English Coursework †Titanic Essay

Many people across the world watch films. It is so popular because it puts a story on the screen and into life so that people can see it. People watch films for the entertainment value, or are simply too lazy to read and enjoy the magic of a book. The advantages of watching a film at the cinema rather than on video is the bigger screen, and the surround sound, also the atmosphere. This all adds up and creates a bigger impact than a video. People make films to tell a story or get a message across, such as â€Å"Pearl Harbour,† which tells us the story of a real historical event through the eyes of a fictional love story, very much like â€Å"Titanic.† Or â€Å"Shrek,† which puts a message across through the tale. Some films are just made purely for entertainment value, or to make money, such as the Harry Potter films, that were built up from a very popular book franchise. In film they use different camera shots for different reasons, such as:- > Close Up – with this shot, you can see the emotion on the face of the character; they use it to show the emotion more clearly. > Long Shot – The use this type of camera angle to show a large shot of the set or in the case of â€Å"Titanic† the boat. > Point of view shot – These are used to show you what the character can see, a good example of this in â€Å"Titanic† is when Rose is stood on the end of the boat looking out to sea, > Medium Shot – These show the characters body and face, and are used a lot. > Zoom in/out – These can be used to show a long shot of the set and then zoom in to show the emotion on the characters face instead of switching from Long shot to Close-up. > Panning – This can be used to show a large area, or a when a character is walking. An example of this on â€Å"Titanic† is when they go from the back of the boat to the front. They also use Sound Effect to make what is happening sound more real, such as an explosion or band. They also use backing tracks, which can be used to emphasise the emotion a character is feeling. For example, if it was sad, they might use a love song. They use costume to show you what time something was set it, or the class of the people, particularly shown in â€Å"Titanic,† as Jack is very poor and Rose is rich. The characters who wear the costumes are also very important. They have to look the part and sound the part, not just be able to read the lines. They have to act the way a person of that time would. For my GCSE coursework, I will be writing a Media essay on â€Å"Titanic,† which was directed by James Caremon. It was made in 1997, and was the most expensive film made at the time. It won many awards, and is one of the great love stories told, based on a real historical event. The Titanic was quoted as being â€Å"Titanic, wasn’t just another ship, it was bigger, faster, and more luxurious than any other ship before her.† She had two sister ships, The Olympic and The Britannic, all of which were owned by White Star Line, a series of very luxurious ships. It was built in Harland and Wolff Shipyard, and was 882 ft 6 inches, by 92 ft 6 inches. It had 2212 people onboard, 20 lifeboats, which only had room for 1178 people. This was because they thought that the ship was â€Å"un-sinkable,† and didn’t think they needed more. It only had 705 survivors after it sank. The Titanic was under the control or Captain E.J Smith, a much respected Captain. Some people would not travel if the boat was not under his control. It set sail on April 10th 1912 from Cherbourg France, to Queensland Ireland, and then continued out to sea. Titanic sank at 2.20am, on April 15th. The Titanic sank because it hit an ice berg, which pierced its hull and flooded it, making it sink. Captain Smith had ignored the iceberg warnings. This was The Titanic’s maiden voyage. Disaster is defined as â€Å"sudden or great misfortune,† this means something that happens, which usually kills a lot of people, this could also be linked to tragedy, which is defined as â€Å"sad event; dramatic, literature word dealing with serious, sad topic,† which I think means when something bad happens, which brings sorrow, not necessarily to just one person. I think that the amount of people does alter the seriousness of a disaster because it makes it harder to cope with. A Man-Made disaster is something that man has inflicted upon itself, such as when the Twin Towers got destroyed, many people died. I think that a man-made disaster is sometimes worse that a natural one, because you can’t stop a natural disaster, but to inflict one, is just wrong. I think that James Cameron’s depiction of â€Å"Titanic† is very accurate to the real event. Although he told us the story through the eyes of a romantic tale, all the facts are very accurate. The times, the date, the crew, even the people who were on board, such as John Jacob Astor who was the richest person on the ship, is in the film. All of the crew bare a striking resemblance to the real people and are names the same, particularly in the case of Captain Smith. The Real Captain E.J Smith – Captain E.J Smith in the film The numbers of people that died and the ways that they died are very accurate, many people froze in the water, and other chose to go down with the ship. Also the musicians, who are in the film, go down playing, which was noted by the survivors. I think that we are told the real historical every through a love story because it gets us more involved, we can relate to the characters and it opens out emotions more when the tragedy happens. I think that the opening of a film is important because it draws the person in. In â€Å"Shrek† it is funny, which makes the person want to watch more, and also shows you that it is a comedy film. The titles tend to show you what type of film a film is. It also shows you what time period it is set in, and what genre it is. They usually have the theme song for the film on in the background. In the case of â€Å"Titanic† there is the slow adaption of the theme song playing, and the real shot filmed of the real Titanic. I think this shows you that it will be a sad film, but the pace of the music. It then switches into the film and does a panning shot of the film, to show you how big and magnificent it is. Also the reaction of the people towards it, which shows you that it is even magnificent for them, even though it is set in their time period. Setting is important, because it shows is where and when the film is set. A good example of this in â€Å"Titanic,† is the way the different groups of people are treated at the beginning. The rich are aloud to stroll onto the boat, with their luggage being taken care of, bringing dog and other pets. Whereas the poor have to go through lice inspections just to get on, but the rich can bring animals. This shows you how people were treated and in what time period it is set, and is typical of Edwardian England. Rose is first introduced to us twice, ages 101 and when she was younger going onboard Titanic. When she is older, I think she seems like a very normal nice old woman, mid-class and has a caring family. Whereas the younger Rose seems like a bit of a snob by the way she reacts to the Titanic when she first sees it. She is obviously very rich, and leads an upper-class life. We can tell that she is a nice person, even though she wears a â€Å"snob mask† at the beginning of the film, later on we find out the true her. She is shown as someone who is not afraid to ask questions, unlike many women of that time. She asks about the lifeboats and their capacities. When we first meet Jack, he is gambling in a bar. We can tell that he is poor and doesn’t have much to his name. We can tell that he is very cunning by the way he plays cards and wins. He is shown as a very nice person who cares deeply for Rose. He doesn’t seem to care about the class rules, which shows he is a true romantic because he is willing to defy those rules for love. He cares very much about Rose and her safety, even over his own. This is shown at the end, when he lets her sit on the floating table, while he stays in the water, knowing that he will freeze to death. Cal is Rose’s fiancà ¯Ã‚ ¿Ã‚ ½ and is introduced getting out of his very expensive car and getting his man servant to do favours for him. This shows us that he is very rich and has some power. He is shown as quite a snob, and only wants Rose as a trophy on his arm. He is selfish and hits her if she does wrong. He doesn’t agree with Rose’s friendship with Jack, which later turns into love. Molly Brown is shown as quite a loud mouth and is not liked very much by some of the rich people because she was not brought up with money, she is what they called â€Å"new money† her husband struck rich recently, and they did not like this. She is shown as a very nice woman because she helps out Jack when he is going to the dinner with them. Rose’s Mother is shown as a snob; all she seems to care about is the way that her family is seen and how much money they have. She wants Rose to marry Cal just so she can have money again. She doesn’t seem to care much about Rose or her feelings, but in the end we find out how distraught she is about Rose not getting in the lifeboat when she has the chance and shows her true feelings. Mr. Andrews in the man responsible for making the Titanic, he is so sure that it will not sick, and doesn’t put enough life boats onboard. He is shown as a very kind man, who cares very much for Rose. He helps her to safety when the ship is sinking, but does not get on a lifeboat himself. I think this is because distraught about his ship sinking and by the fact that there weren’t enough life boats, which he decided, and now people would die because of the decision. Mr. Ismay, was the designer of Titanic, he just wanted the fame by having her in the news, he pushed the engines too hard by making them go faster and faster when they didn’t need to. If the Titanic wasn’t going so fast she might have been able to turn in time and not crash. Ismay is shown as a coward in the film, he is expected to go down with the ship, but instead he jumps on a lifeboat when no one is looking. The Captain is shown as a very important and respected man. Although it was Ismay who suggested going faster, is was the Captain that made it so. I think that he is depicted as quite a noble man because he goes down with the ship. Rose and Jack first properly meet at the back of the ship when Rose is about to commit suicide. He shows his caring by telling her that he’ll jump in after her even if it means his own death. This becomes one of the themes of the film â€Å"You Jump, I Jump!† Jack first sees Rose as she is looking over the railing of the upper-class deck, it is love at first site and he knows that he has to be with her. I think that this is significant, because although he doesn’t know her he still wants to be with her, even thought he knows there is a vast class difference. I think the setting is significant in the places where the rich and poor are kept. The rich have expensive, luxurious rooms and a fancy dinning area, whereas the poor are kept in bunkers and have a large hall where the dance and socialise. The places where the poor are kept do not look expensive and are very dirty, and infested with rats. As the ship is sinking, it uses many shots, Long shot and close up. It uses long shots to show the ship from afar, there is not music and it is all dark. This shows the isolation of the ship and that it is very unlikely someone will arrive in time to save them. The close up shows the ships breaking apart and falling, it has very dramatic music in the background, and lots of screaming. The characters are all running around franticly and all the glamour of the ship seems to of faded. The atmosphere is created by the screams of the people, watching the ship fall apart. The emotion is created, by watching what is happening to these people, freezing to death, crying for help, desperately trying to get on a life boat. So desperate that they cut one down whilst drowning. My favourite parts of the film are where the ship sinks, and when Jack and Rose are stood on the edge of the ship. There is soft romantic music in the back ground, the main theme song, and there are close ups of their faces, showing the love on them, panning shot around them, stood on the edge, and point of view shots, where you see what Rose does on the edge of the ship. I think this sequence is important in the film because it shows that Rose doesn’t care about class boundaries either, she returns to him, and still loves him, even thought he is of a low class. Also it is the last time Titanic sees daylight. I think that â€Å"A Night to Remember,† another depiction of the historical event, made is 1958, and directed by Roy Baker, is similar to that of â€Å"Titanic.† The most fundamental difference centres on exactly what question each film is answering. â€Å"A Night to Remember† answers the question â€Å"How did the tragedy happen?† whereas â€Å"Titanic† answers â€Å"What was it like to live through it?† â€Å"A Night to Remember† shows us The Californian, the ship that failed to answer to Titanic’s distress call, whereas we aren’t shown that in â€Å"Titanic.† The shots are not that different, they use the same type, but the point of view is very different, â€Å"Titanic† uses a 1st person narrative, whereas â€Å"A Night to Remember† uses the 3rd person narrative. The treatment of the passenger is similar, but I think that the people in the life boats were treated differently on â€Å"Titanic† than â€Å"A Night to Remember.† I think that the way they are treated in â€Å"Titanic† is more like they would be. I think that James Cameron decided to have Rose die at the end of the film because it lets her return to Jack, and that his love for her is still strong, she has finally let go of what happened. She does this by dropping the â€Å"Heart of the Ocean† in the ocean. I think that it shows Rose with all her pictures with her because it shows how far she has come in life, the impact that Jack had on her. It shows her riding on a Horse like a man would do at that time and various other things she wouldn’t have done if she continued as she was before meeting Jack, like fly a plane. If she hadn’t met Jack, she wouldn’t have done any of these things. I think that the theme tune is significant, because it is titled â€Å"My Heart Will Go On,† I think this is saying that Rose’s love for Jack will continue even though he is dead, which is shown when she returns to him at the end. He is still waiting for her, and he still loves her. Even though their physical love has ended, their mental love will go o forever. I think that the film â€Å"Titanic† was made to retell the tragic events that happened, to make our generation live it all over again, get involved in it, be sad about it. By telling us the story, we can tell what it would have been like for someone who went through that, and we can emphasise with them more, and if a film can make someone do that, I think that it make them a better person for it. I think that the events that happened on April 14th 1912 are some of the most horrific and saddest I have ever heard of, and I think that this is a great film and it will truly be loved for generations to come.

