ORGANISATIONAL PSYCHOLOGY Essay Example | Topics and Well Written Essays - 250 words

ORGANISATIONAL PSYCHOLOGY - Essay Example H). Harry Potter was influenced by Dumbledore, while people like Richard Brandson or Steve Jobs are inventors of their own new way. Harry Potter teaches that leader must be supported and directed on a way, so such a leader can continue some eternal path, fighting for a Greater Good. But leaders like Richard Brandson do what they want to do, something they have passion about. You can’t say Harry enjoys hunting Voldemort, but Mark Zukenberg does enjoy his work. People stand beside Harry to fight for a Greater Good, and follow Steve Jobs to develop themselves in a way their leader does. Another thing that differs in these types of leaders is kind of power. Manda H. Rosser mentions several kinds of power, which leader can have (Rosser, M. H). I think Victor Cram from HP is a type of leader similar to Richard Brandson or Steve Jobs. They both have an Expert kind of power, and they’re successful in a particular

Safety Management System in the Airline Essay Example | Topics and Well Written Essays - 1500 words

Safety Management System in the Airline - Essay Example In this paper, the consequences of a poor safety culture on the effectiveness of an airline organisation namely Southwest Airlines will be taken into concern. Moreover, the procedures to detect or measure a poor safety operational culture along with setting effective plans in order to improve a safety culture in the organisation will also be portrayed in the discussion. Consequences of a Poor Safety Culture in the Airline The notion of safety culture is considered to be the ‘engine’ which drives the procedure towards the objective of preserving the utmost resistance in relation to any operational associated hazards in relation to airline industry. The consequences of a poor safety operational culture are the occurrence of individual as well as organisational accidents which in turn impose considerable impact upon the effectiveness of a particular airline organisation such as Southwest Airlines. ... In this context, it can be said that the chief kinds of human error include decision and skill-based faults. The pilot of a respective airline can make a rule-based mistake which ultimately results in the person to take a wrong decision that ultimately causes the crash. From the viewpoint of the skill-based errors, the accidents are duly caused due to the malfunction of the memory or the attention of the pilot about a particular operational function (Shappell & Wiegmann, 2004). The effect of the individual accidents leads to huge damage to the people. Along with the individual accidents, organisational linked accidents can take place in the systems of an organisation like Southwest Airlines. The chief reason for the occurrence of organisational accidents is the lack of technological innovations. It involves various people who work at different functioning levels within the organisation. The crucial effect of organisational accidents often disturbs the entire working procedure of the airline organisation such as Southwest Airlines which ultimately puts huge amount of people into danger (Reason, 1998). For instance, the cause of Lexington Plane Crash which occurred in the year 2006 was human error that can be considered as a type of individual accident. In this regard, it has been viewed that the pilot involved in the crash used the wrong pathway to take off the plane or flight which ultimately led towards the crash. The effect of this plane crash led to the death of 49 people and posed tremendous negative impact upon the business image as well as the customer service linked facilities of the organisation by a considerable level (ThinkReliability, 2011). Detection or

Different Propaganda Means in World War II Essay Example for Free

Different Propaganda Means in World War II Essay 1. Introduction a) General Background We know that propaganda used in war had effects on the outcome of the war from GCSE Modern World History second edition that propaganda means used in war had contributed to the war efforts which directly affected the outcome of the war. Many propaganda means such as movies and songs flourished during this era and even until today. b) Rationale of Research Our paper aims to show how the propaganda means helped to contribute to the war effort by blinding the civilians from facts, so that they would continue to support the government in their war efforts and not lose poise in the war. The sources that we have selected were produced and used at the period of war and thus are eligible as a primary source. c) Research Questions * How does propaganda affect the outcome of war? * How effectual is each different mean of propaganda? d) Scope of Research We will only be looking at the 4 different means of propaganda stated: o Chaplins (1940) movie- The Great Dictator o Almanac Singers (1942) song- Round and Round Hitlers Grave o Clampetts (1942) cartoon- Any Bonds Today o Smiths (1942) propaganda poster about war bonds We will also bring in historical knowledge that we obtained from the books and websites indicated in the bibliographical section. e) Limitations of Research Our paper will only discuss how propaganda is effective in the primary sources that we will be using. We will only mention how effective each of these sources are, bringing in historical background to support our view. Our paper will only be discussing on these specific sources mentioned and not propaganda as a whole broad topic. 