Business Plan for an Offshore Engineering Services Coursework

Business Plan for an Offshore Engineering Services - Coursework Example This location inhabits companies offering identical and similar services and a couple of technical universities from where the personnel intake is relatively easy. Huge investment is warranted in machines, equipments and human resources. However, the company wishes to start with few leased equipments and machines that need huge investment. The land for office premises is planned to be taken on a rental basis, which has to be paid for one year at the time of commencement of business. Thalatech (name of the firm) is a start-up firm, which has exciting business opportunities in the UK market where it is intended to concentrate its business in the first few years. The firm plans to provide technical services for offshore telecommunication projects - cable installation and surveys- throughout the country and expand its business to foreign countries in the near future. The service includes power cable installation for connecting oil platforms and its surveys for companies engaged in oil production and distribution. The major activities of the company involve the installation and maintenance of submarine fiber optic cables and other marine engineering services. ... This is the reason why it is planned to be located near to sources (i.e., similar firms and technical universities) of abundant workers-skilled and unskilled. The company envisages to providing professional service and advice to keep itself far ahead of its competitors, domestic and global. It firmly believes that it could capitalize the abundant business opportunities where its competitors are lagging behind. Falcon is likely to achieve 150 % of what its competitors are doing because of favourable location (near to airport) and other completive advantages such as personalized and professional service. A pilot market study to explore the key aspects of business finds that the firm would be able to achieve a substantial growth in sales over the next two years from the date of commencement of business. 1.2 Finance Required As the nature of the service of the proposed company is of highly technical and demands high professionalism, huge amount of funds is needed to finance the investment in various equipments machines and workforce. The company, therefore, plans to start with leased equipments that need huge investment. Moreover, in the beginning, the firm plans to hire only highly qualified and experienced staff, who have proved their mastery over the field. In addition to that, a very few unskilled laborers are to be deployed and trained by technicians and experienced staff. This also incurs costs. The office premises (land and office building) and other initial legal charges are also to be met by the start-up capital apart from those mentioned above. All these need huge capital and the company plans to raise funds for these needs through that contributed by shareholders. 1.3 Financial

Population Change And Resource Cousumption Essay Example for Free

Population Change And Resource Cousumption Essay Introduction The Islands of the Caribbean has for centuries been enticing to travelers and a major tourist destination. The islands are very famous and popular for their stretches of beaches with soft sand and the easy life that the island offers. The islands are located at the south east region of North America towards the Eastern side of Central America. The Caribbean consists of over 7, 000 islands. The islands are a chain that is 2, 500 miles long and over 160 miles wide. These islands have enclosed the Caribbean Sea. The islands support a very exceptional diversity of ecosystem. These however have been endangered by water pollution, human encroachment as well as deforestation, McGranahan, G., S. Lewin, (1999). The map below shows the islands of the Caribbean. The Caribbean Population change The population in the Caribbean has been growing tremendously. It is approximated that the population has increased by 85% for the years between 1970 and 2001.This is approximately an increase from 285 million people to around 528million people. Over this same period, the annual population growth rate has fallen from 2.5% to 1.5%. This is largely attributed to urbanization, factors to do with social development and improved programs of birth control, Leakey, Richard and Roger Lewin, (1996). The majority of the population in the Caribbean is more concentrated along the coastline where the land terrain is gently sloping. Consequently the high population, along the Caribbean coastline can result to high pollution of the water supply by the facilities for sanitation which more often than not will be located close to the water sources. The figure below shows the population size in the Caribbean islands by country. Pos Country Population 1 Â  Cuba 11,382,820 2 Â  Dominican Republic 9,183,984 3 Â  Haiti 8,528,000 Â  Puerto Rico (United States) 3,955,000 4 Â  Jamaica 2,651,000 5 Â  Trinidad and Tobago 1,305,000 Guadeloupe (France) 448,000 Martinique (France) 396,000 6 Â  Bahamas 323,000 7 Â  Barbados 279,000 Â  Netherlands Antilles (Netherlands) 183,000 8 Â  Saint Lucia 161,000 9 Â  Saint Vincent and the Grenadines 119,000 Â  United States Virgin Islands (United States) 112,000 10 Â  Grenada 103,000 Â  Aruba (Netherlands) 99,000 11 Â  Antigua and Barbuda 81,000 12 Â  Dominica 79,000 Â  Cayman Islands (United Kingdom) 48,000 Â  Bermuda (United Kingdom) 64,000 13 Â  Saint Kitts and Nevis 43,000 Â  Turks and Caicos Islands (United Kingdom) 26,000 Â  British Virgin Islands (United Kingdom) 22,000 Â  Anguilla (United Kingdom) 12,000 Â  Montserrat (United Kingdom) 4,000 Source UNEP, (2000): Access to water in the Caribbean Water access in the Caribbean is insufficient. This is more so in the rural areas and among the poor population. By the year 2004, it was approximated that at least 9% of the Caribbean population or 50m million people had inadequate access to the supply of water, Shiklomanov, (2000). In addition it was also approximated that 132 million people translating to 23% of the population had inadequate access to sanitation. The accessibility of water supply still remains unpredictable to date considering the financial constraints of the local and central government in the Caribbean and the inadequate finances in the service providers sector. The Caribbean islands have over the years greatly caused water pollution due to poor sanitation. Â  For instance, in the Caribbean, only an approximate 50% of the population can be able to access the sewer system. This is quite alarming; with emphasis on the fact that even the existing sewer systems are not at most instances functioning properly.26 percent of the Caribbean population uses other different sanitation forms like septic tanks and variety of latrine types. The lack of fresh water in the Caribbean can be attributed to the problems of inadequate resources in the forms of finance and human capital. However, demographic and physical factors also contribute in that; there is a shortage of a base for natural resources and limitation of surface areas, Hopfenberg, Russell and Pimentel, David, (2001). For instance, there is limited space for fresh water, arable land, and convectional sources of energy and mineral resources. The Caribbean is also vulnerable to natural disasters, which compromise the availability of the water recourses within the islands. Types of Caribbean water use In the Caribbean, water is used both for domestic purposes and economic use. The water is used especially in the farming of bananas and cotton among other crops. The use of water per capita in the Caribbean varies from one