TQM Process Improvement Strategies Essay Example

TQM Process Improvement Strategies Essay Name: Course: Instructor: Date: We will write a custom essay sample on TQM Process Improvement Strategies specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on TQM Process Improvement Strategies specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on TQM Process Improvement Strategies specifically for you FOR ONLY $16.38 $13.9/page Hire Writer TQM Process Improvement Strategies There is an unprecedented increase in the level of competition in the various business fields and markets. This has been driven largely by the presence of technological improvements and changes in the consumer needs resulting in diversified products for satisfaction of such consumer needs and wants. Hence, in an increasingly competitive society, in the business world, there is a dire need by organizations and modern manufacturers to ensure continued evaluation of their management principles. Constant evaluation of the existent strategies of management, operation and other practices in the organization aims at providing the highest management process in line with the trends in the market in terms of changes. Hence, success in the modern business world is achieved through efficiencies brought about by improvements through total quality management. Essentially, total quality management is defined as the chronological approach used by management in continuous improvements in operations, organizational process and functions. This is usually achieved by understanding the consumer needs and wants and striving to exceed such consumer expectations through efficiencies in the organizational processes. In addition, the main objectives for the use of TQM are to ensure adequate focus on the consumer, continuous improvement of the organizational processes, and participation of all individuals in the organization, in the TQM activities (Gupta, Shakti Kant, 2). Accreditation is an essential asset to an organization irrespective of the field of operation. Hence, organizations usually select and aim for goals, which are realistic and achievable with the resources available to the organization. Establishment of standards enables an organization achieve the select goals and objectives and thus in the process ensuring the satisfaction of the consumer needs and wants. Hence, the presence of goals with respect to the existent standards provides managers in an organization with the opportunity to focus on achievement of such on a holistic platform. Hence, daily activities in the organization are relegated to the lower hierarchal executives for execution. This focus is essential as it entails the need for constant evaluation of the existent standards and goals in the organization (Imai, 19). The effectiveness or appraisal of the standards in existence, in an organization, is evaluated through the focus on either the structural aspect or the outcomes because of the existent standards. Accreditation programs in the contemporary organizations focus on three essential aspects in the execution of tasks in the organization. The first is the focus on the structural aspect of the issue of services or the development of products. The second is the focus on the process aspect in an organization. The third and last focus is on the outcome of the procedures in the organization during execution of tasks (Gupta, Shakti Kant, 5). Accreditation is usually used as a means of achievement of quality in the organization. Accreditation programs in organizations play a significant role in continued updating of standards of quality in any organization. Continued evaluation and subsequent improvements in organizational processes and products is essential for the achievement of the consumer satisfaction. This is achieved because of the guaranteed high quality, considerable costs and the delivery of the service by an organization. This is a means of seeking and subsequently achieving and ensuring consumer satisfaction. Hence, the means of constant evaluation of the existent goals and standards in organizations is a means of ensuring the achievement of competitive advantage. Thus, the improvement of quality in the organizational processes and thus ensuing that the efficiencies accrue numerous benefits to the organization such as reduced process costs, increased profitability, better consumer relationships from satisfaction through high quality goods and services and the achievement of a strong brand image. Hence, improvements are used to align the existent resources such as the skills, labor and funds with the organization’s strategic goals and objectives (Gouranourimi, 48). For instance, manufacturing organizations around the world have increased their use of Total Quality Management practices and business process re-engineering (BPR) programs aimed at achievement of the consumer