History - French Revolution Essay Example for Free

History French Revolution Essay I truly believe it was the collective effect of all the causes of the French Revolution that finally caused the people to rise up. In 1789 the people of France were suffering under the rule of Louis XVI, who used the countries money to provide him and his family the most luxurious life imaginable, while the people starved. The political regime of the time was a absolute monarchy (regime in which the country is ruled by a King or Queen, who inherit this position and has absolute power), but in theory there was a form of parliament, Estates General that consisted of elected representatives. This group of people could only meet if the King allowed or requested the meeting and in the 175 years of the parliament’s existence there had not been a single meeting. This fact frustrated the people because the King did not take their opinion and needs in consideration. Louis XVI would do as he pleased, a clear example of that was placing people in jail for no absolute reason except maybe his dislike for them. During the 18th century France was in a number of wars leaving the country with a lot of debts. In 1780’s the country had to borrow more money simply to pay interest (the amount of money paid on the money borrowed) on their debts. The royal family had a lifestyle the country could not support because only the lower classes were taxed, the peasants (people who worked on the land), while the higher classes, clergy (the religious leaders, individuals that worked for the roman catholic church, ex: priests) and the nobles (entities with a high social rank, ex: Ladies and Lords) did not pay tax at all. In other words the tax system needed a urgent reform (improvement). The social structure was horribly unfair. It was divided in three groups that were called â€Å"Estates†. The first estate was the Clergy, the people who belong to this estate worked for the Roman Catholic Church, which was at the time the main religion in France. At this specific stage in time the church owned a lot of land and most of their high officials were extremely wealthy. The Nobles formed the second estate. They were given many special rights and privileges. The third estate was made up of 98% of the people. This estate was where all the peasants, middle class traders and all kinds of professionals (ex. Lawyers). They paid heavy tax and had absolutely no privileges at all. Above all the estates was the King and his family with the absolute power. â€Å"It was the collective effect of all the causes of the French Revolution that finally caused the people to rise up. † History Essay Lara Ismael Nogueira Martha  For many centuries people in the whole of Europe accepted the authority of both their Kings and the Roman Catholic Church, a clear example of that was the â€Å"Divine Right of Kings† (this concept simply means that people believed their Kings and Queens were a representation of God and had to be respected and adored as such). Finally during the 18th century many philosophers started questioning these ideas. These period was called the Age of Enlightenment because the people began to question the old ways, led by the church, and created their own. Science had great advances during these times because everything was new, there was something to be discovered everyday†¦ it was at this point that Theocentrism (God in the center of the universe) was put aside and gave room for a complete new way of thinking and living, Anthropocentrism (man in the center of the universe). Diderot was a clear example of a philosopher that question the church and made his opinion well known. He was the leader of a group made up of philosophers that called themselves the â€Å"Encyclopaedists†, they’re goal was to write a series of books called â€Å"Encyclopaedia† (books that contained all existing knowledge). As they began to write the books they became more and more aware of the situation in France. They made their books public, therefore everyone could read them, this act helped spread the revolutionary ideas more than they already were. As the popularity of the Encyclopaedia grew so did the need for individual opinions. Another great example was Rousseau he was the true star, known as the father of democracy, he believed in equality among the people, and wrote about rules that weren’t based or chosen by God but by the people. This was the basic principles of democracy. In May of 1789 the representatives formed the National Assembly and met outside Paris against the Kings will and started a process of reform. They vowed to continue working until they had drawn up a new constitution for the country. However the process was very slow and the people of Paris grew impatient, the bread prices were constantly rising and the unemployment rate grew. On the 14th of July of 1789 angry people invaded the Bastille, killed the governor also some of the soldiers who tried to stop them and freed prisoners. When the news of the takeover reached other parts of France the ordinary people revolted and just like that the revolution started. â€Å"It was the collective effect of all the causes of the French Revolution that finally caused the people to rise up. † History Essay Lara Ismael Nogueira Martha In conclusion all this events such as the rise of bread prices and the unemployment rate in the country, the lack of interest the King showed for his people’s needs and the unfairness between classes made the people of France stand up for all they believed they deserved and needed.

Effect of Stress on Job Performance

Effect of Stress on Job Performance STRESS AND JOB PERFORMANCE People react to stress in different ways. Some copy much better than others and suffering fewer of the harmful effects of stress. Just as stress differs as a function of the individual, it also differs as a function of ones type of occupation. Some occupations are, of course, inherently more stressful than others. All of the stress-strain-health relationships have an obvious impact on the organization and industry. Both physical and mental illness renders the employee unlit for work, and combine both to lessen the satisfaction obtained from work and reduce job performance and productivity levels. There are various ways that stress symptoms or outcomes are reflected in the workplace. Evidence from a growing body of research suggests that certain individuals, in a variety of occupations, are increasingly exposed to unacceptable levels of job-related stress (Schultz Schultz, 2002). Occupational stress is any discomfort which is felt and perceived at a personal level and triggered by in stances, events or situations that are too intense and frequent in nature so as to exceed a persons coping capabilities and resources to handle them adequately (Malta, 2004) Occupational stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources or need of the worker (Sauter and Murphy. 1999). Performance is defined as the outcomes and accomplishments valued by the organization or system that one works in. Each individual is exposed to a range of stressors both at work and in their personal lives which ultimately affect his or her performance. Pressure at work can be positive leading to increased productivity. However, when this pressure becomes excessive it has a negative impact. The individual perceive themselves as being unable to cope and not to possess the necessary skills to combat their stress. Stress is acknowledged to be one of the main causes of absence from work (Mead, 2000). The occupational stressors can be categorized into four major groups. Firstly, the working conditions, including shift and week-end work, inadequate remuneration, hours of work, discrimination and safety at the work environment. Secondly, relationship at work including quality of relationships with peers, subordinates and supervisors. Thirdly, role conflicts and ambiguity including ill-defined role, functions, expectations, and duties. Fourthly, organization structure and climate which includes communication policy and practice, major changes in the workplace, culture of the organization, and lack of participation in decision-making. Another cause is career development including under utilization of skills or failing to reach full potential. Another contributing factor is the nature of the job which might amount to an immense amount of physical and emotional exhaustion (Parikh Taukari, 2004) The main objective of this study is to identify role of different contributing factors of job stress and to investigate level of stress on those factors in the organization. And also to find that how job performance is affected by job stress. There are different factors of job stress i.e. work overload, work under load, supervision role conflicts, career development, physical environment repetitive work, work family conflict and coworkers. RESEARCH HYPOTHESES There is difference in level of occupational stress among the employees of different departments of the organization. High level of stress adversely affects the performance of the employees. STRESS AT WORLKPLACE (OCCUPATIONAL STRESS) In todays changing and competitive work environment stress level is increasing both in WORKERS as well as MANAGERS .As a result of this work stress, more and more managers are showing signs of chronic fatigue and burnout. Research has concluded that stressed out managers are not good for organization and shareholders also .In most case stress reduced efficiency among individuals as well as reduced productivity also. Stress is the problem in amongst all the countries of the world ,irrespective of whether the economy is strong or weak .To know about the actual work stress we should have to know about the behavior of the individuals ,causes of the stress, its consequences and then how it can be reduce . â€Å"Considered from an individual`s points of view stress is our body`s physical, mental and chemical reaction to circumstance that frighten, confuse, endanger or irritate to any person†. If controlled stress, is a friend that strengthens us for the next encounter .if handled poorly, it becomes an enemy which can cause diseases like high blood pressure, ulcer, asthma, and over reactive thyroid. As per the medical explanation of the term â€Å"Stress is the body`s general response to environment situations.† it can lead to Physiological discomfort. Some kind of emotional unhappiness. Strained relationship with other people. In very simple words stress refers to an individual`s reaction to a disturbing factor in the environment. Different discipline and different professional have viewed it differently. Agarwala at 1979 believed that the confusion in definition is primarily due to the fact that the same term is used variously by scholars of different disciplines .Thus, in physic, stress is a force which acts on a body to produce strain. According to Beehr and Newman â€Å"Job stress is a condition arising from the interaction of the people and their jobs, and characterized by changes within people and force them to deviate from their normal functioning.† Stress can be defined as â€Å"Bodys non specific response to any demand made on it. Stress is not by definition synonymous with nervous system tension or anxiety. On one side Stress provides the means to express talents and energies and pursue happiness, on the other side it can also cause exhaustion and illness, either physical or psychological† One of the common accepted views of stress is provided by Selye through THREE STAGE MODEL OF STRESS. He called it General Adaptation Syndrome (GAS). Selye defines stress as â€Å"an adoptive response to the external situation that results in physical, physiological, and behavioural deviation for organizational participant.