Essay on Motivations for Emigration to the New World

As it continued to grow, colonial America stood as a terrific opportunity for those poor Englishmen seeking a way out of economic and religious turmoil. Depression created chronically unemployed drifters across the countryside. Takeover of national power by the Church of England led to unfair treatment of other religious sects. But was it economic of social concerns that pulled more British citizens away from their homeland and toward the dangerous, uncharted Americas? In my opinion, more migration was directly linked to the yearning for wealth and the escape of poverty than the wish for a safer religious environment. It is true that many colonies, Plymouth and New Hampshire for example, were founded with religious freedom as a main†¦show more content†¦Plymouth, following Jamestown thirteen years later, was only founded in New England because its settlers were blown off course (allegedly on purpose) from their planned destination, the Jamestown area. England hoped to creat e a colony of economic worth above all else. Once English colonization had been established in the Americas, great agricultural success (mainly of tobacco and sugar) proved very appealing to poor Englishmen seeking a way out of poverty. In 1612 John Rolfe perfected the cultivation of tobacco, making it easy to grow yet highly profitable. The Great Migration of 1630-1642 brought approximately 68,000 English, primarily indentured servants, to America. Indentured servants got a ticket to America in exchange for service to a wealthy landowner. In Virginia and Maryland, those with enough money to pay their own passage received free land upon arrival in the colony. Carolina was formerly created in 1670. Its founders hoped to form an economy from growing foodstuffs to provision the tobacco colonies and the sugar plantations of the West Indies, whose economies evolved around their single crop. Like the colonies Carolina sustained, its creation was based on a rich economic atmosphere. New England colonies, especially Massachusetts, too k advantage of cod-filled waters and dense lumber-producing forests. The coast of Newfoundland was often referred to as the gold mines of NewShow MoreRelatedCommon Reasons for Immigrating to a Different Country Essay884 Words   |  4 PagesStates of America on the grounds of economic reasons, personal reasons, and political reasons. These reasons contribute to a person leaving his or her native country and joining the culture of someone else’s. The term for this movement is emigration. Emigration is the act of leaving ones native country or region to settle in another. It is the same as immigration but from the perspective of the country of origin. America, also known as the land of opportunity, is the country where natives ofRead MoreThe Middle Passage, By Lorraine Hansberry, Africa For The Africans By Marcus Garvey1794 Words   |  8 PagesAmericans still experienced discrimination and prejudice. The idea of an emigration movement came about and was debated among the African Americans who were searching for freedom and liberty. The play, A Raisin in the Sun by Lorraine Hansberry, and the essay, â€Å"Africa for the Africans† by Marcus Garvey, both portray the idea of emigration. Hansberry and Garvey’s works contrast each other in portraying the purpose of emigration. Beneatha’s possible decision to emigrate to Africa is because of her personalRead MoreThe Islamic Revolution Of Iran2209 Words   |  9 Pagesfreedoms results in a great exodus and undercuts the intellectual capital of the country. 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The story of Jamestown is told in a much more authentic, elaborate style than our textbooks has presented. As Kupperman points out, Jamestown was not only important to United State’s history but also to British history. From the motivations to the lasting effects, she gives an accurate account of all components involved in Jamestown. Also, there is a chapter devoted to the Native American experience, which shows a non-Western view of events. The book is written in a format that isRead MoreThe Environment Is A System Of Living Things1393 Words   |  6 Pagesour planet with the request for more nutrition from less land and water supplies. As the total population develops, enhancing expectations for everyday comforts and improving living standards without destroying the Earth is a global challenge. Our world population is growing at about eighty million people a year, which equates to an average of two-hundred and twenty thousand people per day. (2) In the event that current trends persist, a host of questions regarding the fate of mankind and the planet’sRead MoreEconomic Immigration: the Case of Spain4636 Words   |  19 Pagesmy topic it proved to be a very interesting one. I learned many new things while writing this paper and it was really interesting to read all this information about immigrants and their reasons to go to Spain and not some other country. I. Introduction 1. The term immigration and the general theories behind it Immigration is the introduction of new people into a habitat or population. It is a biological concept

Mimesis in Alice in Wonderland - 2678 Words

Essay on mimesis in Alice in Wonderland and Through the Looking Glass A quest in search for the elements which consitute a new notion of mimesis in Carrolls Alices Adventures in Wonderland and Through the Looking-Glass Mimà ©sis ve svÄ›tovà © literatuÃ…â„¢e/Klà ¡ra Kolà ­nskà ¡, Úterà ½ 10:50 – 12:25 â€Å"Who in the world am I?† Ah, that’s the great puzzle.[1] This question, asked by Alice herself at the beginning of Alices Adventures in Wonderland, anticipates the theme of identity and the reflection of mimesis in the literary nonsense and the author develops the subjects to the utmost and deepest experience in the two texts. By setting his main character in the world which creates a†¦show more content†¦In Wonderland and through-the-looking glass world language is not only the means of communication, the characters use it the same way as people use power; to gain superiority upon one another. As Daniel Whiting comments: The invention view seems to assume that whether an utterance has meaning and what meaning it has it entirely up to the speaker.[8] This can been seen especially in the character of Humpty Dumpty, who gives his own meanings to the words. Carroll is toying with the language and communication using its ambiguity and various references to con fuse Alice. Moreover, the communication gains a new meaning, its role is no longer to transmit a message to the listener; it is transformed into meta communication. Most of the conversations in the two texts consist of talks on how to communicate, Alice being the one who communicates on a different level than the characters she encounters. As Gabriel Schwab puts it: As in a dream, language is both malleable and concrete; words are condensed, dialogues stripped of their pragmatic function, meanings are displaced metonymically, and references are suspended or transformed.[9] Having pointed out the fact that Alice is copiously being challenged by the language games with the characters, one observes another significant motif in

