HRM Information Systems

HRM Information Systems ABSTRACT Information technology is expected to drive Human Resource (HR)s transition from a focus on Human Resource Management (HRM) to Strategic Human Resource Management (SHRM). This strategic role not only adds a valuable dimension to the HR function, but also changes the competencies that define HR professional and practitioner success. The study aims at investigating what role if any do Human Resource Information Systems (HRIS) play in SHRM. It attempts to examine how HR professionals and managers in different organizations see the effects of HRIS on strategic HR tasks and job roles. It also tries to find out if there is any significant difference in the usage of HRIS between Small/Medium (SME) size and large size companies. A survey questionnaire was sent to different companies. The target group of the questionnaire was HR managers, HR directors, and HR professionals in companies based in England. The scope was widened to include both large and small/medium sized organizations across all the business sectors. The results of the survey reveal that HR professionals not only consider HRIS usage as a support for strategic HR tasks but also perceive it as an enabling technology. The study also indicates that large sized firms are most likely to experience considerable HRIS usage in support of strategic HR tasks. Moreover, there was no significant difference in proportion to the size of a company regarding HRIS usage in support of commitment management and managing trade union relations with organizations. Low response rate of this study makes generalization rather difficult however, future research would benefit from higher response rates for more generalized results OVERVIEW The relationship between the HR strategies and the firms performance is an issue that has caused significant differentiations in the literature mostly because of the existence of many parameters that can influence the results produced through the examination of this problem in practice. Moreover, because within a firm, the participants and the interests are many it is difficult to identify the role and the significance of each particular organizational element particularly when there is no specific corporate plan for such an investigation. RESEARCH PROBLEM The human resources strategies followed by modern organizations present significant differentiations in accordance with the firms position in the market, its performance and its financial strength in general. In the long term, the application of specific human resources strategies has been found to be related with the performance of the organization. Moreover, where appropriate HR plans have been applied, the organizational performance has been found to be increased. AIMS AND OBJECTIVES OF THE RESEARCH Current research as already mentioned above will focus on the examination of the relationship between HR strategies applied within a particular organization and its performance. In order for the above task to lead to valid results, a series of other issues are going to be examined at a secondary level. These issues are indicatively: a) Which is the significance of the HR for the organizational operation, b) How the HR strategies can be more effective? c) Is there any chance for innovation in firms with specific HR plan or any relevant initiative has to be adapted to the existed framework? d) Which are the main aspects of organizational growth and e) Are there any other factors that can influence the firms performance and which would be their interaction with the HR strategies already implemented in the particular firm? LIMITATIONS OF THE RESEARCH Current research is limited by the fact that it is rather unlikely for companies to provide data related with their employees problems related with the workplace. On the other hand, any programs or support tools existed are very likely to be provided by all firms that would be engaged in the research of current project. For this reason, although the job satisfaction and the personal development of employees would be rather easily monitored, the existence of problems in the workplace would be difficult to be proved. For this reason current research as already described above focuses on the examination of the human resources strategies followed by organizations in general as these practices can be observed in most firms of modern commercial market. The existence of specific differentiations in accordance with the specific issue will have to be proved either by statistics released in general or by cases examined particularly in the legal area. INTRODUCTION According to Likert, Every aspect of firms activities is determined by the competence, motivation and general effectiveness of its human organization. Of all the tasks of management, managing the human component is the central and most important task because all depends how well it is done. This quotation sums up the importance of human components in an organisation and the need for managing it effectively. Human resource management is concerned with all aspects of managing the human resources of an organisation. More specifically, human resource management involves determining the organisations heed of human resource, recruiting and selecting the best available employees, developing, counselling and rewarding employees, acting as a liaison with union and government organisation and handling other matters regarding to the well being of employees. Each of these functions is necessary to some degree irrespective of nature and size of the organisation. That is why in most of the organis ation a separate department know as Personnel/Human resource Department is created for the effective performance of these functions. The relationship between the HR strategies and the firms performance is an issue that has caused significant differentiations in the literature mostly because of the existence of many parameters that can influence the results produced through the examination of this problem in practice. Moreover, because within a firm, the participants and the interests are many it is difficult to identify the role and the significance of each particular organizational element particularly when there is no specific corporate plan for such an investigation. Organization must have a set of unique resources for gaining competitive advantage moreover proper utilization of those resources matters a lot. Today organization employee acts as a main resource and knowledge, skills and abilities have to be deployed and used to the maximum effect if the organization is to create value. LITERATURE REVIEW Human resources should be considered as a significant organizational asset. In this context, the application of the appropriate strategies for its development, can lead to the improvement of the corporate performance both in the short and the long term. However, there are also companies where human resources are not considered as having particular importance for the firms growth. In this context, Haines (1997, 95) supported that there are firms that view their human resources as an expense rather than an asset an element that is expendable and perhaps discarded when