Strategic Management Assignment Example | Topics and Well Written Essays - 3000 words

Strategic Management - Assignment Example Many research scholars still argue over creating cogent definition of strategic management. Various research scholars like Michael Porter, Philip Kotler, John Kotter, VA Zeithaml and many others successfully tried to create a theoretical framework of the concept but still their frameworks failed to create a universal theory of strategic management probably due to multidimensionality of the concept. Organizations use strategic initiatives in accordance with culture, leadership style, frequency of crisis and business objectives. Gray (1) has bifurcated strategic planning from strategic management and described two aspects in the following manner. ... Meyer (3) illustrated strategic management as process that helps top level management of the company to understand business objectives, future threat and opportunities; identifying suitable strategy to deal with these issues and taking control over external variables; creating direction to accomplish strategic objective of the organization. Nutt and Backoff (4) have modified the concept of Meyer. According to them strategic management actually combines short and long term planning of the organization in order to achieve organizational objectives like increasing profitability, increasing control over existing product portfolio, achieving high growth rate, expanding many business in foreign market, creating market entry barrier for competitors by increasing competency level (Tyndall, Cameron and Taggart, 1990, p. 9). Strategic management is a multidimensional concept and the study cannot cover all the aspects of strategic management. The study will focus on a particular concept of stra tegic management in order to create a cogent representation of assignment topic. This report will analyze Michael Porter’s generic competitive strategies from the view point of theoretical concept and real life application in order to understand functionality of the concept. 3.0 Michael Porter’s Generic Competitive Strategies In 1980, Michael Porter developed the basic strategic model for companies in order to achieve competitive advantage over competitors. He modified the concept into more confined model in 1985. Main agenda of the model is to help organizations to create a sustainable and not easy to copy strategy with which they can not only achieve competitive advantage over adversaries but also can build a sustainable

Reflection and Journal Article Review Essay Example | Topics and Well Written Essays - 750 words

Reflection and Journal Article Review - Essay Example Although one could appreciate the wonders and benefits these technological gadgets could accord the aged, the applicability of these technology solutions are mostly availed only in developed countries. These unique products are not globally accessed due to the prohibitive costs and the diversity in health care provided to the elderly according to cultural orientations. I was made aware of the crucial importance relegated by the older population in terms of maintaining independence despite their age. The statement that reveals that â€Å"seniors fear moving into a nursing home and losing their independence more than death† is astounding. The various products thought to provide the aged with independence is perceived as a way to replace a loved one or a family member who is supposed to provide the needed care. In eastern culture, older people are not sent to nursing homes but are retained in the nuclear household with a family member to attend to their holistic needs. The reason , apart from economic, is the cultural value for extended family ties and filial piety. The practice stems from Confucianism and has been defined as including â€Å"the responsibility of each person to respect their parents, obey them, take care of them as they age, advise parents, and of course to love them. Loving one’s parents and offering them respect is the spring from which other forms of filial piety flows. A relationship with parents must be centered on love and respect† (Conjecture, 2011, par. 2). Therefore, technology is not openly embraced to replace the love and care that would be accorded by family members in times of need of the elderly family member. Further, the issues that were presented as a consequence of greater reliance to technology, particularly the fact the seniors are always apprehensive to use or try out new products and systems, should be addressed. Otherwise, these unique products would be deemed useless if the target market, for which they are supposed to protect, secure and maintain in safe and in good health condition, would be compromised by inefficient and unsupportively erroneous application. The essence is the use of technology should not replace the delivery of health care services that only committed people could provide. Article Review from Peer Reviewed Journal Summary The article entitled written by Dr. Ronald Klatz and published in the Generations, Journal of the American Society on Aging in 2002 presented issues of discovering anti-aging medicine in response to the projected continued increase of the aging population. The author presented the official definition of anti-aging medicine as â€Å"a medical specialty founded on the application of advanced scientific and medical technologies for the early detection, prevention, treatment, and reversal of age-related dysfunction, disorders, and diseases† (Klatz, 2002, 1). The continued research on this field of endeavor was revealed to encompass five key areas, to wit: genetic engineering, cloning, nanotechnology, artificial organs, and nerve impulse continuity (Klatz, 2002, 2). The benefits are revealed to be pronounced and consistent with modern health care issues.\ Critique The article presents another technological breakthrough aimed to focus not only on according longevity in life span, but also in improving the quality of the elders’ lives. There were initial apprehensions on supporting this kind of medical and technological breakthrough in terms of determining the repercussions to health care in general. But as trends in the aging populat

