Cultural competence Essay

This paper explores the Hmong people’s views toward medicine within the lens of their culture. It will take into account their history and also seek to explain the natural aversion these people have to most modern techniques in medicine. The Hmong people have a large immigrant population in the United States and represent unique challenges to most medical practitioners that can be used as a model to teach new methods of treating patients who may not understand western medicine. Understanding the Hmong is the first step in devising better techniques for nurses and other health professionals who seek to provide the best standard of care to all peoples in a safe, professional and cooperative way. Medical Views of the Hmong People: The Importance of Cross-Cultural Understanding As the United States becomes a more racially and ethnically diverse nation, health care systems and providers must adapt to be able to better care for patients’ with regard to their perspectives, values, and cultures. Failure to understand and manage social and cultural differences may have significant health consequences to the patient and could lead to ineffectual practices in the delivery of care. This is particularly significant in the treating of patients from the Hmong ethnic group. Whose cultural beliefs and practices are often opposed to the methods of modern U. S. Medicine. The Hmong people are made up of peoples from China, Vietnam, Laos, and Thailand. Indigenous to South East Asia, many of them resided in Laos until 1975 when Pathet Lao came into power and began to persecute them for their involvement (on behalf of the United States) in Vietnam. As a result of this political crackdown many Hmong fled Laos and have been accepted as refugees in many western countries including the United States. Although they are a largely diaspora population they have managed to hold onto their cultural traditions as well as assimilated (partially) to the culture s of their home countries. These traditions are passed down from elders to youth and are a strong pillar through which the Hmong are able to maintain their history and community. Currently there are 245,000 Hmong people residing in the United States, most of which live in California, Minnesota and Washington. As their numbers grow so does the importance of dynamic care practices that can better suit their medical needs. The Hmong are a primarily Shamanistic culture, with a strong reverence for ancestral spirits. Their beliefs in spirits are not regulated to simply deceased family members, but in all things both animate and inanimate. These spirits reside in a mirrored Spirit realm, where the spirits of their ancestors and also that of trees dwell. The individual is thought to have multiple spirits residing in them that regulate both the spiritual and physical health of the person. Illness is thought to come from evil spirits who attempt to harm the native spirits that reside in individual’s body. These spirits are the cause of all illness and exist in the spirit realm. It is to be noted that these spirits exist on the same plane as regular mortals, however the deity Saub made us blind to them after conflicts between the spirits and the mortals. It is only through the utilization of shamans that we may access them, and treat illness. As the malevolent spirits descend on the body, they may cause the native spirits to leave their human host, this is thought to be manifested in the physical world as serious illness. The Hmong believe that illness is intrinsically linked with a spiritual imbalance, therefore the Shaman is called upon to conduct rituals to bring back the wayward spirit and to discern the cause of its leaving. These beliefs can be in direct opposition to the belief of modern medicine, which relies heavily on scientific and empirical evidence. The simple diagnosis of illness can be greatly impeded when the patient believes that their rash comes from evil spirits as opposed to the contact of a poisonous material. Also this can breed a general distrust of western medication, when for centuries the answers to illness have always lied with the shaman and not with pills and elixirs. The language barrier also is challenging, but in a novel way, whole concepts in the Hmong culture are untranslatable, and the nuances in regional practices of the Hmong make each group individual in their phrasings and pronunciations. Even with the assistance of a native translator many concepts remain completely lost in translation, especially for American nurses who are often the first line of care for these people. Traditionally when a Hmong person becomes sick they are taken to see the community Shaman. The Shaman is considered a very important member of Hmong society as they are able to communicate and travel with spirits. They serve the role of both doctor and priest in that they care for the physical and spiritual wellbeing of the person. Because of the link between spiritual and physical illness, it is held that the main means to achieve health wellness is through ritual to appease the spirits. This can be dangerous