† He has suggested a three stage model and states that when an organism is confronted with a threat the general physiological response occurs in the three stages . Selye said that †¦There can be up to three phases that our resistance levels go through when we are exposed to a stressor. The first is the alarm phase. The bodys resistance to physical damage drops for a short-time. This is so our bodies can prepare to cope with the stressor by using up available energy and normally protective stress hormones. Temporarily some of our defenses against physical damage drop so that our blood pressure increases, blood-sugar rises, muscle tension increases, we breathe faster and deeper and we get a surge of adrenaline-like substances to give us extra physical capabilities should we need them. If the stressor no longer exists the body returns to its normal level of resistance. However if the stressor persists, (we cant fight or flee from it or and this goes beyond his original thinking we are unable to apply counteracting psychosocial resources) our level of resistance increases beyond normal, relaxed levels When our bodies start to run in higher gear. High levels of stress hormones continue to help us cope with the stressor. This is appropriately called the resistance phase. If there is no relief the body can continue for days, weeks, even years until either the stressor is suddenly removed or because it is very energy-consuming our body collapses often with more dangerous and extreme physical reactions. They are the same as in the alarm phase only more intense and more relentless. It is here in this third or exhaustion phase that our health suffers or even death can occur. Our level of resistance to physical disorder, disease and psychological pressure is at its lowest. It is characterized by feelings of lethargy an absence of energy and bodily resources to cope. MEASUREMENT OF ROLE STRESS: In the context of India two measures have been developed by Indian researchers and have been extensively used in research in India. They are given below: ORGANIZATIONAL ROLE STRESS: This instrument developed by Pareek (1983) this instrument based on the key concept t understand the integration of the organization .It is through this role that the individual interacts and gets integrated with the system. An n organization can be defined as system of roles, where role has been defined by the expectations various significant persons, including himself / herself, have from that position. The concept of role and the related concepts of ‘role space and ‘role set have a built- in potential for conflict and stress (Pareek 1999). From the point of view of an individual, two role systems are important: Role Space and Role Set. ROLE SPACE:- Each individual occupies and plays several roles simultaneously. A person can be a son a father a member of a club and so on at the same time. All these roles constitute role space time. All these roles constitute role space. In the center of the role space is the self. Role space is the self. Role space thus can be defending as â€Å"the dynamic inter-relationship between the self various roles an individual occupies.† ROLE SET;- The individual`s role in the organization is defined by the expectations of other significant roles and those of the individual himself .thus the role set is â€Å"the pattern of relationship between the role being considered and other roles. The organization role stress scale consists of 50 items measuring ten different types of organizational role stresses. These roles stress are Following: Inter role distance (IRD):-it is expected when there is a conflict between organizational and non organizational roles. Role stagnation (RS):- it is the feeling of being stuck in same role. Role expectation conflict (REC):- Stress is generated by expectation of different significant persons such as superior , subordinate, and peers ,about the same role and the role occupant`s ambivalence as to whom to please. Role Erosion (RE); Here stress is the function of the role occupant`s feeling that some function which should properly belong to her role are transferred to some other role. Role Overload (RO) ; when the role occupant feels that there are too many expectations from her. Role Isolation (RI); Stress refer to the psychological distance between the occupant role and other roles in the same role set. Personal Inadequacy; It arises when the role occupant feels that he does not have the necessary skills and training for effectively performing the function expected from his role. Self Role Distance (SRD):- When the role the person occupies goes against his self concept. Role Ambiguity (RA):- It refers to the lack of clarity about the expectation of the role. Resource Inadequacy (RIN):- Stress is evident when the role occupant feels that he is not provided with the adequate resources for performing the function expected from his role. SOURCES OF STRESS It has been said that stress result form a misfits between environmental demands and personal adequacies to meet these demands .However, management of stress is not possible unless the individual is aware of the specific source of stress. Stress can be emanating from variety of sources. Pestonjee (1983) has identified three important sectors of life in which stress originates .These are (a) Job and organization (b) Social Factors (c) Inter Psychic sector .The first namely , job and organization, refers to totality of the work environment (task ,atmosphere, colleagues , compensations, policies ,etc.)The social factors refer to the social / culture context of life .It may include religion, caste, language, dress and other factors. The intra psychic sector encompasses those things which are intimate and personal like temperament, values, abilities, and health. It is contended that stresses can originate in any of these sectors or in combinations thereof. Factor intrinsic to the Job: These are related to poor working conditions shift work, long hours, poor technology, travel, risk and danger, work over load. Role in the organization: When a persons role in an organization is clearly defined and understood, and when expectation place upon the individual are also clear and non- conflicting, stress can be kept to a minimum. Ivancevich and Matteson (1980) have identified three critical factors- role ambiguity ,role conflict , and degree of responsibility for others are major source of stress. Relation -ship at work: The working relationship which one has with people working in the same organization can also be a major source of stress. Career Development : A host of issue such as job security , fear of job loss, obsolescence or retirement and numerous performance appraisals can create pressure and strain. Organizational structure climate: just being part of an organization can present threats to a persons sense of freedom and autonomy. It seems that the position in the organization has something to do with stress. However the research evidence its inclusive .some studies have found that position in the organization does make a difference in job stress. Nature of Profession: The research evidence suggests that certain kind of occupations cause greater stress. Than others in a study of comparative degree of stress amongst professionals Mishra(2001)collected data from 144 doctors and 82 nurses drawn from various hospitals , their result show that nurses experience greater stress in their job as compared to doctors. Predispositional stress: The degree of stress seems vary with the personality and predispositional factor. Some individuals experience greater stress than others. Doctors with internal locus of control reported higher organizational stress than the internal . (Kumar 1988) The below chart shows one example of the structure of a department in an organization, indicating typical causes of stress that may effect stress at certain levels in the structure, and particular. Causes that are affecting individuals. Stress is contagious; anyone who is not performing well due to increases the amount of pressure on their colleagues, superiors, and subordinates. SYMPTOMS OF STRESS As stated earlier Stress is caused by or reaction to the external events and bring about changes in our response and our general behavior. The presence of Stress can be estimated by the analysis of certain symptoms an individual shows. These symptoms can be divided into three different categories. They are Feelings ,Behavoiur and pshysological . When the individual experience Stress, one or more of the following symptoms can be exhibited: Feelings The individual becomes anxious about the outcomes and is scared. The person feels that he has got something to loose or something wrong will take place. In an anxious state the person does not want to be corrected or interrupted. He looks out for other areas where he can forget about the stress-causing event for a while. The person becomes irritable and moody. During high level of Stress the individual develops a negative frame of mind and suffers from low self-esteem. The person loses faith in his capabilities and is afraid of the failures. The individual does not have a focused approach and is not able to concentrate and is involved in his own plans and thoughts. Physiological and Behavioral Changes Speech problems. Impulsive Behavior Crying for no apparent reason. Laughing in a high pitch and nervous tone of voice. Grinding of teeth Increasing smoking and use of drugs and alcohol. Being accident-prone Perspiration /sweaty hands Increased heart beat Trembling/Sleeping problems Diarrhea / indigestion / vomiting/ nausea Butterflies in stomach Headaches Premenstrual tension Pain in the neck and or lower back Susceptibility to illness Loss of appetite Nervous ticks Dryness of throat and mouth. Tiring easily or over eating CONSEQUENCES OF STRESS The effect of stress is closely linked to individual personality. The same level of stress affects different people in different ways each person has different ways of coping. Recognizing these personality types means that more focused help can be given. Stress shows itself number of ways. For instance, individual who is experiencing high level of stress may develop high blood pressure, ulcers, irritability, difficulty in making routine decisions, loss of appetite, accident proneness, and the like. These can be subsumed under three categories: Individual consequences Organizational consequence Burnout Individual consequences: Individual consequences of stress are those, which affect the individual directly. Due to this the organization may suffer directly or indirectly, but it is the individual who has to pays for it. Individual consequences of stress are broadly divided into behavioral, psychological and medical. v Behavioral consequences of stress are responses that may harm the person under stress or others. Behaviorally related stress symptoms include changes in productivity, turnover, as well as changes in eating habits, increased smoking or consumption of alcohol, paid speech, and sleep disorders. v Psychological consequences of stress replace to an individual mental health and well-being from or felling depressed. Job related stress could cause dissatisfaction, infact it has most psychological effect on the individual and lead to tension, anxiety irritability, and boredom. v Medical consequences of stress affect a persons well being. According to a research conducted, it revealed that stress could create changes in metabolism, increase heart and breathing rates, increases blood pressure bring out headaches and induce heart attacks. Organizational consequences: Organizational consequences of stress have direct affect on the organizations. These include decline in performance, withdrawal and negative changes in attitude.  ¯ Decline in performance can translate into poor quality work or a drop in productivity. Promotions and other organizational benefits get affected due to this.  ¯ Withdrawal behavior also can result from stress. Significant form of withdrawal behavior is absenteeism.  ¯ One main affect of employee stress is directly related to attitudes. Job satisfaction, morale and organizational commitment can all suffer, along with motivation to perform at higher levels. Burnout:- A final consequence of stress has implementation for both people and organizations. Burnout is a general feeling of exhaustion that develops when an individual simultaneously experiences too much pressure and few sources of satisfaction. STRESS AND YOUR PERFORMANCE So far, we have seen that stress is a negative experience. We have seen the short-term burnout. The Positive Effects of Pressure Sometimes, however, the pressures and demands that may cause stress can be positive in their effect. One example of this is where sportsmen and women flood their bodies with fight-or-flight adrenaline to power an explosive performance. Another example is where deadlines are used to motivate people who seem bored or unmotivated. We will discuss this briefly here, but throughout the rest of this site we see stress as a problem that needs to be solved. The Negative effect of pressure In most work situations jobs, our stress responses cause our performance to suffer. A calm, rational, controlled and sensitive approach is usually called for in dealing with most difficult problems at work: Our social inter-relationships are just too complex not to be damaged by an aggressive approach, while a passive and withdrawn response to stress means that we can fail to assert our rights when we should. Before we look further at how to manage stress and our performance, it is important to look at the relationship between pressure and performance in a little more detail, first by looking at the idea of the â€Å"Inverted-U†, and second by looking at Flow. This is the ideal state of concentration and focus that brings excellent performance. Pressure Performance – the Inverted U The relationship between pressure and performance is explained in one of the oldest and most important ideas in stress management, the â€Å"Inverted-U† relationship between pressure and performance. The Inverted-U relationship focuses on peoples performance of a task. The left hand side of the graph is easy to explain for pragmatic reasons. When there is very little pressure on us to carry out an important task, there is little incentive for us to focus energy and attention on it. This is particularly the case when there may be other, more urgent, or more interesting, tasks competing for attention. As pressure on us increases, we enter the â€Å"area of best performance†. Here, we are able to focus on the task and perform well – there is enough pressure on us to focus our attention but not so much that it disrupts our performance. The right hand side of the graph is more complex to explain. Negative Thoughts Crowd Our Minds We are all aware that we have a limited short-term memory: If you try to memorize a long list of items, you will not be able to remember more than six or eight items unless you use formal memory techniques. Similarly, although we have huge processing power in our brains, we cannot be conscious of more than a few thoughts at any one time. In fact, in a very real way, we have a limited â€Å"attention capacity†. As we become uncomfortably stressed, distractions, difficulties, anxieties and negative thinking begin to crowd our minds. This is particularly the case where we look at our definition of stress, i.e. that it occurs when a person perceives that â€Å"demands exceed the personal and social resources the individual is able to mobilize.† These thoughts compete with performance of the task for our attention capacity. Concentration suffers, and focus narrows as our brain becomes overloaded. As shown in the figure, this is something of a slippery slope: the more our brain is overloaded, the more our performance can suffer. The more our performance suffers, the more new distractions, difficulties, anxieties and negative thoughts crowd our minds. Other research has shown that stress reduces peoples ability to deal with large amounts of information. Both decision-making and creativity are impaired because people are unable to take account of all the information available. This inability accounts for the common observation that highly stressed people will persist in a course of action even when better alternatives are available. It also explains why anxious people perform best when they are put under little additional stress, while calm people may need additional pressure to produce a good performance. Notes on the research behind the Inverted-U: While this is an important and useful idea, peoples evaluations of stress and performance are by necessity subjective. This has made it difficult to prove the ‘Inverted-U idea formally. Also, for ease of explanation, we show a smooth curve here. In reality, different people have different shaped and positioned inverted-Us at different times and in different circumstances. This is all part of â€Å"lifes rich tapestry†. Entering a State of Flow When you are operating in your â€Å"area of best performance†, you are normally able to concentrate, and focus all of your attention on the important task at hand. When you do this without distraction, you often enter what Professor Mihaly Csikszentmihalyi of Chicago University describes as a state of ‘flow. This involves â€Å"being completely involved in an activity for its own sake. The ego falls away. Time flies. Every action, movement, and thought follows inevitably from the previous one, like playing jazz. Your whole being is involved, and youre using your skills to the utmost. You perform at your best in this state because you are able to focus all of your efforts, resources and abilities on the tasks at hand. While you are sufficiently motivated to resist competing temptations, you are not so stressed that anxieties and distractions interfere with clear thought. This is an intensely creative, efficient and satisfying state of mind. It is the state of mind in which, for example, the most persuasive speeches are made, the best software is developed, and the most impressive athletic or artistic performances are delivered. Helping Yourself to Get Into Flow One of the frustrations of management is that managers can feel that they lose the ‘right to these periods of deep concentration when they must be readily available to others, and be able to deal with the constantly changing information, decisions and activities around them. Studies of good managers show that they rarely get more than a few minutes alone without distraction. This alone can be frustrating, and can contribute strongly to managerial stress. In jobs where concentration is a rare commodity, there are various solutions to creating the periods of flow that sustain good performance. Solutions include working from home, or setting aside parts of the day as quiet periods. Another solution might be to delegate the activities that require the greatest levels of concentration, allowing the manager to concentrate on problems as they arise, serving to create a flow of its own. One of the key aims of this site is to help you manage stress so that you can enter this state of flow, and deliver truly excellent performance in your career. MANAGING STRESS IN THE WORK PLACE Every responds to stress in a different way, it is only by understanding the nature of individual responses that you can start fighting stress yourself and others. Reduction or elimination of stress is necessary for psychological and physical well being of an individual. Efficiency in stress management enables the individual to deal or cope with the stressful situations instead of avoidance. Strategies like tie management, body-mind and mind-body relaxation exercise, seeking social support help individual improve their physical and mental resources to deal with stress successfully. Apart from helping employees adopt certain coping strategies to deal with stress providing them with the service of counselor is also useful. Many strategies have been developed to help manage stress in the work place. Some are strategies for individuals, and other is geared toward organizations. Individual coping strategies: Many strategies for helping individuals manage stress have been proposed. Individual coping strategies are used when an employee under stress exhibits undesirable behavior on the jobs such as performance, strained relationship with co-workers, absenteeism alcoholism and the like. Employees under stress require help in overcoming its negative effects. The strategies used are: Exercise: One method by which individual can manage their stress is through exercise. People who exercise regularly are known to less likely to have heart attacks than inactive people are. Research also has suggested that people who exercise regularly feel less tension and stress are more conflict and slow greater optimism. Relaxation: A related method individual can manage stress is relaxation. Copying with stress require adaptation. Proper relaxation is an effective way to adopt. Relaxation can take many forms. One way to relax is to take regular vacations; people can also relax while on the job (i.e. take regular breaks during their normal workday). A popular way of resting is to sit quietly with closed eyes for ten minutes every afternoon. Time management: Time management is an often recommended method for managing stress, the idea is that many daily pressures can be eased or eliminated if a person does a better job of managing time. One popular approach to time management is to make a list, every morning or the thins to be done that day. Then you group the items on the list into three categories: critical activities that must be performed, important activities that should be performed, and optimal or trivial things that can be delegated or postponed, then of more of the important things done every day. ROLE MANAGEMENT: Some what related to time management in which the individual actively works to avoid overload, ambiguity and conflict. SUPPORT GROUPS: This method of managing stress is to develop and maintain support group. A support group is simply a group of family member or friends with whom a person can spend time. Supportive family and friends can help people deal with normal stress on an ongoing basis. Support groups can be particularly useful during times of crisis. BEHAVIORAL SELF-CONTROL: In ultimate analysis, effective management if stress presupposes exercise of self-control on the part of an employee. By consciously analyzing the cause and consequences of their own behavior, the employees can achieve self-control. They can further develop awareness of their own limits of tolerance and learn to anticipate their own responses to various stressful situations. The strategy involves increasing an individuals control over the situations rather than being solely controlled by them. COGNITIVE THERAPY: The cognitive therapy techniques such as Ellis rational emotive model and Meichenbaums cognitive strategy fir modification have been used as an individual strategy for reducing job stress. COUNSELING: Personal counseling help employees understand and appreciate a diverse workforce, the holistic approach adopted by the counselor gives him a comprehensive view of the employee as client and enable him to deal the issues of work related problems in a larger context with his awareness of the inter-relationship among problems in adjustment with self, other and environment and that a work concern will effect personal life and vice-versa, the employee would receive help regarding the problem in all life. One of the advantage of the individual interventions is the individual can use these skills to improve the quality of life in offer domains like family, social support and self, thus reducing the negative carry of experiences in these domains into the work life which might effect his occupation mental health. ORGANIZATIONAL STRATEGIES: The most effective way of managing stress calls for adopting stressors and prevent occurrence of potential stressors. Two basic organizational strategies for helping employees manage stress are institutional programs and collateral programs. Work Design Stress Management programs Work schedules Health promotions programs Culture Other programs Supervision Institutional programs: Institutional programs for managing stress are undertaken to established organizational mechanism Effect of Stress on Job Performance Effect of Stress on Job Performance STRESS AND JOB PERFORMANCE People react to stress in different ways. Some copy much better than others and suffering fewer of the harmful effects of stress. Just as stress differs as a function of the individual, it also differs as a function of ones type of occupation. Some occupations are, of course, inherently more stressful than others. All of the stress-strain-health relationships have an obvious impact on the organization and industry. Both physical and mental illness renders the employee unlit for work, and combine both to lessen the satisfaction obtained from work and reduce job performance and productivity levels. There are various ways that stress symptoms or outcomes are reflected in the workplace. Evidence from a growing body of research suggests that certain individuals, in a variety of occupations, are increasingly exposed to unacceptable levels of job-related stress (Schultz Schultz, 2002). Occupational stress is any discomfort which is felt and perceived at a personal level and triggered by in stances, events or situations that are too intense and frequent in nature so as to exceed a persons coping capabilities and resources to handle them adequately (Malta, 2004) Occupational stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources or need of the worker (Sauter and Murphy. 