Abortion Issues in Midwifery

Abortion Issues in Midwifery This topic has been chosen to examine in detail the impact of law and ethics upon nursing practice and midwifery, including the ethical dilemmas that face nurses and midwives on a day-to-day basis. It is thereby demonstrated that despite the governance of health professional practice by bodies such as the Royal College of Nursing and the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, ethics and law play a very important role, and health professionals must always act within the law to avoid legal actions being brought against them. The various schools of thought in relation to ethics are also examined and utilisation of the same via decision-making models. In relation to the general ethical dilemmas which face nurses and other healthcare workers in practice, Fletcher et al 1 discuss the ethical principles, explaining that although all health professionals face such dilemmas during practice, a multi-disciplinary approach has to be adopted in solving ethical problems. Fletcher et al outline the main ethical principles applicable to nursing ethics as the principle of respect for persons, respect for autonomy, justice, beneficence and non-maleficence. Fletcher et al explain that the origins of moral philosophy date from 600 BC, and that the two most influential schools of thought are consequentialism and deontology. Consequentialism is explained as the justification of an action by examining the consequences of undertaking that action. Branching out from this school of thought are the various approaches, the first explained is teleological theories or unilitarianism, associated with the philosophical writings of Jeremy Bentham and John Stuart Mill. Fletcher et al state that Mill stipulated that the utility or ‘happiness’ principle stated that actions can only be regarded as moral if they promote the greater amount of happiness and the absence of pain. Thompson et al 2 explains this ideology as a means to try to justify moral principles with regard to an overall goal or sense of purpose in society, the purpose being the pursuit of happiness, which is ‘built in’ in man. They discuss that that this stemmed from Aristotle in 320 BC, and that this form of ethics is known as teleological eudaemonism, the former word referring to his belief in the ‘built in’ purpose in nature, and the latter word describing the quest for happiness. They further explain the significance to health care, as they are under a duty to try to prevent or reduce pain wherever possible and promote the health and well-being of patients. ______________________________________________________________________________ 1 ‘Ethics, Law and Nursing’ (1995) pp 7-17 2 ‘Nursing Ethics’, pp233-238 Thompson et al justify the means by which health professionals can evaluate what likely consequences of treatment may be including side-effects. As act unilitarianism, although they note that where health professionals have to take into account the wider responsibilities to the patient, the hospital, research or otherwise, then rule utilitarianism is more applicable. They conclude that this ideology emphasises the achievement of goals that are important to the context of human life, and the practical application of principles or rules and that consideration of the consequences of application are important to consider to determine whether a particular course is right or wrong. Fletcher et al set out the separate branches from this notion, ‘act’ and ‘rule’ utilitarianism. Firstly dealing with ‘act’ utilitarianism, this is explained as each action is to be considered according to the consequences that ensue from it, morality determined by examining whether the greatest good came from that act. In relation to ‘rule’ utilitarianism, this is described as following of the general basic rules being in existence, forbidding murder, theft etc, rather than looking at the consequences that may ensue from that action, as by following these rules the greatest good must ensue as a natural result. Fletcher et al also discuss ‘preference’ utilitarianism, as being the allowance of discretion of individuals in undertaking a certain action and to judge the morality of each with regard to their own judgement rather than following a rule or principle. This is plainly applicable to health practice. The second school of thought explained by Fletcher et al is deontology, explained as the promotion of the importance of compliance with a duty when undertaking an action, the consequences thereof being irrelevant when considering to take such an action. This is explained as stemming from religious justification, that the explanation of such duties are the ‘laws’ sent from God, as God can be relied upon to distinguish what is right and wrong. Fletcher et al discuss the contribution to the school of thought by Immanuel Kant, a German philosopher (‘Groundwork of the Metaphysic of Morals’) who stipulated that the basis of morality lay in the ‘categorical imperative’, a moral command, set by established moral laws. Following such moral rules is regarded as imperative, regardless