Corporate Governance Jordanian Industrial Companies

Question: Part 1 Assessment Criteria: Demonstration of knowledge of the issues and evidence of wide reading to support your analysis Demonstration of your ability to apply the knowledge to identify keys issues leading to your recommendations Evidence of sound reasoning and the exercise of professional judgment to support your recommendations Development and statement of concise recommendations for presentation to the Chairman and shareholders Overall structure and professional presentation of the report to the Chairman and shareholders High quality written communication of concepts and terms in ordinary English as not all shareholders can be assumed to be professionally competent in corporate governance Required Assume you have been engaged as a corporate governance consultant to a board of directors of a public company listed on the stock exchange. Your assignment is to prepare a report to be submitted to the Chairman of the board explaining and analyzing how the company should define and delineate the separate roles, duties and responsibilities of the companys board of directors from those of the CEO. Your report should contain specific recommendations on the separate roles of directors and the CEO. The Chairman has specifically indicated that she intends to make your report available to shareholders of the company and that the document will be published on the companys web site. Part 2 Assessment Criteria: Demonstration of knowledge of the issues and evidence of wide reading to support your analysis Demonstration of your ability to apply the knowledge to identify keys issues leading to your recommendations Evidence of sound reasoning and the exercise of professional judgement to support your recommendations Development and statement of concise recommendations for presentation to the AICD Overall structure and professional presentation of the report to the AICD High quality written communication of concepts and terms using language for an audience that is assumed to be professionally competent in corporate governance. Answer: Part 1 Executive Summary The present business culture wars between government, regulatory bodies and the board of directors are emphasizing the need to define roles and responsibilities in a company. As per the case between Westpac Banking Corp and ANZ Banking Group, the regulators are accused of turning out to be a culture police. The main objective of the report is to assign separate roles, duties and responsibilities to the company directors as well to the Chief Executive Officer (CEO) of the company so as to maintain smooth functioning of the business and its culture along with projecting a brighter image of the company to the stakeholders. Analysis of Defining and Delineating Separate Roles and Responsibilities of the Companys Board of Directors from those of the CEO The disputes in assigning and performing roles and responsibilities for board of directors, management professionals and shareholders of the company have resulted in creating a disturbance in the general prosperity of the company. According to the chairman Greg Medcraft of Australian Securities Commission, the directors should not be held criminally responsible for any disobedient culture of the company. Creating a healthy business culture is the responsibility of the CEO of the company who is also directly accountable for the matters related to business. The functioning of corporate governance depends on the board of directors structure, techniques, methods, roles and responsibilities. Therefore, the board of directors is considered as a vital part of the corporate governance. Appointment of directors is done by the shareholders who are the policy-makers of the company (Jan Sangmi, 2016). From the scenario of the case, it is observed that the directors of the companies are showing their concerns about their roles and responsibilities and are not ready for any kind of changes implemented in holding directors accountability for wayward culture of the company. The roles of board of directors should be focused on three main areas. First, the policy-making in which the directors are to make policies which distinguish the responsibilities and roles among the board and other management professionals. Secondly, decision-making by which directors are to make decisions regarding agreements with other organizations and thus delegate the powers of maintaining prosperity in the company to others. Thirdly, the role is not to oversight in which directors are to do the supervision and not to manage the organization (Arnwine, 2002). The general duties of the directors include the endorsement of success of the business, to exercise and emancipation the power of the company and to show care and carefulness for the company (Waller, 2012). The responsibilities of directors are to monitor the performance along with affairs of the company, to manage the company properly, to ensure good corporate governance and to describe the structure for authority delegation to management (Aina, 2013). According to the Australian Financial Review (April 2016), Patrick Durkin, directors of boards advised that the defiant culture of the company should be managed by the CEO and not by the directors. The separate roles and responsibilities of the CEO in consideration of the case are to manage the company, and to perform the power as well as strategies given by directors to strengthen the decision making policy, to take responsibility and accountability for decisions, to face the consequences related to the moral and legal act of the com pany (Ferrell Ferrell, 2011; Kakabadse, 2006). As stated in the case by founder and director of IBIS World, Phil Ruthven, if right kind of strategies was made to assign the roles and responsibilities for CEO, the problem of passing matters as an excuse to higher authorities will be sorted out. Specific Recommendations Made for the Separate Roles of Directors and the CEO For smooth function of a company both directors and CEO should come into common understanding of the business strategies. Though directors and the CEO should function for the success of the company but their roles and responsibilities are to be separated. The role of directors should not only to lead the meetings but should encompass establishing proper communication with the CEO. Directors should avoid the over engagement in the management proceedings and hence pass on the responsibilities of managing company to CEO. Directors should continuously monitor the performance and progress of the CEO in order to develop better strategic plan for the company. As per the scenario presented, directors should make an organizational structure more efficient to limit liability of decline in cultural harmony of the company to CEO (Arnwine, 2002). The directors active participation in setting board agenda would be fruitful for managing information flow of the company (Gabrielsson, Huse, Minichill i, 2007). On the other hand, CEO plays a vital role in business operations. CEO should be given an independent authority so as to involve in decision-making process more effective. The roles of CEO should be separated for better corporate governance. The CEO should be allowed to make suggestions to the directors and at the same time disapprove of the wrong decisions imposed to him. Proper communication channel should be initiated for the CEO to make efficient interactions with the directors. The CEO should work more on the objective of the company than the personal interest (Brickle, Coles Jarrell, 1997). An ethical working environment should be created by the CEO to manage the salvo in the company. The CEO should not show any kind of waywardness to the top management as directors are the ultimate governing entity of the company. The directors as well as the CEO of the company should enhance their relationship for the accomplishment of the organizations aims. Self-interests of dire ctors and the CEO should not collide to maintain peace in the company. The preferences of the directors and the CEO should be focused on serving stakeholders attention. The directors should not try to influence the behavior of the CEO by using its top management power. CEO of the company should completely work on improvement of the culture of the business to uphold strong and better coordination between the management professionals. The buck stops with the CEO unless there is equal participation of directors. Community and public relations should be highlighted by directors and the CEO in order to project organizations mission, programs, strategies and positive image to the stakeholders. Part 2 Executive Summary Corporate governance is concerned with efficient decisions taken by the managers that result in positive outcomes, which is beneficial for the stakeholders. The need of good corporate governance is determined to be of paramount substance at present day organizations because of the separation between management and the owners. The protection of the interests of the investors is a feature of a good corporate strategy. If the investors do not get adequate returns of their investment, they will take no more interest in investing (Al- Haddad, Alzurqan Al_Sufy, 2011). Corporate governance ensures the establishment of control mechanisms, which ascertain that the money of the investors is not invested in wasteful projects (Drobetz, Schillhofer Zimmerman, 2003). Relation between Corporate Governance and Return of Investors It is believed that a good corporate governance strategy tremendously contributes to increasing the returns of the company. In the presence of a weak corporate governance strategy, a manager can exploit his/her power to fulfill personal interests at the expense of the investors. It is argued that if the cash flows and opportunities of investment exist in a company, a positive dividend payout ratio will gear up the price of the share. The managers oriented towards growth tend to overinvest and pay less dividends (Gugler, Mueller Yurtoglu, 2004). In a survey conducted by McKinsey, it is found that if in a nation the law does not protect interests of the shareholders, they prefer to invest in companies that have strong corporate governance (Chen, Chen Wei, 2009). In most of the advanced economies, the corporate governance strategy involves proper funding of the companies from the investors along with ensuring return of the investors profit. A contract between the managers and the inve stors ensures the ways in which the funds are invested along with specifies about the allocation of profits between the management and investors. To overcome the problem of unanticipated events, certain residual control rights are alienated among the managers and the investors that give rights of decision-making. At the time of funding, the investors generally take all the control rights but because they are not equipped enough to take decisions like managers, so certain portion of residual rights are given to the managers. Now, the role of corporate governance lies in the fact that it sets a limit to the residual control rights of the managers (Shleifer Vishny, 1997). The Australian Institute of Company Directors (AICD) can make the investors understand the significance of a sound corporate governance strategy in protecting their interests. The investors are not willing to consider the importance of corporate governance in the investment decision because they might be thinking tha t the governance of companies always gives a chance for exploitation for the managers. It seems that the investors think that higher sales growth is not always possible due to good corporate governance. However, the investors should be made apparent the fact that a good governance strategy will increase the profit and the value of a firm. The company that has good corporate governance is also able to pay a higher amount of cash to the shareholders. Good corporate governance is also associated with effective compensation to the executives and directors, in the form of options in stock (Brown Caylor, 2004). The investors especially the small investors may be of the view that governance strategies believe in giving benefits to directors and executives in a way or the other. They should be made realized of the positive effects caused to investors too because of a sound governance. A good corporate governance strategy also helps in making long-term flows of international investment and enhances economic performance of a nation. Proper corporate governance also helps in the effective division of equity shares among the outsider investors and the insider ones. The external investors can gain a control over the activities of the management and insider investors. The stockholders also get a right to interfere in the top-level decision-making because of the policies laid at the governance strategy. The philosophy of core corporate governance addresses two tribulations. One is regarding vertical governance amid the secluded shareholders and the managers. The other one is concerned with horizontal governance amid a secluded shareholder and a controlling shareholder. The challenge that is needed to be addressed by the policy-makers is to make a strategy of governance in such a way so that both the controlling and other stakeholders remain in a win-win situation (Bocean Barbu, 2007). The existing conflicts among the managers and the shareholders seem to be another reason due to which the investors do not consider corporate governance as important in decision-making. The increasing trends of scandals have been raising questions on the effectiveness of corporate governance (Kang, Cheng Gray, 2007). Recommendations The theories and examples suggest that good corporate governance is very essential for proper functioning of a company. Investors get their rights protected by means of a sound governance strategy and the chances of exploitation by a manager get diluted. However, the corporate scandals are reducing the belief in the governance strategies. The reduction in sales growth, as well as increase in compensation of directors and executives are few other features of a governance strategy that have faded away the belief in corporate governance. The AICD must undertake campaigns to educate the investors about the need of sound corporate governance. The main focus should be to give live examples of companies that have witnessed a high growth in profit and shareholders return due to the presence of good corporate governance. The trust of corporate governance can be gained by giving examples of long-term benefits that firms have gained. In the short run, there may be downfall in the performance of a company despite the presence of governance strategy and that can lead to low return on investment. Subsequently, the management can decide that due to low returns, the dividends should be reinvested. The investors should be taught to create a sense of trust so that the business can reinvest the dividend and yield an enhanced return to the investors in the future. References Al-Haddad, W., Alzurqan, S. Al_Sufy, F 2011, The Effect of corporate governance on the performance of Jordanian Industrial Companies: An empirical study on Amman Stock Exchange. International Journal of Humanities and Social Science, vol. 1, iss. 4, pp. 55-69. Barbu, C.M. and Bocean C.G 2007. Corporate governance and firm performance, Management Marketing-Craiova, vol. 1, pp.125-131. Brown, L., D. and Caylor, M., L 2004, Corporate governance and firm performance, Georgia State University, pp. 1-52. Chen, K.C., Chen, Z. Wei, K.J 2009, Legal protection of investors, corporate governance, and the cost of equity capital, Journal of Corporate Finance, vol. 15, no. 3, pp.273-289. Drobetz, W., Schillhofer, A. Zimmermann, H 2004. Corporate governance and expected stock returns: evidence from Germany, European Financial Management, vol. 10, iss. 2, pp.267-293. Gugler, K., P., Mueller, D.C. Yurtoglu, B., B., 2003. Corporate governance and the returns on investment. In EFA 2002, Berlin Meetings Presented Paper, pp.1-53. Kang, H., Cheng, M. Gray, S 2007. Corporate governance and board composition: diversity and independence of Australian boards, Corporate Governance: An International Review, vol. 15, iss. 2, pp.194-207. Shleifer, A. and Vishny, R. W 1997. A survey of corporate governance, The Journal of Finance, vol. 52, iss. 2, pp.737-783. Aina, A 2013, Board of directors and corporate governance in Nigeria, International Journal of Business and Finance Management Research, vol. 1, pp. 21-34. Arnwine, D 2002, Effective governance: the roles and responsibilities of board members, Proc (Bayl Univ Med Cent), vol.15 no. 1, pp. 19-22. Brickley A, Coles J Jarrell, G 1997, Leadership structure: separating the CEO and chairman of the board, Journal of Corporate Finance, pp. 189-220. Ferrell, O and Ferrell, L 2011, The Responsibility and accountability of CEO: the last interview with ken lay, Journal of Business Ethics, pp. 209-219. Gabrielsson, J, Huse, M Minichilli, A 2007, Understanding the leadership role of the board chairperson through a team production approach, International Journal of Leadership Studies, Vol. 3 no. 1, pp. 21-39. Jan, S. and Sangmi, M 2016, The Role of board of directors in corporate governance, Imperial Journal of Interdisciplinary Research, vol.2 no. 6, pp. 707-715. Kakabadse, A 2006, Chairman and chief executive officer (CEO): That Sacred and Secret Relationship Journal of Management Development, vol.25 no.2, pp. 1-32. Waller, L 2012, Directors duties and liabilities where are we now and where are we going in the UK, broader commonwealth, and internationally? International Journal of Business and Social Science, vol.3 no. 2, pp. 21-45.

