New Public Management Essay Example For Students

New Public Management Essay INTRODUCTIONPublic sector reforms adopted in a number of countries such as USA, UK and New Zealand in the last fifteen years and characterised by efficiency units, performance management, contracting out, market type mechanisms, and agency status have come to be known as the New Public Management or NPM. Appearance of the NPM as shifting the paradigm from the old traditional model of administration has been promoted by a remarkable degree of consensus among the political leadership of various countries and is presented today as the major tool for public sector management reforms. The elements of NPM have been implemented in diverse forms in different countries depending on their historical nature of bureaucracy and public sector management and reform objectives. For instance, more emphasis was given to performance management in Scandinavian countries, while a stronger accent was on market type mechanisms, contractualisation of the public service and systematic approaches to improving service quality in New Zealand, the UK and the USA. The long-term benefits from these reforms have not been empirically validated. Nevertheless, the major donors are agreed that what developing countries must do to improve public sector management is to sweep away the traditional public administration paradigm that underpins their bureaucracies and introduce the new public management (Turner and Hulme 1997: 230). Mongolia has not escaped from this trend. The Government of Mongolia is preparing to introduce public administration reforms based on the New Zealand experience of contract relationship between resources used and outputs purchased. However, there is a question mark about Mongolias capacity to implement such reforms and wether they meet current needs. Therefore, assuming that the concepts of NPM are quite familiar, attempts have been made to asses the Mongolian situation against prescriptions of the New Zealand model of Public Sector Reform, particularly in relation with the countrys transitional circumstances. THE NEW ZEALAND MODEL OF PUBLIC MANAGEMENTThe proponents of the New Public Management have often identified New Zealand as a good example of this contemporary mode of administrative reform called NPM. New Zealand has implemented an enormous number and range of management reforms since 1988. These include accrual basis accounting and appropriations. Budgeting for outputs rather than inputs, separation of service delivery functions from advisory and regulatory functions, replacing permanent department heads with chief executives appointed for a fixed term, discretion for managers to spend their operating budgets as they deem fit, individual employment contracts for most senior managers, annual purchase agreements between ministers and their departments, annual reports, and audited financial and performance statements (Schick 1998:2). Every element of reform has been designed to establish or strengthen contract-like relationship between the government and ministers as purchasers of goods and services, and departments and other entities as suppliers. This ?new contractualism replaced the relational contracts that characterise traditional public administration (Schick 1998:3). Managerial reform is based on a simple principle: managers cannot be held responsible for results unless they have freedom to act, that is, to spend and hire within agreed budgets as they see fit, to make their own choices concerning office accommodation and other purchases, and to run their organisation free from ex ante control by outsiders. The New Zealand experience shows how effective management practices in the private sector can be brought into a public sector environment and adapted. The change was driven by ideas that have only recently entered mainstream economics and they have been applied with full fidelity to their internal logic. Although one can justify that the country has vastly enlarged the stockpile of public management ideas and practices, however, there remain concerns related to contract-like arrangements in the public sector and there is much more to be accomplished before a final assessment can be made (Schick 1998:4). TRANSITIONAL FEATURES OF PUBLIC ADMINISTRATION IN MONGOLIAAfter the collapse of the socialist block, radical political and economic changes occurred in most former socialist countries. According to Hesse (1993) the former socialist countries have a number of common characteristics, such as:? a transition from one party rule to a multi-party, pluralist system with democratic and accountable government;? the deconcentration and decentralisation of political power;? the creation of distinct spheres of economics and politics; and,? economic liberalisation. No socialist country has yet completed the full process of economic liberalisation. This is mainly because the task of transforming a former socialist economy is significantly more complicated than the issues facing a typical developing country. In many cases even rudimentary institutions that can be easily converted to market concepts and terminology. The process can be characterised not simply by a transition to a new economic system but also as a fundamental transformation of the whole society and all of its institutions in line with the market philosophy. Earlier literatures on civil service reforms in developing countries indicate that strategically administrative reform was successful, when it was implemented as part of the main economic and political change. There was less chance of its success, when it was undertaken on its own as a separate activity. Unfortunately those who are involved in the design of main economic and political change strategies underestimate the fact that administrative change needs to be undertaken before or together with economic and political change. It is often assumed that there is no political support and not adequate financial and technical resources to undertake public administration reforms. As a result public administration lags behind other sectors and is often criticised for being an obstacle to reforms in other sectors. This characterises the current situation in Mongolia. Despite the profound political and socio-economical changes, which have taken place in Mongolia since 1990, public administration