028 Develop Positive Relationships with Children

Develop positive relationships with children, young people and others involved in their care. 028 Outcome 1: Be able to develop positive relationships with children and young people. A/C1; Positive relationships with children and young people are important as it has a huge effect on the way we can work with them. When a child is being left into my room in the morning I would go over to greet the child and lift them and make them feel secure. When the child trusts me it helps them to feel comfortable with me, making it easier for them to be separated from their parents.If a child feels emotionally secure they are more likely to participate in play and learning activities unlike a child that sits and cries for their mummy, I would try and bring the child into activities that I know that they enjoy. For example a child in my room was upset and wanted their mummy, I went over to the child and asked her â€Å"would you like to play with the sand. † The child was happy to as it is h er favourite activity. Children are less likely to show unwanted behaviour if they have strong relationships as I can recognise and meet their needs.The more a child feels confident talking to me it will help their language to develop quicker. I can plan more accurately as I understand a child’s developmental needs and know their interests. I am able to respond to children more effectively because I can recognise their expressions and emotions. The Principles of building and maintaining relationships are as follows: Communicating effectively is one of the most important aspects of building a relationship. The way we do this depends on the child’s age and stage of development.I also use facial expressions, body language and gestures. Identifying and sorting out conflicts and disagreements fairly to maintain the child/young person’s trust. I indentify the difficulties and help them to find ways to overcome them. I would always be consistent and fair as children re ly on this. Consistency means not only keeping behavioural boundaries in place but to make sure the staff are not excitable one day and then quiet and withdrawn the next. Showing respect and courtesy helps the children to copy our actions.For example when I hand out toast at break time I would always say `thank you` when I place it down on their tray. I always speak in a warm and friendly tone, and bend down to their level. Valuing and respecting individuality as each child has different strengths, talents and attitudes; by doing this I show that I am comfortable with their differences. Realising that a child has certain interests and building upon them. For example a child in my group loves Mickey mouse so I brought in a Mickey mouse teddy that helped him go down to sleep easier at sleep time.Keeping promises and honouring commitments are very important as children/young people need to know that can they rely on me. I have an understanding of confidentiality as this is essential ab out trust and respect. I need to know when it is ok to breach the confidentiality, aware that there may be a threat. I would never pass on anything said in private, do not gossip because once the breach of confidentiality is broken all trust is then lost. A/C2; Observed A/C3; Building relationships with children and young people change according to the age and stage of a child.It is important to think about their needs and interests. How I would respond to a 12 year old boy would be different to a 4 year old. Building relationships with babies is an absolute necessity as babies need to form an attachment or bond with the early years worker to make up for them missing their parents. The term `key person` is what the EYFS use to describe the role of a person who will take care of the baby or child and develop a special relationship with them. Constancy is important; babies can make more than one attachment although they do need to have one strong relationship.It is important to try an d encourage children to develop strong relationship with other staff so they feel comfortable and secure if the key person is absent. By holding or cuddling a baby this helps to build strong relationships as the baby feels wanted and reassured. Children under the age of 3 years need strong attachments to one person as the still stress over their parents leaving. This can happen during the settling in period. For example a new boy joined our nursery, at the start mummy stayed with him and he sat on her knee and I slowly introduced myself.Next day mummy had informed me that he loved play dough, so after bending down to the child’s level I asked would he like to help me get the play dough table set up. He followed me, giving mummy time to leave the room. The child was fine until he turned round and noticed mummy had gone. He cried, I offered my hand out and said not to worry as mummy will be back soon. I said to the child about making star shapes to show mummy. Mummy came back i n after half an hour. As the week went on, by the end the child came to me, we got his favourite activity and he was distracted.Now he comes into my room without stressing about mummy. I have always enjoyed working with children. I have three children myself and when they were in primary school I would have been a parent helper. I also became a reading partner. I have an understanding of how to approach children, I always smile and I always appear approachable. For instance if a child in my room appears sad, I would go over to where the child is, when I know the time is right I would give eye contact with a smile. I would then ask if there is anything the child would like to do, maybe do a painting or read a book.I always want the children to feel that they are not being excluded. I improve on building my relationships with the children by communicating with the parents. I work two days a week, I have been told a few times by different mummies that their child has missed me, one chi ld in particular kept saying â€Å"go to gems, see weese† the child’s mummy laughs and says that her child continuously tries to say my name â€Å"weese for Louise† I could do more by attending courses on how to understand relationships etc.I can always learn from communicating with my colleagues on how to sort out conflicts. 028 Outcome 2: A/C1; Positive relationships with people involved in the care of children and young people are important as the child’s welfare can be properly monitored, plans for the children`s care and education are more effective and children are given consistent care. Good communication with everyone in the workplace is important; it is also essential to ensure that colleagues work well together and can share our skills/ideas and gain information with each other.Everyone should work together to meet the needs of the children in the setting and find out what their interests are. If colleagues do not have good relationships then it may cause bad feelings and a divide between colleagues. It may be the case that you will all not work well together and are not able to share information, and then the parents and children may suffer. It is important to have good communication with the children in the etting as this ensures you will have a good relationship with them which will help them feel more comfortable when they are settling in or provide reassurance during transitions in their lives as well as supporting them in their play and learning. Good communication is needed to ensure that information is passed on correctly to the families that will benefit the children. Also if the parents see that you have a good relationship with the children it will help them feel more relaxed and helps them to trust us to care for their children. A/C2; Observed