country to another. It is also different in the various urban areas, rural areas. It also varies depending on the numbers of people with public taps, house connection or even where there lacks an improved water source. It is estimated that in average the water use in the urban areas is approximately 240liters per capita every day. This level of water use is as high as the water use in the United States. It is also two times higher than water use in Central Chile. The Quality of Water The quality of water in the Caribbean is poor even to those people that can access it. This is clearly indicated by the intermittent water supply within the countries in the Caribbean. There is also very low pressure of the water and in fact, the drinking water is of low quality. M. Wackernagel, M., Manfreda C., and Deumling D., (2002). However, there is some difference on water qualities some of the countries and cities, some of the cities and countries have good quality water and a consistent supply and are on par with the water quality and supply in the developed countries. Inspire of the high amounts of rainfall received in the Caribbean islands, the availability of fresh water is quite a big problem. The island commonly goes through severe shortages of fresh water. This is especially so because of the limited storage capacity for storing water to be used during the dry periods. Â  It is not possible to construct large water reservoirs since the land resource is scarce. More over, the heavy down pours accompanied by very steep topography, soil that is easily eroded, river channels that are short, all can contribute to heavy siltation of the water reservoirs reducing the capacity of water storage even further. In the Caribbean, people often depend on ground water though only limited quantities of this important resource is available. The fact that the islands in the Caribbean are surrounded by salty water makes fresh water unavailable even from underground sources. Water problems and the potential solutions in the Caribbean The lack of access to quality safe water The problem of water safety in the Caribbean can be solved. This can be done through the desalination of the sea water that surrounds the island so that there is a constant supply of quality and fresh water. However, this would call for the use of high technology which is very costly and expensive. The technology may not be available in the Caribbean but it would be a good solution to the water shortage in this area. In the recent past however, the Caribbean has improved in terms of water access, for instance it is estimated that water access has increased from 33% of the people in the year 1970 to an approximate 85% in the year 2000.This then implies that almost seventy seven million people are still lacking the supply of water in their houses. Lack of Access to Sanitation Sanitation is very important to any healthy population; a proper sanitation system should be put in place to ensure that the waste from the Caribbean island is disposed appropriately. Since most of the people live along the coastline, the sewer systems should be located away from these areas to prevent or even stop polluting the surrounding water sources, Kurlansky, M. (1992). Â  For example, a large portion of the population uses septic tanks and latrines, the rest of the people do not have safe access to sanitation. Some of the people in the Caribbean use underground water resources and this can be contaminated by poor sanitation facilities. Failure to treat sanitation waste In the Caribbean, only the sewage and waste of at least 14% of the homes gets treatment from the local plants. The rest of the waste finds its way down to rivers, oceans, lakes and the aquifers at located underground. This is a health hazard and risks the aquatic life within the region. It has the potential to damage the ecological system. To curb this problem, all the sewage and related waste should be treated with the available sanitary plants. More of such facilities should be put up to immediately stop the waste from draining to the water bodies. This way the available water sources will be clean and free of contamination. Service provision The authority of provision of sanitation and clean water rests in the hands of either the national or regional companies or the municipalities. Consequently, the municipalities that are larger have established municipal or even inter-municipal utilities for the public use, Ron N., (2006). The finances from these utilities are kept separately from the larger finances of the cities. This has caused misunderstandings and mismanagement of the public facilities. The system should be streamlined so that there is no confusion in the provision of the utilities and that efficiency and effectiveness is maintained. It should be cleared up on the roles and responsibilities of the various authorities that mange and regulate these essential utilities. Ground water Lack of water reservoirs in the Caribbean call for the use of under ground water sources. These sources do not have enough water supply but they help to put the water problems at manageable levels. However, the ground water is threatened by pollution and over exploitation, Kurlansky, M. (1992). The available aquifers have been over used or polluted by the agricultural activities and mining. The under ground water sources should be taken care of and at all cost not be polluted. The aquifers are of utmost importance in the Caribbean and the government and other non-governmental organizations should come to the aid of these resources. Population control The population in the Caribbean is over concentrated within the costal areas. The resources within this coastal region are over stretched and very vulnerable to pollution and over use. Â  Efforts should be done to see that the population is evenly distributed or that the facilities and especially sanitation in the over populated areas increased. By over stretching the facilities to beyond the possible limits, the Caribbean is putting the future of its population’s health at a risk, Rogozinski, J (1999). Conclusion The Caribbean is a fascinating series of island with a lot of economic activities especially tourism. The islands however are faced with a population problem and the scarcity of quality and clean water sources. Most of the available sources like the underground aquifers are over used or even polluted. The sanitation facilities within this region are very wanting and a lot has to be done to keep water problems at a distance in these very attractive islands, Shiklomanov, (2000). Â  References Rogozinski, J (1999): A Brief History of the Caribbean, New York Kurlansky, M. (1992): A Continent of Islands: Searching for the Caribbean Destiny, Addison-Wesley Publishing Ron N., (2006): The Little Green Handbook: Seven Trends Shaping the Future of Our Planet, Picador, New York Wackernagel, M., Manfreda C., and Deumling D., (2002): Ecological Footprint of Nations Hopfenberg, Russell and Pimentel, David, (2001): Human Population Numbers as a Function of Water Supply, Environment, Development and Sustainability Shiklomanov, (2000): Appraisal and Assessment of World Water Resources, Water International UNEP, (2000): Global Environmental Outlook, Earth scan Publications, London, UK Leakey, Richard and Roger Lewin, (1996): The Sixth Extinction: Patterns of Life and the Future of Humankind, Anchor, McGranahan, G., S. Lewin, (1999): Environmental Change and Human Health in the Caribbean, Stockholm Environment Institute, Stockholm, Sweden

Sparta Vs Athens :: essays papers

