Strat-Management Essay Example | Topics and Well Written Essays - 1500 words

Strat-Management - Essay Example DP world is amongst the world’s largest port operating entities that has an established business base and considerable potential with the ventures expanded over different major ports of the world that are hub to the services, containers and shipping. Company specialization: It specializes in the ports and terminal operations. The company has enjoyed control over three major cargo terminals in this area and has recently decided to sell as high as 60 percent of its terminal stakes (portstrategy 2012). It facilities the functions of performing cargo terminal services across the major docks and primarily on the Belgian docks as in this particular case. This move of selling the shares comes as a result of agreement and settlement with a locally operated company in the name of Zuidnatie, which aims to overtake and purchase as many as 60 percent of the overall shares of the company that were owned by it previously. This decision has various repercussions ranging from business view po int, to economic and strategic since the brand name is already established and also the services delivery infrastructure has been in place as well. Therefore understanding its long term, short term impacts is vital along with the possible angles and dimensions under which this move may have been initiated. Core idea: The idea behind selling its break bulk terminal is trigged by the move and motive to focus on the core services which is that of deep water container facility. This move is accompanied by that of expansion of its services and facilities usage in the Delwaide Dock terminal, which again is a front line terminal and would enable better focus on the core stream. The overall sales are worth around 60 million dollars. Repercussions: Since the decision is of major significance, it has both internal impacts and external, each of these need to be evaluated in terms of the possible impacts on DP world, this will be looked into with reference to the internal variables, internal fa cilities, the workers response, and on external front, it would be gauged against the supply chain factor, the market competition, the rivals response, the possible loss of customers and clients by giving up the terminal that has long been associated with DP world and other factors. All these need to be critically evaluated and observed in order to assess the impacts and determine whether this decision would augur any positives for the company or possibly lead to the negative impacts on the overall organization. It is potentially amongst the top three largest stevedores in the Port of Antwerp and its decision to abandon and sell its services will have impacts both on DP world itself and the overall terminal’s environment since it is an established entity and has been around and has earned the clients trust for considerable time (Barnard 2012). Under the law and rules and regulation of the porting industry, 70 jobs have to be cut off in lieu of this decision which would includ e 40 white collar jobs, and 30 blue collar jobs (Nobx 2012). The trend: DP world has exhibited similar behavior in recent times, and this is not the only and unique function being performed, the selling of its 20 percent shares to the Russian giants was one similar example. Another similar event came to forth in form of DP world’

Pathophysiology of subtrochanteric hip fracture Essay

Pathophysiology of subtrochanteric hip fracture - Essay Example For instance, Mr. Smith tripped and fel on the pavement outside his home meaning that his cause of the fracture was falling. In young individuals who still have stronger bones; things like car accidents (Handoll and Parker 81) mainly cause hip fractures. The ORIF, on the other hand is the surgery done by a surgeon to put up the fractured parts of femur bone back together using particular metal hardware. It also encompasses putting the hip back together. Hip fracture is mostly detected through the nervous system. For example, Mr. Smith grumbled of agonizing pain in his right leg and hip. He employed IV infusion where Patient Controlled Analgesia (PCA) for pain management using Morphine 1mg bolus dose with a 5-minute lockout. Therefore, he had to undergo postoperative care following an open reduction and internal fixation (ORIF) with compression plate and bone screws of the right femur. This means that as a caregiver, it is important to understand him and take his condition seriously. This is because, in elderly people like him who are above 80 years, complications can turn out to be life threatening (Handoll, Cameron, Mak and Finnegan 42). This means that there is the need to ensure hospitalization and intensive post surgery care in order for him to recover well and to be able to walk again. However, before that, it is important to understand his medication history and his response to treatment. After assessing him well, I noticed that his vital signs were stable, BSL was within normal restrains, IVTD/saline was running 8 hourly and had been ordered to use low molecular weight heparin. I also learned that he was on supplement oxygen to maintain his oxygen saturations above 95 percent, he had a Bellovac drain in situ that was to be removed in 24 hours time as well as TED stockings in situ on both legs (Chi-Chuan et al. 340). I also learned that Mr. Smith had a history of type 2 diabetes and has a 60 pack-year smoking history. This means he used one full packet of cigarettes every day for 60 years. With this information, it is easy to take good care of him since as a nurse, have sufficient information concerning hip fractures and with the addition information