Strategic Plan For Gnc Essays - Nutrition, GNC, EAS,

Strategic Plan For Gnc Company Background General Nutrition Companies Inc., was founded 65 years ago in Pittsburgh, Pennsylvania on the premise that Americans wanted to maintain control over their health. David Shakirian founded the company. In 1935 he launched a dream of his by establishing a little health food store in Pittsburgh, Pennsylvania. He called it Lackzoom. The products that were offered at his store included yogurt and healthy foods such as honey, grains and healthy sandwiches. The concept of being a health store and serving health food was thought to be a fad that would soon pass over back then. To the surprise of many of Shakarian's critics, many people embraced Lackzoom. David and his store came a long way from its first day's receipts of 35 dollars to open a second store six months later. Since those first two stores, Lackzoom, which is now GNC, has grown to be the largest manufacturer of vitamins and mineral supplements in the United States (1998 Annual Report). General Nutrition Companies, Inc., collectively with its subsidiaries, is the only nationwide specialty retailer of vitamin and mineral supplements, sports nutrition products and herbs, and is also a leading provider of personal care, and other health-related products. The products were sold through 3,757 General Nutrition Centers, 2,531 of which were owned and operated by the company and the other 1,226 stores were franchised. Much of the growth of GNC has occurred in the last 7 years. Since 1992, the Company has opened or acquired in the United States 2,593 new GNC stores (SEC 10k form). The company's initial growth was through company-owned stores located primarily in regional malls. Many of the stores that were created in the past 7 years have been franchises. This franchise initiative has enabled GNC to expand into secondary locations as well as International markets. It appears that there is no end to the growth of GNC. At a Franchising meeting on February 6,1999 GNC awarded an d agreed to open an additional 323 domestic and 428 international franchise locations. All of these stores report to GNC headquarters, which is located in Pittsburgh, Pennsylvania. Pittsburgh is also home to one of General Nutrition's three distribution centers. The other two distribution centers are located in Atlanta and Phoenix. The products that are distributed through these channels are manufactured in Greenville, South Carolina. This facility is one of the largest and most modern vitamin and supplement manufacturing facilities in the United States. Within the coming months a new 600,000 sq.ft. manufacturing plant and distribution center in Anderson, SC will open which will double the capacity of the company (www.gnc.com/about/history). The company has many products that it distributes from their first-class distribution centers. These products include vitamin and mineral supplements, herbs, diet products, food products, personal care, and miscellaneous health care products. These products are sold under the General Nutrition's various proprietary brand names, including Ultra Mega, GNC, Pro Performance, Preventive Nutrition, and Harvest of Nature. In addition, the Company carries various third-party brand name products including Weider, Twin Lab, EAS, and Met-Rx. The company's product mix focuses on high-margin, GNC proprietary brand, value-added products emphasizing vitamin and mineral supplements, sports nutrition and herbal products. The Company has seen amazing growth over the past 5 years. Below is a chart that exemplifies their revenue growth: Company Growth (dollars in thousands except per share data) 1994 1995 1996 1997 1998 Net Revenue?. $672,945 $845,952 $990,845 $1,193,485 $1,417,746 Operating earnings. 97,750 137,116 60,347 191,171 183,337 Diluted earnings per share 0.44 0.78 0.05 1.24 1.18 Operating earnings as adjusted 98,425 138,699 152,413 195,254 194,548 Total Number of Stores 2,115 2,543 3,047 3,435 4,091 Comparable store sales (GNC owned stores, not franchise) 5.80% 10.30% 0.30% 7.90% -0.20% As you can see net revenue increased to 1.4 billion dollars, an increase of 18.8 % over 1997. This increase was driven by the success of the Company's store expansion program and increased demand for the Company's products, as reflected by increased sales, across all business segments. During 1998, the Company developed a web site, GNC.com, to sell products via the Internet. Although still in the early stages of operation, the Company expects sales to increase based on the growth of the Internet. The history of GNC shows their excellence in planning and execution of these

Calculate MD5 Hashing for a File or String Using Delphi

Calculate MD5 Hashing for a File or String Using Delphi The MD5 Message-Digest Algorithm is a cryptographic hash function. MD5 is commonly used to check the integrity of files, like to make sure that a file has been unaltered. One example of this is when downloading a program online. If the software distributor gives out the MD5 hash of the file, you can produce the hash using Delphi and then compare the two values to make sure theyre the same. If theyre different, it means the file you downloaded is not the one you requested from the website, and therefore may be malicious. An MD5 hash value is 128-bits long but is typically read in its 32 digit hexadecimal  value. Finding the MD5 Hash Using Delphi Using Delphi, you can easily create a function to calculate the MD5 hash for any given file. All you need is included in the two units IdHashMessageDigest and idHash,  both of which are a part of  Indy. Heres the source code: uses IdHashMessageDigest, idHash; //returns MD5 has for a file function MD5(const fileName : string) : string; var   Ã‚  idmd5 : TIdHashMessageDigest5;   Ã‚  fs : TFileStream;   Ã‚  hash : T4x4LongWordRecord; begin   Ã‚  idmd5 : TIdHashMessageDigest5.Create;   Ã‚  fs : TFileStream.Create(fileName, fmOpenRead OR fmShareDenyWrite) ;   Ã‚  try   Ã‚  Ã‚  Ã‚  result : idmd5.AsHex(idmd5.HashValue(fs)) ;   Ã‚  finally   Ã‚  Ã‚  Ã‚  fs.Free;   Ã‚  Ã‚  Ã‚  idmd5.Free;   Ã‚  end; end; Other Ways to Generate the MD5 Checksum Apart from using Delphi are other ways you can find the MD5 checksum of a file. One method is to use Microsoft File Checksum Integrity Verifier. Its a free program that can be used only on the Windows OS. MD5 Hash Generator is a website that does something similar, but instead of producing the MD5 checksum of a file, it does so from any string of letters, symbols, or numbers that you put in the input box.

