The High Cost Associated With Medicare - 790 Words

The high cost associated with Medicare requires approaching health care reform from an intentional perspective. One approach to help achieve integrated and efficient care is to foster accountability for quality and cost through performance measurements and â€Å"shared savings† payment reform. The approach provides a practical and feasible method for providers and organizations to improve their current revenue cycle processes, while maintaining provider incomes and reducing overall health care costs. Rising health care cost currently threaten the sustainability of the Medicare program. Although advances in biomedical knowledge and technological innovation offer cost saving improvements, the differences in spending across regions and health systems highlight the opportunity to improve efficiency by providing better care at lower cost (Fisher, McClellan, Bertko, Lieberman, Lee, Lewis, Skinner, 2009). On average regions with lower Medicare spending provide higher quality care and achieve better health outcomes. While regions with higher spending, due largely to the over use of â€Å"supply-sensitive† services, demonstrate high levels of inefficient use of health care resources. Providing a need to approach payment reform by addressing three barriers to care: lack of accountability, the volume reward system, and the penalties associated with cost saving innovations. One proposed method for addressing this issue is to realign payment incentives to better support health care providers.Show MoreRelatedMedicare : A Form Of Social Insurance1050 Words   |  5 PagesBackground on Medicare Medicare is a form of social insurance. It provides several types of health insurance to its beneficiaries. The large majority of those who benefit from medicare are people who are 65 years old or older. There are some exceptions to this for people under the age requirement but have certain disabilities or diseases. Medicare is made up of four parts: A, B, C, and D. Medicare part A is Hospital Insurance. This means that it covers the costs associated with a hospital visit,Read MoreNational Patient Safety Goals ( Npsgs )1525 Words   |  7 PagesNational Patient Safety Goals (NPSGs), established in 2002 by the Joint Commission, is to help accredited organizations address specific areas of concern in regard to patient safety (Catheter-Associated, 2015). NPSG.07.06.01 Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTI) is a 2015 NPSG (The Joint Commission, 2015). Our facility has 1.32 CAUTIs per 1000 device days (Carson, 2015). Decreasing CAUTIs can be achieved with a strictRead MoreSwitzerland Case Study976 Words   |  4 Pages(Cherry, B, (2014)) Government funded programs provide health coverage for the unemployed, elderly, low income and retired. â€Å"100 million Americans receive health insurance from government funded programs.† (Centers for Medicare and Medicaid, (n.d)) G overnment funded programs are Medicare, Medicaid and childrens health insurance programs. According to a report released by the Commonwealth Fund, â€Å" the number of uninsured in the U. S has declined. About 29 millions American were uninsured in 2015.†(CollinsRead MoreNational Patient Safety Goals ( Npsgs )1524 Words   |  7 PagesNational Patient Safety Goals (NPSGs) were established in 2002 by the Joint Commission to help accredited organizations address specific areas of concern in regard to patient safety (Catheter-Associated, 2015). NPSG.07.06.01 Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTI) is a 2015 NPSG (The Joint Commission, 2015). Our facility has 1.32 CAUTIs per 1000 device days (Carson, 2015). Decreasing our CAUTIs can be achieved with a strictRead MoreSwitzerland Health Care System993 Words   |  4 Pages(Cherry, B, (2014)) Government funded programs provide health coverage for the unemplo yed, elderly, low income and retired. â€Å"100 million Americans receive health insurance from government funded programs.† (Centers for Medicare and Medicaid, (n.d)) Government funded programs are Medicare, Medicaid and childrens health insurance programs. According to a report released by the Commonwealth Fund, â€Å" the number of uninsured in the U. S has declined. It is estimated that approximately 29 millions AmericanRead MoreThe Patient Protection And Affordable Care Act1639 Words   |  7 Pagesabout the reimbursement rates for Medicare patients. Who makes up the Accountable Care Organization? We will also take a look into the Affordable Care Act and how the ACO is a part of that. What is the Accountable Care Organization? â€Å"Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients† (www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/indexRead MorePrivate Insurance Essay931 Words   |  4 PagesSharp rises in insurance premiums have forced employers to shifts costs to the employee by increasing deductibles, coinsurance, and pharmacy benefits (Trude, Christianson, Lesser, Watts, Benoit, 2002). Employers may offer their employees a choice of plans in the defined benefit model of health insurance benefits. Many of these plans have high-deductibles (referred to as high deductible health plans or HDHPs) that shift costs to the employee, the premiums are generally less expensive than managedRead MoreThe Tradeoffs Associated With The Medicare-For-All Policy721 Words   |  3 Pagesto fully evaluate the tradeoffs associated with the Medicare-for-all policy, it is imperative that a source of funding, or a payment model, is identified. Without this information, it is difficult to determine not only who would benefit and who would suffer, but how the system as a whole will respond to the healthcare choices of over 323 million people. Another important detail lies in the potential cost savings and efficiency for middle-class families. The Medicare-for-all plan promises to save theRead MoreMedicare : A Federally Administered Health Insurance Program1423 Words   |  6 Pages Med icare is a federally administered health insurance program that was started in 1965 by President Lyndon B. Johnson, taking effect in 1966. The Medicare program was aimed at aiding the high percentage of elderly individuals who were without health insurance coverage and thus improve their health. Originally, Medicare provided health insurance coverage for retirees and their spouses 65 years and older. However, in 1972 Richard Nixon signed the first change to Medicare, allowing for certainRead MoreCase Study Of Porter s Five Forces Model813 Words   |  4 Pagesconcentration of competitors. The hospital that I work at is the largest between Memphis and Nashville and has the busiest ER in the state of Tennessee. Therefore, the concentration of competition is low for that particular hospital. There are high fixed costs with a hospital such as buildings, overhead, equipment, and salaried personnel. Yet, a hospital does not cut their prices to increase patient census. However, i t could be questionable in a low census period as to whether there are additional

Essay about The Australian Automotive Manufacturing Industry

The Australian automotive manufacturing industry has experienced substantial structural change (â€Å"Productivity Commission†, 2014). This has been in response to changing market and competitive conditions overseas and in Australia, and reduced levels of assistance from governments (â€Å"Productivity Commission†, 2014). Following similar decisions by Holden and Ford, these factors have led to Toyota’s decision to abandon manufacturing in Australia by 2017. AMWU National Vehicles Secretary Dave Smith said â€Å"the decision would cost thousands of jobs, not only at Toyota but all the way down the supply chain† (â€Å"Devastating day†, 2014) and represents the â€Å"collapse of the automotive industry in Australia† (Novak, 2014). The purpose of this report is to†¦show more content†¦The difference is that according to stakeholder theory, a wide view is taken in that businesses have a responsibility to all of their stakeholder groups not just to shareholders (Freeman, Harrison Wicks, 2007). Broadly, a stakeholder is anyone that can affect or be affected by the activities of an organisation. EMPLOYEES A major consequence of Toyota ceasing their manufacturing in Australia by 2017 is that 2400 Australian Toyota employees will lose their jobs (Novak, 2014), and for some employees, retrenchment can lead to prolonged unemployment (â€Å"Productivity Commission†, 2014). In line with shareholder theory, businesses don’t have a responsibility to provide employment to a country as it is not a responsibility of business (Friedman, 1970). Therefore, Toyota doesn’t have a responsibility to provide employment to Australia as their only responsibility is to their shareholders and manufacturing in Australia simply isn’t viable, thus their decision cease their manufacturing in Australia is in accordance with shareholder theory. However according to stakeholder theory, Toyota needs work with the Auto Manufacturing Workers Union in defining the provision redundancy payments and retraining to their retrenched automotive manufacturing employees. Redundancy payments help displaced employees with immediate financial pressuresShow MoreRelatedAustralian Car Manufacturing Industry Comes to an End719 Words   |  3 PagesIntroduction It is believed that the Australian car manufacturing industry has come to an end. The following essay will argue that the government should not provide finances to save the automotive manufacturing industry. There is a continuous debate between the shareholders of the automotive businesses and the Australian citizens on what should be done with this issue. In order to determine the strength of the argument, the following essay will completely analyze relevant information; examine theRead MoreImpact Of Globalisation In Australia1479 Words   |  6 Pagesgrowth in manufacturing and service industries, with limited growth in the rural sector. The car manufacturing industry in Australia had high levels of protection in motor vehicles, with an effective rate of protection, in excess of 200% and 57.5% for passenger motor vehicles, since the 1950s. However, the cuts in protection enabled an increase in imports, but the increased efficiency has led to a comparable rise in exports. Globali sation has benefited the consumer, at the expense of Australian manufacturersRead MoreImpact Of Globalisation In Australia1077 Words   |  5 Pagesflows, technology transfers and the migration of labour since its foundation as a colony. The impact of globalisation has changed the structure of Australia’s trade, with considerable growth in manufacturing and service industries, with limited growth in the rural sector. The car manufacturing industry in Australia had high levels of protection in motor vehicles, with an effective rate of protection in the, in excess of 200% and 57.5% for passenger motor vehicles, since the 1950s. However, theRead MoreThe Impact Of Subsidies And Tariffs On The Motor Vehicle Industry1512 Words   |  7 Pageson News.com.au. The key issues raised in the article include: †¢ Australian domestic car sales in steady decline and in 2014 fall to a 48 year low †¢ $1.3B loss over 10 years †¢ $1.1B of government funding over 13 years †¢ Ford to close manufacturing plants in Australia in 2016 †¢ Keep 1500 engineering jobs in Australia This paper explores the impact of subsidies and tariffs on the motor vehicle industry; the reduction of domestic Australian vehicle sales; the impact in the shift from low skilled to highRead MoreCase Study : Car Manufacturing Industry Essay1306 Words   |  6 PagesGroup assignment Car manufacturing industry Nick 18929667 Zac 18920117 Matt 18932827 Brandon 18976121 Guy 18684312 Description The car manufacturing industry in Australia involved three main competitors including, Ford Australia, GM Holden and Toyota Australia. There were four but in 2008 Mitsubishi Australia, but stopped production of the last domestic Mitsubishi model the 380. Mitsubishi stopped the production of the large sedan because smaller cheaperRead MoreCase Study : Hybrid And Autonomous Technologies1558 Words   |  7 Pages3.1 Option 1: Continue with existing 3-pronged strategy and expand operations within the Australian market to focus on hybrid/autonomous technologies The first strategic option proposed is to expand operations within the Australian Market to focus on hybrid and autonomous technologies in addition to the existing three pronged strategy. The goals of this option include increasing production locally by adding new models for export and simultaneously transitioning models made overseas to being madeRead MoreThe Consequences of Globalization in Australia1293 Words   |  5 Pagesprotection of the world economy such as the successive reduction in trade barriers since the Second World War. Consequences that arise as a result of Globalisation are known to be both positive and negative. One consequence faced by Australian businesses and industries is the aggravation of unemployment. Another is competition, in which demand and supply are balanced out by a regulatory function when businesses challenge each other by offering the best price, quality and service of their ability.Read MoreStrategic Options For The Australian Market Focus On Hybrid / Autonomous Technologies1484 Words   |  6 Pagesstrategy and expand operations within the Australian market focus on hybrid/autonomous technologies †¢ Option 2 – Maintain 3-pronged strategy, seeking to leverage government support †¢ Option 3 – Remove two prongs, greater focus on the existing importing global model. Along with reducing the local manufacturing presence, and expanding the existing dealer network. 3.1 Option 1: Continue with existing 3-pronged strategy and expand operations within the Australian market focus on hybrid/autonomous technologiesRead MoreGlobalisation and Australian Automotive Industry3628 Words   |  15 PagesJapanese cars ply the streets, a mobile call can be enough to buy equities from a stock exchange half a world away, local businesses could not function without U.S. computers, and foreign multinationals have taken over large segments of service industries. Impact of Globalisation, both theoretically and practically, can be observed in different economic, social, cultural, political, financial, and technological dimensions of the world. Globalisation has created a new world order and is graduallyRead MoreToyota Australias The Australian Employee Is Inevitable1005 Words   |  5 Pagescompetitiveness, capability could not match the changed automotive market in Australia. In addition, no matter how Toyota Australia choose, the injury to Australian employee is inevitable. The only way for Toyota Australia to be more ethical is taking some remedial measurement. Recommendation(s) Based on the case evaluation, I recommend Toyota Australia terminate its operation and withdraw its manufacturing factories from Australia. On the basis of this recommendation, I will provide some suggestions

