A letter from Banquo Essay

I write to all of you hoping that this letter will find you in the best of health. As all of you know, in the past few days Scotland was struck with a great misfortune when King Duncan was gruesomely murdered in his sleep while on his visit to Macbeth. And I have reason to believe that Macbeth is the one responsible for King Duncan’s murder because he had the motive and the opportunity to do so. And as I recall our encounter with the three witches when we were returning from the battlefield I realize that the witch’s prophesy to Macbeth, â€Å"All hail, Macbeth! that shalt be king hereafter† [Act1, Scene3,Line54] has embedded in him a desire to rule and be king which was further implanted deeper in him by his wife whose grandfather, Kenneth III was overthrown by King Duncan’s ancestor, Malcolm II, many years ago and was waiting for a chance to avenge her grandfather’s death. But what Macbeth didn’t realize was that he had started to believe what he wanted and did not see the three witches for what they really are. And with each day passing by Macbeth thought more and more of the prophecy that he shall be king until it was the day to name an heir to the throne of Scotland during which King Duncan named Malcolm as the heir. As Macbeth watched I overheard him talking to himself and saying â€Å"The Prince of Cumberland! that is a step on which I must fall down, or else o’er-leap, For in my way it lies. Stars, hide your fires; Let not light see my black and deep desires.† [Act1, Scene4, Lines55-58] which shows that Macbeth was seriously thinking about the throne and the prophecy. It seemed as if greed, ambition and voracity were beginning to take hold of Macbeth. And on the night we escorted King Duncan on his visit to Macbeth’s castle, I  noticed how Macbeth didn’t come out to welcome the King like Lady Macbeth did. Instead he only showed up at dinner time. And after everybody went to their rooms Macbeth came to my room and we agreed to discuss the prophecies at a later time. But I also said to Macbeth, † So I lose none in seeking to augment it, but still keep my bosom franchised and allegiance clear, I shall be counsell’d.† [Act2, Scene1, Lines32-35] hoping that this will stop Macbeth from thinking that I will help him make the prophecy true. Nevertheless what I had feared the most happened on that night; King Duncan was murdered. And as we all came to see what happened I could see a look of fear and guilt in Macbeth’s eyes. I realized that Macbeth had done what he wanted to in order to make the prophecy true. However Macbeth had not only killed his King who praised him for his courage and his valor, he also killed his cousin who was of his own flesh and blood. Indeed! What a true cousin Macbeth is. He was no different from the butcher who kills innocent lambs. All this time he thought that killing King Duncan would make the prophecies true but he never realized that he was deceiving and leading himself into a pit of trouble. None of us could have imagined that the courageous soldier who was loyal to his king could be easily corrupted by the witches’ prophecies. We all knew Macbeth as the soldier who fought for his king without mercy but it appears that his strive for ambition and his insurgent desire made him kill his own king and cousin without mercy. And if any one among you still does not believe that Macbeth is responsible for King Duncan’s murder then think back as to who had the strongest motive to kill the King and who could have done the crime without being suspected easily. It is Macbeth. My fellow Scots I believe that now we should take action against Macbeth for it shall be unjust if we let him go without punishing him for his bloody deed. In the end I hope that you may have found my letter convincing enough and I am certain that all of you will do what is best for Scotland.

Collaborative Working Essay

There are many different ways to define ‘Collaborative Working’. According to The National Center for Biotechnology Information bookshelf (NCIB) Collaboration in health care is defined as health care professionals assuming complementary roles and co-operatively working together, sharing responsibility for problem-solving and making decisions to formulate and carry out plans for patient care. Collaboration between physicians, nurses, and other health care professionals increases a team member’s awareness of each other’s type of knowledge and skills, leading to continued improvement in decision-making. To work collaboratively it is also important for all team members to be willing to take part and trust other health professionals to accomplish a collective outcome, which is the health and wellbeing of the patient. Thomas et al (2005) mentions that willingness is one step of developing interpersonal collaboration and trust has been seen as a vital part to assist the development of effective team working. All professionals need to trust each other and learn new competencies and be able to take on new roles without resentment, as this requires a willing and trusting approach. Therefore, to give the patient the best possible care, it is imperative to  work in conjunction with other healthcare professionals to meet the needs of the patient. Each professional has to show mutual respect for one another in order to be able to work together or else there will be conflict in the team and the outcome of the patient will suffer. Thomas et al (2005) continues to say that confidence has been pointed out as an important feature in collaborative working as professionals who are confident in their own roles have the ability to work flexibly into other boundaries without feeling jealous or threatened. Confidence shows leadership and allows others to trust the work of that individual, therefore creating a trusting environment for them all to work together. The terms interprofessional, multiprofessional and interdisciplinary are all related to collaborative working, Thomas et al. (2005) defines the prefix ‘multi ‘ as the participation of staff from different professions, and the prefix ‘inter† means collaboration in the areas of decision making thus indicating that healthcare professionals, be it consultant, nurses, social workers or community staff work together to provide a high quality care and to achieve the best outcome for the patient. With skills and knowledge coming from these colleagues that major in different backgrounds, overall the team can provide an excellent service and duty to patients due to having specialists from different areas working together in the same team. Collaborative working involves interaction of various groups or professions to accomplish a general goal, which normally in the health care setting is the care of the patient. As a result of problem solving, an open and flexible approach to the roles and tasks of individual team members provide a more patient focused healthcare. Read more:  Sharing Responsibility Role of Local and State Bodies The aim of this essay is to establish what skills and knowledge are required to work collaboratively successfully. I will describe a care pathway, which will look at the care a patient received from different services in which I participated. In the health care service, working with people is a part of the working day. According to Goodman & Clemow (2010), working with other people is a fact of everyday life, whether you will be working the in community or in a  hospital environment you will be constantly interacting with people to assess, plan implement and evaluate care provided. Goodman and Clemow (2010) go on to say Nursing work is primarily people work, be it one-to-one patient care or team care. The principle of a care pathway is to recommend the most appropriate care required to meet the patient’s needs. According to Middleton & Roberts (2000) care pathways are evidence based care which is delivered to the patient by the correct individual at the specific time and the suitable environment. Middleton & Roberts (2000) continue to say that integrated care pathways are used to determine multidisciplinary practice based on guidelines for particular patients. According to the Royal College of nursing (RCN) 2014, care pathways are also known as integrated care pathways, anticipated recovery maps, critical pathways or care maps. Communication is very important in the healthcare service to ensure that the patient will receive the correct care plan to meet their needs. According to the Royal College of Nursing (RCN) 2014, communication is at the heart of everything we do in our society. It’s central to our learning, our work and our leisure interests. It is vital in health care, where patients/clients can feel vulnerable, isolated and anxious, therefore teams need to rely on good communication to help them deliver safe, coordinated and effective healthcare. Without communication between certain individuals in the team, it can cause conflict or friction between some colleagues therefore delaying the goal of impeccable patient care. Communication shared amongst teams can achieve a holistic goal that is clear and in which the outcomes are met amongst the team (RCN) 2014. Communication is not only verbal, it is also non-verbal and listening also plays a part. If health professionals are not working together then there is a failure of communication and errors will occur and the wellbeing of the patient will suffer. This may also happen when health professions used different terminologies within their profession, which others may not understand. This demonstrates the need for communication to be shared in a manner which all members can understand to avoid confusion and reduce the risk of mistakes  happening, i.e. language line, interpreters and other professionals who understands the language. Due to the importance of patient confidentiality I will be keeping the identity of my patient as anonymous and a pseudonym will be used for the purpose of the essay to protect the patient. This complies with the NHS Code of Practice on Confidentially (2003). Throughout this essay my patient will be referred to as Mr A. The Tuberculosis (TB) Services must be accessible to all health care professions in the community or hospital. An important part of the role of the TB service is to promote awareness of TB and ensuring that all suspected cases of TB are promptly referred for investigations, diagnosis, treatment, support to control the spread of TB. The most common pathway by which patients can access the TB service includes referrals from GP surgeries, accident and emergency, laboratory microbiology, hospital wards and other hospital specialties such as HIV (Gum clinic), rheumatology and paediatrics. TB services have one designated referral number, fax, email address and contact address. The care pathway for patients who show signs and symptoms of TB will require a number of investigations, which will include a Mantoux Skin test, when a small amount of Purified Protein Derivative (PPD) is injected into the arm and the results will be read 48/72 hours later, a chest x-ray, sputum samples or a bronchos copy. Once these investigations have been completed and if the results are positive for active TB, the patient will be commenced on TB treatment. This treatment will be for a minimum six months to two years depending on the type of TB diagnosed. My role as the Support worker for the TB team is to assist patients, to help them understand and come to terms with their diagnosis. In addition to this I will ensure that they receive the correct medication as distributed by the nurses, monitor any side effects and bring them to the attention of the specialist nurses who will give further advice or discuss with the senior consultant who will be able to decide on an appropriate care plan if needed. I also support patients with any welfare and social matters such as housing, immigration and social benefits. My role involves acting as the advocacy for patients and links them with the required services. In order  for this to work, I have to build a very good rapport with my patients, and I feel that this enables them to become open and honest with me, which results in us achieving our desired goal. Patient Scenario Mr A was admitted via accident and emergency complaining of chest pains, lethargy, loss of weight, cough and night sweats, the typical symptoms of TB. His chest x-ray showed left sided pleural effusion and sputum sample results were smear positive, indicating that he was infectious, His Mantoux result was 18mm and was diagnosed with smear positive pulmonary tuberculosis. Mr A was born in Romania and entered the UK originally in 2009. He was house sharing with other Romanians for three months until they were evicted by the police as they were possibly squatting and he became homeless. He was of no fixed abode with no clear connections in the UK. He has been living on the streets ever since being evicted. He has no means of contact, no money and has very limited understanding of English. Mr A was referred to the TB Service by the consultant on the respiratory ward. Due to his lack of English language, a Romanian interpreter needed to be booked to allow sufficient communication between staff and Mr A. I made a telephone call to the hospital interpreting service to book a Romanian interpreter to assist with the assessment. The TB assessment was carried out in the ward with the Romanian interpreter present. The TB assessment form was completed using Roper et al (2000) Activities of Daily Living. This assessment model looks at the patient’s needs as well as any possible problems connected with the patient i.e. social, physical, psychological and medical. According to Roper et al (2000) this model will give a holistic view of the individual instead of just the illness. This model recognises the impact of cultural, environment, and economic factors that affect both health and well-being (Barrett et al, 2012). Prior to our assessment on the ward I received a telephone call from the Infection control nurses to inform us of his sputum results. The results of his test were smear positive and this indicated that the patient was  infectious therefore he was placed in to a negative pressure side room. A negative pressure room is used to prevent the spread of TB. The National TB Centre describe a negative pressure room as a room where more air is drained than is supplied, so infectious particles are contained within the room by continuous air current being pulled into the room under the door. Therefore, when the negative pressure room is used airborne particles generated in the room cannot escape to the corridor. During this assessment it was brought to my attention that Mr A had no income and was homeless. My role as the Support Worker is to help patients with any welfare and housing issues. I was able to make a telephone call to the hospital social services for advice on Mr A and had a long conversation with the advisor. We agreed that I needed to contact Greenwich Social Services for further advice. I was informed by Greenwich Social services that Mr A was not entitled to any public funds because of his no recourse to public funds on entry to the UK. Due to Mr A’s situation, I spoke to my colleagues in Find and Treat who informed me that Mr A might be eligible for accommodation, and a referral form was faxed to me for completion with my patient. Find and Treat is a Department of Health Organisation within Public Health England that works alongside TB services to provide holistic, preventative and stabilising support to homeless people who are on TB treatment and have no recourse to public funds. The completed referral form was faxed back to Find and Treat. I received a telephone call from Find and Treat to inform me that the referral had been accepted at the homeless shelter and the next step was an interview with the shelter home manger and his allocated case worker to meet the patient to ensure that all his needs were met whilst in their care. The case worker and the manager met the patient in the ward in my presence with the interpreter to complete their full assessment for placement in view of the referral information and facts we presented. Once the meeting was complete, I had to liaison with the discharge coordinator on the ward to inform them that Mr A had been accepted at the shelter home. Prior to his discharge from the ward, the TB nurse checked  his TB medication and I booked transport for my patient to get to the organised accommodation and he was taken on the same day. The following day I made a telephone call to his case worker asking about his (Mr A) progress and how he was settling in. He was reported to be settling in well and had no concerns. Mr A had been visiting a homeless unit for food and shelter prior to this admission to the ward. Due to his smear positive sputum results; it is a requirement to refer all smear positive index cases to Public Health England (PHE) as TB is a notifiable disease. It is my duty to gather as much information as possible regarding the homeless unit. I completed an incident reporting form with all the information from the shelter unit and faxed it to PHE. I had a conversation with PHE by telephone to arrange an incident meeting between the shelter home, PHE and the TB nurses. Once a date was agreed with all parties we met at the shelter home to identify contacts and organise screening. It was agreed that all contacts who needed to be screened for TB were to be referred to the TB Service. Collaborative working sometimes may not always work smoothly as expected. Some team members may feel left out or not appreciated, Elizabeth Lark (2006) says to work collaboratively you need to be focused on a two way related dimension. The task that needs to be achieved, in this case the outcome of the patient, and the relationship with and between the people that need to be engaged in it. Therefore it is clear to say that all team members need to feel appreciated and valued in collaboration to make it work professionally. Another factor that may cause problems in collaboration is personality conflict, a lack of understanding in other professionals’ sphere and the influence of hierarchy in job roles within the multidisciplinary teams. Elizabeth Lark (2006) continues to say that these types of conflicts can be resolved by giving team members the chance to discuss their concerns in group meetings to identify clear working responsibilities before implementing the care of the pati ent. As a Support Worker collaborative working is very important to me to ensure that a service work as a team to give patients the required care they need to enable them to be able to return to their normal healthy lifestyle. When caring for patients we need to set standards and be professional regardless of the patient’s background and belief. The importance of my role as a Support Worker in advocacy and linking patients with other service has lead to the recovery of our patients, as many of our patients do not understand the diagnosis and the stigma related to the TB diagnosis. Having access to all these services has made it possible for me to help Mr A on the road to recovery and enable him to live a normal life again where he will be helped and assisted with some form of work and earn a living. Due to his lack of the English language it would have been very difficult for him to access these services by himself as I was the main link for Mr A to receive the correct care. Mr A was very happy with the care he received from all the different services, he said via the interpreter â€Å"I would not have known where to go to get help, I thank you all†. The care given to Mr A was delivered over a period of three months. He remained in hospital for 4 months, during this time I ensured that all of the hospital resources were coordinated to ensure that the highest level of service was delivered and that Mr A could return to living a normal healthy life style. My role as a Support worker in this collaborative working has helped other healthcare professionals such as ward staff, infection control nurses and hospital social services to gain better knowledge of TB and how working together to overcome obstacles to ensure that the patient can receive the correct care needed. We were able to identify the patient’s needs, which allowed the nurses and other services to coordinate and plan interventions to meet the patient’s requirements in regards to his recovery. It is evident that collaborative working does have the best outcome for patient. Working collectively has enabled me to expand my knowledge and skills required to work along side other health providers and social services. Communication is the key skill required in collaborative working to ensure and accomplish the best outcome for your patients. All services and organisations need to work well together and leave their differences, misunderstanding and challenges aside for the sake of the patient’s outcome.  Collaborative working takes away any additional stress and worry for patients who just want to overcome their illness and this was reflected in Mr A’s situation. References Barrett D, Wilson B & Woodlands A, (2012) Care Planning A Guide for Nurses, Second Edition, Essex, Pearson Education limited. Goodman B & Clemow R, (2010) Nursing and Collaborative Practice, Great Britain, MPG Books Group Lark E, (2006) Collaborative Advantages – How Organisation Win by Working Together, Hampshire, Palgrave Macmillan Middleton S & Roberts A (2000) – Integrated Care Pathways : a practical approach to implementation Oxford, Reed Education and Professional Publishing Ltd Roper N, Logan W & Thierney A J, (2000) The Roper Logan Tierney Model of Nursing Based on Activities of Living, Edinburgh, Churchill Livingstone. Thomas,J Pollard K C and Sellman D, (2005) Interporessioanl Working in Health and Social Care. New York, Palgrave Macmillian National Centre for Biotechnology Information Bookshelf http://www.ncbi.nlm.nih.gov/books/NBK2637/ Professional Communication and Team Collaboration – Patient Safety and Quality Access on 25/09/14 Royal College of Nursing http://rcnhca.org.uk/communication – First Steps for HCAs Accessed on 15/10/14 National TB Centre https://www.ndhealth.gov/Disease/TB/Documents/Infection%20Control.pdf Accessed on 30/10/14 NHS Code of Practice https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/200146/Confidentiality_-_NHS_Code_of_Practice.pdf Accessed on 08/11/14 Royal College of Nursing http://www.rcn.org.uk/development/practice/perioperative_fasting/good_practice/service_improvement_tools/care_pathways Accessed on 15/11/14

