Communication skills are vital within a nurses role

Communication skills are vital within a nurses role Communication is natural to most people. We learn to communicate from birth and it is something that most people do without being aware of it. Communication is simply the name for expressing, sharing and understanding information. To examine a model of communication, for example, Shannon and Weavers model of communication (Brooker and Waugh, 2007) there are three components to successful communication. The first part is the sender. This is the source of the information which is to be shared. It could be a person talking, a radio or a newspaper or book. The next part of the model is the message. This is the information itself. It could be words spoken by the person or words from the book or newspaper. The last stage is the receiver. This is the person who is receiving the message. That would be the person listening to the words of another, the person hearing the radio or the person reading the book or newspaper. Communication can be separated into two categories, verbal communication and non-verbal communication. Knapp et al (2010) defines Non-verbal communication as communication without the use of words. Non- verbal communication can include body language, touch and gesture. Non-verbal communication can be more influential than verbal communication (Argyle, 1988 cited in Chambers, 2003) Verbal communication is achieved through the use of spoken or written language. Scammell (1990) states that its purpose include: to instruct, to teach, to educate, to express feelings and emotions, to help or seek help. Although there are two separate categories, both are used together in everyday life by most people without thinking. In this explanation, communication sounds very straight forward but the barriers to communication can be very complex, this is especially relevant in people who have had a stroke as will be explored later in this text. The nurse has a vital role in caring for the patient who has had a stroke. It is within the nurses role to assess, plan, implement and evaluate a personalised care plan for the patient (Brooker Nicol 2003 cited in Brooker and Waugh, 2007). Although the nurse will be assessing the patient holistically, they must also ensure they realise the importance of communication in the patients recovery. It is fundamental the nurse understands and expects the communication problems that the patient may encounter. It is also essential that the nurse can communicate effectively with other members of the multi disciplinary team to ensure that patient receives high quality evidence based care. The nurse must also communicate well with the relatives of the patient as they may not fully understand what to expect in the recovery process (Glass Maddox 1992). The Nursing and Midwifery Council (2008) have clear guidelines on the responsibility of the nurse to communicate effectively with patients in their care. The nurse has a duty of care to meet the patients communication and language needs. The nurse should use evidence based practice and research to decipher effective communication strategies for each patient, trying to get to know the patient as an individual and documenting successful communication techniques. The nurse may also refer to the patients relatives to gain knowledge of communication strategies which work already. The nurse must have a sound knowledge of the pathophysiology of a stroke to understand how to communicate; this is explored in the next paragraph. Firstly, to understand the communication problems that a patient who has suffered a stroke encounters, how a stroke manifests must be understood. According to the World Health Organization (WHO) statistics, 15 million people will have a stroke on an annual basis (WHO, 2004 cited in Ross, 2009) the correct medical terminology for a stroke is a cerebral vascular accident (CVA). A stroke usually happens when an artery within the brain becomes blocked thus leading to the death of cells which have had their blood supply cut off (Chang et al, 2006a). The term for cell death, in this way, is infarction. Another reason for a stroke is when there is a haemorrhage within the brain, or an artery bursts also resulting in cell death. If the blood supply is cut off then the cells dies and this can cause serious damage to important areas of the brain (Chang et al, 2006b). Different areas of the brain control different aspects of the body and depending on where the stroke has taken place can affect how the patient recovers. The patient who has suffered a stroke may have very serious communication difficulties after the stroke. For most people, the language centre of the brain is in the left hemisphere, although a small amount of left handed people may have their language centre on the right hemisphere. If the stroke happens within this area and there is damage then the person can suffer language problems (Horton, 2001). This is called Aphasia. Aphasia can prove to be a very complex barrier in communication. Aphasia can alter the way they communicate, from speaking and pronouncing words, having correct grammar to understanding words (Bannister, 1992 cited in Clarkson, 2010). Aphasia can also disrupt the patients ability to write and read. When a patient suffers a stroke they may be left with aphasia. The patient may not be able to adequately understand language or express language (Clarkson, 2010). A patient with a stroke can be left unable to even recognise simple words or instructions. This can be very infuriating for the patient as they may not be able to express their needs or preferences. The nurse may also find it hard to assess what the patients needs are which could effectively slow recovery. Communication strategies are essential in the plan of care for the patient who has had a stroke, as will be discussed in the next paragraph. There are many communication strategies which have been implemented within a clinical setting to overcome barriers in communication. The nurse must strive to increase the patients confidence when communicating ensuring that the patient has opportunity to make decisions about their care. Alternative and Augmentative communication systems can be put in place to assist with communication (Glennen DeCoste, 1996a). One of these methods is the use of picture cards. Picture cards are used to give the patient the opportunity to express a fundamental need (Speakability.org.uk, 2010). These picture cards can be of varying size but are usually about A4 size. They contain pictures of basic items and usually a phrase accompanying the item, e.g. a pair of spectacles and a phrase stating I need my glasses. The cards are accessible to the patient so it means that they can express needs without speaking. The nurse can quickly decipher what the patient needs and can deliver the care quickly and effectively. Although picture cards may be effective, they can be reinforced by gesture or mime. The patient may use a cup to signal the fact that they are thirsty. This could also be reversed with the nurse holding the cup to ask the patient if they are thirsty. The use of a medical passport has also become more common within clinical area. This consists of a booklet which is usually passport size, which is full of pictures and phrases, like the picture cards (Speakability.org.uk, 2010). This may have pictures of things like a clock and the phrase How long will I have to wait? This means the patient can maintain control over their healthcare and also be more involved in decisions and treatment options. The picture cards and the medical passport are a non-verbal way of the patient communicating wit h the nurse or even family members (Glennen and DeCoste, 1996b). However in order to obtain these responses from the patient, the nurse may have to use a different communication strategy such as questioning. Referring back to the communication model from earlier, the nurse must understand that although it seems very straight forward, it is altered completely in a stroke patient. The patient may be trying to send a message but be unable to find the correct words or grammar to express themselves (Clarkson, 2010). The patient may also have difficulty understanding the message so although the words are correct, they may be unrecognisable to a stroke patient. The nurse could use a verbal form of communication to encourage the patient to, for example, use the picture cards or medical passport. The nurse could use questioning as a tool to assess needs and deliver appropriate care. The nurse must assess the type of questioning needed in certain situations, e.g. if there is important information needed quickly then the nurse could use closed questions to ascertain a yes or no response. Closed questioning may also be useful in stroke patients as an open question may be difficult to answer because of the aphasia. It is important to add that sometimes people with aphasia can say yes when they mean no and vice versa (Clarkson, 2010) so the nurse could summarize what the patient wants, by repeating back to them verbally, just to clarify the correct information has been communicated. The nurse must communicate with clarity, avoiding medical jargon or eloquent grammar, using clear and concise language which is not too complex. Nurses are often seen by the patient as their link to understanding the medical jargon which doctors may use (Castledine, 2002). When relaying information, the nurse must simplify the language so that the patient has a better understanding of the definition, this is especially relevant to patients who have had a stroke due to nature of this condition. Simple language may even be difficult for the patient to understand, so the nurse must relay the information in a simple format, always clarifying that the patient has understood what is being said. In conclusion, this essay has explained the importance of the nurse understanding what communication actually is and why it is relevant in patients who have had a stroke. This text has explored how a stroke manifests and what barriers a stroke patient may encounter when trying to communicate. In summary, it is evident that there are many different ways to communicate with a patient who has had a stroke but it is the nurses responsibility to ensure that they research and build rapport with the individual patient to effectively communicate in the easiest manner. The nurse has legal obligations to meet communication and language needs of the patient. This essay explored two specific strategies used in communicating with patients with aphasia. This essay concludes that communication barriers can be complex and the nurse must ensure that care is delivered in a person-centered, individual, holistic basis. Word Count: 1921 .