satisfaction. The advantages accrued form the use of such programs is the need to ensure a strong relationship based on consumer experiences. Consumer experiences are essential in that they determine they determine the relationship of the organization with the existent consumers of the services and products issued by the organization. It is an express indication of the ability of the organization to provide high value goods and services that provide the much needed consumer satisfaction. In an organization, the management is tasked with initiating and talking up the act of decision-making in order to align the organizational processes with the organizational goals and objectives. This is considered as the provision of the strategic direction with the aim of accruing long-term results, which are usually achieved in terms of the financial position of the organization. This entails the decision-making in terms of the competitive priorities of the organization, the policies used in the various processes in the organization and other sectors, as well (Powell, 21). The second phase is the improvement planning which involves the identification and prioritization of the improvement actions, which essentially contribute to the achievement of the overall strategic goals and objectives. Improvements could take the form of new designs or ensuring continued improvements in the organizational processes to achieve the goals and objectives of the entity in its market of operation. Essentially improvement projects are selected based on their levels of contribution to the organizational efficiencies and effectiveness of the processes in the competitiveness of the organization in its market of operation. Prioritization of such essential processes provides the organization with the much-needed focus for the achievement of the strategic goals and objectives. It is also essential to ensure refined select competitive priorities, which should undergo continuous improvement (Powell, 21). This is also actualized on continued investigations into the consumer needs, wants, expectations and preferences and how such relate to the performance of the organization when compared to other organizations in the market of operation. Additionally, the processes, which are prioritized for continuous improvement, are selected based on their level of impact related competitive priorities of the organization identified for improvement. TQM is a process, which applies quantitative models and human resources to improve the resources supplied by an organization to the consumers. Such ensures that the consumers of the goods and services are the primary targets of the TQM processes and activities. The execution and implementation of the TQM strategies has several salient features. Such include the presence of a distinct approach or TQM model, elements of quality in the process, the leadership in the TQM processes, multifaceted and dimensioned approach in the TQM process for maximization of the benefits or results of the process. Leadership in an organization is essential to ensure the success of the TQM processes. Leadership is at times characterized as animalistic in terms of the approach used by the organization. Commitment from the top management of the hierarchal order of the organization in terms of provision of the direction of the TQM processes. Good management is essential in the processes to ensure the achievement of the organization’s strategic goals and objectives. Involvement of the organization’s top management falls as a critical aspect in the TQM processes because of the issue of guidance and direction in the entire process. The involvement of top management ensures the ability of evaluation of all the organizational processes to gain information of the priorities in the organization. Such priorities are related to the relationship of the organization with consumers and the entire market in general. They usually provide the direction in terms of obvious areas as which accrue larger costs to the organization. Additionally other issues such as quality of services and products rest with the various organizational departments (Powell, 27). The commitment of the management should be driven by a strong desire by the organization to ensure improved quality in the processes, services and products to consumers for eventual satisfaction of the consumer needs and wants. TQM results usually focus on the presence of long-term benefits. Hence, there is a dire need to delegate duties, responsibilities and tasks to the senior mangers for the overall achievement of the strategic goals and objectives. Such should also be replicated in the entire organization to ensure that all employees are in active participation, in the TQM processes. Top management provides monitoring and control as it acts as an oversight authority towards the achievement of the