Key success Factors for Lenevo Core Competence of Lenovo

Key success Factors for Lenevo Core Competence of Lenovo Lenovo has its own unique core competence generating Competitive advantages. If we carefully review the unique business development history of Lenovo, it is not hard to track that what are the sources of Lenovos competitive advantages, and how these core competence have been built up, and to estimate if its competitive advantages are sustainable for its ongoing global expansion. In Lenovos early stage, it has some advantages from its parent. ICT supported Lenovo by providing ICTs facilities free of charge; Legend used ICTs name for doing business and then gained the strong support of government. These can be seen as supportive elements for building core competence. (Liu, 2005) The Ability of Learning Lenovo presents a significant ability of learning for capability development can be regarded as one of its core competence. An important source of learning was its customers. Lenovo learned from its customers through its direct contact with customers and its extensive PC distribution network. Apart from carefully observing customer purchasing habits, Lenovo actively sought out customer help to guide its product and service development. (Xie White, 2004). Another source of learning was from those multinationals. As mentioned earlier, even while it produces its own brand, Lenovo learned a lot from HP, IBM and Compaq such as marketing and management skills, personnel training, product design and customer services. (Xie White, 2004). The third source of learning is its internal RD activities. They attained the awareness of that proper RD activities should be combined with the engineering, and manufacturing, instead of purely pursuing cutting-edge technologies such as large-scale integrated circuits and digital switches (Xie White, 2004). A related view in terms of learning is that developing countries MNCs develop their advantages through the accumulation of technology and skills. Tolentino (1993) claims the importance of the accumulation of technological competence in the expansion of firms from developing countries. The Capability of Competing on Price Another core competence is Lenovos super capability of competing on the basis of product price. An article in Wall Street Journal (1997) points out that the prices of Lenovos products are only roughly two-thirds of those of foreign brands. Lenovo successfully maintained a lower cost structure than multinationals, (Liu, 2005) Firstly, the management costs of Lenovo are lower than those of its competitors especially foreign firms doing business in China. (Liu, 2005) .Second, owning to more foreign component producers such as Seagate (the no.1 hard driver producer in the world) have established manufacturing operations in China, Lenovo and other Chinese PC makers benefited from cost savings of cheaper components purchasing. Apart from these above, Lenovo constantly concentrated on the cost reduction in all activities including manufacturing, RD, marketing, distribution etc. and accumulated great experience in this field. (Liu, 2005) The Ability to Establish and Manage Effective and Efficient Distribution Network Among domestic and foreign IT companies, in Chinese market, Lenovo can be awarded as the no. 1 company with the best distribution network management. Lenovo have approximately 50 authorized distributors in each of the seven regions in China, and each distributor has its own reseller network. There are over 2, 000 resellers in Lenovos distribution network. Additionally, it has 130 1+1 PC specialty shops in major cities. (Liu, 2005) To be compared, IBM has no more than ten main distributors in some major cities. It could be imaged t hat how hard to manage and control such a huge network. But Lenovo has cultivated a positive relationship with its distributors by implementing a win-win strategy. Many distributors had grown with Lenovo over years. (Liu, 2005) Even when Lenovo constantly increased the depth and breadth of its distribution network, it never encountered any big conflicts among its distributors. The huge and effective network gives Lenovo much greater geographic coverage than either domestic or foreign companies in Chinese IT market. (Liu, 2005) Therefore, the ability of building and managing such huge distribution network and constantly exploring the potential of the network can be seen as another source of Lenovos core competence. (Liu, 2005) To be concluded, the abilities of learning, cost reduction and building and managing sophisticated distribution network are supposed to be the core competence of Lenovo. Additionally, in Chinese market, the brand name-Lenovo is also an important core competence of Lenovo. But in the context of global scale, the brand of Lenovo is still waiting for customers recognition. (Liu, 2005) These core competences sustain Lenovos success in domestic market. However, Lenovo is undertaking its new globalization strategy. The question is that if they can generate sustainable competitive advantages for global competition and what are the challenges of existing in its globalization process. The next section is the case study of Lenovo acquiring IBM PCD (Personal Computer Division) and the objective is to challenge its international expansion strategy and its core competence in the context of global competition. (Liu, 2005) Giant Step of Globalization: The Acquisition of IBM PCD Lenovo group ltd. has completed its $1.75 billion purchase of IBMs PC Division, creating the third-largest PC vendor in the world and giving IBM greater entree into the rapidly growing Chinese market. According to the agreement of the acquisition, Lenovo will gain control of IBMs Think desktop and ThinkPad laptop brands, as well as the thousands of IBM PC customers. Lenovo is allowed to use the IBM name for five years. However, the new Lenovo will have a strong IBM presence. Many of the top executives have moved over from IBM, including Stephen Ward, the former vice president and general manager of IBMs PC Division and now CEO of Lenovo. Yang Yuanqing, president and CEO of Lenovo Group Ltd, will become chairman. In addition, 10,000 of Lenovos 19,000 employees are former IBMs employees, and IBM will continue to provide service and support for the IBM products. Lenovos headquarters will move to Armonk, New York, and IBM also holds an 18.9 percent stake in the new company. (Burt, 2005; Daniels, 2005; Khanna, 2005; Dowling, 2005) The Lenovos Strategy for Global Expansion Apparently, Lenovo realized that there are not so much potential of Chinese PC market after becoming the leading PC maker in China. And becoming a real global player is the Urgent mission for Lenovo. A common view of firms internationalization process is that the internationalization is the process of accumulating experiential knowledge and market commitment in foreign markets (e.g. Bilkey Tesar, 1977; Johanson Vahlne, 1977; Chang, 1995). Firms tend to start their internationalization process by exporting to countries with similar culture. (Sharma Blomstermo, 2003). Lenovo chose the most efficient way (the acquisition) for its global expansion and foreign market entry. The founder Liu Chuanzhi has such a comment on the acquisition in an interview (Chandler, 2004): We have a $3 billion business with 27% market share in China. Theres not much room to expand. The global PC market is $200 billion, so theres still a lot of potential. IBM has all the things we need. This deal brings us market share, Management know-how, technology, and international reach. The strategy decision to acquire IBM PCD has been given careful considerations in Lenovo. In 2002, Lenovo almost refused the suggestion of the acquisition approached firstly by IBM since the top managers of Lenovo thought it was too risky. (Chandler, 2004) But they also saw this as a great opportunity to become a global PC maker. After one years consideration, analysis and learning from big multinationals, they understood the opportunities and challenges related to this deal and decided to implement this acquisition. (Chandler, 2004) As Liu Chuanzhi said in the same interview as above: As discussions progressed, we gained confidence that many of the risks wed feared could be distributed or controlled. For example, we worried about losing customers. So we worked out an agreement that would allow us to continue using the IBM brand, to keep the IBM salespeople, and even to keep the top IBM executive as CEO. That gave us confidence we could give customers the same level of service and quality after the acquisition. (Chandler, 2004) The main advantage of acquisition is that it provides the fastest way to enter foreign markets and rapidly build the firms presence in these new national markets. Through the acquisition, Lenovo becomes the third biggest PC multinational of the world from a little-known Chinese PC maker and then makes a giant step forward of internationalization. (Chandler, 2004) Furthermore, acquisition provides the great opportunity to acquire valuable resources of the acquired company. Through the acquisition, Lenovo attains the IBMs global market share, global management skills, top PC