50 Words with the Most Whimsical Prefix

50 Words with the Most Whimsical Prefix 50 Words with the Most Whimsical Prefix 50 Words with the Most Whimsical Prefix By Mark Nichol The prefix be- has a variety of interesting roles in language: Causation The prefix is affixed to a verb to indicate a causative agent, as in belittle, meaning â€Å"to diminish by criticism or mockery.† Creation Become and begin, and the archaic-sounding beget, are words starting with the prefix that indicate something coming to be; the prefix also appears in words expressing the near opposite, such as behead. Intensification It’s one thing to be dazzled by a luminous object, but a reference to being bedazzled implies a higher order of enchantment. Position Be- indicates relative placement, as in below or between. Its addition to a word transforms nouns and adjectives into verbs, as in besiege and beware (â€Å"be aware†). It also changes intransitive verbs (those that do not take an object) into transitive ones, as with becalm. The simple act of attaching these two letters to an existing word enhances English by providing us with terms that entertain us with their vivid imagery. Here are some more or less obscure be- words and their definitions: becloud: to obscure or muddle bedaub: to excessively ornament or anoint bedazzle: to enchant bedeck: to fancily clothe or decorate bedevil: to annoy bedew: to moisten bedight: to equip or adorn bedim: to obscure, or to reduce light bedizen: to adorn or dress in a tacky manner bedraggle: to drench befit: to be appropriate for befool: to delude or trick begrime: to make dirty begrudge: to give reluctantly beguile: to seduce behoove: to be appropriate bejewel: to adorn with jewelry belabor: to emphasize unnecessarily belaud: to fulsomely praise belay: to stop or hold off from beleaguer: to trouble or bother belie: to falsely imply, to reveal something as false, or to contradict bemire: to expose to or engulf in mud bemock: to ridicule benight: overcome by literal or figurative darkness benumb: to deprive of sensation bepuzzle: to confuse bequeath: to leave an inheritance (the noun form is bequest) bereave: to deprive (one so treated is bereft) beseech: to beg (the past tense is besought) beseem: to be fitting or suitable beset: to attack, harass, or surround besmear: to stain or obscure, or to defame besmirch: see besmear besort: to fit or become (also a noun meaning â€Å"appropriate associate†) besot: to infatuate or muddle besoul: to endow with a soul bespatter: to splash bespeak: to claim, request, address, or identify besprinkle: to scatter or disperse bestir: to rouse bestow: to put to use or in place, or to convey a gift bestrew: see besprinkle betake: to commit, or cause to act bethink: to recall, or to cause to consider betroth: to promise to marry, or to give in marriage bewhisker: to provide with whiskers (or, as bewhiskered, to have whiskers) bewhore: to corrupt sexually, or to characterize as a whore bewig: to place a wig on bewray: to betray Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:Definitely use "the" or "a"35 Genres and Other Varieties of FictionCaptain vs. Master

An Explanation of Chain Migration

An Explanation of Chain Migration Chain migration has several meanings, so its  often misused and misunderstood. It can refer to the tendency of immigrants to follow those of a similar ethnic and cultural heritage to communities theyve established in their new homeland. For example, its not unusual to find Chinese immigrants settling in Northern California or Mexican immigrants settling in South Texas because their ethnic conclaves have been well-established in these areas for decades. Reasons for Chain Migration   Immigrants tend to gravitate to places where they feel comfortable. Those places often are  home to previous generations who share the same culture and nationality.   The History of Family Reunification in the U.S. More recently,  the term chain migration has become a pejorative description for immigrant family reunification and serial migration.  Comprehensive immigration reform  includes a pathway to citizenship that critics of the chain migration argument often use as a reason to deny unauthorized immigrants legalization. The issue has been at the center of U.S. political debate since the 2016 presidential campaign and throughout the early part of Donald Trumps presidency. The U.S. policy of family reunification began in 1965 when 74 percent of all new immigrants were brought into the U.S. on family reunification visas. They included unmarried adult children of U.S. citizens (20 percent), spouses and unmarried children of permanent resident aliens (20 percent), married children of U.S. citizens (10 percent), and brothers and sisters of U.S. citizens over age 21 (24 percent). The government also increased family-based visa approvals for Haitians after a devastating earthquake in that country in 2010. Critics of these family reunification decisions call them examples of chain migration. Pros and Cons   Cuban immigrants have been some of the prime beneficiaries of family reunification over the years, helping to create their large exile community in South Florida. The Obama administration renewed the Cuban Family Reunification Parole Program in 2010, allowing 30,000 Cuban immigrants into the country the previous year. Overall, hundreds of thousands of Cubans have entered the U.S. through reunification since the 1960s. Opponents of reform efforts often are  opposed to family-based immigration as well. The United States allows its citizens to petition for legal status for their immediate relatives- spouses, minor children,  and parents- without numerical limitations. U.S. citizens also can  petition for other family members with some quota and numerical restrictions, including unmarried adult sons and daughters, married sons and daughters, brothers, and sisters. Opponents of family-based immigration argue that it has caused migration to the U.S. to skyrocket. They say it encourages overstaying visas and manipulating the system, and that it allows too many poor and unskilled people into the country. What the Research Says   Research- especially that performed by the Pew Hispanic Center- refutes these claims. In fact, studies have shown that family-based immigration has encouraged stability. It has promoted playing by the rules and financial independence. The government caps the number of family members who can immigrate each year, keeping the levels of immigration in check. Immigrants with strong family ties and stable homes do better in their adopted countries  and theyre generally a better bet to become successful Americans than immigrants who are on their own.

