtinen and Lehtinen, (1982) has given three dimensions of service quality. Physical quality- tangible aspect of services, Corporate quality- companys image by its current and potential customers and Interactive quality- two way interaction between customer and service provider. By ignoring physical features of product in the consumption of services, Gronoose (1982, cited in GI-DU Kang, 2006) decomposed service quality into two dimensions: Technical quality- what service is provided. Function quality- how service is provided. Technical (outcome) quality is concerned with what customer actually receives from service. Functional (process) quality is concerned with how the outcome of the process is delivered to the customer such as speed of service and behaviour of customer service staff. Gronoose model of service quality also recognises that customers perceived quality is largely influenced by the firms image customer already have in his mind. Gronroose further suggest that when customers evaluate expected services with the services experienced they bring their prior experiences and overall perception of service firm. Parasuraman et al., (1985), also considered service quality into two dimensions: outcome and process quality and state that evaluation of service quality can not be made solely on outcomes of services, it should also evaluate service delivery process( GI-DU Kang, 2006/). He further argued that these two dimensions (process and outcome quality) are Interco related therefore it is necessary to consider that when evaluation occurs. In case of process quality: evaluation of service occurs while it is being delivered; however in outcome quality, evaluation takes place after the delivery of service. Swart and brown (1989), by considering established work on the dimensions of service quality identified by gronroose(1982), lenthin(1982) and parasuramn(1985), suggested two dimensions of service quality: WHAT ( evaluation of service after its performance) and HOW( service evaluation during performance). Rust and Oliver, (1994) proposed three-component model of service quality, which evaluates customers perception of service quality by considering three dimensions: Customer-employee interaction (functional or process quality); The service environment; and The outcome (technical quality) Although there is no generalized model of measuring service quality, GAP model of (parasuraman et al., 1985) has received adequate support from the researchers of various field ( nitin seth and desh much, 2006). In 1988 this model was then proposed as SERVQUAL. Parasuraman et al. (1988) state that: The SERVQUAL provides a basic skeleton through its expectations/perceptions format encompassing statements for each of the five service quality dimensions. The skeleton, when necessary, can be adapted or supplemented to fit the characteristics or specific research needs of a particular organization. He further suggests that SERVQUAL is valid and reliable tool that service provider can use to understand the customers expectations and perceptions about service quality and thus improve services. The SERVQUAL is multiple item scale that consists of 22 statements which measures customer expectations and perceptions along five dimensions: Tangible, Responsiveness, Assurance, Empathy and Reliability. SERVQUAL instrument is the original formulation of parasuraman et al., (1985,1988,1994) which measured service quality by undertaking extensive investigation in four service areas: Bank, credit card company, long distance telephone company and a firm offering appliance repair and maintenance services. From exploratory investigation of 1985, parasuraman et al., conclude that there are ten main determinates which customer consider when evaluating service quality: Reliability: Responsiveness Competence Access Courtesy Communication Credibility Security Understanding the customer Tangible In later study of 1988, Parasuraman et al., found that some of determinates are correlated, therefore he refined the list of dimensions and presented five high order dimensions which subsume previous ten( Amy wong). Parsuraman et al., (1988) defined these dimensions as follows: Reliability: ability to deliver or perform the promised services dependably and accurately. Responsiveness: willingness to help customers and provide prompt services. Assurance: it is concerned with the knowledge and courtesy of employees and their ability to inspire trust and confidence. Empathy: caring and paying individualized attentions/services to each customer. Tangible: physical features of service as appearance of equipments, facilities, personnel and communication material. SERVAQUAL is conceptual model, which is based on the view that customers perception of service quality is the result of gap between expectations and perceptions ( parasuarman et al., 1985,1988 cited in Patrick). Parasuraman et al., (1985) developed Gap model of service quality to identify where gap exist and to what extent: GAP 1: Gap between customers expectations and managements perceptions about those expectations. GAP 2: Gap between customers expected standards and specifications of service and managements perceptions of customers expected service standards.