concerning his health history, it is now easy to take care of him. What I need to ensure is that he takes all his medications well and in time in order to recover quickly (Keene, Parker and Pryor 307). QUESTION 2 Discuss the immediate prioritized post operative care for Mr. Smith using current evidence and literature to support/justify your reasoning: A. Identify Nursing Problem/Diagnosis - Priority 1 The problematic nature of curing hip fracture sterns in part since fracture is anatomically different from other proximal femoral peritrochanteric breakages as well as tricky characteristics of femoral shaft breakages (Doherty and Lyden 141). This means that it must be cured with particularly modeled implants that can endure massive muscular forces for lengthened periods of curative. It is not strange to note that this breakage has considerably higher rates of malunion and nonunion than other femoral fractures. Successful outcomes can be attained incase there is an advanced comprehension of the breakage and the precise treatment alternatives. o Identify four (4) key pieces of assessment data to support this problem The process of nursing assessment is very critical in nursing process to both the patient and the nurse because it helps the nurse know and understand the patient well and helps the patient to feel free and share important information with the nurse (World Health Organization pp19). Therefore, the four key pieces of assessments in nursing diagnosis include assessing the history of

Salem Witch Trials Coursework Example | Topics and Well Written Essays - 250 words

Salem Witch Trials - Coursework Example ended rights, the jail conditions of accused were but harsh, with the accused witches often tied for months inside cold flooded, foul smelling cells; in effect, forcing many innocent prisoners to accepted their punishment for offences they knew little about.2 Those who attempted to escape would immediately be executed when caught. The examinations for evidence were humiliating at best, for the accused were often stripped naked and tortured even more to confess. The accusers were but a section of the puritans with strong beliefs in the existence of demonic sprits and the associated control over every bad thing in life; and was the case when their children begun behaving contrary to their doctrinal beliefs, leading to the Salem witchcraft accusations. The accused witches were taken before appointed magistrates, literally questioned, with their accusers appearing in the courtrooms in a grand display of name calling screams and writhing of the supposed demonic spirit possessed young girls, which to the disbelief of many, were the complete evidence in the trials. Belief in the dangers of supernatural powers had long been cultivated by the community, and that the challenges such as the after effects of the wars, smallpox epidemic, among other conflicts as well the soaring crime rates only cemented the simmering tensions and

Individual Development Paper Essay Example | Topics and Well Written Essays - 750 words

Individual Development Paper - Essay Example The ability to understand what the other is going through helps in all the segments of our waking life and livelihood like management, sales, marriage and parenthood. Strengthening this aspect of my emotional intelligence would really mean that I have already taken care of the earlier three aspects of emotional intelligence. Goleman opines that empathy builds on self-awareness. People who cannot read their own emotions are alexithymic, they are confused and bewildered about their own and other peoples' feelings. I suspect that I am a bit of an alexithymic myself. Once during my adolescence my house was flooded, I remember that I did not react at all and continued doing whatever I was doing instead of panicking and controlling the situation. At that time I thought I was rather cool, but now I realize that I was too detached and cold (not cool as I had earlier thought). Had I been empathetic I would have perhaps cried yet swung into action for either throwing out the water or stemming the source. This cold trait has surfaced time and again in my dealing with my business employees as well. I am not able to comprehend when they drop work due to personal emergency. It seems to me that work has less priority in their life than their domestic troubles. I am able to now understand why my subordinates find it difficult to confide in me, why I am usually am the last to know about the problems brewing in the environment. Root cause of this shortcoming is that I need to have empathy towards others. The plan is to improve my cognitive skills which will include: Set a role model. There are a number of people I know who are naturally empathetic towards others. I will have an inner voice mapping my emotions or lack of them against those of the role models. It would be easy to emulate them initially whenever I feel emotionally blank. Self-motivation- I will reinforce my behavior by constantly conducting an inner conversation with myself, to help me manage challenges or difficult situations. Learning social cues - I will try to see my self as part of a larger social fabric and try to react to situations from community's point of view. Recognize facial expressions, tone of voice and gestures and anticipate other person's state of mind. Others too- Try to understand from others perspective too and see if my state of mind is broad enough to take a just decision or too narrow that I am considering only myself in the outcome. Listen sympathetically - Not to interrupt or contradict till the speaker has finished and his /her message is understood completely. Maintain eye contact, gesture warmly and keep relaxed at all times. The key to know if my plan has worked is the enhancement of following traits in my personality: More responsible and assertive without being abusive More popular and dynamic Enjoy meeting others and help in solving their problems Greater understanding of others perspective and being more concerned Better at resolving conflicts, rather than being the cause of conflicts. Subordinates become friendlier and confide in me. The basic competency needed to develop empathy is self awareness. It means that I have to have the ability to recognize my own feelings. I have to be open and clear about my emotional reactions to different situations. I have to be motivated to develop empa