remained the same until recently. The organisation and activities of all levels of the former public management institutions were no longer appropriate for attaining the goals of the reforms in all spheres of economic and political life. This finds its expression in the weakening of the prestige of all state institutions, their inefficient and non-operational activities, and also the ineffectiveness of Mongolian legislation and decisions of public and management institutions. Socrates oresteia EssaySUITABILITY OF THE NEW ZEALAND MODEL FOR MONGOLIAThe reasons explaining why the Government wants such a radical approach to public administration reform in the country are quite clear. The previous administrative reforms did not bring significant improvements in the public sector management and were limited by a number of structural changes in state institutions. Although there were the first attempts by the Government to separate policy coordination, regulatory and implementing functions, the question of whether the structures and functions of recently established agencies are appropriately designed to ensure efficiency and effectiveness of government operations has not been clear. At the same time, the demand for accelerating public reform with the aim to improve overall efficiency has been increased by the pressures from donor organisations. However, it should be noted that there is not sufficient justification and factual arguments developed by both the advocates and the opponents for why the country should not adopt the New Zealand model. Before making a final decision the questions such as what are the real obstacles to success of NPM in Mongolia and what are the real recipes for potential success need to be answered, in other words, there is a need to study the consequences first. It must be admitted that the task to make such a complete analysis is beyond the scope of the current work and for the time being there is very limited literature available to make a base for developing the arguments for why the country should implement NPM. Schick stresses the importance of preconditions for successfully implementing the NPM approach and claims that countries striving to uplift themselves after decades of mismanagement should not ignore these preconditions. He identifies the establishment of a formal public sector, which is based on strong civil service system and long standing habit of public managers to spend public money according to prescribed rules as one of the preconditions. In addition, he notes that if contracts and the rule of law are underdeveloped in business relations, it is highly improbable that they can be safely or effectively applied in the conduct of the governments business (Schick 1998:6). Whether Mongolia has these preconditions may be even questionable that some other developing countries, the public sector of which were operating under colonial systems and in which market mechanisms have been established for years. The transitional features of the public management of Mongolia mentioned earlier could serve as an explanation for why such emphasis should be made. If the New Zealend model is all about applying the best techniques of private sector management in public management, the question of whether just newly emerging private sector of Mongolia has accumulated those techniques and practices is even more doubtful. NPM is often attempted assuming that proper capacity exists, which is not always the case. The actual capacity of Mongolia to apply NPM should be thoroughly investigated, especially when it comes to managers ability decide and to have responsibility. Otherwise the reform may have a impact on the public confidence in the government operations. In Addition, as Hughes (1994: 83) claims, implementation is a real problem if there is insufficient attention paid to it. Implementation is much more costly in developing countries where a traditional model bureaucracy is not well developed and some basic preconditions are not ensured. In Mongolia, informal estimates have been made that USD 20 million are required to implement NPM reforms. This accounts only for the transitional periods from the old to the new system. Some potential donors like the Asian Development Bank and the World Bank are committed to provide technical assistance and program loans in support of the reforms. So far neither the national government nor the donor agencies have made an estimation of how much the country would benefit from the reforms. It is not meaningful to think that if USD 20 million were available to the country today, this would have an automatic impact on the structure, efficiency and vision of the public administration and sustainability of reforms. NPM requires good planning and a very good estimate of the real capacities to implement it and a good program of assistance or training to build these capacities. To some extent, the donors commitments are influenced by their willingness to show at least ane developing or transitional country, where the NPM model will successfully work and it has been encouraged by the interest of the current Government of Mongolia in the model. The major donors are often quick to sell a model that is pre-packaged without carefully looking at the implementation side of it. Public management reform is a difficult process to define and implement in general. In the developing countries problems of inefficiency, culture impact, political pressure and other factors such as corruption and a lack of competitiveness and sophisticated markets render this task even more difficult. Reform programs should have a long-term perspective and be free from political ambitions that could negatively affect their long-term effects and objectives. As there has always been a tendency for the public sector reforms to be donor driven, it is much more desirable to develop a Mongolian version of reform that satisfies the needs of the country and its administrative environment and reality, which may or may not be NPM. The conclusion to be made here is that sooner or later the country should move towards some forms of NPM. However, rather than taking such an extreme and prompt action to immediately adopt the most advanced model of it, the focus should be on capacity building to ensure necessary pre-conditions have been established for its future successful implementation. Political Issues

