Electronic Medical Record Implementation: Costs and Benefits

Electronic Medical Record Implementation: Costs and Benefits Sheryl L. Venola Assignment 3 (24 July 2011) NURS 517 Intro to Health Care Financing Saint Xavier University Professor: Dr. Roger Green, DNP, MSN, BSN Abstract This paper discusses the adoption of an electronic medical record system purchased by Howard Regional Health System in Kokomo, Indiana; the rationale behind its timing and choice in expenditure; the ramifications of not implementing the system (e. g. recent health care legislation requirements); the benefits to the organization as well as to the patients it serves, and a cost effectiveness analysis. Additionally, the American Recovery and Reinvestment Act of 2009 is discussed including compliance mandates that will require eligible providers and health care institutions to meet electronic health technology implementation deadlines or face no compensation for their implementation as well as reductions in Medicare and Medicare reimbursements. Also included are discussions of the â€Å"meaningful use† guidelines established by the Centers for Medicare and Medicaid and the differences between electronic medical records and electronic health records. Finally, the advantages and disadvantages of electronic medical records are detailed. In response to the to changes in the health care delivery system as a result of the Affordable Care Act (ACA) signed into law in March of 2010, Howard Regional Health System (HRHS) has recently purchased the Cerner electronic medical record (EMR) system at a cost of $22,000,000. According to chief executive officer, James Alender, accountable care is the focus of this change in addition to stimulus money for electronic health record (EHR) system implementation, which could offset their initial expenditure by approximately $3,100,000 based on the volume of Medicare business the organization had in 2008 (Munsey, 2011). This monetary investment comes in the wake of health information technology implementation requirements set forth in the American Recovery and Reinvestment Act of 2009 (ARRA). The Recovery Act specifies that eligible providers and hospitals with a fixed Medicare and Medicaid patient populations must adopt EHR systems by 2015 or face reduction in their compensation under these programs (Department of Health & Human Services [DHHS], 2009). Additionally, the act assigned funds to the Centers for Medicare and Medicaid Services (CMS) to assess existing EHR systems and to provide incentives for eligible providers and hospitals in implementing such systems. With continued funding and legislative measures affecting the organization’s financial future, the adoption of the Cerner system seems to be one of the most important steps in ensuring its financial security in the years to come. If hospital executives and the Board of Trustees were to ignore the requirements set forth in the AARA and ACA legislation, the institution would be in serious jeopardy of losing not only is share of federal funding, but its ability to participate in health care delivery on any level at all. This would signal their demise and would certainly affect the surrounding community as it is one of two hospitals in Kokomo, Indiana, and is the only health care organization of its size in this region of the state. The patients Howard Regional serves will benefit from electronic recording of their health and medical information in many ways. Alender states that Kokomo’s â€Å"snowbirds† should have access to their records so they can be as mobile as they are, suggesting that this will reduce health care costs by reducing duplication of tests, if treatment is obtained away from home. He goes on to assert that digital records will allow more efficient movement of patients through the system allowing seriously ill patients to move more quickly through the emergency department, and other acute care departments within the system. Additionally, if that same patient requires further care away from HRHS, the treating hospital would have access to the previous records so that work already completed is not repeated (Munsey, 2011). Their medical information could be updated with each visit rather than their having to â€Å"provide the same information over and over again (Gurley, 2003). † Gurley also agrees that because patients and providers are better informed through electronic record-keeping, there is less duplication of testing as well as enhanced treatment coordination among health care providers. Along with the patients, the hospital reaps many tangible and intangible benefits from EMR as well. The information in the electronic record is easily accessible to multiple clinicians at multiple locations at the same time, with nearly immediate retrieval time. For this reason, it is updated frequently and is available for access at any workstation whenever the information is required making time spent with patients more efficient (Gurley, 2003). According to Shi and Singh (2003, p. 65), one of the most important aspects of electronic records is the integration of specific patient profiles with clinical decision making tools built into the software which provide evidence-based practice reminders and guidelines for effective, efficient treatment. This type of alert system can result in reduction of medication errors and in appropriate treatment options, saving both the patient and the clinician from harm. The data analysis capability of the EMR can also be used to identify developmen ts among patient populations allowing for early intervention when indicated. It can also be utilized to identify areas in which the organization may need to expand or scale back depending on the trends the data indicates (Dolan, 2011). Having used the Cerner system in the past, this RN noted that with the clinical record being streamlined in such a way that narrative documentation was necessary only by exception, completing it required less time, which left more time for bedside care along with completion of educational requirements, which were also mostly computerized. Hence, the savings could be significant and provide for increased nurse satisfaction related to the ability to provide more actual patient care as well as complete proficiencies without having to stay after a shift or come in on a day off. As mentioned above, EMR can reduce duplication of services, assist in fast-tracking acutely ill patients, reduce the duplication of tests and services that aren’t medically necessary (e. g. the patient’s condition has not changed substantially), allow clinicians to spend less time on documentation possibly reducing overtime, each of which can result in cost savings for the institution. According to Randall T. Huling Jr. , MD, president of Olive Branch Family Medical Center in Olive Branch, Mississippi, since switching over to EMR in January of 2010, they have increased revenue by an estimated $650,000 with an annual cost reduction of more than $85,000. Additionally, they have been able to raise provider productivity by 10,000 visits, raise their fee collection percentage from 68 to 72 percent, and increase the charges per patient from $157 to $172 (Byers, 2010). Wang et al (2003) performed a five-year cost-benefit analysis using primary data from several internal medicine clinics, using their own internally developed EMR system, utilizing a health care organization perspective framework and a conventional paper-based medical record as the reference point. Costs of implementation were approximated to be $3,400 per provider in the first year and included redesign of workflow processes, extraction of data from paper charts, and training. Yearly maintenance cost, including system and network administration and additional technical support personnel, were estimated to be $1,500 per provider annually. The temporary loss of productivity resulting from the transition to an electronic from a paper system, was interpreted using a decreasing loss rate of 20% in month one, 10% in the second month, and 5% in the third, returning to baseline in the following months. With annual averages for provider revenues, this cost amounted to $11,200 in the first year. Although their five-year net benefit per provider was $86,400 and the â€Å"net financial return to a health care organization from using an ambulatory medical record system is positive across a wide range of assumptions (Wang, et al, 2003, p. 401),† the authors cautioned that several variables could affect the net revenues organizations could expect. The patient mix can affect revenues depending on the number of capitated versus fee-for-service patients served by the health care organization. With capitated arrangements, savings to the patient resulting from decreased use of utilization of services, revenues accrue to the provider. However, less utilization of services in fee-for service arrangements result in loss of revenue to the provider, but the payer (i. e. the insurer) saves in expenses. They did postulate that these insurers might provide incentives to providers using EHR realizing that their profits could be increased with more providers utilizing these systems, The study evaluated cost savings from drug suggestions and warnings provided by the EMR software, which aided in prescribing of formulary drugs and prevention of adverse drug events. However, the study was not able to evaluate the intangible cost savings from averted malpractice claims, injury to patients, or reduced quality of life of clients. Additional tangible and intangible savings that were not included due to unavailability of sufficient data were reductions in malpractice premium costs, decreased staffing needs, less paper charting-related storage and supply costs, increased provider productivity, generic drug substitutions, enhanced reimbursement resulting from proper coding, and reduced denials related to insufficient documentation of medical necessity (Wang et al, 3003 p. 402). Limitations of the study cited by the authors included the fact that the research model was centered on primary data from their institution, published literature estimates, and an expert opinion panel which they convened. They also conceded that EMR implementation might produce other costs, including greater system integration expense for larger institutions dependant on the complexity of the various system interfaces involved. Additionally, although effectiveness of electronic medical record interventions has been well-established in inpatient settings, there is less certainty of their effects in the outpatient environment. Other costs could be related to decreased or lost productivity during unexpected network or computer system downtime, reassignment of clinical staff, or redesign of the workflow process (Wang et al, 2003, p. 402). Obviously the above results are based on one study utilizing results from a group of ambulatory clinics making it difficult to extrapolate data to a