Ikea Global Marketing Essay

IKEA crossing cultural boundaries to furnish the globe 1. How has IKEA successfully sold its home furnishing products in so many countries around the world? Do global customer segments truly exist? Ikea targets consumers who tend to have a young ‘mental age’ — that is, people who have a youthful outlook regarding the design of home furnishings. Industry analysts have described IKEA’s approach as targeting middle-class consumers including first-time home buyers, young families, and people renting their homes that transcend global needs. However, students may argue for forces against global segments, such as resistance to international brands in favour of local brands and anti-western sentiments. Students may also note cultural/attititudal differences in various product categories that make targeting global segments difficult. 2. How important in its marketing is the role of IKEA’s Swedish brand image? What are the implications for marketing? Students should answer the question in relation to the role of country-of-origin effects. These country-of-origin effects influence how consumers rate quality, and sometimes, which brands they will ultimately select. Consumers tend to have an established attitude or even a preference when it comes to a particular product being made in a particular country. This attitude might be positive, negative or neutral. This plays a critical role in IKEA’s marketing strategy, serving to differentiate its value proposition from its competitors and position its brand clearly in the minds of consumers. (Hint: Elaborate on how Ikea utilizes its C-O-Effect in its marketing efforts) 3. To what extent has IKEA practised a standardised strategy versus an adapted strategy in its global strategy? What are the advantages and disadvantages of this approach? IKEA’s products are manufactured, packaged, and positioned the same way regardless of the country in which they are sold to a global segment. However, IKEA localises its advertising to consumers where absolutely necessary for various country markets, and has created different versions of their products to appeal to cultural preferences. The major advantages of IKEA’s global standardised strategy are: 1. Cost savings/Mass Production 2. The design and implementation of a standardised marketing mix. 3. Branding control. The major disadvantage are: 1. Unable to fully localise its product range to meet the specific cultural needs and sensitivities of different markets. 2. Limited selection of advertising appeals for some markets to arouse the attention of local consumers. 4. Some say communications, especially the internet and television, enable a global culture to be broadcast to all societies. Are the cultures of the world becoming more similar or more different? Discuss. Global marketing, travel, pop music, popular culture, networked news media and the internet are all forces pushing the world into a more global culture resulting in similar consumer behaviour. Students could discuss the increasing role of technology as a driver of global media with global television networks and the internet, enabling the transfer of cultures across boundaries and acting as important global promotional tools for global brands.

