Effect of Sustainability on Development Essay Example | Topics and Well Written Essays - 3250 words

Effect of Sustainability on Development - Essay Example Sustainability is important and especially with a focus on global warming and environmental degradation, property developers and contractors have emphasized on construction and building projects that would be beneficial to the environment. Sustainability highlights these benefits and purchasers, developers and occupiers or builders and even buyers want a sustainable environment so that they could be part of a healthy and beneficial environment. Saving energy and utilizing renewable energy are some of the elements of sustainability as sustainability is about renewal rather than depletion and using natural energy resources in a manner that would environmentally advantageous for the future. A study on environmental energy resources and sustainable developments examined the extent to which energy efficiency is incorporated in refurbishment and capital expenditure of office buildings and also suggested a cost benefit analysis. The three aspects of construction technology, building refurbishment and property management are integrated along with sustainability goals. The levels of capital expenditure vary to ensure that buildings are more energy efficient. The emphasis has been on cost of implementation and with increased energy efficiency there may even be a demand for high rents. Studies have suggested that office building construction phases contribute significantly to global warming although during the entire lifecycle of a building, CO2 omissions are a major problem. Innovative approaches and energy related changes and efficiency considerations are more applicable in case of new buildings as with various building designs and constructions techniques, new environmental considerations for construction have also evolved. All this caters to the idea of sustainability although the number of new buildings constructed each year is small in proportion to the buildings which already exist. However capital expenditure on a building enhances the sustainability factor proving that sustainability and energy considerations comes with a price although have long term environmental benefits. The increased importance given to sustainability and energy efficiency have affected decision making by developers and also have started determining market price and it is essential that we understand the link between the environment and built structure and environments and try to harmonize the two. The moot point remains that purchasers and developers are affected and influenced by sustainability factors and energy efficiency considerations is not just a buzz phrase in the construction business but also suggests acceptability of projects and developers by buyers who tend to appreciate building and construction projects that have sustainability as a basis of property development. The foundations of sustainability

The Proslavery Thought of George Fitzhugh Essay Example | Topics and Well Written Essays - 500 words

The Proslavery Thought of George Fitzhugh - Essay Example Fitzhugh had revealed not only the sectional divide over slavery on the eve of disunion, but also the ideological distance amid the revolutionary generation of Virginia slaveholders and mid-nineteenth century Carolina planters. The political ideology of secession, exemplified by his speech, belonged to the surge of reaction with the intention of followed the age of revolution in the Atlantic world. The political ideology of secession in America consisted mainly of formal constitutional arguments and proslavery thought. The systematic construction of Southern constitutional theory and the theoretical defense of slavery proved to be very influential in the long term and provided the ideological justification for secession. Under the political and intellectual guidance of Fitzhugh, slaveholders formulated the "Carolina doctrine" of nullification, or the state veto of a federal law, state ownership of national territories, and the constitutional right to secession with the intention of helped make disunion a reality. The proslavery argument was also central to the growth of political separatism in America. Regardless of the individual political beliefs of proslavery writers, their works were crucial in the construction of a separate Southern identity based on slavery.

International business - ideas international Essay

International business - ideas international - Essay Example ver, Hindi is the main language in which most of the high budget films are getting introduced in the market, and Bollywood is the front face of the Indian film industry. The Bollywood has earned an international repute for its excellence in the field of film production. The liberalized foreign investment regime has given a tremendous opportunity to the foreign film makers. But, the foreign film production company should remember that the India is a very sensitive market as far as the films are concern. There are many religions, languages and rituals are practiced in India so, before making a film these points should be clarified as the films are one of the main mass Medias in India. The Film World is a private limited company. It was found in late seventies in Melbourne, Australia. It is having a vast experience in producing high quality films in the Australia and in the international market. The film world is one of the upcoming films production companies in the Australia. The company is packed with full of talented work force. It believes in producing quality work. It has many successful achievements throughout the journey for more than two decades. In the mid of eighties that is in 1985, the FilmWorld ventured into the film production and distribution in Kuala Lumpur, Malaysia. The early ninety was a great time for the company as it was going through a tremendous success in the Australia and Malaysia. During the last few years the company is producing approximately four films in Australia and three films in Malaysia in a yearly basis. Due to the recent advancement, the company is looking for the opportunities in the Indian film market. India has the world’s biggest film industry in terms of number of movies produced in a year; it is almost eight hundred movies yearly. It works efficiently as one of the great sectors for the foreign investment. However, for any foreign investors the background check is very important and there lies the importance of the

Associated Memorial Health Center Assignment Example | Topics and Well Written Essays - 1250 words

Associated Memorial Health Center - Assignment Example HR training and development responsibilities that address the problems in the case study include: AMHC HR should be involved in finding ways that will enable staff to enhance their career growth and development. Therefore, this HR responsibility will assist in solving the retention issues especially turnover rate in the organization. Most of the retention issue arises due to the high turnover rate of current staffs in the AMHC. There is also poor communication between staff and supervisors in the organization and late performance reviews and lack of promotional opportunities. These problems lead to high staff complaints. Therefore, AMHC should address the communication issues through proper training of both staff and supervisors. They need to be trained on the importance of the communication. HR managers should address the issues of performance reviews immediately. Staff needs to be trained to enhance opportunities of getting promoted in the organization. Proper training through leadership and management programs give staff opportunities of being promoted. HR should design training and development programs that change the behavior of staffs towards patients. Some of the issues that can be addressed include inattentiveness to patients by staff, rude behavior towards patients and patients waiting for long without getting any assistance. This behavior can be changed and the only way is to train the staff importance of providing clinical services efficiently.

