Epidemiology and Surveillance Essay Example for Free

Epidemiology and Surveillance Essay Scott L Tomar, a profession at the University of Florida describes public health surveillance as the ongoing systematic collection, analysis, interpretation and dissemination of data regarding a health-related event for the use in public health action (Tomar, 2007). The information collected from surveillance is implemented in planning, evaluating and to put together research hypothesis (Tomar, 2007). He explains that this surveillance contributes and aids in the decrease of not only morbidity and mortality, but also the supervision in health improvement. Surveillance is a component of communication and organization for monitoring and preventing diseases and illnesses. The United States does not have a surveillance program in place for periodontal disease. It is not being monitored state, country wide or even locally. These systems have been used for decades for other diseases; fortunately periodontal surveillance is just in its beginning stages. The Association of State and Territorial Dental Directors and the centers for disease control and Prevention’s Division of Oral Health created the NOHSS, National Oral Health Surveillance systems. This program assists in monitoring and determining the responsibility and/or consequence of oral diseases, delivery system and the water fluoridation at state and national levels. NOHSS also has implemented signs to look for in the surveillances which are, adult dental visits, tooth cleaning, tooth loss, fluoridation status, child caries experience, child untreated caries, dental sealants and cancer of the oral cavity and pharynx (Tomar, 2007). The risk factors for periodontal disease according to the NIDCR, National Institute of Dental Craniofacial Research are smoking, hormonal changes in girls and women, diabetes, diseases of cancer or aids and their treatments, medications, and genetic susceptibility. If these factors would be monitored and put into a data base this desased can be prevented or treated more accurately. It would minimize the adverse affects or health risks it can cause to the population. Surveillance can measure what is orally, to be more exact periodontal with the population. The future of the treatment and prevention of this disease can benefit from search and awareness of the problem. Surveillance can obviously help reach this goal. Once all the factors, information and data are collected and analyzed by the surveillance dentist, hygienist and oral surgeons can be more informed and educated about this growing problem. The Centers for Disease Control and Prevention (CDC) has partnered with the American Academy of Periodontoly to initiate the CDC Periodontal Disease Surveillance Project. This project concentrates on population-based surveillance at all levels. Surveillance has improved tremendously and has developed valid self-reported This initiative has made significant advancements toward the goal of improved surveillance, including developing valid self-reported measures that can be obtained from interview-based surveys to predict prevalence of periodontal issues in populations. The project’s goal is to confirm and find validity These eight questions will be field tested in the United States population in two phases. As noted in the article, a pilot will use a small convenience sample of United States subjects to lay the groundwork and justify further testing of these questions in a national survey. The key objective of this pilot phase will be as follows: 1) to confirm that these questions, or a subset of them, have sufficient validity for predicting periodontitis in this sample of the United States population; 2) to determine whether non-response rates to these questions differ among racial/ethnic groups; and 3) to assess the logistical aspects of conducting the pilot. I am a firm believer that surveillance should be used on many aspects of public health. Your health is determined not only by your own genetics and personal choices, but also by the environment around you. We all strive to live long, healthy lives and where we live, work and play affects our health. If you care about your health, the length and quality of your life, and the health and lives of your friends and family, then you should care about public health and the one week out of the year dedicated to bettering the lives of you and your surroundings. Surveillance makes it easier to view ones surroundings.

Shell’s strategic position in the light of its external and internal environment

Shell’s strategic position in the light of its external and internal environment Shell Strategic Analysis The paper analyses Shells strategic position in the light of its external and internal environment and the key forces and pressures acting on it. The paper takes an overview and then uses PESTLE, SWOT and Value chain analysis to provide a strategic insight of the firm. PESTLE; SWOT; Value Chain Analysis Shell Strategic Analysis Introduction and Company Overview Shell Group provides energy and petrochemical services across the world. With its headquarters in Hague, the Netherlands, and largest subsidiary in the United States, its mission is to position its self as a global leader in the oil and gas sector with a superior competitive advantage in terms of meeting energy demand responsibly. Shell Group belongs to Royal Dutch Shell Plc, based in Wales and England (Shell, 2010 [online]). Its upstream strategy focuses on the exploration of new natural reserves of oil and gas and investing in projects to gauge technological and know-how value-added advantages. As for the downstream strategy, the company selects growth markets to invest in and uses existing assets to acquire consistently high cash returns (Shell, 2010 [online]). Performance focus, growth delivery and new project plans form its strategic framework with strong priority given to competitive performance, profitable growth and sharper delivery. The group operates in more than 90 countri es with over 100,000 employees and 44,000 service stations. Shell has the share of 2% in the global oil market and 3% in the gas sector. In 2009, its earnings were $12.7 billion which fell sharply from 2008s $27 billion figure (Shell, 2010 [online]). The paper will explore how the external and internal environments of the company are affecting its strategy and operations and overall success. Comprehensive PESTEL Analysis Political Forces As declared by EU and UN, carbon emissions are to be charged with penalties and taxes, oil and gas companies have been forced to settle government pressures through partnership agreements and alliances to support their operations by offering an incentive to the government in the form of the betterment of the economy. Oil has been found to gauge economic development of a country (BBC, 2010 [online]). Due to its intense demand, especially in the U.S, government tends to come under the pressure of the leading giants and ease strictness on them, though; they still raise questions regarding the environmental impacts but with the demand pressures from the customers, governments allow Shell and companies alike to find new reserves to meet the demands (The Guardian, 2010 [online]). However, these new means include bio-fuels which do not harm the environment. But Shell has strong reliance on oil and gas reserves and has no intention to venture into bio-fuels in future despite of all social an d political pressures. Shell has been engaged with the Climate Action Partnership with the US, as an attempt to gauge a positive image of the company in terms of a socially responsible business, while it actually uses highly carbon intensive production methods (Foe Europe, 2010 [online]).The partnership is focused towards reducing the amount of greenhouse gas emissions in the atmosphere, but while the government is going in that direction, Shell, using its strategic alliances with the government has lessened the regulatory control over its high carbon emitting fuel products. Shell has been forced to take on such diplomatic measures to ease political