to the person as their illness may go undiagnosed and untreated as the afflicted wait for the results of the ritual to affect them. Among the largest problems with treating the Hmong is noncompliance, as their tradition may prevent them from actually utilizing the medicine given to them from western hospitals and pharmacies. The treatment of psychological disorders in the Hmong people also poses a unique challenge to western health professionals. In the Hmong tradition those with unexplained psychological illnesses such as bi-polar disorder, schizophrenia, multiple personality disorder, and some neurological disorders (i. e. epilepsy) are considered to be chosen to become shamans. The symptoms with these maladies are often closely associated with spiritual intervention such as: multiple personalities exhibited being the manifestation of different spirits attempting to possess the body, or epileptic seizures being a communication from spiritual forces. This has caused these disorders to be revered in the Hmong tradition and have led to many of them going undiagnosed. The usual protocol for such episodes are for the child (as these ailments often present themselves in childhood) to be blessed and sent to learn with a shaman teacher, so that they may use their gifts for the community and become a shaman themselves. As shamans are highly respected and important members of the community any attempt to stifle or diminish their gifts can be construed as going against the wishes of ancestral spirits. To have a shaman in ones family is considered one of the highest honors, thus creating a situation where the illness goes both undiagnosed and untreated. Interactions between American health professionals and the Hmong people have even been documented in the book The Spirit Catches You and You Fall Down by Anne Fadiman where culture clashes between ignorant parents and culturally insensitive medical staff ends very tragically for a young girl diagnosed with epilepsy. The combination of the Hmong parents unwillingness to trust the medicines of the Merced doctors and doctors unwillingness to understand the culture of the Hmongs and to tailor the care of the daughter unfortunately end in the girl in a vegetative state. This book goes through the history of the Hmong and makes the reader understand the nature aversion they have to medicines. To them healing is their religion, and to these people the American method of medicine is entirely too invasive. They feel we cut and defile bodies, we take too much blood and we cause dramatic personality changes with our drugs. This failure to understand these concerns is damning for Lia Lee (the little girl) and led to both noncompliance and also fear about regarding possible surgeries for the very young child. This book is assigned reading for many medical programs and is compelling read, The importance of its theme of cultural understanding cannot be stressed enough. When Lia was brought to the emergency room for the last time, the staff at the hospital assumed that she had a big seizure because of her parent’s unwillingness to give her seizure medications that had been prescribed. They all silently agreed that it was just a matter of when. It was to the disappointment of many and a shock to Neil Ernst and his wife Peggy Philp when another neurologist who had treated Lia previously announced that it was septic shock and not under medication that had caused the â€Å"big one†. The fact that Neil Ernst did order a septic workup on Lia indicated that he was not treating her symptoms but was had used previous experience with the parent’s noncompliance as all- purpose explanation that blinded him from seeing exploring other more obvious possibilities of Lia illness. The role of the nurse as educator is paramount in these situations. A nurse when performing her role in the health care setting always has the opportunity to bridge the gap between the patient and the physcians. Anne Fadiman after researching the book for eight years ascertains that â€Å"We do not know if Lia would be able to walk and talk today had she been treated by Arthur Kleinman instead of by Neil Ernst and Peggy Philp. However, I have come to believe that her life was ruined not by septic shock or noncompliant parents but by cross-cultural misunderstanding. † In modern medicine there has been an increased prominence put in patient education and understanding. What could have saved Lia’s life is a more tailored course of treatment that both respected her families beliefs while also allowing for the benefits of modern medicine. When helping patients it is always important to respect their cultures and traditions, but it is more important to build understanding between their traditions and what will best allow them to get better. Nurses can play the greatest role in building cross-cultural trust, when they (as the first line of care) educate patients on their medications and dietary recommendations. In a more diverse America we will need more Nurses to be able to not only respect cultural boundaries, but foster cultural cooperation to better treat all patients.

