Human Morality Essay

A common question throughout history has always been about human morality. Because of our higher thinking capacity, we are hardwired to adapt and refine our basic instincts to survive; therefore, it is obvious this question would be disputed throughout time. Are humans innately good, bad, or plainly neutral? The position that any one person takes may be derived from any number of ideas, be them philosophical thoughts or scientific inquiries. This essay asserts that morality is innate, and uses both scientific studies and ideas from philosophers to support this argument. Man is essentially good, and the different ways people are nurtured—from societal influences to parental influences—creates the large spectrum and variety of behavior that may not be deemed â€Å"good† or â€Å"moral.† The magazine Smithsonian published an article named â€Å"Born to Be Mild† in January of 2013 on morality in young children. This article wrote about a few different studies done on children by three different experimenters. In one of the studies titled â€Å"Spontaneous Altruism by Chimpanzees and Young Children,† Felix Warneken tested the morality of humans through young babies (because they have had little to no socialization) and also tested morality of chimpanzees, the closest relative to humans. In this study, 18-month-old toddlers were tested to see if they would help others in need by retrieving a dropped item that an adult struggled for. In almost all instances, the child returned the item. Warneken stated, â€Å"[Helping at that age] is not something that’s been trained, and [the children] come to help without prompting or without being rewarded† (Tucker 39). Not only did the toddlers help people in need, they also helped without social cues (such as the distress someone in need has). Many toddlers in the experiment Warneken created helped retrieve a can that had fallen off a table next to an adult and the adult failed to realize something was amiss. When Warneken tested the chimpanzees to see if they would return the same answers, he tested chimpanzees that were nursery-raised and semi-wild chimps. Both tests displayed the same results as the tests on the toddlers—chimpanzees were willing to help both humans and other chimps in need with no reward for themselves (Tucker 39-41). The fact that most of the toddlers and human relatives, the chimpanzees, helped others in need both with and without social cues strongly points to the idea that human morality is innate. A second study highlighted in the Smithsonian article was a reproduction of a previous study from the mid-2000s. The original study was an animated presentation shown to six to ten month old babies in one group and three month old babies in a second. The animated presentation consisted of a red circle attempted to climb a hill. In one instance, a triangle helped the circle climb, and in another, a square knocked the circle down. When the square and triangle were presented to the older group of babies, almost all babies chose the helping triangle over the hindering square. For the younger group, the researchers tracked the eye movement of the babies to either the triangle or square, because the babies could not physically grab the object. In the reproduction, done by another experimenter, the results were the same. Once again, evidence suggests that because babies seem so morally good, humans are innately good, and it is the nurture we receive as we are socialized into this culture th at may cause some people to seem morally corrupt (Tucker 38-39). It should be noted that because the reproduction provided the same results as the original study, an even stronger case was created for the idea of innate human morality. The messages that Machiavelli gives in â€Å"The Qualities of the Prince† may cause one to believe that humans are innately evil because through â€Å"The Qualities of the Prince,† Machiavelli details how to be cunning, take control, and maintain control as a ruler of a province. His teachings seem to create humans as greedy people, hungry for more. This is actually very incorrect. Machiavelli clearly states, â€Å"it is necessary for a prince†¦to learn how to not be good† (42). I emphasize that Machiavelli wrote a man must learn to not be good. One can assume from this that Machiavelli is saying man is at least in some degree, wholesome and moral. After all, humans were never meant to civilize and evolve. We are, in true form, animals that have an instinct to survive. Ruling and gaining power is a man-made idea. Opponents to the idea that humans are moral might suggest that if ruling is man-made, evil is already within us because we created the concept of ruling others; however, if man were truly evil, he would not take murder as a heavy offense, and would kill others in his way to get what he wants instead of just gaining control. The examples of rulers that Machiavelli writes help to reiterate this point. These men were not born thinking of war and control. They were raised and socialized to lead and gain power. Steinbeck and the messages he delivers in The Grapes of Wrath also point to the idea that human morality is innate. The author often writes of the distinct line of those with, and those without—in other words, the owners and the migrants or farmers. Steinbeck makes a point to write about how close-knit the migrants are in many instances. Steinbeck writes â€Å"‘I lost my land’ is changed†¦[to] ‘We lost our land.’,† ‘I have a little food’ plus ‘I have none’†¦.is ‘We have a little food’† (151); â€Å"the twenty families became one family† (193); and â€Å"when a baby dies a pile of silver coins grew at the door flap† (195). All of these quotes show the goodness in others, to do something for someone in need. This is all in contrast to the owners, which on multiple different pages Steinbeck writes how disconnected they are from the land, and â€Å"the quality of owning freezes you forever into ‘I’† (Steinbeck 152). These owners are so encompassed by the material culture around them, by the greed and the blanketed reality that they cannot see with a moral compass anymore. Of course they have one, for at one point they might have been like the farmers, caring for others and instituted into the â€Å"we† group. Proponents for human neutrality might argue that the owners were never at any point good, that they were neutral and socialized into the owning culture, unlike the farming culture. This is not the case, however, through a passage that Steinbeck wrote very early in The Grapes of Wrath, which said, â€Å"Some of the owner men were kind because they hated what they had to do, and some of them were angry because they hated to be cruel, and some of them were cold because they had long ago found that one could not be an owner unless one were cold† (31). This insinuates that in all types of owners, there is a moral compass. Even in the coldest owners, deep within them, they acknowledge the idea that the work they do is wrong. Because the owners know what is wrong, they know the opposite as well—what is right. If the owners were not innately good, their views on what is right or wrong would be skewed by their societal influences. While people will never give up the argument of human morality, it is a safe bet to argue that humans are innately good. We possess the ability to help spontaneously and without reward, as shown in the scientific studies, and we understand what is right and wrong. Our societal influences and the way we were raised affects if we will channel our morality or go against it, as shown by Machiavelli in â€Å"The Qualities of the Prince† and by Steinbeck in The Grapes of Wrath. Works Cited Machiavelli, Niccolo. â€Å"The Qualities of the Prince.† A World of Ideas. Ed. Lee Jacobus. 8th e. Boston: Bedford, 2010. Print. Steinbeck, John. The Grapes of Wrath. New York: Penguin, 1939. Print. Tucker, Abigail. â€Å"Born to Be Mild.† Smithsonian Jan. 2013: 35-41, 76-77. Print.