Of Mice and Men: John Steinbeck Essay

Task: Say what happens on each of the three times we Curley’s wife and what we learn about her. Curley’s wife only appears three times throughout Of Mice and Men, even though she is a pivotal character in the story. The three times she appears are all small parts in the book, but are key scenes. They give us clues about her appearance, character and an insight into her life before she married Curley. The final time we see her is the vital scene where the plot comes together. The first time we see Curley’s wife is chapter 2, where she visits the bunkhouse. Curley’s wife enters the bunkhouse where Lennie and George are unpacking and George is telling Lennie where to go if he gets into trouble. Curley’s wife comes in looking for her husband; she stands in the doorway provocatively trying to get attention from Lennie and George. George ignores Curley’s wife, knowing what she is trying to do, but Lennie is instantly besotted with her. After Curley’s wife doesn’t get very far with Lennie and George she turns her attention to Slim and leaves the bunkhouse. This is only a short scene in the book, but we still learn a lot about Curley’s wife. The fact that she is only ever referred to as Curley’s wife suggests that she is only ever seen as the possession of Curley’s and has no individuality of her own. We learn that she has full, rouged lips and wide-spaced eyes, heavily made up. Her hair was hung in little rolled clusters, like sausages†. The part about her hair could be taken as an insult about her appearance and that she has failed in making herself attractive. She is descried as wearing mainly red rouged lips, fingernails were red, red mules with little bouquets of red ostrich feathers† which could be interpreted as a colour of danger or a sexual colour which she uses to gain attention from the ranch hands. Curley’s wife strives for attention; by always wearing a lot of make-up and bright clothing she gets the attention she craves so much. Because Curley’s wife is the only woman on the ranch she has no other women to walk to or be friends with and is therefore seen as a sexual object by the ranch hands. She uses this sexual image the ranch hands have of her to gain attention. Her body language suggests that she flirts provocatively her body was thrown forward†, showin her legs†. Her voice was said to have a brittle quality, which could imply that she is as so brittle herself, easily broken or venerable. Because Curley’s wife cannot escape from the sexual image that the other men have of her she uses it as a means of getting the attention she lacks. It is shown this scene that she doesn’t have a good relationship with Curley, because even though she says she is looking for Curley, when she is told where he is she looks apprehensive and rushes back to the bunkhouse as if she would be in trouble if she were not there. Also in this scene shows us that she is lonely and wants someone to talk to because when George answers her brusquely she still stays there and tries to talk to them. After she has gone George speaks of her despairingly bitch†, piece of jail bait† meaning that she has failed to impress him. This scene is like a prediction of what will happen later on in the story, before Curley wife comes into the bunkhouse George is telling Lennie where to go if he gets into trouble, then Curley’s wife walks in. This could be an indication that she is or has something to do with what gets Lennie into trouble. Over all in this scene we find out that Curley’s wife is lonely, pretty, flirty, frightened of her husband and is seen as a possession of Curley’s. The second time we see Curley’s wife is in chapter 4. This scene is where we see Curley’s wife visit Crooks room, gathered there are all the misfits on the ranch. They have been left behind while everyone else has on into town for the night. These people are left behind because they are misfits i.e. are not a young healthy white male. Crooks is black and is crippled, Candy is old and crippled, Lennie has learning disabilities (seen as being thick) and Curley’s wife is a woman. Candy, Lennie and Crooks are discussing the plans for the farm they are going to own, when Curley’s wife comes in looking for Curley. Candy and crooks want Curley’s wife to leave so the don’t get into trouble, but she persists in trying to talk to them. She asks them if they know what happened to Curley’s hand even though she all ready has worked out what has happened. When Crooks tells her to leave or he’ll tell the boss not to let her in the barn any more she becomes angry and tells him not to open his mouth, she threatens that if he dose she will get him strung up on a tree. Curley’s wife only leaves when she thinks the other ranch hands including, Curley have come back from town. Again in this scene we are shown that Curley’s wife is a very lonely person and only wants someone to talk to well, I ain’t givin you no trouble. Think I don’t like to talk to somebody ever’once in a while? Think I like to stick in that house alla time†. She is also again shown to use her appearance to get attention, Her face was heavily made up. Her lips were slightly parted. She breathed strongly, as though she had been running†. Curley’s wife shows discontent in the life that she has now and a great dislike for her husband Curley, Sure I gotta husban’. You all seen him. Swell guy aint he?