HRM Research Paper Example | Topics and Well Written Essays - 1750 words - 1

HRM - Research Paper Example ional human resource in Kaiser Permanente has put several measures in place to ensure that both internal and external laws are enforced in a very effective and appropriate way. This plays a very vital role in ensuring that good relationship is maintained in the entire organization and to the extended environment. On the other hand the organizations has several policies which are put in place to ensure that the organization’s goals and objectives are fully achieved. However, for the goals to be met the policies of Kaiser Permanente must be fully implemented. Decisions made in the organization can be borrowed from the transnational scope which implies that Kaiser as an organization can make its decisions on international scope (Harris 98). On the other hand the organization also makes its decisions basing on a worldwide perspective but not on a local perspective. The style of management is also another ideal secret to successful growth of Kaiser. As an organization it has put in place measures to ensure that all leaders or heads of different department are qualified and able to manage the duties of the department bestowed to them. On the other hang the human resource management strategies should put measures in place to ensure that the style of management suits each and every employee within the organization. This enables all the works to discharge their duties effectively and efficiently. However the challenge arises when it comes to coming up with the suitable way of catering for every employee irrespective of the country they come from. The other feature of good leadership in this organization is prevalence several managers from different places of the world therefore the services offered by this managers is commendable (Harzing and Ruysseveldt 45). Multicultural way of operation has also be embraced to ensure than not only the demotic people get employed but also people from the international world, however the core principle of international human resource

Compare the Economies Essay Example | Topics and Well Written Essays - 750 words

Compare the Economies - Essay Example Examining unemployment levels is one important way of looking at the reason behind the reported high poverty levels in a country. The unemployment level for this purpose shall refer to the number of non-working (and therefore unproductive) individuals who are of working age (usually 15 years old and above). The number of people in a given population without jobs indicates the type of labor force the country has. Unemployment rates may invoke questions such as "Why aren't there enough jobs for everyone of working age" "Are there not enough business enterprises or investments in the country that contribute to job creation" or "If there are available jobs, why aren't the people employed" "Do people choose not to work at all" or "Are there issues in literacy and education as well" In addition, trends in unemployment levels may indicate how a country is progressing in terms of its growth and development. Since Vietnam and the Philippines are still in their developing stages, the unemploym ent level could be an important indicator of how well and how fast they are achieving their development goals. In summary, a country's unemployment rate may provide a lot of insights on its economic growth and development. High unemployment rates could only mean two things:... High unemployment rates could only mean two things: either job seekers could not be given the jobs they are looking for or people simply do not want to work, that is, participate in the labor force. Given the status of the two countries chosen for this assignment as being underdeveloped and having large populations under the poverty line, it is highly unlikely that people in these two nations would not want to work and earn income at all. The latter type of situation is more likely to occur in highly developed countries wherein governments can provide for substantial subsidies for their citizens living allowances. In the case of Vietnam and the Philippines, both countries barely have enough financial resources to offer free education to the public, much less to provide for the daily needs of their poor. Thus, unemployment in this context shall be focused on not having enough jobs for qualified job seekers. A country's economy is usually gauged as positive or negative in terms of what goods and services it produces, how much of these are actually produced, how these goods and services are produced and for whom and how production rates can grow over a period of time. Simply put, a country's economic growth largely depends on its capacity to produce. Productivity in turn is influenced or affected by the availability and utilization of capital, natural resources and the labor force, among others. In order to produce goods and services, there must be work involved in the process and work is done by skillful and knowledgeable workers, which constitute the labor force. Thus, all things being equal, if more people are able to work, more goods and services may be produced and if there is a constant increase in the number of people who work, steady productivity

Nursing-introduction to personal & professional development Essay

Nursing-introduction to personal & professional development - Essay Example e simple understanding of multiplication and division, percentages, conversion of units and the handling of different ratios and proportions in medication. So, in mastering the skill of numeracy, proper learning framework and teaching is very much required for the nurses so that they can perform not only well in classrooms but also in their practical settings. Adequate guidance and support by practitioners and educators is also required for the new nurses. In United States a shocking number of patients die every year just because of severe medications errors on the part of the nurses. Institute of Medicine, a generally cited estimate, places thousands of deaths as the result of calculations and medications errors and concludes these errors the fourth leading cause of causalities in United States. Numbers are very important in medicine and drug therapy. The term numeracy skills mean the utilization and recognition of numeric data or numbers accurately and clearly. This data may be used on forms and in performing other numeric calculations. So, we can say that the use of numeric data in a proper way is very required for a professional nurse. Furthermore, it is also important to use this data effectively and competently which is only possible if a nurse learns the basic skills of numeracy. Remember, the success of any nurse always depends on the professionalism associated with the use of numeric data. As already mentioned, that nurses always require proper understanding of the numeric data. Some basic courses or entry level lessons in home nursing always include the ability to understand and learn medication calculations plus numeric data related to various tests. These calculations may be in fractions, numbers and percentages and considered as the building blocks of the career of any nurse. So, here the question arises why numeric data is so important? Actually various calculations are always required for the proper assessment of the patient. For example, if

Problems of Industrialization in Pakistan Essay

Problems of Industrialization in Pakistan - Essay Example To improve production, the country is attempting to industrialize her agricultural activities by adopting modern farming practices and use of technology implements. However, as a developing country, Pakistan has problems of industrialization that stem from different factors. These problems encompass the social, political, and economic aspects of the country includes factors like the country's poor infrastructure, the low level of literacy characterized by lack of skilled labor, poor governance with unstable political environment, as well as the unfavorable fiscal monetary and fiscal policies that may discourage industrial investors. This paper expounds on the different factors undermining the efforts to industrialize the operations in the country and not the negative effects that may result from industrialization in a given country. The factors were identified from the responses in a survey that was carried out to seek information from a variety of industrialists in the country in re lation to the industrialization problems they have encountered, or the factors they consider detrimental to the process. Thesis Pakistan is a developing nation that is dependent on agriculture as the country is endowed with fertile lands fit for the economic activity. Nonetheless, the process of industrializing her agricultural activities has been faced by several problems impeding the whole process. Industrialization Problems in Pakistan Electricity and energy shortages One of the major problems cited to impede the industrialization process in Pakistan is insufficient supply of electricity and energy in the country. Electric power and other energy supply are essential requirements for industrialization. Electric energy is used in driving most of the machines in an industry. Similarly, the mechanized systems also use other forms of energy like fuel from the petroleum products and biofuels in combustion to move machine parts in the lubrication of some moving parts. Just like the situ ations witnessed in many other developing countries, the country has insufficient supply of electricity. Frequent energy shortages in the country are a barrier to industrial development in the country (US Library of Congress, para.2). The power generation capacity of the country cannot support the required economic development prompting for outsourcing of energy resources (Khan, para.1). Her energy supply is among the lowest even in the category of the developing nations. The country has a per capita supply of 0.19 ton petroleum equivalent (Khan, para.1). The issue of poor energy supply as a hindrance to industrialization has been cited by the local industries like the textile industry (Khan and Khan, 21). The industries complain non-guaranteed and thus unreliable energy supplies. Lack of trained and skilled workforce The other important factor that was identified that undermines industrialization in the country is low level of education resulting into lack of skilled manpower. A la rge proportion of the Pakistani firms (about 70%) cite shortage of skills as one of their major challenges (Pakistani Development Forum, 19). There is a large mismatch between the required skills and technology in the country and what is available. The country has a high proportion of low-skilled laborers (about 60-75%), a relatively high proportion of medium-skilled laborers and very low proportion highly-skilled personnel (Pakistani Development Forum, 22). This last category comprises the skilled professionals like