( specification gap) GAP 3: Gap between service quality standards and actual service delivered to customer. (Service performance/delivery gap) GAP 4: Gap between actual service delivered and service quality organization promised to deliver. (Communication gap) GAP 5: Gap between customers expected and perceived services.( perception gap) Parasuramne et al.,( cited in dr Arash) state that gaps in service quality can help firm to identify the areas where performance is lacking. Author further state, a negative service gap would facilitate firms to prioritise the performance improvement of those service features where expectations are high. If any of service gaps is turning positive, indicating that expectations are exceeding the perceptions, firm can review service feature, which they are oversupplying and can, redeploys resources into those features, which are performing below the expectations. Gap five (Perception gap) given in the above model is main driver behind SERVQUAL methodology. Although SERVQUAL model has been widely used in service industry, it has received criticisms from many authors on both theoretical and operational grounds. Francis buttle,(1996) has criticised SERVQUAL on the following basis: SERVQUAL focuses only on the service delivery process and neglects outcome quality; no adequate evidence that consumer consider expectations and perceptions gaps when assess service quality and finally five dimensions of SERVQUAL are not universally accepted. Besides huge criticism, Parasuraman et al., (1991,1994) argued that SERVQUAL is the most valid tool for measuring service quality than any other method because it uses expectation/perception gaps and with little modification, SERVQUAL can be use across business services. 1.2 Role Of Call Centre. Intensive global competition and increased emphasis on customer satisfaction has enhanced the role of call centres in service industry. Today call centre is the main source that links the organization with its customers. Call centre, by serving high volume of customers at low cost and within less time span, has become the integral part of firms marketing and customer service strategies (olukemi O sawyer,2009). David Holman (2002) state that rapid growth of call centres in service industry is attributable to its capability of reducing the cost of existing functions; provide new means of generating revenues and improving customer service quality. According to Taylor and Bain (1999) call centre: is a dedicated operation in which computer utilising employees receive inbound, or make outbound, telephone calls, with those calls processed and controlled either by an Automatic call distribution(ACD) or predictive calling system. Taylor and Bain (1999 cited in Alison M. Dean, 2002) has further described call centre in three essential parts: first the call centre is dedicated operation where employees are focused entirely on customer service function, second those employees are using phones and computers simultaneously and third the calls are processed and controlled by an automatic distribution system. Environment of call centre is very complex in nature, as it requires smooth blend of technology, human talent and process in order to work efficiently. Like other business, work in call centre also involves interaction with the customers, yet it is unique in its features. Houlihan (2001) contend that Call centres by using modern technologies facilitate management to determine the speed and volume of work. Hutchinson et al., (2000) further suggests that this system will also help firm to improve employees performance by monitoring their work on regular basis. In Call centre employees are acting as representative of the firms services. Olukemi O. Sawyerr,(2009) state that it is a positive interaction between customers and call centre employees that helps firm to determine customers perception of firms services. Today call centres serve both business as well consumer clients and are accountable to perform various business functions such as taking order, handling client inquiries, resolving complaints, dispatching, telemarketing, pre-sale and post-sale services (Alan miciak, 2001). Besides rapid growth, call centre are embraced with the challenges of retaining and attracting employees. Lack of trained staff, high workload and high level of stress are main attributes of call centre environment, which foster high turn over (Olukemi O. Sawyerr, 2009). Recruitment of staff of the wrong personality type is also the endemic reason of high turn over in call centre industry (Barnes 2001, p. 3) Taylor and Bain, (1998) has resembled the working environment of call centre with the assembly line production. Call centre environment rarely encouraged team working among employees as performance of employees is measured on the basis of individual interaction with the customers (olukemi O sawyer ( 2009) . Varca (2001) further argued that, in call centre employees have less control over a job, as information delivered by employees to customers is previously scripted and interaction take place between them is not face to face 1.3 Call centre management: Complex nature of call centre environment poses great challenge for managers to control the operations of call centre. In call centre managers responsibility is two fold. In one hand they are responsible to take capital-intensive decisions and introduce latest technology to cope up with the technological development; on the other hand they are responsible for handling call centre employees who