†, I’m glad you bust up Curley a little bit. He got it comin’ to him. Sometimes I’d like to bust him myself†. She has this dislike for Curley because of his failure to satisfy her emotionally. Even though this scene is a gathering of the ranch misfits Curley’s wife has a slight advantage over the others. This is because she has a superior social standing as a young white female, she uses this to threaten dominate the other misfits. This happens on several occasions i.e. when she talks down to them You bindle bums† and also when Crooks orders her out of his room. By doing this he aggravates him and she attacks him verbally You know what I could do?† Well, you keep your place then Nigger. I could get you strung up on a tree so easy it ain’t even funny†. Crooks was an easy target for Curley’s wife to pick on because he is black. People were prejudiced against ethnic minorities in those days and this made it easy for her to frighten Crooks. In my opinion I think that she took pleasure out of his suffering and this particular scene shows a nasty side of her personality. The last time we see Curley’s wife is in the barn with Lennie, chapter 5. In this scene all of the men on the ranch except Lennie are outside taking part or are watching a horseshoe tournament. Lennie is in the barn playing with has pup, but accidentally kills it by stroking it too hard. Curley’s wife enters the barn because she is lonely and wants someone to talk too. She tries to flirt and impress Lennie by telling him about her life before she met Curley. She only really gets Lennie’s full attention when he tells her he likes to stroke nice things. When he tells her she invites Lennie to stroke her soft hair, but when Lennies stroking becomes harder, she panics; in a effort to stop her panicking and screaming Lennie puts his hand over her mouth, this in turn makes her panic even more. In the end Lennie like with the pup breaks her neck. He half-buries her in the hay and runs off. Candy later finds her body. Even though this is the last time we see Curley’s wife we still learn a lot about her and things we already know are reinforced. The fact that Curley’s wife is lonely is reinforced again in this scene I get lonely† this again makes her crave attention from other people. She attempts to gain Lennie’s attention in many ways in this scene, one of the ways she tries is by flirting here feel right her†. Another way is by playing on her own loneliness for sympathy even she shows none for Lennie when he shows her his dead pup. She tries to impress Lennie by telling him about her life before she met Curley She looked closely at Lennie to see whether she was impressing him†. Curley’s wife shows herself to be impatient and selfish by not letting Lennie tell his story before hers she went on with her story quickly, before she could be interrupted†. Again in this scene like the one before she shows a great dislike for Curley. This is because she married Curley only because she was let down by a man who said he could put her in movies, she married Curley so she could get away from home, but this turned out to be a hasty and bad decision for her. Because Curley doesn’t give his wife the attention she needs and tries to keep her from the other men on the ranch, she begins to hate Curley and seeks the attention from the other men on the ranch. Curley’s wife is also naive and lacks any common sense; this is because she believed that the man at the Riverside dance could put her in movies, when it is most probable that he just said it to sleep with her He says he was gonna put me in the movies. Soon’s he got back to Hollywood he was gonna write to me about it† I never got that letter†. Also the fact that she let Lennie to stroke her hair after he told her that he killed his pup by stroking it shows that she lacks any common sense. Many of the characters show contempt for Curley’s wife; they feel that she is a troublemaker. Candy calls her a tart and even when she is dead he says to her you god-damn tramp†¦Ever’ body knowed you’d mess things up. You wasn’t no good. You ain’t no good now, you lousy tart†. In my opinion I think that she deserves pity rather than contempt, because her husband is insensitive, possessive and aggressive. From the three times we see Curley’s wife we can say that she is a pivotal character in the story. Because of her hasty marriage to the possessive Curley she has become lonely in her isolation. To try to escape from the loneliness she uses the sexual image the ranch hands have of her to gain attention from other people, even those at the bottom of the social hierarchy. The fact that she is known only as Curley’s wife and is never called by her real name by ether the ranch hands or the author shows that she is seen only as a possession and is not treated as an individual.