the skills possessed becomes obsolete; however when human resources are viewed as an asset, companies enhance individual value through training and human development and ensure continued contribution to the organization. The importance of human resources for the corporate performance has in any case proved both in the literature and the empirical research conducted in all industrial sectors. In accordance with the above, in order for a firm to achieve a stable and continuous growth, it is necessary that its employees are satisfied as this term has been explained in the literature. More specifically, in accordance with Kim (2005, 669) job satisfaction is an affective or emotional response toward various facets of ones job. Job satisfaction has been a topic of great interest for researchers and practitioners in a wide range of fields, including organizational psychology, public administration, and management. On the other hand, the existence of job satisfaction has been extensively related with the level of payment of employees in the particular sectors of a specific organization. Indeed, the study of Rudman (2003) showed that paying for performance is a big issue in contemporary human resources management; organisations have long believed that production and productivity improve when pay is linked to performance, and have developed payment-by-results (PBR) systems and incentive schemes to support th is belief. In the same context, it is noticed by Blinder (1990, 117) that employees usually feel that profit sharing and gain sharing are good for personal effort, company growth and productivity, and workplace atmosphere. However, in order for the firms to achieve the maximum level of growth, it is necessary to design and apply the appropriate HR policies as indicated by each particular firms needs. The use of fit as a criterion of evaluation of the appropriate corporate strategy has been extensively used in practice. Towards this direction Wright (1998, 56) mentioned that the basic theory behind fit is that the effectiveness of any HR practice or set of practices for impacting firm performance depends upon the firms strategy (or conversely, the effectiveness of any strategy depends upon having the right HR practices). In other words, the issues that need to be considered by a firm before applying any relevant HR strategy are many. Indicatively, Katzell (1975, 5, 11-12) tried to identify the relationship between the employee satisfaction (as a result of a specific HR strategy) and the corporate performance and found that policy-makers must face up to a serious dilemma and find some way to resolve it; the dilemma is this: policy-makers would like to achieve two objectives for work organizations, on the one hand to enhance productivity and performance, and on the other to improve the quality of working life and job satisfaction for employers because under certain conditions, improving productivity will enhance worker satisfaction and improvements in job satisfaction will contribute to productivity; what it does mean is that there is no automatic and invariant relationship between the two. Under these terms, corporate performance has been found to be related with the employees performance within a particular organization. From a different point of view, Lawler et al. (2003, 15) supported that HRs greatest opportunity to add value may well be to play a role in the development and implementation of corporate strategy; HR can make a logical case for being an important part of strategy development, because of the importance of human capital in the ability of the firm to carry out its strategy. In other words, HR strategy can influence the firms growth in accordance with the measures provided for the personal and professional development of the firms employees even in the long term. The implementation of appropriate diversity strategy has to be considered in this case as absolutely necessary because in case of inequality in the workplace, no cooperation would be regarded as existed even if such cooperation exists, it will be problematic. In this context, Mathews (1998, 175 ) noticed that before diversity strategies are implemented, the organizations cultural environment, management and evaluation systems should be examined to ascertain if existing personnel/human resources processes will support or hinder diversity in the organization; then, appropriate strategies can be designed to develop and manage diversity based on these findings. From the same point of view, Ramlall (2003, 60) supported that given that several large-scale studies have proven that HRM is a critical driver in an organizations financial performance, it is imperative for HR and other leaders to understand the critical nature and utmost importance of understanding the effectiveness of all HR activities in creating value for the organization. To a more thorough examination of the problem, Christensen managed to identify the five elements that are considered as most crucial in the improvement of the employees productivity (as this improvement is expected to lead to the increase of the corporate growth). More specifically, Christensen supported that there are five elements which are extremely important for the effectiveness of employees within a particular organizational environment. These are (1958, 34): a) The technical organization of the group; b) The social structure of the group; c) The individual task motivation, i.e., the willingness to work hard that each member brings to and maintains toward his job; d) The rewards he receives from doing the job, and e) The satisfactions he obtains from being an accepted member of the group. The above elements can exist in any organization and can influence the productivity of its employees either in the short or in the long term. HUMAN RESOURCE MANAGEMENT (HRM) During and after 1970s, several changes took place in many countries which led to the term Human resource Management in place of the traditional term Personnel Management. These changes, declining importance of trade unionism, shift from industrial employment to service sector employment, growing competition, deregulation of economies, etc. As a result, three important roles of human resources have emerged as stated below. Human resource policies can be integrated with strategic business planning and used to reinforce appropriate culture. Human resources are valuable and a source of competitive advantage. Human resources can be tapped mostly effectively by mutually consistent policies which promote commitment and Foster a willingness in employees to act flexible in the interests of the adaptive organisations pursuit of excellence. The term Human resource management has been the subject of considerable debate, and its underlying philosophy and character are highly controversial. Much of this controversy stems from the absence of a precise formulation of and agreement on its significance and definition (Storey, 1989; and 1995a), as cited by Bratton and Gold (2003: 7). Obviously, definition of the subject matter is needed for analysis and understanding of HRM theory and practice. HRM DEFINITION HRM has a variety of definitions but there is general agreement