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Concepts of End of Life Care

Share this: Facebook Twitter Reddit LinkedIn WhatsApp 1. Patients and families often struggle with many decisions during terminal illness. What are some decisions that patients can make about their end-of-life wishes? Patients have right of autonomy and make any decision that they seem fit during terminal illness about their treatment course. Patients have right to withdraw from any therapies at any time. Also, they have legal right to refuse any treatment or never start a therapy, as long as all the information is provided, this is called decisional capacity. Other decisions that patients need to make during end of life (EOL) care includes – organ and tissue donations, advance directives, resuscitation, mechanical ventilation and feeding tube placement (Lewis, Heitkemper, Bucher, Harding, Kwong

Assignment 1: LensCrafters Case Study

Assignment 1: LensCrafters Case Study.

This assignment requires student complete an analysis of the LensCrafters case from Chapter 6 of the text.Write a six to seven (6-7) page paper in which you:Evaluate LensCrafters’ operations strategy and explain how the organization seeks to gain a competitive advantage in terms of sustainability.Analyze how operation management activities affect the customer experience. Select two (2) operation management challenges and provide the solutions for confronting them.Examine LensCrafters’ value chain and evaluate its effectiveness to operations in terms of quality, value creation, and customer satisfaction. Determine the different types of performance measurements that can be used to measure LensCrafters’ service-delivery system design. Select at least two (2) types that can be applied and provide justifications for the selection. Examine the different types of technologies applied to LensCrafters’ service operations and evaluate how the technologies strengthen the value chain.Use at least three (3) quality resources in this assignment. Note: Wikipedia and similar Websites do not qualify as quality resources.Your assignment must follow these formatting requirements:Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.The specific course learning outcomes associated with this assignment are:Apply the concept of operations management. Compare and contrast the difference between a supply chain and a value chain.Analyze the types of measures used for decision making. Analyze the five key competitive priorities and their relationship to operations strategy.Analyze different types of technology and their role in manufacturing and service operations.Use technology and information resources to research issues in operations management. Write clearly and concisely about operations management using proper writing mechanics.
Assignment 1: LensCrafters Case Study

Heat Presentation

best assignment help Heat Presentation. I need an explanation for this Physics question to help me study.

Instructions:
For this assignment, you will create an original 3-5 minute presentation explaining what heat, thermal energy and temperature are. These are closely related topics so you will need to explain how they are similar and how they are different. You will also need to explain the basis for the temperature measurement systems of Celsius, Fahrenheit and Kelvin. Finally, which countries still utilize the Fahrenheit scales versus the countries that use the Celsius scale? This aspect of the presentation can be done creatively to help make the point. You will also choose the mechanism that you will use for your presentation.
You will need to research the various tools that are available to help you make your choice. This could be something such as a narrated PowerPoint, a narrated Prezi, a YouTube video, or something that is a combination of tools such as Jing, or Screencast.
Your presentation needs to contain accurate visual information, accurate oral information, and be accessible for viewing and listening. The presentation should be engaging and creative. This is to be original work, but based on research. So, you will need to cite your sources in a bibliography at the end of your presentation. If you use a publicly available image as part of your presentation, cite this along with your other research.
You will be assessed on:
Visual information – 10 points
Oral information – 10 points
Successful use of the technology – 10 points
The overall appearance and sound of your presentation – 10 points
References – 10 points
Heat Presentation