Sparta Vs Athens In Ancient Greece there were two different major forms of government, Oligarchy and Democracy. The two city-states that best represent each form of government were Sparta (oligarchy) and Athens (democracy). The democratic government in Athens, though de cently equal, fair and fairly advanced for its time, did not meet the needs of the Greeks. During a time of many military battles Athens decided to worry more about comfort and culture. It is the oligarchy in Sparta that put a war-like attitude as it's first priority and best met the needs of Ancient Greece. The Athenian democratic government, which may have given the citizens in Greece more freedom, was not the best form of government at the time. The democracy in Athens cannot really be called a true democracy since there were several flaws in the governme nt and the way it worked. Only ten per cent of the total population of Athens actually had voting rights and all of these citizens were upper class men who were over thirty years old. Women, no matter what the class or age, were given no freedom at all. They were first owned by their fathers and then were passed from them to their husbands who then gave them nothing more than the responsibilities of managing the household and educating the children. During a meeting of the Assembly, a policy could be adopted and formed into a law but once the meeting of the assembly ended, the enforcement of that law was left in the hands of people who may not agree with that specific law. Also, a rule of the Assembly said that if a certa! in speaker became too powerful, he could be expelled from the country if given a majority vote by the Assembly. This rule could easily be abused and really infringed on the freedom of speech that most democracies have. The Assembly was made up of five hundred men who were chosen from a list of those who were eligible to serve on the council. Since most of the population was of a lower economic class, the time taken away from their normal work by serving on the Assembly lowered their earning potential , causing their already poor situation to worsen. Life may have been sophisticated and graceful in Athens but the Athenians were often mocked by opposing countries and other city-states for having no bravery, patriotism or courage. This was shown by the repeated attacks on Athens. If the Athenians had a more war-like

Criminal Justice Essay

Dear Sir: As far as I know, the Abstract (also this email’s attachment), is written as the final section of the Paper, after everything is said and done. Because you are the one doing the methods, the analyses, the results, and the discussion, I leave it up to you to key in the two or three remaining sentences for the final Abstract. Hence, the initial Abstract: â€Å"In an attempt to initiate a reliable measure of the levels of perceptions of Criminal Justice Major Undergraduate College Students, this study possibly sharpens the definition of predictive behavior of the students who as respondents were surveyed by use of carefully formulated questionnaires to determine their general perceptions of the U. S. Criminal Justice System, their general perceptions on immigration law, immigration reform, and immigration control, as well as the students’ specific perceptions on the U. S. ’s ongoing Mexican immigration control. To perform comparison, the perception scores were statistically analyzed carrying out correlation test, t-test, and regression analyses tests between the general perception scores versus the specific perception scores. The results showed that   † Thank you very much. Very truly yours, Writer of†32344972† Urgent revision xxx Urgent revision on your â€Å"A STUDY OF UNDERGRADUATE COLLEGE CRIMINAL JUSTICE MAJOR STUDENTS PERCEPTIONS OF THE CRIMINAL JUSTICE SYSTEM†. Date Revision Deadline Instructions March 19 8:16 March 20 8:16 I am still waiting for the Abstract to be downloaded in a Word document to complete my order. Once again, this was one of the three items I requested in my order. xxx

Edwards-Enterprise Essay

The company which is into manufacturing plastic bottles for the detergent industry requires a great deal of resources to be managed for fetching optimized costs, synchronism among various processes, managing the supply chain of the company, managing the customer relationship using IT and to create professional sense for managing the business. The JD Edwards-Enterprise One is an effective method to fetch right degree of mapping of an organization so that the supply chain of a business is effectively managed to reduce running costs and costs related to effort and time to interact among the business peripherals/ departments like operations, administration, human resources, finance and many others (Oracle.com, 2008). The JD Edwards would facilitate the organization for the following: 1. It minimizes the cost of supply chain, resource management and integration among the business departments for fetching the resources timely and cost effectively. 2. The seamless integration to manage the supply chain of the business processes is made possible using the ERP system JD Edwards. 3. The handling of various issues and exceptional situations takes a professional turn and is managed under controlled environment. The traditional system of the organization was incurring large running costs and was not able to tap resources for fetching the exact order in the resource management and to organize the very distribution of resources for better management of the final product. The JD Edwards ERP solution for the organization would bring wholesome professionalism and management of the resources to achieve the very objective of the business.

Work Law Policies

Work Law Policies Introduction Industrial relations and work policies are crucial factors of economic growth and development for a capitalist nation. Australia, being a capitalist nation, is one of the developed countries that have been in labour crisis for a long time. The involved stakeholders have been striving to unveil the best work policies and industrial relations that would bring a lasting solution to the citizens.Advertising We will write a custom research paper sample on Work Law Policies specifically for you for only $16.05 $11/page Learn More Unfortunately, the political regimes have ascended into power by using these mysteries as stepping stones, whereby, the ruling government fails to deliver the best policies, thus giving a clear path for the opposition who seem to have what the citizens have yearned for a long time. In 2007, the Rudd-led opposition party had a renowned mantra for campaigning in the federal election of Australia. There was a heated debate in th e entire nation concerning the existing industrial relations and working policies that were seen to have deprived employees of their rights, and had been introduced by the Howard’s ruling government. The public was tried of the working policies and industrial relations and it felt inferior to the government and employers who denied them labour rights as required by the international labour rights. According to the international industrial relations organisation, the work policies and industrial relations must adhere to three factors, which include efficiency, equity, and voice (Wooden â€Å"Industrial Relations Reform† 244). Looking into these factors; firstly, the efficiency of a policy is determined by factors that include streamlined enforcement of regulations, reasonable employees’ benefits, and effective training programs. Secondly, the ability of a policy to enhance equity is determined by its ability to advocate for the rights of employees in relation to living wages and salaries, safety at the workplaces, health insurance, non-discrimination policies, discipline and dismissal policies, and work to family balancing. Finally, the