Bilingual Education Essay Example for Free

Bilingual Education Essay Bilingual Education isn’t an issue that’s been short lived. The programs have existed as far back as the late eighteenth century; Immigrant students were then instructed in their first language. Ohio became the first state to adopt an actual bilingual education state legislation in 1839. Other states soon followed, although the variation in language was somewhat broader (Lipka n.p). Controversy has been constant over what methods are actually effective, and what methods need to be retired. Since we are a nation that doesn’t have a national language and requires every child to obtain an education, the responsibility to provide one, becomes ours. With more and more immigrants coming from Mexico, the need for a successful bilingual education method is exploding. Educating any student in a language foreign to their own seems ridiculously absurd. One that doesn’t understand the language well can’t obtain anything taught in the foreign language. Although many approaches of bilingual education are used throughout the United States, they all vary in theory and in teaching style. The students have to be thoroughly taught English before joining an English speaking classroom making Immersion the most successful method. During the Civil Rights movement in the 1960’s, bilingual education became an issue, making legislation necessary to help resolve the problem that had been affecting students and families so harshly (Lipka n.p). â€Å"In January 1968, President Lyndon B. Johnson signed the Bilingual Education Act, which incorporated native-language instruction into the curriculum (Lipka).† Although the Bilingual Education Act was signed, the discrimination didn’t stop. A few years it was found in the court case Lau vs. San Francisco School District that the Bilingual Education Act wasn’t being carried out in their school. The law suit represented 1,800 other students; eight-year-old Kenny Lau sued the San Francisco School District over English-only instruction in a school where most students spoke only Chinese. These students couldn’t learn in the English, because none of the students understood English. â€Å"The Supreme Court ruled that schools without special provisions to education language-minority students are not providing equal education and violate the Civil Rights Act of 1964. The Federal government publishes new materials in nearly seventy languages and allocates sixty-eight million dollars for bilingual education† (PBS n.p). After the Supreme Court hearing things still weren’t better for minority speaking students. Help was needed then, and remains the same today. There are many different methods that educators choose to use in their classrooms, although some are controversial. â€Å"The bilingual programs of today are mostly a product of the Bilingual Education Act (Title VII) passed in 1968† (ECS n.p). Some states have mandated laws that enforce a strict bilingual program that is taught in all public schools in their state, while others aren’t as strict. Some states need the programs more than others. According to ProEnglish, â€Å"15 states account for 94% of students who speak languages other than English in their home.† Therefore, we know that in these fifteen states we must teach English efficiently. These students all speak a native language in their homes, so on the contrary to some beliefs, these students are not easily going to pick up on a native language. Today we know more about educating students of a minority language then we did in the past, but we are still struggling with it today. Some people even believe we should completely throw bilingual education out. If that happens, there wouldn’t be opportunity for those native speaking students. We would have much larger number of non-English speaking Americans, and a lot more citizens that couldn’t find jobs. Lastly, it would be breaking the Civil Rights Laws. There are countless misconceptions about bilingual education. Some even believe that it’s simply a lost cause, but statistics show other wise. â€Å"In 1990, only three percent of U.S. residents reported speaking English less than well or very well. Only eight-tenths of one percent spoke no English at all (Crawford n.p)†. There are many effective methods to teaching these students. Some argue that if taught the native language, it can’t be transferred to the one learned, while this may be difficult for some, it is possible (Crawford n.p). Students would have an easier time transferring their knowledge from their native language opposed to being taught in a language that isn’t understandable at all. Critics complain about the tax dollars we spend to teach these non-English speaking students, but they also complain about all the minorities that have to live on welfare. Maybe if they were better educated it wouldn’t be quite the case. Critics also believe that bilingual education programs aren’t promoting English, but merely teaching students only in their native language. Most every program in the United States promotes the teaching of English in one form or another. Although, they are not trying to remove ones culture and linguistic heritages, they are just preparing them for success in the public school systems and in the English speaking nation we live in. â€Å"According to one study, school districts reported that 28% of limited English proficiency (LEP) elementary school students receive no native-language instruction. Among those who do, about a third receive more than 75% of their instruction in English; a third receive from 40 to 75% in English; and one third of these receive less than 40% in English (Crawford n.p). Hispanic dropouts continue to remain high. There is multiple factors associated with these statistics, such as; family poverty, English proficiency, some simply never even enrolls in school (NCES n.p). â€Å"In 2005, more than one-fifth (22.4 percent) of Hispanics 16 through 24 years of age were dropouts, according to the National Center for Education Statistics (NCES n.p)†. The Hispanic dropout rate can be lowered with good bilingual education plans for teaching those who can’t speak English. The rate is especially high in Mexican immigrants. â€Å"In fact, the status dropout rate of 44.2 percent for Hispanic 16- through 24-year-olds born outside the 50 states and/or the District of Columbia was more than double the rate of 16.1 percent for Hispanic youths born in the United States (NCES n.p)†. These individuals don’t have the education that is necessary to succeed in the United States, which is not fair according to Civil Rights laws. There are multiple causes for the high dropout rate, but their understanding of the language is a leading cause. So, to be equal to all students, we must provide the same opportunity to native-speaking students. Methods are plentiful to educating students whom don’t speak the dominant language, but most generally only a few methods are currently used in public schools in the United States. First, the submersion method, in a submersion program the native speaking student is placed in the classroom right along with the English speaking students (Queen n.p). Students are expected to learn what the other students are being taught even though they may not fully understand the language. You could basically consider this method a â€Å"sink or swim† type of education. It sounds absurd for one to expect another to learn something in a language they cannot even decipher. This method may not be considered Bilingual Education to some because only one language is being used. Even if this is the case, students are still being educated in a language unfamiliar to them. Students cannot understand something they aren’t familiar with. If they seem they are picking up on the language conversationally, they still may not register thoughts in English to actually learn material that is being taught in the classrooms. This method will not work for most students; native speaking students will continue to fall behind. Eventually students won’t be able to catch up with other students their age. Submersion is therefore, no one way for a student to learn anything. Students that fall behind could potentially add to the high statistics in the high dropout rates. Many schools today have English as a Second Language (ESL) programs, such as the Scott County School district uses today. This is when a non-English speaking student is placed in English speaking classrooms for part of their classes, while for others they go to an ESL classroom. When in the ESL classroom they concentrate on learning English to succeed in their English speaking classes. This method can be very effective if the student’s participate, but if they fall behind there is going to be many hardships catching up. Some students will never catch up to their age group in school and won’t finish their education (Queen n.p). Students in ESL programs aren’t given enough time to learn the language well enough to succeed; therefore the time they spend in English speaking classrooms could be considered useless to some. If they’re not understanding of the language, this seems like a waste of the student’s time. It can also be an imposition to the English speaking students in the classroom. Special time and attention would have to be given to these native-speaking students. That time would then take away from the English-speaking student’s education. Students aren’t actually taking in anything they’re learning, other than picking up on a few English words, then this is a waste of time to not only the teachers that aren’t qualified to teach them, but to the English speaking students in the classroom as well. Minority students must receive intensive instruction, since the drop out rate of non-English speaking students in the public system is so high, measures must be drastic. â€Å"The General Accounting Office reported in February 2001 that out of 70 studies reviewed; only three focused specifically on how long it took students to attain English proficiency. General estimates ranged from four to eight years (ECS n.p).