Communication Strategies for Therapeutic Relationships

This reflective essay aims to refresh critique and develop existing knowledge and understanding of communication techniques and how these transferable skills and approaches can build therapeutic relationships with a patient that lies within the scope of professional boundaries. This essay identifies in a role play video clip the different approaches to building therapeutic relationships and traces the barriers that prevent the nurses from engaging in such a relationship. In addition to the above, it offers an analysis of both vignettes critically reflecting on their therapeutic skills and approaches. It will draw in on my own personal experience from clinical practice and the skills developed with the assistance of Borton’s reflective model. It is indispensable that nurse’s caring for children, adolescents, adults and their families develop and maintain effective communication techniques as it makes it central to the provision of compassionate, trusting and collaborative therapeutic relationships. Reflecting and critiquing can be viewed as an in-depth examination reviewing an experience so each stage can be described, explored, assessed and be accordingly used to inform and change future practice. Evaluating the main communication skills and approaches to building therapeutic relationships identified in the video, it is clear to distinguish between who is a good nurse and who is not. The nurse’s in the video should serve as client advocates and as part of an interdisciplinary team whose members may have different ideas about priorities of care. The techniques used by the first nurse were poor and her approach created a stressful relationship between nurse and patient. In the beginning, the nurse doesn’t offer any form of recognition which is easy to criticize as acknowledging the patient and indicating awareness of change would have shown that the nurse saw Mrs. Miller as an individual. Giving information such as “Hello, My name is…” can build trust which is key in later on forming a therapeutic relationship and building a better rapport. Mrs. Miller was “really uncomfortable” as she was left unattended too all night. The nurse exhibited non- accepting gestures such as rolling her eyes and not maintaining eye contact. Non-accepting gestures can create barriers between nurse and patient as it can imply to them that the nurse does not have a genuine interest in their requests and make them feel like the nurse is rejecting not only their communication but also themselves. If she had expressed an accepting gesture towards Mrs. Miller it would have conveyed that the nurse recognised and empathised with her whilst simultaneously following the train of thought. Examples of this include head nodding, eye contact, and non-judgemental facial expressions. A critical component in therapeutic nursing is active listening. The nurse does not fulfill this useful technique as she and the patient seem to continuously talk over each other. When actively listening, a nurse can hear and understand what the patient is saying, which more importantly allows for the proper interpretation and translation of what the patients expressing. Silence can enable this as it allows for the patient to focus on the issues that are of most importance and it encourages the person to put thoughts and feeling into words only if the nurse is listening passively and attentively. A client and nurse relationship can be characterised as a partnership where both work together to improve the patient health status and fulfil purposeful objectives where they agree about the nature of the problem, develop and implement a plan designed to reach the objectives which in this case is a comfort and pain relief. Reflecting on the dos and don’ts in the video, the nurse shouldn’t have procrastinated the patient’s reasonable request. As a nurse, she didn’t offer herself to help or seem interested in what the person thought. A positive outcome in developing their relationship could have occurred if she had offered her full attention, interest, and desire to understand, without demanding anything from Mrs. Miller, leaving the offer unconditional. When Mrs. Miller expressed “I didn’t sleep all night and I kept buzzing the buzzer and the nurse would not come in”, the nurse didn’t refrain from showing a negative response as she immediately crossed her arms and said, “Well you’re not the only patient I have today”. This is a very defensive and judgemental gesture. Research shows that being defensive prevents the patient from expressing their true concerns and it is a failure in considering the patient’s feelings whilst also making them feel as if they need to defend a position, all while the nurse is just protecting herself from weakness. A therapeutic connection between the nurse and Mrs. Miller in the first vignette did not form as the development of their relationship for the nurse proved a challenge and it seemed she does not have the skills to cope with difficult reactions from her patients. Each experience linking nurse and patient whether short or extended is an opportunity for healing. Evaluating the second episode for different therapeutic techniques and communication barriers, it was straightforward to highlight the experiences and interactions that enhanced the development of this nurse and Mrs. Miller’s relationship. In the beginning of the vignette, the nurse acknowledged the patient by giving recognition i.e. “Mrs. Miller, you were resting. I didn’t want to disturb you”. You can see that respect for this nurse is crucial to the care and quality of a patient’s experience, where each component of the person is recognised and valued. Almost