Leadership Style Essay Example for Free

Leadership Style Essay The main focus of any organization is viability or productivity (Mastrangelo, Eddy and Lorenzet, 2004). This is further heightened by the increasing changes in product market activities (Chartered Institute of Personnel and Development (CIPD), 2001). The fact that consumers now have a better and affordable access to market information has brought about an increase in their market power and the resultant effect is a more challenging and competitive market especially in the private sector. The public sector on the other hand is under increasing pressure for a more effective utilization of public funds. Consequently, the quest for a competitive advantage and increasingly better performance is becoming a major factor for consideration in virtually all organizations. In this light, the CIPD (2001) emphasized on the role of leadership as a major factor essential for an enhanced organizational performance. Taormina (2008) supported this in stating that in leadership is vested the ability to decide how organizations will be run and it plays a major role in influencing the organization to success. The CIPD (2001) further added that leadership (or people management) is the main element harnessing other success factors in an organization for effectiveness. A number of authors have also supported the foregoing discussions on the leader-success relationship (e. g Harris and Kuhnert 2008; Mastrangelo, Eddy and Lorenzet, 2004). Furthermore, research works have identified certain pointers to high performance leadership. A major one among these is leadership behavior or leadership style (Mastrangelo, Eddy and Lorenzet, 2004; Taormina, 2008). Leadership Style and Organizational Success: Drawing a Correlation Leadership style is one of the major traits that may be used to draw a line of difference between high performance and low performance organizations (Adeyemi-Bello, 2001). Since the management in an organization has a great impact on how it will be run, the style of leadership within the management cycle has a way of dictating the direction that such an organization will go. Taormina (2008) buttressed this point in his work. He established the fact that leadership behavior go along way in determining the culture or the prevailing atmosphere in an organization and this will in turn affect employees’ attitude towards performance and ultimate success of such an organization. A number of dichotomies on leadership behavior have been presented. However, leadership style can be broadly categorized into two – ‘People-Centered’ leadership and ‘Task-Centered’ leadership (Adeyemi-Bello, 2001 pg 150; Taormina, 2008 pg. 87). ‘People-Centered’ leadership Versus ‘Task-Centered’ leadership Various progressive attempts have been made at investigating leadership from the behavioral angle. However, a remarkable point was reached in the 1950s with the introduction of ‘Ohio State model’ which talked about ‘task-oriented’ and ‘people-oriented’ leadership (Taormina, 2008 pg. 87). These two categories seem to have been a perfect one that describes leadership behaviors because it is still being referred as at present. According to Adeyemi-Bello (2001), task-oriented style emphasizes on production and organizational goals. This leadership style is concerned about how the organizational goals may be implemented. People-oriented leaders on the other hand show great concern for the followers (Adeyemi-Bello, 2001). They create a warm environment within the organization and foster a strong positive relationship among members of the organization. While this style offers a system that respects the personality, feelings and opinions of the employees and gives them a feeling of empowerment (Taormina, 2008), task oriented approach is thirsty for achievements sometimes at all cost (Adeyemi-Bello, 2001). Subsequent studies after the initial presentation of these leadership models have made attempts at differentiating between them. The intention was to determine which one should be preferred above the other. However, Adeyemi-Bello (2001) explained that current researches have shown that preferences for any of the two styles depend on the current situation within the organization. There are cases where one style will fail to impact a good result, not because it is less effective but because the situation at hand does not create an environment conducive for its functionality (Mastrangelo, Eddy and Lorenzet, 2004). Furthermore, Jacques, Garger and Thomas (2008) remarked that the recent behavioral theory of leadership took the studies a step further by suggesting that the two behavioral approaches will be more effective when adequately blended under any given situation. Their paper revealed that graduates of project management performs better in leadership than those from another management related courses because of their ability to blend the two leadership styles; a training that the other group did not receive. Adeyemi-Bello (2001) had earlier presented this fact in her work. The result of her survey on 29 Baptist church leaders shows a better result when the two styles were combined in church leadership than when each one was singly adopted. She concluded for the extension of these results into leadership in other realms of human activities. The implications of these results are quite obvious. A paradigm shift in the content and delivery of leadership training programs has become very necessary. The current training inculcating strategic planning and tasks-focused practices should pave way for a more balanced approach in management training. People managers should also learn to engage in a better interpersonal relationship with those under them, create a warmer environment conducive for a healthy work relationship, and engage in strategies that will give employees a feeling of empowerment (Adeyemi-Bello, 2001; Monstarangelo, Eddy and Lorenzet, 2004; Taormina, 2008). The case of Kleine Plastics in the UK presented by Ludlow (1987) serves as a good example in driving home the points that has been raised so far (in Tyson and Kakabadse eds. ). The work contrasted between the leadership attributes of Joseph Kleine, the founder of Kleine Plastics and that of David, his son at a particular time during the early stages of the company’s development. It reviews Joseph Kleine’s attitude as ‘a charismatic leader with whom his managers and work force wish to identify’ (pg. 23). He engages a style that trusted and respected his employees and empathizes with their situations. To him, these people were his main assets. This, coupled with his result oriented tendencies, propelled the work force towards a high performance level. However, David Kleine could not maintain this approach when he had to stand in during his father’s absence. He wanted result at all cost without due regards for his team members. Objections to his propositions by his managers were downplayed no matter how genuine they may be. Though work was still progressing, enthusiasm and productivity level dwindled. The return of Joseph was welcomed with protests from every quarter. David style was found to be less effective because of its lack of ‘human face’. Conclusion Leadership style is an issue that will still continue to be a subject of interest among research workers. The world is ever changing and people are becoming increasingly dynamic in attitude and thinking. This calls for a leadership approach that will keep up with the pace of the changes. A dynamic leader is one that is better equipped to respond to changes and easily enlist the cooperation of people in managing them effectively towards a greater level of production performance.

Is Hong Kong A Preferable Travel Destination?

