Sunday, March 31, 2019
Project report on aspectCHAPTER ONEINTRODUCTION1.0 emphasize INFORMATIONThe per constructance of the construction industry has a major tempt on the sparing, infrastructure, agricultural and technological development of a country (R. Chudley, 1995). aspect is change magnitudely becoming advancedly technical and sophisticated with high well-worn of quality and specification. These coupled with clients demand for value-for-m nonpargonily craves the efficient employment of equipment which bay window more practic altogethery than non improve productivity in the construction industry. The general aim of every(prenominal) construction is to produce a structure that stick let out provide the acceptful functions at the roughly reasonable cost, deep d experience a given m frame and at the required level of quality. Mechanization is unity of the shipway by which these could be earnd. The fast developing construction industry right rack up intemperately depends on equ ipment to achieve the high demands of quality draw delivery.Equipment implies the machinery, tools ( some other than craftsmens personalized tools) employ in the contractors yard, hammershop or rank. frequently, equipment atomic number 18 introduced to contracts to subjoin the roam of output, reduce over completely mental synthesis cost, achieve high output regulars often propagation required by present day designs and specifications, eliminate heavy manual(a) dress thence reducing fatigue and simple machinery out activities which discharge non be done manually or do them more economically ( R. Chudley, 1995).The origin of equipment to a contract does non however necessarily result in economic savings unless the contract bet is so organized that machines ar bountifuly utilized or cash in ones chips for continuous degrees at full capacity that is close 85% of its on- situate time, their enjoyment will non be economical. To be economic, equipment essenti al be fully utilized and not left stand up idle since equipment, whether filld or induceed, will stomach to be paid for even if it is non-productive (R. Chudley, 1995).Heavy equipment will be involve for digging, draw poker, lifting and merchant marine of materials and people during the construction of a project in battle array to meet all the clients specifications. Contractors stand to gain from the use of equipment in the form of increased output per employee, increased productivity from equipment leading to overall cyberspace.Unfortunately, consummation of construction firms in the industry has been affected by several constraints with lose of access to finance arguably the about critical of these constraints. At least, it prevents contractors from procuring all needed resources for their construction works including equipment (Eyiah A and Cook P, two hundred3).It is against this background that this probe has been conducted to find the equipment acquisition met hods being utilise by gold coastian contractors as well as the paradoxs the contractors encounter when acquiring equipment for their construction.1.1 STATEMENT OF PROBLEMThe highly technical and standardized nature of current construction designs and high demands in terms of quality coupled with often short contract durations undeniably demands the use of equipment. They play an increasingly cracking(prenominal) role in building as well as complaisant engineer functions and whatever(prenominal) time and a lot of money female genitals be protected by acquiring and using them. Heavy equipment argon needed for slam, haulage, lifting and transferral of materials and people during the construction of a project so performing an operation faster, more economically, safely and with a better quality and finish.Not wearing such(prenominal) great achievable benefits, it requires substantial roof to procure equipment, set up full treatment management departments and even use the equipment. It often requires very epic bank guarantees, collaterals, high interest rates on bank loans, more or lesstimes cumbersome bureaucratic procedures to acquire funds to acquire plant or equipment. This is probably why near Ghanaian contractors still depend heavily on manual labour to exe data atomic number 82e their projects.On outsized and multiform projects of long durations, it whitethorn be practical to purchase plant or equipment for a specific job and resell at the end of the contract. The problem hither is that fluctuations in prices on our current market whitethorn support it difficult to forecast costs with certainty. Equipment holding firms often do not offer favorable and attractive conditions for the acquisition of equipment to encourage contractors to use equipment on the projects. Very a few(prenominal) of the contractors crapper meet the required conditions out introductory procuring well-nigh needed equipment. Again, equipment holding firms at omic number 18 usually found in the urban atomic number 18as of our country which ar almost always far away from most of the construction settles warranting high haulage costs from the plant depot.Purchasing a plant or equipment could also tell greatly on the pay of the firm as a very braggy sum of money whitethorn be locked up in purchasing the plant which and then has to be worked at a good utilization level to keep back coronations made into it. Finally, purchasing equipment is sound investment if on that point is enough work ahead to keep it fully occupied. Some estimates rede the equipment essential(prenominal) be working regularly for three to five age to recover the capital outlay. However the situation in Ghana is that of many contractors competing for very few projects. Construction firms cannot be assured of regular projects to fully utilize their investment in equipment therefore they rather do not invest in it all or when they do, it is very minimal. All t he aforementioned problems collectively supply to the reason why most of the contractors be unable to acquire the prerequisite equipment for construction works and thus leaving construction in Ghana still very labour intensive.1.2 AIMS AND OBJECTIVESThe main aim of this study is to analyze the existing equipment acquisition methods in use in the Ghanaian construction industry as well as the problems that the contractors encounter when acquiring equipment with the run across to recommending better and more effective practices in the construction industry.Specific objectives of the probe argon to* Find out existing equipment acquisition options use by the Ghanaian contractor.* Identify problems faced by the Ghanaian contractor in acquiring equipment for construction works.* Examine existing ar grazements (if any) made amid equipment strike and manufacturing companies and the construction companies.* Recommending better acquisition options as well as solutions to some of the m ajor problems the contractors face when they try to acquire equipment.1.3 SCOPE OF WORKA number of firms inwardly the D1 and D2 of contractors by the Ministry of Water, Works and Housing and the Ministry of Roads and re run short in the Kumasi Metropolis will be identified, selected and studied.The equipment items that will be cover chthonic the study will let in general equipments, earth pitiable, lifting, transporting and excavation equipments.CHAPTER TWOLITERATURE REVIEW2.1 INTRODUCTION CONSTRUCTION EQUIPMENTEquipment plays an increasingly important role in building as well as civil engineering operations, and both time and money can be saved by the efficient use of mechanistic aids. Equipment implies the machinery, tools (other than craftsmens personal tools) and other equipment used in the contractors yard, workshop or site. These whitethorn flow from small progress held index finger tools to jumbor and more expensive equipment such as mechanical excavators and genus Gruss. The aim of any construction activity or project is to produce a structure of the right quality and standard at an optimum cost within an acceptable time frame. The use of equipment for construction bugger offs needed where using manual labour will not help achieve the projects objectives. Generally, equipment are introduced to contracts for one of the undermentioned reasons* Increased production.* Reduction in overall construction costs.* Carry out activities which cannot be carried out by the traditionalistic manual methods in the context of economics.* Eliminate heavy manual work thus reducing fatigue and as a consequence increasing productivity.* Replacing labour where there is a shortage of personnel with the obligatory skills.* Maintain the high standards required particularly in the context of geomorphological engineering works (R. Chudley, 1997).2.1.2 SOME COMMON CONSTRUCTION EQUIPMENT USED DURING CONSTRUCTION.Presented here is a outline description of some of t he important construction equipment that may be used during the construction of a building project.18.104.22.168 EARTH move MACHINESThe equipment described here include the bulldozers, graders, trumperypers and so onthat are used to move coarse volumes of comprehendd materials during construction.BULLDOZERThe primary earth-moving machine is the heavy-duty tractor, which when fitted with tracks to grip the ground and with a large movable blade attached in front, is called a bulldozer. The bulldozer as shown in fig 2.1 infra may be used to clear brush, small trees, debris, remove boulders, and level ground. They may even be used as towing tractor or a pusher to a scrapper. They rest essentially of a track or wheel mount condition building block with a mould blade at the front. umteen bulldozers give way the capacity to adjust the mould blade to form an angledozer which can incline the mould blade about a central swivel point. They become even very useful especially in civil en gineering projects, which often require the moving of millions of cubic meters of earth. These bulldozers are however not curb for final leveling and cannot be used for pointing thus requiring other equipment to load.TRACTOR SHOVELThese are sometimes called loaders or loader shovels and primary function is to scoop up loose materials in the front attach pailful, elevate the bucket and deposit the material into an confederate transport vehicle. Tractor shovels are driven towards the pile of loose material with the lowered bucket. The speed and the power of the machine will then enable the bucket to be filled. To increase their versatility, the tractor shovels can be fitted with a 4 in 1 bucket enabling them to mail out bulldozing, excavating, lifting and fill up activities.Like the scrapper, the tractor shovel is not fitting for work in rocks and waterlogged areas and will require a crawler tractor to work in the latter condition. GRADERSSomewhat quasi(prenominal) to scraper s are graders which are self-propelled, wheeled machines with a long, inclined or goodly adjustable steel blade. Graders are primarily finishing equipment they level earth already moved into position by bulldozers and scrapers. They are similar to the bulldozers in that they book a long slender adjustable mould blade, which is usually slung to a lower place the centre of the machine. The mould blade can be suitably change in both the even and just planes through an angle of three hundred the latter enabling it to be used for grading sloping banks. This prat Deere grader seen in Fig 2.2a below has a laser leveling unit mounted on its blade which constantly adjusts the height of the blade to stop that the ground is made precisely flat.The low motive power of a grader does not generally allow for use in excavations. A grader cannot load nor move teases of significant quantity over a long distance. It is massive in size and therefore not suitable for work in small and/or con fined areas and corners.SCRAPERSA scraper is a machine that may be pulled by a tractor or may be self-powered and consists of a blade and a bowl or container. The bowl is lowered to cut and collect soil where site denudation and leveling operations are required involving large volume of earth. The soil may then be released so as to form an even layer of a predetermined thickness or be carried off for disposal elsewhere.To obtain upper limit efficiency, scrappers should endure downhill and as much as possible remove smooth haul passageways and hard surfaces mazed up before scraping. Scrappers are not suitable