Describe the differences between the R list and vector Essay

Describe the differences between the R list and vector - Essay Example Visualising data as graphs ,maps and boxplots is another important requirement . R comes with strong graphical and mapping facilities. â€Å"R is an integrated suite of software facilities for data manipulation. R is very much a vehicle for newly developing methods of interactive data analysis. Many consider R as a statistical system. It is an environment in which most of classical and modern statistical techniques have been implemented†.(Venables et al 2009) . â€Å"Every thing is an object in R. All Objects are built of a basic set of built-in objects. The type of an object define how it is stored in R. Objects in R also are members of a class. .Classes define what information objects contain and how these objects may be used â€Å".(Adler Joseph 2009) All kinds of vectors can be created using the c(†¦.) function where c stands for combine or concatenate . Numeric vectors containing a sequence of values can be created using the sequence function seq( ) or using the operator :. Vectors can also be created by repetition of elements using rep( ) function(Alder Joseph 2009) Vectors can be used in arithmetic expressions ,in which case the operations are performed element by element. The elementary arithmetic operators are +,-,*,/ and ^ (Venable etal 2010).Vectors need not be of the same length A lot of built in mathematical functions are available in R which can take a vector as an argument and return another vector as a result .Such functions are called vectorised functions .Such functions make calculating and plotting mathematical functions easy. Lists are created using the list function .Objects in the list can also be named . Components in the list can accessed by the double subscript `i` where i is the position in the list. If the objects in the list are named ,the components can be accessed using

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Kohlberg's Stages of Moral Development in Thank You for Smoking (2005) - Essay Example Some of the characters in the film swing across these moral stages, depending on their changing goals and target audiences. Characters in â€Å"Stage 1: Obedience and Punishment† display morality that comes from following authority (Crain, 1985). Nick Naylor (Aaron Eckhart) shows Stage 1 morality because he is initially focused on what his boss and company think is right. Instead of following the government or traditional social norms, Naylor follows the goals and norms of his company and boss. Naylor’s boss BR (J.K. Simmons) seeks for ideas on making smoking a more lucrative business. He tells Naylor: â€Å"We don't sell Tic Tacs, we sell cigarettes. And they’re cool, available, and addictive† (Sacks & Reitman, 2005). Naylor responds with a recommendation of product placement in the movies. He is responding to the pressure of doing what is right, based on what his company demands from him. Furthermore, Naylor displays loyalty to his boss, even when the latter does something wrong. BR steals Naylor’s idea of product placement in the movies and presents it to Captain (Rob ert Duvall) as his own. Naylor does not correct Captain anymore for fear of reprisal. Morality, in this stage, is â€Å"external† to the people, and not something they feel they must be personally responsible for, so they follow their bosses as the basis of their morality (Crain, 1985). Aside from Stage 1, characters in Thank You for Smoking exhibit morality in â€Å"Stage 2: Individualism and Exchange,† when they focus on the relativity of morals and the importance of making compromises to gain something. Naylor shifts to Stage 2, when he explains to his son that being right heavily relies on one’s argumentation skills. He tells his son: â€Å"That’s the beauty of argument, if you argue correctly, you're never wrong.† Morality is relative to the person doing the argumentation and his/her persuasiveness. Furthermore, flexible morality is another indicator of an individualistic approach to morality. Naylor admits to his son that to be in his job, he must have â€Å"flexible morals† (Sacks & Reitman, 2005). Flexible morals allow him to stay unaffected of the negative views on tobacco smoking. Jeff Megall (Rob Lowe) is another example of someone who manifests Stage 2 because he is not concerned of maintaining the social order or universal principles. Megall emphasizes that individuals have different opinions, so he calls himself a â€Å"facilitator† because â€Å"people decide for themselves† (Sacks & Reitman, 2005). He believes in the individual differences of morality and does not judge them. Heather Holloway (Katie Holmes) illustrates Stage 1 morality too because she exchanges something to gain another. She enters into a sexual affair with Naylor, so that she can access and expose his secrets as a reporter (Sacks & Reitman, 2005). These are examples of people, who believe in individualistic views of morality, as well as the flexibility needed to undergo social transactions for the purposes of personal gai n. The next stage is â€Å"Stage 3: Good Interpersonal Relationships,† and characters show this level of morality, when they do what is good based on what their family and community value as good behaviors (Crain, 1985). Naylor wants to be a better father to his son. In order to do this, he thinks that it is right to spend more time with him. Joey’s mother and stepfather are alarmed of what he is learning and inhaling from his father, but Naylor does not care, because he simply wants to have more quality time with Joey (Sacks

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Listen actively - Essay Example Listening to Olivia my childhood friend becomes a task when she has full five minutes to speak and I could not utter a word. Initial one-two minutes went good and I focused as much as I could, but the rest three were impossible to pass. She had been reading Dan Brown’s Da Vinci Code and since, I have already read it before; the story entailed minimal interest for me. Secondly, I was having this surging urge to check my cell phone for facebook, twiter, email, messages updates. Overall, this experience taught me I am not a good listener and I rather like to interrupt the speaker to add my piece of mind. On the other hand, Olivia is good at listening according to her those five minutes were significant. Since, I shared my thoughts about bullying issues, which I have been facing in the school lately. I must say it feels refreshing to be listened intently and I shared the stuff, which I was not intending to share with her. Question 2: Recalled an encounter in which you were saying something important but the other person gave you negative feedback. How did the feedback affect your communication? Your relationship? Is negative feedback ever appropriate? If so, under which circumstances? I was out with a friend in the mall and we were just discussing some relationship issues she recently had. I do not like to share my personal issues with people as they do not understand how I establish actions to secure myself. After more than half an hour of sharing done by her, she started asking me a lot of questions. Initially, I tried to give secure answers by not giving answers which would depict me as a loser about my situation, but later on I shared a bit of my dilemma. Exactly after my sharing she abruptly started concluding pessimistically the whole story without empathizing. Her negative feedback made me more defensive and I got a little angry too and eventually this made me regret the sharing I did. For the next time, I

World War I Causes and Outcomes Essay Example for Free

World War I Causes and Outcomes Essay The causes of World War I included a growing rate of militarism, which was accompanied by an arms race. Also imperialism, as economics and fighting for colonies among the European nations were prevalent. Alliances such as The Triple Alliance and The Triple Entente also started the war along side nationalism. The effects of the war included 8.5 million deaths just from soldiers, 16.1 million in total, higher taxes, rationing of food and other products, a propaganda war, and famine. Germany was blamed for the war so they owed millions of dollars in reparations to many different countries so Germany had to skyrocket their taxes and began a famine. Personally, I believe that World War I could have been prevented if it werent for certain actions. For example, if Austria-Hungary had negotiated seriously with Serbia in July 1914, war could have been avoided. However, Germany egged Austria-Hungary on to be completely unreasonable. It turned out to be the result of a hundred little pressures all building up until eventually it just exploded. Also, if it werent for the three alliances it could have possibly been avoided. I would say that World War I was justified in the fact that Germany was trying to take over Europe in a very bad and hostile way so they had to be stopped. Its hard to say that a war that caused millions of deaths was justice but when you think about it, they had no right to take over Europe and wouldve hurt and killed many innocent civilians in the process. Germany ended up paying their debt to the war by owing reparations and money so in another sense it was justified.

Effects of Behavioral Interventions on Disruptive Behavior and Affect in Demented Nursing Home Residents Essay Example for Free