technologies and the outstanding ability of RD, experienced managers and other personnel, and as Liu Chuanzhi mentioned, the International reach. (Chandler, 2004) Lenovo appears great confidence on their ability of learning for absorbing these merits from IBM PCD. (Chandler, 2004) For example, IBM PCD was commonly regarded as the sophisticated expert in serving corporate customers, while Lenovo was significantly good at selling PCs in consumer market. Such a successful combination of these advantages of both sides will definitely result in great performance. Additionally, Lenovo hopes that combining Lenovos price advantage with IBMs engineering will deal with Dells formidable threat (Forelle, 2005). The Necessity to Form the Strategic Alliance Lenovo was known as one of Chinas most promising companies in the early 1990s, with its sales more than tripled between the year 1994 and 1998, and Asias leading PC vendor outside Japan at the end of the 1990s (Lau, 2004a). However, before the declaration of the alliance with IBM, the company had encountered with obstacles for its further expansion and development. (Lau, 2004a). Though Lenovo is the largest PC maker in China with more than a quarter of the market share, it does little business outside the country. The increasing fierce competition from aggressive foreign rivals such as Dell and HP in the past few years in Chinese market has put further pressures on Lenovos margins. (Lau, 2004a). - Rather than just continue to concentrate on the domestic Chinese market, the decision to go global is a necessity for Lenovo at that critical time. Under these circumstances, Lenovo decided to form the deal with IBM to acquire its low profitability PC business with US$1.75bn. According to the terms of the agreement, Lenovo pays US$650m in cash and up to US$600m in shares (which later changed to US$800m and US$450m share value), giving IBM an 18.9 per cent stake as well as shouldering US$500m in debt; and IBM will become the Chinese PC makers preferred supplier of support services and customer financing. For Lenovos part, the acquisition quadruples its sales to more than US$12bn and expands its sales market globally; besides being given the ownership of the Think family trademarks, Lenovo also gains the right to produce IBM-branded PCs under a five-year licensing agreement (FT reporters, 2004; Simon, 2004). Motives toward Lenovo IBMs Strategic Alliance Lenovos takeover of IBMs PC division has been described as snake ate the elephant, and the deal pulls Lenovo from the eighth-largest PC maker in the world to the third-largest just behind Dell and HP (Buetow, 2005; Ling, 2006; London, 2004). The motivations that drive the formation of the strategic alliance between Lenovo and IBM can be analyzed from two perspectives. For Lenovos aspect, though Lenovo is the largest IT Company in China, its products are mainly within China. Michele Mak, an analyst at ABN Omro, once commented that Lenovos distribution network is its biggest problem, and it is not well adapted to serving the small and medium-sized companies who usually buy directly (Lau, 2004a). Thus, in the first place, with an intention to expand its business globally, the firm needs a well-developed worldwide distribution network, which happens to be the advantage of IBM. As what has been announced by Lenovo, the agreement between the two firms includes broad-based strategic alliance under which Lenovos products will be integrated into IBMs global service offerings, which also became the impetus to the deal. - Secondly, as a world-leading company like IBM, it has specialized and advanced skills in sales and marketing functions, for Lenovo, the sales and marketing support, as well as the RD support are significant and of a necessity in its way to a multinational enterprise, which is also part of the agreement (Lenovo.com, 2007c). - Thirdly, the use of IBMs globally recognized brand is an impetus to accelerate the alliance, and also perceived as a sweet victory for Lenovo. The local brand Lenovo, formerly known as Legend, will become more valuable in the market after its association with the ThinkPad series of laptops. And also, Lenovos right to use the IBM brand on the computers for five years adds more value and trustworthiness to the brand, as despite the fact that Lenovo is the largest PC maker in China and Asia, it is little known elsewhere in the world, even with the ownership of ThinkPad family trademarks, it can hardly divert the loyal customers from IBM to Lenovo (London, 2004). Furthermore, analysts said that the deal could enable Lenovo to cut procurement costs (Guerrera and Dickie, 2004). The Performance after Acquisition The fiscal report combining two months after the completion of the acquisition truly shows a magic turnaround of PCD (Ramstad, 2005) with a profit of $33 million, while the PCD recorded a pre-tax loss of $149 million before joining Lenovo. (Liu, 2005) Further, the latest fiscal report (The First Fiscal Quarter Report 2005/2006, Lenovo) reported on 11th Aug 2005 illustrates a great performance of Lenovo Group Ltd., with revenue up 234% from organic growth in emerging markets and PC business acquisition, EBITDA up 135% to HK$829 million, pre-tax profit increased 54% to HK$515 million, and profit attributable to shareholders up 6% to HK$357 million. (Liu, 2005) However, this turnaround remains some strong arguments. Ramstad (2005) argues that Lenovo gives no evidence of the sustainability of the turnaround and there are some accounting differences. Nevertheless, the fact is that Lenovo has achieved the first step of Success. (Liu, 2005) The time will answer such questions such as whether the acquisition is successful or not, how Lenovo efficiently and effectively manage the global business, and What is the final result of this acquisition? (Liu, 2005) From the reports in Lenovos archive, the following critical success factors were identified in planning stage: 1) Top management support: Believed to be critically important in the early stage to engender commitment, provide direction and resources. CEO of Lenovo and senior managers decided to implement ERP project in 1998 and invested 30 millions RMB in the project. (Tang, 2007) 2.) External expertise: In the planning stage, technology support and management consultancy was received from 38 vendors and consultants. Regarding to implementation plan and SAP process. Deloitte and SAP Corporation were participated in planning Lenovos ERP system. (Tang, 2007) 3.) Project management: Detailed project plan was developed with the help from ERP vendor and consultants. Before the implementation, Deloitte supplied with FastTrack solution, business process re-engineering and module designing for Lenovos ERP project. (Tang, 2007) 4.) Clear Goals: Project objectives and staged implementation developed. From senor managers statement presented earlier, the goals of ERP implementation are support rapid business growth, address data sharing issues, and obtain a competitive advantage and new management techniques. (Tang, 2007) 5.) Balanced project team: Mix of IT professions and senior management. Project team consist consultants from SAP Corporation and Deloitte, IT professionals in Lenovo and heads of other departments (SCM, finance, sales and productions). (Tang, 2007) Organizational System-Knowledge management Lenovo Group puts priority on knowledge management, and established specific knowledge management department in 2003 to conduct planning and implementation of knowledge management of the whole group. Cultivation and introduction of knowledge-type workers also achieve notable effect, and recruited a lot of talents acquainted with knowledge management knowledge and software.(Ming,_ _ _ _) At the beginning of 2004, Lenovo integrated knowledge management, information management and flow management to the flow management department. This integration makes knowledge management more executable not only more authoritative, but also practicable with feasible means, because the flow management department takes charge of deciding posts, deciding flow and deciding organization, and enjoy authoritativeness within the company. (Ming,_ _ _ _) When knowledge management and information system are integrated, knowledge management becomes more practical and feasible, and this orientation has made knowledge management play a more important role in the company. Because knowledge management and business execution are combined together, i.e. knowledge comes from business and should feedback to business, the flow requires that knowledge be turned over, then the authoritativeness is represented. As index management of the flow, including deciding posts, deciding responsibility and review, knowledge management is closely related with unfolding of various items of work of the company, not confined to simple knowledge management. (Ming,_ _ _ _) System Design Lenovo carries out knowledge management in four steps. The first step is the definition of knowledge. Lenovo has many business flow links or activities, the first step is to tidy up the business flow of the company, identify activities in the flow, find knowledge hidden behind various activities to