Health Law and Regulations Essay

In understanding regulatory agencies the differences between regulation and legislation needs defining. Legislation is the law that has been passed by a voting process and regulation is the responsibility of the regulatory board appointed to enforce laws once the law is passed; it sets forth rules on how the laws are to be implemented and to what degree. In health care the Department of Health and Human Services (HHS) has the predominant responsibility to enforce legislation that impacts the health and well-being of Americans. Under the umbrella of HHS there are 13 regulatory agencies tasked with setting rules on the enforcement of the legislation passed by lawmakers. Regulatory Agencies Two of the most influential regulatory agencies within HHS are the United States Food and Drug Administration (FDA) and the Center for Medicare and Medicaid Services (CMS), these two agencies have substantial influence on every aspect of health care delivery. The FDA is responsible for protecting and promoting public health through the regulation and supervision of food safety, medical devices, drugs, vaccines, blood products and biologics. In addition, they monitor medical errors and adverse reactions and reporting such to providers, (U.S. Department of Health and Human Services, 2011). CMS controls the Medicare program and works in collaboration with state governments to oversee Medicaid, and the State Children’s Health Insurance Program (SCHIP). In addition to these responsibilities, CMS dispenses criteria from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), surveys and certifies quality standards in long-term care facilities, and clinical laboratories, (Centers for Medicare and Medicaid Services). The proportion of national health spending sponsored by both federal, state, and local governments was 45% in 2010, a significant source of revenue depended on by providers of health care, (Centers for Medicare and Medicaid Services, 2011). Current FDA Regulations The Patient Protection and Affordable Care Act (PPAC Act), amended the Public Health Service Act (PHS Act) to create a shortened authorization route for medications found to be â€Å"highly similar† or â€Å"interchangeable† with an FDA-approved medication, (U.S. Department of Health and Human Services, 2011). The goal is similar to the Drug Price Competition and Patent Term Restoration Act of 1984 (â€Å"Hatch-Waxman Act†), which produced condensed methods for the approval of drug products under Federal Food, Drug, and Cosmetic Act (FFD&C Act). The outcome is aimed at the FDA’s instituted policy of allowing confidence on what is already known about a drug, thus protecting time and resources, (U.S. Department of Health and Human Services, 2011). To help increase access to affordable prescription medications, the FDA implemented measures to expedite the development and approval of generic drugs. Generic drugs cost 50 to 70% less than their brand-name counterparts equating to a savings of eight to ten billion dollars a year at retail pharmacies, (Crawford, June). These savings do not include the use of generic drugs in an institutional setting. PPAC expands on the practice of generic drugs and incorporates using medications that have the same efficacy as another more expensive medication leading to more options in the prescribing of medications. The practice of using generic drugs is not without concern. As evidenced by the case Pliva v. Mensing where the question was; the safety standards for brand-name drug labeling also apply to generic-drug manufacturers. The patients in the case took the generic drug metoclopramide and developed tardive dyskinesia, which was listed on the label. The patients argued the warning was not adequate and the manufacturer argued the â€Å"changes being effected† process was not available to generic-drug manufacturers because the FDA requires labels for generic versions of drugs to be identical to those of the brand-name drugs, (Glantz & Annas, 2011). The FDA upheld the manufacturer’s claim although the FDA added the manufacturer had a responsibility to request a label change if the manufacturer knew a stronger warning was needed to market the drug safely. The court found in favor of the manufacturer stating â€Å"federal law still preempted injured patients from bringing lawsuits in state courts, because the state laws in question require a safer label, not communicating with the FDA about the possibility of creating a safer label,† (Glantz & Annas, 2011, p. 682). Despite this regulatory standing, a controversial issue may entail for the FDA in the allowance of medications to be â€Å"interchanged† to promote an additional avenue for savings in prescription medications. Much foresight needs to be included to protect the safety and well-being of patients. Current CMS Regulations The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009 (ARRA), is legislation aimed at the adoption and â€Å"meaningful use† of health information technology. CMS was authorized to establish incentive programs for eligible Medicare and Medicaid providers who adopt, implement, upgrade, or â€Å"meaningfully use† certified electronic health records (EHR). The term â€Å"meaningful use† is an acknowledgement that improved health care is not the product of technology but a method to exchange and use health information to support clinical decisions at the point of care. To qualify for CMS’ incentive program the provider must obtain certified electronic health record technology. An incentive of $44 thousand can be achieved by an eligible professional who shows â€Å"meaningful use† over a five year period. Hospitals implementing a certified EHR system can qualify for a t wo million dollar base payment. In 2015 Medicare will implement a reduction in payment to those not displaying â€Å"meaningful use†. The decrease in payment begins at one percent and rises each year that hospitals and providers receiving Medicare payments do not make evident â€Å"meaningful use,† to a maximum reduction of five percent, (Centers for Medicare and Medicaid Services, 2011). The use of EHRs is encouraged by touting improved efficiency, cost-effectiveness, quality, and safety of health care delivery. A study on the use of EHR in 2952 hospitals in the United States revealed 12% of hospitals had instituted electronic physicians’ notes across all clinical units and 17% had instituted computerized provider-order entry for medications in all clinical units, (Jha, et al., 2009). The cited barriers to implementation of EHR were inadequate capital (74%), maintenance costs (44%), resistance of physicians (36%), unclear return on investment (32%), and lack of available staff with expertise i n information technology (30%), (Jha, et al., 2009). Ironically, the hospitals who had implemented the use of EHRs cited financial reasons such as additional compensation for electronic health record use (82%) and financial enticements for implementation (75%), (Jha, et al., 2009). The estimated cost of purchasing, installing, and implementing an EHR system in a provider’s office is approximately $40,000 and this figure does not reflect the cost of maintenance, (Blumentha, 2009). A survey by the American Hospital Association revealed â€Å"the median annual capital investment on information technology was over $700,000 and represented 15% of all capital expenses. Operating expenses were much higher at $1.7 million, or 2 percent of all operating expenses,† (National Institutes of Health, 2006, p. 18). Although there are indisputable reasons for implementing an EHR system, CMS’ incentive program is merely a pittance compared to the ongoing costs of operational expenses. The concept of all health care providers possessing an EHR system is ideal. As with any form of electronic technology comes the prospect of personal information being violated. The Health Insurance Portability and Accountability Act (HIPAA) does provide for penalties from $100 to $1.5 million, depending on the violation and whether it was done unknowingly or willfully and can include imprisonment up to 10 years. HIPAA protects the health information of individuals; â€Å"it does not create a private cause of action for those aggrieved,† (The General Counsel Department of Health and Human Services, 2005). Conclusion Federal regulatory agencies are a necessity to interpret and assist in the implementation of legislation. Without federal regulatory agencies the United States would have over 50 different interpretations on one piece of legislation. The FDA and CMS play a significant role in the ever changing health care arena. The FDA is based on scientific integrity evidenced by the recent publication of defined key principles of scientific integrity. Through this commitment to scientific integrity and quality the FDA provides medical safety to the American people. Through research and establishing guidelines the FDA has been instrumental in making generic drugs available to the public, saving them more than eight billion dollars annually. The PPAC tasked the FDA has been tasked with expanding on the generic drug practice by discovering medications that have the same efficacy as another medications leading to more cost saving options in the prescribing of medications. CMS has been tasked with implementing HITECH that has the promise of decreasing costs and errors in health care delivery. This is a lofty goal with over 80 percent of the United States hospitals without any type of electronic health record in place. The financial incentive provided by the federal government through CMS does not seem to be enough of a motivator to encourage the financial commitment of an EHR. Although, after 2015 when hospitals and providers have not demonstrated â€Å"meaningful use† these providers of Medicare services may be more inclined when losing one percent of their Medicare payments. These regulatory agencies and the legislation cited in this paper are a minute representation of the responsibility and obligation the federal agencies have to protect the well-being of the American people. The cited legislation delegated to these regulatory agencies is not only focused on health but financial constraint and safety of the American people. References Blumentha, D. (2009, April 9). Stimulating the Adoption of Health Information Technology. Retrieved from The New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMp0901592 Centers for Medicare and Medicaid Services. (2011, October 17). Medicare and Medicaid EHR Incentive Program Basics. Retrieved from CMS.gov: https://www.cms.gov/EHRIncentivePrograms/35_Basics.asp Centers for Medicare and Medicaid Services. (2011, September). National Health Expenditures 2010: Sponsor Highlights. Retrieved from CMS.gov: https://www.cms.gov/NationalHealthExpendData/downloads/sponsors.pdf Centers for Medicare and Medicaid Services. (n.d.). About us. Retrieved from CMS.gov: http://www.cms.gov/home/aboutcms.asp Crawford, L. (June, 23 2004). The Law of Biologic Medicine. Retrieved from FDA: http://www.fda.gov/NewsEvents/Testimony/ucm113745.htm Glantz, L., & Annas, G. (2011, August 25). Impossible? Outlawing State Safety Laws for Generic Drugs. Retrieved from The New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMp1107832 Jha, A., DesRoches, C., Campbell, E. G., Donelan, K., Rao, S., Ferris, T., . . . Blumenthal, D. (2009, April 16). Use of Electronic Health Records in U.S. Hospitals. Retrieved from The New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMsa0900592#t=articleBackground National Institutes of Health. (2006, April). Electronic Health Records Overview. Retrieved from National Institutes of Health: http://www.ncrr.nih.gov/publications/informatics/EHR.pdf The General Counsel Departmentof Health and Human Services. (2005, June 1). SCOPE OF CRIMINAL ENFORCEMENT UNDER 42 U.S.C.  § 1320d-6. Retrieved from The United States Department of Justice: http://www.justice.gov/olc/hipaa_final.htm U.S. Department of Health and Human Services. (2011, November 16). FDA Fundamentals. Retrieved from About FDA: http://www.fda.gov/AboutFDA/Transparency/Basics/ucm192695.htm U.S. Department of Health and Human Services. (2011, March 10). Implementation of the Biologics Price Competition and Innovation Act of 2009. Retrieved from U.S. Food and Drug Administration: http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/ucm215089.htm

Fat Tax Essay

Imposing a fat tax on saturated fat, junk foods, sodas, etc. would be best because of many health and money related issues that it could possibly solve. A fat tax could help control many health problems the United States is facing today by giving some incentive to buy healthier foods. Taxing these certain foods may help control the way people eat and in turn change lifestyles to much healthier ones than there are now. The healthier lifestyles would help lower the amount of money spent on health care, in turn saving money. The tax, along with saving the United States money, would also produce large revenue helping to boost the economy and pull out of the debt crisis. Many other countries have begun taxing fatty foods and have produced very nice revenue because of the levies. The tax might pose some problems at first, but in the long run will prevail and produce great gains for the country. In order for a tax to work, it will have to be done correctly. A very organized operation, in which the correct fatty foods would be taxed in order to target certain items which create health problems, would be a start. The United States as a whole is becoming a very unhealthy society because of how Americans eat. Fast food restaurants are part of the main cause because of their affordability and accessibility. It is so easy for people to skip cooking healthy foods and just stop off at McDonalds to grab a quick burger. â€Å"The United States obesity rate has reached up to 34% according to the United States Center for Disease Control and Prevention† (Salahi 1). A fat tax could possibly slow the consumption of these fatty foods and fast foods, which in turn would reduce the obesity numbers. Obesity is not all that these fatty foods are causing; there is also heart disease, diabetes, and many others, all of which come about because of behavior. Imposing a tax on the fatty foods that cause these diseases could change the behavior of the consumers (Vijayaraghavan 1). An example of behavior change is gasoline prices, the higher gas prices have changed the types of vehicles being made. If a tax was levied on junk foods, sodas, etc. , there should also be a price drop in fruits, water, and healthier foods, which would push the consumer to buy the healthy foods. If consumers would begin to purchase these healthier foods, the death rate of around 300,000 people per year will drop (Chouinard 22). Studies have shown that the healthier the person, the more productive he/she usually is because of an active lifestyle. The fat tax, if effective, could possibly produce a healthier, happier, and more productive society as a whole. If the country becomes much healthier as a whole, then a lot of government spending would begin depleting causing huge gains in Medicare and Medicaid where costs have doubled in the past ten years. The government could then use that money to put towards other areas needing improvement in health-care. Although taxing certain foods would create large revenue for the nation, as well as decreasing the enormous bills for health care, which citizens are taxed for anyway. â€Å"The Congressional Budget Office predicts, with a three cent tax, a fat tax could produce twenty-four billion dollars within four years† (Salahi 1). That type of revenue could pose great possibilities for both state and federal government funding for other areas needing improvement. Seventeen states in the United States already have certain taxes on junk food which produces somewhere around one billion extra revenue dollars annually. If the United States would impose these taxes nation-wide, that would be an extra fifty billion dollars of revenue to a broken economy and could help the debt crisis immensely (Drinkard 1). As well as producing a large revenue for the country, if effective with obesity, a fat tax would also drop our health-care expenses which are somewhere around one hundred billion dollars per year. The amount of money saved on health-care, combined with the revenue generated by tax dollars, the United States could possibly earn three-hundred billion dollars over a four year period (Salahi 2). The money produced by the taxes would create great opportunities on both state and federal levels. The debt crisis that the United States is facing would begin to deplete and could create new organizations regulating this fat tax in which new jobs would be created. In 1917 the United States imposed a tax similar to this fat tax on sweets and sodas as part of a plan to help pay for involvement of World War I. At that time, the taxes seemed to appear during times of need when money was needed to produce, and it worked. The United States is in a debt crisis, and if the country would impose these taxes on fatty foods it would produce much needed revenue to help pull the country out of debt (Drinkard 4). Many European countries such as France, Denmark and Hungary have already begun instituting a tax on unhealthy food to boast a healthy society and produce revenue. Denmark has setup its fat tax by the percentage of saturated fat in each item. The tax is around three dollars per two and a half pounds of saturated fat. Denmark’s plan was to impose the tax in order to increase the life expectancy average of its citizens by trying to force people to eat healthier (Jaslow). They are trying to force the citizens to avoid the saturated fat because of heart disease and cancer that it can cause. Romania was planning to start a tax on fatty foods that was more complex and was said to raise around seven-hundred million Euros a year. The plan was pushed aside though because of already high and steadily rising food prices. Hungary believes their fat tax will be most effective on peoples buying habits because of its citizen’s low salaries. The people will have to choose the cheaper, healthier foods in order to survive with the amount of money they make. Hungary also plans to levy a 25% extra tax on fatty foods and drinks, and if passed, it will be the first in the world (Cain 2-3). The United States also has had its own versions of this fat tax before on sodas and candy in the early 1900’s, but most only lasted a short while each time they were instituted. In Denmark their plan to tax the saturated fat in order to make people live healthier has backfired on them, and obesity rate has actually increased (Dietriffic 3). Although there are many reasons a fat tax would really help the United States, there are still some grey areas and problems it would pose. First, the government would be controlling how people make some of their decisions. The higher taxes pose a problem for certain companies which produce these fatty foods causing them to slow production which would result in more and more job losses. This country already has too high of an unemployment rate to put itself in a position in which that rate will grow any higher. The debt crisis in the United States is a big problem for the tax as well as unemployment, because now an already struggling society is being taxed. The United States has instituted a tax similar to this before in 1932 and expected to raise around twelve million dollars, but it was overturned after two years because of lack of revenue production and was very unpopular (Drinkard 4). Such a tax would still be unpopular today with people who do not have an obesity problem. They would be taxed trying to solve a problem that has nothing to do with them, and targeting strictly obese people would be immoral. The tax could possibly backfire as well, and the obesity rate would continue to grow larger as people just spent more money on food. There was a study done on smoking bans in bars that showed the drunken driving fatalities increased because people drove further to bars in order to be able to smoke, and that is an example of what might happen with the fat tax. In other words, the fat tax could be passed, and then not necessarily work and just fade out like in the past or could have the opposite effect like it has had on Denmark. There is no actual way to change the eating habits of people; they can only be given incentive to try to change (Montopoli 2). The problem with the tax at this time is taxing people who are already struggling to make ends meet. With the unemployment rate being so high, it is going to be really hard to pass a tax to increase prices on food even more than they already are because humans must eat to live. In a case where the tax causes people not to be able to pay for the high cost of food, then people then the government ends up spending more with food stamps. This result would then make the gains of the fat tax ineffective because the revenue produced would keep up with the government spending caused by the high cost of food. A manufacture’s tax would erase the problem of over taxing citizens, but then could cause the companies to either increase their prices or go under, and turn would create greater unemployment. A fat tax should be imposed in order to first off help with our debt crisis. The revenue that this tax could produce for the United States government could make great gains in the right direction. It could create new jobs in the Government to regulate how this tax is accessed. The health gain that could be possible because of the fat tax would be huge for the country. If the country were able to stop the consumption of these fatty foods and drop the obesity rate, it would help drop government spending in turn also helping with the debt. The obesity rate drops and the production climbs according to health studies. If our production is increased in all areas, that will also help with greater revenue gains (Drinkard 7). To have a healthy society as a whole, would make the country a better place to live in and would boost spirits to a society that is down and out due to a very slow economy. If health-care could move away from studies on obesity and heart disease caused by unhealthy eating habits, then Americans could focus more on different diseases such as cancer. In order for this fat tax to work, it must be setup correctly with much research from others who have imposed similar taxes thus far. If certain foods deemed unhealthy are taxed in order to boast healthy eating habits, then the foods that are healthy need to be subsided that way it really puts some incentive in eating healthy. It is too easy to just stop by a fast food restaurant and grab a quick burger and fries although it is one of the unhealthiest things to do. There must be something extra, subsides on healthy food, in order to change the way people are going to eat. Cigarettes are a good example of how taxing fatty foods would not work; just because you tax something and raise the price is not going to prevent people from buying it. The extra subsides on healthy food give the extra edge for people to buy them which in turn will then create the healthy eating habits (Salahi 1). The most important part of the tax at this time is the amount of revenue it will produce, and the United States needs it desperately. If the revenue is produced according to plan, then it has served its purpose over a four year period and will begin to help with the health issues on its own eventually. It is a serious issue in the United States and needs to be addressed, but it will be a long process to get to that point. The possibilities posed by the fat tax are wonderful and would help the United States greatly.

