Interprofessional Collaboration

Interprofessional communication and collaboration are a significant part of ensuring safe and effective patient outcomes. In the case detailed below the health care team failed to communicate and collaborate care of patient A, ultimately leading to a negative outcome. Patient A is a female white 38 year old G1P0 with Type I diabetes since the age of 9. Due to her high risk pregnancy and history of non compliance with medical therapy she had been coming in since 28 weeks gestation for twice weekly non stress tests. One Saturday as patient A was at the hospital for her non stress test she was found to have elevated blood pressure and proteinuria. Dr. A, an obstetrician (OB), who was on call for the weekend decided to send the patient home on bed rest and to follow up with her primary OB physician, Dr. B on Monday. At her follow up appointment with her primary OB, she was found to still have elevated blood pressures, blood sugars in 200's, 2+ protein in her urine and had some elevated blood work. Primary OB decided Patient A needed to be induced due to patient A’s unstable condition. Primary OB is not on call this particular Monday and asked Dr. C to induce her patient. Dr. C was not happy about inducing her because of her high risk status but agreed to do so. Dr. D, a laborist and pediatrician, wanted the patient transferred to a higher level of care facility because he felt due to patient A’s history best care for the newborn would be at another facility. Dr. D and Dr. C argued about patient A’s care and disposition at the nurses’ station which was in close proximity to patient A’s room. The nurses who were without a manager at the time were unable to control the altercation between Dr. C and Dr. D. Patient A who overheard the discussion eventually asked to be transfer to another hospital to seek care elsewhere. This paper highlights the importance of effective interprofessional collaboration that is missing in this case. As well, potential plans of action and potential outcomes are discussed. Plan to Address Conflict The major conflict in this situation was a lack of communication between providers regarding the best plan of care of the patient. In addition to the obstetrician, members of the interprofessional team should include the pediatrician, a nurse leader, and the patient. Legare et al (2011) describes a stepwise approach to interprofessional collaboration and the shared decision-making process. The members of the interprofessional team must start by exchanging information and options available related to the care of the patient. Next, the values of both the patient and the healthcare providers should be clarified and addressed. The feasibility of each option should be weighed. Often, certain options are not feasible based on resources or time. In this case, the skills and comfort of the healthcare team members needed to be considered. Once a decision is made, the information needs to be disseminated, including the plan of care and rationales for the decision made. SBAR (Situation, Background, Assessment, and Recommendation) is a useful tool in succinct and structured communication. (Boaro, Fancott, Baken, Velji, & Andreoli, 2010) To prevent future situations similar to this one, Standard Operating Procedures, or SOPs, should be developed and followed. These SOPs should address staff competency, scope of practice, role clarification, and the resources and limitations of the facility. The interprofessional team should develop these SOPs together to ensure they reflect the values of the involved disciplines. (Gardner, 2010) Additionally, resources are available to aid hospitals in developing a structure for interprofessional collaboration. A national interprofessional competency framework detailed by the Canadian Interprofessional Health Collaborative (CIHC) provides an integrative approach to describe competencies required for the interprofessional collaboration to be effective. They are as follows: (1) interprofessional communication (2) patient/family centered care (3) role clarification (4) team functioning (5) collaborative leadership (6) interprofessional conflict resolution. (CIHC, 2010) CIHC suggests that having a competency framework because it helps the team make sense of the learning practice, it will differentiate matters by relevance, give the team members a chance to apply the learning to practical situations and then associate the learning elements by integrating them. CIHC, 2010) When this patient arrived to the unit, if the team had used the six suggested competencies providing best care for this mom and baby could have been achieved easier. Discussion of Outcomes The intent of interprofessional collaboration is one that will foster the safe practice of all health care professionals, and enables the achievement of better outcomes. Some outcomes needed for this particular situation would be as followed: 1. Shared decision making between all pr oviders involved. What is the best practice that can be provided for a safe outcome for mom and baby? Inducing the mom because it was best practice was made by the OB, but she didn't factor in safe practice for the pediatric doctor in this situation. 2. Demonstrate professional conduct during inter professional collaboration. Make sure if there are any discussions with team members, disagreements with the care that is being provided that it is not done where the patient can hear it. 3. That the interprofessional team can acknowledge the various skill levels of everyone involved. The pediatric hospitalist is this situation felt that the patient’s diagnosis of Type 1 diabetes, uncontrolled throughout the pregnancy put the baby at risk for having glucose controlled problems and felt that a higher level of care was needed because it was beyond his skills set. Interprofessional collaboration was necessary in this situation. No one discipline has all of the knowledge needed to provided complete patient-centered care. True interdisciplinary patient-centered care includes a partnership between health care professionals as well as the patient. This collaborative and coordinated approach improves patient outcomes and quality of care (Orchard, Curran, & Kabene, 2005). In this case, the interprofessional team failed to communicate effectively. This lack of communication and professional conduct led to a failure to recognize the skill levels of the team members, and prevented the team from making a shared decision that would benefit the patient. Conclusion In order for patient A to achieve a positive outcome several factors related to interprofessional collaboration needed to be addressed in this case. First, to improve collaboration and understanding, clear team roles of the health care providers should be defined. Scopes of practice as defined by standard operation procedures and discussions of available resources should be taken into account. In addition, distribution a consistent communication tool such as SBAR could be used. Had the healthcare providers involved with this case practiced as a team, positive outcomes such as: open communication, trust, professionalism and improved patient outcomes and experiences would have been achieved. References Boaro, N., Fancott, C., Baker, R., Velji, K., & Andreoli, A. (2010). Using SBAR to improve communication in interprofessional rehabilitation teams. Journal of Interprofessional Care, 24(1), 111-114. Gardner, D. (2010). Expanding scope of practice: Inter-professional collaboration or conflict? Nursing Economics 28(4), 264-266. Legare, F., Stacey, D., Pouliot, S., Gauvin, F. P., Desroches, S., Kryworuchko, J., †¦Graham, I. D. (2011). Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model. Journal of Interprofessional Care 25, 18-25. Orchard, C.A., Curran, V., & Kabene, S. (2005). Creating a culture of interdisciplinary collaborative professional practice. Medical Education Online. Retrieved from http://med-ed-online.net/index.php/meo/article/viewArticle/4387. Canadian Interprofessional Health Collaborative. ( 2010). A National Interprofessional Competency Framework. Retrieved from http://www.chic.ca/files/CIHC_IPCompetencies_Feb1210.pdf

Succubus on Top CHAPTER 4

â€Å"Doug!† He shrugged. â€Å"It's not a big deal. I mean, it's pretty hot, really.† â€Å"But I didn't do those things. It's not really me.† â€Å"She sounds just like you. Her name begins with a Gtoo.† â€Å"But it's not†¦Ã¢â‚¬  I swallowed, noting the similarities as well. Doug watched me appraisingly. â€Å"You can't really blame them. Description-wise, you two match, and everyone knows you and Mortensen are chummy – not to mention what a zealous fan you are and all. After they read the story, Casey even made the brilliant observation that you guys came in together yesterday. You should have seen the speculation that started.† â€Å"But†¦that was nothing.† No one at work even knew Seth and I were dating. I hadn't wanted that widely known. â€Å"We hadn't done anything.† Doug shrugged again, rising from the computer. â€Å"Too bad. I wouldn't have thought less of you if you had, you know. It's your business anyway.† I groaned. â€Å"Not when it's in print for everyone to see.† â€Å"I thought it was all fictitious,† he reminded me with a sly grin, putting on his coat. â€Å"It is! Doug, what am I going to do?† â€Å"Don't know, Kincaid. I'm sure you'll figure something out. Maybe start with asking Mortensen why he's putting his fantasies on display for everyone to see.† He tweaked my cheek, and I squirmed out of his reach. â€Å"As for me, I've got a rehearsal to get to. Big night tomorrow. Later.† My shift proceeded miserably after that. Now that I knew what the looks were for, the experience moved into a whole new realm of humiliation. I hated idle speculation, hated people thinking terrible things about me. I mean, it wasn't like I hadn't ever tied someone up before or had sex in an elevator, but come on. It wasn't the kind of thing I wanted people to consider publicly. I liked to keep my intimate affairs discreet. I therefore stayed in the office as much as possible, only going out to help when absolutely necessary, and to check if Seth had returned yet. Finally, a couple hours before closing, I saw him back at his table. I sat down opposite him in a rage, not even caring what others would think of us being together. â€Å"Why did you do it? Why did you write me in like that?† Seth looked up from his laptop, his expression clearly implying whatever writing he was working on still held his attention more than I did. For all I knew, I was at the center of an orgy in some novel now. â€Å"What?† â€Å"The story!† I threw American Mystery onto the table loudly. â€Å"You wrote me in. I'mGenevieve.† He blinked. â€Å"No you aren't.† â€Å"Oh yeah? How come both our names begin with a G? How come we look alike?† â€Å"You don't look anything like her,† he countered. â€Å"That's not what half the store thinks. They think she's me! They think you've written up a fling we had in an elevator.† Realization flashed across his face, and to my horror, he actually smiled. â€Å"Really? That's funny.† â€Å"Funny? It's terrible! They all think I'm a bondage freak.† â€Å"Thetis,† he began gently, still damnably serene, â€Å"I – â€Å" â€Å"Don't ‘Thetis' me. It won't work.† â€Å"I wrote that story, like, six months ago. Long before I met you. The publishing world doesn't move that fast.† â€Å"Well, the others don't know that.† I hovered on the verge of tears. â€Å"I'd never write in anyone so blatantly.† â€Å"Yeah? Well, they don't know that either,† I said, slouching back against my chair miserably, arms crossed. Seth sighed, his amber brown eyes compassionate as he regarded me. â€Å"Look, do you want me to say something? Tell them that it wasn't you?† â€Å"Lord, that would just convince them even more that it was me. Besides, what are you going to do, call a press conference to clear my name?† â€Å"I'm sorry,† he told me seriously. â€Å"I never thought anything like this would happen.† A hesitation. â€Å"Do†¦do you still want to go out tomorrow night? I mean†¦if you don't†¦Ã¢â‚¬  The old adorable shyness fell over him, and I couldn't stay mad. â€Å"No,† I told him. â€Å"I still want to go, but†¦I think we should, you know, show up at the concert separately. Most of the staff will be there, you know.† He opened his mouth to speak but then reconsidered. I suspected he had been about to accuse me of overreacting, but apparently my radiating fury made him think better of it. Seth wasn't exactly the confrontational type. Or, considering the mood I was in, perhaps he just wasn't the stupid type. â€Å"Okay,† he finally said. â€Å"We'll meet there.† â€Å"Georgina?† Looking up, I saw Paige standing over us, disapproval all over her face. I hadn't even noticed her approach. She wore another of her beautiful power suits, this time in an electric violet that looked stunning with her dark skin. â€Å"Can I speak to you for a few minutes?† she asked, tone grim. â€Å"In private?† I followed her to her office, letting her close the door behind us. Not surprisingly, a copy of American Mystery sat on her desk. â€Å"So,† she began crisply, â€Å"I've been hearing some rumors – â€Å" â€Å"Damn it. It's not me.† I proceeded to relate to her my own recent discoveries, pointing out Seth's observation concerning how long it took for works to come out in print. When I finished, I think I had mostly convinced her of my innocence, though sordid stories flying around the workplace still obviously distressed her. Studying nothing in particular, Paige drummed her lacquered red nails against the desk as she thought about what to do. â€Å"This will get cleared up with the staff in time. That, or they'll just get over it. What I don't like is the idea of any outsiders drawing conclusions. You do sound like that character, and anyone else who reads the story could make the same mistake. I don't want rumors starting that half of Seth's reason for working here is that he gets sexual favors on the side, courtesy of our employees.† â€Å"Oh Lord.