Crooks Essay Example for Free

Crooks Essay Crooks as the biggest victim on the ranch discuss Monday 24th October 2011 In the novel ‘Of Mice and Men’ Steinbeck presents Crooks, the black stable-buck as the biggest victim on the ranch because of his race. Crooks is also the most damaged person, emotionally and physically. He has a crooked back and has begun to mimic the cruel and violent behaviour of the other men on the ranch. The impact of his loneliness also makes him push people away, leaving him even more lonely and segregated. The other men exclude Crooks because he is black. He is not allowed to go into the bunkhouse with all the white men because they are racist and follow the racist behaviour of segregation. It is clear that Steinbeck is critisising wider society through his description of Crooks. Crooks has his own room ‘had his bunk in the harness room’ he lives alone and is no more important than the animals symbolised by the nearness to the animals. He is alone all the time and gets lonely but never admits it because he is too proud. Steinbeck show’s the irony of Candy saying ‘must be nice to have a room all to your self’. When Lennie comes in to his room, Crooks has right to ask him to leave but instead acts as though he didn’t want Lennie to stay. He says – ‘come on in and set a while†¦long as you wont get out and leave me alone. ’ The ellipsis’ show his hesitation after he admitted he wants the company he realizes and changed it around to say he wants to be alone. This is so Crooks can maintain his pride and his dignity. He his so lonely that he admits to Lennie – ‘just a guy talking to another guy doesn’t matter if he understands. ’ This tells us Crooks is happy talking to Lennie even though Lennie does not understand most of the things Crooks is saying. It is the company and the talking to another human that matters to him. Steinbeck also adds that Crooks ‘reads a lot’. Steinbeck implies that even though Crooks is treated badly he could be the most educated worker on the ranch has a better understanding of things than most of the other men and is wiser because he is older and has seen more things. Also he has a ‘Californian Civil Code’ book, because he has this book and reads it often he knows a lot about the laws of discrimination in different areas. He is interested in is rights as a black man unfortunately, despite his knowledge Crooks is unable to change anything. Slim is the only man who treats Crooks sympathetically. He respects Crooks more and talks to him some times. Slim is ‘kind’ and ‘is a good listener’ but Slim and Crooks are the opposite- Slim is respected and has power whereas Crooks is disrespected and beaten by the men because of the colour of his skin. Slim is a ‘tall man’ who is ‘capable of killing a fly on the wheelers butt without touching the mule’ but Crooks was just a ‘stable buck, nigger with a ‘crooked back’. Through this contrast, Steinbeck provokes pathos about Crooks’ life. Ironically, even Slim is effected by the hardship on the ranch casually drowns four pups. Steinbeck depicts Crooks as the most physically damaged person on the ranch. One of the reasons for this is that the white men beat Crooks, just because he was black. The boss uses Crooks to let his anger out – ‘the boss gives him hell when he’s mad. ’ Even though the boss hired Crooks to do a job he beats him when he is angry, this shows Crooks is of a low status on the ranch and that he matters the least. The men are also very cruel to Crooks when they say ‘ Jesus we had fun. They are referring to a time when they beat Crooks. This is very cruel he had no way of defending himself by fighting back because he has a crooked back and is much weaker he also has no one on his side. What is more brutal is that they did it just for pleasure this suggests that the ranch is corrupting everyone. Steinbeck warns us of the consequences of brutality in the wider world. Furthermore the cruelty Crooks faces made him cruel to Lennie when he says – ‘I don’t blame the guy you travel with for keeping you outta sight. ’ and ‘what if he don’t come back. Crooks wants to frighten Lennie and is clearly jealous of the companionship he has with George. When ‘Crooks face lightened with pleasure in his torture’ it shows that Crooks has learnt from the other men how to be cruel. This is also another way he has been damaged emotionally by the ranch because most of the men become cruel and it is a violent world where only the fittest will survive. Crooks wishes that he could have what George and Lennie have so he gets dragged in to the dream against his better judgment – ‘Never a god dammed one of em gets it just like hea ven. Here is Crooks talks about men trying to get land for themselves. He does not believe in God because his life has been so bad that there cannot be a God but he still equates land with heaven. Crooks is lonely and has a room to himself on the ranch and in it there were ‘hung broken harness strips in process of being mended, strips of new leather. ’ Ironically ’Being a stable buck he was more permanent than other men’ His permanency does not give him status he is all alone and unlike the bunk house where games are played in the evenings his room is filled with work objects so he would not get much time to relax or rest. Also in his room is ‘a range of medicine bottles for himself and the