ability of a policy to promote the voice of employees is determined by its position to allow employees to join labour unions at will, participate in the decision-making processes, and enjoy the freedom to air their grievances without the fear of victimisation. These factors form the basis for judging the validity and efficiency of such policies in a country.Advertising Looking for research paper on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More This paper compares and contrasts the â€Å"Forward with Fairness† (2005) with â€Å"Work Choices: A New Workplace Relations System† (2005) with regard to their adherence to efficiency, equity, and voice. However, it is important to note that the Forward and Fairness policy was intr oduced as a political agenda aimed at counteracting the Work Choices and thus it seems more efficient though it could not have been implemented without hitches that are discussed in this paper. Work Choices: A New Workplace Relations System In 2005, John Howard, the then Australian Prime minister, together with his political affiliates argued that Work Choices was a modernised and simplified method of regulating work and industrial relations in Australia. Howard’s Work Choices received criticisms that were beyond reasonable doubts, since the majority of Australians felt the need to have workplaces that guaranteed fairness and freedom to employees. The government had failed to ensure that employees had such rights at the workplaces, and the citizens were longing for a change of government in the next federal election (Rudd and Gillard 20). In 2005, the Australians were in full support of the implementation of the Work Choices for it promised better working conditions and hence improved living standards. However, this anticipation did not materialise due to various factors that lied in the relations between the government and employers. The government could not have implemented the policies because of the lobby activists that operated from within and the great influence of employers in the economic growth and development of the country. Hence, the problem was in the poor leadership that considered the interests of a few and ignored the needs of the vast majority. Looking into the components of the Work Choices, the first was â€Å"New protections of minimum wages and conditions† (Wooden â€Å"Implications of Work Choices† 108). Howard and his affiliates promised to look into the needs of Australian employees in relation to protection and wages at the work place (Kramp 52).Advertising We will write a custom research paper sample on Work Law Policies specifically for you for only $16.05 $11/page Learn More This clause was supposed to be implemented by setting up an independent body to look into the employees’ wages and salaries in an effort to promote their living standards. The independent body was supposed to set up policies that defined the minimum wages that could be given to different qualification standards in the country (Lye and McDonald 34). Secondly, it was supposed to set up standards for safety net, through which the government would set the minimum set of conditions for employment. Those conditions included maximum working hours in a day for an employee, the right to have an annual leave and its minimum duration, and the right to have a personal leave based on personal affairs such as sickness and parental care leave. Those minimum conditions were passed into law and were implemented by the Fair Pay Commission. The commission noted that all labour agreements concerning the salaries and wages between the employer and the employee should meet those minimum conditions. In additi on, Work Choices stipulated that the maximum number of working hours in a week should not exceed thirty-eight, in excess of which overtime pay must be offered as per the number of excess hours. Concerning the annual leave, the employee has a right to have a payable annual leave of at least four weeks and five weeks for shift workers. However, the Fair Pay Commission noted that an employee has a right to cash out a leave and the employer had no right under the law to force an employee to do so or to refuse to do so if the employer wishes. Concerning the personal leave, an employee has at least ten days of paid personal leave in twelve months that is cumulative, but a compulsory compassionate leave of two days to care for the ill and attending funerals of the loved ones. If the compassionate leave occurs after exhausting the twelve days of both compassionate and personal leave, an employee may be given an additional two unpaid days in the case of an emergency leave. In the case of a p arental leave, an employee has a right to take up to fifty-two days of unpaid leave in the case of birth or adopting a child, but both parents cannot take leave exceeding one week in the case of birth or else three weeks for adopting a child. In the case of casual employees, an eligible employee for this policy should have served for at least twelve months continuously under one employer.Advertising Looking for research paper on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More In addition to the first component of the Work Choices, it also offered for ‘The Protection against Unlawful Termination’ from a workplace. Work Choices promised Australians that it would continue to protect employees against unlawful termination from their working places regardless of the size of businesses where they are employed. However, there were definitions of unlawful termination and according to Work Choice; unlawful termination is the dismissal of an employee from the workplace because of temporary absenteeism at workplace duet o injuries or illness, or willingness to join a trade union. Others include acting on behalf of other employees like in the case of airing their grievances, participating in proceedings that would tarnish the image of an employer, dismissal based on gender, race, disability, or any other form of discrimination, and refusal to negotiate with an employer. In the case of unlawful dismissal, the Work Choices stipulated that employees were e ligible to a compensation of at least $4000. Looking, into the above first component of the Work Choices, it emphasised on all the three factors that a good working policy must adhere to, which include efficiency, equity, and voice. The second influential policy for the Work Choice was the ‘Awards’. The policy stipulated that workers would remain eligible to their awards regardless of their coverage by workplace agreements. In addition, it defined the awarding conditions of an employee under which an employee is fully eligible to receive the award from the employer. Those conditions included long service leaves such as annual and parental leaves, but other conditions that had been included in other jurisdictions were removed and they included superannuation, notice on termination of employment, and jury service. However, under the awards, there were some removable elements from the awarding offer and they included traineeships, independent contractors, and labour hired workers for they served under temporary labour agreements. By considering the above policies of Work Choices, Australians were anxious of attaining a simpler and fairer labour system that would have boosted their living standards. Howard and his affiliates promised to protect the rights of both the employer and the employee by introducing an office of the workplace rights, which would have the mandate of ensuring that the protection of the two parties is guaranteed. This office would also ensure that both the employee and the employer meet their obligations and impose penalties on the offender in the case of breaches of