that it has a closer fit with business strategy than previous models, specifically personnel management. In all the debates about the meaning, significance and practice of HRM, nothing seems more certain than the link between HRM and performance (HRM Guide October 2006). Below are some of the definitions of HRM, although it can be argued that these will only be ones of several possible definitions. De Cenzo and Robbins (1996: 8) defined HRM as the part of the organization that is concerned with the people dimension, and it is normally a staff or support function in the organization. HRM role is the provision of assistance in HRM issues to line employees, or those directly involved in producing the organizations goods and services. Acquiring peoples services, developing their skills, motivating them to high levels of performance, and ensuring their continuing maintenance and commitment to the organization are essential to achieving organizational goals. This is much the case regardless of the type of organization, government, business, education, health, recreation, or social action. The authors proposed an HRM specific approach as consisting of four functions- staffing, training and development, motivation, and maintenance. In addition, Bratton and Gold (2003: 7) define HRM as the strategic approach to managing employment relations which emphasizes that leveraging peoples capabilities is critical to achieving sustainable competitive advantage. This is achieved through a distinctive set of integrated employment policies, programs and practices. The authors presented HRM functions as planning, recruitment and selection, appraisal and performance management, reward management, development, employee relations, health and safety, and union-management relations. Moreover, to Alan Price (2004: 32) HRM aims at recruiting capable, flexible and committed people, managing and rewarding their performance and d eveloping key competencies. Contributing to the working definition of HRM is Abecker et al., (2004). They see HRM as a strategic and target oriented composition, regulation and development of all areas that affect human resources in a company. Efficient and effective management of these resources to a large extend, affects human resource behaviour, and consequently the performance of the organization as a whole. Moreover, the authors identified HRM with the field it covers. These include planning aspects- personnel requirements analysis and personnel asset analysis, and change aspects- recruitment, personnel development and labour displacement (Ibid). Next, is the diagrammatic representation of the said field. Human Resource Management Change Aspects Planning Aspects Personnel Requirement Analysis Labour Displacement Personnel Development Recruitment Personnel Asset Analysis Figure1: Fields of HRM (Source: Abecker et al., 2004) It is however, somehow strange, that, an important aspect of HRM, payroll or compensation/payment is missing from the field in figure 1 above propounded by the authors. Abecker et al., (2004) like the previous other authors, did not present a conclusive and detailed definition of HRM including the other concepts (HR processes). Lastly considered are the opinions of various management scholars who have taken a more in-depth look at the whole concept of HRM. These opinions should be given the greatest weight, since they reflect more in-depth research on the subject than is done by most textbook authors. Few such authors are Dessler et al., (1999), and Torrington et al.,(2005). According to Torrington et al., (2005: 5) HRM is fundamental to all management activity and has evolved from a number of different strands of thought. It is best described as a loose philosophy of people management rather than a focused methodology. Thus, distinction has been made between HRM as body of management activities on one hand (generically described as personnel management) and then on the other as a particular approach to execute those activities (carrying out people-oriented organizational activities than traditional personnel management). An organization gains competitive advantage by using its employees effectively, drawing on their expertise and ingenuity to meet clearly defined objectives. Torrington et al.,(2005: 5) identified the role of the human resource functions with the key objectives. These four objectives are the corner stone of all HR activities. These include Staffing, Performance, Change-management and Administration. Staffing objective focuses on finding the appropriate pool of human resources needed to ensure full and timely supply of work force (Ibid). It therefore involves designing organizational structures, identifying working conditions for different groups of employees followed by recruiting, selecting and developing the personnel required to fill the roles. Performance objective aims at ensuring workforce motivation and commitment for effective performance. Consequently, employees training and development remain important. Moreover, managing change effectively and efficiently remains one of the core objectives in almost every business. Key issues here include recruiting and/or developing people with the required leadership skills to drive the change process. Change agents are employed to encourage acceptance of change by coming out with reward systems associated with the change process. Employees involvement is also paramount here and is encouraged. The aim is to avoid resistance to change, more especially where it involves cultural changes (attitude, philosophy or long-present organizational norms). Administration objective aims at facilitating the smooth running of the organization. Hence, there is the need for accurate and comprehensive data on individual employees, records of achievement in terms of performance, attendance, training records, terms and condition of employment and personal details are (Ibid). However, for the purpose of this study, literature on the HRM concept will be based on the opinions of Dessler et al., (1999). The authors defined HRM as the management of people in organizations. It consists of the activities, policies, and practices involved in obtaining, developing, utilizing, evaluating, maintaining, and retaining the appropriate number and skill mix of employees to accomplish the organizations objectives. The goal of HRM is to maximize employees contributions in order to achieve optimal productivity and effectiveness, while simultaneously attaining individual objectives and societal objectives Dessler et al., (1999: 2). To the authors, the function of HRM include assisting the organization in attracting the quality and quantity of candidates required with respect to the organizations strategy and operational goals, staffing needs, and desired culture. Helping to maintain performance standards and increase productivity through orientation, training, development, job design, effective communication, and performance appraisal. Helping to create a climate in which employees are encouraged to develop and utilize their skills to the fullest. Helping to establish and maintain cordial working relationship with employees. Helping to create and maintain safe and