work on shift pattern (George Robinson, 2006). Call centre operations are equipped with advanced technological features such as ACD, ANI (automatic number identification) and DNIS (number identification service). ACD (Automatic call distribution) controls inbound calls traffic; place these calls in queue and then transferred them to call centre agents according to priorities. Moreover ANI and DNIS technology provide comprehensive database of customers and call handling statistics (Paul R. Prabhaker,) By using above technologies, managers can track: number of calls answered per agent, average speed to answer call, number of calls abandoned and time taken to abandon, occupancy rate of agent, number of calls answered within standard time frame, calls waiting longest in queue, agents sitting idle, agents on calls and agents on breaks or completing post call wrap up work (George Robinson, 2006). This information enables manager to set targets for call centre agents and achieve desired results. In call centre management, technology plays crucial role as it not only helps to determine the speed of work but at the same time it provides the means to measure quality of work and worker performance (Callaghan and Thompson, 2001). According to Bain et al., (2002), call centre management requires both hard and soft measures; hard measures includes number of calls answered, while soft measures consist of relationship between call centre employees and customers. Audrey Gilmore (2001) has described tangible and intangible dimensions of service quality offered by call centres employees. Tangible aspects are easy to measure and consist of number of calls answered, length of calls, average calls time and standardized response, while intangible dimensions are difficult to measure and include courtesy or empathy customer experiences from call centre service. Author further states that call centre management often consider tangible dimensions of service delivery to judge the employees performance that result employee frustration and stress. Retaining and attracting call centre employee having high performance calibre is the significant challenge in call centre management. It has been proved by research studies that selection criteria developed for hiring call centre staff is at the minimal attention of management. When hiring call centre staff, it is imperative for management to consider personality traits of the employees in order to make sure that they will be high performer and can deliver quality services in stressful environment (Olukemi O. Sawyerr, 2009). Author has presented FFM (five factor model) that illustrate the relationship between five dimensions of personality (conscientiousness, agreeableness, emotional stability, extraversion, and, openness to new experience) and performance of call centre employees. Performance could be service performance, turn over intension or absenteeism. It is often viewed that management of call centre is measuring what is easy to measure rather than what is important to measure (Call Centre Management, 2000, p. 5). Alan Miciak, (2001) state that firms are more interested in measuring customer satisfaction with the product and service offered by business rather than customer satisfaction with call centre performance. Author further argued that to assess call centre performance, manger often utilizes measures as: average talk time; abandon rates; calls per hour and occupancy rate that are based on telephone technology and may not be true indicators of performance measurement. Australian Council of Trade Unions (2002, p.30) claims that measurements used by call centre to evaluate performance are highly focused on productivity rather than quality. Research work of various author presented above has placed emphasis on soft than hard measures; tangible than intangible dimensions; quantitative than qualitative measures for evaluating call centre performance. These measures can only monitor and control efficiency of call centre in handling high number of calls, while measuring quality of service delivered by call centre agents is far away from these measures. 1.4 Role of call centre employees: What the business thinks it produces is not of first importance; what the customer thinks he is buying and considers value is decisive; it determines what a business is (Drucker, 1989). Customer satisfaction which usually comes at the cost of high service quality, is essential for organization success as it provides firm, profitable means to differentiate it self from others. Service quality is an important factor that, if delivered efficiently by firms front line employees, can be main driver of firms sustainability (Carlzon, 1987). In call centre, employees play very essential role in delivering high customer quality and thus facilitate management to establish large customer relationship base (Frenkel et al., 1998). Call centre employees are also recognized as front line employees, customer contact representative (CCR) or customer sales representative (CSR) as they are directly engaged in the process of service delivery and maintain high level of interaction with the customers. Service organizations are now developing high number of measures, for reducing employee turn over as well as improving employee satisfaction. Robinson and Morley (2006) state that high turn over bring significant cost impact for both