and regulatory pressures onto the company, when it faces a decline in the conventional natural oil reserves and has to find new alternative forms of oil reserves to meet the demand, which are more carbon intensive but allow it to stay profitable (Foe Europe, 2010 [online]). In underdeveloped nations such as Nigeria, which craving for basic necessities, welcomes companies like Shell to bring in foreign direct investment and more job opportunities. Thus, despite of social pressures to reduce exploitation of workforce and gas flares that is destroying lives, the government gives ease to the multinationals in order to support the growth of the economy (Foe Europe, 2010 [online]). Free trade agreements among the European and Americas allow Shell to more profitability engage in exports of oil. Russia is a hub of oil reserves and Shell took on the opportunity to exploit the reserves in Russia to meet the challenge of its growing demand, and its increasing lack of conventional oil reserves around the world. Russian government, previously had a high export duty on oil imports, has recently reduced it by 2.6%, which is benefiting Shell and other oil companies with their plants in Russia to export the oil products to their home countries and respective countries where they sell the fuels (Shell, 2010 [online]). Environmental Forces Conventional oil reserves are fast declining but Shell since 1995 has been engaged in finding new forms of oil reserves as oil sands in Canada to oil shale, but with the expense of environmental degradation (The Guardian, 2010 [online]). Research has shown that carbon emissions are much higher from the unconventional oil reserves being used in the manufacturing of fuel, and Shell having invested a large amount of capital in projects to extract oil from unconventional reserves has become the worlds most carbon intensive company (Foe Europe, 2010 [online]). Social Forces Oil and gas companies harm not only the environment but to the workforces as well as there are various security and health issues to consider. 20 people were reported to have died due to severe working conditions in 2009 (Shell, 2010 [online]). In Nigeria, Shells operations have been causing gas flares consistently which has caught social attention but the company is reluctant to take action due to its cost reduction strategy (Foe Europe, 2010 [online]). Globally, consumers are engaged in responsible consumption and the companies have been obliged to encourage responsible consumption (Dess, 2009). Shell took on the initiative in 2007 to advertise itself as a manufacturing facility that does not harm the environment but uses its waste (carbon dioxide) to cultivate flower growth (Foe Europe, 2010 [online]). This encouraged consumers to develop a positive image of Shell but later on, news reports on the matter suggested a different story. Only one of the plants in Netherlands was engaged in the flower growth while the rest were heavily involved in carbon emissions (The Guardian, 2010 [online]). This hampered Shells image further as not only was its accused of destroying the environment but also of misleading the consumers. Technological Forces The oil and gas industry has been benefited greatly owing to technological advancements in drilling and extraction of oil and gas. Heavy capital investments are required to acquire the advance technological equipment to extract oil and gas from unconventional reserves. Shells biggest strength is its investment in smart technologies that allow it to make the most out of the oil and gas reserves (Shell, 2010 [online]). Economic Forces Oil prices have increased the world over, which has resulted from heavy taxations from the government due to which costs of production have risen (Shell, 2010 [online]). Using extensive, costly technology which requires heavy investments, further forces the companies to charge high prices for fuels (The Guardian, 2010 [online]). There is a growing demand for energy, which is expected to rise up by 57% in the next 20 years (Shell, 2010 [online]). This becomes a challenge when there are fewer natural reserves of oil and gas left to meet this demand. Shell has used its scenario planning efforts to invest in new projects to extract oil and gas from unconventional reserves to be able to meet the growing demand in future, but this also translates to higher prices for customers (Shell, 2010 [online]). Legal Forces Environmental safety and carbon emission regulations have increased for all oil and gas companies, including Shell (BBC, 2010 [online]). With the growing concerns all over the world over the drastic changes occurring in the environment due to global warming, the government raises strong questions against major companies responsible for global warming, the oil and gas companies. Shell and BP are quite on the main screen when such allegations are put forward. Oil and gas companies are enforced with strict employment safety and health regulations as the manufacturing plants are dangerous for human health. This has a heavy cost potential for companies (Hill, 2009). Comprehensive Porters 5 Forces Analysis Level of Competition There is a high level of competition in the industry but among few players. Shells major competitor is British Petroleum. British Petroleums strategy has also been focused on acquisitions, partnerships and alliances to build up a larger framework to meet growing demand. Currently BP has acquired contractual agreement with the government of Azerbaijan and Gulf of Mexico, while Shell gauged its success in 2009 in Iraq, Canada, and Australia and also in the Gulf of Mexico (BP, 2010 [online]). The competition among these two companies is intense due to their similar strategy to obtain cost reduction, performance focus and growth. While, BP has invested in solar energy, giving in to the political, social and environmental pressures, Shell is still glued to the oil and gas reserves to stay ahead in the game (Oil and Gas, 2010 [online]). While BP has lowered its stakes by investing in solar energy, Shell is playing a much risky game by perusing new oil reserves through heavy capital investments (BP, 2010 [online]). Threat of Substitutes With the advent of alternative energy sources, the threat of substitute products has risen, such as from bio fuels. Many companies are now investing in bio fuel technologies to respond to social, environmental and political pressures (The Guardian, 2010 [online]). Threat of New Entrants Threat of new entrants is low, as it requires a heavy capital investment to set up plants and use advance technology for extraction domestically and internationally to meet the demands. There are heavy fixed costs involved in the industry which can only be curbed once economies of scale are received (Oil and Gas, 2010 [online]). Bargaining Power of Suppliers Bargaining power of suppliers is low. There are few suppliers in the industry. The industry is focused on low cost production and, thus, alternative energy sources are searched and invested in heavily, the suppliers of which are low, but under the influence of the manufacturers (Oil and Gas, 2010 [online]). Bargaining Power of Customers Bargaining power of customers is low as there are not many fuel companies available in the industry which offers conventional, alternative and bio mass fuels. Detailed SWOT Analysis Strengths Shell has obtained competitive edge in terms of technology. In 2009, it spent over $1.2 billion in research and development activities (Shell, 2010 [online]). Shell has obtained first mover advantages by using unconventional oil reserves which has given its cost benefits (Shell, 2010 [online]). The company has taken a much focused strategy for performance, which has allowed it to reduce costs by $1 billion by 2010 (Shell, 2010 [online]). Shell signed a joint venture with Cosan (S.A) Company to produce and sell ethanol and extract power from sugar cane in Brazil. The company sensed its cost benefits and its prospect to enhance its presence in the ethanol market (Shell, 2010 [online]). Shell has invested $ 1 billion in solar and wind energy which is part of