hospital setting even when that hospital has significant outpatient programs. Indeed, Thompson and Fleming (2008) pose questions regarding the uality and quantity of data found in existing literature, suggesting that health care institutions be cautious in their information sources in order to be better informed in the EMR decision-making process. The authors state that amount of comprehensive studies are lacking requiring hospitals to obtain more sources containing information they are seeking and rigorously compare data so that they can better extrapolate the results to their individual organizations (Thompson & Fleming, 2008 ). They also caution using staff time savings as a factor unless that variable is given a value and that it is used to actually cut costs. For example, if an average of 30 minutes per staff member is realized in utilization of the EMR, how will that impact staffing? Will staffing needs be reduced allowing for fewer staff members per shift, resulting in actual cost reductions? If staff are able to complete other duties that would have required use of overtime or coming in on days off, this would also decrease expenditures. However, the authors point out that staff members are often allowed to perform other tasks that don’t result in salary reductions, although this is implicit when staff time saving related to EMR is discussed (Thompson & Fleming, 2008). It is obvious that the decision to adopt an electronic medical record is not an easy one to make given all the variables discussed previously, but the information presented thus far has not taken into account the more recent changes produced by health care reform. These changes are discussed in the following paragraphs. The American Reinvestment and Recovery Act provides incentives for eligible providers (EP) and health care organizations (i. e. those who serve a defined percentage of Medicare and Medicaid recipients) for the implementation of EHR. The use on EMR and EHR are have often been used interchangeably, but they are not the same. An electronic medical record is the legal record of the care a patient receives from a health care provider or institution during their encounter with either entity. The electronic health record belongs to the patient and encompasses the entirety of their care across all providers within a community, region or state (Garets & Davis, 2006, pp. 2-3). For the purposes of reimbursement, however, providers must use a certified EHR (EHR Incentives, p. ). The recovery Act has appropriated $140,000,000 for each of fiscal years 2009 through 2015, with an additional $65,000,000 for 2016 to be used for administrative funding. Funds are to be made available until completely utilized. â€Å"In coordination with the Office of the National Coordinator (ONC) for Health Information Technology, CMS will develop the policies, such as the definition of ‘meaningful use,’ needed to implement the incen tive program (DHHS, 2009). In addition, it will be necessary to provide education to eligible participants to facilitate their understanding of all the conditions and guidelines regarding their eligibility, the selection of Medicare or Medicaid incentive programs, the incentive payments, and the demonstration of â€Å"meaningful use. † Recovery Act reporting compliance will require guidance to individual states, which will involve Federal and State staff time and require modification of accounting and payment data reporting systems (DHHS, 2009). When the aforementioned requirements were set forth by the DHHS in 2009, the meaningful use guidelines had not yet been established. Following is a link to the summary overview for meaningful use objectives of EHR* (Blumenthal & Tavenner, 2010) as it currently stands, which outlines the steps individual providers and health care institutions (hospitals, ambulatory care centers, clinics, et al) must take in order to receive stimulus funds for the costs associated with implementing electronic health systems (EHR). The initial payments will be made beginning in 2011 depending on each state’s timing in adoption of the Medicare and Medicaid programs. For hospitals, the calculation is based on the volume of Medicare and or Medicaid patients served, but the baseline payment is $2,000,000. Each program is separate, but EPs and institutions can apply for one or both programs, however if they choose only one program, they cannot later add the other, so it benefits them to choose both at the outset since they can drop out of either one at any time (EHR Incentives). Given the stakes of not participating, providers should work diligently to eet all the requirements set forth in order to maximize the return on investment they should obtain in simply adopting EHR. The incentives offered will merely help them realize those return sooner rather than later. Finally, given the state of internet security and the government’s desire to push providers toward electronic data capture, it is only natur al that there would be concerns regarding EMR and EHR technology. Advantages of EHR over paper records include an expansive storage capability, availability of the data from many access points at the same time, and nearly immediate retrieval time (Gurley, 2003). The paper record is fragmented and depending on the charts used (e. g. some tend to fly open when dropped, causing paper to be scattered), pieces of the record can be lost. Additionally, when a patient is hospitalized more than once, their old chart must be retrieved in order to provide continuity of care. Electronic systems bypass this and allow clinicians to obtain information from previous visits much more quickly allowing the patient to have a streamlined entry to and exit from the system. Electronic health records also have built-in medical alerts and reminders allowing providers to be notified of abnormal lab results, potential drug interactions, and timing of tests required for monitoring blood levels associated with certain conditions or as a side effect of medications. It can also provide evidence-based practice plans for certain diseases and disorders facilitating the provider’s choices in judging the right path in caring for each patient. The electronic software allows the clinician to capture information enabling them to provide payers with the outcome based criteria they require in reimbursing the physician. Finally, EHR provides a major step in ensuring patient safety by clearly written order entry by physicians avoiding the mistakes that can occur with handwritten orders when those entries are illegible (Gurley, 2003). The major disadvantage of EHR adoption appears to be the costs associated with implementing them. According to Kent Gale, start-up costs could range from between four and five million dollars for a smaller (200-bed) hospital to $100,000,000 for an organization with three hospitals. He went on to tate that a typical 400-bed facility with a more extensive EHR would likely spend between $20,000,000 and $30,000,000 (Byers 2010). Also, unless one is technologically-savvy, there can be considerable learning needs on the part of physicians and staff. In these cases, it is much better to have systems that are more intuitive and user-friendly in order to get everyone onboard. As previously mentioned, privacy concerns are at the forefront in people’s minds where electronic documentation is concerned. Security measures must be ever-evolving in order to meet the challenge and audits of access to medical data must be done to ascertain the appropriateness of information access. Paper records have also had the potential for unauthorized access without the knowledge of the patient or provider and these invasions of privacy are much harder to detect (Gurley, 2003). Essentially, the electronic record has its advantages and disadvantages, but with all the benefits they can provide to patients, providers, insurance companies, as well as the government in collection of statistics, it appears to be the best choice for all concerned. With a great deal of effort and constant vigilance, electronic health records can provide for safer, more cost efficient care, and conserve resources for use in other areas that are currently lacking. I believe that in the end, Howard Regional’s decision to adopt EHR will result in huge savings and increased revenues that will benefit not only the organization, but the communities they serve. References Blumenthal, D. , & Tavenner, M. (2010, August 5). The â€Å"Meaningful Use† Regulation for Electronic Health Records. New England Journal of Medicine, 363, 501-504. Retrieved from http://ww. nejm. rg/doi/full/10. 1056/NEJMp1006114? ssource=hcrc Byers, J. (2010, November). EMR implementation: One day at a time. CMIO: Information, Evidence & Effectiveness in Medicine, Digital. CMIO. net, 10-12. Retrieved from http://d27vj430nutdmd. cloudfront. net/5165/51383/51383. pdf Department of Health and Human Services Report (2009). Centers for Medicare & Medicaid Services: Medicare and Medicaid Incentives and Administrative Funding. Retrieved from http://www. hhs. gov/recovery/reports/plans/hit_implementation. pdf Dolan, P. L. (2011, May 2). Electronic medical records: What your data can tell you. American Medical Association: American Medical News. Retrieved from http://www. ama-assn. org/amednews. EHR Incentives: Eligibility. (n. d. ). Retrieved July 18, 2011, from Centers for Medicare and Medicaid Services website: https://www. cms. gov/pf/printpage. asp? ref=http://www. cms. gov/ehhttps://www. cms. gov/pf/printpage. asp? ref=http://www. cms. gov/ehhttps://www. cms. gov/pf/printpage. asp? ref=http://www. cms. gov/EHRIncentivePrograms/15_Eligibility. asprincentiveprograms/01_Overview. asprincentiveprograms/01_Overview. asp Garets, D. , & Davis, M. (2006, January 26). Electronic Medical Records vs. Electronic Health Records: Yes there is a difference [White Paper]. Retrieved from A HIMSS AnalyticsTM website: http://www. himssanalytics. org/ Gurley L. (2003). Advantages and Disadvantages of the Electronic Medical Record. American Academy of Medical Administrators, 2004. Retrieved from http://www. aameda. org/MemberServices/Exec/Articles/spg04/Gurley%20article. pdf Munsey, P. (2011, March 26). Howard Regional up to the challenge. Kokomo Perspective. com. Retrieved from http://www. kokomoperspective. com Shi, L, & Singh, D. A. (2008). Delivering health care in America: A systems approach. Sudbury, MA: Jones and Bartlett Publishers. Thompson, D. L. , & Fleming, N. S. (2008, July). Finding the ROI in EMRs. Healthcare Financial Manager, 62(7), 76-81. Retrieved from http://www. hfma. org/publications/hfm-Magazine/hfm-Magazine Wang, S. J. , Middleton, B. , Prosser, L. A. , Bardon, C. G. , Spurr, C. D. , Carchildi, P. J. , †¦ Bates, D. W. (2003, April 1). A cost benefit analysis of electronic medical records in primary care. American Journal of Medicine, 114(5), 397-403. Retrieved from http://www. amjmed. com/article/S0002-9343(03)00057-3/fulltext