form a knowledge map and expose the hidden knowledge(Ming,_ _ _ _) The second step is to conduct efficient classification over knowledge. Behind each post there contains corresponding contents of organizational management, once posts are set, the flow has been decided and it is hard to modify. Of course, this is based on alignment of knowledge. (Ming,_ _ _ _) - The third step is to encourage staff contribute knowledge. In order to establish a knowledge management incentive system of vigorously promoting staff passing on knowledge, Lenovo Group sets knowledge management as an index of assessing staff performance. Lenovos knowledge management system includes assessment tools, using every piece of information of knowledge, the user shall have to give a score of appraisal. (Ming,_ _ _ _) To a certain stage, Lenovo will conduct statistics to form a statement. In this way, according to the latest and most valuable knowledge ranking of every month or every week, staff members with most knowledge contribution will be awarded corresponding material incentive. (Ming,_ _ _ _) Process of Implementation In the concrete process of implementation, Lenovo divides the whole process into four stages as follows: pilot demonstration stage, knowledge integration summarization stage, optimization sharing stage and business audit stage. (Ming,_ _ _ _) First stage: pilot demonstration. Select pilot units and implement knowledge management. Explore problems and resistance arising out of the process of implementation of knowledge management and seek corresponding solutions, endeavor to pose a demonstrative effect on whole group upon knowledge management in pilot units. (Ming,_ _ _ _) Second stage: knowledge integration. Based on experience from pilot stage, divide the group into many teams and many project teams to swiftly promote various departments set up their own knowledge system. The main work is concentrated on effective classification, integration and issuing of current knowledge. This stage is not intended to pursue optimization of knowledge system, and the key is to establish the primary knowledge system of the whole group as soon as possible. (Ming,_ _ _ _) Third stage: dynamic sharing. Operate knowledge management flow, realize dynamic running of knowledge database, and optimize incessantly the established knowledge system in the dynamic updating process. Promote learning sharing and help others solve problems, conduct knowledge quality assessment in the process of sharing and application, and implement knowledge contribution incentive measures. (Ming,_ _ _ _) Fourth stage: knowledge audit. Carry out audit over validity of each link of activities of the whole flow, and provide programs of improvement and promote management improvement. (Ming,_ _ _ _) Lenovo recruits expertise of two types as map retrieving operation and flow management to conduct appraisal and testing over the system, and arrange quite a lot of human resources to update and maintain knowledge database. Each piece of knowledge has a valid period, and the system will retrieve automatically after the valid period to ensure constant updating of knowledge. (Ming,_ _ _ _) Innovation and Entrepreneurship in Lenovo Lenovo, a prestigious IT company in China, is a shining example of entrepreneurship in China. It has achieved sustainable development in the highly competitive high-tech industry in the past decades. However, the development of Lenovo is zigzag but forward moving.(Bao, 2 _ _ _) - Lenovo developed the software and the Chinese character card, which helped the company to accumulate the necessary capital for its further development. In its eveloping period (1987-1988), Lenovo took up the most market share of the product through further research and development. Meanwhile, it began to act as the agent for the other international famous PC brands. In so doing, it learnt advanced international technology, and established its sales network. .(Bao, 2 _ _ _) Then the company entered the third period (1989-1996). Both its software business and agency business achieved steady growth. Meanwhile, it started to develop the overseas market. Thus the company has become a company with technical industry, manufacturing industry and trade industry. But soon, it faced the worldwide IT restructuring, its overseas sales declined, but Lenovo made a quick change. It started to manufacture the PC with its own brand instead of other international famous brands. This innovation brought rebirth to the company. .(Bao, 2 _ _ _) In 1996, the company took up 10% of the market share and ranked the first place in China. The company smoothly entered the forth developed period (1997-2000), during which its PC business continue to enjoy steady growth. .(Bao, 2 _ _ _) According to the IPC market survey in August, 1998, Lenovo ranked one of the top three in Asia pacific area and its sales volume of household computers ranked the first place in the area. In 1999, its total sales volume reached RMB 9,000 millions. All this indicates that Lenovo has developed into a large international IT company. .(Bao, 2 _ _ _) - The forth developed period laid a good foundation for the fifth period-the renovation period (2001-2007). With the competition of PC market becoming more and more fierce, the profit is getting smaller. Accordingly, Lenovo made some adjustment of the company structure. On one hand, it continued to do the PC business to achieve its scale merit; on the other hand, it developed the business in the fields of servers, mobile phone, IT service and e-commerce to seek new profit growth. Thus, Lenovo achieved phenomenal growth in this period. .(Bao, 2 _ _ _) - Mr. Liu Chuan Zhi, the president of the company, made different innovations in different periods of the development of the company. In the starting period, he adopted a layer structure, a flat organization through which the company can enjoy rapid development. In the developing period, he changed the structure into a ship structure to adapt to the increasing scale of the enterprise. In the developed period, he adopted the united fleet structure for the company. And accordingly, he changed his leading style from centralization to cooperation, decentralization and coaching to meet the needs of the different periods of development of the enterprise. .(Bao, 2 _ _ _) Mr. Liu projects his vision of the future and adopts both steady forward moving strategies, through which Lenovo has won a lot of market chances. Besides, he shows his upbeat attitude at critical moments. .(Bao, 2 _ _ _) In 1992, the business of the company was not satisfactory in overseas market. Mr. Liu Changed his strategy and focused on the market in China so that the company still achieved growth in difficult times. In 1999, the company failed temporarily in its transformation into an internet company. At the critical moment, Mr. Liu made a quick change and entered e-commerce field with the existence of former software business, which has proved to be a success. .(Bao, 2 _ _ _) Whats more, he is very strong in coaching, for he has successfully left his managing position to his successor. All this indicates that it is the entrepreneurship that led the company to one success and another. .(Bao, 2 _ _ _) Strong lure of Brand opportunity Lenovo is a good illustration of the strong lure of brand, opportunity, and purpose. Its acquisition of IBMs personal computer operations, in 2005, made it the third-largest personal computer company in the world. (Ready,Hill Conger) The IBM acquisition produced something of a halo effect for Lenovo, and Chinese workers felt pride that China had been able to buy part of an American business icon. Lenovos brand was and is attractive to ambitious young workers with dreams of their own-people who are building careers and not simply looking for jobs. (Ready,Hill Conger) Lenovo was an early standout for these rising stars. Lenovo also built a global perspective into its brand promise; to become a great company it would have to expand beyond its home market. That meant opportunity. (Ready,Hill Conger) - President and CEO Bill Amelio describes his company as a stage without a ceiling for every employee- worldwide. In a truly global spirit, Lenovos top-team meetings rotate among Beijing, Hong Kong, Singapore, Paris, and Raleigh, North Carolina. (Ready,Hill Conger) - Lenovos brand promise credibly communicates that nationality doesnt matter; if an employee demonstrates capability and vision, there are no limits. The playing field is level. (Ready,Hill Conger) - Lenovos brand promise credibly communicates that nationality doesnt matter; if an employee demonstrates capability and vision, there are no limits. The playing field is level. (Ready,Hill Conger) What makes Lenovos talent-tracking process work, however, is that the career maps are linked to key slots across the globe and accountability for the entire process rests squarely with line leadership, not with HR. Its employees are ambitious, and Lenovo needs to demonstrate that it is serious about developing their careers. (Ready,Hill Conger) 6) Lenovos PCs can be priced competitively to those of Dell and HP without sacrificing quality or any features. Lenovos low cost advantage is never based on cutting RD and low quality. (Ready,Hill Conger) Lenovo have improved its manufacturing efficiency by centralizing production in China where most of the components are made which will eliminate shipping cost before assembly. Further, as mentioned earlier, Lenovo can maintain a low cost of overhead. For example, before the deal, IBM PCD can achieve 24% of gross margin, but the net profit was negative owning to its high cost of overhead. Meanwhile, Lenovo only has gross margin of 14% but with a net profit of 5%.(Ready,Hill Conger)

