Research Articles Base

Particular Common Law

This paper will try to discuss and state a specific aspect of common law which is the duty of care. It will try to assess and to view the different features and characteristics of the duty of care and how it is applied to a particular situation.  It will try to identify and emphasize the different viewpoint that this particular common law advocates.             The situation and facts of the case are these. Robert had been asked by his next door neighbor, Edgar, to help clear Edgar’s garden. This work required him to use dangerous equipment such as a chainsaw and powerful chemical weed killers. Robert was working in the garden clearing a patch of ground that had become a wilderness. He told Edgar’s 6-year-old son, James, to keep away from the area. Unfortunately, whilst Robert was having his lunch, James went into the area that had been treated with weed killer and fell over a pile of rubbish, landing with one hand in the weed killer. James developed severe burns to his hand. Edgar was furious about what ad happened to his son and stormed into the garden to have words with Robert. Robert was using the chainsaw at the time and did not hear Edgar approaching and Edgar tapped Robert on the shoulder and Robert swung round in surprise, catching Edgar with the chainsaw and cutting off Edgar’s hand.             The vital questions that must be asked in this case is, does Robert owe and breached a duty of care to Edgar and the legal implications surrounding the damages that was sustained by Edgar. Before explaining and answering these questions a proper rationalization on the rule of law must be made.             In tort law, a duty of care is a legal obligation imposed on an individual requiring that they exercise a reasonable standard of care while performing any acts that could foreseeable harm others. For an action in negligence, there must be an identified duty of care in law. Duty of care may be considered a formalization of the implicit responsibilities held by an individual towards another individual within society. It is not a requirement that a duty of care be defined by law, but it will often evolve through the jurisprudence of common law. Individuals who are considered to be professionals within society are often held to a higher standard of care than those who are not. Engineers and doctors will be held to reasonable standards for members of their profession, rather than those of the general public in cases related to their fields. Breach of duty of care, if resulting in an injury, may subject an individual to liability in tort. Duty of care is an important prerequisite in the tort of negligence, as the duty of care must exist and must have been breached for the tort to occur. Important cases have been tried and decided by different levels of the judiciary that makes the exact definition and the legal explanation regarding the subject of duty of care. These decisions and cases are tried to further define and to characterize the aspect and the nature of the phrase duty of care. These decisions are also significant since they provide the jurisprudence and the outline for other cases that touches the same topic which is duty of care. Among the cases that full explain and central to the idea of duty of care is the case titled Donoghue v Stevenson. DUTY OF CARE Donoghue v. Stevenson is a famous House of Lords case in the area of delict and tort law. From this case springs the core principle of the modern law of negligence and duty of care. It establishes a principle that has guided the courts to this day, and places the notion of a duty of care at the heart of the law of negligence.  A duty of care is a term that the courts will use to determine whether the defendant is liable. It is only one factor that the courts will consider, but it will be the first question that the courts will ask. The case is perhaps most well known for the speech of Lord Atkin and his ‘Neighbor’s Principle’ where he applied Luke 10 of the Bible to law. The practical effect of this case was to provide individuals with a remedy against suppliers of consumer products, even if they did not have a contract with them. The case, brought under Scots law, did not technically bind England, but nonetheless, due to the commonality between the Scots civil system and the English common law, the principle has since been adopted across the United Kingdom and elsewhere in the world.  In 1990 in England the House of Lords restated the ‘Neighbor Principle’ of Lord Atkins to take account of public policy In this case, May Donoghue alleged that she drank some of the contents of a bottle of ginger beer manufactured by the respondent. When a friend of Ms. Donoghue poured the content of the bottle, they saw a rotting snail on their beer. As a result, May Donoghue allegedly suffered shock and severe gastroenteritis. Because of her injuries and the pain that she suffered she sued the respondent. In Donoghue v. Stevenson Lord Atkins stated the now famous “Neighbor Principle” with regards to the proper interpretation of the duty of case. Lord Atkin’s statement about the foreseeability of the effects of one’s acts on one’s neighbours is central to the existence of a duty of care in the law of tort/delict, especially on the then developing nascent tort/delict of negligence. In this judgement he formulates what is commonly known as the “neighbour principle”. In this legal principle he declared that; …there must be, and is, some general conception of relations giving rise to a duty of care, of which the particular cases found in the books are but instances. … The rule that you are to love your neighbor becomes in law you must not injure your neighbor; and the lawyer’s question: Who is my neighbor? receives a restricted reply. You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbor. Who, then, in law, is my neighbor? The answer seems to be — persons who are so closely and directly affected by my act that I ought reasonably to have them in contemplation as being so affected when I am directing my mind to the acts or omissions that are called in question. In Donoghue v. Stevenson Lord Macmillan meanwhile asserted that ‘the categories of negligence are never closed’, in the sense that the courts possess the power to create new duty situations expanding the area of liability.  In this case, Lord Atkin’s formulation of the ‘neighbor principle’ was not qualified by reference to particular kinds of loss nor to the distinction between acts and omissions. Subsequent courts however, interpreting the Donoghue opinions, soon came to the conclusion that their scope was limited to personal injury and damage to property.  The broad ‘neighbor principle’ was treated as an obiter dictum, with the ratio limited to the particular case of the duty owed by a manufacturer to an ultimate consumer. Lord Oliver further explained, that the discussion of duty of care should be located by reference to specific areas of liability such as negligent misstatements, the distinction between acts and omissions, liability for the acts of third parties, and the exercise of statutory duties and powers which represent the outermost boundaries of liability. After Donoghue v. Stevenson, the law recognized a general duty of care protecting the personal safety and health and tangible property interests of an individual. Liability for physical harm caused by negligent misstatements is now well established as part of the Donoghue duty. The general duty may, however, be qualified in relation to certain types of plaintiff, such as trespassers, or may be specially extended to cover deserving claims such as those of rescuers. Certain defendants, such as public authorities and others serving the collective interest may benefit from a qualified immunity in respect of physical harm. The limited nature of liability for omissions also affects the protection accorded to physical interests.  