What is Microeconomics Free Essays

In Incentives, Commitments, and Habit Formation in Exercise: Evidence from a Field Experiment with Workers at a Fortune-500 Company study a wellness incentive program implemented at a large corporate headquarters office. Three groups of employees were given different types of financial incentives to visit the on-site fitness center, and their gym-going behavior was monitored for many months afterward. The incentives were that a set of employees received $10 per gym visit over 1 month. We will write a custom essay sample on What is Microeconomics or any similar topic only for you Order Now After the month was over then they were offered a 2 month contract to continue going with a little bit of a twist, to see the effect of it. How does a commitment contract work? The employee puts down a certain amount of money, they get to choose the amount. If they don’t stick to their commitment, they lose the money. They need to be able to go to the gym every 2 weeks over the next 2 months. It is all about risk vs commitment. How much do you really want this, do you want to see personal growth in yourself, are you doing it just so you don’t lose the money, it is all in your hands the way you decide to play it. Why would anyone want to take up this offer, the best possible result is breaking even? This was made to differentiate between your long-term preferences vs the short-term preferences. You may set a schedule saying I’m going Monday and Friday every week. You go Monday and you feel great after going and are excited to continue on Friday. You make it to Friday and you make plans with your friends instead of having your gym time. It was a long week so you want to have a good time. You should be able to reward yourself after a long week but do you think that you would feel even better and have a better time out if you went to the gym beforehand. With having this contract, say you know you haven’t been to the gym in 13 days and you need to go tomorrow or you lose your money. That might push people to get to the gym, not just for the money but that specific trip could make them want to keep going back in the long run. So the best-case scenario for a commitment contract is not just breaking even: its changing behavior in a positive way. About 1 out of every 8 employees offered a chance to create a commitment contract decided to do it (Royer, Stehr, Sydnor, 2015). Below are the results of the commitment contract subjects. It was shown that there was a spark in the gym visits more for the group who signed the contracts than when they were offered the $10 per visit. With the contract you are putting your own money on the line. You have something to lose if you don’t hold up your end of the bargain. In the long run it is not about the money, it is about your lifestyle and goals. You have things you want to achieve and sometimes you just need a little nudge to get you going. After the 2 month commitment ended, it was wanted to be known the long term effects of the subjects. It was shown that they had noticeably more frequent gym visits on average. Main Hypothesis: Does linking incentives to fitness really help you get to the gym more? Why is it that after the free trial period ends that most of the memberships decline? Why do people not continue on? See no results? Have no incentives? Commitment devices (Fitbit/ Apple Watch) may be the best way to achieve long-term changes New Year’s resolutions for most seem to be about Eating healthier, go to the gym more, and cut out sugar, most of health/Fitness related. Get statistics on the New Year’s resolutions. How may are making this there resolution and how many actually keep this resolution. 45% of people said that there 2018 resolution was to lose weight/get in shape Fitbit (27.4 million users) and My Fitness Pal (19.1 million users) are 2 of the most used fitness trackers in 2018 Only 8% of people keep their resolutions. People tend to over set goals. When they are too big to reach, you tend to fail. You also don’t want to under set your goals because you may be able to reach them too easily and not get the results out of them that you had really hoped. If you fail at your goal, that doesn’t mean you should give up. You just have to reevaluate the goal. You want to get back out there achieve your goals. Ex. You said you wanted to go to the gym 4 days a week, but that was too much with your schedule, you shouldn’t quit all together just go 2 days a week instead. Sources: https://www.statista.com/statistics/378105/new-years-resolution/ https://www.statista.com/statistics/650748/health-fitness-app-usage-usa/ https://www.huffingtonpost.com/entry/new-years-resolutions-psychology_us_5862d599e4b0d9a59459654c Economic Concepts: Everything is in the incentives, put it all out there. 54864132751300 Supply describes the total amount of a specific good or service that is available to consumers (Something needed or wanted) available to someone. (Market driven) People want a membership, they want to achieve their fitness goals, and they want to be a better version of themselves Demand consumer’s desire and willingness to pay a price for a specific good or service. Cost of membership may increase as more member sign up In the study- they had to put up their own money, they were able to risk for their goals 45720036575900 Cost – (of an object or an action) require the payment of (a specified sum of money) before it can be acquired or done. The money they had to put up, their time, their energy, their commitment Benefit -an advantage or profit gained from something. Better body, feel good about themselves, achieved goals Bottom line https://www.investopedia.com/articles/economics/11/five-economic-concepts-need-to-know.asp Concluding thoughts Reading articles, writing this essay has got me thinking about my fitness goals and lifestyle. I own a Fitbit and I do enjoy it but I need to get back to using it for all of its features and feeling proud of what I have accomplished in a day. You need to be persistent and have goals. You can’t just decide one day to start working out. You need a plan and be physically and mentally ready to conquer the task you set up for yourself. You need an incentive first, that is what gets your foot in the door, and then you continue going because you want to better yourself. Once you start the drive to better body helps keep going back. How to cite What is Microeconomics, Papers