Leadership and Managment Assignment Example | Topics and Well Written Essays - 1750 words

Leadership and Managment - Assignment Example e private sector played have played a major role in the English NHS system.2 The Italian Model of Universalism The Italian model was introduced to cover the shortcomings of the English model especially when it comes to selective coverage. It aimed at focusing on introducing a centralized system of financing to allow the government better control of spending. This model saw the introduction of more decentralized health care service provision and introduction of an internal market. The NHS structure in this model consisted of the national government, the regional level and the local authority level of health care provision. The central government’s major task was to oversee how the regions spend their finances and setting the National Health Fund. The local authorities dealt directly with provision of health care services. The main aim was to reduce interegional disparities inorder to maintain a uniform health structure qithin the entire country. This model was not entirely succ essful as a result of poor motitoring and oversight on the part of the central government. There were also problems with funding and increased unemployment rates therefore people not being able to afford health services. These issues led to passing of new laws that would help bring changes and stability in the health sector. The major aim of the laws was to decentralize financial allocation to the local and intermediary level inorder to better meet the needs of the local citizen. This was argued because the local authority would for example better understand the needs of the society as compared to how the central government would.3 Effective Health care governance Health care governance is the process and srtucture needed to ensure better high quality provision of health care services. For... This paper approves that free communication flow using the bottom up and down bottom approach through provision of accessible information sources is among the key strategies that should be adopted by any healthcare organization. This will ensure free feedback from clients, and to enable the staff or colleagues to understand the organization’s policies, goals and objectives in order to be more motivated and enthusiastic towards better provision of services to the public. Focus should be put on transparency of activities to both stakeholders and colleagues. Transparency in communication also helps in giving the staff a clear picture of their tasks and the subsequent outcome. This in turn helps to build their morale and motivation to put more effort to their tasks. Transparent communication makes the staff feel part of the organization or have a sense of ownership. This essay makes a conclusion that application of leadership patterns can be in any organization that has its goals of success merged with the objectives of profit maximization. Managers in a medium sized organization can apply the remarkable pattern of leadership while doing away with the toxic pattern that could result in the firm’s failure and eventual pull out of the industry. Remarkable leadership could be applied by the human resource manager in the organization acting as a coach and training other managers in other departments to act as role models for their followers. The human resource manager can still establish interpersonal relationships with all employees and other manager.