Why I Read :: Personal Narrative, Autobiographical Essay

"Why did you read all four books?" a peer asked me after I revealed my summer reading list. "Well," I said, "I thought they would punish me if I didn't." Was this a total lie to get someone off my back, or was it the truth? While it was probably a combination of both, I decided I read for myself. I read to find out about the issues I had been struggling with, like time and humanity. To have feelings that I have never experienced and to escape. With these books I was no longer a scared middle-class white boy from Tennessee, and though it may be cheesy, I was anyone, anywhere. The issue of time has caught my attention since reading Siddhartha. I desperately want to understand time since it is the basis of society. We live in the present, but these words are in the past. Sure, you could read the words over again, but the first impression is the past. So the past is really all we can look at. But the past does not matter if it is temporary. In 1984 Orwell states, "he who controls the past controls the future." The verb "controls" is very important here. It is in a present tense, stating that he who can change the past owns the future. So why would the past matter if it is changeable? The year could not even be known. It could be the same day forever. Why does the past matter anyway... or even the present? On a large time scale everything we know is but a blip. Einstein's Dreams proposes a profound statement which indirectly points out that the supernatural controls time. We will not be able to slow down the last second, so it will last 'forever'. We can't to uch time; it's out of our reach. So therefore, life as we know it has an ending when God says so. Time will continue to pass until the end at its seemingly eternal rate. It's like a river, unstoppable and ever flowing. Trying to battle the current is futile. The pain just makes you feel time pass more slowly when in fact the river keeps running. While personal existence may seem unimportant, Celie from The Color Purple brings across an important statement, " I'm poor, I'm black, I may be ugly... But I am here." While the past, future, and present may seem incredibly small, it's all we have.

Nurses’ Work Hours

I have been a staff nurse in the emergency room for fourteen years. I have worked a variety of 8, 10, 12, and even 16 hour shifts. I currently am working 8 and 12-hour shifts on nights. Previously, I also worked some 12-hour day shifts. I personally have been struggling with working the 12-hour shifts. My commute to work is 1 hour one way and I have fallen asleep several times driving home from work. The last four hours of my shift I experience great fatigue and even have had trouble staying awake. I have come close to having medication errors and feel that my quality of care is less during the last four hours. When working 12-hour shifts I average around 5-6 hours of sleep before returning to do another 12-hour shift. During an interview with another colleague also working 12-hour shifts she states she also experiences feeling very tired and less alert. She actually admits to having a medication error that she feels was associated with the long hours and fatigue. With these concerns I ask, â€Å"Are nurses work hours a concern for nurses and patient safety†? Introduction As demands for flexible work hours and a balance between home and work life have increased for nurses, twelve hour shifts are more common. The nursing shortage has also contributed to nurses’ working longer hours to cover shifts. Nurses must remain alert to provide safe care and prevent errors in medications and procedures. Nurse work hours are a concern to me regarding patient safety. I am also concerned with the health risk of nurses working long hours so I decided to do a search on how long hours affect nurses and their patients. I searched evidenced based research articles available from a variety of trustworthy healthcare sites like CINHAL, ANA, and Nursing Journals. I organized this literature review in three categories. These categories are: Positive and negative effects of long hours, effects of long hours on patient safety, and if there are any health effects on the nurse working 12-hour shifts. Literature Review Positive and Negative Effects of Long Hours There are both advantages and disadvantages of working 12 hour shifts (Ede, Davis, & Sirois, Circadian, 2007). One advantage is working less days during the week, which is desirable of most nurses. It is also easier to have all the shifts covered because you do not have to hire as many nurses (Circadian, 2007). In a qualitative study by Richardson, Turnock, Harris, Finley, & Carson (2007) the purpose was to examine the impact and implications of 12-hour shifts on critical care staff. Two groups and questionnaires with critical care staff from three critical care units were reviewed. Positive effects were found with planning and prioritizing care, improved relationships with parents/relatives, good quality time off work and ease of travelling to work. Less favorable effects were with caring for patients in isolation and the impact on staff motivation and tiredness. Acceptable patterns of work were suggested like no more than 2-3 consecutive shifts should be worked and rest periods between shifts. The survey concluded that most of the nurses that responded wanted to continue with 12-hour shifts. Systems and practices need to be developed to improve on the negative effects of working 12-hour shifts. In one of my interviews the nurse agreed that she enjoys 12-hour shifts because she has more days off during the week and feels she has more time with her family, although I personally disagree. She also states it is easier to provide day care for her children. Disadvantages of longer work hours according to Circadian (2007) included that it is harder to cover absences, limited family and social time during working days, more pay lost when a day is missed and increased percentage of night shifts. Longer work hours have also been associated with increased tiredness, less sleeping hours, driver fatigue returning home, and increased risk of errors or near errors ( Richardson et al. , 2007); (Scott, 2006); (Scott, 2010); (Chen, 2011). I have no time with my family on the days I work 12 hours. Even though I have more days off I feel I am spending at least one day recovering after working a long shift. I personally would rather have interaction with my family daily especially since the kids are in school. A colleague I interviewed also agreed that when working 12 hour shifts she had limited time with her family. Effects on Long Hours on Patient Safety As a result of nursing shortage hospital staff nurses are working longer hours with few breaks (Chen et al. 2011). In one quantitative study by Scott, Rogers, Hwang, & Zhang (2006) they randomly selected 1148 critical care nurses and sent them a demographical questionnaire to fill and return related to medical errors and the hours they worked. The objective of this article was to describe the work patterns of critical care nurses, determine if there was a relationship between the occurrence of errors and the hours worked by the nurses, and explore whether these work ho urs had adverse effects on nurses’ vigilance. The 502 respondents consistently worked longer than scheduled and for extended periods. Longer work duration increased the risk errors and near risk errors and decreased nurses’ vigilance. The findings supported the Institute of Medicine recommendations to minimize the use of 12 hour shifts and to limit nurses’ work hours to no more than 12 consecutive hours during a 24 hour period (IOM, 2006). Although the findings note that 12 hour shifts can have negative effects, most participants wanted to continue working them. Nurses are responsible for the safety of their patients. Nurses must remain alert to provide safe care, recognize discrete changes in patient conditions, and intercept potentially dangerous errors in medication and procedural orders (Keller, 2009). Nurses’ work hours are a concern given the expectation of their sustained vigilance to maintain the well-being of patients. The 12 hour shifts worked by many nurses are associated with reduced sleep times, difficulties staying awake, frequent overtime, and significant risk for error (Rogers, Hwang, Scott, Aiken & Dings, 2004)( Scott, Rogers, Hwang, & Zhang, 2006). Even though 12 hour shifts may be preferred by many nurses, studies indicate that extended shifts worked by hospital staff nurses are associated with higher risk of errors. Long hours coupled with insufficient sleep