of the consequences of an action taken in compliance. Fletcher et al emphasise that the deontological perspective reinforces the need to follow obligations, what ought to be done, and how, in a certain situation. The obligations that befall nurses are described as contractual, as part of the terms and conditions of employment; obligations similar to family ones are seen via the role of carer, though artificially created, and moral obligations, such as the obligation to respect patient confidentiality, patient’s autonomy, to do good (beneficence) and to do no harm (non-maleficence). Fletcher et al explain that these obligations can conflict in practice situations. The obligations of nursing staff must be balanced against the rights of the individual as patients, as enshrined in The Patient’s Charter, effective from April 1992. Thompson et al further explain that deontological theories can also be distinguished into act deontology and rule deontology, the former being based upon the ability of an individual to impose their own moral duty into a situation when considering whether to take a form of action, and the latter being the emphasis upon moral duties and laws taking a universal form. They discuss the linkage of this school of thought to religious beliefs, as such rules can be argued as coming directly from God, as in the Ten Commandments. They do not discuss how this school applies to health practice, though it can be seen that this could be applied in paternalism (see below) when considering a patient’s autonomy. Religious writers such as J.F. Keenan, from the Catholic perspective 3 explain that there has been a turn to virtue ethics which has rejected the modern practice of establishing that morality is governed by human rights language, which is considered the extent to which the principle of autonomy can be exercised. Keenan states that virtue ethicists ask whether there is a character building nature to the proposed course of action and that all moral evaluations are subject to a three sided question, who are we, who ought we to become, and how can we get there? He further explains that virtue ethics considers that actions should be considered in the context of whether they will affect the type of person they will become by undertaking that action, rather than asking whether there is a right in a certain way. Fletcher et al discuss the issue of autonomy 4 as a basic principle that health professionals should always fully inform a patient about the diagnosis, forms of treatment available, and obtain his consent thereto, that is to treat him an an ‘autonomous being’. It is discussed that this may cause problems if the patient is mentally impaired or a minor, therefore it is recognised that there cannot be strict adherence to this principle, as patients would often not have the specialist knowledge to enable them to make a well-informed decision. The dilemma described in this instance is that the principle of autonomy can conflict with the principles of beneficence and non-maleficence. Fletcher et al explain that paternalism may be used quite often by health professionals, namely the belief that they can make a decision in terms of treatment on a patient’s behalf without considering their wishes or overriding the same. This is exercised in accordance with the principle of beneficence, though it is explained that usually patients are told and their wishes are taken into consideration. Fletcher et al 5 distinguish between legal rights and natural rights, the former enforceable via courts, and the latter deriving from natural law, originally thought of as coming from God, but in modern terms, has become enshrined in the concept of human rights, which have also become legal rights via the Universal Declaration of Human Rights 1948, itemising rights including the right to liberty and to life. ______________________________________________________________________________ 3 Catholic Medical Quarterly May 1992: Assisted Suicide and the Distinction Between Killing and Letting Die: J. F. Keenan 4 Ethics, Law and Nursing’ (1995) pp 35-56 5 (ibid) pp139-143 Fletcher et al 6 discuss the law governing abortion, stating that it is a criminal offence under section 58 of the Offences against the Persons Act (OPA) 1861 to unlawfully do any act with intent to procure a miscarriage, which made abortion illegal prior to the enactment of the Abortion Act (AA) 1967. Fletcher et al explain that the Abortion Act 1967 did not repeal this earlier Act, but set out grounds which specified when abortion was legal, as a defence to a charge of criminal abortion. They state that this has been amended by section 37 of the Human Fertilisation and Embryology Act (HFEA) 1990, which specify five grounds, including that a pregnancy has to be less than 24 weeks advanced; the risk or threat to the mother’s life, mental or physical health is too great to allow continuance of pregnancy; if there is a substantial risk that the child would be born with abnormalities rendering it severely handicapped; and, a unilateral act by a doctor to avert an immediate risk to the life or health of