Cupid Metaphors Essay

In Shakespeare’s play A Midsummer Night’s Dream, metaphors concerning the moon, flowers, and Cupid are prevalent and have a significant impact on the play. The play focuses on a romantic situation between four Athenians: Hermia, Lysander, Helena, and Demetrius. As the story unravels, many comparisons are made to enhance the language and the messages that the characters try to convey. The moon is personified as a chaste woman who can be both gentle and fiery. Flowers are used as romantic symbols with the power to influence love. Cupid is personified as an armed child who strikes people’s hearts even if that love was not meant to be. Various events in the play are compared to the moon, which is constantly being personified as a woman. In the beginning of the play, Hippolyta and Theseus are discussing how they are to get married in four days. Theseus complains about how slowly the moon wanes. He compares the moon to a stepmother and a widow who keeps her stepson waiting for his inheritance because it takes so long for her to die (1:1, 1-6). Theseus is saying that the days are passing by too slowly and he wants to get married already. As the play progresses, Theseus tells Hermia that her life will consist solely of â€Å"chanting faint hymns to the cold fruitless moon† (1:1, 73). Once again, the moon is personified as a cold and barren woman. Theseus warns Hermia that if she chooses not to comply with her father’s wishes, she will stay a virgin priestess forever, living her entire life without a husband or children, just like the moon. The moon is compared to things much more destructive and emotional later on in the play. Oberon and Titania, the king and queen of fairies, have been in a disagreement for a long period of time. Their constant fighting has affected nature adversely, causing spring, summer, fertile autumn, and angry winter to change places. Titania vividly describes their arguments as having caused the moon, the â€Å"governess of floods,† to be pale in anger, filling the air with rheumatic diseases (2:1, 103-104). The moon is personified as a female ruler who controls the tides of the ocean. It is also given the human emotion of anger when it turns pale. When Bottom and Titania are together, Bottom speaks about crying for mustardseeds being eaten by oxen. Titania states â€Å"the moon methinks looks with a watery eye; and when she weeps, weeps every little flower, lamenting some enforcà ¨d chastity† (3:1, 193-195). Titania says that the moon is â€Å"misty-eyed, and when she weeps, so does every little flower in grief for violated chastity.† The moon is again personified as a woman and she is crying because the mustardseeds have been wronged. When it is time for Bottom to sleep, Titania orders her fairies â€Å"to fan the moonbeams from his sleeping eyes† (3:1, 168). The first metaphor â€Å"to fan the moonbeams† is comparing moonlight to a solid substance that can be fanned away. The second metaphor is the sleeping eyes of Bottom. Bottom’s eyes are not literally sleeping. It is Bottom who is doing the sleeping, not his eyes. Flowers are associated with love and emotions throughout the play. Theseus attempts to convince Hermia to marry Demetrius so that she would not have to spend the rest of her life living as a virgin priestess of the moon goddess. He tells her that it is better to live a life with love in it even if it is not the love she originally desired rather than to live without love at all. Theseus says â€Å"thrice-blessà ¨d they that master so their blood to undergo such maiden pilgrimage; but earthlier happy is the rose distilled than that which, withering on the virgin thorn, grows, lives, and dies in single blessedness† (1:1, 74-78). He compares women who are chaste to unplucked roses who wither up and die. Married women are compared to roses that have been plucked and made into a sweet perfume (1:1, 76-78). Oberon desires an Indian prince that was given to Titania by the prince’s mother. In order to obtain the Indian prince, Oberon plans to make Titania fall in love with a beast by spreading the juice of a flower on her eyelids while she is sleeping. He tells the story of how this special flower came into existence. Cupid took aim at a beautiful young virgin queen, but his fiery arrow was put out by the watery, virginal moonbeams and struck a little western flower. The flower which used to be white as milk, turned purple from being wounded by the arrow of love (2:1, 155-168). The flower is personified and given the ability to be afflicted with love in this play. When Titania wakes, she is compelled to fall madly in love with Bottom, clumsy and grotesque with an ass’ head. When he goes to sleep, Titania tells Bottom to stay with her, saying â€Å"I’ll give thee fairies to attend on thee, and they shall fetch thee jewels from the deep, and sing while thou on pressà ¨d flowers dost sleep† (3:1, 150-153). The flowers are compared to soothing objects that can calm people and bring sleep. Seeing Titania and Bottom together, Oberon cannot believe how someone as beautiful as Titania can dote on Bottom, whose looks are repulsive. Before she fell asleep, Titania wove a wreath of fresh, fragrant flowers for Bottom and placed it on his hairy forehead. Oberon cannot stand to see such beautiful flowers rest on Bottom’s hairy temples. Oberon states that the flowers on Bottom’s head had â€Å"tears that did their own disgrace bewail† (4:1, 54-55). He says that the drops of dew that lay in the center of the flowers made the flowers look like they were crying in shame to be decorating the head of an ugly jackass. The flowers are personified as people who can cry and feel degradation. In love with Hermia, Demetrius pushes Helena away. Helena, heartbroken, complains about love and Cupid. She says â€Å"and therefore is winged Cupid painted blind. Nor hath Love’s mind of any judgment taste† (1:2, 235-236). In modern times, we say â€Å"love is blind,† however, in this case cupid is blind. Helena personifies love as a child who does not have any judgment. Cupid is so often misled in making a choice because of his rash judgment. When telling the story of the flower, Oberon says â€Å"Young Cupid’s fiery shaft quenched in the chaste beams of the watery moon† (2:1, 161-162). The â€Å"fiery shaft† is a metaphor used for Cupid’s arrow which can cause fiery passionate love. Fixing the love damage that Puck created, Oberon spreads the love juice on Demetrius’ eyes while he is sleeping. While doing so, Oberon says â€Å"Flower of this purple dye, hit with Cupid’s archery, sink in apple of his eye† (3:2, 102-104). The first metaphor â€Å"flower of this purple dye, hit with Cupid’s archery† is comparing the purple flower to Cupid’s bow. By saying this, Oberon is saying that the flower can â€Å"hit† the same way a bow of Cupid can. The second metaphor of this line is â€Å"sink in apple of his eye.† The metaphor is referring to the â€Å"apple† of Demetrius’ eyes, comparing it to his passions and desires. Love is much talked about throughout the play. Hermia’s father is full of anger and he does not support Lysander and Hermia’s relationship. Lysander tells Hermia that â€Å"the course of true love never did run smooth† (1:1, 134). Lysander is saying that love is hard and it can feel like a long and rough road for two lovers. In Lysander and Hermia’s grief and despair, Lysander makes a speech about the transience of love. Love is â€Å"swift as a shadow, short as any dream, brief as the lightning in the collied night† (1:1, 144-145). Lysander compares the briefness of love to the quickness of a shadow, a dream, and a lightning. He means that with love comes many difficulties, such as pressure from parents, sickness, or death. Lysander goes on to say â€Å"The jaws of darkness do devour it up; so quick bright things come to confusion† (1:1, 148-149). He compares his love with Hermia to something bright but fades away quickly because of the confusion brought to it by time and nature. When asked to give up her child to Oberon, Titania refuses, telling him that this Indian prince was given to her by his mother, a female worshipper. She says â€Å"when we have laughed to see the sails conceive and grow big-bellied with the wanton wind† (2:1, 128-129). Titania is saying that when the sails filled up with wind, they looked like they had big, pregnant bellies. She is comparing the sails of ships to big, pregnant bellies of women. Due to Oberon’s unspecific details on whose eyes Puck was suppose to spread the love juice on, causes Lysander to fall in love with Helena. When Hermia questions Lysander, he treats her cruelly saying â€Å"Get you gone, you dwarf, you minimus of hindering knotgrass made, you bead, you acorn† (3:2, 328-330). Lysander is insulting Hermia, calling her a dwarf, a tiny little weed, scrap, and an acorn. In this metaphor, he compares Hermia to a tiny, unwanted plant, useless scrap, and an acorn. A Midsummer Night’s Dream is encased with many metaphors pertaining to the moon, flowers, and Cupid of the play. As the reader follows the Athenian lovers and the fairies on their journeys, various messages are conveyed through symbols and metaphors. The language and messages evokes vivid images in the reader’s head. The moon is compared to a woman who is capable of controlling time, controlling the seas, crying, and being fruitless. Flowers are symbols of romance, raw human emotions, and fairy magic. The flowers can metaphorically make people feel compelled to fall in love and are also capable of crying and feeling shame in this play. Cupid is portrayed as a controller of love. Just like love, Cupid is a young boy who is irrational. He is a child with a blindfold and wings, ready to take aim randomly, causing people to be afflicted with love. The moon, flowers, and Cupid are the main themes of metaphors presented in A Midsummer Night’s Dream by William Shakespeare.