Listening Skills and Healthcare

Abstract This study uses a quantitative survey technique, and summarized data collected is used to correlate results with listening skills as its fundamental principle (Punch, 1998). A survey was sent out on the Internet and yielded results from various gender, socioeconomic backgrounds and education levels. Communication issues have been maintained by employing a number of methods.Advertising We will write a custom research paper sample on Listening Skills and Healthcare specifically for you for only $16.05 $11/page Learn More Pain faces scale training of participants and research assistants and maintaining good relationships with participants are used in our recruitment to further develop partnership between the study population and researchers and to maintain feedback. Each step undertaken to gather and analyze data, validate findings and present research outcomes in which comprehensive and accessible findings will be used to facilitative growth and c ontinued development. The purpose of this research is to develop a better understanding of listening skills and how better listening skills well as ability to recognize nonverbal expressions will assist the healthcare industry and its consumers. Introduction The merriam-webster dictionary defines pain as â€Å"suffering or distress of body or mind†. It is argued that effective communication between healthcare provider and patient is an important element in improving treatment compliance. Holmes et al, (2007) on the other hand provides that pain interferes with person’s ability to communicate by altering normal patterns of verbal and nonverbal communication. Listening skills is something that has been emphasized in the medical field for years. Professors in medical schools have been attempting to teach their students to be better listeners to their patients (Holmes at al, 2007). As we seek to integrate effective communication skills in healthcare, the best question, and yet difficult to ask, is: does listening skills, as well as purposeful nonverbal communication, while being applied, more likely to improve the relationship between healthcare providers and patients? Listening skills is something that has been emphasized in the medical field for around 2,500 years and the problem of communication challenges often leading to misdiagnosis has always been an issue. Frischenschlager and Pucher (2002) argue that describing pain to a physician falls solely on the patient. And in most cases, physicians often lack the skills to read patient’s nonverbal signs or even interpret the slang they use.Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Therefore communication problems between providers and patients remain to be a major problem in the healthcare professional. The provider-patient as demonstrated by the pain scale (figure 1-Appendix) illustrates their interrelationships. The research conducted sought to answer the question, â€Å"Can pain faces be distinguished from other emotional expressions?† Literature reviews on the ability to recognize facial expressions and listening skills issues facing both patients and health care providers in social dynamics of healthcare professional will be discussed. A thorough investigation on communication of health issues affecting these communities are illustrated which provides a synthesis of the existing problems. This literature review is coined around personal and situational issues, as well as empirical research on the communication concerns with support of reviewed of population studies and themes are summarized. As the cultural context of health issues has a major influence on our communities, sociological literature on this pandemic is highlighted. To affirm this analysis, researchers linked various responses to research from the related areas and concluded with references f or future research on the health and sociological dimensions. The current literature was reviewed using Communication Mass Media Complete database and searched online article using listening skills and facial expressions in healthcare as key words using Google. The research concentrated on both young, middle and old age population as my headline and designed my research article around a pain face scales instruments to perform a thorough analysis on how participants can identify non-verbal signs to communicate their pain issues. The finding being that if a â€Å"Lay† person could do it WELL then with a little training, a Healthcare Provider could do it as well. Training that included spending more time with their patients. Our careful analysis and research will then be used to identify the validity and applicable evidences that can be used in health care practices Objective This paper seeks to explore the relationship between healthcare provider and the patient, highlighting difficulties they experience when communicating to each other about pain issues. Our analysis aims at providing evidenced-based guidelines that will provide a set of recommendations that can improve listening skills on the patient and the service provider.Advertising We will write a custom research paper sample on Listening Skills and Healthcare specifically for you for only $16.05 $11/page Learn More While much has been done to encourage physicians to improve their listening skills, research indicates that listening, as well as provider-patient interactions can improve with adequate training and follow-up. As the number of studies increases, the results, effects and outcomes of patient-provider communication, there is still a much research to be done in the field. Background Questionnaires were designed and distributed over the internet. This environment allowed participants to freely and openly rate facial expressions as much as possible. Participants were well acquainted with internet and use of facial expressions in their day to day activities. This equipped them with considerable knowledge of what was expected of them as many of the expressions such as anger, happiness, sadness, disgust, surprise, fear and pain in facial expressions related well with their personal experiences. Literature Review Analysis The most frequent complaint among patients is pain. According to Baird et al (2008), an estimation of 30 million people in the United States are suffering from chronic pain. It can not be assumed that the most prevalent pain always occur naturally. Acquiring effective communication skills requires the employment of observation and application practice of communication expressions. According to the US Bureau of the Census (1995), nearly 7% of the US population deals with chronic pain every year making it a high priority concern within the healthcare community. Evidence from the US Department of Commerce shows that pain associa ted problems costs billions of dollars in the healthcare industry. It adds that related problems such as chronic pain management and how to effectively deal with pain and cost management to be also of concern. The same studies also evidences high occurrence of opiate dependence among the mentioned group. Pain can be explained in different perspectives depending on individual experiences. Frischenschlager and Pucher (2002) provide that pain cannot be measured or quantified. Health care provider should in this case assess pain on individual perspectives. Therefore verbal and non-verbal description of their current health status depends solely on the patient.Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More This simply means that the overall communication context is influenced by the dynamic exchange of the service provider and patient interaction. However, this has never been the case. As Frischenschlager and Pucher (2002) state, â€Å"problems with the communication between doctor and patient are a frequent result (p.416). Pain has often been defined as a warning sign indicating something wrong within the body. Pain is classified into two categories; acute and chronic pain. People in pain often undergo intense psychological experience. Acknowledging the importance of patients understanding how to respond to pain is important in communicating pain issues to the providers. Issues associated with patient communication process are outside the scope of medical research. In this regard, Brannigan et al (2008) quotes, â€Å"pain should be looked at as a multi-dimensional affair and not just a one a warning sign† (p.12). Thus, being able to communicate effectively and knowing which m essages to communicate are equally important. Pain Theories Frishenchlager and Pucher (2002) categorize pain theories into two groups; 1) the Frey theory and 2) the Goldscheider’s approach. Frey’s theory defines pain as special pain pathways that connect pain-specific nerve endings leading to the brain. The Goldscheider’s approach states that nerve endings are not specific to any center of the brain and that pain can only be experienced when the level of pain reaches to an intense point that can not be tolerate leading a patient to expressing their discomfort. Frishenchlager and Pucher (2002) links psychological factors such as distraction, relaxation, fear, depression, former pain experiences, family and cultural influences to be among factors that affect the way that people experience pain. In their analysis, Frishenchlager and Pucher (2002) redefine pain as,†Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦unpleasant sensory and emotional experience associated with actual o r potential tissue damage or described in terms of such damage† (p.419).Their definition gives equal weight to emotional and physical pain experience hence the rebirth of gateway theory that links emotions to physical pain, considered to be a breakthrough in theories of pain. Effects of pain and patients’ inter-personal relationships are not only becoming important topics in research, the management of chronic and acute pain are also of paramount importance. In this regard, future research should take deeper studies in defining what chronic pain is and how it effects the population (Smith, 2008; GangHeong, 2000). Pain is now being thought of as the Fifth Vital sign that offers way for physicians to assess overall health of an individual. Pain can be considered as chronic if the symptoms last up to three months. Walid et al (2008 argue that pronounced pain changes the behavior of an individual. They provide guidelines on how to determine levels of Chronic Pain as to incl ude; duration of illness; number of treatments and consulted doctors; psychological impairments such as depression, helplessness and loss of self-esteem; social impairments such as social isolation, changes in the patient’s social role and position; and Job-related impairments such as having to take days off because of being ill that can subsequently lead to dismissal. Diagnostic classification of chronic pain It presupposes: A continuous, torturing pain, which; Cannot be explained well by an organic damage; and Psychosocial problems or emotional conflicts are recognizable and can be brought into direct connection with the pain the patient experiences. Gromala and Shaw (2004) define chronic pain as pain that lasts from one month to a year. Their analysis records a statistic of 57 million people in North America with majority being the disabled people. To this we come to the conclusion that pain is indeed a difficult problem for both physicians and patients (Bennett et al, 2009). McCosker (2004) defines pain an â€Å"inner experience and others cannot truly observe its effects or share in its suffering† (p.62). Frischenschlager and Pucher (2002) links withdrawal symptoms as part of the psychological challenges a person undergoes when experiencing chronic pain. They add that when someone isolates themselves from the society to heal results to withdrawal making the pain more intense. When a person life revolves around their illness, pain becomes part of their life. Facial Action Coding System The Facial Action Coding System (FACS) dates back in to the mid 19th century (Piderit, 1858). The most influential theorist was Charles Dawn in which he argues in his book ‘The Express of Emotions in Man and Animals† that facial expression is universal and innate characteristics. He further added that facial expressions played a crucial role in the experience of emotion (Darwin (1896). FACS is defined by Ekman (1984) as â€Å"changes in the fac ial musculature comprised a large portion of emotional state† (p.319). He argues that the expressions were based on a â€Å"theoretical study designed to measure specific facial muscle movements believed to be associated with emotional expression† (p.321). Ekman and Friesen (1978) further distinguish between two different types of judgments to include message judgments that refer to specific behavior and those made about behavior. They argue that facial expressions such as anger or happiness can clearly be distinguished from pain expressions, while to accurately measure the assumptions of psychological state, inferences about that which is being measured is required. Ekman and Friesen (1978) define pain scale as a measurement that â€Å"identifies specific responses to specific stimuli, natural unfolding of specific behavior over time†¦.which segment is likely to produce the most expressive behavior† (p.322). The intensity of facial expressions are measured at four (1=low, 2=medium, 3=high and; 4=very high). The low ratings often display mild expressions such as smile with slightly raised corner of the mouth and corners of the eye without displaying the teeth. Medium rating expresses moderate expressions. This is often displayed like half smiling and half laughing, with eyebrows slightly raised and lips apart, exposing teeth. High rating emotions are displayed such cry or laugh, with an open mouth, raised eyebrows and cheeks. Very high rating, display intense expressions when crying or laughing and lips are completely apart, teeth showing and cheeks substantially raised. Nonverbal Communication There are many ways a healthcare provider can look beyond what their patients are saying to what their patient’s body is telling them. Cooper (1979) gives several suggestions for what a healthcare provider