Muscular and Skeletal system Worksheet Assignment

Muscular and Skeletal system Worksheet - Assignment Example 4. How does the saying â€Å"use it or lose it† apply to muscles? What type of exercise is the best way to improve muscle strength? Muscle size? In your answer, be sure to explain how the different types of exercise work to increase strength or size! The saying â€Å"use it or lose it† applies to muscles in the sense that muscles grow because of usage and working out. The lack of these activities brings about atrophy to muscles and their core neuro-pathways. The best type of exercise for improving muscle strength is resistance exercise while weightlifting improves muscle size. Resistance training develop muscle mass that causes one to revel in sturdier bones, an increased metabolism, and improved glucose management. Weightlifting enables one to regulate the quantity of weight that one lifts, target specific muscles, determine direction, rate, and scope of motion of every lift accurately. All muscles cross a joint to allow the movement of body parts. The attachment points of muscle to bone allow bone-to-bone connections through the muscles origins and insertion points. The origin point of a muscle connects a stationary bone to a more flexible one at the insertion

Boutique Designers Essay Example | Topics and Well Written Essays - 1250 words

Boutique Designers - Essay Example "Charles Eames was the first architect to be totally at home with technology. He used technology with an artist's flair", particularly, he with wife Ray Eames 'developed a new method to bend plywood into complex curves over three geometric lanes" (Dezine Holdings Ltd). From 1900-1909, the name Charless Rennie Mackintosh, Josef Hoffman and Frank Lloyd Wright have surfaced with the introduction of Ingram Chair, Hill House Chair and Willow Chair (Dezine Holdings Ltd). In the middle of the century, notable designers like "Eameses, Gio Ponti, Harry Bertoia, Arne Jaconsen and Eero Saarinen led the way in the modernist organic style" as the public went for "warmer and softer furnitures, organic forms, warmer products like timber and upholstered chairs" (Dezine Holdings Ltd). In the 70's to 80's, industrialization has brought forth changes in designers' thoughts. Particularly, "the industrial style or Hi Tech movement developed" and there were great advances in "office furniture and equipment" (Dezine Holdings Ltd). At the closing of the century, the designers pursued "meaning and purpose for their furniture designs" with the exploration of some strange and unusual forms such as the W.W Stool by Phillip Starck (Dezine Holdings Ltd). Karim Rashid is one of the sought-after and bankable interior designers of the modern generation. A half English and half Egyptian, Karim Rashid "was born into an art family" with his father an abstract painter, his brother Hany Rashid "a computer-based organic architecture" and his sister a musician (http://www.rashidglobal.net). It was his father that them art and design (http://www.rashidglobal.net). Rashid, therefore has a strong art influence. "Karim Rashid pursued graduate design studies in Naples, Italy, with ettore sottsass and others, then moved to Milan for one year at the Rodolfo Bonetto studio" (Designboom). He went solo in 1993 and opened his design practice in New York. It is in New York where he designs products for companies such as namb, issey miyake, pure design, fasem, guzzini, tommy hilfiger, sony, zanotta, citibank, and others" (Designboom). Rashid's works were highly praised by Design Awards Bodies. In 2007, he won the title for the Cooper Hewitt National Design Awards Product Design Finalist, "in 2006 with an Honorary Doctorate from the Ontario College of Art and Design, in 2005 with an Honorary Doctorate from Corcoran College, the Sleep05 European Hotel Design Award, and the 2005 Pratt Legends Award. Karim has also won the prestigious I.D. Magazine Annual Design Review, Red Dot Design Award, and Chicago Athaneum Good Design Award numerous times throughout his career" (http://www.rashidglobal.net). Because of his modern and innovative designs, he holds an associate professorial position and is a "frequent guest lecturer at universities and conferences" on industrial design (http://www.rashidglobal.net). Concepts and Works Rashid boasts of "over 3000 designs in production, over 300 awards and working in over 35 countries" (Karim Rashid Inc.) "Like an omnipresent vibrant spirit, he creates and utilizes a global feeling. He is an example of synchronicity in permanent movement. In him, work and person meld, inseparably subjective, manically productive and sensitive" (Karim Rashid I

Business law- policies Essay Example | Topics and Well Written Essays - 1500 words

Business law- policies - Essay Example Supervisors are required to keep an active outlook for disputes. Company policy is to avoid disputes through proactive action on the part of both employees and company management. In case a dispute arises, the concerned employee’s actions shall be investigated by the immediate supervisor. If all employees involved in a dispute belong to one section or department then the immediate supervisor shall conduct the investigation. If employees from different departments or sections are involved in a dispute then the concerned supervisors will investigate the dispute through mutual consultation. The level of dispute investigation should be raised as deemed appropriate by the investigating authority. Throughout the course of the investigation, the investigating authority must ensure confidentiality of all concerned parties. Moreover, the employees involved in the dispute must not divulge any details of the investigation to any part of the company or outside it until the investigation is not deemed complete. Failure to do so may result in the termination of employment. A thorough investigation of the dispute must be followed by measures to resolve the dispute as amicably as possible. In case that the termination of employees is deemed as the only resolution then regular termination policies shall be enforced. Moreover, the investigators must ensure that the employee agrees to his termination so that the company does not fall liable to claims of compensation by terminated employees. The final investigation report must contain measures to avoid such disputes in the future. Any recommended lines of action to avoid disputes shall be implemented by HR in no more than 6 weeks since the end of the investigation. {company name} holds exclusive rights to discharge or terminate the employment of any employee after due process requirements are met. Upon discharge or termination the concerned employee will be