Literature: a Mirror of Life Essay

In this course you have been exposed to many authors, genres, writing styles and themes. For your Key Assignment, you will reflect on what you learned from the works of fiction, poetry and drama you have read and consider the impact literature has had—and will hopefully continue to have—on your own life. Please write a final paper of 1500 words or more discussing the following questions. Be sure to begin your paper with an engaging introduction and clear thesis statement, develop each point in the body of your paper using examples and quotes from the assigned readings, and conclude your paper with a restatement of your thesis and closing remarks. As always, be sure to maintain your credibility by including in-text citations and a reference list correctly formatted in APA style. Short Stories: Analyze the elements of fiction, including setting, characters, point of view, plot, symbolism, themes, tone and irony. Cite specific examples from the assigned stories for each element. Which of the short stories we read was your favorite, and why? Give several reasons. Poetry: Break down the elements of poetry, including imagery, figurative language, symbolism, word choice, themes, tone and sound. Cite specific examples from the assigned poems for each element. Which of the poems we read was your favorite, and why? Share several reasons. Drama: Review the elements of drama, including setting, characters, plot, stage directions, symbolism, themes and dialogue. Cite specific examples from Trifles for each element. How has reading the play deepened your understanding of live performances, television dramas and movies? Values and Morals: Values and morality have been recurring considerations in many of our assigned works. Talk about personal values and moral codes as they are conveyed in each of the following: one short story (chosen from the Phase 1 or Phase 2 reading lists), one poem (chosen from the Phase 3 reading list), and the play, Trifles. Which of all the works we’ve read is your favorite and why? In what ways do you think it will make a lasting impact on you personally and professionally? Final Considerations: Discuss how literature can provide â€Å"a reflection of life† which can help us understand our own struggles, triumphs, values and moral codes and increase our empathy for others. What  is one thing you learned about yourself this term as a result of gazing into literature’s â€Å"mirror?†

Mandatory external rotation of accountantsoffices Essay

Mandatory external rotation of accountantsoffices - Essay Example In the U.S., the Securities and Exchange Commission is responsible for spelling out audit requirements. The SEC is more focused on internal audit as compared to external mandatory rotation of audit firms. Financial accounting reporting and auditing have been the key areas affected by the European crisis. In an attempt to resolve the predicament, both Europe and the U.S. have tried to come up with rotation. Rotation has been viewed as a solution to mitigate the threats associated with financial independence generated by developed nations (Mihaela et al., 2010). At a time when the world is facing a crisis new audit policy has to be a crucial factor in avoiding losses. Auditors usually find themselves in a fix due to the fact of being familiar with the management and being intimidated by their clients, which adversely leads to long-term client-audit relationship. Over the recent years, the subject of long-term audit and client relationship has raised eyebrows within public and social re alms. Mandatory external rotation of accountants’ offices is believed to increase auditor independence and quality of audit and financial reporting (Velte & Stiglbauer, 2012). On the other hand, external auditing increases the cost of auditing in the first two years. This is because the risk of liability from auditors is significantly high in the first two years than within subsequent years. Due to the audit concentration of the four big companies, external mandatory rotation is almost not realized. The big four has a command on the number of companies they audit each year. In addition, the big four has vast experience in consultancy and have advisory services to attest to it. Therefore, this makes it hard for small and mid-sized accounting firms, which are looking forward to enter into a new market (Velte & Stiglbauer, 2012). In other cases, there have been arguments on the quality of auditing in

Monetary Policy in 2007 Recession Essay Example | Topics and Well Written Essays - 500 words

Monetary Policy in 2007 Recession - Essay Example Notably, the monetary policy influenced the cost of credit and circulation of money. The heightened control of the availability of money promoted a healthy economy amidst the terrible crisis that threatened to reverse the gains the United States had achieved. The Federal Reserve Bank employed vibrant measures of boosting the economy by lowering the interest rates and skillfully controlling the amount of the bank reserves and offsetting the monetary shocks including the financial panic (Blinder & Zandi, 2010). In this respect, the monetary policy averted the economic collapse in the United States amidst panics over the solvency of numerous financial institutions. The Federal Bank adopted a comprehensive action plan that encompassed the lowering of the interest rates. The zero-rating of the interest coupled the decrease in the rates. The bank bought the Treasury bonds, as well as other securities in order to cut the long-term interest rates. In concerted efforts with the Federal Deposit Insurance Corporation that increased the deposit insurance limits, the Federal Bank spearheaded the actions of putting downward pressure on the long-term interest rates (Blinder & Zandi, 2010). The action was instrumental in facilitating the households and businesses to borrow funds. In this respect, the Federal Bank made the money available for the citizens and businesses to acquire during the severe 2007 economic downturn. In essence, the adoption of the monetary policy spurred aggregate demand and the revitalized real economic activities. Arguably, the policy cushioned the US economy from plunging into unprecedented inflation. The significant tightening of t he monetary policy by the Federal Reserve influenced faster economic recovery during the 2007 financial crisis (Carvalho, Eusepi, & Grisse, 2012). The policy shaped the aggregate demand in the United States.     

Wal-Mart, Target and Kmart Essay Example | Topics and Well Written Essays - 500 words

Wal-Mart, Target and Kmart - Essay Example Kmart has a long history; recently it is trying to emerge from bankruptcy reorganization. Kmart is slowly losing its customers to Wal-Mart. Before being bankrupted Kmart was the second best retailer after Wal-Mart. Both companies used different strategies to outsmart each other. They tried different strategies to woo the customers. After coming out from bankruptcy Kmart found that it has lost most of the customers to Wal-Mart and other retailers like Target. Its total net profit also declined considerably. Target took this opportunity to its full advantage and started aggressive campaigning. Though the think tank of Target knew that most of Kmart's customers would go to Wal-Mart rather than coming to Target's stores, they started slashing the prices of the products and announced heavy discounts on them. They used innovative ideas to woo the customers. To maintain its top position Wal-Mart used to slash the rates so that when customers come to purchase the items would buy other products also. These items were termed as loss leaders. Most of the middle class families are Wal-Mart's customers. Target aimed at upper middle class. Because of this stiff competition between Wal-Mart, Kmart, Target, Costco, etc., customer has wide range of choices to choose. Customer can buy products at discount rates.

Assignment two Essay Example | Topics and Well Written Essays - 250 words

Assignment two - Essay Example It would also be wise to talk to the director of the Human Resource department to inform him or her that the ad that was placed in the newspaper had errors (Professional Advertising, 2011). To applicants who applied for the coding position, it would be extremely fair to send them an apology letter telling them of the mistake and how sorry the company feels for inconveniencing them. The firm should also place the old ad in the same newspaper and make sure that it is cancelled and beneath it should be the correct advertisement (Professional Advertising, 2011). In conclusion, the correct ad should also state the cancelation of the previous ad, and explain that the new ad is the correct advertisement. Just to spice up matters, the new ad should incorporate brilliant ideas so that the readers do not get the wrong impression. For instance, the ad could be colorful with easily understood language that would make the reader enjoy reading the

Five Year Strategic Plan Essay Example | Topics and Well Written Essays - 750 words

Five Year Strategic Plan - Essay Example The plan would entail the leadership curve. The medical staff must know that unity of command is of utmost essence under such equations. It will make sure that the staff knows exactly who to follow and what kind of principles and duties lie upon their entireties. Leadership instills in the staff a sense of comprehension that they must work to their end limits and give in their best time and again. There is no room for any hiccups and this must never be realized upon at any level (Owen, 1990). This is the reason why employees should always look up to their seniors whenever they believe that they are in confusion or doubt, and seek prior approval of tasks from the leaders who are in charge of the peculiar situations. Moving on to the next phase of this plan, as a chief executive of the medical center, I need to devote more time towards the different tasks which take place under my eyes. This is because my vision will lead the way for a number of steps that shall take place within the medical facility. If I am not adhering to following the standards, then this would only mean that there is a transgression of sorts which must be resolved at the earliest. My undertakings would let the people know where the anomalies occur and how best to remove them as soon as possible. The plan would also discuss the ethical considerations which must be significantly outlined as far as this medical center’s activities and operations are concerned. This is because ethics is the core basis of the medical and health profession and it cannot be denied its due right. The patients who are most needy and who look forward to receiving medical help and assistance should always be given facilitation no matter where they belong from, what kind of living standards they have or which ethnic minorities they are a part of (Morrison, 2011). This ethical debate has been

Planet Venus Essay Example | Topics and Well Written Essays - 1000 words

Planet Venus - Essay Example Venus is the closest planet to earth both in distance and radius and this proximity has meant that we know more about it than any other planet. As shown below a lost has been discovered regarding the planets formation, composition, and visibility. Picture of Venus Venus was formed approximately 4.6 billion years ago together with the rest of the solar system when our sun was formed in a cloud nebula referred to as the solar nebula (Cain). The cloud nebula must have been destabilized by a strong external force such as a nearby supernova as it began to deteriorate and with its crumbling down many stars were formed including our sun which due to its gravity attracted residue from the nebula that rotated in the form of hot rocks. The rocks would join together to form the planets of our solar system and one of them was Venus. It is believed that Venus must have collided with another huge object that affected its rotation as it the only planet to rotate in a clockwise manner. Proof of this is also seen in the fact that Venus has the longest day in the solar system the equivalent of 243 which is longer than the time it takes to revolve around the sun. In spite of this collision, Venus would still remain the biggest region within its location and it is believed it might have even absorbed the object that collided with it. While Venus is similar to earth in size being 95 % the size of our planet and given their close proximity it is likely that they formed during the same time. Venus does however have some stark differences that have made it be nicknamed earth’s evil twin by scientists. Comparative photo of Venus and Earth by NASA The lower atmosphere of Venus is filled with Carbon Dioxide and nitrogen while the upper atmosphere has a strong presence of sulphur dioxide which makes the temperatures of Venus extremely high due to a Greenhouse effect. With recordings of over 460? Centigrade the temperature on Venus are the hottest recorded on any planet even surpass ing Mercury which is the closest to the sun and the sulfur fumes make the environment acidic as it rains sulfuric acid in the upper atmosphere. These factors make Venus a lifeless planet as the places are highly inhospitable for terrestrial life as we know. The surface of Venus unlike other planets does not have craters due to meteorites and two theories have arisen to explain this: either the gases are so thick that any object that enters the atmosphere will burn up due to the air pressure with the exception of the largest of meteorites, or the planets volcanoes have been erupting frequently and so cover any asteroid collisions that have occurred (Redd). The planet does not have any water on the surface due to the high temperatures but it does have two huge continents that have mainly volcanic plains. Venus also lacks a magnetic field like that of the earth and it is thought that the main cause of this is that the core has cooled down significantly thus lacks many ionized particles . Several projects have been initiated to send probes to Venus so as to explore the planet a significant number of which were done by the USSR during the cold war era where it was competing with USA in the space race. The first successful landing was done in 1970 by the Venera -7 space probes however, several fly by missions had been done before it. The Venera successfully transmitted date from the planet’s surface regarding its composition and in 1975 the Venera – 9 sent the first images from the planet. From then other probes have been sent as well as fly by missions conducted with the European Union sending its own orbiters to study the planet (Anatoly). Photo of surface of Venus from Nasa 2005 Venus is a highly inhospitab