1999). Performance is defined as the outcomes and accomplishments valued by the organization or system that one works in. Each individual is exposed to a range of stressors both at work and in their personal lives which ultimately affect his or her performance. Pressure at work can be positive leading to increased productivity. However, when this pressure becomes excessive it has a negative impact. The individual perceive themselves as being unable to cope and not to possess the necessary skills to combat their stress. Stress is acknowledged to be one of the main causes of absence from work (Mead, 2000). The occupational stressors can be categorized into four major groups. Firstly, the working conditions, including shift and week-end work, inadequate remuneration, hours of work, discrimination and safety at the work environment. Secondly, relationship at work including quality of relationships with peers, subordinates and supervisors. Thirdly, role conflicts and ambiguity including ill-defined role, functions, expectations, and duties. Fourthly, organization structure and climate which includes communication policy and practice, major changes in the workplace, culture of the organization, and lack of participation in decision-making. Another cause is career development including under utilization of skills or failing to reach full potential. Another contributing factor is the nature of the job which might amount to an immense amount of physical and emotional exhaustion (Parikh Taukari, 2004) The main objective of this study is to identify role of different contributing factors of job stress and to investigate level of stress on those factors in the organization. And also to find that how job performance is affected by job stress. There are different factors of job stress i.e. work overload, work under load, supervision role conflicts, career development, physical environment repetitive work, work family conflict and coworkers. RESEARCH HYPOTHESES There is difference in level of occupational stress among the employees of different departments of the organization. High level of stress adversely affects the performance of the employees. STRESS AT WORLKPLACE (OCCUPATIONAL STRESS) In todays changing and competitive work environment stress level is increasing both in WORKERS as well as MANAGERS .As a result of this work stress, more and more managers are showing signs of chronic fatigue and burnout. Research has concluded that stressed out managers are not good for organization and shareholders also .In most case stress reduced efficiency among individuals as well as reduced productivity also. Stress is the problem in amongst all the countries of the world ,irrespective of whether the economy is strong or weak .To know about the actual work stress we should have to know about the behavior of the individuals ,causes of the stress, its consequences and then how it can be reduce . â€Å"Considered from an individual`s points of view stress is our body`s physical, mental and chemical reaction to circumstance that frighten, confuse, endanger or irritate to any person†. If controlled stress, is a friend that strengthens us for the next encounter .if handled poorly, it becomes an enemy which can cause diseases like high blood pressure, ulcer, asthma, and over reactive thyroid. As per the medical explanation of the term â€Å"Stress is the body`s general response to environment situations.† it can lead to Physiological discomfort. Some kind of emotional unhappiness. Strained relationship with other people. In very simple words stress refers to an individual`s reaction to a disturbing factor in the environment. Different discipline and different professional have viewed it differently. Agarwala at 1979 believed that the confusion in definition is primarily due to the fact that the same term is used variously by scholars of different disciplines .Thus, in physic, stress is a force which acts on a body to produce strain. According to Beehr and Newman â€Å"Job stress is a condition arising from the interaction of the people and their jobs, and characterized by changes within people and force them to deviate from their normal functioning.† Stress can be defined as â€Å"Bodys non specific response to any demand made on it. Stress is not by definition synonymous with nervous system tension or anxiety. On one side Stress provides the means to express talents and energies and pursue happiness, on the other side it can also cause exhaustion and illness, either physical or psychological† One of the common accepted views of stress is provided by Selye through THREE STAGE MODEL OF STRESS. He called it General Adaptation Syndrome (GAS). Selye defines stress as â€Å"an adoptive response to the external situation that results in physical, physiological, and behavioural deviation for organizational participant.† He has suggested a three stage model and states that when an organism is confronted with a threat the general physiological response occurs in the three stages . Selye said that †¦There can be up to three phases that our resistance levels go through when we are exposed to a stressor. The first is the alarm phase. The bodys resistance to physical damage drops for a short-time. This is so our bodies can prepare to cope with the stressor by using up available energy and normally protective stress hormones. Temporarily some of our defenses against physical damage drop so that our blood pressure increases, blood-sugar rises, muscle tension increases, we breathe faster and deeper and we get a surge of adrenaline-like substances to give us extra physical capabilities should we need them. If the stressor no longer exists the body returns to its normal level of resistance. However if the stressor persists, (we cant fight or flee from it or and this goes beyond his original thinking we are unable to apply counteracting psychosocial resources) our level of resistance increases beyond normal, relaxed levels When our bodies start to run in higher gear. High levels of stress hormones continue to help us cope with the stressor. This is appropriately called the resistance phase. If there is no relief the body can continue for days, weeks, even years until either the stressor is suddenly removed or because it is very energy-consuming our body collapses often with more dangerous and extreme physical reactions. They are the same as in the alarm phase only more intense and more relentless. It is here in this third or exhaustion phase that our health suffers or even death can occur. Our level of resistance to physical disorder, disease and psychological pressure is at its lowest. It is characterized by feelings of lethargy an absence of energy and bodily resources to cope. MEASUREMENT OF ROLE STRESS: In the context of India two measures have been developed by Indian researchers and have been extensively used in research in India. They are given below: ORGANIZATIONAL ROLE STRESS: This instrument developed by Pareek (1983) this instrument based on the key concept t understand the integration of the organization .It is through this role that the individual interacts and gets integrated with the system. An n organization can be defined as system of roles, where role has been defined by the expectations various significant persons, including himself / herself, have from that position. The concept of role and the related concepts of ‘role space and ‘role set have a built- in potential for conflict and stress (Pareek 1999). From the point of view of an individual, two role systems are important: Role Space and Role Set. ROLE SPACE:- Each individual occupies and plays several roles simultaneously. A person can be a son a father a member of a club and so on at the same time. All these roles constitute role space time. All these roles constitute role space. In the center of the role space is the self. Role space is the self. Role space thus can be defending as â€Å"the dynamic inter-relationship between the self various roles an individual occupies.† ROLE SET;- The individual`s role in the organization is defined by the expectations of other significant roles and those of the individual himself .thus the role set is â€Å"the pattern of relationship between the role being considered and other roles. The organization role stress scale consists of 50 items measuring ten different types of organizational role stresses. These roles stress are Following: Inter role distance (IRD):-it is expected when there is a conflict between organizational and non organizational roles. Role stagnation (RS):- it is the feeling of being stuck in same role. Role expectation conflict (REC):- Stress is generated by expectation of different significant persons such as superior , subordinate, and peers ,about the same role and the role occupant`s ambivalence as to whom to please. Role Erosion (RE); Here stress is the function of the role occupant`s feeling that some function which should properly belong to her role are transferred to some other role. Role Overload (RO) ; when the role occupant feels that there are too many expectations from her. Role Isolation (RI); Stress refer to the psychological distance between the occupant role and other roles in the same role set. Personal Inadequacy; It arises when the role occupant feels that he does not have the necessary skills and training for effectively performing the function expected from his role. Self Role Distance (SRD):- When the role the person occupies goes against his self concept. Role Ambiguity (RA):- It refers to the lack of clarity about the expectation of the role. Resource Inadequacy (RIN):- Stress is evident when the role occupant feels that he is not provided with the adequate resources for performing the function expected from his role. SOURCES OF STRESS It has been said that stress result form a misfits between environmental demands and personal adequacies to meet these demands .However, management of stress is not possible unless the individual is aware of the specific source of stress. Stress can be emanating from variety of sources. Pestonjee (1983) has identified three important sectors of life in which stress originates .These are (a) Job and organization (b) Social Factors (c) Inter Psychic sector .The first namely , job and organization, refers to totality of the work environment (task ,atmosphere, colleagues , compensations, policies ,etc.)The social factors refer to the social / culture context of life .It may include religion, caste, language, dress and other factors. The intra psychic sector encompasses those things which are intimate and personal like temperament, values, abilities, and health. It is contended that stresses can originate in any of these sectors or in combinations thereof. Factor intrinsic to the Job: These are related to poor working conditions shift work, long hours, poor technology, travel, risk and danger, work over load. Role in the organization: When a persons role in an organization is clearly defined and understood, and when expectation place upon the individual are also clear and non- conflicting, stress can be kept to a minimum. Ivancevich and Matteson (1980) have identified three critical factors- role ambiguity ,role conflict , and degree of responsibility for others are major source of stress. Relation -ship at work: The working relationship which one has with people working in the same organization can also be a major source of stress. Career Development : A host of issue such as job security , fear of job loss, obsolescence or retirement and numerous performance appraisals can create pressure and strain. Organizational structure climate: just being part of an organization can present threats to a persons sense of freedom and autonomy. It seems that the position in the organization has something to do with stress. However the research evidence its inclusive .some studies have found that position in the organization does make a difference in job stress. Nature of Profession: The research evidence suggests that certain kind of occupations cause greater stress. Than others in a study of comparative degree of stress amongst professionals Mishra(2001)collected data from 144 doctors and 82 nurses drawn from various hospitals , their result show that nurses experience greater stress in their job as compared to doctors. Predispositional stress: The degree of stress seems vary with the personality and predispositional factor. Some individuals experience greater stress than others. Doctors with internal locus of control reported higher organizational stress than the internal . (Kumar 1988) The below chart shows one example of the structure