John Calvin

Early reformers dwelt on correcting mistakes in the Roman Catholic Church’s doctrines. This was a dangerous undertaking because it led to persecutions sometimes. The Roman Catholic Church had already split before John Calvin defected from it. He was, therefore, a second generation reformer. There is a controversy surrounding John Calvin’s birth.Advertising We will write a custom essay sample on John Calvin specifically for you for only $16.05 $11/page Learn More According to Skoczylas (2001), Calvin was born in 1506. However other sources such as the Christian Classic Ethereal Library (CCEL) (n.d.) claim that he was born on 10th July 1509 in Noyon, France. In his early years, Calvin was educated by the Roman Catholic Church (CCEL, n.d.). However, in 1533, Calvin disengaged from the Roman Catholic Church after establishing contacts with people opposed to its teaching (Roxborogh, 2001). Reformers before him gave little thought to spreading th e word of God beyond the Christians strongholds. Calvin’s calling, therefore, embarked on correcting this mistake. His training on legal issues and his organization skills enabled him command a large and loyal following (Skoczylas, 2001). For that reason, Calvin’s teachings and writings form the foundation of many theological studies. This essay is, hence, a summary of the life of John Calvin and his impact on Christianity. Calvin spent his early life in a family of staunch Catholics. His father, actually, wanted him to join priesthood (CCEL, n.d.). CCEL (n.d.) adds that, as a fourteen year old, Calvin went to school at the college de Marche in Paris. This college was meant to prepare him for university studies. Before the end of 1523, he was forced to transfer his studies to College Montaigu (CCEL, n.d.). During his stay here, Calving started using the name Ioannis Calvinus. Ioannis Calvinus was the Latin form of the name John Calvin (CCEL, n.d.). As a student, most o f his personal effects were paid for by the Roman Catholic Church. For instance, his education was catered for in part by a few small parishes (CCEL, n.d.). He later relocated to Orleans to join a law school. Calvin completed his studies on civic law in 1532(CCEL, n.d.). In 1553, he disengaged from the Roman Catholic Church and began studying on his own before embarking on a number of Christian writings (Roxborogh, 2001). Finally, Calvin continued with his writing, preaching and lecturing until he met his death on 27th May 1564 (CCEL, n.d.). Haykin (2001) states that earlier reformers gave little thought to missions. It is obvious that they had no concern for oversees missions. These reformers were, therefore, not keen on capturing the minds of non-Christians. John Calvin defected from the Roman Catholic Church and started doing what most of the earlier reformers had not done. Through his writings, he advocated on advancing Christ’s kingdom to non-Christians (Haykin, 2001).Ad vertising Looking for essay on religion theology? Let's see if we can help you! Get your first paper with 15% OFF Learn More Although he toured other towns to spread the gospel, Calvin spent most of his life in Geneva (CCEL, n.d.).The bible says that the word of God should be preached in all towns, starting from Jerusalem. Calvin, perhaps, thought that Jerusalem had experienced enough and it was now time to establish missions elsewhere. According to Calvin, the advancement of the church depended on God’s mercy (Haykin, 2001). It is from this mercy that God created man as the noblest creature on earth. Therefore, man is endowed with intelligence and free will (Skoczylas, 2001). These kinds of teachings by Calving were meant to liberalize the Roman Catholics and free the minds of Protestants. For that reason, Calving was also credited with the establishment of a more democratic world. Alongside Lutherans and Anglicans teachings, Calvin’s ideas and examples were regarded highly by the Protestants (Roxborogh, 2001). It is, therefore, difficult for a protestant church to understand itself without reference to Calvin’s work. However, not all people welcomed his teachings. According to Wellman (n.d), Calvin is the most loathed theologian of the last 2000 years. His haters include many in the church and secular spheres. Calvin’s conversion from Roman Catholicism was sudden. In 1533, he developed friendship with Pierre Robert and Melchior Wolmar who were Protestant Reformers (Wellman, n.d). His new friends used lectures and writings to criticize the Roman Catholic Church. These teachings radicalized Calvin from a staunch Catholic to a vocal Protestant. Calvin was later accused of unorthodox behavior after helping Wolmar draft a speech that advanced protestant views. This forced him to leave Paris in 1533 to avoid persecution (Roxborogh, 2001). It can be concluded that early reformers gave little thought to missions beyond Chri stian strongholds. Calvin’s greatest impact on Christianity was, therefore, the establishments of missions in areas occupied by non-Christians. Calving endeavored to spread the word of God to the last part of the world. Additionally, he can also be credited with liberalizing the Christian mind. To date, Calvin’s teachings act as the base for the reformed and Presbyterian theological practices (Roxborogh, 2001). Many believe that Calvin taught most of the significant things about God (Roxborogh, 2001). Finally, it is practically impossible for a Protestant church to understand itself without reference to John Calvin’s work. References Christian Classic Ethereal Library. Biography of John Calvin: John Calvin-French reformer and theologian.  Web.Advertising We will write a custom essay sample on John Calvin specifically for you for only $16.05 $11/page Learn More Haykin, M. A. G. (2001). Reformation and revival: John calving missiona ry influence in France. A Quarterly Journal for Church Leadership10 (4), 1-7. Web. Roxborogh, J. (2001). John Calvin (1509-1564). Web. Skoczylas, A. (2001). Mr. Simson’s knotty case: divinity, politics, and due process in early eighteenth-century Scotland. McGill-Queen’s Press. Web. Wellman, S. Essential facts about John Calvin, as well as a very extensive reading list!  Web. This essay on John Calvin was written and submitted by user Violet D. 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.