Finally, it must be remembered that, despite the existence of a general duty of care, claims for compensation for physical loss may be limited by other considerations such as remoteness and causation as well as by the manner in which damages for loss are calculated in different cases.  REMOTENESS OF DAMAGES                         The purpose of the rules about remote damages is to prevent somebody who is in breach of a duty, be it delictual or contractual, to be held liable indefinitely and without any limitations for any and all harmful consequences that arise from his breach of duty.  Before looking in detail at the theoretical approach to remote damages as a method of seeing this, it seems useful to point out a few related issues to better understand the concept. The issue of remote damages can arise not only in the context of delictual liability, but anywhere in the legal system where a liability for damages can arise. Besides in delict this would be in contract. In both delict and contract generally the pursuer must not only show that the defender’s action caused the damages he suffered, but in addition he must also prove that these damages are not too remote. However, because of the different nature of contractual and delictual duties, the rules about the remoteness of damages are different in delict and contract. Basically, there are different tests in the law of delict and the law of contract in order to determine the sufficient remoteness of the damages in question. In this portion only the rules about remote damages in delict will be discussed.                 In order to receive damages, the pursuer has to show the chain of causation. This consists of two individual steps: There has to be a causal connection between the defender’s original conduct and the injury suffered as a consequence thereof, as well as between the caused harm and the losses arising out of it.  In each of those two steps the question of remoteness can arise. In addition to the factual causation, the necessary proximity between original conduct and injury respectively injury and loss has to be established.             If an injury is too remote to be legally connected with the defendant’s original conduct, as a consequence the defendant cannot be held liable at all. The concept of remoteness of injuries is therefore used to determine the existence of any liability on the part of the defender. Contrary to this, remoteness of damage is concerned with the extent of liability once it has been established. The more recent literature seemingly does not consider the concepts of remoteness of injury and remoteness of damage to be necessarily connected. The problem of remote injuries now obviously is sometimes seen as an aspect of the delictual duty of care.                        Although there is unanimous agreement on the fact that damages do not only have to be causally connected but also must not be too remote from the injury, there are different opinions on how it should be determined if a damage actually is too remote to be recovered from the defender.  The most commonly cited classical authority in determining the remoteness of damages is the Obiter Dictum by Lord Kinloch. He states that:. …the grand rule on the subject of damages is, that none can be claimed except such as naturally and directly arise out of the wrong done; and such, therefore, as may reasonably be supposed to have been in the view of the wrongdoer. Lord Kinloch’s statement suggests a direct and natural consequences test, whereas in the end it introduces the reasonable foresight of the defender as a criterion for determining the remoteness of damage. Therefore Lord Kinloch has actually referred to a series of test of tests that that will determine the remoteness and extend of damages or injuries. When the damages and injuries have been measured and assessed, the defendant through the orders of the courts has to pay the offended party for the damages that he/she had caused. Damages and compensations are awarded by the court to restore the plaintiff to the pre tort position.  Personal injury and property damage may both have economic consequences. A person who sustains an injury may lose not simply the use of a limb but also the earning capacity which goes with it. He will receive compensation for loss of future earnings as well as for loss of the limb and facility in question.  As far as property damage is concerned, the courts will have primary regard to the market value of the property in question when assessing compensation for its loss. In these cases the law of tort provides compensation for economic losses arising directly out of physical loss Damages are classified as physical harm and damage to property and pure economic loss. Economic loss is further categorized as liability for negligent misstatement, negligence in the performance of a service, economic loss arising from defects in building and products and relational loss arising from damages to the property of a third party. In the situation presented in the beginning of this paper, Robert owe a duty of care to Edgar in the scenario since he is inside the premise of Edgar’s property and he is working and dealing with harmful chemicals and dangerous equipments. Duty of care also exists on Robert since he was asked by Edgar to help clean the garden. Because of this duty of care, Robert must exhibit the a standard of care wherein every aspects of his work does not compromise and endanger Edgar and other individuals. In the circumstances that followed Robert was clearly in breach of the duty of care that is mentioned. First, he since he was working with chemicals namely the weed killer, he did not foresee that leaving a weed killer can do damage and injure someone, in this case, the son of Edgar. He was also negligent with regards to the circumstances on how the son of Edgar came into contact with the weed killer. Aside from carelessly leaving the weed killer without proper precaution and prudence he also neglectfully failed to clean up the a pile of rubbish causing the son to fell over. Another breach of the mentioned duty of care in the part of Robert is the accidental injury suffered by Edgar when he was injured by the chainsaw being used by the defendant causing the amputation of the hands of the latter. On the part of Robert, care must be properly observed in handling and using dangerous equipments such as a chainsaw. A standard of care should be implemented by Robert when he is using the chainsaw. When he injured Edgar he is negligent and careless since he immediately turned around without properly assessing the situation around him. It can be argued that Robert did not exhibit the proper caution and vigilance that is necessary in his part. With regards to the injury suffered by Edgar, he must be justly compensated for the damages that he endured. Compensations and monetary reparation must be made using factors such as loss of income and competitive advantages that his work would bring since he had lost the use of one of his arms due to the injury. Plaintiff can also be entitled for the loss of enjoyment of life, pain, suffering and embarrassment brought about by the accident. The court can also award money to give the plaintiff an alternative gratification equivalent to the lost of a main body part, namely the hand. Lastly damages can also be sought by Edgar with regards to the hospital bills, medicines and other expenses related to the treatment of his injuries.               Credit:ivythesis.typepad.com