and fatigue is even risker (Scott et al, 2010). More than two-thirds of 895 hospital staff nurses reported â€Å"struggling to stay awake on duty† at least once during a 28-day data gathering period (Rogers, Hwang, Scott, & Dinges, 2003). Nurses reported fighting sleep about once every five shifts (2,258 out of 11,218 shifts). Drowsiness was not confined to the night shift; more than half of these episodes occurred between 6 A. M. and midnight. Nurses who reported shorter sleep durations were more likely to struggle to stay awake, fall asleep, and make errors while on duty (Scott et al, 2010). Effects on Nurses Working Long Hours Studies examing the health and safety consequences of nurses themselves are beginning to shed some doubt about the wisdom of continuing to use the twelve hour work schedule. According to one study, adverse health and safety outcomes of extended work hours include increased rates of musculoskeletal disorders, needlestick injuries, motor vehicle accidents, and inadequate sleep (Greiger-Brown, & Trinkoff, 2010). All of these can be attributed to reduced vigilant attention, fatigue, and decreased neuromuscular fine motor control associated with sleep deficiency. In an interview with one colleague she states that her body, â€Å"hurts all over†, when working a twelve our shift. I have fallen asleep driving before which could of resulted in injury of myself or someone else. Lengthening of the shift duration from 8 to 12 hours significantly restricts the opportunity for sleep and produces sleep deficiency (Smith et al. , 1998). Working without adequate sleep between shifts can lead to negative chronic health effects including Cardiovascular Disease, metabolic syndrome, diabetes, obesity, decreased immune function, and increased cancer risk (IOM, 2006). In a quantitative study by Chen, Davis, Pan, & Daraiseh (2011) a total 145 nurses wore monitors for one 12-hour day shift to record heart rate (HR) and work pace(WP), which were used to calculate energy expenditure(EE). The purpose of this study was to determine whether hospital nurses are experiencing physiological strain at work by examining their physiological and behavioral response patterns over 12-hour shifts. The EE and HR data presented in the study revealed a moderate physiological strain experienced by 12-hour shift nurses, regardless of their slowed paces during the last four hours. The study noted that although work pace slowed during the last 4 hours, the nurses’ heart rate continued to be elevated, which could lead to cardiovascular disorder. Moreover, inadequate work break and sleep, family care-giving responsibility and aging presented challenges that may have prohibited nurses from full recovery and potentially exacerbated the negative impacts of the 12 –hour shifts. Overall their results relates to EE and HR suggest that nursing workload of 12-hour has a negative physiological impact on nurses. Policy Implications Although there are negative effects noted in working twelve hour shifts, I don’t think it is going anywhere due to the fact that nurses love them, and the increase in nursing shortage. Keeping this in mind instead of focusing on stopping twelve hour shifts, there needs to be interventions on how to improve the 12 hour shifts to provide safer patient care and prevent health problems in nurses. The preliminary policy implications I have discovered is the possibility of limiting how many twelve hour shifts a nurse should work in a row, mandating breaks while working twelve hour shifts, allowing the night shift to nap, regulate how many hours a nurse can volunteer to work, and allow the older nurses to have an option between 8 and 12-hour shifts. In my institution there is no limit on how many hours a nurse can voluntarily sign up for as long as it is approved if it puts the nurse in overtime. Our breaks are not mandated, if we get one great, and if not we can get paid for not getting a break. Most of the time, our breaks are interrupted. Regarding naps, physicians on the night shift are allowed to sleep if there are no patients, but there is no policy stating the nurse can sleep. Some nurses actually work 24 hour shifts, but are allowed to sleep at night if they are not busy. There are times though that they are busy the whole 24 hours. In one interview a nurse stated that if she lays her head down and naps for about 20 minutes she feels much more alert. I have also tried taking a nap at work when there were no patients in the ER, and I did feel so much more alert, especially driving home. It is therefore wise to consider limiting shift length and hours worked per week per IOM recommendations. After reviewing the literature it is clear that the main problem is nurses not getting enough sleep between shifts which causes fatigue. In a study of nurses’ sleep habits, Geiger-Brown (2010) found that 58 percent averaged only 5. 5 hours of sleep. When they work three or four 12-plus hours a day, they are also unable to easily reestablish a â€Å"consistent sleep schedule†. In one research article it noted that allowing the nurses to nap, especially the night nurses showed improvement in alertness and feeling less fatigued and ultimately showed a reduction in errors or near errors (Fallis, McMillan, Edwards, 2011). It also noted that anagement needs consider to mandating that the 12 hour plus nurses are taking full uninterrupted breaks which also improves alertness. Most nurses are not taking full breaks and stay longer than the scheduled 12 hours which reduces their sleep and recovery time between shifts (Greiger-Brown, & Trinkoff, 2010). In a recent review of studies between 1970 and 1998, 12 hour shifts nurses were fatigued in 5 of 7 studies, and of 10 studies measuring performance, 4 were negative, and 6 were neutral; none showed positive effects. In this review, laboratory studies showed deteriorated performance; but field studies found no difference between 8 and 12 hours. Recent studies with stronger designs and methods have increased the evidence that questions the safety of 12-hour shifts. More recent studies as mentioned earlier demonstrate an increase in patient care errors when nurses work 12 hour shifts compared to 8 hours. The research question that has been uncovered related to nurses’ long work hours is if the long hours affect the health of the nurse and patient safety? In my institution other colleagues have stated that they feel that when working 12 hours or longer more than two days in a row really decreases their quality of care because they are tired. I feel more studies need to be done on the impact of working hours and the nurses’ health along with more evidence regarding patient safety. One ethical implication researching effects of 12-hour shifts is that the managers do not want to take away 12-hour shifts due to nursing shortage because they do not have to hire as many nurses to cover shifts. Another issue is that most nurses enjoy the twelve hour shifts even though they know they become really tired because they enjoy having more days off during the week. Managers may fear that nurses will leave to find jobs that offer 12-hour shifts. I feel this is ethically a problem with colleagues and coalitions because they are not looking at the negative effects on the nurses and the patients. With research it has become obvious that working longer hours can effect both the health of the nurse and safety of the patients yet our facility along with many others have not come up with adequate resolutions to the problem. Conclusion Twelve hour shifts contribute to flexible patterns of work, but the effects of delivery of direct care and staff fatigue are important topics for deeper examination. More recent studies as mentioned earlier demonstrate an increase in patient care errors when nurses work 12 hour shifts compared to 8 hours. Although 12 hour shifts are popular, evidence shows us that extended working hours, and working while fatigued and sleep deprived reduce vigilance and impair physical/behavioral functioning. The result has damaging effects on patient safety, quality of care provided and the health of the nurse. I believe it is the responsibility of the nurse to recognize the risks of working longer hours to keep the patient safe and to also maintain their own health. I used the Patterns of Knowing (White, 1995) to view my topic and to gather information on this literature review. These patterns of knowing in nursing include empirics, esthetics, ethics, and personal knowing (White, 1995). I used empirics by gathering factual information regarding my topic. I discussed issues in regards to ethics on my topic that was mentioned in chapter 3. I included my personal knowledge and experience with working longer shift hours, and also looked at the esthetic form by putting it all together and acknowledging what the problem is. Doing this literature review I realize that working the longer hours does put a strain on my overall health, and also has potential to put my patients at risk. I will focus more on getting better sleep, and I have asked my manager about working only 8 hour shifts. I also really want to pursue gathering more information about night nurses being able to nap.