Free Essays on The Puritans

PURITANS The Puritans were a group of people who grew discontent in the Church of England and worked towards religious, moral and societal reforms. The writings and ideas of John Calvin, a leader in the Reformation, gave rise to Protestantism and were pivotal to the Christian revolt. They contended that The Church of England had become a product of political struggles and man-made doctrines. The Puritans were one branch of dissenters who decided that the Church of England was beyond reform. Escaping persecution from church leadership and the King, they came to America. The Puritans believed that the Bible was God's true law, and that it provided a plan for living. The established church of the day described access to God as monastic and possible only within the confines of "church authority". Puritans stripped away the traditional trappings and formalities of Christianity which had been slowly building throughout the previous 1500 years. Theirs was an attempt to "purify" the church and their own lives. What many of us remember about the Puritans is reflective of the modern definition of the term and not of the historical account. Point one, they were not a small group of people. In England many of their persuasion sat in Parliament. So great was the struggle that England's Civil War pitted the Puritans against the Crown Forces. Though the Puritans won the fight with Oliver Cromwell's leadership, their victory was short-lived; hence their displacement to America. Point two, the witchcraft trials did not appropriately define their methods of living for the 100+ years that they formed successful communities. What it did show was the danger that their self-imposed isolation had put them in. Most of the Puritans settled in the New England area. As they immigrated and formed individual colonies, their numbers rose from 17,800 in 1640 to 106,000 in 1700. Religious exclusiveness was the foremost principle of their society. The s... Free Essays on The Puritans Free Essays on The Puritans PURITANS The Puritans were a group of people who grew discontent in the Church of England and worked towards religious, moral and societal reforms. The writings and ideas of John Calvin, a leader in the Reformation, gave rise to Protestantism and were pivotal to the Christian revolt. They contended that The Church of England had become a product of political struggles and man-made doctrines. The Puritans were one branch of dissenters who decided that the Church of England was beyond reform. Escaping persecution from church leadership and the King, they came to America. The Puritans believed that the Bible was God's true law, and that it provided a plan for living. The established church of the day described access to God as monastic and possible only within the confines of "church authority". Puritans stripped away the traditional trappings and formalities of Christianity which had been slowly building throughout the previous 1500 years. Theirs was an attempt to "purify" the church and their own lives. What many of us remember about the Puritans is reflective of the modern definition of the term and not of the historical account. Point one, they were not a small group of people. In England many of their persuasion sat in Parliament. So great was the struggle that England's Civil War pitted the Puritans against the Crown Forces. Though the Puritans won the fight with Oliver Cromwell's leadership, their victory was short-lived; hence their displacement to America. Point two, the witchcraft trials did not appropriately define their methods of living for the 100+ years that they formed successful communities. What it did show was the danger that their self-imposed isolation had put them in. Most of the Puritans settled in the New England area. As they immigrated and formed individual colonies, their numbers rose from 17,800 in 1640 to 106,000 in 1700. Religious exclusiveness was the foremost principle of their society. The s...

Influencing Buyers Behavior Essay Example | Topics and Well Written Essays - 250 words

Influencing Buyers Behavior - Essay Example Just like in many other countries, businesses prefer their adverts run during the prime hours such as before the news, during and after news because it reaches out to a significant percentage of the targeted audience. Experts suggest that is crucial for companies to consider consumer preferences before embarking on the production process (Marr, 2013). This is the reason why Coca-Cola, a leading multinational beverage company, produces beverages targeting consumers in specific parts of the world depending on their preferences. As a matter of fact, many business analysts suggest that accurate identification of the consumer preferences is among the major factors that have given Coca-Cola a competitive edge in the beverage industry. Liu, Denizci Guillet, Xiao and Law (2014), suggest that consumer preferences are influenced by numerous factors numerous factors such as the geographical location, climate, culture and religion. For example, some religion denominations such as the Seventh Day Adventist discourage consumption of beverages that have caffeine such as Coke, one of the leading brands of Coca-Cola (Marr, 2013). Customer preferences based on the geographical location and culture of the people explains why Coke is popular in the USA where most people take caffeine, while Fresca, a caffeine-free soft drink is popular in most of the African and south American countries where a significant percentage of the population avoid caffeine. Jones, R. B., Soler-Lopez, M., Zahra, D., Shankleman, J., & Trenchard-Mabere, E. (2013). Using online adverts to increase the uptake of cervical screening amongst â€Å"real Eastenders†: an opportunistic controlled trial. BMC research notes, 6(1),

A Secure Internet Banking Information System in Distributed and Research Paper