† I covered my face with my hands, wondering how celebrities dealt with truly large-scale scandals. This small one was bad enough. I wanted to disappear. It tainted the beauty of what Seth and I were trying to build. â€Å"I think the best way to approach this is – â€Å" Her words dropped off as a grimace crossed her face and one hand clutched her stomach. I started toward her. â€Å"Are you okay?† She nodded, forcing a strained smile. â€Å"It†¦it's nothing.† â€Å"The hell it is. You should call your doctor†¦or at least go home.† â€Å"No, it'll pass. Besides, I've got too much to do. I need to make the new schedule and go over some inventory stats.† â€Å"That's crazy. I can do that stuff.† She shook her head, arguing again, and I argued right back. At last, Paige yielded, which only verified something must be seriously wrong. Those who went head-to-head with her rarely won. So, I finished my shift doing her extra jobs and serving as backup. It was exhausting, but I was happy to do it, still worrying about her and her baby. When we closed, I headed straight over to the suburbs, following the directions Bastien had given me. When I pulled up to his house, I could only sit in my car and stare for a few minutes. Now, I had a few well-formed ideas about the American Dream. After all, I'd been alive in the days when the term was first coined. I'd seen it arise, seen the mythology that surrounded it, seen the white picket fences and cute, well-kept neighborhoods. I'd even watched Leave it to Beaver. Seth's brother, for example, lived north of the city and had a pretty nice chunk of it carved out. But this? This was an American Wet Dream. Bastien's house went on forever, expanding ostentatiously beyond its marble and taupe facade. Even if he'd had a wife and family, I doubted they could have filled it up, and anyway, the kind of people who lived in these places didn't have large families. After all, this was the generation that had, what, 1.75 kids? The garage had three doors, as advertised, and tasteful shrubs and ornamental trees decorated the lawn. Since it was dark now, I couldn't see the rest of the neighborhood in detail, but I suspected I'd find more of the same. One house, next door, was lit up and busy with people. It was even bigger than Bastien's and probably the location of the party. â€Å"Are you compensating for something?† I asked when the incubus opened his door. Mitch Hunter flashed me the million-dollar grin. â€Å"My sweet sister, you and I both know that's not true. Love your haircut.† I'd come as Tabitha Hunter, lean and blond, though I'd conceded to his earlier complaints and given myself shoulder-length hair. He kissed my cheek and ushered me inside for a quick tour. After a few rooms, it all started blurring together. Cherry hardwood floors. Gorgeously painted walls. Sleek black appliances. Wainscoting. A hot tub out back. Enough guest bedrooms to house a Girl Scout troop. And cute, cleverly placed knick-knacks everywhere. â€Å"Isn't this going a bit far?† I asked, pointing to a framed copy of the Lord's Prayer in the foyer. â€Å"Tabitha, my love, man cannot survive on bread alone. We can, however, survive on delicious appetizers and hamburgers, so let's head over.† We arrived considerably after the starting time, since I'd been at work, and the party was in full swing. Maybe I shouldn't have been so quick to dismiss these suburbanites after all. â€Å"Mitch!† called a loud voice as we shouldered our way through the people. Most were dressed for the barbecue theme in shorts, T-shirts, and Hawaiian prints. â€Å"Hey, Bill,† returned Bastien, extending his hand to a plain yet well-groomed man with silver-streaked black hair. I recognized him from his photos. Dana's husband. â€Å"This is my sister, Tabitha. Hope you don't mind me bringing her.† â€Å"No, no! The more the merrier, I say.† He allowed a small, artificial laugh and smiled at me, making his eyes crinkle. â€Å"Especially ones so pretty. Makes me wish I was a younger man,† he teased with a wink. Unable to resist, I looked up at him through my lashes and said demurely, â€Å"I've always thought age was kind of irrelevant, Bill.† I held onto his proffered hand. â€Å"I know I'm always happy to learn from those with more†¦experience.† His eyes widened slightly, lighting with both intrigue and alarm. â€Å"Well,† he said after an uncomfortable moment, â€Å"I should probably spread myself around.† He remembered to let go of my hand. â€Å"Feel free to find something to eat, and don't forget to try the pool.† He glanced at me and my come-hither smile consideringly, hesitated, and then reluctantly departed. â€Å"Don't ever do that again,† hissed Bastien, steering me toward the kitchen by the arm. â€Å"Do what?† â€Å"Flirt with this group! You're supposed to be bolstering my wholesome image, not leading on my target's husband.† â€Å"I wasn't leading him on. Besides, what's it matter? Scandalize them both.† â€Å"No. Dana only. My show.† I cut him a look but said nothing. He wanted me as an observer but not a participant. It figured. All the glory for himself, praise from those above. He'd always had this competitive need to make himself shine. It was one of the things that I liked about him – an eager desire to prove himself the best. I guess I'd had it once too, but not anymore. As far as I was concerned, he was welcome to all the fame and fortune of this gig. â€Å"Just play my sweet, angelic sister,† he continued in a whisper. â€Å"Possibly my sweet, angelic, and frigid sister.† Moving through the house gave me a chance to take in more of the party's theme. Faux palm trees. Glittering, decorative suns everywhere. Small appetizer tables set up here and there, laden with deviled eggs, cocktail wieners, and cubed cheese. It was silly in some ways, but someone had obviously paid a lot of attention to detail. I appreciated that. All of the guests looked like Bill – and Bastien and me, I realized. Clean-cut, with every hair in place. High quality, conservative clothes (in a tropical sort of way). Upper-class. White. They freaked me out. The kitchen proved to be the true hub of food, and I decided to simply gorge myself rather than risk more conversation that might upset Bastien. I loaded up a paper plate with a hamburger, potato salad, and some kind of weird Jell-O-fruit-whipped-cream hybrid dessert. My efforts to simply eat unnoticed proved futile, as I soon found myself surrounded by a group of women. I didn't know where they'd come from. One minute I was just eating, the next minute six perfect faces were smiling at me. They were like a pack of wild dogs, yipping nonstop, honing in on lone prey. They'd even managed to separate me from Bastien, all the better to tear me apart. The incubus now stood across the room with a similarly ravenous group of men, no doubt discussing cigars and lawn mowers. I shot him a panicked look, but he merely shrugged. â€Å"Mitch's sister,† oozed one of the women. â€Å"I should have known! You guys look exactly alike.† â€Å"Well, not exactly alike,† tittered another. She wore an appliqu? ¦ sweater vest. Yikes. â€Å"We were just talking about stamping. Do you stamp, Tabitha?† â€Å"Urn, like use stamps?