Application of Nursing Theory Essay Example | Topics and Well Written Essays - 1500 words

Application of Nursing Theory - Essay Example Dorothea stated that patients could recover more quickly and holistically if only they were allowed to conduct their daily living activities on themselves to best their abilities. The theory can be applied is solving problems that may arise in the nursing care units both patiently focused problems as well as administrative issues in meeting their needs as well as identifying possible ways of solving and coping with their problems (Orem, 2003). When a patient is unable to conduct their self-, care needs a self-care deficient result. In the hospital, setting it is the job of the nurse to determine the resulting deficits and ways of supporting and solving the deficits. This can be achieved by total compensation, partial compensation as well as educative and supportive assistance. Dorothea described self-care requisites that are necessary for good health of the patient. These include food, water, elimination, air, activity and rest, social interaction, and hazard prevention necessary to ensure good health of an individual. The scenario chosen involves problems in the nursing leadership, in a nursing unit. The manager of the unit ought to recognize the associated problems and develop ways of solving them (Castle, Engberg, & Men, 2007). A nursing unit is experiencing rapid turnover its nursing staff including nurse managers. A new manager from an outside source is appointed to lead the nursing unit. Similar to the role that is played by a nurse in the care of patients ensuring that patients need to take care of their activities of daily living to improve on their health, the leadership management in the nursing unit needs to recognize the deficits in their system to solve their problem. A major issue in the nursing unit is a rapid turnover of the staff including the manager due to leadership and organization issues that affect them. As a result, a new nurse manager is introduced in to the organization and is required to take care of the

Middle Eastern Studies Essay Example | Topics and Well Written Essays - 750 words

Middle Eastern Studies - Essay Example It is important to understand how the countries came to be and what the balance of power has been. But things are changing rapidly. By looking at the following three media sources, we can get a sense of what is happening and how modern people from the Middle East view the world. Haaratz is a liberal Israel newspaper. One of the main issues in Israel these days is the problems in Iran. Israeli government officials are plotting a potential attack on Iran. Haaretz, as a liberal voice, can sometimes be critical of this idea. There is clearly an emphasis on politics over other issues. The paper is not concerned with oil (as Israel has none) or youth issues. Much of the discussion is existential: how should Israelis live, how should they treat the Palestinians, etc. There is much opinion and much discussion in this newspaper, and many ideas are generated by it. It is a great example of Israel’s free press. There is no censorship of the materials—and the paper is frequently cr itical of the government. Tehran Times appears to be strongly influenced by government censors. The stories present the president of Iran in a favourable light. The paper also pushes a paranoid line, suggesting that Iran is surrounded by enemies which wish to do it harm. There is an article about Iranian prisoners who may be executed in Saudi Arabia. The attitude appears to be negative. The oil sanctions are clearly affecting the Iranian economy, and there are stories about this. Youth unemployment is high. Iran is suffering from the kind of huge demographic change which Richards talks about in his chapter. The old order is fading, but not fast enough. The old order still has enough power to put down uprisings, as they did in 2009, but this will last forever. One day they will fall and the consequences of this will be unforeseeable. Reading the Tehran times, it is clear that there is kind of siege mentality the people of Iran are suffering from. All of this is evident from the paper . It appears to be a sad country. The United States is considered to be an enemy, according to this paper. We can see how Iran is trying to build alliances with other misfit countries in the region. Overall, this is a depressing newspaper for a depressing country. Al Jazeera is like the CNN of the Middle East. It is based out of Qatar and provides regional coverage in a less biased manner than other local media. The headlines are often outward looking and focus on the international scene, but from the point of view of all people in the Middle East. The tone is a unifying and quite liberal one. It is clear that Al Jazeera is not the organ of any dictator or tyrant. They have done a lot to inspire the revolutions that have occurred over the last few years. They appear to support democracy and even women’s rights—ideas which are alien to many Arabs in the region. There is even some objectivity shown towards Israel. There is an emphasis on oil news as this the main commodi ty traded in the Middle East and the source of much wealth. Overall, the news is a bit soft-ball but it is clearly not censored by any government. The Middle East is a rapidly changing area of the world. Every month brings something new. All of last year the world focused on Libya. Now, with Gaddafi dead, the world has turned to watch the civil war unfolding in Syria. Only a few years ago, we all watched Iraq

Leisure in Society. Golf Essay Example | Topics and Well Written Essays - 2000 words

Leisure in Society. Golf - Essay Example According to ESRC fact sheet the most popular leisure time activity in the UK is watching TV. However, the main problem, which arises, is the lack of movement and physical activity in the lives of the British population. According to the research conducted in Bristol over 10Â  % of 11-year-old children should move more actively and are recommended to make daily exercises. The other survey conducted by the Avon Longitudinal Study of Parents and Children came to the conclusion that children from more well-to-do families make less exercise than children from poorer social background and girls were less active than boys / BBC News, 2005/. Medical surveys, which took place in 2002, showed the same results that over 22Â  % of male and 23Â  % of British female population were obese. Besides, some part of the population was not obese but overweight. These are 43Â  % of males and 34Â  % of female population of the UK. Thus, according to the Body Mass Index over 50Â  % of all adult population of Great Britain is overweight and were recommended to control their weight / Office for National Statistics, 2005/. On the other hand, it should be mentioned that there is a growing interest to the sport activities in the UK. Thus, the General Household Survey made a research of the most popular sporting activities of grown-ups (aged 16 and more). The results of the survey are represented on the table below/ Office for National Statistics, 2005/ : The only corrections, which I would like to make in this list is to include angling. Thus, according to the Environment Agency approximately 11Â  % of all British population has fished during the past two years / Environment Agency, 2007/. Therefore, I would like to mention this kind of sport activity as one of the popular activities of the UK population both of men and women. On the other hand, the other hand, which we also should take into consideration, is the organization of the sport activity. Thus, according to

Design Thinking summative assignment Essay Example | Topics and Well Written Essays - 2000 words

Design Thinking summative assignment - Essay Example The combination allows individuals who may not be trained as designers to apply ingenious tools to deal with a wide range of challenges. It allows the management to take advantage of individual competences that go unnoticed in the traditional problem solving strategies. This paper presents an analysis the concept of design-thinking. It also describes the application of design thinking criteria in Coca-Cola Company. It highlights the benefits identified by embedding design-thinking opportunities through design. The concept of Design-Thinking in Coca-Cola Company The Coca-Cola Company has maintained a significant market share globally for many years, which can be attributed to the company’s competitive strategy of design thinking. Diet Coke is a brand that was developed through design thinking with the intention of offering a new drink targeted at consumers who are gradually moving away from high calorie drinks and also to lessen the company’s carbon foot print emanating from the carbon based preservative ejected in to the atmosphere globally when every carbonated drink is opened (Boutzikas, 2000). The product was also focused on increasing the variety of Coca-Cola products as well as getting precise and instantaneous response with regards to customer preferences. It came in to the US market in 1982 as the first soft drink to use the Coca-Cola trademark since 1886 (Vrontis & Sharp, 2003). In the design thinking for the development of Diet Coke, everyone was considered as part of the whole process. According to (Brian, 2010), success is not only accomplished through combining the managers and the subordinates together, also requires people who are creative and good designers who are motivated by business matters. The Diet Coke project focused on promoting a common attitude with regards to inventiveness in the factory and to bring in external desires such as taste, fashion, music, photography and other things that could help in promoting creativity in the workplace. Design thinking requires a conducive environment for people to feel free to think and utilize their full potential, which results in an amalgamation of different characteristics that the new product will serve (Badke-Schaub et al. 2010). Free collaboration between the various departments in the company enhanced the development and marketing of Diet Coke in 1982 emerging as the bestselling low calorie beverage in the US within a very short period. According to Vrontis & Sharp (2003), free collaboration between the skill sets in the development of Diet Coke was enhanced by allowing each player in the project team to act out of free will to accomplish a common objective. The skill sets involved included strategy and design. Despite being in a different career path, Diet Coke project team participated equally in the project. Each of the components meant a lot in the success of product competitiveness (Boutzikas, 2000). Research and development have significantly contribu ted to innovativeness that has helped Coca-Cola to maintain global competitiveness. Diet Coke was developed in a design thinking approach that linked the global research and development centers to the company’s External Technology Assessment and Acquisition hubs that play an important role of enhancing the link between the company, its associates, industrialists, technological innovators and academics (Isdell & Beasley,