possible benefits of the TQM process. Management also provides direction in terms of the corrective actions required as well as the adoption of new processes in the organization from the TQM processes. The involvement of the top management of the organization is essential in TQM in that it enforces the gravity of the need for evaluation of the processes in the organization using TQM processes. Contemporary organizations identify that customer needs, wants and expectations in terms of the services and products provided by the organization are the primary drivers of the need for evaluation of the processes in the organization. Additionally, connection between the improvement deployment process and the strategic competitive priorities of the organization is needed. TQM focuses on the presence of incremental changes and the eventual improvement, even though gradual, of the process in an organization. Such could be considered as a forward-looking approach as it aims at the achievement of positive results (Gouranourimi, 49). The results of TQM are usually measured best from an economic perspective. Such effects could lead to bankruptcy or financial success based on the approach used in the TQM process. Results of TQM are at times determined by the resources held by an individual organization. The differences in terms of results and benefits are due to the presence of imperfect imitability. This means that organizations are exposed to different conditions and resources leading to the difference in circumstances and thus the results of the TQM process. This is brought about by the presence of what is described as isolating mechanisms. Isolating mechanisms include time compression diseconomies whereby issues such as skills and experience may take longer to accrue leading to slow realization of the benefits of the TQM process (Imai, 41). Others include the presence of connectedness of resources in that an organization might acquire resources, which might require additional resources, which an organization mi ght be unable to achieve or acquire. Hence, resources cannot be imitated by an organization resulting into varied benefits of possibly failure of the TQM. TQM requires dedication in terms of the allocation of resources by the organization for actual achievement of the goals and objectives in target by the organization. The goals and objectives should be formulated with respect to the available resources. Dedication of the resources is based on the uniqueness of the organization in terms of its ability to achieve the provided goals and objectives form the use of the TQM (Yousaf, 9). This requires adequate top management involvement, as well as the general employee population in terms of understanding their roles in the achievement of the provided goals and objectives using the TQM processes provided. Work Cited Imai, Masaaki. Kaizen (ky’zen), the Key to Japan’s Competitive Success. New York: Random House Business Division, 1986. Print. Gouranourimi, Farshad. â€Å"Total Quality Management, Business Process Reengineering Integrating Them for Organizations’ Improvement† American Journal of Scientific Research, 46 (2012): 47-59. Print. Gupta, Shakti Kant, Sunil. â€Å"Total Quality Management and Accreditation Strategic Essentials for the next Millennium† Hospital Notes, 2. 2. (April-June 1999): 1-6. Print. Powell, C. Thomas. â€Å"Total Quality Management as Competitive Advantage: A review and Empirical Study† Strategic Management Journal, 16. 1. (1995): 15-37. Yousaf, Nadeem. â€Å"Top Management Commitment for TQM-a process model† Pakistan’s 10th International Convention on Quality Improvement. (2006): 1-11. Print.

Chemical Formula for Ethanol - Chemistry

Chemical Formula for Ethanol - Chemistry Question: What Is the Chemical Formula of Ethanol? Ethanol is ethyl alcohol or grain alcohol. It is the type of alcohol found in alcoholic beverages. Heres a look at its chemical formula. Answer: There is more than one way to represent the chemical formula of ethanol. The molecular formula is CH3CH2OH. The empirical formula of ethanol is C2H6O. The chemical formula also may be written as CH3–CH2–OH. You may see ethanol written as EtOH, where the Et represents the ethyl group (C2H5). Learn how to distill ethanol. Ethanol Properties Ethanol, like other alcohols, is flammable, volatile, and colorless. It has a characteristic odor. Ethanol has psychoactive properties. Other forms of alcohol also have such properties, but ethyl alcohol is considerably less toxic to humans than methanol or isopropanol. Ethanol Uses In addition to its recreational use, ethanol has many other applications. It is an important disinfectant and antiseptic. It is a common solvent, of particular use because it is miscible in both water and organic solvents. Ethanol is used for the synthesis of other organic compounds. Ethanol is a clean-burning fuel.