Study on the use of reflection in nursing

Study on the use of reflection in nursing In recent years, reflection has undoubtedly become an important concept in nursing, stimulating debate and influencing nursing practice and education around the world. Much has been written about the theory of reflection, the majority of which has been applied to the educational setting (Price 2004). However, the process of reflecting has been described as a transferable skill which may be incorporated into clinical practice, enabling practitioners to better understand themselves and others, and solve problems (Mantzoukas Jasper 2004). Indeed, the capability to reflect consciously upon ones professional practice is generally considered important for the development of education and, hence, for clinical expertise (Mamede Schmidt 2004). Reid (1993) defines reflection as a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice (Reid 1993, p. 305). The nursing profession seems to advocate the need for nurses to be educated and practice in ways that develop their critical thinking, autonomy and sensitivity to others (Reed Ground 1997). Bulman (2004) contends that reflective practice may provide a means of achieving this. Within an intensive care setting, some evidence exists to suggest a strong relationship between lived experience and learning, with most critical care practitioners learning from previous experience (Hendricks et al 1996). More recently, reflection has been closely associated with the concepts of critical thinking and deconstruction. It is argued that a combination of these principles create a retrospective and prospective dimension, giving the practitioner the ability to deconstruct events, to reason the origins of situations, and to consider what has gone before and what may happen yet (Rolfe 2005). In order to be effective in practice there is a requirement to be purposeful and goal directed. It is suggested therefore that reflection cannot just be concerned with understanding, but must also focus on locating practice within its social structures, and on changing practice (Bolton 2001). This suggests that a structured approach to reflection is of benefit to the practitioner. Indeed the use of a model or framework of reflection is advocated as a tool which can aid and facilitate the practitioner in reflection, promoting a process of continuous development (Bulman 2004). Reflection is seen as a dynamic process and not a static one (Duke 2004), and thus the use of a framework which adopts a cyclic approach to reflective practice seems appropriate. One such framework is Gibbs (1988) Reflective Cycle, which is adapted form a framework of experiential learning, and uses a series of questions to guide, and provide structure for the practitioner when reflecting on an experience. Gibbs (1988) highlights 6 important areas of consideration when reflecting on a specific situation, encouraging the practitioner to consider what happened, why it happened and what could be done differently in the future. The 6 components of the Reflective Cycle are outlined below: Description What happened? Feelings What were you thinking and feeling? Evaluation What was good and bad about the situation? Analysis What sense can you make of the situation? Conclusion What else could you have done? Action Plan If the situation arose again, what would you do? It is clear that the idea of reflective practice has come to have a considerable impact on the nursing profession. This paper will focus on 2 clinical scenarios occurring within an intensive care setting. The issues raised will be discussed within the context of Gibbs (1988) Reflective Cycle. The aim in doing so is to highlight the benefits of a structured reflective process, and to identify ways in which clinical practice may be improved in the future. Scenario 1 Description The first scenario concerns the care of an elderly, critically ill patient, who was being treated in a surgical intensive care unit. At the time of this scenario the patient had been in intensive care for almost 3 weeks, having been admitted with respiratory failure requiring intubation, and displaying clinical symptoms consistent with sepsis. The patient had many other underlying medical problems, was morbidly obese, and despite antibiotic therapy was requiring high levels of inotropic and ventilatory support. Despite the patients symptoms, no definite source of sepsis had been identified. The above patient was being cared for by the author on a 12 hour day shift and at the morning ward round it was noted that the patients condition had deteriorated significantly over the previous 2 days, with increased inotrope dependence and worsening renal function. With few treatment options left to try, the consultant anaesthetist decided that the patient should have a CT scan to identify or rule out an abdominal problem as a source of the sepsis. The patient was reviewed by a consultant surgeon who felt that in view of the patients co-morbidity, surgery of any kind would not be appropriate, despite potential positive findings on CT. Knowing that a CT scan had been carried out 1 week previously with no significant findings, the author raised concerns about the benefit of such a procedure, and suggested that at the very least the patients family should be informed or consulted about the planned investigation. The patients son had been spoken to the previous day and informed that the prognosis was very poor. Withdrawal of treatment had been mentioned as a possibility in the event of no improvement in the patients condition. The son however was not informed about the scan which went ahead the same day. Transferring the patient to the radiology department for scan proved difficult. The patient was sedated for transfer resulting in a need for increased inotropes due to further hypotension caused by the sedation. The patients large size also created a problem in finding an appropriate transfer trolley to take the patients weight. Again the author voiced concerns, stating that perhaps transfer was inadvisable in view of the patients unstable cardiovascular status. The anaesthetist decided that we should proceed with the scan. The patient remained unstable throughout the transfer, requiring a further increase in inotropes on arrival at scan. Whilst on the CT table, the patient became dangerously hypotensive and bradycardic, and it seemed that cardiac arrest was imminent. Adrenaline boluses were administered, and large fluid boluses of gelofusine were also given. In view of this, the CT scan was abandoned midway, and the patient was quickly transferred back to ICU. Further adrenaline boluses were needed during transfer. On arrival back to ICU, the author was met by the patients son, who was not aware that the patient was being scanned. He was made aware of the patients poor condition. Back in ICU it was decided that further resuscitation was not appropriate. The son was present when the patient died a few minutes later. Feelings On the day these events took place, the predominant thoughts and feelings of the author were ones of guilt and inadequacy. Having considered the multiple health problems faced by the patient at this time, the author felt that the process of transferring the patient to CT scan and carrying out the scan itself may cause the patient stress, discomfort and potential danger, and ultimately be of little or no benefit. During the transfer and scanning process, the author became increasingly anxious about the immediate safety of the patient, and the potential for deterioration in the patients condition. When the patient became dangerously bradycardic and hypotensive, the authors thoughts were concentrated on trying to prevent cardiac arrest. On returning to ICU and meeting the patients son, it seemed that neither the dignity of the patient or the concerns of the family had been respected. The author felt an inadequacy and felt that the interests of the patient had not been properly advocated. The patient passed away in a distressing and undignified manner, and the son did not have the opportunity to spend personal time with the patient prior to this happening. The author felt guilty, as it seemed that the CT scan should not have happened and that the undignified circumstances surrounding the patients death need not have occurred. Evaluation Looking back on the events of scenario 1, it seems that there were both positive and negative aspects to the experience. During transfer to CT scan and the emergency situation which followed, the author felt that there was good teamwork between the different professionals involved in the care of the patient. Because of this, prompt action was taken, preventing cardiac arrest. However, it seems that this situation may have been avoided, which in turn raises many questions relating to the care of the patient. Ethically, one must question how appropriate it was to scan a severely septic, unstable patient, especially when corrective treatments would have been inappropriate in the event of an abnormality being discovered. Should the author have advocated the interests of the patient and family more forcefully? Was there a lack of communication and consensus between the critical care team? The events of this incident culminated in a clinical emergency situation which led to the patients death. Thus, the author feels that the patients clinical condition and the ethical issues and dilemmas surrounding the patients care must be examined and discussed, in the hope that lessons can be learned through the reflective process. Analysis Sepsis Most illness and death in patients in intensive care is caused by the consequences of sepsis and systemic inflammation. Indeed, sepsis affects 18 million people worldwide each year (Slade et al 2003), with severe sepsis remaining the highest cause of death in patients admitted to non-coronary intensive care units (Edbrooke et al 1999). Sepsis is a complex condition that results from an infectious process, and is the bodys response to infection. It involves systemic inflammatory and cellular events that result in altered circulation and coagulation, endothelial dysfunction, and impaired tissue perfusion (Kleinpell 2004). Dellinger et al (2004) define sepsis as the systemic response to infection manifested by 2 or more of the following: High or low temperature (>38 °C or Heart rate > 90 beats per minute Respiratory rate > 20 breaths per minute or PaCO2 High or low white blood cell count (> 12,000 