Don Martin Limited Marketing Analysis Case Study

Don Martin Limited Marketing Analysis - Case Study Example The business has attempted several strategies to increase its profits, including increasing the prices of its products, increasing production lines, and promoting the business through newspapers and radio. Due to these pitfalls, marketing strategy is exceptionally paramount for the success of the business (Pearce and Hardy 379). Most of the customers in this business are low income earners. They also live within the business jurisdiction. Due to their limited income, these customers require low priced products. To attract more customers from the area, Don Martin limited has decided to open credit account to its customers. Despite offering credit to customers, the business has continued to lose them due to poor services and high cost of its products. Frequent increases in price to maximize profit have, therefore, discouraged customers from shopping in Don Martin limited. To attract more customers and compete effectively in the market, the business should consider reducing the cost of its products. The demographic size in the business location is high. The business is located along the thoroughfare street right in the middle of the city blue-collar district (Michael and Kenneth 379). The business potential customers are blue-collar workers who constitute both middle and lower class males and females. There are different products in the business essential to the potential customers. The number of people in the town where the business is located is high enough to make the business succeed and earn adequate profit. To attract a considerable number of potential customers into the business, the business managers and administrators must consider improving the quality of their services. As confirmed by Don Martin, many customers expect quality services from the salespersons in the business. The business potential customers are middle aged people. Most of the products sold in the store are regularly used by middle aged people. Additionally, most of the blue-collar jobs a re done by energetic middle aged people. Middle aged people buy products from Don Martin limited during weekends and in the evenings. To attract most of these customers, Don Martin administrators should consider offering their services over the weekends and during evening hours. Middle aged people also prefer buying their household products close to their residential areas. Therefore, Don Martins limited should consider opening businesses nears their residential areas. They should also consider improving their services delivery. This is due to the fact that most young people prefer quality services for their money. To attract and retain middle aged customers, the business management should consider advancing its service delivery to potential customers. In the recent past, Don Martin limited has faced severe reduction in its customers due to its poor services. To attract more customers, Don Martin limited should conduct market survey to understand its customers’ needs. The bus inesses should ensure that the relevant products are offered to young people in their area of coverage. On the other hand, the business has also relied on outdated service delivery methods. As observed by Don Martin, the other stores have offered different products for shoppers to compare. Don Martin limited lacks variety of products and services for the potential shoppers to compare. In its early years, Don Martin lim

Dangers of Vaccinations Research Paper Example | Topics and Well Written Essays - 2250 words

Dangers of Vaccinations - Research Paper Example Vaccination is defined as the injection of a killed microbe in the body as a way of stimulating the immune system against the microbe, thereby preventing a disease. Sometimes called immunization, vaccinations work to stimulate the body’s natural disease-fighting system, the immune system. When healthy, this system is able to detect invading bacteria and other viruses and respond by producing antibodies to fight and destroy them. Vaccination, therefore, prepares the immune system to keep a disease away. A killed or weakened virus is used to immunize against a viral disease, while if the intention is only to immunize against a bacterial disease, a small portion of the dead bacteria is often used to stimulate the formation of antibodies to ward off any invasion of the whole bacteria. Childhood vaccinations are common and most parents prefer them because they help in protecting the kids from a range of deadly diseases. It is, however, difficult to know whether the vaccine itself is safe. While the vaccines have been successful, there have been persistent concerns that vaccinations lead to autism and other dangerous diseases and conditions. Even with the efforts of the public health officials from the United States to shed light on the misconceptions of vaccine safety that have existed for more than twenty years, little success has been realized in the change of perception. A number of parents are becoming reluctant about taking their children for vaccination even though various studies have found no proof that vaccination leads to autism and other diseases

Proposal Term Paper Example | Topics and Well Written Essays - 1000 words

Proposal - Term Paper Example Our people and years of experience in the market have made us an organization of choice. Our extensive network with major health service providers ensures that our customers receive comprehensive health care services. Access Mortgage Company can definitely take benefit from our extensive range of products and services. Besides we are also willing to offer the additional services of psychological counseling as well as substantive abuse rehabilitation with minimum costs. At a total cost of $125 per employee per month, Access Mortgage Company can enjoy both of these benefits besides getting the regular services of our company. Introduction Caring and providing for healthcare of the employees is one of the best investments organizations do in order to ensure that employees remain healthy and motivated. Psychological counseling as well as rehabilitation of the employees are some of the steps which can ensure that the employees are provided the requisite level of support by the organizatio n to remain productive and constructive not only for the organization but for the society as a whole. Psychological counseling as well as the providing help in rehabilitating the employees against substantive abuse is one of the key issues which an organization has to handle. Increasing pressure and stress level can really put a lot of pressure on the employees and can result into low productivity as well as irritating behavior. Offering professional help in such circumstances therefore can serve as one of the key steps towards ensuring the rehabilitation of the employee. United Health Group is one of the diversified health and well being company offering diversified range of services including insurance plans. United Health Group offers these services through its subsidiary with the name of UnitedHealthCare. UnitedHealthCare and Optium are two of the best services in the country offering advance level healthcare services including insurance plans to ensure that every American has a ccess to quality healthcare. In order to achieve this aim, we also partner with different organizations to offer custom made insurance plans which can cater to the different needs of the organization. This proposal will present details about our Company and what kind of products and services it can offer you to comprehensively offer your employees the option of psychological counseling and substantive abuse rehabilitation. History of the Company & Competitive Landscape UnitedHealthCare is part of United Health Group Inc, one of the leading and diversified groups offering health and well being related services across US. Established in 1977, UnitedHealthCare has evolved over the period of time and is now offering insurance plans to individuals as well as small and middle sized employers. Managed by approximately, 30,000 employees, company have been able to develop market for itself and have served as a cost effective alternative for individuals and firms to afford quality healthcare. (Hoovers) The overall competitive landscape suggests that the rising cost of healthcare has made it almost mandatory for Americans to go for medical and health

White People and American Citizen Essay Example for Free

White People and American Citizen Essay The short story â€Å" How it Feels to be Colored Me† was written in year 1928 by Zora Neale Hurston who grew up in Eatonville, Florida. Zora grew up in an predominantly all black town. She had begun to realize the differences between blacks and whites at the beginning of her teens. Zora only had contact with the white people who passed through her town. These people who passed through Eatonville, Florida usually were going to Orlando or coming from Orlando, Florida. I believe the main reason why the story was written was to focus on the differences between black and white people. When Zora Hurston states â€Å" I have no separate feeling about being an American citizen and colored. I am merely a fragment of the Great Soul that surges within the boundaries. My country, right or wrong. † I believe she’s describing her feelings of being an American citizen and being colored. She does not have separate feelings of either. Zora seems to accept her identity for being colored and an American citizen. I think Zora is trying to achieve dignity/pride in America as an American. Zora doesn’t want to harp on the past Nor does she want the actions of others to affect her. Zora believes that she is an American citizen whether she’s black or white and everyone has the same rights. How It Feels to Be Colored Me Analysis by Terissa7. N. p. , n. d. Web. 15 June 2014. . â€Å"How it Feels to Be Colored† The short story â€Å" How it Feels to be Colored Me† was written in year 1928 by Zora Neale Hurston who grew up in Eatonville, Florida. Zora grew up in an predominantly all black town. She had begun to realize the differences between blacks and whites at the beginning of her teens. Zora only had contact with the white people who passed through her town. These people who passed through Eatonville, Florida usually were going to Orlando or coming from Orlando, Florida. I believe the main reason why the story was written was to focus on the differences between black and white people. When Zora Hurston states â€Å" I have no separate feeling about being an American citizen and colored. I am merely a fragment of the Great Soul that surges within the boundaries. My country, right or wrong. † I believe she’s describing her feelings of being an American citizen and being colored. She does not have separate feelings of either. Zora seems to accept her identity for being colored and an American citizen. I think Zora is trying to achieve dignity/pride in America as an American. Zora doesn’t want to harp on the past Nor does she want the actions of others to affect her. Zora believes that she is an American citizen whether she’s black or white and everyone has the same rights. How It Feels to Be Colored Me Analysis by Terissa7.

Rewilding North America Essay Example for Free

Rewilding North America Essay The earth is a planet that contains not only human beings but also animals. Unfortunately, people do not respect animals well enough since the idea is that human beings are much smarter than animals. However, we are two different kinds that cannot survive without each other. Luckily, there are some people who care about animals and try to make people be a part of wildlife like old times. A lot of animals die because of human beings almost everyday. Most of those occur on roads and highways. Therefore, scientists research to prevent those losses. One of the most important things that they did is called â€Å"Y2Y† which is a short form of Yellowstone to Yukon. Y2Y is a corridor that includes national forests, isolated parks and most importantly it is roadless, Y2Y is not only preserve animals but it also makes people change their minds. For example, the pressure of Y2Y makes people build bridges on highways for the animals. So that, the animals that live there have a chance to avoid the cars on the highways. In addition to Y2Y, isolated parks play a vital role of preservation of animals. Although I think isolated parks are great opportunities for animals in order to live fearlessly, some scientists strongly oppose. They claim that because of isolated parks, animals have to live in smaller areas. According to the scientists, if the area where animals live gets smaller, there will be less species exist. The scientists who have two opposite sites argue that if single large is more beneficial for animals or several small. In conclusion, human beings and animals are parts of the ecosystem which cannot be thought either one of them do not exist. In my opinion, the world would be a better place if people try to be more responsible and respectful to animals.