Epidemiological Research Article Assignment Example | Topics and Well Written Essays - 1250 words

Epidemiological Research Article - Assignment Example Strotmeyer et al research article that is based on an epidemiological study. This research was carried out to describe retention by age and visit type with a view to determine the characteristics associated with visit types in a longitudinal study among older adults (Strotmeyer et al, 2010). The article will be critiqued against the basic principles governing epidemiology and biostatistics to determine whether the components of its research design supports the research question. Direct health-care providers and epidemiologists differ in their approach to who constitutes a patient. This is despite the fact that all of them are concerned with the occurrence and subsequent control of a disease (CDC, 2012). Biostatisticians are concerned with general health of the inhabitants of a community or area while Clinicians are interested in the health of the individual (CDC, 2004). Biostatistically therefore this study has succeeded in identifying its patient subjects. The sample of this cardiovascular health study was 5888 persons aged between 65-102 years irrespective of their individual health status (Strotmeyer, et al, 2010). Both the clinician and epidemiologist would be interested in diagnosing the correct type of cardiovascular disease that the patient is suffering from (CDC, 2012). The point of departure which this study succeeds in doing is that it seeks to establish how age affects long term retention of participants in a cardiovascular health study. It also aimed at determining characteristics of visit types for a longitudinal epidemiological study of older adults (Strotmeyer et al, 2010). The choice of population in this study will influence the application of the findings of this study in other settings. The research question is contained in the abstract party of this research paper. The question presents a statement of purpose because it clearly states what is actually being investigated (Thompson Writing Program, 2014). The purpose of this

Recruitment and Selection Strategies Recommendation Essay Example for Free

Recruitment and Selection Strategies Recommendation Essay It is the responsibility of the HR department of Landslide Limousine services to provide data for the job competency and an analyses and minimum qualifications to staff the company. The HR department is responsible for interviewing candidates, integrating information collected by the rest of the department to determine financial and salary recommendations and make final decisions on entry-level hires and promotions (Cascio, 2013). Diversity in the workplace can compose a range of different elements. The differences in national origin, primary language, social status, religion and age can benefit or harm the business. Managing diversity within Landslide Limousine services will effectively be the key to leveraging the advantages and minimizing the disadvantages of diversity in the workplace. Workplace diversity objectives: A workplace that values are integrated into a board range of organizational values. The Landslide Limousine will support all staff members, families, career and cultural responsibilities. The Landslide is a business that is free from discrimination and harassment. Methods for screening candidates can be an overwhelming experience for the interviewer and interviewee. As the interviewer for the company, you probably have seen a lot of applications and resumes with a variety of education and experience. Each candidate interview might seem like a good candidate, with perfect grades and resumes that are very impressive. It is impossible to know rather the person will be a good fit for your company until an actual interview is conducted. Choosing the wrong person could be costly to the company and a waste of time for both the company and the employee. The best way to conduct interviews is to: Screen first by phone Then conduct an in person interview with a set of behavioral questions. This  allows interviewer to discover if the candidate is motivated, a team player and their desire to learn new things. Laws to consider in Austin Texas for the recruitment and selection process: Affirmative Action- Law set to enforce by the Office of Federal Contract Compliance Programs to band discrimination in the workplace. Child Labor- This law was set in place and enforce by the Wage and Hour Division of the United State Department of Labor. Foreign Labor- This law is set in place when a business wishes to hire a foreign national. After the recruitment and selection process and a candidate is chosen. It is then the responsibility of the supervisor to make sure the employee is aware of their job responsibilities and set goals to achieve during the year to be more of an effective employee to make the company more successful. The performance management and plan discussed below and in plan past recommendations is used