The Nightingale and the Rose

I like this story entitled The Nightingale and the Rose because the power of love shown by the nightingale is so amazing. The Nightingale willing to sacrifice himself for something he believed in, that why he had a great power to fulfill his dream to made a red rose flower for the student. The plot of the story is very simple. A young student thought that he was madly in love with the professor's daughter. He felt miserable because he could not find a single red rose in the whole garden to give to his love, and he knew that without the rose she would not agree to dance with him in the ball to be given by the prince the next day. The Nightingale overheard this and was deeply touched by what she believed was the expression of the young man's true love. So she decided to help the young man, but she was told that the only way to get a red rose in this cold winter was for her to build it out of her music and her heart's blood. The Nightingale of course also valued her life, but she was ready to lay down her own life for the happiness of the young couple. She therefore did what she was told to do. The next morning, the most beautiful red rose appeared, but the Nightingale was found dead under the rose-tree. Not knowing what it had cost to produce the rose, the student thought that he was very lucky to find this flower and he immediately plucked it and ran to the professor's daughter. The professor's daughter, however, turned him down because she had already agreed to dance with the Chamberlain's nephew who had given her precious stones. The student was very angry, so he threw the rose away and returned to his reading. This is a touching story of love, but not the love between the young student and the professor's daughter, because neither of them understood what true love is. The girl was interested only in power and money, and the young man, in what he considered practical. The only person who understood love, treasured love, and was ready to sacrifice her life for love was the Nightingale. For her love is eternal music, love is the most precious thing: even more precious than life itself, and true love is always in the giving rather than in the taking. The main theme of this story is love, in fact the young Student needs a red rose to conquer the girl he affirms he loves, even if at the end she doesn’t appreciate his act. This makes us understand two things: on the one hand, that love often brings sorrow, as happens to the tender Nightingale whose gesture of love is not understood by the silly Student. On the other hand, it is very difficult to distinguish between real, authentic love and a more superficial sentiment, and only a very sensitive person can appreciate the full value of this feeling. Besides there are other themes: ingratitude, because the Student is ungrateful towards the Nightingale, whose act of love he is too arid to grasp; generosity, because the altruist Nightingale sacrifices her life to help the Student and her sacrifice is actually wasted. As for the girl, she is not merely superficial but also vain and materialistic, as she loses all interest in the Student once she is promised something more ‘precious’ like the jewels of the Chamberlain’s nephew. This fairy tale is very incisive and, despite its apparent simplicity, leaves the reader with a clear moral message: it is important to remember that some people sometimes sacrifice their life or suffer to help others, but at the end they aren’t returned with the same emotional intensity and their actions are not even fully understood. This is a moral message that should be born clear in mind, in an age and period when most people appear to be interested only in their own welfare, without being able to look beyond their limited, subjective perspective, thus failing to see what or who is outside the borders of their very narrow egoistic world.