Effects of Behavioral Interventions on Disruptive Behavior and Affect in Demented Nursing Home Residents Essay Behavioral interventions might ameliorate them and have a positive effect on residents’ mood (affect). Objectives: This study tested two interventions—an activities of daily living and a psychosocial activity intervention—and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia. Methods: The study had three treatment groups (activities of daily living, psychosocial activity, and a combination) and two control groups (placebo and no intervention). Nursing assistants hired specifically for this study enacted the interventions under the direction of a master’s prepared gerontological clinical nurse specialist. Nursing assistants employed at the nursing homes recorded the occurrence of disruptive behaviors. Raters analyzed videotapes filmed during the study to determine the interventions’ influence on affect. Results: Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups. Conclusions: The treatments did not specifically address the factors that may have been triggering disruptive behaviors. Interventions much more precisely designed than those employed in this study require development to quell disruptive behaviors. Nontargeted interventions might increase positive affect. Treatments that produce even a brief improvement in affect indicate improved quality of mental health as mandated by federal law. Key Words: affect †¢ Alzheimer’s disease †¢ behavior therapy †¢ dementia †¢ nursing homes Nursing Research July/August 2002 Vol 51, No 4 proximately 1. 3 million older Americans live in nursing homes today (Magaziner et al. , 2000). By 2030, with the aging of the population, the estimated demand for long-term care is expected to more than double (Feder, Komisar, Niefeld, 2000). Thus, nursing home expenditures could grow from $69 billion in 2000 to $330 billion in 2030 (Shactman Altman, 2000). About half of new nursing home res idents have dementia (Magaziner et al. , 2000). The disease has an impact on four major categories of functioning in persons with dementia. These are disruptive behavior (DB), affect, functional status, and cognition (Cohen-Mansfield, 2000). This article will focus on the first two categories. Disruptive behavior has received much more attention than affect has (Lawton, 1997), perhaps for three reasons. First, more than half (53. 7%) of nursing home residents display DB with aggression (34. 3%) occurring the most often (Jackson, Spector, Rabins, 1997). Second, DB threatens the wellbeing of the resident and others in the environment. Consequences include: (a) stress experienced by other resiCornelia K. Beck, PhD, RN, is Professor, Colleges of Medicine and Nursing, University of Arkansas for Medical Sciences. Theresa S. Vogelpohl, MNSc, RN, is President, ElderCare Decisions. Joyce H. Rasin, PhD, RN, is Associate Professor, School of Nursing, University of North Carolina. Johannah Topps Uriri, PhD(c), RN, is Clinical Assistant Professor, College of Nursing, University of Arkansas for Medical Sciences. Patricia O’Sullivan, EdD, is Associate Professor, Office of Educational Development, University of Arkansas for Medical Sciences. Robert Walls, PhD, is Professor Emeritus, University of Arkansas for Medical Sciences. Regina Phillips, PhD(c), RN, is Assistant Professor, Nursing Villa Julie College. Beverly Baldwin, PhD, RN, deceased, was Sonya Ziporkin Gershowitz Professor of Gerontological Nursing, University of Maryland. A Note to Readers: This article employs a number of acronyms. Refer to Table 1 to facilitate reading. 219 220 Effects of Behavioral Interventions Nursing Research July/August 2002 Vol 51, No 4 TABLE 1. Acronyms Term Activities of daily living Analysis of variance Apparent affect rating scale Arkansas Combined Disruptive behavior(s) Disruptive behavior scale Licensed practical nurse(s) Maryland Mini mental status exam Negative visual analogue scale Nursing home nursing assistant(s) Observable displays of affect scale Positive visual analogue scale Project nursing assistant(s) Psychosocial activity Research assistant(s) Acronym ADL ANOVA AARS AR CB DB DBS LPN MD MMSE NVAS NHNA ODAS PVAS PNA PSA RA decreases in targeted behaviors (Gerdner, 2000; Matteson, Linton, Cleary, Barnes, Lichtenstein, 1997). However, others reported nonsignificant reductions (Teri et al. , 2000), no change (Churchill, Safaoui, McCabe, Baun, 1999), or increased behavioral symptoms (Mather, Nemecek, Oliver, 1997). These studies used nursing home staffs to collect data, had sample sizes below 100, and measured an array of DB with different assessments. Only in the last decade have researchers investigated affect. Compared to studies to reduce DB, far fewer studies have measured interventions using affect as an outcome measure. Studies reported positive outcomes on affect from such interventions as simulated presence therapy (Camberg et al. , 1999), Montessori-based activities (Orsulic-Jeras, Judge, Camp, 2000), advanced practice nursing (Ryden et al. , 2000), music (Ragneskog, Brane, Karlsson, Kihlgren, 1996), rocking chair therapy (Watson, Wells, Cox, 1998), and pet therapy (Churchill et al. , 1999). The studies on affect used global measures that relied on observer interpretation, which could have compromised objectivity. Theoretical Bases A number of conceptual frameworks have guided intervention research on persons with cognitive impairment (Garand et al. , 2000). The theoretical basis for this study was that individuals have basic psychosocial needs, which, when met, reduce DB (Algase et al. , 1996) (Table 2). The interventions, one focusing on activities of daily living (ADL) and the other focusing on psychosocial activity (PSA), and a combination (CB) of the two, were developed to meet most of the basic psychosocial needs that Boettcher (1983) identified. These included territoriality, privacy and freedom from unwanted physical intrusion; communication, opportunity to talk openly with others; self-esteem, respect from others and freedom from insult or shaming; safety and security, protection from harm; autonomy, control over one’s life; personal identity, access to personal items and identifying material, and cognitive understanding, awareness of surroundings and mental clarity. The section on study groups specifies which interventions were designed to meet which needs. Positive affect usually accompanies interventions that meet basic psychosocial needs (Lawton, Van Haitsma, Klapper, 1996). Several researchers and clinicians have suggested that displays of affect may offer a window for revealing demented residents’ needs, preferences, aversions (Lawton, 1994), and responses to daily events (Hurley, Volicer, Mahoney, Volicer, 1993). The study reported here dents and staff; (b) increased falls and injury; (c) economic costs, such as property damage and staff burn-out, absenteeism, and turnover; (d) emotional deprivation such as social isolation of the resident; and (e) use of physical or pharmacologic restraints (Beck, Heithoff, et al. 1997). Third, before the Nursing Home Reform Act (Omnibus Budget Reconciliation Act, 1987), nursing homes routinely applied physical and chemical restraints to control DB with only moderate results (Garand, Buckwalter, Hall, 2000). However, the Act mandated that residents have the right to be free from restraints imposed for discipline or convenience and not required to treat the residents’ medical symptoms. Thus, researcher s have tested a wide range of behavioral interventions to reduce DB and replace restraints. The Act (1987) also stipulated that all residents are entitled to an environment that improves or maintains the quality of mental health. Interventions that promote positive mood or affect fulfill this entitlement. Therefore, this article will report the effects of an intervention to increase functional status in activities of daily living (Beck, Heacock, et al. , 1997), a psychosocial intervention, and a combination of both on reducing DB and improving affect of nursing home residents with dementia. TABLE 2. Basic Psychosocial Needs Relevant Literature Literature suggests that behavioral interventions offer promise in managing DB. A wide range of modalities and approaches have been tested: (a) sensory stimulation (e. g. , music); (b) physical environment changes (e. g. , walled garden); (c) psychosocial measures (e. g. , pet therapy); and (d) multimodal strategies. Many studies found significant Territoriality Communication Self-esteem Safety and security Autonomy Personal identity Cognitive understanding Nursing Research July/August 2002 Vol 51, No 4 Effects of Behavioral Interventions 221 adopted the inference by Lawton et al. (1996) that frequent displays of positive affect when basic psychosocial needs are met might indicate improved emotional wellbeing. is leg continually and without apparent reason needs redirection. This intervention lasted 45–60 minutes a day during various ADL. PSA Intervention. A PNA also conducted the PSA intervention, which involved 25 standardized modules designed to meet the psychosocial needs for communication, selfesteem, safety and security, personal identity, and cogni tive understanding through engagement in meaningful activity while respecting the individual’s unique cognitive and physical abilities (Baldwin, Magsamen, Griggs, Kent, 1992). The intervention was chosen because it: (a) provided a systematic plan for the PNA to address some of the participant’s basic psychosocial needs; and (b) represented clinical interventions that many long-term care facilities routinely used, but had not been formalized into a research protocol or systematically tested. Each module contained five psychosocial areas of content (expression of feelings, expression of thoughts, memory/recall, recreation, and education) and stimulated five sensory modalities (verbal, visual, auditory, tactile, and gustatory/olfactory). For instance, Activity Module I involved life review, communicating ideas visually (identifying and making drawings), clapping to different rhythms, massaging one’s face, and eating a snack. Initially, many participants tolerated less than 15 minutes of the activity but eventually habituated and participated 30 minutes. CB Intervention. This treatment consisted of both the ADL and PSA interventions and lasted 90 minutes daily. Placebo Control. This involved a one-to-one interaction between the participant and PNA. It controlled for the effect of the personal attention that the PNA provided to the three treatment groups. The PNA asked the participant to choose the activity, such as holding a conversation or manicuring nails. It lasted 30 minutes a day. No Intervention Control. This condition consisted of routine care from a NHNA with no scheduled contact between participants and the PNA. Instruments: Disruptive Behavior Scale. The 45-item disruptive behavior scale (DBS), designed to construct scores based on the occurrence and severity of behaviors, assessed the effect of the interventions on DB (Beck, Heithoff et al. 1997). Gerontological experts (n 29) established content validity, and interrater reliability tests yielded an interclass correlation coefficient of . 80 (p . 001). Geropsychiatricnursing experts weighted the behaviors using a Q-sort to improve the scale’s capacity to predict perceived patient disruptiveness. Factor analysis identified four factors (Beck et al. , 1998). Two corresponded to two—physically aggressive and physically nonaggressive—of the three categories from the factor analysis of the Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, Marx, Rosenthal, 1989). The third category of the Inventory was verbally agitated; in contrast, the factor analysis of the DBS produced a third and fourth category—vocally agitated and vocally aggressive. To obtain a score for the DBS, a trained individual completed a DBS form for every hour of a shift by check- Methods The primary aim was to conduct a randomized trial of the ADL and PSA interventions individually and in combination (CB) for their effect on DB and affect on a large sample of nursing home residents. The experimental design consisted of three treatment groups (ADL, PSA, and Combined) and two control groups (placebo and no intervention). Individual residents were assigned to one of the five groups at each of seven sites in Arkansas and Maryland, which controlled for site differences. To demonstrate the practicability of the interventions and assure adherence to the treatment protocols, certified nursing assistants were hired and trained as project nursing assistants (PNA). They implemented the interventions Monday–Friday for 12 weeks. Afterward, one-month and two-month follow-up periods occurred. Nursing assistants employed by the nursing homes (NHNA) recorded DB. To measure affect, raters were hired for the study to analyze videotapes filmed during intervention. Research Subjects: The sample initially consisted of 179 participants. The study design allowed for the detection of an improvement in DB scores on the Disruptive Behavior Scale (DBS) (Beck, Heithoff et al. , 1997) across time of at least 1. 