Financial Management of Goldman Sachs

To ensure adequate returns to the shareholders which will depend upon the earning capacity, market price of the share, expectations of the shareholders. 3. To ensure optimum funds utilization. Once the funds are procured, they should be utilized in maximum possible way at least cost. 4. To ensure safety on investment, i. e, funds should be invested in safe ventures so that adequate rate of return can be achieved. 5. To plan a sound capital structure-There should be sound and fair composition of capital so that a balance is maintained between debt and equity capital.Functions of Financial Management: 1. Estimation of capital requirements: A finance manager has to make estimation with regards to capital requirements of the company. This will depend upon expected costs and profits and future programmes and policies of a concern. Estimations have to be made in an adequate manner which increases earning capacity of enterprise. 2. Determination of capital composition: Once the estimation h ave been made, the capital structure have to be decided. This involves short- term and long- term debt equity analysis.This will depend upon the proportion of equity capital a company is possessing and additional funds which have to be raised from outside parties. 3. Choice of sources of funds: For additional funds to be procured, a company has many choices like- a. Issue of shares and debentures b. Loans to be taken from banks and financial institutions c. Public deposits to be drawn like in form of bonds. Choice of factor will depend on relative merits and demerits of each source and period of financing. 4.Investment of funds: The finance manager has to decide to allocate funds into profitable ventures so that there is safety on investment and regular returns is possible. 5. Disposal of surplus: The net profits decision have to be made by the finance manager. This can be done in two ways: d. Dividend declaration – It includes identifying the rate of dividends and other bene fits like bonus. e. Retained profits – The volume has to be decided which will depend upon expansional, innovational, diversification plans of the company. 6.Management of cash: Finance manager has to make decisions with regards to cash management. Cash is required for many purposes like payment of wages and salaries, payment of electricity and water bills, payment to creditors, meeting current liabilities, maintainance of enough stock, purchase of raw materials, etc. 7. Financial controls: The finance manager has not only to plan, procure and utilize the funds but he also has to exercise control over finances. This can be done through many techniques like ratio analysis, financial forecasting, cost and profit control, etc.Goldman Sachs is a leading global investment banking, securities and investment management firm that provides a wide range of financial services to a substantial and diversified client base that includes corporations, financial institutions, governments and high-net-worth individuals. When we use the terms â€Å"Goldman Sachs,† â€Å"the firm,† â€Å"we,† â€Å"us† and â€Å"our,† we mean The Goldman Sachs Group, Inc. (Group Inc. ), a Delaware corporation, and its consolidated subsidiaries. References to â€Å"this Form 10-K† are to our Annual Report on Form 10-K for the fiscal year ended December 31, 2011.All references to 2011, 2010 and 2009 refer to our fiscal years ended, or the dates, as the context requires, December 31, 2011, December 31, 2010 and December 31, 2009, respectively. Group Inc. is a bank holding company and a financial holding company regulated by the Board of Governors of the Federal Reserve System (Federal Reserve Board). Our U. S. depository institution subsidiary, Goldman Sachs Bank USA (GS Bank USA), is a New York State-chartered bank. As of December 2011, we had offices in over 30 countries and 48% of our total staff was based outside the Americas (which includes the countries in North and South America).Our clients are located worldwide, and we are an active participant in financial markets around the world. In 2011, we generated 38% of our net revenues outside the Americas. BUSINESS PRINCIPLE Our clients’ interests always come first. Our experience shows that if we serve our clients well, our own success will follow. Our assets are our people, capital and reputation. If any of these is ever diminished, the last is the most difficult to restore. We are dedicated to complying fully with the letter and spirit of the laws, rules and ethical principles that govern us.Our continued success depends upon unswerving adherence to this standard. Our goal is to provide superior returns to our shareholders. Profitability is critical to achieving superior returns, building our capital, and attracting and keeping our best people. Significant employee stock owinership aligns the interests of our employees and our shareholders. We take great pride in th e professional quality of our work. We have an uncompromising determination to achieve excellence in everything we undertake. Though we may be involved in a wide vvariety and heavy volume of aactivity, we would, if it came to a choice, rather be best than biggest.We stress creativity and imagination in everything we do. While recognizing that the old way may still be the best way, we constantly strive to find a better solution to a client’s problems. We pride ourselves on having pioneered many of the practices and techniques that have become standard in the industry. We make an unusual effort to identify and recruit the very best person for every job. Although our activities are measured in billions of dollars, we select our people one by one. In a service business, we know that without the best people, we cannot be the best firm.We offer our people the oopportunity to move ahead more rapidly than is possible at most other places. Advancement depends on merit and we have yet to find the limits to the responsibility our best people are able to assume. For us to be successful, our men and women must reflect the diversity of the communities and cultures in which we operate. That mearns we must attract, retain and motivate people from many backgrounds and perspectives. Being diverse is not optional; it is what we must be. We stress teamwork in everything we do. While individual creativity is always encouraged, we have found that team effort often produces the best results.

Business law Research Paper Example | Topics and Well Written Essays - 1500 words

Business law - Research Paper Example There are tones of organizations turning to the arbitration processes whereby majority are avoiding courts and preferring to solve disputes through an arbitrator. Preference of this method of solving legal disputes has left numerous concerns as to whether all these parties are all for it. This is the basis for the choice for the articles below on arbitration, in order to evaluate the process keenly to eliminate any uncertainties pertaining to it as well as provide a scrutiny of what the legal system requires to do so as to enforce arbitration processes and close loop holes that are manifesting in the mechanism and utilize it properly since despite many encumbrances facing it, it is a cost effective procedure that can be very popular among contracting parties. â€Å"Forced Arbitration: Corporations Opting Out of Justice and Fairness† and â€Å"Delaware Rapid Arbitration Act to Take Effect in May 2015† are two articles of my choice that will help me scrutinize the process of arbitration and the reasons why organizations are preferring this method of dispute resolution. The scrutiny of these articles will enable me understand arbitration especially that which touches on business organizations and its ability to provide justice to the aggrieved parties. This study will also help identify strengths and areas of improvement in the process in the legal system concerning Arbitration. â€Å"Forced Arbitration: Corporations Opting Out of Justice and Fairness† article contends that the contractual agreements giving permission to allow arbitration as a means of resolving conflicts. This contractual agreement is present in many businesses and individuals sign without the knowledge that they have embedded their signature to permit such a process. This is the reason why the article calls the process as a forced arbitration because majority of participant are unaware of