Tata Nano developing international markets Essay

Tata Nano developing international markets - Essay Example The company has generated approximate revenue of US$ 96.79 billion in 2013 (Tata Group, 2014). The income of the company accounts to almost 3.2% of total GDP in India. In January 2008, vehicle manufacturing segment of the Tata group, Tata Motors has launched a new car model named Tata Nano. The chairman claimed at the launching ceremony that Tata Nano was â€Å"people’s car†. The company advocated that the car would benefit the middle and lower middle income classes of the nation, who were unable to afford expensive cars (Tata Group, 2014). In addition to that, the vehicle was said to be manufactured after considering all safety standards, generated less pollution and highly fuel efficient in nature. The car has gained high success in the Indian automobile market. However, it should be noted that the product has acquired a global recognition and is regarded as cheapest car in the world. This research paper aims to study ways through which Tata Nano can be launched in ot her international markets. The context of the paper will also present an appropriate outline of the marketing plan for introducing the car in a new international market (Abeles, 2001). The non-blue zones in the above world map are markets where Tata Motors are yet to enter. Hence, it is evident that there are numerous new markets where Tata Motors can expand its business. Some markets from the above where Tata Nano is still not traded are: The political authorities of most world nations are actively promoting their domestic automobile industries. This is because progress of automobile industry of a nation helps in enhancing domestic income by generating higher employment opportunities (Alesina and Rodrik, 1994). It also helps in accumulating productive foreign direct investment and stimulates technology transfer within country borders. The government authorities in several countries have introduced new energy conservation policies for the automobile sector. In addition, the

Managing Interest rate and exchange rate volatility Essay

Managing Interest rate and exchange rate volatility - Essay Example (Buckley, 1996) Assume for example that Junor Plc issues a fixed rate bond to fund its financing needs and at the same time gives out a loan to another party at a floating interest rate. Her interest payments will therefore be fixed while interest receipts will be variable and will depend on prevailing rates. She will therefore be facing basis risk since her interest expenses and revenues will be determined on different basis. A company faces gap risk when it has both fixed rate liabilities and assets. When fixed rate liabilities exceed fixed rate assets then there is positive Gap, with a positive gap a rise in short term rates increases margins while declining rates decrease margins. On the contrary if fixed rate liabilities are less than fixed rate assets, then there is negative gap. In this case a rise in short-term rates decreases margins while a decrease increases margins.(Buckley, 1996). Changes in interest rates will therefore affect both the cash flows and expected cash flows of Junor Plc in that an increase in interest rates will mean higher cash outflows for the company. Changes in interest rates have also been the major determinants of business cycles or trade cycles in emerging markets such as Thailand in recent times. (Elekdag and Tchakarov, 2006). The figure above is an indication of how interest rates and business cycles are related in Thailand. High interest rates lead to low output whereas low interest rates lead to high output. Therefore Junor Plc is likely to face decreases in demand for its products during a period of the high interest rates and increases in demand during lower interest rates. The degree to which a company is affected by currency fluctuations is referred to as foreign exchange exposure. (Shapiro, 2003). Foreign Exchange exposure can be divided into two main types-Accounting exposure and Economic exposure. Transaction reflects the firm’s risk to exchange rate movements regarding

Course Project 5 Case Study Example | Topics and Well Written Essays - 750 words

Course Project 5 - Case Study Example Today’s turbulent economic conditions make it hard make structured decisions and long term planning; information is the most required asset for organizations who want to be able to respond instantaneously to changing factors and micro-blogging websites like twitter are quickly becoming the fastest sources of news there are- providing instant and relevant updates. Answer 2. Twitter is a global platform which is accessed by people all over the world. It is a free and very popular social media site and can be invaluable for global organizations who want to communicate on a frequent basis and in a personal way with their employees. With the ‘tweets’, the organization can share news and any relevant information; if the employees are subscribed to the channel, they will receive those tweets on their homepage without any need for a formal communication process. With things like retweeting and replying back, the employees living in any geographical location can directly talk to administration and because of the transparency of the platform can even receive comments or initiate a discussion with other employees. The connectivity provided lets employees talk about operations and strategies in an informal way. The use of humor which is rampant on Twitter changes the tone of the conversation, giving everyone the same amount of conversational authority and may help overcome barriers of cultural differences as you just have 140 characters to make your point. This leads to a more collaborative environment and better idea generation, effecting the overall operations. Answer 3. The instant connectivity allowed by twitter can be utilized by Project Managers very effectively to keep in touch with their employees. A dedicated project twitter profile can be updated with news, important information or used to communicate with employees on an instantaneous basis. It can also prove to be a good forum to share about any setbacks or milestones

Personal Statement - Essay Example | Topics and Well Written Essays - 500 words

Personal Statement - - Essay Example Healthcare professionalism is a very noble career. This clinical health practice docket, nonetheless, is incomplete without sports medicine/physical or occupational therapy. Healthy life and physical fitness within the society is what motivates me to undertake this course at the university level. Working with the entire societies with an aim of keeping them physically fit motivates me a lot as a sports person. Physical therapy, as an occupation, will give me a better chance as a medical practitioner to share my overall experiences as a sports person with individual patients. As a sports person, I think I need to be more enlightened clinically. This would be significant especially in the field track events emergencies. The Historical Black College would play a crucial role in my life by putting into practical the theoretical clinical practices, which affect individual sportspersons out in the field. Secondly, based on merit beginning with the A-level qualifications, I believe I am qualified to undertake this health course in your noble college. My skills and talents are not classroom oriented. Outside classroom, I have undertaken various sporting activities as well as unifying my colleagues from different colors. I am a liberal thinker thus totally against racism. Through my liberal thinking capability, I have always been involved in Cottonwood Christian Center Church activities, Youth Media Teams as well as High school clubs such as the African Decent club (HS). Based on my self-assessment, I remarkably became the first black girls to make the white cheer team. I believe that if these innate self-attributes are carried to the field of clinical health practices, then a more elaborate and patient-oriented healthcare sector would be achieved. Concisely, sports health to some degree need individuals who have experience and understanding to some sporting activities of which I have. For example, I have an advanced experience in sporting activities as a

Advise to Crumbly Caravans Ltd Coursework Example | Topics and Well Written Essays - 750 words

Advise to Crumbly Caravans Ltd - Coursework Example The Scottish Law of Contract, in regard to the law of agency, defines the relationship between a principal and an agent, as well as that between an agent and a Third Party, and gives clear guidelines on how each party should act towards each other, with clear stipulations of the duties and responsibilities of either the principal to the agent, agent to the principal and agent to the Third Party. The most fundamental duty of an agent towards the principal is that; the agent has a duty to follow the instructions issued by the principal to the agent fully, and perform them as instructed (Macgrego & Davidson, 2008 p17). Further, in addition to this duty, the Scottish Laws of Contract, in regard to agency also provides for the adherence to the commercial agents Regulations of 1993, which is related to the fulfillment of the European directive, requiring that a commercial agent should comply to, and perform reasonable instructions that are given by the principle (White & Willock, 2007 p22) . However, the most fundamental aspect of the duties of the agent to the principal is that; the Scottish law requires that the instructions issued by the principal should be clear and unambiguous, providing that an agent is not liable for any instructions that are not clear, or which the principal may have issued ambiguously.The ‘Crumbly Caravans Ltd.’ case, is a case of a Third Party affected by the relationship between the principal,and the agent,... The law provides that an agent must not disobey the reasonable and material instructions that have been issued by the principal, and in cases where the agent then violates this provision, then the agent becomes liable for any loss that might be suffered by the principal (Mcbryde, 2007 p77). The agent, in addition to the duty of following and performing the instructions issued by the principal, is required to perform the duty of skill and care towards the principal, where the agent must not act in a way that can cause loss to the principal (Macgregor, 1997 p272). Although the duty of skill and care may vary, it expressly requires the adherence and performance of the instructions given to an agent by the principal, in such a way as to avoid causing any loss on the side of the principal (White & Willock, 2007 p9). Nevertheless, the most significant rules applying in the Scottish law of contract in regard to the relationship between an agent and a principal are fiduciary duties, which re quires that the agent should always act in such a way, that his actions benefits the principal (Mcbryde, 2007 p72). Therefore, the agent is required to act in a way consistent with the requirement of the principal, especially regarding the duty of disclosure, where the agent is always required to disclose that he is acting on behalf of the principal (Macqueen & Thomson, 2007 p29). Another of the fiduciary duty of the agent to the principal is the duty to be loyal, and to negotiate appropriately with a Third Party where negotiations are applicable, however with a duty to conclude the deal in accordance with the instructions of the principal. Further, the agent is under duty to communicate all the information available to him to the principal

Critiques of Management Theories Assignment Example | Topics and Well Written Essays - 2500 words

Critiques of Management Theories - Assignment Example This paper therefore gives an account of certain management theories by providing a detailed critique on each and how they affect organizational management. Additionally, the theories are going to be discussed in correspondence to the contributions of Frederick Taylor and Max Weber, and how they would have perceived each of these theories. Before getting into the main discussion of these management theories, foremost of all, Taylor’s and Weber’s contributions will thus be looked at briefly as discussed below. Frederick Taylor’s contributions to organizational management are considered very instrumental in changing the perceptions and approach to management. Taylor came up with what is known as scientific management. The theory is credited for the belief that it would improve the working environment by motivation employees through remuneration and maintaining that managers should concentrate on activities that promote worker’s cooperation. Weber on the othe r hand developed principles that came to be known as ideal bureaucracy which mostly insisted on the division of labor and specialization, positive relationship and competency as the key tools for effective management (Rainey, 2011). The Hawthorne Studies The Hawthorne studies were an analysis which was conducted between 1927 and 1932 at Western Electric’s Hawthorne Company in Cicero, Illinois. Several research teams engaged in the study including Elton Mayo and Fritz Roethlisberger from Harvard faculty members and William Dickson the head of Hawthorne’s employee relations research division. The study was focused on the effects of different levels of lighting on the productivity by controlling the lighting in the area in which the employees work. These were known as the physical and environmental influences of the workplace. The lighting or illumination studies also focused on the psychological aspects such as how lighting manipulates group pressure, leadership and team work. The employee’s group productivity was assessed and compared with that of another employee group whose lighting was left unaltered. The findings were that as illumination was increased in the experimental employee group, productivity also improved. This was suggested that it was due to the impact of the motivational effect on the workers as they were pleased by the attention from the researchers and as a result of the interests being shown in them during the study. Regardless of the experiment, one reasonable conclusion is that the productivity of the other group not exposed to lighting continued to increase considerably. The illumination studies after a while was therefore short-lived, but its evaluation effect is still practiced to date. These findings thus become the contributing factors to the strengths and weaknesses of the Hawthorne effect. The strength of this study is that it is surely a tool that gives a framework which can be used to increase the productivity o f workers within an organizational set-up through the motivation of workers, appreciating their work input and output, and maintaining quality working environments. This can be applied in today’s hospitals and healthcare systems, by improving the working conditions and work environments of medical staff and other personnel. Additionally, it enhances motivation on medical workers when consistent positive changes are made in the working environment, thereby enhancing work behavior and quality service delivery from hospitals and the health care systems. On the contrary, the weaknesses of the study are that as much as it