† I asked with a frown. â€Å"I mean, I mail things†¦Ã¢â‚¬  The Stepford Wives giggled again at this. â€Å"Oh! That's so funny.† â€Å"We mean rubber stamps. Arts and crafts stamps,† explained one of them. She'd introduced herself as Jody – the only name I could remember among the group. Probably because she seemed to have a slightly higher IQ than the rest. And was the only one of us without blond hair. â€Å"You use them to decorate things. â€Å" She dug into her purse and produced a small invitation on beautiful ivory cardstock. Scrolling vines and flowers decorated the front. â€Å"This is the invitation Dana made for this party.† I stared. â€Å"Seriously?† Somehow I'd imagined the â€Å"Great Job!† kind of stamps that teachers used on well-written papers. This was beautifully inked and in different colors. It looked professional, like something from Hallmark. â€Å"Mitzi's having a stamp party next week,† exclaimed one of the other women. â€Å"We could show you how to do it.† â€Å"Ooh†¦that would be so fun!† â€Å"Yes! Let's!† â€Å"Gee, it looks kind of time-consuming,† I told them, wishing desperately that I was somewhere else. I was sure I could have held my own in a cigar and lawn mower conversation better than a stamping one. â€Å"I don't think I have the time.† â€Å"Oh, but it's so worth it,† one assured me earnestly. She wore earrings that spelled ALOHA in dangling letters. â€Å"Betsey and I made bridal-shower invitations for her sister all day yesterday, and the time flew by. â€Å" â€Å"Did you use those cute dove stamps?† cooed another, not unlike a dove herself. â€Å"I spent all Tuesday looking for those at the mall.† â€Å"Don't you guys work?† I asked, wondering at their frequent use of â€Å"all day.† A century ago, I wouldn't have given it a thought. But this was the age of the so-called modern woman. We weren't supposed to lounge around in parlors anymore and pass out from wearing corsets. They turned to me, mouths agape. â€Å"Well, there's so much to do around the house,† Jody finally said. â€Å"Most of us are too busy with those things.† Like stamping? â€Å"Besides,† laughed Bitsy or Muffin or whatever the hell her name was, â€Å"it's not like we need to. Do you have a job?† â€Å"Well, yeah†¦Ã¢â‚¬  â€Å"What's your husband do?† â€Å"Oh. I'm not married.† This got more stares, and then suddenly they erupted with ideas and suggestions of â€Å"perfect single men† who worked with their husbands. I had to get out of here. Either that or render myself funconscious with the wrought-iron pig wearing an apron that sat on the kitchen table. I turned anxiously to Jody. â€Å"Didn't I hear there was a pool somewhere?† She brightened. â€Å"There sure is. I'll show you.† We extracted ourselves from the others, and she led me toward the back of the house. â€Å"Sorry if they're a little overwhelming,† she apologized. â€Å"I sort of feel responsible for their stamping frenzy. â€Å" The fact that she'd used the word â€Å"frenzy† to describe them made me laugh. â€Å"How so?† â€Å"I got them into it.† Her dark eyes twinkled. â€Å"Never thought it'd go this far, though. I used to be an elementary art teacher, and sometimes they remind me of the kids. They're all good souls, though.† â€Å"Why don't you teach anymore?† Drawing pictures with children sounded like a wicked cool job to me. If nothing else, the grading had to be easy. â€Å"Well, Jack likes me at home, and this way I get to take out my artistic urges on the house – and enable the neighbors. Every time I get hooked on a new project, our house takes the brunt of it: pottery, beading, watercolors†¦Ã¢â‚¬  â€Å"And stamping?† She laughed. â€Å"And stamping.† â€Å"Could you, like, teach part-time and still get everything done around the house?† â€Å"Maybe. But I've also got my CPFV duties, so my schedule's pretty packed.† CPFV? Damn. For a minute there, Jody had seemed like a pretty cool person. â€Å"You're a member?† Her expression registered mild surprise. â€Å"Yes, of course. We all are. You should come to a meeting someday. I know Dana would love to have you.† â€Å"Where is Dana?† I hadn't even seen the main attraction tonight. â€Å"I mean, I'm such a fan and all. When Mitch told me we were coming, I couldn't even believe it.† Pursing her lips, she glanced around with a cute frown. â€Å"I'm not really sure where she is. She's probably just mingling. Everyone wants to talk to her. But don't worry – you'll see her before you leave.† â€Å"That'd be great.† She smiled and gave my hand a quick squeeze. â€Å"I hope we get to see you around. Oh – here we are.† We arrived in a massive, glass-encased sunroom containing a crystal blue pool. It looked lovely and inviting. When Jody asked if I had a suit, I assured her I had one under my clothes and thanked her for helping me. She returned to the main party, and I slipped into a bathroom where I shape-shifted into a turquoise bikini. Some people eyed me curiously, probably wondering who I was, but they left me alone once I was in the pool. I dove under, swimming laps, enjoying the solitude water offered. It had been a long time since I'd been able to do this. I knew Seth swam at a local health club; he said it helped clear his head sometimes. He and I would have to go together one of these days. Or better yet, swim in the ocean somewhere. Yes, that was the way to go. Moonlit beaches and tropical air, away from this crummy rain. Maui. Cancun. Hell, why did we even have to constrain ourselves to North America? We could go to the French Riviera, the Greek Islands†¦ I was so caught up in my fantasies that when I climbed out of the pool, I didn't notice the woman in front of me. I sidestepped, ever quick on my feet, just barely avoiding collision. â€Å"Sorry,† I said. â€Å"I didn't see – â€Å" I froze. It was Dana. She looked exactly like her promotional pictures. Slim, average height, shoulder-length black hair, and penetrating blue eyes. Her bio placed her in her forties, but she looked a lot younger than that. The result of all that clean living, I supposed. She wore khaki shorts and a green T-shirt, modestly covered by a white button-up blouse tied in a knot over her stomach. A smooth, cool smile settled on her face, and those eyes reminded me of a hawk seeking out prey. â€Å"No harm done,† she said in that same hypnotic radio voice. â€Å"I don't think we've met. I'm Dana.† She extended a hand, and I took it. â€Å"Yes. Of course you are. I mean, I know you are. I've seen your pictures. Er, I mean, I'm a fan and all†¦Ã¢â‚¬  â€Å"And you are†¦?† â€Å"Oh. Sorry. I'm Tabitha Hunter. Mitch's sister. Though maybe you knew that. Everyone says we look alike. I guess we do. I've never really thought about it†¦much†¦Ã¢â‚¬  Ye gods, why was I rambling like this? I had worked dukes and bishops who were ten times scarier than her. They hadn't turned me into a blathering idiot. What was it about one radio bigot that should prove so unsettling? The eyes, I decided. They reflected no warmth. They were shrewd. Conniving. The kind of eyes that warned she had not risen to where she was today without hypervigilance. The kind of eyes that had an agenda. â€Å"It's nice to meet you,† she said, still maintaining that too-perfect smile. â€Å"I didn't know Mitch had a sister. You seem to be†¦enjoying the pool.