Economic data analysis using software STATA Essay

Economic data analysis using software STATA - Essay Example variables; GDP, the rate of inflation, the rate of un-employment, long term interest rate, short term interest rate, the CPI-consumer price index an, the money supply (M) and regression analysis done using STATA. When investing, you are most likely to hear the terms inflation, unemployment, Consumer Price Index (CPI) and Gross Domestic Product (GDP) about every day (Barnes, R 2007). Investors are often made to feel that these terms should be looked deeply as a surgeon would study a patients chart prior to operating (Barnes, R 2007). Countries really need to find a level of understanding which can assists them in decision making without engaging piles of data to solve the problem. Inflation in the increase in the  money supply. It can also mean an increase in price levels for different commodities. Generally, inflation is about a prices increase as compared to some set levels (Richmond, H 2006). According to Gay, A (2006), if the money supply goes up, this is usually manifested in higher price levels for commodities, however, he continues to state that, this manifestation takes only a short while and that, it is simply a matter of time. According to Dawson, G. et al. (2006), Gross Domestic Product in a country represents the total aggregate output of its economy. Further to him, the GDP figures which are reported to investors and those that want to invest are already adjusted for inflation. For example, if the gross GDP is calculated to be 6% above than the preceding year and inflation calculated at 2% over the same period, then the GDP growth would be reported as 4% (6%-2). The relationship between inflation and GDP is like a delicate dance where any can break affecting the masses (Dobson, S & Palfreman, S 1999). The annual GDP growth is vital for each and every country in that, if the overall economic output declines or holds steadily, then many organizations will not be in a position to increase profits which is the sole driver of stock performance in all of

Pros and Cons of Embedded Journalism Essay Example | Topics and Well Written Essays - 1000 words

Pros and Cons of Embedded Journalism - Essay Example Before acceptance to join the military, reporters sign contracts that give a standard or guidelines of when and what they can report on. This paper discusses the advantages and disadvantages of embedded journalism. Pros First, embedded journalism improves the relationship between the government and the armed forces media. After journalists embedment they become part of the military troop that travels around with them recording their activity in accordance to the agreement. Reporters depend on the military for food, shelter, and protection from the enemy. The regular contacts between the two build trust and reduce the common suspicion that normally exists between the two parties. Both informal and formal settings that develop during the embedment period can result in great transparency because the government and the armed forces will find it easy to pass information freely. Secondly, embedment of journalists allows them to travel with the military watching their every move. They are l ike watchdogs that make the military responsible of their every activity. According to Komarow as quoted in college of journalism and mass communication, US media helped in making sure that the US armed forces were held accountable for bombing an Afghan wedding party. This is after the initial investigators went to the scene together with the journalists for investigations and they unearthed a hidden agenda that in bombing, US armed forces wanted to erase evidence. Pressure from the media caused them to take responsibility (Berens, 2004, p.1). Thirdly, since the embedded journalists can access the battle scenes, they get more information and faster than those removed from the battle zones. Hannah and Baylor concur with this and argue, â€Å"Reporters travelled by aircrafts to and from the battle zones and were free to observe the combat operations† (Hannah, 2007, p.8). With the modern technology then this accessible information can be passed on instantly to other destinations . Fourthly, embedded journalists receive information from different perspectives. Their physical presence allows them to talk to the soldiers, commanders, and talk to the people around the battle filed. Multiple sources of information make interesting stories. Cons Embedding of journalists has so many disadvantages. First, the contract that journalist’s sign with the military hinder them in their reporting. According to Lehrer, â€Å"Before joining their  battalions, the embedded journalists had to sign a contract restricting when and what they can report† (Lehrer, 2012, P.1). Embedding is the driving force behind coverage and embedded journalists can only describe military actions in general terms and they are restricted from reporting on future missions.  Those who opt to stay outside the embedment are not left free since the government to comply at times harasses them. According to Rajan, â€Å"the distinction between patriotism and fair reporting becomes fuzzy in such circumstances† (Rajan, 2005, p.13). Secondly, embedded journalists work hand in hand with the soldiers and depend on them for protection, food and other social amenities. This closeness may hinder proper scrutiny and reporting of foul actions. Fortner and Fackler argues that, â€Å"