for use in waterlogged areas and in rocky grounds. They cannot be used in loading and also would need transportation amongst sites. Microsoft Encarta 2006 R. Chudley, 19922.214.171.124 EXCAVATORSThese form part of the main equipment items that are often used in construction. They are primarily used to excavate as well as load different typefaces of soil. Each different type of excavator has specific soil conditions where it works best. Below is a brief description of some of the familiar excavating equipment found in construction. All of them can easily be classified under one of the following categories Multi intend, General or Universal and Purpose Made excavators.MULTI-PURPOSE EXCAVATORMulti-purpose excavators like the one shown if fig. 2.4 are fitted with a loading and excavating front bucket and a stooge backactor bucket. When in operation using the backactor bucket, the machine is raised off its axels by rear mounted hydraulic outriggers or jacks and in some models by placing the front bucket on the ground. TRENCHERA trencher is designed to excavate trenches at constant width with a high point in time of the true and speed. It can cut trenches of widths between 250 and 450mm and up to 4.00m deep. It consists of a number of excavating buckets mounted on a continuous mechanism on a vertical boom. The boom is lowered into the ground to the require d depth to be excavated. The bedevil is then transferred along a cross conveyor to deposit the fellate along the side of the trench.A trencher as shown in fig 2.5 is most suitable for long and deep trench excavation and it also gives a fairly accurate and clean trench width and would therefore not require further trimmings to sides of trenches it excavates.A trencher cannot load materials it excavates and also unable to work in rock.SKIMMERSkimmers are used for surface stripping and shallow excavation work up to 300mm deep where a high degree of accuracy is required. They usually requires sequent haulage vehicles to remove the spoil and they also give birth to be transported between sites on a low-loader.The qualified nature of the bucket movement does not allow high output rates as compared with other over site excavating equipment. A sailor requires a large operational area and is therefore not recommended for work in small and restricted areas.BACKACTORBackactors are about the most common excavating equipment used in construction. They are suitable for trench, foundation and basement excavations especially in restricted areas. They can be used with or without attendant haulage vehicles since the spoil can be set alongside the excavation for use in backfilling. Unlike the face shovel, they excavate by moving the bucket towards the chassis of the machine. It then raises the bucket in a shut in position to discharge the excavated material through the front outspoken bucket. They can also be used to load hard but broken down materials. They require a low-loader transportation between sites and trenches excavated using the backactor may need other equipment for trimming to obtain desired smooth edges. Shown below in fig 2.6a and b are pictures of a John Deere and cat backactors respectively.FACE SHOVEL The primary function of this machine is to excavate against a face or a bank above its own track or wheel level. It is suitable for clay and can be used in excavating and even rock which needs to be loosened, usually by blasting prior to the excavation. A face shovel has the added advantage of loading materials excavated into dump trucks. It can also be used extensively for relocating spoils within a given radius or short distance and for heaping spoils for futurity use.Face shovels like the one shown in fig. 2.7 above usually require attendant haulage vehicles for the removal of the spoil and a low-loader transportation between sites most especially in developed areas. They are also not suitable for deep excavations.126.96.36.199 TRANSPORTING EQUIPMENTThese are mainly used for the transportation of personnel, materials, machines and equipment from one site to the other or from one location to the other within a relatively large site. They range from conventional saloon car to the large low loader lorries designed to transport other items of builders equipment between construction sites and the equipment yard or depot.VANSThese transpor t vehicles range from the small twain person plus a limited amount of materials to the large vans with purpose designed bodies such as those designed to carry sheets of glass. The vans can be supplied with an uncovered tipping or non-tipping container mounted behind the passenger cab for use as a pick-up truck.LORRIESLorries which are usually referred to as haul vehicles are available as road or site scarcely vehicles. The road haulage vehicles bind to comply with all the requirements of the concerning vehicle usage which among other requirements limits size and axle loads. The site only vehicles are not so restricted and can be designed to carry two to three times the axle load allowed on the public highways. They are also designed to withstand the rough terrain encountered on many construction sites.Lorries specifically designed for the transportation of large items of equipment are called low loaders and are usually fitted with integral or removal ramps to facilitate loading e quipment onto the carrier platform. PASSENGER VEHICLESThese can range from a simple framed cabin which can be situated in the container of a small lorry or pick-up truck to a conventional bus or coach. These vans can also be designed to carry a limited number of seated passengers by having obstinate or removable seating together with windows fitted in the van sides thus giving the vehicle a dual function. DUMPERSDumpers are used for horizontal transportation of materials ranging from aggregates to wet concrete on and off construction sites generally by means of an integral tipping skip.Highways dumpers or dumper trucks are similar but larger design and can be used to carry materials such as excavated spoil along the roads. A wide range of dumpers are available with variuos carrying capacities with hydraulic see for either a side, front or elevted tipping. They are designed to traverse rough terrain but they are not desinged to carry passengers. Shown above in fig. 2.8a and 2.8b a re shown a standard site dumper and a dumper truck respectively.FORK LIFTSThese are used for horizontal and limited vertical transportation of mterials positioned on pallets or banded together such as brick packs. They are generally suitable for construction sites where the building height does not exceed three storeys. They are available in three basic forms namely staright mast, overhead and telescopic boom (shown in fig. 2.9a-c) with various height, reach and lifting capacities.HOISTSHoists are designed for vertical transportation of materials, passengers or both. Material hoists are usually mobile and they can be dismantled, folded onto the chassis and moved to another position or site under their own power or towed by a haulage vehicle.Passenger hoists are designed to carry passenger passengers although they most can be suitable of carrying the load of passengers as well as materials. 188.8.131.52 CRANESCranes are lifting devices designed to raise materials by means of rope operati on and move the load horizontally. Crane types can range from simple rope and auction block to complex tower cranes but most can be placed within one of three groups namely static (operate from a mend position), mobile (operating position can be changed by cran under its own power) and tower (can be operated from a fixed position or check mounted to become mobile) cranes.Several forms of cranes can be identified. Some of these are listed below* Self propelled cranes* Lorry Mounted cranes* Track mounted cranes* gantry/Portal cranes* Tower cranesBelow in fig. 2.10 is shown the different types of cranes used in the construction industry.184.108.40.206 Concreting equipmentthese equipment perhaps fall among the group of equipment that may be readily found on most constrction sites since concrete usually forms a large propotion of the materials used in construction.Concreting equipment can simply as classified under the following headings mixed bag, transportation and placing.CONCRETE MIXER SThese are used in mixing concrete especially in large volumes. Apart from the very large output socials most concrete socials in general use have a rotating drum designed to produce concrete without segregation of the mix. intimately small batch mixers are of tilting drum type with outputs up to 200 lit/batch. They are generally hand loaded which makes the quality control of successive mixes difficult to regulate.Medium batch mixers can achieve outputs up to about 750lit/batch and may be designed with a tilting drum mixer or as a non-tilting drum mixer with a reversable drum. These mixers usually have integral weight bacthing loading hoppers, scrapper shovels and water armoured combat vehicle thus giving better qualtity control than the small batch mixers.The pictures shown in fig. 2.11 and 2.12 are the very common 10/7 concrete mixer and 6m3 capacity ready mix concrete machine. EQUIPMENT FOR TRANSPORTING CONCRETE.Wheel barrows are the most common form of transporting concrete i n small volumes. However for large volumes of up to about 600 litres, dumpers are more appropriate. Ready mixed concrete trucks are used to transport mixed concrete of volumes between 4-6m3 from a mixing equipment or depot to the site. Discharge can be localize into placing position via a chute or into some form of site dumper such as a dumper, crane skip or dumper.VIBRATOR After placing concrete in its formwork, excavated area or mould, the concrete must be properly worked around any insets or reinforcement and ultimately compacting the concrete to the required consolidation. This can be done to some degree satisfaction using tamping boards or rods but most appropritely using vibrators. fire hook vibrators consist of a hollow steel tube casing in which is a rotating impellar which generates vibrations as its heard comes into contact with the casing.Microsoft Encarta 2006 R. Chudley, 19972.2 EQUIPMENT ACQUISITIONGenerally, a construction company has two options in acquiring equipm ent it may either own machinery and equipment or utilise it. Management must decide early on whether the equipment needed on site is to be employ or purchased straightaway, if it is not already available within the company. Purchasing equipment is sound investment if there is enough work ahead to keep it fully employed. Some estimates suggest the equipment must be working regularly for three to five years to recover the capital outlay J.E. Johnston, 1981. The decision to purchase will incessantly have important financial consequences for the firm, since considerable capital sums will be locked up in plant, which must then be operated at an economic utilization level to produce a profitable rate of save on the investment .In recent years however, the growth of the independent equipment hire sector of the construction industry has greatly facilitated this latter option and roughly 50-60% of equipment presently used on projects is hired. Many firms however prefer to hire only tho se items of equipment which are required to meet peak demand or specialized duties F. Harris and R. McCaffer, 2001. 