Authorities Having Jurisdiction Research Paper Example | Topics and Well Written Essays - 1500 words

Authorities Having Jurisdiction - Research Paper Example Accreditation and license can be obtained after complying with the requirements set by Canadian Architectural Certification Board- Conseil Canadien de Certification en Architecture (CACB-CCCA) and Canadian Architectural Licensing Authorities (CALA). Terms of Reference The purpose of this report is to profoundly inform the aspiring architects of the preparations and requirements for their chosen career. The report focuses on the authorities with jurisdiction to architectural practice in Canada. Introduction The design and creation of a home is one of the most important things an architect can do (www.raic.org, Becoming an Architect). A home is not just a place made of cement, bricks or wood. It becomes alive, a source of energy and love, of hope and of comfort. It is the foundation where the family share and pursue its purpose. It is where families get together, talk heart-to-heart, and rest. Home also offers privacy and safety. Hence, architects matter because †there’s n o place like home.† Besides home, architects build offices, schools, towers, churches and a lot more. According to the Royal Architectural Institute of Canada (2010), â€Å"architecture is the art, the science and the business of building.† The â€Å"versatile† and talented people with finesse for design, solid engineering skills, and knowledge of the social trends and understanding of codes or laws are called the architects (www.raic.org, Becoming an Architect). It is very important to have a better understanding of the work of the architects. Architects do not just get the title for themselves. They have to earn it. Architects have to abide to the rules and regulations. They are to follow the guidelines set by the authorities who have jurisdiction, impact and influence to their works. This research report aims to have a better understanding of these authorities and their requirements. Discussion Before a person becomes an architect in Canada, he or she needs to meet the requirements of the provincial or territorial architectural regulatory body. In Canada, a document by seven validation or accreditation agencies called Canberra Accord exists to aid the portability of educational licenses between the signatory countries (www.canberraaccord.org, Canberra Secretariat). One of the signatories to the Canberra Accord is the Canadian Architectural Certification Board- Conseil Canadien de Certification en Architecture (CACB-CCCA). There are two purposes of CACB-CCCA. The first is â€Å"to administer the programme of accreditation of the Canadian School of Architecture in accordance with established criteria and procedures† and second is â€Å"to certify educational qualifications of architectural graduates as individual applicants† (www.canberraaccord.org, CACB-CCCA). The CACB certifies the educational qualifications of the graduates of architecture and this certification is the mandatory first step towards licensure and registratio n after graduation (pmeenligne.ca, Certification). Prior to registration or licensure, an examination called ExAC is developed. ExAC or the Examination for Architects in Canada is adopted by all Canadian Architectural Licensing Authorities, except the Architectural Institute of British Columbia, to â€Å"test the minimum standards of competency acquired by an Intern during the Internship period, to ensure both public safety and he professional and skilled delivery of architectural services†

Java zone Essay Example | Topics and Well Written Essays - 250 words

Java zone - Essay Example As a consequence, birds, reptiles and other animal species in these forests have increasingly been endangered as almost all forests are gone only to create space for this lucrative plant. It took the intervention of North America to realize that there has been a significant drop in the number of birds in Central America. As per the reports of the researchers, this is attributed to cutting down of tree previously used as coffee shades. As such, this work pertains to biodiversity more than anything else. The information is similar to the context that constitute of biodiversity. This is due to the reality that most farmers in Nicaragua and other Central American nations have been affecting biodiversity through their own action. In biodiversity, people look at the short term benefit of their action, which similar to the java zone farmers who cut down the forest not caring for the long run impacts. Cutting down the trees negatively affects biodiversity, given that they are natural habitats of some other creatures such as birds, and mammals. Is it right to compromise the biodiversity to increase the sales volume of

Energy Sources Of The Future Essay Example for Free

Energy Sources Of The Future Essay Since Industrial Revolution, the use of fossil fuels has been the main source of power for their extensive use in industries, vehicles and in various scientific discoveries. This is continuing till today especially as some of the energy sources are being used up, but the needs of the current power are on the increase whereas the different sources of the planet continue to deplete. Notwithstanding electricity being generated in the power plants is making extensive use of the fossil fuels. The way human is interfering in the natural process for meeting his varied needs is causing the depletion of the fossil fuels at 50 million times more at the rate, which it is being formed. Coal, Oil and Natural gas are the three forms of energy found very near to the surface of the earth. Coal as a source of energy is being extensively used in United States. Oil is another major source of fossil fuel getting extracted every year in the form of petroleum like gasoline, kerosene, gas oil, lubricating oils, and fuel oils to be used in vehicles. Another form is Natural gas mainly being used is methane and is highly inflammable. All over the world scientists are declaring non renewable form of sources as scarce with the continuous search for the alternative renewable sources of energy like wind, air, sun power, heat etc. These forms of energy sources can be replenished continuously. Renewable sources of energy like solar, wind, biomass etc. are dependent on the solar energy directly or indirectly while on the other hand hydroelectric power is not essentially a renewable source of power because in case it is used in the large scale projects, it can result in ecological damage and irreversible consequences. (Farret Simoes, 2006) In 1991, a national wind resource wind inventory by the United States Department of Energy found that three states of the United States, North Dakota, Kansas and Texas have enough of the wind energy to meet the electricity needs of the whole nation. It was found that wind has much greater capacity to produce electricity than any other form of energy would produce. Much of the advancement made in the designs of the wind turbine since 1991 enabled the turbines to operate at lower wind speeds for harnessing more of the wind energy and for harvesting it at much greater heights. Comparatively very large share of the land area can be utilized for generating wind in very scarce populated wind rich areas like Patagonian region of Argentina, Great Plains of North America, Northwest China, and eastern Siberia. In 2002, it was found that it has comparatively higher rate of generating capacity of around 31, 100 megawatts (electricity forum. com) and is increasing continuously satisfying the needs of 40 million Europeans. Utilization of the wind is cheap, conducive to the environment, available in plenty and best renewable source of power. (Associated Press, 2008) Another form of alternative source of energy being experimented on a large scale is the power of sun. Though rate of solar power striking earth is in a very small fraction yet it provides around 10000 times of total commercial energy used by humans on planet. Solar power is an attractive dominant long-term alternative sustainable source of energy. The benefits are manifold- its availability is limitless, environmental friendly, and can be transmitted to earth from sun without any cost. (National Academy of Engineering, Online) Solar panels constitute most common means for tapping solar energy. Sunlight is converted to electricity through the use of solar cells photovoltaics. No doubt solar panels are used for capturing light energy, scientists are still working for improving methods of harvesting sun’s energy. Stephen Maldonado and his team of Michigan University are working upon the designing those systems that can be used for converting solar energy into chemical bond energy, which in turn can be used for producing electricity. The main disadvantage of solar energy is that it cannot be stored for long period and has to be consumed immediately. To overcome this limitation, they are using plants as model because plants are able to convert solar energy into chemical bond energy for producing chemical fuels so they are hoping to devise that system which is able to store solar energy in the form of chemical bonds for long periods of time. (Steinberg, 2009) Geothermal form of energy may not be as conducive as far as its effects are concerned as compared to solar or wind, but it is also best renewable source of energy for the next generation and is one of the most cheaper forms of energy producing 50 times less quantity of CO2, nitric oxide, and sulfur emissions than other conventional use of fossil fuel power plants with other benefit being not requiring power storage. Geothermal energy is limitless and inexhaustible and â€Å"Geothermal power plants run at 89 to 97 percent uptime, in contrast to 75 to 90 percent uptime being offered from coal and nuclear. † (triplepundit, 2009) There is no doubt of the fact that our future lies in tapping nuclear power responsible for extricating 16 per cent of the world’s electric power. There are around 442 nuclear plants which are under operation in 30 countries with most of them operating in Western Europe and North America. Nuclear power creates no impact on global warming, as their emission level of greenhouse gases is virtually nil. From the uranium mining process to waste disposal including reactor and construction, in the whole of nuclear chain emanates only 2-6 grams of carbon per kilowatt-hour. This is very similar to the wind and solar power. It is a fact that if all over the world 440 nuclear power plants had to be closed down and in place are used the mix of non-nuclear sources, there would be an increase of 600 million tones of carbon every year. Though the nuclear plant is costly affair but it is more feasible if its long terms benefits are seen. (The International Atomic Energy Agency, 2004) Among the other sources of energy Algae is being rendered as an important alternative source of energy to biofuels on account of its higher level of energy contents, and yield per acre and its capacity to grow best in water. Its capacity to grow in water is quite huge. As per U. S. Department of Energy (DOE), algae have a potential capacity for producing 100 times more oil per acre than soybeans. Due it’s a higher content level, oil from algae can get refined into biodiesel, green gasoline, jet fuel or ethanol. Moreover, algae require only water, sunlight and CO2 for its growth. (Donovan Stowe, 2009) Looking at the benefits of the several alternative sources of energy, along with their cost effectiveness and the non pollutant properties, the need of the hour is to put an end to the use of the conventional source of energy and make use of the most cost effective alternative sources of energy. The innovative and technologically advanced use of the gift of nature will create an environment of the fresh air with more comforts for the whole human race. Reference List Associated Press. 2008. Wind energy could fuel future power needs. Retrieved on June 14, 2009 from W.W. W. : http://www. electricityforum. com/news/aug03/windenergy. html Donovan, J. Stowe, N. (2009). Is the Future of Biofuels in Algae? Retrieved on June 14, 2009 from W. W. W. : http://www. renewableenergyworld. com/rea/news/article/2009/06/is-the-future-of-biofuels-in-algae? cmpid=rss Farret, F. A. Simoes, M. G. (2006). Integration of alternative sources of energy. New Jersey: John Wiley and Sons. National Academy of Engineering. 2008. Make solar energy economical. Retrieved on June 14, 2009 from W. W. W. : http://www. engineeringchallenges. org/cms/8996/9082. aspx/