Work Stress and Cigarette Smoking Behaviours

Question: Describe about the Work Stress and Cigarette Smoking Behaviours. Answer: Introduction Background and Problem of the Research Smoking is one of the primary threats to the health of human beings. Apart from the younger adults, the individuals involved in the health related professions are highly exploited to the addiction of nicotine due to the smoking initiation. From the context of UK, it has been observed that 90% of the health professionals are engaged in smoking due to the continuous working pressure from their respective workplace settings (Smith et al. 2013). Based on the various reports, it is ascertained that individuals already smoked 100 cigarettes in their lifetime are not likely to quit. Although, the rate of smoking is minimised in the younger adolescents, different evidence suggest that the smoking behaviour among the older adolescents associated with the health profession is continuously rising (Nelson et al. 2012). Therefore, it is crucial to understand the nature of the tobacco experience by the nurses. The certain understanding is further complicated by the empirical studies with the utili sation of various assumptions. These assumptions are highly focused on the perceptions or the experiences gained by the nurses during their professional commitments. Therefore, this study should need to be based on developing the correlation between the smoking behaviours of the individuals and the significant factor driving such activity. Aim and Objectives of the Study The key aim of the research is determining the significant correlation between the work pressure and smoking behaviours among the nurses working in the health institutions in UK (Hasselhorn, Tackenberg, and Peter 2013). With the help of achieving the predefined aim, it is expected to gather useful understanding regarding the significant factors forcing these health professionals towards smoking habit. Furthermore, some important research objectives have been formed in line with the identified aim. Evaluating the relationship between the depression at work and smoking behaviour among the nurses Determining the correlation between the smoking resistance self efficacy and smoking behaviours Conducting assessment of the relationship between the smoking resistance self efficacy and depression Hypothesis of the Study The null hypothesis and the alternative hypothesis of the overall research are outlined below. The study is performed with the intention of developing the useful findings regarding the identified context of the research for supporting the statement as part of the alternative hypothesis (Saksvikà ¢Ã¢â€š ¬Ã‚ Lehouillier et al. 2013). H0: There is no significant correlation between the stress levels and smoking behaviours among the nursing professionals H1: There is the presence of a significant correlation between the stress levels and smoking behaviours among the nursing professionals Method Introduction The section is developed based on the valuable information collected from the research participants. The section will highlight the approaches made and the techniques adopted for ensuring the effective collection of research data and supporting the analysis. In case of this particular study, selection of proper sample for deciding the appropriate research participants is highly important (Maslach and Jackson 2013). The particular decision for choosing the participants for the investigation should need to represent the identified context of the study. Apart from that, selecting the proper design and intended procedures also provide useful impact to the overall outcomes of the investigation (Jarczok et al. 2013). Additionally, the approaches and practices performed as part of the research method are all determined by complying these with the ethical guidelines and principles. Design of the Study The entire viability of the research is based on accessibility of the participants from the different health related institutions of the London area. It is evident that not all the nurses from the hospitals or nursing homes are unwilling to participate in the study due to their sensitivity issues. On the other hand, the extracting the feedbacks from the nurses is highly significant for the achieving the aim of the study (Schernhammer et al. 2013). Because of that, the cross-sectional study is selected as the particular design of the research. The fundamental reason of selecting such research design is the particular support obtained for conducting the study based on the survey questionnaire. The identified approach will ensure the anonymous responses from the research participants. Procedures of the Study The procedures of the study will be discussed to ensure the suitable collection of research data. The data collection process is mainly divided in two categories, such as primary and secondary data collection procedure. Primary data plays the significant role in answering the basic questions of the research and achieving the goal with developing a sound conclusion of the overall study (Tavolacci et al. 2013). It is decided that the Primary data will be collected by undertaking the survey questionnaire method. The questionnaire comprises of a set of questions towards the participants of the study, as they are formed in a structured manner to extract their close-ended responses (Kim et al. 2013). Secondarily, the secondary data will be collected by the works of previous scholars and academicians for shaping up the primary understanding reflected by the collection of primary data. Ethical Considerations Ethical implications are highly followed during the research. It is mentioned earlier that some nurses from the health facilities might find the topic of the research as highly sensitive. As a result, they might be reluctant to participate in the research. Hence, the data collection approaches and other practices of the research are performed by providing due emphasis to protect the personal identifies of the participants (Chao et al. 2015). During the execution of the proposed research methods, the respondents are assured to provide due protection for their privacy to ensure the proper and unhesitant participation to the investigation process. Participants of the Study The participants of the research are ten nurses from the healthcare facilities of London. For selecting the nurses, non-randomized sampling techniques was used, as the particular size of the population is high and complicated regarding the process of selection (Neville and Cole 2013). Results and Discussions Result The significant results of the study are generated by the effective involvement of the questionnaire survey dedicated to collect the responses from the research participants. Firstly, based on the scale of five, the stress levels of the nurses are measured by their feedbacks, where five represents the higher involvement of stress during their working commitment. Based on the stress level, the smoking behaviours of these nurses are measured to develop the understanding regarding the correlation between the perceived level of stress and smoking habits. From the table formed below, the suitable responses obtained from the respondents are highlighted effectively. Participant No. Average Cigarette Consumption in a Week Stress Level in an Average Week 1 20 5 2 2 2 3 40 5 4 2 1 5 10 4 6 20 4 7 5 2 8 1 1 9 25 5 10 9 3 (Table 1: Smoking Habit of the Nurses in relation to their Perceived Level of Stress; Source: Created by the Author) Discussion From the identified table, it is clearly acknowledged that nurses tend to smoke more cigarettes during their professional period when the perceived level of stress is high. It is reflected from the data collection that their average cigarette consumption in a week increases as their stress level during the week is becoming high. It can be stated that the escalating working pressure as part of the profession is leading the nurses of the country to become addicted to smoking habits. Conclusion and Recommendations Conclusion From the overall findings, it can be reflected that there is a significant correlation between the work stress and cigarette smoking behaviours among the health professionals including the nurses of healthcare system. Increasing work stress creates rising depression among the female professionals to drive them engraining continuously in the smoking behaviours. From the application of the study, it is notified that the social factors are widely responsible for adolescent professionals to involve in the cigarette smoking within different communities. Strengths and Limitations The key strength of the intended study is developing the useful knowledge forcing the professional nurses of the healthcare settings to generate a smoking habit. The utilisation of the self-structured questionnaire for gauging the average stress during the workplace is also another primary importance of the study. Alternatively, there are some significant limitations of the study. One of which can be identified in the use of self-reporting questionnaire as the survey instrument for the data collection. The particular type of questionnaire cannot be verified by the other sources. Apart from that, neither any screening procedures nor chart reviews are performed during the development of research findings. It would help the entire finding of the study to be more rational and valid. Recommendations The entire study is conducted to highlight the smoking behaviours and stress experienced by the nursing professionals, where the result of the investigation may vary for the other healthcare professionals of the country. Therefore, it is recommended for the future research works to provide a broader emphasis to the context (Chao et al. 2015). Apart from that, the future studies must need to capture the various socio-demographic perspectives for devising the broad conclusion regarding the chosen subject. References Chao, A., Grilo, C.M., White, M.A. and Sinha, R., 2015. Food cravings mediate the relationship between chronic stress and body mass index.Journal of health psychology,20(6), pp.721-729. Hasselhorn, H.M., Tackenberg, P. and Peter, R., 2013. Effortreward imbalance among nurses in stable countries and in countries in transition.International journal of occupational and environmental health. Jarczok, M.N., Jarczok, M., Mauss, D., Koenig, J., Li, J., Herr, R.M. and Thayer, J.F., 2013. Autonomic nervous system activity and workplace stressorsa systematic review.Neuroscience Biobehavioral Reviews,37(8), pp.1810-1823. Kim, M.J., Son, K.H., Park, H.Y., Choi, D.J., Yoon, C.H., Lee, H.Y., Cho, E.Y. and Cho, M.C., 2013. Association between shift work and obesity among female nurses: Korean Nurses Survey.BMC Public Health,13(1), p.1. Maslach, C. and Jackson, S.E., 2013. A social psychological analysis.Social psychology of health and illness,227. Mouchacca, J., Abbott, G.R. and Ball, K., 2013. Associations between psychological stress, eating, physical activity, sedentary behaviours and body weight among women: a longitudinal study.BMC Public Health,13(1), p.1. Nelson, C.C., Li, Y., Sorensen, G. and Berkman, L.F., 2012. Assessing the relationship between workfamily conflict and smoking.American journal of public health,102(9), pp.1767-1772. Neville, K. and Cole, D.A., 2013. The relationships among health promotion behaviors, compassion fatigue, burnout, and compassion satisfaction in nurses practicing in a community medical center.Journal of Nursing Administration,43(6), pp.348-354. Saksvikà ¢Ã¢â€š ¬Ã‚ Lehouillier, I., Bjorvatn, B., Hetland, H., Sandal, G.M., Moen, B.E., Magery, N., kerstedt, T. and Pallesen, S., 2013. Individual, situational and lifestyle factors related to shift work tolerance among nurses who are new to and experienced in night work.Journal of advanced nursing,69(5), pp.1136-1146. Schernhammer, E.S., Feskanich, D., Liang, G. and Han, J., 2013. Rotating night-shift work and lung cancer risk among female nurses in the United States.American journal of epidemiology,178(9), pp.1434-1441. Smith, P., Fritschi, L., Reid, A. and Mustard, C., 2013. The relationship between shift work and body mass index among Canadian nurses.Applied Nursing Research,26(1), pp.24-31. Tavolacci, M.P., Ladner, J., Grigioni, S., Richard, L., Villet, H. and Dechelotte, P., 2013. Prevalence and association of perceived stress, substance use and behavioral addictions: a cross-sectional study among university students in France, 20092011.BMC Public Health,13(1), p.1.