of a department in an organization, indicating typical causes of stress that may effect stress at certain levels in the structure, and particular. Causes that are affecting individuals. Stress is contagious; anyone who is not performing well due to increases the amount of pressure on their colleagues, superiors, and subordinates. SYMPTOMS OF STRESS As stated earlier Stress is caused by or reaction to the external events and bring about changes in our response and our general behavior. The presence of Stress can be estimated by the analysis of certain symptoms an individual shows. These symptoms can be divided into three different categories. They are Feelings ,Behavoiur and pshysological . When the individual experience Stress, one or more of the following symptoms can be exhibited: Feelings The individual becomes anxious about the outcomes and is scared. The person feels that he has got something to loose or something wrong will take place. In an anxious state the person does not want to be corrected or interrupted. He looks out for other areas where he can forget about the stress-causing event for a while. The person becomes irritable and moody. During high level of Stress the individual develops a negative frame of mind and suffers from low self-esteem. The person loses faith in his capabilities and is afraid of the failures. The individual does not have a focused approach and is not able to concentrate and is involved in his own plans and thoughts. Physiological and Behavioral Changes Speech problems. Impulsive Behavior Crying for no apparent reason. Laughing in a high pitch and nervous tone of voice. Grinding of teeth Increasing smoking and use of drugs and alcohol. Being accident-prone Perspiration /sweaty hands Increased heart beat Trembling/Sleeping problems Diarrhea / indigestion / vomiting/ nausea Butterflies in stomach Headaches Premenstrual tension Pain in the neck and or lower back Susceptibility to illness Loss of appetite Nervous ticks Dryness of throat and mouth. Tiring easily or over eating CONSEQUENCES OF STRESS The effect of stress is closely linked to individual personality. The same level of stress affects different people in different ways each person has different ways of coping. Recognizing these personality types means that more focused help can be given. Stress shows itself number of ways. For instance, individual who is experiencing high level of stress may develop high blood pressure, ulcers, irritability, difficulty in making routine decisions, loss of appetite, accident proneness, and the like. These can be subsumed under three categories: Individual consequences Organizational consequence Burnout Individual consequences: Individual consequences of stress are those, which affect the individual directly. Due to this the organization may suffer directly or indirectly, but it is the individual who has to pays for it. Individual consequences of stress are broadly divided into behavioral, psychological and medical. v Behavioral consequences of stress are responses that may harm the person under stress or others. Behaviorally related stress symptoms include changes in productivity, turnover, as well as changes in eating habits, increased smoking or consumption of alcohol, paid speech, and sleep disorders. v Psychological consequences of stress replace to an individual mental health and well-being from or felling depressed. Job related stress could cause dissatisfaction, infact it has most psychological effect on the individual and lead to tension, anxiety irritability, and boredom. v Medical consequences of stress affect a persons well being. According to a research conducted, it revealed that stress could create changes in metabolism, increase heart and breathing rates, increases blood pressure bring out headaches and induce heart attacks. Organizational consequences: Organizational consequences of stress have direct affect on the organizations. These include decline in performance, withdrawal and negative changes in attitude.  ¯ Decline in performance can translate into poor quality work or a drop in productivity. Promotions and other organizational benefits get affected due to this.  ¯ Withdrawal behavior also can result from stress. Significant form of withdrawal behavior is absenteeism.  ¯ One main affect of employee stress is directly related to attitudes. Job satisfaction, morale and organizational commitment can all suffer, along with motivation to perform at higher levels. Burnout:- A final consequence of stress has implementation for both people and organizations. Burnout is a general feeling of exhaustion that develops when an individual simultaneously experiences too much pressure and few sources of satisfaction. STRESS AND YOUR PERFORMANCE So far, we have seen that stress is a negative experience. We have seen the short-term burnout. The Positive Effects of Pressure Sometimes, however, the pressures and demands that may cause stress can be positive in their effect. One example of this is where sportsmen and women flood their bodies with fight-or-flight adrenaline to power an explosive performance. Another example is where deadlines are used to motivate people who seem bored or unmotivated. We will discuss this briefly here, but throughout the rest of this site we see stress as a problem that needs to be solved. The Negative effect of pressure In most work situations jobs, our stress responses cause our performance to suffer. A calm, rational, controlled and sensitive approach is usually called for in dealing with most difficult problems at work: Our social inter-relationships are just too complex not to be damaged by an aggressive approach, while a passive and withdrawn response to stress means that we can fail to assert our rights when we should. Before we look further at how to manage stress and our performance, it is important to look at the relationship between pressure and performance in a little more detail, first by looking at the idea of the â€Å"Inverted-U†, and second by looking at Flow. This is the ideal state of concentration and focus that brings excellent performance. Pressure Performance – the Inverted U The relationship between pressure and performance is explained in one of the oldest and most important ideas in stress management, the â€Å"Inverted-U† relationship between pressure and performance. The Inverted-U relationship focuses on peoples performance of a task. The left hand side of the graph is easy to explain for pragmatic reasons. When there is very little pressure on us to carry out an important task, there is little incentive for us to focus energy and attention on it. This is particularly the case when there may be other, more urgent, or more interesting, tasks competing for attention. As pressure on us increases, we enter the â€Å"area of best performance†. Here, we are able to focus on the task and perform well – there is enough pressure on us to focus our attention but not so much that it disrupts our performance. The right hand side of the graph is more complex to explain. Negative Thoughts Crowd Our Minds We are all aware that we have a limited short-term memory: If you try to memorize a long list of items, you will not be able to remember more than six or eight items unless you use formal memory techniques. Similarly, although we have huge processing power in our brains, we cannot be conscious of more than a few thoughts at any one time. In fact, in a very real way, we have a limited â€Å"attention capacity†. As we become uncomfortably stressed, distractions, difficulties, anxieties and negative thinking begin to crowd our minds. This is particularly the case where we look at our definition of stress, i.e. that it occurs when a person perceives that â€Å"demands exceed the personal and social resources the individual is able to mobilize.† These thoughts compete with performance of the task for our attention capacity. Concentration suffers, and focus narrows as our brain becomes overloaded. As shown in the figure, this is something of a slippery slope: the more our brain is overloaded, the more our performance can suffer. The more our performance suffers, the more new distractions, difficulties, anxieties and negative thoughts crowd our minds. Other research has shown that stress reduces peoples ability to deal with large amounts of information. Both decision-making and creativity are impaired because people are unable to take account of all the information available. This inability accounts for the common observation that highly stressed people will persist in a course of action even when better alternatives are available. It also explains why anxious people perform best when they are put under little additional stress, while calm people may need additional pressure to produce a good performance. Notes on the research behind the Inverted-U: While this is an important and useful idea, peoples evaluations of stress and performance are by necessity subjective. This has made it difficult to prove the ‘Inverted-U idea formally. Also, for ease of explanation, we show a smooth curve here. In reality, different people have different shaped and positioned inverted-Us at different times and in different circumstances. This is all part of â€Å"lifes rich tapestry†. Entering a State of Flow When you are operating in your â€Å"area of best performance†, you are normally able to concentrate, and focus all of your attention on the important task at hand. When you do this without distraction, you often enter what Professor Mihaly Csikszentmihalyi of Chicago University describes as a state of ‘flow. This involves â€Å"being completely involved in an activity for its own sake. The ego falls away. Time flies. Every action, movement, and thought follows inevitably from the previous one, like playing jazz. Your whole being is involved, and youre using your skills to the utmost. You perform at your best in this state because you are able to focus all of your efforts, resources and abilities on the tasks at hand. While you are sufficiently motivated to resist competing temptations, you are not so stressed that anxieties and distractions interfere with clear thought. This is an intensely creative, efficient and satisfying state of mind. It is the state of mind in which, for example, the most persuasive speeches are made, the best software is developed, and the most impressive athletic or artistic performances are delivered. Helping Yourself to Get Into Flow One of the frustrations of management is that managers can feel that they lose the ‘right to these periods of deep concentration when they must be readily available to others, and be able to deal with the constantly changing information, decisions and activities around them. Studies of good managers show that they rarely get more than a few minutes alone without distraction. This alone can be frustrating, and can contribute strongly to managerial stress. In jobs where concentration is a rare commodity, there are various solutions to creating the periods of flow that sustain good performance. Solutions include working from home, or setting aside parts of the day as quiet periods. Another solution might be to delegate the activities that require the greatest levels of concentration, allowing the manager to concentrate on problems as they arise, serving to create a flow of its own. One of the key aims of this site is to help you manage stress so that you can enter this state of flow, and deliver truly excellent performance in your career. MANAGING STRESS IN THE WORK PLACE Every responds to stress in a different way, it is only by understanding the nature of individual responses that you can start fighting stress yourself and others. Reduction or elimination of stress is necessary for psychological and physical well being of an individual. Efficiency in stress management enables the individual to deal or cope with the stressful situations instead of avoidance. Strategies like tie management, body-mind and mind-body relaxation exercise, seeking social support help individual improve their physical and mental resources to deal with stress successfully. Apart from helping employees adopt certain coping strategies to deal with stress providing them with the service of counselor is also useful. Many strategies have been developed to help manage stress in the work place. Some are strategies for individuals, and other is geared toward organizations. Individual coping strategies: Many strategies for helping individuals manage stress have been proposed. Individual coping strategies are used when an