immediately the nurse sits down offering herself and giving her presence, interest, and desire to understand. The nurse actively listens to Mrs. Miller and indicates an accepting response without inserting her own values or judgements. Listening is a difficult skill as it requires you to eliminate any external noise and focus your attention on all the verbal and non-verbal messages. Mrs. Miller states how she has a biopsy procedure to get done and the nurse effectively plays the role of a functioning resource person by making the information available to her which increased her knowledge of the biopsy procedure and prepared her for what to expect, i.e. “They will put you to sleep with anaesthesia”. This seemed to enhance the wholeness and wellbeing of Mrs. Miller and facilitate in building trust between nurse and patient. Feeling as if she has someone to confide in, Mrs. Miller described an experience she had with a nurse on the night shift as “rude and awful” and when she would come in, “she would just stick her head in” and leave. The nurse passively listens, a skill which involves being present non-verbally, maintaining eye contact whilst head nodding and then she actively listens by reflecting and directing questions back to Mrs. Miller by restating what she had said “so you felt like you weren’t cared for?. This approach conveys to Mrs. Miller that the nurse has listened and understood what the client’s basic message was whilst also allowing for her to get a clearer idea of what she has said. After Mrs. Miller revealed her ordeal in the hospital during the night, the nurse showed compassion towards her by placing her hand on hers and expressed her sincerest apologies, “I am so sorry that happened to you”. A critical component of therapeutic nursing and communication is the act of touch. The laying on of hands and touch can demonstrate care and empathy but it is also central to the idea of healing. The nurses use of various therapeutic and communication approaches to help Mrs. Miller express her idea’s and feelings in a way that demonstrates respect and acceptance enabled the development of a therapeutic relationship between nurse and patient, which was solely influenced in a positive way by their interactions. It is easy to say that from the video even brief encounters like this one can be therapeutic. Patients can act out when stressed about upcoming procedures or if they are in pain but it requires a mature and patient nurse to transfer their skills and knowledge with the therapeutic use of one’s self to respond in healing ways in less than ideal situations. My clinical nursing practice experience in Parklands care home provided me with the opportunity to work with real patients, experience a nursing home environment which I may now pursue once I have earned my degree and it offered me the chance to learn how to work with fellow nurses and other members of the healthcare team, but most importantly it presented me with numerous moments to deliver individualised and holistic care by the use of therapeutic touch. Below there will be subheadings based on Borton’s 1970’s Reflective framework, where I have critically reviewed on how I developed the use of therapeutic touch in my placement. What? : What I have learned is that there is a required need for other alternatives to pharmacological therapy among older adults with dementia due to their harmful side effects. The therapeutic use of touch offers a non-pharmacological treatment which can decrease behavioural symptoms such as restlessness. What surprised me was how the use of touch can provide a healing effect and make the residents feel my “caring nature” and what I hoped for at Parklands was for the residents to believe that I took into consideration all of their needs. So what? : So, the important message I have gained an understanding in during my experience is that touch is a nursing intervention and so, what I have learned is that residents were more responsive to a good listener, touch and a reassuring word as it communicated to them that I cared, especially as the therapeutic use of touch affectionately transmits warmth. So, what I need to know more about is that with touch there has to be acceptability and that may vary from person to person as I have to take into consideration their culture and background. Experience in completing more clinical practices will develop my self-awareness. Before I used to believe touch was an invasion of privacy and could be interpreted wrongly as ‘sexual’ to the resident. So, the ideas of what I had previously thought about touch have changed as it can facilitate comfort and healing. Now what? : Now what I can do with my new perception is connect with my patients by offering myself with a simple application of touch which portrays a genuine interest. Experience will be beneficial as I will be enhancing my self-awareness and knowledge base around the use of therapeutic touch and this will give me confidence when interacting with members of a multidisciplinary team and patients themselves. Reviewing both vignettes showed how each experience we have with our patients can be healing and helpful but also harmful and unfeeling. Mastering the skills required for developing a therapeutic relationship is a lifelong process assisted by reflection which can be viewed as an impersonal scrutiny and valued judgement of your work or another’s using an objective approach which is to highlight you or your colleague’s strengths and weaknesses. When engaging a therapeutic relationship and effectively using the different approaches and techniques such as touch, active listening, and recognition you can help your patient achieve harmony, peace of mind, body, and spirit.