RISK FACTORS: ANAEMIA AMONG ANTENATAL MOTHERS

RISK FACTORS: ANAEMIA AMONG ANTENATAL MOTHERS Anemia in pregnancy constitutes a major public health problem in developing countries. It is defined as reduction in the oxygen carrying capacity of the blood as a result of fewer circulating erythrocytes than normal or a decrease in the concentration of Haemoglobin (Hb) (Hoque et al., 2009). During pregnancy, there is an increase in amount of iron required to increase red cell mass, expand plasma volume and to allow growth of fetal-placental unit (Scholl, 2005). The deficiency occurs through reduced production or an increased loss of red blood cells. Anaemia in pregnant women in developing countries is generally presumed to be the result of nutritional deficiency. In Malaysia, the incidence of anaemia among pregnant mothers attending public antenatal clinics was reported to be 35% (Jamaiyah et al., 2007). Hadipour et al. (2010) reported a higher incidence of anaemia among Iranian pregnant women i.e. 51.4%. Iron deficiency anaemia is the most prevalent nutritional deficiency problem affecting pregnant women. Pregnant women are considered to be the most vulnerable group, since the additional demands that are made on maternal stores during this period exposes them to various latent deficiencies that manifest themselves as anaemia (Hoque et al., 2009). Increased iron requirements, low pre-pregnancy iron stores and continued inadequate dietary intakes of iron exacerbate this physiologic anaemia during pregnancy in many regions of this world (Christian et al., 2003). Brabin et al. (2001) reported a strong association between severe anaemia (OR 3.51, 95% CI: 2.05-6.00) and maternal mortality. Anaemia may result from both nutritional and nonnutritional factors, specifically besides iron, deficiency of micronutrients such as vitamins A, C and B-12 and folic acid may contribute to the development of anaemia. These nutrients may affect haemoglobin synthesis either directly or indirectly by affecting absorption and/or mobilization (Ramakrishnan et al., 2004). Systemic evaluation of the efficacy of antenatal iron supplementation is known to raise haemoglobin concentration, although it effects are influenced by dose and compliance level (Christian et al., 2003). Inability to meet the required level for iron and other vitamins either as a result of dietary or supplementary gives rise to anaemia (Idowu et al., 2007). According to the World Health Organization (WHO, 1998), anaemia should be considered when the hemoglobin level is below 11 g/dL. Anaemia ranges from mild, moderate to severe and WHO classifies the hemoglobin level for each of these types of anemia in pregnancy at 10.0 -10.9 g/dL (mild anemia), 7-9 g/dL (moderate anemia) and The effects of maternal anemia on the fetus were considerable and include the following: the prematurity rate among infants of anemic mothers was 18.1%, 3 times that of infants born to nonanemic mothers; the perinatal loss in the anemic mother was 13.1%, twice that of the nonanemic mother (6.8%); and the stillbirth rate among infants born to anemic mothers was 91.0/1000 compared with a rate of 15.7/1000 among infants born to nonanemic mothers. The findings indicate the seriousness of severe anemia in pregnancy. Etiological factors are considered since this will be the basis of rational therapy. Iron deficiency anemia may develop for several reasons. There is usually a dietary deficiency of iron, and there may also be a lowered absorption from the gut. Also, there may be excessive blood loss due to hookworm and menorrhagia, and there are the demands of repeated childbearing. Apart from hookworm infestation, insufficient dietary intake of iron was the principal cause of anemia among the women in the study with iron deficiency anemia. Among the women with megatoblastic anemia folic acid was the prime deficiency leading to this type of anemia. The anemia was aggravated by increasing malnutrition as demonstrated by diminished serum albumin and globulin concentration. The diagnosis of severe iron deficiency anemia was made by estimation of the hemoglobin concentration, supplemented in some cases by serum iron studies. Megaloblastic anemia in pregnancy can only be diagnosed with accuracy by a bone marrow smear. Consideration of the etiology of anemia in Malaysia led to a standard treatment among the pregnant women studies. The treatment approach is reviewed in detail. In Malaysia, pregnant women from a lower social-economic group indicated the prevalence of anaemia was 30-40%. Since then, Malaysia has had tremendous economic changes and is expected to have changes in the prevalence of anaemia as well. This study was conducted with the aim of identifying of risk factors that contributing anaemia among antenatal mothers such as sociodemografic data, prenatal care and maternal health status. 1.1 PROBLEM STATEMENT Anaemia still constitutes a public health problem in the world, especially in the developing countries (Royston Armstrong),1989,Abou Zahr Royston,1992).Nutritional anaemia is found more among rural mothers, where poor dietary intake and parasitic infections are more common. Many women start their lives with insufficient iron stores, but also, because of inadequate child spacing, they have little time to build up their iron levels between pregnancies (WHO,1975). The effect of anaemia in pregnancy has been shown to be associated with an increase risk of maternal and fetal morbility (Tasker,1958;Llewellen-,1965;Lourdeadin,1969;Baker,1978). However, risk factors such as anaemia in pregnancy can be controlled and monitored by good antenatal care and appropriate action, including referral, in accordance to the level of severity of the anaemia. In Malaysia, 30 to 40% of pregnant women and 25% of women from rural communities suffer from iron deficiency anaemia. The most common haematologic complication of pregnancy and is associated with increased rates of premature birth, low birth weight and perinatal mortality. According to Jamaiyah et al.(2007), found that the prevalence of anaemia during pregnancy is 35% and mostly of the mild type and more prevalent in the Indian and Malays. WHO estimates that more than half of pregnant women in the world have a haemoglobin level indicative of anaemia. ( Base on the many contradicting finding of this similar study, therefore the aim of this study is to determine the factors that contributing anaemia during pregnancy among mothers admitted at antenatal ward, Hospital Jeli, Kelantan. 1.2 Objectives 1.2.1 General objectives To determine factors associated with anaemia during pregnancy among mothers admitted at Antenatal Ward, Hospital Jeli, Kelantan. 1.2.2 Specific objectives 1. To determine the haemoglobin level for mothers who admitted at antenatal ward ,Hospital Jeli, Kelantan 2. To determine factors associated with anaemia mothers. 1.3 Benefit of study Knowledge on factors associated anaemia during pregnancy among mothers such as factors social demographic, prenatal care of maternal status and maternal nutrition of the mothers. To prevent and reduce the prevalence of low birth weight among infants and to prevent maternal and prenatal mortality. 1.4 Conception frame work Figure 1: factors that contributing with anaemia Anemia in pregnancy constitutes a major public health problem in developing countries. (Brabin et al.2001). This conceptual framework describe those maternal factors that may influence anaemia among antenatal mothers. The important factors are the socio demographic data such as the age of mother, race, parity, education level of mothers, Occupation of mothers, Occupation of father and number of dependent. Perinatal care variables that were studied were access to antenatal booking, number of visit to antenatal clinic ,parity,Period of Gestation (POG) ,vitamin and iron supplements, family planning and eating taboos. Maternal health factors such as past medical history, Big baby, APH, placenta praevia, hyperemesis , Hb level ,Multiple pregnancy and others were included in this study to determine the factors that contributing anaemia mothers. CHAPTER 2 LITERATURE REVIEW 2.1 Definition of anaemia in pregnancy In pregnancy , anemia has a significant impact on the health of the fetus as well as that of the mother. The physiologic expansion of the plasma volume is detactable as early as 6 to 8 weeks gestationan (Wood Ronneberg, 2006). The world health organization (WHO) defines anemia in pregnancy as haemoglobin concentration of less than 11.0g/dl. WHO estimates that more than half of pregnant women in the world have a haemoglobin level indicative of anemia ( Iron is essential for multiple metabolic processes, including oxygen transport, DNA synthesis, and electron transport. Iron equilibrium in the body is regulated carefully to ensure that sufficient iron is absorbed in order to compensate for body losses of iron. While body loss iron quantitavely is as important as absorption in terms of maintaining iron equilibrium, it is a more passive process than absorption. Consistent errors in maintaining this equilibrium lead to either iron deficiency or iron overload. Iron balance is achieved largely by regulation of iron absorption in the proximal small interstine. Either diminished absorbable dietary iron or excessive loss of body iron can cause iron deficiency. Decrease absorption usually is due to an insufficient intake of dietary iron is an absorbable form. It si support by Ladewig et al.(2006), found that the common anemia of pregnancy are due to either to insufficient haemoglobin production related to nutritional deficiency in iron or folic acid during pregnancy. Anemia is the most common haematologic complication of pregnancy and is associated with increased rates of premature birth, loe birth weight and perinatal mortality. According to Allen (2000), iron deficiency anemia is a factor that can cause preterm birth and low birth weight and can effect the neonatal health status. Haemoglobin values drop during the second trimester of pregnancy because of the dilution of the blood caused by plasma increases and this physiologic anemia is normal. During the third trimester, haemoglobin levels generally return to pre pregnancy levels because of increased absorption of iron from the gastrointestinal tract. Generally, a women is considered anemia if her haemoglobin is less than 11 g/dl during the first and third trimester or less than 10.5 g/dl during the second trimester (Cunningham et al., 2001). In malaysia, ion deficiencies always happen in malay and Indians pregnant women because their particular eating habits of different races. It support study done by mohanambal et al.(2002), found that iron deficiency was sees in Malays and Indians, no iron deficienciency was seen among the Chinese. 2.2 Factors associated with anemia 2.2.1 socio- demographic factors Malaysian infant mortality diffentials, because socioeconomic development has very clearly had a diffential impact by ethnic group. The Chinese rates of infant mortality are significantly lower than the Malay or Intdian rates. Low socioeconomic level was the most important risk factor for anaemia among antenatal mothers. And was independent of other factors, including those related to production and nutrition, health service and prinatal care. It is support by Sohl Moore (2000), reported that there are clear genetic and constituonal influences that act on foetal growth, it is estimated that 40% of birth weight is due to heredity and the remaining 60% to environmental factors. According to kennedy et al.