Shell Renewables SBU (Shell, 2010 [online]). Shell has 20% brand preference which is the highest among its competitors (Shell, 2010 [online]). Weaknesses Shell currently has a severe lack of association with bio fuels, which are growing in demand There is also lack of substantial countering of the social pressures and the media exposures on part of Shell (Foe Europe, 2010 [online]). Opportunities Bio-fuel and low-carbon emission fuels sector is growing and is highly encouraged by the government, society and is healthy for the environment (The Guardian, 2010 [online]). Promoting a better health and safe environment in the plants is a good opportunity for Shell using commercials or public relations campaign. Threats Government and interest groups are taken strong actions against heavy carbon emitting fuel companies, like BP and Shell Heavy investments in unconventional gas reserves are full of stakes as these reserves allow for a large amount of carbon emission. This is potentially dangerous for the companys image and acceptance (Oil and Gas, 2010 [online]). Value Chain Analysis Primary Value Chain Activities Inbound Logistics Shell is currently in contract with Cosan, a Brazilian company to supply ethanol. Azherbaijan and Russian suppliers are also used to supply oil and gas reserves (Shell, 2010 [online]). Operations The performance strategy involved restructuring and reorganizing the operations of the company to upstream and downstream where priorities were towards performance focus, competitive growth and new project investments. The overall operational performance has also met with improvement as efficiency rates have rose. The reorganization will allow faster implementation of future growth strategies as well (Shell, 2010 [online]). Outbound Logistics Shell has an extensive global outbound logistics network which allows it to distribute the refined oil in the most cost efficient manner. It uses light transportation (Shell, 2010 [online]). Marketing and Sales Shell markets itself as the largest fuel provider, where its service centers are located in 90 countries worldwide. It adds the image of an innovation and quality-focused company which does not compromise on performance. Although, Shell has previously received an excellent amount of sales revenue, recently, there has been a decline, due to rise in oil prices, rising social exposure of the workforce exploitation and environmental degradation by the company (Shell, 2010 [online]). Service Shell uses its helpline service to address customer complaints and queries. Other than that, there is no extensive or special form of service that Shell offers to customers with regard to complaints and queries. Shell service stations have the direct interaction with the customers and the company makes sure that the employees address to customers appropriately and offer services in the standard way (Shell, 2010 [online]). Support Value Chain Activities Procurements Shell is now engaged in e-procurement, using the help of SAPs support systems to enhance its supply chain activities. SAPs support offers an ERP system that allows procurement to be done online (SAP, 2010 [online]). Technology Development Over $1.2 billion have recently been spent by Shell in research and development of new technologies to gauge the most benefit out of the reserves of oil and gas and find new opportunities for investments (Shell, 2010 [online]). Technological innovation development in extracting energy is a key strength of the company and it is continually engaged in investing in new technologies that would give it an edge over its competitors. Human Resource Management Human resource activities are the most challenging for Shell as it has to face several employment issues starting from health, and work environment to safety issues. These are true for factory workers who work in high danger zones (Shell, 2010 [online]). In Nigeria, a high rate of people dying in the factory has become common. As shell is a global competitive company, it seeks highly talented and experienced people who seek innovation and growth for the company for its management. Shell offers learning and development opportunities for its diverse workforce. It offers monetary and non-monetary forms of incentives to employees (Shell, 2010 [online]). The human resource management uses online application system for interested candidates and uses simulation based testing tools for hiring appropriate employees for middle management and senior management posts. Firm Infrastructure Shells infrastructure is heavily reliant on technological support, by means of ERP, data management, research and development, marketing, procurement, human resource management, extraction and production operations (SAP, 2010 [online]). This allows a strong network of coordination and communication to be maintained globally. Conclusion Shell Group with industry leadership in terms of cost, quality and technology, is faced with immense social, political, economic and legal challenges. Its strategy to focus on performance, new ventures to exploit unconventional oil and gas reserves and achieve profitable growth in return has met success, but the pace has slowed due to economic influences. for big oil giant like Shell, keeping diplomatic alliance with the governments of many countries has become common but this not something to rely on and to put heavy capital investments at stake like Shell is doing right now, by continuously investing in new plants for oil and gas extraction from unconventional reserves such oil sands and oil shale. Such attempts are increasingly causing environmental degradation and the government may go strictly against them in future once more drastic environmental changes become dominant. Clever strategy is to continue ethanol and solar and wind energy production and invest in more bio fuel ener gies to tap new opportunities.

Asthma :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  Asthma is a chronic illness that affects many people. Asthma affects approximately 155 million people around the world. The pharmaceutical industry approximates $5.5 billion in sales for asthma medication per year for a condition that is incurable.   Ã‚  Ã‚  Ã‚  Ã‚  Asthma is an inflammatory disease of the airways. The narrowing of airways occurs due to inflammation and excessive mucous secretion. The constriction of the airway gives rise to common asthmatic symptoms of wheezing, coughing, tightness in the chest, and shortness of breath. The usual form of control for asthma is bronchiodilators and corticosteriods.   Ã‚  Ã‚  Ã‚  Ã‚  Although, bronchiodilators are used in asthma therapy they have no effect on the inflammatory process. Bronchiodilators are a class of drug that relaxes airway smooth muscle by increasing cAMP and opening potassium channels. Corticosteriods on the other hand are now considered the first line of treatment for patients with severe and chronic asthma. Corticosteriods bind to a receptor in the cytosol, which translocates to the nucleus and binds DNA to activate genes. The main action of corticosteriods is to suppress multiple inflammatory genes, such as cytokines, inflammatory enzymes and adhesion molecules. The effectiveness of the corticosteriod is in most part due to the inhibition of transcription factors, such as AP-1 (activation protein 1), Nuclear factor-b (NF-b), and nuclear factor of activated T-cells (NF-AT), which are required for inflammatory response.   Ã‚  Ã‚  Ã‚  Ã‚  The FcRI is the receptor for the IgE antibody. The FcRI is composed of a  chain that binds the Fc portion of the IgE, the  chain and the  chain together form a tetrameric structure. Due to the fact that release of mediators from mast cells in asthma is IgE-E dependent one approach would be to block the activation of IgE using blocking antibodies that do not result in mast cells. A humanized murine monoclonal antibody directed to the FcRI-binding domain of human IgE (rhuMAb-E25) reduces allergen specific IgE after intravenous administration. RhuMAb reduces early and late responses to inhaled allergen and eosinophils counts from induced sputum.