Hong Kong’s Environmental Problems and Solutions

lmovementHong Kong’s environmental problems and solutions Hong Kong is one of the top financial centers in the world. Thus, the environmental quality of Hong Kong is very important. It is because the environmental quality is indirectly linking to the image of Hong Kong. Moreover, the living standard of Hong Kong residents is also under influencing of the environmental quality. However, Hong Kong is now surviving serious environmental problems. Poor air quality, noise problem and heavy traffic loads are the three important problems of Hong Kong.The members of Hong Kong should try their best to tackle these problems. Problem of air quality in Hong Kong is serious so we need to try our best to solve it. Three are two main reasons that causing the serious air pollution problem in Hong Kong. One of them is the increasing number of vehicles. Another is the huge amount of pollutants from industrial production. First of all, vehicle is a significant source of air pollution in Hong Kon g. Commercial vehicles like buses and trucks always emit a huge amount of pollutants.These pollutants contain large amounts of particulates that worsen the air quality. Secondly, the pollutants from industrial production are giving a helping hand in causing the air pollution problem. During the process of industrial production, energy conversion is always taken place. However, energy conversion operation will give out a certain amount of pollutant. For example, nitric oxide is formed when industrial combustion takes place. Air pollution has deep influence on human as well as the natural environment. For the human, the main influence is the health effect.American Academy of Family Physicians (2010) explained that people who affected by air pollution will suffer from difficulty in breathing, coughing and even worsen their respiratory disease. In more serious case, the effect of air pollution may induce the permanent disease. For the natural environment, air pollution will intensify th e problem of global warming. As there are a lot of particles emitted to the air, the heat released from the land will trap by these particles. Thus, the earth will become more and more hot. Once the global temperature is increase, more energy is generated in order to reduce the temperature.However, more particles are emitted through the generate process. Thus, it will become a cycle. As we know the seriousness of the air pollution, we should take actions to deal with the problem. â€Å"The Hong Kong Special Administrative Region Government gives high priority to controlling both street-level air pollution and smog. † (Environmental Protection Department, 2011) To reduce the pollutants emitted from vehicles, the Environmental Protection Department (2011) pointed out that the government has adopted a tighter fuel and vehicle emission standards and strengthens vehicle emission inspections against smoky vehicles.These measures can effectively control the pollutants emission from vehicles. One the other, the waste gas giving out from industrial production should also be regulated. The government can install system on power generation plant and develop green energy power to reduce the emission of suspended particles. As a result, pollutants from industrial production can be largely reduced. We should take immediate actions to solve the serious noise problem in Hong Kong. As Hong Kong's economy has grown in  recent decades, so too has the noise that comes from transport, construction, commercial and industrial sources in this compact, densely populated city. † (GovHK, 2011) There are two main sources of noise pollution in Hong Kong. They are noise from transportation and industry. Transportation is the main source of noise pollution. Because of their mobile nature, the areas under their influence can be extended. Vehicles produce the most extensive noise effect compare to trains and aircrafts. It is because it is difficult to control the noise produced from vehicles.The source is thus difficult to chase as they are mobile. Heavy trucks, higher speed cars and frequent stop and start of cars always produce higher level of noise. On the other hand, industry is another important source of noise. In construction industry, high level of noise is always produced from the use of equipments. There are piling, compressor and bulldozers that produce high level of noise. Moreover, noise will also produced in manufacturing industry. During the operation of machines, noise is generated. Noise has more impacts than we expected. It will affect our health, daily life and environmental quality. The most immediate and acute health effect of excessive noise is impairment of hearing. † (Singh. N, 2004) Prolonged exposure to noise can damage our ear cells. This may caused temporary or even permanent hearing loss. Also, noise can violate our cardiovascular system. It will make us hard to focus and concentrate as well as causing headaches. For the effect on our daily life, people’s working efficiency will be affected. Under noisy environment, teaching and learning will become less effective. Teachers and students need to pay more effort on concentrating on their work.To tackle the noise problem, the Environmental Protection Department (2011) purposed to reduce traffic noise through careful land use planning. Better road planning will divert the noisy road from the residential areas and thus reduce the disturbance to the residents. Lastly, there is an urged to deal with to problem of traffic congestion. â€Å"The problem of traffic congestion in Hong Kong is caused by the lack using of public transport† (Lo I, 2004). Hong Kong is such a small place but there are a few million vehicles on the roads. We can see that there are a lot of private vehicles running on the road everyday.The increasing of private vehicles increases the demand of the usage of the roads. As more and more vehicles are riding on the roads at the same time, the road system will then cannot afford. Traffic congestion occurs. Another cause of traffic congestion is less well-planned road system in Hong Kong. In Central, traffic congestion is common. It is because of the poor road system. Many vehicles will rush to Central at the rush hour, but the poor road system cannot help to divert the vehicles flow rate. So many vehicles are concentrated in Central and caused traffic congestion.What are the impacts of traffic congestion? Firstly, Lo I. (2004) claimed that people are needed to pay heavy time cost for traffic congestion. The wasting of time may lead to the loss of business, late for work and school. So traffic congestion can also cause the economics loss. In addition, the image of Hong Kong will also be affect. Hong Kong is an international financial center that gives the world an image of efficient. However, traffic congestion will make the damages of this image. People will wonder why Hong Kong, such a well-developed c ity, is having the problem of traffic congestion.So, measures should be taking to relieve this problem. The government should have a better road planning in order to release the heavy traffic burden in Central. Education cannot be avoided in order to educate the citizen to use more public transport. To conclude, poor air quality, noise problem and traffic congestion are the three issues that the government needs to deal with. These problems are not only affected the people’s standard of living but also the image of Hong Kong. It is no doubt that the Hong Kong people should focus on these problems and solve them together.