Particular Common Law

This paper will try to discuss and state a specific aspect of common law which is the duty of care. It will try to assess and to view the...

International Trade

International Trade                 This paper is about international trade. It discusses the statement “International trade is really, at best, a zero-sum game. For every winner, there is a loser. It is not so much about creating growth in developing economies as it is about finding ever cheaper products for consumers in the developed economies.” Using different theories on international trade, as well as different examples, it criticizes the said statement. Explanations for the said judgments are also given for further evaluation of the statement. As an introductory, the reader is given a background on international trade and the theories related to it. Then the discussion on the statement is presented with examples to apply the theories behind it. As a concluding part, the topic is wrapped up as to the final judgment regarding the said statement.   International Trade: An Introduction             The pure theory of international trade encompasses the determinants of trade and its consequences, the ways of controlling it together with its consequences, and the interaction between international trade and other real aspects of the economy. What is the reason why country A exports good X while country B exports good Y?             According to the Ricardian Theory, trade is attributed to the differences in the countries’ ability to produce different goods. One produced one good relatively cheaply, while the other another good. These differences arise from the differences in labor productivity. This theory is also known as the classical theory of trade, the earliest and the simplest of all trade theories.             Another neo-classical theory is the Heckscher-Ohlin theory. It explains countries’ differing abilities in different goods with reference to the differences in their endowments of their factors of production. It justifies some of Ricardo’s point. This theory remains to be the dominant mode of thought within the theories of international trade and underlies much normative analysis.             The last one is the so-called modern trade theory. It reemphasizes technology on one side; while on the other side, it stresses the role of product differentiation in international trade. The latter is a new, and apparently fruitful, area of research that integrates imperfect competition into international trade theory. It explains the ‘intra-industry’ trade, which is the simultaneous act of importing and exporting (at the same time) of countries, of very similar goods. The explanation for this type of phenomenon is impossible for the earlier trade theories, since they depend only on costs differences of production to be able to generate trade. International Trade Theory of David Ricardo Absolute and Comparative Costs: The Principle of Absolute Advantage             The seed of the modern theory of international trade comes from Adam Smith. His concern lies on the division of labor as a way to enhance efficiency. This is where he is well known to and he further generalizes this to the specialization between trades and between countries.                Thus countries trade, and should trade, in order to acquire their consumption more cheaply. They buy where prices are lower compared to their place. This is due to the fact that prices are considered as immediate determinant of trade.             Another argument relating to international trade that Smith claims is the idea that international trade allows greater specialization and division of labor through market extension. Therefore, it presents possibilities for additional gains through the reduction of costs below their autarky levels. Trade can increase the economic welfare of both countries involved. Thus, not only can absolute advantage describe international trade patterns, it also provides the rationale to prescribe their implementation as a means of raising economic welfare.             Take this example to further explain the principle of absolute advantage. Britain was the least-cost producer of cloth while America is the least-cost producer of food. Britain will export cloth, because he can gain from it due to its low cost of production. On the other hand, he will import food, because producing it will cost him more than importing it. Same is true with America. Nevertheless, if both goods are produced more efficiently in Britain, applying the principle of absolute advantage suggests that both goods be purchased from Britain. However, this is not applicable in the long-term. Therefore, Ricardo proposes the law of comparative advantage to address this type of situation.    The Principle of Comparative Advantage             This theory explains why it can beneficial for two countries to trade, even if one of them is capable of producing both goods more efficiently. What matters for this principle is not the absolute cost of production. Instead, it is focused on the ratio between how easily the two countries can produce different kinds of things.             To illustrate its difference from absolute advantage, take this situation as an example. In Portugal, production of both wine and cloth is possible, compared with England that requires greater work. However, the two countries have different relative costs of production for the two goods. In England, it is very hard to produce wine while it is moderately difficult for the production of cloth. In Portugal, both productions are easy. Therefore, while it is cheaper to produce cloth in Portugal than in England, it is cheaper still to for Portugal to produce excess wine, and trade that for English cloth. Conversely, England will benefit from this trade because it can now get wine at closer to the cost of cloth, with its cost of production for cloth unchanged. In simpler terms, country A exports the good for which its input requirements are relatively lower compared with those of country B.             In conclusion, international trade takes place because some goods are produced more cheaply abroad compared at home. Ricardo’s model explains this pattern of trade through the relation of prices to certain features essential to the economies concerned. However, this requires several assumptions. First, there is only one factor of production, and that is labor. Second, its productivity differs between countries. Third, labor is perfectly mobile between industries within a country but perfectly immobile between countries. Fourth, there are constant returns to scale in each industry. Lastly, there are no impediments to trade, such as tariffs, etc. Extension of Ricardo’s Theory             While Ricardo expressed his theory in terms of the labor theory of value, Haberler re-expressed his theory in terms of opportunity costs. The opportunity cost of good X is the amount of good Y that has to be surrendered in order to obtain a unit of X. In Ricardo’s theory, the transformation occurs by shifting labor from one industry to the other, so opportunity costs are naturally defined in terms of relative labor productivities. The same concept applies to cases involving several factors of production. If the opportunity costs were constant, the whole of the above theory would follow as is. We have just treated the labor requirements as being part of the bundles of factors, with lower requirements indicating greater efficiency.                 While the Ricardian theory is a supply theory of international trade, its differences in supply conditions that give rise to the possibilities of trade. Trade also occurs even when, demand conditions are identical across countries. In any case, the analysis may be completed without the assumption of identical demand without any fundamental differences. The Heckscher-Ohlin Theory of Factor Endowments             Heckscher and Ohlin asked why productivities differed across countries. They also wondered why the possibilities of transformation differed. According to Ricardo, it is due to the differences in technology. Still, they argue that the ability of the countries varies with their endowments of the different factors of production. Provided with demand patterns that do not differ much between countries, the Heckscher-Ohlin theory of trade states that countries will export the goods whose production is relatively intensive in the factors with which they are well endowed.             In this approach, it stresses the role of factor endowments. There are seven assumptions to be taken in this approach. First is that consumption should be determined by identical and homothetic preferences. Second is that technology is the same across countries. These first two assumptions separate endowments as the cause of trade. On the other hand, the next two restrict the technology in important respects. They are: (3) the exhibition of constant returns to scale but diminishing marginal returns to any single factor, of the production functions for each good; and (4) the difference in the requirements of different factor inputs for the said goods. If one good requires more labor compared to the other at one set of factor prices, the same applies to all sets of factor prices. This situation is better known as the exclusion of ‘factor-intensity reversals’. It allows a clear identification of labor-intensive product.             The other two assumptions describe economic behaviour. They are: (5) the presence of perfect competition in all factor and product markets; and (6) the lack of impediments to trade, such as tariffs, etc., although there is no possibility for the migration of the production factors. Lastly, the final assumption that there are only just two factors, two goods and two countries, imposes world restrictions. In addition, there should also be homogeneity between the factors within the countries, identical between them, as well as fixed in supply.                   The first two assumptions are necessary in answering the question regarding the appearance of the ‘factor-endowment-related’ trade. The next three, on the other hand are among the critical ones. The fifth assumption ensures the equality of prices and costs, as well as of consumption prices and marginal utilities. The technical identification of the labor-intensive good is allowed through the fourth assumption. The third assumption, on the other hand, centers on the translation of price signals into quantity changes. The absence of this assumption would not necessarily invert the trade pattern, although it would make it impossible to prove the constant dominance of the H-O result. The Modern Trade Theory             This theory primarily hinge around technology. It also considers the effect of the economies of scale and degree of monopoly to the patterns of trade. The explanation of the ‘intra-industry’ trade is also possible because of this theory. Although this theory returns to the basic approach of Ricardo, it pays more attention to the determining factors of technology. The changing technology is the one that determines trade, that is why a move from equilibrium to disequilibrium theories is necessary for this discussion.             In conclusion, technological differences and changes can provide us further explanation regarding the international trade in manufactured goods. While goods are relatively young, we expect them to be exported by the innovating country. Subsequently trade may end, as knowledge is diffused, or reversed, as factor endowments replaced knowledge being the principal trade determinant. The fact that one innovation frequently leads to another, means that innovations tend to originate in just a few countries. However, changes in relative dynamism can occur, like the case of Western Europe and Japan. There are at least two channels through which research and development is translated into export advantage. Yet, it is not clear which of the two is dominant over the other. Neither does it give a clear explanation why some countries are more dynamic than others do. Therefore, we are not yet in the proper position to develop a more formal model of technology similar to the Heckscher-Ohlin Theory. Trade as a Positive-Sum Game             Trade between economies is not like sports competition. A sports contest is described as a zero-sum game. By that definition, if one competitor does better, its opponents are doing worse. However, because specialization is allowed in trade, each nation can concentrate making the products it produces relatively well (absolute advantage). Trade therefore, simultaneously makes all nations better off. To conclude this statement, trade really is a positive-sum game.             Take the case of Nike and Reebok. These two companies are almost purely rivals that are selling the same products. Only a small fraction of Nike’s sales is to Reebok workers, and vice versa. So one’s success tends to be at the expense of the other. However, for the major industrial countries, despite the fact that they sell products that compete with each other, they are also each other’s main export markets and main suppliers of useful imports. A successful European or Japanese economy helps the US by providing us with larger markets.             In addition to that, the purpose of international trade is not to export. Instead, it is to import, and this makes trade useful for us. What a country really gains from trade is its ability to import the things it wants. Exports are not an objective in and of themselves. The need to export implies a burden that a country must bear. This is due to the fact that import suppliers are crass enough to demand payment from the other party.             Trade patterns influence a number of factors. Among them are: (1) employment in high-wage manufacturing jobs; (2) growth trends relative to one’s productivity; (3) employment shares in the service sector; and (4) the overall wage levels.            Applying that, international trade again, is not a zero-sum game. When productivity rises in Japan, the main result is a rise in the Japanese real wages. American or European wages are in principle at least as likely to rise as to fall, and in practice seem to be virtually unaffected.             It would be possible to belabor the point. However, it is clear that while competitive problems could arise in principle, as a practical, empirical matter the major nations of the world are not in economic competition with each other, to any significant degree. It is normal to have rivalry for status and power, as countries that grow faster will see their political rank rise. Nevertheless, asserting that the growth in Japan diminishes the status of the US is very different from saying that it reduces the standard of living in the US. It is the latter that rhetoric competitiveness asserts.                                  Credit:ivythesis.typepad.com

