Wednesday, July 31, 2019

Planning and Budgeting Essay

â€Å"Planning and budgeting are the two key major roles in the financial functioning of a healthcare organization. Planning covers the entire process and procedures of preparing the organization for their future financial goals. Budgeting include all of the detailed plans, which are expressed in dollar terms and they tell how the organizations resources will be obtained and used during a specific time period† (Gapenski, p. 253 & 259). In this paper there will be a brief discussion of what Ben Massell Dental Clinic, should take into consideration, when making pricing and service decisions. As well this paper will also cover the overall planning process and the components of their financial plan. Also this paper will briefly discuss how time analysis may help Bill Massell Dentistry to make sound management decisions. And lastly there will be a recommended major investment and a likely determination of how Ben Massell should address any financial risk and required returns. â€Å"In 1912 a philanthropist by the name of Morris Hirsch established the Morris Hirsch clinic with a goal in mind, which was to provide an out-patient medical service to those within the community, who weren’t able to afford proper medical care. Years later in 1929 a dental clinic was soon added. Then, in 1956 Dr. Irving M. Goldstein a dentist and former chief of staff of the Morris Hirsch clinic, he and his brother Dr. Marvin Goldstein decided to relocate their establishment to Pryor St, located in downtown Atlanta. They sought after one of Atlanta’s most premier builders and developer who had his eyes on the exact same building that the Goldstein brothers had chosen† (Massell, 2012, para. 1). The clinic resided in its new location for the next three years, and then in 1959 urban renewal and eminent domain laws, made it possible for the clinic to relocate once again. Soon, Ben Massell with the help of the Jewish Federation of Greater Atlanta was able to obtain a secure home on for his clinic located on 7th St in the Midtown area of Atlanta. And from that point on the clinic has remained there for the past 49 years. In honoring Ben Massell’s involvement, assistance and his financial generosity with the clinic it was then named, the Ben Massell Dental clinic (Massell, 2012, para. 2). When making pricing decisions, the managers of Ben Massell Dentistry Clinic, need to determine whether or not if their services are not only affordable, but are beneficial to the clients they serve. The managers of the Ben Massell Dental Clinic, also need to determine whether or not if they’re offering a substantial amount of volume discounts to clients and payer groups, and they need to determine exactly how large of a discount should be given to all of their clients. When making service decisions since the managers are not the ones who set the prices for the services, they have to decide whether or not that the payment is sufficient to assume the risks associated with providing services to the covered or non-covered population. The Planning Process is where the financial plans and budgets are developed for an organization to reach its financial goal. The process includes, value statement which describes the things the company values the most, mission statement describes the overall purpose for the existence of the company, and vision statement defines the company’s goals. Since, The Ben Massell Dental Clinic is a non-profit organization, their overall planning process consist of providing clients with the most advanced dental care. They describe themselves as the only resource for comprehensive and quality dental care at no cost to those in need of dental care. They offer a variety of services with the help of 140 volunteer dentists to better serve individuals who do not have access to proper dental services. Also The Ben Massell Dental Clinic is in partnership with, St. Joseph’s Mercy Care Services. With this partnership it allows clients to receive a general health screening for various health conditions. Along with the help of The Georgia Lion’s Lighthouse, clients are also able to receive a free exam and eyewear if needed. In order for clients to qualify for dental service without payment, they must meet certain guidelines. These guidelines include the following: new clients must live in one of the 13 major counties, Butts, Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry, Paulding and Rockdale. Other qualifications include: showing proof of residence for the last six months, having no insurance or dental coverage and having a household income that falls below 125% of the current poverty level. The chart below gives us an exact example of a client’s eligibility. The components of the Ben Massell Dental Clinic financial plan arrive from the donations of major funding organizations in which some they have partnered with and other businesses that surrounds the Atlanta area. Also donations can be accepted directly from their website from those individuals of the community, who have a desire to take part in helping others to get the proper dental needed. These include, â€Å"The Jewish Federation of Greater Atlanta, which provided 14 percent of the clinics budget for the fiscal year of 2009-2010, United Way of Metropolitan Atlanta provided 6 percent through the support of United way employees, other organizations such as, the Google grants program assisted in the advertisement of the Ben Massell Dental Clinic website and the Grants to Greens Foundation contributed towards the materials in reconstructing, the building using recycled materials that are energy savers and cost efficient† (Jewish Family & Career Services [JF&CS], 2012, para. , 2, 3, 4). Time value analysis is the use of time value of money techniques to value future cash flows. â€Å"The reason why time analysis is so important in healthcare is because current amount of made being made is worth more than future dollars. By using this method this gives the dental clinic an opportunity to accept 25 new clients per week and 100 new clients within a months’ tim e. Using the time lines method allows the clinic to keep track of 5 new clients per day during a five day work week. It also helps managers to keep track of payments from other organizations and makes it easier to administer their services to everyone with ease of access, which will allow the operation to flow evenly without hassle. An example of this would be, when new clients are referred over to their clinic, they can easily keep track of what organization has sent the client and who’s responsible for assisting in making the payments for particular procedures administered to the clients. Adding an additional certified dentist could be a possible major investment for the Ben Massell Dental Clinic, even though they offer a large amount volunteer dentist, they only spend half a day’s time within the office. So by adding an additional certified dentist to the organization, this could not only lessen the wait time for clients, but it would also bring in additional revenues, grants and other sources of income to assist the clinic in progressing towards a better financial goal. The average salary of a dentist in Atlanta Georgia is $108, 00. 0 per year (â€Å"Dentist Salary,† 2012, para. 2). Which, can be considered as the net present value, the pertinent financial ratios consists of those organizations making payments for clients that, they refer to the clinic and the break even analysis would be the clinic meeting 25 patients per week on a weekly basis, 100 new clients a month and 1,200 new clients a year to cover the salary of the new dentist that may be add ed to the organization. Financial risk and required returns are two very important factors in healthcare financial management. Financial risk is defined as the risk an investor takes when investing in something and the expected return on that investment is much less than expected. Required returns are defined as the expected outcome on an investment made by an investor whether it is higher or lessor. In order for managers at The Ben Massell Dental Clinic to address financial risk and required returns, managers first need to look at their current financial status and the amount of new clients being referred over to them on a daily weekly to monthly basis. Depending upon the current numbers of incoming new client and their current financial status, managers can then make their decision on whether or not if hiring another dentist would be a great idea for the clinic. In conclusion planning and budgeting covers the entire process of preparing a business for the future. Since it is so important to the success of any organization, especially in healthcare many managers of an healthcare organization have a tendency to spend a great deal of time focusing on the overall planning process in order to keep the business in a successful financial state.