† Therefore we know that learning a foreign language enough to learn isn’t easily done and it isn’t necessarily a speedy process. We have to give intensive instruction, and we must not give up on these students. This method isn’t effective enough though, it takes years to learn English in ESL programs as researchers have found. Being as this method takes so long, there is not time for students to keep up with their classes. Many students will not succeed, and will never accomplish what is required to graduate high school. One of the biggest controversies schools and state legislators are facing is the argument with immersion versus Bilingual Education. The ESL method is used a frequently in the U.S, but many ESL supporters are starting to follow the new immersion trend, because it doesn’t take students as much time to learn English. Immersion method of teaching students are intensively taught English for a period of time, for example one school year. After they have learned English well enough to understand, and to actually have the chance to learn English. They are placed back again in English speaking classes and that’s where they will continue their education. Immersion can stop students from dropping-out and falling behind. Critics argue this is just a loss of time, but with ESL they are in the long run loosing even more time. â€Å"At a leadership meeting a participant decided to speak up, she was an ESL teacher. She said, Research shows that it takes five to seven years for a student to master English well enough to succeed in a mainstream classroom, she said, adding that this finding was only for children who were already proficient in their first language. For kids without good language skills of any kind, it takes 10 years, said the teacher† (Triangle Business Journal N.P). Students that don’t speak well enough English get thrown into English speaking classrooms that they are not ready to be. Upon this happening students continue to fall behind and could be accounted for such high dropout rates in native speaking students, especially in the Hispanic students. Native-speaking students will have a hard time understanding material in English when you present it before they truly understand enough but, if you make sure they understand the English first, teaching them in English is going to be much more effective and that should be a given. Bilingual Education will be effective in different ways for all different students. Any language students learn differently, some like more visual aide, while others like lots of verbal explanation. That being said, there is no difference in teaching students of another language. Every student has similar basic needs, therefore there should be a basic method used everywhere. We can’t expect these students to sink or swim; a good method must be used. Since most of these students don’t have any sort of an English background at home, then educators can’t expect them to receive any help from the home. So, all the English has to come from the school. Since every student is going to learn at their own pace, we must teach them extensively, without doing so understanding English will not come quick enough. Teaching them English isn’t taking them away from any of their native culture; it’s preparing them for success in the United States. Preparing students for success in English educators will be abiding the civil rights law, and offering each student the same education. If parents don’t want their child speaking two languages or learning English, they should take their child to a private school that will only teach their child in their native language. Although, most native-speaking parents want their children to be fluent in English as well as the language they speak at home. There are also so many advantages to being bilingual today. When traveling foreign countries one could commute with others. It also leads to exposure to both cultures, and one will become more culturally diverse. If one wanted to move to another for another country for any different reason they would have an easier time adjusting. The United States today there are many different language being spoke all over, all the time. Employers look for multi-lingual speaking employees so that they can meet everyone’s needs. Places such as the hospital, multi-language speaking employees are essential, because not only do English speaking patients come in, as well a lot of other native-speaking patients. Scott City and surrounding areas there are a lot of Spanish speaking people, whom need the same things English speaking people do. Therefore, offering one who is bilingual on the job is going to help tremendously. Since the United States has no official language, I suppose we can’t expect everyone to speak English. According to ProEnglish, over 30 states have adopted English as their official language. Some federal legislation implicitly standardizes English (Wikipedia n.p). Knowing English could almost be considered essential to survive and succeed in this English speaking country. â€Å"According to the 2000 census, the United states has 215 million that are speaking English. While only 28 million speak Spanish, and next a Chinese language who has about two million speaking in the United States (Wikipedia n.p). This should be enough proof to any educator or legislator that knowing English is essential. If one is bilingual in English and Spanish, then even better. English is most essential to be successful in the United States. There are endless reasons that knowing English in the United States that would be essential to anyone. The United States is the â€Å"land of the free†, so there is not law stating one must speak the most commonly spoken language: English. To be exact about ninety-six percent of Americans speak English (Wikipedia n.p). To be successful, one will want to understand the language. Most colleges in the United States are all taught in English, although you could go to a school speaking your language, the majority will be teaching in English. Students that want to succeed and go to state colleges they’re going to need to understand English. The opportunity is available for all students, but some might have it harder with the different method that’s used in schools across the United States. All methods can work in teaching students; some are just more successful than others. We must educate these native-speaking students so that they have the equal opportunity that English-speaking students do. The need for bilingual education is astronomical; it’s simply what’s right. Students need to learn English to have the same opportunity for success as others. Some might even have more opportunity once they are fluent in more than one language. The point is we need a good program that works efficiently to educate every native-speaking student in the United States. All the methods have their perks, but we need the most effective and efficient program to teach these minority students. The submersion method doesn’t help any student that is struggling with English, they simply sink or swim. The method might be cheaper, but it will not help any student with the need for Bilingual Education. The only advantage some consider is budgeting. The English as a Second Language program defiantly is a step-up from the Submersion program, but it shows many weaknesses as well. The program wastes time with students in English-speaking classrooms, that don’t even understand the language. Although they are being taught English, and have an instructor also teaching in their native language, the teaching of English, simply isn’t intense enough. That’s why Immersion is the best way to educate these minority students that cannot speak English, although they may loose a year of education, they are not going to fall behind anymore than that. When they finish the program, they will be able to understand and speak English. When they are put into English-speaking classrooms they will understand everything being taught. This is what we need for these native students to keep up with the English speaking students. This will minimize minorities’ falling behind; dropout rates, and maximizes English understanding. Immersion is the best way to teach these students, and will in turn help these students succeed to fullest of their potential. Immersion makes Bilingual Education is faster and more successful. When structured English immersion plans were used in California, â€Å"after two years of instruction, students made significant gains in reading and writing in English as well as math, relative to students’ nationwide taking the Stanford 9, most of whom are native English speakers (NCPA n.p)†. This seems proof enough, that immersion is the way to teach our minority students English successfully. Citations: 1. National Center for Educational Statistics. Student Effort and Educational Process.n.d. 2006. 10 April 2009 . 2. Education Commision of the States. n.d. 11 April 2009 . 3. Queen, Robin. Bilingual Education. 2005. 12 April 2009 . 4. Jones, Madison and Renee Bou-Waked. School Choice and Hispanic Dropouts. 12 November 2007. 8 April 2009 . 5. Crawford, James. Ten Common Fallacies about Bilingual Education. November 1998. 7 April 2009 . 6. Hood, John. Immersion vs. bilingual education.†Triangle Business Journal (1997): n.p. 7. Lipka, Sara. The Battle Over Bilingual Education. The Atlantic Online (2002): n.p. 8. PBS. Master Time Line. n.d. 10 April 2009 . 9. ProEnglish. The status of bilingual education in America. n.d. 8 April 2009 . 10. Wikipedia. Languages of the United States. n.d. 9 April 2009. .