Executive Summery Essay Example | Topics and Well Written Essays - 250 words

Executive Summery - Essay Example The business plan was developed with the aim of obtaining start-up financing through bank loans. Conservative financial projections indicate that the firm will incur a loss during its first operating year although it will show a tidy profit by the last quarter of the first year. The strategy is to increase the sales by 50% each succeeding year by hiring more employees and establishing two more branches within the neighborhood of the target market segment which are teenagers who ideally attend the same school and live within the same local residential area. This firm has a strong social orientation in the sense it will market these video games to make profits and also a social impact by positively changing the wrong public perceptions about video games as educational as well as entertaining to the video gamers. Towards this objective, it will work cooperatively with non-governmental organizations (NGOs), the media, and advocacy groups to promote awareness of environmental issues like the global warming phenomenon and climate change (Pugari & Wright, 1999) by using social media marketing

Models of the criminal law Essay Example | Topics and Well Written Essays - 500 words

Models of the criminal law - Essay Example The impact that each of these has on criminal justice is that they are what decides on the justice to be served, on how a criminal will be treated within the criminal justice system. These two models are connected to how a criminal is handled, including his prosecution, defense, and sentencing. The concept of justice is defined by both of these models. Issues arise between the different organizations when they cannot come to a conclusion that supports the ideas of all parties involved. The conflict model can be seen between prison officials and police officers. While the police are more concerned with getting every criminal possible off the street and into a prison, away from the public, the prison officials are concerning themselves with the possible overcrowding of prisons, which could cause them to release criminals back to the streets. Neither party can achieve what they want to without going against the wishes of the other party. In this scenario, it becomes almost a chain reaction of criminals being caught, then released, then possibly caught again if they are convicted of another crime. The consensus model can be seen in regards to the court system and the police officers (Walker, 2004). The goals of both systems is to catch, try, and punish the criminals. They work together to make sure that they reach their idea of what justice is; they are capable of working together to get the desired results. The consensus model shows that these different parties and organizations are able to cooperate with each other, working around and working towards that one common goal that they share. The model that best represents the criminal process in this country is the conflict model. The different organizations involved in the criminal justice system are constantly at ends with trying to decide what is right or what is wrong, and what punishment should be given. When something has finally

Marketing plan for Air Canada Coursework Example | Topics and Well Written Essays - 3750 words

Marketing plan for Air Canada - Coursework Example SWOT analysis of Air Canada has been conducted in this paper. With the help of SWOT analysis strengths, weaknesses, threats and opportunities of the firms are highlighted. Air Canada performs its business operations and functions in a very competitive industry. Many strong players are present in the airline industry of USA. The study highlights that the competitor companies are creating strong pressure on Air Canada. For this reason Air Canada is developing its business processes and services for holding its positing in the competitive market. Company analysis has been done in this paper. The customer base of Air Canada has been discussed in details. Upcoming product and marketing objectives of the Air Canada have been analysed in this study. Air Canada is one of the largest airline companies in Canada. This airline company was founded in 1936. Air Canada deals with charter and scheduled air transport. It covers 178 destinations of the world. At present Air Canada is ninth largest passenger airline based on fleet size. The company has its headquarters in Montreal, Quebec. This firm is the founding member of Start Alliance. Air Canada was initially owned by the federal government of Canada. The airline market of Canada was deregulated 1980s. In 1988 the company Air Canada was privatised. The major accusation done by Air Canada is acquiring Canadian Airlines which enhanced the growth and development of the company. Presently Air Canada serves 35 million passengers throughout the year. It has a strong air transport network through the world. With strong mission, vision and values the company is able to perform its business activities and functions efficiently. The mission of Air Canada is to connect Canada with the world. The company facilitates the people in moving from one place to another by bringing them together and enriching their experiences. The firm aims to establish connection