Tuesday, July 30, 2019

A Critique of the Crito and an Argument for Philosophical Anarchism

A Critique of the Crito and an Argument for Philosophical Anarchism by Forrest Cameranesi In this essay I will present a summary and critique of Plato’s dialogue Crito, focusing especially on Socrates’ arguments in favor of his obligatory obedience to the Athenian state’s death sentence.In response I will argue the position that no one naturally holds any obligation to obey the arbitrary commands of another (or any body of others such as a state), and further that no one can come to hold such obligations even by contract; although people may still be obligated to obey commands issued to them, when what is commanded is obligatory independent of it being commanded by anyone.Thus I will argue that that if, as both Socrates and Crito presume, the command that Socrates be executed is contrary to true justice (that is, contrary to any natural moral obligations, independent of its legality), then Socrates has no obligation to obey it; and in fact those tasked to carry o ut the order are morally obligated to disobey it, and by their obedience become conspirators to a moral crime. The dialogue begins with Socrates in prison, awakening to Crito’s presence in his cell, Crito having bribed the guards to gain entry.After brief pleasantries and some talk of when the day of Socrates’ execution will fall, Crito admits to Socrates that his purpose there is to free him from prison and take him abroad to Thessaly, which he assures him can be successfully done thanks to the aid of a number of foreign benefactors. But Socrates is hesitant to leave, believing himself obliged to remain and allow his punishment to be completed, even though his sentence, they both concede, is unjust.Still, Socrates is eager to be convinced otherwise, if Crito can do so by means of reason, and so Crito plies Socrates with many arguments in favor of his escape, arguing not only that it is possible and desirable to escape, and that Socrates could live well outside of Athe ns, but that it is the just thing to do: for the sake of the welfare of his children, who will suffer without his care; for the sake of standing fast against his enemies in the state of Athens, who are attempting to wrong him by this sentence; and for the sake of his friends’ reputations, which will be besmirched by those who know either Socrates nor his friends, and will think that Socrates died only because his friends could not or would not buy his freedom. But Socrates dismisses these arguments, especially the last, arguing at length that the opinions of the many are not a relevant consideration in any such decision; a very important argument, to which I will return later in this essay. For now the relevant point is that Socrates' only concern, in the question of whether or not to escape, is whether or not escaping is just; not what people at large may think of their decision or what other consequences may follow from it.On the topic of justice, and counter to Critoâ€⠄¢s argument that Socrates is obliged to fight back against wrongs committed against him, Socrates suggests (and Crito accepts) the principle that to return harm for harm is harmful, to return evil for evil is evil, to return injustice for injustice is unjust, etc. ; and thus that such vengeance ought not be perpetrated, for it is just as harmful, evil and unjust as the act being avenged, and one must never do such wrongs.Socrates considers it harmful and unjust to the state to disobey its laws, and feels thus obligated to obey them instead, for to do otherwise would be harmful, unjust, and wrong; and here I disagree with Socrates. Though I accept his principle of justice, that one must not return wrongs in kind for to do so is merely to do more wrong, I do not believe that merely resisting attempted harm to oneself necessarily harms the attacker; and even if the attacker does suffer harm from the resistance it is as a result of his own wrongdoing, not any wrongdoing on the part of the defendant.If someone attempts to strike at me, I step out of his way, and he falls on his face as a consequence, I have not harmed him, although he has come to harm. If he attempts to strike at me, I hold up a shield, and he injures his fist upon it, I have not harmed him, although he has come to harm. Somewhat more analogously to the case at hand, â€Å"harm† may come to a street gang initiate whose initiation task is to mug me, inasmuch as he loses his status within the gang (and perhaps the gang itself loses status in the community), should I evade him and escape; but certainly I did not do that harm, though it was a consequence of my actions.Likewise, â€Å"harm† may come to the state as a consequence of successful disobedience against it, inasmuch as its power and thus its authority will be less respected, but this is not the same as the disobedient one directly harming the state, say in the way a foreign conqueror would. None of these situations involve doing anything directly to harm the aggressor, but rather only the consequences of the aggressor’s own actions failing. Thus, such resistance is not prohibited by the principle that one ought never do harm, for one is not doing harm merely by evading harm, even if harm indirectly results as a consequence of such evasion.Certainly we would not say that it is obligatory to allow oneself to be assaulted or robbed, even if we say that to retaliate in kind is forbidden. In all these circumstances, the aggressors are being harmed as a consequence of their own actions; and in the latter two cases, of the mugger and the unjust state, they suffer only in their reputation, losing the respect or fear and subsequent power they might have otherwise enjoyed, yet which, for their failure, they do not deserve.In my third example, as in the case before Socrates and Crito, the only loss suffered is a loss of reputation and the power that reputation often entails. This connection between reputation and power is an important facet of my argument, for it is self-evident to me that the only significant power the state itself has is its reputation, the respect and obedience that people give to it; with no obedient subjects to enforce its laws over those who are not so obedient, or with insufficient portions of the populace willing to tolerate such enforcement, the state would have no power.In fact I argue that in such a case the state would not exist; and really, that no states ever truly exist, in any strict sense. There are merely masses of people, with an assortment of opinions on what is good, bad, morally neutral, permissible, impermissible, and obligatory; all of whom exert whatever influence they can manage, by whatever means they find best, to see that their opinions on such matters are enforced — that justice, as they understand it, prevails. And when some person or block of people manages to secure sufficiently unchallenged influence ver the behavior of the other people in an area (that is, when sufficient people act to enforce one code of behavior and a sufficient portion of the remainder tolerate them), we falsely attribute the existence of some sort of social entity above and beyond the collection of individual people, and call that entity the â€Å"state†. But even a monarch only has his power because enough people believe in and support the monarchy, and enough of the remainder tolerate it; as has been demonstrated wherever a monarchy was overthrown from within by a democratic revolution.It is important to note, however, that this does not mean that democracy entails legitimacy; it only means that all states are on some deep level democratic, differing only in the degree that the people delegate their power to other people, in effect casting their vote as â€Å"whatever he says. † The prevailing opinions may still be entirely wrong; I merely claim that it will nearly always be the majority opinion which prevails. I say â⠂¬Å"nearly† because this phenomenon is dependent upon the relatively small differences in true personal power between most individuals, which are quickly diluted in larger groups, but still present in sufficiently small groups. A knight may be stronger and more skilled than any peasant, but it does not take many fed-up peasants working together to counter the power of that knight, so as the size of the group the knight is a part of grows, his relative power over the whole group decreases rapidly, unless it is bolstered by the support or at least tolerance of other members of the group.Thus for groups of any significant size, the differences in personal power between individuals can be safely ignored, and so the determining factor is not who supports a position but how many support it). The opinions of the people who encompass the legislature of this â€Å"state† — be it one person as in an absolute monarchy, some minority in an oligarchy, or the majority in a dir ect democracy — then become â€Å"the law†.Those things judged by such people as obligatory become required by law; those things judged as forbidden become prohibited by law; and those things judged as permissible are allowed by the law. But in any form of government, especially in a direct democracy such as ancient Athens, the laws of men are nothing but the opinions of men backed by power, that power resting ultimately in the will of the majority; the only differences between government thus being the degree and structure of power delegation, and what the opinions of those delegates are.With it thus established that states are no more than masses of people and their laws no more than the opinions of said people backed by power, not only do I object to Socrates’ insistence that he must be obedient to the state’s death sentence, but it is plainly obvious to me that Socrates himself ought to conclude this, if he was to be consistent with his own earlier po sition that the opinions of men, as such, are irrelevant, no matter what power they may be backed by. But why, my dear Crito, should we care about the opinion of the many? † says Socrates. â€Å"Good men †¦ are the only persons who are worth considering†. Crito eventually concedes this point, agreeing that the opinions of the many are irrelevant; only the opinions of good men matter. But what is it that makes a man good? Is that not part of what is at question here: which sorts of acts are right and which are wrong, which are just or unjust? (A good man, I take it, being one who acts rightly or justly).Certainly being good cannot be merely being seen as good in the eyes of the many, or supporting the commands of the many, for then the opinions of the many and the opinions of good men could never conflict, as good men by definition would always be of the opinion that the majority is right; and Socrates' statements differentiating their opinions would make no sense. So Socrates must agree that goodness is something objective, independent of the opinions of the many.Yet in the dialogue, after Socrates and Crito discuss at some length their agreement to disregard the opinions of the many in considering what ought or ought not be done, and to consider only what is or is not just, Socrates proclaims â€Å"From these premises I proceed to argue the question whether I ought or ought not to try to escape without the consent of the Athenians†. But from where does this concern for the consent of the Athenians come, when we have just disregarded the opinions of the many (in this case the many of Athens); for what is consent if not simply the opinion that something ought to be permitted?Socrates answers, in the voice of the Laws of Athens (speaking to him): â€Å"You, Socrates, are breaking the covenants and agreements which you made with us at your leisure, not in any haste or under any compulsion or deception, but having had seventy years to thi nk of them, during which time you were at liberty to leave the city, if we were not to your mind, or if our covenants appeared to you to be unfair. In short, Socrates is concerned with his obedience to the people of Athens (or at least the government collectively representing them) because he feels he has implicitly agreed to be bound by the decisions of the Athenian government by remaining in the city. But in response I argue that no one can, by any contract implicit or explicit, alter the natural moral obligations which are binding on all men at all times.The most exemplary and broadly agreeable instantiation of this principle is that one cannot sell oneself into slavery, for all men have natural rights (which is to say, obligations naturally owed to them by others) which they cannot give up even if they so choose.For instance, if we grant that all are naturally obliged to refrain from striking me except in such instances as I consent to them doing so, then while I may vary whethe r or not I consent to be struck, and thus vary whether or not it is morally permissible to strike me at that moment, I cannot vary whether or not it is morally permissible to strike me contrary to my consent, for it is naturally obligatory that none do so. That is, I cannot, in a morally binding way, agree that â€Å"henceforth so-and-so may strike me as he pleases regardless of my consent at that moment†.Any such contract offering terms contrary to natural obligations is invalid; and thus contracts of slavery, whereby one waives all of ones natural rights (which is to say, all obligations naturally owed to oneself by others), are the epitome of invalid contracts. This relates to the situation at hand with Socrates and Crito in that a contract to obey the arbitrary commands of some entity (e. g. the state of Athens), provided only that they are issued forth in prescribed proper manner (e. . by the formal proceedings of the Athenian court) and otherwise irrespective of the con tents of those commands, seems to me no different than a contract to slavery, with the entity in question (the state) as the slave master; for what is slavery but complete subjugation to the arbitrary will of another? Socrates himself admits this similarity, saying (once again in the voice of the Laws, speaking to himself) â€Å"can you deny in the first place that you are our child and slave? Yet Socrates has a reply here as well, already quoted above: he has had many years in which he was free to leave the city if he did not wish to be bound by its laws, and by remaining he has implicitly agreed to be bound by them. Certainly a man cannot be a slave if he is free to leave his bonds at any time. But I respond that even such â€Å"voluntary† bonds are contractually invalid, for remaining on the lands of another still does not make one subject to the arbitrary will of the landowner. The only obligation owed to the owner of some property, as such, is to refrain from acting upo n his property contrary to his consent.Likewise the only punishment the property owner may apply simply for disobeying his commands (but not violating any natural obligations, e. g. harming someone or their property, which may warrant further punishment) is to refuse him the use of his property; in the case of land, ejecting him from the premises. By voluntarily entering and remaining in my home, my guests do not become subject to my arbitrary authority, to be enforced as I see fit; at most I have the authority to eject them from my home, if I grow tired of their presence there.Nor by voluntarily entering a corporate office do I become subject to the authority of the corporation, beyond the revocability of my permission to remain therein. Likewise, even if we grant that the city of Athens is the property of the state of Athens (i. e. of its people collectively, rather than parcelled out into individually owned plots), the greatest punishment morally justified simply for behaving in ways the state dislikes (but not in any way which is truly unjust) is banishment from the city.Thus, while the state may have the moral authority to forbid and punish legitimate injustices (which I agree it does, though no more so than any individual), it does not have the moral authority to enforce its arbitrary will upon those who reside within its borders; it merely has the authority to eject them from its lands if it chooses to do so, for which it needs no cause at all, if it is indeed the legitimate owner of those lands.Thus if Socrates truly believes that he has done nothing unjust, then he should not (if accepts my principle regarding contracts and natural obligations) feel subject to the punishment decreed for him, though he may concede the state’s authority to banish him, if he holds the state to be the legitimate owner of the city.I would further question whether it is right to presume that a state is the legitimate owner of its territory (rather than each citizen o wning their own portion in private, as well as some public portions in common), and thus whether it even has the authority to banish the disobedient; but that is another lengthy topic, for which I do not have room in this essay. In conclusion, I see no reason for Socrates to consider the will of the people of Athens (as channeled via their government) binding pon him; and I believe he should seek an answer to the question at hand, whether or not to escape from his punishment, solely by asking whether he has done anything to warrant that punishment — and it appears that he believes he has not. There is no guarantee that his opinion on this matter is correct; the state of Athens may in fact be correct, and thus Socrtes’ punishment just. But to defer to the public opinion over one’s best judgment is never epistemologically sound.Men of reason do not turn to authority, even democratic authority, to answer questions of biology or chemistry or physics, but instead we appeal to evidence and sound logical arguments to determine the answers; and I see no reason why questions of ethics should be subject to any less rigorous and independent methodologies. By denying that any person, text, or institution has any special epistemic or alethic authority (the ability to magically divine or reveal the truth, or to create it by fiat), we do not deny the existence of objective truth.Nor by denying that any king, law book, or legislature has any special deontic authority (the ability to magically divine or reveal our obligations, or to create them by fiat) do we deny that there are objective standards of justice. In both cases we merely concede that we are all in the same standing regarding truth or justice, respectively; and we leave it to each individual to seek it for themselves, to sway others with arguments where they can, and to act upon it as they deem necessary or appropriate, regardless of decrees or prior agreements to the contrary.