Is Hong Kong A Preferable Travel Destination? One of Hong Kongs important incomes is from tourism. In 2010, the annual number of inbound tourists has 30 million. Mainland Chinese visitors accounted for 22.7 million, followed by the visitors from Taiwan, accounting for 2.2 million people; Hong Kong is one of the most popular tourist places. Why the tourists like to travel Hong Kong? In this project we will analysis Mainland Chinese this group of tourist in Hong Kong. And we will analysis what reasons attract the tourist. We will analysis some products is it enough for tourists? Introduction of Hong Kong History Hong Kong the full name is the Hong Kong Special Administrative Region of the Peoples Republic of China. It is located in the Pearl River estuary, the South China Sea on the Hong Kong Island, the Kowloon Peninsula, connected to the mainland China, and the New Territories. Under the principle of One Country, Two Systems, Hong Kong became a Special Administrative Region of the Peoples Republic of China on 1 July 1997. Climate Hong Kong has a sub-tropical climate with distinct seasons. Hong Kong Spring is on March to May. The temperature and humidity are rising. Evenings can be cool and average temperature is Summer is on June to August. It is very hot, humid and sunny, with occasional showers and thunderstorms. The temperature can exceed 31 °C and high humidity levels can make it feel even hotter. In summer time, the average temperature can have 26à ¢Ã¢â‚¬Å¾Ã†â€™- 31à ¢Ã¢â‚¬Å¾Ã†â€™. The tourists can enjoy the sunshine and swimming in Repulse Bay Beach. Then it is autumn. Autumn is on September to November. There are pleasant breezes, plenty of sunshine and comfortable temperatures. Many people regard these as the best months of the year to visit Hong Kong. The tourists can go hiking in Lamma Island. In autumn the average temperature is Winter is from  December to February. It is quite cool, dry and cloudy, with occasional cold fronts. The temperature can drop below 10 °C in urban areas. The tourist can go to Temple Street to eat Pot Rice. The average temperature is 12à ¢Ã¢â‚¬Å¾Ã†â€™ -20 à ¢Ã¢â‚¬Å¾Ã†â€™. Attraction In Hong Kong, the attraction has two types. It is a natural and man-made attraction. First we will introduce Tai O. Tai O is located in the west of Lantau Island, New Territories, the existence in Hong Kongs most famous fishing village. Tai O is a natural attraction, Near Tai O there are lots of the growth of mangroves, visitors can enjoy the natural beauty of the local. Also the tourist can see the hut in Tai O. This is a Hong Kong early fishing village, and it is the homes of the fishermen. Hong Kong Disneyland is a man-made attraction. It is located Tsuen Wan, Hong Kong Lantau Island. Hong Kong Disneyland was officially opened on September 12, 2005. Also there have hotels too. There have six themes. For example, Fantasyland, Tomorrow land, Toy Story land etc. This park can attract the family to travel. The tourists can go there by rail MTR Disneyland Resort Line from Sunny Bay Station and Disneyland Resort Station. Analysis of Mainland Chinese The increasing and growth number of Chinese mainland visitors to Hong Kong. Last year, it has 5,550,000 of mainland individual visitors. Mainland visitors go to Hong Kong from China, generally about 25-44 years old. The visitors will stay around 3-4 days; over half of the visitors will spend on shopping. And they have a higher average education and income. Now, the Mainland visitors go to Hong Kong visit is very easy. Because the Hong Kong Government has provided the Signed a multi-line , they can visit Hong Kong still the holidays. First, mainland visitors visit Hong Kong main purpose is shopping, For example: they will buy an electronic products, preferred clothes, jewelry, beauty cosmetics and health products. It is because Hong Kong have most international brand, and have confidence guarantee. Ad Hoc Quota Trial Scheme for Cross Boundary Private Cars is means a self-driving tour of China and Hong Kong, Guangdong and Hong Kong traveling by car, is the implementation of a pilot scheme by the Hong Kong Government and the Guangdong provincial government plans to allow cross-border traveling vehicles in Hong Kong and Guangdong Province. But this plan stops in March 2012. Tourism products in Hong Kong Transportation Hong Kong provided a wide range of transportation to cater the transport demands so Hong Kongs transportation network is highly developed. Over 90% of daily travels (11 million) are on public transport, the highest such percentage in the world. Our target consumers could go everywhere that they like. Payment can be made using the Octopus card, a stored value system introduced by the Mass Transit Railway (MTR), which is widely accepted on railways, buses and ferries, and accepted like cash at other outlets go to the urban city. Mass Transit Railway is the most convenient way to understand how to go the place that we want to visit. There are all together ten lines in the MTR system, with a total of 83 railway stations and 68 light rail stops. It is utmost comfortable to go to the Hong Kong International Airport into the city center or rural place like Tai Po and Yuen Long and other famous attraction like the Hong Kong Disneyland. Bus services have a long history in Hong Kong. They could take the bus to go everywhere. There are also a variety of non-franchised public buses services, including feeder bus services to railway stations operated by the railway companies, and residents services for residential estates (particularly those in the New Territories). Taxi is the most relax transportation in Hong Kong as it is just carry yourself and your family. Taxi fares are charged according to the taximeter; however, additional charges on the fare table may apply, such as road tolls and luggage fees. Urban taxis are the most expensive, while Lantau taxis are the cheapest. The standard of service among different kinds of taxis is mostly the same. Attractions Hong Kong is frequently described as a place where East meets west, reflecting the cultures mix of the territorys Chinese roots with influences from its time as a British colony. Hong Kong had many attractions for our target consumers. We had classified into 2 parts: natural and man-made attraction. Man-made attraction For the sightseeing, we provide the visitor visit Avenue of Stars which with commemorative plaques, celebrity handprints, descriptive milestones, movie memorabilia, a life-size statue of kung fu action hero Bruce Lee and a bronze rendering of popular cartoon character McDull and also there is the perfect vantage point to catch the A Symphony of Lights multimedia show. After visit Avenue of Stars, if they want to shopping, they could go to Times Square which is the One-stop shop and eat paradise and highly cater their required of services. Causeway Bay is one of Hong Kongs most popular shopping areas and Times Square is its biggest mall. It has around 230 shops, including fashion, sportswear, furniture, electronics, toys, two department stores and around 17 restaurants offering food from all over the world. They could visit Ocean Park which offers affordable marine animal education and entertainment and is a private organization