International Trade

International Trade This paper is about international trade. It discusses the statement “ International trade is really...

Management case studies

Case Study 1: Leadership that Gets Results   Introduction Leadership can refer both to the process of leading, and to those entities that do the leading. Leadership has been a central, and sometimes controversial, topic in the study of organizations. In spite of claims to the contrary, there is substantial evidence that leadership is positively related to a variety of individual and organizational outcomes. Leaders, by their very roles, are responsible for making decisions that help their organizations adapt and succeed in competitive environments. Leaders do not merely impose goals on followers, but work with others to create a shared sense of purpose and direction. The discussions that follow present the impact of leadership in providing competitiveness among organizations analyzing from the leadership style of Meg Whitman of eBay.   Discussion Leaders primarily work through and with other people. They also help to establish the conditions that enable others to be effective. Leadership is a function more than a role. Although leadership is often invested in – or expected of – persons in positions of formal authority, leadership encompasses a set of functions that may be performed by any different persons in different roles throughout a community. Leadership comprises the aptitude and ability to inspire and influence the thinking, attitudes, and behavior of other people (1991;  1985; 1989;  1985; 1988). Leadership is a process of social influence in which one person is able to enlist the aid and support of other individuals in the achievement of a common task (1997). Although this specification seems relatively simple, the reality of leadership is very complex. Intrapersonal factors such as ideas and emotions, interact with interpersonal processes (i.e., attraction, communication, influence) to have effects on a dynamic external environment. Each of these aspects brings complexity to the leadership process. Whether a crisis is instantaneous and unanticipated, or gradual and long-term, effective leadership is what sets one organization apart from its competitors and often even determines it fate. According to  (2000), during the challenging times, individuals engage in mutual communication processes that avoid the structure to achieve the performance levels. The difficulty is that most of the people are dealing with the very same fears, anxieties, and uncertainties. All these were considered by Whitman in her strategic management of the employees and staff of eBay along as guided by key corporate values that the company upholds to be able to deal efficiently with their clients and customers. As such, the company was able to gain competitive position in the market as it generated and accumulated sales through  management techniques.    Conclusion Leaders manage and managers lead, but the two activities are not synonymous. Management functions can potentially provide leadership; leadership activities can contribute to managing. As such, managers should be creative as well as discerning when it comes to analyzing and assessing the resources of the company. Developing and evaluating the efficiency of a particular operation strategy will be helpful in maintaining the overall competitiveness of the business organization. In effect, being able to contemplate the factors that will greatly influence the success of the business should be highly considered through objective investigation of the current conditions of the business environment particularly the industry to which the company belongs.     Case Study 2: Fosters Starts the Change Process   Introduction Change management is basically defined as the formulation and assimilation of change in a methodical process. The major objective of change management is the introduction of innovative means and systems in the work organization. Businesses must normally undergo change in order to evolve to a higher level of for instance, stability, management or production. Appointing a new head officer, for example, can greatly enhance his subordinates based on his management principles and personality. This paper aims to delve into the concept of managing change providing imperative discussion in relation to a case study of Fosters.   Discussion Organisational change is part of and a result of struggles between contradictory forces, also change management practice is related with endeavouring to manage their competing demands. According to (1994), major change is occurring in most of today’s organisations. The presence of this continuous and overlapping change has become a way of life in the corporate environment. Change continues to shrink today’s global boundaries and push businesses to their competitive limit.  (1996) believe that modern organisations passed by the guild structures and as organisations grew larger, skills become increasingly fragmented and specialised and positions become more functionally differentiated. It can be said that organisational change is one of the critical determinants in organisational success and failure (1998).  (2000) provides a very useful framework for thinking about the change process, one which is anchored on problem solving. Managing change is seen as a matter of moving from one state to another, specifically, from the problem state to the solved state. Diagnosis or problem analysis is generally acknowledged as essential. Goals are set and achieved at various levels and in various areas or functions. Ends and means are discussed and related to one another. Careful planning is accompanied by efforts to obtain buy-in, support, and commitment. In the case of Fosters ( 2004), the company has been able to distinguish the constraints that highly affect the competitive position of the organization. The management was able to point out the problem with operational expenses and the declining prices of wine in the market. As such, they were able to conceptualize means of cutting the expenses through critical evaluation of the manufacturing processes and the supply chain management system being employed as well as strategic measures to compete in the pricing strategies of the competitors. Business expansion and alternative business ventures in the form of non-alcoholic products will highly contribute in the impending changes that the organization will undergo. Furthermore, the significant role and initiatives of as new chief executive and leading decision-maker of the company will greatly direct and dictate the fate of the company.   Conclusion Perhaps the space between the new organization design and implementing it into actuality is the whole coverage of organization change and development. People are adaptive to change. However, certain skills must be present from the initiators of change so as to successfully implement their project. Thus, managers need to have the necessary abilities not only in detecting what needs to be changed but also how to introduce the change effectively.  In this light, effective planning and management of change require careful consideration of the impact of structure change on middle managerial work roles and work satisfaction levels – to maintain their resistance, and maximise their commitment to the containing and accelerating pace of change within the organisation. Business leaders who want to get ahead in today’s marketplace must learn to respond to a growing number of changes in how they structure companies, conduct business, implement technology, and relate to customers and employees.   Credit:ivythesis.typepad.com

Management case studies

Case Study 1: Leadership that Gets Results Introduction Leadership can refer both to the process of leading, and to those entities t...