Introducing government in america Essay

A. Defining Democracy 1. Democracy is a means of selecting policymakers and of organizing government so that policy reflects citizens’ preferences. B. Traditional Democratic Theory 1. Equality in voting 2. Effective participation 3. Enlightened understanding 4. Citizen control of the agenda 5. Inclusion 6. Democracies must practice majority rule and preserve minority rights. 7. The relationship between the few leaders and the many followers is one of representation. C. Three Contemporary Theories of American Democracy 1. Pluralist theory states that groups with shared interests influence public policy by pressing their concerns through organized efforts. 2. Elite and class theory contends that societies are divided along class lines, and that an upper-class elite pulls the strings of government. 3. Hyperpluralism contends that many groups are so strong that government is unable to act. D. Challenges to Democracy 1. Increased Technical Expertise 2. Limited Participation in Government 3. Escalating Campaign Costs 4. Diverse Political Interests (policy gridlock) E. American Political Culture and Democracy 1. Political culture consists of the overall set of values widely shared within a society. 2. Liberty 3. Egalitarianism 4. Individualism 5. Laissez-faire 6. Populism F. A Culture War? (Is America polarized into rival political camps with different political cultures?) G. Preview Questions about Democracy VI. The Scope of Government in America (pp. 23–26) A. How Active Is American Government? B. Preview Questions about the Scope of Government VII. Summary (p. 26) LEARNING OBJECTIVES After studying Chapter 1, you should be able to: 1. Describe what government is and what governments do. 2. Understand how politics is the struggle over â€Å"who gets what, when, and how.† 3. Identify the important features of the policymaking system and explain how public policies are the choices that government makes—and declines to make—in response to political issues. 4. Understand the nature of democratic government and traditional democratic theory, and the key questions concerning democracy. 5. Distinguish among the three contemporary theories of American democracy and politics (pluralist, elite and class, and hyperpluralist) and identify some of their strengths and weaknesses. 6. Understand the nature of American political culture and identify the elements of the American creed. 7. Understand the nature of the scope of government in America and the key questions concerning the scope of government. The following exercises will help you meet these objectives: Objective 1: Describe what government is and what governments do. 1. Define the term â€Å"government.† The institutions that make authoritative decisions for any given society. 2. What are the two fundamental questions about governing that serve as themes throughout the textbook? 1. How should we govern? 2. What should government do? 3. List the five functions that all national governments perform. 1. Maintain a national defense 2. Provide public services 3. Preserve order 4. Socialize the young 5. Collect taxes Objective 2: Understand that politics is the struggle over â€Å"who gets what, when, and how.† 1. Define the term â€Å"politics.† Determines whom we select as our governmental leaders and what policies these leaders pursue. 2. Give examples of the â€Å"who,† â€Å"what,† â€Å"when,† and â€Å"how† of politics. 1. Who: Voters, candidates, groups, and parties 2. What: New taxes, medical care for the elderly 3. When: When people speak up 4. How: Voting, supporting, compromising, lobbying Objective 3: Identify the important features of the policy system and explain how public policies are the choices that government makes, and declines to make, in response to political issues. 1. Draw a diagram of how a policy system works. Political issues get on policy agenda Policymakers make policy Policies affect people People Linkage institutions Policy Agenda Policymaking institutions Policy People 2. List four key linkage institutions in a democratic society. 1. Parties 2. Interest groups 3. Media 4. Elections 3. Define the term â€Å"policy agenda.† The issues that attract the serious attention of public officials and other people actually involved in politics at in given point in time. 4. How does a government’s policy agenda change? Responds more to societal failures than successes. For example, when jobs are scarce and business productivity is falling, economic problems occupy a high position in the agenda. 5. List the four major policymaking institutions in the United States. 1. Congress 2. The Presidency 3. The Courts 4. Bureaucracies 6. Define the term â€Å"policy impacts.† The effects a policy has on people and problems. Impacts are analyzed to see how well a policy has met its goal and at what cost. Objective 4: Understand the nature of democratic government, traditional democratic theory, and the key questions concerning democracy. 1. Define the term â€Å"democracy† as used in this text. A system of selecting policymakers and of organizing government so that policy represents and responds to the public’s preferences. 2. List the five cornerstones of an ideal democracy. 1. Equality in voting 2. Effective participation 3. Enlightened understanding 4. Citizen control of the agenda 5. Inclusion 3. Explain the principles of majority rule and minority rights. When choosing among alternatives, the will of over half the voters should be followed, but restraints protecting the minority’s rights. Objective 5: Distinguish among the three contemporary theories of American democracy and politics (pluralist, elite and class, and hyperpluralist) and identify some of their strengths and weaknesses. 1. Complete the following table comparing pluralist, elite and class, and hyperpluralist theories according to who holds the power and how policy is made. Theory| Who Holds Power| How Policy is Made| Pluralist| Groups with shared interests| Pressing their concernsthrough organized efforts| Elite and Class| Upper -class| They can afford to finance election campaigns and control key institutions| Hyperpluralist| Groups| Groups are so strong that government is weakened| 2. List the major challenges facing American democracy. 1. Increased Technical Expertise 2. Limited Participation in Government 3. Escalating Campaign Costs 4. Diverse Political Interests Objective 6: Understand the nature of American political culture and identify the elements of the American creed. 1. What is ‘political culture’ and why is it crucial to understanding American government? An overall set of values widely shared within a society. It is crucial to understanding American government because Americans are so diverse in terms of ancestries, religions, and heritages. A set of shared beliefs and values unites Americans. 2. List and give an example of the five elements of the American creed according to Seymour Martin Lipset. 1. Liberty 2. Egalitarianism 3. Individualism 4. Laissez – faire 5. Populism 3. List three ways in which America might be experiencing a crisis of cultural values. 1. A loss over time of traditional values, such as the importance of religion and family life 2. An unfavorable comparison with the citizens of other countries in terms of values such as patriotism or support for moral principles 3. The division of society into opposed groups with irreconcilable moral differences Objective 7: Understand the nature of the scope of government in America and the key questions concerning the scope of government. 1. Make a list of items that illustrate the scope of American government. Owns 1/3 of the land I the U.S., owns and operates over 400,000 nonmilitary vehicles, employs over 2.2 million people, etc 2. What is gross domestic product and how does the term illustrate the scope of American government? The sum total of the value of all the goods and services produced in a nation. Gross domestic product illustrates the scope of American government because it not only spends large sums of money but also employs large numbers of people. About 18 million Americans work for our government. KEY TERMS Identify and describe: Government – The institutions that make authoritative decisions for any given society public goods – Services the government provides that can be shared by everyone and cannot be denied to anyone politics – Determines whom we select as our governmental leaders and what policies these leaders pursue political participation – The ways in which people get involved in politics single-issue groups – Groups so concerned with one issue that members cast their votes on the basis of that issue only, ignoring the politicians stand on everything else policymaking system – Reveals the way our government responds to the priorities of its people linkage institutions – The political channels through which people’s concerns become political issues on the policy agenda. In the US, linkage institutions include elections, political parties, interest groups, and the media. policy agenda – The issues that attract the serious attention of publ ic officials and other people actively involved in politics at any given time political issue – The result of people disagreeing about a problem or about the public policy needed to fix it policymaking institutions – Congress, the presidency, and the courts public policy – Every decision the government makes policy impacts – The effects that a policy has on people and on society’s problems democracy – A means of selecting policymakers and organizing government so that policy reflects citizen’s preferences majority rule – In choosing among alternatives, the will of over half the voters should be followed minority rights – Rights the majority cannot infringe on representation – The relationship between the few leaders and the many citizens pluralist theory – States that groups with shared interests influence public policy by pressing their concerns through organized efforts elite and class theory – Contends that our society, like all societies, is divided along class lines and that an upper-class elite pulls the strings of government hyperpluralism – Groups are so strong that government is weakened, as influence of many groups cripples government’s ability to make policy policy gridlock – Each policy coalition finds its way blocked by others political culture – The overall set of values widely shared within American society Gross domestic product – The total value of all goods and services produced annually by the United States Name that term: 1. Something in which any member of society can share without diminishing the supply to any other member of society. ____Public Goods__________ 2. It consists of subjects and problems getting the attention of government officials and their associates. _________________________ 3. This is a choice that government makes in response to an issue on its agenda. ____Policy Agenda_________ 4. This arises when people disagree about a problem or about public policy choices made to combat a problem. _____Political Issue________ 5. Political parties, elections, and interest groups are the main ones in the United States. _____Linkage Institutions___ 6. The effects a policy has on people and on society’s problems. _____Policy Impacts_______ 7. The most fundamental aspect of democratic theory. _____Majority Rule_______ 8. According to this theory of American government, many groups are so strong and numerous that the government is unable to act. _____Hyperpluralism______ 9. This problem is magnified when voters choose a president from one party and congressional majorities from the other party. ____Policy Gridlock_______ 10. A key factor that holds American democracy together. ____Political Culture________ 11. The total value of all goods and services produced annually by the United States. __Gross Domestic Product____ MULTIPLE CHOICE QUESTIONS Circle the correct answer: 1. Which of the following statements is TRUE? a. There is no relationship between political knowledge and age. b. In the mid-1960s, there was virtually no relationship between political knowledge and age; now, in the early twenty-first century, political knowledge increases with age. c. In the mid-1960s, there was virtually no relationship between political knowledge and age; now, in the early twenty-first century, political knowledge decreases with age. d. Today, in the early twenty-first century, there is virtually no relationship between political knowledge and age; in the mid-1960s, political knowledge increased with age. e. Today, in the early twenty-first century, there is virtually no relationship between political knowledge and age; in the mid-1960s, political knowledge decreased with age. 2. Political scientists argue that higher levels of political knowledge a. foster tolerance. b. foster intolerance. c. promote partisanship. d. promote bipartisanship. e. increase wealth. 3. Despite their differences, all governments a. provide public services. b. maintain a national defense. c. collect taxes. d. All of the above e. C only 4. Which of the following is an example of a public good? a. Libraries b. Parks c. College education d. All of the above e. Both a and b 5. Single-issue groups a. aid effective policymaking for the public interest. b. are concerned with a wide range of problems. c. have very little influence on voters or politicians. d. tend to have a narrow interest and to dislike compromise. e. view politics as a vocation, rather than as an avocation. 6. Which of the following is NOT a component of the policymaking system? a. People b. Linkage institutions c. Policy agenda d. Criminal justice institutions e. Policymaking institutions 7. Which of the following is TRUE of the policymaking system? a. Linkage institutions transmit people’s interests to government. b. Media investigate social problems and inform people about them. c. Elections enable Americans to make their opinions heard by choosing their public officials. d. People, linkage institutions, media, and elections all help to shape the policy agenda? e. All of the above 8. In a democratic society, parties, elections, interest groups, and the media are all examples of ____ between the preferences of citizens and the government’s policy agenda. a. cross-pollination b. inputs and outputs c. ideological bridges d. obstacles e. linkage institutions 9. Karl Marx and Freidrich Engels published a. The Communist Manifesto b. A Theory of Democracy c. The Federalist Papers d. Poor Richard’s Almanac e. War and Peace 10. Which of the following is NOT a type of public policy? a. Congressional statute b. Regulation c. Court decision d. Budgetary choices e. Mandate 11. The principle of â€Å"one person, one vote,† is an expression of the principle of a. equality in voting. b. effective participation. c. enlightened understanding. d. inclusion. e. citizen control of the agenda. 12. The principle of traditional democracy theory guaranteeing rights to those who do not belong to majorities and allows that they might join majorities through persuasion and reasoned argument is called the principle of a. majority rule. b. minority rights. c. representation. d. pluralism. e. enlightened understanding. 13. Pluralists a. believe that the public interest will prevail through bargaining and compromise. b. depend on fragmented, decentralized, and dispersed power in the policy process. c. oppose the principle of majority rule. d. compete through a system of â€Å"minority rule† for influence. e. All of the above 14. Who referred to the U.S. as a â€Å"nation of joiners†? a. Thomas Jefferson b. Alexis de Tocqueville c. Robert Putnam d. Ronald Reagan e. George H. W. Bush 15. Increased technical expertise poses a potential challenge to democracy because a. it is difficult to have an informed â€Å"nontechnical† public debate on technical issues. b. it goes against the tenets of pluralist political theory. c. it violates the notion of one man, one vote. d. elected officials find it hard to understand technical experts. e. interest groups have a difficult time securing technical expertise. 16. A condition that occurs when no coalition is strong enough to form a majority and establish policy is a. PAC. b. policy gridlock. c. policy failure. d. policy impact. e. hyperpluralist policy. 17. The overall set of values widely shared within a society is called the society’s a. political culture. b. public opinion. c. media influence. d. linkage institutions. e. popular culture. 18. America’s bountiful frontier provides a partial explanation for which element of the American creed? a. Egalitarianism b. Populism c. Individualism d. Opportunism e. Liberty 19. Which of the following is NOT a possible way that Americans may be experiencing a crisis of culture values, according to Wayne Baker? a. A loss of traditional values, such as religion and family life b. An unfavorable comparison with citizens of other countries in terms of patriotism and/or support for moral principles c. The division of society into opposed groups with irreconcilable moral differences d. A decline in citizens’ commitment to equal opportunity e. None of the above 20. Which of the following statements is TRUE? a. When expenditures grow, tax revenues must grow to pay the additional costs. b. When taxes do not grow as fast as spending, a budget deficit results. c. In 2009, the federal deficit was more than $400 billion. d. The national debt is more than $9 trillion. e. All of the above TRUE FALSE QUESTIONS Circle the correct answer: 1. The voter turnout rate among young Americans is consistently higher than among older Americans. T / F 2. Emergent communication technologies and the proliferation of television channels make it easier to avoid information about politics. T / F 3. All governments protect national sovereignty, frequently by maintaining a national defense and armed forces. T / F 4. The daily recitation of the Pledge of Allegiance in public schools is a tool of political socialization used to instill national values among the young. T / F 5. The courts are an example of a linkage institution. T / F 6. The policy agenda responds more to societal failures than it responds to societal successes. T / F 7. Most people around the world believe that democracy is the best form of government. T / F 8. Over one-third of the nation’s wealth is held by just 1 percent of the population. T / F 9. The tax burden on Americans is small compared to other democratic nations. T / F 10. Lincoln’s famous phrase, â€Å"government of the people, for the people, and by the people,† is a classic expression of laissez-faire. T / F