horses. ’ This is another example of him being no more important that the animals and also part of the discrimination against him. Steinbeck depicts Crooks as a victim by the description of his physical appearance. – ‘His body was bent over to the left by his Crooked spine’ His lean face was lined with deep wrinkles, and he had thin, pain-tightened lips which were paler than his face. ’ His body is bent over because a horse has kicked him on the ranch so the ranch damages him physically. His lined face shows the evidence of the brutality of the ranch, he is older and weaker because of the hard work he has done and his thin, pain-tightened lips show the pain he is in. yet he still has to work everyday and he tries to soothe the pain by repeatedly applying liniment to his back. This reminds us of his pain – ‘he poured his liniment into his pink palmed hand. ’ Although Crooks is damaged by the ranch and has no status, he is a very proud, dignified man who wants people to respect the few rights he has, ‘you got no right to come in here’ he said to Lennie because his room was the only thing people has respect. He has read about black rights, he is interested in what rights he could have in other places. Although Crooks had the right to ban Candy and Lennie from his room the desire for company overrode this. He was happy to have the company of the two men, ‘well, why’n’t you kick ‘em out? ’ ‘I di’nt care much’. Steinbeck makes us sympathise with Crooks as he is presented as the biggest victim on the ranch because he is damaged mentally, physically and emotionally. Steinbeck also makes us sympathise with Crooks because he is lonely and how he is lonely from the isolation from the other men.

Ethical issues in Monsters Inc.

Ethical issues in Monsters Inc. The movie Monsters Inc. tells us about the minor world that includes humans are living their life without any little knowledge about the other side of the world. This is the world where even a single child knows the exit and then the place is incorporates real monsters in the closet. The world of monsters is quite different from the human world. The first difference is related to the scary monsters have made the land dense with its population. Therefore, electricity which is generated through geothermal, solar, or fossil fuels etc. was produced by exploiting the power of children’s screams. The monster world is facing a severe energy crisis due to the fact that children are getting less sensitive to the scare tactics of monsters due to the productions demonstrated in games, video games, and television. Business Portrayal of Monster, Inc. The business world at Monsters Inc. is depicted basically in a positive light. The adversary in the film was not stretched out to incorporate Monsters Inc. in general however rather was depicted as character blemishes in the identities of two monsters. At Monsters Inc., representatives are reasonably joyful. This is portrayed throughout the morning get-together where representatives cheerfully welcome one another and also talks in an energized way about the other days work. There are sufficient precautions set up to ensure the wellbeing of the workers. For example, the Child Detection Agency (CDA) is a SWAT-like group that assembles at whatever point there is a reported locating of human world items like toys, attire, or real youngsters, spanning the dimensional crevice and entering the world of monsters. Human articles or kids are considered to a great degree lethal and perilous (Anderson, 2001). The CDA is in charge of catching all unworldly protests and detoxifying all beasts that have come into contact with such objects. Furthermore, due to the mechanical supplies used to bring kids doors to the monster world, employees are obliged to wear hard caps for assurance if there should be an occurrence of the malfunctioning of an equipment. The last case displayed to depict the business world as positive is that of the satisfactory break structure and work plan. Workers work throughout ordinary daytime business hours, are given time off for lunch breaks, and are left at their recreation to appreciate evening exercises, for example, participating in dates, going out to supper, or for the relaxation at home. Ethical considerations and policies Ethical Issue # 1 The first ethical issue that is observed in this particular film is related to the generation of energy at Monster, Inc. Just like humans, monster enjoy utilizing electricity at their houses for various uses like watching televisions and to power lights. But the only difference that is found in this scenario is that in the human world the generation of power is carried out through deforestation and coal mining where deforestation has dangerous and devastating after effects on species that live in that particular area. The monster world generates power through the after effects of screams of children. However, it can be said that this is one of the serious concerns for disturbing the emotional condition of children while being unethical to them. Many other ways of doing so can be discovered and the Research and Development team is the one to do so. Their motto, ‘’we scare because we care’’ can be seen as they really care for the audience but they are doing t hem for their own self-interest. This is what also witnessed in the human world as well. This is specifically related to the corporate social responsibility. The utilitarianism approach should be adopted here which states that there is a dire need to maximize usefulness and eradicate any sort of misuse that damages or expose an unethical behavior and attitude towards the public. According to me, the employees in the RD department should be encouraged to find out some new improved ways to generate power without being