the mother. Fletcher et al explain the right of nurses to exercise a conscientious objection, for example to carrying out an abortion, the rights of which are enshrined under section 4 of the AA 1967 and the HFEA 1990, the former being the refusal to participate in an abortion, the latter a right to refuse to participate in any treatment defined by the Act. This can be utilised where the individual health worker’s personal moral code conflicts with such a practice. However, as stated by McHale and Tingle, 7 this must be actual participation in treatment, not a mere refusal to type a letter of referral 8. It is explained that such an individual can leave him/herself open to a legal action against him for an omission if there is a duty to act, though in practice this is rarely undertaken as another member of staff could perform the same treatment. Nursing staff may also record their objections to a specific course of treatment prescribed by another health professional on personal moral grounds, which might be affected by their contract of employment when the employers make decisions with regard to this. Additionally, Ann Young 9 states that the refusal of the health professional can be made unless the treatment is necessary to save life or prevent grave permanent injury to the physical or mental health of the mother. However, she criticises the ambiguity of the word ‘grave’ as this could constitute depression as well as a serious heart defect. In Selective Reduction and Feticide: The Parameters of Abortion 10, David Price emphasized that there is ambiguity in the use of the term of abortion by medical practitioners and lawyers alike. He noted that Glanville Williams’ definition of abortion 11 states that For legal purposes, abortion means feticide: the intentional destruction of the foetus in the womb or any untimely delivery brought about with the intent to cause the death of the foetus. ______________________________________________________________________________ 6 (ibid) 7 ‘Law and Nursing’ p 208 8 Jannaway v Salford AHA [1988] 3 All ER 1079 9 ‘Legal Problems in Nursing Practice’p 209 10 (1988) Sweet Maxwell Limited and Contributors: David P.T. Price 11 Textbook of Criminal Law, (2nd ed., 1983), p.292 In the context of non-consensual abortion, Price explains that this can occur where the death of a foetus was caused by an act of non-consensual violence upon a pregnant woman. He argues that this act may not necessarily fall within the definition of a criminal abortion under section 58 OPA 1861, and would rather be treated as an assault. He states that in the United States, courts are prepared to extend the crime of abortion, which is similar to section 58, to non-consensual assaults upon women resulting in foetal death 12 though in this case the man causing foetal death was charged with assault rather than foetal murder. Looking at an American viewpoint, in Bioethics and Medical Ethics 13, Thomas Platt considers that the emphasis on autonomy ignores the deeper metaphysical issue of the degree to which any human act can be regarded as freely chosen. He states that the scientific perspective purely states that human behavior is the result of genetic and environmental factors. He stipulates that it has to be the environment in which a person has been raised which will determine how a person will respond to a suggestion, for example abortion, and that in less technologically developed cultures, they would respond in a different way to the West. Verena Tschudin 14 explains ethical decision making models in many forms including Jameton’s model, which requires identification of the problem, gathering of data to identify options and make a decision to act and then assess the consequences thereof; Crisham’s model; initially ‘massaging’ the dilemma, outlining the options, reviewing the criteria, before the act and evaluation thereof and the Nursing process model, which requires assessment, planning, implementation and evaluation. The latter involves a series of questions at assessment level, planning identifies whether the ethical problem is a question of teleology or deontology, with a series of questions to follow, implementation requires consideration of whether one would like to receive the same treatment, and finally evaluation considers whether the act has solved the problem and what was gained, with a series of questions. In relation to the exercise of patient consent, this is described as an exercise of a patient’s autonomy. The UKCC’s guidelines re that the health professional must ‘explain the intended test or procedure to the patient without bias and in as much detail as the patient requires’, and that if no questions have been asked then the health professional should assess the amount of information the patient requires 15. It is explained that a nurse, as per Clause 1 of the UKCC Code of Professional Conduct must ‘act in such a way as to promote and safeguard the interests and well-being of patients and clients’. This is explained to go so far as stating his/her opinion that there has been insufficient information provided to the patient to render