Comparative Federalism Essay Example | Topics and Well Written Essays - 750 words

Comparative Federalism - Essay Example The distribution of power among the central and the states is derived from the written constitution. Both forms of the government rule directly over the people. It is also sometimes seen as a compromise between the extreme concentration of power and loose confederation of independent states for governing a variety of people living in a large territory. Similarities and Dissimilarities with India and USA’s Federal Form of Government USA being the largest democratic countries in the world became the Federal republic state in the year 1789 by promulgating its constitution and India on the other hand in the year 1950 by launching its constitution. Smaller states by forming a union got affiliated with the strong central government that came to be called as Federal government in USA and central government in India. Both the countries have a written form of constitution. Secondly, USA has got its bill of rights to protect the fundamental rights of the people and India has guaranteed the fundamental rights in the articles 14 to 34 in part iii. Thirdly both the countries have Federal forms of government at the centre. The law enacted by the centre is much more superior to the law passed by the state. Both the countries have three basic divisions of labor and power in the Federal system of government; they are known as executive, legislature and judiciary. The executive governs the country, legislature enacts law, and the judiciary administers justice. Both the countries have bicameral form of legislature. In USA president is the chief executive head whereas in India prime minister is the head. USA has got the House of Senate and the House of Representatives as the upper and lower house of legislature while India has Rajya sabha and Loksabha as the upper and lower houses. A well organized judiciary is present in both the countries as apex and Supreme Court. Lastly, both the countries have a threat to democracies so the divisions of power are somehow or the other c hecked by the other houses of power. Firstly, USA’s constitution is very rigid and has undergone amendment only 27 times but the Indian constitution on the other hand is very voluminous and flexible has been amended 94 times. In USA all the states have their own constitution while in India all the states follow the Indian constitution. Secondly, USA has the presidential form of government but India has the parliamentary form of government. USA follows the bi-party system whereas India has got multi party system. President of USA can hold his office for only two terms whereas in India nothing as such rule is there. In India, Loksabha or the lower house is much more powerful while in USA the upper house i.e., house of senate is more powerful. A senate member is directly elected whereas in India, Rajyasabha members are indirectly elected. Last but not the least, USA has got the advanced judicial system while India is rapidly developing in its judicial system (Lingam) Possible Re forms for the US Government Adopting from India: India has always followed and encouraged in peace keeping operations but on the other hand USA has tried to maintain peace with the help of machinery and men. India has shown real patience to its rival countries by providing timely help to those in need. It had also undergone friendship agreement with its enemy countries like China & Pakistan, timely help to Bangladesh when Pakistan tried to overtook it. These are the policies which the US government may adopt from India (Schaffer, 73; Kesselman, Krieger and Joseph, 286) Possible Reforms for the Indian Government Adopting from the US Technology transfer is what India can learn from US Federal government. It is quite evident from the history