employee under stress exhibits undesirable behavior on the jobs such as performance, strained relationship with co-workers, absenteeism alcoholism and the like. Employees under stress require help in overcoming its negative effects. The strategies used are: Exercise: One method by which individual can manage their stress is through exercise. People who exercise regularly are known to less likely to have heart attacks than inactive people are. Research also has suggested that people who exercise regularly feel less tension and stress are more conflict and slow greater optimism. Relaxation: A related method individual can manage stress is relaxation. Copying with stress require adaptation. Proper relaxation is an effective way to adopt. Relaxation can take many forms. One way to relax is to take regular vacations; people can also relax while on the job (i.e. take regular breaks during their normal workday). A popular way of resting is to sit quietly with closed eyes for ten minutes every afternoon. Time management: Time management is an often recommended method for managing stress, the idea is that many daily pressures can be eased or eliminated if a person does a better job of managing time. One popular approach to time management is to make a list, every morning or the thins to be done that day. Then you group the items on the list into three categories: critical activities that must be performed, important activities that should be performed, and optimal or trivial things that can be delegated or postponed, then of more of the important things done every day. ROLE MANAGEMENT: Some what related to time management in which the individual actively works to avoid overload, ambiguity and conflict. SUPPORT GROUPS: This method of managing stress is to develop and maintain support group. A support group is simply a group of family member or friends with whom a person can spend time. Supportive family and friends can help people deal with normal stress on an ongoing basis. Support groups can be particularly useful during times of crisis. BEHAVIORAL SELF-CONTROL: In ultimate analysis, effective management if stress presupposes exercise of self-control on the part of an employee. By consciously analyzing the cause and consequences of their own behavior, the employees can achieve self-control. They can further develop awareness of their own limits of tolerance and learn to anticipate their own responses to various stressful situations. The strategy involves increasing an individuals control over the situations rather than being solely controlled by them. COGNITIVE THERAPY: The cognitive therapy techniques such as Ellis rational emotive model and Meichenbaums cognitive strategy fir modification have been used as an individual strategy for reducing job stress. COUNSELING: Personal counseling help employees understand and appreciate a diverse workforce, the holistic approach adopted by the counselor gives him a comprehensive view of the employee as client and enable him to deal the issues of work related problems in a larger context with his awareness of the inter-relationship among problems in adjustment with self, other and environment and that a work concern will effect personal life and vice-versa, the employee would receive help regarding the problem in all life. One of the advantage of the individual interventions is the individual can use these skills to improve the quality of life in offer domains like family, social support and self, thus reducing the negative carry of experiences in these domains into the work life which might effect his occupation mental health. ORGANIZATIONAL STRATEGIES: The most effective way of managing stress calls for adopting stressors and prevent occurrence of potential stressors. Two basic organizational strategies for helping employees manage stress are institutional programs and collateral programs. Work Design Stress Management programs Work schedules Health promotions programs Culture Other programs Supervision Institutional programs: Institutional programs for managing stress are undertaken to established organizational mechanism

Postoperative pulmonary complications

Postoperative pulmonary complications INTRODUCTION: Abdominal surgery involves a high risk of the development of postoperative pulmonary complications (PPCs). This is thought to be due to the disruption of normal respiratory muscle activity when a patient is anaesthetised, thereby impairing ventilation, expectoration and forced residual capacity (Auler et al 2002, Warner 2000). This may continue postoperatively leading to atelectasis, pneumonia and respiratory dysfunction (Richardson and Sabanathan 1997). Furthermore, abdominal pain resulting from the surgical incision may limit deep breathing (Dias 2008). Exercises which promote lung inflation may help to counteract the decreased lung volumes which patients tend to present with following surgery (Guimarà £es 2009). Incentive spirometry (IS) is commonly used as a prophylactic treatment to prevent pulmonary complications following surgery. An incentive spirometer is a device that uses visual feedback, such as raising a ball to a line, to encourage a maximal, sustained inspiration (Overend 2001). IS is often promoted as a useful tool for rehabilitation of the respiratory muscle function following surgery. It is hypothesised that inspiration to full capacity discourages the development of atelectasis by preventing the collapse of the alveoli, and encourages correct respiratory muscle control and coordination, thereby decreasing the incidence of PPCs (Overend 2001). Incentive spirometry is a low-cost intervention, and allows the patient to experience regular rehabilitation with minimal therapist hours (Hall 1991). However, recent arguments have claimed that this technique has little more effect than conventional physiotherapy, deep breathing methods or no intervention at all (Dias 2008). Several recent randomised controlled trials have attempted to determine the effect of incentive spirometry in comparison to other interventions such as deep breathing exercises, or no specific post-operative rehabilitation. The aim of this systematic review was to evaluate recent literature to determine the prophylactic effect of incentive spirometry for the avoidance of pulmonary complications in patients recovering from abdominal surgery. METHOD: A wide-ranging search of the literature was carried out, utilizing a series of key words deemed optimal for recruitment of relevant articles (Table 1). Several databases were searched by this method (Appendix 1). These included PubMed, PEDro, CINAHL, Medline via OVID and Cochrane. Reference lists sourced from several of these articles were then hand-searched. Limits were set to locate randomised controlled trials on humans, published in English from 1985 onwards. Articles published prior to 1985 were deemed to be potentially unreliable and irrelevant due to the advances in technology and medical knowledge regarding respiratory physiotherapy since this time. Articles which fulfilled the inclusion criteria (Table 2) were then assessed for methodological quality using the Physiotherapy Evidence Database (PEDro) Scale. The PEDro Scale is an 11-item Scale devised to rate the methodological quality of randomised controlled trials relating to physiotherapy (Maher et al 2003). The components of the PEDro Scale are seen in Table 3. The PEDro Scale was selected to consider the value of the methodology used for each RCT because there is a high level of recent, independent evidence to indicate that the scores generated by this Scale are of sufficient reliability to support decision-making in physiotherapy (Maher et al 2003, Mosely et al 2002). The RCTs assessed by the author were all included within the PEDro database, thus had already been rated by persons with specific training in applying the PEDro Score to RCTs. The scores gained from this are therefore regarded to display a high level of accuracy. Prior to assessment, the exclusion criteria was set as a PEDro Score of less than five out of ten. A PEDro Score of five or greater is evidential of a study of moderate to high quality (Mosely et al 2002). A summary table (Appendix 2) was constructed to display the information retrieved from the four articles included in the review. This data included: PEDro Score, sample size and follow-up, outcome variables, intervention, limitations, results and clinical implications of the findings. This systematic review evaluated the benefit of the use of incentive spirometry in comparison to a control group or other intervention. This was achieved by considering the incidence of pulmonary complications (defined by a variety of outcome variables) between the groups involved in each trial. RESULTS: Search method and study selection: The initial search produced 85 non-duplicate articles of which 24 were screened. The criteria for inclusion into the review are documented in Table 2. After reading the abstract of the 24 articles selected, a further 16 records failed to meet one or more of the inclusion criteria. The remaining eight articles were then assessed for eligibility by applying the exclusion criteria (Table 2). One review article was excluded. Three RCTs were deemed to exhibit low methodological quality having produced a PEDro Score of less than five out of ten, and were excluded. The remaining four RCTs selected for the review are documented in Appendix 2. The complete search process is shown by Figure 1. Methodological quality: Table 4 shows the level of methodological quality for each article. All articles rated six or above on the PEDro Scale, and demonstrated competency in the aspects of random allocation, baseline comparison, assessor blinding, and adequate follow up. Those trials by Stock et al (1985) and Schwieger et al (1986) failed to include concealed allocation and intention to treat. Due to the nature of the intervention, none of the trials had subject or therapist blinding. Intervention and outcome variables: The four studies selected for the review include the use of IS as an intervention. Outcome variables were obtained from common methods used to diagnose pulmonary complications, including (but not limited to) blood gas analyses, body temperature, sputum analysis, chest radiography and spirometry. None of the studies documented in Appendix 2 found any significant difference between the intervention of IS and other intervention or control groups in the development of pulmonary complications. Pulmonary complications: Hall et al (1991) compared the intervention of IS to a control group of patients receiving conventional chest physiotherapy. Pulmonary complications developed in 15.8% (95% CI 14.0-17.6%) of those patients undergoing regular maximal inspirations with the use of an incentive spirometer, compared to 15.3% (95% CI 13.6 17.0%) of patients receiving conventional chest physiotherapy (Hall et al 1991). Similarly, Schwieger et al (1986) found no statistically significant benefit to promote the use of IS. 40% of those patients performing regular IS developed pulmonary complications. The control group, receiving no specialized post operative respiratory care, had a 30% incidence of the development of respiratory complications (Schwieger et al 1985). Two studies (Hall et al 1996, Stock et al 1985) compared IS against other interventions designed to have a prophylactic effect on the development of pulmonary complications following abdominal surgery. Hall et al (1996) found that IS has different levels of efficacy depending on a patients risk of developing a PPC. Post operative respiratory complications were found in 8% of low risk patients randomised to receive incentive spirometry, and in 11% of those who undertook deep breathing exercises. PPCs were detected in 19% of high risk patients receiving IS and 13% of patients who received a combination of IS and conventional chest physiotherapy (Hall et al 1996). Stock et al (1985) found no notable difference in the development of PPCs between patients randomised to IS, continuous passive airway pressure and coughing and deep breathing exercises. Post operative atelectasis All of the studies considered in this review included the presence of atelectasis detected by radiograph as a specific outcome variable to indicate a PPC. No studies showed a significant difference in the presence of post operative atelectasis between groups. Swieger et al (1986) found atelectasis to affect 30% of the IS group and 25% of the control group. Stock et al (1985) recorded a 24 hour postoperative