or In severe sepsis impaired tissue perfusion along with micro vascular coagulation can lead to multiple organ system dysfunction, which is a major cause of sepsis-related mortality (Robson Newell 2005). While all organs are prone to failure in sepsis, pulmonary, cardiovascular, and renal dysfunction occur most commonly (Hotchkiss Karl 2003). When multiple organ system dysfunction occurs, Dolan (2003) promotes evidence-based sepsis treatment whereby patients should receive targeted organ support. This includes mechanical ventilation, renal replacement therapy, fluids, vasopressor or inotropic administration, and blood product administration, to maximize perfusion and oxygenation. In recent years new therapies have emerged which have been shown, in some cases, to increase the chance of survival from severe sepsis. Recombinant human activated protein C has been shown to have anti-inflammatory, anti-thrombotic and pro-fibrinolytic properties (Dolan 2003). In a randomised controlled trial, Bernard et al (2001) found a significant reduction in the mortality of septic patients who had been treated with activated protein C. The National Institute for clinical excellence (2004) now recommends this treatment for adult patients who have severe sepsis resulting in multiple organ failure, and who are being provided with optimal ICU support. Steroids, the use of which in ICU has long been debated, have also been shown, in low doses, to reduce the risk of death in some patients in septic shock (Annane 2000). Despite the development of specific treatments to interrupt or control the inflammatory and procoagulant process associated with sepsis, its management remains a major challenge in healthcare (Kleinpell 2004). The patient in scenario 1 was clearly in a state of severe sepsis, with respiratory, cardiac and renal failure, and receiving some of the supportive treatments mentioned above. Indeed it seems that the severity of this condition should not have been underestimated. In view of this, the ethical issues surrounding the decision to take this patient to CT scan must now be considered. Ethical Dilemmas and Consensus Ethical issues have emerged in recent years as a major component of health care for critically ill patients (Friedman 2001). Thus, caring for these patients in an intensive care setting necessitates that difficult ethical problems must be faced and resolved (Fisher 2004). Traditionally, much of the literature in biomedical ethics comes from theoretical perspectives that include principled ethics, caring ethics and virtue ethics (Bunch 2002). Although these perspectives provide an ethical awareness, which can be helpful, they do not of necessity give much direction for clinical practice. Melia (2001) supports this notion, suggesting that many discussions of ethical issues in health care are presented from a moral philosophical viewpoint, which as a consequence leaves out the clinical and social context in which decisions are taken and carried through. Beauchamp Childress (1994) identify 5 principles pertinent to decision making in intensive care. These are: salvageability, life preservation, non-maleficence, beneficence, and justice. Ethical dilemmas occur when two or more of the above principles come into conflict. The principles of beneficence (doing good), non-maleficence (doing no harm) and justice (fair treatment) are well established within the field of bioethics. Within a critical care context however, the dilemma between salvageability and life preservation becomes an important focus for health care professionals. Indeed, Prien Van Aken (1999) raise the question of whether all medical means to preserve life have to be employed under all circumstances, or are there situations in which we should not do everything that it is possible to do. This question becomes particularly relevant when a patients condition does not improve but rather deteriorates progressively. Curtin (2005) suggests that at some point in the course of t reatment, the line between treating a curable disease and protracting an unpreventable death can be crossed. In such incidences Prien Van Aken (1999) identify a transitional zone between the attempt to treat the patient, and the prolongation of dying, in which a conflict between the principles of life preservation and non-maleficence develops. These concepts seem particularly relevant to scenario 1 where the interests of the patient may have been neglected in favour of further attempts to treat the patients condition. This, in turn created a conflict between the principles of salvageability and life preservation. The decision to perform a CT scan on a patient with such cardiovascular instability and a very poor prognosis, meant that the patient was subjected to dangers and harms when there were few, if any benefits to justify this. Hence, the conflict between the ethical principles was not resolved, and the professional duty of non-maleficence toward the patient was not respected. Such conflicts and dilemmas in intensive care can be made all the harder by the availability of advanced technologies. Callahan (2003) writes that one of the most seductive powers of medical technology is to confuse the use of technology with a respect for the sanctity of life. In addition, Fisher (2004) contends that it has become all too easy to think that if one respects the value of life, and technology has the power to extend life, then a failure to use it is a failure to respect that value. This is particularly true of diagnostic technologies (such as CT scanning) which must be used with caution, especially in cases where the diagnostic information will make little or no difference to the treatment of the patient, but can create or heighten anxiety and discomfort for the patient (Callahan 2003). Medical technology is a two-edged sword, capable of saving and improving life but also of ending and harming life (Curtin 2005). Good critical care medicine carries the responsibility o f preserving life, on the one hand, and making possible a peaceful death, on the other. Callahan (2003) concludes by warning that any automatic bias in favour of using technology will threaten that latter possibility. Consensus between members of the intensive care team is also highlighted as an important issue in ethical decision making. Effective communication and collaboration among medical and nursing staff are essential for high quality health care (Woodrow 2000). Collaboration can be seen as working together, sharing responsibility for solving problems, and making decisions to formulate and execute plans for patient care (Gedney 2000 p.41). In intensive care units where ethical problems are faced frequently, care has to be a team effort (Fisher 2004). In a qualitative study, Melia (2001) found that there was a strong desire within the intensive care team that ethical and moral consensus should be achieved in the interests of good patient care, even though it was recognised that there is no legal requirement for nurses to agree with ICU decisions. Cobaoglu Algier (2004) however, found that the same ethical dilemma was perceived differently by medics and nurses with the differences being related to the hospitals hierarchical structure and the traditional distinctions between the two professions. Similarly, it has been observed that differences between doctors and nurses in ethical dilemmas were a function of the professional role played by each, rather than differences in ethical reasoning or moral motivation (Oberle Hughes 2001). It seems therefore that while the medical and nursing professions share the same aims for patient outcomes, the ideas surrounding how these outcomes should be achieved may differ (Fisher 2004). These differences have contributed to the development of the concept of the nurse as patient advocate, which sees advocacy as a fundamental and integral role in the caring relationship, and not simply as a single component of care (Snowball 1996). The role of the nurse advocate should be that of mediator and facilitator, negotiating between the different health and illness perspectives of patient, doctor, and other health care professionals on the patients behalf (Mallik 1998). Empirical evidence is sparse and philosophical arguments seem to predominate in the field of patient advocacy. There is some evidence to suggest that nurse advocacy has had beneficial outcomes for the patient and family in critical care areas (Washington 2001). Hewitt (2002) however found that humanistic arguments that promote advocacy as a moral imperative are compelling. Benner (1984) writes of advocacy within the context of being with a patient in such a way that acknowledges your shared humanity, which is the base of nursing as a caring practice (Benner 1984, p. 28). It has been argued that advocacy, at least in a philosophical sense, is the foundation of nursing itself and as such should be regarded as an issue of great importance by all practitioners (Snowball 1996). Conclusion It can be concluded that sepsis in a critical care environment is a complex condition with a high mortality rate, requiring highly specialised treatments. As such, the ethical issues and dilemmas faced by health care staff caring for a septic patient can be both complex and far reaching. It must be noted, that there can be no general solutions for such ethical conflicts; each clinical case must be evaluated individually with all its associated circumstances. A study of ethical principles would suggest that it is important that the benefits of a specific treatment or procedure are established prior to implementation, and that these benefits outweigh any potential harms or risks to the patient. The ultimate decision maker in the scenario under discussion was the consultant anaesthetist, who should have provided a clearer rationale for performing a CT scan on such an unstable patient. As the nurse caring for the patient, the author recognises that the final decision regarding treatment rested with the anaesthetist. However, the author could have challenged the anaesthetists decision further, advocating the patients interests, with the aim of reaching a moral consensus within the team. Perhaps then the outcome would have been more favourable for all concerned. Action Plan By reflecting on this scenario, the author has gained an understanding of sepsis and the potential ethical problems which may be encountered when caring for a septic or critically ill patient. As a result, the author feels