2.2.1 ECONOMIC CONSIDERATIONSThe introduction of equipment to a project does not necessarily result in economic savings since extra temporary site works such as road works, foundations, hard standings and anchorages may have to be provided at a cost which may be in excess of the savings made by using the equipment. The site layout and circulation may have to be planned around equipment positions and accommodation. The full advantage of employing the equipment can only be realized if the equipment is well managed, both on and off the site, and this requires a thorough understanding of the economic aspects of using equipment and vehicles. For example, a crane will become expensive if the design does not allow a fairly continuous programme of work whilst it is on the site.To be economic, plant must be fully utilized and not left standing idle since equipment, whether hire d or owned, will have to be paid for even if it is non-productive. Full utilisation of equipment is usually considered to be in the sphere of 85% of on site time, thus making an allowance for operation daily and planned maintenance which needs to be carried out to rid of as far as practicable equipment breakdowns which could disrupt the construction programme. Many pieces of equipment work in conjunction with other items of equipment such as excavators and their attendant haulage vehicles therefore a correct sense of balance of such equipment items must be obtained to achieve an economic result (R. Chudley, 1995 R.E Calvert et al, 1996).2.2.3 EQUIPMENT POLICY220.127.116.11 OWN only EQUIPMENTThe policy practiced by many enterprises is to purchase, or lease long term, most of the equipment needs and thereby provide availability at all times, with the added advantage of the prestige attached to demonstrating the use of owned equipment. However, much capital will be locked up in the equip ment, which must become capable of generating a sufficient rate of return. A major evil of this dodge is the problem of maintaining adequate levels of utilisation. Equipment holdings are usually built up to religious service a growing demand, and will become a heavy financial obligation in the case of an economic recession. Any available work may then subsequently need to be undertaken to sustain the fleet, since equipment cannot easily be exchange in a declining market.18.104.22.168 HIRE ALL EQUIPMENTMany specialiser hire/rental firms offer the supply of equipment now on the open market. To take advantage of this facility avoids both the responsibility of maintenance and the ligature up of capital. The equipment may be hired for a specified period and often times the equipment operator also is provided by the equipment supplier.The main disadvantage of hiring is that the hire rate depends on market forces and suppliers are largely beyond the control of the hire, except for limited ne gotiation between competing firms.22.214.171.124 A compounding OF HIRE AND OWNA mixed policy of owning and hiring equipment may be the preferred option. For example, regularly required items might be purchased and hiring adopted only to smooth out demand (Edwards D.J, 2003).F.T. Edum-Fotwe (1990) writes that serious consideration should also be given to the extent to which the equipment is to be operated before an acquisition decision is made. He outlines the following factors concerning the level of operation of a equipment1. Acquire equipment new and operate to a down value and sell it.2. Acquire second-hand equipment and operate to scrap value.3. Acquire equipment new and operate to scrap value.4. Acquire a second-hand equipment and operate to a down value and resell. 2.2.4 FINANCING OF EQUIPMENTA firm, having decided to defile a equipment instead of hiring, has the following methods of paying for the equipment.1. Cash or outright purchase2. Hire Purchase3. Credit Sales4. Leasing5. H iring126.96.36.199 CASH OR OUTRIGHT PURCHASEWhen using this option, the buyer pays cash or now at the time of purchase, thereby providing tangible asset on the balance sheet. Obviously, this option is only possible if cash is available and therefore presupposes that profits have been built up from investors such as shareholder, bank loans, etc. Also, some large or technically unusual contracts sometimes include monies to permit the contractor to purchase the necessary equipment at the start of the project F. Harris and R. McCaffer, 2001. R. Chudley, 1997 simply identifies some of the advantages of outright purchase as1. Equipment availability is wholly within the control of the contractor.2. Hourly cost of equipment is generally less than hired equipment.3. Owner has choice of costing method used.J.E. Johnston, 1981 however advices that besides the purchase price of a equipment, consideration should be given to the following points1. keen outlay and interest charges2. The cost of mainte nance and repairs3. The cost of transporting equipment between sites4. indemnification premium and5. Standing time on site.When examining the need to own equipment, the following points must be considered 1. Will the item of equipment generate sufficient disorder to provide an adequate rate of return on the capital employed?2. Is ownership of the equipment, rather than obtaining it by some other method, absolutely necessary for the business?3. Is outright purchase the only way of acquiring the equipment? F. Harris and R. McCaffer, 20012.2.4.1.1 equal OF OWNING AN EQUIPMENTThe cost of owning and operating construction equipment is affected by factors such as the cost of the equipment delivered to the owner, the severity of the conditions under which it is used, the attentions with which the owner maintains and repairs it and the demand for used equipment when it is sold which will affect the salvage value. In his report, Effects of equipment breakdown on civil and building constr uction works, Markus S. Clarke (2001) identified the costs involved in owning and operating equipment asi. DepreciationWhen a unit of equipment is placed in operation, it begins to wear out. Regardless of the care in maintaining and repairing it, the equipment will wear out or become obsolete and has to be replaced. The owner of the equipment has to provide a reserve fund to replace it when it is worn out. Where the contractor fails to include an appropriate allowance for depreciation of his equipment in his estimate, there will be no funds available to replace the equipment when they become aged or obsolete.ii. alimentation and repairsThe cost of maintenance and repairs varies considerably with the type of equipment, the service to which it is assigned and the care it receives. The annual costs of maintenance and repairs is expressed as a piece of the annual cost of depreciation or independent of depreciation and it must also be sufficient to cover the cost of keeping the equipme nt operating.
Saturday, March 30, 2019
Cardiovascular ailmentCardiovascular DiseaseIntroductionThis paper utilizes qualitative data drawn from a series of focus group discussions with patients alimentation with coronary thrombosis thrombosis nervus indisposition which explored their misgiving of and adherence to a cocksure monitoring and medication regime. These findings ar drawn upon in order to contextualize, from the patients perspective, the outcomes of the sections of wellnesss coronary soft nucle utilizationdness Disease study do fabric st enumerategy.The paper focuses wariness on the consequences of this regulatory nestle to clinical and pretend attention for those patients al entrap living with coronary eye distemper.Case StudyPatient is 59 yrs old and had a myocardial infarction 2 years ago. He is obese, a smoker and poorly motivated. The case exemplifies many of the difficulties that frequently rebel in managing cardiovascular distemper, and suggests potential avenues for improving outcomes through the application of a unhealthiness management programme.The coronary Heart Disease National receipts exampleBy the mid 1980s, it had been gener entirelyy accepted by around clinicians that in that location was strong evidence to support the existence of a additive relationship between cholesterol levels and cardiac death rate (Shaper et al. 1985, Stamler et al. 1986), and that at that placefore lumbering aggregate cholesterol levels would flash back the jeopardy of individua magnetic dips growing coronary marrow disease.This opened the way to the process of establishing a recommended cholesterol threshold level at which intervention should be instigated (Leitch 1989). Since past, the trend has been towards setting ever- unkepter threshold targets for treatment for those designated as existence at graduate(prenominal) risk of developing coronary purport disease and for those already living with the disease.In 2000, the Department of wellness published i ts Coronary Heart Disease National Service Framework which set out 12 standards for the prevention, diagnosis and treatment of the disease (Department of wellness 2000). The National Service Framework standard Number 3 recommended that GPs let out and develop a register of diagnosed patients and those patients at high risk of developing coronary midriff disease. Dietary and lifestyle advice (what the document terms modifi adapted risk f performers) was to be offered to these patients, and their medication reviewed at least ein truth 12 months. It was too recommended that statins be prescribed to any unrivaled with coronary heart disease or having a 30% or greater 10-year risk of a cardiac event, in order to lower their blood cholesterol levels to slight than 5 mmol/l or by 30% (which ever is greater). These recommendations were vigorously promoted when they were merged into the new General aesculapian service contract that came into operation in 2003.The relative performance of an individual Primary plow Organization in meeting for each one of these indicators attracts full stops on a sliding scale that ar then converted into payments for individual GPs. In relation to the management of patients with coronary heart disease, higher payments argon received if a Primary C ar Organization increases the percentage of patients with coronary heart disease who shit their total serum cholesterol regularly monitored, and whose last cholesterol reading was less than 5 mmol/l (Department of wellness 2004a).The roughly recent Department of wellness bestride report on the National Service Framework argues that the abundant growth in statin therapy since 2000 . . . is 1 of the most important markers of progress on the NSF, and was directly saving up to 9,000 lives per year (Department of wellness 2005 19). statin drug prescriptions have been rising at the rate of 30% per year since 2000, and in 2004/5 750 trillion was spent on statins, equivalent to most 2.5 million people on statin therapy in England (Department of Health 2005). In July 2004, low doses of statins became procurable over the counter without prescription for the first prison term, for those at obligate risk.The Public Health Discourse(S) Of Cardiac RiskThe application of risk discourses in the field of universe wellness (or much precisely the ascription of wellness risk to particular doingss) as conceptualized inwardly those elements of the risk lit most cultivated by Foucauldian notions of governmentality, ar seen as serving to construct the amicablely vicious as distinct from the responsible for(p) citizen (Foucault 1977, Turner 1987, Lupton 1995). In a akin(predicate) way, Dean (1999) argues that once risk has been attributed to particular wellness behaviours, the distinction is then drawn within public wellness policies between active citizens who ar perceived as able to manage their profess heath risks, and at-risk neighborly groups who become the object of targeted interventions designed to manage these risks.Two distinct dimensions or bettermentes to the conceptualization and public wellness management of cardiac health risks too emerge from an examination of the guiding determine and principles which inform the Department of Healths Coronary Heart Disease National Service Framework (Department of Health 2000).While one approach (described below as the epidemiological exemplar of risk) generally conforms to the personalized at-risk discourse, a mhoment discourse (described below as the accessible model of risk) which is much more concerned with health risk at a fond and material level ass excessively be discerned within the National Service Framework. These two distinct and arguably competing discourses of risk point to a complexity in incumbent public health insurance policy that might not be anticipated from a reading of the governmentality literature alone.The first conceptualization of cardiac risk within the Coronary Heart Disease National Service Framework is one that target be termed the loving model of health risk. This model essentially reflects a socio-stinting understanding of the determinants of population health, and draws attention to the grandeur of screaming material, social and psychological risk factors in gain to the k instantern biological factors in heart disease.In the National Service Framework, this social model is reflected in the endorsement (albeit at a rhetorical level) of an interventionist portion for the state in addressing these wider determinants of the disease The Governments activenesss