Forms of Contract for Construction Work

Forms of Contract for Construction Work 1.0 Introduction The Scenario A leading manufacturer of confectionery in the UK suffered a devastating fire at their factory in Sheffield. Their insurers have authorised an immediate commencement of the rebuilding work and have been paying a sum of approximately  £1 5m. per month to the insured company as â€Å"Business Continuity† insurance to cover both loss of profit and to allow products to be imported from another country for packaging and sale. The factory site has been cleared using an enabling works contract and it has been decided that an experience single contractor, who is capable of undertaking this type of work would be appointed. It is now the responsibility of an experienced project manager to administer the rebuilding of the factory, which currently is thought to be in the region of  £60m worth. The time scale and who the project manager will use to achieve the delivery of the new building and process equipment to enable the manufacture of confectionery to re-start, including any trials, performance tests and commissioning at the earliest possible opportunity is for him/her to decide. On this account, time of completion and quality is the primary concern and cost is secondary, thus, a form of contract with a procurement route or strategy that would facilitate the construction of the rebuilding to start immediately, while all other preparations (e.g Engineering works) towards the building objective are going on, would be the appropriate or desired form of contract†. Chapter 2 2.0 Forms of contract Standard form of contract for the execution of work and the appointment of consultants are basically used in the construction, Engineering and processing industries. These contracts are prepared by one body in isolation or jointly prepared by bodies representing employers, consultants and contractors. Some of the forms of contracts by these bodies are: Joint contract Tribunal (JCT) forms of contract Engineering Contract (NEC 3) forms of contract Institute of Civil Engineers (ICE) forms of contract Association of Consultant Engineers (ACE) forms of contract Association of Consultant Architects (ACA) forms of contract General Condition/works forms of contact 2.1 Criteria for the Selection of Forms of Contract According to the office of building and development in Australia (1996), there are a variety of forms of contract and procurement route that are available for acquiring a new or rebuilding of building, facilities or infrastructure, which are basically determined by a number of criteria, which are: Type of client Level of involvement required by the client The project size and complexity Speed Time available for construction Risk allocation Approach to the design solution Cost certainty and method of financing the project Specialist input Capacity for variations Ability to change scope of work and Contract Administration Separation of design and management 2.2 Contract Types 2.2.1 Traditional Contract Traditional contracts are the type of contracts that separate the design from the construction stages with consultants leading on design and the contractor responsible for the construction execution. In this type of contracts, a consultant (an architect in most cases) acts on behalf of the client/employer as the contract administrator and most risks are passed to the contractors and sub-contractors. Traditional contracts embraced ‘sort it out latter mentality, where time, cost and other related problems are left to the end of the project, which often leads to dispute. Overlapping of design and construction stages in the traditional contract is not encouraged and there is wide criticism that traditional contracts polarise the parties resulting in extreme inefficiencies and encouraging dispute. However, it focuses on the clients main requirements of design control, time and cost certainty. Most of the JCT, ICE and General Conditions/work contract forms adopt the traditional contr act. According to Holt (2010), examples of traditional contracts include: JCT Standard Building Contract with Quantities JCT Intermediate contract JCT Minor Works Contract NEC Engineering and Construction Contract (option A and B fixed price) 2.2.2 Design and Build Contracts Design and Build contract is probably the recent form of procurement and it is available from most of the contract producing bodies (Keown 2010). In a design and build contract, the client employed consultant to prepare documents outlining his requirement in a form of a brief initial designed scheme (Employers Requirements). A single contractor is then appointed to deliver the designed scheme as required (contractors proposals) by employing his or her own design team and then carries out the execution of the work using both the employers requirements and the contractors proposals. The contractor could also engage the original consultant to complete the design through a novation agreement and term or use his own design team for the purpose, which would be verified by the clients design team. Under the design and build method, there is no independent contract administration rather the employer uses ‘employers agent to administer the contract. Examples of Design and Build proposed by Holt (2010) are: JCT Design and Build Contract The NEC Engineering and Construction Contract (ECC) -Target cost contract with Activity schedule or Bill of Quantities (Main option C). 2.2.3 Non-Traditional (Management) Contracts Non-traditional contracts such as management contracts are specialist forms of contract, where a specialist e.g management contractor or project manager manages the construction activities on behalf of the client/employer. It is suitable for large, complex and fast-track projects such as high-rise buildings. Management form of contract tends to solve the problems associated with traditional contracts by a means of collaborative working and trying to unite the various project participants in order to avoid polarisation. It claims to remove traditional contract inefficiencies and increase cost and time certainty. Construction procurement by management contract requires great care and high level of sophistication by employer and contractor. According to Keown (2010), advantages of using management contract include: It is a quick method of procuring a competitive tendered. It facilitates a quick start of construction activities on the site. Flexibility design activities can extend into the construction period. It gives the opportunity for changes in the scope of work. It avoids polarisation of parties by collaborative work. It encourages early contractor input on the programme, buildability and content of work contract packages. The employer/client has an opportunity to stop the project before proceeding to construction, for a set fee to the contractor. Examples of Non-traditional (management) contract proposed by Holt (2010) are: JCT Construction Management Appointment JCT Management Building Contract The NEC ECC, Management Contract main option F JCT Construction Excellence (CE) Chapter 3 3.0 Review of Different Forms of Contract The JCT, NEC3, ICE, and ACA forms of contract are intended to be reviewed for the selection of a suitable form of contract for the rebuilding of the confectionery factory. 3.1 Joint Contract Tribunal (JCT) 2005 JCT form of contract, which was formerly known as RIBA contract until 1977 was the first form of building contract agreed between architects and builders established in 1931 (Chappell, et al. 2001). The JCT now comprises professional bodies, which are: Royal Institute of Chartered Surveyors (RICS) Royal Institute of British Architects Scottish Building Contract Committee British Property Federation Construction Federation Local Government Association National Specialist Contractor Council Limited The JCT forms of contract embraced the traditional procurement philosophy and are very popular in the UK. According to the survey carried out in 2004 by Royal Institute of Chartered Surveyors (RICS 2006), which was tagged RICS contracts in Use Survey 2004, approximately 78% of construction contracts were procured using JCT in the UK. As noted previously that most JCT contracts are basically traditional contract, they required well- developed design before the construction works to commence. It is a form of contract that is fairly complicated and is always criticised for polarising construction team and encouraging claims; this must always be borne in mind when considering selecting JCT forms of contract. However, it also offers collaborating working contracts like Construction Excellence (CE) that has not been tested in the market (Keown 2010). The JCT 2005, which is the current and updated form of contract, has varieties of procurement methods for small and large projects that are basically intended for building/construction work, particularly in the private/commercial sector depending on procurement criteria being considered. According to Keown (2010), most JCT forms of contract do not have any express clauses on ground condition, thus, they are often amended and include terms that exclude liability for ground conditions. So, JCT contracts are not suitable for: Rail or road related works; Civil or earthworks; Mechanical or electrical plant/installations works; Landscape or archaeological works; and Ecological or environmental works The JCT 2005 various forms of contract use to suit the ever changing construction industry are: The Minor Works (MW) Building Contract This form of contract is very popular and suitable for small construction works, which are relatively simple in nature. It is lump-sum form of contract that based on drawings and specifications, but not re-measurement contact and requires an independent contract administrator. According to Keown (2010), it is suitable for construction work that worth  £100,000 (2008 prices). The Minor Works with Contractors Design (MWD) Contract In this form of contract, which is a version of Minor works (MW), the contractor provides design, which is limited to discrete parts of the works. However, it should be noted that it is not a design and build contract. Intermediate Building Contract (IC) This form of contract is another popular form of JCT contract suitable for construction works of a simple content without complex building service installations (BrunswickIS 2007). It is a lump-sum contract based on drawing and specifications, ranging from  £100,000 to  £800,000 (2008 rough financial prices) (Keown 2010). It also requires independent contract administrator and a quantity surveyor. Intermediate Building Contract with Contractors Design (ICD) This form of contract is a version of the intermediate building contract, which the contractor can provide design that is limited to discrete part of the works. It should be noted that it is not a design and build contract. Standard Building Contract (SBC) The SBC is a modern and sophisticated construction contract, which is suitable for larger projects that value  £500,000 upwards (2008 prices) given by Keown (2010). The SBC requires considerable experience to operate and understand it effectively and an independent contract administrator and quantity surveyor are needed. It is unsuitable for projects with substantial substructure work, excavation and earthworks. SBC comes in three formats: Standard Building Contract with Quantities (SBC/Q) Standard Building Contract with Approximate Quantities (SBC/AQ) Standard Building Contract without Quantities (SBC/XQ) The SBC/Q and SBCXQ are lump-sum contracts based on drawings and specification, if there is a bill of quantities, then these rates and prices are for valuing variations. While the SBC/AQ is a re-measurement contract. All these forms of SBC made provision for the contractor to provide design known as ‘contractors Design Portion, which is limited to discrete parts of the works such as the piling, mechanical and engineering works. However, it should be noted that it is not a Design and Build Contract. Design and Build Contract (DB) JCT design and build is a sophisticated contract requiring considerable experience to be used effectively. The employer/client provides the initial design that sets out his requirement in the contract document (Employers Requirement) and the contractor completes the design (contractors Proposals) and commences the construction work. It is a lump-sum contract that requires adequate time and great care to draft the employers requirements as it does not encourage change of scope or variation without incurring an additional cost. Design and build contract does not require an independent contract administrator, rather the employer/client uses an ‘Employers Agent to administer the contract. Major Project Construction Contract (MP) JCT MP Contract is suitable for large projects, which both the client and contractor are sophisticated and experienced construction parties working on large projects that value around  £10m upward (2008 prices) (Keown 2010). It is similar to Design and Build, where the client provides initial design and the contractor completes the design and commences the execution work. Thus, adequate time and great care are required in drafting the employers requirement as there is little scope for change later.. Prime Cost Building Contract The JCT prime cost building contract is a cost reimbursement form in which the contractor is paid by a fixed fee or a percentage fee in addition to the incurred cost. According to Keown (2010), this form of contract is used where the scope of work could not be defined such as refurbishment work or where the works have to start immediately such as emergency work after fire damaged. In this form of contract, cost of the project cannot be ascertained until the completion, and it could be used alternatively to the NEC 3 ECC Main Options E, which is also a cost reimbursement contract.. JCT Management Contracts (MC) The JCT has two forms of management contracts, which are Construction management form and Management contract form. Both forms require great care and a high level sophistication and experience by the employer and the contractor. They are not popular in the UK but sometimes used on large, complex and fast track projects. Construction Management: In this form, the contractor acts on behalf of the client as only a construction manager to manage the construction work by supervising the trade subcontractors employed by the client. Management Contract: In this form, the main contractor acts as construction manager for the works and employs the subcontractor. The main contractor does not carry out any construction works but manages the work carry out by his subcontractor for a fee plus the prime cost. The JCT Construction Excellence (CE) This form of contract is radically different from all other JCT forms of contract because it is a partnering/collaborative contract newly introduced in 2007 to enter the collaborative contract market that is dominated by the NEC and PPC2000 forms. In JCT CE form, the parties are referred to as ‘suppliers and purchasers and it took the form of traditional two party contract used for procurement of construction works and construction services. The contract terms and condition are short and straightforward, and can be priced either by lump sum or by target cost having a guaranteed Maximum cost facility. What is unusual about this form is that the risk associated with the project is identified and then allocated the risks between themselves, particularly respect to time and cost. According to Keown (2010), â€Å"As of 2009, the JCT CE contract appears to be rarely used, thus, it has not been tested in the market†. In my opinion, JCT forms of contract are not the best option for the rebuilding of the confectionery factory because: JCT forms of contract are basically intended for building/construction work, thus, will therefore, be inadequate in addressing the engineering aspect of the factory. It required well- developed design before the construction works to commence, thus, unsuitable for work that would commence immediately. It is always criticised for polarising construction team and encouraging claims, thus, may not encourage a good relationships among parties involved, which is required for the success of the project. So, JCT forms of contract will not be considered for the rebuilding of the confectionery factory†. 