unfavorable to the children and public. The issue was resolved through the discovery that laughter generates more power than the current scream tactic. This was found when a human child named as Boo slips through the door opened up by the monster Sully. Sully has already brought Boo home and so, he is not in any sort of trouble due to the fact that the employers of Monster Inc. had created some sort of panic in the mind of employees that children are extremely toxic to t hem. When Boo laughs, there was a great surge of power at his home. So, this shows that employees can also be encouraged to discover new ways to continue the business in an appropriate and ethical manner. If the company promotes employee voice of concern then employees can voice their views in this regard Ethical Issue # 2 The culture of fear introduced by the head of the company, Mr. Waternoose by discovering the Child Detection Agency in order to remove toxicity caused by the children. However, this was not the case at all. The head of this particular company was preventing the employees from forming any sort of associatio (Cahill, 2010)ns with the children. The head of the company is not following the Teleological theory of ethics as he does not focus much on the consequences of his actions which are totally unethical . The employees are always in a state of fear and anxiety as soon as they learn about the children being close to them but they are not toxic at all because of the fact that when the child enters Mr. Waternoose’s sight, he picked him up. The culture of the company emulated by the attitude of the employees was getting disturbed by this particular scenario. Mr. Waternoose should have thought about its employees for not creating any sort of instability in the work environment throu gh the creation of this culture. It is always necessary to maintain the culture of any particular company in order to make an organization a great workplace for its employees. More than that, after watching this film, the employees should be trained to not act accordingly as long as they have not witnessed the same thing in general. Only then, they can persuade themselves to believe and act accordingly. In this case, the employees haven’t experienced any sort of toxicity until they found out themselves due to the floating toys from human world to the monster world. Ethical Issue # 3 Mr. Waternoose values company first which is a good thing to maximize profit but it should be done in an ethical manner. This is already proved by the excerpts that Mr. Waternoose comments on the well-being of his company by saying that this company has been in his family for three generations and that he would do anything to maintain the continuity of his business. However, the CEO was recorded to have said that he will kidnap a thousand children before letting his company die and that he will not tolerate anyone if anyone comes in his way. This gives us an unethical approach towards the adoption of scare tactics because it was sole responsibility of his company to generate electricity and it can also be considered as an act of self-interest as the CEO can use the same tactic for his personal home use. Other Ethical Issues The other more minor moral issues depicted incorporated the violation of business strategies in light of the fact that you were asked by a companion or sentimental interest as seen by the various workers that damage the approach in regards to the harmfulness of youngsters when asked by the loveable creature Sully. An alternate business moral issue introduced was the real trick of the inconvenient impacts of innovative research and developmental initiatives that led to the astray causing detrimental effects to research subjects. In the film, the two misguided creatures were the CEO and Randall. Together these workers occupied with exploration amazingly risky to youngsters, however felt their activities were supported due to the severity of energy crisis. Conclusion The film Monsters, Inc. is focused around an electric organization in the monstrous world. The organization, Monsters, Inc. produces power for their city through screams of youngsters and refining the shouts into clean vitality to run the city. Also like any organization in any sort of world, beast or human, things need to run easily. Numerous things need to fall into spot for an organization or business to get fruitful and acquire gainfulness. Certain assets need to be utilized, human assets need to be given careful consideration to, and an aggressive environment is required for an organization to run quick and proficient. The four separate elements of generation the shouts as common assets, the processing plant and refineries as capital, the scaring and different laborers as work, and Mr. Waternoose as the ambitious person who began the organization. Monster, Inc. transforms clean energy from the shouts of little kids for all of Monstropolis and its monsters. The treatment of any organizations human assets incredibly influences its benefit, which is the reason it is something that needs to be given careful consideration to. In the event that an organization disregards their laborers, the workers may feel ignored and rebel against the employers. An effective productivity of the organization enormously lessened reflecting the breach of human code of conduct and whole scare floors must be closed down, and in view of this the motivation and encourage to work in such an environment lessened due to the reduction in their morale. The most productive use of natural resource is laughter of children. At the point when boo got away through her wardrobe into Monstropolis Mike and Sully needed to conceal her from the CDA. To keep boo from hollering, Mike needed to make her laugh, however when she did giggle, the power would go haywire and things would short out. The thought of competition is communicated all through the film by staying informed of the amount of scare points handled by every monster, and each creature needed to have the highest scare points in light of the fact that they then would get prevalent around the monstrous world. References Anderson, D. K. (Producer), Doctor, P. (Director). (2001). Monstern, Inc [Motion Picture]. Cahill, L. S. (2010). TELEOLOGY AND UTILITARIANISM ETHICS. Retrieved from http://www.ts.mu.edu/readers/content/pdf/42/42.4/42.4.4.pdf