influence the wider determinants of health which overwhelm the distribution of wealth and income. A wide range of its policies testament have an impact on coronary heart disease including social and legal policies and policies on transport, housing, employment, agriculture and food, environment and crime (Department of Health 2000 segment 1, Para 17). There is also an explicit ac noesisment that these risk factors disproportionately disadvantage particular sections of society, demonstrated in the higher incidence of coronary heart disease among the manual social classes. It is also acknowledged that there is inequity in health service provision . . . there argon unjustifiable variations in fiber and access to some coronary heart disease services, with many patients not receiving treatments of proven rough-and-readyness (Department of Health 2000 particle 1, Para 13).This formal acknowledgement of the governments role in addressing the wider social and economic influences on cardiac health risk could to some degree be said to conform to Becks (1992) notion of the risk society wherein many of the health risks faced by the population argon a consequence of unchecked scientific and industrial progress. Beck asserts that in response a greater public aw atomic number 18ness or reflexivity of risk has emerged which reflects a shift from ig norance or private fears close the unknown to a widespread knowledge some the world we have created. The question of whether a reflexivity concerning the social and environmental factors associated with cardiac risk post be discerned in a patients own discourses of cardiac risk is something that impart be explored in the discussion below.The foster risk discourse emergent within the National Service Framework (Department of Health 2000) is one which reflects a predominantly epidemiological understanding of health risk. In this model, the relative risk of an individual developing heart disease is base upon a calculation of the mean values associated with certain lifestyle behaviours such as smoking, diet and exercise that are drawn from amount population data for heart disease incidence. This is a statistical approach that all too very much perceives such calculated health risk factors as being realities or causative agents in their own right, practically with little acknowl edgement of the social and material context of these health behaviours.Nevertheless, it is on the basis of this epidemiological model of health risk that the Department of Health has confidently set national guidelines that now require Generalvalue and principles underlying the CHD National Service FrameworkNine stated values underlying development of national policies for CHDProvision of quality services irrespective of gender, disability, ethnicity or age.Ready availability of consistent, accurate and relevant culture for the public. love of health impact in regard to social and legal policies and policies on transport, housing, employment, agriculture and food, environment and crime.Public health programmes led by health and local authorities to come across targets for CHD are met.Reduction in health inequalities. Re fountains will be targeted at those in superior need and with the greatest potential to benefit. Evidence-based. CHD policies are to be based on the best av ailable evidence.Integrated approach for the prevention and treatment of CHD in health policy, health promotion, primary plow, fraternity wish well and hospital mission. Maintenance of ethics and standards of nonrecreational practice.Recognition of the importance of voluntary organizations and carers at home in addressing CHD. 4 stated principles underpinning the CHD NSF. Reducing the burden of CHD is not just the responsibility of the NHS. It requires action right across society. The quality of care depends onready access to appropriate servicesii. the calibre of the interaction between individual patients and individual cliniciansiii. the quality of the organization and environment in which care takes place.. excellence requires that important, simple things are done right all the time.. Delivering care in a more structured and formationatic way will easily improve the quality of care and reduce undesirable variations in its provision.Practitioners to set and monitor high risk patients and to prescribe the recommended drug treatment regime. It can be argued that this regulatory or conductorialist approach to clinical decision- do constitutes a repugn to the discretion that has been traditionally enjoyed by general practitioners in relation to the clinical management of patients.This second official discourse of health risk could be seen as indicative of the regulatory and surveillance forms of governmentality give away within Foucauldian social theory. From this perspective, those social groups whose health behaviour or lifestyle are seen to cliff outside the acceptable bounds of self-management then become constructed as at-risk.These are social groups who are seen to, deliberately expose themselves to health risks rather than rationally avoiding them, and therefore require greater surveillance and regulation (Lupton 1995 76) once identified these groups and individuals then become subject to various health promotion or health improvement in itiatives.Implicit in such forms of governmentality as apply within health policy interventions designed to manage risk are a set of assumptions about the nature of human action predicated on the notion of the rational actor model. Jaeger, Renn, Rosa and Webler (2001) have argued such models of ground operate at three levels of abstraction. In its most general form, it presupposes that military personnel are capable of acting in a strategic style by linking decisions with actions. That is, human beings are goal-orientated who have options available from which they are able to select a course of action appropriate to meeting these goals. The second level of abstraction which the authors term the rational actor paradigm, and which is the level at which rationality is probably understood by policy-makers, contains the following assumptions all actions are individual choices individuals can distinguish between ends and means to achieve these ends individuals are motivated to pursue their own self-chosen goals when making decisions about courses of action/behaviour individuals will always choose a course of action that has maximal personal utility, that is it will lead to personal satisfaction individuals possess the knowledge about the potential consequences of their actions when they make decisions. Finally, that rational actor theory is not only a normative theory of how people should make decisions about in this case health behaviour, but is also a descriptive model of how people select options and justify their actions (Jaeger et al. 2001 33).Many of these rational actor assumptions underpin and inform the Coronary Heart Disease National Service Framework. Such assumptions manifest themselves in a seemingly un sturdy approach to the promotion of risky health behaviour change which plays down the influence of culture, habitus and the material basis of group socialization. This uncritical rationality also threatens the sustainability of the National Service Framework strategy in former(a) ways. The social psychological and sociological literature see the notion of trust as constituted through two dimensions, the deliberative or rational and the emotive or non-rational.As Peter Taylor-Gooby (2006) has pointed out in his work on the problematic of public policy reform, the rational deliberative processes associated with the achievement of greater efficiency in the provision of public services have inadvertently served to undermine the non-rational processes that contribute to the building of trust in public institutions and in public sector professionals. In this context, the National Service Framework will need to build trust two in terms of the origination of the biomedical evidence for the effectiveness of statins and other cardiac drug interventions, as well as the more affective elements associated with the belief that the national targets are designed with the best interests of patients in mind rather than being drive by finan cial considerations alone.Significantly, disposed(p) its centrality to a disease management strategy, uncomplete the Coronary Heart Disease National Service Framework (Department of Health 2000) nor the NHS profit Plan (Department of Health 2004b) which sets out the governments priorities Coronary heart disease and the management of risk 363 for primary and secondary healthcare up to 2008, attempts to mend the use of the term risk, and by extension higher risk. Nevertheless, the conception of risk that shapes the practical interventions proposed within both these strategy documents is clearly the epidemiological one that is described above. In the past, such public health interventions have been for the most part concerned with bringing about health behaviour change, however now the strategy would appear to be less focused on boost greater responsibility for the self management of cardiac risk and more on ensuring compliance with clinical management regimes of monitoring and d rug treatment.Optimising deal out Through Disease ManagementIn the last 15 years, there have been dramatic advances in the pharmacotherapy of heart disease, most notably the design of angiotensin converting enzyme ( sorcerer) inhibitors. (Jaeger et al. 2001 33) Unfortunately, numerous studies have suggested that ACE inhibitors are substantially underutilised in heart disease patients. Moreover, there are a multitude of factors which whitethorn confound heart disease management heart disease closely never occurs in isolation, and comorbidities such as hypertension, diabetes, coronary artery disease, chronic pulmonary or renal disease and arthritis occur frequently.The presence of these comorbid conditions may intercede with heart disease management in several(prenominal) ways. In PATIENTs case, pre-existing renal insufficiency may have contributed to her intolerance to ACE inhibitors. In addition, her use of NSAIDs could promote salt and water retention and sabotage the antih ypertensive effects of her other medications. (Jaeger et al. 2001 33)Multiple comorbidities may also return in polypharmacy, which, in turn, may compromise compliance and lead to undesirable drug interactions.Adherence to dietary sodium restriction is often problematic (as in patients case), particularly in older individuals who are either not responsible for preparing their own meals, or who rely heavily on tinned goods and prepared foods. Depression, anxiety and social isolation are common in patients with heart disease, and each may interfere with adherence to the heart disease forage or with the patients willingness to seek prompt medical attention when symptoms recur. Similarly, the high cost of medications may limit access to therapy in patients with restricted incomes. sensible limitations, such as neuromuscular disorders (e.g. stroke or Parkinsonism), arthritis and sensory deficits (e.g. afflicted visual acuity), may compromise the patients ability to understand and comp ly with treatment. Finally, cognitive dysfunction, which is not uncommon in elderly heart disease patients, may further confound heart disease management.Impact on clinical Outcomes disrespect the widely publicised effects of ACE inhibitors, b-blockers, angiotensin sense organ blockers and other vasodilators on the clinical course of heart disease, morbidity and mortality rates in patients with established heart disease remains very high. heart disease is the leading cause for repetitive hospitalizations in adults, and in 1997 Krumholz et al. account that 44% of older heart disease patients were rehospitalised at least once within 6 months of an initial heart disease admission. Remarkably, this rate was no better than that reported in several prior studies go out back to 1985. (Krumholz et al. 1998)From the disease management perspective, it is important to recognise that the majority of heart disease readmissions are associate to poor compliance and other psychosocial or behavio ural factors, rather than to progressive heart disease or an astute cardiac event (e.g. myocardial infarction). Thus, Ghali et al. reported in 1988 that 64% of heart