Monday, July 29, 2019

A Study of the Conversion Options for the Bataan

T. S. undertook a study of the options for converting the Bataan Nuclear Power Station to fossil fuel (coal or natural gas) combustion. One aim of the study was to find another market for Philippine and Australian coal or natural gas (LNG). The essential question regarding the Bataan Reactor is: how to obtain a financial return from a very expensive power station that * has never produced electricity; * is costing the Philippinec State a sizeable sum in interest; and * has environmental, safety and social concerns over its use as a nuclear power station. The retrofitting of the turbine generator with a fossil fuel fired steam raising system was suggested as a means of utilising part of the plant, and obtaining some return for past and future expenditure. The report/proposal examined some options for fossil fuel firing, and compared those options with nuclear operation. Background The Bataan Nuclear Power Plant was completed in 1984, whilst construction commenced in 1976. It is a Westinghouse light water reactor, that uses pressurised water as it heat exchange medium between the reactor and the steam generators. Its design thermal capacity is 1876MW(t), whilst its rated power output is 621MW(e)1. The technology that is incorporated into the plant is essentially early seventies, but has been modified to incorporate more recent safety devices, such as those recommended by the US Nuclear Regulatory Commission, after evaluation of the Three Mile Island incident. The plant, which was in the process of commissioning at the time of the EDSA revolution, has not been fired, although nuclear fuel was delivered to it storage facilities. Maintenance has continued, with the integrity of the plant and ancillaries being ensured. Conclusion of Study The Philippine Government has previously stated that the Philippines will have nuclear power, but that power will come from new plant and not the Bataan reactor. President Ramos announced on the 8th October 1994 that the Reactor would be converted to a 1000MW combined cycle gas plant. (Although an announcement for a specific conversion scheme has been made, it is still considered that there is time for other options to be considered. ) We found that conversion is technically possible, but economically unwise. New and dedicated coal or natural gas fired power plants would give much higher efficiencies, and thus would give the Philippines much better value per peso spent on fuel consumed. The M. E. T. T. S. ‘s study concluded that the only way of obtaining a reasonable return from the Bataan ‘machine’ is to use it as a nuclear power plant. Our report specifically came to the following conclusions: * That the use of the present ‘nuclear’ turbine/generator in a fossil fired system would be highly wasteful of energy (fuel), A new pulverised coal power station and/or combined cycle natural gas power stations at other site(s), would be a better investment in terms of fuel efficiency and levellised power costs, * The Bataan site is inappropriate for coal fired plant, due to environmental constraints and materials (coal and ash) handling problems, * More assessable sites could be found for co mbined cycle natural gas fired plants around Manila Bay, and Batangas, * The Bataan reactor has been maintained in a good condition since mothballing, and The reactor is of basically sound design and construction, and could with modest expenditure become one of the most modern and safest light water reactors in East Asia. To fire the plant as a nuclear facility, the sea water intakes to the condensers would need to be cleaned (with some equipment being replaced), some of the reactor monitoring systems would need to be further upgraded, whilst the second power transmission system would need to be reconstructed. Staff would need to be retrained and re-licenced. A description of the study is presented in the attached article by Clarke, Ebeling and Cordero. The article was presenred at The First Philippine International Conference on Energy Efficiency and Demand Side Management, Manila, January 1995. Options for the Conversion of the Bataan Nuclear Power Plant to Fossil Fuel Firing Dr. Michael C. Clarke, Director, M. E. T. T. S. Pty. Ltd. , Sydney, Australia Mr. Douglas R. Ebeling, Associate, M. E. T. T. S. Pty. Ltd. , Sydney, Australia Eng. Donato L. Cordero, Engineering Manager, Bataan Nuclear Power Plant The following Executive Summary of a major report formed the basis of a paper presented at the 1st Philippine Conference on Energy Efficiency and Demand-side Management, Manila, January 1995. ) Capital costs and power generation costs are summarised in Table 1, for one coal conversion option, and the conversion of the plant to natural gas fired, combined cycle operation. For comparison purposes figures are also presented for the refurbishm ent, commissioning and running the plant as a nuclear power station. Electricity costs from nuclear operation are considerably cheaper than for ither the two conversion options. If power costs was the only criteria for operating the plant then nuclear firing would clearly win. Both coal and natural gas conversions will have environmental consequences for the region. By the installation of best available technology and the application of best available practice, the impact will be minimised. The cost of technology and practice however will increase the cost of electricity produced by the plant. Table 1. SUMMARY TABLE, FOSSIL FUEL CONVERSION OPTIONS, BNPP – Revision, March 1995 CONVERSION TO COALCONVERSION TO N. GASNUCLEAR COMPARISON POWER OUTPUT MW(e)8001700 620 ENERGY OUTPUT GWH5,600 (With FGD – 5400)12,2004,613 CAPITAL COST $USm750 (With FGD – 1070)1385380 (UPGRADE) Electricity Cost ? US/kWH4. 82 (With FGD – 5. 94) 5. 24, 4. 34 (FP $230/170)3. 50 Electricity Cost P/kWH1. 21 (With FGD – 1. 49)1. 31, 1. 09 (FP $230/170)0. 88 CAP. COST/POWER OUT0. 94 (With FGD – 1. 34)0. 810. 61 CONSTRUCTION TIME42 MONTHS4218. 24 FGD Flue Gas Desulphurisation (+ Selective Catalytic Reduction) FP Fuel Price, Natural Gas ($US230 /tonne for LNG, $US170 /tonne piped gas) – (Coal $US 55 / tonne) Notes on Table 1 For comparison purposes, the two fossil fuel conversion options and the nuclear comparison have each had the electricity cost based on a pay-back period of twenty years. In each case (for the table) it has been assumed that the full capital cost has been borrowed. When financing packages are being considered, different pay-back periods are likely to be used. The periods are likely to increase with increasing debt. With the natural gas conversion option, an equity contribution would probably be included, since a BOT financing scheme may be used, that ties gas production, reticulation and use into one commercial package. The electricity costs for coal and natural gas conversion are based on a reasonably optimistic scenarios, where no excessive ancillary capital works are charged against the plant. If environmental or other factors require such works, then increase in the electricity cost would occur. It is further considered that the plant required for conversion would be sourced from low cost countries; China, India, Australia, the Philippines etc, as far as possible. The costings for conversion are further premised on the use of the site allocated for construction of PNPP 2, in that it is supplied at no cost, and is geologically stable. If the time required for the construction and commissioning is crucial, then the upgrading of the plant as a nuclear station is clearly the preferred choice. Further, the financial analyses indicate that the nuclear firing of the plant offers the cheapest electricity. Given that the nuclear fuel price is likely to remain stable over the foreseeable future (as against likely rises for coal and natural gas), the nuclear upgrading# and operation offers greater financial certainty to investors. # M. E. T. T. S. ‘s estimate for upgrading the nuclear plant to 1997/8 standards is $US380m. It is backed by further external assessment, and includes new safety features. $US300m is the cost of a basic upgrading based on calculations carried out by the National Power Corporation. SUMMARY – COAL FIRING The conversion of the PNPP I plant to coal firing has some advantages. Coal technology is well proven, and only a small variation in the normal use of that technology is required to convert the plant. The power station will have a capacity similar to the design capacity for the nuclear plant, and will not be the largest plant in the new echelon of Luzon’s power facilities. The plant of 800 MW(e) capacity will be relatively inexpensive at a capital cost of $US505m – without Flue Gas Desulphurisation, Selective Catalytic Reduction, or excessive expenditure on coal or ash handling and ignoring the previous expenditure on the nuclear system. A construction and commissioning period of 42 months is envisaged. The coal option however offers unique co-economic opportunities. The ash waste product would be valuable if used in ancillary industry. By using the Lahar produced by the Pinatubo eruption as an aggregate, with the ash, iron oxide and cement, valuable building materials could be produced. The disadvantages include designing and fitting an environmentally acceptable coal fired power station into the Bataan region. The materials handling alone will create many environmental, management and operational difficulties. The infrastructure requirements for materials handling will also raise engineering and environmental questions that will need to be solved before construction begins. Other environmental questions concerning emission reduction and control must also be answered before work can commence. Another major disadvantage is the requirement for premium fuel, that is expensive in 1994, and in all probability will become relatively more expensive as the demand for ‘clean’ coal increases in the future. SUMMARY – NATURAL GAS FIRING (COMBINED CYCLE, GAS TURBINE) Natural gas provides the cleanest option for the conversion of the Bataan power station to fossil fuel firing. It further offers the most flexible power output to the grid. Options exist for running a part (or whole) of the plant as a single cycle peak load provider, or running the whole plant as a base load facility. The environmental hazard that would be created by such a plant is low compared to coal. Thermal pollution to the sea would be greater than the nuclear option, in that if a 1700MW(e) plant was built with 46% efficiency, the waste heat would be 2000MW(t). This heat would be partially dissipated into the atmosphere (250MW) as against to the sea (1750MW). The additional heat discharge to the sea would be about 500MW(t). NOx emissions can be successfully controlled by modern technology. Steam or water injection, ammonia addition or innovative combustion designs will produce acceptable (but not zero) NOx emissions. At 1700MW(e), the power station would be the largest in the Philippines, and would certainly require a review of the Luzon energy plan. The total consumption of natural gas over a twenty five year period would be 2. 