2. Literature Review Chaplins and Clampetts movies plus Almanac Singers song criticised the Axis Powers. They were anti-Nazi Propaganda and were efficient in spreading propaganda. Clampetts cartoons and Smiths poster appealed to the Americans to support the war through buying war bonds. Chaplins movie shows that Hitler is uncivilized, as seen in a cake fight whilst discussing war issues with Italy-an ally. Clampetts cartoon shows that the Axis Powers were uncooperative when they stepped on the Dove of Peace. Almanac Singers song lyrics (Appendix 2) was insulting, Wished I had old Hitler /with a rope around his neck and continues about dancing round Hitlers grave. The first movie was produced to ridicule Hitler with very little purpose except for a speech (Appendix 3) because America was still a neutral country during 1940, but in Europe war had commenced. All resources made use of either audio or visual. It was the era whereby poems were no longer effectual and popular means of expression. Hence, propaganda was conveyed in posters, songs aired on radio and movies in theatres worldwide. Audio and visual aids provided a lucid picture of happenings and task definition enabling the government to easily persuade the people to do their biddings. The movies were directed by famous people (such as Warner Brothers, Charles Chaplin), whom civilians thought were trust-worthy and thus easily swayed. Moreover, most propaganda accentuates the importance of war bonds in the War. Bugs Bunny in Any Bonds Today (Appendix 6) was saying that without the bonds, we cant make tomorrows plan, which is to win the war. Even in this song there is a propaganda poster (Appendix 5) on war, patriotism and to procure war bonds (Appendix 4). Smiths poster was specifically on war bonds but just in a different form. The poster illustrates the repercussions without war bonds and shows a Nazi shadow cast over children. Therefore, buying bonds will safeguard them from the Axis. Patriotism resulted in exceedingly successful recruitment and maintenance of peace in the country. Patriotism prevented war at home while combating enemies. It was evoked through a poster signifying victory (Appendix 5), shown as the backdrop of Clampetts movie and also through criticising and making Axis Powers look inferior. Hence, Allies gain confidence. Not all movies were totally censored by the government and thus contained more truths. However, animated cartoons were still successful. The audience were predominantly children and upon listening to the catchy tunes and vivid pictures, persuade their parents into buying bonds for their well-being. The success of war propaganda for bonds reaped 185 billion dollars enabling the vast expansion of arms. Chaplins speech gave Germany hope that when dictators die, liberty will return to the people; this helped alleviate tension in Europe. The song (Appendix 2) was performed by a band formed by the government for propaganda purposes. Their songs were highly popular at that era and helped stir patriotism in the Americans. All the propaganda, even if not asking to acquire war bonds, was useful in convincing the people that the Axis were inferior to the Allies. 3. Research Methodology We have evaluated the germane resources that we can access and selected four sources that we will be using in our paper. These sources are primary sources as they were produced and released during World War II. After the selection of the resources, we analysed each of the sources individually to detect the characteristics of each source. We also accessed the impact they had at that time derived from historical knowledge. We then look at critics standpoint of these sources and found out that reviews and critics on these sources were scarce and extraneous to our paper and we decided to prohibit these critics, as most did not have any relevance to our paper. Subsequently, we look at all the sources and list down their similarities and differences from the examination of each source. 4. Results Analysis All the sources that we have used proved to be valuable in showing us the influence these propaganda tools may even have on us. These sources were used by the Allies to convince the civilians that the Axis Powers are the unscrupulous guys and they are to remove these threats. Chaplins The Great Dictator and Almanac Singers Round and Round Hitlers Grave were aimed at Hitler and the purpose of the movie was to destroy Hitlers reputation. These sources ridicule Hitler and persuaded the people to despise and condemn him. Clampetts cartoons and Smiths poster applied more to the persuasion of the civilians to buy war bonds to help to lighten the burden the economy have to take. These sources use patriotism to persuade the civilians to help to buy war bonds. 