incidence of atelectasis of 50%, 32% and 41% for patients receiving incentive spirometry, coughing and deep breathing exercises and continuous passive airway pressure, respectively (p FEV/FVC Two studies (Stock et al 1985, Swieger et al 1986) considered the change in forced expiratory volume and forced vital capacity following abdominal surgery. Stock et al (1985) noted an average decline of forced vital capacity to 49%, 62% and 69% of the preoperative value at 24, 48 and 72 postoperative hours respectively (p DISCUSSION: This systematic review provides a comparative analysis of the use of incentive spirometry for a prophylactic effect on the development of pulmonary complications following abdominal surgery. Four RCTs comprised the results analysed in this review. Two of these articles rated 6/10 on the PEDro Scale (Stock et al 1985, Swieger et al 1986) and two articles were awarded a score of 8/10 (Hall et al 1991, Hall et al 1996). While each study evaluated the use of IS for prevention of PPCs following abdominal surgery, the comparisons within each study varied. Only one trial (Schwieger et al 1986) compared the IS intervention group to a control group which received no specialised post operative respiratory care. Hall et al (1991) instead considered the IS intervention group to patients receiving conventional chest physiotherapy. Two trials, (Hall et al 1996, Stock et al 1985) compared the use of incentive spirometry to other specific respiratory physiotherapy modalities. Hall et al (1996) also investigated the effect of the patients putative risk factors on their incidence of development of PPCs. It is difficult to make comparisons between the selected studies, due to the high variance of intra-study comparison. Participants Two of the studies had high numbers of participants (Hall et al 1991, Hall et al 1996), allowing for the assumption to be made that the results gained from this are accurate and representative of the sample population. Two studies had comparatively low numbers of participants (Stock et al 1985; n=64. Swieger et al 1986; n= 40). The studies with low participation rate exhibited high levels of incidence of PPCs compared to the larger studies. This indicates that the low number of participants may have caused an exaggeration of the incidence of PPCs considered in these studies. The overall male: female ratio of the studies investigated was 679:758. The gender imbalance was particularly pronounced in the trials which had low levels of participation (Stock et al 1985, Swieger et al 1986), with females outnumbering males. This makes the results more generalizable to females and decreases external validity (Juni et al 2001). This is particularly important to the analysis of respiratory function due the gender-related differences regarding function, shape and size of the lungs and the chest cavities (Becklake and Kauffman 1999). This can alter the respiratory mechanics and thus create gender biased results (Auler 2002). Publication bias is also a possible limitation of this review. Studies which obtained undesirable results are less likely to be published, thus the available literature may be biased toward a favourable outcome (Egger 1998). Intervention and outcomes The intervention itself may create bias with respect to using the comparability between the studies evaluated in this review. The administration of incentive spirometry varied slightly between trials. For example, in the trial by Schwieger et al (1986), patients were instructed to breathe deeply (with use of IS) for five minutes hourly, twelve times daily for three postoperative days. The participants in the study by Hall et al (1996) required patients to maximally inspire and hold ten times per hour. This means that broad term of incentive spirometry may actually correlate to a slightly different intervention for each study, so the incentive spirometry results evaluated in this review may not be entirely comparable. The comparable intervention of conventional chest physiotherapy is also questionable as this could also involve incentive spirometry, thus give the same results as IS whilst appearing as a separate intervention. There was inconsistency in follow up time between the four trials (see Appendix 2), which makes it difficult to pool results. Variances of outcome measures across the four studies were also a source of limitation. Outcome variables for each study are summarised in Appendix 2. The definition for pulmonary complication is potentially limiting as this would affect the diagnosis and thus results gained. The professional ability of those assessing the outcome measures (e.g radiologists) needs to be taken into account. Trial methodology Due to the nature of incentive spirometry, neither patient nor therapist blinding was carried out. This introduces the possibility of performance bias and detection bias (Juni et al 2001). Concealed allocation was missing from two studies ( Stock et al 1985, Schwieger et al 1986). A lack of concealed allocation allows for the possibility that an investigator may change who gets the next assignment, thus making the intervention group less comparable to the control group (Shulz 2000). Intention to treat analysis is also devoid in two studies (Stock et al 1985, Schwieger et al 1986), therefore clinical effectiveness may be overestimated in these trials (Hollis and Campbell, 1999). CONCLUSIONS: This review found that there is currently no evidence to support the hypothesis that incentive spirometry has a prophylactic effect on the incidence of pulmonary complications in patients recovering from abdominal surgery, compared to other physiotherapy modalities such as deep breathing exercises and conventional physiotherapy. Another recent systematic review (Guimarà £es et al 2009) has obtained similar findings. One study (Schwieger 1986) found that there is no significant difference in the development of PPCs between post abdominal surgery patients receiving incentive spirometry and those who received no specialised post operative respiratory care. This was the only study to compare incentive spirometry against a control group receiving no other form of physiotherapy, so it is difficult to completely rule out the possibility that IS may have some prophylactic effect which has been masked by an equal prophylactic effect of the other therapies. The clinical implications of this i s that if incentive spirometry does in fact provide some prophylactic effect on postoperative abdominal surgery patients, this benefit is no greater than that provided by other forms of physiotherapy. IS is less cost effective than deep breathing exercises, but requires less therapist hours than conventional physiotherapy. Therefore, a higher level of adequate and conclusive research needs to be done before incentive spirometry can be promoted as having a prophylactic effect on the incidence of PPCs following abdominal surgery. Articles used as a template for the review format: Andersson G, Mekhail N and Block J.(2006). Treatment of Intractable Discogenic Low Back Pain. A Systematic Review of Spinal Fusion and Intradiscal Electrothermal Therapy (Idet). Pain Physician; 9: 237-248. Dodd K, Taylor N and Damiano D. (2002). A systematic review of the effectiveness of strength-training programs for people with cerebral palsy. Archives of Physical Medicine and Rehabilitation. 83: 1157 1164. Viswanathan P and Kidd M. (2009). Effect of Continuous Passive Motion Following Total Knee Arthroplasty on Knee Range of Motion and Function: A Systematic Review. Unpublished article. University of Otago, School of Physiotherapy. Dunedin, New Zealand. Articles used in review: Hall J, Tarala R, Harris J, Tapper J and Christiansen K. (1991). Incentive Spirometry versus routine chest physiotherapy for prevention of respiratory complications after abdominal surgery. Lancet 337: 953-956. Hall J, Tarala R, Tapper J and Hall J. (1996). Prevention of respiratory complications after abdominal surgery: a randomised clinical trial. British Medical Journal 312: 148-152. Schwieger I, Gamulin Z, Forster A, Meyer P, Gemperle M and Suter P. (1986). Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy. A controlled randomized study. Chest 89: 652-656. Stock C, Downs J, Gauer P, Alster J and Imrey P. (1985). Prevention of postoperative pulmonary complications with CPAP, incentive spirometry and conservative therapy. Chest 87: 151-157. Other references: Auler J, Miyoshi E, Fernandes C, Bensenor F, Elias L and Bonassa J. (2002). The effects of abdominal opening on respiratory mechanics during general anaesthesia in normal and morbidly obese patients: A comparative study. Anesthesia and Analgesia 94: 741-8. Becklake M and Kauffmann F. (1999). Gender differences in airway behaviour over the human lifespan. Thorax 54: 1119 1138. Egger M and Smith G. (1998). Meta-analysis bias in selection and location of studies. British Medical Journal 316: 61-66. Guimarà £es M, El Dib R, Smith A and Matos D. (2009). Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery.Cochrane Database of Systematic Reviews2009, Issue 3. Art. No.: CD006058 Hollis F and Campbell S. (1999). What is meant by intention to treat analysis? Survey of published randomised controlled trials. British Medical Journal 319: 670-674. Juni P, Altman D and Egger M. (2001). Systematic reviews in health care: Assessing the quality of controlled clinical trials. British Medical Journal 323: 42-46. Maher C. (2000) A systematic review of workplace interventions to prevent low back pain. Australian Journal of Physiotherapy 46: 259-269. Maher M, Sherrington C, Herbert R, Mosely A and Elkins M. (2003). Reliability of the PEDro Scale for rating quality of randomised controlled trials. Physical Therapy; 83: 713-721. Moher D, Liberati A, Tetzlaff J and Altman DG. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. British Medical Journal 339: 332-339. Mosely A, Herbert R, Sherrington C and Maher C. (2002). Evidence for physiotherapy practice: A survey of the physiotherapy evidence database (PEDro). Australian Journal of Physiotherapy 48: 43-49. Overend T, Anderson C, Lucy S, Bhatia C, Jonsson B and Timmermans C. (2001). The effect of incentive spirometry on postoperative pulmonary complications: A systematic review. Chest 120: 971-978. Richardson J and Sabanathan S. (1997). Prevention of respiratory complications after abdominal surgery. Thorax 52: 35-40. Schulz K. (2001). Assessing allocation concealment and blinding in randomised controlled trials: why bother? Evidence Based Nursing 4: 4-6. Warner D.(2000). Preventing postoperative pulmonary complications: The role of the anesthesiologist. Anesthesiology 192: 1467-72.

Free Siddhartha Essays: Themes in Siddhartha :: Hesse Siddhartha Essays

Themes in Siddhartha Siddhartha by Hermann Hesse tells of a man, Siddhartha, and his search for peace.   Siddhartha leaves the Brahmins to become a holy Samamna.   He finds no satisfaction in the deprivation, which the Samanas practice, so he leaves their way of life to find the Buddha.   The Buddha's teachings fail to satisfy his desire to find a path to peace, also.   He then travels to a town but finds no answers there either.   Finally, beside the river, Siddhartha finds peace.   There are two main themes in Siddhartha; the father/son theme and the theme of peace and totality.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The theme of father and own can be found at the beginning and end of the novel.   Siddhartha leaves his father at the very beginning of the book in order to find the peace he feels he has not achieved by being a Brahmin, and Siddhartha never sees his father again.   Siddhartha has a son with a courtesan in the town and has responsibility for him after his mother dies; the boy does not like staying by the river with Siddhartha and runs away, causing Siddhartha the same grief that Siddhartha had caused his own father years ago.   These losses suffered by the by both Siddhartha and his father are all a part of Siddhartha's journey to achieve inner peace.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The theme of peace and totality appears throughout the Siddhartha.   Siddhartha's father performs ablutions in the river and offers sacrifices to the gods in a never ending attempt to achieve peace within himself.   The Samanas practice deprivation and attempt to escape the Self through meditation, only to realize that they only achieve totality for a short time.   The Buddha has found peace and vainly attempts to explain to others how they, too, might achieve peace.