The Last Wave :: essays research papers

The Last Wave SOC 118 "The Last Wave"-Peter Weir dir.(1977) In the film, The Last Wave, the director is trying to communicate the idea of a culture within a culture or sub culture. The dominant culture in the film is the white members of society living in Australia. The subculture in the film is the Aborigines who were natives to the land before the white people settled in Australia. The natives sustained their cultural beliefs and ideologies while living in largely populated cities. The dominant white culture imposes their laws , ideas of societal values and moral beliefs on the native Aborigines. Forcing them to abide by a different law system and way of life than what their peoples have practiced for hundreds of years. In the movie the lawyer, David, represents the dominant culture to the Aborigines because he represents the law that is controlling their fate in the white culture. The director is also giving us many symbols or visual communication such as the consistency of water in the film as well as, the overbearing control of darkness. The film is shot in shadows and overall is very dark , almost forcing us to look beyond the obvious plot and storyline and into the meaning or what the film/director is trying to tell us. The darkness in the film can be seen as unconsciousness. It can also be seen as a prediction of the darkness that will occur in the world when the last wave comes. The last wave meaning a giant tidal wave that will cover the earth , killing humanity. This idea is similar to the Christian belief in the flood that was sent down centuries ago to destroy all the evil in the world. Also, all the modern aspects of the movie (courtroom, David's office..etc) are filmed in light. While, all of the Aborigines' scenes are filmed in darkness or shadows. Giving me the impression of something mysterious or not understood by the whites concerning the Aborigines. The fact that all the modern scenes are filmed in light can also support the idea of the white culture being the predominate culture in the film but yet not dominant enough to take away the shadows(mysterious , mystical)aspect of the Aborigines. The lawyer, David, Also goes through a series of dreams and premonitions. This is stressing the idea of mind power and mystical strength that the Aborigines have. In that way they can be seen as the dominant culture. David is stuck between two worlds. The world he knows and understands and the other world that he is definitely a part of but does not understand.

Anglo American Economic Geography Essay -- economics,

Discuss the intellectual history of Anglo American economic geography since the 2nd world war. Economic concepts have often been used as the foundation for geographic theory; showing a relationship between the two. When the field of economics evolves then so too does the field of economic geography. Economic geography is defined as: a field of geography that helps to describe and explain the areas where economic activities are carried out. It is centered around helping to explain the production and distribution of commodities and how resources are to be allocated and the consequences (Barnes 2009). The Second World War ceased in 1945 and after this the economies of both America and the UK changed rapidly. These economies passed through different systems; Keynesian, Marxian, Neoliberalism, and mixed an economy (Bonney 1995). This in turn meant that economic geography passed through different stages too, with the most significant change occurring directly after the war; the start of the quantitative revolution. The way that the field of economic geography changes has implication s on how the field as a whole is viewed. One of the main points is the interconnectivity with the economy; this also shows how the economy is viewed. Each period has a moment of emergence rapid efflorescence and a period of decline. To understand how economic geography has changed over the last fifty years, a brief explanation of the state of the economy should be covered Directly after the war the US economy was in a state of strong economic growth due to consumers demand increasing, this was due to there being few opportunities to consume at a desired level during the war. The US held 95% of the worlds manufacturing helping it to recover more quick... ...mic Geography. In: Leyson, A., Lee, R., Mcdowell, L. and Sunley, P. eds. 2011. The SAGE Handbook of Economic Geography. London: SAGE Publications. Bonney, R. (1995). Economic systems and state finance. Oxford [England]: Clarendon Press. Hardon, J. A. (2003). The Influence of Marxism in the United States Today. [online] Available at: http://www.therealpresence.org/archives/Communism/Communism_002.htm [Accessed: 21 Feb 2014]. Scott, A. J. (2000). Economic geography: the great half-century. Cambridge Journal of Economics, 24 (4), pp. 483 - 504. Trainer, T. (2010). MARXIST THEORY; A brief Introduction. [online] Available at: https://socialsciences.arts.unsw.edu.au/tsw/Marx.html [Accessed: 21 Feb 2014]. WiseGEEK. (2010). What Is Keynesian Economics?. [online] Available at: http://www.wisegeek.org/what-is-keynesian-economics.htm [Accessed: 21 Feb 2014].