How to Write an Evaluation Essay on Medical Ethics

How to Write an Evaluation Essay on Medical Ethics The purpose of writing an evaluation essay on medical ethics is to demonstrate the quality of a particular place, product, service, or program. You might also want to demonstrate the overall quality of any of the items above. Any valuation you produce will have some form of opinion if you do it properly but the goal here is not to come off as highly opinionated but instead to effectively evaluate something with reason and lack of bias. The key to making this happen is to establish criteria which you will then use to make clear judgments based on fair evidence. Criterion.  Criteria means you establish what an ideal service, products, or place really is. You have to demonstrate to your reader what they should expect from an ideal outcome. Having a clear list of criteria is what prevents your evaluation from seeming more like an opinion piece. For example, if you are evaluating a medical classroom, you want to establish what criteria will make a good school classroom such as the quality of education, the deadline, the teacher, and the interactions used by the teacher and student. You then apply this criteria to the specific classroom you are evaluating for your evaluation essay on medical ethics. Judgement.  The judgment section of your evaluation essay on medical ethics is where you establish whether or not the criteria you listed is met. In other words, you judge the product, place, book, or thing for what it actually is. You take the criteria you established as ideal and evaluate whether your topic or Target meet this standard of quality or whether perhaps it exceeds the standard of quality. Evidence.  The evidence is where you provide support for the Judgment you made. If your judgment is that a particular class does not consistently offer high-quality education, you will need to support this with evidence to show how you came to this conclusion and why that conclusion is sound. Structure of Your Essay.  Generally speaking every paragraph in your evaluation essay on medical ethics will focus on one criterion, followed by one judgment and the supporting evidence. Because of this it is important that your evaluation contain several different lists of criteria and judgments.  You must also make sure that you offer a thesis at the very beginning such that your reader knows what your evaluation is going to be. Once again, you want to clearly state what your criteria, judgment, and evidence will be so that the reader understands when the evaluation is mostly positive and when it is mostly negative. Picking Your Topic.  If you are allowed to select your topic, it is important that you focus on something specific and not something vague. When writing about something in the medical field or the field of ethics, you dont want to cover just medical ethics as a whole. You want to cover one specific aspect not a range of similar aspects. The more you know a topic before you start the easier it will be for you to establish the necessary criteria, judgment and supporting evidence. This concludes our guide on how to write an evaluation essay on medical ethics. We hope you enjoyed it and proudly follow it up with our 10 facts on medical ethics for evaluation essay as well as 20 topics and 1 sample essay.

Learn German Numbers, Dates, and Arithmetic Terms

Learn German Numbers, Dates, and Arithmetic Terms For each number below, two forms are shown for German language learners: Kardinalzahl (Cardinal  number: 1, 2, 3, etc.)Ordinalzahl (Ordinal  number: 1st, 2nd, 3rd, etc.) Notes on Fractions, Decimals, Articles, and Gender In some cases, a  fractional  number (Bruchzahl: 1/2, 1/5, 1/100) is also given. To make fractions (Brà ¼che) for five and above, just add -el  to the number, or -tel  if the number does not end in t: acht  Ã‚  el  Ã‚  achtel  (an eighth)zehn  Ã‚  tel  Ã‚  zehntel  (a tenth) For Dezimalzahlen (decimal numbers), Germans use das Komma (a comma), not a decimal point: 0.638 0,638 (null Komma sechs drei acht)1.08 1,08 (eins Komma null acht) Fun Fact The German expression in null Komma nichts (â€Å"in zero point zero†) means in an instant or in a flash. Although the masculine (calendar date) form is shown for the ordinal numbers, they can also be feminine (die), neuter (das) or plural, depending on the noun they are used with: das erste Auto  (the first car)die zweite Tà ¼r  (the second door)die ersten Menschen  (the first humans) When referring to individual numbers in German, you say die zwei (two) or die einundzwanzig (twenty-one), short for die Nummer/Zahl. An example would be naming the winning numbers for the lottery on television. Numbers From One to Ten (1-10) 0:  null  (zero or nought)1:  eins (one)der erste,  der 1.  (first)Time Construction: no ending on ein in ein Uhr (one oclock); but eine Uhr (one clock or a clock)  with -e ending on the article eineDate Construction: am ersten (on the first);  am ersten Mai or  am 1. Mai (on May first, on the first of May, on 1 May, or on May 1st)2:  zwei (two); the alternative form  zwo  is often used to avoid confusion with  dreider zweite,  der 2.  (second)halb, die Hlfte  (half or one-half)Time Construction: zwei Uhr (two oclock), but zwei Uhren (two clocks)3:  drei (three)der dritte,  der 3.  (third)drittel  (one third or a third)4:  vier (four)der vierte  (fourth)viertel-, das Viertel  (one fourth, one quarter, a fourth, a quarter or quarter)5:  fà ¼nf (five)der fà ¼nfte  (fifth)6:  sechs (six)der sechste  (sixth)7:  sieben (seven)der siebte  (seventh)8:  acht (eight)der achte  (eighth)9:  neun (nine)der neunte  (ninth) 10s, Tens, or Teens 10: zehn (ten)der zehnte,  der 10.  (tenth)11: elf (eleven)der elfte,  der 11.  (eleventh)12: zwà ¶lf (twelve)der zwà ¶lfte,  der 12.  (twelfth)13: dreizehn (thirteen)der dreizehnte,  der 13.  (thirteenth)am dreizehnten (on the thirteenth)14: vierzehn (fourteen)der vierzehnte,  der 14.  (fourteenth)am vierzehnten (on the fourteenth)15: fà ¼nfzehn (fifteen)der fà ¼nfzehnte,  der 15.  (fifteenth)am fà ¼nfzehnten (on the fifteenth)16: sechzehn (sixteen)der sechzehnte,  der 16.  (sixteenth)17: siebzehn (seventeen)der siebzehnte,  der 17.  (seventeenth)18: achtzehn (eighteen)der achtzehnte,  der 18.  (eighteenth)19: neunzehn (nineteen)der neunzehnte,  der 19.  (nineteenth) 20s or Twenties In German, to say in the twenties, short for the 1920s, you say in den zwanziger Jahren. The same method is used for the following decades. The 1900s and the teens are a little different. 20: zwanzig (twenty)der zwanzigste, der 20.  (twentieth)am zwanzigsten Juni, am 20. Juni  (on the twentieth of June or on June 20th)21: einundzwanzig (twenty-one)der einundzwanzigste,  der 21.  (twenty-first)am einundzwanzigsten Juni,  am 21. Juni  (on the twenty-first of June or on June 21st)22: zweiundzwanzig (twenty-two)der zweiundzwanzigste,  der 22.  (twenty-second)23: dreiundzwanzig (twenty-three)der dreiundzwanzigste,  der 23.  (twenty-third)24: vierundzwanzig (twenty-four)der vierundzwanzigste,  der 24.  (twenty-fourth)25: fà ¼nfundzwanzig (twenty-five)der fà ¼nfundzwanzigste,  der 25.  (twenty-fifth)26: sechsundzwanzig (twenty-six)der sechsundzwanzigste,  der 26.  (twenty-sixth)27: siebenundzwanzig (twenty-seven)der siebenundzwanzigste,  der 27.  (twenty-seventh)28: achtundzwanzig (twenty-eight)der achtundzwanzigste,  der 28.  (twenty-eighth)29: neunundzwanzig (twenty-nine)der neunundzwanzigste,  der 29.  (twenty-ninth) 30s or Thirties Note that unlike the other tens,  dreißig  has no z in its spelling. 30:  dreißig (thirty)der dreißigste,  der 30.  (thirtieth)31:  einunddreißig (thirty-one)der einunddreißigste,  der 31.  (thirty-first)32:  zweiunddreißig (thirty-two)der zweiunddreißigste,  der 32.  (thirty-second)33:  dreiunddreißig (thirty-three)der dreiunddreißigste,  der 33.  (thirty-third)34 to 39: consistent with the system from the 20s 40s or Forties 40:  vierzig (forty)der vierzigste,  der 40.  (fortieth)41:  einundvierzig (forty-one)der einundvierzigste,  der 41.  (forty-first)42:  zweiundvierzig (forty-two)der zweiundvierzigste,  der 42.  (forty-second)43:  dreiundvierzig (forty-three)der dreiundvierzigste,  der 43.  (forty-third)44 to 49: consistent with previous systems 50s or Fifties 50:  fà ¼nfzig (fifty)der fà ¼nfzigste,  der 50.  (fiftieth)51:  einundfà ¼nfzig (fifty-one)der einundfà ¼nfzigste,  der 51.  (fifty-first)52:  zweiundfà ¼nfzig (fifty-two)der zweiundfà ¼nfzigste,  der 52.  (fifty-second)53:  dreiundfà ¼nfzig (fifty-three)der dreiundfà ¼nfzigste,  der 53.  (fifty-third)54 to 59: consistent with previous systems 60s or Sixties 60:  sechzig (sixty)der sechzigste,  der 60.  (sixtieth)61:  einundsechzig (sixty-one)der einundsechzigste,  der 61.  (sixty-first)62:  zweiundsechzig (sixty-two)der zweiundsechzigste,  der 62.  (sixty-second)63:  dreiundsechzig (sixty-three)der dreiundsechzigste,  der 63.  (sixty-third)64 to 69: consistent with previous systems 70s or Seventies 70:  siebzig (seventy)der siebzigste,  der 70.  (seventieth)71:  einundsiebzig (seventy-one)der einundsiebzigste,  der 71.  (seventy-first)72:  zweiundsiebzig (seventy-two)der zweiundsiebzigste,  der 72.  (seventy-second)73:  dreiundsiebzig (seventy-three)der dreiundsiebzigste,  der 73.  (seventy-third)74 to 79: consistent with previous systems 80s or Eighties 80:  achtzig (eighty)der achtzigste,  der 80.  (eightieth)81:  einundachtzig (eighty-one)der einundachtzigste,  der 81.  (eighty-first)82:  zweiundachtzig (eighty-two)der zweiundachtzigste,  der 82.  (eighty-second)83:  dreiundachtzig (eighty-three)der dreiundachtzigste,  der 83.  (eighty-third)84 to 89: consistent with previous systems 90s or Nineties 90:  neunzig (ninety)der neunzigste,  der 90.  (ninetieth)91:  einundneunzig (ninety-one)der einundneunzigste,  der 91.  (ninety-first)92:  zweiundneunzig (ninety-two)der zweiundneunzigste,  der 92.  (ninety-second)93:  dreiundneunzig (ninety-three)der dreiundneunzigste,  der 93.  (ninety-third)94 to 99: consistent with previous systems 100s or One Hundreds 100: hundert  or  einhundert (hundred, a hundred or one hundred)der hundertste,  der 100.  (hundredth)(ein) hundertstel  (one-hundredth or one out of one hundred)101: hunderteins (hundred-and-one)der hunderterste,  der 101.  (hundred-and-first)102: hundertzwei (hundred-and-two)der hundertzweite,  der 102.  (hundred-and-second)103: hundertdrei (hundred-and-three)der hundertdritte,  der 103.  (hundred-and-third)104 to 199: continue in the same way 200s or Two Hundreds, and Other Hundreds 200:  zweihundert (two hundred)der zweihundertste,  der 200.  (two-hundredth)201:  zweihunderteins (two-hundred-and-one)der zweihunderterste,  der 201.  (two-hundred-and-first)202:  zweihundertzwei (two-hundred-and-two)der zweihundertzweite,  der 202.  (two-hundred-and-second)203:  zweihundertdrei (two-hundred-and-three)der zweihundertdritte,  der 203.  (two-hundred-and-third)204 to 899: continue in the same way 900s or Nine Hundreds 900:  neunhundert  (nine-hundred)der neunhundertste,  der 900.  (nine-hundredth)901:  neunhunderteinsder neunhunderterste,  der 901.  (nine-hundred-and-one)902 to 997: continue in the same way998:  neunhundertachtundneunzig  (nine-hundred-ninety-eight)der neunhundertachtundneunzigste,  der 998.  (nine-hundred-ninety-eighth)999:  neunhundertneunundneunzig  (nine-hundred-ninety-nine)der neunhundertneunundneunzigste,  der 999.  (nine-hundred-ninety-ninth) 1000s or One Thousands In German, one thousand is written or printed as either 1000, 1.000 or 1 000,  using a Punkt (decimal point) or a space instead of a comma. This also applies to all German numbers above 1,000. 1000:  tausend  or  eintausend (thousand, a thousand, or one thousand)der tausendste,  der 1000.  (thousandth)tausendstel  (one-thousandth or one out of a thousand)1001:  tausendeins (thousand-one or one-thousand-and-one)der tausenderste,  der 1001.  (thousand-first)1002:  tausendzwei (thousand-two)der tausendzweite,  der 1002.  (thousand-second)1003 to 1999:  continue in the same way Fun Fact 1001 Arabian Nights becomes Tausendundeine Arabische Nacht, but its 1001 Nchte (tausendeine Nchte) otherwise. 2000s or Two Thousands, and Other Thousands 2000:  zweitausend (two-thousand)der zweitausendste,  der 2000.  (two-thousandth)2001:  zweitausendeins (two-thousand-one or two-thousand-and-one)der zweitausenderste,  der 2001.  (two-thousand-first)2002:  zweitausendzwei (two-thousand-two)der zweitausendzweite,  der 2002.  (two-thousand-second)2003:  zweitausenddrei (two-thousand-three)der zweitausenddritte,  der 2003.  (two-thousand-third)2004:  zweitausendvier (two-thousand-four)der zweitausendvierte,  der 2004.  (two-thousand-fourth)2005 to 9998: continue in the same way9999:  neuntausendneunhundertneunundneunzig (nine-thousand-nine-hundred-ninety-nine)der neuntausendneunhundertneunundneunzigste,  der 9.999. (nine-thousand-nine-hundred-ninety-ninth) Talking About Jahre (Years) For the years 1100 to 1999 in German, you must say the  hundert rather than the tausend, as for 1152 (elfhundertzweiundfà ¼nfzig) or 1864 (achtzehnhundertvierundsechzig). 1100:  elfhundert  (year, number)tausendeinhundert  (number only)1200:  zwà ¶lfhundert  (year, number)tausendzweihundert  (number only)1800:  achtzehnhundert  (year, number)1900:  neunzehnhundert  (year, number)2000:  zweitausend  (year, number) In the year 2001 can be spoken or written in German as im Jahre 2001 or im Jahr 2001 (zweitausendeins). The phrase im Jahre means in the year, as in: Im Jahre 1350 (dreizehnhundertfà ¼nfzig) (In the year 1350). If the word Jahr is left out, then the year is used by itself, with no im (in the). For example: Er ist im Jahre 2001 geboren. | Er ist 2001 geboren. (He was born in (the year) 2001.)Er ist im Jahre 1958 geboren. | Er ist 1958 geboren. (He was born in 1958.)Kolumbus hat 1492 (vierzehnhundertzweiundneunzig) Amerika entdeckt. (Columbus discovered America in 1492) To convey the Christian calendar use of A.D. (anno domini, year of our Lord) and B.C. (Before Christ), German uses  n.Chr.  (nach Christus) for A.D. and  v.Chr.  (vor Christus for B.C. C.E. and B.C.E., for Common Era and Before Common Era, were used mostly in East Germany like so:  u.Z. (unserer Zeitrechnung) for C.E., and v.u.Z. (vor unserer Zeitrechnung) for B.C.E. 10,000 and Up 10,000:  zehntausend (ten-thousand)der zehntausendste,  der 10.000.  (ten-thousandth)20,000:  zwanzigtausend (twenty-thousand)der zwanzigtausendste,  der 20.000.  (twenty-thousandth)100,000:  hunderttausend (hundred-thousand)der hunderttausendste,  der 100.000. (hundred-thousandth)1,000,000: (eine) Million (million, one million, or a million)der millionste,  der 1.000.000.  (millionth)2,000,000: zwei Millionen (two million)der zweimillionste,  der 2.000.000. (two-millionth)1,000,000,000: (eine) Milliarde (billion, one billion, or a billion)der milliardste, der 1,000,000,000. (the billionth)1,000,000,000,000: (eine) Billion (trillion, one trillion, or a trillion)der billionste, der 1,000,000,000,000  (the trillionth) Fun Fact In German, one million is  eine Million, but two million is  zwei Millionen  (two millions). An American billion is a German Milliarde. A German Billion is an American trillion.​ Mathematische Ausdrà ¼cke (German Math Terms) German English addieren "add" die Algebra "algebra" das Differentialrechnendas Integralrechnen "calculus" dividieren "divide" durchzehn durch zwei (10/2) "divided by""ten divided by two" istgleichfà ¼nf und sechs ist elf "equals""five plus six equals eleven" die Gleichunge Gleichungsformel "equation" die Formel "formula" die Geometrie "geometry" minusweniger "minus""less" multiplizieren "multiply" plusundzwei und/plus zwei "plus""and""two plus two" subtrahieren "subtract" die Trigonometrie "trigonometry"