the same fully understandable to him and enable him to make a fully informed decision 16, which can affect the judgment given by a doctor. ______________________________________________________________________________ 12 Hollis v. Commonwealth 652 S.W. 2d 61 (Ky. 1983) 13 Medicine, Metaphysics and Morals: Thomas Platt: West Chester University 14 ‘Ethics in Nursing’ p 85-95 15 ‘Exercising Accountability’ 16 (ibid) It is explained further 17 that the principle of autonomy is enshrined in law as the right to self-determination. Written consent is usually provided before surgery, in a standard form from the Department of Health, which has been amended in 1991.The case law relating to consent stems from the general principle that every adult person of sound mind and body has a right to determine what happens to his body, and that a surgeon who performs an operation without his consent has committed an assault 18. However, this principle is heavily qualified is discussed. In the case of informed consent, where the patient is given insufficient information about the risks of a certain procedure, the patient must sue in negligence rather than in battery 19. Even the standard set in negligence is weighted heavily in favour of the health professional, as it has been ruled that a doctor is not guilty of negligence as he has acted in accordance with the accepted practice in that field by other doctors 20. This case was affirmed in Sidaway v Bethlem Royal Hospital 21, and in further subsequent cases such as Blyth v Bloomsbury AHA 22 and Gold v Haringey AHA 23, where the restrictive disclosure policy was supported by general medical opinion. It was highlighted that despite this, Lord Bridge has emphasised in Sidaway 24, that even if a health professional acts in accordance with general practice, the court may still take a decision that there has been non-disclosure of material facts. Specific problems are highlighted in the context of where a patient is incapable of providing consent, which is governed by law. The case law has established that a health professional must only do what is absolutely necessary to save the patient’s life, which does not include removal of a womb if it has been considered a further pregnancy would jeopardise the patient’s life 25. Therefore, it is argued that this principle of doing what is necessary to save a life overrides the right to autonomy 26. However, this does not extend to the life of a foetus in risk 27. Regarding accountability, Fletcher et al 28 states that the Code of Professional Conduct stipulates a registered nurse, midwife or health visitor is personally accountable for her practice, even off-duty. This ties in with the professional’s legal duty of care, as explained by Tingle Cribb 29, deriving from Donoghue v Stevenson 30, as the need to take reasonable care to avoid acts or omissions that can be reasonably foreseen to injury a person affected by the acts or omissions, which can result in an action for negligence. Tingle Cribb state that the nurse has to weigh up the potential harm and benefit of the patient at that time, and reach the decision involving the least harm. ______________________________________________________________________________ 17 (Fletcher et al: ibid) 18 Schloendorff v Society of New York [1914] 19 Chatterson v Gerson [1981] 20 Bolam v Friern Hospital Management Committee [1957] 21 [1985] 22 [1985] 23 [1988] 24 (ibid) 25 Devi v West Midlands AHA 26 Re T 27 Re F (in utero) [1988] 28 (ibid) pp104-129 29 ‘Nursing Law and Ethics’ p 13-19 30 [1932] The professional standards are maintained by the UKCC in the Code of Professional Conduct, and each nurse or midwife is under that duty, though they argue that this standard is set by the profession itself. In the case of an allegation of a breach of such a duty, the health professional can be subject to disciplinary action for misconduct. They explain that accountability merely requires a health professional to be able to justify their actions. Fletcher et al consider that it is important for the professional to have regard to the interests of patients and clients rather than purely the rules of the UKCC. Verena Tschudin 31 states that nurses have both a legal and moral accountability, which arises from patient autonomy. Fletcher et al discuss the dilemmas that may occur in healthcare practice, and where the health professional’s moral code is at odds with her duty, The Code of Professional Conduct stipulates that the professional must ensure that no action or omission by that person will be detrimental to the condition of the patient, which can be seen as the principle of non-maleficence. An example is provided that if the incorrect dose of medicine has been administered to a patient, then that health professional’s self-interest should not override her duty to disclose the error as this could not be argued to be in the patient’s best interests. In relation to professional competence, Fletcher et al state that The Code of Professional Conduct stipulates that a health professional must maintain and improve their professional knowledge and competence. As