5 TCF; over half the entire Philippine projected resource from Palawan. Over a billion dollars in capital would be needed to build the plant, plus an additional substantial sum to supply the fuel; either as LNG or pipeline gas. The security of a large gas holding area would need to be addressed. Such a holding area and power station would make a relatively easy target when compared to a coal fired plant with coal yards or nuclear facilities. The installation of the gas turbines could be achieved in eighteen months, but the construction of the steam generators and carrying out modifications to the existing plant would take a further twenty four months. From the preliminary financial analysis, the construction of a new combined cycle power station makes better financial sense. A NUCLEAR COMPARISON Under the four headings (Technology, The Environment, Social and Political Concerns, and Economy) that were used to examine the coal-conversion option, a brief summary has been made of the nuclear option for comparison purposes. Technology Light water reactors are a very common type of nuclear reactor. They have good safety records, and most have high capacity factors. There development has been continuous, with technology now being available from Japan, Korea, France, the United Kingdom as well as the United States. They are used in close proximity to the Philippines (Japan, Korea and Taiwan) and have been armarked for use in Indonesia and Malaysia. The Bataan unit is 1970/80’s technology. It is however essentially the same as new units, and could be readily upgraded to 1990’s standards. The Environment The reactor will produce thermal pollution (waste heat) that will be disposed of, off Napot Point to the South China Sea. An environmental impact assessment cleared the plant for its designed heat disposal, and found that localised heating of the sea would not be excessive, given the strong currents that would ensure dispersion of the hot water. No other polluting emissions could be expected from the nuclear power plant. (Accidental emissions of radioactive material, are most unlikely. Once the plant was upgraded to 1997 standards, one accident in a million years could be expected. ) Social and Political Concerns The perceived problems at the Bataan power plant are its greatest liability. These problems include seismic instability, claims of faulty workmanship and the lack of experience of the operators. Many geological and seismic inspections have been carried out on the site, with the result being that no significant risk is apparent. To convince Philippine Society of the seismic safety of the plant, an educational programme would need to be carried out that emphasised the sites stability, and the high seismic safety factor of the plant (0. 4g). Part of the process of refurbishment and upgrading, would be quality assurance on all systems and components of the plant. Modern QA techniques would need to be used to provide the certainty that all significant parts of the plant meet the highest safety and operational standards. Initially foreign experts would be needed to run the plant. The retraining of Philippine staff would take considerable time and money, with the retrained staff spending a number of years assisting in operating similar plants in neighbouring countries. Economics By comparison with the costs of conversion to coal or natural gas, the refurbishment and upgrading of the plant for nuclear operation would be significantly cheaper. A maximum price of $US300m (including staff training) is a fair limit, compared to fossil fuel conversion alternatives. The nuclear option should have the shortest lag time in terms of upgrading and commissioning. If foreign staff were used to initially man the plant then a period of eighteen to twenty months would be needed for full operation. This relatively short period, may be valuable in that the some of the expensive, old or temporary oil fired power plant could be retired early. Fuel costs, plus operation and management costs for LWRs should cost no more than ? US 2/kWH (0. 54 Centavos/kWH). If the interest on the $US 300m was 12%, with a pay-back period of twenty years for the capital, then a further 0. 9? US/kWH would be added to the power cost. The total power cost would be 2. 9? US/kWH (0. 78 Centavos/kWH). If consideration was given to running the Bataan power station as a nuclear plant, then the environmental and economic benefits (as well as safety) should be emphasised, to overcome social and political opposition. THE PHILIPPINES AND THE NUCLEAR CYCLE The Philippines would be an importer of nuclear fuel and an exporter of spent fuel. The fuel that the reactor would use would be lightly enriched. As the uranium 235 is consumed, some plutonium is formed, part of which is also used up as fuel. The spent fuel rods contain a depleted amount of uranium 235, a little plutonium but mostly non-fissile uranium 238. These fuel rods can be reused in heavy water type reactors (CANDU) that are running in Japan, Korea and Taiwan, as primary fuel. All the wastes would be processed by those countries, whilst the Philippines would receive a financial return for its used nuclear fuel. This is a win-win situation. The sale of the used fuel rods could bring the net production cost of electricity (fuel plus operations and management) to under ? US 1. 5/kWH. PLANT SECURITY AND THE NUCLEAR OPTION Unfortunately there is an ongoing insurgency situation in the Philippines. The insurgency problems are no longer major, and in all probability will recede. All major plant however does need a security system. The Bataan plant was constructed with good external, perimeter and internal security systems. There are commonly perceived notions that Nuclear Plants are susceptible to terrorist attack. These notions are based on a lack of understanding of the compact nature of nuclear plants, and the presence of very considerable containment structures for the reactor and fuel stores – especially American designed LWRs. The plant is easy to guard, and would be able to resist attack with light weapons, including rocket propelled grenades etc. The damage from such an attack would be limited to the knocking out of ancillary plant and structures, including the transformer yard, the auxiliary fuel tanks and administration building. Notes 1. The above power cost figures are based on 1997 projected fuel prices, 12% interest, 85% availability, and 20 years amortisation.. The price of coal and natural gas are considered to be more liable for major increases, than nuclear fuel. The Asian demand for both coal and gas is expected to outstrip supply in the coming decade. 2. The estimated construction time includes planning and design, equipment construction, site modification, plant erection and commissioning, and staff training (coal and natural gas conversion). If major ancillary works are required (eg. major wharves, ash and coal pipelines, shipping channels etc), then both an increase in the construction time and costs could be expected. A Study of the Conversion Options for the Bataan T. S. undertook a study of the options for converting the Bataan Nuclear Power Station to fossil fuel (coal or natural gas) combustion. One aim of the study was to find another market for Philippine and Australian coal or natural gas (LNG). The essential question regarding the Bataan Reactor is: how to obtain a financial return from a very expensive power station that * has never produced electricity; * is costing the Philippinec State a sizeable sum in interest; and * has environmental, safety and social concerns over its use as a nuclear power station. The retrofitting of the turbine generator with a fossil fuel fired steam raising system was suggested as a means of utilising part of the plant, and obtaining some return for past and future expenditure. The report/proposal examined some options for fossil fuel firing, and compared those options with nuclear operation. Background The Bataan Nuclear Power Plant was completed in 1984, whilst construction commenced in 1976. It is a Westinghouse light water reactor, that uses pressurised water as it heat exchange medium between the reactor and the steam generators. Its design thermal capacity is 1876MW(t), whilst its rated power output is 621MW(e)1. The technology that is incorporated into the plant is essentially early seventies, but has been modified to incorporate more recent safety devices, such as those recommended by the US Nuclear Regulatory Commission, after evaluation of the Three Mile Island incident. The plant, which was in the process of commissioning at the time of the EDSA revolution, has not been fired, although nuclear fuel was delivered to it storage facilities. Maintenance has continued, with the integrity of the plant and ancillaries being ensured. Conclusion of Study The Philippine Government has previously stated that the Philippines will have nuclear power, but that power will come from new plant and not the Bataan reactor. President Ramos announced on the 8th October 1994 that the Reactor would be converted to a 1000MW combined cycle gas plant. (Although an announcement for a specific conversion scheme has been made, it is still considered that there is time for other options to be considered. ) We found that conversion is technically possible, but economically unwise. New and dedicated coal or natural gas fired power plants would give much higher efficiencies, and thus would give the Philippines much better value per peso spent on fuel consumed. The M. E. T. T. S. ‘s study concluded that the only way of obtaining a reasonable return from the Bataan ‘machine’ is to use it as a nuclear power plant. Our report specifically came to the following conclusions: * That the use of the present ‘nuclear’ turbine/generator in a fossil fired system would be highly wasteful of energy (fuel), A new pulverised coal power station and/or combined cycle natural gas power stations at other site(s), would be a better investment in terms of fuel efficiency and levellised power costs, * The Bataan site is inappropriate for coal fired plant, due to environmental constraints and materials (coal and ash) handling problems, * More assessable sites could be found for co mbined cycle natural gas fired plants around Manila Bay, and Batangas, * The Bataan reactor has been maintained in a good condition since mothballing, and The reactor is of basically sound design and construction, and could with modest expenditure become one of the most modern and safest light water reactors in East Asia. To fire the plant as a nuclear facility, the sea water intakes to the condensers would need to be cleaned (with some equipment being replaced), some of the reactor monitoring systems would need to be further upgraded, whilst the second power transmission system would need to be reconstructed. Staff would need to be retrained and re-licenced. A description of the study is presented in the attached article by Clarke, Ebeling and Cordero. The article was presenred at The First Philippine International Conference on Energy Efficiency and Demand Side Management, Manila, January 1995. Options for the Conversion of the Bataan Nuclear Power Plant to Fossil Fuel Firing Dr. Michael C. Clarke, Director, M. E. T. T. S. Pty. Ltd. , Sydney, Australia Mr. Douglas R. Ebeling, Associate, M. E. T. T. S. Pty. Ltd. , Sydney, Australia Eng. Donato L. Cordero, Engineering Manager, Bataan Nuclear Power Plant The following Executive Summary of a major report formed the basis of a paper presented at the 1st Philippine Conference on Energy Efficiency and Demand-side Management, Manila, January 1995. ) Capital costs and power generation costs are summarised in Table 1, for one coal conversion option, and the conversion of the plant to natural gas fired, combined cycle operation. For comparison purposes figures are also presented for the refurbishm ent, commissioning and running the plant as a nuclear power station. Electricity costs from nuclear operation are considerably cheaper than for ither the two conversion options. If power costs was the only criteria for operating the plant then nuclear firing would clearly win. Both coal and natural gas conversions will have environmental consequences for the region. By the installation of best available technology and the application of best available practice, the impact will be minimised. The cost of technology and practice however will increase the cost of electricity produced by the plant. Table 1. SUMMARY TABLE, FOSSIL FUEL CONVERSION OPTIONS, BNPP – Revision, March 1995 CONVERSION TO COALCONVERSION TO N. GASNUCLEAR COMPARISON POWER OUTPUT MW(e)8001700 620 ENERGY OUTPUT GWH5,600 (With FGD – 5400)12,2004,613 CAPITAL COST $USm750 (With FGD – 1070)1385380 (UPGRADE) Electricity Cost ? US/kWH4. 82 (With FGD – 5. 94) 5. 24, 4. 34 (FP $230/170)3. 50 Electricity Cost P/kWH1. 21 (With FGD – 1. 49)1. 31, 1. 09 (FP $230/170)0. 88 CAP. COST/POWER OUT0. 94 (With FGD – 1. 34)0. 810. 61 CONSTRUCTION TIME42 MONTHS4218. 