5. Conclusion a. Has our research proved our hypothesis correct / wrong? Our research has proven our hypothesis correct. Our research had shown that propaganda helped to collect the necessary resources needed for war, which is money and manpower. In World War II, propaganda means had evolved into sophisticated structure where many factors are included. Propaganda became an essential tool that would be necessary in war, as it would help the government to haul support from the civilians in order to get enough resources for war. b. Questions for further research 1) Why did poems lose popularity as a form of propaganda means in World War 2? 2) How did movies gain popularity as propaganda means in the war? 3) Why were Audio Aids more effective than Audio-Visual Aids in the war as a propaganda tool? 6. Bibliography a) Books: Lowe, Norman (1997) Mastering Modern World History third edition. New York: Palgrave Publishers Ltd Tate, Nicholas (1999) A History of the Modern World 1917-1952 fifth edition. Singapore: Federal Publications Pte Ltd Walsh, Ben (2002) GCSE Modern World History second edition. London: John Murray Publishers Ltd b) Websites: http://www.graham.day.dsl.pipex.com/ww2001.htm http://www.apcpapercollect.com/propaganda.htm http://www.hitler.org/speeches/ http://www.hitler.org/writings/programme/ http://www.earthstation1.com/Tokyo_Rose.html http://www.playwinningpoker.com/articles/mz/war1.html http://www.warfoto.com/entertain.htm http://lcweb.loc.gov/exhibits/bobhope/uso.html http://www.nauticom.net/www/harts/homefront.html http://www.a2zcds.com/cds/history/world_war_2.htm http://www.ingeb.org/WWII.html http://www.calvin.edu/academic/cas/gpa/ww2era.htm http://www.archives.ca/05/0534/053402_e.html http://www.pbs.org/wgbh/amex/presidents/32_f_roosevelt/psources/#a http://www.42explore.com/worldwar2.htm http://www.ac.wwu.edu/~hansenb2/materialsWW2.pdf http://www.historyguy.com/day_of_infamy.html http://journals2.iranscience.net:800/www.internet-magazine.com/tesla.liketelevision.com/default.htm http://members.home.nl/ww2propaganda/index.html http://www.virtualology.com/virtualwarmuseum.com/hallofworldwarii/ http://www.oldeagle.nu/post/ http://www.hitler.org/speeches/ http://www.hitler.org/writings/programme/ http://www.archives.gov/exhibit_hall/powers_of_persuasion/powers_of_persuasion_home.html http://home.nc.rr.com/tuco/looney/lists/war.html http://www.teacheroz.com/WWIIpropaganda.htm http://members.aol.com/FenixFlyte/chaplin.html http://propaganda.ww2.klup.info/ http://www.graham.day.dsl.pipex.com/ww2001.htm http://www.apcpapercollect.com/propaganda.htm http://www.hitler.org/speeches/ http://www.hitler.org/writings/programme/ http://www.earthstation1.com/Tokyo_Rose.html http://www.playwinningpoker.com/articles/mz/war1.html http://www.warfoto.com/entertain.htm http://lcweb.loc.gov/exhibits/bobhope/uso.html http://www.nauticom.net/www/harts/homefront.html http://www.a2zcds.com/cds/history/world_war_2.htm http://www.ingeb.org/WWII.html http://www.calvin.edu/academic/cas/gpa/ww2era.htm http://www.archives.ca/05/0534/053402_e.html http://www.pbs.org/wgbh/amex/presidents/32_f_roosevelt/psources/#a http://www.42explore.com/worldwar2.htm http://www.ac.wwu.edu/~hansenb2/materialsWW2.pdf http://www.historyguy.com/day_of_infamy.html http://journals2.iranscience.net:800/www.internet-magazine.com/tesla.liketelevision.com/default.htm http://members.home.nl/ww2propaganda/index.html http://www.virtualology.com/virtualwarmuseum.com/hallofworldwarii/ http://tesla.liketelevision.com/liketelevision/tuner.php?channel=608format=tvtheme=guide http://tesla.liketelevision.com/liketelevision/vip/alacart.php?channel=687p=5theme=guide http://www.lib.berkeley.edu/MRC/FilmonVideoVid.html http://www.bcdb.com/bcdb/detailed.cgi?filmtml3p=s http://looney.toonzone.net/miscelooneyous/tvtitles/tvtitles1.html http://www.kidscastle.si.edu/channels/history/articles/historyarticle22.html http://www.smithsonianmag.si.edu/smithsonian/issues02/feb02/war_bonds.html http://www.archives.gov/exhibit_hall/powers_of_persuasion/word_document/bugs_bunny_video_description.txt http://wso.williams.edu/~dgerstei/chaplin/nazi.html http://www.splicedonline.com/95andbefore/chaplin1_dvd.html http://www.aicgs.org/resources/daad/1995010.shtml c) Acknowledgements: Many thanks to our mentor Miss Foo Yang Yann for helping us out in many areas of our paper. d) References: Clown Ministry (2003). Text of Charlie Chaplins speech from The Great Dictator, aka Look up, Hannah. http://www.clown-ministry.com/Articles/Poetry/chaplin-great-dictator.html, last accessed 7 Aug 2003. Florit, Luis A. (2003). The Speech of The Great Dictator. http://w3.impa.br/~luis/chaplin.html, last accessed 7 Aug 2003. Geer, Goopy (2003). Goopy Geers Rare Cartoons Page War Cartoons. http://members.fortunecity.com/goopygeer2/, last accessed 7 Aug 2003. Helfert, Manfred (2003). Round And Round Hitlers Grave (Woody Guthrie/Millard Lampell/Pete Seeger). http://www.geocities.com/Nashville/3448/round.html, last accessed 7 Aug 2003. National Archives and Records Administration (2003). NARA | Exhibit Hall | Exhibit Hall Main Page. http://www.archives.gov/exhibit_hall/, last accessed 7 Aug 2003. Rotten Tomatoes (2003). The Great Dictator (1940): Charlie Chaplin, Paulette Goddard, Jack Oakie, Charlie Chaplin. http://www.rottentomatoes.com/m/TheGreatDictator-1008790/, last accessed 7 Aug 2003.