regards midwives, Fletcher et al state that they requirement is to attend a five-day refresher course, five approved study days every five years or another approved course. There has been an impact in the context of European Community (EC) legislation, as explained by Bridgit Dimond 32, the activities of a midwife are defined in EC Directive 80/155/EEC Article 4, including providing family planning advice to recognise warning signs of abnormalities necessitating doctor referral. Fletcher et al criticise the limitations of the Post-registration Education and Practice Project in 1990 for newly qualified nurses, and those returning to health care practice after five years, requiring five days study leave every three years and demonstration of professional knowledge and competence. However, since then, Ms Dimond has argued that Project 2000 has sought to integrate nurse clinical teaching and practice 33. Fletcher et al explain that ethical dilemmas can arise from the instructions provided by a senior member of staff, which does not accord with the health professional’s personal or moral beliefs. When making a decision on how to act, that professional will have to consider whether she is acting within the law, according to the Code of Professional Conduct, and also in the best interests of the patient as well as her own beliefs. They discuss the remedies available to patients or clients, which are a complaint to the UKCC which would result in a hearing before the Professional Conduct Committee; use of the formal Hospital Complaints Procedure; or a complaint to the nurse’s employer. ______________________________________________________________________________ 31 (ibid) p 116 32 ‘Legal Aspects of Nursing’ pp 444-457 33 (ibid) p 270 In conclusion, in the context of conscientious objections, it has been suggested that there should be ward-based abortions carried out only 34 in special units by professionals who have taken up such jobs as they do not have moral or ethical objections to abortion. Verena Tscudin 35 states that here is however, always a conflict between a nurse or midwife’s duty to preserve life rather than destroy it. The culmination of ethical perspectives in decision-making models assist the professional, though she must also always be mindful of her duty to the patient, the Code of Professional Conduct and the law. ______________________________________________________________________________ 34 Ann Young, p 209 35 (ibid) p 137 BIBLIOGRAPHY Bioethics and Medical Ethics :Medicine, Metaphysics and Morals: Thomas Platt: West Chester University Catholic Medical Quarterly May 1992: Assisted Suicide and the Distinction Between Killing and Letting Die: J. F. Keenan ‘Ethics in Nursing’ (2nd edition) 1992 (Butterworth/Heinemann) pp 85-95: Verena Tschudin ‘Ethics, Law and Nursing’ (1995) Manchester University Press pp 7-17; pp 35-56; pp 139-143: Fletcher et al ‘Legal Aspects of Nursing’ (2nd edition) 1995 (Prenctice Hall) pp 444-457: Bridgit Dimond ‘Legal Problems in Nursing Practice’(2nd edition) 1993 (Chapman Hall) p 209: Ann P.Young ‘Law and Nursing’ (2nd edition) 2001 (Butterworth/Heinemann) p 208: McHale and Tingle ‘Nursing Law and Ethics’1995 (Blackwell) pp 13-19: Tingle Cribb Selective Reduction and Feticide: The Parameters of Abortion ((1988) Sweet Maxwell Limited and Contributors: David P.T. Price ‘Nursing Ethics’(2nd edition) 1993(Churchill Livingstone), pp233-238: Thompson et al 104134 Legally Binding Undertaking 1. I Rebecca Asghar undertake that in line with my contractual obligations this work is completely and wholly original. 2. 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Health Care and Faith Diversity

1. It would help to have pages number with a subtopic as in APA format. Health Care Provider and Faith Diversity- First Draft Elain Brown HLT-310V Spirituality in Health Care Grand Canyon University December 16th, 2012 Abstract (good abstract included. ) When caring for patients whose backgrounds are different to their own, nurses may find it difficult to understand their perspective and needs, and may make assumptions about them that turn out to be mistaken as stated by Komaromy,( 2004).Although there are many different religions, the three that will be elaborated on and compared to the Christian religion are Islam, Buddhism and Bahia Faith. The paper will show that spirituality is inherent, regardless of where you are from or the difference in culture. The basic beliefs about healing and prayer is not that much different from Christianity. They all share the common values of caring for their fellowmen, and receiving healing from illness. Islam This is the second largest religion, n ext to Christianity with 1. billion followers. This is based on the leadership of the Prophet Mohammad and they follow the teachings of the Quran. They believe there is only one God, (Allah and that they should submit to His will. The Islamic (there is a beginning parentheses but no clue where it ends to separate the idea). faith teaches what is called the five Pillars of Islam: faith, prayer, fasting, pilgrimage and aim. Depending on each