can do to read some nonverbal clues that will help them better understand their patient’s pain. Cooper (1979) suggests that man y people talk without looking at the eyes of the other person, especially physicians; and this can suggest that one is not listening at all. Some patients, especially those in pain, have trouble articulating their feelings. Some signs that Cooper (1979) gives for a healthcare provider to look out for: Facial Clues In fear and pain the eyes open wide with the lower lid tensed. The eyebrows rise in a straight line and the mouth opens with the lips tense and drawn back In sadness the eyes look downward with the lower lid raised Cooper (1979) continues on stating that a person’s attempt to control their facial expressions, their nonverbal behaviors, gives away the fact that they are in pain and not able to tell their physician everything. Use of non-Verbal Communication Clinical spectrum of typhoid is broad, ranging from diarrhea, which may be fatal in a shorter incubation period of 48 hours or longer periods of up to 3 months, with an abrupt offset of headache, diarrhea and vomiting. The symptoms are often as a result of loss of large volumes of isotonic fluid. Simple Explanation Not all people who get typhoid look equally sick. Some patients may portray minor symptoms, while others look very ill. While looking at a patient, healthcare provider should be able to identify these symptoms from facial expressions by distinguishes between judgmental facial expressions such as anger or happiness and those made about behavior. In this regard, proper training of facial coding aligned with a dimensional model of emotions should be encouraged in health professional along with spending more time with their patients to distinguish between their facial features. Some symptoms such as diarrhea may be omitted by a patient since many may regard it as routine and unnecessary to mention it to the heath provider which may lead to misdiagnosis and improper treatment regimes. Therefore purposeful nonverbal communication and asking thoughtful questions is more likely to imp rove the relationship between healthcare providers and the patients. Use of nonverbal communication such as body gestures, positions and facial expressions to convey information requires full attention and minimal distraction from the service provider, as reciprocate of showing caring and empathy to the patient. It is proven that verbal communication builds relationship and enable people stay together longer. A patient may also gain a lot of knowledge about themselves that may improve interpersonal relationships. Talking to the healthcare provider about your health concerns, how you feel about yourself and how you feel about life, helps a patient heal and accept their condition. Self disclosure puts someone in a position to see who they really are and binds people together. In addition, every person has their own beliefs, and they are able to reconcile their disagreements with a person they feel close to. Someone may feel unaccepted, your feelings may be hurt and you may feel your r elationship is threatened. To this reason, people need to make their feelings known by revealing and exposing themselves. Often, people who can not express themselves or rather shy individuals experience great anxiety in trying to express themselves. Conclusively, communication is a complex and challenging process but is still absolutely essential asset for communication and building relationships. One progressively move from being a stranger to being close friends with healthcare providers is essential in improving patient’s health. People may often feel that disclosing to much information may turn people away. They also have the perception that disclosing premature information to early, their intentions may be misread as an invasion and some may see it as an attack. Patients often relate their past experiences of telling people very sensitive issues may lead to unfavorable impressions. One patient explained that a person may use information disclosed to them against the ind ividual and we often take risks by sharing personal information with healthcare providers since information shared in a healthcare setting can not be used against them or for blackmail purposes. Therefore, while self disclosure can be useful in helping patients relieve stress, patients should be educated on the importance of disclosing all their health issues and concerns, how to express their pain using facial expressions and the ability of healthcare providers to keep this information confidential (Donabedian 1988; Mechanic, 1998). In â€Å"Healthcare and Listening: A relationship for Caring† by Brannigan et al, (2008) begin with the statement that the â€Å"optimal relationship between healthcare provider and patient is one of trust† (p.168). The authors continue on to explain that this trust relationship cannot exist without effective communication between the doctor and the patient. Research is also found to support that effective communication practices are key i n patient compliance with medical regimens, patient satisfaction, as well as decreasing malpractice lawsuits is found (Morlion et al, 2008). If the goal of healthcare is what Brannigan et al, 2008) states as one that â€Å"†¦. prevents illness and injury, and help patients and their families manage medical conditions through counseling, medicine and therapeutic interventions† (p.168). Patients must trust their healthcare providers with sensitive, possibly life-threatening or life altering, information. It is physician’s responsibility to use limited time that they have with the patient to listen and guide the conversation to get to, potentially, the most important information so that a correct diagnosis can be made. Communication becomes the most important element in the patient/doctor relationship (Eggly and Tzelepis, 2001) A providers’ nonverbal behavior may provide subtle yet powerful messages concerning their perceived efficacy of pain management (Frant sve and Kerns, 2007). They continue that patients may respond to such unintentional â€Å"demand characteristics† that physicians may show; especially those patients who are in pain. The research points out that within the last few decades the relationship between patient and physician has evolved from a parental relationship into a partnership (Eggly and Telesis, 2001). To address this shift, national medical organizations such as the â€Å"Accreditation Council for Graduate Medical Education† has put an emphasis on training physicians in more effective communication. Methodology The design for the research study uses questionnaire posted over the internet to obtain raw data about listening skills facing young, middle and old aged patients and healthcare providers. Quantitative survey technique comprising of participant observation, and quantitative methods of randomly selecting participants were utilized because they were considered appropriate to the cultural and la nguage differences that exists. This research was designed in the quantitative genre of data collection as I believe this approach will allow us to obtain a more comprehensive understanding of health issues surrounding the selected group. Our research methodology of using questionnaire helped us gain better understanding on the complexities of social, economic and cultural factors impacting on them. Quantitative approaches were believed to be appropriate as they are likely to yield more honest opinions in obtaining in-depth understanding of the meanings and events by obtaining raw data from participants. The participants were 108 comprising both male and female who ranged in age 18-60 years and were part of the large study of ability to recognize facial expressions. Target Population Target population consists of both male and female of ages 18 to 60. These samples group is aimed at educating the public, patients and healthcare providers (nurses, General practitioners and physiother apists) dealing with patients with chronic pain on how to recognize facial expressions. Participants were also selected with regards to; recent history of pain, structural deformity, thoracic pain, systematic unwell and constant progressive, non mechanical pain (chronic pain). While the focus of this study was on adults alone, a participant of below 15 years was also included to obtain a holistic view of a Lay† person could do WELL in distinguishing facial expressions. The sampling techniques were randomized sampling (Polgar Thomas, 2008), requesting participants to rate facial expressions and selecting samples to use in the study (Grove, 2007). Instrument Pain scale seems like the most appropriate instruments a physician could use to assess patient’s pain. It is performed by having patients rate their pain on a scale of 1(being no pain) to 10 (being of severe pain) as demonstrated in the graphic rating scale in Appendices A. Pain Scales Pain scale instrument is common ly used by Healthcare Providers to assess patient’s pain. Brannigan and his colleagues (2008) article on ‘Healthcare and Listening’ stated that â€Å"the optimal relationship between the healthcare provider and the patient is one of trust† (p.170). It can not be assumed that effective communication always occurs naturally. Acquiring effective interpersonal relationship between the service provider and the patient requires observation practice and interpersonal listening skills. This responsibility lies heavily on the healthcare provider. Their primary attribute to providing effective care requires being emphatic listeners as a strategy to understand patient’s nonverbal communication and take the time to observe their communication patterns. Common problems often experienced in providing effective communication to patients is lack of empathy and understanding of nonverbal signals and communication apprehension on the part of the patient (Bundy, 2001; McCroskey et al,1998). Testing and Evaluation First of all, pain face scale should be tested to check the ability of patients learn the basics of the program. For the testing, patients should be invited in the survey room where a healthcare provider explains theoretical material and track the way students accept the information from the pilot training program. Then, patients will be proposed to fulfill the assignment established by the program creators to check how they understand the facial expressions. Once the practical assignment is completed, patients should be offered to look through other options of the program. Finally, a healthcare provider should provide with other helpful ideas that might be helpful for patients when living at home. The evaluation of the results should be based on the validity and reliability verification. Project Location And Duration The project implementation will be conducted with the help of the hospital facilities for the project managers to accura tely test and evaluate the effectiveness of the pain scale instrument. More importantly, as face scale deals with exclusive evaluation of facial expressions, it has the correct training that can work out a consistent plan of publishing program implementation. The project results are planned to be delivered in three weeks, as the pain scale should be properly tested and evaluated. The operation will be defined into three stages. First, the department should study the main difficulties in handling pain scale that may appear among the patients dealing with this program. Second, the project team should conduct a research in the field and define what listening skills and technologies will fit best. This stage will take the most of the time allocated for the scheme. Finally, it is necessary to conduct pilot implementation in order to eliminate all possible drawbacks of the program. Data collection Participants were required to read the questionnaire carefully and select the picture of the facial expression such as happiness, pain, disgust, fear, anger and sadness that best described the picture provided. Below is a sample of the data collected over the internet. Respondent IP Address Response for facial Expression (Happiness, Fear, anger, sadness, surprise, pain, disgust Gender Ethnicity/Race Household Income Highest educational level Are you currently a student Specify education level Age -Happiness -Sadness -Anger Male White/Caucasian $40,000 – $59,999 Masters No 25-30 71.233.25.134 -Happiness -Sadness -anger Female White/Caucasian $40,000 – $59,999 Masters Yes 25-30 76.24.221.253 -Happiness -anger -disgust Female White/Caucasian $60,000 – $79,999 Bachelors Yes Masters 36-40 98.95.181.24 Happiness Female Asian $40,000 – $59,999 Masters Yes Masters 22-24 64.246.212.53 Happiness Sadness -Anger Female Black/African American $60,000 – $79,999 Bachelors No Masters 22-24 64.246.212.53 Happiness Sadness -Anger Female W hite/Caucasian $60,000 – $79,999 High School/GED Yes 31-35 208.139.7.64 Happiness -fear -disgust Female White/Caucasian Bachelors No Masters 22-24 75.66.190.118 Happiness -Sadness -Anger Female White/Caucasian $40,000 – $59,999 Bachelors Yes 25-30 189.216.62.1 Happiness -anger -disgust Female White/Caucasian $60,000 – $79,999 High School/GED Yes Bachelors 18-21 75.66.190.34 Happiness -anger -disgust Female White/Caucasian Less than $20,000 High School/GED No Bachelors 25-30 98.239.42.73 Happiness -anger -disgust White/Caucasian $60,000 – $79,999 Bachelors Yes 31-35 207.191.102.215 Happiness -anger -disgust Male White/Caucasian Less than $20,000 Masters PhD 51-55 64.246.212.1 Happiness -anger -disgust Female White/Caucasian Yes 41.239.2.108 Happiness -anger -disgust Female White/Caucasian Less than $20,000 Bachelors Yes Masters 25-30 64.246.212.1 Happiness -anger -disgust Male White/Caucasian Less than $20,000 Bachelors No Maste rs 25-30 178.25.46.77 Happiness -Sadness -Anger Female White/Caucasian $40,000 – $59,999 High School/GED No 31-35 72.20.142.52 Happiness -anger -disgust Female White/Caucasian $40,000 – $59,999 Bachelors No 31-35 74.192.193.253 Happiness -Sadness -Anger Female White/Caucasian $20,000 – $39,999 High School/GED Yes High School/GED 22-24 76.123.128.127 Happiness -anger -disgust Female White/Caucasian Less than $20,000 Associates No Bachelors 22-24 24.242.116.141 Happiness Female White/Caucasian $20,000 – $39,999 Bachelors Yes 25-30 125.231.225.17 Happiness -anger -disgust Female White/Caucasian Less than $20,000 Associates Yes Bachelors 22-24 98.237.151.59 Happiness -fear -disgust Female Asian Less than $20,000 High School/GED No Bachelors 22-24 24.20.195.208 Happiness -anger -disgust Female White/Caucasian Less than $20,000 Bachelors No 22-24 115.134.253.133 Happiness -anger -disgust Female Asian $60,000 – $79,999 High School/GE D No 41-45 114.78.184.77 Happiness -anger -disgust Male Asian $40,000 – $59,999 Bachelors Yes 22-24 99.145.161.1 Happiness -fear -disgust Female White/Caucasian $100,000 or more Bachelors No PhD 25-30 137.132.234.105 Happiness -Sadness -Anger Male White/Caucasian $80,000 – $99,999 Bachelors No 25-30 65.81.247.46 Happiness -anger -disgust Female White/Caucasian $20,000 – $39,999 High School/GED No 31-35 24.18.138.184 -Happiness -fear -disgust Female White/Caucasian $40,000 – $59,999 Masters Yes 25-30 174.32.39.60 Happiness -Sadness -Anger Female White/Caucasian $40,000 – $59,999 Masters Yes 25-30 75.192.145.56 Happiness -fear -disgust Female White/Caucasian $60,000 – $79,999 Bachelors Yes Masters 36-40 Limitations of the study There are many different pain scales used; however, it is the general consensus that none of them are an adequate source of determining ones â€Å"true† pain level. When pain levels are des cribed to medical professionals they are usually assigned meaning by using verbal descriptors such as â€Å"excruciating, unbearable, etc.