healthy work environment. Development of programs to meet economic, psychological, and social needs of the employees. Helping the organization to retain productive employees and ensuring that the organization complies with provincial/territorial and federal laws affecting the work place such as human rights, employment equity, occupational health and safety (Ibid). HRM PROCESSES This sub section illustrates the processes involved in executing the HRM functions. Each of the functions: planning, recruitment, selection, orientation and training, performance appraisal etc. goes through a process. Unless otherwise stated, the rest of this section will be drawn from (Dessler et al., 1999)s literature based on pages 165 to 533. PLANNING PROCESS Human Resource Planning (HRP) process reviews human resources requirements to ensure that the organization has the required number of employees, with the necessary skills, to meet its goals, also known as employment planning. HRP is a proactive process, which both anticipates and influences an organizations future by systematically forecasting the demand for and supply of employees under changing conditions, and developing plans and activities to satisfy these needs. Key steps include forecasting demand for labour considering organizational strategic and tactical plans, economic conditions, market and competitive trends, social concerns, demographic trends, and technological changes. RECRUITMENT PROCESS Recruitment is the process of searching for and attracting an adequate number of qualified job candidate, from whom the organization may select the most appropriate to field its staff needs. The process begins when the need to fill a position is identified and it ends with the receipt of rà ©sumà ©s and completed application forms. The result is a pool of qualified job seekers from which the individual best matching the job requirements can be selected. The steps in recruitment process include identification of job openings, determination of job requirements, choosing appropriate recruiting sources and methods, and finally, generating a pool of qualified recruits. Job openings are identified through human resource planning or manager request. Next is to determine the job requirements. This involves reviewing the job description and the job specification and updating them, if necessary. Appropriate recruiting sources and methods are chosen because there is no one, best recruiting te chnique. Consequently, the most appropriate for any given position depend on a number of factors, which include organizational policies and plans, and job requirements. SELECTION PROCESS Selection is the process of choosing individuals with the relevant qualifications to fill existing or projected openings. Data and information about applicants regarding current employees, whether for a transfer or promotion, or outside candidates for the first time position with the firm are collected and evaluated. The steps in the selection process, in sending order include preliminary reception of applicants, initial applicant screening, selection testing, selection interview, background investigation and reference checking, supervisory interview, realistic job previews, making the hiring decision, candidate notification, and evaluating the selection process. However, each step in the selection process, from preliminary applicant reception and initial screening to the hiring decision, is performed under legal, organizational, and environmental constraints that protect the interests of both applicant and organization. ORIENTATION, TRAINING AND DEVELOPMENT PROCESS Employee orientation is the procedure of providing new employees with basic background information about the firm and the job. Is more or less, considered as one component of the employers new-employee socialization process. Socialization process is an ongoing process of initialling in all employees the prevailing attitudes, standards, values, and patterns of behaviour that are expected by the organization. Training however is the process of teaching new or present employees the basic skills/competencies needed to perform their jobs. Whereas training focuses on skills and competencies needed to perform employees current jobs, employee and management development is the training of long-term nature. The aim is to prepare current employees for future jobs with the organization or solving an organizational problem concerning, for example, poor interdepartmental communication. Training and development processes include needs analysis, instructional design, validation, implementation, and evaluation and follow-up. CAREER PLANNING AND DEVELOPMENT PROCESS It is the deliberate process through which persons become aware of personal career related attributes and the lifelong series of activities that contribute to their career fulfilment. Individuals, managers, and the organization have role to play in career development. Individuals accept responsibility of own career, assess interests, skills, and values, seek out career information and resources, establish goals and career plans, and utilize development opportunities. The career stage identification entails career cycle (the stages through which a persons career evolves). These stages include the following: growth, exploration, establishment, maintenance, and decline stages. Occupational orientation identification is the theory by John Holland. This theory enumerates six basic personal orientations that determine the sorts of careers to which people are drawn. They include realistic orientation, investigative orientation, social orientation, conventional orientation, enterprise orientation, and artistic orientation. PERFORMANCE APPRAISAL PROCESS Performance appraisal may be defined as any procedure that involves setting work standards, assessing employees actual performance relative to these standards, and providing feedback to the employee with the aim of motivating the worker to eliminate performance deficiencies or to continue to perform above par. Processes in performance appraisal contain three steps: defining performance expectations, appraising performance, and providing feedback. First, defining performance expectation means making sure that job duties and standards are clear to all. Second, appraising performance means comparing employees actual performance to the standards that has been set, which normally involves some type of rating form. Third, performance appraisal usually requires one or more feedback sessions to discuss employees performance and progress and making plans for any required development. Some of the appraisal methods include graphic rating scale, alternation ranking, paired comparison, forced dis tribution, and critical incident methods. EMPLOYEE COMPENSATION AND BENEFITS PROCESS Employee compensation involves all forms of pay or rewards accrued to employees and arising from their employment. This however consists of two main components: direct financial payments, and indirect payments. While direct financial payments are in the form of wages, salaries, incentives, commissions, and bonuses, indirect payments are in the form of financial benefits like employer-paid insurance and