Milton Friedmans Contribution to Economics

Biography Milton Friedman was an American economist, statistician, scholar, and an author who is remembered as the father of monetarism and a proponent of free markets. Milton Friedman is a renowned economist born on July 31, 1912 to Jewish immigrants in Brooklyn, New York City (Cole, 115).Advertising We will write a custom report sample on Milton Friedman’s Contribution to Economics specifically for you for only $16.05 $11/page Learn More At the age of twenty, he got his Bachelor of Arts from Rutgers University and went to pursue his Masters at the University of Chicago in 1933. He later earned his P.H.D in 1946 from Columbia University. Thereafter, he taught at the University of Chicago for over three decades. In 1952, he was awarded the John Bates Clark Medal which recognizes economists below the age forty for exceptional accomplishment (Bandyk, 46). Milton Friedman received a Nobel Memorial Prize winner â€Å"in Economic Sciences in 1976 for his achievements in the field of consumption analysis, monetary history, and theory, and for his demonstration of the complexity of stabilization policy† (Bandyk, 46). He previously served as an advisor to President Richard Nixon and was a president of the American Economic Association in 1967. In 1977, Friedman retired from Chicago University and became a senior research fellow at the Hoover Institution at Stanford University. He also became an economic advisor to Barry Goldwater who was the republican presidential aspirant in 1964 (Bandyk, 46). In 1981, he sat at the economic policy advisory board headed by President Reagan and was awarded the Presidential Medal Of Freedom as well as the National Medal of Science, in 1988. Friedman died of heart attack in San Francisco at the age of 94, in November 16, 2006 (Cole, 116). Friedman’s contribution to economics Friedman is referred to as the father of monetarism due to his efforts of coming up with the quantity theory of m oney. This school of thought looks at money supply as a key determinant of the nominal rate of output. Monetarism is the proponent related to contemporary quantity theory of money and Friedman is attributed to its popularization (Schwartz, 256). In 1963, he co-authored with Anna Schwartz in an examination of the significance of money supply and economic activity in the history of U.S, in a book called ‘A Monetary History of the United States’ (1963). They concluded that money supply fluctuations are attributable to fluctuations in the economy (Schwartz, 256). He also collaborated with David Meiselman to show the dominance of money supply over government expenditure and investment as key factors that affect output and consumption. Friedman’s experimental research and part of the theory was on the findings that the short-run outcome of an alteration of the money supply largely relied on output. However, in the end, the effect was mainly on the price level (Schwartz , 258).Advertising Looking for report on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More Friedman was the chief advocate of the monetarist thought of economics. According to him, there is an intact and constant relationship between money supply and price inflation. â€Å"Primarily, price inflation ought to be adjusted with monetary deflation, while price deflation is regulated with monetary inflation† (Schwartz, 258). He legendary wisecracked that price deflation could be dealt with by â€Å"dropping money out of a helicopter† (Schwartz, 258). He counteracted common allegations that price inflation was back then instigated by rising prices of oil or wages. He said in 1970 during one of his lectures, â€Å"inflation is always and everywhere a monetary phenomenon.† Friedman rejected the exercise of fiscal policy as an instrument of demand management; and instead argued that the government’s role in economy regulation should be very limited. He broadly wrote on the Great Depression, which he referred to as the Great Contraction (Schwartz, 257). He argued that it was because of normal financial â€Å"shock† whose extent and gravity were significantly amplified by the successive tightening of the money supply due to ill-advised policies of the Federal Reserve directors. He argued that the Fed was accountable for translating a small or a severe recession into a great catastrophe. Distant from the depression being a letdown of the capitalism system, it was a terrible malfunction of government (Schwartz, 257). Friedman believed in termination of government interference in currency markets therefore producing a massive literature on the matter. He therefore became a proponent of a market practice based on liberally floating exchange rates. Friedman wrote an essay named â€Å"The Methodology of Positive Economics (1953)† which paved way for the epistemological bluepri nt for his later research and to a great extent shaping economic research of the Chicago School of Economics. He said that for economics to be objective as a science, it ought to be liberated to value judgments. In addition, a practical economic theory should be evaluated by its simplicity and productivity as an engine of forecast and not by its explanatory pragmatism (Schwartz, 259). Friedman is also remembered for his contribution on the consumption function and the permanent income hypothesis (1957), which he submitted to as his greatest scientific work. In this work, he argued that rational consumers would expend a proportional sum of money they professed as their permanent income (Cole, 119).Advertising We will write a custom report sample on Milton Friedman’s Contribution to Economics specifically for you for only $16.05 $11/page Learn More Extra gains would be typically saved. Rational consumers will also expect that tax deductions have to rise afterwards to poise public finances. Another of Friedman’s important contribution was his evaluation of the Philips curve (relationship between inflation and employment) in addition to the theory of â€Å"natural rate of unemployment (1968)† (Cole, 120). This brought his association with Edmund Phelps, citing that a government that creates greater inflation cannot lastingly cut unemployment as a result. Unemployment could be in the short term lower, if the inflation is a shock. However, in the end, unemployment will be influenced by the abrasions and flaws of the labor market. Friedman made a landmark input in statistics through his development of sequential sampling. With the help of his colleagues, he invented this sequential sampling technique at the Division of War Research in Columbia. Sequential sampling became â€Å"the standard analysis of quality control inspection† according to The New Palgrave Dictionary of Economics. In the words of the diction ary it states that, â€Å"Like many of Friedman’s contributions, in retrospect it seems remarkably simple and obvious to apply basic economic ideas to quality control; that however is a measure of his genius† (Schwartz, 260). Public policy positions Friedman made great and numerous contributions towards public policy especially in the monetary aspect. Friedman was of the view that if money supply was centrally controlled there would be an automatic system to keep the money supply increasing steadily. However, he emphasized on a â€Å"real† non-government intervention in the gold standard so that money was created through the private market. He advocated for an economy where governments did not meddle with economic behavior and where full employment policies had been consigned to the dustbin. He opposed Federal Reserve’s authority over the economics profession, for instance, through his letter to Robert Auerbach a Housing Bank Committee investigator and an economics professor in 1993 (Bandyk, 46). Friedman wrote an article in 1955 called ‘The Role of Government in Education’ proposing enhancement of publicly driven schools with privately governed but publicly sponsored through vouchers like in Chile and Sweden. He also agreed with permissive policies like legalization of prostitution and drugs.Advertising Looking for report on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More He was also a chief proponent of a volunteer military, urging that the paper was â€Å"inconsistent with a free society.† He was of the view that the draft was discriminatory and illogical hindering young men to nature their future as they deemed fit, under capitalism and freedom (Cole, 123). Friedman did not object to attempts by government to provide essential public goods that could not be effectively supplied by private sector without consumer exploitation. Although, his emphasis was that a good number of services provided by the government could be offered much better by the private sector. He therefore cautioned against a legal monopoly, so as to inhibit private competition. Similarly, he was resoundingly against public monopoly of the post office. He hit newspaper headlines when he advocated negative income tax as a substitute to the present welfare system (Cole, 125). For the period between, 1986 and 1994, Friedman and Michael Walker of Fraser Institute organized a se quence of conferences aimed at giving a clear definition to economic freedom as well as a technique of computing it. This led to the first annual report; Economic Freedom in the World which currently offers data for many peer-reviewed studies as well as influencing policy innumerous nations (Cole, 125). Criticisms A number of Keynesian economists like James Galbraith criticized Friedman’s free market philosophy during the 2007 to 2010 financial crisis as being responsible for the crisis (Cole, 125). In 2007, Paul Krugman, a Keynesian Nobel laureate criticized Friedman on his rigid stand on the sole role of the markets, such that he did not admit to market failure at any point. Krugman was however criticized of being double minded about Friedman (Schwartz, 261). Murray Rothbard of Austrian school criticism, criticized Friedman for attempting to disadvantage individual liberty by making government more resourceful in 1971. He termed Friedman as not qualified to be the free-mark et economics leader. Other people like Naomi Klein have criticized him for his work in Chile and Indonesia (Cole, 127). Conclusion Milton Friedman is certainly a figure to reckon with in the study of economics. He managed to make a legendary name for himself unlike many economists in the field. Apart from bold pieces and unshaken thoughts on free market, Friedman has contributed to policy making in several nations. He has also sat in important policy making boards in the U.S as well as contributing to numerous economic research forums. Every theory or proponent faces criticism, just like Friedman. However, on the overall he has contributed immensely in the study of economics today, to be the father of monetarism. Works Cited Bandyk, Matthew. â€Å"Milton Friedman.†U.S. News World Report. 2009, Vol. 146 Issue 2, p46-46. Print. Cole, Julio. â€Å"Milton Friedman 1912-2006.† Independent Review.2007, Vol. 12 Issue 1, p115-128. Print. Schwartz, Anna. â€Å"Monetary Policy and the Legacy of Milton Friedman.† CATO Journal  28.2 (2008): 255-262. Print. This report on Milton Friedman’s Contribution to Economics was written and submitted by user J0anna to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Coming Down the Pike

Coming Down the Pike Coming Down the Pike Coming Down the Pike By Maeve Maddox LJ wrote: Can you tell me which is correct: coming down the pipe or coming down the pike? I have heard it both ways. The original expression is coming down the pike, but it may be going the way of our friend free rein. The word pike in this expression is a shortening of turnpike. Originally turnpike meant a toll booth, but came to mean the highway itself. My Southern grandmother would say things like That Bessie Dean would take up with the first man that came down the pike. The expression coming down the pike originated before the days of TV and the internet. In those days most new ideas came to town by way of the highway. Upon opening the morning newspaper, one might say Lets see whats new coming down the pike. Heres a quotation from an international website about economics: There is more bad news coming down the pike, news of such magnitude that no amount of ordinary manipulation is liable to conceal it.GlobalResearch.ca In Arkansas pike in the sense of road is still fairly common. In other regions, speakers unfamiliar with the term try to make sense of the expression coming down the pike by altering pike to pipe. For these speakers the metaphor is that of a substance moving through a pipe or a pipeline and not of someone walking along a highway. The coming down the pipe version can only be nurtured by such things as a blog advertising The Pipeline Show. The blog title is Coming Down the Pipe. Piker Also derived from the turnpike pike, the words pike and piker were nineteenth century West Coast terms of contempt for poor white migrants from the Southern statesrather like the word Okie in the twentieth century. An English dialect word piker with the meaning of vagrant, tramp gypsy existed as early as 1828. Vagrants wander the pike. The U.S. word with the similar meaning is thought to derive from the name of a county in Missouri. Presumably many poor people from Pike County moved to California to find a better life. As happens with ethnic slurs, the word piker took on more and more negative meanings. piker: 1. Originally: a cautious or timid gambler who makes only small bets; one who plays for small stakes. Hence: a person who takes no chances; a cowardly or stingy person; a shirker, a ‘small-timer’.   2. Finance. A small-scale speculator or investor.B. adj. (attrib.).  Mean, shirking, cowardly. When I was growing up I often heard my father and his brothers use the word piker in the sense of cheapskate or tightwad. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Expressions category, check our popular posts, or choose a related post below:12 Types of LanguageList of Greek Words in the English Language40 Synonyms for Praise