Research summary Paper Example | Topics and Well Written Essays - 500 words

Summary - Research Paper Example Vascular lesion is considered as its leading cause, but scholars believe that trauma and tumors may also result in AOS. In AOS, there is loss of control in articulation resulting in reduced ability to sequence, time and coordinate the phonemes that lead to speech errors. The articulation is disrupted due to damage in central nervous system. It is characterized by persistent dysprosody or speech having abnormal rhythm, stress and intonation with repeated utterances in order to become articulate. It is often confused with Aphasia or conduction aphasia and Dysarthria. While Aphasia highlights language deficit and cannot select correct phonemes but has speech continuity, AOS uses correct phonemes but cannot articulate due to motor deficiency and therefore, speech is halting and repetitive. On the other hand, Dysarthria affects articulation due to muscle impairment while AOS has linguistic error is due to lack of motor control. There is more than one type of AOS as defined by the damages in different part of brain. The treatment is often focused on speech articulation therapy that is designed to improve intonation and stress through repetition of words and speech sound. Augmentative devices and alternative means like gestures, drawing, writing etc. are used for severe AOS patients. The research shows that efficacy of treatment mainly relies on experimental designs as per the needs of the patients. The study is hugely significant because it has helped to distinguish it from the various other forms of speech disorders. Most importantly, clear diagnosis has helped clinicians to address its intervention techniques. I strongly believe that the paper encourages more in depth study of the subject so that new variant of AOS could be identified. AOS is complex in its characterization and causes. As such, it necessitates early deduction so that patients can use appropriate intervention to bring under control the

Symptoms of Dementia

Symptoms of Dementia 1.1 1.2 a) Dementia and Delirium †¢Ã‚  Alertness: In dementia customers their sharpness is general, they are generally ordinary. In insanity customers the readiness vacillates, depleted and hyper vigilant. †¢Ã‚  Emotion: In dementia customers they are shallow, thoughtless and shallow. In insanity customers they are Irritable, forceful and dreadful. Sleep: In dementia customers they frequently have exasperates rest in throughout the night. They are wanderings all over and befuddled around evening time once in a while. In insanity customers the perplexity exasperates slumber or may have store rest. b) Dementia and Depression †¢Ã‚  Memory and Comprehension: In dementia, customers memory and comprehension are hindered. As infection advancement, long haul memory additionally influenced or lost. In gloom the customers’ memory in some cases weakened. Long haul memory by and large in place and poor consideration. †¢Ã‚  Perception In dementia customers observation is typical; their pipedreams are roughly 30-40%. In gloom the customers recognition is sound-related; their pipedreams are roughly 20%. †¢Ã‚  Emotions: In dementia customers they are shallow, fractious and lax. In gloom: the patients are level, miserable, dreadful and touchy. 1.3 a) Alzheimers Disease Loss of memory is aftereffect of plaques and tangles in the mind that cause the passing of nerve cells. Loss of memory influence the everyday life exercises, for example, correspondence, exercises and security danger. Loss of weight may happen with Alzheimers malady. Case in point: a few patients overlook how to bite and how to swallow sustenance. There is less cerebral cortex which recollect this controls the cerebrum including memory, cognizance, and discourse in Alzheimers patient. The surfaces of the cerebrum adjust and mind cells shrink. There are more plaques looked at inside the typical more seasoned individuals. The liquid filled spaces of the mind increment in size. People with Alzheimers illness have change in their character. For instance: an individual who was obliging and cordial when he has infection will get to be forceful, irate and upset. b) Vascular dementia Vascular dementia is brought about when a vascular occurrence happens denying cerebrum of a sufficient supply of blood and oxygen, bringing about the passing of cerebral tissue. The patients with vascular dementia have passionate switch all over. The patients change in discourse. They talk slower and experience issues in talking. The Patients have disturbance to transient memory, association of contemplations and state of mind. Vascular dementia patients experience issues in strolling. c) Lewy Body Disease 1. This is brought about by a strange vicinity of cerebral cells called Lewy bodies which found all through the mind what creates inside nerve cells. It is believed that these may help the demise of the cerebrum cells. 2. They have tremors and solidness like Parkinsons illness. 3. Memory misfortune: likes other dementia infections. The patients with lewy body illness have influence to short- term and long haul memory. 4. The patients experience issues with fixation and consideration. 5. The patients experience issues judging separations, regularly bringing about falls. The most noteworthy danger element is age. The number individuals found with dementia the age of sixty-five. As the nerve cells got harmed in the mind. Other component can from way of life, for example, hypertension and coronary conduit ailment. The patients have a conceivable hereditary connection that inherited from past era. Case in point if a guardian or kin has a dementia then the persons 1.5 Cognitive effects cognitive impacts lead to dementia patients experience issues with transient memory which can impacts both to individual living with dementia and the individuals around them, for example, a few patients are troublesome after discussion and helping. They are likewise experience issues thinking and are effectively diverted. the patients will have poor ability to know east from west or off and on again loses their ability to know east from west: they experience issues to discover the courses (go to lavatory, can). Functional effects The practical capacity of the customer changes like they experience issues in dressing and different capacities. They need to remind to consume, wash, dress and utilize the latrine and in addition needs help overseeing every day tasks. Behavioral effects They experience difficulty with level of individual cleanliness and dress sense lead to other individuals may be humiliated with somebodys close to home cleanliness or dress sense and would prefer not to be seen with the individual. Their verbal relational abilities are likewise influenced that makes the individuals living with dementia hard to express the things so they begin communicating their needs in some different ways. Psychological effects psychological impacts prompts the patients have changes in their conduct, for example, they get outrage and dissatisfaction and melancholy and in addition they detach themselves and abstain from going out as they discover it excessively hard to deal with the clamor and the other individuals. They lose the inspiration for all exercises of every day living, additionally they feel bore and may have visual mental trips. 2.1 1. Relationship: Dementia patients ought to dependably have associations with relative, companions and help suppliers that is in charge of the social, profound and passionate prosperity. Relationship has an essential part for supporting the dementia patients and it can be produced amid consistently minds and in addition amid sorted out exercises. Help supplier ought to admiration and comprehend dementia conduct. Help supplier and relatives of patients need to keep up their association with dementia customer so that the customer will adapt better and feel valued. 2. Correspondence: Correspondence helps the customer to express about their needs, in the same way as or abhorrence. At the point when speaking with the individual with dementia, compelling relational abilities and non-verbal communication need to be utilized. Help supplier ought to talk obviously, utilizing eyes contact, dont hurry. As an issue with dementia encounters a progressive abatement in capacity to convey. 3. Individuality: Help supplier ought to treat customers exclusively that implies help supplier help every customer similarly and regard them. Case in point, help supplier ought to give customer decision about what they like, for example, garments they need to wear, which exercises they like to do or take an interest. In addition empower the customers freedom however much as could be expected. 4. Feeling: Help supplier need to concentrate on the uniqueness and the rich scope of sentiments and feelings of the individuals living with dementia. Guardians ought to invest time with customers and sway them to discuss their emotions and comprehend them. Anyway dependably utilize a cool methodology to recognize customer’s emotions. 5. Abilities Retained From consideration arrangement, help supplier ought to recognize what exercises they used to like previously. Despite the fact that they are not ready to do the exercises yet the guardians ought to urge the customers to be as autonomous as would be prudent and inspire them to join the exercises of the rest home. Likewise they ought to fare thee well that the customers are getting a charge out of the exercises. 6. Needs of the person with dementia: Physical needs: Person with dementia need guarantee physical needs, for example, consuming, shower, dressing or wear glasses on the grounds that they are not ready to help themselves. Psychological needs: Person with dementia need somebody can convey and comprehend their inclination. Somebody can converse with them and offer with dementia patients. 2.2 Individuality influences PCC of dementia patients. Help supplier ought to take a gander at forethought arrange and realize what they can do, what they like to do and provide for them. Help supplier ought to provide for them what exercises they like to do. Relationship has a part essential for dementia patients. The dementia patients ought to stay in great association with relatives, help suppliers and companions. Relationship for an individual with dementia needs to be minding and trusting on the grounds that just with connections they can adapt better to their malady and feel esteemed and adored. Following the consideration arrangement, help suppliers need to verify that they comprehend and have learning about quiets inclination. Help supplier ought to know how to adapt to customers when they get irate or steamed, cool off patients and fulfill them feel. 2.3 Genuine movement makes opportunities for individuals living with dementia to react fittingly notice use their capacities. Importance exercises will develop with feeling, relationship and feelings. Compelling exercises can trigger memory and capacities. Genuine exercises may be not quite the same as one patient to other patient. 1. Verbal: The customers with dementia have diminishes the correspondence capacities that gets to be most noticeably bad with the progression of time as they are not by any means ready to talk or talk legitimately. They have hard to discover the right word or stuck on the words. They may rehash the same word or expression again and again. They may experience issues in communicating feelings. 2. Vocalization: The customers with dementia cant talk so they convey what needs be by the method for tedious discourse, groaning, creaming and singing. For instance if the customer feels torment then they were shouting or vocalizing. Vocalizations may be troublesome and offensive for others. 3. Gestures: Dementia customers they utilize signals for consideration or say something to help laborer by the motions, for example, tapping, indicating, waving or nodding. The motions of every customer have an alternate significance. For instance when the customer needs to strive for latrine they are tapping on the seat and on the off chance that they need to consume something then they utilize the motion with hands and development of the mouth. 