Philosophy questions Essay Example | Topics and Well Written Essays - 250 words

Philosophy questions - Essay Example The other key responsibility of a CFO is to come out with such financial statements that accurately and in a transparent way reflect on the financial health of the firm (Korey 72). Though, the drafting of the financial reports happens to be the responsibility of all the executives, it is the CFO who has the eventual determining influence on such financial reports. So, while drafting such financial reports, I will always try not to be influenced by any other concern and be above board and professional in the discharge of my duties. One serious responsibility that I will be required to perform will be to honestly and accurately detail the board, if I feel that the CEO tends to differ with me regarding any reporting protocol, and one’s views are misplaced and faulty. No doubt, the board and the investors will look up to me for facts, and not basing my reporting on facts will amount to being unethical on my

Role of a Palliative Care Nurse

Role of a Palliative Care Nurse Palliative Care The role of the expert palliative care nurse is complex and unique. The nurse functions as an integral part of a Multidisciplinary team, providing expert skilled assessment and nursing care, supporting the patient and the family to make informed choices thereby encouraging the patient to continue to make autonomous decisions about their care towards the end of their life. However, often the nurse will find herself dealing with difficult family dynamics with family members having differing expectations of the type of care that the patient should be receiving, staff conflict over treatment methods or strategies and high workloads. These issues can only compound the stresses on the Palliative Care Nurse and to cope with the many dilemmas she must be well armed. The complex needs of the terminally ill patients and their families make the multidisciplinary team approach the most effective method of care Staff from a range of disciplines including medical, nursing, social work, dietitian, physiotherapist, pharmacist and others bring diverse and unique skills. As a team they provide an excellent sounding board for ethical dilemmas thereby hopefully- enhancing ethical practice. (Latimer, 1998) The Nurse in her role is required to act as patient advocate and ensure that the patients rights are respected. Unfortunately this advocacy is sometimes perceived negatively as a threat or implied criticism of medical care. Doctors need to listen to the nurses more accurate perspective of patient concerns. Consistency across the team leads to better outcomes for patients. Reinforcing the same information by both medical and nursing staff help to allay patient anxiety far more than conflicting views on such things as symptom control. (Jeffrey, 1995) The members of the Multidisciplinary team sometimes make decisions regarding treatments, which they may perceive to be of the most benefit to the patient whilst in fact the patient, does not perceive the benefits in quite the same way. Nurses have more prolonged contact with the patient than most other members of the team due to the hands on patient care that they do. They often establish a close rapport with the patient and the family and are most likely to be aware of the patients likes, dislikes, hopes and dreams and are privy to often delicate and very private details of the patients life. The very fact that the nurse spends so much time with the patient makes them more likely to have knowledge of this kind of information. Doctors rounds in a Palliative Care Unit enable the doctor to spend perhaps 30minutes maximum per day in talking to the patient. In the community, appointments times with Doctors are restrictive and Home Visits limited. Patient Nurse dependency ratios in hospit als and palliative care units mean that Nurses are spending approximately four hours per day on one to one patient contact. Again, other team members are very limited in the amount of time they spend with patients due to the number of clients/patients they may have. A dietitian for example may spend 15 minutes with a patient twice during their six-week stay in a Palliative Care Unit or 30 minutes as an outpatient during the course of the Terminal illness. Social workers often spend long periods at a time with patients and/or their families in lengthy discussion however these discussions may only take place a couple of times over the period of the illness. Therefore the Nurse is far more likely to be aware of issues affecting patient care. There can be many difficulties for the Nurse expert providing high quality care to palliative patients whilst respecting their right to autonomy in the setting of the Palliative Care Unit, the role of the Nurse is to painstakingly assess the needs of patient and family. These needs may be constantly changing and there is no room for the Palliative Care Nurse to become complacent in her patient care. Symptoms may be physical such as pain, nausea, and dyspnoea or psychosocial or spiritual. In identifying care needs the nurse must be able to determine