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Technology review - Essay Example Turnitin.com: turnitin.com is an effective plagiarism checker which means its work is to verify and check for any plagiarism that prevails in the paper. It is a very reliable website for instructors which aim to compare the work submitted to the teachers with works on the web in order to check the reliability and uniqueness of the work. It is easily available and online communities can be made through which the instructor can evaluate and access the work. K5learning.com: k5 learning again is an interactive platform for young learners who seek to develop their skills through fun. K5 is a website which accesses young learners and enhance their abilities. Online tests are taken, assessments are done and help is provided to those who need reinforcement so that an effective learning mechanism is generated. Freevideolectures.com: it is an online resource for many learners out there who can easily access online the lectures of reputable teachers regarding various topic of study. This site enables learners to gain knowledge regarding various subjects having lectures of almost 30 respectable universities. This websites offers a vast range of courses and lectures which students aid from to develop better understanding in a convenient and cost effective manner. Tutorphil.com: is an online site to overcome the workload and ease down the frustration level among students. It provides learning methodologies and gives advices and tips to overcome the problems while structuring an essay. It is an interactive site which helps to device proper essays with ease and convenience. At this point I would like to choose my three sites which according to me are the most reliable to generate effective learning. My three sites which I will focus on in my essay are lore.com, turnitin.com and freevideolectures.com. If these three sites are integrated then a very convenient mechanism can be generated which will aid in learning. The reason why I think

Reflective journal Essay Example for Free

Reflective journal Essay My third week of clinical placement at Trillium Hospital assigned on the same unit and same patient. Arrive early in the lobby of 4J Rehab meet with our Clinical Instructor and group mates. Started with pre-conference had briefing for the day activities assigned as schedule to be with our Clinical Instructor in giving 10:00 am medications. After the briefing, I went to the station where, met my new preceptor , exchange of greetings little bit of introduction about me and her. We started by taking the endorsement from the outgoing night shift nurse. Review the plan of care of our assigned patient. She asked to get the manual Blood Pressure Apparatus and handed me her pager. I was thinking why the pager. She notice me in confusion of the pager, she just smiled and said â€Å" I want you to feel your the real nurse and I am just your assistant†, dont worry I am at your side† just answered â€Å"ok†. We went to each patient room, greeted patient, took the vital signs, recorded it my notebook, does the head to toe assessment . After all of these activities we went back to the nurses station where I do the documentation with regards to patients vital signs. At around 9:00 in the morning we do the morning care for each patient, I had the chance to assist her male stroke patient change his catheter. We finished around 9:30 and had our break. After the break 10:00 Am time to give the medication for my assigned patient together with my preceptor as per schedule. My assigned patient is male 51 years old Spanish who has an Ileostomy case. The medication that I was going to give are pain medications and for his hypertension. My clinical instructor asked me also about the medication routes, and the classification of the drugs. So thankful to her my Clinical Instructor she is so kind and willing to give us all the information we need to learn. I also documented in the MAR sheet, signed the drugs that I gave. I also had the chance of changing the dressing of my assigned patient, Ileostomy case. Prepared the materials needed for the procedure. Feeling nervous at the beginning, my first time to do this kind of dressing, packing ribbon on an stoma. With my preceptor around who is so cooperative and teaching me the proper way to do it I feel confident and grateful to her too. Me and my group mates had also the chance to watch doing the bladder scanner knowing the amount of urine in the bladder. One of my group mates did the in and out catetherization, but unfortunately it did work out, something is blocking maybe pus. I also helped the transferring of patient from bed to wheel chair using the manual Hoyer Lift. Get tired that day but happy I learned a lot of challenges, having this positive attitude, experiences during my clinical duty I know I can handle and deal with the situations that I will be encoutering.