Fahad alhajri Research Paper Example | Topics and Well Written Essays - 2500 words

Fahad alhajri - Research Paper Example One would even go further and state that the American government has chosen to keep the Native American areas of New Mexico at bay because it feels that they are more trouble than productive members of American society. This neglect has brought about a negative stigma within the populations where poverty in the state is most prevalent and this has led many of the individuals involved to give up hope of working towards the ending of their own poverty. The poor residents of New Mexico have little political voice and this may account for their being left out of the mainstream American way of life as they continue to sink deeper into poverty. In fact, the suicide rates among the residents of this state are actually quite high and this is often due to the loss of hope in improving their own lives. The political neglect of the people of this state is so great that their problems are not even highlighted during campaigns, and this has ensured that the area in which they live has become an u nappealing location for growing businesses to set up base in. the negative stigma caused by the poverty of the state has made it the least attractive place for those professionals, such as doctors and teachers, to work. This has created a situation where the state even lacks the most qualified professionals who would help to improve not only its health system but also the education of its children. The fact that people are discouraged from working in the area creates a dilemma, because with low quality of education and health care that results, there also develops the problem of high unemployment rates and coupled with low healthcare, the poverty is made even worse within the population. Considering the absence of public and private investment in the neglected areas of the state, better communication between the State and tribal governments, and more consideration to the requirements of the people of these areas, the poverty rate is estimated to upsurge (Kusel). While this may be a fact, it is also true that there are many underlying causes of the rampant poverty within the state and some of these shall be considered in greater detail. The causes of poverty in New Mexico have to be understood in order for decisions to be made on how to remedy them and bring the state into prosperity. Page-Reeves (33) states that New Mexico has the 13th highest rate of food insecurity in the United States and is related to the state of Mississippi as among the states with the highest poverty rates. It has further been seen that one in every four children within the state do not know where they will get their next meal, and this is a source of concern for the strategic planners of the state (Ramirez). Because of the arid nature of the state, there has developed the need for distributing food to the poor and this has led to the setting up of more than 600 emergency food distribution sites that serve more than forty thousand people every week. In some parts of the states, it has b een estimated that quite a large number of the population did not have the required meals in a day to remain healthy. Because of the chronic poverty which has been made worse because of the lack of opportunity within the state, an approximate of 17,000 people in New Mexico are homeless, and these, for instance, include five

Hum M3 Jak Essay Example | Topics and Well Written Essays - 250 words

Hum M3 Jak - Essay Example Values are determined by how someone estimates himself or herself – the level of one’s self-esteem and pleasure. According to Branden, moral values guide people towards the achievement of self-esteem and pleasure (Branden 32). Therefore, psychotherapists should emphasize on moral values to improve the self-esteem of their patients. Values relate to emotions because they are determined by how we think about ourselves, or judge ourselves. On the values scale, I scored medium importance in terms of power and achievement (4.2 and 4.7 out of 7 respectively). My score in terms of Hedonism, self-direction, universalism and benevolence was of high importance. This shows that I have above average value-judgment. In terms of cognitive empathy, I scored 23 out of 37, showing a moderate perspective taking. My score in terms of emotional empathy is 24 out of 37, indicating moderate emotional empathy. Lastly, the dispositional mood scale recorded a score of 4.0 out of 5. This indicates a high positive energy and affectivity as well as high