firms and shareholders. This cost includes direct cost of recruiting, inducting and training new staff and indirect cost that comes in form of reduced customer service. Employee satisfaction is crucial for evaluating service quality from customer perceptions. Satisfied employees are highly motivated, perform job with efficiency, delivering high level of quality services (Prabha Ramseook-Munhurrun, 2009). Edvardsson et al., (1997) further suggest that employee satisfaction can reduce employee turn over, improve productivity and enhance commitment and creativity. Call centres are now being criticized for their inadequate staff management practices. Research on service environment has concluded that some times call centre environment itself restricts the ability of employees to deliver high quality customer services. In call centre employees are called emotional labour and are forced to achieve productivity goal while delivering quality customer services (Alison M. Dean, 2009). Audrey Gilmore (2001), state that call centre employees are under a continuous pressure of answering high number of calls as their performance is measured by how quickly they respond to customers inquiry rather than quality of the call. MacDonald, (1998a, 1998b) further argue that excessive emphasis on quantitative rather than qualitative measures for judging employees performance is the main cause of employee unproductive behaviour. 1.6 Quality Management System: Reevs and Bednar (1994) have defined the term quality as an excellence, value, conformity to specification, meeting customer expectation etc. Excellence in service industry involves providing customers a desired satisfied service by knowing the demands of the customers at first instance. Value involves gaining higher profit margins by maintaining quality as priority, which attracts customers to become the part of the system. Conformity to specification and meeting customer expectations involves developing such a system, which guarantee error-free operations and delivering the desired and satisfied operation output. A product is always valuable and acceptable if the quality standards set by customers are lined up with the product and this can be done by quality management system. Establishment of the quality management system in an organisation provides a priority control over the organisations activities with continues improvement in its performance. Quality management system are mainly implemented for enhancement of the organisations work force and its abilities in providing the product and services according to the customers expectations as well as optimising the resources in terms of value for money (VFM). According to (Dean and Bowen, 1994; Prajogo and McDermott, 2005; Sousa and Voss, 2002à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦.infrastracture) quality management system provides key assurance in achieving the goals and objectives of an organization listed in its policy and strategy. Quality management system provides reliability, diligence and satisfaction in terms of process, procedures, equipment, etc and interacts with all other activities starting from customers perceptions to customers expectation for satisfying their requirement. The term quality control and quality assurance are often mixed up in line discussion of quality management system but these two terms are exceptionally different in meaning. The word quality control is more over related to product and services which identifies the satisfactory of end result, where as quality assurance is process-oriented which identifies whether the process that was carried out is applicable to meet desired objective. 1.6.1 Quality control: Quality control is a commitment to quality; usually stressed more in organization to ensure that examination of quality is applicable to specified standards and can the current system follows the planned actions. Quality control not only includes material and process but also all those elements, which begins from raw material/service introduction to finished goods. 1.6.2 Quality Assurance: According to (James R. and William M. 1996) Quality assurance is the assurance of total efforts involved in planning, organizing, directing and controlling quality in production system with the objective of providing the consumer with product of appropriate quality. Quality assurance is a systematic approach to pursuit the quality (Collins, 1994) and it approaches through quality assurances of product/services that determines whether the expected demands of the customers are satisfied according to their expectation. Usually organizations follows innovations and value added techniques to their plans and strategies in order to implement such system, which must outfit to the customers satisfaction. According to (Moreno-Lonzo and Peris, 1998) purpose of quality assurance is the conformance of the product, service and process with given requirement and standards. 