3.2 NEW ENGINEERING CONTRACTS (NEC 3) FORMS OF CONTRACT The New Engineering Contracts (NEC 3) is a family of NEC standard contract launched in 1991 that was revised in 2005 to replace NEC 2 suite that promotes a partnering culture, and has been cited has the preferred form of contract in ‘Constructing the team, a report by Sir Michael Latham (Knowles 2001). The New Engineering Contract (NEC 3) suite adopts a different approach to the procurement and execution of construction engineering through a proactive means to construction problems as the work progress. It is a Non- traditional form of contract that embraces early collaboration of all parties involved to avoid polarisation that is claimed to be caused by traditional form, and also, intended to create an equitable balance of risk between the parties to the contract. NEC 3 is applicable to a wide variety of major and minor construction works, which include: Building and Civil engineering works; Mechanical and electrical plant/installations works; Process engineering; and Offshore fabrication. Some of the ways by which NEC 3 stage proactive features include: Early collaboration and involvement of all parties, which include the client, project manager, contractor, subcontractor, etc. The contractor proposes how to solve arising problems. It embraces parallel activities between the design and construction activities. It gives no chance for storing up of claims until after the work is accomplished. It is better suited for a project that must be completed quickly, even if that faster completion makes the project more expensive i.e. timely procedure/response and programmes are primary and cost is secondary. The pro-active approach that embraces collaboration of all parties and more man-hours administration is emphasised in the first core clause of the NEC 3, which states that ‘The Employer, the contractor, the project manager and the supervisor shall act as stated in this contract in the spirit of mutual trust and co-operation (core clause 10). The NEC 3 forms of contract that are currently in use are: NEC 3 Engineering and Construction Contract (ECC) NEC 3 Engineering and Construction Subcontract (ECS) NEC 3 Engineering and Construction Short Contract (ECSC) NEC 3 Engineering and Construction Short Subcontract (ECSS) NEC 3 Tern Service Contract (TSC) NEC 3 Framework Contract NEC3 Professional Services Contract NEC3 Adjudicators Contract. NEC 3 Engineering and Construction Contract (ECC) NEC 3 ECC is the most widely used NEC 3 contract for appointing the main contractor for building, civil and all other engineering works including any level of design responsibilities i.e. it allows the contractor to provide design (Clause 21). However, it should be noted that NEC 3 has no specific design and build contract. The ECC has six (6) main options and twenty-two (22) secondary options to choose from. The main options are: Main Option A: Contract type priced contract with Activity schedule. Pricing Mechanism Lump sum Risk Allocation Contractor Suitability suitable for contract that the client wants maximum cost certainty but the need for a complete design is important. Main Option B: Contract type Priced contract with BoQ Pricing Mechanism Re-measurement Risk Allocation Contractor Suitability suitable for contract where there are grounds works and there is uncertainty on the final quantities of the work. Main Option C: Contract type Target contract with Activity Schedule Pricing Mechanism Cost re-imbursement with pain-gain mechanism Risk Allocation Shared between the client and the contractor Suitability suitable for contract where there is a need for an early start on site or the design is incomplete or inadequate. Main Option D: Contract type Target contract with BoQ Pricing Mechanism Cost re-imbursement with pain-gain mechanism Risk Allocation Shared between the client and the contractor Suitability suitable for contract where there is a need for an early start on site or the design is incomplete or inadequate. Main Option E: Contract type Cost Re-imbursement Contract Pricing Mechanism Cost re-imbursement Risk Allocation Client Suitability suitable for contract where it is difficult or impossible to define the scope of work (e.g. refurbishment work) or where the construction works have to start immediately (e.g. emergency work after fire damaged). Main Option F: Contract type Management Contract Pricing Mechanism Cost re-imbursement Risk Allocation Client Suitability suitable for contract where both the client and contractor have experience in construction work that has to start immediately. Ø NEC 3 Engineering and Construction Subcontract (ECS) The NEC 3 ECS contract is similar to ECC but used to appoint a subcontractor after the main contractor has been appointed through the ECC. Ø NEC 3 Engineering and Construction Short Contract (ECSC) The NEC 3 ECSC contract is used for small and medium sized simple and well-defined projects that worth up to  £500,000 (2008 price), where the sophisticated systems of the ECC are nor appropriate. It does not have main options, but can be a lump sum or re-measurement contract. Ø NEC 3 Engineering and Construction Short Subcontract (ECSS) The NEC 3 ECSS contract is similar to the NEC 3 ECSC contract, but used to appoint subcontractors after the main contractor has been appointed under NEC 3 ECSC. Ø NEC 3 Tern Service Contract (TSC) The NEC 3 TSC is similar to the ECC and is used for projects where regular work is required from a contractor over a period of time such as the appointment of suppliers to manage and provide a service. A plan or scheduled of work to be carried out is agreed upon by the client and contractor, and then payment is made using any of the options A, C or E. Ø NEC 3 Framework Contract (FC) The NEC 3 FC is a simple contract which is meant to be used in conjunction with other NEC 3 forms that will provide the contracts for call off contracts. It is used to appoint suppliers to carry out construction work or to provide design or advisory services on an ‘as-instructed basis. According to Keown (2010), the JCT framework contract is probably a better choice now. In my opinion, NEC 3 ECC with option E form of Contract is the best for the rebuilding of the confectionery factory base on the reasons given in the concluding part†. 3.3 Institute of Civil Engineers (ICE) Forms of Contract The ICE standard form of contract first edition was established in 1945 for mainly civil engineering and sometimes on building work that involved a large amount of earthwork. It is considered to be a traditional contract that requires a well-developed designed before the construction work can commence and contract administration under this form of contract is similar to that of the JCT. Experienced practitioners sometimes claimed that the ICE form of contract is complicated and not easy to understand, and are also frequently criticised for polarising construction team and encouraging claim just like the JCT form. According to Keown (2010), ICE contracts have different version, which include: Measurement Version Contract: it could be re-measurement or lump sum contract suitable for large civil engineering work that worth  £300,000 (2008 rough prices). Minor Work Contract: it is a shortened form of the measured version suitable for simple works with 6 months duration and up to  £300,000 worth (2008 rough prices). Design and Construct Contract: it is similar to the measurement version, but the employer provides the initial design (Employers Requirement), which would be completed by the contractor (Contractors Submission) and then carries out the construction work. Term Version Contract: it is used where there is variety of construction works or works at different locations to be executed over a period of time. It also accommodates emergency call out type work. Archaeological Investigation Contract: it is a simple contract for archaeological investigation. Ground Investigation Contract: it is similar to measured version and suitable where the employer intends to develop a site and required specialist contractor to perform substantial on-site investigation. Target Cost Contract: it is essential for a cost re-imbursement contract. However, a target cost mechanism option is provided to give the contractor incentives to control cost. In my opinion, the ICE form of contract is not the best option for the confectionery factory because†: It is mainly suitable for civil engineering works and building work that involves substantial earthwork, thus, may not be adequate for other engineering works like plant installation that is required. It requires a well-developed design before construction work could start, thus, unsuitable for this confectionery factory rebuilding situation which the work has to start immediately. It tends to polarise the construction team and encourages claim, which may be a threat to the progress of the work. 3.4 Association of Consultant Architects (ACA) Forms of Contract The ACA forms of contract is a non traditional collaborative contracts introduced in 1982. It is the only multi party standard form construction contract in the UK, where parties including the client, key consultants, main contractor and specialist subcontractors sign up the same contract i.e. all the parties are in a contract with each other, owe each other a duty of care and can sue each other for breach of contract and duty of care (Keown 2010). There is no suggested limit on cost or type of contract which this form is best suitable for because of its flexible accommodation of alternative clauses (Clamp, Cox and Lupton 2007). The ACA has different forms, which are: Project Partnering Contract (PPC 2000): it is a sophisticated and complicated partnering contract, which requires great care in setting up and running, particularly when preparing the project partnering Agreement. Specialist Partner Contract (SPC 2000): it embraces the PPC 2000 procedures and philosophy, but focuses on sub-contracting and relationship between main contractor, main sub-contractors and specialist. Term Partnering Contract (TPC 2005): it is suitable for works and services that extend over a period of time or where there is periodic/planned maintenance and can also accommodate to call out work. Extend the multi-party contract philosophy to Project Partnering Contract (PPC). In my opinion, the ACA forms of contract are unsuitable for the rebuilding of the confectionery factory because it does not give options for which someone can choose from†. Conclusion In my opinion, NEC 3 ECC form of contract with Main Option E and probably Secondary Options 5, 6, 7, 12 and 14 would be the best form of the contract options for the rebuilding of the confectionery factory because: It is suitable for engineering and/or construction work, which includes civil engineering, building, mechanical and electrical plant/installations work, process engineering and all allied industries that are adequate for the rebuilding of confectionery factory. It does not require well- developed design before the construction works to commence i.e. it encourages a parallel operation between the design and construction activities, thus, suitable for work that would commence immediately as applied to the confectionery factory. It embodies an efficient management process and stimulates good management of the relationship among all the parties involved, thus, avoid polarisation of parties involved. Its collaborative working across the entire chain optimises the project success. It uses clear and simple language, which is straightforward and easily understood. The NEC 3 ECC forms of contract with option E: cost reimbursement contract among other options of NEC 3 ECC would be considered for the rebuilding of the confectionery factory pursuant to the information given from the project proposal that it has been agreed that a single contractor would be employed to carry out the construction work and time cannot be spared for a well-developed design, since the construction work has to start immediately. 4.1 Confectionery Factory Rebuilding Project Parties and Organogram For the rebuilding of the confectionery factory, the identified parties that are likely to be involved in this project are: Client/Employer Project Manger Architect Structural Engineer Civil Engineer Mechanical Engineer Electrical Engineer Technology Specialist Quantity Surveyor Quality Assurance Officer Cost Manager CDM Regulator Facilities Manager Planning supervisors Lawyer Main Contractor Building works Subcontractor Mechanical Electrical Services Subcontractor Plant Installation Specialist Subcontractor Suppliers A detail organogram that shows these parties and their contractual relationship is attached below. 4.2 Contractual Relationships and Agreement For the NEC 3 ECC, option E: cost reimbursement contract chosen for this project, with a project manager leading and plan for a single contractor to execute the project, the contractual relationship will exist between: Client/Employer and Project Manager