A Social Partnerships in the New Millenium

There is also a huge amount being written about the issue, some Industrial Relations commentators have even hailed this as the most exciting thing to happen to UK industry in years. However, not every group completely agrees with this. For example, some groups believe that Social Partnership has had a very negative effect on British Trade Unions. At www.labournet.org.uk a group have named a bulletin board ‘Solidarity’. It is a page dedicated to ‘challenging social partnership’ and it’s apparent corrosive effects on union power. It is very typical of the types of arguments put forward by groups that are oh so against social partnerships. Stakeholders like the authors of solidarity believe that social partnerships tie unions to the coat tails of employers. What they want is a ‘new unionism’ which opposes subordination to the ‘global market’ and builds on the experience of the Liverpool Dockers. This group is completely opposed to any kind of privatisation and really wants more from unions than just a concern for working conditions. They want a break â€Å"..with the narrow work place concerns of ‘non-political’ trade unionism† and believe that unions should fight † for the interests of the working class and oppressed as a whole†. They also see a need for a repeal of all â€Å"anti-union† legislation and an end to state interference into unions, such as social partnership agreements. Taken from ‘Solidarity’, the journal that openly states it’s purpose is to challenge social partnerships in trade unions, here are some ‘facts’ that display how social partnerships have had a harmful effect on British trade unions: In Rover and the car industry, where the unions have identified the interests of workers with commercial success in the ‘global market’, they have been gravely weakened and meekly accepted massive job cuts. USDAW has reached a ‘Partnership Agreement’ with Tesco which takes away the right of the union members as a whole to vote on pay deals. The TUC has collaborated with a privatised utility in the Energy Industry and set up a company with them – Union Energy – thus effectively abandoning the fight for re-nationalisation. They are collaborating with a privatised utility which has decimated trade union members’ jobs. The unions have swallowed ‘Investors in People’ which identifies the interests of union members with the ‘business aims’ of private companies. The TUC and most unions have accepted that the increased competition of the ‘global market’ means unity with ‘our employers’ and competing with workers in other countries. Stakeholders like these aim to challenge social partnership by campaigning for complete independence of the unions from the employer. They reject globalisation and counterpoise to it a working class internationalism which recognises that workers have more in common with those in other countries than they do with ‘our own’ bosses. It is a very Marxist standpoint . They feel that for those in the unions who support their independence from the employers and the state, a systematic struggle against ‘social partnership’ in all its manifestations is a central task if they are to break the unions from the employers’ coat tails. They are insistent that this outlook has only been adopted by union leaders. It has though percolated down to many workplaces, reinforced by the fear of unemployment. This far left view contrasts greatly with those unions that actually see social partnership in a very positive, if slightly unclear light. Unions like FIET, The International Federation of commercial, clerical, professional, and technical employees see social partnership as a â€Å"new and challenging area of work for the union.† For unions that see the millennium as a time to accept social partnership, it will mean unions and companies learning to do things differently, rather than trying to campaign against this change. Some unions like FIET have accepted that we now have a government committed to promoting the partnership approach, and to ensuring that it becomes a permanent feature in the workplace. Unions like this have therefore accepted that social partnership is going to be around for a long time. I think that left wing reactions to social partnerships, like that of ‘Solidarity’ is very much a reactive one rather than considered. I think that those stakeholders set so strongly against this issue need to understand that the government’s political commitment to partnership goes far beyond the UK. We now have a new and positive approach to Europe and this social partnership model is at the heart of the EU’s approach to all Industrial Relations. Indeed Social Partnership does mean long term changes to the Industrial Relations scene in Europe and in Britain, all that unions need to work on is understanding what these changes will mean for their members and the companies that they work in. Looked at from this more positive, optimistic standpoint then social partnership has the potential to deliver some very real benefits: Potentially it means that employers will be working with the trade unions to bring about improvements in the quality of work. It means that employees, through their trade union, will be given a much greater say in how their company is run. Social partnership should give unions the opportunity to be consulted earlier, more often and on a wider range of issues than has happened before. Surely the growth in partnership at work can only be a welcome one, if not somewhat overdue? However, these encouraging and upbeat pointers can only be achieved if the unions get themselves involved in equal terms right from the beginning, otherwise employers could try to do things without the unions. As stakeholders like ‘Solidarity’ state I think that there is indeed a risk that social partnership may be used to try and undermine trade union organisation in the work place. Employers could potentially claim that they can have a partnership directly with their staff and do not require the union’s participation. If the unions are excluded in this way then not only could there be disastrous consequences for union members but social partnership will not work for employers either. Partnership can only be successful when employees as partners are properly supported and resourced through a dependable trade union. To illustrate this point further, let us consider what may happen if the retail sector tried to introduce partnership without trade union involvement : Most employees in this sector work part-time. There are increasingly complex and unsociable working hours in retailing which in turn means that most employees may have very little contact with anyone beyond their shift. In these circumstances employees have less of an opportunity to form a collective view. Simply meeting together can be extremely difficult in such organisations, let alone having the resources and confidence to develop their own ideas and concerns. Therefore it is clear that in most cases employees are unlikely to become equal and effective partners when they do not have the time or the means to generate their own agenda. A dependable and experienced trade union means that employees can enter into partnership properly supported and resourced. To achieve this, a real commitment is required from employers to supporting trade union membership, as the best way for their staff to be given a voice and more importantly the confidence to use it. Basically partnership needs partners. But how will social partnership actually change things in real terms for employees and the unions? By answering this question I will hopefully be able to assess if social partnership is a viable way forward in the new millennium. Firstly, unions need to take a positive approach, for them social partnerships should be about: Co-operation, not confrontation. Improving the quality of working life. Employers listening to and respecting unions and vice versa. Employees developing their own agenda through their trade union. If they agree on the above terms then hopefully it will mean: Moving away from the common practice of the union only talking to companies once a year. At the moment, even with companies with whom there exists a good relationship, unions often only talk to the organisation at the time of the annual wage negotiations. Many unions feel that the annual wage round sometimes becomes a little tired and predictable, with companies offering the lowest increase that they feel they can get away with. However, partnership is different. For the unions, it means talking to companies throughout the year. It means having a constant dialogue with employers about what is happening at all levels of the company. It should also mean that the union is consulted on a wider range of issues. Companies are used to contacting unions when they are implementing redundancies or sell offs. Mainly because there is a legal obligation on them to do this, but unions have not in the past been consulted on the overall direction of a company or about strategic decisions that may affect employees. A Social Partnership means that the union should be consulted on a far wider range of issues than they have been used to. It means earlier and better consultation sessions, theoretically no more being told about something when it has already been implemented. A Social Partnerships in the New Millenium There is also a huge amount being written about the issue, some Industrial Relations commentators have even hailed this as the most exciting thing to happen to UK industry in years. However, not every group completely agrees with this. For example, some groups believe that Social Partnership has had a very negative effect on British Trade Unions. At www.labournet.org.uk a group have named a bulletin board ‘Solidarity’. It is a page dedicated to ‘challenging social partnership’ and it’s apparent corrosive effects on union power. It is very typical of the types of arguments put forward by groups that are oh so against social partnerships. Stakeholders like the authors of solidarity believe that social partnerships tie unions to the coat tails of employers. What they want is a ‘new unionism’ which opposes subordination to the ‘global market’ and builds on the experience of the Liverpool Dockers. This group is completely opposed to