Globalization Essay Example | Topics and Well Written Essays - 750 words - 7

Globalization - Essay Example To justify his claims on the benefits of globalization, the author made use of quantitative data such as reports published by the World Bank and UNDP. The first data cited by the author is the one made by World Bank in 2002 citing that countries that integrated with the world market have experienced rapid growth in terms of GDP ( Wolf p512 ). Similarly, the author also supported this argument by citing the 2003 Human Development Report from UNDP that certain east Asian countries experienced remarkable GDP growth ( p. 511 ). Aside from the secondary data that the author used, he also drew examples from his own first-hand experience as senior divisional economist of World Bank in India during the 70’s. He himself has witnessed the effect of globalization to the standards of living of the people in India. The author tried to present a balanced view of the advantages of globalization not just by citing China but by explaining the growth of even â€Å"hopeless† countries suc h as Bangladesh ( Wolf p.514). The important part of the article dwells on his arguments on why economic integration was not successful in some countries. The author mentioned the interplay of endowments ( natural resources ), institutions ( government ), and policies as obstacles to a country’s development ( Wolfe p 514 ) . The arguments were compelling since he cited Gunnar Myrdal’s theory on underdevelopment regarding â€Å"soft states† or countries that lack political will as manifested by rampant corruption. Consequently, Wolf also linked this factor to the endowment of natural resources as cause of conflicts within since this â€Å"curse resources â€Å" provoke civil wars as in the case of most African states which I disagree with since culture and lack of education may have created this kind of socio-political environment. Lastly, he also cited the importance of choosing the right economic

How are overbearing sports parents harmful to children Coursework

How are overbearing sports parents harmful to children - Coursework Example This research will begin with the statement that sports play an instrumental role in the development of a child. They are not only critical for physical growth, but sports are also important for the psycho-social development of a child. Therefore, all the children who are of school going age i.e. 5 to 16 years of age are encouraged to participate in physical activities like sports, aerobics and even dancing. The involvement of children in different forms of physical training helps them in gaining confidence, it optimizes their muscular and skeletal growth, and it also helps them in winning friends. The types of sports or physical activities may vary across cultures, however, it is universally accepted that children must be encouraged to participate in sports actively alongside their education. The reason behind encouraging young minds to involve in sports is to teach them the skill of balancing life and work. Children who abstain themselves from sports are often find complaining in t he later life about isolation and other associated psychological issues like depression, anxiety and frustration. It has been proved medically, sports during adolescence and early years of adulthood helps individuals in fighting frustration and depression, which is very common among young people these days. Sports activate serotonin release and uptake, which circumcises the accumulation of testosterone, a hormone released in state of stress and anxiety, and it is a cause biochemical cause of aggression among youth.

Final RFP Essay Example | Topics and Well Written Essays - 1500 words

Final RFP - Essay Example This Request For Proposals (RFP) document sets out the requirements to be met by the Enterprise Resource Planning ERP package Enterprise Architecture EA design to be selected to implement these business goals within the operations and management functions of Gadget, Inc. The overall strategic results to be met by the package and design selected as part of the responses to this RFP will include : no more lost orders, eliminating the numerous errors currently made and the accompanying inconsistencies. In terms of applicable Quality Assurance (QA) activities, there will be a series of procedural reviews carried out by the personnel partially involved in the acquisition and implementation process of the ERP packages and EA design and approval The risk management requirements to be met will include a process where the Vendor’s executives identify, analyze and rank every risk noted. Proactive risk identification measures will be put in place. In order to achieve the successful integration of the ERP application and EA design in order to meet the business process improvement requirements set out above, the following requirements will need to be satisfied by the selected Vendor. Gadget Inc., although it accepts that it is relatively small enterprise, expects that each Vendor will draw up an EA design that reflects Gadget Inc.’s business requirements as expressed by the Board of Directors. Gadget Inc. will not accept duplications of previous enterprise architectures drawn up by a given Vendor for one or more different clients. This requirement will be made clear to each Vendor at the Bid Evaluation stage. Gadget Inc. has no specific preferences regarding the ERP application presented by each Vendor bidding for the Contract. Gadget Inc. initially expects that each Vendor will present the ‘standard’ version of