Relationship Between Motivation And Performance

Relationship Between Motivation And Performance 1) To review the literature in order to understand the relationship between staff motivation and performance (including low absenteeism, reduced staff turnover etc.),and how increased empowerment of staff can improve staff motivation(including the comparison with the relevant motivating factors). 2) To review the literature in order to identify what is considered to be good practice in terms of both empowerment and recognition and to compare this with the current practice at the Bombay Hospital THE RELATIONSHIP BETWEEN STAFF MOTIVATION AND INDIVIDUAL PERFORMANCE Shortages can be a symptom of demotivation, poor management and lack of organizational support (Zurn et al., 2005). Shortages are resulting in heavy workload, which is a precursor to job stress, and burnout, which have also been linked to low job motivation. Nurses job motivation is an elusive concept, which is defined within its extrinsic and intrinsic values (Cowin, 2002). Extrinsic values encompass the tangible aspects of the job including wages, benefits and bonuses, whereas intrinsic values include status, recognition, personal and professional development opportunities, and other similar factors (Cowin, 2002). Reasons for nurse demotivation have been well documented in the nursing literature. Such reasons include lack of involvement in decision-making, poor relationship with management, low salaries and poor benefits, lack of job security, poor recognition and lack of flexibility in scheduling (Albaugh,2003). Nurse demotivation has been also linked to emotional exhaustion and b urnout, Which can affect patient outcomes (Aiken et al., 1997). Furthermore Shields Ward (2001) and Tzeng (2002) has also stated that improper motivation is a primary predictor of nurses intent to leave (Shields Ward, 2001; Tzeng, 2002). A study conducted in the United States presented evidence showing that demotivated nurses were 65% more likely to have intent to leave compared to the motivated counterparts (Shields Ward, 2001). Other predictors of intent to leave vary from other motivation factors like low salaries and fringe benefits, inflexible work schedule (Coomber Barriball, 2007; Hayes et al, 2006), career advancement prospects (Tzeng, 2002, Rambur et al., 2003), in addition to poor management and job stress (Rambur et al., 2003). Nurses turnover is linked to situational factors (Larrabee et al., 2003) such as low levels of motivation (Tzeng, 2002). It is worth noting that improper motivation has also been found to be a better predictor of intent to leave as compared to the avail ability of other employment opportunities (Shields Ward, 2001; Purani Sahadev 2007). A study by El-Jardali et al. (2007) also found a negative correlation between motivation and intention to leave in Lebanese nurses. Their studys main objective was to examine the impact of motivation as a predictor variable on intention to leave used as dependent variable in the study. The finding of the study reveals that the main cause of the dissatisfaction and hence intention to leave was negatively associated with hospitals motivation schemes such as compensation and incentives (extrinsic rewards). Purani and Sahadev (2007) used motivation with multi-faceted construct as predictor variable and examine its impact on intention to leave among the nurses in India. Assuming one of the role as interaction and communication with clients and patient of both profession is common, their study also used experience as moderating variables to examine how working experience could affect motivation and inte ntion to leave relationship. Purani and Sahadev (2007) found that employees with long stay at workplace had higher level of motivation and would not incline to quit. Their finding also suggested that motivation and intention to leave relationship framework must also have other demographic variables consideration into the model of motivation and intention to leave. Pearson and Chong (1997) also examined the impact of job content and job information on motivation among Malaysian nurses in large public sector hospital. They found that job information is stronger predictor to nurses motivation and therefore argued that intrinsic factors such as job information and organization commitment also influence nurses motivation. However, they did recommend that motivation with information cues available to nurses are crucial to determine nurses motivation which may lead to intent to leave or higher job burnout, if not available. Tzeng (2002) examined the impact of working motivational factors a s well as job satisfaction factors as independent variables on nurses intention to leave in cross-sectional study in Taiwan. He found that low levels of motivation, emotional exhaustion and burnout and to the poor social image of the nursing profession influenced nurses intention to leave in Taiwans hospitals. This study therefore, suggested that motivation is a multi-faceted construct and should have both intrinsic as well as extrinsic factors to measure job satisfaction (Tzeng, 2002). HOW MOTIVATION AFFECTS EMPLOYEE PERFORMANCE The extent to which employees are motivated in their work depends on how well those employees are able to provide output in their job. Motivation is expected to have a positive effect on quality performance. Employees who are characterized by a high level of motivation show a higher work and life satisfaction. Having a high level of motivation is therefore in itself valuable for employees and a decrease in motivation might affect employees negatively. The motivation leads to high level of initiative and creativity from the employee and where monitoring is difficult, motivation is therefore extremely important for ensuring high quality performance. In Armco Health Center, the quality of employee performance is measured by three individual measures of employee performance. The first measure of the individual performance items is a self-rating measure of employee performance through a program called SAP. The performance of the employee asks to indicate eight-points scale how well the em ployee is doing the job. The second measure of the performance of the Armco Health Center is the extent to which the nurses are willing to conduct tasks that are not part of their job description. The employees are asked to report on the SAP about their willingness to perform additional tasks that are not expected from them regularly and to think constructively about how the organization they work for could be proved. Last item that measure the performance of the nurses are the number of days they were absent. EMPOWERMENT AND STAFF MOTIVATION Nursing is increasingly broad in scope and encompasses an ever widening range of work behaviors and role responsibilities. However, they work within a climate of uncertainty and disempowerment along with high organizational demands placing them under considerable stress (1,2). This condition threatens both physical and emotional wellbeing of nurses and the profession itself and may results to low nurses commitment which in turn may contribute to disengagement or withdrawal of nurses from their organizations (3,4). Consequently, threatens organizational functioning and the quality care, since low nurses commitment leads to absenteeism or poor performance (5). However, the nurses low commitment is being a problem in many countries, Aiken et al(6) have cautioned that the health care workforce faces the serious risk of losing one in five registered nurse for reasons other than retirement. Supportively, several other studies revealed that the turnover rate for hospital registered nurse is among the highest rates found for professional and technical occupational groups (7,8). In addition, in 2002 the Joint Commission on Accreditation of Health Care Organizations (JCAHO) recorded that current annual registered nurse turnover rates range from 18% to 26% (9). Moreover, Victorian Governmental Department of Human Services Research suggests that at low levels of job satisfaction and organizational commitment, retention of nursing staff is difficult and this in turn increases absenteeism (10). The Kingdom of Saudi Arabia, like many other countries is also suffering from nursing low commitment which evidenced by registered nurses high turnover rate and resignation(11). However, some national studies and articles highlighted that governmental