the agreement (Watson 169). In addition, Howard promised that the office of work choices would ensure that both the employees and employers know their rights by offering civic education. However, the new policy would not interfere with the role of the existing Australian Industrial Relations Commission that deals with dispute resolutions at the work place. Work Choic es was believed to concentrate on introducing mechanisms that would boost cooperation between employees and their employers. In so doing, there had to be a transitional stage that is often filled with reluctance and disputes, but it left the issues of dispute resolutions amongst the employees and their employers. This gap could have resulted to minor conflicts that are easily solvable ending up in the industrial courts due to lack of undefined dispute resolution mechanism, which would pose great risks to the employees serving under unfaithful employers. Forward and Fairness Interestingly, forward and fairness is an improvement of Work Choice resulting from the gaps that were left in the drafting and implementing stages of the Work Choices policy. The policy was developed in 2007 under the watch of Kevin Rudd and Julia Gillard who were members of parliament belonging to the Labour Party that was then the Australian official opposition in Howard’s government. According to Rudd and Gillard (16), Work Choices failed to achieve fairness and flexibility at workplaces and it had resulted in the creation of imbalances in the workplaces for two years that it had been in existence. Howard’s government came under much criticism due to failure to deliver much of its promises that had initially adhered to efficiency, equity, and voice. For instance, under the Australian Workplace Agreements, many employees had lost penalties in cases where employers were found to have unlawfully dismissed them, it failed to emphasise on the payments of overtimes, shift allowances, and other awards that had been promised to the citizens before the introduction of the Work Choices. Forward and Fairness promised Australians that it would reverse the situation once the Labour Party ascended into power after the 2007 federal elections. Kevin Rudd and Julia Gillard put more emphasis on their ability to introduce fairer and more flexible policies in the Australian industrial relatio ns and a smooth transition from the Work Choices laws. Mr. Howard did not apply a smooth transition mechanism in his introduction for the Work Choices, but instead he did a rapid transition that resulted in the abolition of some labour institutions, thus giving rise to crises in the country’s labour sector. During the transition in 2006, many citizens lost their jobs as employers were afraid of retaining their contracts (Befort 11). The haste transition had adverse effects to the entire implementation process due to reaction from the opposition and the affected citizens. In addition, some employers got an opportunity to act unlawfully by dismissing contractual workers based on expired contracts and as a result, there were numerous disputes in the industrial courts, which overwhelmed the government. This scenario led to the dismissal of cases that lacked enough evidences and in most cases benefiting the unfaithful employers. Therefore, Rudd and Gillard had learnt from the mist akes of their counterparts and opted to apply a transition mechanism that would not allow for negative reaction from the employers, employees, and the public. In addition, the Work Choices also seemed to have created an imbalance between the employer and employees by inflexible pay arrangements. For instance, the pay arrangement did not specify the employees’ pay limit for eligibility, which exposed the employer to financial risks. Hence, they specified the upper limit of eligibility to be $100,000 and above, where employee earning less than that amount was eligible for the awarding system (Ryan 206). According to Cooper (289), after a successful ascension into power, Rudd and Gillard made a smooth transition that took more than twelve months. By 2009, there had been a great change in the manner in which industrial regulations were conducted in Australia. It is interesting to note that in the transition plan, they had considered the need for employers, who were bound to the o ld order of Australian Workplace Arrangement, to be given enough time to adapt to the new system before its complete abolition, which would be effected after twelve months. That period was necessary for both the employees and employers since it was enough to change the mentality and get prepared to comply with new regulations (Cooper 290). In addition, the Labour government under the leadership of Kevin Rudd assured the citizens of Australia that it would ensure that they have strong and fair safety net of balanced industrial relations and effective award protection. In addition, employees would not be in a position to get into working conditions that undermined the safety net, as had been the case in the Howard’s regime. He promised to ensure that collective enterprise bargaining would be his tool for attaining the desired flexibility between the employees and the employers (Baird, Hancock, and Isaac 89). In conclusion, it is evident that Forward with Fairness Policy was an improvement of the Work Choices. Upon the drafting of the Work Choices implementation plan in 2005, Australians were happy to have a promising future in relation to the improvement of the work place relations, but due to poor implementation strategy, this goal never materialised. Hence, judging the Work Choices by the nature of its appearance in the implementation plan, it was valid in the sense that it adhered to efficiency, equity, and voice. On the other hand, Forward with Fairness is a better policy than the Work Choices since it was founded with consideration to the mistakes that had been made in the implementation process of the former policy. Rudd and Gillard had noted that the failure of the Work Choices hinged on poor implementation strategy that did not consider the transition process needed for adaptation to the new industrial policies by both employers and employees. Hence, they adopted the title ‘Forward with Fairness’, and they achieved the desired results . Baird, Marian, Keith Hancock, and Joel Isaac. Work and Employment Relations:  Ã‚  An Era of Change, Sydney: The Federation Press, 2011. Print. Befort, Stephen 2009, Invisible Hands, Invisible Objectives: Bringing Workplace  Law and Public Policy into Focus. PDF File. 26 Sep. 2013. www.ilera-directory.org/15thworldcongress/files//Thur_W4_BUDD.pdf. Cooper, Rae. â€Å"Forward Labour with Fairness? Industrial Relations under in 2008.†Ã‚  Journal of industrial relations 51.3 (2009): 285–296. Print. Kramp, Ole. Minimum Wage Legislation in Australia, Germany† GRIN Verlag, 2009. Print. Lye, Jenny, and Ian McDonald. â€Å"The Effectiveness of Incomes Policies, Enterprise Bargaining and Inflation Targeting in Australia.† Australian Economic Papers 43.1 (2007):21-38. Print. Rudd, Kelvin, and Julia Gillard 2007, Forward with Fairness Policy Implementation  Plan.PDF File. 26 Sep. 2013. www.airc.gov.au/kirbyarchives/2009exhibn /documents/070428FWF.pdf‎. R yan, Mathew. â€Å"Workplace Relations Reform, Prosperity, and Fairness.† Australian  Economic Review 38.5 (2009): 201-210. Print. Watson, Ian. â€Å"Minimum Wages and Employment.† The Australian Economic Review  Ã‚  37.1 (2008):166-172. Print. Wooden, Mark. â€Å"Implications of Work Choices Legislation.† Agenda 13.2 (2006): 99- 116. Print. Wooden, Mark. â€Å"Industrial Relations Reform in Australia: Causes, Consequences and Prospects.† The Australian Economic Review 34.8 (2001): 243-262. Print.