Explanation of Quote Essay Example | Topics and Well Written Essays - 1000 words

Explanation of Quote - Essay Example One of these is the application of fluid to patients. There are many who have debated on the role of the application of fluids to patients at various times of nursing care. In the view of Gonzales (2008), â€Å"Choosing the right fluids at the right time can make the difference between survival and death.† The common implication is that the administration of fluid to patients on timely basis may either contribute to their deaths or survival. In this essay, this assertion opined by Gonzales (2008) is critically assessed using academic and other professional journals and literature on nursing practice. Explanation of Quote First, it is important to make meaning of some of the major terms used by Gonzales (2008) in the quote. Most importantly is the term, fluid resuscitation. Fluid resuscitation results out of fluid deficit, which also occur as a result of excessive fluid loss in patients with serious ailment. Clinical methods of restoring fluid to patients therefore constitute f luid resuscitation (O’Neill and Perrin, 2002). There are a number of fluids that come to play under fluid resuscitation. Common among these are blood products, crystalloids, colloids, Albumin, Hydroxyethyl starches, Dextrans, Perfluorocarbon emulsions and Hemoglobin-Based Blood Substitutes (Curran, 2012). For Gonzales (2008) to state that ‘choosing the right fluids at the right time can make the difference between survival and death’ is a direct resonance to fluid resuscitation. Imperatively, she wants to imply that the right application of fluid resuscitation at the right time can save a patient’s life. The logical contradiction to this statement could also be given as the wrong application of fluid resuscitation at the wrong time could cause death. Having mentioned a number of fluids that may be used in fluid resuscitation, there is the implication that selection is an important process in fluid resuscitation and should therefore not be taken lightly. Ag ain, knowing the right time to apply fluid resuscitation is very important. So if fluid resuscitation cannot be said to be out rightly good or bad unless in context to the manner in which it is applied, then what are the benefits and risks of the fluid options in fluid resuscitation? In the case of Gonzales (2008), the fluid options given are Colloid and crystalloid in trauma population. Below are some thoughts. Benefits of Colloid and Crystalloid in Trauma Population Trauma is a common situation that health practitioners and especially nurses deal with in their daily duties as healthcare providers. The National Institute of Mental Health (2012) posits that trauma comes in different forms. According to the Institute, there are two major forms of trauma and that â€Å"physical trauma includes the body’s response to serious injury and threat whereas mental trauma includes frightening thoughts and painful feelings.† In most cases, physical trauma cases are those that requ ire fluid resuscitation. On the benefits of using colloids as fluid resuscitators for patients suffering trauma, Kumar and Clark (2002) are quoted as stating that normal saline such as sodium chloride, which is a type of crystalloid â€Å"is useful for both short-term fluid replacement and when the fluid lost has been mostly sodium chloride† (O’Neill and Perrin, 2002). This means that crystalloids are very benefitial in cases

The Regulatory Response to the Corporate Scandals in the USA and the Essay

The Regulatory Response to the Corporate Scandals in the USA and the EU was Diametrically Different - Essay Example In order to have this assurance, investors generally rely on the published annual report and accounts of companies. However, although the annual report and accounts may provide a reasonable approximation of companies’ activities, there are issues not shown in the annual report and accounts that could affect these companies’ financial situations, as well as the reputation of international stock markets2. For instance, despite the fact that the annual report and accounts seemed healthy, the last decade faced a large number of corporate scandals and collapses. These corporate crises have affected several people, as in the case of shareholders, managers, directors, employees and consumers. Some would argue that the main cause of these corporate crises is the weakness of corporate governance regulations in the world, as well as a need to have good corporate governance codes in order to prevent further scandals and collapses.3 As a consequence, countries have been trying duri ng the last decade to develop and update their corporate governance systems. ... In this part, the shortcomings of the USA and the EU regulations that appeared after scandals will be mentioned. Subsequent to that, the difference of the USA response will be explained. In this part, the Sarbanes-Oxley Act and its new provisions, Sections 302 and 404, will be discussed. Finally, the differences of the EU response will be discussed in light of the national and the pan-European level. 1. Corporate Governance Evolution and Scandals It is widely believed that the development of corporate governance codes has often been driven by financial scandals, corporate collapses and similar crises. For instance, at the beginning of the 1990s various financial scandals and corporate collapses happened in the UK, as in the case of Coloroll, Polly Peck and Maxwell.5 These crises led the Financial Reporting Council and the London Stock Exchange to establish the Committee on the Financial Aspects of Corporate Governance in May 1991; Sir Adrian Cadbury chaired this council in order to i mprove the UK’s Code of corporate governance. As a consequence, in December 1991 the Committee issued the Cadbury Report that influenced many corporate governance codes across the world.6 The Report stated several recommendations that focused on corporate governance issues, in particular, the operation of the main board, the role of non-executive directors and the reporting and control mechanism of firm.7 Additionally, the development of corporate governance codes, supported by many non-governmental organizations, issued principles and practices that should govern corporates globally.8 For example, the Organization for Economic Co-operation and Development (OECD) published its Principles of Corporate Governance in 1991; this was revised in 2004.9