more confident to challenge those decisions made relating to treatment, which do not seem to be in the best interest of the patient, or which have the potential to cause more harm than good. The author now has a greater understanding of the professional responsibility to advocate on a patients behalf, with the aim of safeguarding against possible dangers. It is hoped that this will result in improved outcomes for patients in the authors care. Scenario 2 Description This incident occurred in a surgical intensive care unit while the author was looking after a ventilated patient who had undergone a laparotomy and right sided hemi-colectomy 2 days previously. Around 10.30am the patient was reviewed by medical staff and was found to be awake and alert with good arterial blood gases, and requiring minimal ventilatory support. In view of this, it was decided that the patients support should be reduced further, and providing this reduction was tolerated, that the patient should be extubated later in the morning. In the intensive care unit in which the author works an intensive insulin infusion protocol is used (see Appendix A). This is a research based protocol which aims to normalize blood glucose levels and thus improve clinical outcomes for critically ill patients. All patients on this protocol require either to be absorbing enteral feed at à ¢Ã¢â‚¬ °Ã‚ ¥30ml/hr, on TPN or on 5% dextrose at 100ml/hr (Appendix A, note 2). The patient involved in this incident was receiving enteral feed via a naso-gastric tube, and was on an insulin infusion which was running at 4 U/hr. When it was decided that the patient was to be extubated, the author stopped the enteral feed as a precaution, to prevent possible aspiration during or after extubation. The author however did not stop the insulin infusion which breached the protocol guidelines. About 12 noon the patients blood gases showed that the reduction in support had been tolerated, and so the patient was extubated. Shortly after this the author was asked to go for lunch break and so passed on to a colleague that the patient had recently been extubated but was managing well on face mask oxygen. Returning from lunch 45 minutes later, the author found the patient to be disorientated and slightly confused. With good oxygen saturations, the author doubted that the confusion had resulted from hypoxia or worsening blood gases. The author then realised that the insulin infusion had not been stopped with the enteral feed earlier. A check of the patients blood glucose level showed that it was 1.2mmol/L. The author immediately stopped the insulin infusion, administered 20mls of 50% dextrose intravenously, as per protocol, and recommenced the enteral feed. Twenty minutes later, the patients blood glucose level had risen to 3.7mmol/L. The patient continued on the insulin protocol maintaining blood glucose levels within an adequate range. There were no lasting adverse effects resulting from the hypoglycaemic episode. Feelings When it was realised that the insulin infusion had not been stopped, the author felt a sense of panic, anticipating correctly that the patients blood glucose level would be dangerously low. Thoughts then became concentrated on raising the blood glucose level, to ensure that no further harm would come to the patient as a result of the authors mistake. Following the incident, when the patients glucose levels had risen, feelings of guilt were prominent. At this point the author realised how much worse the outcome could have been for the patient. The author felt incompetent, knowing that the patient could have been much more severely affected, or could even have died as the result of such a simple mistake. Evaluation The events of scenario 2 highlight the fact that clinical errors, while easily made, can have potentially disastrous consequences. This is especially true of those errors which involve the administration of drugs intravenously. In the interest of patient safety, it is important that all such errors are avoided. The clinical error outlined above could easily have been avoided. It seems that there was not sufficient awareness, on the authors part, of the insulin infusion protocol and the guidelines concerning the administration of insulin. As a result, the insulin protocol was not adhered to. The following analysis therefore will focus on the importance of insulin therapy in critical care areas, and will consider the safety issues surrounding intravenous drug administration. Analysis Blood Glucose Control in Intensive Care It is well documented that critically ill patients who require prolonged intensive care treatment are at high risk of multiple organ failure and death (Diringer 2005). Extensive research over the last decade has focused on strategies to prevent or reverse multiple organ failure, only a few of which have revealed positive results. One of these strategies is tight blood glucose control with insulin (Khoury et al 2004). It is well known that any type of acute illness or injury results in insulin resistance, glucose intolerance and hyperglycaemia, a constellation which has been termed the diabetes of stress (McCowen et al 2001). In critically ill patients, the severity of this condition has been shown to reflect the risk of death (Laird et al 2004). Much has been learned recently about the negative prognostic effects of hyperglycemia in critically ill patients. Hyperglycaemia adversely affects fluid balance, predisposition to infection, morbidity following acute cardiovascular events, and can increase the risk of renal failure, neuropathy and mortality in ICU patients (DiNardo et al 2004). Research suggests that there are distinct benefits of insulin therapy in improving clinical outcomes. Such benefits have been seen in patients following acute myocardial infarction, and in the healing of sternal wounds in patients who have had cardiac surgery (Malmberg 1997; Furnary et al 1999). More recently Van den Berghe et al (2001) conducted a large, randomized, controlled study involving adults admitted to a surgical intensive care unit who were receiving mechanical ventilation. The study demonstrated that normalisation of blood glucose levels using an intensive insulin infusion protocol improved clinical outcomes in critically ill patients. In particular, intensive insulin therapy was shown to reduce ICU mortality by 42%, and significantly reduce the incidences of septicaemia, acute renal failure, prolonged ventilatory support, and critical illness polyneuropathy. The length of stay in intensive care was also significantly shorter for patients on the protocol. It is unclear as to why improved glycaemic control has been associated with improved outcomes in several clinical settings. Coursin and Murray (2003) have summarized several leading hypotheses including maintenance of macrophage and neutrophil function, enhancement of erythropoiesis, and the direct anabolic effect of insulin on respiratory muscles. The potential anti-inflammatory effects of insulin have also been evaluated (Das 2001). There is also uncertainty over whether it is the actual insulin dose received per se, or the degree of normoglycaemia achieved that is responsible for the beneficial effects of intensive glycaemic management. Van den Berghe (2003) analysed the data derived from their 2001 study and have concluded that the degree of glycaemic control, rather the quantity of insulin administered was associated with the decrease in mortality and organ system dysfunction. In a follow up to Van den Berghe et als 2001 study, Langouche et al (2005) found that a significant part of the improved patient outcomes were explained by the effects of intensive insulin on vascular endothelium. The vascular endothelium controls vasomotor tone and micro-vascular flow, and regulates trafficking of nutrients and several biologically active molecules (Aird 2003). Langouche et al (2005) conclude that maintaining normoglycaemia with intensive insulin therapy during critical illness protects the vascular endothelium and thereby contributes to the prevention of organ failure and death. Whatever the reasons for improved patient outcomes, the study by Van den Burghe et al (2001) has prompted much research in this field, all of which has yielded similar results. In a similar study, Krinsley (2004) found that the use of an insulin protocol resulted in significantly improved glycaemic control and was associated with decreased mortality, organ dysfunction, and length of stay in the ICU in a heterogeneous population of critically ill adult patients. Thus it seems that with the strength of the emerging data in support of a more intensive approach to glycaemic management, insulin infusions are being utilised with increasing frequency, and are considered by many to be the standard of care for critically ill patients (DiNardo et al 2004). It is important to note that a well recognised risk of intensive glucose management is hypoglycaemia. Indeed Goldberg et al (2004) emphasise that in the ICU setting where patients often cannot report or respond to symptoms, the potential for hypoglycaemia is of particular concern. The events of scenario 2 highlight the authors error in the administration of insulin resulting in hypoglycaemia. For this reason some issues surrounding intravenous drug therapy will now be discussed. Intravenous Drug Therapy There is an increasing recognition that medication errors are causing a substantial global public health problem. Many of these errors result in harm to patients and increased costs to health providers (Wheeler Wheeler 2005). In the intensive care unit, patients commonly receive multiple drug therapies that are prescribed either for prophylactic indications or for treatment of established disease (Dougherty 2002). Practitioners caring for these patients find themselves in the challenging position of having to monitor these therapies, with the goal of maximizing a beneficial therapeutic response, as well as minimizing the occurrence of any adverse drug-related outcome (Cuddy 2000). The Nursing and Midwifery Council (NMC) (2004) identifies the preparation and administration of medicines as an important aspect of professional practice, stressing that it is not merely a mechanistic task performed in strict compliance with a written prescription, but rather a task that requires thought and professional judgement. Heatlie (2003) found that the introduction of new insulin protocols and regimes could give rise to problems, espe