during this time. Performance Management Plan A performance management is used as a tool to indicate the employee’s direction and desired direction within the company. This is not the same as a performance appraisal that identifies and discusses job-relevance and performance, strengths and weaknesses. A poll was done to show that 58% of HR executives rated their performance management systems at a C or below average (Cascio, 2013). The one solid payoff for a strong performance management plan is that studies show 51% are more likely to outperform their competitors on a financial standpoint (Cascio, 2013). This tool will be explained and given as a recommendation to Mr. Bradley Stonefield for his Limousine service. Feedback from the employee will be important to Landslide Limousine Service and the employees no matter if the feedback is positive or negative. Employees will have to learn to accept constructive criticism and for Landslide to know how to work with the department and each employee to improve production. A rubric for appraisal will be held by the management team it will require each employee to meet a significant and or attainable requirement. It will be important as a company to demonstrate the standards related to each individual performance. This helps employees to identify what is a failure and what is a success (Cascio, 2013). Management should also be able to give employees a time-frame in order for them to fix the negative parts of their appraisal. Traci’s recommendation would be for  receiving too many negative feedbacks would be to put the employee on probation for 60 days to fix the problem which they received on their appraisal. The employee will have the opportunity to clean up their act to keep their position. This will show the employees are capable of fulfilling the terms and conditions of their terms under the position in which they have been working. Landslide Limousine will offer opportunities for promotions that offer lateral and advancement within the company. Growth with in Landslide will help develop more opportunities to stimulate knowledge and skills in the business. One service that in the future Landslide would like to provide is to offer educational advancement classes that will be available online. In order to take part in these services the employee will have to wait until after their first year and having a good appraisal and not being placed on probation for any reason in order to be considered for a promotion (Cascio, 2013). Employees who are not micromanaged will work better and offer a more flexible schedule for the limousine service. With selecting a schedule; the employee will keep the same schedule for a year. Offering the employees a flexible schedule will also allow more family time for employees. Landslide is big on family and feels that family is very important so employees should not have to miss out on family functions and appointments (Cascio, 2013). Diversity within a company is important. The drivers and administrative staff of Landslide Limousine Services will be diverse, with a diverse group of different ages and race. The appraisal system will also be a diverse group of individuals. The appraisal team’s mission is to help motivate the team of employees to be more valuable to the company. Using the company mission statement and vision will help motivate the team to be successful. Having a diverse group gives the company different experiences from different people and helps provide the drivers with different ideas and each driver can express their experiences and ways of learning in order to improve the team. The more determined the team the better the experiences for our customers and helps the possible longevity of the company. All drivers and staff will be treated as an equal and no one will be heard over someone else. Each driver will be given a job description and with his or hers roles. Each driver will have a background check conducted and diver’s record check by Texas DMV. Ensuring a clear background and driving record will ensure our customers that we are  providing them the best service. A check will be conducted every year to hold the drivers accountable and to ensure our or customers safety at all times. All tickets, accidents, arrest will have to be reported to the administrative office within 5 days of the incident. All arrest for DUIs will call for an automatic termination from the company. All drivers will be put through an intensive training. This training will insure the driver’s capabilities and the driving skills are up to the standards of Landslide Limousines services. The training will help develop stronger individuals and to help them reach their goals and make Landslide Limousine a successful company serving all types of people in the city of Austin, Texas. The organizational performance philosophy is great to have when starting a business. It is important to set the standards for the employees in the beginning. Employees work well when they have a clear understanding of their expectations. The performance management plan gives that clear understanding. Criteria Training evaluation strategies are an important aspect of any company. â€Å"To make an intelligent decision within the HR department and the best way to deploy and manage people, there are two ways that are most essential (1) a description of the strategies that the company would like to use to compete in the marketplace. (2) The design of the job, that includes a description of the work that needs to be done and the skills needed to perform the job and the training and experience requirements required for the number of jobs† (Cascio, 2013, pg. 182). Training should include methods to evaluate: Employee reaction to the training Knowledge and skills gained during the training Application of the knowledge and skills in the workplace The impact of training on the organization. Pretests It is important that Landslide Limousine Company have a written plan for evaluating and training its employees. When there is a clear course objective and content developed, it should not delay until after the training gets completed. â€Å"An evaluation determines the amount of learning achieved by training† (Kirkpatricks Four-Level Training Evaluation Model, 2014). An employee’s performance will improve on the job as a result of training, and the methods of evaluating training are: 1. Gaining  employee’s opinions, questionnaires or informal discussions with employees can help employers determine the importance and suitability of the training program for the employee. 2. Supervisor’s observations allow supervisors to remain in a good position to observe the employee’s performance before and after the training to note the improvements or changes. 3. Improvement in the workplace the ultimate goal in the workplace regards getting constant improvement in the workplace. The training programs helps to make changes throughout the workplace, and it may reduce injury and accident rates. Monitoring and observing training The strategy is very important. It provides the big picture of how you the company intends to evaluate the training across the business. â€Å"The training evaluation strategies help generate coherence to your activities forcing the company to write down and approach the evaluation of the training that helps ensure that the employee and employers have a logical and efficient plan in place† (Kirkpatricks Four-Level Training Evaluation Model, 2014). Collecting feedback An important way for the Landslide Limousine as an employer to determine what the employees has learned during the training events remains during the training, and the training instructor should have specific learning objectives. Evaluations done on the training should get done immediately after the training event to determine if the employee has gained the knowledge, skill, or attitude toward the training. Implementing feedback The behavior of the employee determines if the training changed his or her on-the-job behavior as a result of the training program. If the behavior on the job did not change, it is the responsibility of the supervisors of Landslide Limousine to find out why a change has not occurred from the feedback received. â€Å"The supervisors and training instructor should determine if the training had a positive effect on the job performance† (Kirkpatricks Four-Level Training Evaluation Model, 2014). Landslide Limousine’s management should explain to the employees the importance and applicability of on-the-job training, actual experiences, real world examples, and practicing behaviors to explain the importance to the employees. The final results are determined by the business’ operations, and the results contribute to how good the business functions. How well the training gets done and observed get based off of several things: Improved quality of work Higher productivity Reduction in turnover Fewer grievances Lower absenteeism Fewer accidents Greater job satisfaction Increased profits. In Landslide Limousine the HR department is going to become very important when it comes to recruitment and selection process. It is important to use the tools and information given in the last 6 weeks recommendations for your business to be successful. References Cascio, W. F. (2013). Managing Human Resources: Productivity, Quality of Work Life, Profits (9th ed.). New York, NY: McGraw-Hill Henderson, K. (2014). Acts or Laws Behind Recruitment Selection. Retrieved from http://smallbusiness.chron.com/acts-laws-behind-recruitment-selection-2536.html Hogan, M. (2014). Interview Screening Techniques. Retrieved from http://smallbusiness.chron.com/interview-screening-techniques-1233.html

Service User And Care Involvement Analysis Social Work Essay

Service User And Care Involvement Analysis Social Work Essay This review will consist of an introduction, aims of the review, and methods of data collection, findings on a series of questions and answers on the extent of service user involvement in the discharge process, conclusions, and possible recommendations for change. It will conclude with a reflection piece. The following review will discuss the issue of service user involvement in the discharge/transfer procedure. The review was compiled by the author within a nineteen bedded Forensic Mental Health unit. The ward was at full capacity at the time of writing this review. The service users all had different levels of mental illness, each with a different history, level of cognitive awareness, degree of institutionalisation and willingness to adapt and change. This review will assess to what extent service users are involved with the discharge planning process in the ward, if any, and give possible recommendations on how this process may be improved. Aims of the Review During this placement the author decided on a subject to review, this subject was service user involvement in discharge planning. While collating information for the review some questions arose these questions were: Does the service user feel included in decision making? How does the staff involve the service user in the decision making if at all? Has discharge been discussed with the service user? These questions lead to the author constructing some key questions to carry out in the review these will be discussed further in the findings. 