The Role Of An Occupational Therapist

The Role Of An Occupational Therapist Health care like health itself is a dynamic process which can be subject to change over time. There are an increasing amount of tensions within medicine between various groups of health care practitioners, and between the evaluation of treatment and responding to patients views. This reflects the different strains and demands bearing down on medicine from numerous quarters. I am interested in exploring from the counsellors perspective, in this case the occupational therapist, what exactly they do in an effort to socialize people back into society. For example looking at the role of occupational therapist and the patients environment: physical access to buildings; availability of family and monetary support for living at home. To answer the above question I examined areas such as what is the doctor-patient relationship or in this case the occupational therapist-patient relationship, drawing on Goffmans (1969) work, who states we all play roles throughout our lives, we present ourselves to society, and we are socialized to these roles throughout our lives, especially in childhood. Society has given us our roles- doctor, patient, sick role, etc. and we as actors can perform the role. I also looked at Occupational therapies link to Functionalism, concentrating on Durkheim and Parsons and also drawing on the work of Marx and Weber and how Marx led to the acknowledgment in occupational therapy that labour is the collective creative activity of the people. Description of the research strategy For my research into how occupational therapy contributes to the promotion of health in society, I chose to use qualitative research and in this case qualitative Interviewing. Several researchers have argued that structured interviews are unnatural and restrictive. Informal interviews get deeper. Therefore I used semi-structures face to face interviews. I feel that using semi-structured in depth interviews allowed me use a more open framework, allowing a focus on the conversation and the topics that the interviewee brings up. I started with more general questions and topics to allow the conversation to build up a relationship so the participates felt comfortable and at ease so that they could talk about some sensitive issues if they arose. Semi structure interviews are less intrusive then other methods of research. They allow us to not only gather answers but also reason for the answers, therefore giving a more comprehensive analysis into this area. Therefore I found the major benefi ts of this type of interviewing where that: It is less intrusive to those being interviewed. This is because the semi-structured interview encourages two-way communication. Those being interviewed can also ask questions of the interviewer and feel as though they have their own input. Using this type of interviewing confirms what is already known but also allows the opportunity for learning other information outside of whats being asked. Conducting semi-structured interviews often will provide not just answers, but the reasons for the answers. When individuals are interviewed they tend to open up more and feel more at ease to talk about sensitive issues. (Silverman: 2001) Access I found access to interviewees a little difficult. Getting contacts was the first step, which was done through another occupational therapist I know who passed on a number of email address of willing participants. Once contacted it was difficult to arrange meeting points, days, and times that suited all, but all these issues where overcome and two interviews were successfully scheduled. Ethical considerations Mason (1996) puts forward ways to deal with ethical issues in qualitative which I tried to follow throughout this pilot. This included, deciding what is the purpose(s) of my research, e.g. self-advancement, examining which individuals or groups might be interested or affected by your research topic- in this case it would not be ethically sound to interview the patients themselves as there seen as a vulnerable group, and considering what are the implications for these parties of framing your research topic in the way you have done (1996:26-30). The main ethical considerations I took when interviewing the Occupational therapist, was that before the individual became a subject of research, he/she was notified of: à ¢-  My aims, my methods, my expected benefits and possible hazards of the research I was conducting. à ¢-  I made it clear to the interviewee of his/her right to abstain from participation in the research and his/her right to end at any time that they feel necessary to do so. à ¢-  The confidential nature of his/her answers. I also made it clear during my researching, that no individual would become a subject of research unless they have been given notice and that they freely consent that they would like to participate. No pressure of any kind was used to persuade an individual to become a subject of my research. I will make sure that the confidentiality of individuals from whom I gather my information, shall be kept strictly private. I also stated that at the end of my research any information that would reveal any person involved in the interviewing, will be destroyed, unless already consented that this precise information will be used. http://www.idrc.ca/eepsea/ev-65406-201-1-DO_TOPIC.html Evaluation of Research Process One important use that pilot studies have in qualitative research is to develop an understanding of the concepts and theories held by the people you are studying- what is often called interpretation. This is not simply a source of additional concepts for your own theory, ones that are drawn from language of participants; this is a type of concept that Strauss (1987, pp. 33-34) called in-vivo codes.2 More important, it provides you with an understanding of the meaning that these phenomena and events have for the people who are involved in them, and the perspectives that inform their actions. These meanings and perspectives are not theoretical abstractions; they are real, as real as peoples behaviour, though not as directly visible. Peoples ideas, meanings and values are essential parts of the situations and activities you study, and if you dont understand these, your theories about thats going on will often be incomplete or mistaken (Maxwell, 2004a: Menzel, 1978). Looking at my research questions, through my pilot study I found I had problems in developing the questions as I often got confused between intellectual issues- what I wanted to understand by doing the study- and practical issue- what I wanted to accomplish. According to LeCompte and Preissle, distinguishing between the purpose and the research question is the first problem in coming up with workable research questions (1993, p. 37) I decided to focus on three kinds of questions that are suited to process theory, rather then variance theory. For example I tried to base my research questions around (a) questions about the meaning for events and activities to the people involved in these, (b) questions about the influence of the physical and social context on these events and activities and (c) questions about the process by which these events and activities and their outcomes occurred. For example What does your typical working day involve? Because all of these types of questions involve situation-specific phenomena, they do not lend themselves to the kinds of comparison and control that variance theory requires. Instead, they generally involve an open-ended, inductive approach in order to discover what these meaning and influences are and how they are involved in these events and activities. Decisions about where to conduct my research and whom to include were an essential part of my research methods. I found sampling to be problematic for the qualitative research pilot, because it implies the purpose of representing the population sampled. It ignores the fact that, in qualitative research, the typical way of selecting settings and individuals is neither probability sampling nor convenience sampling. Instead it falls into a third category, known as purposeful sampling (Patton, 1990, p.169). This is a strategy in which particular settings, persons, or activities are selected deliberately in order to provide information that cant be gotten as well from other choices. For example, Weiss argued that any qualitative interview studies do not use samples at all, put panels people who are uniquely able to be informative because they are expert in an area or were privileged witnesses to an event (1994, p.17); I used this form of purposeful selection by choosing full trained Occup ational Therapists to interview. I think selecting those times, settings and individuals that can provide you with the information that you need in order to answer your research question is the most important consideration in qualitative selection decisions. On the negative side, I feel as though one of my interviews suffered slightly due to it been chosen because of its convenience of where and when the interview could take place. Although convenience and cost are real considerations, they should be the last factors to be taken into account after strategically deliberating on how to get the most information of the greatest utility from the limited number of cases to be sampled. Convenience sampling is neither purposeful nor strategic and I feel as though a different individual could have brought more information to light had I chosen more wisely (Patton, 1990, p. 181) If conducting this study again I think I would test out the use of participation observation. In this case it would be of that in an open setting, usually public and in this case a hospital. Gold (1958) states that, when using this technique the participant observer enters the setting without intending to limit the observation to particular process or people and adopts an unstructured approach. Occasionally certain foci crystallise early in the study, but usually observation progresses from the unstructured to the more focused until eventually specific actions and events become the main interest of the researcher. It is important to differentiate between significant and relatively unimportant data in the setting. I also feel several other valuable things were brought to my attention on conducting this pilot study. I found that I need to revise my interview guide, adding questions about issues I hadnt realised were important, such as asking respondent to go through a typical day. I also discovered additional useful questions, such as asking participants to describe specific medical terminology that would illustrate what they had been saying. For example, probing more around phrases such as sensory function, neuromusculoskeletal function, body structure, and client centred. I found that taking a step back and listening to participants experiences in new ways was very important to the collection of the data and feel as though in the future it will help me if I put everything know about Occupational Therapy to one side and do the interview as if I know nothing about this area. Codes Equipment Environment Medical language Patient Life Intervention Medical OT/Patient Academic Skills OT/Patient Social- Work Physical- Work Role of Occupational Therapy In qualitative research, the goal of coding is not to count things, but to fracture (Strauss, 1987, p. 29) the data and rearrange them into categories that facilitate comparison between things in the same category and that aid in the development of theoretical concepts. Above is a diagram of the codes produced after my interviews once the data had been worked through in a systematic manner. Through doing this, many connections were highlighted. For example, looking at the codes Medical Language and Medical OT/Patient. Basically, all patient information, evaluations, and interventions must be documented.(Interview 1, p.3) ..Help them overcome the effects of disability caused by physical or psychological illness, ageing, or accidents (Interview 2, p.2) Therefore this process of coding is the process of combing the data for themes, ideas and categories and then marking similar passages of text with a code label so that they can easily be retrieved at a later stage for further comparison and analysis. Coding the data makes it easier to search the data, to make comparisons and to identify any patterns that require further investigation. http://onlineqda.hud.ac.uk Main Findings After conducting this pilot study and fieldwork, I found that Occupational therapy and Sociology are two completely different sciences. While this is true they encompass a strong underlying relationship. According to Alice J. Punwar and Suzanne M. Peloguin, Occupational therapy is a diverse profession and is hard to define because it has undergone many changes since its beginnings. Early definitions emphasize the use of occupation as a remedial activity to help restore the individual to an improved state of physical and mental health. Now occupational therapy is defined as the use of purposeful activity or interventions designed to achieve functional outcomes which promote health, prevent injury or disability and which develop, improve, sustain, or restore the highest possible level of independence of any individual who has an injury, illness, cognitive impairment, psychosocial dysfunction, mental illness, developmental or learning disability, or other disorder or condition. It inclu des assessment by means of skilled observation or evaluation through the administration of interpretation of standardised or nonstandardised tests and measurements. On the other hand Sociology is understood as the study of human social life, groups and societies (Giddens: 2001) coalescing both of these definitions. Durkheim and Parsons are two of the main theorists whom contributed to the elements of functionalism. Each society has particular social needs or functional prerequisites that must be met in order for the society to strive and survive. Included in these prerequisites, is the need to reproduce new generations, meaning the need for food, clothing, control conflict and the maintenance of social order and of social solidarity. Societies achieve these social needs by developing structures and institutions that have valuable functions. The purpose of any activity or structure is the roll it has in the maintenance of society itself. Society can be viewed as one main structure wit many interrelated and inter-pendent parts. For example, the family, economy and education all work together in an effort to help society survive. Institutions can be seen as being beneficial to societies as the institutions exist for survival of societies. Most literature suggests that they shouldnt come under criticism and instead should be supported. Relating this back to occupational therapists, they should be seen as having a positive role in society. Within a functionalist perspective, roles and social roles are important. The belief is that individuals are socialised through these social roles into society, parent, student, occupational therapist. These social roles largely determine an individuals behaviour. Looking at Kavanagh Faves (1995), two occupational therapists working with homeless people, they stated that Roles are a source of identity and are the frame work of everyday life. Sociologists and Occupational therapists have put this view under criticism. They have argued against the determinism inherent in this view. Mocellin (1995) is an occupational therapist who believes the focus on roles to be stereotyping and that carrying out occupational roles, for example that of a housewife, may not always be therapeutic. Looking at Talcott Parsons model of roles and his theory of the Doctor-Patient relationship, in Bury, M. (2005), he began with the idea that being sick/ill was a type of dysfunctional deviance and that this required reintegration with the social organism. Being ill allows individuals to be excused from their occupation and other responsibilities such as looking after the family, cooking and cleaning. This was seen as potentially detrimental to social order if it wasnt controlled. The development of Parsons sick role was seen as being essential to controlling this deviance to make being ill a transitional state back to the individuals usual role. For Talcott Parsons, Physicians demonstrate Parsons the shift to affect-neutral relationships in contemporary society, with physician and patient being protected by