Rhetorical Analysis Essay

Abraham Lincoln’s â€Å"Second Inaugural Address† and Emily Dickinson’s â€Å"Success is Counted Sweet,† are two inspirational pieces of art that fall under two different types of discourses. The â€Å"Second Inaugural Address,† is a great example and definition of what Rhetoric is. It encompasses all four resources of languages- argument, appeal, arrangement, and artistic devices. â€Å"Success is Counted Sweet,† doesn’t cover the four resources of language that apply to rhetoric; therefore, it is categorized as a poem. According to the chapter, â€Å"rhetoric addresses unresolved issues that do not dictate a particular outcome and in the process it engages our value commitments.† (15). We see how Lincoln’s inaugural speech tries to engage in the values of the people as he brings up the main issue that has effected the country, the Civil War. During the time of Lincoln’s â€Å"Second Inaugural Address,† he was facing a divided nation in the midst of a civil war. Lincoln built an argument within his speech with a goal set in mind: To establish a common ground or compromise between the North and the South. Lincoln only hopes to change the outcome of the nation by stating, â€Å"with high hope for the future, no prediction in regard to it is ventured.† This shows that the unresolved issue has no dictated outcome, but he can only hope for a better future for the nation. A great rhetoric calls people to action and Abraham Lincoln does so by stating, â€Å" let us strive on to finish the work we are in†¦ to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.† Through this statement, Lincoln also creates a patriotic appeal to the nation as well as a sense of loyalty to the country as a whole. Lincoln creates an emotional appeal of unity and forgiveness by speaking about â€Å"peace†, â€Å"binding up the nations wounds,† and to â€Å"care† for the nation in which the Americans live in. Abraham Lincoln’s artistic devices also make his inaugural address a perfect example of a rhetorical discourse. He uses diction by reinforcing the commonality of the divided people, the North and the South. He states how  both, the North and South, â€Å"read the same Bible and pray to the same God,† and neither the North nor South expected for the war the magnitude or the duration which it attained. Lincoln also maintains an optimistic tone throughout the speech and invokes unity with his parallel structured sentences. Emily Dickinson’s â€Å"Success is Counted Sweetest,† doesn’t cover all four resources of language. It is a poem that does not call for action but does create an emotional appeal for the people. Throughout her poem, she created an emotional appeal for success and its value and the desire and want for success. We see how she creates such emotion when she states, â€Å"The distant strains of triumph break, agonizing and clear.† What Dickinson means by this is that gaining success can be the most beautiful accomplishment but at the same time, agonizing to reach. This creates an emotional appeal for those who are living through the Civil War, making the people have a desire for peace, but they have to go through bloodshed in the process of gaining success. Emily Dickinson carries out artistic devices throughout her poem, which also creates an emotional appeal for the audience. She uses metaphors to describe success by stating, â€Å"Success is counted sweetest.† Dickinson also uses her poem to recreate what was occurring at the time of the war. She speaks of the â€Å"purple Host† which is the representation of the Army and â€Å"capturing the flag,† which is the flag of victory during the war. She also appeals to the senses by stating, â€Å"as he, defeated, dying†¦. distant strains of triumph†¦agonizing and clear.† This paints an image of those in the war struggling for success. Dickinson also uses allusion by making this poem an indirect reference to â€Å"V-Day†. Although these pieces were written around the same time, we see how one calls for the action from the nation, meanwhile the other piece just creates an emotional appeal about the Civil War. Lincoln’s attitude showed he believed in justice and had a balanced view upon the nation as a whole and wanted to make a change. He seeks compromise through his inauguration address through an argument, creating emotional appeal, by arranging the speech accordingly, and using artistic devices to make it inspiring. Emily Dickinson focuses on sending the people a message through emotional appeal. She reaches our emotions reminding us how we don’t appreciate success. She also gives us the feeling that only by failing or lacking success we will learn how important it is for the people to achieve success. Although Lincoln’s â€Å"Second Inaugural Address,† and Emily Dickinson’s â€Å"Success is counted Sweet,† are not in the same category, they are both moving and emotional pieces. They are two different works or art that will forever remind us how much of an impact the Civil War was to the United States of America.