Recovery Programme For Patients Undergoing An Anterior Resection

Recovery Programme For Patients Undergoing An Anterior Resection The topic I have chosen for my project is the Enhanced Recovery Programme (ERP) for patients undergoing elective colorectal surgery, and whether this aids with early discharge from hospital. I shall discuss traditional pre and post operative assessments alongside the one used for ERP. I will also discuss each of the seventeen modals used within ERP and how when it is used collaboratively can aid with early discharge. I will also discuss any complications that arise from ERP and traditional surgery and if there is any difference to the patient. Within the conclusion, I will discuss the findings and any way of gaining additional knowledge and skills. I will undertake a comprehensive search of literature using the cinhal, pubmed databases and reading literature that is available within the university library. I will use quantitative research to analyse my data and incorporate this and any further learning into my conclusion. During the last four years of my training, I have developed a keen interest in colorectal surgery and this is something I would like to expand on when I become a qualified nurse. I have nursed a lot of patients on the Enhanced Recovery Programme, but I have never looked into this at any great length and I wanted to see if this had any benefit to the patient or even whether it truly did mean early discharge from hospital. In the early part of the 1990s, surgery underwent a drastic change it went from using long lasting anaesthetics to shorter fast acting ones. Combining the new anaesthetics and analgesic methods together with new surgical techniques, a new surgical pathway was created and this seems to have shortened the post operative recovery period. This means that patients could be taken out of main operating theatres as they didnt need as much recovery time. Minor surgical cases were moved to smaller day stay units (Apfelbaum 2002). The term for this new pathway was called fast tracking. Recovery times for patients on the fast track programme were considerably shorter in comparison to those patients that were not. Arguments were bought up to justify the use of fast track surgery such as reduce the nurses workload, reduce hospital costs and improve patient care by getting them back to their preoperative condition more quickly (Watkins 2001). The expansion of fast track meant that more surgical pro cedures were being performed as day cases. The expansion of the fast track concept to colonic surgery was pioneered by Henrik Kehlet, a surgeon of the Hvidovre University Hospital in Denmark. He stated that of 60 patients who underwent a colostomy on the fast track programme, 59 required a hospital stay of two days. In 2001 Enhanced Recovery after surgery (ERAS) group was formed, it was their job to look into the case mix, clinical management and clinical out comes of colorectal patients. What they found was that in Denmark, the length of stay was considerably shorter than Edinburgh, Sweden and Norway who were practicing care that is more traditional. The length of stay within Denmark was 2 days and the other 4 had an average stay of between 7-9 days (Nygren 2005). With the experiences of Denmark in mind, ERAS group developed a new evidence based concept that was holistic in its approach. There are 17 key elements to the Enhanced Recovery Programme (ERP) (appendix1). The 17 elements can be divided into 3 facets Preoperative, Intraoperative and Post operative. Each one of these facets is evidence based and only when they are used collaboratively in elective surgery do they produce a paradigm shift on how we manage our patients. The concept of ERP is to increase patient satisfaction and decrease patient complications. A patient preparing for traditional open bowel surgery used to be prepared in pre-operative assessment for a stay in hospital of around 14 days (Rickard et al 2004); Enhanced recovery patients are being prepared for a stay in hospital of 5 days (Elwood 2008). What ERAS did was to discover that there is a gap between evidence and practice, one of the consistent findings in health service research was what should be done according to scientific evidence and best clinical practice (Bodenheimer 1999). Improving the quality of care increases the amount of patients that are seen each year. This is because the right things are being done in a timely and organised fashion. Preoperative The effectiveness of the Enhanced Recovery Programme (ERP) depends on changing the patients outlook on their hospital stay. Encourage patients to believe that a shorter stay in hospital is a viable option. Department of Health (2009) states that the enhanced recovery uses evidence based interventions both pre and post operative. It is well established that stress levels rise when faced with the prospect of surgery but this concept has recently been challenged by Fearon K (2005a) in which he suggests that elements of the stress response can be reduced or even eliminated with the application of modern anaesthetic, analgesic and metabolic support. The ERP relies heavily on a multi professional approach involving all members equally. Tradition was that doctors gave the pre assessment teaching. But due to time constraints on the consultants, this was often rushed due to the amount of other patients that needed to be seen and not all patients questions were answered. The introduction of nurse specialist pre assessment clinics helped alleviate some of the pressure, and the atmosphere was more relaxed and the nurses understanding of the programme made it easier for patients to follow (Crenshaw, Winslow 2002). It is essential that all patients are well prepared for the operation, not just for a check on their physical condition but also their psychological needs. Looking after the patients psychological needs is an important part of the enhanced recovery programme as it helps reduce the stress of surgery. Patients are counselled on the important parts of the enhanced recovery programme such as early mobilisation and diet resumption. Screening for malnutrition will also take place at this appointment it should include weight, height and the body mass index should be calculated and any unintentional weight loss should be calculated use of the malnutrition universal screening tool (MUST) should be used (appendix 2). It is also reasonable to discuss discharge at this point. A patient being diagnosed with any disease is hard enough to deal with but then to be told you need an operation. Obtaining consent is a vital component to the success of the programme. Gaining consent is more than signing a bit of paper (Department of health 2009). Consent must be given freely and without coercion. All the facts must be given about the treatment and any risks should be discussed. The core ethical principle according to royal college of nursing (2004) is respect for the individuals rights. Gaining consent is a legal requirement. As a nurse the NMC (2008) states that, we are accountable for our own actions so we must ensure consent is obtained before any procedure is carried out. Some patients may not wish to know all the facts if this is the case the consultant in charge of the patients care should document this in the patients medical records, and all healthcare professionals should adhere to this. Patients are encouraged to bring in their own clothes so they are not sitting around in bed all day. Patients with disabilities or who may require more help are also identified at this visit. It is explained in the pre assessment what is expected of the patient after surgery. Clarke (2005) suggest that only forty two per cent of day surgery patients in the UK are currently offered a pre-assessment visit, within my own personal experience a pre assessment appointment is well advised, as this gives the patient time to ask any questions and alleviate any last minute fears. This part of the ERP has not changed from the preoperative counselling for traditional surgery. The preoperative assessment is a critical component of ERP as it gives patients autonomy over their own care. One of the main principles of the enhanced recovery care is that bowel preparation is avoided as this can cause dehydration and electrolyte imbalance particularly in the older patient (Burch, J.2009) a point that is also raised by Holte (2004a) he also goes on to state that bowel prep can also be very stressful. The trust that I am placed only one of the consultants uses bowel preparation usually in the form of an enema as these help prevent post operative constipation and contamination of the surgical area by faeces and is only ever used if a stoma formation is not required. Bowel preparation is still used for traditional surgery with oral sodium phosphate being the most convenient method. However concerns were raised that by not giving bowel preparation this could cause problems post operatively, but these fears have not surfaced (Holte et al 2004b). A recent study by Guenaga (2005) suggested that giving oral bowel preparation can cause anastomotic leaks, and may cause wound infect ions and possibly death. Nil by mouth after midnight originated in 1946 when reports suggested that a higher risk of pulmonary aspiration existed among patients that had general anaesthesia that had not fasted. Reassessment of this tradition began in the 1980s where numerous studies failed to demonstrate that fasting ensured that the stomach would be empty (Crenshaw, Winslow 2002). Also noted was patients that had prolonged fasting would complain of headaches, dehydration, hypovalemia and hypoglycaemia. As a result, in 1999 American Society of Anaesthesiology developed guidelines that support a more liberal preoperative fasting protocol. The original belief of nil by mouth (NBM) from midnight before surgery is still widely adopted for some surgical procedures and is still applied to some elective cases (Maltby 2006).Consumption of oral fluids up to 2 hours prior to surgery is known to reduce post operative vomiting without any adverse effects, contrasting with patients that are starved normally prior to surgery (Khoyratty, Bhavik, Ravichandran 2010).There are several elements of the programme that are important, one element is the careful use of fluids, traditional surgery uses too much (Burch 2009). It is documented that hyperglycaemia increases diabetic complications, in a study by Nygren et al (1999) also found that patients that werent Diabetic had the same amount of glucose within their blood work as patients with type2 diabetes. Patients on the enhanced recovery programme are given two clear carbohydrate drinks to take: 800mls is taken the night before surgery, 400mls is to take with breakfast (Grover 2010) this reduces the preoperative thirst and hunger but it also reduces post operative insulin resistance, therefore patients are in a better anabolic state to benefit from post operative nutrition, The Carbohydrate drink consists of 12.6g of complex carbohydrate in the form of Maltodextrin Nygren et-al (2006). Having these carbohydrate drinks is the equivalent of having 2 roast dinners. A patient on a morning list must not eat after midnight but can have clear fluids until 3am. In contrast, consumption of an appropriate mixture composed of water, minerals and carbohydrates offers some protection against surgical trauma in terms of metabolic status, cardiac function and psychosomatic status. Oral intake shortly before surgery does not increase gastric residual volume and was not associated with any risk of as piration. For normally nourished patients restoration of gastrointestinal (GI) function is one of the primary goals of post operative care. A recent study by Khoyratty, Bhavik, Ravichandran (2010) found that many of their patients voluntarily fasted longer than was given in the written instructions this is not advisable as this can cause post operative complications and can delay the healing process. This was also noted by others (Baril Portman 2007). Food and drink is a basic need and is needed to sustain life and aid with the healing process. A patient will routinely have a catheter inserted on the operating table and close monitoring of Urine output is vital, minimum output per hour is usually 35mls if it reduces then the team should be called because understanding fluid management is vital for the ERP to work. Intravenous fluid will have been prescribed avoiding normal saline and ideally stopping after 24hours (Billyard et al 2007). Fluid balance charts are vital as 60% of a males body weight and 55% of a females body weight is made up of water and electrolytes; one third of this fluid is extracellular (ECF) and two thirds intracellular (ICF). A reduction of 5% in total will result in thirst and thus considered to be mild dehydration (Welch 2010). Inadequate fluid intake or fluid loss can also cause dehydration. Patients who have had major abdominal surgery will have some fluid loss. With reference to preoperative and post operative patients Intravenous fluid on traditional surgical patients were given 3.5 to 5l of intravenous fluid on the day of surgery (Tambyraja et al 2004) however recent studies have found that providing no more fluid than is necessary to maintain fluid balance (for example a patients body weight), as this reduces post operative complications thus reducing a patients stay in hospital (Brandstrup et al 2006).For more traditional surgery the patient would normally be on restricted oral intake but this is not the case with ERP so monitoring intake is vitally important. Poor urine production can lead to renal failure and electrolyte imbalance. Monitoring fluid balance is important because as nurses we need to carefully monitor a patients input and output, as poor monitoring can lead to poor outcomes. The hourly catheter bag is changed to a leg bag on day 1 after the operation to make it easier for the patient to mobilise but strict fluid balance must be maintained (Burch J 2009). This should include stoma output if a patient has had a stoma. The catheter is usually removed on day 2 post operatively as long as there are no post operative complications and strict out put is still monitored. While fluid balance charts are a good and useful tool for monitoring fluid balance they are only as accurate as the data recorded on them, another good way of monitoring fluid loss or gain is to weigh a patient, as 1000mls is equivalent of 1kg any rapid weight gain can be directly related to a change in fluid status. The detrimental effects of fluid imbalance can be life threatening, therefore the importance of strict monitoring and accurate recording can not be stressed enough. Nursing staff of all levels should strive to complete fluid balance charts as fully and as accurately as possible. Traditional surgery required starving a patient the day before surgery. When a patient returned from theatre they were not allowed to eat until the Surgeon could hear normal bowel sounds and sometimes this may not happen for 4-5 days post operatively. So a patient could be starved of anything to eat and drink for as long as a week. A patient undergoing colorectal surgery may already be malnourished and the complications following surgery are greatly increased. Malnutrition can affect every tissue, muscle and organ within our bodies it can also have an affect on our psycho-social welfare (Todorovik 2003). National Institute for Clinical Excellence (2006) state in their nutritional support in adults that malnutrition is usually caused by physical factors. A recent study into nil by mouth versus early feeding found that of 837 patients that met with inclusion criteria found that early feeding reduced the risk of any type of infection although the risk of vomiting was increased (Lewis, e t al 2001). Patients on the programme are