RESEARCH PROPOSAL ON WHAT IS PERSON CENTRED PLANNING?

WHAT IS PERSON CENTRED PLANNING? We all think about, and plan our lives in different ways. Some people have very clear ideas about what they want and how to achieve it, others take opportunities as they arise. Some people dream and then see how they can match their dreams to reality. Sometimes it is useful to plan in a structured way, and person centred planning provides a family of styles that can help do this. Person centred planning is not just about services, or disability, it is something that everyone can use to plan their lives. Styles of person centred planning share common values and principles, and are used to answer two fundamental questions: • Who are you, and who are we in your life? • What can we do together to achieve a better life for you now, and in the future? Person centred planning is not simply a collection of new techniques for individual planning to replace previous approaches. It is based on new ways of seeing and working with people with disabilities, fundamentally about sharing power and community inclusion. “One of the most common misunderstandings of person centred planning is that is a short series of meetings whose purpose is to produce a static plan. This misunderstanding leads people to underestimate the time, effort, uncertainty, anxiety and surprise necessary to accurately support people’s lives over time” John O’Brien and Herb Lovett. The origins of person centred planning Person centred planning may appear to be a relatively new, but its roots extend over twenty-five years, emerging from progressive changes in thinking about better ways to include people with disabilities in society. In the wider community, person centred planning has been developed from philosophies underpinning: • The social model of disability and the disability movement that demands a shift in the balance of power between disabled people and the services on which they rely. • The inclusion movement that calls for a passionate commitment to diversity and for intentional community building.   Within services, person centred planning has been influenced and stimulated by: • Normalisation and social role valorisation that insists on people with disabilities having a quality of life and position in society which is equal to and would be valued by non-disabled people.   • The accomplishment framework that focused services on five areas to improve peoples’ quality of life within their community. • Dissatisfaction with earlier planning approaches leading people to develop creative ways of fully including people with learning disabilities. • Best practice in social work assessments which emphasised the assessor‘s expertise in negotiation and problem-solving and imaginatively designing solutions using available service and community resources Person centred planning is not a fad from America. It has evolved from excellent practice and progressive thinking in communities and services. The values underpinning person centred planning Person centred planning is: Person centred planning is not: a powerful way to support positive change a cure-all a different way of working together just coloured posters instead of paperwork a better way to listen and respond to people just a more sophisticated assessment different for different people a standard package an invitation to personal commitment a service routine working towards inclusive communities just a better way to put together service packages for anyone who wants it just for those who are ‘ready‘ All means all Person centred planning is rooted in the belief that people with disabilities are entitled to the same rights, opportunities and choices as other members of the community. Disability does not justify poor treatment, low standards, injustice or oppression. Person centred planning starts from an assumption of common decency: ’What is a decent way for our society and our services to treat someone of this person‘s age, gender and culture in terms of their living arrangements, security and autonomy?‘. Traditionally, services have gathered people with the highest support needs or the most challenging behaviour into large segregated facilities, while allowing those who require less support to live more independently in the community. Professionals have ‘matched‘ people to different services along a continuum: the more support people are seen to require, the more strangers they have to live with and the more differences there will be between their home life and the lives of other people in their community Person centred planning challenges the whole idea of batching people together on the basis that they are perceived as needing a similar type or level of assistance. It challenges the assumption that because someone needs a lot of help it is acceptable for them to have an impoverished or restricted life. ‘All means all‘ means that it is morally unacceptable for people to be rejected by community services or excluded from community participation on the basis of the level or type of support they need. This means that people who practise person centred planning place a high value on loyalty and sticking with people over time, even when they test to the limit our capacity to accept, believe in and include them.   Everyone is ready The focus of professional effort in the lives of disabled people has traditionally been on the person‘s impairment. People are channelled into different services depending on the category of their impairment, for example, learning difficulty, sensory impairment or loss of mobility. This leads to a process of assessment which analyses and quantifies the impairment and its impact on the person‘s ability to undertake a range of tasks. This assessment results in a description of the person in terms of what she cannot do: her deficits. Professionals then set goals for people to try and overcome these deficits We have tended to focus on what people cannot do, spending years trying to teach people to clean their teeth or tie their shoelaces, to become more ‘independent‘. The most serious consequence of this is that people‘s participation in ordinary community life is then seen as dependent on their success in achieving these goals. People are only given opportunities when staff feel they are ‘ready‘. They have to earn the right to be part of their own community. People who expected services to help them to manage their own lives have instead become trapped in a world where others make judgements about their future. Person centred planning starts from the other end. It asks ‘How do you want to live your life? What would make sense for you?‘ before looking at ‘How could we work with you to make this possible, given your particular situation and the things you need help with?‘. It challenges the traditional notion of ‘independence‘ in two ways. Firstly, it sees independence in terms of choice and control rather than physical capacity to carry out particular tasks. “Real independence is nothing to do with cooking, cleaning and dressing oneself. If you ask me what is my experience of being independent, I would not automatically think about self help skills but of being able to use my imagination to create fantasy, of enjoying music and drama, of relishing sensual pleasures and absorbing the natural life around me.”