User Adoption Momentum of E Banking In Malaysia

User Adoption Momentum of E Banking In Malaysia In the era of globalization and with the increasing competition in all the fields around the world many companies have modified their strategies so they can reach their customers around the world easier and cheaper. However the rapid growth of systems that rely on electronic technology especially those relating to the Internet and personal computer- led to a significant change in the exchanging of products and services. Many  Service organizations have adopted modern technology to reduce costs and enhance customer service quality, delivery, and standardize core service offerings. In addition a lot of non-banking companies entered the banking industry by offering products and financial services, giving the customers a lot of options and alternatives to carry out their banking transactions, this difficulty of the business process in the financial sector forces the banks to develop an alternative technological channel to attract customers and improve their perception. The rapid technological diffusion makes the internet the best way to provide customers with banking services regardless of the limits of time and geography. And thats what makes banks  consider the  internet as an important part of their strategic plans. Internet technology has changed the design and the way of delivering the financial services and as a result the banking industry has made continuous innovations especially in the field of communications and information technology that ultimately led to the emergence of the idea of what is known as the online banking. Banking services through the internet is a way to keep the existing customers and attract others to the bank, In this paper we define online banking as an internet portal, through which customers can use different kinds of banking services ranging from bill payment to making investments (Pikkarainen et al., 2004). Compared to the traditional approach, online banking is an inexpensive straightforward way to conduct banking business, exchange of personalized information and buying and selling goods and services from any place at any time. Despite the many benefits provided by this service to the bank and its customers, it remains a double-edged sword and not used by every customer, because the increasing distance between the bank and customers may lead to lack of confidence and an increasing in security concerns. As a result, the quality of electronic banking services become an important area of attention among the researchers and banks managers due to its strong influence on the business performance, lower costs, customer satisfaction, customer loyalty, and profitability (Seth et al., 2004). The main objective of this study is to focus on the importance of understanding the customers perception about internet banking by investigating and measuring the impact of selected factors such as perceived usefulness (PU), perceived ease of use (PEOU), security and privacy (PC) and how they can influence the customer acceptance to conduct banking transactions via the internet, Based on the empirical data collected from individual customers in Bahrain. In the next section we will give some background information about the internet banking sector and review the relevant literature in this area, the following section describes the research methodology, which is then followed by the data analysis and the results from the survey, The paper concludes with a discussion, outlining the implications of the findings and the limitations of the study. 2.0 LITERATURE REVIEW Technology Acceptance Model (TAM) External variables Perceived usefulness Perceived ease of use Behavioral intention Actual system use Figure 1: The original Technology Acceptance Model (Davis, 1989) The Technology Acceptance Model (TAM) is a perfect model which show how users accept and use a technology. In (TAM) the main determinants of users acceptance of new technology are perceived usefulness (PU) and perceived ease of use (PEOU) (Davis, 1989). Although (Chen and Barnes 2007; T.C. Edwin Cheng et al. 2006) found that perceived ease of use, perceived usefulness and security and privacy affect customer adaptation intentions, Qureshi et al., (2008) claimed that Perceived usefulness, security and privacy are the main perusing factors to accept online banking system. Celik (2008) stated that perceived usefulness and perceived ease of use are direct determinants of customers attitudes towards using internet Banking. Traditional service quality and website features (PU, PEOU and PC) that give customers confidence build trust in e-banking (Yap, K et al. 2010). Aderonke and Charles. (2010) found that Banks customers who are active users of e-Banking system use it because it is convenient, easy to use, time saving and appropriate for their transaction needs. Also the network security and the security of the system in terms of privacy are the major concerns of the users and constitute hindrance to intending users. Yap, K et al. (2010) claimed that Traditional service quality and website features that give customers confidence build trust in e-banking. Sadeghi and Hanzaee. (2010) found that According to the model of seven factors on the following dimensions: convenience, accessibility, accuracy, security, usefulness, bank image, and web site design. Some of these factors illustrate a significant statistical difference between males and females. Safeena et al. (2009) found that perceived usefulness, perceived ease of use, consumer awareness and perceived risk are the important determinants of online banking adoption. These factors have a strong and positive effect on customers to accept online banking system. Alda ´s-Manzano et al. (2009) found that TAM beliefs and perceived risks (security, privacy, performance and social) have a direct influence on e-banking adoption. Trust appears as a key variable that reduces perceived risk. Involvement plays an important role in increasing perceived ease of use. Riyadh et al. (2009) stated that Seven variables affecting e-banking adoption by SMEs are identified. They are: organizational capabilities, perceived benefits, perceived credibility, perceived regulatory support, ICT industries readiness, lack of financial institutions readiness and institutional influence. Al-Somali et al. (2009) found that the quality of the Internet connection, the awareness of online banking and its benefits, the social influence and computer self-efficacy have significant effects on the perceived usefulness (PU) and perceived ease of use (PEOU) of online banking acceptance. Education, trust and resistance to change also have significant impact on the attitude towards the likelihood of adopting online banking. Jahangir N. and Begum N. (2008) noted that perceived usefulness, ease of use, security and privacy, and customer attitude are significantly and positively related to customer adaptation. Hanudin Amin. (2007) found that perceived usefulness, perceived ease of use and perceived credibility had a significant relationship with behavioral intention. Further, these measures are good determinant for undergraduate acceptance for internet banking. Results also suggest that PU and PEOU had a significant relationship with computer self-efficacy. Z Liao and WK Wong. (2008) found that perceived usefulness, ease of use, security, responsiveness and convenience significantly influence customer interactions with Internet e-banking. In particular, individuals would place a great emphasis on the security of Internet-based financial transactions. As a conventional practice, commercial banks and financial institutions must continuously review security policy and strengthen the security control of Internet e-banking Wai-Ching Poon. (2008) found that all elements for ten identified factors are significant with respect to the users adoption of e-banking services. Privacy and security are the major sources of dissatisfaction, which have momentously impacted users satisfaction. Meanwhile, accessibility, convenience, design and content are sources of satisfaction. Besides, the speed, product features availability, and reasonable service fees and charges, as well as the banks operations management factor are critical to the success of the e-banks. WAP, GPRS and 3G features from mobile devices are of no significance or influence in the adoption of e-banking services in this study. Results also reveal that privacy; security and convenience factors play an important role in determining the users acceptance of e-banking services with respect to different segmentation of age group, education level and income level. Padachi et al. (2007) found that the most significant factor is ease of use and that other important elements featured reluctance to change, trust and relationship in banker, cost of computers, internet accessibility, convenience of use, and security concerns. Chen, Y. H. and Barnes, S. (2007) pointed out that perceived usefulness, perceived security, perceived privacy, perceived good reputation, and willingness to customize are the important antecedents to online initial trust. It is also discovered that different levels of trust propensity moderate perceptions toward the web site and online with respect to online initial trust, including perceived usefulness, perceived security, perceived privacy, perceived good reputation, and willingness to customize. Both online initial trust and familiarity with online purchasing have a positive impact on purchase intention. T.C. Edwin Cheng et al. (2006) found that The results provide support of the extended TAM model and confirm its robustness in predicting customers intention of adoption of IB. This study contributes to the literature by formulating and validating TAM to predict IB adoption, and its findings provide useful information for bank management in formulating IB marketing strategies. We analyzed the data using Structured Equation Modeling (SEM) to evaluate the strength of the hypothesized relationships, if any, among the constructs, which include Perceived Ease of Use and Perceived Web Security as independent variables, Perceived Usefulness and Attitude as intervening variables, and Intention to Use as the dependent variable. The results provide support of the extended TAM model and confirm its robustness in predicting customers intention of adoption of IB Moutaz Abou-Robieh. (2005) found that there was a correlation between respondents attitudes towards e-banking and their comfort level and feeling of security with regard to their age, level of education, and annual salary. 2.1 Perceived ease of use (PEOU) Safeena et al. (2009), Jahangir N. and Begum N. (2008), Z Liao and WK Wong. (2008) and Amin. (2007) stated that perceived ease of use have a strong and positive influence on customers intention to adopt and use internet banking. 2.2 Perceived usefulness (PU) Several studies showed that perceived usefulness influence customer interactions with internet banking, which effect the adoption of e-banking services (Sadeghi and Hanzaee. 2010; Safeena et al. 2009; Al-Somali et al. 2009; Jahangir N. and Begum N. 2008; Hanudin Amin. 2007, Z Liao and WK Wong.2008 ). 2.3 Perceived credibility (PC) Previous research has shown that security and privacy are the most concern for consumer, which have a direct or indirect influence on e-banking adoption (Aderonke and Charles, 2010; Sadeghi and Hanzaee, 2010; Alda ´s-Manzano et al., 2009; Riyadh et al. 2009; Jahangir N. and Begum N., 2008; Z Liao and WK Wong., 2008). Privacy put barriers on using online services (Hernandez and Mazzon, 2007). Moreover, Wai-Ching Poon. (2008) and Moutaz Abou-Robieh. (2005) noted that privacy and security factors play an important role in determining the users acceptance of e-banking services with regard to age, education level and income level. 3.CHALLENGES 4.1 RESEARCH MODEL AND HYPOTHESES The model of the study is presented below: Perceived usefulness Perceived ease of use Perceived credibility Intention to use Electronic Banking The representation of the proposed framework depicted the pattern and structure of relationships between the set of the measured variables. The purpose of the study is to measure correlations among variables and then use it to identify whether any relationships exists between these measured variables or not. We will extended TAM and add PC into the framework to test the effect of these three factors on e-banking adaption. In the extended model of TAM study, like (Safeena et al. 2009; Alda ´s-Manzano et al. (2009); Hanudin Amin, 2007), the attitudes factor has been neglected to simplify the model. The present study investigated the relationship between perceived usefulness, perceived ease of use, perceived credibility and customer intention to use electronic banking in Bahrain. Here perceived usefulness, perceived ease of use and perceived credibility, were being considered as independent variables and customer intention to use electronic banking was being considered as a dependent variable. Perceived usefulness According to the Davis (1989) and Davis et al. (1989), perceived usefulness is the degree to which a person believes that using a particular system would enhance his or her job performance. Perceived usefulness is defined as the individuals perception that using the new technology will enhance or improve her/his performance (Davis,1993). In Addition, Laforet and Li, (2005) and Eriksson et al., (2005) defined the term perceived usefulness as the subjective probability that using the technology would improve the way a user could complete. We hypothesize that People tend to use an application to the extent they believe it will aid their performance. H1: Perceived usefulness (PU) has a positive effect on customer Intention to use Electronic banking. Perceived ease of use According to Davis (1989) perceived ease of use refers to the degree to which a person believes that using a particular system would be free of effort. The most significant factor on adoption Internet Banking is ease of use. (Padachi et al., 2007). Hence an application perceived to be easier to use than another is more likely to be accepted by users. And By applying these to electronic banking context we can hypothesize that: H2: Perceived ease of use (PEOU) has a positive effect on customer Intention to use Electronic banking. Perceived Credibility Perceived credibility is defined as the degree to which a user feels the certainty and pleasant consequences of using an electronic application service, when there is no financial risk, physical risk, functional risk, social risk, time-loss risk, opportunity cost risk, and information risk Jacoby and Kaplan (1972). However, (Ganesan,1994) present another definition of PC stating it as the extent to which one partner believes that the other partner has the required expertise to perform the job effectively and reliably. PC is usually impersonal and relies on reputation, information and economic reasoning (Ba and Pavlou,2002). Wang et al. (2003) stated that perceived credibility is consists of two important elements namely privacy and security, which affect directly consumer adaptation of electronic banking systems. Security refers to the protection of information or systems from unauthorized intrusions (Egwali, 2008). For the purpose of this research, perceived credibility (PC) is defined as users perception of protection of their transaction details and personal data against unauthorized access. Therefore, for studying the effect of perceived credibility on users acceptance in Bahrain electronic banking services, we pose the following hypothesis to determine it effect on users intention H3: perceived credibility has positive effect on customer Intention to use Electronic banking. 