4.Communication aids Communication helps is things helping correspondence in the middle of guardian and customer with dementia, for example, picture book, music, blaze cards. Case in point: a few customers utilize the cards with where they need to strive for visit. Picture book can indicate what they need. In addition, if an individual is not ready to talk that individual may utilize a board to compose words on. 3.2 1. Sensory losses The lost of sight and listening to prompt trouble in correspondence with dementia patients. They will misfortune association with other individuals. Case in point: without glasses, they are cant see non-verbal communication and not able to get significance of correspondence. 2. Communication accomplice: The correspondence accomplices are the individuals who help the dementia customers in correspondence and may be they are not accessible at constantly. The correspondence accomplices may be life partner, relative or companions. 3. Health status: Infections and sicknesses will have a terrible impact on correspondence capacity of dementia patients, for example, Parkinsons ailment and stroke, the patients will have hard to talk obviously. 4. Environment: Environment can be a correspondence obstruction as it influences the correspondence of the individuals with dementia, for example, extensive loud environment, individuals in a room or close-by talking excessively boisterous or excessively quick, and absence of powerful correspondence expertise among human services help laborers. 5. Culture: Society is a variable that additionally influences to correspondence, for example, stress, utilization of motions. Frequently, dementia patients talk their dialect or help laborers dont comprehend the dialect of customers. For instance: Arabic individual conversing with help laborer in it dialect. 6. Age: Now and again its truly hard to comprehend the needs of dementia customers for the more youthful parental figures when the dementia customer chatting with more youthful individual. As some of more youthful they talk quick or talk in more youthful statement consequently the dementia customer misjudged. Elderly age can relate with tangible misfortune and influence to correspondence. 7. Gender: Sexual orientation additionally has impact on correspondence as some male patient use distinctive words with female. This could be a sex boundary like Female patients can without much of a stretch impart their story and issues than male patients. 8. Reverting to original language: At times an individual with dementia talk will return to unique dialect and may review words that others dont comprehend which can be a boundary there would be an issue if no translator is accessible. 9. Expressive and reciptive correspondence issue: The patients with dementia cant discover words to convey. They are not able to express what they need. Open is the point at which they dont comprehend what impart to them, verbal and non-verbal correspondence. 3.3 1. Communication partner Help laborer ought to peruse consideration arrange and verify accomplices are presented with patient. In addition, help specialist verify that patient with dementia are agreeable with correspondence accomplices. 2. Environment: Verify customer with dementia they are agreeable and commonplace questions in their room. In the event that he/she feels good then put sign and images which can be helpful like on the off chance that he needs to go can then he put the finger on the sign. Verify give the sufficient lighting and proper space for moving the customer. 3. Verbal and non-verbal: Help specialist verify that they talk gradually, obviously to patients with dementia to comprehend the non-verbal correspondence, help laborer ought to utilize eyes contacts. 4. Singing: Singing is a system to empower patients with dementia correspondence. Help specialist ought to search for a few melodies in the past which help dementia patient to bring the gorgeous memory. Singing help to quiet down patient with tension and bring back cheerful memory. 5. Music: Music sways dementia patient to impart. Music can lessen tension, unsettling and cool off dementia understanding. Some music can be utilized with fundamental activity of arms or legs that likewise amuse them and urge them to do exercise. 6. Activities: Exercises in day by day living can sway dementia patient to correspond with others. Exercises help communicating their inclination, diminishing uneasiness, provide for them upbeat time. It can provide for them compelling things to discuss and can help to determination unfinished business. 7. Communication helps: Photos, new paper cuttings, memory books all energize correspondence on the grounds that dementia patient can utilize straightforward signs structure them to impart. Checking vision and portable hearing assistants are likewise paramount. PUSHPINDER KAUR

Dreams, Hopes and Life Expectation of the Korean Immigrants: Past and Present Essay

At the beginning of the 21st century, America is filled with millions of immigrants coming from all over the world. Immigrants dream about good life and good education, prosperity and even good friends. Many Korean immigrants dream about social stability and prosperity, well-paid job and social security. Immigration to America allows Koreans to be better positioned in the world and give them a chance to survive and prosper in different environments. Thesis Half a century ago, Korean immigrants came to America dreaming about material success and job opportunities, while today they dream about good education and human rights protection. At the beginning of the 20th century, there was a great gap between economic and political development of Korea and the USA. Korean immigrants came to America dreaming about their own house and a car, good healthcare services and good food. During the middle of the century, new production in America became customer oriented, and tried to meet the needs of a particular groups of customers. Similar to The Rogarshevskys or the Confino’s, many Korean immigrants coming to America supposed that through persistence, hard work and determination they could achieve high social status in the foreign land. These dreams were caused by economic instability and low social position affected Korea. Poverty in Korea was one of the main problems faced by the population. In the USA, Koreans dreamt about good