Post Sigmoid Coletomy Care

This paper will critically examine the care needs and management of Mr Braun. An appropriate framework will be used, namely the ABCDE. Alternative treatment will be analysed using the 5 WHs critical decision making too (Jasper, 2006)l. His care will be based upon the nursing process ensuring that patient outcomes are agreed, implemented and evaluated. The assessment framework to be used is this assessment is the ABCDE assessment framework. The ABCDE framework looks at Airway, Breathing, Circulation, Disability, and Exposure/Elimination.The reason for choosing this framework is that it uses a systematic method of assessing, it aids with elimination of post op complications. In addition, it is a commonly accepted framework which is widely used and can be used in critical care situations, pre & post-operative care and emergency situations. Furthermore, it allows the nurse to use her skills in accessing the patient’s needs. The disadvantages of the framework are that it is a medic al model in the sense that it looks specifically at the biological aspects of care and lumps emotional/psychological/cultural/social care under the exposure/elimination catergory.Therefore it does not promote exploring these issues in great detail (Younker, 2008 & Hargan 2012) Cancer Physiology Bowel cancer normally starts in the rectum or sigmoid colon. It starts as adematous polyps and then progresses to adematous carcinomas. It spreads by direct extension via the bowel circumference, submucousa and outer bowel wall layers. It can also spread to other areas by direct extension, for example, to the liver, pancreas and spleen. Metastasis is normally by way of the surround lymphnodes.Primary cancerous cells can also travel into the lymphatic and circulatory system causing secondary cancer in other organs such as liver and pancreas (LeMone & Burke, 2003). Mr Braun is undergoing an operation for his sigmoid colon cancer. One route to take would be the traditional method. This consists of open bowel surgery. This entails making a large opening. A bowel prep is given prior to surgery, there is a longer starvation process, which can cause dehydration and electrolyte imbalance. Furthermore, it causes stress on the body, insulin resistance in the body is longer and the recovery period is longer.In addition it causes longer paralytic ileus (Siddiqui et al. , 2012). The alternative treatment to the traditional method would be the laparoscopic method. Mr Braun would have a smaller incision, therefore making a quicker recovery. He would be in less pain and would be able to mobilise quicker. He would have a quicker return of GI function and a lesser period of paralytic ileus. He would be able to deep breath better as he would not be experiencing a lot of pain, therefore he would be at less risk of contracting a chest infection.This would all work towards him having an earlier discharge, for example, 3-5 days post op compared to anywhere between 8-12 days on the traditional method. Research has also shown that community rehabilitation is much quicker, 2-3 weeks rather than 6-8 weeks on the traditional method (Jenson 2011). Further research shows that patients undergoing laparoscopic surgery have fewer complications post discharge (Hargan 2012). It appears then the laparoscopic route has better outcomes for the patient and in addition, the NHS.Being able to discharge a patient between 3-5 days who experience fewer complications post operatively not only frees up beds but costs less to treat the patient. Therefore, after weighing up the pros and the cons of both the traditional and the laparscopic it would seem that Mr Braun would be better off having the laparoscopic route. It appears from research that the lapascopic route is the route which is used in almost 90% of colorectal surgery. However, the route that is taken ultimately depends on the surgeon’s choice. Prior to collecting the patient from the recovery roomBefore collecting Mr Braun fro m the recovery room I will need to check the bed area. This includes checking that the oxygen is working. I will need to ensure that there is a nasal tube and a venturi mask. I will also need to check the suction is working and ensure that a new tube is present by the bedside. I will also need to make there is a yonker. I will put a dynamap beside the bed which will allow me to take Mr Braun’s clinical observations on return to the ward. I will also ensure that a drip stand is next to the bed as he may be on fluids or have a PCA on his return to the ward (Nicol et al. 2012).Collecting the patient from the recovery room On collecting the patient from recovery, I will take with me a kidney bowel in case the patient needs to be sick on his return journey, a pair of gloves, a oropharyngeal (geudel) airway in case his airway becomes compromised in anyway and a pocket mask for mouth to mouth. My first priority is to ensure that Mr Braun is safe to return to the ward. I will check h is level of consciousness