A Secure Internet Banking Information System in Distributed and Heterogeneous Computing Environment - Research Paper Example It will provide information regarding the investigation approach, method of data collection and analytical approach to be used in the study. In today's volatile environment banking and financial institutions are implementing information systems in order to achieve growth and increased market share. The implementation of Information Technology provides the benefits of increased reliability and accuracy by reducing the chances of failures in the business system. The interdependencies in the business can be managed better through the implementation of an information system. With the provision of economies of scale, implementation of Information Systems in a banking organization also leads to several other problems, which should be addressed for the maximization of benefits attached. It is important to develop a deeper understanding of the importance of security issues related to the implementation of secure online banking information system in a distributed and heterogeneous computing environment. Previous research in the field provides a recognized conceptualization regarding the information system as an important source of competitive advantage for service organizations. The organizations should take necessary steps in order to save the technology from being copied by other organizations (Barney, 1991). The open nature of information technology and the ability of competitors to gain access to the same technology do not allow the hard aspect of e-commerce to become a source of competitive advantage. The implementation of an information system in a bank leads to customer benefit by reducing the transaction costs and providing the customers with increased bargaining power. With the increasing awareness in the industry players regarding the information technology, it has become inevitable for the firms to find a competitive advantage in the soft aspect of information management (Brynjolfsson & Hitt, 2000). Even if hard elements are easily accessible, two possible sources of comp etitive advantage remain effective utilization of these hard technologies within the wider organization of the firm, and unique combinations of the soft organizational and hard systemic aspects of the e-commerce revolution. Organizations need to change to make optimal use of new technologies (Penrose, 1959).  Ã‚  

Discussion of Management of Patient Traction

Discussion of Management of Patient Traction 1. List nursing interventions and preventative management related to skeletal traction. a. The weights used by the patient should be known and recorded in the nursing documentation; the weights must not be removed from the skeletal traction unless a life-threatening situation happens for removal of these destroys their purpose. b. The traction system must be thoroughly checked at least once every shift or every 6 to 8 hours and always after some interventions such as moving a patient, physiotherapy, and radiographic examination because the system may be inadvertently altered. c. The nurse must guarantee that the cords are attached securely by standard knots that will not shift or come undone, the weights hang freely and should not rest on the floor nor catch or jam, the ropes are in the wheel grooves of the pulleys, and that the ropes are not frayed. d. The ends of the cords must be short or approximately 5cm and bound back to themselves with the use on an adhesive tape which will prevent fraying of the cord end and possible slipping and accidental disruption of the traction. The knot itself should also be uncovered. e. The pulleys must be free running and oiled to prevent squeaking and friction should be minimized, the efficiency is maintained and the patient should not be disturbed by noise. f. Pointed ends of the pins or wires used should always be covered to prevent injury not only to the patient but also to the staff. g. The nurse should also evaluate the patients position; the patient should be on a firm-based bed to give full support and comfort to allow efficient action of the traction system and prevent the patient from slipping down the bed. h. the nurse should maintain alignment of the patients body in traction as ordered by the physician which will promote an effective line of pull. i. The patients foot is positioned properly to prevent foot drop, inward rotation, and outward rotation otherwise the foot can be supported by orthopedic devices such as foot support to maintain a neutral position. j. The elbows and knees should be protected with the use of a semi permeable film dressing or protective wool and inspected for pressure ulcers because these parts of the body are often used by patients in repositioning themselves. Also, to prevent these parts from being injured, an overhead trapeze can be helpful for the patients movement. k. Back care should always be provided and bed should be kept dry and free from crumbles and wrinkles to prevent bed sores or pressure ulcers. l. If available, a pressure relieving air-filled or high density foam mattress overlay can be used to reduce risk for pressure ulcers. m. The bed linens should regularly be changed. The patient is instructed to raise his torso while the nurses on both sides of the bed will roll down and replace the upper mattress sheet and as the patient raises the buttocks off the mattress, the nurses will slide it under the buttocks. To finish the changing, the nurses will replace the lower part of the bed linens while the patient rests on his back. The traction should not be disrupted. n. The neurovascular status should be assessed initially every hour and then every 4 hours. o. The nurse should instruct the patient to report instantly if any change in sensation or movement happens. p. The patient should also be encouraged to do active flexion-extension ankle exercises and calf-pumping exercises ten times hourly to prevent venous stasis or DVT. Anti-embolism stocking and compression devices may be used for preventive measures. q. The nurse should also inspect for looseness of pins or wires and signs of infection at the sites where the traction is inserted every 8 hours. Purulent discharge, redness or inflammation may indicate infection, though these signs subside normally after 72 hours. r. Pins that are mechanically stable require weekly pin site care. The most recommended cleansing solution used is chlorhexidine solution. If early signs of infection are present, frequency of pin site care is increased. s. The nurse ensures that the site is only covered by a sterile absorbent non-stick dressing and rolled gauze for the first 48 hours. After this, loose cover dressing or none is suggested. A bandage will only be used if the patient is exposed to airborne dust. t. The nurse should instruct the patient to take showers within 5 to 10 days of pin insertion and encourage them to leave the pin exposed to water flow and dry them with a clean towel and left to open air. Dressing may be applied if ordered. u. The patient is encouraged to perform active exercises to prevent loss of muscle mass and strength and prolonged rehabilitation. The patient can perform the following: pulling up on the trapeze, flexing and extending the feet, ROM and weight-resistance exercises for the non-involved joints. v. Isometric exercises of the immobilized extremity such as gluteal-setting and quadriceps-setting exercises are important for maintaining strength in major ambulatory muscles. 