for commercial purposes. The park divided into 2 parts: The waterfront and Summit. The waterfront had Amazing Asia Animals, Ocean Express Waterfront Station, Aqua City, Whiskers Harbor and Cable Car Plaza. For the Summit, there are Summit cable car station, ocean express summit station, marine world, polar adventure, adventure land, Thrill Mountain and rainforest. They could spend a whole day to have a look on Hong Kong and play with their friends, family or relatives. Nature attraction Hong Kong Global Geopark of China is the famous place for the travelers to get in touch with the history of nature. They could take a tour to view covering an area of 50 square kilometers; the Geopark includes the Sai Kung Volcanic Rock Region and the Northeast New Territories Sedimentary Rock Region, which, together, feature eight scenic areas containing Hong Kongs major exotic landforms. Finally, they could go to Cheung Chau to view The Cheung Chau Bun Festival as it is the best way to feel the traditional mood in Hong Kong. Every year, the people of Cheung Chau get busy making papier-mà ¢chà © effigies of deities, preparing costumes, baking buns and building a bamboo tower. Theyre preparing for the thousands of people that will soon descend upon their tiny island for what Time.com deemed one of the worlds Top 10 Quirky Local Festivals. It is an easy way to find that Hong Kong provided a wide range of transportation and attraction to cater the rich mainland Chinese people. Accommodation Since there are more than 50,000 rooms available in Hong Kong. Most accommodation places are linked by the public transport system to ensure all attractions are close together. We use hotel ratings in order to divider their quality, such ratings are very useful for tourists to choose their accommodation places. In Hong Kong, there have five types of hotels. There are five-star hotels, four-star hotels, three-star hotels, boutique hotel and budget hotel. We think the Mainland visitors may consider on those two types hotels, because they need the quality of the hotels. For a five-star hotel, it always offers most luxurious premises, as well as swimming pool and sport and exercise facilities. For example, The Peninsula, Kowloon, Hong Kong, offers the ultimate in luxury accommodations with the most spacious hotel rooms and suites in Hong Kong. Each one of the guest rooms equipped with advanced technology for the convenience of hotel guests and is comfortable and stylish. However, its room rate range from $5000 to $16000. For a four-star hotel, it may lack of certain facility like 24-hour room service or individual phones or showers in bathroom, but overall it is a larger and comfortable hotel accompanied with many basic amenities. This hotel is located in Causeway Bay Hotel Hong Kong. The hotel provides the easiest walking distance between Causeway Bay MTR subway stations and The Hong Kong Convention and Exhibition Centre, which is one of the tourist attractions and business areas that can be accessed within 10 minutes drive. Catering services Since Hong Kong is a city which Chinese and western culture combined, it is also famous for both type of food. Chinese Cuisine is the most famous type of food in Hong Kong. Since Western food is already adapted to local tastes, it is a good place for homesick travelers who have had enough of Chinese food. For some richer visitors, they can follow the Michelin guide to find some Western restaurants with excellent menu and service. We think the Mainland visitors may try some Hong Kong local food, so we have some ideas for the visitors. Dim Sum is one of the famous menus of Cantonese food; it dominates in food style of breakfast since Cantonese people tend to avoid fried foods early in the day. Dim Sum comes in countless variations with a huge price range from $8 to more than $100 per order. Common items include steamed shrimp dumplings, pork dumplings, barbecued pork buns, and Hong Kong egg tarts. The other famous Cantonese food is Chinese Barbecue, it is known as Siu Mei, restaurants usually use steamed chicken as these barbecued meats. Those meats are roasted on spits over an open fire or in a rotisserie oven. Chinese barbecue restaurants usually have highly flexible menus that allow you to pair your roast meats with rice, noodles or rice noodles. Combo plates enable solo diners to sample several meats in one meal. Rice with roasted pork Char Siu, roasted duck, all are common dishes of that. For the western style of food, there are numerous selections in Hong Kong. Italian, French, German, Mediterranean, Mexican and American all feature strongly. Given Hong Kongs cosmopolitan population and passion for dining trends, foreign travelers would not be hard to find out their home type of food. For the famous places of Western food in Hong Kong, Cà ©page is sure one of them, it serve French cuisine, influenced by Eastern type of cooking style and are served in the chic. The restaurants name is French for wine blend, an allusion to its impressive wine list of over 2,000 bottles, its recommended dish are Steamed Tasmanian Salmon, Aromatized with Diced Vegetables and Oriental Sauce. Ming Court is the other place; it has raked in rave reviews from the citys most respected food connoisseurs. Its executive chef applies his 30 years of experience to ensure that every dish bears his signature style of delicate presentation and exquisite taste. Braised E-Fu Noodles with Fresh Abalone Slices and Prawn are its recommended dishes. Suggestions for the Hong Kong Tourism Industry In order to develop the tourism industry, there are some suggestions provided for different sectors. For Hospitality industry, when the peak tourist season was coming, the hotel room and staff always not enough to supply. Therefore, they should build more hotel or other types of accommodation in Hong Kong. Also, hotel can organize a large-scale job fairs to recruit the talents and allocate the manpower efficiently, such as Disneyland and Ocean Park. Disneyland and Ocean Park is one of the popular attractions in Hong Kong, most of the tourists visiting there, so it should build more hotels in there. Mystery Customer Service Association published the 2010 Global smile report, shows that Hong Kong smile index is only 53 and ranking in third last. The company should provide training course and teaching the staff how to serve the customers, it can help to build up the good image of tourism. For Hong Kong Tourism Board, because travelers become more and more, the tourist facilities are insufficient to cope with the large number of travelers, they should develop more attractions, such as Disneyland, can build more mechanical rides. It also can strengthen efforts to publicize; they should do more advertising in other foreign countries and attract foreigner interest. Moreover, Hong Kong Tourism Board needs to organize more large-scale events for tourists, such as Tourism Festival, Winter Festival. This type of events is one of characteristically in Hong Kong. Recommendations to Government There are many recommendations for the Government of Hong Kong that are in favor of the Tourism Development. First of all, it is strongly recommended to the HK government that the 2nd Cruise Terminal at Kai Tak, which is