. John Corbett. Person centred planning is not the same as… Person centred planning is not synonymous with “needs led” or “client centred” or “holistic” assessment or care planning. These start with the individual but are not necessarily person centred. The definition of “needs” used in care management, for example, is a “system construct”. Needs are defined as those things for which the person is deemed eligible according to interpretation of policy and the resources of the local social services department. Person centred planning goes beyond this definition of needs, considers people’s aspirations, is not limited by entitlement to services and is not necessarily dependent upon professional involvement. Person centred planning is concerned with the whole of someone’s life, not just their need for services. Jean and her daughter Lucy prepared for Lucy’s transition review by doing an Essential Lifestyle Plan. Great effort went into producing a really detailed picture of what matters for Lucy. Jean left the meeting feeling crushed and physically sick. Though several people at the meeting were really enthusiastic about the plan and said how helpful it was for them as professionals to think about their contributions to Lucy’s future, the social worker was apologetic. She said ” I’m sorry we don’t recognise ELP. We don’t have the resources to implement it. We can only meet needs not wants” The social worker was confusing assessment for council services and broader life planning. Jean and Lucy did not expect social services to deliver everything in the plan. They wanted the professionals to listen to what was important to Lucy and her family and work out what they could do to contribute towards achieving these things. They also wanted help with problem solving other sources of support and resources. What can person centred planning be useful for? • Help people to work out what they want in their lives • Clarify the supports needed for people to pursue their aspirations • Help to shape the contributions made from a range of service agencies to ensure these are effective in helping people meet their goals • Bring together people who have a part to play in supporting people for joint problem solving • Energise and motivate people based upon better understanding of and commitment to a person   Show service agencies how they can adjust their activities at both operational and strategic levels in order to better support people to achieve their goals It is equally possible to be “client centred” or “holistic” without being person centred. The key issues here are about who decides what is important in planning and the power balance within it. Professionals can undertake planning which is centred on an individual but where the focus is exclusively upon professional concerns and judgements. “Information gained from technical assessments can be helpful, but only in the context of a knowledgeable account of a person’s history and desired future” , John O’Brien and Herb Lovett. Key features of person centred planning Person centred planning has 5 key features: 1. The person is at the centre Person centred planning is rooted in the principles of shared power and self-determination. Built into the process of person centred planning are a number of specific features designed to shift the locus of power and control towards the person. Simple practical examples of this are that as far as possible the person is consulted throughout the planning process; the person chooses who to involve in the process and the person chooses the setting and timing of meetings. 2. Family members and friends are partners in planning Person centred planning puts people in the context of their family and their community. It is therefore not just the person themselves that we seek to share power with, but family, friends and other people from the community who the person has invited to become involved. Person centred planning starts from the assumption that families want to make a positive contribution and have the best interests of the person at heart, even if they understand those best interests differently from other people. 3. The plan reflects what is important to the person (now or for the future), their capacities, and what support they require In using person centred planning we seek to develop a better, shared understanding of the person and their situation. The planning process can be powerful – people’s views change, new possibilities emerge, alliances are created, support is recruited, and energy is gathered and focused. The resulting person centred plan will describe the balance between what is important to the person, their aspirations and the supports that they 4. The plan helps build the person’s place in the community and helps the community to welcome them. It is not just about services, and reflects what is possible, not just what is available. The focus of person centred planning is getting a shared commitment to action, and that these actions have a bias towards inclusion. In this context services are only part of what people want and need; and planning what services you need comes after planning what sort of a life you want. 5. The plan results in ongoing listening, learning, and further action. Putting the plan into action helps the person to achieve what they want out of life. Person centred planning is not a one off event. It assumes that people have futures; that their aspirations will change and grow with their experiences, and therefore the pattern of supports and services that are agreed now will not work forever. Person centred planning is a promise to people based on learning through shared action, about finding creative solutions rather than fitting people into boxes and about problem solving and working together over time to create change in the persons life, in the community and in organisations. To fulfil this promise we need to reflect on successes and failures, try new things and learn from them and negotiate and resolve conflict together. Different styles for different purposes There are several different styles of person centred planning that can help people to achieve different purposes. Each style is based on the same principles of person centred planning: all start with who the person is and end with specific actions to be taken. They differ in the way in which information is gathered and whether emphasis is on the detail of day to day life, or on dreaming and longer term plans for the future. The common planning styles in use in the UK include Essential Lifestyle Planning, PATH and Maps, and Personal Futures Planning. It is crucial not to divert energy into pointless debates about which is the best planning style. People should consider rather which style might be best used in which circumstances. Styles can be used to complement one another. The purpose of a person centred plan is to achieve one or more of the following: 1) To develop a ‘picture’ of the person’s desired future and describe the actions needed to move in that direction (PATH and MAPs are useful for this purpose) 2) To look at where the person is now, how they would like their life to change and mobilise and engage people to help the person to become a part of their community (Personal Futures Planning is useful for this purpose) 3) To learn and provide a single place to record, on an on-going basis: • What has been learned about what is important to the person and what is important for the person • What others are expected to know and/or do to help the person get what is important to them and what is important for them • The balance between what is important to the person and what is important for the person where there is a conflict between them • What needs to stay the same and what needs to change and who will do what (by when) in acting on these (Essential Lifestyle Planning is useful for this purpose) Each planning style combines a number of elements: a series of questions for getting to understand the person and her situation; a particular process for engaging people, bringing their contributions together and making decisions; and a distinctive role for the facilitator(s). PATH and MAPs focus strongly on a desirable future or dream and what it would take to move closer to that. In Essential Lifestyle Planning and Personal Futures Planning facilitators gather information under more specific headings. Particular sections – such as the section in Essential Lifestyle Planning on how the person communicates and the section in Personal Futures Planning on local community resources – ensure that someone gathers together what is known and records this information so that everyone can use it. People may need to focus on different areas of their lives at different times, and therefore use one planning style at one time and another at another time. We need to learn what is important to people on a day to day basis and about the future they desire. Sometimes it is important to learn about the day to day issues first, and then move on the learning about a desirable future. In other situations we need to hear about peoples dreams, and later learn about what it is important on a day to day basis. In considering what style to use facilitators need to consider the context and resources available to the person. Whether the person has a team to support her, or lots of friends and neighbours who want to get involved or a circle of support can influence the decision about which planning style to use. If the person has a team who do not know her very well, then starting with a planning style which invests a lot of time in really getting to know the person, for example Essential Lifestyle Planning, could be a useful place to begin. If