Background of the ethical issue

The ethical issue in question involves the Walter Reed Army Medical Center scandal emanating from various allegations of appalling living conditions, and management at the medical center in Washington D. C. This is as reported by Washington Post in February 2007. Washington Post reported cases of neglect of veterans which are under investigation ever since 2004. After the case was reported, various ethical issues emerged in that the soldiers were treated un-ethically.Initial exposure of the neglect by hospital administration was reported by a series of articles beginning 18th February 2007. These articles outlined cases of neglect at Walter Reed Medical Center, as reported by wounded soldiers and their relatives. The complaints included the disengaged clerks, unqualified platoon sergeants and over-worked managers who made it difficult for the soldiers to obtain appropriate medical care at the center (Celia V, 2007).In this way, the soldiers found themselves in a medical limbo, living in building plagued by mold, peeling paint and rodents as they wait endlessly for medical appointments and government paperwork that would help them get their lives back in order (Celia V, 2007). This in effect provoked a huge coverage from the media, prompted house hearings, and caused the firing of the top brass at the medical center and the resignation of the army secretary (Celia V, 2007). Resolving the problem using the five ‘I’ format Identifying the problemFrom the report, the care and the management of the wounded men and women in uniform is under responsibility of unqualified people. Moreover, the building of the medical center is reported as rodent and cockroach-infested, poor beddings, plagued by mold, with stained carpet and with no heat and water. The care and welfare of wounded soldiers require the highest standards of excellence and treatment by those who are responsible. When this is not met, it violates the ethical principles which under laid by the U. S government as it is the sole agent for the care of the soldiers.Investigating the problem The government should ensure that the care of wounded soldiers is carried out properly and also with set criteria of restoring those injured. It is unethical to find that the soldiers once injured in duty were not given the proper medical attention they required. Further, the living conditions are at bad state. The army officials should investigate and obtain the root cause of the problem, whether it is due to lack of resources to repair the buildings, or if the center is under poor management. This can be done by sending some officers from the U.S army to evaluate the situation at the ground, as well as by conducting interview with the patients and their relatives. In this way, it is possible to come up with clear solutions to the problems affecting the army medical center. Innovating the solution From the findings of the investigations, the management should come up with resolutions geared towards elevating the problems which the medical facility is experiencing. Such solutions may include allocating resources to repair the roofing, purchase of quality beddings, re-painting the walls, and also putting new carpet.Moreover, the management should look in to the issues concerning the individuals who are responsible in running the medical facility in an effort to determine their competence, and effectiveness while executing their roles. Those found not competent enough should be sacked and replaced by more vibrant staff capable of providing quality care to the injured soldiers. Management should also think of alternatives such as residential care. This is whereby the injured soldiers could be discharged to a home care.This care would involve family members and significant others to take care of the needs of the injured soldiers. Additionally, the government should provide funds and other resources to facilitate proper care while the injured soldiers are at the residential home care. Isolating the solution From the analysis of the findings, the primary problem in this case is poor management of the army medical center. Implementing the solution The president should appoint a team from the United States Department of Veterans’ Affairs to look into the issues regarding this medical center.This team should sack all the medical management staff whom they find not competent enough, and replace with new ones. The teams should also source funds and other resources for the repair of the facility, and also purchase new equipments. Further, the team should also consider alternatives such as residential care as explained above. Evaluating the decision taken By implementing the above decision, the medical facility will be restored to its effectiveness and thereby enable it to properly take care of the injured soldiers.This is because this decision was taken out of proper criteria of handling a problem, that is, five ‘I’ format. Five ‘Ià ¢â‚¬â„¢ format helps a decision maker to critically evaluate a specific problem and come out with an informed solution. This is because it thoroughly examines all possible alternatives in an effort to come out with the best possible solution. It looks into all factors, moral, social-economical and ethical, while dealing with a particular problem. Reference Celia Viggo Wexler (2007). Walter Reed Scandal: How Mainstream Media Let Us Down. Washington Post.