now under building progress, should be completed as soon as possible as it can be very helpful to the tourism industry in a way that it can create efficiency for the cruise customers as there will be more space to park and more ports for the cruise ships. Secondly, the HK government should have more and more promotions and advertisements overseas to increase the number of the inbound tourists and the advertisements should be promoting the cultural and the leisure activities that can be done in HK such as a mix culture of HK and not only focus on Mainland Chinese market. And the HK government is also recommended that it should put more efforts on the HK Airport to make more spacious and to reclaim more land for development of the runways which in return will be one of the contributing factors for the development of the tourism industry of HK. It is because this will be a reason for the efficiency of the customers that are both in bounding and out bounding as the airport will be able to cater more and more flights and will provide more space to airlines. Conclusions All in all, Hong Kong has a wide range of facilities and products to cater to this object China rich. Provide multiple choices and quality in basic necessities, the economy status of China began to raise, the message of the people the crescendo ability, in line with the visa policy with China, Hong Kong an advantage compared to other cities. So for the Chinese rich people, Hong Kong is a choice. Access To Higher Education: Reflective Practice Access To Higher Education: Reflective Practice Firstly this assignment is based on three models of reflective practice, Kolb’s, Gibbs and John’s with an explanation of the structure of each model. To understand all three of the models they will all be described in detail explaining how they should be utilized. This assignment will also seek to critically evaluate all three of the models. All of these models can assist someone to reflect on some everyday situations and seriously think about what to change when things go wrong and how to put them right on another occasion. Starting with Kolb’s model of reflective practice, this model has been structured on four stages of learning which are, concrete experience, reflective observation, abstract conceptualisation and active experimentation. Concrete experience is having an experience which can be evaluated, reflective observation is looking at the experience to see what was done, abstract conceptualisation is learning from the experience and active experimentation is planning and trying out what has been learned. (Mcloud 2010) There are also other parts to Kolb’s model that focus on the way someone will learn, these are diverging, assimilating, converging and accommodating. Diverging is to feel and watch, assimilating is to think and watch, converging is to think and do, and accommodating is to feel and do. (Kolb 1984) With Kolb’s model it is suggested by him that whoever is using it should think about what they are doing and reflect on this by reviewing what they did. Using the information and learning from their experience. (Arora 2008) The end outcome should be to learn from their experience and to turn the negatives into positives. Anyone using this model should plan what they could do next and think about how they could improve their experience. Kolb’s model of reflection has been criticized because of insufficient attention to the process of reflection itself, ‘it’s lack of empirical support, it’s very rigid and sequential nature and it’s simplification of the learning process in general’. (Smith 1996) This model of reflection will not suit everyone’s learning experience as it does not take into account the abilities of different learners and can also seem a little complicated to follow with the use of some uncommon words that are not understood by all individuals. According to research Kolb’s model of reflective practice does not show the full extent of reflection. (Boud et al1983) Now we move onto Gibbs model of reflective practice which is based on six questions: Description: What happened? Feelings: What did you think and feel? Evaluation: What did you find good and what was bad about the experience? Analysis: What do you make of the situation? Conclusion: What should you do to make the experience better? Action plan: If it happened in the future what would you do?(Gibbs 1988) With the Gibbs model of reflective practice it is suggested by him that whoever uses this model should describe what happened and think about what they were feeling to evaluate the situation and work out what went well and what did not go well. The person using this model should analyse what sense they can make of the situation and decide what they could have done to make the situation better. (Jasper2003) It is also suggested that anyone using this model should develop an action plan to improve the situation if it should happen again. Gibbs model of reflective practise is described as self-explanatory and easy to use. (Jasper 2003) Gibb’s model does not give the learner enough specific questions to answer and does not give them enough scope to be more critical of themselves. ‘‘It also does not consider whether there is a difference between teaching practice and the requirements or expectations of learners’’. (Jasper 2003) (Jasper 2003) explains that Gibb’s ‘‘model comes from an educational context as opposed to a practical context’’. (Jasper 2003) The learning styles of many reflective models have still not been proven according to some and may be of no benefit to some learners. (Barrett 2013) Finally, John’s model of reflective practice is based on five questions with sub headings. Reflection: What were you trying to achieve? Influencing factors: What things like internal and external knowledge affected your decision? Could you have dealt with it better: What other choices did you have and what were the consequences? Learning: What will change because of this experience? Description of the experience: How has this experience changed your way of knowing? (Dran 2011) It is suggested by Johns that anyone using this model of reflective practice should work out why they did what they did and if anything swayed their decision to do what they did as well as what other things they could have done instead. It is also suggested by Johns that the person using this model thinks about what will change because of the experience and if it has changed their view of what they did. One weakness of this model is that ‘the outside framework does not leave any room for learners to use their own awareness, standards and priorities and some learners and practitioners doubt the value of reflection’. (Davis 2005) Reflective practice can often be interpreted in the wrong way. (Loughran, 2000) It could be seen that if practitioners are extremely busy they may find the pressure of completing reflective models a little tiresome. There are also some ethical concerns, which may breach confidentiality and privacy so anyone using reflective models of practice should take this into consideration. It should be noted that dealing with emotions in this way can be upsetting and do more harm than good. (Davis 2005) Boud and Walker (1998) are unsure of reflective