Marketing Mix Kinder Bueno Marketing Essay

Marketing Mix Kinder Bueno Marketing Essay Today ferrero is one of the largest confectionary companies in the world. Ferrero has sales product all around the world. The ferrero family keeps on delight its universal consumers with a seemingly inexhaustible line of single, high-quality product, not only in the spread and candy aisles, but also in the bakery and beverage part. Kinder Bueno is one of the best-sellers of the company and at the heart of ferrero success. Kinder Bueno is sold at 30 countries around the world. Kinder Bueno has great market power in the world. The aim of this report is to evaluate the marketing strategy of Kinder Bueno. This report will mention all aspects of Kinder Buenos marketing mix, these include: product, price, place and promotion. Product Kinder Bueno is a chocolate bar comes from Ferrero. It is a hazelnut cream filled wafer with some smoothly chocolate covering. The brand of Kinder was launched in 1968 which products for children debuts. Kinder Bueno chocolate bar originally comes from Germany, where it was first come out in 1990. It is the most principle and significant source of income for Ferrero. Ferrero use its recipe for their own product, which was available from 1946. Ferrero produce special package for Kinder Bueno. As we know Kinder Bueno is special package like that. This package contains chocolate bar like small candy so that can easily and convenience to storage and enjoy it everywhere at any time. Moreover, Kinder Bueno label contains Kinder Bueno and picture of glass and half milk and hazelnut. It illustrates their special recipe for making milk chocolate with hazelnut. Price Brand Name Price Kinder Bueno 43g $4.53 per 100g Timeout 40g $6.20 per 100g Mars bar 80g $2.6 per 100 g Good product is a crucial point. However, price has a significant impact on customers as well. Setting an appropriate price is also a key to launch the product widely and successfully. When pricing goods, the very important factor is the cost and feature of goods itself. Obviously, the cost of produce the original chocolate is not so expensive. Producing original chocolate is a traditional production project, Ferrero had started with chocolate. Tables above are determine whether price is different between packages and compare with competitor products. This price based on products sold in Woolworths price at this time. The other two competitors product, one is Timeout which is Cadburys product, this company is the worlds largest confectionary producer established in the year 1824 in London. The other one is Mars which is a famous chocolate factory called Mars, Inc. Established in United Kingdom in 1932. According to the research and price table above from supermarket comparison it is easy to find that Kinder Bueno is not winning by price competition. We can easily know the Kinder Buenos price is the middle price of this three companys product. The highest one is Timeout which is $6.2 per 100g; second one is Kinder Bueno which is $4.53 per 100g. The third one is Mars bar which is the cheapest one on the shop shelf is $2.6 per 100g. Although its price is a little higher than others (such as small differences in price cant play a leading role in customers choice), Kinder Bueno focuses on non-price competition. They emphasises distinctive product features and quality to distinguish its chocolate bar from its competing brands. Kinder Bueno develops diversified products focusing on health care. And also because of its prestige products and long history, Kinder Bueno has a great advantage of building customer loyalty. For prestige products, it seems to sell better at high prices than at lo w ones, just like Kinder Bueno. Because of a proper price and such famous brand, all target customers from the child to the old ready to try it. Place (Distribution) When a commodity is labeled well the price, the next procedure is that how to distribute to customers rapidly and widely. In supermarket, they display the product as sort. All of confectionery goods are arranged together. Ferreros product displayed large part of confectionery section, because Ferrero have lots of different products than other company. It increase chance to be choose by customer. And Ferrero product often display at other section especially at Woolworth. It is kind of advertising that customer can pick it up at any place. Next important part of place is which distribution channels should company uses to sell it. In fast moving consumer goods (FMCG) market, most company choose channel C to sell their product. Channel C is a long-standing channel, especially for consumer products, it takes goods from the producer to wholesaler, then to a retailer, and finally to consumers. Global distribution makes Kinder Bueno spread every corner of the world. Products flows from manufacturers to retailers free and fast accelerate the speed of final transaction. Aside from convenience stores, large retail stores such as Coles, Woolworths, Safeway, and Franklins in Australia, many Grocery Stores are also played a significant role in the distribution of Kinder Bueno. Except that, internet has a powerful distributor, either. Shopping online becomes fashion trends. Professional website such as EBay, amaze, provide formal platforms to put goods. These are big advantages for Kinder Bueno, because there would be more room in the stores for them, increasing the chance of sales. Promotion