sectors in Riyadh city were suffering for many years from high turnover rate of nurses that reached to 70% in some hospitals and resulted in high nurses shortage (12,13) . Along with working condition, salary, nursing disempowerment and uncertainty being cited to explain why the nurses exhibit poor work performance or uncommitted to their organization. In a research conducted by Attree (17) that studies the relationship between nurses perception regarding their control and governance , revealed that registered nurse were dissatisfied with their governance, perceived lack of control over their everyday practice and commented on a popular perception that they had become disempowered , lacked influence and asserted that they have fairly little power. Its the managers and physicians who have the power, not nurses. Both managers and physicians decided, told and expected from the nurse to just get on with it, without discussion, or negotiation. As Salvage (18), nurses may see themselves as skilled practitioners, but the public still clings to its old image of the nurse as the doctors handmaiden. This indicates that nurses are not powerless due to lack in competence, motivation, and/or information, but because lack of awareness and enabling system and structure. Foser and Hoggett (19) termed this situation as a Do more with less culture where rhetoric is designed to empower the exhausted workers by emphasizing their commitment to organizational goals . However, disparity between the nurses desired and perceived autonomy and control over daily job activities interferes with nurses attempts to perform according to their expectations as professionals and may contribute to disengagement and withdrawal from the profession of nursing (17). Parallel to this is the national view of nursing in Saudi culture. Abu- Zinada (11,20) stated in many articles that the nurses were disempowered, and have a feeling of uncertainty. In contrast, she saw that the nurse has the right to make decisions that are separate of the physician ones. Moreover, Al-morshed (21) considered that the nurses were not assistants to the physician or that their role is limited to giving injection or helping a patient, since the nursing is a science before everything. Thus, creating conditions that foster a sense of empowerment in healthcare settings are critical to both employee wellbeing and organizational success(22) . For employee well-being, empowerment offers opportunities for learning, development, and playing a more active role in operational decisions through the personal development and involvement in decision making. As a result, employees can sense their feelings of self-worth, meaningfulness, job satisfaction and morale that result from their contributions and control or autonomy over their work. Additionally, empowerment is essential for enhancing nurses role, strengthening the professional image, and continuously improving the healthcare system. It allows the nurses to perform in a professional manner by being more autonomous, responsible and participative (23). For organizational success, many hospitals uses the concept of empowerment as a retention strategies to improve nurses commitment by fostering the desire not to leave the organization for selfish interests or marginal gains, and increase willingness to work by making personal sacrifice, performing beyond normal expectations , endure difficult times with an organization and increasing acceptance of organizations values and goals . As a consequence, nurses will be less burned-out and more engaged in their work and will contribute to organizational effectiveness (24). Although, the concept of empowerment is frequently used in health services and in nursing ,particularly in relation to the quality of care, since the mission of nursing is to provide safe and quality nursing care thereby enabling patients to achieve their maximum level of wellness(25). Also empowerment play a significant role in the management of job stress and job satisfaction as well as in nurse attraction and retention ( 26). Hence, creating healthy work conditions that empowered nurses and provide freedom to act according to their expectation as a professional, may be a fruitful strategy for nurse managers and administrators to retain nurses who currently work by promoting their commitment to the organization, especially in a critical care settings. Nowadays, many seek power but few possess it. Nurses are not exception (Marquis and Huston, 2000). In health care settings, an unequal power base exists among administrator, physicians, and nurses as a result of the competing goals of administration and the coexistence of multiple lines of authority (Sabiston and Laschinger, 1995). The rigidity of hierarchical rule-bound structures has been specifically blamed for nurses inability to sufficiently control the content of their practice (Laschinger and Havens, 1996). Kanter (1993) proposed that an individuals effectiveness on the job is influenced largely by organizational aspects of the work environment. This author identified power and access to opportunities to learn and grow, as structural determinants affecting the behavior of the individual. This power is derived from the ability to mobilize information, support, and resources necessary for getting the job done. Access to these empowering structures is influenced by the degree of formal and informal power an employee has in the organization (Kanter,1993). Formal power evolves from having a defined job that affords flexibility, visibility and centrality to organizational purpose and goals whereas informal power is determined by the extent of employees networks and alliances with sponsors, peers, and subordinates within the organization. Access to these empowering structures has a positive impact on employees, resulting in increase in their job satisfaction, level of organizational commitment and feelings of autonomy. Consequently, employees are more productive and effective in meeting organizational goals (Dutcher and Adams, 1994 ; Laschinger et. al., 1999). Nurses autonomy or control over work was seriously limited by unequal power relationships with medical staff, which enhanced physician power and restricted the nurses freedom, and consequently hindered their empowerment (McParland et al., 2000). To achieve excellence in nursing requires empowered staff nurses in order to be effective in their roles, and to be more autonomous (Marquis and Huston, 2000). Nurses who perceive them to be empowered are more likely to enhance client care through more effective work practice. Thus by providing the sources of job-related empowerment and autonomy, work methods and outcomes could be improved (Kanter, 1993; Sabiston and Laschinger, 1995). EMPOWERMENT IMPROVES MOTIVATION Empowerment. Thomas and Velthouse (1990) define empowerment as personal power that flows from professional growth, which is correlated with job satisfaction. Klakovich (1995) further states that the empowerment of nursing staff may be the critical variable in achieving positive organizational outcomes while maintaining the caring values of the nursing profession Klakovich (1996) defines three dimensions of empowerment as reciprocity, synergy, and ownership. Empowerment is a reciprocal leader-follower relationship that advances and aligns strategies, both organizational and individual (Klakovich, 1995). The Reciprocal Empowerment Scale tool reports in three subscales: reciprocity and synergy sub-scales represent the interactive leader/follower process; the ownership subscale represents the outcomes . Reciprocity involves a leadership behavior pattern of sharing power, support and information. Empowerment Research has shown correlations between nursing leadership job satisfaction and e mpowerment (Laschinger et al., 2003; Mrayyan, 2004). In recent years, the idea of empowerment has become popular in the nursing literature (Kluska et al., 2000; Laschinger Finegan, 2005). The review of the literature reveals empowerment being used in various contexts; such as, mental health, chronic care, and health promotion (Dahlgaard Dahlgaard, (2003), Paterson(2001) . In these contexts, the concept of empowerment incorporates positive and respectful relationships through constant dialog (Ellefsen Hamilton, (2000) Prybil( 2003). Morrison, Jones, and Fuller (1997) performed a non-experimental descriptive study that explored the effects of leadership style and empowerment