† At times doctors give examples and patients are asked to choose from those descriptors such as the McGill Pain Questionnaire. While there are an abundance of appropriate words to describe pain they are not words we use. Therefore it is important that patients and physician’s come to a mutual understand and achieve shared meaning when communicating about pain (Faunce et al, 2006). Although pain is the most common medical complaint most patients seeking treatment for pain are not chronic pain patients. Chronic pain patients develop a pain vocabulary that is influenced by medical specialist treatment and by exposure to repeated pain assessment measures (GangHeong, 2000). When dealing with pain it is of vital importance that the provider and patient develop a â€Å"shared meaning† of pain descriptors since the medications that a re given to deal with pain are very potent and therefore it is important to get a correct diagnosis and for the patient to have a good relationship with their health care provider (Roberts and Bucksey, 2007). According to Butler and his colleagues (2009) both the VAS and VRS (in appendices) are based on the assumption that people have a â€Å"shared† meaning or understanding of pain and its descriptors. The results of this study did not support this, as hypothesized participants were personalized in their use of pain descriptors and presumably in their understanding of the word as well. Butler et al, (2009) have shown that a valid assessment for pain cannot be developed if people in pain do not have a shared perception of the dimension. Butler et al (2009) go on to state that caution should be used when relying on the use of word to convey pain intensity. Also words meant to describe only the most acute pain have little understanding when brought together with other pain asse ssments. When attempting to clarify pain levels in a medical setting more than just relying on VAS or VRS is needed. Butler and his colleagues (2009)continues to addresses the idea that language and pain are interrelated and that pain can be better understood by the understanding of the language. Since patients and doctors use different descriptors for pain it is difficult to reconcile the descriptors. Also, since the descriptors for the illness and pain given by the doctors are at times so grave the patient’s initial reaction is not a favorable one. Also it is found that since language descriptors for pain differ from person to person, it is difficult to assign a value to each descriptor. It is understood that pain caries from person to person so the terminology differs from person to person (GangHeong, 2000; Darmohray et al, 2008; Beckett et al, 2009). Pain face scales as well as other scales are still under scrutiny for their lack of patient interaction, the scale does not take into account the fact that pain is a very personable experience and must be treated as such (Crichton, 2001). Future Research and the required Changes in Healthcare According to Roberts and Bucksey (2007), there have been two significant social changes that have helped put emphasis on the importance of effective communication for healthcare providers: The first came in 1999 when the Institute of Medicine announced that medical mistakes are not unusual or isolated, rather that they happen everywhere and often. Also they concluded that these mistakes were not minor but deadly. They went on to say that the disclosed mistakes were only a small sampling handpicked to be given to the public, while the real bulk of the incidents were never disclosed to the general public. Healthcare providers were outrage to have to admit their mistakes and patients were fearful as safety became a national priority. After panels were put together to as quoted by Brannigan et al, (2008) to â€Å"set standards, address safety issues, and review medical errors; it became apparent from the research conducted that poor communication and concealing mistakes were two significant factors that ultimately led to legal recourse† (p.170). The second problem was the public’s loss of trust, high profile scandals by individuals or groups in power caused the public to be critical to those who were in a profession that was perceived as prestigious (Brannigan et al, 2008.) In recent years various medical organizations (such as the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education) have begun to emphasize improved training and demonstration of competence in communication skills. The nursing profession is also beginning to advocate good listening and communication as a quality needed to be a good nurse; skills which one must possess to demonstrate caring to a patient. The idea that listening is important to be a well rounded medical professional is not a new concept but it is just being framed as a skill and an expectation of a skill that all medical professionals should have the basic concept of(Bundy, 2001; Bennett et al, 2009). Brannigan et al,(2008) proceeds to say that methods to improve communication and effective listening on the part of the physician have been studied since the 70’s, however the early research focused mainly on the physician’s communication skills, medical skill training communication skills and how the physician performed in clinical encounters. As studies become more recent they include the elements of empathy, time, trust, malpractice, and patient satisfaction. The patient can benefit in positive ways from a healthcare provider who is an effective communicator such as the patient’s improvement in emotional health, functional status, and a change in physiological measures, particularly in patients with chronic conditions (Morlion et al, 2008). Considering the ris ks involved for both the patient and the physician the importance of effective, thorough, and willing communication and listening goes beyond just a â€Å"courtesy† and on to an ethical obligation (Castro-Lopes et al, 2008). Listening and the sensitivity associated with communication are required by both parties: from patients to provider and from provider to patient. This is an underdeveloped area of communication, according to McCroskey et al (1998), and needs to incorporate considerations of communication and listening is required. Recommendations Communication Apprehension and Healthcare In some cases, lack of good communication relationship between the healthcare provider/patient relationships relies on the patient. The patient can experience what is called Communication Apprehension also known as â€Å"CA†. CA is â€Å"an individual’s level of fear or anxiety associated with either real or anticipated communication with another person or person’sâ €  (McCroskey et al, 1998). This is the definition that has been used to describe people who have â€Å"CA†, people who are anxious about real or upcoming communication situations. It is clear that this anxiety or â€Å"discomfort† caused by the â€Å"CA† can cause very real physical effects to the person suffering from the ‘disorder’ (McCroskey et al, 1998). There are clear indicators if a person is â€Å"high CA†. A â€Å"High CA† when presented with a situation where they have to communicate will experience the fight or flight syndrome. These are the people that would rather die than speak in public. These types of people may even have problems with their speech or they may use a high amount of vocal pauses (uum, ya know, ahhh). Others may have a negative perception of these people because of their lack of communication skills. Because â€Å"more talk† is better in the United States, someone with High CA is likely to be co nsidered as a less attractive socially and may seem less desirable to be around just because of their unwillingness to speak up. These kinds of self-crown perceptions tend to affect the patient/doctor relationships. In some cases, people with high CA may still be apprehensive to speak up when in pain or in the presence of a Healthcare Providers (McCroskey et al, 1998). When the person is having trouble speaking up they can often leave out details that are important to a potential diagnosis or frustrate the physician leading to a breakdown in communication (Bundy, 2001). McCroskey et al (1998) revealed that trait CA had a small relationship with patient question asking and information seeking. Sate CA had a strong relationship with patient question asking and information seeking. In the health care environment High CA’s are going to ask fewer questions, start fewer conversations, and avoid communicating with their physician whenever possible. Because in other contexts High CAà ¢â‚¬â„¢s should have more state anxiety when communicating with someone of elevated status such as their physician five more research questions were formed to flesh out the patients fear of communicating with the doctor and the trait and state CA. A patients fear or anxiety related to communicating with their physician is consistent with the theory that patient apprehension can seriously interfere with the physician/patient communicative relationship and be associated with negative outcomes for the patient. There are many elements which factor into communicating with the physician, such as disconfirmation communication, language usage, controlling interaction, nonverbal communication, apprehension, trust, and willingness to discuss personal issues. Butler et al, (2009) found that â€Å"individuals, who are apprehensive about communicating with a particular person, do not normally initiate interactions with that person† (p.56). So if you are uncomfortable with your doctor you would not initiate a conversation with him/her about an intimate problem (Eggly and Tzelepis, 2001). The most effective way to treat chronic pain is through an ongoing, collaborative relationship with a primary care provider or pain specialist. According to Frantsve and Kerns (2007) giving providers communication training can lead to positive outcomes, including greater satisfaction ratings by individuals with chronic pain. Most patients indicated that they believed that their relationships with providers were better when their providers spend more time with them, at least twenty minutes or more, and displayed a greater amount of interest in their life and issues (Darmohray et al, 2008). McCroskey and his colleagues (1998) article on effective physician-patient communication identified four communication relationship to include; 1) engagement 2) empathy 3) education and 4) enlisting the patient in the doctor – patient relationship. They mention communication skills required b y doctors to include: 1) active listening 2) eliciting patients’ perspective on illness 3) decoding and responding to patient emotions 4) negotiating treatment plans more effectively It is clear that communication is a necessity in a good doctor-patient relationship. The process of communication requires encouraging two way dialogue and establishing partnership between two parties; the patient and the service provider-that creates an atmosphere of caring. This bridges the social gap between the provider and the patient, effectively uses verbal and non-verbal communication and creates a friendly atmosphere that allows a patient to tell his or her story and ask questions. Pain face scales should be personalized in relation to patient’s educational level and their ability to express their pain and treatment instructions. This can first start by asking a patient to recall or to repeat instructions given to them. This is one way of ensuring effective communication by enabli ng patients understand their health conditions and available treatment options (Curtin, 1987; DiMatteo, 1994; Hal 1988; Ong, 1995). The relationship between a patient and a client is one important way of ensuring healthcare providers communicate the outcomes of the patient’s illness. Important aspects to consider when determining communication inter-relationships are educational background, sex, age and ethnicity as earlier stated by McCroskey and his colleagues (1998). Others factors such as ample time allocated to patient-provider personal contact and privacy should also be considered when identifying characteristics that can improve communication relationships between the two parties. Also, service providers should improve practices in their own settings by adopting behaviors and techniques that could result to increased patient knowledge and effective communication. It is evidenced that establishing good relationship between healthcare provider and the patient creates an atmosphere of caring and bridges the gap between them. This means that facial expression should be personalized in accordance to the patient’s educational level