disease exacerbationswere attributable to noncompliance with diet, medications or both and that 26% were related to environmental or social factors. Similarly, in 1990 Vinson et al. (Vinson, 1995) found that over one-half of all readmissions were directly attributable to problems with compliance, lack of social support, or process-of care issues, and these authors concluded that up to 50% of all readmissions were potentially preventable.More recently, Krumholz et al, reported that lack of emotional support among older heart disease patients was a strong independent predictor of adverse outcomes, including death and hospitalization precept and ObjectivesThe above considerations return the rationale for a systems approach to heart disease management.The objectives of this approach are as followsTo optimise the pharmacot herapy of heart disease in accordance with current consensus guidelines. (Vinson, 1990)To maximize compliance with prescribed medications and dietary restrictions.To identify and respond to any psychological, social or financial barriers that might interferewith compliance with the prescribed treatment regimen.To provide an appropriate level of inspection through telephone contacts, home visits andoutpatient clinic visits.To enhance functional capacity by providing an individualized programme of exercise and cardiac rehabilitation.To enhance self-efficacy by component the patient and family understand that heart disease can be controlled, largely through the patients and familys efforts.To reduce the frequency of acute heart disease exacerbations and hospitalizations.To reduce the overall cost of care.The Disease Management TeamAlthough the composition of a disease management team may vary both from centralise to centre and from patient to patient, a suggested list of team penis s are given belownurse coordinator or case managerdietitiansocial services representativeclinical pharmacistphysical therapist/occupational therapistexercise/rehabilitation specialist home health specialistpatient and familyprimary care physiciancardiologist/other consultants. distributively team member provides their own unique expertise and/or perspective, and these are then woven into an integrated package tailored to meet each individual patients needs, expectations, and circumstances. Importantly, not all patients will require the services of all team members, and it is therefore essential to identify a team leader. In most cases, this will be the nurse coordinator or case manager, who, in addition to being the patients primary contact person and educator, is also responsible for coordinating the efforts of other team members, including the selective activation of appropriate consultations on an individualized basis.In addition to the team itself, several other components are essential for effective disease management. First, the patient and family should be provided with universal learning about heart disease, including common etiologies, symptoms and signs, standard diagnostic tests, medications, diet, activity, prognosis and the role of the patient and family in ensuring that heart disease remains under control.This randomness should be provided in a readily understandable patient-friendly format and several patient-oriented heart disease brochures are now commercially available. In addition to these materials, the patient should be given a scale (if not already owned) and a chart to record daily weights, an accurate and detailed list of medications supplemented by medication aids if needed (e.g. a pill box), and particular information about when to contact the nurse, physician, or other team member in the event that questions or new symptoms arise. In this regard, the importance of establishing an effective one-on-one nurse-to-patient relationsh ip cannot be overemphasized, as this interaction will often be critical to the early diagnosis and effective outpatient treatment of heart disease exacerbations.Patient PerspectiveWhile the above studies indicate a beneficial effect on cost, hospital readmissions, etc., they do not address concerns related to the patients perspective on this interdisciplinary care. What issues are important to the patient, and what the advantages are to the patient of participating in an heart disease disease management programme?In recent years, it has become increasingly evident that it is scant(predicate) to merely provide high quality medical services. In a competitive market, it is essential that the patient is also satisfied with the medical encounter, both in terms of the process of care as well as the clinical outcomes.Healthcare is an constancy, and like all industries, customer satisfaction is critically important. However, unlike most industries, which deal with a tangible product, the healthcare industry deals with a multifaceted service, the myriad qualities of which are difficult to quantify. As a result, the assessment of patient satisfaction is often complex, and the development of a validated and universally accepted instrument for measuring patient satisfaction has been elusive.Despite these problems, several patient satisfaction questionnaires have been developed, (Garg, 1995) and these have been helpful in defining those issues which are important to patients, and in identifying specific concerns that patients often have with respect to current approaches to healthcare delivery. (Garg, 1995)Factors which have been consistently shown to play a pivotal role in determining patient satisfaction include communication, involvement in decision- making, respect for the individual, access to care and the quality of care provided. (Philbin, 1996) Not surprisingly, problems in each of these areas are frequently cited as factors which strike patient satisfaction. S everal components of the heart disease disease management system will be of direct serve upance in answering patients questions and dower her cope with this new and frightening diagnosis. In particular, the nurse case manager will establish an effective rapport with the patient and her family, and provide an ongoing source of information and emotional support. The patient education brochure and other printed materials will help answer many of Patients questions and assist in relieving some of her anxieties.The nurse, clinical pharmacist and physician (s) can provide detailed information and teaching about the medications used to treat heart disease, and the dietitian can directly address the dietary questions and provide an individualized diet that takes Patients current dietary practices and food preferences into account. The social service representative can assist patient with any financial concerns she may have, make provisions to understand an adequate social support network , and serve as an additional source of emotional support. The physical therapist or exercise specialist can help in providing recommendations about activities and in the development of an exercise or rehabilitation programme.The nurse case manager, social service representative, home care specialist, and physician will provide assistance to patient in making the transition from the hospital back to the home environment, and they also will ensure a high level of follow-up care. Perhaps most importantly, the comprehensive care provided by the disease management team will promise patient that she truly is being cared for, and that all of her needs and concerns are being met.Invariably, this will lead to a high level of patient satisfaction. In addition, in the case of patient there is good reason to remember that implementation of a disease management programme at the time of her initial hospitalization may have eliminated the need for a second hospitalization. (Young, 1995)To the ex tent that patient might have to pay for some of the costs of readmission (e.g. deductible or copayment), the disease management programme would also hold on her money, a benefit which is universally viewed in a favorable light. And finally, based on compelling data from recent clinical trials, optimizing Patients medication regimen should translate not only into an improved quality of life, but also into increase survival.ConclusionIn summary, heart disease management systems provide a win-win-win situation. They are a win for the providers, because they improve clinical outcomes and quality of life. They are a win for the payors, because effective disease management programmes slack health care expenditures. And they are clearly a win for the patients, who gather multiple benefits, including improved quality of life and well-being, enhanced self-efficacy due to a greater sense of health control, improved exercise tolerance and functionality, increased survival (as a result of mo re optimal utilisation of heart disease medications), and, in some cases, reduced out-of-pocket expenditures. ReferencesDepartment of Health (2000) National Service Framework for Coronary Heart Disease (London DoH).Department of Health (2004a) GMS Statement of Financial Entitlements (SFE) 2004/5 (London DH).Department of Health (2004b) The NHS Improvement Plan Putting People at the Heart of Public Services Cm 6268 (London The Stationary Office).Department of Health (2005) The Coronary Heart Disease National Service Framework Leading the Way-Progress Report 2005 (London DH Publications).Foucault, M. (1977) Discipline and penalise The Birth of the Prison (London Allen Lane).Garg R, Yusuf S, for the Collaborative Group on ACE Inhibitor Trials. Overview of randomise trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA 1995 273 1450-6Ghali JK, Cooper R, crossbreeding E. Trends in hospitalization rates for heart failure in t he linked States, 1973-1986. Evidence for increasing population prevalence. Arch Intern Med 1990 150 769-73Jaeger, C., Renn, O., Rosa, E. and Webler, T. (2001) Risk, Uncertainty, and lucid Action (London James James/Earthscan).Krumholz HM, Butler J, Miller J, et al. Prognostic importance of emotional support for elderly patients hospitalized with heart failure. Circulation 1998 97 958-64Leitch, D. (1989) Who should have their cholesterol concentration measured? What experts in the United Kingdom suggest. British Medical Journal, 298(6688), 1615 1616.Lupton, D. (1995) The Imperative of Health Public Health and the Regulated Body (London Sage).Philbin EF, Andreou C, Rocco TA, et al. Patterns of angiotensin-converting enzyme inhibitor use in congestive heart failure in two community hospitals. Am J Cardiol 1996 77 832-8Redfern, J., MacKevitt, C. and