on nursing job satisfaction. The participants included various nursing personnel, such as nurse managers, nursing assistants, nursing clinical leaders, licensed practical nurses and staff nurses. The researchers examined how staff nurses perceived empowerment The researchers results in their variance analysis i ndicated a statistically significant difference in empowerment among different job classifications within the organization Empowerment accounted for more variance with job satisfaction for licensed personnel than for unlicensed personnel, as well as, for differing by type of satisfaction. The researchers findings indicate the importance of empowerment to staff nurse job satisfaction. They also show the contribution of empowerment to job motivation and how they vary by personnel. This study gives reason for performing this research study that examined the relationship of nurse empowerment and motivation Furthermore, studies have shown that Indian nurses had a moderate empowerment level and their actual work empowerment perception was significantly lower than their expectation (Huang, Lin, Hsu, Chen, Huang, 2003). The findings also showed that nurses had the lowest score on participation in decision making. Researchers pointed out that the nursing leaders tended to use authority and might only consult several members opinions for decision making. The opportunity for nurses to participate in decision making is limited. As such, frontline nurses might think decision making is the managers responsibility, not theirs (Mok Au-Yeung, 2002). Participation can be seen as the highest level of empowerment. Nurses level of participation in decision making (PDM) can be used as an important indicator of empowerment. In western health care system, it has been found that the area where nurses prefer to be involved in decision-making is more related to the context of nursing practice, such as nursing unit operation (Blegen et al., 1993). Yet, in Indian nurses PDM is still not well studied. The extent to which nurses prefer to be or are actually involved in decision making is still not clear. Laschinger and Finegan (2005) surveyed 273 medical, surgical and critical care nurses concluding that structural empowerment had a direct effect on organizational trust and respect, job motivation and commitment. An important addition to the understanding of empowerment in nursing education was another finding that empowerment increased motivation level of the nurses (Falk-Raphael, Chinn, Anderson, Laschinger, Rubotzky, 2004) Work empowerment has been linked to many other important organizational outcomes, such as job motivation, organizational commitment, lower levels of job stress and empowering leader behaviors (Spence-Laschinger, Tuer-Hodes, 2003). Hollinger-Smith and Ortigara (2004) stated that nurses perceptions of work empowerment are related to commitment to and trust in the organization, autonomy, participation in organizational decision-making, and job motivation. Increased autonomy and work motivation have been directly linked to nurse retention and increased patient satisfaction (Hollinger-Smith Ortigara, 2004). Empowering work environments can also influence nurses ability to practice in a professional manner, ensuring excellent patient care and positive organizational outcomes. Organizational changes have a direct effect on the work environment and may contribute to higher rates of demotivation, burnout and absenteeism among staff (Kuokkanen, Savikko Doran, 2007). Factors of empowerment c an also provide a way to measure the effects of organizational changes (Kuokkanen et al., 2007). To achieve excellence in nursing requires empowered staff nurses in order to be effective in their roles, and to be more autonomous (Marquis and Huston, 2000). Nurses who perceive them to be empowered are more likely to enhance patient care through more effective work practice. Thus by providing the sources of job-related empowerment and autonomy, work methods and outcomes could be improved (Kanter, 1993; Sabistonand Laschinger, 1995). In Sochalskis (2002) survey of nurse empowerment , it was found that 1 out of 3 staff nurse participants (manager and staff level) were dissatisfied and hence demotivated in their job. Increasing job satisfaction, as it positively correlates with empowerment and organizational commitment, is a strategy to help retain employees (Laschinger, Finegan, Shamian, Casier, 2000). As patient care becomes more technologically advanced and complex, (requiring greater experience on the part of nursing staff to perform the job correctly), workplace stability and a utonomy become invaluable in a hospital setting (Laschinger et al,2000.). Many researchers have concluded that building collaborative decision making teams will empower both nursing and managerial staff; which boosts morale and work performance (Cowin, 2002 Kluska et al., 2004). Ellefsen and Hamilton (2000) concluded that nurse empowerment encourages nurses in management positions to perform their duties efficiently and with confidence and competence. Research suggests when hospital leadership encourages subordinate empowerment; there is a direct link to increased subordinate job satisfaction and motivation (Laschinger, Finegan, Shamian, Wilk, 2001). Evidence has shown that empowered nurses shift their self-perceived role from that of a subordinate to collaborator; which encourages consensus building, improves job ownership, improves trust and the followers motivation, sense of responsibility and organizational commitment( Wagner ,2006 Watson, 2002). Empowerment not only increase s job motivation, but inspirational and visionary transformational leadership encourages the highest level of staff efficiency and productivity (Keuter, Byrne, Voell, Larson, 2000; Moss Rowles, 1997). Masi (2000) concluded that empowerment provides opportunities for choice and promotes autonomy, which allows subordinates to demonstrate their competencies. The espoused benefits of empowerment The supposed benefits of empowerment can be broadly divided into two areas: benefits for the organization; and benefits for the individual. Much of the empirical research into empowerment has focused on organizational benefits assuming that these are the driving force behind attempts to engender empowered working (Cunningham et al., 1996). Certainly the motivation for managerial adoption of empowerment is typically driven to help managers manage and improve work organization and job performance, not to primarily create an environment that is beneficial for the employee (Psoinos and Smithson, 2002). Global competition and a changing business environment have prompted organizational change in response to increased pressures to improve efficiency and performance (Lawler et al., 1992). It has been argued that organizations with higher levels of empowerment have demonstrated improvements in various economic performance areas (Applebaum et al., 1999). The economic benefits of empowerment s pecifically may be difficult to assess as often it is introduced as part of a broader initiative such as BPR and TQM (Psoinos and Smithson, 2002). Despite the espoused organisational benefits Argyris (1998) argues that empowerment has still not delivered the promised benefits, remaining a myth rather than reality. While it could be argued that the primary motive for empowerment is initially driven by the need to improve the economic performance of the organisation, benefits to the individual employee have also been identified. Nykodym et al. (1994) found that employees who consider themselves empowered have reduced conflict and ambiguity in their role, as they are able to control (to a certain extent) their own environment. They suggested that this reduces emotional strain on the employee. Similarly, it has been suggested that empowered employees have a greater sense of job satisfaction, motivation and organisational loyalty (Koberg et al., 1999, Spreitzer et al., 1997). Empowerment cannot only impact attitudes but it can also impact on performance, specifically employee productivity (Koberg et al., 1999) and employee effectiveness (Spreitzer et al., 1997). Overall the literature points to many potential benefits to both organisations and employees like if the workplace empowerment is successful, then it produces a win-win situation (Lashley, 1999). However, despite the strong support for empowerment in theory, in practice empowerment may exist in rhetoric