practice as a required part of a course. Another criticism on the impact on someone using a model of reflective practice is that the practitioner always wants to find ways of doing things better which can lead to them feeling down hearted and unworthy. If a practitioner is to assume that the word ‘critical’ has the same meaning as ‘negative’ then this could make them feel very low indeed and also extremely worthless. (Quinn 1988/2000). Quinn (1988/2000) suggests that ‘the inappropriate use of reflective Models may actually devalue practitioners’ professional work instead of promoting it. It seems that not everyone would like to utilize the same model as we all adapt to each situation differently and the learning process is not the same experience for everyone, just as all models of reflection are different models of reflection so are we as humans. If used correctly in the right situation these models of reflection can be very valuable however used badly can be detrimental to our thought process and feelings of usefulness. (Quinn 1998/2000) Table of References www.academia.edu/1057509/Experimental_learning_.termpaper (Accessed 30 May 2014) Davis. C. et-al (2005) Changing practice in health and social care sage publications London Thousand Oaks New Delhi in association with the Open University p85 www.docstoc.com/docs22730941/JOHNS-MODEL-OF-STRUCTURED-REFLECTION (Accessed 10 June 2014) http://ebookily.org/doc/example-of-gibbs-1988-reflective-cycle-in-nursing (Accessed 12 June 2014) Finlay.L.Reflectingon‘Reflectivepractice’http://www.open.ac.uk/opencetl/files/ecms/web-content/Finlay-(2008)-Reflecting-on-reflective-practice-PBPL-paper-52.pdf pp 10 11 12 (Accessed 2June 2014) www.3.hantsgov.uk/reflection-2.doc (Accessed 2 June) McLeod S. A. (2010). Kolb Learning Styles. www.simplypsychology.org/learning-kolb.html (Accessed 10 June 2014) http://prezi.com/qsys43dbyzy9/gibbs-criticalreflectionmodel/ (Accessed 1 June2014) http://www.scribd.com/doc/48449899/BREAKING-BAD-NEWS-REFLECTION (Accessed 12 June 2014) http://www.scribd.com/doc/69580365/Johns (Accessed 10 June 2014) http://www.silkysteps.com/forum/showthread.php?t=7386 (Accessed 12 June 2014) http://www.ukessays.com/essays/education/an-overview-of-peer-reviewing-education-essay.php (Accessed 12 June 2014) www.ulh.nhs.uk/for-staff/educationtrainig/clinical-education/leadership-in-practice/gibbsreflectivecycle.pdf (Accessed 1June 2014) http://wikipedia.org/wiki/Reflective_practice (Accessed 3 June 2014) http://www.worc.ac.uk/adpu/documents (Accessed 30 May 2014) Part B Without realising at first Gibb’s model of reflection was the one out of all the models which I automatically started to and still continue to use. I found the model very user friendly, and this is a reflective model that is in plain speaking English without the use of any uncommon words. It has made me think seriously about situations in my studies and made me realise what I am doing wrong and what I should think about to improve the way I study. Sometimes I do things and do not really think about what I am doing however this model of reflection has taught me to actually stop, think and reassess a situation. Here is an example of Gibb’s model of reflective practice applied to my own learning experience. Description: What happened? I was given assignments to complete. Feelings: What was I thinking and feeling? I was feeling a little daunted and unsure of the work ahead of me. Evaluation: What was good and bad about the experience? I thought the assignments were quite hard to do and found putting things into my own words very hard. Once I thought I finally understood a little more I felt much better. Analysis: What sense can I make of the situation? I get too stressed and rush myself too much to get my work done all at once. Conclusion: What else could I have done? I could have organised my time better and done my work in small chunks. Action plan: If it arose again what would I do? I will organise my time better and work in small chunks rather than trying to do it all at once.

Determinants And Implications For Focused Antenatal Care Interventions

Determinants And Implications For Focused Antenatal Care Interventions The coverage of antenatal care (ANC) in many areas is known and there are a number of interventions to encourage use of ANC services by pregnant women. However, for women who attend ANC, it is important that they register at the appropriate time and pay a given number of visits over the pregnancy period to ensure that they receive the interventions recommended for the antenatal period at the right time. When a pregnant woman makes regular contact which her skilled antenatal care provider, she is in a position to receive various services such as those meant for prevention of eclampsia, intermittent preventive treatment for malaria, early detection of HIV/AIDS infection and prevention of mother-to-child transmission, micronutrient supplementation, birth preparedness and provision of information on danger signs occurring while she is pregnant or during delivery.1 Presently, Nigeria is transiting to the Focused Antenatal Care (FANC) approach promoted by the World Health Organization (WHO ) which is aimed at ensuring that each antenatal visit counts and that antenatal care interventions are delivered at the appropriate time.2 FANC is one of the pillars of safe motherhood. The goal of FANC is to ensure that pregnancy is normal through for major actions: identification of pre-existing health conditions, early detection of complications arising during the pregnancy, health promotion and disease prevention and birth preparedness and complication readiness planning.3The interventions are deployed in such a way that they are appropriate for the womans stage of pregnancy.4 Unlike the previously used routine care which was ritualistic and frequent visits, the FANC approach emphasizes evidence-based goal-directed actions, family-centred care, quality, rather than quantity of visits as well as care by skilled providers.3 4 Thus, numerous routine visits are no longer recommended and are considered a burden to women and the health care system. The FANC approach also deemphasizes the routine risk assessment approach for classifying women into high and low risks groups.2 With the risk assessment approach, women attending antenatal care were offered services which include blood pressure check, urinalysis to detect protein or bacteria, and blood test to rule out syphilis or anaemia.5 However many women classified as low risk end up having a false sense of security, are unable to recognize and respond to problems and end up developing complications. In addition, most high risk women give birth without complications and the excess care provided constitutes an inefficient use of scarce resources. The FANC approach in Nigeria requires that pregnant women would have paid the first visit for ANC by the 16 week of pregnancy or earlier when the women first thinks she is pregnant, the second between the 24th to 28th week, the third at the 32nd week and the 4th at the 36th week of pregnancy.2 Some authors have considered early booking to mean that a woman pays her first visit before the 14th week to achieve the aim of improved outcome of pregnancy both for a mother