2. Discuss a component of cast care for the pediatric client or adult client. Identify manifestations of compartment syndrome. After cast application, the nurse must teach the client to report the following: a. When the toes or fingers become blue, swollen or difficult and painful to move b. When the limbs become painful c. When the client feel numbness d. When the client have blister-like or burning pain e. Presence of discharges or wetness or unpleasant smell from the cast f. If the client dropped anything from the cast The nurse must also teach the client or the care taker the following proper care of the cast: a. The cast should be kept dry. Allowing it to dry naturally is a must and it should be left uncovered. b. External heat such as a hairdryer or by sitting in front of a fire should be prevented. c. If an irritation occurs under the cast, anything under the cast should never be poked. d. The skin around the cast should be washed daily and checked for redness or sores. e. The limb must not be hanged down especially on the first few days. f. Exercises for the fingers or toes and other joints of the body should be performed for 5 minutes every hour during the day. There are certain nursing interventions and care after cast application. The following will be discussed below. a. Self-care deficit The goal of care is for the client to maintain everyday activities to a level acceptable for him. The client may need help to achieve this level. The nurse must assess the clients capabilities which will depend to a number of factors such as the site of the cast, the previous level of independence, the support available from family or friends, and some may require referral to a social worker. b. Peripheral neurovascular impairment The goal of care is to reduce the risk of neurovascular impairment and identify any early complications. The nurse must do neurovascular observations and if neurovascular impairment such as compartment syndrome is suspected, the following interventions should be done: Inform the physician immediately Cease elevation of the limb because elevation can increase compartment pressure The cast should be split down to the skin. Threads of padding should not be left uncut for it can impair the circulation If local pressure on the nerve is present, a window is needed to be cut or the cast is bivalve Compartment syndrome requires immediate surgery. (I will duscuss it after these nursing diagnosis and care) c. Impaired skin integrity The goal of care is to indentify signs of localized pressure because cast may cause pressure or localized sores. These are the following signs that should be observed by the nurse: Itching beneath the plaster Burning pain; which should not be ignore because the tissues quickly becomes ischemic which leads to numbness and absence of pain Disturbed sleep, restlessness and fretfulness in children Swelling of the fingers or toes after the immediate swelling has subsided A characteristic offensive smell due to tissue necrosis Presence of discharge The nurse must know that extra padding to a cast can increase the pressure and the padding can fall further down the cast. Cotton wool should not be used for padding because it tends to be compressed into hard small pellets that can cause further problems when it falls into the cast and become lodged. A window should be cut carefully and removed as a whole piece for inspection of potential sore sites but the window should be replaced to prevent local edema. d. Risk for disuse syndrome (stiffness of the joint) The goal of care is to ensure that the adjacent joints retain their normal range of motion because stiffness will occur in joints held in a cast. Such exercises that was discussed before is vital in relation to the importance of using adjacent joints. e. Potential allergic reaction The goal of care is to prevent reactions in client known to have had a reaction in the past and for early detection of any reaction occurring in other clients. The nurse should check if the patient has known allergies. Signs or reaction should be observed such as itching, non-localized burning pain, rashes and blistering of the skin. If these occur, the physician is informed. The cast is removed, the skin is cleaned and a new cast is applied using a different material. Compartment Syndrome If the patient complaints that the cast is too tight, nerve compression and vascular insufficiency can occur due to unrelieved swelling. This can result to compartment syndrome. The cast may be bivalved to relive the pressure while maintaining alignment with the extremity elevated no higher than the level of heart to ensure arterial perfusion. If it is not relieved, fasciotomy is required to relieve pressure built up in the muscle compartment before irreversible damage occurs to the ischemic muscle. 