using the AVPU tool. This tool looks at whether he is Alert, whether he responds to Voice or whether he only responds to Pain and whether he is Unconscious. I will then take a handover from the recovery nurse.This should include informing me of the procedure Mr Braun has had, how well he has responded to the surgery and his current responsiveness/consciousness level. I would need to check with the recovery nurse whether his vital signs are within the normal range. This is for patient safety which is paramount and is at the centre of nursing care. This would need to be checked against the Early Warning Score (EWS) system which includes level of consciousness, the physiological parameters, for example, temperature, blood pressure, Oxygen saturation (SATS), respiratory rate, pulse and urine output.The EWS gives an overall score which informs me whether or not it is safe to take Mr Braun back to the ward. The recovery nurse would also inform me which medication s he has had, information regarding IV fluids, how long they should run for and whether more are needed when it finishes and check they are written up on the drug chart. In addition, I would need to see the wound bed. This would help with later assessment on the ward where I would be able to compare whether there has been any further bleeding or leakage. I would need to see the stoma site.The recovery nurse would inform me whether Mr Braun had a urinary catheter and whether there had been any urine output. After handover I would say hello to the patient and manually take his pulse so that I can get an indication of his heart rate (Nicol et al. 2012). On the ward On returning to the ward I will orientate the patient. I will inform him of every procedure that I do so that I can gain informed consent (NMC 2012). I will immediately carry out a set of clinical observations. This is so I can make a comparison with his perioperative baseline.Although doing the clinical observations with th e dynamap, I will manually take his pulse as it is vital that I know whether it is regular/irregular, strong or weak. ABCDE Assessment Airway The best way to check the airway is to speak to ask the patient and get him to respond to you. If he is able to talk in normally, this will be indicative of his airway being patent. I would need to listen to whether there are any sounds, like barking or gurgling as this could indicate that there is partial obstruction.I would also need to check whether Mr Braun is experiencing any nausea or vomiting. If Mr Braun is experiencing this I would need to immediately administer an anti-emetic as per drug chart instruction. This would help prevent the risk of pulmonary aspiration. I would also need to check whether Mr Braun has any allergies. I would ensure that he is wearing two red wrist bands with the allergies clearly written on them so that other staff members are aware. His allergies would be documented in his nursing notes and on his drug chart with information on what sort of reaction he experiences.Assessing whether Mr Braun has any allergies is extremely important as allergic reactions can cause swelling of the tongue and in the throat which would compromise his airway and leave him with difficulties breathing (Resuscitation Council UK, 2012). Breathing I would now assess breathing by checking Mr Braun’s respiratory rate (RR). The normal range is between 12-20 breaths per minute. In PAC, his RR was slightly raised. This could have been due to anxiety but was more than likely due to his anaemia (this will be looked at further under circulation). I will be able to gain a comparison and start looking for a trend.It is important that the RR is counted for a full minute. His breathing may be irregular and therefore not counting the full minute would give an inaccurate measurement. I would also check Mr Braun’s SATS. The normal range should be >95%. Checking his SATS will inform me whether he is getting enough oxygen and whether his tissues are being perfused adequately. Lack of oxygen can cause hypoxia which if not managed will lead to multiple organ dysfunction and ultimately death. I will also therefor check for cyanosis as this will also inform me whether he is lacking oxygen. It is important to look at how Mr Braun is breathing.For example, is he struggling to breath, is he breathing deeply or is it shallow. Does he have to use his accessory muscles to help him breath. I would check whether his chest is rising equally on both sides. I would also speak as him a question to ascertain whether he is able to speak in full sentences because someone who is struggling to breathe is unable to speak in full sentences. I would look at whether he is breathing fast or slow. Furthermore, I would look at how he is sitting, for example, is he leaning to one side. Also when you are assessing breathing it is important to listen for any wheeze or stridor.RR is one of the first things to alter when a pa tient is deteriorating. It is vital that if Mr Braun is experiencing any of