encouraged to drink and eat straightaway if they feel like it. Usually sips of water are offered and if tolerated they are offered nutritional supplements to drink, usually one about an hour after surgery, if this is tolerated then another will be given and left for the patient to drink at leisure (Fearon 2005b), Billyard (2007) contradicts this and states: the patient should drink at least 2L including three nutrition drinks on returning to the ward. Once a patient can tolerate fluids without vomiting or feeling nauseous, they can progress on to solid foods usually something light. A concern for surgeons was post operative ileus (POI). POI is a well recognised consequence of any abdominal surgery and is frequently experienced by patients, Leir (2007) states that it is not a life threatening complication but is a costly post operative complication. POI is defined as a transient impairment of intestinal motility after abdominal surgery (Han-Geurtz et al, 2007).There are many factors that have shown to increase its progression such as Local intestinal inflammation Anaesthetic Agents Over hydration Post operative analgesia(opiates) Reduced mobility. POI along with nausea and vomiting are the most common complication. POI can be minimised with the use of epidurals. Scoop et al (2006) stated: that mid-thoracic epidural is considered the pinnacle of the enhanced recovery programme. Although it is possible to use Patient Controlled Analgesia (PCA), Morphine can increase the risk of vomiting it can also cause the bowels normal peristaltic movement to temporarily paralyse. Recent research in to POI and the different approaches to treatment found by giving a patient chewing as a form of Sham feeding (making the body think it was eating) helped with gut motility. Schuster et al (2006) found that gum was an inexpensive and of some benefit after colostomy formation. Five randomised trials of chewing gum to restore the natural gut motility found that patients who were chewing gum passed flatus 24% earlier and had bowel movement 33% earlier, which shows a significant and positive conclusion of early discharge which on average 17.6% earlier than those that did not have the chewing gum (Chan and Law 2007). POI is usually diagnosed with symptoms of nausea and vomiting along with abdominal distension, pain and the failure to pass flatus or faeces. Parnaby et al (2009) found although flatus and faeces were passed earlier in patients who chewed gum it did not have any bearing on early discharge or post operative complications. If tachycardia is present then other causes should be excluded. The treatment for POI is inserting a nasogastric tube (NG) although one is inserted during the intubation process during surgery it is removed as soon as the surgeon has finished operating because there is good evidence to suggest that leaving a NGT in place can cause pneumonia (Cheatham et al 1995). Once a diagnosis of POI has been made, all oral intake should discontinue, and the patient should be removed from the programme and the traditional approach should commence. Patients are encouraged to take regular anti emetics to aid the patient with early return of oral intake the trust that I work cyclizine is the anti emetic of choice. Post operative pain is always a concern this is why Professor Kehlet designed the ERP because he believed every patient deserved to have a pain free recovery. For patients to understand pain nurses need to be able to educate the patient. Biggs (2009) states that less than 1% of university education is spent on pain and the effects of pain. It is vital that nurses have an understanding of pain physiology in order to educate our patients and in turn increase patients knowledge and reduce anxiety, increasing patient satisfaction. Regular pain assessments should be maintained at rest and on movement by a competent nurse (DH2009). It is stated by Vickers et al (2009) that pain should be classed as the Fifth Vital sign. In postoperative patients on ERP, it is vital that nurses monitor pain because pain can reduce a patients motivation for all the other parts of ERP. Concerns have arisen about the use of thoracic epidurals as the analgesia of choice due to immobility and urinary retention, but if inserted high enough in a thoracic position it is possible to mobilise safely and with fewer side effects such as constipation, this means that opiates which have an adverse effect on the bowel can be avoided and again this can facilitate to an earlier discharge. 1 gram of paracetamol is given 4 times a day and is given in conjunction with PCA or epidural, this is also part of multimodal approach. Also, the afferent nerves are blocked resulting in less stress response less gut paralysis and a decreased risk of pulmonary complications (Jorgenson et al 2000). The epidural dose is reduced 48 hours after surgery, and once epidural is running at 2mls per hour then a trial without epidural should commence and pain reassessed after 1 hour if minimal or no pain then commence co codomol 30/500 every 6 hours and oral Non Steroidal Anti Inflammatory Drug (NSAID) diclofenac 50mg every 8 hours (British National Formulary, 2009) with this in mind the consultant can prescribe a mild laxative for patents as this will avoid constipation although this is not the case where stoma formation occurs. Alternatively, at the anaesthetists request oral paracetamol 1g 6 hourly may be given also diclofenac 50mgs 8 hourly and 10-20 mgs of Oxynorm every 2-4 hourly. As a nurse I am aware of the importance of pain management within the ERP because psychologically a patient in pain will not feel like eating, or mobilising so keeping on top of pain by using trust pain charts and ensuring that pain relief is delivered on time helps reduce anxiety. In theory, there is not hing stopping nurses from giving paracetamol or co-codamol every 4 hours during the day as making the patient comfortable will aid sleep meaning that paracetamol or co-codamol will not be needed between midnight and six in the morning, it also means that extra pain relief may not be needed thus reducing post operative complications. On saying all of this post operative pain is believed to be at its worst directly after surgery and the intensity is expected to diminish over time (Buyukilmaz et-al 2010), the World Health Organisation analgesic ladder (2007) is used in reverse for surgical patients. on return from surgery patients, initial observations should be taken by the trained nurse so she has a baseline to work with. All further observations should be meticulously maintained as per any hospital policy. The use of Bair huggers during surgery has reduced the incidence if hypothermia during the operation it is important to maintain a constant core temperature as it was found that all of the anaesthetics used during operations caused hypothermia also there are several non pharmacological reasons that warrant the use of Bair huggers for example shaving the surgical site (Sessler and Akca 2002). Wound infection is a serious and costly complication. During colorectal surgery, the incidence of wound infections increases to 10%. Ikeda et al state that all incidences of wound infections occur during the first two hours of any surgical procedure. The primary connection between hypothermia and surgical site infection (SSI) is vasoconstriction because of a decrease in tissue oxygenation and if a patient is immunosuppressed which most colorectal patients are this can also cause SSI. Blood loss during surgery can increase the risk of SSI due to blood transfusions during surgery. On return to the ward from recovery the nurse in charge of the patient must ensure that the wound site is checked for bleeding and check the dressing for any sign of strike through the nurse would expect to see some excess on the dressing but it should be regularly monitored so any problems can be found early. Port sites where a patient has had laparoscopic surgery should be checked. When a stoma has been formed, the nurse should look at the site making sure it is pink/red in colour and it is warm and there is no excessive bleeding. Wound infections can delay discharge so any problems should be found early reported to the patients team and the correct antibiotics can be prescribed early and may only delay discharge by 2-3 days. Anti thrombotic prophylaxis is a must within colorectal surgery; treatment is usually commenced the evening following surgery and continued on a small maintenance dose of 40mg of enoxaprim (Dylan 2010) until the patient has regained full mobility. There are no further advantages in general surgery for extended use of enoxaprim but there are advantages for patients undergoing orthopaedic surgery. Associated use of low dose heparin and continuous use of epidural analgesia is open for discussion as there have been reported cases mainly in the United States of epidural haematomas (Tryba 1998). A patient undergoing stoma formation under ERP pathway can have their discharge delayed due to teaching, on how to care for the stoma. Although pre-operative teaching does occur, the reality often does not sink in until after the operation. The stoma nurse specialist will see the patient on the day after the operation. The patient returns with a clear see through bag so nursing staff can see when t he stoma becomes active. Teaching begins at the bedside where the patient may only want to observe the proceedings, but all of the time the stoma nurse actively encourages the patient to take note of the proceedings. Psychologically the patient may need lots of reassurance as to them this is not natural (Rust 2007). A patient with a stoma should plan for a stay in hospital between 5 -10 days and it usually takes this long for a patient to be able to manage their stoma. To become self caring with a stoma is the patients biggest psychological battle (Bekkers et-al1996). So on my understanding of the research available stoma formation does infact delay discharge by four days depending on the patient and his/her ability to manage. Patients are not always proactive recipients of care (Ellwood 2008). Early Mobilisation is important to reduce complications such as chest infections. Chest infection rates have dropped from 4% to less than 2% this is because patients are not laying in bed for days. Bed rest not only increases insulin resistance it also decreases muscle tone and in addition, there is an increased risk of thromboembolism. On the ward, the physiotherapist has a book which nurses can refer patients and patients should be seen on day 1 following surgery. Patients are encouraged to sit in the chair for two hours on the day of surgery to encourage deep breathing (Francis 2008). A care plan should be formulated with a specific mobilisation plan incorporated. It is essential that a patient should be nursed in an environment that encourages early mobilisation. Anti embolic stockings are also prescribed. The stockings facilitate venous return from the lower extremities. They also provide venous thrombosis. As nurses, we should make sure the patient is lying down as this allows the veins to relax. The stockings should be removed at least once a shift, so that the nurse can inspect the patients legs and feet for any signs of redness as the skin around the heel can break down very quickly. Encourage leg exercises every hour during the day. Muscle contractions compress the veins, preventing a clot. Contractions also promote arterial blood flow. The introduction of the enhanced recovery nurse has been invaluable not only for the patients but also for staff. The role of the ERP nurse (ERPN) is fundamental to the programme as she/he co-ordinates patient care from the beginning. The ERPN works freely within the colorectal team seeing patients in clinics. He/She helps the patient through their hospital admission reinforcing the goals and liaising with hospital ward staff. ERPN works closely within the surgical team, colorectal cancer team and stoma nurses. The biggest challenge for the ERPN was changing the practice of nursing staff on the wards repeated teaching sessions with all new nurses and doctors with regular feedback and all new updates to the programme (Elwood 2008). Unfortunately, within the trust I am placed the already busy colorectal cancer team initiate all of the teaching, ERP has become a large part of the daily schedule within the trust that a need for an ERP nurse is deemed necessary and funding for the post has become available. Although regular care pathways and protocols are in place, an integrated care pathway was drafted but due to increased pressure from our consultants the document was abandoned, and deemed unworkable but after reviewing the evidence it seems to be used within most other trusts that incorporate the ERP as part of their surgical planning. Nursing interventions within the ERP can influence the out come so it is important that the nurse looking after the patient has the most up to date knowledge and skills and able to detect when a patients condition deteriorates. Another useful tool is a patient diary so that the patient can keep a record of when they got up so the patient is aware of when they can get back into bed. On the first day of surgery, the Patient should aim for 2 hours and then 6 hours until discharge (Fearon et al 2005). Patients are encouraged to walk 60 meters from day one post operatively. To enable continuity of care nurses need to consider the clients needs for assistance within the home. Discharge planning begins even before the patient comes into hospital; the process is usually started at pre admission clinic. The nurse will take a full social history; this is obtained so nursing staff on the ward are aware of any social problems. Fearon et al (2005c) stated that patients are fit for discharge after the following criteria has been met Have good pain control with oral analgesia Are eating solid food and no Intravenous Fluids Are independent with all ADLs And willing to go home All patients should be discharged with an information leaflet including a telephone number of the ward in case they have any problems. In some of the trusts, an enhanced recovery nurse specialist post has been created and on discharge, the ERPN will telephone the patients on the programme at home to allay any fears and to check that there are no post operative complications. a telephone helpline has been set up at one London hospital so that patients can have direct contact with someone during out of hours and they are hoping that this will reduce the amount of AE admissions. The ward I worked on would refer all patients on the ERP to the district nurse with first visit being on the day of discharge, making sure that the referral form states that the patient is currently on ERP. Patients can telephone the ward if problems occur within the first 24 hours. Because patients on ERP are discharged earlier, this means that potentially serious complications can occur at home for example ana stomotic leaks (King et al 2006). Therefore, it is important that patients have a port of call once they are home and within the community setting. The need for support at discharge is also unlikely, compared to a patient who has traditional open surgery Readmission rates for patients on ERP shows that from 1998-2008 334 patients of which 99 (30%) were on ERP and 235 were not (Larsson et-al 2010). The 99 on ERP tolerated soft diet approximately 2.5 days earlier than those not on ERP and were discharged at least 2 days earlier from hospital. Recent research done by 2 Doctors searching the colorectal cancer data base for the trust found; ERP has reduced the length of stay by 3 to 5 with no change in mortality or readmission, the best results came from a gynaecology ward where the nursing staff followed the ERP care pathway in its entirety. Conclusion Traditional Perioperative procedures and prac