3. Compare the nursing needs of a total hip replacement patient with a total knee replacement patient. Nursing Needs of a Total Hip Replacement Patient A patient with a total hip replacement requires monitoring for specific potential complications especially the dislocation of hip prosthesis. Nursing needs are more focused on the dislocation of the hip prosthesis. If the patient is undergoing a posterior or posterior-lateral approach for total hip arthroplasty, maintenance of the femoral head component in the acetabular cup is important. The leg should be positioned in abduction to prevent dislocation of the prosthesis. An abduction splint can be used to keep the hip in abduction. Hip should never be flexed more than 90 degrees. Limited flexion is maintained during transfers and when sitting. There are methods to avoid displacement of the hip such as keeping the knees apart at all times, putting a pillow between the legs when sleeping, never crossing the legs when seated, avoding positions such as bending forward when seated in a chair and when picking up an object on the floor. A higg seated chair should be used and a raised toilet seat. The hip should also not be flexed to put on clothing such as pants, stocking, socks, shoes, etc. Monitoring the wound drainage, preventing deep vein thrombosis and infection,are also important for the patient. Nursing Needs of a Total Knee Replacement Patient In other hand, a patient with total knee replacement focuses on the importance in encouraging active flexion of the foot every hour postoperatively, when awake. Also, drainage should range from 200 to 400mlduring the first 24 hours after the surgery and reduces to less than 25ml by 48 hours at which time drainage is removed by the surgeon. A continuous passive range of motion or CPM device combined with physical therapy will help improve the patients postoperative knee mobility and decrease use of analgesics. Usually, 10 degrees of extension and 15 degrees of flexion are prescribed initially, then increasing to 90 degrees of flexion with 0 or full extension by discharge. The knee is usually protected with a knee immobilizer and is elevated when the patient sits in a chair. Ambulation, use of assistive devices and within the prescribed weight bearing limits is encouraged on the day after surgery. 4. Discuss methods to avoid dislocation after hip replacement after surgery. There are several methods to avoid dislocation of the hip prosthesis. These are the following: a. The knees should be kept apart at all times. b. A pillow should be placed between the legs when sleeping. c. Legs should not be crossed when seated. d. Bending forward when sitting in a chair should be avoided. e. Bending forward to pick up an object on the floor should also be avoided. f. A high seated chair and a raised toilet seat should be used because the knees should be lower than the level of the hips when seated. g. The hips should not be flexed to put on clothing such as pants, stockings, socks, or shoes. 5. You are caring for a patient who has had skeletal traction placed to treat a fractured femur. Discuss nursing interventions and assessment techniques related to this type of treatment. When caring for a patient with a skeletal traction on a fractured femur, these arethe nursing interventions and assessment techniques the nurse must do: a. The nurse must check the traction system daily, at least every 6 to 8 hours and always after moving the patient. b. The nurse must also inspect for looseness of pins or wires and signs of infection such as discharge, redness and inflammation at the sites of insertion of the traction. c. Pin sites should be cleaned twice or once daily; chlorhexidine solution is the most recommended solution to use for cleaning. d. Skin breakdown should be prevented by covering the bony prominences used by the patient when moving such as the elbows and heel. e. An overhead trapeze is given to the patient for easy movement. f. The neurovascular status of the fractured femur should be assessed every 4 hours. g. The patient should be encouraged to do calf-pumping exercises for at least 10 times per hour to decrease the risk for deep vein thrombosis of the affected part. h. The use of anti-embolism stockings can also help prevent venous stasis. g. Active exercise such as pulling up on the trapeze, flexing and extending the feet and isometric exercises will maintain strength in major ambulatory muscles. i. Assisting the patient will self-care such as bathing, dressing and toileting is also one of the nurses responsibilities. j. The nurse must also monitor the patient for any potential complications such as DVT, constipation, etc. 6. A patient is being discharged with an external fixator for a fractured humerus. Discuss home care instructions for this patient. Home care instructions for a patient with an external fixator include the following: a. The nurse must demonstrate proper pin site care. The solution that must be used is chlorhexidine solution, and cleaning is once or twice a day. b. The nurse should inform the patient to notify the physician if signs of infection such as redness, tenderness, increased or purulent pin drainage occur. c. The nurse should also describe measures to control swelling and pain such as elevating the extremity to the heart level and taking prescribed analgesics. d. The nurse informs the patient to report uncontrolled pain upon elevation and use of analgesics for it could be an indicator of impaired tissue perfusion, compartment syndrome, or pin traction infection. e. The nurse should also let the patient demonstrate the ability to transfer and use mobility aids safely. 7. Identify various types of traction and the principles of effective traction. a. Skin Traction It is used to control muscle spasms and to immobilize an area before surgery. No more than 2 to 3.5kg of traction can be used on an extremity. b. Skeletal Traction It is applied directly to the bone and is used occasionally to treat fractures of the femur, tibia, and the cervical spine. Two types of pins are commonly used; the Steinmann pin, and the threaded pins such as Denham pin. There are also common types of traction used. These are the following: c. Straight-Leg Traction It is also known as Pughs traction which allows the traction cord to be fixed by trying it to for example, the end of the thomas splint or used as sliding traction using a pulley and weights. It is used as a temporary measure for fractured neck of femur injuries, to rest the hip or relieve pain or muscle spasm. d. Hamilton-Russell Traction It is traditionally been used for fractures of the neck and the shaft of the femur. The arrangement of the foot pulleys multiplies the traction force by 100%. To ensure Effective traction, avoidance of wrinkling and slipping of the traction bandage is important. Also, it is a must to maintain countertraction. Proper positioning is maintained to keep the leg in neutral position. Advice the patient not to turn from side to side. This will prevent bony fragments from moving against one another. 