Impacts of Stress on the Well Being of Undergraduate NursesSanober FazalIntroductionEvery person in this world is surrounded by different kinds of tautnesses. (Kohler et al., 2006) as cited in (Martos et al., 2012) var. refers to a dynamic interaction between the individualist and the environment. In this interaction, demands, limitations, and opportunities cogitate to move may be perceived as threatening to strike the individuals resources and skill. Stress in my point of play is a pressure which effects our mind and unable us to do our daily activities prudishly. It affects our mental, mental, physical and worked up health. match to (Manney, Mk, Paul, Shashidhar, 2011) scholars be more(prenominal) porne to punctuate and it negatively effects on their mental health, educational success, egotism-grooming and effect on future. The alike(p) authors utter medical education as breedful. There ar some(prenominal) factors which origins emphasize and that compromis e the wellbeing of learner nurtures which entrust be discuss posterior in this paper.(ODonnell ,2009) stated that some(prenominal) treat student left the program due to unbearable sieve.The rational for choosing this topic is that its my own observation and experience that stress is higher in undergrad nurses. They are always over burden with assignments, regular papers as well as classes, clinical and, group works. All the while they sp annihilate a penny to sit in front of laptops or books. They halt less clock for themselves as well as for their families and fri terminates. Other than this some undergrad nurses end up with mental distress, many tried to do suicidal attempts and many withdraw the do by for career. Stress is the hurdle in the well-being of students, it affects negatively on their academics and social career.Many theories have been proposed for the better understanding of stress. fit to (Cannon, 1929) as cites in (Davidyan, 2008), he talked about receipt theory. According to him our physical structure works on basic principle of equilibrium (homeostasis). If the external input signal is strong and body cannot cope with it than it really disturb the normal instrument of body and causes stress. If the person handle the situation priggishly than it will be called a balance assign. Another theory given by (Hans selye, 1956) as cited in same member which describe a theory of usual reaction of individual to different stressors. He discussed about one-third stages scandalise reaction, defense and exhaustion. In alarm reaction there is a condition of fight and flight and organism try to control the situation by physiological responses. After which resistance stage occurs. Here body builds resistance against stressor. Last stage is exhaustion where all the energy is lost, no advance resistance exists and individual ends in chronic stress. It indicates that a person should response appropriately in every stage to prevent c omplications of stress.Unfortunately, the prevalence of stress in Pakistani students is very high especially in care for students. In Pakistan the image of nursing profession is very bad. There is no respect for this noble profession therefore, very little researches and studies has been done on it. According to Khowaja (2009) Pakistan is a discriminating society and there is no nurse of nursing thats why there are always issues. A battleground was done on the prevalence of stress by Kumar and Nancy (2011) in Punjab, Pakistan. According to the study, out of 180 undergraduate nurses, 34.4 % had moderate stress, 32.8 % had mild and supreme stress respectively. Another study was carried in CMH College Lahore on 200 students. The expiration showed that the mean stress was 30.87, nearly same with result of Punjab college students. It indicates high purpose of stress in Pakistani nursing students.What Are the Factors of Stress in Undergraduate Nurses?There are many factors of stres s among undergraduate nurses. For exercise they have to do lots of assignment, hard work, GPA, frequent exams, clinical both(prenominal) administrate and unsupervised. Moreover, the other factors which evanesce to stress are fear of faculty, staff, persevering and their different disease status, need of proper guidance and self-awareness. As an undergraduate nurse its my own experience and observation that both the supervised and unsupervised clinical are more stressful because students are expect to do many assignment and skills at the same time. Undergraduate nurses have to do assignment given by their faculty, by staff nurse and they have to give holistic care to patients. They are supposed to take care of severe patients with infectious disease and with aggressive behavior which cause stress in student nurses. Many of these factors were too mentioned in literature. Reevea et al., (2013) also highlighted clinical assignment as one of the factor of stress. It is more time consuming and students become socially isolated. The other cause of stress mentioned in the same articles is neglection from patients and from their attaindance, from staff nurse and other health care professionals. According to Abbey et al., (2011) issues from surrounding society, educational, and financial can also lead to stress. In an article written by somani khowaja (2012) it was mentioned that in Pakistani society work daub violence and lower status of nursing profession is also a cause of stress in nurses. Patients and their relatives think this profession is not strong and always try to abuse them. Magnavita and heponiemi (2011) mentioned physical and verbal violence as source of stress in nursing students during their clinical push throughment. Furthermore, international nursing check over (2012) three main types of stressors are mentioned (1) clinical stressors which include fear of not achieving expectations and communication gap between patients and hospital membe rs. (2) Academic stressors. For caseful ongoing assessment and quizzes, not passing the programme and hectic timetable. (3) ad hominem/ social stressors which means financial issues and issues in home and school works. A cross sectional study was done in Pakistans shifa nursing college by Shomail and Faisal (2012). In this study total 78 nursing students participated. The findings of study on score of stress level in different factors were as follow, theory = 2.37, clinical experience =3.5, college environment= 2.39, social environment=251. In my opinion these factors of stress bring tremendous alteration in an individuals health.What Are Implications of Stress in Undergraduate Nurses?According to labrague (2013), stress has adverse outcomes not only on physical, psychological and social health but as whole well-being. (Shirom, 2003) as cited in (Martos et al., 2012), stress lead to physical, psychological and behavioral impairment in an individual. I have seen many people with st ress who cannot sleep without medications and they left to take proper diet. (Chang et.al 2006) as cited in (Lim, Bogossian and Ahern, 2010) reported consequences of stress on physical health that is increase pressures, sleep disturbance and tiredness. In another literature it says stress in nursing students creates issues in memory, in judgmental skills and in lintel styles, Goff (2011). The students, who take chances stress, mainly have poor people thinking and this further aggravate their psychological problems. I witnessed one of my classmate who developed psychological symptoms in chip year 2013 due to change magnitude stress in her academics. She was admitted in psychiatric ward for more than 2 months and still she takes medications. I observed the same symptoms in her which are mentioned in the literatures. According to literature, undergraduate nurse end up in mental issues due to increase level of stress. It causes emotional distress that is nervousness, low self-esteem , isolation, aggression, anxiety etc.(Jimenez,OsorioDiaz, 2010).In Karachi, Pakistan a study was conducted in three medical colleges and students participated were 360. They prepare gastro intestinal problems especially irritable bowel syndrome in students. It was mentioned in the article that irritable bowel syndrome is because of psychological stress in students. (Naeem et al., 2012). Moreover, (Prasad et al., 2013) also talked about psychological impacts of stress which lead to loss of stringency in educational field, loss of energy which ultimately leads to low sidetrack and patterns of suicide. I also witnessed many cases where people did suicide, left the program, developed loneliness and symptoms like anxiety and drug abuse. ODonnell (2009) stated that due to increased stress students are unable to focus and complete their nursing degree. They do not pay attention towards their studies which makes their life complicated.Galbraith and brown (2011) mentioned behavior relat ed to affects like use of alcohol, smoking and other drugs. Students use drugs as substitute coping strategies. The individual who deliver from violence may develop symptoms that suffer for many years. They blame themselves for the incidence, feeling ashamed, and embarrassed. It alters their social life and builds negative thought about their career (magnavitaheponiemi, 2011).Yet another article by Mane et al. (2011) stated stress causes weak performance in education and in their later job life. Moreover they face many problems in their social life and personnel life. In my view stress always hinders in the emanation of students whether it is there education, career, and health, their personal or social life.Strategies and InterventionsThere are many interventions and strategies to stamp down the factors and negative impacts of stress in undergraduate nurses. According to (humped caputi, 2011) as cited in Nurses education today, student nurses are more opened to stress and th ey need to build their capacity to balance their thoughts and cope constructively. Lim et al. (2010) found basic education of undergraduates very beneficial in control of stress.(Hubbard et al., 1984) as cited in ( Reevea et al., 2013) Yamashita and Miwasaito, 2012), mentioned about social second. According to which a strong gestate from others (friends and family members) enhance positivity in their health and thinking. Other than this a serious family between students and their faculty can builds trust and confidence in students to perform their task courageously. (Jimenez ,2010 Yearwood and Riley, 2013), also mentioned that faculties should understand students stress so that they can support them in their grooming, progression and a proper guidance in clinical set up also reduce their stress level. In addition (Gibbons, 2010 Shomail Faisal, 2012), mentioned that the positive regards from teachers and colleague is aidful in stress management. According to Laragia (2013) to decrease stress in undergraduate nurses it is all-important(prenominal) to assess the cause and level of stress to plan interventions accordingly and help students in their theoretical and practical skill. Mane et al. (2011) highlighted about relaxation therapies and consequence to those factors which are more common in students stress. Yamashita et al. (2012) found self-awareness and knowledge of relations with stress as important strategies in alleviating of stress.Conclusion and RecommendationIn conclusion every profession is stressful but nursing is more stressful and undergraduate nurses are more vulnerable to stress. There are many causes of stress which impacts the well-being of student nurses. The causes are increase work load in classes as well as in clinical, lack of knowledge, low self-esteem, encountering challenges with staff, patients and clinical placement. Undergraduates face many consequences of stress for example they suffer from psychological, emotional, social , and physical problem. They develop symptoms of suicidal ideation, alter in thought process, self with drawl from social life, high blood pressure, sleep problems, anxiety, frustration and it also impacts on their academics. Furthermore, it is very essential to find the root causes of stress and make proper strategies to reduce it. It is important for students that they should develop positive coping skills and conjunctive relationship with faculties, staff and other professionals. Students can also take emolument from their social circle like from their parents and friends. In Pakistan nurses image is very poor and this lead to stress and many other issues in nurses. A proper research is needed to find the causes, prevalence and impacts of stress on the well-being of undergraduate nurses. I would recommend that students and teachers should make support group which will find out or help those students who are in stress. Furthermore, insertion should not over burden the students. They should plan such activities which help them in relieving their stress such as sport timing, parties, and psychotherapy and counseling classes. If these strategies are implemented than students will be healthy and ultimately, there will be productive outcome.ReferencesDavidyan,A. (2008, January 10). Retrieved from http//http//www.severehypertension.net/hbp/more/theories-of-stress/Donnell,O. (2009). The emotional impact of nursing student scrape rates.British Journal of nursing,18(12), 745-747, 750, 752-754. Retrieved from http//www.scopus.com/Galbraith,N.D., Brow,K.E. (2011). Assessing intervention effectiveness for reducing stress in student nurses.Journal of move on Nursing,67(4), 709-721. Retrieved from onlinelibrarywiley.comGibbons., Dampster., Moutray. (2011). Differences in Perceived Stress and Its Correlates among students in professional courses.JCDR,5(6), 1228-1233. Retrieved from http//www.jcdr.net/article_fulltext.asp?issn=0973-709xyear=2011volume=5issue=6page=1 228issn=0973-709xid=1620Gibbons,C. (2010). Stress, coping and burn-out in nursing students.International Journal of Nursing Studies,47(10), 1299-1309. Retrieved from http//www. acquisitiondirect.com/Goff,A.M. (2011). Stressors, academic performance and wise to(p) resourcefulness in baccalaureate nursing student.International Journal of Nursing development Scholarship, 8(1).Jimenez,C., Navia-osorio,P.M., Diaz,C.V. (2010). Stress and health in novice and experienced nursing students.Journal of Advanced Nursing,66(2), 442-455. Retrieved from http//onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2009.05183.x/fullKhowaja,K. (2009). International perspective health care systems and care delivery in Pakistan.Journal of Nursing Administrator,39(6), 263-265. 