vacations. Moreover, legal considerations in compensation, union influences, compensation policies, and equity and its impact on pay rates are the four basic considerations influencing the formulation of any pay plan. Benefits are indirect financial payments given to employees. These may include supplementary health and life insurance, vacation, pension, education plans, and discounts on say company products. Furthermore, income and medical benefits to victims of work-related accidents or illness and/or their dependents, regardless of fault are all part of employees compensation. The processes in establishing pay rates involve the following five steps: First, conducting wages/salary survey to determine the prevailing wage rates for comparable jobs, which is central in job pricing. Second, determine the relative worth of each job (job evaluation) by comparing the job content in relation to one another in terms of their efforts, responsibility, and skills. This eventually results in wage or salary hierarchy. Third, group similar jobs into pay grades, a pay grade comprises of jobs of approximately equal value or importance as determined by job evaluation. Forth, price each pay grade using wage curves. A wage curve is graphical description of the relationship between the value of job and the average wage paid for the job. However, if jobs are not grouped into pay grades, individual pay rates have to be assigned to each job. Fifth, fine tune pay rates. This involves correcting out-of-line rates and usually developing rate ranges. OCCUPATIONAL HEALTH AND SAFETY PROCESS Occupational health and safety process aims at protecting the health and safety of workers by minimizing work-related accidents and illnesses. Laws and legislations to ensure and observe general health and safety rules bound employers. More so, rules for specific industries, for example, mining and rules related to specific hazards, for instance, asbestos have to be adhered to. The following steps are important in this process. Checking for or removing unsafe conditions by using checklist to audit a companys adherence to safety rules that are guarded against hazards, which cannot be removed. Next, through selection, screening out of employees who might be accident prone for job in question without compromising the human right legislation. More so, establishing a safety policy, this emphasizes on the importance of practically reducing accidents and injuries. Setting specific loss control goals by analyzing the number of accidents and safety incidents and then set specific safety goals to be achieved. Enforcing safety rules through discipline and conducting health and safety inspections regularly by investigating all accidents and near misses, and by having a system in place for letting employe

An Indian Democracy Essay -- Essays Papers

An Indian Democracy Donald Grinde is the author of The Iroquois and the Founding of the American Nation, one of the earliest books to argue for an Indian influence on the formation of the American democracy. Since Grinde’s publication and Bruce Johansen’s a year later, there has been a great deal of debate over this issue. Many of the most prominent opponents of the influence thesis have failed to distinguish between the arguments of more extreme authors, such as Gregory Schaaf, who claim that the Iroquois Gayanashagowa was copied by the U.S. Constitution, and those with a more moderate stance, like Johansen and Grinde, who simply point to a clear influence (Johansen, 1998). This paper intends to argue along the lines of these latter authors. Our founding fathers did not copy the Gayanashagowa or Great Law of Peace, but our Constitution was written with reflection upon the Iroquoian government with the goal of synthesizing this model into a form that could satisfy the needs of the Ameri can people. Given the evidence presented by Grinde and Johansen, it is clear that Native Americans influenced early U. S. political minds—if not directly, then at least indirectly. Elisabeth Tooker is one of the strongest opponents of the claim that there was a native influence on the U. S. democracy. She addressed Schaaf’s extreme claim that the U.S. had copied the Gayanashagowa, which is clearly not the case. Tooker sites differences between the Constitution and the Great Law of Peace such as majority rule rather than unanimous consensus. This line of argument works well to refute Schaaf, who’s evidence is based almost entirely on his analysis of such parallels (Johansen, 1998) Tooker’s overall argument, though, is not effective ... ...en Founders . Ipswich, Massachusetts: Gambit Incorporated Publishers. Johansen, Bruce E (1996). Native American Political Systems and the Evolution of Democracy: an Annotated Bibliography. Westport, Connecticut: Greenwood Press. Johansen, Bruce E. (1998). Debating Democracy: Native American Legacy of Freedom. Santa Fe, NM: Clear Light Publishers. Locke, John (1980). Second Treatise of Government. Indiana: Hackett Publishing Company. Moquin, Wayne, ed. (1973). Great Documents in American Indian History. New York: Praeger,. O'Brien, Sharon (1989). American Indian Tribal Governments. Norman: University of Oklahoma Press. Parker, Arthur C. (1968). The Constitution of the Five Nations. Syracuse: Syracuse University Press. Rousseau, Jean-Jacques (1968). The Social Contract. Trans. Maurice Cranston. Harmondsworth, England: Penguin Books.

Sepsis and Barbara

This portfolio will provide evidence of my experience in an acute care setting. I will provide an appendix giving a brief summary of a patient I cared for whilst undertaking a placement in an acute setting. This portfolio of evidence will be based on a patient diagnosed with sepsis secondary to her chest infection. I will discuss extensively the aetiology, pathophysiology and clinical features of a patient presenting with sepsis treated in an acute care setting.I will explore the role of the different healthcare professionals that were involved in the care of the patient describing how they contributed to her holistic care. I will incorporate evidence base supporting the approach used by the doctors, nurses and microbiologists in the diagnosing and caring for the patient. I will equally evaluate practice using findings from contemporary research policy and practice on the care of the adult with acute care needs.I will also discuss the value of our practice in accordance with professi onal, ethical and legal frameworks that ensure the privacy of the patient’s interest and well-being. Finally, I will conclude by summarising this portfolio of evidence in relation to acute care practices and focus on identifying my future learning needs in developing myself personally and my professional practice. It is indicated by Latto (2011) that a meeting between The American College of Chest Physicians and the Society of Critical Care Medicine in 1991 brought about the use of systemic inflammatory response syndrome (SIRS) to define sepsis.SIRS being manifestation of two or more of certain medical signs including, a temperature of less than 36 degrees Celsius or greater than 38 degrees Celsius, a heart rate of over 90 beats per minute, respiratory rate of over 20 breaths