6 units with a power of 80%. This power calculation assumed that the repeated measures would be correlated with one another at 0. 60. Inclusion criteria were age 65; a dementia diagnosis; a Mini Mental Status Exam (MMSE) (Folstein, Folstein, McHugh, 1975) score of 20; and a report of DB in the previous two weeks. To form a more homogeneous group for generalizing findings, exclusion criteria were a physical disability that severely limited ADL; a psychiatric diagnosis; and a progressive or recurring medical, metabolic, or neurological condition that might interfere with cognition or behavior. Study Groups: ADL Intervention. A PNA used the ADL intervention during bathing, grooming, dressing, and the noon meal based on successful protocols that improved functional status in dressing (Beck, Heacock et al. , 1997). It attempted to meet residents’ psychosocial needs for territoriality, communication, autonomy, and self-esteem to promote their sense of safety and security. The intervention also tried to respect participants’ cognitive and physical abilities by prescribing three types of strategies specific to the individual participant. First, strategies to complete an ADL address specific cognitive deficits. For example, the person with ideomotor apraxia needs touch or physical guidance to start movements. Second, standard strategies are behaviors and communication techniques that work for almost everyone with dementia. For example, the caregiver gives a series of one-step commands to guide the resident to put on her shoe. Third, problem-oriented strategies address particular disabilities such as fine motor impairment, physical limitations, or perseveration. For example, a subject who rubs his hand back and forth on 222 Effects of Behavioral Interventions ing the behaviors that occurred. The score for a behavior was the frequency (0–8) times the weight. The item scores were summed to obtain each of the four subscale scores. Mini Mental Status Exam. The Mini Mental Status Exam (MMSE) (Folstein et al. 1975) provided a global evaluation of participants’ cognitive statuses for screening subjects for the study. Test-retest reliability of the MMSE is . 82 or better (Folstein et al. ). Cognition is assessed in seven areas, and scores lower than 24 out of 30 indicate dementia. Nursing Research July/August 2002 Vol 51, No 4 Observable Displays of Affect Scale. The Observable Displays of Affect Scale (ODAS) (Vogelpohl Beck, 1997), designed to rate videotaped data, contains 41 behaviors categorized into six subscales of positive and negative facial displays, vocalizations, and body movement/posture. Raters indicate presence/absence of each behavior during five 2-minute intervals from a 10minute videotape. Scores range from 0–5 for each item. The range of scores for each scale is: facial positive (0–20), Aggression during bathing facial negative (0–20), vocal positive (0–45), vocal negative (0–50), body could stem from physical positive (0–30), and body negative discomfort or rough (0–40). Interrater reliabilities (Kappa handling coefficients) for the ODAS range from . 68–1. 00, and intrarater reliability is . 97–1. 00. Ten gerontological nursing experts established content validity (Vogelpohl Beck). Apparent Affect Rating Scale. The Apparent Affect Rating Scale (AARS) (Lawton et al. , 1996) is designed for direct observation of persons with dementia and contains six affective states: pleasure, anger, anxiety/fear, sadness, interest, and contentment. (In later work, Lawton, Van Haitsma, Perkinson, Ruckdeschel [1999] deleted contentment). Each item has a noninclusive list of behaviors that might signal the presence of the affect from which observers infer the affect. The observer assigns a score of 1 to 5 to measure the duration of the behavior. Visual Analogue Scales. The Positive Visual Analogue Scale (PVAS) and Negative Visual Analogue Scale (NVAS) (Lee Kieckhefer, 1989; Wewers Lowe, 1990) are two 10centimeter lines on separate pages for rating positive and negative affect. The PVAS has end anchors of â€Å"no positive affect† and â€Å"a great deal of positive affect. † The NVAS has end anchors of â€Å"no negative affect† and â€Å"a great deal of negative affect. † Scores range from 0 to 100. Procedure: The study consisted of six phases: (a) preliminary activities, (b) a three-week normalization/desensitization period, (c) a 12-week intervention period, (d) a onemonth follow-up period, (e) a two-month follow-up period, and f) a videotape analysis. Preliminary Activities. The institutional review boards at the University of Arkansas for Medical Sciences and the Univer- sity of Maryland approved the research. Each nursing home identified residents with dementia and sent letters informing persons responsible for the residents that researchers would be contacting them. Responsible persons could return a signed form if they did not want to participate. Willing responsible persons received a telephone call explaining the study followed by a mailed written description along with two consent forms. Those willing kept one consent form for their records and signed and mailed back the other. Screening involved a review of the residents’ charts, recording their diagnoses, and interviews with the staff to find evidence of DB during the previous two weeks. Each resident took the MMSE to meet inclusion criteria. Within each home, female residents who passed these screens were randomized to one of the five groups by a drawing, but males were assigned to the five groups to ensure even distribution of their small number. Simultaneously, research staff members were hired and trained. Normalization/Desensitization. For the next three weeks, each PNA accompanied a NHNA to learn the routines of the facility but did not help care for potential study participants. A videotape technician placed a camera that was not running in the dining and shower rooms to desensitize residents and staff to its presence. In addition, nursing home staffs participated in two-hour training sessions on the DBS. Throughout the study, a gerontological clinical nurse specialist trained any new NHNA and retrained if behaviors reported on the DBS differed from those she observed during randomized checks. Intervention. During the 12-week intervention period, the first three weeks were considered baseline and the last two weeks postintervention. The PNA administered the treatment/s or placebo five days a week. Every day, they asked participants to give their assent and espected any dissents. During weeks 11–12 (postintervention), the PNA prepared the participants for their departure by telling them that they were leaving soon. To facilitate data collection, a separate form of the DBS for each of the three eight-hour daily shifts was developed. Eight one-hour blocks accompanied each item of the scale. The NHNA placed a check mark in the block that corresponded to the hour when the NHNA observed the behavi or. The NHNA completed the DBS on all participants during or at the end of a shift. In addition, a technician videotaped participants in the treatment and placebo groups every other week during an interaction with the PNA and no intervention group monthly during an ADL. The technician monitored positioning and operation of the camera from outside the room or behind a curtain to respect the participants’ privacy. One-Month and Two-Month Follow-up. One month and two months after the research team left the nursing home, Nursing Research July/August 2002 Vol 51, No 4 Effects of Behavioral Interventions 223 esearch assistants (RA) retrained nursing home staffs on the DBS. The NHNA then collected DB data on their shifts Monday–Friday for one week. tervention, week 16 as one-month follow-up, and week 20 as two-month follow-up. Participants with fewer than six observations at any time period were omitted. For each period, a total DBS score represented an averVideotape Analysis. The videotapes ranged in length from age of the participant’s data for the t hree shifts of each day less than five minutes to 40 minutes, depending on the across the five days of the observation week. Therefore, activity and the participant’s willingness to cooperate with total DBS scores were obtained for baseline (M of weeks the treatment (baseline and control participants’ tapes 1–3), intervention (M of weeks 4–10), postintervention (M tended to be shorter). To standardize the opportunity for of weeks 11–12), first follow-up (M of week 16), and secbehaviors to occur, an editor took 10-minute segments ond follow-up (M of week 20). The same procedure from the middle of baseline and final treatment eek tapes yielded subscale scores for physically aggressive, physically and randomized them onto videotapes for rating. Because nonaggressive, vocally aggressive, and vocally agitated videotaping occurred to ensure appropriate implementabehaviors for each of the five time periods. tion of interventions, the treatment groups had more A repeated measures analysis of variance (ANOVA) usable videotapes than the control groups did. consisted of two between- subjects and one within-subjects A master’s prepared gerontological factors. The between-subjects factors nurse specialist intensively trained six were intervention group and state (AR raters on the Observer III Software or MD) to account for regional differSystem (Noldus Information Technolences in scoring DB, and the withinogy, 1993) for direct data entry and subjects factor represented DBS scores the affect rating scales. The raters for the five different time periods. Each reached . 80 agreement with the speanalysis allowed for testing by intervencialist on practice tapes before they tion group, time period, and state. The Screaming may started rating the study videotapes. nalysis of the interaction effect of She monitored reliability for each tape intervention group by time period express pain or monthly, retrained as needed, and rantested the hypothesis that the intervenself-stimulation domized the sequence of rating the tions would decrease DB across time in scales. The raters entered the ODAS treatment conditions as compared to and AARS data directly into a comcontrol conditions. The analysis was puter using the Observer. The system repeated five times, once for each suballowed raters to watch videos repeatscale of the DBS and once for the total edly in actual time and slow action to score. Level of significance was set at document behaviors objectively and 0. 