The companys marketing strategy to take a positive, long-term with clients to establish and maintain good relations. The overall role of promotion is to boost product demand. Marketers also indirectly facilitate favorable connection by focusing information about company goods and activities on interest groups, hidden and current investors, societies in general, and regulatory agencies. For maximum benefit from sale efforts, marketers strive for correct planning, execution, and control of communications. When an organization mix specific methods to promote a special product, that combination establish the promotion mix for that product. The four possible factors of a promotion mix are personal selling, advertising, sales promotion and public relations. For some products, firms use all four ingredients, but for other products, maybe only two or three. For Method, the company uses the advertising to promote the products. Advertising is a non-personal communication about an institution and its products transmitted to a target customer through mass media such as radio, television, Internet, magazines, newspapers, direct mail, and signs on mass transit vehicles. Method businesses will be combined with other promotional activities for companies such as according to the magazines that are about family or healthy; to introduce the products for home clear or personal clear. Promotion is the best way to increase income and benefits and let customer know their brand.The promotion is essential to Kinder Bueno. They use promotion to let more costumers be aware of their product to get an advantage in competition between other companies which have similar product for their good quality. Therefore, Ferrero can gain profits from this product by increasing demand. There are lots of ways to promote. In generally, the company will reduce its price and make advertisement. The Ferrero Company uses promotional tools to publicize their product, such as advertising, TV, radio, online advertising, catalogues and in store advertisements. The Ferrero spends a large of money to publicize their products to customers in order to get a high awareness of new costumers and maintain the number of loyal customers. Product advertising promotes the exterior appearance, features, and benefits of products. These effective tools let the consumers realize their existence in the market. Thats the reason why Ferrero is the most popular chocolate maker in global market. Additional, in 2007, Kinder Bueno was aimed to the new market, the teenage market with a new advertise, the advert can make an impression in customers mind, so the advert is very important to a product. So the Kinder Bueno has a good impression in customers mind. The firm should develop new technology into producing new products with new style and higher quality and new tastes to take over more market share. To capture more market, the company should look for better locations for sales to improve the profit. And use the adoption of strategic alliances to the international marketing. SWOT Matrix 6 Marks Product: _ FerreroKinder Bueno_ Strengths Largest global confectionery supplier Long history Operate 30 countries and sell almost every country Brand is well known to people Kinder Bueno is one of the worlds most famous brand names Kinder Bueno is the most consumed chocolate in UK, Australia and India Maintain a stable growth New dynamic in advertising Kinder Bueno world Weaknesses Small range of products Too much fat Weak experience in world market Recall chocolate bars over salmonella fears Opportunities Exist to expand to new markets Grow of fast moving consumer goods (FMCG) market Introduction of more health-conscious products Taken over by Kraft expand market Threats Consumer health trends Rising raw material prices Rising labor wages Intense competitions ( mars, nestle) Low price of supermarket own brands After merger lose their reputation

Charles Dickens :: GCSE English Literature Coursework

Charles Dickens Charles Dickens, a nineteenth century writer, tells a story about a young boy in England and the adventures that happen to him. In reading the book the reader becomes entwined in the plot by Dickens^Ã’s expert writing and style. Using different scenes and scenarios, Dickens displays his characters' personality in a way the few other writers could. In the book Oliver Twist, Dickens uses different events that happen around Oliver instead letting Oliver decide his own fate. In the book, other characters determine Oliver^Ã’s path in life, and Oliver is the subject around which the story revolves. The accidents in the story give depth to Oliver and add depth to the story that increases elements of mystery and suspense. In the beginning of the book, Mrs. Thingummy is helping Oliver^Ã’s mother give birth to the young child. Mrs. Thingummy takes charge of Oliver^Ã’s life just as he is born by stealing Oliver^Ã’s only link with his father, his mother^Ã’s husband. Stealing the mother^Ã’s ring also commits Oliver to a life of lower social status because of his supposed illegitimacy. Oliver moves to the dark forces in the book when he starts with absolutely nothing from his very birth. The sides of good and evil, light and dark respectively, are also devices used by Dickens to display different sides of the social coin in England. Accidents tie in closely with this device because it is by accident that Oliver transferres to one side or another. After spending time in