24 FGD Flue Gas Desulphurisation (+ Selective Catalytic Reduction) FP Fuel Price, Natural Gas ($US230 /tonne for LNG, $US170 /tonne piped gas) – (Coal $US 55 / tonne) Notes on Table 1 For comparison purposes, the two fossil fuel conversion options and the nuclear comparison have each had the electricity cost based on a pay-back period of twenty years. In each case (for the table) it has been assumed that the full capital cost has been borrowed. When financing packages are being considered, different pay-back periods are likely to be used. The periods are likely to increase with increasing debt. With the natural gas conversion option, an equity contribution would probably be included, since a BOT financing scheme may be used, that ties gas production, reticulation and use into one commercial package. The electricity costs for coal and natural gas conversion are based on a reasonably optimistic scenarios, where no excessive ancillary capital works are charged against the plant. If environmental or other factors require such works, then increase in the electricity cost would occur. It is further considered that the plant required for conversion would be sourced from low cost countries; China, India, Australia, the Philippines etc, as far as possible. The costings for conversion are further premised on the use of the site allocated for construction of PNPP 2, in that it is supplied at no cost, and is geologically stable. If the time required for the construction and commissioning is crucial, then the upgrading of the plant as a nuclear station is clearly the preferred choice. Further, the financial analyses indicate that the nuclear firing of the plant offers the cheapest electricity. Given that the nuclear fuel price is likely to remain stable over the foreseeable future (as against likely rises for coal and natural gas), the nuclear upgrading# and operation offers greater financial certainty to investors. # M. E. T. T. S. ‘s estimate for upgrading the nuclear plant to 1997/8 standards is $US380m. It is backed by further external assessment, and includes new safety features. $US300m is the cost of a basic upgrading based on calculations carried out by the National Power Corporation. SUMMARY – COAL FIRING The conversion of the PNPP I plant to coal firing has some advantages. Coal technology is well proven, and only a small variation in the normal use of that technology is required to convert the plant. The power station will have a capacity similar to the design capacity for the nuclear plant, and will not be the largest plant in the new echelon of Luzon’s power facilities. The plant of 800 MW(e) capacity will be relatively inexpensive at a capital cost of $US505m – without Flue Gas Desulphurisation, Selective Catalytic Reduction, or excessive expenditure on coal or ash handling and ignoring the previous expenditure on the nuclear system. A construction and commissioning period of 42 months is envisaged. The coal option however offers unique co-economic opportunities. The ash waste product would be valuable if used in ancillary industry. By using the Lahar produced by the Pinatubo eruption as an aggregate, with the ash, iron oxide and cement, valuable building materials could be produced. The disadvantages include designing and fitting an environmentally acceptable coal fired power station into the Bataan region. The materials handling alone will create many environmental, management and operational difficulties. The infrastructure requirements for materials handling will also raise engineering and environmental questions that will need to be solved before construction begins. Other environmental questions concerning emission reduction and control must also be answered before work can commence. Another major disadvantage is the requirement for premium fuel, that is expensive in 1994, and in all probability will become relatively more expensive as the demand for ‘clean’ coal increases in the future. SUMMARY – NATURAL GAS FIRING (COMBINED CYCLE, GAS TURBINE) Natural gas provides the cleanest option for the conversion of the Bataan power station to fossil fuel firing. It further offers the most flexible power output to the grid. Options exist for running a part (or whole) of the plant as a single cycle peak load provider, or running the whole plant as a base load facility. The environmental hazard that would be created by such a plant is low compared to coal. Thermal pollution to the sea would be greater than the nuclear option, in that if a 1700MW(e) plant was built with 46% efficiency, the waste heat would be 2000MW(t). This heat would be partially dissipated into the atmosphere (250MW) as against to the sea (1750MW). The additional heat discharge to the sea would be about 500MW(t). NOx emissions can be successfully controlled by modern technology. Steam or water injection, ammonia addition or innovative combustion designs will produce acceptable (but not zero) NOx emissions. At 1700MW(e), the power station would be the largest in the Philippines, and would certainly require a review of the Luzon energy plan. The total consumption of natural gas over a twenty five year period would be 2. 5 TCF; over half the entire Philippine projected resource from Palawan. Over a billion dollars in capital would be needed to build the plant, plus an additional substantial sum to supply the fuel; either as LNG or pipeline gas. The security of a large gas holding area would need to be addressed. Such a holding area and power station would make a relatively easy target when compared to a coal fired plant with coal yards or nuclear facilities. The installation of the gas turbines could be achieved in eighteen months, but the construction of the steam generators and carrying out modifications to the existing plant would take a further twenty four months. From the preliminary financial analysis, the construction of a new combined cycle power station makes better financial sense. A NUCLEAR COMPARISON Under the four headings (Technology, The Environment, Social and Political Concerns, and Economy) that were used to examine the coal-conversion option, a brief summary has been made of the nuclear option for comparison purposes. Technology Light water reactors are a very common type of nuclear reactor. They have good safety records, and most have high capacity factors. There development has been continuous, with technology now being available from Japan, Korea, France, the United Kingdom as well as the United States. They are used in close proximity to the Philippines (Japan, Korea and Taiwan) and have been armarked for use in Indonesia and Malaysia. The Bataan unit is 1970/80’s technology. It is however essentially the same as new units, and could be readily upgraded to 1990’s standards. The Environment The reactor will produce thermal pollution (waste heat) that will be disposed of, off Napot Point to the South China Sea. An environmental impact assessment cleared the plant for its designed heat disposal, and found that localised heating of the sea would not be excessive, given the strong currents that would ensure dispersion of the hot water. No other polluting emissions could be expected from the nuclear power plant. (Accidental emissions of radioactive material, are most unlikely. Once the plant was upgraded to 1997 standards, one accident in a million years could be expected. ) Social and Political Concerns The perceived problems at the Bataan power plant are its greatest liability. These problems include seismic instability, claims of faulty workmanship and the lack of experience of the operators. Many geological and seismic inspections have been carried out on the site, with the result being that no significant risk is apparent. To convince Philippine Society of the seismic safety of the plant, an educational programme would need to be carried out that emphasised the sites stability, and the high seismic safety factor of the plant (0. 4g). Part of the process of refurbishment and upgrading, would be quality assurance on all systems and components of the plant. Modern QA techniques would need to be used to provide the certainty that all significant parts of the plant meet the highest safety and operational standards. Initially foreign experts would be needed to run the plant. The retraining of Philippine staff would take considerable time and money, with the retrained staff spending a number of years assisting in operating similar plants in neighbouring countries. Economics By comparison with the costs of conversion to coal or natural gas, the refurbishment and upgrading of the plant for nuclear operation would be significantly cheaper. A maximum price of $US300m (including staff training) is a fair limit, compared to fossil fuel conversion alternatives. The nuclear option should have the shortest lag time in terms of upgrading and commissioning. If foreign staff were used to initially man the plant then a period of eighteen to twenty months would be needed for full operation. This relatively short period, may be valuable in that the some of the expensive, old or temporary oil fired power plant could be retired early. Fuel costs, plus operation and management costs for LWRs should cost no more than ? US 2/kWH (0. 54 Centavos/kWH). If the interest on the $US 300m was 12%, with a pay-back period of twenty years for the capital, then a further 0. 9? US/kWH would be added to the power cost. The total power cost would be 2. 9? US/kWH (0. 78 Centavos/kWH). If consideration was given to running the Bataan power station as a nuclear plant, then the environmental and economic benefits (as well as safety) should be emphasised, to overcome social and political opposition. THE PHILIPPINES AND THE NUCLEAR CYCLE The Philippines would be an importer of nuclear fuel and an exporter of spent fuel. The fuel that the reactor would use would be lightly enriched. As the uranium 235 is consumed, some plutonium is formed, part of which is also used up as fuel. The spent fuel rods contain a depleted amount of uranium 235, a little plutonium but mostly non-fissile uranium 238. These fuel rods can be reused in heavy water type reactors (CANDU) that are running in Japan, Korea and Taiwan, as primary fuel. All the wastes would be processed by those countries, whilst the Philippines would receive a financial return for its used nuclear fuel. This is a win-win situation. The sale of the used fuel rods could bring the net production cost of electricity (fuel plus operations and management) to under ? US 1. 5/kWH. PLANT SECURITY AND THE NUCLEAR OPTION Unfortunately there is an ongoing insurgency situation in the Philippines. The insurgency problems are no longer major, and in all probability will recede. All major plant however does need a security system. The Bataan plant was constructed with good external, perimeter and internal security systems. There are commonly perceived notions that Nuclear Plants are susceptible to terrorist attack. These notions are based on a lack of understanding of the compact nature of nuclear plants, and the presence of very considerable containment structures for the reactor and fuel stores – especially American designed LWRs. The plant is easy to guard, and would be able to resist attack with light weapons, including rocket propelled grenades etc. The damage from such an attack would be limited to the knocking out of ancillary plant and structures, including the transformer yard, the auxiliary fuel tanks and administration building. Notes 1. The above power cost figures are based on 1997 projected fuel prices, 12% interest, 85% availability, and 20 years amortisation.. The price of coal and natural gas are considered to be more liable for major increases, than nuclear fuel. The Asian demand for both coal and gas is expected to outstrip supply in the coming decade. 2. The estimated construction time includes planning and design, equipment construction, site modification, plant erection and commissioning, and staff training (coal and natural gas conversion). If major ancillary works are required (eg. major wharves, ash and coal pipelines, shipping channels etc), then both an increase in the construction time and costs could be expected.