and ability to understand the technical information. In this regard, patients and health providers should be able to 1).establish and maintain rapport and trust (care), 2). Diagnose communication and problem solving skills to determine diagnosis and treatment (solve) and; 3).counseling and education (education) (Fallowfield, 1998; Kopp,1989; Levinson, 1995; Roter Hall, 1991). The following table provides examples of responsibilities required from both service providers and patients in exchanging factual communication. Share facts Share feelings Service provider Communicate clearly and accurately on diagnosis and help patient apply the treatment to their own life Show care by understanding and respecting them Patient’s responsibility Clearly description health condition and ask questions where needed Be honest by expressing expectations and concerns Two-Way dialogue Both speak and listen without interruption. Both ask questions, exchange information and express opinions to fully understand the other party. Both relationships should be regarded as partnerships in which both parties strive to maximize the results. The patient should also realize that both parties are responsible for the outcome and their cooperation is highly required. Disclosing all required information from a patient to determine proper diagnosis and treatment is also of paramount. The service provider on the other hand should have the required skills that will enable him interpret and analyze information received effectively to explain the condition and treatment to the patient. Bias and Confounding The problems in collecting data over the internet were summarized as follows; communication issues in the around the world have not been adequately addressed, despite best efforts of number of researchers dedicated to the health and welfare issues of these people. The quality of the data collected here can not serve as conclusive, this is because a relative small portion of the population was used, and the research used different definitions for pain. There was also a problem in assessing remote indigenous population, hence compromising the results of the study (Valance, 2001, p.1). Therefore, little data collected here can not be relied on for future research. Since communication issues in respect of listening skills such as engagement, empathy, education and enlisting the patient in the doctor care are increasing at an alarming rate, Valance (2001) suggests that studying the problem more closely with the affected people of the relevant communities is likely to address the problem adequately. Validity of the Research This research conducted sought to answer the question, â€Å"Can pain faces be distinguished from other emotional expressions-such as happiness, disgust, fear, sadness, surpris ed and anger?† This research principle is founded on two principles; Patients people have different cultural and language background—which required the researcher to develop models of inquiry Any attempt to solve problems on middle-aged population will be done in partnership with the consent of the communities surrounding them. Quantitative research methodology used in this research provided a better chance of identifying the nature of the problem because the sampling strategies are better suited in dealing with small samples. It also equipped the researcher with considerable knowledge of the population to be studied contributing to the validity of the results. Internet questionnaire were well guided, informed and driven by personal experiences. Also, the time allocated before the study commenced helped the researcher gain more understanding of health problems facing the world at large. To ensure the middle aged and the old population are able to have a say, equal opp ortunity in the research study and design was responsive to the needs of the population under study. The need for ongoing health campaigns of the communication skills should be provided and extended to the community, schools and preschools. Health related promotional activities should be encouraged to minimize occurrence of pain complains. Results The systematic reviews were identified using the internet and survey monkey database. Pain scales used the grading was simple and easy to apply and showed a large degree of consistency between the grading of the patient that of the health provider, diagnosis and treatment. Patients of ages 51 to 60 of Caucasian, Black/African American decent and Asian origins with average income mostly identified the same facial expression with regards to happiness, sadness, surprise, anger, disgust, disgust and pain. Also, participants of ages 28 to 30 with high income responded well to nonverbal communication signs compared to those of below 15 years. A set of questions were drawn in English language to guide participants and to ensure consistent information was gathered. The iquestionnaire protocol covered the key information area (facial expressions), including opinions on intervention services of the same to uncover their thoughts, perceptions and feelings. The questions were structured in a culturally sensitive manner, using their own language to obtain raw data from participants. In a research sought to measure the occurrence facial expressions on day to day activities, as a strategy to identigy the service gaps regarding health issues within the healthcare profession. Conclusion It is clear that understanding and further research in listening skills knowledge will assist in the communication of pain descriptors and putting at ease the patient in the treatment of pain. What is most needed is for all those involved in Healthcare to understand the listening process as well as having a basic understanding of how to read nonverbal signals. Having this skills along with that of empathy, will empower the healthcare provider to offer a more complete treatment plan to those who they treat and will allow them to see those that are in pain more clearly. This research has provided a set of principles that should be used in the training course to improve listening skills. The three process of communication; caring, diagnosis and problem solving and education of patient-provider provide attention to the most important aspects of healthcare. These processes combined with proficiency in providing health services and appropriate diagnosis and treatment when effectively applied results to better outcomes for the two parties. Emphasizing listening skills, nonverbal aptitude, and empathy, is not a new attitude in the healthcare setting but as seen it is one that is still lacking emphasis. It is proven that verbal communication builds relationship and enable people stay together longer and improves interpersonal relationshi ps. Patients should be educated that by talking to healthcare providers about your health concerns, how they feel about yourself and how they feel about life, helps them heal and accept their condition. Self disclosure puts someone in a position to see who they really are. Healthcare providers should on the other hand learn and understand each patient’s beliefs and cultures. As the objective of this paper strives to improve listening skills and the facial exercises, references used here will provide opportunities to accomplish these goals. Healthcare providers have their own clinical language that requires use of technical words that enable them communicate to each other which may be complex when used with patients. In some instances patients can also speak in their own dialects and slang, which makes it difficult for a health provider to comprehend. But with a little training a Healthcare Provider could be able to distinguish distinguishes between two different types of judg ments; pain expressions and emotional expressions. References Baird,J., Fanciullo,M., Sorensen,A., Washington,T. (2008). Pain Medicine. American  Academy of Pain Medicine, 9(8), 994-1000 Beckett, M., Elliott, M., Richardson, A., Mangione-Smith, R. (2009). Outpatient satisfaction: the role of nominal versus perceived communication. Health  Services Research, 44(5 Pt 1), 1735-1749 Bennett, M., Briggs, M, Closs, S., Staples, V., Reid, I., (2009). The impact of neuropathic pain on relationships. Journal of Advanced Nursing, 65(2), 402-411. Brannigan, M., Davis, J., Foley, A., Crigger, N. (2008, August). Healthcare and Listening: A Relationship for Caring. International Journal of Listening, 22(2), 168-175 Bundy, C. (2001).When communication has gone wrong between a doctor and a patient. Diabetic Medicine, 186-7. Bundy, C. (2001).When communication has gone wrong between a doctor and a patient. Diabetic Medicine, 186-7. Butler, D., Wilson, D., Williams, M. (2009). Language and the pain experience.  Physiotherapy Research International, 14(1), 56-65. Cooper, J. (1979). Actions really do speak louder than words. Nursing, 9(4),1. Crichton, N. (2001). A critical review of visual analogue scales in the measurement of clinical phenomena. Research in Nursing and Health, 13, 227-236 Curtin, R. (1987). Patient-Provider Interaction: Strategies for patient compliance.  University of Wisconsin, 1, 1 Darwin, C. R. (1896). The expression of emotions in man and animals. New York: Appleton. DiMatteo, M. (1994). The physician-patient relationships: effects on the quality of healthcare. Clinical Obstetrics and Gynecology, 37(1), 149-61 Donabedian, A. (1988). The quality of care: How can it be assessed? Journal of the  American Medical Association, 260(12), 1743-48 Eggly, S., Tzelepis, A. (2001). Relational Control in Difficult Physician–Patient Encounters: Negotiating Treatment for Pain. Journal of Health Communication, 6(4), 323-333 Ekman, P. (1984). Expression and the nature of emotion. In K. R. Schere P. Ekman (Eds.), Approaches to emotions (pp. 319-343). Hillsdale, NJ: Erlbaum Ekman, P., Friesen, W. (1975). The Facial Action Coding System. Palo Alto, CA: Psychologists Press Fallowfield, L. (1998). Teaching senior oncologists communication skills: Results from Phase 1 of a comprehensive longitudinal program in the United Kingdom. Journal  of Clinical Oncology, 16(5), 1961-68 Faunce, G., Kenny, D., Trevorrow, T., Heard, R., (2006, November). Communicating pain: Do people share an understanding of the meaning of pain descriptors?  Australian Psychologist, 41(3), 213-218. Frantsve,E., Kerns, R. (2007). Patient–Provider Interactions in the Management of Chronic, Pain: Current Findings within the Context of Shared Medical Decision Making. Pain Medicine, 8(1), 25-35 Frischenschlager, O., Pucher, I. (2002). Psychological management of pain. Institute  of Medical Psychological, 24(8), 416-422 GangHeong, L. (2000). Dialogue, Narrat ive, and a Lived Body in Pain. Florida  Communication Journal, 27(1/2), 43-60. Gà ©linas, C., Fillion, L., Puntillo, K. (2009).Item selection and content validity of the Critical-Care Pain Observation Tool for non-verbal adults. Journal of Advanced Nursing, 65(1), 203-216. Grove, S.K. (2007). Statistics for health care research: A practical workbook. Edinburgh: Elsevier Saunders. In: Chapter 10. Understanding the Sampling Section of a Research Report: Sample Criteria, Sample Size, Refusal Rate, and Mortality. Edinburgh: Elsevier Saunders Gromala, D,. Shaw, C. (2004). Expressing the Immeasurable: A Methodology for Developing a Visualization Tool for Patients’ Assessments of Pain. Cleveland  Journal of Medicine, 70(2), 1 Hall, J. (1988). Meta-analysis of correlates of provider behavior in medical encounters.  Medical Care, 26(7), 657-75 Holmes, J., Gabbard, O., Beck,J. (2007). Oxford Textbook of Psychotherapy. London: Oxford University Press Kopp, Z. (1989). Implementin g a counseling training program to enhance quality of care in family planning programs in Ecuador. American Public Health Association Presentation Levinson, W. (1995). Physicians psychosocial beliefs correlate with patient communication skills. Journal of General Internal Medicine, 10(7), 375-79 McCosker, A. (2004). East Timor and the Politics of Bodily Pain: a Problematic Complicity. Continuum. Journal of Media Cultural Studies, 18(1), 63-79. McCroskey, J., Richmond, V., Heisel, A., Smith Jr., R. (1998).The Impact of Communication Apprehension and Fear of Talking with a Physician on Perceived Medical Outcomes. Communication Research Reports, 15(4), 344-353. Mechanic, D. (1998). Public trust and initiatives for new health care partnerships.  Milbank Quarterly, 76(2), 281-302 Morlion, B., Walch, H., Yihune, G., Vielvoye-Kerkmeer, A., de Jong, Z., Castro-Lopes, (2008). The Pain Associates’ International Network Initiative: a novel practical approach to the challenge of chron ic pain management in Europe. Pain Practice, 8(6), 473-480 Ong, L. (1995). Doctor-patient communication: A review of the literature. Social Science  and Medicine, 40(7), 903-18 Piderit, T. (1858). La Mimique et al physiognomie. Paris: Alcan. Polgar, S., Thomas, S. A. (2008). Introduction to research in the health sciences. (5th edition). Sydney: Churchill Livingstone (Elsevier). Punch K. (1998). Introduction to Social Research: Quantitative and Qualitative  Approaches. London, UK: Sage. Roberts, L., Bucksey, S. (2007). Communicating With Patients: What Happens in Practice? Physical Therapy, 87(5), 586-594 Roter, D., Hall, A. (1991). Health education theory: An application to the process of patient-provider communication. Health Education Research, 6(2), 185-93 Smith, M. (2008).Pain experience and the imagined researcher. Sociology of Health   Illness, 30(7), 992-1006. US Bureau of the Census. (1995). Sixty-five plus in the United States, Economics and Statistics Administratio n. US Department of Commerce, March, 1995. Vallance R. V. Tchacos E. (2001). Research: A Cultural Bridge. Presented at Australian Association for Research in Education (AARE) Dec.2nd –6 2001 Fremantle Walid, M., Donahue, S., Darmohray, D., Hyer, L., Robinson, J (2008). The Fifth Vital Sign — what does it mean? [corrected] [published erratum appears in PAIN PRACTICE 2009 May-Jun;9(3):245]. Pain Practice, 8(6), 417-422 This research paper on Listening Skills and Healthcare was written and submitted by user Taraji Michael to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Eating Disorders essay