the above, the nurse responds quickly. The first thing would be to check whether he is written up for any more oxygen and if so to increase it. The nurse would then have to check in RR and SATS again after 15 minutes to ascertain whether there was any improvement or further deterioration even. If the patient was deteriorating further the nurse would need to involve the doctor who would be able to review Mr Braun immediately and give further instructions on his care (Queen Mary University & City University, 2006).Circulation An assessment of Mr Braun’s pulse needs to be undertaken. This will allow the nurse to ascertain his heart rate. In addition, it would allow me to feel whether his pulse is strong or weak and whether it is regular or irregular. The normal resting pulse should be between 60-80 beats per minute (bpm). In the PAC, Mr Braun was slightly tachycardic, which could be due to anxiety of his diagnosis, hearing about the treatment he would receive or his prognosis. By taking his pulse it will allow for a baseline, pre-operative and peri-operative comparison.His blood pressure (BP) would also be assessed. The normal ranges are 90/60-140/90. Mr Braun’s BP in PAC was 135/80. Although this is still within the normal range, it is slightly high. However, this would be an appropriate BP given his age. It is vital that clinical observations are carried out every 15 minutes for the first two hours post-op as there is a higher risk of complications occurring and clinical signs are the physiological parameters which tell you whether a patient is deteriorating or improving.For example, if a patient is tachycardic and hypotensive this could be indicative of hypovolaemic shock which would need to be managed immediately as this can lead to potential death. It is vital when taking clinical observations that the nurse is aware that she should not only rely on the measurements. Th is is because a patient can be in hypovolaemic shock and still have a normal BP. This is because in hypovolaemic shock, the compensatory mechanisms take over and the body will do everything it can to keep the BP at normal level.Therefore, it is vital that the nurse also observes what the patient looks like, for example, does he look palor, he is sweaty or clammy. These are all important factors when carry out clinical observations. When a patient undergoes surgery he has enforced reduced mobility. Mr Braun will be in bed for a while and due to these factors is therefore at risk of Deep Vein Thrombosis (DVT), which is one of the highest cause of PE leading to hospital deaths. The nurse should check whether he still has his TED stockings on and check that they are not rolled down or creased as this may prevent them from achieving good prophylaxis.Furthermore it could compromise his skin integrity. Mr Braun will probably also be prescribed oral or subcutaneous anticoagulants as a furth er prevention of DVT. Mr Braun’s Hb levels should be checked to ensure that his anaemia is improving. If Mr Braun was assessed in PAC as having met the criteria, which is expected to make a good recovery, for the ERP, his anaemia would have been dealt with prior to him being admitted. He would have been assessed for any co-morbidities and his GP would have been involved to treat his anaemia.If his anaemia had not been treated, prior to his admission, it is likely that Mr Braun would have undergone a blood transfusion during surgery. This would mean that he would have a cannula in situ which would need to be assessed to check for phlebitis. This would need to be documented on the VIP chart (Hargan 2012). The cannula needs to be checked to ascertain whether it is patent. The date of insertion should also be noted on the VIP chart as it is not allowed to stay in for longer than 72 hours. Mr Braun will also have a catheter in situ. Therefore it is important to check for urine out put.Mr Braun should have a urine output of 0. 5ml/kg/hr, in other words half his body weight per hour. Therefore if Mr Braun weighs 80kg, he should have a urine output of 40mls per hour. If going through the traditional method, Mr Braun would have to have a low residue diet approx. 2 days prior to the operation. He would only be allowed clear fluids approximately 12-18 hours before surgery and would then be starved from the midnight before the day of surgery to prevent aspiration. Research has shown that prolonged starvation causes dehydration and electrolyte imbalance.It causes the body to experience insulin resistance for longer and cause the body more stress (Burch & Slater 2012). In contrast, he would have been given carbohydrate loading prior to surgery in the form of iso-osmolarity which 90% passes through the stomach within 90 minutes therefore he would have been able to have it one and a half hours prior to surgery. This would cause less insulin resistance and put his body t hrough less stress. He would be able to come off any IV fluids as he would be encourage to eat and drink at will post operatively.