1.6.3 Costs of Quality According to (Norman .G and Greg .F 1999) all those costs, which are lined up for managing quality, customer satisfaction, market share, profit enhancement can be identified as quality costs. Quality cost can be source to the identification of the opportunities and creating funding priorities for quality improvement through Pareto analysis. Further more (Dale H. Basterfield 1994) stated that Pareto analysis focuses on the quality problematic areas and once the quality issues are being resolved then it measures the effectiveness of the actions taken against quality issues. Following are the components to the cost of quality. Design Costs Appraisal Costs Internal Failure Costs External Failure Costs 1.6.3.1 Design Costs: Design costs are those costs, which are specially designed to prevent the error, which leads to poor quality. Maintaining quality system and providing customers a desired service involves dealing with high prevention cost, which includes dealing with quality planning cost, maintaining process control cost, developing human skills by training cost etc. 1.6.3.2 Appraisal Costs: All those costs which are attached in assuring the quality of products or services, are known as appraisal costs. Purchasing appraisal cost, operation appraisal cost, miscellaneous costs are the examples of the appraisal costs. 1.6.3.3 Internal Failure cost: Before to deliver the product or service to the customer, the product is passed through various operation where quality is inspected many times, so at anytime if the quality is not proved to be satisfactory then the unfinished product or service is being used as scrapped item or in some case the product is again sent through the earlier process until product claims to be in desired quality. All those costs that are involved maintaining the product quality internally are headed under the internal failure cost this may includes product or service design failure costs, purchasing failure costs, operation failure costs etc. 1.6.3.4 External Failure Costs: External Failure costs are often considered as high cost of quality management. When the product or services are ready to be delivered to the customers there are often some uncertainties attached that might includes customer found defects or product was unsatisfactory to the customer expectations, so all those cost which are incurred to correct the product or services can be headed as external failure cost. The real life example includes Toyotas Lexus safety recall 2010. 1.7 Total Quality Management: Total qual

Impact of Parental Incarceration on Children

Impact of Parental Incarceration on Children Parental Incarceration and Children’s Educational Performance Murray et al. (2012b) reviewed samples of the Pittsburgh Youth Study; a longitudinal survey of 1009 inner city boys up to 18 years, to investigate any links between parental incarceration and children’s poor academic performance. They also accounted for type of parental incarceration, the age of the child and the parent’s level of antisocial behaviour. This study is important because it prospectively investigated child outcomes from before to after parental incarceration as well as social environments, which few studies have done. Findings indicated that parental incarceration was associated with increases in delinquency but it did not predict poor academic performance, even after controlling for other childhood risk factors (Murray et al. 2012b). The reason that parental incarceration had no effect on educational performance is argued to point towards resilience among affected children. Murray et al. (2012b) did specify however, that effects sizes for poor academic att ainment and parental incarceration may be different for short term studies. Cho (2009) investigated children whose mothers were incarcerated in state prison compared with children whose mothers were incarcerated in a county jail for 1 week or less (control group) to see the effect of parental incarceration on grade retention rates. Her study was also valid because where possible she minimised selection bias using propensity scores to match control and experimental groups of children (race, gender, age at mothers incarceration and at child outcome and length of incarceration). Cho’s findings indicated that children whose mothers were incarcerated in a state prison facility had lower grade retention rates in the year prior to, during, and immediately after their mother’s incarceration than the comparison group. Surprisingly these findings reveal that parental incarceration may be beneficial for short-term children’s academic outcomes. Also, findings reveal that factors that pre-exist parental incarceration are worth investigating as they t oo may have an impact on children’s outcomes. Another US study by Hagan Foster (2012) that focussed on paternal incarceration revealed that it led to disrupted families unable to monitor school attendance and nurture levels of children’s school performance. Thus the absence of incarcerated fathers can predict educational failure in children. The reason for this may be increased stress for the remaining caregiver thus affecting the quality of supervision and help with academic life (Vacha McLaughlin, 1992 cited in Hagan Foster, 2012). Hagan and Foster’s (2012) results further indicate high levels of paternal incarceration block access to education achievement. On the other hand, Dallaire et al. (2010), informed by ecological systems theory, carried out a qualitative study where they randomly assigned scenarios to teachers describing a female student whose mother was imprisoned. They also examined teachers experiences of these childrens emotional and behavioural adjustment in the classroom. Focus was on maternal incarceration because they believed that it was a greater risk for