Transformation of Nora in Henrik Isbens A Dolls House Essay -- Henri

Transformation of Nora in Henrik Isben's A Doll's House During the time in which Henrik Isben's play, A Doll?s House, took place society frowned upon women asserting themselves. Women were supposed to play a role in which they supported their husbands, took care of their children, and made sure everything was perfect around the house. Nora is portrayed as a doll throughout the play until she realizes the truth about the world she lives in, and cuts herself free. Nora Helmer was a delicate character that had been pampered all of her life, by her father, and by Torvald. She really didn't have a care in the world. She didn't even have to care for the children; the maid would usually take care of that. In every sense of the word, she was your typical housewife. Nora never left the house, mostly because her husband was afraid of the way people would talk. It really wasn't her fault she was the way she was; it was mostly Torvald's for spoiling her. Nora relies on Torvald for everything, from movements to thoughts, much like a puppet that is dependent on its puppet master for all of its actions. Her carefree spirit and somewhat childish manners are shown throughout the play with statements such as, "Is that my little lark twittering out there?" (1). "Is it my little squirrel bustling about?" (2). A lark is a happy, carefree bird, and a squirrel is quite the opposite. If you are to squirrel away something, you were hiding or storing it, kind of like what Nora was doing with her bag of macaroons. It seems childish that Nora must hide things such as macaroons from her husband, but if she didn't and he found out, she would be deceiving him and going against his wishes which would be socially wrong. As the play goes on, Nora seems to transform from her delicate little character into something much more. At the end of act one, Krogstad goes to Nora for the recollection of the money she had borrowed from him. "You don?t mean that you will tell my husband that I owe you money?" (21). Since Nora was wrong in doing so socially, she could not tell Torvald or anyone else about her problem. Not only would that affect their social standard but also Torvald's ego, which inevitably would happen anyway. After Krogstad threatens to expose Nora for forging her father's signature, she realizes that no matter what she does Torvald was going to know the truth. The flaw with... ...ying in a marriage since divorce was frowned upon during that era. Her decision was a succession for all expectations put on a woman and wife by society. The story A Doll?s House is believable. It stands for every marriage where equality never took place. Many women knew their social status and lived as they were meant to, but for the few that realized there was more to the world then the sheltered life they were living, broke free. Nora was one of the women who knew her place and acted accordingly until she saw that her name had no real value. She was not looked at as an individual, but she was seen as her father's daughter or her husband's wife. The turning point for her decision to break free from this world and start her own life is very believable. She comes to see that her marriage isn't real. Nora no longer loves her husband and knows that he does not truly love her as well. She knows that there is so much more to discover in the world to understand, and until she does she will not allow another man to control her life. Works Cited: Ibsen, Henrik. A Doll's House. In Four Major Plays. Trans. James McFarlane and Jens Arup. Oxford: Oxford University Press, 1981.

Case Analysis Questions on Leadership Online (a): Barnes & Noble vs. Amazon.Com

Q1: Summarize Barnes & Noble’s business strategy and business model based in the case descriptions. How have these strategy and business model been evolved since the case was written? Barnes & Noble’s business model simply put was lower cost, and SCM. They sold merchandise at lower cost and they also decreased cost associated with procurement by obtaining better discounts from publishers than other book retailers and by publishing certain titles themselves. Since Barnes & Noble’s held a huge portion of the market share they were able to leverage scales of economies when it came to reducing costs. Lastly, they were able to achieve reduced inventory cost through the business perks provided to them such as longer payment terms and access to books in short supply. Barnes & Noble’s business strategy was to use economies of scale and economies of scope. They used economies of scale through procurement and logistics. Since they were able to get bigger discounts from publishers they were able to produce more revenue when selling merchandise. As far as economies of scope is concerned one can clearly see that Barnes & Noble’s implemented this because they offered other services and they acquired other companies as well as certain percentage stakes in them. They acquired a mail-order book business, a membership club, and a 20% stake in Canada’s largest book retailer to try and broaden their scope. I think one can argue that Barnes & Noble’s business strategy and business model in theory hasn’t changed (I. e. that they use economies of scale still) that they just added new products or services; however, I‘ll make the argument that both has changed. Barnes & Noble realized how big the virtual storefront became so not only did they try to