MGT 501 MoD 5 Cases Managing the Organization Essay

MGT 501 MoD 5 Cases Managing the Organization - Essay Example Highly skilled personnel are the most important valuable of a business enterprise. Qualified workers enable the tasks and the objectives of the company to be achieved appropriately thus putting the organization to a benchmark of great level of success. These goals are ultimately achieved through effective coordination as spelled out in an organization structure that the company might prefer (Buhler, 2008). The type of structure and design a company might opt for, have explicit and implicit effect on how each employee relate with one another in terms of communication. A well designed business structure has significant effects to its members. These effects are portrayed based on how members react to changes within their work environment and their ultimate output. Organizational structures which are well planned are easy get accustomed to and enhance collaboration between employees for the best interest of the company (Buhler, 2008). Effective Communication is a crucial tool within an o rganization which enables it to thrive. Authorities are distributed among different level of ranks. For example, a new employee who has just been hired will know where to report and where to seek for help when confronted with a hard situation. Most companies prefer addressing issues affecting the organization through departmental official who is in turn forward the complain or a request to the executives of the companies for subsequent analysis and coming up with solutions. An organizational structure enables the employees to communicate with the authorities following the right channels which have been put in place (Buhler, 2008). A well-built organization design boosts the morale and confidence of its members. Respect is an important value which motivates workers at their work place. Employees need to feel valued by their employers in terms of their contribution in achieving the organizational main objectives. Giving Incentives to the members is an important motivational factor, wh enever they are faced with challenges in the course of their practice. Incentives help them see more opportunities which might enable them to advance in their carrier. Conversely, organization structure might also have a negative impact on the employee spirit and morale (Walker, 2002). For instance, raising salaries for the heads of projects and giving them incentives e.g. bonus while delaying payments of team member salaries, can demoralize the minor employees involved in those projects. How a business is structured to operate plays a crucial role in relation to the level of motivation an individual might have (Klewes & Langen, 2008). Decision making is an important aspect of an organization structure. How fast or how slow an organization makes decisions depend on the efficiency of a company’s executive coordination. For a simple structure composed of the manager who is answerable to the director, the decision making process is faster hence the quick growth. Big companies ha ve a stratum of management. Responsibilities are more elaborate thus it is important to identify the individuals that are the overseers of certain functions and practices of within the company (Puffers, 2004). Productivity of each employee is best evaluated and determined by a well organized organization structure. Supervisors are able to gauge the efforts that are put in by their subordinates according to the work assigned to them. Supervisors are

Sunday, July 28, 2019

Size of financial sector Essay Example | Topics and Well Written Essays - 2000 words

Size of financial sector - Essay Example Moreover, profitability across all the financial sectors has improved except the insurance sector and it is anticipated to remain strong in the first quarter of the year 2015. Unfortunately, for the insurance and the building society the forecast suggests otherwise. The number of employment in the banking and insurance sector has decreased in comparison to other sectors while the training expenditure has risen. Department, I. M. F. M. C. M. (2014) suggests that this is a clear indication of the existence of shortage of skills and talents in the financial labor market. The financial sector has enormously grown over the last decades. Gloria (2015) illustrates that the parameters that measure these growths are: quantity of the financial market; the share of the GDP; wages; and employment. For instance, the economy of the UK has grown faster since the financial crisis of 2007/2008. It expanded by approximately by 1.9% in 2013. The growth is also attributed to the securitization in the financial market; intermediation of credit; and the subsectors of finance in the financial sector. On the other hand, the insurance sector has been steadily growing (at a steady pace). In addition, the growth is also evident in the increase in the financial claims and contracts such as bonds, stock, fund shares, and derivatives. Before the 200/2008 financial crisis, central banks use a simple modality that would effectively maintain and stabilize the inflation rate. However, in 2009 the interest rates were slashed to a level close to zero (zero lower bound). Jeucken’s (2001) notion indicates that below this benchmark would hav e been practical but wouldn’t have achieved the desired results. Central bank faced an uphill task of dealing with the increasing rate of unemployment as well as the collapse in the output. At some instances central banks have adopted the unconventional

Saturday, July 27, 2019

Early 20th century Shanghai Divergence Essay Example | Topics and Well Written Essays - 1500 words

Early 20th century Shanghai Divergence - Essay Example The article starts off by attempting to place Shanghai in the context of other cities of the world like Amsterdam, Budapest and Houston that Baverstock et al have placed in the category of â€Å"gamma-global-cities†. What this means is that these cities have been given a separate place from the other cities of the world in terms of their tendency to what Wasserstrom calls â€Å"re-globalizing† nature i.e. the ability of the cities to re-integrate them with the global landscape. The author attempts’ to place Shanghai in context leave him bewildered considering the range of transformations that the city underwent in its existence and the fact that it is still a â€Å"work in progress†. The author reaches the view point that Shanghai is a city that is â€Å"good to think† which means that attempts to compare Shanghai with other cities have proved fruitless. And the article quotes Rudolf Wagner who suggests a moratorium in comparing Shanghai with other cities. Wasserstrom is not deterred by the academic community’s decision on de-linking comparisons of Shanghai with other cities. On the other hand, â€Å"While there is a strong case to be made for Wagner’s argument and the modification of it just described, this article argues that this is a good time for Shanghai specialists to enter the admittedly treacherous waters of far-flung comparison. And it will suggest a specific strategy for doing just this by proposing that we think of Shanghai as a reglobalizing When we use the term â€Å"re-globalize†, we effectively mean that there was a time when these cities were part of the global mainstream in terms of their relations with the rest of the world be it for trade or exchange of ideas. Shanghai has a particular significance in this respect as it was one of the cities in the East that had interacted with the West before the opium wars and the hundred years of treaty enforced port-period when it was a bustling port that served as a center for commerce and

Friday, July 26, 2019

Language of art, 3D art, photography Essay Example | Topics and Well Written Essays - 250 words

Language of art, 3D art, photography - Essay Example This is exhibited by both photographs illustrating a scene that is drenched in death as the people within the scenes are consumed by fear and brutality. Both of these photos look like they could have come out of a Hollywood movie in that they are presented in black and white, and the photographer has frozen a moment of action where the viewer is left to wonder what happened next, or even to wonder what happened in the first place. I think that these two photos made such a big impression on me because of the fact that, although it shows such horror in them, I noticed that the photos were more interesting to me than horrifying. I think that this illustrates the desensitization to violence that occurs in America. Everyday, people are bombarded with violent imagery in television shows, books, movies, and advertisements. This has ended up causing a culture which is merely interested in violence rather than repulsed by it. It would be interesting to see how a person reacted to these photos when they were first published in comparison to a person in the 21st

Thursday, July 25, 2019

Registerd nurse interview analysis Essay Example | Topics and Well Written Essays - 250 words

Registerd nurse interview analysis - Essay Example She said that this was tough when her children were still young because they rarely see each other due to her schedule. Sometimes, she cannot be with them on holidays because of her work. She said that she does not regard patients as difficult. Sometimes they can be demanding and grumpy but as a nurse, she has to understand the situation of the patient that they just want to feel better. The resource person narrated that nursing is not just an eight to five job where you punch in and get paid. It is a profession as well as a vocation because the job affects people’s lives. To be successful in this profession, one has to be genuinely concerned with people. A nurse has to understand that patients are already in pain and the least the nurse can do is to alleviate and make the pain bearable to the patient. Nurses also work long hours and they do not follow the Monday to Friday work routine nor the eight to five schedule. It is because illness do not follow schedule and hospitals are open throughout the year. There are also emergency cases where a nurse has to work

Wednesday, July 24, 2019

Recruitment process Essay Example | Topics and Well Written Essays - 500 words

Recruitment process - Essay Example Recruitment is the process of identifying and hiring qualified candidates for a job opening. However, recruitment process involves attracting, hiring, and interviewing new employees. On the other hand, selection process is the evaluation of candidate, through interview, for specific job. There is a difference between recruitment and selection process. Recruitment process mostly involves attracting candidates who are later hired for a job upon qualifications. The selection process involves identifying the qualities needed for a candidate to quality for a job. Internal methods of recruitment are usually done for the preparation of a recruitment process. There are a number of internal methods of recruitment. The first process in recruitment is job analysis. This entails reviewing the manpower plan of the company frequently so as to establish a gap. The Human Resource Manager liaises with the head of departments so as to see whether a job position in a given sector is necessary. Such a position should be ideal in that it should allow for future promotion and expansion. Once such a job position is confirmed, the concerned HR manager fills a requisition form which is sent to the Line Manager. The Line Manager then submits it to the Recruitment Manager upon its approval. The Recruitment Manager has the final say hence his approval leads to creation of a vacancy. (Lee, 2012:19).this new development comes with a myriad of details that include: job posting which involves the possibility of workers within the company applying for the created vacan cy; reference number of the vacancy, postal postal association and the academic qualifications, skills and experience required for the vacancy. The second stage involves writing the Job Description and PS. The departmental heads are vital components when it comes to giving the boundaries of the job in the form of a job description. This is simply because he or she is

Tuesday, July 23, 2019

Tv series Angels in America Essay Example | Topics and Well Written Essays - 500 words

Tv series Angels in America - Essay Example Prior Walker, a gay man who discovers he has AIDS, must deal with the end of a relationship while facing his own mortality. Through his numerous heavenly visions, he learns that he is a prophet, perhaps symbolizing hope and survival. At the beginning of the story, Louis Ironson is Prior’s neurotic boyfriend; later, however, he abandons the relationship once he discovers Prior is suffering from AIDS, unable to deal with a tragedy that symbolizes his own fears. Harper and Joe Pitt must address their own life-changing events: she attempts to numb her repressed life with drugs and must eventually face her husband’s homosexuality; and Joe must struggle with his sexual identity and issues of politics and homophobia. Two main characters are based on actual people: Roy Cohn and Ethel Rosenberg. Cohn’s voyage is not easy; he continually denies his sexuality and, until the end, holds tightly to his judgmental nature and conservatism. The ghost of Rosenberg visits Cohn in t he hospital as she struggles with her unjust execution and the desire to confront her prosecutor. Each character’s journey begins with tragedy and personal struggle, as these elements work well as dramatic sources of self-discovery. The various ways in which the main characters deal with the issue of homosexuality can me seen in their personal relationships and how they look at the world. Whether in or out of the closet, each character must face the stereotypes and social expectations of their sexuality. It is clear that the characters who refuse to face the truth of their sexual orientation struggle with the avoidance of their true nature and, in many ways, this dishonesty eats at their souls. Joe is living a lie through his marriage to Harper and gradually understands he must live a somewhat truer life, while Harper faces the repercussions of his decision. Cohn is perhaps the most repressed and