emotional distance. Medical education and social role expectations teach normative socialization to Occupational therapist to act in the interests of the patient instead of their own material interests, and they are lead by an egalitarian universalism instead of a personalized particularism. Physicians have mastered a body of technical knowledge, it is seen as functional for social order to permit physicians professional autonomy and authority, controlled by their socialization and role expectations. Weber and Marx, look at how people exist within the world and are concerned with how that existence is shaped. Marx believes that the problems in society come from different social organisations instead of being a natural phenomenon. This is what is meant by people being constrained by circumstances, but it is important to remember the other element that stresses peoples ability to act. Drawing on earlier work of the philosopher Hegel, Marx identified that we create ourselves in a historical process, of which the motive force is human labour or the practical activity of men living in society (Bottomore Rubel 1963, p.18). Marx noted how the division on labour traps us into particular lifestyles or activities and the influence of Marx led to the acknowledgment in occupational therapy that labour is the collective creative activity of the people (Wilcox 1993) Conclusion After conducting this pilot study it is clear that my research question is still unanswered but it has provided me with ideas, approaches and clues I may not have foreseen before conducting this study. I feel this may increase the chances of getting clearer findings in my main study and has permitted a thorough check of my planned statistical and analytical procedures, giving me a chance to evaluate their usefulness for the data. I also feel it has greatly reduced the number of unanticipated problems as I now have an opportunity to redesign parts of my study to overcome these difficulties again. Overall, carrying out this smaller scaled study will hopefully lead to a rich and in-dept qualitative research project, and the end result being my research question being answered in great detail. The role of an Occupational Therapist The role of an Occupational Therapist The following essay will give a critical evaluation of the role of an Occupational Therapist (O.T) within vocational rehabilitation in the private mental health setting. Firstly the essay will describe a critical analysis of vocational rehabilitation and the added value of an O.T within this setting. Secondly it will analyse the trends within vocational rehabilitation and how these relate to O.T philosophy and core tenets, thirdly an examination of concepts of management that relate to vocational rehabilitation and finally a justification of the identification of a model relevant to vocational rehabilitation. Work can be seen as being an important part of health and wellbeing and also social inclusion. Waddell Burton (2006) suggest that work is therapeutic, helps promote recovery and rehabilitation. Leads to better health outcomes, minimises physical mental and social effects of long term sickness absence and worklessness, decrease the chances of chronic disability, long term incapacity from work and social exclusion. Also promotes full participation in society, independence and human rights, reduces poverty and improves quality of life and wellbeing. Work can be divided into four different areas: paid (contract, material reward), unpaid (housework, caring, volunteering), hidden (illegal, morally questionable) and substitute (sheltered workshop, work projects, day centres) (Ross 2007). The demand for work is extremely high due to the amount of people that are living. Compared to other countries, the United Kingdom employment figures are high with people being employed with a health related condition increasing (Department of Health 2008). It has been estimated that 175 million days were lost in 2008 due to illness with 600,00 people turning to incapacity benefit. (Department of Health 2008) It has been shown that 40% of medical certificates issued have been related to mental ill health with the average time off working being 15 weeks. (Department of Health 2008) Work has been shown to be good for your health and employers who adopt a good approach to health, by protecting and promoting it, are important in stopping illness from occurring. This is an area in which O.Ts can provide a key role in supporting and maintaining people back into work or who are already in work to stay there. Vocational rehabilitation is important. This has been shown in the governments new mental health strategy No Health Without Mental Health (Department of Health 2011). One of the aims is working to help people with mental health problems to enter, return to employment and stay in it. The application of O.T within this area is important as our core philosophy is to enable individuals to engage in meaningful occupations, therefore there is a key role for O.Ts to play within vocational rehabilitation. The following quote demonstrates that meaningful engagement in occupation can be important, which reflects O.Ts core ethics and philosophies. Not everyone wants to be employed but almost all want to work, that is to be engaged in some kind of valued activity that uses their skills and facilitates social inclusion (College of Occupational Therapist 2007 p9). Currently within vocational rehabilitation, employment specialists are trained in advice and guidance and REC level 3 advanced certificate in recruitment practice. Employment specialities tend not to be mental health professional but have skills in vocational rehabilitation or industry experience (Waghorn 2009). O.Ts already have these skills and also can add a holistic client centred approach from an occupational perspective. O.Ts can also add an educative approach, combine medical and occupational models and use activity analysis. They can assess occupational function/performance, build therapeutic relationships, carry out psychosocial assessments and interventions, cognitive evaluation and training, help with work life balance for the client and work with clients strengths. (Waghorn et al 2009, Devline et al 2006 Joss 2001, cited in College of Occupational Therapist 2007 p15) An O.T can bring seven core skills to vocational rehabilitation: collaboration with the client e.g. building therapeutic relationships, assessment e.g. Model of Human Occupation Screening Tool, enablement, problem solving, using activity as a therapeutic tool, group work and environmental adaptations e.g. graded return to work (Duncan 2006 p45) Current themes and drivers within mental health are social inclusion, return to work agenda, recovery. Social exclusion happens when people are unemployed have poor skills, low incomes, poor housing, high crime, bad health and family breakdown (social inclusion and co-production 2011) A report called Mental Health and Social Exclusion was published in June 2004 by the Office of the deputy Prime Minister. It aimed to improve the lives of people with mental health problems by getting rid of obstacles to employment and social participation. There are five main reasons why social exclusion occurs for people with mental health problems. Firstly stigma and discrimination, in which an O.T can help by activity speaking to employers about mental health and how reasonable adjustments, could be made. An O.T can help by increasing low expectations, help promote vocational and social outcomes, help provide ongoing support whilst in employment by regular outreach appointments and help access basic services e.g. dry runs on transport, membership to sports centres (Office of the deputy Prime Minister 2004). Overall an O.T can help people remain in their jobs longer and return to employment faster and manage the work environment better by grading work, breaking down activities and rebuilding them step by step and making adaptations to the work environment for example. Another trend is recovery. Recovery is building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems (Slade et al 2008). Recovery encourages people to develop relationships which give their life meaning. There are five stages of recovery: moratorium (withdrawal, loss, hopelessness), awareness (realisation), preparation (strengths and weakness regarding recovery), rebuilding (positive identity, goal and taking control), growth (living a meaningful life, self management of illness, resilience, positive sense of self) (Andresen, Caputi Oades, cited in Slade et al 2008). Satisfying work supports recovery and as such O.Ts can have a great impact here by ensuring clients are in jobs they really enjoy and able to cope with the work demands. By working in a client centred way, listening, help identify and prioritise personal goals for recovery; identify examples of own lived experience. Also pay attention t o goals which will enable the service user to get back into work, suggest non-mental health resources (friends, contacts, organisations), encourage self management of problems, discuss what the service user needs in terms of psychological treatment, convey an attitude of respect and continue to support, an O.T can help a service user to achieve their ideal job. The return to work agenda is about helping people in and/or return to work. O.Ts can aid this by grading work activities e.g. working hours to start with 16 hours per week and gradually increase by 5 hours per week until full time hours are achieved for example. Also by providing support whilst in job by light touch support, setting up group work activities and training the service user. A practice called place then train helps increase motivation and confidence by placing someone in work and then training them instead of the other way around. It improves employment outcomes and peoples mental and physical health over a long period of time (Centre for Mental Health 2011). Its philosophy emphases rapid job searching, individualised job placement in work followed by on-the-job training and ongoing support (Twamley et al 2008). Currently the concepts of management in vocational rehabilitation within the private mental health sector follows the following structure: Area manager Service lead Employment specialists Volunteers With the introduction of an O.T manager the following structure will be placed: O.T Manager Band 5/6 O.T Employment specialist/ Volunteers O.T.A Referrals will either come from people themselves or via the community e.g. mental health teams, doctor surgerys, job centres. With new referrals the degree of risk, impact of O.T on service user, consequences of service user not receiving treatment, length of waiting time and the appropriateness of skills and abilities will be considered. To get people on board for the change in management, people will be listened to for their points of views, concern will be shown, the manager must be approachable e.g. leaving door open and using positive body language, change will be promoting in a positive manner e.g. it will benefit the patients and questions will be encouraged, integrity and charisma will be shown, also have a good ability to communicate, set direction and unify and manage change. The Lewins stages of change (Mullins 2007) will be adopted where first unfreezing will take place followed by moving and then refreezing. Unfreezing is about getting ready to change by understanding that change is necessary and moving out of comfort zones. Its about weighing up benefits and negatives of the change. Moving or change is when people are unfrozen and decide to move toward a new way of working. This is often the hardest for people and support is needed. Refreezing is stability once the changes have been completed. These changes have been accepted and become the norm. People create new relationships and become comfortable with the new routines. The O.T manager will provide supervision to the band 5/6 O.T and have supervision from a paid outside O.T at that equivalent level. The Band 5/6 O.T will have supervision from the O.T manager and the Occupational therapy assistant (OTA) / employment specialist and volunteers will be supervised by the band 5/6 O.T. Volunteers will be looked after by the OTA. Management will be in a democratic style by listen to people opinions and having staff work with the manager, not against. Make sure that management set examples by dressing correctly, not being late for work; develop an image, project self confidence, influence others and establish personal authority (Martin et al 2010). Also address self management by managing time, self and case load e.g. size up task, knowing themselves (need for breaks, strengths and weakness), prioritising and planning control(keeping a dairy, decreasing interruptions). Bad management will be discouraged such as not resolving problems, criticising staff, poor decision making, disorganisation, failing to deal with staff issues, done give recognition, inflexibility, and have an uncaring attitude and poor communication skills (Moore et al 2006) Management will consider professional duties and responsibilities such as the code of ethics, continues professional development (competence), health and safety (risk assessments) and deal with the present. A number of factors may influence management style: confidence in staff e.g. their abilities, need for certainty (risks of handing over control), personal contribution and stress (overload, worry, pressure) (Martin et al 2010). The justification of a model relevant to vocational rehabilitation is the Model of Human Occupation (M.O.H.O). M.O.H.O looks at peoples motivation (volition), routine planning (Habituation) and the influence of environment on occupation (performance capacity). Some of these areas will be affected by the service user. Volition is the thought and feelings we adopt whilst doing things. This involved three areas: personal causation, value and interest. To change motivation these areas will need to be addressed. By looking at the service users present and potential abilities relating to work and how able they are to bring about work (what is good, right and important) e.g. security, accomplishment and interests, having positive feelings associated with working. Habituation looks at reoccurring patterns of behaviour that make up our daily routines. A service user can change their habits by learning new ways of doing occupations and by changing their perceived role to one of a worker/bread winner. Performance capacity is how the musculoskeletal, neurological, cardiopulmonary and other body systems are used during performance. If there is a problem in performance capacity, the environment must be addressed. Work is an increasing important aspect in our lifes. Some of us live and breath work spending the majority of our waking hours working. Work gives us a sense of identity, an occupation, money to spend. It also provides us with a role in the community helping others with our knowledge in a particular area. Work provides us with a purpose, includes us within society preventing social exclusion, increases self esteem and gives us a role/meaning within society. Definition Work can be seen as the idea of doing, either mental or physical, giving an economic reward, social interaction, the structuring and organisation of time, opportunity for social interaction, contribution to society and self identity (Baker Jacobs 2003) What can Occupational Therapy offer that is different? Occupational Therapy can offer an approach which looks at the whole of a person by putting the client at the centre of their treatment from an occupational perspective. Occupational therapists can also educate people, focusing on independence and ensuring participation in meaningful activities. Occupational Therapists are able to combine medical and occupations models. This means they can look at the impact that physical, social and cultural environments have on everyday activities. Patch Three The following patch will give a critical evaluation and analysis of social policy, legislation and ethical issues impacting on vocational rehabilitation in a report style. Legislation No Health without Mental Health (Department of Health 2011) The government is helping people with mental health problems to enter, stay in, and return to employment. This can by achieved by using light touch support, increase confidence in returning to and remaining in work, help manage conditions and help the interaction between appropriate work and well being. It