Medicines management †an introduction to non-medical prescribing 2000 word case study The WritePass Journal

Medicines management – an introduction to non-medical prescribing 2000 word case study 1. INTRODUCTION Medicines management – an introduction to non-medical prescribing 2000 word case study 1. INTRODUCTION1.1 . MEDICINES MANAGEMENT1.2 . NON-MEDICAL PRESCRIBING1.3 . CASE STUDY2. PATIENT OVERVIEW3. DIAGNOSIS3.1 . DIAGNOSTIC TOOL3.2. TREATMENT RECCOMENDATIONS4. MEDICATION  4.1. GALANTAMINE4.2. MIRTAZAPINE4.3. LORAZEPAM5. LEGAL, ETHICAL AND PROFESSIONAL ISSUES5.1. ADHERENCE5.2. MENTAL CAPACITY5.3. ETHICAL CONCERNS6. REFERENCESRelated 1. INTRODUCTION 1.1 . MEDICINES MANAGEMENT Medicines management can be defined as; â€Å"†¦a system of processes and behaviours that determines how medicines are used by the NHS and patients.† (National prescribing centre,2002, P1). According to Dr Michael Dixon chair of the NHS alliance, Medicines management services are the processes for designing, implementing, delivering and monitoring patient-focused care, based on need, and include all aspects of supply and therapeutic use of medicines within healthcare settings. â€Å"Poor medicines management within organisations can lead to low public confidence in health services, unaddressed health needs and unsatisfactory patient outcomes and can lead to unscheduled emergency admissions or failure to maintain independence in the community leading to re-admission to hospital and other acute care settings. It can also lead to organisational issues such as, unmet targets, inappropriate allocation of resources, inefficient services, and risk.† (Calderdale pct, 2004) â€Å"Good medicines management means that patients receive better, safer and more convenient care. It leads to better use of professional time and enables practitioners to focus their skills where they are most appropriate. Effective medicines management also frees up resources which means that NHS money can be used where it is most effective. Good medicines management benefits everyone.† (npc.co.uk/mm/index.htm) 1.2 . NON-MEDICAL PRESCRIBING â€Å"Non-medical prescribing is prescribing by specially trained nurses, optometrists, pharmacists, physiotherapists, podiatrists and radiographers, working within their clinical competence as either independent or supplementary prescribers.† (npc.co.uk/prescribers/resources/NMP_QuickGuide.pdf) The Department of health recognised that non-medical prescribers are a large and growing workforce. They found that by the end of 2009 there were over 14,000 nurse prescribers, 1700 pharmacist and supplementary prescribers and many community nurse prescribers and allied health professional prescribers that had qualified to prescribe within their competence. (DOH, London, 2009). 1.3 . CASE STUDY This piece of work is a case study of a service user from the authors practise placement area at the time of writing. The case study incorporates three key elements within it; The service user Three medications prescribed to them The legal and professional issues surrounding the above The case study will look at these three elements in detail within the report. 2. PATIENT OVERVIEW (In order to uphold confidentiality, during this report the service user in question will be referred to as ‘Mary’. (NMC, Code, 2008) Mary is a seventy three year old lady who was admitted to the inpatient practise placement area on the 02/04/2011. Mary has a diagnosis of Alzheimers Dementia and was presenting with increased confusion and according to her care givers (Mary was a resident in a nursing home) had been showing signs of depression and aggression over the last few months culminating in a series of aggressive outbursts which ended in a serious attack on a member of her care home staff. The decision had been made that a hospital admission to the organic illness assessment ward (Older people’s services) was necessary to manage risk, assess the progression of Mary’s condition and reassess her package of care. Mary was initially resistant to all interventions from the ward team and displayed high levels of agitation and aggression. The consultant and nursing team felt that medication would play an important role in the management of Mary’s initial presentation. However Mary’s resis tance to any therapeutic interventions meant that alternative approaches were felt to be the only option at the start of treatment. John was also given a capacity assessment and found to lack capacity which allowed the ward staff to treat Mary effectively in her best interests. (For Mary’s pen story see appendix 1) 3. DIAGNOSIS Mary has a diagnosis of Alzheimers   Dementia. The Alzheimer’s society explain the term dementia describes a group of symptoms these include a decline in memory, reasoning and communication skills a gradual loss and decline in the skills needed to manage the individuals activities of daily living , confusion and a change in behaviour or personality. These symptoms are caused by the physical impact of disease or injury on the brain. There are a number of different conditions that lead to dementia including Alzheimers disease. (alzheimers.org.uk/site/scripts/documents_info.php?documentID=160) 3.1 . DIAGNOSTIC TOOL â€Å"Making a diagnosis of dementia is often difficult, particularly in the early stages The time it takes to make a diagnosis can vary. If scans and other investigations are required, it could be 4-12 weeks. If the person is in the early stages of dementia, a 6-12 month period of monitoring may be required before a diagnosis can be made.† (alzheimers.org.uk/site/scripts/documents_info.php?documentID=121) â€Å"The Mini Mental State Examination (MMSE) is the most commonly used test when a diagnosis of Dementia is being considered The MMSE is the test that the National Institute for Health and Clinical Excellence (NICE)  recommends for deciding whether a drug treatment for Alzheimers Disease should be prescribed.† (http://guidance.nice.org.uk/DT) However NICE do stress it should not be relied on as the only means of assessment alone as diagnosing dementia involves careful monitoring and assessment. 3.2. TREATMENT RECCOMENDATIONS â€Å"Treatment for Dementia should only be initiated and supervised by a specialist experienced in the management of Dementia.† (BNF, 2009, P280) 4. MEDICATION â€Å"Being prescribed a medicine is arguably the most frequent intervention in the NHS† (Shepherd, 2002). Mary’s medication was reviewed on admission to the inpatient ward due to her aggressive and volatile presentation. For the purpose of this report three of the medications Mary was prescribed will be discussed in detail.   4.1. GALANTAMINE â€Å"Acetylcholinerase inhibiting drugs are used in the treatment of Alzheimers disease, specifically for mild to moderate disease.