any kind of privatisation and really wants more from unions than just a concern for working conditions. They want a break â€Å"..with the narrow work place concerns of ‘non-political’ trade unionism† and believe that unions should fight † for the interests of the working class and oppressed as a whole†. They also see a need for a repeal of all â€Å"anti-union† legislation and an end to state interference into unions, such as social partnership agreements. Taken from ‘Solidarity’, the journal that openly states it’s purpose is to challenge social partnerships in trade unions, here are some ‘facts’ that display how social partnerships have had a harmful effect on British trade unions: In Rover and the car industry, where the unions have identified the interests of workers with commercial success in the ‘global market’, they have been gravely weakened and meekly accepted massive job cuts. USDAW has reached a ‘Partnership Agreement’ with Tesco which takes away the right of the union members as a whole to vote on pay deals. The TUC has collaborated with a privatised utility in the Energy Industry and set up a company with them – Union Energy – thus effectively abandoning the fight for re-nationalisation. They are collaborating with a privatised utility which has decimated trade union members’ jobs. The unions have swallowed ‘Investors in People’ which identifies the interests of union members with the ‘business aims’ of private companies. The TUC and most unions have accepted that the increased competition of the ‘global market’ means unity with ‘our employers’ and competing with workers in other countries. Stakeholders like these aim to challenge social partnership by campaigning for complete independence of the unions from the employer. They reject globalisation and counterpoise to it a working class internationalism which recognises that workers have more in common with those in other countries than they do with ‘our own’ bosses. It is a very Marxist standpoint . They feel that for those in the unions who support their independence from the employers and the state, a systematic struggle against ‘social partnership’ in all its manifestations is a central task if they are to break the unions from the employers’ coat tails. They are insistent that this outlook has only been adopted by union leaders. It has though percolated down to many workplaces, reinforced by the fear of unemployment. This far left view contrasts greatly with those unions that actually see social partnership in a very positive, if slightly unclear light. Unions like FIET, The International Federation of commercial, clerical, professional, and technical employees see social partnership as a â€Å"new and challenging area of work for the union.† For unions that see the millennium as a time to accept social partnership, it will mean unions and companies learning to do things differently, rather than trying to campaign against this change. Some unions like FIET have accepted that we now have a government committed to promoting the partnership approach, and to ensuring that it becomes a permanent feature in the workplace. Unions like this have therefore accepted that social partnership is going to be around for a long time. I think that left wing reactions to social partnerships, like that of ‘Solidarity’ is very much a reactive one rather than considered. I think that those stakeholders set so strongly against this issue need to understand that the government’s political commitment to partnership goes far beyond the UK. We now have a new and positive approach to Europe and this social partnership model is at the heart of the EU’s approach to all Industrial Relations. Indeed Social Partnership does mean long term changes to the Industrial Relations scene in Europe and in Britain, all that unions need to work on is understanding what these changes will mean for their members and the companies that they work in. Looked at from this more positive, optimistic standpoint then social partnership has the potential to deliver some very real benefits: Potentially it means that employers will be working with the trade unions to bring about improvements in the quality of work. It means that employees, through their trade union, will be given a much greater say in how their company is run. Social partnership should give unions the opportunity to be consulted earlier, more often and on a wider range of issues than has happened before. Surely the growth in partnership at work can only be a welcome one, if not somewhat overdue? However, these encouraging and upbeat pointers can only be achieved if the unions get themselves involved in equal terms right from the beginning, otherwise employers could try to do things without the unions. As stakeholders like ‘Solidarity’ state I think that there is indeed a risk that social partnership may be used to try and undermine trade union organisation in the work place. Employers could potentially claim that they can have a partnership directly with their staff and do not require the union’s participation. If the unions are excluded in this way then not only could there be disastrous consequences for union members but social partnership will not work for employers either. Partnership can only be successful when employees as partners are properly supported and resourced through a dependable trade union. To illustrate this point further, let us consider what may happen if the retail sector tried to introduce partnership without trade union involvement : Most employees in this sector work part-time. There are increasingly complex and unsociable working hours in retailing which in turn means that most employees may have very little contact with anyone beyond their shift. In these circumstances employees have less of an opportunity to form a collective view. Simply meeting together can be extremely difficult in such organisations, let alone having the resources and confidence to develop their own ideas and concerns. Therefore it is clear that in most cases employees are unlikely to become equal and effective partners when they do not have the time or the means to generate their own agenda. A dependable and experienced trade union means that employees can enter into partnership properly supported and resourced. To achieve this, a real commitment is required from employers to supporting trade union membership, as the best way for their staff to be given a voice and more importantly the confidence to use it. Basically partnership needs partners. But how will social partnership actually change things in real terms for employees and the unions? By answering this question I will hopefully be able to assess if social partnership is a viable way forward in the new millennium. Firstly, unions need to take a positive approach, for them social partnerships should be about: Co-operation, not confrontation. Improving the quality of working life. Employers listening to and respecting unions and vice versa. Employees developing their own agenda through their trade union. If they agree on the above terms then hopefully it will mean: Moving away from the common practice of the union only talking to companies once a year. At the moment, even with companies with whom there exists a good relationship, unions often only talk to the organisation at the time of the annual wage negotiations. Many unions feel that the annual wage round sometimes becomes a little tired and predictable, with companies offering the lowest increase that they feel they can get away with. However, partnership is different. For the unions, it means talking to companies throughout the year. It means having a constant dialogue with employers about what is happening at all levels of the company. It should also mean that the union is consulted on a wider range of issues. Companies are used to contacting unions when they are implementing redundancies or sell offs. Mainly because there is a legal obligation on them to do this, but unions have not in the past been consulted on the overall direction of a company or about strategic decisions that may affect employees. A Social Partnership means that the union should be consulted on a far wider range of issues than they have been used to. It means earlier and better consultation sessions, theoretically no more being told about something when it has already been implemented.

Response paper Essay Example | Topics and Well Written Essays - 500 words - 7

Response paper - Essay Example The entire discussion would have ceased to exist and this would have meant serious problems for the debate that stems here. Since God is all-powerful, all-knowing and completely concerned with justice and the well-being of human beings, He knows for sure what men and women would ideally want within their lives and how the same should be given to them – either abundantly or in scarce capacity. The dictum that surrounds around this philosophy is one which points out the suffering and evil which has started to make waves for all the wrong reasons. Ideally this was something that should have been avoided yet the same does not happen because individuals hailing from any society of the world are bound to go wrong in their actions, behaviors and the thinking ideologies that exist within their aegis. If God created all the good things on this earth, He surely created the wrongdoings and evil as well. He knew it beforehand that man would have to choose on his own which route to adopt a nd which way forward is his success destined. This is in line with the understanding that God has been kind to everyone and gives His people a chance to showcase who they truly are and how they can represent their best selves to their maximum possible levels. My friend is acting as the devil’s advocate and is defending the notion that evil has been made present because it is an opposing force and acts parallel with God, which for me is simply an unacceptable entity. This is because I do not see any other being to be as powerful or even coming anywhere close to how God performs on a daily basis (Peterson, 1998). There could be high-tech robots in place, superficial structures and evil factories giving their best, but there cannot be another God in this world. It has to be felt in a much higher stead to make sure that evil is there of God’s own making and not