United Steel Workers of America and Kaiser Aluminum Essay Example for Free

United Steel Workers of America and Kaiser Aluminum Essay The issue of discrimination has pervaded many aspects of social life. Women, minorities, and unwanted individuals usually suffered from either institutional or bigot discrimination. Because discrimination rests on the twin principles of racial superiority (or its equivalent, the so-called ‘white man’s burden’) and conservatism, it usually transcends beyond what is perceived and indicated. Discrimination, therefore, is sometimes not evident and consequential. Discrimination is the direct manifestation of behavior and psychological outlook of individuals, groups, and even institutions. Thus, discrimination can virtually be found in all aspects of social life – in the family, in the workplace, and in government – so long as the society in general promotes discrimination both on the individual and institutional levels. Case Summary In 1998, the Kaiser Aluminum and Chemical Corporation and the United Steelworkers of America engaged in bargaining which led to prolonged and almost intractable labor dispute. On September 18, 2000, the two-year strike ended, after a binding arbitration. About 3000 workers were involved in the strike. Five plants were affected. The major issues which lead to the dispute are as follows: 1) the company decided to allow budgetary cuts in bargaining unit jobs; 2) there was substantial elimination of supplemental and local agreements; and 3) there was a proposal which reserved 50% of the available jobs in the company to African-Americans. Kaiser argued that it needed to institute several productivity improvements because it was a medium-sized aluminum producer facing tight competitive issues. However what enraged the union is the proposal which reserved 50% of the available jobs in the company to minorities, especially African-Americans. The proposal was generally beneficial to the company because it could theoretically replace union-affiliated employees with employees of minority background. The union saw the move as a general alibi for budgetary cuts in bargaining job units. The Ethical Issue From a moral point of view, the proposal is justified. The proposal not only dispenses distributive justice (this is justice based on opportunity) but also allows affirmative action on the part of the employees. It can therefore be argued that the proposal is an extension of the equal opportunity clause of economic liberalism. By reserving 50% of available jobs to African-Americans, the proposal is essentially increasing the marginal opportunity of such group with respect to other groups. The counterargument which states that ‘the proposal induces discrimination on the part of whites (reverse discrimination)’ is wholly inaccurate. The proposal only decreases the opportunities available to whites; it does not impinge on the right of the whites to equal employment. Perhaps, it may be helpful to employ a historical point of view in analyzing the validity and soundness of the counter argument. For almost three centuries, the minorities (especially the African-Americans) suffered from economic inequities. Many of them were underemployed, underpaid, and to some extent overworked. It may be argued that the proposal is a good-to-fit move to decrease such economic marginality. It may be viewed as a move in improving both economic (opportunities) and social justice (overall standing in society). Deontological Point of View From a Kantian point of view, the proposal has moral universal standing. A proposal which dispenses distributive justice is a general universal ethos. Categorically speaking, the proposal does not in any way put groups into the same categorical ethos. Rather, the proposal is a general tool for evaluating justice of any type – it promotes justice which ought to be directed to particularities – groups, individuals, and institutions. Hence, from Kant’s view, the proposal is simply a manifestation of a universal value.

Monday, July 22, 2019

Hamlet Act Two Essay Example for Free

Hamlet Act Two Essay Hamlet Act ll An important character in the play Hamlet is Polonius. Polonius is often thought to be foolish, and thoughtless. However, Polonius is anything but foolish, and thoughtless. Polonius is a man who is very intellectual, and he provides guidance to those who need it. For example, his advice to Reynaldo on how to  monitor Laertess wild behavior is magnificent and brilliant. His advice to Ophelia  about Hamlet, love, and affection is very accurate. Polonius is considered a fool to some people, because Hamlet is making it seem that way, he wants to put Polonius down, and make Polonius seem like a fool. Hamlet is rude to Polonius, and constantly making fun of him. At one point Hamlet calls Polonius a â€Å"fishmonger†. Hamlet then makes his insult worse by wishing that Polonius were as honest as a fishmonger, which is to say that Polonius is lower than the lowest. Although, Polonius is nothing of the sort, another example of Polonius providing guidance to those who need it is when Laertes is waiting for his ship to depart, Polonius has a couple of minutes to tell  him how to live well. His brief advice is insightful and parental. He tells Laertes to think before  he acts, listen more than talk,  keep good friends close but dont worry  about drinking buddies. Dont get in fights, watch your money, and take care of your appearance, things like that. Polonius is the kind to seek to discover the truth on his own. He studies Hamlet to link his madness to love and betrayal. He then seeks to trial his theories by testing Hamlets sanity through a slew of inquiring questions. A foolish man does not do this. Perhaps, Polonius was just putting on an act, to make people think that he was foolish and stupid. Regardless of his motives, Polonius cannot be described as a simple character. Polonius has gotten a bad reputation, but further depth into his character reveals that Polonius is indeed a complex character with a great deal of wisdom.