† Her eyes glanced down over me and back up, suddenly making me feel self-conscious. Water dripped most unflatteringly off of me, and I uneasily wondered if this suit showed too much skin. At least it wasn't white. Bastien's warning about wholesome image came back to me for real, and I understood his concern now. Looking like a strumpet could be bad for his reputation. If he drew whispers and disdain, he might be ostracized from this group and lose access to Dana. Suddenly, Dana's frostiness didn't seem so weird. It was disapproval. She had, after all, delivered a whole spiel on the abominable state of today's fashions. Here I was embodying it. â€Å"It's very nice,† I said. â€Å"One of the, um, best pools I've swam in.† I stopped before I could say something else even more asinine, and silence fell. She looked as though she expected me to continue and could wait all night until I did. Unfortunately, I had no idea what to talk to this weird woman about. My alleged hatred of homosexuals? Ask if she had recommendations for a more modest swimsuit? â€Å"So, um†¦Ã¢â‚¬  I began. â€Å"This barbecue theme†¦it's really, uh†¦Ã¢â‚¬  I was saved just then – sort of – by Bastien. He strode up to us, appearing very excited to have found Dana. A sharp look in his eyes said he was less thrilled to see me, especially in this state, but he kept it masked from the other woman, instead coming off as amiable and charming as ever. â€Å"Ah, Tabitha, I see you've met our hostess.† â€Å"Yes,† agreed Dana. â€Å"We've been having a most stimulating conversation. Your sister's quite the wordsmith.† I flushed. Bitch. When I was in my zone, I could outtalk her any day. â€Å"Glad to hear it. My Tabby Cat here is nothing if not stimulating.† Oblivious to my horror over my new nickname, Bastien steered her into some pleasant conversation about the creativity of the party and the beauty of her home. Her demeanor warmed up only a bit from what it was with me. She still came off cool and watchful. Maybe she was always chilly around people, and it wasn't just me. In fact, I thought optimistically, this slightly elevated interest in Bastien might indicate that she wanted to throw him up against a wall. They conversed a bit longer about something I lost interest in, and I tried to stay inconspicuous, though I could tell I never dropped off Dana's radar. She was studying me, trying to figure me out. Finally, Bastien said good-bye, and we began our retreat toward the front door – once I'd changed back to decent clothing, of course. Our exit proved more difficult than expected since apparently it was customary to say good-bye to every single person you passed and get continually delayed by meaningless small talk. â€Å"My God,† I exclaimed once we were safely back at his place, â€Å"that was annoying.† He turned on me, anger flashing in those movie-star blue eyes. â€Å"Are you completely out of your mind?† â€Å"Okay, you're right. I've been in more annoying situations. Remember that marquis' party back in Marseille?† â€Å"That†¦that getup! When I first saw you two together, Dana looked ready to explode. Thank goodness this body's more flat chested than your other one. It saved you from looking like a complete pinup.† â€Å"I'm sorry,† I told him. â€Å"I was just trying to escape those stamping women and headed for the pool without thinking. I have a suit just like this at home. It was stupid†¦but I don't really think it caused long-term damage.† I hoped. His expression darkened, and he threw himself into one of the living room's exquisite armchairs. It was covered in white suede. Breathing on it would probably get it dirty. â€Å"I don't know. She was distant with me – you saw it.† â€Å"I was hoping that's how she always is. And she was a bit more responsive with you than me,† I offered helpfully. â€Å"No. You should have seen her when we spoke earlier tonight. Much friendlier. She definitely clammed up with you around.† â€Å"I'm sorry,† I said again, feeling idiotic. â€Å"I guess I shouldn't take a front-row seat to this after all. I'm cramping your style. Or rather, destroying it.† His stormy expression lingered a bit longer, then disappeared like clouds swept away by wind. That was my Bastien. Quick to anger, quick to love. â€Å"No matter, Fleur .Takes a lot more than you to ‘destroy my style.'† He patted his lap and grinned. â€Å"Come here, sis, and I'll tell you the rest of my brilliant plan.† I rolled my eyes. â€Å"Are we that kind of family?† His smile broadened, and I sat down, unable to resist that goofy charm. He slung his arm around me in an old, familiar way, and I leaned into him. It was nice to have the touch and comfort of another living thing, romantic or not. â€Å"So there's another part of this wacky plan?† â€Å"Not so much another part as an entirely different plan. A backup plan, if you will.† â€Å"Oh no. Here it comes.† â€Å"Naturally, I'd much rather disgrace Dana in a horizontal kind of way, but in the very unlikely event that doesn't work, there's a much less exciting – yet effective – way to do it. And you're going to help me.† â€Å"How so?† â€Å"We're going to break into her house. â€Å"

IELTS Essay On Fast Food

Modern habits and lifestyles demand that we achieve many more goals and targets every day. Our iPhone, tablet, GPS and laptop enable us to communicate instantly, get instant answers and have access to instant information. We live very fast lives and many of us want this to extend to our eating habits. Fast food allows us to eat ‘tasty’, economic, convenient meals in a very short time. This is a vexing problem for health professionals and governments globally because, despite advances in scientific research, which tells us how bad a poor diet is for our health, the incidence of obesity is reaching epidemic levels in parts of the world, such as America, Europe and even parts of Asia, and much of it is due to an increased consumption of fast food.Disregard for the advice of health professionals is a malaise that can be directly linked with our modern world and its stressfully quick lifestyle and the highly successful, perhaps too successful, marketing and production of high fat, high sugar, low-nutrient food.What can a government do? They can manage their system of taxation to encourage the provision of healthy cafes, restaurants and fast food outlets. Conversely they can ‘punish’ unhealthy fast food companies with heavier taxation. They can also change the law with regard to the amount of sugar and fat that is allowed in prepared foods.With a determined and sustained campaign to improve people’s awareness and understanding of the dangers of fast food, authorities might do much to ameliorate the situation. However longterm and long-lasting dietary change would need to be part of a wider campaign to promote not just ‘slow' healthy food but a slower pace of life generally.

Focal Point Consultants Essay