4. Methodology To assess the factors influencing the intention to use internet banking in Bahrain, a survey was conducted during the last quarter of year 2010. A Questionnaire were designed and distributed to retail users of banking services of different age group and of different educational level attained across the island. Survey Instrument The questionnaire we prepared for this exercise was divided into 2 sections. The first section concentrates on the general profile of the respondent including his/her age group, education level and profession and income group. In the second section we were interested in finding the factors affecting the customer intention to use internet banking in Bahrain. The respondents were provided with a list of 10 questions; 4 questions on perceived usefulness, 2 questions on perceived ease of use, 3 questions on perceived credibility and finally 1 question on intention to use. The participants were asked to indicate their perception on a likert scales (1- 5) with response ranging from strongly disagree to strongly agree. The collected data were analyzed based on correlation and regression analyses using the statistical package for social sciences (SPSS) version 17computer program. Data collection The questionnaires were distributed directly among the customers through the researchers friends and relatives, a sample of 400 people was randomly chosen from the Bahraini community, all participants were bank customers selected randomly from universities, malls, Internet cafÃÆ' ©s and businessmen from private and public sectors. Also A digital online form was created using Google Documents in the same questionnaire style, Then the link was shared and publicized to Bahrainis through email as well as posting it on discussion forums. Once a subject would answer the questionnaire, the raw data will automatically be logged in a spreadsheet which can be only accessed and downloaded by the researcher. Since the questionnaire form was to be submitted online it guaranteed two things: First, it targeted people who really access the internet. Second, because all questions are need to be answered before submitting. The collection of data will be done automatically, efficiently and there wont be any loss of data The questionnaire we prepared and used had been pre-tested initially with a few number of people (5 users) working in different sectors to ensure consistency, clarity and relevance to the Bahraini case, Minor changes (related to the questions content, wording, sequence) were requested by those people, which we implemented before carrying out the final copy. A total of 200 useable responses were obtained yielding a response rate of 50% (200/400). Demographic profile of respondents: variable category Frequency Valid Percentage Age 18 25 25 35 35 45 45 yrs and above Gender Male Female Education Secondary and below Diploma Bachelor High studies Occupation Government sector Private Sector Self-employment Others Monthly Income in BD Less than 500 500-1000 1000 and above Assumptions or Limitations For this research, the following limitation existed in the collection of data, the survey assumed that the respondents have some familiarity with banks and banking transactions and have been exposed to or have knowledge of the existence of e-banking alternatives. For these responses in particular, it was difficult to ensure the true validity of the responses or the identity of the respondent. REFERENCES Aderonke and Charles. (2010). An Empirical Investigation of the Level of Users Acceptance of E-Banking in Nigeria. Journal of Internet Banking and Commerce, vol. 15 (1). Al-Somali, S.A., Gholami, R. and Clegg, B.(2009). An investigation into the acceptance of online banking in Saudi Arabia. Technovation, vol. 29, pp.130-141. Al Nahian Riyadh, Md. Shahriar Akter , Nayeema Islam. (2009). The adoption of e-banking in developing countries: A theoretical model for SMEs. International Review of Business Research Papers, vol. 5 (6), pp.212-230. Ba, S. and Pavlou, P.A (2002). Evidence of the effect of trust building technology in electronic market: price premiums and buyer behavior.MIS Quarterly, vol. 26 (3), pp. 243-68. Celik, H. (2008). What Determines Turkish customers acceptance of internet banking? International Journal of Bank Marketing. Vol. 26 (5): 353-370. Chen, Y. H. and Barnes, S. (2007), Initial Trust and Online Buyer Behaviour, Industrial Management Data Systems, 107(1): 21-36. Davis, F. D. (1989), Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology, MIS Quarterly,13 (3): 319-339. Davis, F. D., Bagozzi, R. P. and Warshaw, P. R. (1989), User Acceptance of Computer Technology: A Comparison of Two Theoretical Models, Management Science, 35(8): 982-1003. Davis, F. D. (1993). User acceptance of information technology: system characteristics, user perceptions and behavioral impacts. International Journal of Man-Machine Studies,38, 475-487. Davis, F. D., Bagozzi, R. P., Warshaw, P. R. (1992). Extrinsic and intrinsic motivation to use computers in the workplace. Journal of Applied Social Psychology, 22(14), 1109-1130. Egwali A. O., Customer Perception of Security Indicators in Online Banking Sites in Nigeria, Journal of Internet Banking and Commerce, December 2008, vol. 13, no.3. Eriksson K, Kerem K, Nilsson D (2005). Customer acceptance of internet banking in Estonia, International Journal of Bank Market, vol. 23 (2), pp. 200-216. Ganesan, S.(1994), Determinants of long-term orientation in buyer-seller relationships. Journal of Marketing, Vol.58 (2), pp.1-19 Hanudin Amin (2007). Internet Banking Adoption Among Young Intellectuals. Journal of Internet Banking and Commerce, December 2007, vol. 12 (3) Jacoby, J., Kaplan, L. B. (1972). The components of perceived risk. Paper presented at the Proceedings of the 3rd Annual Conference of the Association for Consumer Research, College Park, MD. Joaquin Alda ´s-Manzano, Carlos Lassala-Navarre, Carla Ruiz-Mafe and Silvia Sanz-Blas. (2009). Key drivers of internet banking services use , Online Information Review, Vol. 33 (4), pp. 672-695. Laforet S, Li X (2005). Consumers attitudes towards online and mobile banking in China. International Journal Bank Market vol. 23 (5), pp. 362-380. Moutaz Abou-Robieh. (2005). A Study of E-Banking Security Perceptions and Customer Satisfaction Issues. Nadim Jahangir and Noorjahan Begum. (2008). The role of perceived usefulness, perceived ease of use, security and privacy, and customer attitude to engender customer adaptation in the context of electronic banking. African Journal of Business Management, vol.2 (1), pp. 032-040. Padachi, Rojid, Seetanah.(2007). Analyzing the Factors that Influence the Adoption of Internet Banking in Mauritius. Patrick, T. (2002). Corporate Privacy Credibility Crumbles. Computer world, March, 4(10). Pikkarainen, T., Pikkarainen, K., Karijaluoto, H. and Pahnila, S. (2004), Customer acceptance of on-line banking: an extension of the technology acceptance model, Internet Research, vol. 14(3), pp. 224-235 Qureshi, T.M., Zafar, M.K and Khan, M.B. (2008). Customer Acceptance of Online Banking in Developing Economies. Journal of Internet Banking and Commerce, Vol. 13 (1). Safeena, Abdullah and Hema. ( 2010). Customer Perspectives on E-business Value: Case Study on Internet Banking. Journal of Internet Banking and Commerce, vol. 15 (1). Seth, N., S.G. Deshmukh and P. Vrat, 2004. Service quality models: A review, International Journal Quality and Reliability Management, vol. 22(9), pp. 36-51. T.C. Edwin Cheng, David Y.C. Lam and Andy C.L. Yeung. (2006) Adoption of internet banking: An empirical study in Hong Kong. Decision Support Systems, vol. 42 (3), pp 1558-1572 Tooraj Sadeghi and Kambiz Heidarzadeh Hanzaee. (2010). Customer satisfaction factors (CSFs) with online banking services in an Islamic country I.R. Iran. Journal of Islamic Marketing, vol. 1 (3), pp. 249-267 Wai-Ching Poon . (2008). Users adoption of e-banking services. Journal of Business Industrial Marketing, vol. 23 (1), pp. 59-69 Wang, Y., Lin, H., Tang, T. (2003). Determinants of user acceptance of internet banking: an empirical study. International Journal of Service Industry Management, 14(5), 501-519 Yap, K., D. Wong, C. Loh, and R. Bak (2010). Offline and online banking where to draw the line when building trust in e-banking. International Journal of Bank Marketing, 28(1), p.27-46 Z Liao and WK Wong. ( 2008). The determinants of customer interactions with internet-enabled e-banking services. Journal of the Operational Research Society, vol. 59 (9). User Adoption Momentum of E Banking In Malaysia User Adoption Momentum of E Banking In Malaysia In the era of globalization and with the increasing competition in all the fields around the world many companies have modified their strategies so they can reach their customers around the world easier and cheaper. However the rapid growth of systems that rely on electronic technology especially those relating to the Internet and personal computer- led to a significant change in the exchanging of products and services. Many  Service organizations have adopted modern technology to reduce costs and enhance customer service quality, delivery, and standardize core service offerings. In addition a lot of non-banking companies entered the banking industry by offering products and financial services, giving the customers a lot of options and alternatives to carry out their banking transactions, this difficulty of the business process in the financial sector forces the banks to develop an alternative technological channel to attract customers and improve their perception. The rapid technological diffusion makes the internet the best way to provide customers with banking services regardless of the limits of time and geography. And thats what makes banks  consider the  internet as an important part of their strategic plans. Internet technology has changed the design and the way of delivering the financial services and as a result the banking industry has made continuous innovations especially in the field of communications and information technology that ultimately led to the emergence of the idea of what is known as the online banking. Banking services through the internet is a way to keep the existing customers and attract others to the bank, In this paper we define online banking as an internet portal, through which customers can use different kinds of banking services ranging from bill payment to making investments (Pikkarainen et al., 2004). Compared to the traditional approach, online banking is an inexpensive straightforward way to conduct banking business, exchange of personalized information and buying and selling goods and services from any place at any time. Despite the many benefits provided by this service to the bank and its customers, it remains a double-edged sword and not used by every customer, because the increasing distance between the bank and customers may lead to lack of confidence and an increasing in security concerns. As a result, the quality of electronic banking services become an important area of attention among the researchers and banks managers due to its strong influence on the business performance, lower costs, customer satisfaction, customer loyalty, and profitability (Seth et al., 2004). The main objective of this study is to focus on the importance of understanding the customers perception about internet banking by investigating and measuring the impact of selected factors such as perceived usefulness (PU), perceived ease of use (PEOU), security and privacy (PC) and how they can influence the customer acceptance to conduct banking transactions via the internet, Based on the empirical data collected from individual customers in Bahrain. In the next section we will give some background information about the internet banking sector and review the relevant literature in this area, the following section describes the research methodology, which is then followed by the data analysis and the results from the survey, The paper concludes with a discussion, outlining the implications of the findings and the limitations of the study. 2.0 LITERATURE REVIEW Technology Acceptance Model (TAM) External variables Perceived usefulness Perceived ease of use Behavioral intention Actual system use Figure 1: The original Technology Acceptance Model (Davis, 1989) The Technology Acceptance Model (TAM) is a perfect model which show how users accept and use a technology. In (TAM) the main determinants of users acceptance of new technology are perceived usefulness (PU) and perceived ease of use (PEOU) (Davis, 1989). Although (Chen and Barnes 2007; T.C. Edwin Cheng et al. 2006) found that perceived ease of use, perceived usefulness and security and privacy affect customer adaptation intentions, Qureshi et al., (2008) claimed that Perceived usefulness, security and privacy are the main perusing factors to accept online banking system. Celik (2008) stated that perceived usefulness and perceived ease of use are direct determinants of customers attitudes towards using internet Banking. Traditional service quality and website features (PU, PEOU and PC) that give customers confidence build trust in e-banking (Yap, K et al. 2010). Aderonke and Charles. (2010) found that Banks customers who are active users of e-Banking system use it because it is convenient, easy to use, time saving and appropriate for their transaction needs. Also the network security and the security of the system in terms of privacy are the major concerns of the users and constitute hindrance to intending users. Yap, K et al. (2010) claimed that Traditional service quality and website features that give customers confidence build trust in e-banking. Sadeghi and Hanzaee. (2010) found that According to the model of seven factors on the following dimensions: convenience, accessibility, accuracy, security, usefulness, bank image, and web site design. Some of these factors illustrate a significant statistical difference between males and females. Safeena et al. (2009) found that perceived usefulness, perceived ease of use, consumer awareness and perceived risk are the important determinants of online banking adoption. These factors have a strong and positive effect on customers to accept online banking system. Alda ´s-Manzano et al. (2009) found that TAM beliefs and perceived risks (security, privacy, performance and social) have a direct influence on e-banking adoption. Trust appears as a key variable that reduces perceived risk. Involvement plays an important role in increasing perceived ease of use. Riyadh et al. (2009) stated that Seven variables affecting e-banking adoption by SMEs are identified. They are: organizational capabilities, perceived benefits, perceived credibility, perceived regulatory support, ICT industries readiness, lack of financial institutions readiness and institutional influence. Al-Somali et al. (2009) found that the quality of the Internet connection, the awareness of online banking and its benefits, the social influence and computer self-efficacy have significant effects on the perceived usefulness (PU) and perceived ease of use (PEOU) of online banking acceptance. Education, trust and resistance to change also have significant impact on the attitude towards the likelihood of adopting online banking. Jahangir N. and Begum N. (2008) noted that perceived usefulness, ease of use, security and privacy, and customer attitude are significantly and positively related to customer adaptation. Hanudin Amin. (2007) found that perceived usefulness, perceived ease of use and perceived credibility had a significant relationship with behavioral intention. Further, these measures are good determinant for undergraduate acceptance for internet banking. Results also suggest that PU and PEOU had a significant relationship with computer self-efficacy. Z Liao and WK Wong. (2008) found that perceived usefulness, ease of use, security, responsiveness and convenience significantly influence customer interactions with Internet e-banking. In particular, individuals would place a great emphasis on the security of Internet-based financial transactions. As a conventional practice, commercial banks and financial institutions must continuously review security policy and strengthen the security control of Internet e-banking Wai-Ching Poon. (2008) found that all elements for ten identified factors are significant with respect to the users adoption of e-banking services. Privacy and security are the major sources of dissatisfaction, which have momentously impacted users satisfaction. Meanwhile, accessibility, convenience, design and content are sources of