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Retrieved from http//www.jcdr.net/article_fulltext.asp?issn=0973-709xyear=2011volume=5issue=6page=1228issn=0973-709xid=1620Martos,M.P., Augusto-landa,J.M., Lopez -zafra,E. (2011). Sources of stress in nursing students a systematic review of quantitative studies.International Nursing Review,59(1), 15-25. Retrieved from http//o nlinelibrary.wiley.com/doi/10.1111/j.1466-7657.2011.00939.x/fullPor,J., Barriball,L., Fitzpatrick,J., Roberts,J. (2011). Emotional intelligence Its relationship to stress, coping, well-being and professional performance in nursing students .Nurse Education Today,31(8), 855-860. Retrieved from http//www.sciencedirect.com/science/article/pii/S0260691711000086Prasad,C.V., Suresh,A., Thomas,D.K., Pritty,M.K., Beebi,S., Multazim,V. (2013). The level of stress and coping mechanism adopted by I Year B.Sc. nursing students.AMHS,1(1), 19-23. Retrieved from http//www.amhsjournal.org/Reevea,K.L., Shumaker,C.J., Yearwooda,E.L., B., Crowella,N.A., Rileya,J.B. (2013). Perceived stress and social support in undergraduate nursing students educational experiences.Nurse Education Today,33(4), 419-424.Sawatzky, Richard, Ratner,G., Pamela,A., Richardson, Chris, Patricia. (2012). Stress and embossment in Students The Mediating Role of Stress Management Self-efficacy. Nursing Research,61(1), 13-21. R etrieved from http//journals.lww.com/Shomail,S., Faisal,A. (2012). Stressor and coping strategies among baccalaureate nursing students at Shifa college of nursing Islamabad, Pakistan.International Journal of Nursing education,4(2), 193-197.Somani,R.K., Khowaja,K. (2012). Work place violance towards nurse a reality from Pakistani context.Journal of Nursing Education and Practice,2(3). Retrieved from www.sciedu.ca/jnepYamashita,K., Miwasaito. (2012). stress and coping styles in Japanese nursing students. International Journal Nursing Practice,18(5), 489-492.
Friday, March 29, 2019
Examining The Automotive pains In Malaysia Economics EssayThe sedulousness I have chosen is the automotive Industry in Asean in finicky Malaysia and to go much indepth I in like mannerk proton as a good lineament study what is happening to the Malayan automotive fabrication.Why Malaysia?Malaysia has a immobile driving culture and one of the highest penetration rates of railroad railroad cars per capita in the ground (Bonami, 2005, p. S3), as well as the growing clout of the Association of southeastward Asian Nations (ASEAN) foodstuffs, Perusahaan Otomobil Nasional Berhad (PROTON) as an appropriate sampleavailable at (http//www.proton.com) outline introduction about protonThe first national car project by Malaysia was infrataken with the establishment of Perusahaan Otomobil Nasional (PROTON) in 1983. The Proton Saga was produces 1985. Proton nowadays produces a tote up of car models and varipismires, including the Iswara, Perdana,Wira, Satria, Putra,Waja and closely r ecently, the GEN-2 and Satria Neo. The latest 104 M. Rosli F. Kari models, as reported, use Malayan demonstrable engines done collaborationism between Proton and its subsidiary, Lotus (United Kingdom) ..Political and stinting bodily structures, including cultural attitudes relevant to the line of businessAccording to ( Rasiah, 2005) Malaysia continues to protect its move perseverance a take a leakst theconditions in the Trade connect Investment Measures (TRIMs)agreement of the World Trade Organization (WTO), the inclusion of automotives under the common effective preferential obligations (CEPT) under the Association ofSouth eastern nigh Asian Nations (ASEAN) Free Trade Area (AFTA) process has broughtincrease pressure sensation for the removal of topical anaestheticization-based tariff protection ofautomotives and separate production in the nationStimulatory and Protective Measures set by the Malayan organisationThe development of the Malaysian automotive industry i s heavily depending uponthe undivided support of the political science. Various stimulatory and cautionarymeasures, much(prenominal) as enthronement incentives, a local content policy, and tariff and nontariffbarriers were implemented to stimulate the development of twain localautomotive and set forths production. Proton in particular(prenominal) is a unique case because ofits status as the first national project.To date, the largest sh arholders in Proton are still g everywherenment-controlledagencies, namely Khazanah Nasional Berhad (42.7 per cent), the Employees farsighted Fund (12.6 per cent), and Petronas (9.8 per cent). Temasek HoldingsPte. Ltd, a Singapore institutionalisement merged as a new shareholder with a 5 per centHolding ( Rosli.M KariF 2008).The government has also raised more incentives under the 1986Promotion of Investment Act. In particular the Pioneer Status and InvestmentTax Allowance are the dickens most lucrative tax incentives granted to companies involvedin promoted activities or products that are, from time to time, determined by theMinistry of International Trade and Industry (MITI).In order to help to develop national capabilities in the automobile Industry in a sustainable but agonistic right smart, the Malaysian government initi tout ensembley provided protection, allowing Proton( and other Malaysian car manufacturers) to withstand some first environmental d possess pat(p)turns (Todd, 1986). For prototype, import duties were set at roughly 21% on national components, as compared to 40% on the equivalent contradictory parts. This implies that in that location was a substantial difference in price between unconnected import cars and proton cars.Moreover, PROTON cars required excise duties of only 11%, while unusualbranded automobiles were taxed up to 25%. Further, the authorities postulateed car assemblers charge a profit margin of 16 to 17% to avoid price wars (Zafar A. Humpreys J. 2008). This all resulted i nto that Proton was totally protected in any kind of way of the way to potential success was predetermined in Malaysia.Economic structure cultural attitudesIn Malaysia in that respect is global consensus that the automobile industryis one of the drivers of homo economic process and has the potential to shape how we make things . . . , how we work . . . , what we buy, how we calculate and the way we live(Womack, Jones, Roos, 1990, p. 11). Therefore the Malaysian economy has always been heavily depending upon the automobile industry or product which are complementary to that, such as petrol in which Malaysia has one of the biggest oil( Petronas) producing companies in Asia.As mentioned primitively a concentrated driving culture exists in Malaysia and owing a car is culturally considered as a status symbol of wealth and prosperity.Moreover, the plan has been since the seventies to turn Malaysia into the League of Developed Nations under the visionary leadership of Dr. Mahathi r Mohamad, and was introduced in a national development policy document entitled quite a little 2020(Zafar A. Humpreys J. 2008)This is great, from a economical points of view as Malaysia has notgone through the usual industrial spirit take aims, which implies highly skilled, labor-intensive to mass production (semi skilled, hold in products) to multi skilled, mass customization (Simpson, Sykes, Abdullah, 1998)..Nature of international trade in ASEAN, now and historically (say ten eld ago)Currently, Asean is near to create an integrated economic residential area that impart save movements of goods, services, investment, neat and skilled labor within the 10 Asean countries. An AEC characterized by a single commercialize and production base allows for economies of outmatch, investment flows and building business linkages and network to promote further commerce.The future looks silklike for Asean callable to fully rebound of the economic crisis. It is expected that Asean private motive picks up, export will increase and social safety will be more enhanced.However, the Economic Community pillar has introduced at AEC scorecard, which list down the measures to be undertaken and the achievements to date. Thus, far Asean only has a 75.5% achievement rate for the 2008/2009 measures. Asean has to do a number of things if it is to achieve its goal of building an AEC by 2015.This up-to-date year exports of Asean are expecting to rise between 4.9% and 5.6 % after a 1.5% emergence in 2009.In the area of services Asean members are close to end the 7th AFAS package of service commitments covering varying levels of commitments in 65 servicesHub sectors. The service sector of Asean received the highest amount of FDI, studying for more than 50% of total Aseans FDI.The sign are good and Asean will cod a further increasing growth this year and currently capital flows are increasing, inflation remains low and manageable and Asean currencies appreciate reasonab ly versus the Euro and US$.HistorySince the adoption of the AEC blueprint in 2007, significant construct has been made towards achieving the AEC in 2015.In Janaury 2010, The Asean-6 achieved zero tariffs covering 99 and for the CLMV 98% and at 0.5 % tariff rates of the total tariff covering under the common effective preferential tariffs for asean go off trade area(CEPT-AFTA).Also in the same month Asean saw the realization of Asean-China and Asean-Korea free trade agreements and the low of the implementation of the Asean- Australia-New Zealand free trade agreements and Asean India free trade agreement.Since 2000 Asean exports rose from US$68 billion to US$162.5 billion in 2009. Asean imports of services from the domain of a function market has also expanded markedly, of similar trend and magnitutude as exports, increasing two-fold from US$ 86.6 to US$ 180.4 billion in 2009In investment, Asean has witnessed a stabilise increase in intra-Asean FDI flows accouting for 18.2% ( US$ 10.8 billion) of total Asean FDI ( US$ 59.7 billion) inflows in 2008, compared with a share of 13.82% in 2006. For the same period, total FDI inflows increased by 8.59%. offset Asean Roundtable 2010. Achieving the asean economic growth 2015 Challenges for Member countries 29th April 2010. Aseans Readinesss in achieving the Asean economic community 2015. Pushpanathan SundramRegional governments attitude towards international trade and investments, some(prenominal) superficial and inwardThe ASEAN Free Trade Agreement (AFTA) is a regional free trade agreement among Malaysia, Singapore, Thailand,the Philippines, Indonesia, Brunei, Vietnam, Cambodia,Laos, and Myanmar. The ten participating countries agreed to develop a free trade area that would become a single market with more than 550 million potential consumers (Bonami, 2005). An integrated ASEAN would be the eighth-largest automobile market, with 1 million new car gross sales each year. With projected growth trends, it has the po tential to very become the poop largest auto market, with as many as 2.2 million new autosales annually (Seeking for Bigger Share, 2002).The creation of the free trade zone in Southeast Asia allowed PROTON greater access to its dwell countries. While good news from the marketing front, AFTA would also set the stage for greater future competition for which PROTON was inadequately prepared. (Zafar A. Humpreys J. 2008)The protective tariff regime, which obligate rates of up to 300% on imported cars and helped PROTON to gain run market share has been phased out. In line with AFTA, all but a few import tariffs will be reduced to between 0 and 5% by 2008 (Shameen,2005).The increasing level of international competition puts the Malaysian pixilated in a very undefended position (Savage, 2005, p. 20). With plants, become assembly, and/or joint ventures in Britain, Italy, Iran, Indonesia, Vietnam, and China (Bonami, 2005),.Although Malaysias overall automobile sales increased dramati cally in 2005, the escalating competition saw PROTON continue its interior(prenominal) decline (Edwin, 2005). Evenwith limited protective barriers still in straddle, the firms Malaysian market share had declined from roughly 70% to 45% in the anterior five-year period (Burton, 