Evaluating Business Intelligence Systems W8 assign Essay

Evaluating Business Intelligence Systems W8 assign - Essay Example Additionally, the importance of such transitions for employees have also been explained in this study along with the mechanism through which the success of the BIS initiative can be evaluated. Thus, the study renders a significant insight regarding the organizational initiative of BIS in the modern day scenario. Introduction Business Intelligence System (BIS) is a kind of technology that provides noteworthy business value by improving effectiveness of managerial and technical decision making. It is a structural design and a collection of integrated operational as well as decision support applications and databases to assist business communities with an easy access to business data. In this respect, the continuous advancement in information technology can be identified as the potential driver for sustaining the business in the current highly competitive industrial environment (Srinivasan, 2011). This paper focuses on the issues that guarantee success of BIS and highlights significance of transition process of BIS in the most coherent manner. Issues That Help Guarantee Success of Business Intelligence System The issues that help to construct successful BIS are usually quite similar to the requirements of any other system that involves the use of the technology and seeks to change the organizational functions towards betterment. ... In addition, business management sponsor must be capable and potential enough to communicate the vision related with BIS and ascertain committed efforts from the entire management team. Also, the efficient business driver should be capable to motivate members of the organization to contribute their best towards its productivity. It is worth mentioning that primarily the top level and middle level managers from the different heads (such as regulatory, financial and operational) of the organization are engaged in accomplishing the tasks as a business driver. Similarly, feasibility acts as the other key success issue of BIS. Understanding various data and being capable to communicate these data with its actual meaning is an extremely crucial aspect with respect to BIS. It can be argued in this regard that tools and its applications only cannot guarantee success of information system within an organization. Correspondingly, focusing on the process and basic process control mechanism can form a solid foundation for assimilating the crucial and critical success factors required for the effective implementation of BIS. CSFs Framework for Implementation of BI Systems Source: (Yeoh & Koronios, 2010) With regards to the above mentioned model, critical success factors of the BIS can be divided into three different categories including organization, process and technology. Contextually, these three factors, when aligned carefully and efficiently, usually results in delivering best outcomes from the implementation of BIS. Importance of Transition to the Employees and Shareholders Transition is a very crucial component from the industry point of view.

Escherichia coli Essay Example | Topics and Well Written Essays - 2000 words

Escherichia coli - Essay Example E. coli is basically responsible for many intestinal and extra-intestinal infections. Some of these infewctions incluse meningitis, peritonitis, urinary tract infections, septicemia, Gram-negative pneumonia and mastitis. Based on the virulence properties of the enteric E. coli, these are subdivided into the following: enterotoxigenic, enterotoxigenic, enteroinvasive, verotoxigenic, enterohaemorrhagic and enteroaggregative E. coli. Enterotoxigenic (ETEC), is the causative agent of diarrhea in humans, pigs, sheep, goats, cattle, dogs, and horses. Enteropathogenic (EPEC) is the causative agent of diarrhea in humans, rabbits, dogs, cats and horses. Enteroinvasive (EIEC), is found only in humans, where as verotoxigenic (VTEC) is found in pigs, cattle, dogs and cats. Enterohaemorrhagic (EHEC) is found in humans, cattle, and goats, attacking porcine strains that colonize the gut in the same way as human EPEC strains and enteroaggregative E. coli.. Gastrointestinal Food industry plays a major role in the spread of diseases by e-coli. Most illness has been linked with consumption of undercooked, contaminated ground beef. There are also vegetarian sources as people have also become ill from eating contaminated bean sprouts or fresh leafy vegetables such as lettuce and spinach. Escherichia coli O157:H7 is a leading cause of food-borne illness in various parts of the world. E. coli O157:H7 was first recognized as a cause of illness in 1982 during an outbreak of severe bloody diarrhea; the outbreak was traced to contaminated hamburgers. Since then, more infections in the United States have been caused by eating undercooked ground beef than by any other food. It is a fact based on a 1999 estimate that about 73,000 cases of infection and 61 deaths occur every year in the United States alone. Unhygienic practices are the main cause for infection with E.coli O157:H7. The common way in which this bacterial infection affects human beings is bloody diarrhea, and sometimes may also be responsible for to kidney failure. Illness can also be transmitted from one person to another through contact. Besides, infection can also result from drinking raw milk and after swimming in or drinking sewage-contaminated water. This bacterial has become so common that there are also reports of e-coli in bottled drinking water.

Federalism Term Paper Example | Topics and Well Written Essays - 750 words

Federalism - Term Paper Example Federalism in the US has evolved in the course of the nation’s history from Dual Federalism between 1789 and 1945 after WWII, to Cooperative Federalism between 1945 and 1969 and finally New Federalism from 1969 to present (Robertson, 2012). However, there were also some changes to federalism between Dual Federalism and Cooperative Federalism, especially those occasioned by the 1861-1868 Civil War followed by the Fourteenth Amendment. Then industrialization and globalization that set in between 1865 and 1945, which culminated in the federal government taking over power from state governments when Franklin Roosevelt’s presidency made efforts to revive the economy after the Great Depression. The nation’s first 150 years were described by Dual Federalism, where the Constitution provided for state and national governments. The national government presided over national defense, fostering commerce and foreign policy. On the other hand, state governments dealt with crim inal law, economic regulation and local issues. Each having a distinct area of jurisdiction, the two governments rarely overlapped. Cooperative Federalism marked the intertwining of state and federal authority, where it became difficult to demarcate the beginning and end of the authority of each type of government because they both administered numerous federal programs simultaneously. However, in order to finance their own programs and initiatives, states heavily relied on the federal government for funds.