Letters Home :: Creative Writing Essays

Letters Home The vid screen is dark and ominous, as if it holds secrets that is not for the likes of men to know. John Poldeck, a middle aged, balding man of forty-eight steps forward toward screen and console to activate the beast, this oracle of silicon, plastic, and glass. Today John is hoping for word of his son Kirk, of whom nothing had been heard of since he left for UNDF Marine Corps training at Camp Lejune, South Carolina, a beacon for the phony tough and crazy brave looking for ill conceived adventure and glory. At least that was John’s opinion on the matter. As a mid level market analyst for the transnational ABSCOM John was used to battles fought with market shares, balance sheets, and stock options. For the forty years since the birth of the revamped United Nations war and the conductors of war, the military, had been a dying business. John could still remember the eager look on Kirk’s face when his son had uttered words like, duty, honor, patriotism, words which seemed as alien to John as the worlds the UN exploratory fleet claimed to have found. â€Å"For Christ’s sake John will you turn on the damn console? What the hell is wrong with you today?† John glanced at June, his wife of twenty years and counting. Her dark skinned face was a sharp contrast to his pale complexion, and anger, tinged with concern for her son, clouded and darkened her visage even more. He looked at his wife without comprehension. â€Å"What?† June sighed, and then in a kinder tone, â€Å"The console John. I know you’ve been angry ever since Kirk left for the Marines, hell you’ve been mad ever since he first brought up enlisting. A fool’s errand you called it. Perhaps you’re right. All I know is that he might have sent us a letter today.† A fool’s errand. I remember when I said that John thought. That had been a nasty episode, one of many that had occurred during one of the endless fights he had had with Kirk over this business of enlisting. Try how he might he could never convince his son that business was where the opportunities were. Kirk had then coldly informed his father of his contempt for the Transnationals that now ran everything on Earth, including the UN, and his contempt for anybody connected to them.

Consumer Decision Making Process Essay

The consumer purchase decision process is generally viewed as consisting of sequential steps or stages through which the buyer passes in purchasing a product or service. The various steps in this process, as well as the relevant internal psychological processes, those occur at each stage such as motivation, perception, attitude formation, integration and learning. 1. Problem recognition—is the first step in the consumer decision-making process. This is caused by a difference between the consumer’s ideal state and actual state. There are various causes of sources of problem recognition. These include: a. Out of stock b. Dissatisfaction c. New needs / wants d. Related products/ purchases e. Marketer induced problem recognition f. New products Look more:  the consumer buying process begins when essay 2. Information Search—being the second step in the consumer decision making process, involves a scan of information stored in memory to recall past experiences or knowledge regarding purchase alternatives. External search involves go to outside sources to acquire information such as personal sources, marketer controlled sources, public sources, or through personal experiences such as examining or handling a product. 3. Alternative Evaluation— At, this stage the consumer compares the various brands and services, he or she has identified as being capable of solving the consumption problem and satisfying the needs or motives that initiated the decision process. The evoked set is a subset of all the brands of which the consumer is aware and actively considering in the decision process. A goal of marketers is to ensure that their brands are included in the evoked set of consumers. 4. Purchase Decision—as an outcome of the alternative evaluation stage the consumer may develop a purchase intention or predisposition to buy a certain brand. Once this intention has been made and an intention formed, then the consumer implements it and makes the actual purchase. Many purchase decisions are made on the basis of brand loyalty which is a preference for a particular brand that results in its repeated purchase. Many purchase decisions for non-durable, low involvement items take place in the store and decision and purchase occur almost simultaneously. For these types of decisions top-of-mind awareness of a brand is important as is the influence of packing, shelf displays, point-of-purchase materials, and various sales promotion tools. 5. Post-purchase Evaluation—the consumer decision process does not end once the product or service has been purchased. After using a product or service the consumer compares the level of performance with expectations. Satisfaction occurs when the consumer’s expectations are either met or exceeded, while dissatisfaction results when performance is below expectations. Another possible outcome of purchase is cognitive dissonance which refers to a feeling of psychological tension or post-purchase doubt a consumer may experience after making a difficult purchase choice. Consumers often look to advertising for supportive information regarding the choice they have made. 6. Variations in Consumer Decision Making—consumers do not always engage in all five steps of the purchase decision process nor proceed in the sequence presented. There are three major variations of the consumer decision making process. †¢Routine response behavior—many purchase decisions for low-priced, frequently engaged in brief internal search and making the purchase. Marketers of products characterized by routine response behavior must get and/or maintain their brands in the consumers’ evoked set and encourage brand loyalty. Those not in the evoked set must encourage trial and brand switching.

Human Memory Essay

The human memory is that part of our brains that has the capacity to receive, store, and retrieve information. It is comprised of not one but three types: sensory, short term, and long term. Generally, the process involves receiving information or stimulus from the environment. The stimulus is then received by the sensory memory. Then the information, which is converted into electrical impulses, is passed through the short-term memory, and finally, the long-term memory through the neurons. Sensory A stimuli that is sensed or received by one of the five sense organs are received by the sensory memory, which acts as a protective barrier. There are different types of sensory memory, one for each sense organ. For the visual stimuli that are registered by the eyes, the sensory memory is called iconic. Stimuli that passes through the ears are received by the echoic memory. And the haptic memory is for stimuli that are felt or touched. A stimulus reaches the sensory memory between two hundred and five hundred milliseconds after it was perceived. An example of sensory memory is the ability to remember how something looks like even if you were able to see it for only a few seconds. Based on research, sensory memory is able to retain about 12 items in a very short period of time. Interruption in the smooth relay of sensory information can be caused by problems in the neurons . If there are some neurons that do not connect or there are imbalances, then information flow will stop or will be delayed. Short-Term Information that reaches the sensory memory are transferred to the short-term memory. This type of memory allows retention of information for up to 60 seconds. While it can remember information far longer than the sensory memory, the short-term memory can only retain up to five items. To increase the number of items that the short-term memory can remember, studies showed that grouping or chunking the items into three have been found very useful. Short-term memory will degrade if a person experiences chronic pain or drinks constantly. It can be enhanced through aerobic exercises because of the increased oxygen in the brain. Long-Term After information has passed through the short-term memory, it is then transferred to the long-term memory for storage and for retrieval in the future. Contrary to the two previous memories, the long-term memory can hold information indefinitely, sometimes for a lifetime. Information becomes ingrained in the memory through repetition or rehearsal. For instance, the alphabets has been constantly repeated to young children in order for them to remember each letter. As a result, knowledge of them will remain etched in memory forever. Long-term memory degrades through certain illnesses. It can be improved through constant intellectual stimulation and rehearsal. Long-term memory groups information into facts and skills. Facts is further classified into two: the episodic and semantic. As their names suggests, episodic refers to events that are stored in the memory. All the others are stored in the semantic memory. Skills, on the other hand, is about learned information that needs to be recalled to perform certain actions. The processes involved in the long-term memory are retention, retrieval and deletion. Retention is achieved when there is rehearsal. Deletion happens when there is interference. Retrieval can occur through recall and sometimes, through recognition. When the information is remembered from memory, it is called recall. If there are promptings and cues to remember an information, it is called recognition. Interference Interference is defined as the inability to recall an information because certain items or events interfere with the process. Proactive interference occurs when previous learnings will make it difficult to remember new ones. On the other hand, retroactive interference occurs when new learnings make it difficult or impossible to recall past information. While studying, information gets jumbled in the student’s mind because there are too many to recall. To improve absorption and recall, it is important to rehearse the information over a period of time. This could be done by reading the day’s lessons and memorizing the salient points before going to sleep. If the student will make this a habit, he won’t need to cram everything in his head a few days before the exam. By constantly rehearsing, the retention and retrieval will become easy. Other Factors That Could Affect Memory Age is one factor that could make a person forget an information or make it difficult to retrieve it from its storage. Like any other part of the body, the brain also degrades if it is not constantly in use. Injuries, traumas, medicines, and diseases could also affect memory storage and retrieval. For example, a tumor in the brain can interrupt the flow of electrical impulses, resulting to memory loss. Or a trauma caused by accident could result to sensory memory loss in one part of the body. To improve and maintain a good memory, it is always important to keep on exercising the mind as well as the body. When the mind is seldom used, it degenerates. Reading, learning and engaging in intellectual discourses would keep the mind active. References Gailbuck. (2007). Delving Into the Autistic Brain – Part 1. HubPages. Retrieved August 14, 2008, from http://hubpages.com/hub/autism-sensory-processing Human Memory. Retrieved August 14, 2008, from http://www-static.cc.gatech.edu/classes/cs6751_97_winter/Topics/human- cap/memory.html Mohs, R. How to Improve Your Memory. HowStuffWorks. Retrieved August 15, 2008, from