consists of six main objectives: more people will have good mental health, more people with mental health problems will recover, more people with mental health problems will have good physical health, more people will have a positive experience of care and support, fewer people will suffer avoidable harm and fewer people will experience stigma and discrimination (Department of Health 2011 p6). Its outcome strategies is to focus on how people can be best empowered to lead the life they want to lead, to keep themselves and their families healthy, to learn and be able to work in safe and resilient communities and how practitioners can be supported to deliver what matters to service user. Occupational Therapists can provide high quality employment support which will include building confidence in returning to and retaining work, changing employers and service users beliefs, that they can perform the job and their condition is manageable. Support Interaction between appropriate work and wellbeing and help employees to make appropriate recruitment decisions and manage workplace health. New Horizons (Department of Health 2009) This mentions that work can be good for mental health and wellbeing and support recovery. Those who are unemployed are at an increased risk of developing mental illness and benefit from early support. Employment should be seen as an important outcome to the treatment of mental illness in health care settings. O.Ts can help change attitudes to mental health, can improve health and wellbeing in work, provide swift intervention when things go wrong, coordinate help tailored to individuals needs and build resilience from the early years and thought working lives. Health, Work and Wellbeing Caring for Our Future (Department of Health 2005) Suggests that work is recognised by all as important and barriers to starting, returning to or remaining in work are removed. For people to remain in and return to work, that healthcare services meet the needs of people of working age. That health is not affected by work and good quality advice and support is available. Ensure work offers opportunities to promote health and wellbeing and access to the retention of work promotes and improves population, people with health conditions and disabilities are able to optimise work opportunities and people make the right lifestyle choices from an early age. O.Ts already recognise the importance of work for their patients wellbeing and can provide the assistance necessary to fulfil their key roles in helping patients to remain in and return to work. O.Ts can help people return to work following and absence by employment advice and helping to find a suitable job by adapting the work place environment e.g. time flexibilities. National Skills Framework 5 years on (Department of Health 2004) Help to prevent social exclusion in people with mental health problems, improving their employment prospects and opposing stigma and discrimination. O.Ts can help prevent social exclusion by building confidence, motivation and skills, speak to employers about mental health and how reasonable adjustments could be made, help provide ongoing support whilst in employment and help reduce stigma and discrimination by educating people. Working for a healthier tomorrow (Department of Health 2008) Is concerned with the health of people of working age (females 16 to 59 and males 16 to 64). Identifies factors that prevent good health and changes in attitudes, behaviours and practices. Three main principal objectives: prevention of illness and promotion of health and wellbeing early intervention improvement in health of those out of work O.Ts can prevent illness and promote health and wellbeing by using activity as a therapeutic tool, ensuring early intervention and help those out of work by doing group work to build confidence, motivation and reduce anxieties. Ethics There are at least five potential ethical issues which may be encountered within vocational rehabilitation in a private mental health charity organisation. These are confidentiality, consent, autonomy and welfare, human rights, issues of power and control (College of Occupational Therapists 2005): Confidentiality Safeguarding of confidential information relating to clients, only disclose information when client has given consent, there is a legal justification or it is in public interest to prevent harm. Only disclose to third parties if there is a valid consent or legal justification to do so. Keep all records locked away securely and only make available to those who have a legitimate right or need to see them. Clients can see their records and prior to producing material, issues of confidentiality will be addressed. Use the confidentiality model: Protect (look after information), inform (ensure service user is aware), provide choice (allow service user to decide if information will be disclosed and improve (look for better ways to protect, inform and provide choice) (Department of health 2003) Consent Making sure the client has the capacity to consent. The 2005 Mental Capacity Act makes provision for people who are thought to lack capacity to make their own decisions. It has five key areas: a presumption of capacity every adult has the right to make choices and must be assumed to have capacity to do so unless it is proved otherwise; the right for individuals to be supported to make their own decisions appropriate help must be provided before anyone suggests that they cannot make their own decisions; that individuals must retain the right to make what might be seen as eccentric or unwise decisions; Best interests anything done must be in the best interest for the service user and Least restrictive intervention anything done should be the least restrictive of service users basic rights and freedoms. (Department of health 2007) Autonomy and welfare Respect clients autonomy and promote dignity, privacy and safety of client. Give patients the right to make choices and decisions about their own healthcare and independence. Provide sufficient information to enable them to give informed consent and in a language that can be understood. Make sure client understands the nature, purpose and likely effect of intervention and acknowledge refusal. Human rights A right not to be discriminated against regardless of persons religion, sex, race, colour or mental health A right to respect for private and family life e.g. medical record keeping, parental involvement, collection of data A right not to impact on the individuals freedom of thought, expression or conscience e.g. spoken language and access to interpreters Issues of power and control Respect individuals, enable client to take power and promote partnership Management of Quality Issues Quality assurance The service provided will ensure that it meets the needs and expectations of clients and communities, that there is an understanding of service delivery systems and its key services, that data is analysed, problems are identified, performance is measured and that a team approach to problem solving and quality improvement is used. Clinical Governance Involvement Make sure service users, carers and public are involved within the service by holding focus groups, open days, suggestion boxes, questionnaires, panels e.g. to find out opinions on waiting times, attitudes of staff and the physical environment Risk management Establish what could go wrong and rank this. Think how probable it is likely to occur, what can be done about it and what action should be taken if incident happens again (Health Safety executive 2006). E.g. service users deliberately harming herself in occupational therapy session or a spillage on the floor. The Healthy and Safety at Work Act (1974) states that it is the duty of the employer to ensure so far as is reasonable practical, the health, safety and welfare at work of all his employees (section 2 (1) Health and safety at work act 1974). Although it is the duty of the employee to take reasonable care for the health and safety of him/her and others who may be affected by his/her acts of omission and to co-operate with their employer in regard to any duty or requirements imposed (section7 Health and Safety at Work Act 1974) Clinical audit Identify topics relevant to vocational rehabilitation e.g. referral response times, set standard (3 days), collect data (computer package), analyse data (if standard not met then why) and implement change. Other examples may be how the service compares with standards set by other clinical governance activity. Clinical effectiveness Ensure that all treatment is up to date and based on evidence based practice, National Institute of Clinical Excellence and National Service Framework guidelines. Staffing and staff management All staff recruited have the skills and qualifications needed to do the job e.g. that they are Health Professional Council (HPC) registered, induct them, give supervision and appraisal and deal with poor performance. Also supervision on a regular basis and appraisal once a year. Use an indirect approach which is more centred around the person, talk less and listen more, provide a supportive relationship, ask questions, accept and use ideas, reflect and summaries ideas (Enthwistle 2000) Education, training and Continues Professional Development (CPD) Ensure mandatory training is given e.g. fire training, child protection, health and safety. Complete CPD portfolios and HPC audits; provide training and opportunities to enhance CPD such as visits to another vocational rehabilitation service. The HPC (2011) states five standards for the CPD. A registrant must maintain: an up-to-date and accurate record of their CPD activities demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice make sure that their CPD has contributed to the quality of their practice and service delivery ensure that their CPD benefits the service user present a written profile containing evidence of their CPD on request Use of information systems Use information systems to record treatment sessions that service users attend, time spent preparing treatment sessions, time spent on phone calls to service user and time spent in case discussions. Also handling patient identifiable information by applying the data protection act and locking information away. The data protection act implies that anyone collecting personal information must fairly and lawfully process it, process it for limited, specifically stated purposes, use the information in an adequate relevant and not excessive way, use information accurately, keep information on file no logger than necessary, process information in accordance with legal rights, keep information secure and never transfer information outside U.K without adequate protection (Direct Gov 2009) Patch Four The following patch will provide a reflective narrative of the learning experienced throughout the module utilising the Gibbs reflective cycle. This has been developed from Kolbs ideas and develops the features of the experience-reflection-action cycle (Jasper 2003): Description Action plan Feelings Reflective cycle Conclusion Evaluation Description The Gibbs cycle consists of six stages and asks a series of questions about the experience. Description stage is what happened, feelings stage is what where you thinking and feeling, evaluation stage summarises what is good and bad about the experience, description stage involves making sense of the situation, conclusion stage is what else could have been done and the action plan stage asks if the situation arose again, what would you do. To begin with the whole assignment seemed extremely daunting as I had never participated within a role emerging placement/role before. I had also never completed a patch work text and knew very little of both. As part of the assignment we were asked to discuss ideas with peers. I felt it was a good idea to share information with others and thought that this would be an ideal opportunity to reflect on things I was not sure about and where to go for more information. Whilst discussing ideas with my peers I was thinking how what we had discussed would fit into my assignment and in what patch. It made me feel a little more comfortable sharing with other as we could bounce ideas and thoughts off each other. I feel other peers also felt that group discussions were useful and helpful. From start to finish I felt good about discussing information and still feel that this was of great benefit to all of us. Exchanging views helped put things in some kind of order and others could help in areas where I had difficulties. I do not feel there was anything negative about this experience in general. Sharing ideas with others went well as we all had views to share. To contribute, I helped others to see what went in each patch and gave ideas about the assignment. Overall there is not much I would have done differently with this peer review work. The aim was to share and discuss information and this was done successfully. If I were to do peer review work again I would do the same by sharing ideas and information with others. During my visit to a vocational rehabilitation setting I got to see how the service was run, where referrals come from, meet staff and service users and view leaflets. Upon arrival I felt overwhelmed by information and was intrigued about the service. I was thinking how I could relate this to my assignment and what role an occupational therapist would play within such a service. The service manager, who showed me around, knew about occupational therapy as previously they had worked as an assistant in such a role. This made me feel happier as I could share some ideas with them. I felt the visit went extremely well and it was a positive learning experience. From the start I felt comfortable about visiting the service and knew I would collect lots of relevant information from it. Access to information and ideas was the most significant factor for me. Actually seeing a vocational rehabilitation service running was a great inspiration and thought provoking for me, as I could see where parts of my assignment would fit in. I feel the whole visit went well and managed to collect a lot of relevant information. To complete patch work two we were asked to produce a leaflet aimed at our intended service users. I found this patch difficult because selecting relevant information was not easy e.g. font, colours, headings, content, pictures. When I first started the leaflet I had previous knowledge from another module, so had an idea how to construct the framework. I was thinking what type of content would go into the framework of the leaflet and how. Others mentioned that the leaflet should be easy to read and with bullet points, pictures and a calming background. I felt this would be a good idea, by aiming the leaflet at my service user group in particular. I thought that the leaflet was starting to take shape and it was aimed at who it was intended for. To start with I felt a little lost as to what to so but with help from my peer review group I eventual found a way. The most significant thing to me was being able to reflect ideas with other people about the leaflet. I feel that putting the leaflet together was a good experience as it has taught me how to present information to a targeted audience by using easy to understand phrases rather than jargon. Also working in peer review groups was a good experience as we were able to share ideas with each other and share information. The only thing that didnt go so well was working out how to transfer the leaflet from publisher to a word document, also slimming down the content without vital information being lost. I feel the leaflet went well and managed to collect and produce the correct information. Others did help by offering encouragement and ideas which aided me in producing the leaflet. I realise now that I should have consulted my peer group earlier to starting the leaflet as their ideas helped and guided me. To complete patch three we were asked to critically evaluate and analyse social policy, legislation and ethical issues impacting vocational rehabilitation. I found writing this patch extremely difficult as I had no idea of legislation, ethical issues and quality issues relating to this subject. When I started this patch I felt very nervous and worried as to how I would find such information. I was wondering how I would go about doing this patch and what was involved. When I was looking for information I found a vast array. I had to sieve through relevant legislation and apply it to