create an on-line presence they also created the nook an e-reader device. They self-manufacture this product along with a couple other devices and currently sell them in their stores. They are aggressive in trying to obtain portions of market share in the virtual book retailing industry. Also in June 2011 consumer reports stated that the nook beat the kindle (amazon e-reader device) by one point. So it is apparent that Barnes & Noble is changing their business strategy and model we’ll just have to wait and see how successful they are. Q2: Summarize Amazon. com’s business strategy and business model based in the case descriptions. How have these strategy and business model been evolved since the case was written? The case describes Amazon. com’s business model as â€Å"sell all, carry few†. What that means is that Amazon will make money though SCM and though reduced cost. Amazon was able to achieve reduced or low inventory cost by only carrying a few select titles in their own warehouse in Seattle while offering over one million titles though publishers and wholesalers. Their business strategy revolved around virtual economies of scale. Amazon was able to sell a lot of books at lowers prices by leveraging their buying power with publishers and wholesalers. Amazon. com’s business strategy and business model have expanded a bit. As far as business strategy is concerned amazon is now offering a variety of services and products such as cloud services and other products that aren’t books. Amazon also just implemented a trade in service were you can trade cell phones, video games, and other electronics and books for an Amazon gift card. So this will put them under implementing economies of scope. Their business model is following the same path as there are making money from their new services and by leveraging their buying power with other non-book products. One can also argue that they followed the one of a kind business strategy by offering products through a virtual storefront as opposed to the traditional brinks and motor. Q3: In your opinion, how well did Barnes & Noble counter the moves that Amazon. com had made (up to when the case was written)? How about now? How is Barnes & Noble doing vis-a-vis Amazon. com? I think Barnes & Noble did very well in countering Amazon. com’s moves. They created College Bookstores, a student oriented on-line book site. They also launched a new transaction system as well as launch their own web-site and make a deal with AOL. They also embarked on other system develop projects and marketing ventures. However, even though Barnes & Noble made good stride I don’t believe many of their ideas were successful. Jump into 2012 Barnes & Noble is still competing with Amazon. om and I think they’re doing ok but Amazon. com is playing chess with them and using economies of scope to capitalize on other opportunities. As I mentioned earlier a June 2011 consumer reports stated that the nook (Barnes & Noble) beat the kindle (amazon e-reader device) by one point. As far as overall health of the two companies is concerned I created a bar chart below to depict important factors off of their balance sheets. T he information is current as of Sep. 2011. According to the two balance sheets it seems that Amazon is doing a lot better than Barnes and Noble. If I had to make a prediction I would put my money with Barnes and Noble. Also please note that Table one figures represents millions. Q4: Based on the case and your own research, how do you characterize the competition in the bookselling industry in 2000 and 2011? Applying the Porter’s Five-Force model, which forces are impacting most on the profitability of firms? The competition in the book selling industry is slowly increasing with new entrants and substitute products coming into the market. I would characterize the competition as increasing and becoming more dynamic as book retailers are using the economies of scope strategy to look for new streams of revenue. Applying Porter’s five-force model to the book retailing industry, there are two or three of them that are having the most impact on the book retailing industry. First, is threat of new entrants. Over the past few years there have been a couple of noticeable new entrants in the market, for instance Bilbo, half. com, and AbeBooks just to mention a few. These new entrants are fighting for a piece of the market share, thus likely taking market share from the major players such as Amazon and Barnes & Noble. There also an increasing market with e-books or electronic books. This would fall under threat of substitute products or services in Porter’s five-force model. People are increasingly adapting to using e-books. There are also specific devices such as the kindle and nook that facilitate their usage. Even DePaul University is adopting such technology with their e-book program (books 24Ãâ€"7 and others). I don’t believe the buyers and suppliers parts of the model are having a huge impact because I would imagine that the company with the biggest market share would still have the most bargaining power when negotiating with the two; however, the entrance of e-books does add a dynamic aspect to the SCM part of the industry. I fi would venture to guess I would say that Barnes & Nobles will eventually go out of business unless business and that Amazon. com will survive as they pursue economies of scale by offering cloud services along with other potential revenue generators.