While observing CanGo for last two weeks we at FPC (Focal Point Consultants ) have identified some six major issue that we feel should be addressed to allow the organization to better achieve there over all goals. First Concern—Priority 1 CanGo appears to have a financial issue and there is has not been a complete audit to address this issue. Also CanGo needs to learn how to use the resources that they already have and redefine the processes and procedures. First Recommendation The financial team at CanGo needs to work with all the key areas of the company to conduct an audit of current processes. This audit will allow for everyone to review all the current processes that are in place and determine what they can do to enhance them and at the same time the financial team can use this data to outline how much the current processes are costing the company overall. At the conclusion of this analysis the reports will allow for the company to cut spending in the correct areas so that they can improves the others. There are many things that can be done to make improvements without spending money or having to acquire new technology or devices. Within the warehouse for example the layout can be enhanced even more so that people are not wasting time walking. Minor and Major changes to just the layout will allow the CanGo to improve efficiency and overall performance. Each department head needs to complete a detailed time study on the processes they outlined above. Once this time study is complete then the data can be used to see what is taking the longest and make changes to that process. By taking these steps it will allow CanGo to approach improvements in the correct manner by taking those actions that don’t have ny hit to the company’s bottom line. After all these types of changes are complete that is when and only when money should be spent on new technology and devices to make processes more efficient. Second Concern—Priority 2 The loyalty of customers for the specific targeting market is declining. Second Recommendation Think about how you want to be treated as a consumer. Now apply that same concept to the targeting market. Review the evaluations that are submitted by the consumers. It will tell what impression the company is making. Also, spend time in the Customer Service department. This the first point of contact for consumer. How they are handle will determine whether a consumer will return: Customer service might just be the most critical of all in running your business. If your customers like how they are treated, not only will they keep coming back, but they will refer you to others. Treating customers as individuals and not as a stepping stone up your ladder of success can go a long way. Listen to their concerns and build a relationship with them. If your customer feels as though you have their best interest they will be loyal to you. Your customers can really do a lot of your marketing for you. Word of mouth, especially in a world where Facebook and Twitter are some people’s main way of communicating, is a very powerful tool (Debs Marketing Connections, 2012). Third Concern – Priority 3 Online purchases CanGo has talked about that they have a high rate of items added to the online shopping cart. Although this information does not support the amount of purchases actually received via CanGo’s online website. Third Recommendation  Having a high rate of items added to an online shopping cart means that you have a good storefront and getting customer’s to actually place the items within there shopping carts. This is only one piece of the multipart puzzle. The shopping site needs to be enhanced to entice the customer to actually complete their purchase as that is how we are going to make money overall. Since there is a high traffic volume to the website we would also recommend that the marketing team reach out to a third party website advertising company that will pay to place ads on CanGo’s website. This will drive also be another source of revenue for CanGo so they can then reinvest this money back into the company. Fourth Concern – Priority 4 While Reviewing the video’s from weeks 3 and 4 I saw a issue that they is an issue within the warehouse and they do have a solution but no really reviewed the reports that Debbie provided. I think that these reports should have been reviewed while in the meeting so that they could have discussed all the points of the issue and the recommended solution to the warehouse productivity issue. Then Liz asked the group a question I wonder how the board will feel about this recommendation. Fourth Recommendation A solution to this problem would be to complete a full audit of the issue and do a trial run analysis of the proposed solution. This would allow for recommendations to be made to the board and the results of the proposed solution can be given right away. As people need to see measurable figures so that they can tell if something will be worth putting the time and money into the project. Fifth Concern – Priority 5  In the week 4 Videos they are talking about the market segment of boys in Japan. They ask each other questions about how they can get the market analysis complete and then the gentlemen having lunch say that I will do it. Fifth Recommendation There are a couple of thing on this problem that needs to be solved first managers should not interrupt an employee’s lunch unless it is extremely urgent. This is an issue because the employee stated he is â€Å"Just trying to enjoy my lunch break†. The Manager should have approached the employee at a later time when he was not at lunch. Then there is the issue of the market analysis. This assignment should get assigned out to a third party marketing company that can tap into the market in Japan and gauge what the consumer wants. This would be a lot more cost effective than attempting the complete this analysis on their own and wasting resources that they don’t have in the first place. Sixth Concern – Priority 6 Sales are not increasing as projected for the company possibly due to the design of the online purchasing process. Sixth Recommendation Place a test run on the current online purchase process as a consumer. Time the entire process to see how long it takes. As the test run is being completed, keep the consumers’ needs and wants in mind. Determine if needs were met as well as satisfied. View the information available to see if it’s appealing to lead to the purchase the item. Also, notate likes and dislikes of the experience. Have a group of employees to assist to gather more information for comparison. Determine what updates can be implemented to entice the consumer to make a purchase. Keep track of different trends to keep a competitive edge for things like: 1.  In-store pick up. In the past few months we’ve seen Walmart implement in-store pick up for orders placed online, while Sears and Kmart are going a step further bringing online purchases out to your car. In Chicago, Sears and Kmart are even testing home delivery and bundling items with those from its retail partners at Sears’ Marketplace, further blurring the lines between online only retailers and those that came before. And in Florida, Farm Stores lets shoppers order groceries online and pick up at a drive through. 