91 Methods used to construct review The data for the review was collected over a ten week period within the ward. The author consulted service users notes, attended multidisciplinary team meetings and conducted a series of semi-structured, one to one interviews with service users and staff, including a consultant, doctors, ward manager, nurses, nursing assistants and occupational therapists. A literature search was also carried out using accredited databases including CINAHL and the British Nursing Index. Relevant journal articles were found on these databases using keywords such as service user, involvement and mental health services. Nursing research books were also used to gather information along with web sites underlining national policies and models for mental health nursing. 110 Findings How are decisions made within the placement area regarding discharge planning? A Forensic Mental Health Unit is not part of the prison services it is a service that specialises in the assessment and treatment of people who have a Mental Disorder. According to the Mental Health Care and Treatment Act 2003 a mental disorder is an illness such a personality disorder or learning disability defined by the act, whereby the mental disorder has been a contributing factor to the person offending. Throughout the weeks on this placement research was carried out by the author on policies and procedures for discharge planning. The one in particular that was found to be relevant was the Care Programme Approach (CPA). CPA is about early identification of needs, assignment of individuals or organisations to meet those needs in an agreed and co-ordinated way and regular reviews of progress with the service user and care providers. CPA is also about involving family or carers at the earliest point. The Care Programme Approach requires that service users should be provided with copies of their care plans and it has been increasingly common for service users who have been the responsibility of forensic psychiatrists to have copies of documents relating to their care. (DOH 2008). Systems were in place for comprehensive care planning. There was evidence to show that the service users social, educational and occupational needs were taken into account in the care planning process and other specialist interventions were available. In addition to this, in some cases, discharge/transfer planning was evident from an early stage (not long after admission), although in other cases a few months had elapsed before any document noted those discussions. Discharge planning is enhanced by the Care Programme Approach (CPA) a multi-disciplinary care planning systematic approach that involves service users and their carers. Care Programme Approach is the framework for care co-ordination and resource allocation in mental health services. Decisions for discharge are made through the multi-disciplinary team which consists of consultants, ward manager, nursing staff, occupational therapy and social workers. discharge guidance 4. This will go forward to a tribunal where the service user will be invited to take part, here all the evidence will be put forward and a decision will be made. If the service user is restricted then the decision will be made by the First Minister. When a service user is restricted it means an order has b een applied to them as they are seen by the act to be a more serious offender, this then means that the Home Office is responsible for granting discharge and a representative will be invited to the Tribunal (MHCT Act 2003 SECTION 37/41). Most service users have long term mental health problems and complex social needs and have been in contact with mental health services for more than twenty years so never think about discharge. Being in hospital for so long has become part of their lives so service users see it as pointless being discharged, what would I do. 488 SECTION 117 AFTER-CARE Prior to 1983, no statutory provision was made for the after-care of patients discharged from hospital. Section 117 introduced and defined formal after-care. In particular it stated: It shall be the ditty of the health authority and the local authority to provide in conjunction with voluntary agencies after-care services for any person to whom this Section applies, until such time that the health authority and local authority are satisfied that the person concerned is no longer in need of such services . Section 117 of the 1983 Mental Health Act applies to patients who have been detained under Section 3,37, 37/41, 47/49, 48/49. Before a decision is taken to discharge or grant leave to a patient, it is the responsibility of the RMO to ensure, in consultation with other members of the multi-disciplinary team, that the patients needs for health and social care have been fully assessed, and that the care plan addresses them. The Section 117 meeting The aim of the meeting is to draw up an after-care plan, based on the most recent multi-disciplinary assessment of the patients needs. During the meeting the following areas should be covered as appropriate: Housing Finances Relationships/family Employment Social needs Psychology/mental health difficulties Relapse predictors Known risk factors When the care plan is agreed the team should ensure that a key worker is identified to monitor the care plan. The Care Co-Ordinator can come from either of the statutory agencies, and should not be appointed unless they are present at the meeting, or unless they have given their prior agreement.. The process for Sec 117 can be found in Trust Policy and Procedure and applies to all patients accepted by psychiatric services. What decisions/involvement does the service user have in this process? Within this placement the care and treatment plans are reviewed on a regular basis. Service users are expected to meet with their key worker and other team members on a regular basis, care plans are reviewed at these meetings and a mutual agreement will be decided, on the best way forward, once the care plan has been agreed by all the service user has to adhere to the care plan.