person’s deed during his lifetime, he will go to paradise or hell after death.This faith believes in praying to Allah for healing when one is sick, but at the same time they think God may cause illness as a test, a way of getting mankind to return to God’s purpose. During illness one must seek God’s help with patience and prayer. (Ai(should this be capitalized? ). The Art Institutes – Religious Facts) Religion Facts. com. (Is this acitation, a bit confusing? ) Basically the Islamic religion believes that all illness is caused from the heart and until the heart is right, one cannot be healed.The heart becomes right by asking for forgiveness from Allah, Another important aspect of this religion in health care understanding( watch the spacing between words) regarding touch, such as a female bathing a male patient and handling of the body after the patient passes. Bahia good information This religion was founded by Baha’u’llah in 1863, and has approximately 5-7 million followers. The belief is to develop in spirituality and draw closer to God. There is but one God who is the ruler of the universe.The belief is that God does not need us to worship Him but what he asked us to do, is to benefit mankind (Religion Facts. com). This religion believes that after life the soul separates from the body and begins a journey towards or away from God. Heaven and hell are states of being. The Bahia faith practices daily prayer, avoids intoxication by drinking or smoking, hardworking, believes in educa tion, works for social justice and equality, and practices monogamy. There is a prayer for every occasion, such as for healing, growth, difficulties in life and marriage.One must pray and fast to receive healing, (Boston Healing Landscape, Boston University). Buddhism Founded by Siddhartha Gautama (The Buddha), in c. 520 BC NE India. The religion has since split into several sects and has adapted a wide variety of beliefs( include period) ( Add this to beginning of next sentence). it has. Over 360 million followers. The purpose is to avoid suffering and gain enlightenment and release from the cycle of rebirth, or at least attain a better rebirth by gaining merit.The Buddhist believes in reincarnation of all creatures and is strict vegetarians. They do not think the world is created or ruled by God. (The Big Religion- Chart Religious Facts). The universe is populated by celestial Buddha that inspires people to do well. Anyone can become a Buddha by gaining merit. Each person should w ork for goodness, happiness and peace, develop wisdom which leads to the realization of ultimate truth, they believe. There are several different Buddha that inspire mankind, such as the Medicine Buddha for healing.Healing and lasting happiness is achieved through meditation. Buddha taught that human suffering is caused because they pursue things that do not give lasting happiness. Buddhism has a variety of rituals and practices which are meant to aid to the journey of enlightenment and bring blessings to others and oneself( endofathought needs period) Buddha of Healing is concerned with helping beings to awaken their past deeds and to seek change of their negative patterns this is known as the aspiration to attain enlightenment (Gordon Bell 1196, 1998).Christians are followers of Jesus Christ and is the largest religious group in the world . Today it has over 2 billion believers worldwide and started in Israel in c 30, AD . Christians believe in one God who is a Trinity; Father, So n And Holy Spirit Christians believe that all must come to God for forgiveness and salvation. They believe that there is a physical heaven and hell. ( needs to be clearer, is it a period or comma to much information for one sentence) just like Islam, and that one has to be forgiven and live a life that pleases God to get to heaven , after death.Over time Christianity has split into different religion just like Bahia, but the difference is that their belief is basic and they agree on the fundamentals of the Bible. The Christian believes that he should pray for forgiveness and healing when he(is) are sick. Their belief is built on their faith in Jesus Christ. According to James 5: (12-15), if anyone is sick he should call for the elders of the church who should pray for him and anoint him with oil. The prayer of faith will save him and his sins will be forgiven.Like Buddha the Christian is asked to pray for forgiveness and healing , the Buddha believes that one should meditate to achi eve enlightenment and that one causes unhappiness to himself, by his own deed. Spirituality continues to be a challenge for the health care provider the challenge for the nursing professional is to develop a definition of spirituality which is broad enough to accommodate the uniqueness of all individuals , patient and nurses and all humanity (Trapper and McSherry, 1998). Nurses should strive to respect patients irrespective of belief, values or religious orientation.Even when they may be undeserving in our thoughts. They may be unpleasant but they deserve care. They may appear unpleasant simply because they are misunderstood. (good