Eating Disorders essay Eating Disorders essay Eating Disorders essay  Ã‚  Ã‚     Anorexia Intervention ProgramAnorexia is often connected with low self-esteem and wrong perception of person’s own body.Intervention steps:Giving the person information about the illness and making understand that there is a problem. For this purpose pictures and weight charts may be used in order to help the person to feel that her weight is much lower than the norm.Giving support. Overcoming anorexia is a hard work and it is necessary to find people who would support the person during the period of rehabilitation.Work with self-esteem. As mentioned above anorexia is often connected with low self-esteem and that is why different techniques for the correction of self-esteem should be applied.Discussing food and diet. Support in composing healthy and nutritious menu can be very helpful for the person with eating disorders. It may help to avoid many problems in the future.Planning physical exercises and leisure. Physical activity can be a g ood help for keeping fit and getting in terms with your own body. Training plan can be developed together with the specialist who is aware of the problem.     Bulimia   Intervention ProgramBulimia eating disorder is also connected with low self-esteem. In addition, the questions of self-control are also up to date when we speak about this disorder. The intervention plan will repeat the one suggested for Anorexia but with some changes.Intervention PlanAdmitting the problem. Giving the person facts which prove his/her disorder. Speaking about possible consequences.Giving support. Very often bulimia is connected with the feeling of gilt and fear of rejection. The promise of support from friends and relatives would contribute greatly to the solution of the problem.Dieting plan. Excessive eating should be replaced by a well-planed diet and this can be done with specialists’ help.Physical activity and active leisure. Professional help with composing a training plan can help t o control weight and prevent from consuming extra food.Finding a group of support. Friendly help and people’s support who have the same kind of disorder may be very useful in this situation.   If it is possible, it is necessary to help the person with the disorder to find such a group.