8. Discuss the use of Bucks traction, its uses and the involved nursing considerations. Bucks Extension traction is used to the lower leg. It is a type of skin traction that is used to immobilize fractures of the proximal femur before surgical fixation. During application of the Bucks Extension traction, excessive pressure is avoided over the malleolus and proximal fibula to prevent pressure ulcers and nerve damage. The prescribed weight is usually 5 to 8 pounds. 9. Discuss the nursing care for a patient undergoing orthopaedic surgery. a. Relieving pain is the first goal for the patient. Decreasing the discomfort by moving the affected bone or the injured joint can help. b. Elevation of the edematous extremity will promote venous return and reduce the discomfort. c. Giving alangesics as ordered, d. Monitoring and maintaining the neurovascular status of the patient. e. Assisting the patient in performing activities. f. Assessing the nutritional status and hydration by monitoring fluid intake, urinary output and urinalysis findings. g. Encouraging mobility immediately after surgery to promoted independence in ambulation. h. Assisting the patient in accepting body changes, diminished self-esteem and roles and responsibilities. SOURCES: Brunner and Suddarths textbook of Medical-Surgical Nursing 12th Edition Julia Kneale et. al. (2005) Orthopaedic and Trauma Nursing 2nd Edition Web Assignment 1. Find a research article addressing health teaching needs for the patient with a cast. Explain your findings in a one-page paper. http://www.uptodate.com/contents/patient-information-cast-and-splint-care According to the article, a cast is used to protect your bone and reduce pain as it heals. Minimizing the risk for potential complications is important. It was enumerated in the article some cast care instructions and they are as follows; the cast should be kept above the level of the heart within 24 to 48 hours which can be accomplished by resting it on pillows. Also, fingers and toes where the cast is located should be moved gently. The ice keeps the swelling down. Applying a bag of ice of a bag of frozen vegetables covered with a thin towel to the cast for 20 minutes while awake reduces swelling. The patient should be reminded that ice is not applied directly into the skin. Pain medications should be taken as ordered such as ibuprofen and acetaminophen. The cast should not get wet. To bathe with a cast, cover the cast with a plastic bag and tape the opening shut. Then, the cast is hung outside the tub. Even if the cast is covered with a plastic, it should not be placed with water or allow the water to run over the area. There are waterproof cast available at medical supply stores but are not completely waterproof. A hair dryer on a cool setting can be used to dry the cat in case it got wet, it can also soothe itchiness. Warm or hot setting can burn the skin that is wise it is not advised to be used. A vacuum cleaner can also be used with a hose attachment to pull air through the cast and speed drying. The patient should always remember that the cast should be kept clean. Powder or lotion should not be applied near the cast and the cast should be covered when eating. The padding out from inside the cast must not be pulled. There are also instructions said when to seek care. These are as follows; if there are sore areas or a foul odor from the cast, cracks or breaks in the cast, or the cast feels too tight, if swelling is developed that causes pain and immobility of the fingers or toes, if tingling or numbness is felt on the affected part, if the fingers or toes are blue or cold, if there is severe pain in or near the affected part, and if it becomes soaking wet and does not dry with a hair dryer or vacuum.

Electoral college :: essays research papers

A common misconception among American is that when they vote they elect the President. The truth is not nearly this simple. What in fact happens when a person votes is that there vote goes for an Elector. This Elector (who is selected by the respective state in which a vote is cast) casts ballots for two individuals, the President and the Vice-President. Each state has the same number of electors as there are Senate and House of Representative members for that State. When the voting has stopped the candidate who receives the majority of the Electoral votes for a state receives all the electoral votes for that state. All the votes are transmitted to Washington, D.C. for tallying, and the candidate with the majority of the electoral votes wins the presidency. If no candidate receives a majority of the vote, the responsibility of selecting the next President falls upon the House of Representatives. This elaborate system of Presidential selection is thought by many to be an 18th century anachronism (Hoxie p. 717), what it is in fact is the product of a 200 year old debate over who should select the President and why. In 1787, the Framers in their infinite wisdom, saw the need to respect the principles of both Federalists and States Righters (republicans) (Hoxie p. 717). Summarily a compromise was struck between those who felt Congress should select the President and those who felt the states should have a say. In 1788 the Electoral College was indoctrinated and placed into operation. The College was to allow people a say in who lead them, but was also to protect against the general public's ignorance of politics. Why the fear of the peoples ignorance of politics? It was argued that the people, left to their own devices could be swayed by a few designing men to elect a king or demagogue (McManus p. 19). With the Electoral College in place the people could make a screened decision about who the highest authority in the land was to be (Bailey & Shafritz (p. 60); at the same time the fear of the newly formed nation being destroyed by a demagogue could be put to rest because wiser men had the final sa y. 200 years later the system is still designed to safeguard against the ignorant capacities of the people. The Electoral College has remained relatively unchanged in form and function since 1787, the year of its formulation.