who is the most appropriate team member to refer to provide optimum management of these needs. E.g. although the expert nurse will have counselling skills, she must be aware of her limitations and refer on where appropriate to counsellors, psychologist or social worker. Mount (1993) suggests that we must first attend to physical needs and that to do this we need a detailed knowledge of therapeutics. Skilled listening and attention to detai l are paramount in Palliative Care. Our listening skills not only apply to what the patient is saying, but what they may be leaving unsaid. Nonverbal cues such as facial expressions and demeanour, the need to keep the door to their room open at all times or to constantly keeps the curtains drawn. In order for patients to make choices they need to be accurately and appropriately informed, yet Vachon (1993) suggests that whilst caregivers sometimes decide not to tell patient and family what is likely to happen, at other times they may give too much negative information not allowing the patient and family to have any hope. Patients need to know at what stage their disease is and their prognosis in order to choose where to spend their remaining time. The ethical communication of information should be timely and desired by the patient, accurate and given in words understandable to the patient and family and conveyed in a gentle, respectful and compassionate manner. (Latimer, 1998) An example of such communication would be that when asked by my patient (speaking about his fungating tumour) When will this thing on my neck stop leaking? I need to gently but truthfully explain that it will most likely continue to leak blood and fluid until he dies but also that we will continue to con tain the fluid and minimise the discomfort and attempt to disguise the drainage appliance as best we can. To not advise him of the eventuality of the fluid discharge continuing is to encourage him to have false hope and expectations and further disappointment when the discharge continues and probably worsens. However, the nurse needs to recognise that some patients do not wish to have information relayed to them e.g. a patient who did not want to talk about her illness future and continued to deny that her disease was terminal. Dont tell me that, I dont want you to say those words! Yet respect for patient autonomy demands that patients be given honest answers to their questions. Without this, patients become more uncertain and unable to make decisions about their future. Dying patients are by virtue of their physical and emotional situation, frail and vulnerable their treatment and management during this final phase of their life must be of a high standard both professionally and ethically. The Nurse and other members of the team should seek to do the best for the patient and their family. This includes respecting autonomy, through the provision of truthful information and helping them to set realistic goals while providing genuine attentive care during the full course of the illness. Provision of symptom control hinges on accurate assessment. McCafferty and Beebe (1989) suggest that we dont always make assessment easy by the fact that sometimes we dont readily believe what the patient tells us or the patient may deny having pain or refuse pain relief although they may be hurting. The expert Nurse should remember that the person with the pain is the authority- they are the one who is living the experience and we must believe them if they tell us they have pain. It is all too easy to allow ones own values and beliefs to cloud our judgement Unfortunately I have seen it happen where a nurse usually not experienced in Palliative nursing will make a statement such as He says he has pain rated 8 out of 10 but he doesnt look distressed or She was laughing and talking with her visitors 5 minutes ago and now shes buzzing for pain relief. Such comments display the Nurses ignorance and lack of understanding of pain. It seems apparent that they do not understand about adapta tion or distraction or that laughter stimulates the relaxation response throughout the body systems by lowering blood pressure, deepening breathing and releasing endorphins. Also of great importance is the need for the nurse to explore further if a patient denies pain despite indications that they are in fact suffering pain. There may various reasons for denial for example; sometimes our language when asking questions about the patients pain may be inappropriate. Some patients may not consider a dull constant ache as pain but an ache. Others may feel sore. Other words such as discomfort and pressure may be used instead of Pain We as nurses need to avoid misinterpretation by using such other words. The Nurse needs to explore the issue of pain and help to identify the source. Location. Intensity, and Quality of the pain help to identify the source. Eg. Bone, visceral or nerve pain. Identifying the source aids in determining the appropriate treatment method. The expert Nurse will be aware that nerve pain will not respond as well to opiates and that neuroleptic agents need to employed. As suggested earlier, as Nurses spend the most time with the patients they are able to obtain the most information on the patients response to pain management plans, they are able to educate patients