Free Essays on My Worst Experience In Life

The worse experience of my life is when I was in San Diego at my apartment. Suddenly, I got a phone call from an old friend name Sally Kim. In a nervous voice she said â€Å"Hey Sue, your brother got shot. I thought you should know.† Once I heard that, I hung up with her. I called my boyfriend Jason and told him what I found out. I was screaming at Jason, telling him to get here as soon as possible, so he picked me up to head back to Cerritos to find out what had happened. I arrived at my house. The house was empty. It was so quiet that it seemed like you could hear wind whistling through my house. I had no clue what to do but worry and I couldn’t sleep at that time. I stayed up watching television waiting for my parent’s arrival. Finally my parents arrived around 6:30 am. I jumped right up off my feet and I started to cry and asked, â€Å"What happened, tell me every little thing.† My mom started to cry I gave her a big hug cause I really di dn’t know what to say. I was s! cared myself. Well what happened was that my brother and my cousins were playing video games, socializing, casual drinking and watching television in the garage. They had to leave my house early because it was a school night and my mom doesn’t like it when they stay at my house late. Therefore they left my house between 12 am to 2 am. All of sudden they all see a car - a car that turned off there head lights driving real fast through the residential area. Once they saw the car turn off their headlights with an instinct they new they had to drop and cover. The gun shots were super loud that it woke the neighbors up but not all of them, just a few which came out and stare. No one helped at all but watch. They all just stood there watching my mother run out of the house with fear in her eyes believing my brother Wilson is gone, she was crying her eyes out. When my mom came out of the house she was screaming the top of her lungs she found ... Free Essays on My Worst Experience In Life Free Essays on My Worst Experience In Life The worse experience of my life is when I was in San Diego at my apartment. Suddenly, I got a phone call from an old friend name Sally Kim. In a nervous voice she said â€Å"Hey Sue, your brother got shot. I thought you should know.† Once I heard that, I hung up with her. I called my boyfriend Jason and told him what I found out. I was screaming at Jason, telling him to get here as soon as possible, so he picked me up to head back to Cerritos to find out what had happened. I arrived at my house. The house was empty. It was so quiet that it seemed like you could hear wind whistling through my house. I had no clue what to do but worry and I couldn’t sleep at that time. I stayed up watching television waiting for my parent’s arrival. Finally my parents arrived around 6:30 am. I jumped right up off my feet and I started to cry and asked, â€Å"What happened, tell me every little thing.† My mom started to cry I gave her a big hug cause I really di dn’t know what to say. I was s! cared myself. Well what happened was that my brother and my cousins were playing video games, socializing, casual drinking and watching television in the garage. They had to leave my house early because it was a school night and my mom doesn’t like it when they stay at my house late. Therefore they left my house between 12 am to 2 am. All of sudden they all see a car - a car that turned off there head lights driving real fast through the residential area. Once they saw the car turn off their headlights with an instinct they new they had to drop and cover. The gun shots were super loud that it woke the neighbors up but not all of them, just a few which came out and stare. No one helped at all but watch. They all just stood there watching my mother run out of the house with fear in her eyes believing my brother Wilson is gone, she was crying her eyes out. When my mom came out of the house she was screaming the top of her lungs she found ...

Criminal Profiling of a Serial Killer essays

Criminal Profiling of a Serial Killer essays Sad and horrific events happen all over the world, all the time. Robberies, hate crimes, killings, and vandalism are to name a few. The truth is that people are murdered every day. This is a sad fact, but it is life. Friends kill friends, students kill students, even husbands kill wives. Serial killers and mass murderers are all throughout America, as well as other countries all over the world. Its hard to imagine any human being wanting to kill another person. There are many kinds of killers, and they fall into different groups by their criminal profiles. The criminal profile of a serial killer falls under many categories and has different characteristics than those of other murderers. First it is important to know some background information on the investigative technique more known as criminal profiling. It is hard to say whom exactly developed a criminal profile. It depends on what literature your information comes from. According to crimelibrary.com, psychologists and psychiatrists would often provide advice to police agencies as to the type of criminal they should seek for, as well as why the criminal intended to carry out the crime(Petherick). Origins of the FBI profiling unit can go back to two men who first began profiling, Howard Tetan and Pat Mullany(Petherick). Again, depending on the literature one reads, the development of the criminal profiling over the past several decades usually will be attributed to the Behavioral Sciences Unit at the FBI Academy(Petherick). Some common names of professional criminal profilers are John Douglas, Robert Ressler, and Roy Hazelwood. Criminal profiling methods are not all the same, it depends on the person ar ranging the profile as well as the crime. The FBIs method compares the behavior of the current offender with the offenders the profiler has done in the past(Petherick). When John Douglas first began to come up with his profiles, he already had a p...

Research Paper - Can we really trust our goverment , do we really have Essay

Research Paper - Can we really trust our goverment , do we really have privacy - Essay Example Therefore, governments should balance between the privacy protections whilst embracing technology development at the same time. This study focuses on the areas where the governments have failed to address privacy protection and the recommendations to settle the issue. Several studies have proved that, in the current world people cannot trust governments, as they have intruded into their privacy in the name of security until there is nothing confidential. Security is legitimately a matter of individual inner voice. It has a place with each person to choose what he considers a piece of his private life and how much of it he is eager to open to others. When you welcome a companion into your home, when you stroll on the road, when you post something on the Internet, or when you make a financial exchange, you are discharging some data about yourself (Bazelon 587). As it were, social life essentially includes a rupture of security, and it is or ought to be dependent upon every person to select which choice he is ready to make between the benefits of protection and the benefits of social communication. Yielding some social life for protection includes an expense; relinquishing some security keeping in mind the end goal to have to a greater degree, a social life does as well. Eventually, that is a matter for every one of us to choose (Barnes 1-7). As more of our social life appears to be going ahead in the virtual universe of the Internet, this is the sort of central guideline that ought to educate the open deliberation about protection on the web. Typically, this as on such a variety of different issues requires the administration to assume this liability and to settle for the benefit of every one of us (Oneill 1-41). For instance, there have been more assaults on the protection practices of expansive IT organizations, for example, Google and Face book as of late. Governments are examining Google for unintentionally gathering information transmitted to its

Strategy and strategic management Essay Example | Topics and Well Written Essays - 2750 words

Strategy and strategic management - Essay Example After developing plans, they provide resources that facilitate the implementation of policies and after a specified time, they evaluate whether the goals have been accomplished. Mission statements help managers to set the company direction. Various theories have been put forward by scholars regarding what strategic management entails. The most common is the ten schools of thought developed by Mintzberg. He classifies strategy into three categories namely; prescriptive, descriptive and configuration (Mintzberg, 1990). This theory helps to interpret the process of strategic planning and be able to plan even when there is change in environment as a result of internal or external factors. This paper is a critique of the concept of strategy, the strategy process and how it can be drawn upon and used by contemporary built environment organizations within current climate. Strategy is a plan of action directed towards achieving an organization’s goals and objectives. Managers set the organizational strategies and goals and also device ways of achieving them. Different managers use different approaches to strategize and Mintzberg categorizes them into ten schools for better understanding and thereafter classifies them into three broad categories depending on their purpose. They include; prescriptive, descriptive and configurative (Whittington, 2000). These involve designing, analysis and positioning for the future. The design school of thought is concerned with ways of developing strategies. The manager evaluates the strengths and weaknesses of the organization against the opportunities and threats which are external. Based on the result, the manager is able to formulate a strategy which addresses the shortcomings and tries to maintain a balance between the two. The organizational strategy does not have to be complicated and can be understood and implemented by all staff members while on the other hand, it is static and hence not suitable since