Sunday, July 21, 2019

Development of Nursing Skills in Oral Care Placement

Development of Nursing Skills in Oral Care Placement INTRODUCTION This essay is going to focus on the nursing skills that I developed during a period of placement simulations and in the community, placing emphasis on oral care, communication and bed bath. It will outline the fundamental aspects of clinical nursing skills that I have begun to acquire. This will also highlight the learning processes which took place and how it helped me to enhance my knowledge, and ethical values in order to deliver quality and safety of care. Using other sources of current literature, I will use a reflective model to discuss how I have achieved the necessary level of learning outcome. By utilising this model I hope to demonstrate my knowledge and understanding in relation to these skills as well as identifying areas with scope for learning. Reflection is the process of reviewing an experience in order to describe, analyse, evaluate and so inform learning about practice (Reid 1993). There are many reflective models that I could have used, including Johns (2004), Driscoll (2000), Atkins and Murphy (1994), Kolbs (1984), and Gibbs (1988). However, Gibbs (1988) model of reflection was selected, as a framework, because it focuses on different aspects of an experience and allows the learner to revisit the event fully. By contemplating it thus, I am able to appreciate it and guided to where future development work is required. Skill 1: Oral Care Description I was part of a placement simulation group which went to the multi-skills laboratory to practice delivering and receiving oral hygiene. I was assigned a colleague to brush his teeth using a toothbrush and paste. I put on gloves to prevent contamination (NICE 2003). Seeking his consent, I undertook a briefÂÂ  visual assessment ofÂÂ  his mouths health. I then put him in a comfortable position so that he could tolerate the wash. Thereafter, I cleaned all-round the mouth, gums and tongue. I finished off by helping him to rinse his mouth with mouthwash. I treatedÂÂ  my partner as though he was physically unable to hold the brush himselfÂÂ  to scrub his own teeth, but he was able to communicate with me and was able to assist me in terms of spitting and gargling with water at the end of the procedure. Feelings When first informed that I was expected to undertake this task I felt anxious and concerned. I was aware that I had not brushed anyones teeth outside of my family before and that the mouth is an intimate and personal part of the body which is not usually exposed to anyone other than me or the dentist. I was concerned about how my partner (whom I did not know well at that stage) would react to me examining his mouth. Writers have described such intimate physical assessments as creating a potentially intrusive situation (Lewis 2006, Sturdy 2007) which might cause the patient to feel uncertain and inadequate. I was also concerned that my own anxiety was shared by my partner who also appeared embarrassed and awkward at the time. This anxiety was increased when during the procedure my partner began to cough as though distressed. This caused me to feel hesitant about continuing- a situation recognised by Millon (1994) as a common response for carers to such an experience, although I persevered with his cooperation. When the task was completed I felt comfortable with my performance overall. Evaluation What was good about the experience was that, despite being aware that this role is often delegated to health care assistants (Kelly et al 2010), I was able to deliver a fundamental component of essential nursing care (Essence of Care 2003) quite effectively. The experience helped me to appreciate that oral care provides any nurse with an ideal opportunity to undertake a thorough physical, emotional and cognitive assessment of a patient (DOH, 2001). I was satisfied delivering this aspect of care without harming the patient as no injuries were sustained (having I checked his mouth prior to and after cleansing). Also, I was pleased to have an opportunity to improve my communication skills through the delivery of this skill and to understand the impact that this might have on the development of a therapeutic relationship with future patients. From my colleagues reaction and feedback, I understood how feedback is an important learning tool. Despite my discomfort during the undertaking of this task, the experience highlighted the potentially complex problems I might have to solve in the provision of care needs to patients for whom I may not have had contact with before. Analysis Administration of this clinical skill involved undertaking an assessment of my colleagues mouth before delivering any care in order to help determine the most appropriate means of delivering oral care. Malkin (2009) asserts that this is a critical component of the procedure and was one I was keen not to overlook. The World Health Organisation (WHO 2010) describes a healthy mouth as being free of chronic mouth and facial pain and in the situation described; this is the condition I found my partners mouth to be in. I was therefore happy to proceed with cleaning his teeth as instructed. I selected to use a soft bristled toothbrush and toothpaste. The use of these adjuncts are described by many writers as being the most appropriate in terms of removing plaque and preventing trauma to the gums (Holman et al 2005,McCauliffe 2007).Despite this it has been identified that they are also most often not selected by nurses who appear uncertain about most effective evidence based practice ( McAul iffe 2007). Conclusion Clearly, mouth care is important and that, nurses have a role in assessing and maintaining it (Malkin, 2009).The task identified the role of the nurse in providing encouragement to the patient whilst delivering oral care. His weakness created a sense of dependency upon me and necessitated the utilisation of good communications skills on my part to complete the task properly. It has raised my awareness the effects of nursing interventions on others within my practice. Action Plan At the moment, I read more books a day than practice. My aim is to be proactive in the future by promptly opening up through total participation and doing more practices by brushing my teeth on regular basis. I would consider brushing others also and allowing them to brush mine in order to become familiar with areas that are often not well attended to. Keeping up to date with evidence based principles of practice will be maintained through the scrutiny of journals that refer to this aspect of care. I will take care to remember my feelings when providing and receiving oral hygiene before delivering it to patients in the future. Recognising the potential for embarrassment and awkwardness I will ensure that I treat the patient with sensitivity and discretion at all times. Skill 2: Communication Skills Description I accompanied my mentor to attend to a consultation with R, in persuading him as a non-compliant patient, in taking his medication. He had refused to communicate with anyone, and had been violent and very suspicious of nursing interventions in the past. He would not open his door and started shouting. When he appeared quiet he let us in. I thought it would be nice for him to have some interaction after seeking his consent. I pulled up a chair next to my client so that I was closer to him and was at a similar eye level. I engaged him in a conversation about football. When I mentioned Arsenal, he became interested in the conversation. I realised he was a fan of the club and told me more about the club. I listened attentively, nodding and contributing. I ceased this as an opportunity to explain the need for taking medication and side effects of non-compliance. He understood and pledged to take his medication daily. He took some to our surprise. Feelings Throughout the whole experience I felt terribly nervous as I knew I was being judged on how well I could achieve the skill. My initial perception was that R was a difficult patient and considered withdrawing but I felt emotionally concerned about meeting a professional obligation. I understood that I owed him a duty of care (NMC, 2008) and simply withdrawing was not professional in my view. Evaluation I was pleased to have an opportunity to improve my communication skills through which, I was able to convince him in taking his medication without confrontation. It was good that I sat in the chair next to him and did not just stand over him to show I valued him and that I was not in a hurry. I used good body language and facial expressions as stated by Egan (2002). I understood the impact that this skill might have on the development of a therapeutic relationship with future patients. Ironbar et al (2003) stresses that, therapeutic relationships can be stressful. This requires insight, self-awareness and ability to cope effectively with stress. The downside was that the patient initially felt that I was being nasty as I was persistent in having him take the medicine. Also, I found it difficult to communicate with the patient initially because I did not understand his condition. Barker (2003) reports of how in recent times empathy has been shown to enable nurses to investigate and un derstand the experience of persons experiencing a state of chaos as a consequence of psychiatric order. Analysis There are many reasons why somebody may refuse to communicate. Wilkinson (1992) cited in (Kluijver et al, 2000) defined communication as an open two-way communication in which patients are informed about the nature of their disease and treatment and are encouraged to express their anxieties and emotions. Sheldon, (2009) expands this further by saying in nursing; communication is a sharing of health-related information between a patient and a nurse, with both participants as sources and receivers. The nature of health care demands expertise in interviewing, explaining, giving instructions and advising (Williams, 1997). In this instance, this was exactly what I did. The use of therapeutic communications in nursing, particularly empathy, is what enables therapeutic change and should not be underestimated (Norman and Ryrie, 2004). Egan (2002) argues that empathy is not just the ability to enter into and understand the world of another person but also be able to communicate this understan ding to him. Nurses should be aware that patients, who are paranoid and suspicious of staff interventions as was the case of patient R, might not readily accept support from staff. OCarroll et al (2007) contended that in our professional roles, nurses do not have the same option as we do in our personal life by withdrawing from difficult relationships. I began to feel tearful, but then quickly reminded myself that there must be a reasonable explanation for him refusing to communicate or cooperate with everyone. I felt my client needed a choice and giving him a choice will give him back some of his independence when he could be feeling helpless and vulnerable; and his self-esteem could be decreased (Child Higham, 2005) as his cooperation could be inhibited. The need to build therapeutic relationship with the patient is paramount in gaining trust and respect (Rigby and Alexander, 2008). McCabe (2004) argues that the use of effective interpersonal skills, a basic component of nursing, must be patient centred. If I had been tense and negative, my client would not have enjoyed the conversation and would have felt uncomfortable and rushed (Kozier, et al 2008). Conclusion Communication is without doubt the medium through which the nurse-patient relationship takes place. The skills of active listening and reflection promote better communication and encourage empathy building. Caring for acutely mentally unwell patients requires of the nurse sensitivity, conveying warmth and empathy. Engaging meaningfully and actively listening to patients makes them perceive the practice as valuing rather than punishing, therapeutic rather than custodial. Communicating with patients is in itself nursing and therefore should be encouraged at all levels of nursing care. I feel my caring skill went well, because we were both relaxed and comfortable. As no problems occurred, I would do most things the same again. Action plan My goal for the future is to develop my knowledge by reading about long term conditions like schizophrenia so as to give me insight into those conditions before administering care. If patients appear distressed, I would get other members of staff to help give reassurance to them. I will also use reflective discussions with mentors and peer groups about managing similar situations. Finally, I will be taking the initiative and not being timid about challenging situations- the more times I meet the challenge, the better equipped I become at learning to manage them. Skill 3: Bed Bath Description I was asked with a colleague to bath a dummy patient during a placement simulation. The procedure was outlined by the lecturer present. I prepared the trolley with soap, bowl of warm water, soap and towel.I explained why I was going to give him a bath and gained consent. I drew the curtains to maintain patients privacy and dignity at all times. I washed my hands, put on apron and gloves to prevent infection and contamination and bathed him all round (front, back and sides including crevasses and folds) using separate towel for the private area. I covered the patient with the bath blanket to prevent chilling for his comfort. Whilst carrying out the bed bath I assessed his skin condition for any sores or broken skin.I treated the patient as if confined to bed or he is too unwell to attend to his own hygiene needs but able to communicate with me and reassured him everything was alright. Feelings Before starting, I had many emotions running through me. I expressed that I did not have much confidence in performing the task. This was because I: (1) lacked experience, (2) was concerned that I would not perform to the patients expectations and (3) was still trying to adjust to the laboratory environment. I therefore felt embarrassed that my lack of confidence was so obvious to present lecturer and colleagues. I later felt calm but a little apprehensive due to this. Despite all these, I persevered and finished the task successfully. Evaluation What was good of this experience was that, I upheld the reputation of the profession by maintaining it (NMC, 2008) as I did not speak over the client nor did I ignore him at any point during the procedure The instructions about what I needed to do was clear and I understood it and this give him the utmost respect, comfort and safety. By washing my hands thoroughly before coming into contact with the patient, Pirie (2010) explains that micro-organisms are easily removed through the process of hand washing. With supervision and comments from the lecturer present, I completed the task without harming the patient. Thomas et al, (1997), explains that, supervision is an important development tool for all learners. What was not good about this experience was when I redressed the client without allowing the client to choose the dress which I will prevent happening again. Nurses are taught to include family members where possible, keeping them well informed constantly about the condition and health care which is taking place. This helps make families feel more comfortable and also enables them to gain a clear picture of what is going on. Again, the lecturer was concerned that I appeared to lack confidence, and explained that, being able to express opinions clearly and confidently was essential in my future career as a nurse. In the lecturers view, the only way to develop confidence was to participate regularly which Bulman Schutz (2008) confirms. Analysis Skin care is a fundamental aspect of basic nursing care, with the outcome of these interventions often used to gauge the quality of the care provided (Voegelli, 2010). . Bathing involves actions to keep the skin clean and is essential for healthy skin (Dougherty Lister 2008). There are essentially two bed bath options available for todays health professional. Option one is the traditional soap and water bed bath which is labour intensive. Option two is the use of pre-packaged specialist bed bath wipes that come already impregnated with skin-friendly cleansers and moisturizers (Massa, 2010). Bathing is an intimate activity which requires physical assessment. Writers have described such intimate physical assessments as creating a potentially intrusive situation (Lewis 2006, Sturdy 2007) which might cause the patient to feel uncertain and inadequate. I was prepared not to overlook this area. The use of curtains and screens helped maintain the persons dignity and self-esteem (Child Higham, 2005). Despite this, dignity is seldom defined and there are few guidelines that nurses may use in their practice to safeguard individual patients dignity (Dignity in care (DOH 2006).It is true that healthcare assistants and auxiliaries can perform bed bathing and attend to patients hygiene needs; there are also important roles for the registered nurse, as it is often during the bathing of a patient that the nurse/patient relationship develops (Downey et al, 2008). In addition, the observation of a patient during the process of bathing provides excellent opportunities to make more detailed assessment and observation of the patients condition and progress (Pegram et al 2007). Conclusion Without doubt, provision of bed bath clients is to promote personal hygiene and to give them a sense of well-being and allows the caregivers to monitor changes in the clients skin condition (Evans, 2001). My reflective experience was very basic although a lot of the experience was preparation, planning and assessing which prevented the experience from going badly in anyway. I will also ask if they want to brush their teeth so that they feel more comfortable and also help prevent dental decay or any sores from developing around the gums. I now feel confident and comfortable enough to assist bathing people. Action plan If a situation like this was to arise again I think I would like to try to take out more time to talk to the client about how they are feeling and involve him at every stage of the activity. I also feel that it is important for me to work alongside more experienced members of staff to be able to learn more whilst on my placements. I think it is worth highlighting that as this procedure was carried out on a manikin, it did not reflect proper nurse / patient interaction and that I will now need to try and develop this skill and what I have learned from it to the wider clinical context when assisting patients who really do need help meeting their hygiene needs. I have learned something about giving the patients choice but it really wont be until I apply this skill into practice that I will receive feedback about how effective Ive undertaken the task, from the person that really matters or is in the best place to help me evaluate my actions, that person being the patient. CONCLUSION Administering oral hygiene, bed bathing and how these are combined with care, compassion and communication forms the basis of a holistic approach to care, and with the knowledge I got from supporting literature formed the foundation of my learning and practice. This experience has undoubtedly enhanced my critical thinking as a nurse and prepared me to move forward in my development and practice as a caring and competent nurse. I see myself as being in the right job which offers many opportunities for development and to improve upon my knowledge and skills. I have clearly demonstrated that by using a reflective model as a guide I have been able to break down, make sense of, and learnt from my experience during my placements In spite of above, the processes of learning I went through are more complex than Gibbs suggests. It is not as cyclical as this model implies and I found myself jumping or combining some stages, before coming back. However, it has taken me out of my comfort zone, challenging my thinking.