the dark forces, Oliver then switches back to the light side by a run in with Mr. Brownlow, a compassionate citizen who pities Oliver and later takes care of him. Of all the people that Oliver could run into Mr. Brownlow happens to be one of those people who Oliver desperately needed and who could and would provide for Oliver. In another example of an accident, and a shift back into the dark forces, Oliver happens to make a wrong turn and end up in the hands of a band of crooks who earlier had taken possession of Oliver. By chance the appropriate person was in the alley that Oliver, by chance, walked into when he was passing through the city of London. In the last transition of chance, Oliver is caught breaking and entering into a house that the band of crooks intends to pillage. This house contains another compassionate and tender character that becomes like a mother to Oliver. Luckily, and by chance, the shot that one of the

The Raven :: Literary Analysis, Edgar Allan Poe

Edgar Allan Poe wrote many literary works and had many tragedies in his life. Edgar Allan Poe’s life started in poverty, became better during his adopted years, and once again fell into poverty. Edgar Allan Poe inspired many people with his haunting poetry and short stories. One of his best known poems is â€Å"The Raven.† In this poem he is represented as a lonely fellow in his bedroom, longing for his lost love. Some say this poem is a metaphor for his close friends and family dying. Edgar Allan Poe had a rough life that resulted in many inspiring poems. (Hallqvist 1). Edgar Allan Poe was born January 19 1809 in Boston, Massachusetts. His parents, Elizabeth and David Poe were both involved in acting careers. When Edgar was two years old, his father mysteriously abandoned his family, leaving Elizabeth Poe with Edgar and his two siblings, Henry and Rosalie to raise on her own. Soon after Edgar’s father leaving, his mother fell ill with tuberculosis. Elizabeth Poe suffered with the disease from October until December 8, 1811 when she died. Later in Edgar’s life, his poems would relate back to December 1811 and its misfortunes. â€Å"And all I loved, I loved alone† (Lange 12). Poe said speaking of the tragedy of his mother’s death. (Lange 12-13). While Elizabeth Poe had lain sick, Frances Allan and a few other ladies cared for the Poe household. Frances Allan grew and attachment to Edgar and adopted him after his mother died. His siblings were adopted by different families. Frances loved Edgar as her own. â€Å"Edgar was somewhat spoiled by his doting foster mother† (Anderson 12). Frances and her husband John Allan were very wealthy. (Anderson 12). When Edgar turned six, John moved the family to London for business. There, Edgar attended an English boarding school where he studied French, Latin and literature. In 1820, John Allan’s business in England failed, which caused the family to move back to Richmond. Edgar continued school back in Richmond and began writing poems. One of his first poems was about a crush he had on his friend’s mother. â€Å"Helen, thy beauty is to me Like those Nicean barks of yore, That gently, o'er a perfumed sea,

Clinical Reasoning: Combining Research and Knowledge to Enhance Client Care

Making sound and client-centered clinical decisions in an area that demands accountability and evidence-based practice requires not only scientific knowledge, but also a deep knowledge of the practice of one’s profession and of what it means to be human in the world of combined strength and vulnerability that is health care. Every clinician must understand the importance of applying best research evidence to client care, the essence of evidence–based practice, to improve the overall quality of healthcare. Research continues to find that using evidence-based guidelines in practice, informed through research evidence, improves patients’ outcomes (Dykes et al, 2005). The literature is replete with definitions of evidence-based practice. Simply stated, evidence-based practice is the process of applying research to practice. Originating from the medical field in 1991, the term evidence-based medicine was established to ensure that medical research was systematically evaluated in a manner that could â€Å"inform medicine and save lives and that is superior to simply looking at the results of individual clinical trials† (Wampold & Bhati, 2004). An evidence-based practice is considered any practice that has been established as effective through scientific research according to a set of explicit criteria (Drake, et al, 2001). The term evidence-based practice is also used to describe a way of practicing, or an approach to practice. For example, evidence-based medicine has been described as â€Å"the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients† (Sackett, Rosenberg, Gray, et al, 1996). Evidence-based medicine is further described as the â€Å"integration of best research evidence with clinical expertise and patient values† (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Rather than a relationship based on asymmetrical information and authority, in evidence-based practice the relationship is characterized by a sharing of information and of decision-making. The clinician does not decide what is best for the client, but rather the clinician provides the client with up-to-date information about what the best-evidence is regarding the client’s situation, what options are available, and likely outcomes. With this