healthcare and dental care. In Korea, political instability and totalitarian regime limited freedoms and rights of the citizens. These factors influenced dreams and expectations of the immigrants hoping for better life and government protection. Also, high rates of unemployment in Korea were more likely to be seen as a social problem than was poverty. In America, Koreans dreamt about their own businesses protected by laws and regulations. For instance, â€Å"millions of start-ups began in the past 20 years during a record economic expansion. But the number of minority-owned companies is growing 17% a year — twice the rate of all companies† (Hopkins 2002). In Korea, the human capital assumed that the inadequate incomes of the working poor were the result of characteristics of the labor market rather than the inadequacy of the poor. In America, Korean immigrants dreamt that working hard for many years they could earn for living and could send some money to their relatives in Korea (Lower east Side Tournament Museum 2007). Today, Korean immigrants come to America dreaming about great opportunities for personal development, social security, government protection, social freedoms and high paid job. For many immigrants, the American dream coincides with humans’ rights, equal opportunities and freedom. Many foreign students suppose that education in the USA opens new opportunities for immigrants helping them to â€Å"become equal† to native citizens and obtain professional skills. â€Å"But the higher level of education clearly gives Asians a leg up in the United States† (Hopkins 2002). Even today, Korean immigrants are satisfied with low paid jobs looking for government protection and support. According to statistical results, â€Å"Korean students comprise 10.4 percent of all international students in the USA. Smith revealed that the Korean government has plans to implement various reforms, including revising the college admission system starting in 2008† (Ten Percent Increase in Korean Students Studying 2007). In this very case, the dream about ‘good education’ is therefore a key element of improved intellectual potential and future career success. Another dream of Korean immigrants is a desire to achieve high social position and fair compensation for their job. From the social point, knowledge and career opportunities give the feeling of personal freedom and mobility so desirable for Koreans. Korean immigrants dream about freedom of choice and freedom of speech. To some extent, knowledge and stable social position embodies personal democracy (Ten Percent Increase in Korean Students Studying 2007). For instance, democracy and absence of physical oppression has allowed creativity and entrepreneurship to flourish. Also, career opportunities mean that everything is possible if you are energetic person who is driven by success. This dream coincides with the slogan of Independence. Although, the main features of ‘the Korean dream’ is the great faith in personal courage that help to realize dreams. In sum, the dreams of Korean immigrants have changed over time influenced by economic and social changes n Korea and new opportunities opened in the USA. Thus, a dream about stable social posit6ion and fair compensation, equal and democratic rights, good education and professional development are still vital. In America, knowledge gives total freedom and guarantees complete control over life. For Korean immigrants, education means absence of restrictions and compulsions, and in correlation with the idea of will, it is the opportunity to act as would be desirable. The immigration to America gives Koreans a chance and hope to change their life. In contrast to the previous age, modern immigration deals with psychological and social factors rather than political or economic. Works Cited 1. Hopkins, J. Asian business owners gaining clout. USA TODAY. 2002. 25 October 2007. 2. Lower east Side Tenement Museum. 2007. 25 October 2007. 3. Ten Percent Increase in Korean Students Studying in the USA. 2007. 25 October 2007.

Experience of Hope Among Caregivers: Concept Analysis Essay

The term hope refers to undetectable strength that permits us to overcome our weaknesses, boosts us up when we fall, and continue to motivate us to move forward in any given situation. The theoretical description of hope is not universal but many shared elements are present in the definition of hope (Herth, 2000). According to Cutcliffe and Herth (2002), review of the literature has shown eight distinct key elements that outline and describe hope, such as, multidimensional, dynamic in nature, essential to life, focused on the future, personalized, part of a process, goal oriented, and connected to nursing (Table 8, p.839). The theoretical background for this analysis is grounded on concept of hope as established by Herth, who based her theory on Stress Appraisal & Coping outline by Lazarus and Folkman (Borneman, Stahl, Ferrell & Smith, 2002). Analysis of concept of hope among caregivers using Walker and Avant approach will expend the understanding of the concept. Clarification of defining attributes of hope, identification of antecedents that affect the insight of hope, discussion of probable consequences of hope, and explanation of the significance of terms will help the author and the reader with sharing of mutual language. Connection of hope to the vital attributes will be shown by the use of model case. Contrary and borderline case will distinguish this concept from other nursing concepts. Review of empirical literature will provide proof of this concept existence. Aims or Purpose In general, analysis of specific concept â€Å"aims to pull apart an interesting phenomenon with a view to understanding more about what it is and how it works in practice† (Tutton, Seer, & Langstaff, 2009, p. 120). The objective of concept analysis is to comprehend what is the concept about and differentiate it from other concepts. Furthermore, in order to modify and explain concept that originates from nursing research, theory or practice a concept analysis is conducted. Concepts are the building blocks for nursing theories and their examination is vital to active and correct implementation (Maputle & Donavon, 