(1998) and Ecob and Smith (1999), among the socio-economic factors are income, education, occupation, household leadership and gender differences related to roles within the family. It support the findings studies by Tuntiserance et al. (1999), studied a cohort of 1797 pregnant women visiting antenatal clinics, they found that significantly factors between socio-economic indicators and pregnancy outcomes. The indicators were family socio-economic status, maternal education, maternal occupation, family income and work exposures, while the pregnancy outcomes were base on anaemia mothers. Age of mother Maternal age is an important and dependent risk factor for adverse pregnancy outcome(Delbaere et al.,2007). Epidemiological studies suggest that there is a trend in developing nations to delay the age of the first pregnancy. Maternal age > 35 years for first pregnancy is associated with low birth weight, intra uterine growth retardation and prematurity. It is supports the finding study by Ann et al. (2007) that have same conclusion that increasing maternal age to be associated with low birth weight and anaemia during delivery. Educational level of mother Educational level of mother are linked to certain prenatal risk factors such as anaemia and to proven detrimental to birth outcomes . this can help intervention workers to identify the at risk mother. Early identification can result in focused programs administered directly to the individuals most likely to benefit (Wasser, 1995). According to Currie and moretti (2003) started that the effect of maternal education on birth weight I the US with a policy increasing the supply of colleges when the mother was teenager. The rationale is that the opening of a college reduces the cost of higher education in a way that is uncorrelated with the unobservable term correlating both education and health. Family income Family income is generally considered a primary measure of a nations financial prosperity. Income or poverty status had a statistically significant effect on anaemia mothers and both low birth weight and the mortality rate. According to Duncan and Brooks-Gunn (1997), found the effects of income or poverty status and a number of pregnancy-related health services on birth outcomes for white and black women also found that for whites but not for blaks. Prenatal care of mothers Antenatal care is the clinical assessment of mother and fetus during pregnancy, for the purpose of obtaining the best possible outcome for the mother and child. Antenatal care traditionally involves a number of routine visits for assessment, to a variety of healthcare professionals, on a regular basis throughout the pregnancy. Number of children (parity) Parity was determined to all the number of previous pregnancies resulting in either live birth or still births after 22 weeks of gestational age. Maternal parity and age were significantly positively associated with anaemia mothers. Women often become anaemic during pregnancy because the demand for iron and other vitamins is increased. The mother must increase her production of red blood cells and, in addition, the fetus and placenta need their own supply of iron, which can only be obtained from the mother. In order to have enough red blood cells for the fetus, the body starts to produce more red blood cells and plasma. It has been calculated that the blood volume increases approximately 50 per cent during the pregnancy, although the plasma amount is disproportionately greater. This causes a dilution of the blood, making the haemoglobin concentration fall. This is a normal process, with the haemoglobin concentration at its lowest between weeks 25 and 30. The pregnant woman may need additional iron supplementation, and a blood test called serum ferritin is the best way of monitoring this. Many women are anaemic during pregnancy. A recent study by the Anaemia Working Group found that about one-third of pregnant Malaysian women are anaemic. (Dr. Milton Lum , 2009).Anaemia occurs because there is increased demand for iron and vitamins in pregnancy. The mother has to produce more red blood cells for herself and the foetus. More plasma is also produced.The blood volume increases by about 50% during pregnancy with a disproportionate increase in plasma. This leads to a dilution of the blood with the haemoglobin falling. The haemoglobin is at its lowest level between 24 and 30 weeks of pregnancy. Poor diet: If the diet is low in iron and vitamins, especially folic acid, there is a risk of anaemia as these are the raw materials needed to produce sufficient numbers of red blood cells. Vegetarians who have a strict diet may not get enough iron or vitamin B12 in their food. Family history: Some women whose family members have anaemia because of inherited genes are at increased risk. Chronic conditions like kidney or liver failure, and cancer increases the risk. Chronic blood loss from some parts of the body due to ulcers, haemorrhoids, etc, may lead to iron deficiency anaemia. 2.3 Regulation of iron transfer to the fetus Transfer of iron from the mother to the fetus is supported by a substantial increase in maternal iron absorption during pregnancy and is regulated by the placenta .Serum ferritin usually falls markedly between 12 and 25 wk of gestation, probably as a result of iron utilization for expansion of the maternal red blood cell mass. Most iron transfer to the fetus occurs after week 30 of gestation, which corresponds to the time of peak efficiency of maternal iron absorption. Serum transferrin carries iron from the maternal circulation to transferrin receptors located on the apical surface of the placental syncytiotrophoblast, holotransferrin is endocytosed, iron is released, and apotransferrin is returned to the maternal circulation. The free iron then binds to ferritin in placental cells where it is transferred to apotransferrin, which enters from the fetal side of the placenta and exits as holotransferrin into the fetal circulation. This placental iron transfer system regulates iron tran sport to the fetus. When maternal iron status is poor, the number of placental transferrin receptors increases so that more iron is taken up by the placenta. Excessive iron transport to the fetus may be prevented by the placental synthesis of ferritin. 2.4 Effect of anemia on maternal mortality and morbidity The major concern about the adverse effects of anemia on pregnant women is the belief that this population is at greater risk of perinatal mortality and morbidity. Maternal mortality in selected developing countries ranges from 27 (India) to 194 (Pakistan) deaths per 100000 live births. Some data show an association between a higher risk of maternal mortality and severe anemia, although such data were predominantly retrospective observations of an association between maternal hemoglobin concentrations at, or close to, delivery and subsequent mortality. Such data do not prove that maternal anemia causes higher mortality because both the anemia and subsequent mortality could be caused by some other condition. For example, in a large Indonesian study, the maternal mortality rate for women with a hemoglobin concentration 2.5 Maternal anemia and birth weight The relation between maternal anemia and birth weight has been reviewed more extensively elsewhere in this issue. In several studies, a U-shaped association was observed between maternal hemoglobin concentrations and birth weight. Abnormally high hemoglobin concentrations usually indicate poor plasma volume expansion, which is also a risk for low birth weight. Lower birth weights in anemic women have been reported in several studies. In a multivariate regression analysis of data from 691 women in rural Nepal, adjusted decrements in neonatal weight of 38, 91, 187, and 153 g were associated with hemoglobin concentrations à ¢Ã¢â‚¬ °Ã‚ ¥20, 90-109, 70-89 and 2.6 Maternal iron deficiency anemia and duration of gestation There is a substantial amount of evidence showing that maternal iron deficiency anemia early in pregnancy can result in low birth weight subsequent to preterm delivery. For example, Welsh women who were first diagnosed with anemia (hemoglobin 2.7 Maternal anemia and infant health An association between maternal anemia and lower infant Apgar scores was reported in some studies. In 102 Indian women in the first stage of labor, higher maternal hemoglobin concentrations were correlated with better Apgar scores and with a lower risk of birth asphyxia. When pregnant women were treated with iron or a placebo in Niger, Apgar scores were significantly higher in those infants whose mothers received iron. A higher risk of premature birth is an additional concern related to the effect of maternal iron deficiency on infant health; preterm infants are likely to have more perinatal complications, to be growth-stunted, and to have low stores of iron and other nutrients. In the Jamaican Perinatal Mortality Survey of >10000 infants in 1986, there was an à ¢Ã¢â‚¬ °Ã‹â€ 50% greater chance of mortality in the first year of life for those infants whose mothers had not been given iron supplements during pregnancy, although the iron status of these infants and their mothers was not assessed. Apart from this survey, there is little known concerning the effects of maternal iron status during pregnancy on the subsequent health and development of the infant. 2.8 Benefits of iron supplementation on maternal iron status There is little doubt that iron supplementation improves maternal iron status. Even in industrialized countries, iron supplements have been reported to increase hemoglobin, serum ferritin, mean cell volume, serum iron, and transferrin saturation. These improvements are seen in late pregnancy, even in women who enter pregnancy with adequate iron status. When compared with unsupplemented pregnant women, differences in iron status due to supplementation usually occur within à ¢Ã¢â‚¬ °Ã‹â€ 3 mo of the time supplementation begins. Supplementation can reduce the extent of iron depletion in the third trimester. However, for women who enter pregnancy with low iron stores, iron supplements often fail to prevent iron deficiency. The benefits of iron supplementation on maternal iron status during pregnancy become even more apparent postpartum. This is illustrated by a Swedish study in which all pregnant women who did not take iron supplements had less than sufficient iron stores in late pregnancy compared with 43% of supplemented (200 mg Fe/d) women. Use of nutritional supplements Intake of iron supplements during pregnancy was also found to have a protective effect with anaemia in pregnancy. This is consistent with the findings of some other studies on iron supplementation and pregnancy outcome (Hesss et al.,2001). Iron supplementation during pregnancy protects a women from becoming anaemic because the required amounts may not be supplied from dietary intake during this period. Controlled trials of iron supplementation during pregnancy have consistently demonstrated positive effects on maternal iron status at delivery. The prevalence of low hemoglobin or hematocrict is reduced: serum ferritin, serum iron and almost every other measure of maternal iron status, including bone marrow iron, are increased in comparison with controls (Mohamed, 1998). Malaysia has gone a long way towards improving the nutritional status of the population. Malnutrition has been defined as a pathological state resulting from a relative or a absolute deficiency or excess of one or more essential nutrients, it can comprise four forms-under-nutrition, over-nutrition, imbalance and specific deficiency (Park, 20000. Antenatal booking Antenatal booking is a an assessment of the physical, social, psychological and emosional state of the pregnant women. The main purpose of the booking visit to obtain a comprehensive history, establish the gestational age and identify maternal and ftal risk factors. Baseline investigations are performed. According to Adesina et al. (2003), stated that early antenatal booking and good control in pregnancy are strongly advocated as means of achieving good pregnancy outcome. It support by Tayie and Lartey (2008), found that early antenatal care was associated with pregnancy outcomes. Number of visits to antenatal clinics Antenatal clinic (ANC), refer to pregnancy related services provided between conception and delivery consisting of monitoring health status mother and her pregnancy. ANC was expected to ontain of mother to get anaemia and preterm delivery rete, a higher average birth weight and decreased neonatal mortality. According to Kost et al.(1998), antenatal clinic (ANC) visits could possibly be seen as indicator of the mothers sense of responsibility to her unborn baby. Visit to ANC services could also have a positive influence on the attitude of the mother, will impact on birth-outcomes. Total numbers of ANC visits for the current pregnancy were categorized as >4 visit and 4 ANC visits with an appropriate health care provided (World health organization,2004) ANC visits as part of primary health care to early detection and treatment of probable problem areas, and contribute to the quality of the birth outcome. ANC has been associated with improved maternal and perinatal outcome, but there is no agreement on the most effecting timing of visit antenatal mother. In Malaysia, the frequency of ANC visit depends on the gestational such as 0-28 week every one mont, 28-36 week every 2 week and 36-4- week every 1 weeks. Antepartum haemorrhage (APH) vagina bleeding is an important factor predictor of adverse effects anemia mothers. About 50% of women who bleeding in last half of pregnancy have placenta praevia or abruptio placenta. When ever the bleeding occurs at the beginning of pregnancy, however the cause is often unknown ( Valero de Bernabe et al.,2004). CHAPTER 3 METHODOLOGY 3.1 Study Location This study were carried out at the antenatal ward, Hospital Jeli, Kelantan. 3.2 Study Design A cross-sectional study design were done in antenatal ward, Hospital Jeli, Kelantan from period of January until March 2011. 3.3 Sampling 3.3.1 Sampling population All mothers who admitted to antenatal ward, Hospital Jeli, Kelantan during the period of January until March 2011 were included in the study. 3.3.2 Sampling frame A list of all antenatal mothers who are admitted at antenatal ward Hospital Jeli, Kelantan during the period of January March 2011 were obtained. 3.3.3 Sampling Method Simple random Sampling, where all antenatal mothers who fulfil inclusion criteria were selected. 3.3.4 Sample Size The minimum sample size required in this study was 30. Data were collected by using close and open ended questionnaires and recode review of admission registered at antenatal ward, Hospital Jeli, Kelantan. In this study, all antenatal mothers who admitted were choosing by Universal sampling. 3.3.5 Inclusion Criteria Mothers who are willing to participate study All The citizen mothers 3.3.6 Exclusion criteria Mothers whos refuse to participate in this study Non citizen mothers Mothers who not understand Malay and English language. 3.4 Research Instrument An interviewer administered questionnaire was developed with two sections: Section A (demographic data) Factors socio demographic (Maternal age, races, education level, family income, employment status, employment status of husband , Hb level and number of dependents. Section B (prenatal care of mothers) Period of gesational , antenatal booking, antenatal clinics ,parity, nutritional supplements,. Section C ( Maternal Health Status) Factors of maternal health status (past medical history, big baby, infection during pregnancy, Ante partum hemorrhage and hyperemesis during pregnancy. 