LAN Essay Example | Topics and Well Written Essays - 2000 words

LAN - Essay Example The justification of the selected computing devices and the network equipment is required. The second step includes the network design. The design will clearly identify, floor connections, office connections, servers, workstations, printers, scanners and cable types. The third step is to implement a Wide Area Network (WAN) to connect other locations or Internet connectivity. 2 Network Pre requisites 2.1 First Floor The first floor includes Administration, Staff Office and the technical staff. The staff office will access the file server which is the ‘Students notes distribution server’ for uploading notes. Students are facilitated at the same time for downloading the notes. The lecturers will connect their laptops with the wireless access points installed equipped with the new 802.11n technology. Since the requirement of high bandwidth multimedia transmission is increasing, improving the (QoS) (Quality of service) is essential. A comprehensive illustration of Quality of services is available on network dictionary as â€Å"Quality of Service (QoS) refers to the ability of a network to provide higher priority services, including dedicated bandwidth, controlled jitter and latency (required by some real-time and interactive traffic), and improved loss characteristics, to selected network traffic over various WAN, LAN and MAN technologies.†.Keeping this in mind a new technology 8.2.11n is introduced by the IEEE (Kuo 2008). For keeping the network robust and efficient 802.11n protocol provides comprehensive support for voice and video services (Cai, Ling et al. 2009). These wireless access points are connected with a Cisco switch. For providing security, Virtual local area network (VLAN) is the best match for this scenario. The VLAN will split all domains for better administration, management and security. VLAN uses encryption techniques for transmitting data over the network. Access policy list is configured in the router for defining the rou tes. The router processes the data packets based on parameters. Internet protocol and subnet is the composition of the router to handle the routes on the destination. The policy for lecturers is to access to the file server, printers and email server. In this way, data transmission from the educational domain is secured. No one can determine the wireless network because only lecturer Internet protocol pool is allowed to communicate. If anyone tries to access the wireless network from outside, he or she is prompted to enter the Wired Equivalent Privacy key (WEP). A good illustration of WEP is available in the network dictionary which says † Wired Equivalent Privacy (WEP) is a security protocol, specified in the IEEE Wireless Fidelity (Wi-Fi) standard, 802.11b, that is designed to provide a wireless local area network (WLAN) with a level of security and privacy comparable to what is usually expected of a wired LAN.† WEP provides security by an encryption algorithm. No one in the school can access the wireless network or the lecturers system. An additional Cisco switch installation has been proposed. Although one access point within a range of approximately 200 feet is enough for connecting 253 laptops. The staff can access the printer on the network. The printer is shared on the network and is visible at â€Å"My network places† in case of Microsoft operating systems. The requirement for the administrative staff is to access the email server,

Role of the Family Nurse Practitioner (FNP) Essay

Role of the Family Nurse Practitioner (FNP) - Essay Example Sherwood (1997) tells us that environments are still somewhat restricted and that practice varies from state to state which causes some difficulty in efficient use of the NP where needed. The University of Texas Health Science Center defines Advanced Practice Nursing as "as a registered professional nurse who is prepared for advanced practice by virtue of knowledge and skills obtained through a post-basic or advanced education program of study acceptable to the State Board of Nurse Examiners"(Sherwood, et. al., 1997 pg3). The FNP is qualified to be the first person seen on entry to the healthcare system. This is usually client oriented and comprehensive, allowing for a continuum of care based on the collaborative practice studied and provided by the FNP. The focus of the practice is wellness and maintenance which allows the client to see the same practitioner longer before having need to be referred out to a specialist. Alternatively, Bennett defines a FNP as a healthcare professional who works directly with families and physicians to provide the best level of care. FNP's differ from physicians in that they practice in many settings. They possess advanced Masters level nursing degrees which has provided them with special training and experience to assess, treat, counsel, and monitor patients. They perform a collaborative practice in which they work with healthcare professionals as a team. They are able to order testing, refer patients and treat non-life threatening conditions (Bennett, 2004). The Texas Board of Practice on this same thought states that the APN acts independently and/or in collaboration with other health care professionals to deliver health care services (Texas Board of Practice, Section 221). They accordingly accomplish comprehensive health assessments with the goal of managing common acute illnesses, appropriate referral, managing chronic conditions that have remained stable. In t his description there are included; Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Midwives and Certified Nurse Anesthetists. The role originated in the University of Colorado in 1965. In 1974 the American Nurses Association published educational guidelines for credentialing of a NP. Since then, there have been many changes in the program and of course since there are so many types of programs available, there are concerns as to the quality and effectiveness of those programs. That curriculum includes advanced physiology, pharmacology, and clinical practice emphasizing a particular role. Texas strengthened even more of the program in the sense that they increased content for path physiology, pharmaco-therapeutics, practice roles, and preceptorship (Bennett, 2004). In most cases, registered nurses are required to obtain a Masters degree in nursing and have at least one year of RN experience before they are allowed to enter a Nurse Practitioner program, however, that is not always true. Nurse Practitioners can come from a variety of backgrounds. There are programs that admit students into graduate study without prior experience as a nurse. When that happens they must have a Baccalaureate in a field other than nursing and are required to complete an accelerated program which incorporates a Bachelors in nursing going straight into a Masters level NP program (Rich, Jorden, &

FDI attraction in Chile Affected by the Country's Socio-Economical Essay

FDI attraction in Chile Affected by the Country's Socio-Economical Inequality - Essay Example In 2006, the nominal GDP per capita of Chile was recorded as the highest in Latin America. The country however is undergoing a lot of economic inequality (Trading Economics, 2013b). The socio economic inequality is the gap between the rich and the poor. The income difference of a group of individuals, society or the residents of a country is called the socio economic inequality. The economic inequality varies by the economic structures of the countries (Mankiw, 2009). According to several economists the inequality of the distribution of wealth is very essential. This improves competition and increases the efficiency of the individuals. The wealthier individuals tend to save more and spend more which helps the economy in growing. Inequality amongst the individual also increase the social and health related problems of the individuals. The economic growth of a society is also affected (Froyen, 2009) The social inequality has a direct impact on the social cohesion of the individuals, th e population’s productivity and crime rate of the society, cultural and civic participation and economic welfare as a whole (Wessels, 2000). The analysts such as Martinez (2011) are of the view that high growth rate is no excuse for the economic inequality. According to a recent report about three million Chileans are very poor. About 500,000 of the people of the Chilean population are those who are extremely poor. The economic model of Chile and the progressive growth which the economy has shown with time is sufficiently appraisable but still the growing inequality in Chile has caught attention of various economic analysts. Chile is categorised amongst a few countries which have a worst income distribution system. The percentage of the poor population is very high in the economy (OCED, 2002a). According to OECD (2002b), Chile is a nation of population of more than 17 million people. It comes under the category of developed countries and has the worst income distribution syst em amongst those countries. Several economists are of the view that the economic system of Chile would not improve by the economic growth. To improve the economy’s income distribution the government would have to take decisions to redistribute the wealth of the individuals by placing higher taxes. Another economist was of the view that Chile must focus on economic growth and nothing else. The increase in the level of the per capita income of the individuals will surely increase the well being of the individuals. The person who is a resident of Chile and lives on less than $64,134 pesos (US$135) per month is considered to be poor. But a person who lives on less than $32,067 pesos (US$67) monthly is considered to be destitute, according to the official data (Martinez, 2011). A few of the economists are of the view that creating opportunities is a part of the economic growth. Those who are utilising that opportunity are competent. For the incompetency of the rest of the individu als it is unfair to impose taxes and burden those individuals who prove themselves and are the contributing factors fro the economy. ETHICAL FAMILY INCOME TO IMPROVE SOCIETY Felipe Kast, minister of planning for Chile called the ranking by the OECD (2002b) report â€Å"shameful for its levels of inequality.† He added that Chile has plans set in line to take the people out from extreme poverty. The government plans a program of IEF – Ethical Family Income which will use a series of bonds and cash incentives for the children

Keeping the elderly in their home vs nursing home placement Essay

Keeping the elderly in their home vs nursing home placement - Essay Example vels of investigation, the major concerns emerge in terms of public health care and questions of whether the individual or government should be responsible for funding nursing home residents. Achieving a substantial approach to the question of nursing home care will aid the nation by contributing to socio-political debates regards health care costs. One organization that supports this issue is the National Family Caregivers Association. This organization greatly considers the importance of supporting individuals that aid people in at-home living situations. One of the major things I learned in researching this subject was the strong change that has occurred for at-home care. With technological advancements, seniors now have many increased options for caregivers and other such aid that allow them to refrain from nursing home care. Prior to the investigation I would have further question cost issues between caregivers and nursing

NASAs Space Infrared Telescope Exploring Essay Example | Topics and Well Written Essays - 500 words

NASAs Space Infrared Telescope Exploring - Essay Example I also read about how supernovas, also known as exploding stars, combine with other materials floating in space to form planets and new galaxies ("Life and Death", 2004). These concepts kept dancing around my head and made me wonder about finding life on one or more of these planets or galaxies. Earth was created in much the same way. Scientists are theorizing that the same icy organic materials visible for the first time with the assistance of Spitzer was how our planet came to have so much water and the beginning of biogenic materials from which to begin the process of life here on earth ("Spotting Life", 2004). Spitzer found an interesting clean gap behind a star called CoKu Tau 4, which is 1million years old, only 3 billion years younger than Earth. A planet orbiting CoKu Tau 4 could cause this gap. A planet Spitzer is not able to discern this planet, however, what if this is a younger version of Earth What if all of the carbon-based, life-enabling materials are available for this planet circling CoKu Tau 4 to create life from What if future manned explorations travel to this star system and encounter life What would life be like How would NASA and the world respond What if instead of being carbon-based, these life forms were methane based A recent article on Universe Today, that spoke of lake on Titan, Sa