2. Pick up depots.  Smaller retailers without a vast network of stores like Walmart or Sears may open designated pick up locations for goods ordered online. Retail consultant Neil Stern of McMillan/Doolittle points to French retailer Chronodrive. com as an example. 3. Mobile Apps. Smartphones are the dominant cell phone and apps for all platforms are growing. The ones that allow for price comparisons or send out coupons are already among the most heavily used with good reviews, but we’re just getting started. 4. Less flash more function. Forget about flashy apps or features like virtual dressing rooms.  Consumers haven’t responded to these and rightly so. Maybe the technology will get there, but until it does, user reviews are better gauges of clothing fit and quality than any technology can offer. 5. Video. Look for more user-generated video on retail sites. Retailers are letting customers upload video clips modeling new clothes or using a new purchase. Davis believes this is one trend that will definitely pick up speed. 6. Social networking. Facebook and Twitter aren’t even close to played out yet. Consumers can increasingly â€Å"like† or follow a favorite retailer and get discounts or tips on deals.  JCPenney is using Facebook to actually sell goods and more than 12 million consumers â€Å"like† Victoria’s Secret on Facebook as of last month (March), making it the most popular retailer on the site (its Pink brand ranks No. 2, according to the ChannelAdvisor Facebook Commerce Index). That’s an active population of customers reaching out and requesting information from the retailer. And social shopping is just getting started, says Jim Okamura, managing partner at Okamura Consulting, a group specializing in online retail. There’s evidence (that Facebook offers) a good return on investment and there are a lot of retailers that haven’t done anything yet,† he says. â€Å"This is going to be the year of Facebook testing. 7. Daily deals and flash sales. This may seem like a very crowded playing field, but sites like Ruelala and OneKingsLane are reproducing at a furious pace. And based on how quickly many items sell out, often within minutes of email notifications going out, more will jump on this popular trend. 8. Retail based social networks. This is one trend experts don’t expect to happen at any large level. Sears is still trying to build a social network of its own customers and Walmart tried and abandoned a similar effort, neither attempt bodes well for its success. Facebook really owns this space, but look for small, focused sites to create communities of like-minded users, says Okamura. 9. International. â€Å"There’s been an accelerating trend in international or cross border e commerce, of small niche online retailers are now doing 10-20% of their sales outside of their own country,† says Okamura. Look to online shops like SousVide Supreme that sells specialized cooking equipment and StyleTrek. com, a community built to launch up and coming international designers as models. Other big name retailers like Zara and Top Shop are building out their online business to reach U. S. shoppers, even as the store base grows more slowly. 10. Deal aggregators. Of course there are always deal sites, like Dealnews, ConsumerSearch, FatWallet and Brad’s Deals that are cutting through the din of so many sites and sales to bring consumers only the information they’re interested in. (Forbes, 2012).

Anticipated Challenges and Planned Responses

ANTICIPATED CHALLENGES AND PLANNED RESPONSES As our business enters the world of food industry, INTERNAL QUALITY CONTROL 1. Sanitation Problem Every food would not be one if it is not clean. It takes several stages to ensure that our products are not only edible or delicious, but most importantly safe for every consumer. This is also a serious matter of all food industries because its good name is at stake. Orion Foods Inc. being a competitive newcomer, will go through big paces to earn the market’s trust, which is too costly. We have to respond to regulatory authorities which provide the compulsory national framework for food or meat hygiene programmes through laws and regulations. Response Hygienic measures are to be taken during the various processing steps in the manufacture of meat products – the Meat Processing Hygiene.This is part of a firm’s Quality Management (QM) based on the following three principles crucial for meat processing operations: * Prevent m icrobial contamination of raw materials, intermediate (semi-manufactured)goods and final products during meat product manufacture through absolute cleanliness of tools, working tables, machines as well as hands and outfits of personnel. * Minimize microbial growth in raw materials, semi-manufactured goods and final products by storing them at a low temperature. Reduce or eliminate microbial contamination by applying heat treatment at the final processing stage for extension of shelf life of products Fig. *** Microbiological contamination in the meat processing chain Figure *** shows the extent of contamination among meat processing operations, and the possible remedies, if any. If these processes were relinquished, it would highly contaminate meat which is unsuitable for further processing. Final products could be unattractive, tasteless or shorter in shelf life. In light of this issue, Quality Management schemes are needed.Such schemes have technical and hygienic components. The fo rmer encompasses product composition, processing technologies, packaging, storage and distribution. The hygienic aspect, related to meat processes, focuses not only for the final product, but also for the raw materials in various processes. It has two useful schemes: * Good Hygienic Practices (GHP) It follows general hygienic rules and applies recognized hygienic principles as well as laws and regulations issued by the competent authorities, referring to meat and meat products, equipment, Premises and personnel.GHP schemes are not factory specific, they apply to all types of meat plants. They are intended to establish and maintain acceptable hygienic standards in relevant meat operations. * Hazard Analysis and Critical Control Point (HACCP) HACCP are factory and product specific strictly sanitary control schemes that shall prevent, detect, control and/or reduce to save levels accidentally occurring hazards to consumers’ health. Despite GHP in place, accidental hazards cannot be ruled out and may occur at any processing step of the individual meat product.Specifically for meat processing plants, such hazards may be provoked by failures such as: * batches of incoming raw meat materials with abnormal tissues or * heavy contamination, * breakdowns in refrigeration, * failure in cooking/sterilization operations, * abnormal pH or a * in raw or finished products, * errors in levels of application of * curing salts and other additives, * technical problems in sealing of * vacuum packages or cans with * the risk of recontamination.