(discharge guidance)no.16 Rights, Relationships and Recovery (2006): The Report of the National Review of Mental Health Nursing in Scotland Service users are encouraged to be fully involved in all aspects of their care as far as they are able to. Service users past and present wishes should be taken into account, their views and opinions with regards to their treatment plan must also be recorded, as stated in the Mental Health (Care and Treatment) Act Scotland 2003. These wishes and aspects will be turned into a care plan that is individual to the service user. The principles of the act underpin any decision made relating to a detained service user in Scotland. The Milan Committee devoted a chapter in the act that referred to high risk patients it stated that service users should have the right of appeal to be transferred from a high or medium secure facility to that of a facility with lower security conditions. (Mental Health Care and Treatment Scotland Act 2003). This however seemed to be the problem across the board, lack of medium/low secure facilities to discharge /transfer appropriate service users to. Service users have the opportunity for regular one-to-ones with their key workers (weekly basis) or more regularly if they require. Service users have the opportunity to put forward their thoughts on discharge and any other aspect of their care at the review, such as their rights, beliefs and their right to a tribunal. The author attended these independant tribunals while on this placement and at these tribunals people had stated that their human rights had been violated (The Human Rights Act 1998). They felt they were still being discriminated against for offences they had committed 20-30 years ago and feel they were being held under excessive security hence the reason for the tribunal to appeal against this level of security. this would mean they would be granted grounds access on a trial period which may be supervised, then become unsupervised for a trial period to see how the service user would cope, this in turn will lead to a further tribunal taking place in a set time agreed f or example 4 or 6 months away, where the service user may be granted discharge/transfer to a lower secure unit depending that all provisions that had been put in place had been adhered to, for example, risk assessment reviewed, treatment regime being followed, attend all social/therapy/strategy groups that were agreed. The review takes place every four months, again this is a multi-disciplinary meeting and service users are invited to attend with the support of advocacy or someone of their choice. The Human Rights Act 1998 gives legal effect in the UK to certain fundamental rights and freedoms contained in the European Convention on Human Rights (ECHR). These rights not only affect matters of life and death like freedom from torture and killing, but also affect your rights in everyday life: what you can say and do, your beliefs, your right to a fair trial and many other similar basic entitlements. During the time spent on this placement it was noted that service users and key workers met at the beginning of the week to discuss how they felt things had been for them, the service user has the opportunity to discuss what changes they would like to happen, this is then recorded in the service users notes and taken forward to the clinical team that week where it would be discussed if any changes in care and treatment would take place, the service user is then informed of any changes and decisions made which they have the right to appeal against (The Human Rights Act 1998). The opportunity arose for the author to take part in these weekly reviews, during this one-to-one time most service users were able to express their thoughts and feelings about issues they had encountered that week and describe what therapeutic strategies they used to get through it. The service user will be provided with a copy of the Treatment Plan Objectives, or informed in detail of the contents of the treatment plan, in the event that any learning or specific reading or language difficulty information should be provided in a way that is most likely to be understood. Arnstein (1969) constructed a ladder of participation which described eight stages of user participation in services, including mental health. These stages ranged from no participation to user controlled services. The above service users would be placed on the sixth rung of the ladder in the partnership range as they agree to share planning and decision-making responsibilities. Partnership Partnership, like community, is a much abused term. I think it is useful when a number of different interests willingly come together formally or informally to achieve some common purpose. The partners dont have to be equal in skills, funds or even confidence, but they do have to trust each other and share some commitment. In participation processes as in our personal and social lives building trust and commitment takes time. discharge guidance 16.6 908 Does this placement area reflect its practice on local or national policies regarding service user involvement in discharge planning? (Mental Health Care and Treatment Scotland Act 2003). (The Human Rights Act 1998). When asked their views on the subject the Ward manager and senior nursing staff presented documentation which reaffirmed current practice within the ward. The Ten Essential Shared