statement). Patients of different faith, need to be given the opportunity(watch spacing) by the care giver to express, their beliefs and expect it to be incorporated in their care. This should start at admission, when certain questions need to be asked as a part of the admission process. They should be â€Å"what is your . religious belief : or â€Å"ho w do you cope under stress? good idea) This will give the nurse more knowledge of the patient and these values should be a part of the care plan. It is very important that all patients trust their caregiver to do the right thing for them regardless of color, creed or kind. The nurse should do no further harm to her patient, whether it be physical or spiritual.. Cultural sensitivity and religious belief are very important parts of nursing care. The nurse should also be aware that people from the same culture may also have different faith, and should treat each patient as an individual. good) When patients view health care workers as being sensitive to their culture and faith, then they are more likely to respond to care, education and healing. If a patient feels that he is in an environment where he perceives bias then he probably won’t respond as well to treatment. .In keeping with the Christian philosophy, the Bible stated that Jesus went around different regions, villages a nd cities , where he preached, taught , and healed the sick and broken hearted. He showed empathy, sometimes just by a touch.Nurses may not always be able to touch, but maybe just a smile may be all that patient need to see to feel welcomed. (more of a conclusion needed to tie the comparison together). References The Big Religion Chart –Religious Facts Komaromy , Carol : Cultural diversity in death and dying; Nurse Management 11-8 (Dec 2004):32-6 Illness and Health: Division of Graduate Medical Science (Boston University, school of Medicine) Dorsey, L (1998) Healing words: The power of prayer and the practice of medicine ; San Francisco, CA Harper Collins James 5 verses 12-15. Overall peer review . The paper provides evidence of th e perspective healing of 3 religions. I would have liked to seen it more incorporated in how nurses could use traditions. 2. The flow of the paper was well with one or two needs to separate sentencespreventing run on . 3. The organization was well with subtitles. Components for healing and Christian Philosophy of Faith and Healing could have have been additional subtitles. 4. The paper met the wording requirement thereby following the assigned guidelines. The writer had a good understanding of what was expected in the assignment.

Kudler Fine Foods Virtual Organization

Marketing is an important tool for any business. It is how a company makes their product known to the public. Without marketing, the consumers will either not know that the product even exists or will not know all the applications of the product; who makes it, what it is and what it is made from, when came on the market, where it can be purchased, how it can help the consumer and why the consumer should even purchase the product in the first place. According to Tom Ash, Marketing is the process whereby demands for products, services and ideas are anticipated, managed and satisfied (2011). Now, marketing research, on the other hand is just as important, just as effective and the results are just as significant to the success of a company. Creating a marketing strategy is just as important as business creating a business plan. In order to develop your strategy for your business it does require some form of research (Stein, 2009). After all, how could a company, not matter how big or small, know how to put their product or service on the market without researching what the market is looking for to begin with? Kudler Fine Food’s marketing strategy reaches out first to the senses by describing their delicious food and spirits; it targets an audience that would prefer finer foods as well as their locations. Kudler describes each of its three locations and points out that they are spacious and located in fashionable shopping areas. Kudler not only details what they sell, but who they are, what their mission is and what their history is. In my opinion, a company that is so open to the public about itself is using a remarkable marketing strategy. I must say that I am a visual person and while seeing the pictures that Kudler offers on their web-site, their lyrical description of the foods they offer makes me wish that this was a real place! For this reason, I believe that visual marketing is the most powerful and effective marketing tool ever created. The bakery, meats and seafood, produce, cheese and wine are so much easier to sell when they are visually mouthwatering to the consumer! The most interesting tactic that I am aware of on the Kudler Fine Food’s ite is the survey. I personally think this is a great (as well as free) way to obtain feedback on their stores and learn how to improve them in an effort to meet their customer’s needs; not the needs of their own. It aids Kudler in learning what and where their strength and weaknesses are simply by