and her unborn child.6 Thus, by 36 weeks, a pregnant woman should have made the required minimum of four visits while those with risk of complications of conditions that can impact on pregnancy would require additional visits. The time of booking and ANC attendance can affect the effectiveness of interventions recommended for pregnant women and thus the goals of FANC. Early booking helps ensure that problems are detected and managed early.2 The first visit gives the opportunity to record information on family, maternal and medical history, carry out a physical examination, request laboratory tests, provide care including intermittent preventive treatment (IPT) for malaria in pregnancy (if beyond first trimester), provide counselling including birth plan, use of insecticide treated bed nets (ITN), HIV counselling and testing and to discuss the schedule for care. The subsequent visits are necessary for noting complaints, targeted physical examination, reviewing test results, providing care including IPT for malaria, obtaining information on use of ITN, birth plans and carrying out HIV counselling. Justification for the study Interventions for pregnant women aim protect the woman and her unborn baby for the remaining period of the pregnancy and their provision should be timely. The later the timing of first visit the shorter the period of cover and the higher the risk of development of problems and complications for the woman and her baby. Thus it is not just important to know the proportion of pregnant women attending ANC, it is also important to know when attendees commence such visits and whether they pay an adequate number of visits. Although a number of studies have documented the timing of first visit and number of visits to ANC in the south-west region of Nigeria, little is known about the pattern in the south eastern region of the country. Additionally, most of the studies are limited in scope as they are facility based (usually tertiary hospital based) and thus reflect experience amongst pregnant women who are able to access such facilities even though primary health centres are the closest to people and usually the only available point of care in rural areas. Aim: This study is aimed at documenting the socio-demographic predictors of timing of ANC booking and subsequent attendance amongst pregnant women in order to understand the impact these can have on deployment of focused antenatal care interventions for pregnant women. Objectives: To determine the timing of booking and pattern of subsequent ANC attendance among pregnant women attending primary level facilities To examine whether the timing of ANC booking and clinic attendance is affected by individual level socio-demographic factors To assess the appropriateness of timing of booking and attendance for effective delivery of focused antenatal care interventions To examine how the findings of the study can impact on the deployment of antenatal care interventions for pregnant women. CHAPTER TWO LITERATURE REVIEW The concept of focused antenatal care is based on the assumption that since every pregnancy faces the risk of development of complications, every pregnant woman should be monitored to avoid development of such complications.2 Lack of antenatal care is known to be a major risk factor for development of negative pregnancy outcomes. However, when antenatal care is appropriately delivered, it has the potential to positively impact on maternal mortality and morbidity.7 Studies have shown that many women obtain care quite late during the pregnancy period and the care obtained is usually inadequate.2 8 9 The first visit for antenatal care in Africa usually takes place around the fourth to fifth month of pregnancy.5 In the African region, 73% of pregnant women aged 15 49 years pay at least one visit to a health care provider for antenatal care while only 44% pay at least four visits.10 A study by Al-Nasser in Saudi Arabia showed that majority (60.8%) of pregnant women attending antenatal clinic in primary health care centres were first seen before the 20th week of gestation.11 Fekede, et al noted that 42.8% of 360 pregnant women in an Ethiopian town attending antenatal clinic did so for the first time within the 3rd trimester while only 6.5% had the recommended minimum of four visits.12 In Nigeria, the figures assessing antenatal care utilization are below the African regional values as 58% of women aged 15-49 years receive ANC from a skilled health provider at least once during pregnancy while 45% of women make four or more visits for ANC.2 10 Based on the 2008 NDHS the median gestational age at booking is 5 months.2 Among 395 women attending antenatal clinic in public and private facilities covering the primary, secondary and tertiary levels of care in Ibadan, southwest Nigeria, 25.8% paid the first visit for antenatal care within the first trimester. Mean gestational age at booking was found to be 18.5 (Â ±6.3) weeks while the mean number of antenatal visits was 4.0 (Â ±2.4).13 A study carried out among 378 pregnant women attending a tertiary hospital in Edo state Nigeria noted that the 6th month of pregnancy as the peak period of first visit for antenatal care among the women.14 Okunlola et al found a mean gestational age at booking of 21.82 (Â ±7.0) weeks wi th only 14.1% of the women paying attending for the first time within the first trimester.6 In a tertiary facility in Osogbo Nigeria, the mean gestational age was found to be 20.3 (Â ±6.2) weeks and 82.6% of those studied booked late.15 Amongst 400 women attending antenatal clinic at a tertiary facility in Ile Ife, Nigeria, 71% had registered by the 20th week of gestation.16 Aluko and Oluwatosin found low rates of first trimester booking and irregular visits for antenatal care among women attending clinics in a mission hospital in Ibadan south west Nigeria.17 Socio-demographic factors and parity have been found to directly influence the timing of first visit for antenatal care though the results are sometimes dissimilar. Most women (79.9%) attending antenatal clinic in a tertiary hospital in Edo state Nigeria were found to have booked late.18 However, there was no significant difference in age, parity, level of education and social class between women booking early and late. In a study carried out among pregnant women attending a the Lagos University Teaching Hospital, Adegbola found a mean gestational age at first booking of 18.5 (Â ±8.3), 18.4 (Â ±7.4) weeks for nulliparous and primiparous women respectively.19 The overall mean gestational age at booking was 19.1(Â ±7.2) weeks. Women with parity 5 booked at significantly higher mean gestational age of 25.9 (Â ±) weeks and women of lower social class tend to book earlier for antenatal care. Similarly Adeyemi, et al found that late booking was thrice as common in multiparous women com pared with the nulliparous group and the difference was significant.20 Other authors have found an association between parity and timing of first visit, and number of antenatal visits.11 21 A number of studies have documented the factors that affect use of ANC amongst women in the developing countries;9 these determinants are also likely to affect the timeliness of attendance for ANC. Chandrashekar, et