Communication journal Article Example | Topics and Well Written Essays - 1000 words

Communication journal - Article Example The leader is also important in ensuring that that communication within the group is effective – that there are no elements of dictation from them or other group members. The leader also serves the important role of facilitating the process of designing and meeting objectives and the course of action, so as to get the response expected from the audience (LaFasto & Larson, 2001). b). Establishing an agenda on how to meet the goals of the group is also very important to the success of group presentation, as the agenda defines the clarity of the group’s goals. Through establishing the agenda, the group is able to narrow down to the areas that are important for the presentation and the expected results. Through the agenda on meeting goals: the leadership guides the actions and the preparations of the group, to ensure that they fall within the range, which counts towards the realization of the goals. Through establishing the agenda, the group gets a sense of direction, givin g preference to areas of priority and areas that should be addressed first. Through the agenda, the group is able to tie down all individual presentations into one whole, to ensure that there is coherence in meeting the set goals. Through establishing the agenda, unifying elements become evident, from the overall scheme and it helps develop the link between the different elements. From doing this, the entire group develops an understanding of the role to be played by each member – towards meeting goals, and that the individual roles blend together to form the desired discussion. Establishing the agenda guides group preparation, helps in giving rehearsals a sense order, and the links between introductions and transitions are established. Through the agenda, reflection is directed towards different aspects of presentation (LaFasto & Larson, 2001). c). Encouraging group members to express their opinions and to ask questions is very important, as the core aim of group work is to promote the development of a range of skills, including communication and interpersonal skills. Through encouraging the members to express their opinions and to ask questions, their input is captured, and their contribution towards the success of the group’s goals is guaranteed. Under ideal conditions, the group’s presentation should incorporate the input and the participation of each member, which can only be guaranteed through incorporating the opinions of the different members and addressing their questions, so that they do not weaken the entire presentation (LaFasto & Larson, 2001). d). Encouraging group members to know one another is somewhat important, as group presentation do not fully rely on the personal interaction existing between members. For instance, multinational congresses feature presentations, where different members of the presentation group have not met, but it is important that the boundaries of their presentation are clearly defined. However, know ing one another is important, as it can help in assigning different roles to members, responsibilities and presentation areas that are favored by the skills they posses. For instance, technical areas of the presentation are better presented by members who have background knowledge in technical concepts. However, the

Globalism and increased Essay Example for Free

Globalism and increased Essay With the current trends that prevails within societies, globalism and increased connectedness has brought about considerable advantages for people to move and transfer from one destination and culture to another. The patterns then of ethnoscapes transcend to create better means for analyzing the role of individuals in the socialization process. Seeing this, such dynamics then becomes crucial as it shapes the dynamics of the social realm by tapping into social networks, connections, and brings about a new definition and meaning on how people perceive reality and the physical boundaries that bind people together. Applying the principle of ‘ethnoscape’ in my artwork, it can be argued that it seeks to complement the themes provided by the term. In particular, the two females in the picture demonstrate the connections and scope of how the process can be applied in the way people view the world today and its associated realities (Nowakoski, p. 1). The two females then justify the existing perspectives of how one can now transcend over common boundaries and become vital instruments in the development of an ‘ethnoscape’. To better understand this transition, it is first important to look at the woman in the background and determine her relevance of how the term ‘ethnoscape’ is applied. Here, it can be argued that the symbolism of the woman facing backwards and in fetal position exemplifies the relative constraint felt by people to move. There are specific boundaries that bind the woman to exhibit herself and become a vibrant individual in her own right. This analogy can then be related to the trends of the past, where common ideas of nation and government are dictated by the sovereignty and geographical proximities and boundaries of a given land. Here, the meaning of location and place denotes not where the people are but rather the particular standards and norms that derive the place as is (Nowakoski, p. 1). These constraints in meaning then emanate in the woman as she herself feels enclosed with what she has. In addition, she has a fixed boundary that is mandated by the location she is in. On the other hand, the foreground picture of the naked woman demonstrates the liberation from the traditional meanings of place and territory. Here, she portrays the idea of today’s ethnoscape where one is liberal and free to choose wherever she wished to go. In a way, this creates appropriate features as it allows the formulation of what she really wants. These in turn are not limited to the idea that she can only create networks via the use and application of place but rather transcend over territories and debunking the meaning and control that place-based networks have over individuals (Nowakoski, p. 1). Overall, the artwork is a depiction of a woman’s transcendence from the common boundaries dictated by location to a more connected and opens means to create networks and affiliations. Here, the idea of ‘ethnoscape’ becomes applied as it showcases the ability of the woman to recognize her abilities and not limiting her roots to mainly the geographical and land boundaries that bind people together. Work Cited Nowakoski, Pete. Transnationalism and Globalism. 1996 accessed 9 August 2010 from, http://english. emory. edu/Bahri/transnationalism. html

Likewise the conclusion of my research Essay Example for Free

Likewise the conclusion of my research Essay I would like to study and research about Japanese business culture and Japanese way of making decisions, and analyze them. Every country’s business culture has always close relationship with its own culture, so I have to approach from Japanese culture to business culture for clear understanding. Also, I compare and contrast them with Korean business culture and decision processing. The approach would be Japanese business culture from foreigner (who understand Japanese culture)’s point of view, and analyze it if pros and cons exist. To observe Japanese business culture closer, I am willing to join Japanese company through internship or part-time job. These methods will make me experience the culture and decision process. At the same time, I can immerse myself to the organizational culture it promotes and how the management goes about on processes and ideas. Likewise, by reading a lot of case studies, it can help me to define and develop my research. Moreover, I will compare and contrast how Japanese and Korean companies go through this worldwide recession, not by countries’ policy, but by companies own policy. The company’s result and plans to mitigate the current recession will teach me lessons concerning efficiency and effectiveness. As far as communication and interaction is concerned, I will use a lot of observation and interviews with native Japanese people. Therefore, it is important that I enhance my Japanese language skill so that I could communicate profoundly with Japanese business people and understand Japanese culture better. This is essential in my research so I can actively get the needed information that I want. To conclude my research, I shall try to maximize the information gathered in my selected Japanese company and compare it accordingly to my selected Korean company counterpart. I wish to see that there are traits and cultural aspects of Japanese culture that are embedded in its organizational culture. There are specific factors that affect the company to make decisions and strategies accordingly and proved to be successful in addressing the problems and issue. Likewise, the conclusion of my research will highlight the similarities and differences between the organizational cultures of Japan and Korea. Under this framework, there are several traits that shall be given to fully understand how each mindset of such company operates. Lastly, the conclusion seeks to address the limitations of this study and what it has failed to address during the course of interview and analysis.