Conquering Everyday Dilemmas Of a Content Officer With Ann Handley

Conquering Everyday Dilemmas Of a Content Officer With Ann Handley How can you improve your content marketing? How can you take advantage of an opportunity to entice people? Every company has the typical branding and collateral, but goes above and beyond with a tower of donuts! Today, we’re talking to Ann Handley, award-winning content marketing expert and Chief Content Officer (CCO) for MarketingProfs. Ann shares how she organizes her team, what’s she focusing on for the company, and how she measures effectiveness and success. CCO: Person at a management level who manages content what a company sells and does MarketingProfs educates and trains marketers; helps them figure out how to use modern digital tools, tactics, and techniques Six Elements of Campaign Marketing: Strategy, plan, create, communicate, analyze, and management Identify whats important to marketers; always ask what does our audience need to know to be successful in marketing? Focus on the Future: Plan what needs to be done now to know what you will offer in the next six months Remote teams require knowing what everybodys working on and where things are at; MarketingProfs’ philosophy is â€Å"When in doubt, cc† Utilize project management tools; don’t buy helpful tools and then not use them Hire people who are able to work in your company’s environment and who value and crave the type of autonomy offered Metrics used to measure success depends on the content; review open rates, trends, and other indicators what metrics matter more holistically and broadly Ann redesigned and re-launched her Website because to align her personal and professional worlds Focus on your distribution strategy to make your content stand out; distribute conversational and helpful content via email to connect directly with people Links: Ann Handley MarketingProfs Everybody Writes MarketingProfs Campaign Framework Total Anarchy Newsletter Confab ClickZ Andy Crestodina Value vs. Vanity: Revealing Which Marketing Metrics Really Matter The Most What topics and guests should be on AMP? Send your suggestions! If you liked today’s show, please subscribe on iTunes to The Actionable Content Marketing Podcast! The podcast is also available on SoundCloud, Stitcher, and Google Play. Quotes by Ann Handley: â€Å"In my heart, Im really more of a storyteller. The idea of really crafting a story to connect with an audience really was my sweet spot.† â€Å"For me, its not about one particular metric. Its really getting a sense of the metrics that matter more holistically and more broadly.† â€Å"What does our audience need to know to be successful in marketing? Thats really the lens that we look through to identify what it is that we need to either develop or to promote.† â€Å"What am I all about? Im all about content.†

Explore the concept of accountability with regards to the registered Essay

Explore the concept of accountability with regards to the registered nurse having the responsibility of delegating care to suppo - Essay Example In this way, the burden of each and every activity in the hospital or any health care facility is not solely carried by few individuals but rather designated to many other individuals who have the appropriate knowledge and skill in performing hospital duties. Furthermore, errors committed in giving health care will be minimized if not avoided because of mastery of the skill to the tasks that has been designated to the assistants. In everything that has been done, it is the patient’s best interest that is taken into account. A patient has put the trust in our hands for us to deal and treat his disease, thus it is just necessary to return the trust and be their advocates in promoting their well-being. In this text, support workers are team members whom tasks are delegated to by the registered practitioners. Support workers may represent health care assistant, rehabilitation assistant or technician, therapy assistant, assistant practitioner or technical instructors. Registered pr actitioner on the other hand pertains to a registered professional who usually delegates the task i.e. the Health Professions Council (HPC) or the Nursing and Midwifery Council (NMC) (CSP, 2006). Discussion The health care practitioners are bound within the scope of both the criminal and civil courts so as to assure that what they are doing are within the limits of legal requirements especially since they are dealing with human life. Registered health care providers are responsible to their acts of health practice and patient care thus must conform to the conditions and terms set by the regulatory and professional bodies. Currently, heath support workers do not have professional registrations (Department of Health, 2004; Scottish Executive Health Department, 2004). When a registered health care provider has delegated tasks to a support worker, it is to note that the registered practitioner must understand the skill and knowledge needed to perform the delegated assignment. It is the registered health care provider’s responsibility to delegate a task and on the other hand, the support worker is responsible for taking the assigned job sand also for the actions he/she used for accomplishing the specific task. This principle applies when the support worker has sufficient knowledge, judgment, and skills in carrying out the delegated task given that the task is bounded within the standards and conduct set at the work place. Meanwhile, supervision and feedback regarding the task must be appropriately delivered by the registered professional (Mackey & Nancarrow, 2005). Delegation, Accountability and Responsibility Delegation is the process undertaken wherein a registered health practitioner distributes a task to a support worker who is believed to be capable in fulfilling the work. With delegation as basis, the support worker is trusted with the obligation for the task. In a stricter sense, delegation is different with assignment. In delegation of task, the supp ort worker is responsible for the task and the registered health practitioner is held accountable to the support worker. In assignment, both the responsibility and accountability for a specific task passes from one person

International Economics Essay Example | Topics and Well Written Essays - 4000 words

International Economics - Essay Example As a substitute, the United Nations supports the use of special drawing rights (SDRs), a creation of the International Monetary Fund (IMF) – a proposal supported by Russia (Bryanski, 2009). The SDR is the designated international reserve asset that is the unit of payment on IMF loans; it has an advantage over the US dollar in that its valuation is calibrated against a basked of currencies, rather than on the currency of a single country. Preferably, however, the UN recommends the establishment of a new reserve system that is not based on just one or even several currencies, but should instead serve the need for stable international liquidity. In response, several European officials expressed their disagreement, citing the market as the ultimate determinant of which currencies countries would hold in reserve. Several have voiced the concern that political or administrative decisions cannot reformulate the world’s currency system (Vayrynen, in Charbonneau, 2010), and in the entire post-war period the currency exchange system had been based on the U.S. dollar (Sundaram, in Charbonneau, 2010). EU officials fear that any intervention by an administrative body into the workings of the market would just create additional problems and would make things even less predictable (Piebalgs, in Charbonneau, 2010). Some simply reject the idea of an artificial currency as the SDR as the reserve currency of the international financial system, stating that it is a non-starter because it is created by political decision making (Al-Jasser, in Kessler, 2009). Based on this scenario, some sectors have voiced the possibility that the yuan (or renminbi), the currency of China, may in the span of a decade gain the status of reserve currency and present itself as a suitable alternative to replace the U.S. dollar. Supporters cite the relative stability of the Yuan during the recent financial crisis, saying that it is a better holder of value than the dollar. This

Measuring Respect Essay Example for Free

Measuring Respect Essay Campbell-Ewald, an award winning integrated communications agency, noticed that their customer relationship management (CRM) solutions were not meeting the expectations that they should. In order to gain an understanding of how respect influences customer loyalty and purchasing, they team up with a research company, Synovate and developed three different surveys. The surveys consisted of 27 to 29 attitudinal statements that customer use a 5-point scale to rate. They statements were designed to measure how the customers defined respect and how important respect was in determining a purchase. They selected more than 5,000 customers from each business sectors: insurance, automotive, and retail, and mailed them the survey to complete. The customers they selected to survey were adults at least 18 years of age (Cooper Schindler, 2011). Once they had received the completed surveys they analyzed the results. They then used the results to validate the relevance of its five â€Å"People Principles†. The five â€Å"People Principles† were: ? Appreciate me ?Intentions don’t matter; actions do ?Listen; then you’ll know what I said. ?It’s about me, not about you. ?Admit it- you goofed! These five â€Å"People Principles† have helped companies like General Motors, Continental Airlines, and Farmers Insurance incorporate respectful behaviors into their business operations (Cooper Schindler, 2011). When Campbell-Ewald and Synovate developed the surveys they knew that they needed to address respect from all areas such as how a customer ranks respect to loyalty, respect to purchases, respect to continue purchases, and respect to referrals. By gaining a complete overview on how a customer reviews respect then they could develop the five â€Å"People Principles† that their clients could use to improve customer service, increase revenue, gain a competitive advantage, and build a thriving business. Campbell-Ewald knew that their research, findings, and developments would be what would make them successful. By using the numerical scale survey they were placing the same standards on all statements, which make the evaluation process easier. When conducting a survey, the more customers you select to survey will increase the number of responses that a research company will receive back. It is not likely that all 5000 customers responded but I am sure well over 50 percent responded, which gave them a diverse poll of responses. Whereas, if they had chose to survey only 100 customers then they may have received only 30 responses, which is not enough when conducting such research. Using the numerical scale makes tally and measuring the result easier, which will make the comparison easier. Also, by using the numerical scale a research firm eliminates the opportunity for researchers to be swayed by a person comments or opinions, a person either agrees or does not agree with no explanation.