The global fashion brand of zara

The global fashion brand of zara. This report will be discuss about Zara which is a global fashion company, operated in more than 400 countries in Asia, Africa, Middle East, America, and Europe, with more than 500 stores all over the world (Zara, 2011). Zara’s global operations are located in important shopping district in all places. Until now, the operation of the business still using brick-and-mortal system which means that Zara only sell their product in physical store, they do not sell it via online (Brick and Mortal, 2011). Even though Zara is a global company, they are still facing some problems such as decision maker and information management in operation issue and DOS system issue. This report will discuss more about those two issues. Key Decision Makers and Information Management in Operations The decision makers in the operation management are the commercials at the HQ and store managers. The decision made by store manager’s could impact on the replenishment of garments as it is limited to a single order which is twice a week, based on manually auditing of the quantities required for the store. There is a process that should be followed in ordering new garments. Store managers will order the products to a PDA based on regional sales patterns, prediction of sales, and also availability of the garment. After that, the store manager will determines what should be ordered from the list of offer. In every single store itself, the head managers would divide the offer into some segments and allocate this to different employees. Those employees would walk through the store using their own PDA did whatever had been assigned to them, to the store manager’s handheld device. HQ and the commercial team will analyze and determine which stores had been the most effective in selling the products. It is done in order to give the right product to the right store. Since there is a possibility of difference in the local customer demands and ultimately local trends (past performance), the store manager does not have much control over the extent to which its orders will be met. Must be note that the future production for each Stock Keeping Unit (SKU) which is the consolidation of fabric, color, garment, and also size order is determine by the collaboration with the product managers. Because of the different number in supply and demand in different areas, good prediction should be made in terms of how much demand it will be. It will impact to the number of product that will be produced in the process. Product managers indirectly rely on the information provided by store manager’s orders. In addition, the commercials in charge of the fulfillment would occasionally ship samples that were not requested by the store managers. This again suggests where the true decision power lies. By analyzing the decision makers in all parts of the operations and the flow of information, stronger conclusions can be drawn as to where information is urgently required in order to streamline procedures. Since the entire supply chain relies on the subjective orders that are placed by the store managers, the accuracy of this information is very important in contributing a success of Zara’s operations. This so-called ‘theoretical inventory’ is required in order to keep the supply chain robust without leading to excess supply (Feinstein and John, 2008, 760). In the current system, store manager’s order information is taken to be sacred, and the numbers of it are subsequently used for shipment and production. At the moment, store managers have to manually assess their inventory. This is a relatively slow procedure and suggests that there is room for improvement. Resources are wasted since managers are preoccupied with a somewhat administrative task. Admittedly, this is done to ensure that the manager gains an insight of the inventory so that correct decisions can be made for the quantities that need to be replenished. Information would probably help to speed up this process, so that the managers can focus on employees and customers, instead of having to roam the shops twice a week. When store managers have no clear idea of how much inventory is at the distribution centers, information should be given as a base to make smarter orders that suitable to the market. If store managers assure a customers that a particular sold out garment is reordered and will arrive in two days, the chance that it this order does not come through (due to a lack of information from the distribution centers), could be potentially damaging for Zara. Information from the distribution centers and from the production facilities must be made as clear as possible to make sure a better overview of the garment availability, in order to adjust the orders and pass on this information to the customers. This would overcome the current blind order system. DOS System Issue Other problem faced by Zara is DOS system issue. Zara and the IT partner have agreement in using DOS as their operating system for all the applications of the company for long time ago. DOS is considered to be an outdated system. The question of changing the OS has therefore been raised. It has been already acknowledged that staying so far behind in terms of technology can be risky for