on the need to take regular analgaesia; and they can be the most influential in management of pain (Lindley, Dalton and Fields, 1990). Of course we as nurses in Palliative Care need to be aware that not all pain will respond well to traditional or orthodox treatments. Seeing a patient in pain and trying all pharmacological methods without success is distressing for staff as well as the patient and it is then that nurses should further attempt to employ other methods such as relaxation, distraction and music. Studies have shown that that listening to music disrupts the chronic pain cycle. Laughter, Massage and relaxation therapies have also been shown to interrupt this chronic pain cycle (Owens Ehrenreich, 1991) and massaging a dying patients back or feet with oil blends incorporating lavender instils in many cases a feeling of peace, contentment and lessening of pain. Heat and cold packs are also said to be beneficial in the treatment of chronic pain however heat applications are said to be contraindicated in patients with poor vascular supply and in malignancy. Most institutions have policies related to the use of thermal applications. As most nurses working with palliative patients will know, bowel management is of MAJOR importance! The Narcotics we administer to alleviate the symptom of pain have the side effect of causing the symptom of constipation. Vigilant monitoring of a patients bowel status is essential but it is of great importance that patients are not quizzed about their bowel actions in front of visitors or during meal times. Privately and quietly please! Cameron (1992) describes the types of constipation, these being primary and secondary due to pathology or iatrogenic. The goal of bowel management should be the prevention of constipation rather than treatment of constipation and appropriate assessment, regular administration of aperients, appropriate diet and fluids and provision of conditions favourable to bowel evacuation should all be part of the nurses management plan and patient education is paramount here for without the knowledge that opioids will contribute to constipation but that regular ap erients will counteract this symptom, the patient is unable to make informed choices about his symptom control. Nausea and vomiting are other symptoms the nurse can provide valuable assistance in controlling again through adequate assessment and intervention. The nurse needs to be aware of possible causes of nausea and vomiting such as hypercalcaemia, disseminated carcinoma, renal failure and vestibular stimulation particularly in patients with primary brain tumours or secondary cancer deposits. Constipation and radiotherapy, urinary tract infection and chemotherapy- the causes are many and varied. Hogan (1990) suggests that an understanding of the various pharmacological and non-pharmacological interventions is the foundation of symptom control but that the nurses commitment to alleviate the symptoms is the most important variable. Simple techniques like minimising cooking smells, presenting small meals and ensuring offensive odours such as foul linen bags from the vicinity can all be employed in conjunction with pharmacological methods to minimise nausea and vomiting. Successful management r equires an understanding of the cause of the symptoms. Other symptoms that may prove troublesome for the terminally ill patient include oral thrush and stomatitis, diarrhoea, lethargy and insomnia. Dyspnoea can be the cause of great distress and the expert nurse will be aware of the need to employ techniques to minimise discomfort. These may include reducing exertion by the patient, positioning them to allow maximum comfort when breathing and improving air circulation by use of fans or open windows. Humidification by methods such as nebulised saline may also be helpful. Pharmacological methods such as morphine either orally, subcutaneously or as a nebulised solution have also been found to decrease the perception of breathlessness (Chater, 1991) and anxiolitics such as Lorazepam s/l are quite helpful. Reassurance and providing a calm environment are also helpful techniques to employ. Distressed relatives around the bedside can further increase the patients respiratory distress and it is at such times that the nurse needs to take them asi de and explain to them what is happening and how they can help by remaining calm and distracting the patient or helping them to relax. For the terminally ill patient, being in control is vital and the nurse must appreciate that the patient though suffering an illness from which he will eventually die must be allowed to keep his self respect. This self respect can be eroded enough by the nature of the disease its symptoms and suffering, sorrow and emotional pain. There are times when we as nurses see patients admitted to hospital who have already had their autonomy undermined. Whilst it may have been their wish to stay at home longer or until the end, families may feel the burden of care is too great and that they can no longer cope. This is usually when a new symptom presents that the family feel unable to manage. Nurses in the community may sometimes be able to prevent this situation arising by offering a more frequent or higher level of care supported by a Palliative Care Service, education of the family about