per minute and white blood cells count of greater than 12000 or less than 4000. Further on to recognise sepsis, a patient has to have at least two signs of SIRS as well as a documented infection. Sepsis, as defined by Matot and Sprung, (2001) â€Å"is the systemic inflammatory response to infection. In addition to this definition, Herwald and Egesten (2011) indicate that sepsis could also be defined as the existence of bacteria or other micro-organisms in the blood, hypotension or shock. Rello, Diaz and Rodriguez (2009) emphasise that there is a difference between sepsis and systemic inflammatory response syndrome (SIRS) as sepsis is systemic inflammatory response to  infection  while systemic inflammatory response syndrome is a tool used to simplify the diagnosis of sepsis.Sepsis occurs as a result of the body fighting infection that has spread though the body via the blood stream as defined by Sepsis Alliance UK (2012). Barbara presented with low blood pressure, a high temperature, tachycardia and an increased respiratory rate. Patients who present with sepsis can progress to severe sepsis which is defined by Marini and Wheeler (2010) as â€Å"a syndrome caused by infection and defined by the presence of vital sign abnormalities and new organ system failure caused by the ensuing inflammation and coagulation. Associated with severe sepsis, there are three integrated responses as explained by Kleinpell, R. (2003) which are; activation of inflammation, activation of coagulation, and impairment of fibrinolysis. As the body detects infection, its natural response is inflammation. â€Å"Inflammation is a response of a tissue to injury, often injury caused by invading pathogens. It is characterized by increased blood flow to the tissue causing increased temperature, redness, swelling, and pain. † Kleinpell (2003).Ball (2011) in describing the process of inflammation in the body explains that inflammation occurs due to the white blood cells releasing pro-inflammatory mediators called cytokines these are proteins, peptides, or glycoproteins which include tumour necrosis factor alpha, interleukin-1 and interleukin-6, the white blood cells also releases a platelet-activating factor which is a lipid mediator that is well-known for its ability to cause platelet formation. The work of these mediators is to repair damages caused and prevent further damages from occurring.Normally, the body’s response in order to prevent damage by the release of these pro-inflammatory mediators is to release anti-inflammatory mediators which are interleukin-4 and interleukin-10 these are also cytokines which are a type of protein. In severe sepsis, there are excessive pro-inflammatory mediators which are not regulated by the anti-inflammatory mediators which results in overwhelming inflammatory reactions causing impaired tissue function and organ damage. Due to the pro-inflammatory mediators being released and unregulated by anti-inflammatory mediators, coagulation is promoted which is the clotting of blood.This happens in the capillaries which obstructs the flow of blood into the tissues causing hypoxia which then leads to the dysfunction of orga ns. Hypoxia is defined by Wiebe and Machulla (1999)  as â€Å"reduction of oxygen supply to tissue below physiological levels. † The activation of coagulation then causes fibrinolysis to be activated. Fibrinolysis is the process of breaking down of blood clots as defined by Leslie, Johnson, and, Goodwin (2011). This happens because the levels of plasminogen rapidly reduce.Plasminogen is a protein that when activated by enzymes transforms into plasmin which promotes dissolving of blood clots. Though the plasminogen levels fall rapidly, the antiplasmin levels remain normal which causes an end result of a decrement in the fibronolytic response. â€Å"The imbalance between inflammation, coagulation, and fibrinolysis that occurs in severe sepsis results in systemic inflammation, widespread coagulopathy, and microvascular thrombosis, conditions that can lead to multiple organ dysfunction†Ã‚  Kleinpell (2003)   Severe sepsis if not properly treated can then lead to septic shock.Septic shock is defined as sepsis with hypotension which is unresponsive to fluid resuscitation as well as abnormal perfusion that may include lactic acidosis, oliguria or alteration in mental status, Sepsis Alliance UK. (2012). In relation to the care that Barbara received whilst being treated for sepsis, there were different health care professionals involved throughout her stay in the hospital. An inter-professional team worked together to ensure that she was given holistic care taking into consideration the social aspect of her life, her spiritual values, her emotional and mental state of mind and full physical care.On recording Barbara’s clinical observations, we passed on our results to the doctors as Barbara was scoring a mews of seven. Guidelines on the Modified Early Warning Signs chart advices that if a patients’ scores a MEWS of four or more, the patient must be referred for urgent medical review, NHS Outer North East London Community Services (2011) The doctors immediately ordered for blood cultures to be taken. The blood cultures were used to investigate the reason why Barbara had an increased temperature as an increased temperature is a sign of infection as described by Hegner, Acello and Caldwell (2009).The blood tests and cultures taken were also to test for the serum lactate level, white blood cell count, tests to check how the liver and kidneys were functioning. The doctors then prescribed fluids to help in increasing Barbara's blood pressure. Working collaboratively to enhance the care that Barbara received, the microbiologists were involved in the diagnosis and care she received through the involvement by the doctors requesting for blood samples to be taken and investigating the reason why Barbara had an elevated temperature.By collecting a sputum sample from Barbara, the microbiologists were also involved in looking for the medication sensitive to the bacteria causing Barbara’s chest infection. The microbiologis ts also took blood for arterial blood gases test. They were very efficient in delivering the results of the blood tests showing that Barbara had an increased white blood cell count. Her serum lactate levels were 3. 