05. The researchers believed that the precisely. The raters indicated their small group sizes justified the liberal perception of the participants’ positive and negative level of significance. For the videotape analysis, analyses of affect by placing a vertical mark at some point between covariance occurred for the 14 variables observed from the the two end anchors of the PVAS and NVAS. They videotapes during intervention. The baseline score served marked neutral affect as negative. s a covariate for the final score. While a multivariate analysis would have been desirable, it would have had Intervention Integrity: The PNA and video camera techniinsufficient power with this number of variables and subcian underwent two weeks of intensive training on general jects. The 14 univariate analyses do inflate the Type I error aging topics, stress management, information on dementia, rate. and confidentiality/privacy issues. Training also involved instruction on the study interventions, DBS, and research Results protocols. Of the 179 initial participants, 36 did not finish; the greatA gerontological clinical nurse specialist viewed treatest attrition occurred in the no intervention control group. ment and placebo videotapes biweekly in a private office to Attrition resulted from death (39%), withdrawal of fammonitor PNA compliance with research protocols, provide ily’s consent or at nursing home staff’s request (26%), discorrective feedback to PNA, and help PNA recognize and charge (18%), and change in health status/medications meet participants’ needs as they changed during treatment. hat did not meet inclusion criteria (17%). This left 143 The possibility for contamination appeared to be low participants: 29 in the ADL, 30 in PSA, 30 in CB, 30 in the because NHNA were unlikely to change their care practices placebo, and 24 in the no intervention, but 16 with incomand had little opportunity to observe PNA. Further, NHNA plete data were dropped. Table 3 gives the demographic were b linded to the hypothesis of the study, the nature of the statistics for the 127 participants with complete data. No interventions, and the participants’ group assignments, statistically significant demographic differences emerged although they probably could identify the no intervention among the five groups. In short, this sample primarily conparticipants. sisted of elderly, white females with severe cognitive impairment. Analysis: Reviewers checked for completeness of all data. For the videotape analysis, the final number was 84 The researchers designated intervention weeks 1–3 as baseparticipants with 168 videotape segments. Most were line, weeks 4–10 as intervention, weeks 11–12 as postin- 224 Effects of Behavioral Interventions Nursing Research July/August 2002 Vol 51, No 4 TABLE 3. Description of the Sample by Intervention Group No Intervention 19 89. 5 78. 9 84. 2 86. 47 (6. 37) 11. 47 (6. 43) ADL Number in group Percent female Percent white Percent widowed Mean age (SD) M MMSE (SD) 28 78. 6 82. 1 64. 3 82. 29 (8. 40) 11. 44 (7. 69) PSA 29 82. 1 85. 7 66. 7 82. 18 (7. 64) 10. 65 (6. 76) CB 22 81. 8 77. 3 77. 3 82. 82 (9. 81) 7. 91 (5. 41) Placebo 29 75. 9 86. 2 75. 9 86. 45 (6. 92) 11. 11 (6. 39) Total 127 81. 0 82. 5 72. 8 83. 64 (7. 97) 10. 55 (6. 64) Note. ADL = activities of daily living; PSA = psychosocial activity; CB = combination. emale (79%) and widowed (69%) with a mean age of 83 (SD 7. 44). Participants had a mean score of 10 (SD 6. 34) on the MMSE, indicating moderate to severe cognitive impairment. Table 4 displays the means and standard deviations for the DBS overall and the four subscales across the five time periods for the five groups. No significant differences emerged for the interventi on-by-time interaction for any of the dependent variables. Thus, the results failed to support the hypothesis that the interventions would decrease DB across time in treatment groups as compared to control groups (statistical analysis tables on Website at: http://sonweb. nc. edu/nursing-research-editor). However, the main effect of state was significant in three analyses. Arkansas recorded significantly more behaviors than Maryland did for the dependent variables of physically nonaggressive (p . 001), vocally agitated (p . 001), and overall DBS (p . 002). Further, the main effect of time was significant for overall DBS (p . 002) and the four subscales of physically aggressive (p . 001), physically nonaggressive (p . 027), vocally aggressive (p . 021), and vocally agitated behaviors (p . 008). The significance resulted from increased DB after the PNA had left the home (generally from intervention or postintervention to first follow-up). For the videotape analysis, the hypothesis stated that treatment groups, compared with control groups, would display more indicators of positive affect and fewer indicators of negative affect following behavioral interventions. In general, neither the positive nor the negative affect scores were particularly high, indicating that this sample had relatively flat affect. Results from the analysis of covariance tests supported increased positive affect but not decreased negative affect. Compared to the control groups, the treatment groups had significantly more positive facial expressions (p . 001) and positive body posture/movements (p . 001), but not more positive verbal displays on the ODAS. The treatment groups displayed significantly more contentment (p . 037) and interest (p . 028) than the control groups did on the AARS. For the negative affects on the AARS, the treatment groups had a shorter duration of sad behaviors (p . 007) than the control groups did. Comparison of VAS scales likewise showed that the treatment groups displayed more positive affect (p . 012). Discussion In contrast to other studies (e. . , Hoeffer et al. , 1997; Kim Buschmann. , 1999; Whall et al. , 1997), this study found no treatment effect on DB. The interventions were a synthesis of approaches believed to globally address â€Å"triggers† of DB and meet psychosocial needs (Boettcher, 1983). They did not address the specific factors that might have been triggering the particular behavior (Algase et al. , 1996). Such triggers include under/over stimulation, unfamiliar or impersonal caregivers, and particular individual unmet psychosocial needs. For example, aggression during bathing could stem from physical discomfort or rough handling (Whall et al. 1997). Interventions much more individually designed require development. Increasing DB across all groups was reflected in the DBS scores at 1-month follow-up. Two factors may explain this increase. First, the PNA had warned participants that they would be leaving. Second, the ADL and CB participants no longer received care from the familiar PNA, and PSA, CB, and placebo participants no longer had a daily activity or visit. The increased stress and time constraints for NHNA as they resumed caregiving of the ADL and CB participants may explain the heightened DB in the control groups. Such changes may trigger increased behavioral symptoms in persons with dementia (Hall, Gerdner, Zwygart-Stauffacher, Buckwalter, 1995). Two measurement issues may have affected outcomes. First, observers view behaviors differently (Whall et al. , 1997) and come to expect particular behaviors from certain residents (Hillman, Skoloda, Zander, Stricker, 1999). If the NHNA were accustomed to a participant’s DB pattern, such as persistent screaming, they may have overlooked decreases in that behavior. Initial training and retraining of raters occurred as needed; however, some Nursing Research July/August 2002 Vol 51, No 4 Effects of Behavioral Interventions 225 TABLE 4. Weighted Scores for Disruptive Behavior by Intervention Group and Time Period No Intervention (n = 19) Mean (SD) 408. 71 (427. 24) 303. 69 (408. 44) 281. 97 (410. 85) 418. 31 (630. 58) 292. 85 (405. 15) 114. 66 (202. 89) 90. 85 (182. 70) 77. 98 (173. 15) 130. 92 (257. 12) 128. 20 (195. 67) 191. 97 (157. 75) 117. 11 (112. 30) 118. 23 (137. 08) 154. 46 (225. 05) 100. 45 (153. 30) 55. 16 (74. 70) 42. 89 (54. 54) 33. 26 (47. 06) 64. 72 (77. 89) 28. 09 (37. 02) (continues) DB Category Time Period DBS total Baseline ADL (n = 28) Mean (SD) 172. 51 (191. 47) 182. 45 (181. 3) 164. 56 (154. 95) 207. 22 (205. 58) 190. 70 (291. 06) 20. 67 (30. 52) 32. 59 (51. 29) 15. 02 (26. 10) 44. 18 (100. 62) 21. 45 (36. 47) 95. 50 (105. 28) 87. 58 (87. 58) 85. 04 (89. 60) 88. 81 (85. 69) 148. 75 (187. 28) 22. 85 (32. 10) 28. 37 (32. 50) 21. 15 (26. 54) 30. 72 (48. 95) 18. 28 (24. 55) PSA (n = 29) Mean (SD) 348. 02 (467. 50) 306. 81 (393. 03) 303. 24 (367. 54) 373. 17 (533. 05) 300. 20 (366. 42) 85. 87 (199. 01) 83. 94 (167. 53) 82. 82 (166. 93) 113. 49 (235. 71) 81. 30 (151. 85) 162. 41 (206. 65) 130. 82 (142. 72) 133. 92 (145. 97) 141. 47 (188. 99) 164. 92 (223. 63) 49. 64 (93. 15) 43. 80 (64. 6) 37. 90 (53. 43) 54. 47 (90. 33) 40. 26 (45. 26) CB (n = 22) Mean (SD) 287. 66 (373. 73) 300. 84 (379. 33) 286. 21 (365. 78) 374. 10 (510. 10) 312. 83 (433. 18) 68. 84 (126. 18) 67. 14 (137. 79) 61. 04 (127. 78) 92. 68 (205. 52) 60. 40 (131. 54) 136. 67 (189. 03) 124. 64 (164. 49) 125. 99 (157. 78) 159. 97 (202. 75) 146. 53 (201. 83) 34. 49 (55. 91) 40. 73 (52. 60) 31. 18 (33. 85) 36. 95 (42. 70) 32. 82 (51. 32) Placebo (n = 29) Mean (SD) 325. 96 (337. 14) 337. 60 (328. 94) 336. 80 (366. 55) 389. 92 (434. 43) 319. 15 (384. 59) 49. 26 (90. 24) 62. 10 (112. 71) 59. 67 (106. 37) 76. 79 (165. 45) 48. 25 (101. 4) 167. 01 (177. 80) 164. 62 (161. 48) 175. 36 (189. 80) 201. 68 (212. 06) 87. 67 (127. 38) 47. 20 (79. 70) 39. 55 (57. 74) 32. 69 (55. 77) 29 . 30 (47. 60) 30. 18 (52. 85) Intervention Postintervention 1 month follow-up 2 month follow-up Physically aggressive Baseline Intervention Postintervention 1 month follow-up 2 month follow-up Physically nonaggressive Baseline Intervention Postintervention 1 month follow-up 2 month follow-up Vocally aggressive Baseline Intervention Postintervention 1 month follow-up 2 month follow-up 226 Effects of Behavioral Interventions Nursing Research July/August 2002 Vol 51, No 4 TABLE 4. Weighted Scores for Disruptive Behavior by Intervention Group and Time Period (Continued) NoIntervention (n = 19) Mean (SD) 47. 65 (97. 22) 68. 32 (103. 13) 68. 01 (116. 62) 84. 50 (112. 48) 73. 07 (117. 12) DB Category Time Period Vocally agitated Baseline ADL (n = 28) Mean (SD) 33. 49 (84. 39) 33. 91 (62. 52) 43. 17 (72. 10) 43. 48 (64. 39) 50. 53 (117. 95) PSA (n = 29) Mean (SD) 46. 92 (98. 70) 52. 84 (96. 03) 52. 50 (90. 78) 68. 22 (98. 89) 48. 89 (92. 33) CB (n = 22) Mean (SD) 62. 49 (98. 97) 70. 43 (110. 85) 69. 08 (107. 29) 82. 14 (118. 97) 75. 80 (129. 67) Placebo (n = 29) Mean (SD) 50. 0 (92. 05) 48. 25 (81. 63) 48. 59 (72. 20) 63. 74 (95. 30) 54. 11 (80. 61) Intervention Postintervention 1 month follow-up 2 month follow-up Note. Scores were created by assigning each behavior with a severity weight prior to summing and then averaging across day and then week(s). DBS = disruptive behaviors; ADL = activities of daily living intervention; PSA = psychocial activity inte rvention; CB = combination of the two interventions. NHNA appeared to continue to consider participants’ behaviors, such as repetitive questioning, to be personality characteristics or attention-seeking efforts rather than DB. Thus, they may have under-reported behaviors. Further, staff may prefer withdrawn behaviors, such as isolating self and muteness (Camberg et al. , 1999), and view them as nonproblematic. Second, categorizing a behavior as disruptive without understanding its meaning to the person with dementia may be conceptually flawed. For example, screaming may express pain or self-stimulation. Two design features may explain differences between the findings of this study and others. First, this study had both placebo and no intervention control conditions. Just a few other studies randomized subjects to treatment or control groups or included two control groups (e. g. , Camberg et al. , 1999). In most studies, control conditions preceded or followed treatment conditions (e. g. , Clark, Lipe, Bilbrey, 1998). In both designs, subjects served as their own controls, which limits examination of simultaneous intra- and extra-personal events that might affect DB frequency. Second, many control groups came from separate units or different nursing homes (e. g. , Matteson et al. , 1997), which makes it difficult to control for differences in environment, staff relationships, and personalities. This study occurred at seven sites in two different geographical areas, but at each site, the randomization of female participants distributed the groups across all nursing units to control for environmental and staff characteristics. Acknowledged limitations include the following. First, in spite of the large overall sample, the group sizes were small (range 19–30) with the greatest loss in the no inter- vention group. Larger groups might have provided more definitive findings on the relationship between behavioral interventions and DB frequency as Rovner et al. (1996) did (treatment group 42; control group 39). Second, NHNA served as data collectors because using independent observers would have been cost-prohibitive. These results suggest that future intervention research should consider the individual characteristics of the person with dementia (Maslow, 1996) and the triggers of the behavior (Algase et al. , 1996). Studies that have individualized interventions have demonstrated decreased DB (Gerdner, 2000; Hoeffer et al. , 1997). Researchers need to continue to refine methods for identifying what works for whom (Forbes, 1998) to minimize the prevalent trial-anderror approach to DB management.