International Relations Theory and the Environmental Crises Research Paper

International Relations Theory and the Environmental Crises - Research Paper Example The main ecological challenges of the deterioration of the physical health of the environment are still not analyzed in the context of a full-fledged ecological crisis. Let us start analysing the critical situation of our physical environment through various warning signs that emanate from nature including the warming of global climate, thinning of the stratospheric ozone shield, accelerating loss of biodiversity, acidification of freshwater lakes, soil erosion, desertification, and many others (Laferriere & Stoett, 1999, p. 3), IR theorists have remained unable to concentrate on the upcoming environmental crises. The study of the environmental crises in relation to the IR can be initiated by understanding the notion that the underlying causes of ecological degradation are political and wherever they are not, are followed by the human consequences of natural disasters. Many theorists believe that such 'attacks on nature' indicates a commitment to material growth and state power, which requires the systematic control and use of human and non-human nature. Therefore IR theory tells us that 'Positivist' theories are most likely the ones to replicate IR epistemology and are aimed to a limited extent to consider the methods adopted by the natural sciences.This way we see that examining the congruence between realism and environmental crisis requires an appraisal of key realist assumptions and recommendations, and hence of their likely implications for the state of the world. The concept of security that is produced in the classic realist texts of the immediate post-war period is clearly dependent on the container schema. However, it is equally clear that the compelling nature of the realist discourse is dependent not on one single schema and derived metaphors, but on a densely interconnected network of schemas and metaphors which are not static but have their own inferential dynamics (Beer & Hariman, 1996, p. 209). That means realism supports all kinds of power seeking techniques inclusive of all weapons of mass destruction. If we analyze the environmental crisis in the light of Darwinian studies of evolution, it is clear that we would find a solid basis which supports both 'realist' theories of international relations and 'rational choice' approaches throughout the social sciences (Masters, 2004). IR policy suggests that if a policy is perceived as a strict response to international structure, it is to argue that there need be no direct connection between a realist perspective in international affairs and one's particular ideological affinity in the 'domestic' sphere. This has been a controversial argument made about Hobbes which represents either realism's greatest strength or its greatest weakness, depending on one's interpretation.

Swatch Marketing Strategy Case Study Example | Topics and Well Written Essays - 2000 words

Swatch Marketing Strategy - Case Study Example It is evidently clear from the discussion that during the last few years, Swiss Watch Industry is holding a prominent position in the economy, by expanding its export operations. The brand name of Swiss, which provides its consumers the best quality goods with appropriate guarantees as well. This report is an overview of the marketing plan for the company to explore the market, and shows what strategies the company should adopt. The company should have clear objectives regarding the way market should be approached because the market is highly competitive in nature. The major objectives of the Swiss industry are that evaluating the customer preferences, provide needful product, and capture the market and a proficient market share. It is necessary to understand the taste and preferences of new customers. Moreover, the company should follow a customer-oriented approach, by understanding the strategy of its competitors. It is necessary to capture the market and maintain profitability thr ough innovative measures and designs. Like any other company, the marketing function of Swatch to has a great contribution to the success of the product in the market. The company was formed after the merger of two largest watch makers ASUAG and SSIG. Swatch dominates the watch market of the world at present. The company actually took over this position after facing a severe crisis in 1970 that is they faced the serious drop in its sales during that period. The peculiarity of Swatch products is that they range from very low priced products to that with the very high price. One of the important factors behind the company's success is that they had very good marketing strategies. Swatch was considered in the market as a fashion accessory or product. This impression was created through the continuous advertisement and publicity portraying this impression. The marketing plan of the company was to make available in the market the cheapest as well as the costlier watch. In order to make c heaper watch the company introduced several technologies. "The bottom end of the market was the subject of a technological revolution, which made watches much cheaper to produce". Â  The company offers products in various designs. Another success factor in its marketing strategy is that it sponsors many sports events the major one being Beach Volley Ball. The marketing aim of the CEO to make Swatch into a fashion accessory took the company to heights. In order to achieve this objective the company focused on reducing the prices of the watch to make it available to every common man. The marketing strategy helped the company to make record sales of one million units after the implementation of the strategy. The major contribution of the company's marketing function is that it helped the company to mark its presence in over 80 countries. The company has therefore sold over 333 million watches all over the world. The other element that contributed to the success of the brand is the inn ovative product design. The company introduced many smart and trendy designs in the market The Company made trendy designs and made that available at every store. Thus the brand gained wide popularity among the teenagers. Swatch made a landmark design in the 80's that posted record sales in the financial data of the company.