3.5 Definition of study variables The dependent variable: Antenatal mother The independent variables socio demographic factors Age Ethnicity Educational level Primary school Secondary school Tertiary level Occupational of mothers Housewive Professional Non professional Occupational of husband Professional Non professional Agriculture forestry Montly family income. It is divided to 3 categories; 1000-2500 >2500 Hb level of mother during admission Mild anemia ( 10.0 10.9 g/dL ) Moderate anemia (7.0 9 g/dL) Severe anemia ( Number of dependents ii. Prenatal care of mothers Number of children (parity) all the numbers of previous pregnancies resulting in either live births or still births after 22 weeks of gestational age. Number of visits to antenatal clinics that divided to 3 categories 0-4 visit 5-7 visit Above 8 visit Gestational age of mother Time measured from the first day of the womens last menstrual cycle to the current date. Use of nutritional supplements such as iron, folic acid, multivitamin and others iii. Maternal Health status Past medical history -Gestational Diabetic Mellitus (GDM) -Pregnancy Induced Hypertension (PIH) -Thalasaemia Infection Ante Partum Haemorrhage -Placenta praevia -Placenta abruptio Hyperemesis 3.6 Definition of terms 1. Anaemia: Anaemia is a lack of red blood cells, which can lead to a lack of oxygen carrying ability, causing unusual tiredness. Human resource management: Tesco Human resource management: Tesco The aim of the assignment is to evaluate strategic human resource management of Tesco Plc with reference to theory and practical approach, to study their Human Resource Management functions and evaluate the contribution of approaches and organisational structure. Human resource management is the process of acquiring, appraising, training, and compensating employees and of attending to their health and safety, and fairness concerns. HRM functions include a wide range of activities, and key among them is the responsibility of human resources. This includes deciding what staffing needs the company has and whether to hire employees or use independent contractors, recruiting and training of the employees, ensuring they always give high performance and ensuring personnel management practices to confirm laws and regulations. HRM activities also include managing employee benefits and compensation, personnel policies and employee records. TRADITIONAL DEFINITION Human resource management is the moulding of the human resources in such a fashion that the goals of the organisation are met and at the same time the need satisfaction of all the employees at all levels is attained to the highest possible degree. MODERN DEFINITION Human Resource (Personnel) Management is the planning, organizing, directing and controlling of the procurement, development, compensation, integration, maintenance, and separation of human resources to the end that individual, organizational and societal objectives are accomplished.- Edwin B. Flippo CONTEMPOPARY DEFINITION Human resource management (HRM) is the effective management of people at work. HRM examines what can or should be done to make working people more productive and satisfied.- John M. Ivancevic NATURE OF HRM Human resource management is a process of bringing organizations and people together in order to meet each others goals. Some of its features are as following: Pervasive force- Human resource management is pervasive in nature. Action oriented- Human resource management focuses on performance rather than written rules and procedures. Employees problems are solved through rational policies. Individual oriented- It helps employees in developing their potential full. It allows them to give their best efforts to the organization. It motivates them through systematic process of recruitment, selection, training and development with fair wage policies. People oriented- HRM is about people at work, as individuals as well as groups. It puts people on their assigned jobs to produce good results. Future oriented- HRM does help an organization to meet its goal in the future by preparing motivated and competent employees. Development oriented- HRM helps in developing full potential of the employees. Integrating mechanism- HRM helps in building and maintaining strong relations between people working at different levels in an organization. Comprehensive function- HRM is concerned a decision which can have an impact on the staff. Auxiliary- The purpose of the HR department is to advise and assist the operating managers to do work related to personnel more efficiently and effectively. NATURE OF HRM IMPORTANCE OF HRM People have always been the center of the organizations, and their importance is increasing in todays knowledge based industries. Success of an organization depends on knowledge, skills and abilities of the employees, especially as it helps to establish core competencies over its competitors. HRM helps an organization and its people to reach their goals at following level: Enterprise Level: Organizations can attract and retain best of the people in the organization if it has good human resource practices. Planning in advance helps the company to know what type of people it requires in short, medium and long term. It helps in training the employees for challenging roles, developing right attitude towards the company, promoting a spirit of team among employees and developing commitment and loyalty through reward schemes. Individual Level It helps in building teams and promotes team spirit among employees. It allows growth opportunities to people who have capabilities and potential to rise. It generates compassion and commitment in people towards their jobs. Society Level: Society as a whole is good beneficiary of human resource practices. It helps in generating employment opportunities. It puts talents to the best use. Companies that have good HRM policies stay ahead of their competitors and produce excellent results. National Level: Effective use of human resource results in better exploitation of physical, natural and financial resources. People with proper attitude and values and right skills help the nation to get ahead and compete with the best of countries. TESCO- COMPANY BACKGROUND Tesco was founded in 1919 by Jack Cohen. He started his new business venture by selling surplus groceries from a stall in the east end of London. On the first day, he made  £1 profit from  £4 of sales. Tesco has come a long way since then and is the fourth largest food retailers in the world after Wal-Mart of the USA, Carrefour of France and Home Depot of the USA. Tesco PLC is listed on the LSE, with the symbol TSCO. It is listed on NASDAQ and Irish Stock Exchange as well. Today it is operating 5,008 stores worldwide of which 2,545 stores are in the UK, and employing over 472,000 people worldwide of which 287,669 are in the UK. Not only Tesco has managed to monopolise the food sector, it has also diversified into a number of other sectors, some of which are insurance, mobile networks, clothing and electronics. However this assignment will focus on the retail sector in the United Kingdom. Albeit that Tesco has 2,545 stores locally, it is considered as operating in global environment. Apart from the United Kingdom, Tesco has stores in six other European countries; Poland, Hungary, Czech Republic, Slovakia, Republic of Ireland and Turkey. Furthermore, it also operates in Asia, and has stores in Malaysia, China, Korea, Thailand, Japan and Taiwan. Tesco requires people across a wide range of both store-based and non-store based jobs:- In store, checkout staffs, stock handlers, supervisors and many specialists such as bakers and pharmacists are needed. For distribution depots it requires people skilled in stock management and logistics. Head office provides the infrastructure that helps to run Tesco efficiently. In the head office, main roles include human resources, legal services, marketing, information technology, property management and accounting. FUNCTIONS OF HRM IN TESCO PLC RECRUITMENT AND SELECTION Recruitment involves attracting the suitable applicant to apply for the vacancies. Tesco advertises for the jobs in different ways. The process varies upon the type of job available. Tesco, first of all, looks at its internal Talent Plan to fill a vacancy. In this process, its current employees who are looking for a move, either at the same level or on promotion, are listed. If it can not find suitable people in this Talent Plan, Tesco advertises the post internally over its intranet for two weeks. For recruitments from outside the organisation, Tesco advertises vacancies through its website www.tesco-careers.com or through display boards in stores. Applications for the managerial positions are made online. Applicants who are chosen, have an interview followed by attendance at an assessment centre for the final stages of the selection process. People who are looking for store based jobs with Tesco can submit their CV at the store or can register through Jobcentre Plus. The store prepares a waiting list of people applying and calls them as jobs become available. For jobs that are hard to fill or are specialised in nature, such as pharmacists and bakers, Tesco goes for external advertising through following mediums: Through radio and television Through website and offline media By placing advertisements on Google or in magazines. Tesco seeks the most cost effective way of attracting right applicants. Tough it is expensive to advertise on radio and television, it is necessary to ensure that right people get to know about the vacancies. Tesco makes it easy for the applicants to find out about the available jobs and has a simple application process. An applicant can find about management jobs, head office jobs and local jobs, through Tescos website. There is an online application form for applicants to submit directly. Skills required There are six work levels within the organisation and each level requires particular skills and behaviours. Level 1 These are frontline jobs and include working directly with customers, various in-store tasks such as filling the shelves with stock. Candidate should have the ability to work accurately with enthusiasm and should be able to work in a team. Level 2 This includes leading a team of employees who are involved in dealing directly with the customers. Candidate should have the ability to manage resources, set targets and constantly work manages and motivates others. Level 3 This includes running an operating unit. It requires management skills that include planning, setting targets and reporting. Level 4 These are supporting operating units and requires good knowledge of the business, ability to lead others and skills to analyse and make decisions. Level 5 People working at this level are responsible for working of Tesco as a whole and should have ability to take major decisions and to lead others. Level 6 This includes the top level management of Tesco PLC which is responsible for Tescos performance. This level requires from candidates an excellent overview of retailing and ability to lead the whole organisation. This framework of Tesco describes the skills and behaviours required at each job and every level of in the company. This helps the candidates to understand whether they possess the right skills and knowledge to carry out their roles. SELECTION Selection involves choosing the most suitable people from those who have applied for a particular job. Screening candidates is an important part of the selection process. This process makes sure that people selected for the interview are best fit with the job requirements. In the first stage of screening, selectors will carefully look at each applicants CV. A well written and positive CV helps Tesco assess whether an applicant matches the specifications required for a particular job. The company also provides a tool called job type match on its webpage. It helps people to let them know where they might fit within the organisation. Candidates who pass screening have to attend an assessment centre. The assessment centres are held in stores and are run by managers. They help to provide consistency in the process of selection. Applicants are given various tasks, this includes working in teams or problem solving exercises. These involve examples of the problems they might have to face at work. Candidates who get approved by the internal assessment centres then have an interview. Line managers take part in the interview to make sure that the candidate fits job requirements. TRAINING Training means acquisition of skills and knowledge by a person for carrying out particular jobs and tasks. The benefits of training employees in an organisation are as follows: It motivates them by increasing their sense of ownership in the organisation. Training makes the employees more productive, organised and flexible. They are able to meet the needs of external and internal customers. Training makes them more effective by imparting new skills and abilities in areas such as decision making. Tescos business image helps Tesco grow. This is because customers are more confident in the competence and knowledge of staff. Tescos training and development