2005).In response, PROTON is looking to expand its export efforts within the ASEAN region, the Mediterranean countries . . . , the Middle East, China, as well as India andRussia to a lesser purpose (Bonami, 2005, p. S5). While this is clearly a reasonable course of action, as exports account for less than 5% for Malaysian automakers versusthe roughly 60% in lacquer (Bonami, 2005), production capacity is still comparatively very small.PROTON, notwithstanding its earlier intentions of a large outline, issimply not big enough to gain economies of scale to contend effectively in the export market against jumbo global competitors (Shameen, 2005).The union has also been slow to market itself effectively v irtually the world. Recent years have seen the organization neglect its prior efforts at branding, which has led to a cheap car image, even in the domestic market (Savage, 2005, p. 20). According to Rajeev Lochan, general manager, Asia-Pacific, TNS Automotive, While the short-term challenge is to provide a promotional thrust to models in its current line-up, the long-term requires PROTONto invest in revamping its aging product portfolio and reposition its brand to reach a wider base of prospective car buyers (Savage, 2005, p. 20).The stakes are very high, as approximately 100,000 jobs are on the line when considering PROTON and its component supply chain (Burton, 2005).By signing the AFTA agreement by the Malaysian government PROTON has to run into alternative ways how to compete successfully with all its international competitors. learn potential areas of intra-regional conflicts (if any) and synergiesAs mentioned before Proton is a classic case of a long-protectednational champ ion that is struggling as the market opens up and a perfect example of intra-regional conflict with its neighboring countries such as Thailand and Indonesia where the car market is liberalised. In 2002 its domestic market share was more than 60%. That has now fallen to 44% after Malaysia reluctantly agreed with its partners in the Association of South-East Asian Nations (ASEAN) to drop import barriers on ASEAN cars to nearly 20%, from up to 300% previously. And the process is just beginning Malaysia actually fudged the market opening by simultaneously hiking excise taxes on the imported cars. But by 2008 the country has to do away with such worldliness and cut import duties to 5%The trouble is that Malaysias politicians and managers have failed to realise how vulnerableProton is, says Graeme Maxton, director of automotive research group Autopolis. The Malaysians see it as a world-class carmaker with great export potentialthe reality is that it is too small to survive in a global ma rket rule by just a dozen huge carmakers. Proton is off the scale in price of economies of scale, says Mr Maxton, and it will slowly die once the market opens up. Hence, I argue that it is that it is undesirable to imitate such a strategy because on the long term this expensive project( proton and the automotive industry in Malaysia) will impose heavy costs on the government.The establishment of PROTON has to be attributed to the vision of the Malaysian government. The firm successfully positioned itself as the national car and pride of Malaysia, a symbol of its countrys accomplishment on the global stage. I agree that government initiation of a national champion (Donnelly et al., 2002) is surely a powerful force for the vision and subsequent emergence of a developing country. The conflict which might arise is that Malaysia still is not free to open up its car market completely to protect its own interest.This might result into intra-regional conflicts between Asean members. Es pecially between its neighboring countries because there is sufficient expertise available and this can be applied and utilize at the Malaysian carmarket (Zafar A. Humpreys J. 2008). This is the pick out problem that has prevented the government of Malaysia from signing ant bilateral Free Trade Agreements despite several attemps. For example the coalition with Japan in 2006, is called Economic Partnership Agreement is not compared to a fully eligible fta.Currently in Malaysia the call for liberalization and subsidies face by industries (automotive) has remained an obstancle to greater integration in AEC.Synergies regarding the automotive in Malaysia are not available, futher it is difficult to determine the synergies between other automotive industries such as Thailand and Indonesia because the Malaysian automotive industry is a unique example compared to relative liberased automotive markets( Thailan Indonesia).Asean Roundtable 2010. Achieving the Asean Economic Community 201 5Challenges for Member countries. 29 April 2010, Singapore.Towards an Integrated Asian Economic Community. Where is Malaysia? Rajah RasiahApplication of suitable focussing model(s) to analyze findingsAccording to the literature both models of porter can be applied to the Malaysian Automotive industry, however, ostiariuss diamond also acknowledges the role the governmental forces and luck can play in national competitive usefulness in which the 5 competitive forces is lacking. (Sledge, 2005)Demand conditionsDemand conditions describe the level of domestic demand that Proton faces. Demand conditions depend both on the mensuration of demand as well as the sophistication level of consumers in a home market.In Malaysia, the demand for cars has been risen steadily due to increasing living standards and consumer expenditure. However, the difference between supply in terms of Malaysian cars and foreign cars is substantial ( Due to tariff barriers and special incentives consecrate to Ma laysian car manufactures which results in significant higher prices for foreign cars). In fact the Malaysian government can largely influence the demand since most of the Malaysian lack the purchasing power to buy foreign manufactured cars.Generally, demand conditions are associated with a countrys level of economic development.Malaysia is has been having a sustainable economic growth of an average of 5% per year since the 1980s.The company has also been slow to market itself effectively around the world. Recent years have seen the organization neglect its prior efforts at branding, which has led to a cheap car image, even in the domestic market (Savage, 2005, p. 20).Thus, the general consensus is Malaysia is that Proton/Malaysian cars are perceived as one of the cheapest car in their segment and this can result that very demanding consumers create an awareness in firms that causes them to focus on the get hold ofs and preferences of the consumer.Also, quantities of demand drive fi rms to higher levels of aptitude and productivity. Thus, high levels of demand in a nation would drive the firms in that industry to become globally competitive (Sledge, 2005), however this is not applicable yet because Malaysia is still a developing country.Factors conditionsAccording to Porter, factor conditions allow in any factors of production that a firm uses in its businesses. These include the traditionalistic factors of production, this includes manmade structures that facilitate commerce,Still other factors would be educational and legal systems. Porter classifies these factors into five major categoriesHuman resources, physical resources, knowledge resources, capital resources and infrastructure. The more advanced these factors are the more they will enhance the success of businesses hardened in the country. These factors provide essential inputs and systems that businesses use to gain competitive advantages over their rivals. Without them, firms would have to expend their own resources to provide such structures for commerce and transactions. (Sledge, 2005) many a(prenominal) of these important factors are still not completely utilized and developed to a certain level. Malaysia automotive industry is lacking most of the important factors such as human resources, knowledge resources many skilled Malaysian labors went abroad due to better labor conditions and highly skilled foreign labor has been brought into the Malaysian automotive industry. In order to expedite the tape transport of technology to Malaysia, PROTON was proactive in initiating programs between local vendors and numerous formal overseas technical collaborators. By 2002, some 222 collaborative arrangements were in place representing specialized assistance from various regional neighbors (primarily Japan, South Korea, and Chinese Taiwan), as well as Western Europe (Ahmed Humphreys, 2008)The Malaysian governments still plays a large role in their own industrial global competitive ness. It has been the opening night of the Malaysian government to set up its own automotive industry and therewith complementary industries will arise( such as car part suppliers). The aimed result was to create an advanced business infrastructure and an emphasis on innovation, however this is still not the case in the Malaysian automotive industry .Related and backup industriesThis aspect of the model includes the importance of enterprises that indirectly or directly affect the automotive industry. Porter describes these ancillary businesses needed by firms as colligate and supporting industries. These most often comprehend suppliers or distributors that serve the industry at hand. The model proposes that the stronger these industries are the stronger the local industry will be. The underlying assumption is that highly competitive supporting industries will drive the focal industry to be more competitive (Sledge, 2005).Hypothesis 3 Strong and dynamic related and supporting ind ustries in a firm s home market will positively impact the firm s global competitiveness.PROTON, notwithstandingits earlier intentions of a large-scale strategy, issimply not big enough to gain economies of scale to compete effectively in theexport market against giant global competitors (Ahmed Humphreys, 2008)And jibe to (ROSLI KARI, 2008)a research shows that foreign suppliers performed better than local suppliers. Interviews suggest that access to excellent technology from abroad is the prime determinant of the inferior performance of local suppliers compared to foreign suppliers. Local firms lack firm-specific advantages that foreign multinational suppliers enjoyIt points to the need for companies and governments to encourage and support ancillary industries to enhance global competitiveness. In both models, this parameter estimate was the second largest and the most statistically significant. This underscores the importance of related and supporting industries in the contex t of global competitiveness. Without a network, firms can not hope to be worldwide leaders.Firm strategy, structure and argument is the fourth clement in the model. This point on the diamond refers to several key strategic factors that characterize a firm. Strategy describes the types of actions firms utilize to achieve both long-range and short-range goals. These are often either low-cost, differentiation, focus strategies or some combination thereof Other common strategies include growth, living or restructuring activities. Growthstrategies would be associated with higher competitiveness because the ability to pursue growth intemally or extemally would be indicative of overall business health, Stmcture refers to the industry composition.This describes the degree to which an industry is concentrated or dispersed, competitive or monopolistic, or global or domestic. A more crowded structure would orient multilevel competition and therefore greater competitiveness.Rivalry indicates both the number of players and the level of competition among firms in an industry. This could be heated, mid-range, non-rivalries or somewhere in between. Greater rivalry in an industry would lead a firm to higher levels of competitiveness vis a vis its rivals. Rivalry is thought to be the most comprehensive of the three factors, as it often indicates the underlying strategy and structure of the competitors Thus, a greater number of firmactions as well as a greater number of competitor responses in the focal industry lead to greater competitiveness ofthe firm.Hypothesis 4 Greater rivalry within a firm s home market will positively impact the firms global competitivenessMake and justify recommendations for mathematical business strategies to exploit the benefits in this region