Oscar Wilde Art Essay -- Oscar Wilde Writer Papers

Oscar Wilde Art We begin another chapter in the life of Oscar Wilde, the year 1888, many things have taken place, Oscar has been married and bore two children, Vyvyan and Cyril and his touring of the United States and other countries have brought forth success to the literary giant. Some of his successful writings are "The Picture of Dorian Gray"(1891), "A Woman of No Importance"(1894) and his most resent essay known "The Decay of Lying". Is it true that lying has fallen to its deepest shadow of shame? In the words of Wilde it is shamefully true. How could this type of atrocity take place, it seems that the Victorian society is still under the belief that the Romanticism of life is still coursing through their veins, dead veins as Wilde might best put it. Oscar views romanticism as crude and childlike, and something that should remain in the past. Wilde has criticized the likes of Wordsworth and other writers of the Romantic Era, if they had their way they would continue to send us into nature and recommend the following advice: "The solutions to societies problems can best be remedied here, within the confines of nature, this is where you should be. Walking, talking, and embracing the great outdoors and receiving all that nature has to offer. Here is where you can find yourself." Wilde's view of this remedy is outlandish, extreme and insane. It was Wilde’s observation that the literary works of the day no longer offered the reader a source of delightful fiction, there was a cry out for a change and it was, Wilde who answered that call in the form of an essay called "The Decay of Lying". This essay was a wake up call to the present day writers about their failure in their Art. There needs to be a clear explanation of ... ... his fellow writers to will follow in his path, this form which is to see art for the simple purpose of being art. Works Cited Page Abrams, Donaldson, David, Smith, Lewalski, Adams, Logan, Monk, Lipking, Stillinger, Ford, Christ, Daiches, Stallyworthy. Norton Anthology of English Literature, New York and London Published 1993. Laver, James. Oscar Wilde, Great Britain, Published in 1954 Sullivan, Kevin. Columbia Essays on Modern Writers, Ocsar Wilde New York & London Published 1972 The Victorian Web. Oscar Wilde ,<http://landow.stg.brown.edu/victorian/victov.html> 10/28/99, <www.google.com><Internet Explorer Browser> <http://www.nyu.edu.library/bobst/research/fales/exhibits/Wilde/00main.htm> <http://www.nyu.edu/library/bobst/genlinfo.htm> www.google.com 10/28/99 Wilde, Oscar. Poems and Essays, Great Britain Published in 1956 Oscar Wilde Art Essay -- Oscar Wilde Writer Papers Oscar Wilde Art We begin another chapter in the life of Oscar Wilde, the year 1888, many things have taken place, Oscar has been married and bore two children, Vyvyan and Cyril and his touring of the United States and other countries have brought forth success to the literary giant. Some of his successful writings are "The Picture of Dorian Gray"(1891), "A Woman of No Importance"(1894) and his most resent essay known "The Decay of Lying". Is it true that lying has fallen to its deepest shadow of shame? In the words of Wilde it is shamefully true. How could this type of atrocity take place, it seems that the Victorian society is still under the belief that the Romanticism of life is still coursing through their veins, dead veins as Wilde might best put it. Oscar views romanticism as crude and childlike, and something that should remain in the past. Wilde has criticized the likes of Wordsworth and other writers of the Romantic Era, if they had their way they would continue to send us into nature and recommend the following advice: "The solutions to societies problems can best be remedied here, within the confines of nature, this is where you should be. Walking, talking, and embracing the great outdoors and receiving all that nature has to offer. Here is where you can find yourself." Wilde's view of this remedy is outlandish, extreme and insane. It was Wilde’s observation that the literary works of the day no longer offered the reader a source of delightful fiction, there was a cry out for a change and it was, Wilde who answered that call in the form of an essay called "The Decay of Lying". This essay was a wake up call to the present day writers about their failure in their Art. There needs to be a clear explanation of ... ... his fellow writers to will follow in his path, this form which is to see art for the simple purpose of being art. Works Cited Page Abrams, Donaldson, David, Smith, Lewalski, Adams, Logan, Monk, Lipking, Stillinger, Ford, Christ, Daiches, Stallyworthy. Norton Anthology of English Literature, New York and London Published 1993. Laver, James. Oscar Wilde, Great Britain, Published in 1954 Sullivan, Kevin. Columbia Essays on Modern Writers, Ocsar Wilde New York & London Published 1972 The Victorian Web. Oscar Wilde ,<http://landow.stg.brown.edu/victorian/victov.html> 10/28/99, <www.google.com><Internet Explorer Browser> <http://www.nyu.edu.library/bobst/research/fales/exhibits/Wilde/00main.htm> <http://www.nyu.edu/library/bobst/genlinfo.htm> www.google.com 10/28/99 Wilde, Oscar. Poems and Essays, Great Britain Published in 1956

Kurt Vonnegut and Slaughter House Five :: Biography Biographies Essays

Kurt Vonnegut and Slaughter House Five Kurt Vonnegut is one of the favorite dark humorists of the past century. Combining humor and poignancy, he has become one of the most respected authors of his generation. For twenty years, Kurt Vonnegut worked on writing his most famous novel ever: Slaughter House Five. The novelist was called "A laughing prophet of doom" by the New York Times, and his novel "a cause for celebration" by the Chicago Sun-Times. However, Vonnegut himself thought it was a failure. He said that, just as Lot's wife turned into a pillar of salt when she looked back, so his book is nothing but a pillar of salt. Kurt Vonnegut tied in personal beliefs, characters, and settings from his life into the novel Slaughter House Five. Kurt Vonnegut grew up in Indianapolis, Indiana. He alluded to Indiana in his writings frequently and considered himself a Midwesterner. There were three traumatic experiences Vonnegut talked about in this novel that happened to him as he was growing up. One was when his father took him to the pool when he was young and taught him to swim by the "drown if you don't" method. Another time, he and his family went out to see the Grand Canyon. As he was looking over the edge his mother touched him and he wet his pants. The third experience he mentioned was when his family was touring a cave, he was very scared and then the tour guide asked everyone to turn off all their lights and it was pitch black except for two glowing red dots from his dad (Modern Critical Interpretations 4). These experiences showed through Vonnegut's novel as his alienation from others throughout the book (Novels For Students 464). Kurt Vonnegut's personal beliefs in life, we also in Slaughter House Five. Vonnegut believes that only heart believes in freewill but it is non-existent. In his novel he writes about a group of aliens called tralfamadorians who come and take Billy to their world and put him in a zoo (Kurt Vonnegut Jr. 75). While Billy is with them, they teach him this also, and they are obviously the far superior race. Another belief that Vonnegut has, is that war is horrible, he says "war is not an enterprise of glory and heroism, but an uncontrolled catastrophe for all involved" (Novels For Students 265).