4mmols/l. An increased white blood cell count along with an elevated temperature proved to the doctors that Barbara had an infection.The doctors commenced Barbara on the sepsis six bundle. The sepsis six bundle is a guideline within the Surviving Sepsis Campaign which gives information on what should be done in the first 6hrs that sepsis is diagnosed in a patient in order to aid safe recovery. The nurses ensured that from the moment Barbara was admitted, it was a duty to monitor her clinical observations. With the use of the Modified Early Warning Signs (MEWS) chart, we recorded her observations which enabled us to monitor changes in her blood pressure, respiratory rate, temperature, heart rate and oxygen saturation.This was also a way for us to assess her consciousness l evel checking to see if she was alert, responsive to voice alone, responsive to pain alone or unconscious. This enabled us to check for signs of improvement in her health or for deterioration. Our duty as nurses was to provide 24hr care to Barbara. With a blood pressure of 85/42 mmHg we ensured that Barbara got enough fluids as were prescribed by the doctors. These fluids were given intravenously to increase Barbara’s blood pressure.In a patient with sepsis, due to vasodilation as an inflammatory response to the infection, arterial circulation is ineffective therefore; intravenous fluids are required as advised by Institute for Healthcare Improvement (2011) Apart from receiving care from the nurses, we referred Barbara to the occupational therapist. The role of an occupational therapist as defined by Institute For Career Research, (2007) is to help in the development, recovery and maintaining of daily living and work skills of people with conditions that are disabling mentall y, physically, emotionally and developmentally.Institute For Career Research (2007). They ensured that on returning home, patients will have everything needed to make them comfortable. If need be, they will get their houses modified with a stair lift, a ramp or any additional equipment needed for them to make living at home easier. In relation to Barbara, the occupational therapist focused on her personal care, they assessed how easy or difficult it was for her to wash and dress herself and if she could manage cooking her food in the kitchen.This enhanced collaborative working as this enabled the nurses to be aware of what steps needed to be taken to provide optimum care to Barbara. We were informed by the occupational therapist that she would need all care in the area of her personal hygiene and assistance in most areas of her activities of daily living. With the information derived from the occupational therapist, we were able to refer Barbara to the social services to ensure that when she was fit for discharge, extra measures were taken to provide her with care in her own home.Barbara also received care from the physiotherapist. The role of the physiotherapist is to work as part of the multidisciplinary team to assess the patient and then provide treatment. Treatment would include exercise, movement, hydrotherapy, electrotherapy, massages and manipulation. A physiotherapist is also involved in providing health education this is elaborated by NHS Scotland (2002). In relation to Barbara, after we had referred her to the physiotherapy, they ensured that she received physiotherapy for her chest which was a series of claps on her chest, back and under her arms.This was very helpful to Barbara as due to her chest infection, she had a lot of mucus in her breathing passages and with treatment from the physiotherapist; she managed to cough it up. This positively enhanced the care that Barbara received as through collaborative working, the physiotherapist encouraged the loosening of mucus from her breathing passages which enabled us as nurses to acquire a sputum sample to send to the microbiologist to test for what antibiotics were suitable to treat Barbara’s chest infection.In addition to having lung cancer, Barbara also had liver and bone metastasis. With her consent, we involved the Macmillan nurses in her care. They focused on the social, emotional and practical impact cancer had on Barbara. They also gave her information on different support groups which were accessible to her and meetings where she could share her experience and listen to others experiences. Involved in the care of Barbara was the church priest.As Barbara was too ill to attend the hospital Sunday services as were her wishes, we invited a priest who could give her communion, emotional and spiritual support through her stay in the hospital. Barbara had a reduced appetite so we commenced her on a food diary in which we recorded everything that Barbara ate and how much of it she ate. After three days of commencing Barbara on the food diary, we showed it to the dietician. Barbara was quite ill and did not have the strength to take part in most of her activities of daily living including feeding herself.The dietician came to the ward to review Barbara and then prescribed ensure drinks and little cups of procal shots. These are nutrient supplements which provide protein, fat and carbohydrate in the body. All healthcare professionals worked together to enhance the quality of care that Barbara received although because Barbara had been diagnosed with sepsis, the decision of the dietician to provide Barbara with medication to boost her nutrition arguably caused deterioration in Barbara’s health.Studies show that when treating a patient with sepsis, permissive underfeeding is required to ensure that recovery is enhanced as encouraging a lot of dietary intake would cause lipogenesis which would result to excess production of carbon dioxide and res piratory overload, hyperglycaemia and over usage of energy which would lead to stress for the patient. Vincent, Carlet and Opal (2002).In supporting the doctors’ decision to prescribe intravenous fluids for fluid resuscitation on Barbara, Evidence has shown from the Surviving Sepsis Campaign (2011) under the sepsis resuscitation bundle that patients who are suspected of being in septic shock should be commenced on fluid resuscitation immediately. Guidelines on the Surviving Sepsis Campaign states that, â€Å"In the event of hypotension and/or lactate ;gt; 4mmols/L (36 mg/dL) deliver an initial minimum of 20 ml/kg of crystalloid (or colloid equivalent). † As explained by Winters and Glatter (2009), serum lactate levels are used to identify patients who have sepsis.They explain that an elevated serum lactate level is a method of forewarning of an increased mortality in patients with sepsis or septic shock. This proves that ordering for blood tests to check the serum lact ate level of Barbara was a positive step in treating Barbara by identifying the diagnosis of Barbara’s condition. Current evidence from the Surviving Sepsis Campaign (2011) indicates that analysing serum lactate levels in septic patients is not conclusive as â€Å"a number of studies have suggested that elevated lactate levels may result from cellular metabolic failure in sepsis rather than from global hypo perfusion.Elevated lactate levels can also result from decreased clearance by the liver. Although blood lactate concentration may lack precision as a measure of tissue metabolic status, elevated levels in sepsis support aggressive resuscitation. † This gives reason to why the doctors ordered for blood tests to be taken so as to measure Barbara’s serum lactate level. Through continuous input of intravenous fluids, Barbara’s blood pressure increased to 99/55 and remained stable and she was now scoring a MEWS of 3 as her respiratory rate was still elevate d at 24 breaths per minute and a heart rate of 105 beats per minute.Barbara’s temperature was still a little bit elevated at 37. 