the person has family and friends or a circle who know and love her, then starting with dreams through PATH or Maps is useful. centred planning some people were getting better lives when people listened to them closely and cared about them enough to act on what they heard, solving sometimes very difficult problems on the way. Person centred planning approaches are simply (sometimes very powerful) aids to doing this. Some people will benefit greatly using the methods of some of the well-developed styles of person centred planning. Other people might plan or start to plan in less structured, “on the move” ways like Mike and Graham Mike had spent many years in various institutions. He has autism and a bi polar disorder. He eventually was discharged at the age of 40 into a group home with 3 people from the institution randomly chosen to ” get on with each other “. He hated the home he lived in and the people he lived with. Several violent incidents at the home made him anxious and worried and he was eventually moved to another group home to share a double bedroom with another tenant and two other tenants in the home. He again had nothing in common with the other 3 men. When I met him he was confined to his room, indeed his bed, and refusing to participate in any outside activity. He was depressed and unwilling to engage in any planning about his future. At the time a property became available to the charity that I work for as a short life property on lease from the Local Council. It needed a lot of work doing to it and, as it was only a short-term lease, we had much debate about whether we should take on the lease. Mike agreed one day to come for a walk with my colleague and me to see this house. We had no intentions of Mike moving to the home but thought it would be good to get him away for the day from the place he was living. Mike went to the house with us, sat in a room with no television, bed, carpet and with a large hole in the wall and roof, and said he would like to stay there forever. That is how unhappy he was with his previous accommodation and life. His previous tenancy was at a place where he shared with people he did not like and which was run on quite an institutional basis with regular, stipulated meal times, bed times and personal support times. The place was attractively furnished and well maintained but it was not a home to Mike. This was the first step of his person centred plan because Mike wanted to persuade us that the best course of action was for him to stay at this house with no facilities whatsoever. By listening to his stilted words charged with emotion and frustration we realised we had to help him do something in his own way and not impose our standards and expectations of appropriate housing on him. We compromised on another room, found a bed and some bedding and asked the full time resident caretaker, looking after the security of the property while it was being renovated, to “keep his eye on Mike”. Just to make sure we still had some “control factor in this” we agreed with Mike that he needed to go home to “his real home” when work was taking place and to get support from the staff at the home (he never went back once). We also insisted this was a temporary measure ( that was seven years ago!). Graham is a man in his early forties who lives in a small village. He has lived there all his life with his dad. Every weekday morning he is picked up by the There are dangers in focussing too much on the process of planning to the detriment of the desired outcomes. In exploring the uses of person centred planning we social work bus which takes him to a day centre in the local town. Graham knows everyone in the village. He goes to the local pub every Friday and shops in the post office almost every day. Recently his father was diagnosed as having terminal cancer. It looked like Graham would have to leave the village and provision would have to be found for him elsewhere. Graham‘s social worker began looking at the options available in the local town. At the day centre they knew that Graham would be devastated to lose both his father and his community at the same time. One of the support workers, Fergus, decided to see if anything else could be done. He travelled to the village one day and began knocking on doors. He explained to Graham‘s neighbours that he would have to move out into supported housing when his father died. Nobody wanted that to happen. Graham and Fergus called a meeting to which about twenty people came. Between them they sorted out how they could support Graham to stay living in his own home when the time came. Two months ago Graham‘s father died. Graham feels the loss deeply but he has insisted on remaining in the house when he has always lived. He still attends the day centre and someone from his support circle meets him off the bus everyday and goes home with him to cook a meal. No one thought he would manage to sleep on his own but he does. There are fourteen people from the village in Graham‘s circle of support. Between them they are determined to ensure that he does not have to move away. Where is the evidence? In public services, we are increasingly and rightly looking for evidence to justify expensive activities and interventions. Some have questioned the application of person centred planning approaches on these grounds. Obviously evidence of effectiveness is important and the Department of Health has recently commissioned a major study to be undertaken in the near future. Having said this, the key issue is not “should we undertake person centred planning?” but rather to establish how to make person centred planning most effective. This is because a key purpose of person centred planning is to find out what is important to people and to act on this knowledge. If we do not do this we must ask ourselves serious ethical questions about our activities as professionals, staff and managers. In one local authority area recently a presentation was made to the Social Services Committee. The presentation was by a group of managers and staff from the Learning Disability Section of the SSD who had been introducing person centred planning for some of the people who use the service. The elected members were suitably impressed by the presentation but one asked a question along the lines of:”Let me get this clear, you are introducing an approach that finds out what is important to people so that we can make sure that services are responsive to them? You mean to say we don’t do that for everyone already!”. The surprise of the elected member reflects the views of many advocacy organisations and family groups who feel strongly that we need to get much better at hearing and responding to people’s concerns.We  must be really careful to keep our eyes on the prize of people getting better lives. This does not mean that how planning is done is unimportant, but that it will vary in different circumstances. Long before anyone developed person don’t need evidence to know that we should do this. Summary • In it’s fundamentals, person centred planning is a way of helping people to work out what they want, what support they require and then helping them to work out how to get it. It is about life not just services • Person centred planning has its roots in changing philosophies about people with learning disabilities and in better practice in supporting people • Person centred planning is not synonymous with “needs led”, “client” or “patient centred” planning or “holistic” assessment • There are five main features of person centred planning. These can be used to test “person centredness” • Different styles can be useful for different purposes and in different circumstances • Though there are some well developed styles, it is vital not to undermine person centred work simply because it does not come under the name of these styles. Remember the goal is better lives • Equally, approaches that are fundamentally not person centred must not be re-labelled or tinkered with and presented as person centred • We need evidence about how to do good person centred planning, not about whether we should do it. This is fundamentally an ethical issue • Person centred planning should not be denied to any groups of people Helen Sanderson and Martin Routledge. With extracts from People, Plans and Possibilities by Helen Sanderson, Pete Ritchie, Jo Kennedy and Gill Goodwin. If you want to read more you can order People, Plans and Possibilities from Inclusion Distribution Credit:ivythesis.typepad.com