information communicated in culturally and linguistically appropriate ways clients are supported to make decisions for themselves whenever and to the extent possible. According to Burns and Grove evidence-based practice is nothing more than a problem-solving approach to the care that we deliver that takes into consideration the best evidence from research studies in combination with clinical expertise and the patient’s preferences and values (Burns & Grove, 2004). Pierce described in â€Å"Evidence-Based Practice in Rehabilitation Nursing† that â€Å"making patient-care decisions with current information and one’s clinical expertise enhances the ability to provide the best practice†. The author added that â€Å"evidence-based practice is a process that begins with knowing what clinical questions to ask, how to find the best evidence, and how to clinically appraise the evidence for validity and applicability to the particular care situation†. Then, the best evidence must be applied by a clinician with expertise in considering the patient’s unique values and needs. As stated by Law& MacDermit, â€Å"evidence for practice is not only about using research evidence, but using it in partnership with excellent clinical reasoning and paying close attention to the client’s stated goals, needs, and values†(Law & MacDermit, 2008). Although the terms best practices and evidence-based practice are often used interchangeably, these terms have different meanings. Evidence-based practice can be a best practice, but a best practice is not necessarily evidence-based; best practices are simply ideas and strategies that work, such as programs, services, or interventions that produce positive client outcomes or reduce costs (Ling, 2000). In order to bring research and knowledge into someone’s practice, it’s necessary to think critically. Becoming a critical thinker is a prerequisite of becoming an evidence-based clinician. But what is critical thinking? Critical thinking involves the application of knowledge and experience to identify patient problems and to direct clinical judgments and actions that result in positive patient outcomes. Critical reflection requires that the thinker examine the underlying assumptions and radically question or doubt the validity of arguments, assertions, and even facts of the case. Critical reflective skills are also essential for clinicians; however, these skills are not sufficient for the clinician who must decide how to act in particular situations and avoid patient injury (Wheatley DN, 1999). Critical reasoning is a process whereby knowledge and experience are applied in considering multiple possibilities to achieve the desired goals (Noll et al, 2001) while considering the patient’s situation (Fowler, 1997). According to Simmons it’s a process where both inductive and deductive cognitive skills are used (Simmons et al, 2003). Each client’s problem is unique, a product of many factors, including the client’s physical health, lifestyle, culture, relationship with family and friends, living environment, and experiences. Thus, a health care professional does not always have a clear picture of the client’s needs when first meeting a client. Because no two clients have identical problems, a clinician is always challenged to observe each client closely, search for and examine ideas and inferences about client problems, consider scientific principles relating to the problems, recognize the problems and develop an approach to client’s care. When clinicians make healthcare decisions for a population or group of clients using research evidence, this can be described as evidence-based healthcare practice. Another prerequisite to becoming an evidence-based clinician is to be a reflective professional. Reflection is an important aspect of critical thinking. As described by Miller & Babcock reflection is â€Å"the process of purposefully thinking back or recalling a situation to discover its purpose or meaning. With reflection, a clinician seeks to understand the relationships between theoretical concepts and real-life situations. The importance of reflecting on what you are doing, as part of the learning process, has been emphasised by many researchers. The concept of reflective practice was introduced by Donald Schon in his book named â€Å"The Reflective Practitioner† edited in 1983, however, the concepts underlying reflective practice are much older. John Dewey was among the first to write about Reflective Practice with his exploration of experience, interaction and reflection (Dewey, 1933). Schon described the concept as a critical process in refining one's artistry or craft in a specific discipline. The author recommended reflective practice as a way for beginners in a discipline to recognize consonance between their own individual practices and those of successful practitioners. He also stated that reflective practice â€Å"involves thoughtfully considering one's own experiences in applying knowledge to practice while being coached by professionals in the discipline† (Schon, 1996). As it was earlier said, there are a few steps toward evidence-based practice and rehabilitation. The first and the most important step in evidence-based practice is to determine a well-designed question that not only affects quality care but is of interest to the rehabilitation clinician and is encountered in practice on a regular basis. A useful ramework for formulating an appropriate clinical question is suggested