4? C but not scoring on the MEWS chart. The MEWS chart played a very important role in helping us evaluate Barbara’s health status. Although different studies show that there are pros and cons of using the MEWS system to evaluate patients’ health status. Studies show that the modified early warning scoring systems in the accident and emergency department or an acute care setting can help healthcare professionals identify patients that are at risk of deterioration.Though, concerns have been raised questioning the sensitivity of this system as a risk assessment tool in comparison with the early modified warning score (EWS). Griffiths and Kidney (2011), in their survey assessing the use of MEWS in the UK’s acute care departments found out that over 90% of respondents in the survey supported the use of the Early Warning Score in hel ping identify deterioration or improvement in patients who are admitted to the acute care departments to the use of the Modified Early Warning Score.This is evidence that supports the practice of nurses in monitoring Barbara’s condition through the use of modified early warning score. On the other hand, another study shows that many issues arose in implementing the MEWS chart in recording patients’ observation. The problems encountered with the MEWS chart include complaints of font size, size of the boxes provided to write in and due to this, some staff members have been reluctant to engage with the process making it difficult to monitor deterioration in acutely ill patients.NICE (2011) I think that the MEWS chart was very effective in helping us monitor Barbara’s condition because we were able to use the information recorded on it as a means of communication with other healthcare professionals involved in her care. In caring for Barbara, we ensured that her con fidentiality was optimised. This is a professional requirement for every nurse by the Nursing and Midwifery Council (2008). Through the use of a model called ‘Situation – Background – Assessment – Recommendation’ (SBAR), we ensured that communication between all health care professionals were detailed and solely on a need to know basis.This model did not only protect the confidentiality of Barbara, it also encouraged assessment skills helping to provide all information to health care professionals in a manner that makes it difficult to omit any information. In communication with other bodies involved in Barbara’s care, SBAR stood as a guideline in divulging information. Stating the situation Barbara was in, giving background information only in relation to her present condition, providing results of assessments carried that would relate to their function in the care of Barbara and finally getting the recommendation from the other body.This wa y, disclosure of information is kept to a minimum. Confidentiality is a key concept in protecting people that are vulnerable. Apart from being an ethical requirement, confidentiality also is a legal requirement. The legal principle of confidentiality lies within the Data Protection Act (1998), which simplified by Mind (2005) states that â€Å"Confidence is breached by the unauthorised use or disclosure of confidential information. † This act emphasises the principles that define confidentiality one of which includes sensitive personal data.This has to do with matters relating to a persons’ ethnicity, religious and political beliefs, physical and mental health, sexual orientation as well as criminal offences. In relation to Barbara, whenever we received a phone call from people claiming to be family members, in order to protect Barbara’s confidentiality, we never disclosed results of tests or doctors’ orders. We always gained consent from Barbara before gi ving information out to other parties involved in her care.Timing when caring for critically ill patients is a valuable commodity which makes it important to be able to identify when a patient is in need of urgent medical attention. In the course of looking after Barbara through her admission in the hospital, I realised that prioritising care was the main issue surrounding her treatment. Observing my mentor who was in charge of Barbara’s care as well as nine other patients, using the ABC technique she was able to prioritise the care that Barbara received.Ensuring that she had open Airways, Breathing with addition of oxygen therapy, Circulation through constant monitoring of her blood pressure. Prioritising of care is a skill that is essential in a care setting because if it was decided that all patients would be cared for in respect of their bed position on the ward, that would have had a negative impact on Barbara because she would not have received the urgent attention that she needed which could lead to a tragedy.Through prioritising care, my mentor was able to organise herself in caring for the other patients she was in charge of placing Barbara on the top of her list because she was in constant need of urgent care as when it was time for her intravenous fluids to be commenced because she had organised her time accurately she was able to meet up with demands placed by Barbara’s condition as well as demands of her duty to the other patients.In conclusion, this portfolio of evidence has defined the different stages of sepsis. It has explored the causes, pathophysiology and clinical manifestations. Fluid resuscitation was highlighted as the most important step to take in recognising a patient with sepsis. I described the different roles of the healthcare professionals in relation to the care that Barbara received.Using information from the surviving sepsis campaign, I explained the guidelines used in the treatment of sepsis and related it to the steps taken by the doctor to treat Barbara. I identified the key strength of my mentor in working under pressure by prioritising care. This is an area that I will need to develop myself in the course of attending placement in the future. I will research on techniques of prioritising patient care and research on the process of triage in relation to a care setting.

Report On The Synthesis And Syntheis Conditions Of...

A REPORT ON THE SYNTHESIS AND SYNTHEIS CONDITIONS OF MESOPOROUS SBA-15 SILICA 1. MATERIALS: 1.1. A Surfactant: The surfactant to be used in this is a triblock copolymer: - poly(ethylene oxide) block – poly(propylene oxide) block – poly(ethylene oxide) block commonly known as pluronic 123 or P123. This substance is a structure directing agent (Kim Stucky 2000) where P signifies that the copolymer is in form of a paste, 12 is a number multiplied by 300 to give an approximate molar mass of PPO while 3 signifies PEO is 30 wt% of the whole compound (Johansson et al. 2015) Figure 1: Chemical formula and properties of the surfactant P123 (Tianyuan et al. 2013) P123, a nonionic surfactant, is easy to separate, biodegradable, nontoxic and not costly to purchase (Stevens et al. 2006), (Zhao et al. 1998). P123 has the potentials to template ordered mesoporous materials and also to form more stable mesoporous silica materials (Kipkemboi et al. 2001). 1.2. Silica Precursor: There are two common silica precursors that can be used in the synthesis of SBA-15. These are Sodium metasilicate and Tetraethylorthosilicate (TEOS). Sodium metasilicate has been said to be preferred to TEOS because SBA-15 synthesized using the former is said to have pore walls slightly thicker than those prepared using the latter (Fulvio et al. 2005). Also, the cost of purchasing sodium metasilicate is low compared to the cost of TEOS which make