the patients symptoms and how to help manage them. Sometimes admission is not what the patient wishes but the service is unable to provide appropriate management in the home. There is then an onus upon those providing the care to look at all options to enable the patient to achieve his goal of returning home. To be autonomous means to have choice and control in our own lives yet we must accept that total autonomy is hardly ever possible. Sometimes there are circumstances in which it is not possible to challenge on the patients behalf- times when the patient may wish to have their autonomy eroded. There are times when the patient may not want our advocacy and times when we may not be able to give it- for example controversial ethical issues such as euthanasia. (Coyle, 1992). The nurse may sometimes develop feelings of helplessness and insecurity because of her unrealistic expectations of herself. The complex role we play in management of the terminally ill sometimes may lead the nurse to think she should be all things to all people the doctors handmaiden the patients advocate, the families sounding board. Sometimes nurses can become over involved, infringing on the autonomy of the patient and the family (Scanlon, 1989) and must be aware of when to withdraw. At times when caring for a patient with uncontrollable physical or emotional pain the nurse may feel herself to be a failure. Add to this the likelihood of inadequate resources and staffing, staff conflict and role conflict and there is a pretty good recipe for stress. Abraham and Shandley (1992) list five main sources of work stress. These being: 1. Work overload, 2. Difficulties relating to other staff, 3. Difficulties involved in nursing critically ill patients 4.concerns over patient treatment an d 5. Nursing patients who fail to improve. This again emphasises the fact that nurses specialising in palliative care are likely to suffer high levels of stress. CONCLUSION To help cope with these high demands and continue to maintain the delicate balance between what the patients want and what the health professionals think the patient needs, nurses need to arm themselves with expert knowledge of symptom control, and be well aware of ethical issues related to palliative care. Nurses also need to maintain open active communication with their peers and other members of the facility. We must also realize that even if we do not influence a situation or supply an answer to all needs and if our patients do not maintain total autonomy, it is enough that we have been with them, supporting them as best we can in their journey to the end of their life. Bibliography:

Comparing Women in Raisin In the Sun, House On Mango Street, and Yellow

Roles of Women in A Raisin In the Sun, The House On Mango Street, and A Yellow Raft In Blue Water      Ã‚  Ã‚   A Raisin In the Sun, The House On Mango Street, and A Yellow Raft In Blue Water all contain strong, defined images of women. These women control and are controlled. They are oppressed and liberated. Standing tall, they are confident and independent. Hunched low, they are vulnerable and insecure. They are grandmothers, aunts, mothers, wives, lovers, friends, sisters and children. Although they span a wide range of years and roles, a common thread is woven through all of their lives, a thread which confronts them day in and day out. This thread is the challenge they face as minority women in America to find liberation and freedom from lives loaded down with bondage. These women fight to live and in their living they display their strengths and their weaknesses. They demonstrate the opposition many women face being viewed as the inferior sex as well as discrimination against their ethnicity. In this struggle Hansberry, Dorris and Cisneros depict women attempting to find con fidence and security in the society around them. Comparing and contrasting the novels A Raisin In the Sun, The House On Mango Street, and A Yellow Raft In Blue Water, three principal images of women emerge: their strength, bondage and liberation. These images combine to depict the struggle of many minority women, regardless of their ethnic background, and shapes the character they draw from society.    "Now--you say after me, in my mother's house there is still God...There are some ideas we ain't going to have in this house. Not long as I am at the head of this family" (Hansberry 51). From Mama's ardent statement in A Raisin In the Sun, addressed to ... ... in the past has held them down. Finding strength in this new liberation they will be released to assist others in gaining their freedom and becoming whole individuals. We take courage and inspiration from the lives of Beneatha, Esperanza, Mama, Evelyn, Rayona and others as they display the struggle toward true womanhood and the strength to "come back. For the ones who cannot leave as easily as you" (Cisneros 105).    Works Cited: Blicksilver, Edith. The Ethnic American Woman. Kenall/Hunt Publishing; Iowa, 1978. Cisneros, Sandra. The House on Mango Street. New York: Vintage Books, 1991. Dorris, Michael. Yellow Raft on Blue Water. New York: H. Holt, 1987. Hansberry, Lorraine. A Raisin in the Sun. Literature and Its Writers: An Introduction to Fiction, Poetry, and Drama. Eds. Ann Charters and Samuel Charters. Boston: Bedford Books, 1997. 1829-96.