What Is Marginal Revenue in Microeconomics

In microeconomics, marginal revenue is the increase in gross revenue a company gains by producing one additional unit of a good or one additional unit of output. Marginal revenue can also be defined as the gross revenue generated from the last unit sold. Marginal Revenue in Perfectly Competitive Markets In a perfectly competitive market, or one in which no firm is large enough to hold the market power to set price of a good,  if a business were to sell a mass-produced good and sells all of its goods at market price, then the marginal revenue would simply be equivalent to the market price. But because the conditions required for perfect competition, there are relatively few, if any, perfectly competitive markets in existence. For a highly specialized, low output industry, however, the concept of marginal revenue becomes more complex as a firms output will affect the market price. That is to say in such an industry, the market price will decrease with higher production and increase with lower production. Lets take a look at a simple example. How to Calculate Marginal Revenue Marginal revenue is calculated by dividing the change in total revenue by the change in production output quantity or the change in quantity sold. Take, for example, a hockey stick manufacturer. The manufacturer will have no revenue when it doesnt produce any output or hockey sticks for a total revenue of $0. Assume that the manufacturer sells its first unit for $25. This brings marginal revenue to $25 as the total revenue ($25) divided by the quantity sold (1) is $25. But lets say the firm must lower its price to increase sales. So the company sells a second unit for $15. The marginal revenue gained by producing that second hockey stick is $10 because the change in total revenue ($25-$15) divided by the change in quantity sold (1) is $10. In this case, the marginal revenue gained will be less than the price the company was able to charge for the additional unit as the price reduction reduced unit revenue. Another way to think of marginal revenue in this example is that the marginal revenue is the price the company received for the additional unit less the revenue lost by reducing the price on the units that had been sold prior to the price reduction. Marginal revenue follows the law of diminishing returns, which holds that in all production processes, adding one more production factor while holding all other production factors constant will eventually generate lower per-unit returns due to inputs being used less efficiently.