Strategic Management Study Guide

STRATEGIC MANAGEMENT TEST 2 (Chapters 3, 4, and 6): STUDY GUIDE †¢Know definitions and be able to recognize examples of concepts †¢Test will be multiple choice, 45-50 items †¢Bring scantron sheet and #2 pencil Additional free student study resources available including an interactive quiz from the publisher at: http://highered. mcgraw-hill. com/sites/0078029317/student_view0/chapter1/chapter_quiz. html Chapter 3: Assessing the Internal Environment †¢What is value chain analysis? How is it useful for understanding competitive advantages?Strategic analysis of an organization that uses value-creating activities. It is useful for understanding the building blocks of competitive advantages. †¢In the value chain, what are the 5 primary activities? Which 4 activities are support activities? Primary- inbound logistics, operations, outbound logistics, marketing and sales, and service. Support- general admininistration, human resource management, technology development , and procurement. †¢Relating to primary activities, what specific activities are associated with inbound logistics? Operations? Outbound logistics?Marketing and sales? Service? Inbound logistics- receiving, storing, and distributing inputs of a product. Operations- all activities associated with transforming inputs into the final product form. Outbound logistics- collecting, storing, and distributing the product or service to buyers. Marketing and sales- activities associated with purchases of products and services by end users and the inducements used to get them to make purchases. Service- actions associated with providing service to enhance or maintain the value of the product. †¢What is a Just-in-time inventory system? were designed to achieve efficient inbound logistics. Parts and deliveries arrive only hours before they are needed. †¢Relating to support activities, what specific activities are associated with procurement? Technology development? HR management? General administration? Procurement- purchasing inputs used in the firm’s value chain, including raw materials, supplies, and other consumable items as well as assets such as machinery, laboratory equipment, office equipment, and buildings. Technology development- development of new knowledge that is applied to the firm’s operations.HR management- activities involved in the recruiting, hiring, training, development, and compensation of all types of personnel. General administration- general management, planning, finance, accounting, legal and government affairs, quality management, and information systems: activities that support the entire value chain and not individual activities. †¢How has Walgreen’s used information systems to be a sources of competitive advantage? Introduction of a computer based prescription management system- automates telephone refills, store to store prescription transfers, and drug reordering.Also provides information on drug inte ractions and frees up pharmacists from administrative tasks to devote more time to patient counseling. †¢What are the two levels of interrelationships among value-chain activities? 1. Interrelationships among activities within the firm 2. Interrelationships among activities within the firm and other stakeholders. †¢What is resource-based view of the firm? Perceptions that firms’ competitive advantages are due to their endowment of strategic resources that are valuable, rare, costly to imitate, and costly to substitute. What are the 3 types of firm resources? Tangible, Intangible, and Organizational Capabilities. †¢What are the 4 kinds of tangible resources? Financial, physical, technological, and organizational. †¢What are the 3 kinds of intangible resources, Human, Innovation and Creativity, and Reputation. †¢What examples of organizational capabilities? Ex. Outstanding customer service. Excellent product development capabilities, innovativeness of p roducts and services. Ability to hire, motivate, and retain human capital. What are the four criteria that a firm’s resources must possess to maintain a sustainable advantage? 1. Resource must be valuable in the sense that it exploits opportunities and/or neutralizes threats in the firm’s environment. 2. It must be rare among the firm’s current and potential competitors. 3. It must be difficult to imitate. 4. Must have no strategically equivalent substitutes. †¢How can the following four resource characteristics help sustain a competitive advantage based on inimitability: physical uniqueness, path dependency, causal ambiguity, and social complexity? 1.Inherently difficult to copy. 2. Resources are scarce because they were acquired through a unique series of events. 3. Costly to imitate because competitor cannot determine what the resource is and/or how it can be re-created. 4. Costly to imitate because the social engineering required is beyond the capabilit y of competitors, including interpersonal relations among managers, organizational culture, and reputation with suppliers and customers. †¢Substitutability can take which two forms? 1. Substitute a similar resource that enables it to develop and implement the same strategy. . Very different firm resources can become strategic substitutes. †¢ See exhibit 3. 7 – what are the implications for competitiveness based on differing characteristics of a resource or capability? The less valuable, less rare, easier to imitate, more substitutes, the less competitive advantage. †¢What are the four factors that help explain the extent to which employees will be able to obtain a proportionally high level of a firm’s profits? 1. Employee bargaining power. 2. Employee replacement costs. 3. Employee exit costs. 4. Manager Bargaining Power. What are the two approaches to use when evaluating a firm’s performance? Financial ration analysis and taking a broad stakehold er view. †¢What is financial ratio analysis? How can historical comparisons, industry norm comparisons, and competitor comparisons each serve as useful reference points? 1. Technique for measuring the performance of a firm according to its balance sheet, income statement, and market valuation. 2. Provides a means of evaluating trends. 3. Assesses relative performance. 4. Gain valuable insights into a firm’s financial and competitive position. What is the balanced scorecard? Why is it useful? a method of evaluating a firm’s performance using performance measures from the customers, internal innovation, and learning, and financial perspectives. Provides managers with a fast, but comprehensive review of the business (operations measures that drive the future financial performance). †¢What are the four key perspectives of the balanced scorecard? 1. Customer perspective- measures of firm performance that indicate how well firms are satisfying customer’s exp ectations. 2.Internal business perspective- measures of firm performance that indicate how well firms internal processes, decisions, and actions are contributing to customer satisfaction. 3. Innovation and learning perspective- measures of a firm performance that indicate how well firms are changing their product and service offerings to adapt to changes in the internal and external environments. 4. Financial perspective- measure of firm’s financial performance that indicate how well strategy, implementation and execution are contributing bottom-line improvement. †¢What are the limitations of the balanced scorecard?Lack of a clear strategy, limited or ineffective executive sponsorship, too much emphasis on financial measures rather than nonfinancial measures, poor data on actual performance, inappropriate links of scorecard measures to compensation, inconsistent or inappropriate terminology. Chapter 4: Recognizing a Firm’s Intellectual Assets: Moving Beyond a Firm ’s Tangible Resources †¢What is the knowledge economy? An economy where wealth is created through the effective management of knowledge workers instead of by the efficient control of physical and financial assets. How has the emphasis shifted between intangible and tangible resources as a result of changes in the competitive environment? Shifted from tangible resources such as land, equipment, and money. Efforts were more directed toward the efficient allocation of labor and capital. Now intellectual and information processes create most of the value for firms in large service industries. †¢What is the market value of a firm? What is the book value of a firm? What does the difference between the two values represent? In what types of firms does this difference tend to be the greatest?Market value- the value of a share of its common stock times the number of shares outstanding. Book value- is primarily a measure of the value