Implementing a Supply Chain Management System

Implementing a Supply Chain Management System Advantages and Disadvantages of Implementing a Supply Chain Management System A Supply Chain Management system is an information system which integrates the primary inbound logistics business activity. Supply Chain Management system supports inbound and outbound logistics procurement as well as procurement support activities. Supply Chain Management systems support three basic processes which are source, purchase and settle; because Supply Chain Management systems support the three basic processes the process itself of the supply chain has become faster and more efficient. One advantage of implementing a supply chain management system within an organization is that it has expanded supply chain speed which is the dollar value of good exchanged in a given period of time; this allows for companies make their processes quicker and more efficient. Another advantage for implementing a Supply Chain Management is that the Supply Chain Management System enables both the supplier and the customer to reduce the size of inventories therefore reducing inventory costs which in the long run will assist the company grow because they are keeping their costs low. This reduction in inventory costs is possible because the speed and the efficiency provided by information systems enable processing of small orders fast. SCM Systems also help improve delivery scheduling this occurs because the suppliers are able to deliver materials and components at the time and sequence needed this enables just-in-time inventory which allows manufacturers to reduce raw materials and handle of raw materials. SCM Systems also are an advantage because it creates processes to achieve strategies. The SCM Systems are mainly developed for support for business processes which assist organizations achieve competitive advantage over other companies as well as helping to avoid creating systems that are unrelated to organizations strategy. The last advantage of a SCM system is it fixes bullwhip effect which is the tendency of consumers to buy more than they would need in the immediate fu ture. The disadvantages to implementing a Supply Chain Management System are that it can be expensive and difficult for some employees to learn. While some employees want change and are not reluctant to modifications to their current system many other employees will resist the change; which would result in the organization having to deal with this which can drive costs of implementing such a system even higher. Another reason implementing a SCM System is a disadvantage is because for some organizations it may require them to change substantially because their current system is very basic; therefore, implementation of such a highly advanced system could change the organization considerably. If a company grows significantly, such as NIKE did, then SCM can become a hindrance because the company grows and the system could become irrelevant towards the companys main objective. An additional drawback of implementing a SCM System is that there could be a lack of appreciation for the system just a s there was for NIKE; this is based on the statement made by the Nike CIO, Gordon Steele, he thought that that this system would have been an easier solution for the problems Nike was facing but in essence it turned out to much more complicated. Another disadvantage for implementing a SCM System is that even though a company may think that they have trained their employees enough, the reality of this can be that there is never enough training available, which Nikes CIO stated again. Options for Acquiring a SCM System Companies must first acknowledge that there is a problem with their organizational system. In the case, Nike sensed that there was an issue with their current business model in that it focused on centralization but increasingly became more and more decentralized. Its only option was to acquire a SCM system to create greater supply chain visibility. They were to find vendors by shopping around for SCM systems and the organizations that program them. So they had to search for information on how to solve their problem. Nike understood that they had to quickly and accurately analyze the impacts of proposed SCM . Business should use information to evaluate alternative brands in the choice set and assess the capabilities of each. Negotiation of the terms and conditions would follow. The purchase decision follows and the business decides to buy the program. Nike addressed this issue by implementing SAP ERP in conjunction with i2 software to be its information system. The final step is the post purchase evaluation in which the company takes further action after the purchase based on their satisfaction or dissatisfaction. The advantages of each option: Reduce costs of buying and selling, increases supply chain speed, reduces size and cost of inventories, and improves delivery scheduling. This disintermediation that occurs when eliminating the middle layers in the supply chain will increase market efficiency. The disadvantages of each option: Technology and user training. Raw Material Purchasing Process In order for there to even be a raw material purchasing process there must be a supply chain for which the raw materials get transferred through. A supply chain is considered a network of organizations/facilities that transform raw materials into products delivered to customers. The main purpose of a raw material purchasing process is for a company to be able to successfully transfer raw materials into intermediate goods which can then be transferred to finals good and delivered to the customer; this is all done to ensure that the customer gets the service as efficiently and prompt as possible. The processes itself is started once the customer realizes that there is a need or want for a product. The customer then places an order for their service through the retailer. The retailers then in-return must order from the distributors that would dispense to the retailers. The distributers are then required to order from the manufactures that develop or create the product but in order for the distributers to develop or create the product they have to order the supplies from the suppliers that they receive their materials from. The suppliers are the ones with the original raw material. Once the supply chain is complete from the customers realization up to the suppliers being notified of the raw material being needed all items are delivered and the suppliers payment goes through the same process; retailers get paid by customer the retailers pay the distributors distributors pay manufactures-manufactures pay supplier. Potential Pitfalls in Implementing a SCM System The increasing outsourcing that occurs is one of the potential pitfalls that may be Encountered when implementing a supply chain management system. Shrinking product lifecycles, intensifying economic pressures, and constant changes in supply, demand, and product make supply chain optimization harder than ever. Existing systems generate plans that become obsolete the moment theyre finished, while spreadsheets and ad hoc databases lack the visibility and collaborative capabilities organizations need to swiftly and effectively monitor and respond to change. Another downfall encountered is that user training must be administered and completed before implementing a supply chain management system. Major Tasks that need to be Completed Evidently Nike has not spent enough time and effort in implementing their supply chain process to coincide with the organization. Which is why they now must purchase a new SCM system, but before implementing this new system, major tasks must be done in order for it to work efficiently. A successful SCM System requires a change from managing individual functions to integrating activities into key supply chain processes. Supply Chain Management entails coordination and configuration of the process that is necessary to make products available in a timely, reproducible and pleasing manner. Nike must first come up with a strategy for managing all the resources that go toward meeting customer demand for their product or service. A big part in Supply Chain Management, that Nike failed to strive in, is monitoring the supply chain so that it is efficient, costs less and delivers high quality and value to customers. As Nike grew and times changed, their central control became more centralized leading them to 27 different order managements systems worldwide. This clearly has led to their downfall, and evidently Nike must look over and choose suppliers to deliver the goods and services they need to create their product. Supply chain managers must develop a set of pricing, delivery and payment processes with suppliers if not satisfied with the original and also create a better system for monitoring and improving their relationships. The manufacturing step is most important because this is when supply chain managers schedule the activities necessary for production, testing, packaging and preparation for delivery. Nike must develop a proper procurement process, this is important because Nike extends globally. This is the process of strategic plans made with suppliers to support the manufacturing flow management process and the development of new products. Procurement delivers the responsibility for assuring the quality of purchased raw material/services and linking supplier operations to distribution through manufacturing activities. This step allows for measurement of quality levels, production output and worker productivity. Nike must ensure that the manufacturing processes are flexible to respond to market changes and accommodate mass customization. The product development and commercialization must be looked at as well because it is such a lengthy task. Customers and suppliers must be combined into the product development process in order to reduce time to market because the appropriate products must be developed and successfully launched with shorter time-schedules to remain competitive. If Nike is to attain competitive advantage, then their ultimate aim should be to achieve supply chain excellence before their competitors do. What Nike realized, later than other companies, is that the most important assets to an organization are their employees and consumers. Steele quotes You can never train enough which is only the truth. To ensure that this new system is successful the employees must all need to know how to use work with the system. Hence this is why Nike has now made training an important part of business. As important is the customer service management process; an organization that strives to be successful should use the following steps to build customer relationships: determine mutually satisfying goals for organization/customers establish and maintain customer relationship, and produce positive feelings in the organization and the customers. We all know companies like Nike exist to serve their consumers; hence they must find a clear and concise way of knowing exactly what their consumers want and passing that information through the supply chain to the suppliers correctly.