2013). In nursing, the concept of hope plays significant part in the plan of care. It is assumed that this concept analysis of hope  among caregivers will help nurse’s acquire better knowledge of the concept and help them implement gained understanding in patient-centered care settings. Accurate assessment of fading hope among caregivers will allow for implementation of supporting interventions. Application of patient-centered interventions, based on acquired findings, will help with delivery of evidence-based holistic care (Duggleby et al., 2009). Literature Review Caregivers of dementia patients face many challenges on a daily basis and their hope is â€Å"very much tied to how the person they were carrying for was doing that day† (Duggleby, Williams, Wright, & Bollinger, 2009, p. 517). The experience of carrying for a patient with dementia is perceived to be distinctive and as vital to the experience as the illness itself. The research has shown that physical, psychological, and spiritual stress is part of everyday struggles among caregivers. Furthermore, their physical and mental health is affected by the experience of caregiving. Hope among caregivers of dementia patients’ balances stress and sense of well-being (Duggleby et al., 2009). According to Herth (2000), hope is â€Å"one of the most essential elements in the lives of people with cancer† and has influence on â€Å"effective coping, especially during times of loss, suffering, and uncertainty† (p. 1431). Contribution from hope to enhancement of quality of life and impact on the progression of disease, among cancer patients, has been noted. Nursing practice has been known for contributing to support people in enhancing and preserving their hope (Herth, 2000). Terminally ill patients perceive hope as a treatment or cure that can extend their life regardless of their terminal diagnosis. They depend on hope for energy to keep moving forward when promising treatments fail to deliver positive outcomes. Hope can offer the capability to tolerate distress and cope with unbearable situation. Overall, â€Å"hope is exactly what is needed to stay engaged in the living while shouldering the burden of an uncertain future† and it â€Å"gives life meani ng, direction, and an optimistic focus† (Johnson, 2007, p. 451). Uses of Concept The concept of hope is vital in terms of disease and health problems. Milne, Moyle, and Cooke (2009) examined the significance of hope for patients  diagnosed with chronic disease, such as COPD. The live of individuals and their family members is burden by chronic illness. Dealing with condition that is chronic, on a daily basis, requires constant life modifications and hope is known for contribution to better understanding of illness and enhances future outcomes. Additionally, â€Å"hope is an intrinsic part of being human; a basic human response essential for life and to have no hope is to plunge into despair† (Milne, Moyle, &Cooke, 2009). Hope has been known as a significant part of patients’ existential needs, especially among patients that are terminally ill. Maintaining hope among home-bounded palliative patients was analyzed by the use of social and psychological approach by Olsson, Ãâ€"stlund, Strang, Grassman, and Friedrichsen (2010). Considering that hope â€Å"is a dynamic experience that is central to attaining both a meaningful life and dignified death†, terminally ill patients, uphold it by conversing about their future and by getting emotional and practical support (Olsson et al., 2010, p. 607). Elements that nurture hope among terminally ill patients include: family support, faith, short-term goal attainment, and presence of symbols that are associated with hope (Olsson, 2010). Defining Attributes The defining attributes of hope are relief of burden and inner strength. Carrying for a loved one, who has chronic or terminal illness, can influence negatively quality-of-life and overall health. The negative consequences, such as physical, social, and economic stress can be defined as burden of caregiving. Caregivers have many roles and responsibilities that can affect that burden. Some of the negative outcomes experienced by caregivers are: â€Å"stress, anxiety, depression, sleep deprivation, physical pain, and other chronic health conditions† (Williams et al., 2013). Additionally, fear of unknown and loneliness are included in the caregivers’ experience. In order to manage every day challenges, caregivers rely on hope as a psychosocial and spiritual source (Williams et al., 2013). Hope as a psychosocial and spiritual source provides support to caregivers during challenging transitions and provides support to improve their quality of life. It is part of the experience of caregiving, especially the uncertainty of the future. In many situations, hope serves as an inner strength to keep going and having an optimistic view of the future. Many caregivers refer to hope  as an inner source for coping with given situation (Williams et al., 2013). Model Cases Caregivers of chronically or terminally sick patients rely on hope during everyday struggles. The following model cases are presented to portray how caregivers experience hope when their loved ones suffer from chronic or terminal illness. A caregiver of a person suffering from Alzheimer’s disease states: â€Å"I think hope is the future, hope is what we do every day of our lives†¦I think hope is to overcome any obstacles that come in our way† (Duggleby et al., 2009, p. 517). â€Å"Hope is what happens to me every day†¦.It is what drives us and gets us up in the morning† (Duggleby et al., 2009, p.517). It is the inner strength that helps us to overcome obstacles on a daily basis. Everyday challenges faced by caregivers can be managed by incorporation of hope into finding some relief of the burden of caregiving. â€Å"The initial cancer diagnosis was just over a year ago†¦A few weeks ago we received bad news that was hard to take in†¦My partner is not showing any emotion and says he accepts it, but I am feeling anger, sadness, and fear. I am still shocked with the soberness†¦I try to be the best person I can be, but sometimes it is hard to find the strength to do that†¦I guess I need to look for hope every day because