satisfaction. Besides, the speed, product features availability, and reasonable service fees and charges, as well as the banks operations management factor are critical to the success of the e-banks. WAP, GPRS and 3G features from mobile devices are of no significance or influence in the adoption of e-banking services in this study. Results also reveal that privacy; security and convenience factors play an important role in determining the users acceptance of e-banking services with respect to different segmentation of age group, education level and income level. Padachi et al. (2007) found that the most significant factor is ease of use and that other important elements featured reluctance to change, trust and relationship in banker, cost of computers, internet accessibility, convenience of use, and security concerns. Chen, Y. H. and Barnes, S. (2007) pointed out that perceived usefulness, perceived security, perceived privacy, perceived good reputation, and willingness to customize are the important antecedents to online initial trust. It is also discovered that different levels of trust propensity moderate perceptions toward the web site and online with respect to online initial trust, including perceived usefulness, perceived security, perceived privacy, perceived good reputation, and willingness to customize. Both online initial trust and familiarity with online purchasing have a positive impact on purchase intention. T.C. Edwin Cheng et al. (2006) found that The results provide support of the extended TAM model and confirm its robustness in predicting customers intention of adoption of IB. This study contributes to the literature by formulating and validating TAM to predict IB adoption, and its findings provide useful information for bank management in formulating IB marketing strategies. We analyzed the data using Structured Equation Modeling (SEM) to evaluate the strength of the hypothesized relationships, if any, among the constructs, which include Perceived Ease of Use and Perceived Web Security as independent variables, Perceived Usefulness and Attitude as intervening variables, and Intention to Use as the dependent variable. The results provide support of the extended TAM model and confirm its robustness in predicting customers intention of adoption of IB Moutaz Abou-Robieh. (2005) found that there was a correlation between respondents attitudes towards e-banking and their comfort level and feeling of security with regard to their age, level of education, and annual salary. 2.1 Perceived ease of use (PEOU) Safeena et al. (2009), Jahangir N. and Begum N. (2008), Z Liao and WK Wong. (2008) and Amin. (2007) stated that perceived ease of use have a strong and positive influence on customers intention to adopt and use internet banking. 2.2 Perceived usefulness (PU) Several studies showed that perceived usefulness influence customer interactions with internet banking, which effect the adoption of e-banking services (Sadeghi and Hanzaee. 2010; Safeena et al. 2009; Al-Somali et al. 2009; Jahangir N. and Begum N. 2008; Hanudin Amin. 2007, Z Liao and WK Wong.2008 ). 2.3 Perceived credibility (PC) Previous research has shown that security and privacy are the most concern for consumer, which have a direct or indirect influence on e-banking adoption (Aderonke and Charles, 2010; Sadeghi and Hanzaee, 2010; Alda ´s-Manzano et al., 2009; Riyadh et al. 2009; Jahangir N. and Begum N., 2008; Z Liao and WK Wong., 2008). Privacy put barriers on using online services (Hernandez and Mazzon, 2007). Moreover, Wai-Ching Poon. (2008) and Moutaz Abou-Robieh. (2005) noted that privacy and security factors play an important role in determining the users acceptance of e-banking services with regard to age, education level and income level. 3.CHALLENGES 4.1 RESEARCH MODEL AND HYPOTHESES The model of the study is presented below: Perceived usefulness Perceived ease of use Perceived credibility Intention to use Electronic Banking The representation of the proposed framework depicted the pattern and structure of relationships between the set of the measured variables. The purpose of the study is to measure correlations among variables and then use it to identify whether any relationships exists between these measured variables or not. We will extended TAM and add PC into the framework to test the effect of these three factors on e-banking adaption. In the extended model of TAM study, like (Safeena et al. 2009; Alda ´s-Manzano et al. (2009); Hanudin Amin, 2007), the attitudes factor has been neglected to simplify the model. The present study investigated the relationship between perceived usefulness, perceived ease of use, perceived credibility and customer intention to use electronic banking in Bahrain. Here perceived usefulness, perceived ease of use and perceived credibility, were being considered as independent variables and customer intention to use electronic banking was being considered as a dependent variable. Perceived usefulness According to the Davis (1989) and Davis et al. (1989), perceived usefulness is the degree to which a person believes that using a particular system would enhance his or her job performance. Perceived usefulness is defined as the individuals perception that using the new technology will enhance or improve her/his performance (Davis,1993). In Addition, Laforet and Li, (2005) and Eriksson et al., (2005) defined the term perceived usefulness as the subjective probability that using the technology would improve the way a user could complete. We hypothesize that People tend to use an application to the extent they believe it will aid their performance. H1: Perceived usefulness (PU) has a positive effect on customer Intention to use Electronic banking. Perceived ease of use According to Davis (1989) perceived ease of use refers to the degree to which a person believes that using a particular system would be free of effort. The most significant factor on adoption Internet Banking is ease of use. (Padachi et al., 2007). Hence an application perceived to be easier to use than another is more likely to be accepted by users. And By applying these to electronic banking context we can hypothesize that: H2: Perceived ease of use (PEOU) has a positive effect on customer Intention to use Electronic banking. Perceived Credibility Perceived credibility is defined as the degree to which a user feels the certainty and pleasant consequences of using an electronic application service, when there is no financial risk, physical risk, functional risk, social risk, time-loss risk, opportunity cost risk, and information risk Jacoby and Kaplan (1972). However, (Ganesan,1994) present another definition of PC stating it as the extent to which one partner believes that the other partner has the required expertise to perform the job effectively and reliably. PC is usually impersonal and relies on reputation, information and economic reasoning (Ba and Pavlou,2002). Wang et al. (2003) stated that perceived credibility is consists of two important elements namely privacy and security, which affect directly consumer adaptation of electronic banking systems. Security refers to the protection of information or systems from unauthorized intrusions (Egwali, 2008). For the purpose of this research, perceived credibility (PC) is defined as users perception of protection of their transaction details and personal data against unauthorized access. Therefore, for studying the effect of perceived credibility on users acceptance in Bahrain electronic banking services, we pose the following hypothesis to determine it effect on users intention H3: perceived credibility has positive effect on customer Intention to use Electronic banking. 4. Methodology To assess the factors influencing the intention to use internet banking in Bahrain, a survey was conducted during the last quarter of year 2010. A Questionnaire were designed and distributed to retail users of banking services of different age group and of different educational level attained across the island. Survey Instrument The questionnaire we prepared for this exercise was divided into 2 sections. The first section concentrates on the general profile of the respondent including his/her age group, education level and profession and income group. In the second section we were interested in finding the factors affecting the customer intention to use internet banking in Bahrain. The respondents were provided with a list of 10 questions; 4 questions on perceived usefulness, 2 questions on perceived ease of use, 3 questions on perceived credibility and finally 1 question on intention to use. The participants were asked to indicate their perception on a likert scales (1- 5) with response ranging from strongly disagree to strongly agree. The collected data were analyzed based on correlation and regression analyses using the statistical package for social sciences (SPSS) version 17computer program. Data collection The questionnaires were distributed directly among the customers through the researchers friends and relatives, a sample of 400 people was randomly chosen from the Bahraini community, all participants were bank customers selected randomly from universities, malls, Internet cafÃÆ' ©s and businessmen from private and public sectors. Also A digital online form was created using Google Documents in the same questionnaire style, Then the link was shared and publicized to Bahrainis through email as well as posting it on discussion forums. Once a subject would answer the questionnaire, the raw data will automatically be logged in a spreadsheet which can be only accessed and downloaded by the researcher. Since the questionnaire form was to be submitted online it guaranteed two things: First, it targeted people who really access the internet. Second, because all questions are need to be answered before submitting. The collection of data will be done automatically, efficiently and there wont be any loss of data The questionnaire we prepared and used had been pre-tested initially with a few number of people (5 users) working in different sectors to ensure consistency, clarity and relevance to the Bahraini case, Minor changes (related to the questions content, wording, sequence) were requested by those people, which we implemented before carrying out the final copy. A total of 200 useable responses were obtained yielding a response rate of 50% (200/400). Demographic profile of respondents: variable category Frequency Valid Percentage Age 18 25 25 35 35 45 45 yrs and above Gender Male Female Education Secondary and below Diploma Bachelor High studies Occupation Government sector Private Sector Self-employment Others Monthly Income in BD Less than 500 500-1000 1000 and above Assumptions or Limitations For this research, the following limitation existed in the collection of data, the survey assumed that the respondents have some familiarity with banks and banking transactions and have been exposed to or have knowledge of the existence of e-banking alternatives. For these responses in particular, it was difficult to ensure the true validity of the responses or the identity of the respondent. REFERENCES Aderonke and Charles. (2010). An Empirical Investigation of the Level of Users Acceptance of E-Banking in Nigeria. Journal of Internet Banking and Commerce, vol. 15 (1). Al-Somali, S.A., Gholami, R. and Clegg, B.(2009). An investigation into the acceptance of online banking in Saudi Arabia. Technovation, vol. 29, pp.130-141. Al Nahian Riyadh, Md. Shahriar Akter , Nayeema Islam. (2009). The adoption of e-banking in developing countries: A theoretical model for SMEs. International Review of Business Research Papers, vol. 5 (6), pp.212-230. Ba, S. and Pavlou, P.A (2002). Evidence of the effect of trust building technology in electronic market: price premiums and buyer behavior.MIS Quarterly, vol. 26 (3), pp. 243-68. Celik, H. (2008). What Determines Turkish customers acceptance of internet banking? International Journal of Bank Marketing. Vol. 26 (5): 353-370. Chen, Y. H. and Barnes, S. (2007), Initial Trust and Online Buyer Behaviour, Industrial Management Data Systems, 107(1): 21-36. Davis, F. D. (1989), Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology, MIS Quarterly,13 (3): 319-339. Davis, F. D., Bagozzi, R. P. and Warshaw, P. R. (1989), User Acceptance of Computer Technology: A Comparison of Two Theoretical Models, Management Science, 35(8): 982-1003. Davis, F. D. (1993). User acceptance of information technology: system characteristics, user perceptions and behavioral impacts. International Journal of Man-Machine Studies,38, 475-487. Davis, F. D., Bagozzi, R. P., Warshaw, P. R. (1992). Extrinsic and intrinsic motivation to use computers in the workplace. Journal of Applied Social Psychology, 22(14), 1109-1130. Egwali A. O., Customer Perception of Security Indicators in Online Banking Sites in Nigeria, Journal of Internet Banking and Commerce, December 2008, vol. 13, no.3. Eriksson K, Kerem K, Nilsson D (2005). Customer acceptance of internet banking in Estonia, International Journal of Bank Market, vol. 23 (2), pp. 200-216. Ganesan, S.(1994), Determinants of long-term orientation in buyer-seller relationships. Journal of Marketing, Vol.58 (2), pp.1-19 Hanudin Amin (2007). Internet Banking Adoption Among Young Intellectuals. Journal of Internet Banking and Commerce, December 2007, vol. 12 (3) Jacoby, J., Kaplan, L. B. (1972). The components of perceived risk. Paper presented at the Proceedings of the 3rd Annual Conference of the Association for Consumer Research, College Park, MD. Joaquin Alda ´s-Manzano, Carlos Lassala-Navarre, Carla Ruiz-Mafe and Silvia Sanz-Blas. (2009). Key drivers of internet banking services use , Online Information Review, Vol. 33 (4), pp. 672-695. Laforet S, Li X (2005). Consumers attitudes towards online and mobile banking in China. International Journal Bank Market vol. 23 (5), pp. 362-380. Moutaz Abou-Robieh. (2005). A Study of E-Banking Security Perceptions and Customer Satisfaction Issues. Nadim Jahangir and Noorjahan Begum. (2008). The role of perceived usefulness, perceived ease of use, security and privacy, and customer attitude to engender customer adaptation in the context of electronic banking. African Journal of Business Management, vol.2 (1), pp. 032-040. Padachi, Rojid, Seetanah.(2007). Analyzing the Factors that Influence the Adoption of Internet Banking in Mauritius. Patrick, T. (2002). Corporate Privacy Credibility Crumbles. Computer world, March, 4(10). Pikkarainen, T., Pikkarainen, K., Karijaluoto, H. and Pahnila, S. (2004), Customer acceptance of on-line banking: an extension of the technology acceptance model, Internet Research, vol. 14(3), pp. 224-235 Qureshi, T.M., Zafar, M.K and Khan, M.B. (2008). Customer Acceptance of Online Banking in Developing Economies. Journal of Internet Banking and Commerce, Vol. 13 (1). Safeena, Abdullah and Hema. ( 2010). Customer Perspectives on E-business Value: Case Study on Internet Banking. Journal of Internet Banking and Commerce, vol. 15 (1). Seth, N., S.G. Deshmukh and P. Vrat, 2004. Service quality models: A review, International Journal Quality and Reliability Management, vol. 22(9), pp. 36-51. T.C. Edwin Cheng, David Y.C. Lam and Andy C.L. Yeung. (2006) Adoption of internet banking: An empirical study in Hong Kong. Decision Support Systems, vol. 42 (3), pp 1558-1572 Tooraj Sadeghi and Kambiz Heidarzadeh Hanzaee. (2010). Customer satisfaction factors (CSFs) with online banking services in an Islamic country I.R. Iran. Journal of Islamic Marketing, vol. 1 (3), pp. 249-267 Wai-Ching Poon . (2008). Users adoption of e-banking services. Journal of Business Industrial Marketing, vol. 23 (1), pp. 59-69 Wang, Y., Lin, H., Tang, T. (2003). Determinants of user acceptance of internet banking: an empirical study. International Journal of Service Industry Management, 14(5), 501-519 Yap, K., D. Wong, C. Loh, and R. Bak (2010). Offline and online banking where to draw the line when building trust in e-banking. International Journal of Bank Marketing, 28(1), p.27-46 Z Liao and WK Wong. ( 2008). The determinants of customer interactions with internet-enabled e-banking services. Journal of the Operational Research Society, vol. 59 (9).