Change Management Plan :: Business Management Analysis

Change Management Plan Change is essential to today's business environment. If a company is to survive and succeed on a macro level, they should analyze and adopt the best overall plan for change on an enterprise level. When examining the best way to make changes in a company that will globally affect the company, it is usually best to look at the total picture before acting, lest the plan fail. This paper will briefly summarize four key areas that leaders and managers must understand in order to successfully make a change, or in the case of our model company CrysTel, manage change dynamically throughout the life of the company. In order to understand completely the change it wants to make, the company must understand the implications of the change and the human variables of change implementation. The company should also strive to understand how to monitor the progress of the change, and how to ensure the continued success of the change. The following paragraphs are an explanation of what CrysTel is, why i t needs to change, and how these four key areas can be manipulated to help it succeed in its dynamic need for change in the ever-changing environment it lives in. Implications of Organizational Change CrysTel is a telecommunications company that exists in a very dynamic environment, and it has the need for all aspects of itself to be dynamic and able to change relatively quickly. The upper management recently realized that CrysTel has the need to bring more products and services into its portfolio. That means that everybody who works for the company needs to be good at analyzing the best way to change, implementing a change, and sustaining the change. It also means that CrysTel employees need to change with the organization. In order for all of the employees to be good at the constant change that will be happening and be as dynamic as they need to be, they have to have good and dynamic leaders and managers to aid in the effort. Without the support from above, the employees will probably lose focus and the desire to see the company succeed (Miller et al, 2004). If the company does not prepare well, it might experience a high turnover rate as well. A study conducted by Lester Coch a nd John R.P. French showed that if a group of workers was not prepared for a change properly, that group exhibited a high turnover rate (Krietner & Kinicki, 2003).

Staff Recruitment and Selection Essay -- Business Management Studies

Staff Recruitment and Selection In this section I will be explaining and discussing the organisations (Southgate college) procedures for recruiting and selecting staff and also identifying the Key factors that have to be considered at every stage of this process. Procedures 1. Job analysis: is there a need for a vacancy? Either because: (i) The nature of the job has changed, which could result in restructuring hence the availability of more jobs. (ii) A person has left or been promoted, leaving an available space in their former position 2. If there is a vacancy a job description is complied: (i) The task of the job (ii) The behaviour to achieve these tasks So Southgate College will have to write a job description to show what the job is (i.e. Admissions Assistant) and what it involves. In the job description there must be a list of tasks required and what will be essential to do the job. 3. Person specification Characteristics and the qualities needed of the person needed for the job: (i) Physical make up: what should the jobholder look and sound like, Gender or ethnicity, generally the law does not allow the employees to specify. (ii) Qualifications: education, formal qualifications and experience (iii) Specific skills (iv) Hobbies and interests (v) Personality: temperament (vi) Personal circumstances The reason for the person specification is to find out more about the candidate and what the person is generally like. A person specification sets out the qualities of an ideal candidate. 4. Job advertisement: based on the applicant's personal profile Plus: 1. Wages and salaries 5. Holidays 2. Hours of work 6. Address telephone number 3. Perquisites 7. Closing date 4. Duties 8. Method of application: Application form Application form and c.v. Letter of application and c.v. 5. Drawing up a short list for interview: The short list consists of 4-5 people who best fit the person specification and the job description. There may be differences in age, experience, and qualifications. 6. Selection interviews: (i) Structuring the interview; depends on the nature of the job, size of the organisation. As Southgate College is a big organisation, interviews are conducted by a panel: Personal officer Head of departm... ...sight before actually applying for the job. The information written in these three documents are very important because in all the documents the information must be written accurately and also not misleading for the applicant e.g. the duties involved in the job. The information must be high quality for the applicant to be able to understand what is written and also to make sure the person knows what each document is telling them for example the applicant can not read a document which tells him a set of duties to do but the other document says something completely different. There is two ways of testing the applicant: 1. Informal method- this way of testing is based on an interview were questions are asked Through this method the employer will be able to find out what the person has to offer and what kind person he is on terms of e.g. appearance, attitude, body language. 2. Psychometric tests- this tests the person’s personality it will show the interviewers what the person is like generally. The questions must be checked before they can be asked the reason for this is to remove bad questions and also to remove social, racial or sex bias.

Three Mile Island Case :: essays research papers

5a) If I were on the School Board I would not have agreed to the issue framed for the arbitrator. I believe that the issue was not neutral, rather that it favored the association and Ms. Kimball. Statements in the issue such as, â€Å"...when the grievance absented herself from work for illness...†, support Kimball’s argument. In the Position of the School District section of the handout, the School Board states that when Kimball called in to report the absence she simply informed the district â€Å"that she would not be in.† In my opinion, this should have replaced the prior statement of her calling out â€Å"due to illness†.   Ã‚  Ã‚  Ã‚  Ã‚  I also think that the School Board should not have agreed to the issue starting with the question â€Å"Was the School District wrong...† this automatically influences the arbitrator to question the School Board’s decision. The issue could have either been changed to impose the question of Kimball being wrong, or to a question of a neutral sort.   Ã‚  Ã‚  Ã‚  Ã‚  If I were the School Board I would have proposed this issue to the arbitrator:   Ã‚  Ã‚  Ã‚  Ã‚   Should Denise Kimball be paid for Tuesday and Wednesday, April 3 and 4, after   Ã‚  Ã‚  Ã‚  Ã‚  calling to inform her place of employment â€Å"that she would not be in† due to the   Ã‚  Ã‚  Ã‚  Ã‚  Three Mile Island Incident of March 30, 1979? I feel that this issue is not only factual but puts weight in the School Board’s argument.   Ã‚  Ã‚  Ã‚  Ã‚  5b) Although I do not believe that the issue to the arbitrator was fair to the School Board, if I were the arbitrator, I would have ruled for the association and Ms. Kimball. I feel based on the severity of The Three Mile Incident and the fact that Kimball had a legitament note from a physician with a diagnosis of â€Å"environmental stress, emotional stress, and anxiety†, that she should be paid for the days missed. This right is upheld by the Applicable Pennsylvania Statutes: School Laws of Pennsylvania under Section 1154, which is covered in the handout.   Ã‚  Ã‚  Ã‚  Ã‚  The School Board’s argument of â€Å"she was not sick on the days in question† covered in the Position of the School