only and control is the reality for employees (Sewell and Wilkinson, 1992). Although it may be considered that employee empowerment will improve organizational performance but it is possible that empowered employees are not necessarily more motivated or have higher levels of job satisfaction (Collins, 1999). Thus the benefits of empowerment should not be assumed to automatically occur nor should the rhetoric of empowerment be confused with the reality. Measurement of the employee benefits is very difficult t o achieve. Unlike organisational benefits which can be measured using objective facts, individual benefits are much more complex. Certain objective measures, such as absence and turnover rates have been applied in this context (Psoinos and Smithson, 2002). However, it is often considered that softer measures of employees attitudes may provide informative insights omitted by other more tangible measures (Psoinos and Smithson, 2002). FACTORS IMPORTANT FOR MOTIVATING EMPLOYEES One of the most perplexing healthcare retention issues is keeping newly licensed nurses from leaving after just a year or two of employment in the clinical setting (Zucker, Goss, Williams, Bloodworth, Lynn, Denker, et al., 2006). Kovner, Brewer, and Djukic (2007) presented evidence that 13% of newly licensed 1490 RNs had changed principal jobs after one year, and 37% reported that they felt ready to change jobs. Nurses leave the profession mainly because of low pay and poor job satisfaction (DiMeglio, Padula, Piatek, 2005)Hence pay and motivation at workplace are very important factors of retaining the staff. Therefore, nurse leaders are faced with two challenges: to recruit sufficiently qualified nurses and to establish rewarding work cultures that promote retention. Recruiting a younger generation of nursing staff members and meeting retention demands of cross-generational nurses will be a challenge like no other previously seen in healthcare (Cordinez, 2002). Newly licensed nurse s recruitment and retention into the workplace are fundamental strategies for ensuring that healthcare systems have the continued capacity to deliver patient care (Berliner Ginzberg, 2002). Understanding why newly licensed registered nurses choose to remain in nursing is an essential component of recruitment and retention strategies. Despite a recent four year trend of increasing nursing school enrollment and graduation of qualified nurses (American Association of Colleges of Nursing, 2005), the latest data on the shortage of RNs in the United States is estimated to reach about 500,000 by 2025 (Buerhas, Staiger, Auerbach, 2000.This study shows that nursing shortage is going to increase and hence motivating factors like pay,proper work environment and empowerment are necessary for retaining the experienced nurse staff. Hecker (2005) predicts that more than one million new and replacement nurses will be needed by the year 2014. The problem is that many of the newly licensed nurses w ill not remain in nursing and will choose to leave the profession within four years of graduation from a nursing program (Sochalski, 2002). In a study by Bowles and Candela (2005), 30% of newly licensed RNs left their first nursing position within one year of employment, and 57% left their first nursing position within two years of employment.This study further provides evidence that adds to the case study done by Kovner, Brewer, and Djukic (2007) which also adds to data and evidence that nurses are leaving their profession due to lack of empowerment and motivation in hospitals. The nursing shortage and the high incidence of turnover among newly licensed nurses within the first year of employment need to be investigated. It is well documented that nurses are leaving the profession because they are dissatisfied with current working conditions and not because they are disenchanted with the ideal of nursing, which originally attracted them to the profession (Lynn Redman, 2005; Strachota, Normandin, OBrien, Clary, Krukow, 2003). There is limited research that addresses newly licensed registered nurses career choices post-graduation. The future of nursing rests in the ability to recruit and retain upcoming generations to the profession.Currently, however, there is limited knowledge concerning what influences the decisions of newly licensed registered nurses to remain in nursing. Thus, the objective of this study was to identify factors that influence newly licensed registered nurses decision to remain in nursing. The shortage of people entering professional nursing, nurses dissatisfaction, and high turnover of newly licensed registered nurses are issues of concern. The national shortage in the nursing workforce highlights the critical importance of encouraging nurses to remain in practice. Evidence suggests that a shortage of nurses is detrimental not only to quality of patient care, but also to staff morale, which in turn affects staff retention (Wilson, 2006). The socialization and assimilation of newly licensed nurses into the healthcare system is a pivotal event that influences the retention of nurses (Aiken, Clarke, Sloane, Sochalaski, Silber, 2002). Professional socialization and work readiness are contributing factors to the retention of newly licensed registered nurses. The transition from student to new nurse is a vital period in several ways. It is the quality of this transitional experience that is likely to influence new nurse retention (Clare van Loon, 2003; Duchsch er, 2001; Ewens, 2003). Professional socialization, a potential buffer to the effects of reality shock, includes the acquisition of knowledge, skills, identity, occupational traits, values, norms, and self-concept (Mamchur Myrick, 2003). The process of professional socialization, from career choice to transition to enculturation to the practice setting is influenced by others, especially other nurses (Beck, 2000; Hinds Harley, 2001). It is this initial professional socialization of nurses that will determine the success or failure of retaining new nurses in the healthcare workplace. The increasing complexity of health services and the acuity of patient care create an expectation by the healthcare organization that the new nurse will hit the ground running (Cowin Hengstberger-Sims, 2006, p. 61). Furthermore, Cowin and Hengstberger-Sims believe the workplace expects newly licensed nurses to quickly fulfill their potential as knowledgeable workers, but the health organization remune rates newly licensed nurses at the lowest possible pay scale. These researchers asserted that incongruencies such as high level of stress related to responsibility and high workloads paired with minimum pay compound the effects of reality shock of nurses new to the field. The healthcare workplace demands work readiness from its newest nurses and the partnership of responsibilit

Biology Essays Heart Disease

Biology Essays Heart Disease The Biological Basis and Risk Factors for Coronary Heart Disease. Coronary heart disease is a blanket term which describes all types of heart disease caused by blockage of the arteries that supply blood to the heart. Lack of sufficient blood is associated with a lack of oxygen, also called ischemia. Hence coronary heart disease is also called ischemic heart disease. Angina, heart attack and heart failure and are all clinical forms of coronary heart disease.1 Overall, coronary heart disease is the leading cause of death in the Western world.2 In the UK, heart attacks are responsible for around 150,000 deaths every year and cost the NHS approximately  £719 million per year. Almost half of all heart attack sufferers die within 20 days of the attack.3 The heart of the problem The heart is a vital organ, pumping blood which carries essential oxygen and nutrients all around the body. As a powerfully active muscle, the heart needs a ready and plentiful supply of oxygen and nutrients itself; however these are not extracted from the blood that flows through it. Instead, the heart has its own specific blood supply – the coronary arteries. There are two major coronary arteries – the right and left. The volume of blood which flows to the heart is largely determined by the width of these vessels and is not so dependent on the power at which the blood is pumped through them. Unlike other organs which can use the oxygen within veins if needed, the heart is completely reliant on the coronary arteries’ supply. Hence their ability to expand and supply more blood when required is essential.4-6 Coronary heart disease develops when various materials build up within the walls of the coronary arteries causing a narrowing of the vessels and potentially leading to complete blockage. The obstruction of blood flow to the heart which results from this build up within the coronary arteries can cause a range of cardiac problems. When the blood flow to the heart is only temporarily interrupted, usually during exercise and times of exertion when the heart muscle requires more oxygen, the condition is known as angina. A person with angina will experience short attacks of chest pain which usually clear up with rest. Ultimately, insufficient blood flow can result in actual physical damage to the heart tissue. In severe cases, where blood flow is completely blocked, the portion of the heart affected may die from lack of oxygen– this is termed myocardial infarction, commonly known as a heart attack. Symptoms of heart attack include prolonged and severe chest pain, weakness and shortn ess of breath. In rare cases, patients with coronary heart disease experience heart failure. This is a broad condition which describes any symptoms showing that a patient’s heart is not performing as it should. 