by Sackett & colleagues. (Sackett, 2000). They proposed that a good clinical question should have at least three and sometimes four components: Patient or Problem; Intervention; Comparison (not mandatory); Outcome of interest. This has been referred to as the PICO (Patient /Problem, Intervention, Comparison, Outcome) or PIO (Patient / Problem, Intervention, Outc ome) approach. The question usually comes from diverse sources. As stated by Pierce, â€Å"the most common source is the rehabilitation practice itself†. Once the question in searching of evidence was formulated, the next and probably the most important step is to find the relevant evidence in the literature that will help in answering the question. It can be difficult to distinguish relevant from irrelevant information and to decide which source contains the most credible information and research data. Using research findings in practice improves care. Research utilization occurs at three levels—instrumental, conceptual, and symbolic: 1. Instrumental utilization is the direct, explicit application of knowledge gained from research to change practice (Gills & Jackson, 2002). 2. Conceptual utilization refers to the use of findings to enhance one’s understanding of a problem or issue in nursing (Gills & Jackson, 2002). 3. Symbolic utilization is the use of evidence to change minds of other people, usually decision makers (Profetto-McGrath, Hesketh, Lang, & Estabrooks, 2003). According to Hameedullah & Khalid, â€Å"all evidence must be appraised in the following areas: validity, importance and applicability to the clinical scenario† (Hameedullah & Khalid, 2008). Performing the previous steps will result in the appearance of a concrete piece of evidence which should be valid and important for the question in consideration. Now is the time to combine the clinical expertise and experience with the evidence generated to improve the outcome of specific client scenarios. It is also important to remember client’s values and circumstances while making such decisions. The evidence regarding both efficacy and risks should be fully discussed with the client in order to allow them to make an informed decision. This approach allows the formation of a decision in consultation with the client in the presence of good evidence and is consistent with the fundamental principle of evidence-based practice i. e. ntegration of good evidence with clinical expertise and patient values (Hameedullah & Khalid, 2008). Whether the intervention was appropriate and resulted in good clinical outcome for a certain group of clients, in a particular clinician’s hands, will only be answered by careful prospective outcome research. As Strauss and Sackett have suggested, we need to ask whether we are formulating answerable qu estions, finding good evidence quickly, effectively appraising the evidence, and integrating clinical expertise and patient’s values with the evidence in a way that leads to a rational, acceptable management strategy (Straus & Sackett, 1998). Although the importance of research-based practice was identified decades ago and has gradually been adopted by rehabilitation professions, there are a number of challenges for clinicians who are attempting to be use research to aid in clinical decision-making. According to Bohannon and Leveau most challenges can be grouped under one of three areas: research methods, clinicians’ skill, and administrative factors (Bohannon & Leveau, 1998). The research procedures of randomly assigning patients to an experimental or control group, using standardized outcomes measures that may not have real-world relevance, and the difficulty of blinding investigators and clients to the research procedures all make research results difficult to be implemented, interpreted and utilized clinically (Ritchie, 2001). Evidence-based practice requires clinicians to read current research literature, understand research methodology, and incorporate best evidence into practice as appropriate. As Sumison noted in one of his studies, it may be difficult to use in client-centered practice. The research literature may be difficult to access and relevant information is often not compiled in one place (Sumison, 1997). Interpreting and implementing research evidence also requires clinical skill, judgement, and experience. Deciding what constitutes evidence that justifies a change in practice can be challenging and the opportunity for bias exists at every stage of the process as Pomeroy observed in one of his articles from 2003 (Pomeroy, 2003). There are many other factors that present challenges to clinicians who are attempting to use evidence to guide their practice. Time constraints are almost universally identified as a primary limiting factor. Schreiber and Stern stated that â€Å"clinicians refer to pressures of today’s health care environment and administrators’ emphasis on productivity as factors that directly inhibit their ability to seek out, gather, read, and integrate cientific information relevant to daily practice† (Schreiber and Stern, 2005). The concept of evidence-based practice is of great importance for rehabilitation and physiotherapy to allow for increased insight for all involved including patients, clinicians, third-party payers, and government and health care organizations, into the clinical decision-making processes. The purpose of promoting this paradigm is optimum quality of care with conservation of professional autonomy.