module is flexible and structured, which caters to each individual employee needs. This allows the company to identify the potential customers and who have desire to do a bigger and different role to take part in training and develop their skills and leadership capabilities. Tesco follows two types of training methods for the training purpose of its employees. These methods are on the job training and off the job training. On the job training methods include: Shadowing: In this method, a new employee is shown how to do a particular work by an employee who is already working there for a long time and has got good knowledge and skills for that work. Coaching: In this method a designated colleague helps trainees and inspires them to find solutions for the problems they face. Mentoring: In this method, an experienced member of staff acts as an advisor for the new entrants. Job rotation: In this method the trainee is given full responsibilities on a temporary basis. On the job training is directly relevant to the work of the employees and they get to know the people in their area and feel part of a team. The advantages of on the job training methods are as follows- It is costs much less than the off the job training methods. Managers can keep a check on the progress of employees and can help if a problem arises. The employee works during training. Hence, this method of training is more productive. The employee can apply what he/she has learned while working. This results in a better learning. In areas such as team building, organisation and planning or communications, off the job training methods are more appropriate. It involves attending qualified Tesco training staff or external courses run by professional training organisations. At the A Level Options programme detailed induction training is provided from day one. It helps in developing new recruits into managers. This makes new employees meet other trainees and learn about the company and the business objectives extensively. With this kind of elaborate training schedule, they are able to develop the first level management position while working as a Team Leader DEVELOPMENT Development focuses on the growth of the person and extending his/her abilities. Tesco takes the responsibility for training and development of its staff. Primarily, the trainee is responsible for his/her development. The trainee and the manager, both contribute to the programme. The contribution is shown in the following table: TRAINEE LINE MANAGER Identifies and agrees development needs Helps to put together the personal developmental plan Attends workshop and development days Coaching and guiding the trainee as per the developmental plan. Collects evidence of achievements Reviews performance regularly. This he does to ensure that the trainee gets the best from the training Uses the feedback he receives to improve performance and review his development plans Provides feedback Employees of Tesco are encouraged to ask certain strategic questions about themselves in order to assess their ability and skills regarding progress. These questions are:- Do I know how? Can I do it now? What are my current skills? What do I need to achieve a higher position? Options programme Options programme of Tesco provides a long term strategy for development. The employees PERSONAL DEVLOPMENT PLAN includes: Activity plans A learning log A plan, do, review checklist. This is done to monitor when plans are completed. This enables trainees analyse their own progress. Long lasting competencies are produced with the help of personal development. Employees become more productive, positive and valuable to the organisation in the long term. It is a known fact that recruiting new staff costs more than retaining existing staff, therefore for an organisation like Tesco, retaining staff is of prime importance. Development also helps to increase the level of motivation amongst the employees. According to motivation theorists, if employees are given the support to grow their abilities, skills to perform their jobs well and greater responsibility, they become more effective. Tesco needs to ensure that it has the right calibre of staff to build its management team of the future. It requires a staff who can be flexible and who can adapt to change. THE BENEFITS OF TRAINING AND DEVELOPMENT All businesses, for financial and non-financial reasons, have to monitor and evaluate the costs and benefits of their training and development activities. The business needs to be aware if the investment of its time and money in selection and training of the employees producing any improvements. An employee needs to be given positive and structured feedback on their progress. This gives them a direction and much of confidence. This is reflected in their behaviour while dealing with customers and inspires higher customer confidence in Tesco. The tools of Tesco for monitoring and evaluation of training and development includes: Scheduled tasks Timetables Measures Checklists Employees are able to assess themselves by setting aims in Activity Plans, Recording Outcomes, Personal Development Plans and in Learning Logs. Activity plans need to have SMART objectives: Specific- This describes exactly what needs to be done Measurable- It has a target that can be measured against. Achievable- This is possible within the trainees current skills, role and experience. Realistic- It is achievable within the time and resources available. Time framed- it has a clear deadline. 360 DEGREE APPRAISALS Tesco also uses 360 degree method of performance appraisal. It involves taking feedback from all the people concerned with the employee in the organisation. In other words, all the stakeholders of the organisation who are in contact with the employee assess the persons performance and give feedback for the same. Apart from 360 degree appraisal, Tesco uses a more informal approach to development. In this approach, employees are asked to write down three that according to them they are good at and three things that they believe they could do better. The employee can make out the actions that he/she should continue to do and the bring improvement to the areas they could do better. Managers and trainees hold a weekly informal session and more formal four weekly sessions in order to track progress against their personal development plans. The feedback is carefully recorded and scored. Trainees are given a colour coded development rating: REWARDS AND BENEFITS It is important for an organisation that its people feel rewarded for the work they do. Tesco offers a wage rate that is higher than minimum salaries across all its businesses internationally. Tesco focused on its core rates and even in tough financial year, its pay competitiveness still improved in many markets. In most developing countries, staffs give priority to good basic pay and being paid fairly for overtime. In Malaysia, where there is no legal minimum wage rate, a Tesco employee receives 30% more than the Poverty Line Index for households. Tesco also provide its employees a wide range of competitive benefits in line with local labour laws and regulations. Some of these benefits are from paying at least 75% of the medical expenses, prescription drugs, dental and vision coverage after 90 days employment in the US to providing tuition subsidies in South Korea. Tesco has formulated long term reward plans for all markets so that it has clear plans on how to invest in pay and develop benefits for its employees in each country. All management teams of Tesco share in the success of its business. They are growing through bonus schemes linked to profitability. In the year 2009, Tescos employees received  £98 million worth of free shares in its Shares in Success scheme. A pay out of  £144 million was shared between fifty five thousand employees in Tescos Save as You Earn share option scheme. Tesco offers a wide range of staff discounts throughout the group. In Thailand, Tesco introduced staff discounts linked to its own Tesco clubcard in which staff received higher rewards than its customers. Tesco UK won two awards for its pension schemes. At the 2009 financial Times Pension and Investment Scheme Management Awards, Tescos schemes were awarded Defined Benefit Pension Scheme of the Year and Trustee Excellence- Large schemes. These award recognise how the funds are invested, how it communicates with its staff, how well it carries out the administration of the scheme and strength of the governance. The scheme aims at providing people with an annual income after they retire. Tesco provides benefits on ill health and death, based on their pay and their service. This benefit is one of the ways to reward loyalty and also contribute in attracting and retaining its employees. COMMUNICATION Tesco wants employees to share their views on issues that affect and business, and communicate with them regularly through face to face briefing, store and depot forums, publications, intranet and staff question times. Tescos annual staff survey, called Viewpoint, is kept confidential and anonymous. Results are fed into local plans at office, depot and store level. All of Tescos employees are given right to join a trade union and it is important for both company and employees that they exercise their rights. Tesco has a leading partnership with Usdaw in the UK, and agreements with Katz in Hungary and Solidarity in Poland. Head Office staff of Tesco gains shop floor experience through annual programme called TWIST (Tesco Week In Store Together). In the peak shopping periods such as Christmas and Easter, all head office provide support to their store colleagues through a programme called Helping Hands. Whistle-blowing Tescos whistle blowing policy and helpline number is there in all the countries. Protector Line is a confidential telephone line and e-mail address for employees to report grievances and raise ethical issues. All the calls are invested properly and serious matters are reported to the CEO. The feedback is monitored by the compliance committee. The Group Audit committee reviews the numbers of call and the quality of investigation each year. It also reviews plans to ensure that the staff is well aware of the facility. In 2009, there were around 1,700 employment related calls to the helpline. There was an increase from the last year showing that employees are gaining confidence in the service. Most of the calls are related to personnel issues, commercial issues and security and trading law. Personnel issues are resolved through grievance procedures. In the autumn of the year 2009, Tesco launched a service called Every Comment Helps, in the UK. Customers can contact the company via free text messages, e-mails, free phone calls or a card commenting on the experience in store and stating whether it was good or bad. The messages are transferred to the manager who then decides whether a stock or display issue needs to be solved, or provides feedback to the member of the staff who has been commented on. BUSINESS STRATEGY Tesco with its well-established and consistent strategy for growth tends to solidify their core UK business and expand into new markets. The objective for the strategy is to broaden the scope of its business so that it delivers strong sustainable long term growth and following the customers into large expanding markets in UK, such as telecoms, non-food and financial services, and new markets abroad, initially in Asia and Central Europe and recently in United States. Tesco adopted the strategy of diversifying its business in 1997, and this strategy been the foundation of its success in recent years. The businesses in which Tesco entered over past twelve years now are competitive, have scales and in fact they are the market leaders in some of the markets outside UK. The Tesco group has been making good progress with this strategy. It has five elements, reflecting Tescos four established areas of focus, and also Tescos long term commitments on environment and community. The momentum that this strategy has given the business has allowed the group to continue to grow despite economic downturn. The objectives of the strategy are: To be successful as an international retailer To grow business in UK. The UK is Tescos biggest market and core of its business. Tescos aim is to provide its customers a wide range of choices with excellent value. To develop its retailing services including Tesco Personal Finance, Telecoms and Tesco.com To consider community before taking any decision. CONCLUSION Tesco is a large organisation with many job opportunities, including management, graduate, school leaver and apprentice posts. Tesco needs people with right skills and behaviour in order to support its growth and development. Tesco has detailed job descriptions, person specifications and clear organisational structures. It provides friendly way of applying for jobs and a consistent approach to recruitment and selection. Hence, it can manage its changing demand for staff. An essential element of Tescos continuing growth is an efficient and effective training and development of employees to compete in this increasingly commercial world. Tesco wants its employees to be flexible and committed in order to fulfil the needs of its expanding business. Tescos expansion depends upon retaining existing customers and attracting new ones. Its structured methods of training and development of new and existing employees provides a strong base for its continuing growth.