† (BNF, 2009, P280) Galantamine is a medication used to treat moderate Alzheimers dementia disease. Alzheimers occurs as a result of atrophy of the cerebral cortex. The disease causes changes in central neurotransmitter function especially the cholinergic system. It is linked to a lack of sufficient acetycholine levels. Evidence also points to raised levels of glutamate (a neurotransmitter). Galantamine is one of the centrally acting inhibitor of acetylcholinerase. It is a reversible acetylcholinerase inhibitor medication which works by increasing levels of acetylcholinerase in the synaptic cleft of central nervous system neurons. Galantamine is used to ‘slow’ neuronal degeneration by impeding further atrophy of the cerebal cortex. Evidence for the drug relates to an individual’s cognitive enhancement, however there is no cure for Alzheimers dementia and so medication is purely palliative. (Aarbakke, J et al, 2006) Interactions of Galantamine from a patient safety perspective include:- Warfarin effects are enhanced. Antipsychotics and barbiturates effect is reduced (Johns dose of Zuclopenthixol increased to counteract this) Muscle relaxants effects are modified. Dosage of Galantamine must be carefully considered and the individual’s renal functioning and Creatinine levels must be checked prior to treatment. Side effects of Galantamine include:- Nausea Sleep disturbance Headache Dizziness Drowsiness and fatigue Depression (Treated with Mirtazapine in Mary’s case) (BNF, 2009, P281) Mary was prescribed Galantamine Hydrobromide (Reminyl XL) a prolonged release medication. The Scottish medical consortium state Reminyl XL is recommended for the treatment of moderate Alzheimers dementia and allows a reduction in dose frequency and is as cost effective as immediate release forms of Galantamine. (scottishmedicines.org.uk/files/reminyl_XL_Summary_Advice__FINAL__for_website.pdf) 4.2. MIRTAZAPINE Mirtazapine is a medication used to treat depression. Theories explain the cause of depression as a neurobiological change resulting in too little Noradrenaline and 5HT in some central nervous synapses. Mirtazapine is an Atypical antidepressant. It is a presynaptic alpha2 adrenoreceptor antagonist and increases central noradrenergic and serotonergic neurotransmission which then increases the release of noradrenaline. Mirtazapine has an antihistamine effect with sedative effects and so is beneficial to Mary due to her agitation and restless presentation. Mirtazapine is also suitable for older adults due to its anticholinergic effect. (Aarbakke, J et al, 2006) Interactions of Mirtazapine from a patient safety perspective include:- Alcohol – Sedation increased Warfarin – Enhances anticoagulant effect Anxiolytics and hypnotics – Sedation increased. Mary is also prescribed Lorazepam at present and this is monitored closely when given for over sedation. Withdrawl from Mirtazapine must be staggered due to side effects of withdrawing. (medicinenet.com/mirtazapine/article.htm) Dosage – Mary is on a titrating dose of Mirtazapine and so may be experiencing side effects which she is not used to and may cause her further distress. It was important that Mary be monitored closely and reassured during this time. Side effects of Mirtazapine include:- Increased appetite and weight gain (regular weight assessed and diet chart commenced) Oedema Sedation (Mary is monitored closely for over sedation due to her other medications sedative effects) Dizziness and headache Postural hypotension (Mary’s blood pressure is checked daily) â€Å"Mirtazapine causes few antimuscarinic effects and is therefore recommended over Trycyclic antidepressants† (BNF, 2009, P215). 4.3. LORAZEPAM Lorazepam is an Anxiolytic. Benzodiazepine anxiolytics are indicated for use short-term in anxiety states. However they are also used as an adjunctive therapy at the beginning of anti-depressant treatment to ease the initial worsening of symptoms, as in Mary’s case. Interactions of Lorazepam from a patient safety perspective:- Respiratory Depression- (Mary was monitored and physical obs taken post dose) Sleep apnoea syndrome (Mary was on arms length observation levels anyway) Severe hepatic impairment Myasthenia Gravis Side effects of Lorazepam include:- Drowsiness Lightheadedness Confusion Ataxia Headache Hypotension (Mary’s bp was taken on a daily basis) Confusion and Ataxia may be particularly apparent in elderly and should be closely monitored. (BNF, 2009,P189) 5. LEGAL, ETHICAL AND PROFESSIONAL ISSUES Therapeutic interventions which involve the prescribing and administration of medications have legal, professional and ethical implications. In Mary’s case these included the following issues. 5.1. ADHERENCE One of the problems with medication administration as part of planned care was Mary’s resistance to all interventions from the ward staff. â€Å"People with dementia often have problems taking prescribed medication. They may forget to take it without prompting or supervision, and can lack awareness of their health problems. Some believe they do not need medication as they think there is nothing wrong with them.† (Stapleton, L. 2010) Medication adherence can be improved by applying some simple measures:- Ensure patients know what drugs they are taking, why they are taking them, and when.   Also check that they are aware of any possible side effects, and what to do if they experience them. Check that all patients with dementia are able to take their medication safely by organising dosette systems, and ensure carers can help patients where necessary. Give all patients and their families’ information about how to contact the clinic nurse by providing verbal information and written leaflets. Ensure patients have a written treatment plan. (Stapleton, L. 2010) According to Cheesman (2006), adherence is an approach to achieving the best use of medication involving the sharing of information between healthcare professionals and patients. The prescriber can promote an effective therapeutic relationship by building a patient’s confidence in their ability to self-manage their condition. 5.2. MENTAL CAPACITY â€Å"The Mental Capacity Act 2005 provides a statutory framework to empower and protect people aged 16 and over who lack, or may lack, capacity to make certain decisions for themselves because of illness, a learning disability, or mental health problems. The act was fully implemented in October 2007 and applies in England and Wales. If someone is unable to make a decision for themselves at the material time because of an impairment of the mind, then that person can be said to lack the mental capacity to make that decision.