of its tangible resources: total assets- t otal liabilities. The difference between the two represents the firm’s intellectual capital ( a measure of the firm’s intangible assets). In firms where knowledge and the management of knowledge workers are relatively important contributors to developing products and services and physical resources are less critical, the ratio of market to book value tends to be much higher. †¢What is intellectual capital and how can it be increased?Intellectual capital= market value of firm-book value of the firm. To increase: attract and leverage human capital effectively through mechanisms that create products and services of value over time. †¢What is human capital? Social capital? Explicit knowledge? Tacit knowledge? Human capital- the individual capabilities, knowledge, skills, and experience of a company’s employees and managers. Social capital- the network of friendships between talented people both inside and outside the organization. Explicit knowledge- knowl edge that is codified, documented, easily reproduced, and widely distributed.Tacit knowledge- knowledge that is in the minds of employees and is based on their experiences and backgrounds. †¢How is new knowledge created? Through the continual interaction of explicit and tacit knowledge. †¢How has employee loyalty to the company changed relative to loyalty to the profession? Knowledge workers place professional development and personal enrichment above company loyalty. †¢What is a first critical step in the process of of building intellectual capital? What are the other processes organizations use to build human capital?Hiring talented individuals, developing them to fulfill their full potential to maximize their joint contributions. Retain the best and brightest. †¢Why do many companies use employee referrals for new hires? Incentive bonuses paid to the referrers are cheaper than what they would have to pay headhunters to find candidates, plus the current employe es would find good candidates because they are putting their reputation on the line for them. †¢What strategies are used to develop human capital? Encouraging widespread involvement, Transferring knowledge, monitoring progress and development, and evaluating human capital. How as the importance of evaluating human capital changed in recent years? Collaboration and interdependence are vital to organizational success. Individuals must work collectively. Traditional past systems evaluate performance from a single perspective. †¢What is 360 degree feedback? Superiors, direct reports, colleagues, and even external and internal customers rate a person’s performance. †¢What are the 6 benefits of diversity in a firm’s workforce? 1. Cost argument- firms with more effective management in diversity will have a cost advantage over those that are not. 2.Resource acquisition argument- firms with excellent reputations as prospective employers for minorities will have a n advantage in the competition for top talent. 3. Marketing argument- for multinational firms this will be useful. 4. Creativity argument- less emphasis on conformity to norms of the past and diversity of perspectives will improve the level of creativity. 5. Problem solving argument- people with different perspectives have a better shot at solving complex problems than those who all think alike. 6. Organizational flexibility argument- greater flexibility leads means better reactions to environmental changes. What is network analysis? Closure relationships? Bridging relationships? Analysis of the pattern of social interactions among individuals. †¢How can effective social networks be advantageous to an individual’s career? Private information now available. Access to diverse skill sets. Power. †¢What is groupthink? – tendency in an organization for individuals not to question shared beliefts. †¢What are intellectual property rights? What actions can be ta ken to manage intellectual property? Intangible property owned by a firm in the forms of patents, copyrights, trademarks, or trade secrets. What are dynamic capabilities? The ability to sense and seize new opportunities, generates new knowledge, and reconfigure existing assets and capabilities. Chapter 6: Corporate-Level Strategy: Creating Value Through Diversification †¢What is corporate-level strategy? What two related issues does it address? a strategy that focuses on gaining long-term revenue, profits, and market value through managing operations in multiple businesses. Acquisitions and mergers. †¢How is related diversification different than unrelated diversification? What are the potential benefits of each?Related diversification- a firm entering a different business in which it can benefit from leveraging core competencies, sharing activities, or building market power. Unrelated diversification- a firm entering a different business that has little horizontal interac tion with other businesses of a firm. †¢Be familiar with the classifications of Exhibit 6. 2 3M was using exorbitant rebates to retailers, which pushed them into a â€Å"monopolistic position† and courts ordered 3M to pay 68. 5 million dollars to another tape company. †¢In related diversification, what is meant by economies of scope?Cost savings from leveraging core competencies, sharing activities, or building market power. †¢What is a core competency? What are the three criteria for assessing if a core competency creates value? Firm’s strategic resources that reflect the collective learning in the organization. 1. Must enhance competitive advantage by creating superior customer value. 2. Different businesses in the corporation must be similar in at least one important way related to the core competence. 3. Must be difficult for competitors to imitate or find substitutes for. †¢What are sharing activities?What are the two payoffs associated with sh aring activities. -Having activities of two or more businesses value chains done by one of the businesses. -1. Cost savings -2. Revenue enhancement †¢In related diversification, what is market power? Firm’s ability to profit through restricting or controlling supply to a market or coordinating with other firms to reduce investment. †¢What is pooled negotiating power? the improvement in bargaining position relative to customers and suppliers. †¢What is vertical integration, in its associated risks and benefits? an xpansion or extension of the firm by integrating preceding or successive production processes (occurs when a firm becomes its own supplier or distributer). Pros- secure supply of raw materials or distribution channels. Protection and control over assests and services required to produce and deliver. Access to new business opportunities and new forms of technology. Eliminating the need to deal with a wide variety of suppliers and distributors. Cons- cos ts and expenses associated with increased overhead and capital expenditures. Loss of flexibility resulting from large investments.Problems associated with unbalanced capacities along the value chain. Additional administrative costs associated with managing a more complex set of activities. †¢What 5 issues should be considered in making vertical integration decisions? 1. Is the company satisfied with the quality of the value that its present suppliers and distributors are providing? 2. Are there activities in the industry value chain presently being outsourced or performed independently by others that are a viable source of future profits? 3. Is there a high level of stability in the demand for the organization’s products? . Does the company have the necessary competencies to execute the vertical integration strategies? 5. Will the vertical integration initiative have potential negative impacts on the firm’s stakeholders? †¢What is the transaction cost perspec tive? A perspective that the choice of a transaction’s governance structure such as vertical integration or market transaction, is influenced by transaction costs, including, search, negotiating, contracting, monitoring, and enforcement costs, associated with each choice. †¢What is unrelated diversification? What is a parenting advantage?A firm entering a different business that has little horizontal interaction with other businesses of a firm. Parenting advantage- the positive contributions of the corporate office to a new business as a result of expertise and support provided and not as a result of substantial changes in assets, capital structure, or management. †¢What is restructuring? What are the three types of restructuring? The intervention of the corporate office in a new business that substantially changes assets, capital structure and management. 