boeing case study :: essays research papers

Summary William Boeing founded the Boeing airplane company in early 20th century. After strings of acquisition and mergers, this company grew and became the current largest world aerospace industry. Followed by previous reorganizations in 19990s, this company decided to start its branding campaign in May 2001. This campaign was consisting of lots of effort and structural changes for the first time in this corporate history. The media was showing the initial success of this campaign just after its beginning. Few days after the grand opening of the new headquarter in Chicago, which was part of campaign, the world shocked by the act of terrorism. On September 11, 2001 terrorist used this company’s product as weapon of mass destruction to massacre innocent people. Four Boeing airplanes used by terrorist caused a great concern for this company about its swinging campaign. Some serious decision needed to be taken about branding process. Problems Although Boeing’s top management considered this company as a top global brand, critics believed this company did not make adequate changes in regard to its growth, in other words, did not adapt itself to 21st century. Public was thinking of Boeing as a traditional company which does not promote its public image as other similar corporation does. Business Week’s survey suggested that Boeing received no rank among top best 100 companies by public in year 2000. In order to catch up with global growth, Boeing started its branding campaign a bit too expansive and no body predicted such a disaster on septer11, 2001, which caused lots of problems for this company. Goals Boeing moved for right track. They decided to compete with other global brands in terms of public image and goodwill. As Phil Condit, Boeing CEO and chairman, announced at Farnborough air show in 2000, this company goals are focusing on: running healthy core businesses, leverage the company’s strength into both new products and services, and open new frontiers. Achieving these major goals can improve Boeing public image both domestically and internationally. There are other areas of weakness existed within this company such as adaptation to new business and communication methods. Boeing must have more participation in areas of public to prove that it is seeing beyond the traditional boundaries. Solution For achieving its dreams, Boeing needs a total restructure and re-branding campaign. These processes require Boeing a precious plan and research. These plans can guide Boeing thorough its restructure, it can reveal the weakness areas and it can ease the whole process.