† (Alzheimers society, 2011). According to the law, a person is defined as being unable to make decisions for themselves if they are not able to undertake at least one of the following: understand information given to them retain that information long enough to be able to make a decision weigh up the information available to make a decision communicate their decision by any possible means, including talking, using sign language, or even through simple muscle movements such as blinking an eye or squeezing a hand. (Rethink, 2010) Mary was found to lack capacity as she was unable to retain or weigh up the information given to him to make a decision. Mary lacked any insight into her recent worsening of symptoms, changes in behaviour and aggression. This is often the case with dementia disease. â€Å"The act encompasses five main principles: 1   A presumption of capacity − Every adult has the right to make their own decisions and must be assumed to have capacity to do so unless it is proved otherwise. 2   The right for individuals to be supported to make their own decisions − All reasonable help and support should be provided to make their own decisions. 3   It should not be assumed that someone lacks capacity simply because their decisions might seem unwise or eccentric. 4   If someone lacks capacity, anything done on their behalf must be done in their best interests. 5   If someone lacks capacity, before making a decision on their behalf, all alternatives must be considered and the option chosen should be the least restrictive of their basic rights and freedoms.† (Warren, L. 2010) â€Å"When considering a persons views and wishes it is important that they are given weight, and are carried out, unless the effects would be detrimental to that person.† (National archives, 2010) The multi-disciplinary team worked to all these principles in Mary’s case by:- 1. Presuming capacity by letting Mary make decisions until the capacity assessment had been done and a formal plan of care put in place. Mary was also supported to continue to make decisions on a daily basis which she was deemed to have capacity to make e.g. what to wear that day. 2. Support was provided in the form of an Independent mental health advocate (IMHA). 3. Mary was found to have capacity to make certain decisions even if they seemed strange to the ward staff. Staff supported her in this. 4. Mary had a best interest assessment and the findings were used to formulate a comprehensive care plan for Mary. 5. The MDT sought input from the deprivation of liberty safeguarding team (DOLS) around the intervention decisions with Mary to ensure they were applying the least restrictive care. 5.3. ETHICAL CONCERNS When working with people with dementia ethical practise should be considered as dementia is a long-term illness with no cure. Treatment is purely palliative and the evidence for the benefit versus drawbacks to treatment is not fully understood. (www.mind.org.uk) Foot Anstey solicitors explain that Advance directives and lasting power of attorneys put in place can ensure that the service user receives the treatment and care they want when they are no longer able to voice their requirements themselves. (www.repod.org.uk) Healthcare professionals must make the service user the centre of care decisions in the service user’s best interests to uphold ethical practise. 6. REFERENCES Aarbakke, J et al, (2006) Illustrated Pharmacology for nurses. Hooder Arnold, London. Alzheimers society (2011). Diagnosis and assessment. [Internet] Available from: alzheimers.org.uk/site/scripts/documents_info.php?documentID=260 [Accessed on 5/4/11] British National Formulary (March 2009) Galantamine, pg 281-282, BMJ and RPS, London. British National Formulary (March 2009) Mirtazapine, pg 215-216, BMJ and RPS, London. British National Formulary (March 2009) Lorazepam, pg 188, 190 BMJ and RPS, London. Calderdale pct, (2004) Improving health, improving lives: commissioning strategy for Calderdale. [Internet] Available from: calderdale.nhs.uk/fileadmin/files/Public_Information/Publications/Strategic_Plan_Appendix_1.pdf [Accessed on 6/4/11] Cheesman S (2006) Promoting concordance: the implications for prescribers.Nurse Prescribing; 4: 5 205-208. Dixon, M (2010) Modernising medicines management. A guide to achieving benefits for patients, professionals and the NHS, Executive summary. National prescribing centre, (2001) [Internet] Available from: npc.nhs.uk/developing_systems/intro/resources/library_good_practice_guide_mmmexecutive_summary_2002.pdf [Accessed on 10/4/11] Fittock, A. (2010) Non-medical prescribing by nurses. National prescribing centre [Internet] Available from: npc.co.uk/prescribers/resources/NMP_QuickGuide.pdf  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   [Accessed on 6/4/11] MedicineNet.com, Mirtazapine index. [Internet]   Available from: medicinenet.com/mirtazapine/article.htm [Accessed on 30/1/11] Modernising Medicines Management. A guide to achieving benefits for patients, professionals and the NHS. National Prescribing Centre, (2001). [Internet]   Available from: npci.org.uk/medicines_management/medicines/medicinesintro/library/5mg_intro_to_mm.php [Accessed on 6/4/11] The National Archives (2010) Mental Capacity Act, 2005. [Internet] Available from: legislation.gov.uk/ukpga/2005/9/part/1 [Accessed on 10/4/11] National prescribing centre (NHS) Medicines management [Internet]. Available from: npc.co.uk/mm/index.htm [Accessed on 9/4/11] Non-medical prescribing programme, (2009) DOH, London. [Internet] Available from: dh.gov.uk//TheNon-MedicalPrescribingProgramme/index.htm [Accessed on 5/4/11] Nursing and Midwifery Council. (2008). The code: Standards of conduct, performance and ethics for nurses and midwives. [Internet].   Available from: nmc-uk.org/Nurses-and-midwives/The-code/The-code-in-full/   [Accessed on 10/4/11] Rethink National Advice and Information Service. (2010). Mental Capacity Act 2005. [Internet] Available from: rethink.org/living_with_mental_illness/rights_and_laws/laws_you_need_to_know_about/mental_capacity_act.html [Accessed on 12/4/11] Scottish medicines consortium (2004) NHS Scotland, Treatment for Alzheimers dementia [Internet] Available from: scottishmedicines.org.uk/files/reminyl_XL_Summary_Advice__FINAL__for_website.pdf [Accessed on 13/4/11] Shepherd, M. (2002). Medicines. Nursing Times,   VOL: 98, ISSUE: 15, PAGE NO: 43 [Internet] Available from: nursingtimes.net/nursing-practice-clinical-research/medicines/206461.article [Accessed on 12/4/11] Stapleton, L (22 Nov, 2010) Can nurse prescribing improve medication concordance in people with dementia?. Nursing Times, 106:46 [Internet] Available from: nursingtimes.net/nursing-practice/clinical-specialisms/prescribing/can-nurse-prescribing-improve-medication-concordance-in-people-with-dementia/5022174.article [Accessed on 11/4/11] Warren, L (2010) Mental capacity Act, 2005 Factsheet. [Internet] Available from: alzheimers.org.uk/site/scripts/documents_info.php?documentID=354 [Accessed on 5/4/11]