offering a one minute survey for customers that have visited their store to do. Of course, no web-site is perfect; they each have room for growth. On the Kudler Fine Food’s web-site, in my opinion, the area that could use additional market research is the specific types of foods that the consumer is in the market for. The web-site lists the different types of food that they sell, of course, but if they went a little further and offered additional market research that informed the visitors of the web-site as well as the store what products they they sell are good for you and in what way, I think the web-site would be much more beneficial to the consumer. This would be especially effective in a time where people are so careful about eating healthy foods and stores that help them find those foods. According to McGonagle, â€Å"Competitive intelligence is the selection, collection, interpretation and distribution of publicly-held information that has strategic importance, it is the analytical process that transforms disaggregated competitor intelligence into relevant, accurate and usable strategic knowledge about competitors, position, performance, capabilities and intentions, a way of thinking. It uses public sources to locate and develop information on competition and competitors and it is highly specific and timely information about a corporation† (2009). This relates to the Kudler Fine Food’s marketing strategy because Kudler uses its selection, collection, interpretation and distribution of publicly-held information about not only themselves, but about the products the sell. I can say that I have not really been able to locate any company that Kudler is competitive with on their web-site but I do notice that their selection can be considered competitive in any market. The way in which Kudler describes their position, performance, capabilities and intentions is very relative to a marketing strategy because they are not hiding behind any veils or doors about whom they are or who they portray what they are about. The importance of competitive intelligence and analysis in regards to the development of Kudler Fine Food’s tactics offers the consumer the opportunity to tell them what they do or don’t like, which store they have hopped in, how the learned about Kudler Fine Food’s, and why they shopped there and why they will shop there again. Any tactic a business can use in analyzing their own web-site through the eyes of their customer is a very strong use of competitive intelligence. Kudler Fine Food’s also utilizes the tactic of visual aids which entice the consumer even more. The competitive intelligence used in this tactic is by making their food look better than that of their competitors. It is their attention to detail and the responsibility they take in creating and selling food’s that are affordable, healthy and accessible to their customer. Doing research can involve finding out who else is in the niche, how they are advertising, what keywords they are targeting, where they are advertising, and many other factors. This does not mean that you follow your competition or stalk them because you very well could be wasting a great deal of time doing this (Stein, 2009). Kudler uses the wording ‘Finest Foods’. Now while there is no way to prove that their food is the finest available, they believe that it is. That is the greatest strength in marketing research in the development of Kudler Fine Food’s; believing that your company and your product is the best on the market. Every company has something different to offer the consumer. Whether it be a product: cosmetic, mechanical, clothing or a service, the best way to market yourself and your product is by believing in the product or service. References Ash, T. (2011). Why marketing is important to your business. Retrieved May 17, 2011 from http://www.articlesbase.com/viral-marketing-articles/why-marketing-is-important-to-your-business-410123.html McGonagle, J. (2009). An overview of competitive intelligence. Retrieved May 17, 2011 from http://www.combsinc.com/chapt1.htm Stein, J. (2009). Why is marketing research important to developing marketing strategy. Retrieved May 17, 2011 from http://www.articlesproductions.com/f77/why-marketing-research-important-developing-marketing-strategy-1006/

Rounding Numbers - Printable Worksheets

Rounding numbers is a concept that is often taught in the second grades through to the seventh grade and the size of numbers to be rounded. All rounding number worksheets are in PDF. Rounding Tutorial 1. Rounding Whole Numbers - Tens Place 1. Rounding Whole Numbers - SOLUTIONS 2. Rounding Whole Numbers - Tens, Hundreds, Thousands, Ten Thousands Place 2. Rounding Whole Numbers - SOLUTIONS 3. Rounding Decimal Numbers - Tenths, Hundredths, Thousandths Place 3. Rounding Decimal Numbers - SOLUTIONS When a child struggles to round numbers, a grasp of place value is missing. Place value refers to the value of the digit depending on its place. For instance the one in the number 4126 is in the hundreds place. Children making errors in rounding usually need to step back and work on place value.