it is the one part of disease that I can control, unlike how the cancer progresses†¦But I can chose to hope. There may be light at the back of the tunnel yet – every once in a while it sneaks in when I’m not looking† (Williams et al., 2013). Additional Cases Additional cases provide an example of what the concept is not and deliver supplementary clarification (Walker & Avant, 2011). Two additional cases, contrary and borderline, are discussed to provide clarification of the concept of hope. Contrary Case â€Å"Mr. B is a 62-year-old Caucasian who is carrying for 72-year-old Filipino wife with stage IV non-small cell lung cancer (NSCLC). Mrs. B has completed several lines of chemotherapy with disease progression. Mr. B is in excellent health with no chronic health problems, and he works full time as a manager. They have two children and five grandchildren†¦Mr. B and his wife do not see eye to eye on important issues and they have different styles of  coping. Mr. B was raised as a Protestant but does not subscribe to any religion as an adult. Mrs. B is a Catholic and gains support from her faith and church community. Mr. B finds meaning and purpose in life from his family and providing for their needs. He also derives meaning from his work while experiencing the stress of multiple demands on his time. Mr. B has great difficulty coping with his wife’s disease and treatment†¦Mr. B describes waves of emotion and an inability to control his feeling of helplessness, ange r, and fear. He chooses not to share his feelings with his wife for fear that he may cause her more distress. While struggling with many unknowns, Mr. B anticipates being alone in the home the couple has shared for more than 40 years. He perceives that his responsibility as a caregiver is to protect Mrs. B from suffering and negativity (Fujinami, Otis-Green, Klein, Sidhu, & Ferrell (2012), p. E213). This case study presents a scenario of struggling with burden of caregiving. Mr. B has no inner strength to cope with his situation. He feels hopeless and decides not to inform his wife about struggles with his role as caregiver and fading hope. Open communication with his wife about struggles with many unknowns could bring Mr. B some hope and relief from burden of his wife’s disease. Borderline case Some of the critical attributes of the concept of hope are present in a borderline case (Walker & Avant, 2011). The next case offers similar attributes to the main concept . â€Å"A 46-year-old woman, incompletely injured at C5, moving around with the aid of crutches and a wheelchair, described her personal experiences of faith, hope and will power: ‘I really have hope, you always have hope, you just hope to manage a new, little thing, and then you hope to succeed†¦and if you have faith, then you hope and then†¦and all the time you have this (hope) within you, and to keep it (the hope) you need the will as well as the belief that you will make it†¦And she summarized her years’ experience as follows: ‘I really need to have hope. I need both faith and hope to cope with this. And willpower. Because if I give up, I will end up sitting here (in a wheelchair) and nothing can help me† ( Lohne, & Severinsson, (2005), p. 319). According to this case, f aith, hope and will power are relentlessly related. Patients who suffer from traumatic injuries depend on on hope to cope with a new situation. They also need  willpower, faith to hope and effectively cope with lifestyle changes. Antecedents and Consequences The circumstances or instances occurring prior to main concept are the antecedents (Walker & Avant, 2011). Antecedent to hope can be related to crisis. The examples of crisis include: terminal or chronic illness, hardship, harm, a life frightening condition, or a change. Tough decision that needs to be made or a challenge in one’s life could also be an antecedent to hope. Overall, antecedent to hope can be anything that is crucial in persons’ life since hope is exceptionally linked to persons’ life experiences (Stephenson, 1991). â€Å"The consequences or outcomes of hope can be a new perspective† (Stephenson, 1991, p. 1459). Hope provide inner strength, empower and energy in ones’ life experience. Fulfillment of hope delivers encouragement, purpose for ones’ actions, calmness, and relief (Stephenson, 1991). Empirical Referents The theoretical framework offers different structure for understanding the concept of hope. Herth (2000) pursued to establish if theory driven interventions enhance hope and quality-of-life among participants with an initial relapse of cancer. Groundwork for this study was constructed on The Hope Process Framework. Implementation of nursing interventions during group session intended to focus on diverse attributes of hope, such as experimental (searching for hope), spiritual or transcendent (expending the boundaries), relational (connecting with others), and rational thought (building the hopeful veneer) (Herth, 2000, p. 1434). This study has shown that by focusing on the four attributes of hope, patient-centered nursing interventions enhance the level of hope and increase patient’s quality of life. Suitable research instruments are mandatory to assess the concept of hope. In order to measure the level of hope Herth Hope Index (HHI) can be used. HHI is a valuable instrument that is used to measures hope using 12-item Likert-type scale. The level of hope among terminally ill patients was assessed by the use of HHI and Background Data Form (BDF). The BDF delivered information on age, sex, diagnosis, and level of education, activity and fatigue. The results have shown no influence on the level of hope by those variables, moreover, reveling that hope remained stable  (Herth, 1990). Conclusion This paper sought to deliver concept analysis of hope. The understanding of this concept analysis was based on literature, attributes, and empirical evidence. The critical attributes, antecedents, and consequences were identified and empirical reference was provided for better understanding. Hope as a concept is multidimensional and the understanding of hope among caregivers of chronically or terminally ill patients is significant. 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