al found that women who are poor, illiterate, multiparous, unskilled and over 30 years of age were less likely to receive antenatal care in India.22 Age was found to be a significant predictor of ANC attendance in a community based study in Ethiopia where women aged 15-24 years were found 2.75 times more likely to attend than those aged 25-34 years.12 Geographic place of residence can also have an impact as women living in urban areas are more likely to receive antenatal care during pregnancy. Women have also been found to concurrently use multiple antenatal care providers and this can affect the timing of booking in a facility. Adeoye, et al found that 25% and 30.5% of women attending two antenatal care clinics in a tertiary facility in Ebonyi state were concurrently using both formal and informal providers of antenatal care.23 Of 535 women attending a tertiary facility in Enugu Nigeria, 69.5% were booked in more than one facility.24 The time of commencement of ANC visits has implications for the period of protection that pregnant women have from interventions. For example where women attend antenatal care late in pregnancy, they may not receive the recommended 2-3 doses of Intermittent Preventive Treatment (IPT) for malaria in pregnancy using sulphadoxine-pyrimethamine combinations.25 Data from the 2008 National Demographic and Health Survey (NDHS) shows that among 11,027 women aged 15 49 years with a live birth within a period of 2 years preceding the survey, only 8.0% received at least one dose of IPT while 4.9% received 2 or more doses.2 The proportion was 9.9% and 5.4% respectively for the south east region of Nigeria. It is important that pregnant women are available at the appropriate time for delivery of IPT which is best given when the growth of the foetus is occurring at its highest velocity (16th 24th week) as this helps to reduce placental parasitaemia, foetal growth reduction and the resultant low birth weight.26 It is also known that the negative impact of malaria is worse among women with their first and second pregnancies compared to those that have had more than two pregnancies.27-29 Thus primi and secundi-gravidae need to pay their first visit early enough to ensure adequate protection through the pregnancy period. The same consideration holds sway for interventions such as insecticide treated nets for which the potential protective time period depends on how early in pregnancy a woman starts sleeping under the net. All it all, timely attendance to ANC is important to enhance the potential for positive pregnancy outcomes since it provides pregnant women with the opportunity to receive recommended interventions and the protection from problems and complications. Socio-demographic and maternal factors such as parity can affect the timeliness of ANC visits by pregnant women. CHAPTER THREE METHODOLOGY Study area: This study will be carried out in Enugu State, South-East Nigeria. Enugu state comprises of 17 Local Government Areas (LGAs), has a total population of 3,257,298 people and an annual growth rate of 3.0.30 Three of the 17 LGAs (Enugu North, Enugu South and Nsukka) are urban, one (Enugu East) has a mix of urban and rural areas while the remaining 13 LGAs are rural. The people of Enugu are of Igbo ethnicity and are predominantly Christians. A substantial proportion of the working population in the state is engaged in farming, trading, and public service employment. Study site: Two areas will be purposively selected for the study to enable collection of data across for those in both urban and rural areas of the state. These are Udi LGA comprising Udi North and South Development Councils will be used to represent the rural areas while Enugu North and South LGAs will represent the urban areas. Udi has a population of 234,002 while Enugu North and South have a population of 244,852 and 198,723 respectively.30 Udi LGA has 14 primary health facilities that offer ANC services while Enugu North and South (referred to as Enugu) together have 12 primary facilities that offer ANC (appendix 1). Study design: This will be a cross-sectional study involving eliciting of information from pregnant women attending primary health centres for antenatal care through exit interviews using a pre-tested questionnaire. Sampling and sample size: All the primary health care facilities providing ANC in the study LGAs will be used for the study. Since the level of attendance of ANC varies for different facilities, a proportionate method will be used for determining the sample size for each facility. The proportion will be determined by considering the average weekly number of antenatal clinic attendees to the facility relative to the total from all facilities as reported by the heads of the facilities and the relative proportion will be computed. The minimum sample size required for the study is 374. This was determined using the formula for determination of sample size for population proportion,31 an ANC coverage level of 58%,2 a confidence level of 95% and an error margin of 0.05. Z= 1.96 at 95% confidence level, (two-sided). p=ANC coverage = 58% d=margin of error tolerated = 0.05 Considering a potential refusal rate of 10%, 411 women will be sampled. Study tools: Data will be collected using a pre-tested interviewer administered questionnaire (appendix 2) which will be administered by trained field workers. The questionnaire will be pre-tested amongst pregnant women attending ANC at the Primary Health Centre Abakpa, Enugu East LGA which will not be used for the study. Data analysis: Epi Info statistical software will be used for data entry while SPSS and Stata Softwares will be used for data analysis. Data will initially aim to elicit the determinants of timing of booking of ANC. Subsequently, a continuous socio-economic status index will be generated using the principal component analysis technique in STATA software package 32 to enable disaggregation of data into socio-economic quintiles. Information that will be used include households asset holdings including television, radio, refrigerator, car, bicycle, rechargeable lamp, kerosene lamp, electric fan, air conditioner, motorcycle.33 The SES quintiles generated will be used in assessing differences in timing of booking for women of various SES groups. Logistic regression analysis will be employed for examination of the determinants of the timing of booking. Data analysis will also aim to estimate the proportion of women attending at the appropriate time for delivery of recommended interventions . Chi squared test will be used to test for significance of differences observed for categorical data while chi squared for trend test will be employed for ordered categorical data. All tests of significance will be done a p value of 0.05. Ethical considerations: Ethical clearance will be obtained from the Research Ethics Committee of the University of Nigeria Teaching Hospital Enugu, while permission to carry out the study will be obtained from the Primary Health Care Coordinator of the LGAs as well as from the heads of facilities to be used. Written consent will be obtained from patients who are interviewed after they have been informed of the objectives of the study and the voluntary nature of their participation.