4-6 Why do coronary arteries become blocked? In healthy arteries, the walls are smooth and blood flows easily. The process leading to the development of coronary heart disease begins with the development of ‘fatty streaks’. These are yellow patches which appear within the wall of the coronary artery. The streaks are made up of a special type of cell called foam cells, which are rich in fats, plus smooth muscle cells. Over time, streaks can turn into plaques. Plaques, also known as atheroma, are fatty lumps which form within the lining of the arteries. There are various different kinds of plaques. Some are made up of a soft inner core of cholesterol covered by a thin firm outer layer. Others are completely solid and composed of smooth muscle cells and various other strong materials. Calcium may also build up on a plaque making the problem worse.4,7 What is the blockage like? Plaques cause several problems to coronary blood flow. Firstly, a plaque itself can be big enough to narrow the artery and reduce the space available for blood to flow through it. Secondly, as blood is thrust against the side of the plaque with each heart beat, the outer shell of the plaque may crack open exposing the cholesterol core. When the cholesterol core is exposed, blood clotting is triggered within the artery. Clots reduce the blood flow even more. This whole process can happen repeatedly causing the artery to become narrower and narrower and eventually leading to complete blockage.4,7 Overall, the process of plaque formation and associated thickening, loss of elasticity and narrowing of the artery walls is known as atherosclerosis. Atherosclerosis is the major cause of coronary heart disease however, it is also present to some degree in almost every adult male in Western societies. What causes atherosclerosis to occur is complex and uncertain and there is much still to learn. Current thinking is that atherosclerosis results from some kind of ‘response to injury’ where initial non-specific injury to the lining of the artery wall triggers the whole process to start up.4,7,8 Risk factors Everyone has some chance of experiencing heart disease, however, various factors have been identified which increase the risk of developing coronary heart disease. These include:4,6,7,8 High cholesterol Smoking Lack of exercise Unhealthy diet Obesity Diabetes High blood pressure (hypertension) Mental stress High levels of certain blood clotting factors Family history Alcohol and coffee Male gender Ethnic group (e.g. Southern Asians in the UK are at higher risk) Most of these risk factors increase the risk of coronary heart disease by increasing the likelihood that atherosclerosis will develop within the coronary arteries themselves. Also, these risk factors have been found to ‘interact’. Hence if you have two or more risk factors your overall chance of developing coronary heart disease is proportionally higher than if you just had one risk factor.8 Heredity as a risk factor Coronary heart disease often occurs within several members of the same family, indicating that a genetic link may be involved. However, it is difficult to determine if the link between family members is due to genes or shared environmental factors, such as diet and exposure to smoke. Genetic factors have been shown to influence cholesterol levels and the amount of blood clotting factors a person has in their blood, which in turn has a knock-on effect on the risk of developing atherosclerosis. Overall, it seems that a combination of genetics and the environment would best explain the family link to heart disease. It has been estimated that 40% of the risk is controlled by genes, and 60% is due to environmental factors.4,6 High cholesterol as a risk factor There are two types of cholesterol found in the blood – ‘good’ HDL cholesterol which can protect against the development of heart disease and ‘bad’ LDL cholesterol which promotes the development of atherosclerosis. There is lots of evidence to show that unhealthy amounts of these two types of fat in the blood, i.e. high LDL and low HDL levels, can increase the chance of developing coronary heart disease. This is because high levels of cholesterol in the blood encourage the formation of plaques within the artery wall and promote the overall process of atheroschlerosis.4,6 The cause of high LDL levels has not been clearly established but dietary factors are likely to be involved. There is evidence that a diet high in saturated, but lacking in polyunsaturated, fat may contribute to high cholesterol levels. There is relatively little actual cholesterol in the diet, but saturated fat is converted into cholesterol in the liver.4,6 Lack of exercise as a risk factor Lack of exercise is a proven risk factor for the development of coronary heart disease. Overall, the risk is a third less in people who exercise compared to those who don’t.8 It seems that physical exercise has a protective effect on the development of coronary heart disease. The mechanism underlying this has not been fully elucidated but certain hypotheses have been put forward. Exercise may increase levels of good HDL cholesterol and also reduce the blood clotting which occurs within atherosclerotic arteries and causes further blockage. Exercise might also help enlarge the coronary arteries and hence increase blood supply to the heart. In order to gain full health benefits from exercise in the reduction of coronary heart disease risk, five bouts of moderate physical activity per week, each lasting a minimum of 30 minutes, are recommended. Conclusion Coronary heart disease is a serious condition caused by the build-up of fatty deposits within the walls of the vital arteries that supply blood to the heart. Coronary heart disease is the major cause of death in Western societies but to a large extent is preventable. Recognising the key risk factors which contribute to the development of atherosclerosis is an important step towards reducing the overall incidence of coronary heart disease. References Walton J, Beeson PB, Bodley Scott R, 1986. The Oxford Companion to Medicine: Volume I, A-M. Oxford: Oxford University Press. Higgins M, 2001. Patients, families and populations at high risk for coronary heart disease. European Heart Journal, 22: 1682-1690. Association of the British Pharmaceutical Industry, 2005. Hitting the Target: Medicines and Coronary Heart Disease and Stroke. Available at: http://www.abpi.org.uk/publications/publication_details/hitting_target/section5b.asp [Accessed 14 March 2005]. Julian DG Campbell Cowan J, 1992. Cardiology: Sixth Edition. London: Bailliere Tindal. Vander AJ, Sherman JH, Luciano DS, 1994. Human Physiology: The Mechanisms of Body Function. International Edition: McGraw-Hill. Edwards CRW Bouchier IAD (Eds), 1991. Davidson’s Principles and Practice of Medicine: Sixteenth Edition. London: Churchill Livingston. Singh VN, 2005. Coronary Heart Disease. Emedicine. Available from: http://www.emedicinehealth.com/articles/10951-1.asp [Accessed 14 March 2005]. PRODIGY Guidance, 2004. Preventing Heart Disease and Stroke. Patient information leaflet. Available at: http://www.prodigy.nhs.uk/clinicalguidance/releasedguidance/webBrowser/pils/PL82.htm [Accessed 14 March 2005].