the company. But, it is aware that there is also a risk in changing the system to the newest OS. To give an idea whether a new OS investment would give any benefit to Zara or not, the analysis is conducted. Sustainable competitive advantage of company might be at risk due to a lack in IT investment (Qin, 2009, 13). Other competitors might see this as an opportunity to fight against Zara. Refer back to a more resource-based view, a new operational system might installed a software that more modern and allow Zara to develop its capabilities. Various business processes of Zara could be enhanced and orders could be made much more efficiently. Referring to the previous information requirements, new software could be used to automatically update the POS terminals for every sale that is made which would prove useful not only at the store level, but throughout the entire supply chain (Dun, Ross, and Michael, 2000, 445). If all POS terminals had been interlinked, store managers would have an online overview of the theoretical inventory order in the store. It helps a lot in determining the order requirements (Ward and Elizabeth, 2006, 60). Store managers would not have to do a manual audit twice a week. They could more concentrate to the administration, because the system could help them in auditing process. Moreover, a tailored POS application for the new OS could ensure that orders, which form the basis of the shipment and the production facilities, would be made based on theoretical inventory in effect giving more accurate orders. At present, PDA is used by personnel to count the number of items required by the store and to make new orders based on the perceived demand. If Zara would have the right software, they can remove the use of PDA. If indeed the automated POS terminals would update the theoretical levels with sales at the end of the day, then in principle orders could be made on a continuous basis. Stagnancy in this case would then not be measured of inventory levels, but rather the frequency at which shipments arrive. Assuming that orders would then occur on a daily basis, optimization of the inventory at the distribution centers is needed. By using modern e-supply management software, orders could be linked through an in-house developed Enterprise Resource Planning (ERP) system that would link orders made from stores to the rest of the supply chain (Leon, 2008, 7). This would allow the demand and supply suitable very closely though a more flexible delivery system. This is not only because store managers would make orders based on inventory levels at the distribution center, but also because HQ could align the supply to the stores demand accurately. As a result, production could be adjusted on a daily basis by monitoring the orders that would come in, making the production process even leaner. These adjustments would still need to be made based on order quantities, since this would ensure the autonomy of the store managers. In contrast to the current system, however, the software could provide information on the Economic Order Quantity (EOQ) which is command to make sure the number of a products stock that buyers want is enough in the, to meet customer demands, whilst minimizing the cost of inventory (Sweeney et.al., 2010, 609). The inventory level at which garments also must be reordered (also known as the ‘reorder point’). It would provide store managers with a structured approach towards inventory management, without compromising autonomy. Further savings can be made if voice over IP (VOIP) software is installed so they could make calls between shops freely. New OS could also support wireless applications. In addition, if the distribution centers would be connected to the network on the OS, store managers could easily place the orders after viewing whether the required garments are available or not. The order would be made to keep the inventory level at the store updated, and a signal could get sent online to the distribution centers and the production facilities. It would give Zara more benefit indirectly from extra sales due to more efficient customer service, since more attention can be paid to the customer. But, routine checking still needed to make sure that the theoretical inventory levels match actual levels, since garments could go missing or get stolen. Further benefits from an IT network could be derived. If all stores have this online access to other stores, store manager could direct a customer to another local Zara store in case of a stock out if they do not have the stock for certain product. The system should be set up in such a way so that shipments could be made from another local store, further reducing the ordering period. In totaling, ordering information, merging data into one system, and returns information leading to a more precise measurement of the stocks and to a real time measurement. Not only that, new OS is able to prevent any hold up from its terminal vendors. Indeed at the moment Zara has no insurance that its supplier can provide terminals supporting DOS for a long term. Zara’s bargaining power toward its supplier would increase. Therefore, an upgrade of Zara’s OS is therefore recommended. The global fashion brand of zara

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