Behavior Change Plan to Prevent Coronary Heart Disease

Behavior Change Plan to Prevent Coronary Heart Disease Maintaining a Healthy Lifestyle Behavior to Prevent a Reoccurrence of Coronary Heart Disease James J. Speen Introduction Justification for choosing the health behavior I am a 57 year old male, diagnosed with diabetes mellitus II, and cardiovascular disease stemming from atherosclerosis. In March of 2006, I experienced an acute angina pectoris attack while testing for a brown belt in Tae Kwon Do. The angina attack led to an emergency department visit at a local health facility and ultimately culminated in a quadruple coronary artery bypass graph (CABG). My healthcare providers are continually stressing the importance of making healthy choices and maintaining a healthy lifestyle in order to prevent a reoccurrence of coronary heart disease (CHD). Further, supporting my physician’s opinion, Ferris, Kline, and Bourdage (2012) state that â€Å"biopsychosocial health displayed no direct relationship to CHD risk, but positively predicted a healthier lifestyle. A healthier lifestyle was related to lower levels of CHD risk.† Over the past 6 months, I have strayed from my regimen of healthy eating and daily exercise and am beginning to feel the negative effects of weight gain, sore joints, and decreased endurance during physical activity. It is now behavior modification time. This will be accomplished by discontinuing my current unhealthy behaviors and resuming a healthy lifestyle consisting of a regimen of eating heart healthy foods and exercise. Justification for the behavior change plan I used the Theory of Planned Behavior (TPB) model, as outlined in our textbook, Health Psychology A Biopsychosocial Approach (Straub, 2012) to evaluate my current behavior. First, I determined that continuing my behavior would eventually lead to another CABG or even worse my death. Secondly, after considering my doctor’s views regarding CHD prevention through lifestyle modification; I chose to comply with my healthcare provider’s advice. And finally, I realized that I am the only one who can manage my controllable health risk factors. Method Materials and Procedure I monitored my pre-change caloric intake, blood glucose, and physical exercise levels for seven days. My caloric intake and amount of exercise was recorded using the MyFitnessPal mobile application. Blood glucose levels were measured each day with a OneTouch Ultra 2 blood glucose meter. Glucose measurements were performed twice each day at 6:00a.m. and at 10:00p.m.. This data was used to establish my base line cardiac healthy lifestyle compliance. After this period, I enacted a behavior change plan to regain control over my controllable cardiac health risk factors. I added the use of a HoMedics model KS-701 digital dietary scale to accurately measure my food portions and increased the amount of water that I consumed daily. Additionally, 1 hour of cardiovascular and strength training exercises was added to the daily regimen. Caloric intake and exercise activity were recorded using the MyFitnessPal mobile application and blood glucose was measured with the OneTouch Ultra 2 blood glucose meter. Nutritional data consisting of caloric intake, carbohydrates, fat, protein, cholesterol, sodium, sugar, and fiber from the MyFitnessPal application along with blood glucose data, was imported into an Excel spread sheet for data comparison and analysis. Average daily values for each category were computed for both the pre-behavior change and behavior change periods. Results The pre-behavior change average nutrition information showed that I was consuming too much fat, cholesterol, and sodium. Additionally, both my a.m. and p.m. average blood glucose readings exceeded the National Institute of Health (NIH) blood glucose recommendations of pre- meal: 70–130mg/dL and 2-hours post meal: The modified behaviors showed significant improvements across the scope of all values monitored when compared to my behavior change goal. Refer to Table 2 for a more detailed comparison of behavior change to the behavior change goal. Additionally, Table 3 demonstrates the effect that positive health risk behavior modification has on un-healthy controllable health risk behaviors. Discussion What worked and what didn’t work with my change plan This behavior intervention was successful from the standpoint that the cycle of unhealthy lifestyle choices I was making, was interrupted. Furthermore, a modest improvement in controllable cardiac health risk factors was realized. Even though, I was unable to implement the cardiovascular and strength exercise portion of my plan; I experienced a 6 pound weight loss attributable to overall daily caloric reduction. External and internal factors that contributed to the effectiveness of my change plan External factors affecting my change plan were the abundance of family support and the inability to implement the exercise component of my plan due to a severe lower lumbar sprain requiring a lengthy time to heal. Internal factors that helped motivate me to make change were the chronic joint pain and decreased physical endurance I was experiencing. Another positive motivator was being able to see the real-time qualitative results of my daily nutritional choices. Shortà ¢Ã¢â€š ¬Ã‚ term and longà ¢Ã¢â€š ¬Ã‚ term consequences of not changing my behavior According to the South Australian Department of Health (2012),†the short-term consequences of not changing [my] behavior may include impairment of [my] daily health and wellbeing and reduce [my] ability to lead an enjoyable and active life†. Additionally, continued un-healthy nutrition choices can contribute to stress, fatigue, and can affect my ability to work. Furthermore, poor nutritional choices have been associated with increased incidences chronic medical conditions, such as obesity, diabetes, hypertension, and hypercholesterolemia. The long-term consequences of not making healthy lifestyle changes to reverse the abovementioned chronic medical conditions lead to serious life-ending diseases. Uncontrolled hypertension causes thickening of the heart muscle which reduces the heart’s pumping efficiency. Kidney failure is also caused by unmanaged high blood pressure in diabetics. Furthermore, uncontrolled hypercholesterolemia leads to increased plaque buildup in the arteries, which may form blockages, and induce a heart attack. The adverse effects of diabetes are immense. According to WebMD (2012), â€Å"complications from diabetes are caused by damage to the body’s blood vessels, nerves or both†. Damage to the vascular system causes blindness from diabetic retinopathy. Retinopathy is caused by the retina dying from insufficient blood flow. Peripheral neuropathy is damage to the nerves in the feet and can lead to open wounds that will not heal. Over time, these open wounds become infected. Left untreated, the wound develops gangrene and the limb needs to be amputated. Eventually, the cumulative negative long term effects of living an unhealthy lifestyle void of heart healthy nutrition and a regime of exercise will culminate to that moment we sometimes hear about — where we are lying on our deathbed and the most prominent thought in our mind is, — I wish I would have. References Ferris, P.A., Kline, T.J., Bourdage, J.S. (2012). He Said, She Said: Work,  Biopsychosocial, and Lifestyle Contributions to Coronary Heart Disease Risk.  Health Psychology, 31(4), 503-511. Straub, R.O. (2012). Staying Healthy: Primary Prevention and Positive Psychology. In  Health psychology: A biopsychosocial approach (pp.167-169). New York, NY:  Worth Publishers. National Diabetes Education Program (U.S.),. (2014). Know your blood sugar numbers.  Author. United States Centers for Disease Control and Prevention Derrher/WebMD, D. (2012). Effects of Uncontrolled Diabetes on Eyes, Kidneys, Heart,  and More. Retrieved from http://www.webmd.com/diabetes/risks-complications-uncontrolled-diabetes South Australia Department of Health. (2012, July 6). The Risks of Poor Nutrition :: SA Health. Retrieved from http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/healthy+living/is+your+health+at+risk/the+risks+of+poor+nutrition Table 1 Pre-change Health Behavior Table 2 Behavior change compared to behavior change goal Table 3 The effect of positive health risk behavior modification on un-healthy controllable health risk behaviors