children than paternal incarceration. They found that the teachers in their experimental treatment group rated these students as less competent than teachers in a control group in which the child’s mother was described as being away for other reasons such as military deployment. Their findings are important to consider because they argue that no empirical research has examined the experiences of children with incarcerated parents in the school setting or with their teachers. More research is required because children of incarcerated parents have poor education al performance and are stigmatised as revealed by Dallaire et al. (2010) study. Other findings revealed that the quality of the care giving situation and the stability of care were the greatest risks to childrens academic achievement cited by these teachers. Teachers also suggested that they felt younger children suffered more and that maternal incarceration had a greater impact than paternal incarceration because of the roles mothers play. Teachers also noted that they had witnessed some teachers stigmatising these children by expecting less from them and that it would be a bad idea to include information about the parents incarceration in the childs permanent record because of possible mishandling of the information. Findings by Dallaire et al. 2010 therefore suggest that it is stigma effects and labelling processes at hand that predict poor educational performance in children rather than the parental incarceration itself. Therefore, environmental factors play a part in how well c hildren of incarcerated parents do in schools. Parental Incarceration and Children’s Mental Health Parental incarceration might cause mental health problems due to the separation involved, limited contact opportunities, and inadequate explanations given to children and the challenges faced by alternate caregivers (Murray et al. 2014). Children of incarcerated mothers have also been found to exhibit symptoms of posttraumatic stress disorder, depression, and long-term trauma (Cho, 2010). Foster Hagan (2013) looked at maternal and paternal incarceration separately as potential sources of traumatic stress for children during the transition of their children to adulthood. They found that childhood maternal imprisonment increased depressive symptoms compared to not having this experience. Results indicate a gendered vulnerability of male children to maternal imprisonment in adolescence (ages 13–18) that results in uniquely high levels of young adult depressive symptoms. Findings suggest males may be vulnerable to both maternal and paternal imprisonment occurring in adolescence. They also further find that race and ethnic minority youth are more likely to be affected by paternal incarceration. Findings also suggest that both paternal and maternal imprisonment experienced during childhood (ages 0–18) and it is therefore influential on child mental health problems Tasca et al. (2014) argue that little is known regarding variation in the presence or absence of mental health problems within a group of children of incarcerated parents. Their aim was to fill this void in this body of work by comparing incarcerated mothers’ and fathers’ reports of mental health problems among their children. In an effort to advance work on the needs of children of incarcerated parents, they assess whether incarcerated mothers are more likely than incarcerated fathers to report that their children are experiencing mental health problems. Their study contributes to the literature in that it covers most races allowing for a diverse analysis along multiple demographic dimensions. Tasca et al. (2014) findings suggest that incarcerated mothers reported 15.5% of their children were in need of services for mental health problems, compared with only 6.1% of incarcerated fathers’ children. Among paternal incarceration cases, the majority of children were Latino/Latina, whereas the majority of children in maternal incarceration cases were White. While controlling for child age, race/ethnicity, and gender, incarcerated mothers, compared with incarcerated fathers, reported that their children were 2.368 times more likely to have mental health problems. Race/ethnicity (Latino/Latinas) and gender (girls) were negatively related to mental health problems. On the other hand, child’s age was positively related to mental health problems. Regardless of type of parental incarceration, however, the risks posed to these children of prisoners are significant and substantial. Tasca et al. (2014) study highlights that children of incarcerated parents are not a homogenous group. Murray et al. (2012) study results include data samples on general mental disorders, internalizing problems and educational performance from reports by children, teachers, parents, of children’s academic performance. They used results from studies that had sta ndardised test scores to see if parental imprisonment is a risk or causal factor for negative outcomes for children. For poor mental health, effects across all showed almost zero association with parental incarceration. On the other hand, Swisher Roettger’s (2012) results showed that paternal incarceration during childhood is associated with higher depression scores. Surprisingly, white male youths suffered more than black male youths. For blacks and Hispanics there was no significant difference found.