1. Asset restructuring 2. Capital restructuring 3. Management restructuring What is portfolio management?Method of assessing the competitive position of a portfolio of businesses within a corporation, suggesting strategic alternatives for each business, and identifying priorities for the allocation of resources across the businesses. †¢What is the Boston Consulting Group’s (BCG) growth/share matrix? What are the 4 quadrants in the matrix? What are the suggested strategies associated with each of the quadrants? What are the limitations of the BCG matrix? Each of the firm’s strategic business units is plotted on a two-dimensional grid in which the axes are relevant market share and industry growth rate. 1.Stars-competing in high growth industries with high market shares, long term growth potential and should continue to receive substantial investment funding. 2. Question marks- competing in high growth industries with but have weak market share, resources should be invested to enhance their competitive positions. 3. Cash cows- have high market shares in low growth industries . Have limited long run potential, but represent a source of current cash flows to fund investments into starts and question marks. 4. Dogs- have weak market shares in low growth industries, weak positions and limited potential.Most recommend they become divested. Limitations of BCG matrix- 1. the only compare based on two dimensions. 2. View them as a stand-alone entity, ignoring common business practices and value creating activities that may hold promise for synergies across business units. 3. The process becomes largely mechanical, substituting an overly simplified graphical model for the important contributions of the CEO or other managers experience. †¢What are the three primary means by which a firm can diversify? 1. Through acquisitions or mergers 2.Pool the resources of other companies with their resource base, commonly known as a joint-venture or strategic alliance. 3. Diversify into new products, markets, and technologies through internal development. †¢What are the benefits and potential of mergers and acquisitions? 1. A means of obtaining valuable resources that can help an organization expand its product offerings and services 2. Can provide the opportunity for firms to attain the three bases of synergy—leveraging core competencies, sharing activities, and building market power. 3. Can lead to consolidation within an industry and can force other players to merge.Cons- competing firms can often imitate any advantages realized from the M&A. there can be cultural issues that may doom the intended benefits from the endeavors. †¢What is a divestment? The exit of a business from a firm’s portfolio. †¢What is a strategic alliance? Joint venture? How do they differ? What are their potential advantages and downsides? Strategic alliance- a cooperative relationship between two or more firms. Joint venture- new entities formed within a strategic alliance in which two or more firms, the parents, contribute equity to form the new legal entity.A strategic alliance is a cooperative relationship. A joint venture is a special case of alliances where both firms contribute equity to form a new legal entity. Pros- Reducing manufacturing or other costs in the value chain. Developing and diffusing new technologies. Cons- many fail to meet expectations. Without proper partner, a firm should never consider it. Little attention is often given to nurturing the close working relationships and interpersonal connections that bring together the partnering organizations. †¢What is internal development?What are its potential downsides? -Entering a new business through investment in new facilities, often called corporate entrepreneurship and new venture development. -It may be time consuming, firms may forfeit the benefits of speed that growth through mergers and acquisitions can provide. †¢How can managerial motives erode value creation? They may often act in their own self-interests (CEOS). â€Å"growth for gro wth’s sake†, excessive egotism, and the creation of a wide variety of antitakeover tactics. †¢What is meant by growth for growth’s sake? Egotism? Manager’s actions to grow the size of their firms not to increase long-term profitability, but to sever managerial self-interest. -Manager’s actions to shape their firm’s strategies to serve their selfish interests rather than to maximize long-term shareholder value. †¢What are the antitakeover tactics of greenmail, the golden parachute, and poison pill? Greenmail- a payment by a firm to a hostile party for the firm’s stock at a premium, made when the firm’s management feels that the hostile party is about to make a tender offer. (sort of like a bribe)

Communication and Assessment in Nursing Essay

The structure of this essay is designed to show the importance of relationship centered communication. However it will begin with a brief definition of the essential concepts intrinsic to the topic of therapeutic communication, distinct therapeutic nurse-patient relationship. Thereafter, it will focus on verbal and nonverbal communication, listening, understanding, empathy and important aspects of confidentiality and privacy. IntroJust as chemistry sciences were adopted as the 20th century medical model, patient’s perspective into a relationship-centered communication has been suggested as appropriate for the 21st century. It is the medical dialogue that provides the fundamental vehicle through which the battle of perspectives is waged and the therapeutic relationship is defined (Roter D. 2000). In many regards, the primary challenge to the field is the development of therapeutic communication that will provide a valid representation of the therapeutic relationship (Craven & Hirnle 2000). The purpose of this essay is to explore the implications of therapeutic communications in the nature of the patient-nurse relationship and its expression in routine of medical practice. Therapeutic communication is defined as the face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient (http://tpub.com/content/medical ). Communication is an essential process when providing culturally competent nursing care and it must be therapeutic in nature to be effective. It involves the use of techniques such as using silence, offering self, restating, reflecting, and seeking clarification to name a few. Therapeutic communication involves displaying a genuine interest in the person communicating that is demonstrated trough the use of a relaxed and comfortable body posture. Therapeutic communication requires the components of empathy, positive regard, and a positive sense of self (Craven & Hirnle 2000). But no single definition could possibly capture the rich and complex nature  of the relationships between patients and nurses. Each relationship is distinct, because both patient and nurse are distinctive and the way they interact and relate is unique (Parbury 2006). The therapeutic nurse/client relationship stands at the core of health nursing. Through the establishment of this relationship, nurses are ideally suited as therapists to lead clients toward accomplishing their health goals (Parbury 2006). Therapeutic relationships between patients and nurses are formed in the majority of situations. In this type of relationships nurse’s perspective is primarily that the patient is a patient, but there is also recognition and understanding of the patient as the person (Parbury 2006). There are few similarities between the therapeutic relationship and friendship. It’s important to both to have worth, friendliness, trust, care, honesty and respect. Some differences in values and attitudes can hinder both as well as poor communication strategies. A feeling of satisfaction is important to both and also transference (involves clients feelings and acting toward the therapist as they did to other individuals in the past, mother/father for example) can occur in both ( Craven & Hirnle 2000). Let’s look into differences between the therapeutic relationship and friendship. Contract. A contract implicit on exploit is usually negotiated between client and workers and may include payment together they agree on. Limits are set whereas in friendship there is usually no monetary reward or contracts exchanged (Craven & Hirnle 2000). Aims. In helping relationship there are specific goals. Friendship on the other hand, does not usually have agreed upon goals, it’s usually spontaneous. Focus. Helpee’s needs are the focus of attention in the helping relationship- the helper temporally sets aside personal needs. In contrast, friendship usually means that mutual needs are met in sharing way (Beck & Polite 2004). Time. Therapeutic relationship require time that is planned, limited and sometimes