Capabilities (ESCs) DOH (2004) he explained was the model now being followed on the ward, has just been implemented into this area of placement within the last two years, which the ward staff have adopted well by providing a person-centred approach as much as possible. This new person-centred model embraced the ethos of the above, and senior staff stressed that good practice dictated that service users have the opportunity to appropriately influence delivery of care and support. A review of policies and procedures as well as discussions with staff provided evidence that the policies were actually in place. Throughout the placement, the author noticed that efforts were being made all the time to nurse according to the new model. Included were regular one to one sessions between nurses and service users to hear their views and thoughts, these already took place before the ESCs were introduced. Moreover some staff do find it difficult to adopt the ESCs and the mental health act due to the restraints of the environment (secure ward); however they are prepared to embrace the opportunity for further education and support. 211 Identify barriers and constraints. Before a decision is taken to discharge or grant leave to a patient, it is the responsibility of the RMO to ensure, in consultation with other members of the multi-disciplinary team, that the patients needs for health and social care have been fully assessed, and that the care plan addresses them. Section 117 of the 1983 Mental Health Act applies to patients who have been detained under Section 3,37, 37/41, 47/49, 48/49. While on placement and conducting this review the author noted that one of the barriers to effective involvement came from some of the service users, due to the complex nature of the area the service users had become institutionalised and found it difficult to be thinking about discharge at this stage in their lives, so they just accept the way things are and do not get too much involved as far as care plans are involved and just say what they think the staff want to hear. In secure settings engagement of service users in assessment and treatment can be difficult, as there is a potential risk of perceived coercion. Moreover with the lack of medium secure facilities around this can hinder service users from moving on within the specified time limit agreed, as there are no provisions. 138 Recommendations for Development SMART Most service users were more concerned about their futures and life post discharge. They wanted their time between now and then to be concerned with preparing them for discharge. It was frustrating for many service users that they felt that little in the way of such preparation was taking place. Continue to provide service users with support and skills needed appropriate to their function and skills already held, for example cookery groups, IT groups. Provide groups that enhance social skills such as coping strategy groups, anger management, alcohol/drug treatment/groups. High secure units should ensure that at the point of discharge patients have a copy of their discharge care plan in a suitable format which includes appropriate information about the circumstances that might result in their return to a secure mental health provision such as However a recommendation that high secure units should ensure that factors to be weighed in assessing relapse are part of the risk assessment included in the discharge plan of all service users. The National Service Framework for Mental Health states that Service users and carers should be involved in planning, providing and evaluating training for all health care professionals (Department of Health, 1999). This is the case in most health care provisions but for more education, training and information to be more readily available. Strengthening the user perspective and user involvement in mental health services has been a key part of policymaking in many countries, and also has been encouraged by World Health Organization (WHO) in order to establish services that are better tailored to peoples needs and used more appropriately. 265 Reflection In this review, I need to reflect on the situation that took place during my clinical placement to develop and utilise my interpersonal skills in order to maintain the therapeutic relationships with service users. In this reflection, I am going to use Gibbs Reflective Cycle Gibbs (1988). This model is a recognised framework for my reflection. Gibbs (1988) consists of six stages to complete one cycle which is able to improve my nursing practice continuously and learning from the experience for better practice in the future. During the first week of placement I was encouraged to work closely with my mentor. This gave me the opportunity to orientate myself to the ward and get an overview of the needs and requirements of the service users. This also provided me with the chance to observe how the nursing team worked on the ward. During this time I had learned that if the concept of inter-professional working is to succeed in practice, professionals need excellent team working and communication skills. Good communication, as we have staged in our group work theory, (skills for practice 3) is crucial in the effective delivery of patient care and poor communication can result in increased risk to the service users. I have learned the valuable skills required for good communication and will transfer these into practice by adapting to the local communication procedures (expand). The NMC advices that at the point of registration students should have the necessary skills to communicate effectively with colleagues and other departments to improve patients care (NMC, 2004). 256