Movie Analysis Of Braveheart Film Studies Essay

Movie Analysis Of Braveheart Film Studies Essay Some movies have big war scenes with huge musical scores to reflect the big action. One of these film is Braveheart. William Wallace, played by Mel Gibson, is the central character and hero of the movie. He is the motivator of men. He is a leader of men. He rallies his Scottish countrymen to his belief that the English had to be fought and Scotland had to be independent. This film has some huge battle scenes of men fighting hand to hand combat. These scenes are so realistic and dramatic for me to observe to give me a feel of this era of history when war was fought man-to-man. William Wallace is a courageous and heroic figure in this film. He is the one who believes in an independent Scotland and desires to remain free from the English influences from the south. He wants the Scottish to retain their own ways, their own beliefs, and their own cultural traditions separate from the English as long as possible. This movie was suspenseful, dramatic, and entertaining for me from start to fi nish because of my respect for the central character and hero, William Wallace, as well as the great musical score to reflect the themes, characters, and plot lines more powerfully. The music for this film is essentially designed to reflect the characters and the plot line. The long warring history of England and Scotland is an important part of the background story to this film. Some of the subtitle text provides insights into this era of time and the background of the relationship between the two peoples and the two kingdoms. The Scottish and English have never really been at peace with each other over the political authority over the territories that comprise Scotland. Even today, there could be debates and disputes found in the pubs in Scotland and England over exactly what the nature of their past relationship is and how it affects their current political relationship. This film provides a living history lesson to that past time period when the Scottish and English warriors fought it out over respect, integrity, and the willingness to lay everything on the line for freedom, independence, and separation from each other. The musical score reflects these theme s as the heroic music is felt when Wallace and the Scots are doing their thing, and the tension and oppression of the English is felt when they are present and especially when they are winning the battles. The Scottish spirit and temperament of this older time period is clearly represented in the films hero, William Wallace. The music attempts to amplify and magnify his heroic qualities. He is played by famous action hero actor, Mel Gibson, who provides this character with relentless, courageous energy and emotion from start to finish. William Wallace is able to lead his Scottish men into battle with exceptional courage and leadership capabilities. Wallace knows how to give his warriors a serious motivational speech before these battles where the Scottish usually are underdog and at much lower odds to win against the usually superior English in regards to military manpower and military weaponry. Wallace is always fighting undermanned and with less weaponry than his English opponents. Yet, at the same instant, Wallace is fighting with his men for higher, spiritual causes and reasons that put their English opponents often at the actual disadvantage. This motivation and spiritual upliftin g energy personified in this central character, William Wallace, is the driving force behind the films plot and battle scenes. The musical flourishes are always important. The music dominates the action. The music is suppose to make us in the audience feel the action. Wallace makes his men and himself believe that they are capable of taking on any opponents force of any size and greatness and defeating that opponent because of their brave hearts. Thus, the music indeed reflects the central theme in this film about English-Scottish history and their long legacy of fighting and warfare that the men with the braver hearts usually won over the men with the better weapons and greater numbers. Because the combat was face-to-face, hand-to-hand, the men with the braver hearts would ultimately achieve victory. The heroic traits of these men are clearly reflected in the intense musical score. William Wallace was aware of thus all important factor of the brave heart when motivating his warriors to fight it out with a more powerful foe. Wallace understands that the brave hearted men in his Scottish forces are going to out fight and out last the English soldiers and warriors as the battles drag on. Wallace knows this is a war that has to be won on the spiritual level first and foremost to be able to achieve victory on the battlefields. This is war that needs to be taken to the next level spiritually and idealistically so Wallace can motiv ate his Scottish men to believe in themselves no matter how bad it gets and now matter how close defeat approaches. This is a war that William Wallace believes that the Scottish have to will themselves to victory through their brave hearts. Thus, the musical score in this film was very important for understanding the central character, William Wallace, and his range of emotions from high to low, from good to bad, and how he was always trying to bring out the best in his men. He is able to be the person who can really be a hero and the musical score was able to reflect these heroic qualities, especially the music during the battle scenes. Film No. 2 Babel The music is exotic in this film because of the fact that the central characters in this film are in four different places and settings simultaneously. One of the central characters is Richard. He is the wealthy white American man who has taken his wife to Morocco to save their marriage. Another central character is Richards nanny, Amelia, who is charge of the two children back in San Diego. A third central character is Chieko in Tokyo, Japan whose father is the one who originally gave the hunting rifle to a hunting guide during a Morocco hunting trip in the past. A fourth set of central characters are the two brothers, Ahmed and Yussuf, who are sons of a goat herder in charge of the goats and shooting jackals with the gun their father Abdulla purchased from Hassan the hunting guide for a good price. These central characters are all in motion at four different places and settings simultaneously. The director does an excellent job in painting the musical score the right way for this p lot line, the character development, and the overall mood of the film. The Morocco setting to start the film offers some traditional music from this region that really does bring an exotic mood to the opening. The two young brothers, Ahmed and Yussuf, are really doing what kids do when given the responsibility of a loaded gun. These young brothers begin daring each other to try shooting things with it besides the intended jackals as their father desired. The two brothers begin shooting at targets to test the gun. Ahmed then turns and shoots at a passing car down on the mountain road. Yussuf, who is a much better shot, takes the gun and shoots at a tour bus coming down the same mountain road in the distance. The boys dont think nothing happened at first, but then the bus slows to a stop. The boys take off running as fast as they can and become worried sick about the accident. They know that someone was probably injured or killed by the gun shot fired by Yussuf who had a good aim too. And they hide the information from their father Abdulla at first becaus e of the great fear of getting caught. This secret becomes even more significant when Abdulla at dinner reveals that an American tourist had been shot on a tour bus in their area. This is something that strikes great fear in the hearts of these two young brothers. In turn, they want to make sure they dont get caught for it. These decisions are typical of two young brothers who look out for each others back. Yet, when the police investigator comes up the driveway when their father is not around, the boys lie about the location to buy more time for themselves and to permit them the opportunity to tell their father. This tell-all to the father becomes a bad time for the brothers as they fight, turn on each other, and become bitterly mad at each other. The father fears their safety and decides to flee with them and the rifle. The music in the sequence featuring the father and two brothers is very moody and exotic in quality because they are mountain dwellers who live very simple lives. Yet, they are suddenly wrapped up in this awful tragedy. The traumatic sequence in the film featuring Richard is something that is suspenseful, tense, and tragic in tone and implication because of the musical score accompanying his presence in the story line. The continuous fear in him that his wife will die from the gun shot wound to her neck without any proper medical aid on this village mountain top in Morocco. Richards character goes through so many different kinds of emotions during his ordeal waiting for the medical helicopter. He has to forge trusting relations with Moroccan villagers, including the village healer, as well as relationships with his fellow bus passengers for a time period to try to get them to see his predicament and his tragedy from his shoes. Richard is a master at getting people to feel like he does and have empathy for his position in this ordeal. The character of Richard teaches us in the film audience the terrifying situation of being face to face with a tragic loss of a loved one. At many points, Richards wife seems ready to die. This constant on the edge of his seat about her death makes him reflect on many things in his life. He becomes a different kind of man than he was before this shooting incident occurred. The music is tense, moody, and changing all the time during this back and forth situation with Richard and his injured wife. The villagers are trying to help them but they dont have the medical technology necessary to save her. The music becomes sorrowful as Richard faces the reality of her impending death coming soon. The central character of Amelia, Richards hired nanny, is another intriguing person for us in the film audience in relation to music and her character development because of her risks and boldness of personality to take Richards children without his permission to her sons wedding in Mexico. She will not miss her sons wedding no matter what she has to do. These white children are very reluctant to go to Mexico. They are socialized to fear Mexicans and Mexico itself. However, in the sequences of the wedding and wedding celebration, these two white children become happier and more relaxed the more fun they start having with the Mexican children their same age. The music in this sequence of the film is very important and it reflects the good time everyone is having. This is probably the most important musical section in the film. Film No. 3 The Color Purple In watching this film, The Color Purple, my awareness and knowledge of the struggle of the African American people in the Deep South earlier this century was increased significantly. This films sets, background scenery, music, and characters were all arranged to bring the most dramatic effect on us in the audience. The excellent performance of the actors and actresses was critical to understanding the plot and action, but the musical score provides the emotions and pain felt by these characters. The protagonist, Celie, is a poor woman with little education who at age fourteen is sexually abused and impregnated by her own father, Alphonso. After she is moved out of her family home, she is forced to marry this widower with several children. This husband is called Mister throughout the play. Celie has to deal with physical abuse from him as well. This play is about Celies development from a naà ¯ve, uneducated woman to a courageous, individual woman who stands up for herself. This musical score in the early part of the film is a tragic one which gives us a feeling about Celies character. She is facing such awful things and her life is affected by it. The music becomes stronger as Celie learns to stand up for herself and become a stronger person because of two strong women, Sofia and Shug Avery. These two women prove to Celie that she as a woman must sometimes stand up for herself. For example, in one scene, Sofia, who is Harpos wife, is fighting back with Harpo. This display of courage and strength by Sofia impresses Celie. In another scene, Shug demonstrates her courage to speak her mind and convey to Celie that a woman can be an independent, fearless creature when wanting to be. In this film, Celie learns from Sofia and Shug how to be an adult woman. Sofia provides the toughness and courage displays against her husband Harpo that impress Celie and make her recognize her need to be more like her. Shug ends up becoming Celies lover who shows her the joys and pleasures of enjoyable sex between two women which is the opposite kind of sex from what she gets from her husband called Mister. Shug is actually Misters mistress who comes to live in the household because of poor health. Even though at first Shug is very mean and aggressive towards Celie, the two women began to have a sexual attraction for one another. Furthermore, Shug remains in the household to help protect Celie from Misters physical abuse. This friendship blossoms into a love relationship which is a central part of the whole play. Celie and Shug are doing the unthinkable for two women living in the same household supposedly both lovers of Mister. These two women are having a lesbian love affair right under the nose of Mister. The musical score during their sexual moments and love moments is very important in the development of Celies character as she learns to really care about someone else, Shug. This is a dramatic part of the play because of the forbidden nature of it. I thought the performances of the two actresses for this key scene in the film when the friendship turns into a love affair was excellent. I was on the edge of my seat wondering what was going on. Yet, in a sense, this is what a great film is all about and the music fit the scene perfectly. Celie and Shug have crossed a forbidden line in Misters household. He has no conception that these two women would be doing this behind his back. He doesnt have a clue but us in the audience know exactly what is going on. Music plays an important part in this film in developing the realtionships among the characters. One of the more important relationships for Celie that doesnt emerge until the end of the play is with her sister Nettie. Celie has long thought that Nettie may be dead since she never received any letters from her. Celie is introduced to lost letters from Nettie to find out that her sister isnt dead but has traveled to Africa with some missionaries and returned. This discovery empowers Celie to think that her sister was alive the whole time. The musical interludes are very important to show the hopeful mood of Celie. The empowerment from getting to know herself also has something to do with her confronting her abusive husband and telling him off for the years of abuse she endured. At the end of the film, Celie feels her empowerment and independence as a woman. She has the courage to move to Tennessee with Shug Avery and another woman to begin a profitable business sewing tailored pants. Upon her return to Georgia, she has inherited a lot of land from her stepfather and her husband, Mister, has reformed his ways. In the very end, everything comes to right order and Nettie and Celie are reunited. The music plays out in a happy manner and the film brings these two sisters back together in a happy reunion. This is an interesting film experience for me because it makes me understand the hardships and struggle of the poor black women of the earlier part of this century in the Deep South. Celie, the protagonist, was an interesting character who had to endure so much pain and so man problems in her life as an African American woman. Although she finds her own identity and empowers herself through her following the two role models of Sofia and Shug, the pain is evident in most of her situations. The musical score was very important for her character development.