scheduled. In addition time is finite and perhaps negotiated by a contract. Time in friendships is mostly spontaneous and tends to have fewer limits (Parbury 2006). Objectivity. Therapeutic relationships require that the helper strives to be objective, and to act in client’s best interests. Objectivity is mostly impossible in friendships due to the fact that self interest is largely paramount (Gladys, Husted and Husted 2001)Acceptance. The helper tries to accept the client in therapeutic relationship thereby is able to understand the behavior of imposing value and judgments. On the other hand friendships usually terminate when differences in values or interests become too great. After actively listening to a patient it is natural for a nurse to respond verbally. The nurse’s initial verbal responses set the direction for further interaction. Because there is a variety of possible ways to respond, nurses must ensure that their verbal responses move the relationship in a desired and intended direction (Parbury 2006). Choice of the response is based on insight into how it may affect the patient, the interaction and the relationship. A nurse who has this insight and awareness is in the best position to respond in the manner that both matches the current situation and realizes the response’s desired intent (Parbury 2006). Nonverbal responses are very important and the ability to recognize and interpret this kind of responses depends upon consistent development of observation skills. As we continue to mature in our role and responsibilities in the healthcare team, both clinical knowledge and understanding of human behavior will also grow (Beck & Polit 2000). Our growth in both knowledge and understanding will contribute to our ability to recognize and interpret many kinds of nonverbal communication. Our sensitivity in listening with our eyes will become as refined as-if not better than-listening with our ears (Roter 2000). Most frequently, the relationship and communication between patient and nurse  begins with an interview, during which the nurse collects pertinent data about the patient (Parbury 2006). The effectiveness of an interview is influenced by both the amount of information and the degree of motivation possessed by the patient (Parbury 2006). Factors that enhance the quality of an interview consist of the participant’s knowledge of the subject under consideration; his patience, temperament, and listening skills; and our attention to both verbal and nonverbal cues. Courtesy, understanding, and nonjudgmental attitudes must be mutual goals of both the interviewee and the interviewer (Roter 2000). Understanding a patient’s experience, that is, viewing the world from patient’s perspective is one of the most essential aspects of interacting and building relationships in nursing (Parbury 2006). In patient-nurse relationship it is the nurse’s responsibility to make mutual understanding easier, which would be the basis of meaningful interaction. Mutual understanding requires time, effort, commitment and skill. It can be challenging for one person to understand and appreciate another person’s reality. Listening and effective attending would give ability to the nurse to develop an understanding of the patient’s experience (Parbury 2006). Effective listening demonstrates open acceptance of the patient, and encourages the patient to interact. Listening to the patient and watching how he listens. Observing how he gives and receives both verbal and nonverbal responses. When nurses listen, just listen, they pay careful attention to what they hear and observe, they focus on what is expressed by the patient and they try to determine what the patient is meaning. Effective listening requires receptivity, sustained concentration and astute observation. The skill of listening is fundamental and crucial to patient-nurse relationship (Ooijen 2000). Listening permeates the entire relationship; if meaningful interpersonal connections are to occur, listening must be engaged in throughout every interaction in therapeutic relationship (Parbury 2006). The skills of clarification are used whenever nurses are uncertain or unsure about what patients are saying. Clarification is often achieved trough the use of probing skills. At times a restatement of what a patient has said is an effective means of clarifying (Parbury 2006). Other times, nurses clarify what a patient has said by sharing how they might feel, think and perceive the situation if they were the patient. Reflecting feelings is useful too, because it conveys the nurse’s recognition of feelings and confirms the existence of emotions. When used to collect information, therapeutic communication requires a great deal of sensitivity as well as expertise in using interviewing skills (Roter 2000). To ensure the identification and clarification of the patient’s thoughts and feelings, we, as the interviewers, must observe his behavior. By using the skills of understanding nurses can arrive at knowing what patient is experiencing and thus are in a better position to be empathetic. Empathy is the ability to perceive the world from another person’s view, and take on the perspective of another, while not losing one’s own perspective (Parbury 2006). The ability to enter to another person’s experience to perceive it accurately and to understand how the situation is viewed from the client’s perspective is very important in therapeutic communication. By using therapeutic communication, we attempt to learn as much as we can about the patient in relation to his illness. To accomplish this learning, both the sender and the receiver must be consciously aware of the confidentiality of the information disclosed and received during the communication process (Roter 2000). Confidentiality is not merely keeping patient information inside the confines of a particular setting, but also considering what should be shared, trough reporting and recording, with other nurses and other health care professionals (Parbury 2006).There has to be a therapeutic reason for invading a patient’s privacy. Information that has no direct bearing on the nursing or other healthcare of the patient should be considered confidential and treated as such (Parbury 2006). Finally, interpret and record the data we have observed. As I mentioned earlier, listening is one of the most difficult skills to master. It  requires maintaining an open mind, eliminating both internal and external noise and distractions, and channeling attention to all verbal and nonverbal messages (Roter 2000). Listening involves the ability to recognize pitch and tone of voice, evaluate vocabulary and choice of words, and recognize hesitancy or intensity of speech as part of the total communication attempt. The patient crying aloud for help after a fall is communicating a need for assistance. This cry for help sounds very different from the call for assistance we might make when requesting help in transcribing a physician’s order (Roter 2000). Also advances in both video recording technology and participant observations have led us to consider ways in which these observational methods may be blended to answer research questions. Such innovations in data collection have t he potential to extend our understanding of social interactions in important ways (Paterson, Bottorf & Hewat 2003). ConclusionFinally, essential nature between patients and nurses is that of mutual understanding. It is clear that to function effectively in the therapeutic communication, we need to be informed and skilled practitioners, but not only that, active listening, empathy, understanding is necessary when we there to help our patients. They become calmer and more appreciated after having someone listen to them and express their feelings. Nurse needs to have the ability to express verbally and nonverbally, clarifying and reflecting with the patient, spending time and accepting and understanding behavior of imposing value and judgments. Also let the patient know that we care and that they are able to trust because of information that they share with us stays confidential and their privacy will not be damaged. Clearly therapeutic communication is central to health nursing and through this process nurse-client relationships can be enhanced. References: Andersen, C., & Adamsen, L. (2001). Continuous video recording: a new clinical research tool for studying the nursing care of cancer patients. Journal of Advanced Nursing, 35, 257-267. Beck C.T., Polit D.F. (2000) Nursing Research: Principles and Methods Patient Education Counseling. Journal article 39(1):5-15. Lippincott W&W. Carol, D. Tamparo, Wilburta, Q. 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