RESEARCH PROPOSAL ON WHAT IS PERSON CENTRED PLANNING?

WHAT IS PERSON CENTRED PLANNING? We all think about, and plan our lives in different ways. Some people have very clear ideas about what...

MANAGEMENT OF ANEMIA

MANAGEMENT OF ANEMIA IN RENAL PATIENTS   Introduction               Anemia is a serious medical condition which manifests in renal patients. Management of anemia in these patients is a collaborative effort which involves the general practitioner, the nephrologists, the specialist and the nurse. This paper will look into the roles these healthcare professionals play in the management of anemia.   Body   Renal failure can either be acute or chronic. Acute renal failure is the clinical condition associated with rapid, steadily increasing azotemia, with or without oliguria. The causes of renal failure can be grouped into three diagnostic categories: prerenal (inadequate renal perfusion), postrenal (obstruction), and renal. Prerenal and postrenal are potentially reversible if diagnosed and treated early, and some of the causes of primary renal injury which result in acute tubulointerstitial nephropathy are also treatable, such as bacterial infections, drug reactions, and metabolic disorders.             Initial evaluation of acute renal failure should seek reversible or specifically treatable causes of acute renal failure. Bladder neck obstruction is probably the most common cause of sudden, and often total, cessation of urinary output, especially in older men. A preceding history of difficulty in voiding is frequently given.             Chronic renal failure on the other hand is the clinical condition resulting from a multitude of pathologic processes which lead to derangement and insufficiency of renal excretory and regulatory functions (uremia). Chronic renal failure may result from any cause of renal dysfunction of sufficient magnitude.             When disease causes kidney failure or otherwise compromises the ability of the kidneys to remove toxic materials from the blood and maintain fluid, electrolyte, and acid-base balance, therapeutic dialysis by diffusion across a semipermeable membrane may be used. The patient’s own peritoneum or a machine using a synthetic semipermeable membrane such as cellophane may be used – peritoneal dialysis and hemodialysis, respectively.             Anemia is a frequent problem in patients with renal failure especially those in end stage and in chronic kidney disease (CKD) who are not yet receiving dialysis and can lead to major health complications if left untreated. The successful management of these patients entails repletion of iron stores, often through use of intravenous iron, particularly in patients receiving erythropoietin therapy. To encourage patient compliance with anemia management protocols, the nephrology nurse can play a key role in patient education in reducing barriers to proper management and in raising the awareness of the benefits of treating this condition (, 2001).             Nurses play a key role in helping to maintain Hb levels in the range recommended to mitigate anemia-related risk factors in both predialysis patients and those with end stage renal disease (ESRD). This is actually a situation which calls for a team approach comprising of the nephrologist, general practitioner, specialist and the nurse. Additional progress in anemia management can be obtained by understanding, the importance of early diagnosis and treatment of iron deficiency. Several factors contribute to iron deficiency in renal failure patients. First, observations with patients in the predialysis period, on hemodialysis, and on peritoneal dialysis suggest that intestinal iron absorption is reduced during ESRD. Poor absorption of iron can lead to the depletion of both circulating iron and iron stores, which is referred to as absolute iron deficiency. It has been suggested that low iron absorption in these patients may be explained by the intestinal mucosal changes that develop with uremia, including changes in activity of certain digestive enzymes–decreased activity of dipeptidases and increased activity of disaccharidases. Intestinal inflammation with associated histologic alterations may also be related to low iron absorption. Erosions and ulcers are additional gastrointestinal complications that often develop during ESRD. These are associated with gastrointestinal bleeding, which may also contribute to the development of iron deficiency. In hemodialysis patients, significant blood loss may also be caused by blood remaining in the dialyzers and dialysis lines postdialysis (, 2002). All patients returning to the dialysis facility following hospitalization should be immediately assessed to determine their clinical status. This process should include both a complete review of hematologic parameters and an individualized assessment for the presence of comorbid conditions that could affect hemoglobin (Hb) levels either acutely or chronically (, 2004).             Anemia may be aggravated during hospitalization, and patients returning to the dialysis facility may present with Hb levels that are significantly lower than baseline. Clinical data indicate that anemia can persist after hospitalization, with some patients requiring up to 6 months to regain preadmission Hb levels. To optimize anemia-related outcomes, a special approach to minimize post-hospitalization anemia may be warranted. Nursing interventions to proactively manage comorbid conditions, modify the anemia management prescription before hospitalization, and/or initiate a Rapid Ramping approach afterward can often minimize the severity of any decrease in Hb while shortening the time required to reaehieve targeted Hb levels (2004).             Proactive nursing interventions, including appropriate patient assessment, timely initiation of therapy, and individualized dose calculations, can help ensure that patients attain and maintain targeted Hb levels. The anemia manager should monitor the trends in Hb levels and note the increase after weeks of therapy; iron parameters should remain within the targeted range. Assessment should be negative for other conditions that may contribute to a low Hb, and if the Hb levels rose, the Epoetin alia dose should be gradually decreased to the prehospitalization level of 80 Units/kg TIW. The Hb should be restabilized weeks after discharge (, 2004).             The iron status of patients with renal failures should be evaluated on a regular basis during both the predialysis and dialysis periods, since these patients are at risk for developing iron deficiency (, 2002).             The role of the nephrology nurse in the anemia management of ESRD patients has been reviewed previously. Nephrology nurses often play a key role in managing patients with CKD. Because of recognition of the importance of active management of CKD patients at earlier stages in the disease practice, more CKD patients are likely to be referred to nephrologists before they need dialysis (, 2001). The advanced practice nurse, who is functioning as a physician extender, is more likely to work with patients in the predialysis setting than the nephrology nurse in standard practice who is usually involved with dialysis management. The advanced practice nurse may fulfill essential roles in identifying CKD patients at risk for developing anemia and managing the iron and EPO requirements of these patients (e.g., laboratory assessments of iron and hematology indices, prescriptions of therapies, etc.) (, 2001).             However, as more patients are being cared for by nephrologists at the predialysis phase, the nephrology nurse in the standard setting is likely to have increased contact with CKD patients. Nephrology nurses who do not oversee the direct medical management of CKD patients may still play vital roles in identifying anemic patients, promoting compliance, educating patients and health care personnel, and administering therapies. These functions are essential because several barriers exist to optimal anemia management in the CKD patient. For instance, patients and care providers may not understand the importance of anemia management and may question whether it is worth bringing CKD patients into the office weekly for injections. Nephrology nurses can communicate the importance of anemia management over the long term and assure patients about the safety and efficacy of the available therapies. Reimbursement for EPO may involve a great deal of red tape, even though it is an important therapy. The health care team must be unified in its commitment to overcoming the barriers to these interventions (, 2001).             Early identification and aggressive treatment of anemia in CKD patients may improve patient outcomes such as cardiovascular function, quality of life, and morbidity/mortality. There is a need for greater awareness of the importance of early intervention. Nephrology nurses have assumed increased clinical responsibilities within today’s practice setting, and their role in managing CKD patients may increase in the future. Nephrology nurses can have a major impact on the clinical outcomes of CKD patients, primarily through patient education and improved patient compliance (, 2001).  (, 2002).             Documentation of anemia-related assessments, interventions, and outcomes is an integral component of proper anemia management for patients with ESRD. In addition to promoting vital communication among medical professionals, documentation helps fulfill regulatory, legal, and payer reimbursement requirements, thereby ensuring that nursing contributions to patient well-being are recognized and that access to care is preserved (2003).             It is important for nephrology nurses to understand the relationship that exists between renal disease, cardiac disease, and anemia. Even mild cases of chronic kidney disease (CKD) have been associated with an increase in adverse cardiovascular outcomes. And anemia, which can result from both CKD and congestive heart failure, has been shown to exacerbate the adverse consequences of these conditions. An early, aggressive correction of anemia in patients with CKD can be implemented to break this cycle and stop disease progression. Studies have shown that anemia correction improves both cardiac and renal function and can result in increased hemoglobin levels, decreased number of hospital days, and improved quality of life. An effective strategy for managing anemia in patients with renal disease and comorbid cardiovascular disease includes the administration of both recombinant human erythropoietin and intravenous iron. In addition, the nephrology nurse plays an integral role in managing anemia and improving outcomes in these patients. Therefore, the nephrology nurse should have an increased awareness of the link between anemia and renal/cardiac disease as well as available treatment options (, 2005).   Recommendation and Conclusion               Anemia has long been recognized as a serious health problem in patients who have renal failures, especially those requiring dialysis. Successful treatment of anemia (i.e., increasing the hematocrit [hct] towards normal) in such patients is associated with reduced morbidity/mortality and significant improvements in cardiovascular and brain function as well as quality of life.             Although recent data indicate that the current anemia management protocols are resulting in good patient outcome, health care providers can still improve patient health by more aggressively addressing the problem of iron deficiency. A good starting point would be to establish a simple iron deficiency management protocol that involves early detection and treatment during both the predialysis and dialysis periods. Clinicians can also improve the outcome of iron deficiency by optimizing iron therapy. The administration of safe and effective IV iron supplements, close monitoring of iron and hematologic parameters, and maintenance IV iron therapy will help clinicians achieve good patient outcome. Taken together, improvements in anemia and iron deficiency management will ultimately improve patient health and quality of life and may also reduce financial burden.           REFERENCES   Credit:ivythesis.typepad.com

MANAGEMENT OF ANEMIA

MANAGEMENT OF ANEMIA IN RENAL PATIENTS Introduction Anemia is a serious medical condition which manifests in renal pat...