Marketing and consultancy for food trucks Lab Report

Marketing and consultancy for food trucks - Lab Report Example The consulting services for concepts, menu, and the graphics are availed (Festa, 2012). There are five key stages of the management consultancy process that are quite essential for a food truck industry. Once apparently followed the chances of the project failing are minimal. This stage is a major determinant of the food truck consultants, which provides they provide value that relies on the people that are served. The expectation from the team is frequently set at this point. When the roles are set, the parties involved are aware of what they are supposed to do to attain the goal of the business (Food company consultancy, 2009). The staffs are very flexible, and the choice of who to head the business is never a big deal. The flexibility offers a chance to select the most competent and the profitable personnel from the crew. The food truck consultants echo the cry of the crucial steps while signing the clients should be the establishment of the well-defined expectations to have defined roles. Once that is done, there is no likelihood of the friction while on the road since everyone knows his or her roles. This step is quite imperative in the food truck industry. The overall expectations on the touch points and the derivable set the project and let the clients know what their expectations and what they cannot expect. It is always important to take care not to be too ambitious at this stage. The next step to undertake while after this is to make sure that all that is set can be attained or if possible exceed the objective. At this point, it is imperative to get the team and gear to the customers to survey the field and have a clear expertise of the ground (Magazine, 2012). After getting the food truck industry, the consultants will spend their precious time with the customers in this phase. At this stage, problems may occur, so it is always the high time to figure out the probable source and act appropriately (Magazine, 2012).

What About Bob Essay Example | Topics and Well Written Essays - 1000 words

What About Bob - Essay Example Bob Wiley from the film What About Bob? displays several distinct features of psychological disorders described and identified in the DSM-IV Manual. Among the mental illnesses Bob exhibits Agoraphobia, Germophobia, Panic Attacks, Generalized Anxiety Disorder (GAD), Histrionic Personality Disorder, and Factitious Disorder. These disorders all manifest themselves separately and, according to the Axes of the DSM-IV, completely or partially fulfill the criteria of the previously mentioned disorders. In the beginning of the film, Bob describes his disorder as a fear of germs, and a nervous feeling whenever he leaves the confines of his home. He describes his compulsive need to fake illness to hide his disorders, and that he often â€Å"blacks out† or â€Å"loses consciousness†. He exhibits germophobia when interacting with public telephones, along with a general agoraphobia shown when he stepped out of his home and fell into a crouched position as a large truck goes by. These phobias are compounded by a general anxiety that extends to all other of his activities. The agoraphobia is perhaps the clearest of Bob’s diagnosable problems. Bob avoids public and confined situations (which may hint at an element of claustrophobia), such as the elevator, which is an experience he endures as he screams at the top of his lungs. Whether it is the elevator or the bus, Bob pushes through it saying â€Å"Baby steps to†¦Ã¢â‚¬  and following the Doctor’s advice. Bob exhibits pathological nervousness when in situations where getting away can be difficult or where getting help may be difficult if his anxiety occurs. He states this quite clearly when he tells Dr. Marvin about his fear of his heart exploding, or about his fear that he will not find a bathroom in time and his bladder will explode. Nevertheless, Bob’s agoraphobia does not inhibit him from going out in public. Even

Term Paper on Forest Resource Management in Bangladesh Essay Example for Free

Term Paper on Forest Resource Management in Bangladesh Essay Introduction Forests are a very important source of natural resources like wood, bamboo, thatching material etc. It also has a great influence on the environment like climate, water availability, soil erosion, flood and nutrient turnover. It is also the last portion of the world’s fauna and flora. Wood which is the main forest produce has been used from the very early days of human civilization. Even though substitute has been found for most natural materials wood remains irreplaceable in most of its uses. Wood is the major cooking fuel for vast majority of the world’s population; it provides the raw material for pulp, paper and cellulose base industries and is still a major component in the building industry. Wood is playing as important a role in human lives today as it did in the ancient times. It is still vitally necessary in the lives of people, particularly in the developing countries. With the increase in the population of the world, the pressure on land increased very greatly. This together with the requirement of timber for an increasing world population has resulted in large scale destruction of forest. According to Porte (1989) 33 million acres of tropical forests are cleared every year. The situation in Bangladesh is not any better than other developing countries. In fact because of its small land base and very large population, the situation here is more precarious than most other countries. The population of the country more than two and a half fold in the last four decades, while during the same period of time there has not been any addition to the existing forests except for the establishment of about 250,000 acres of plantation in the newly accreted coastal char land. Even though on record about 6.1 million acres of forest exists in Bangladesh, in reality, less than half of that can be considered as productive. This has been the result of over exploitation of trees resources for meeting the demand of population which is much larger than what our forest can support. A portion of the forest has also been lost to jhuming and encroachment. This has resultant in diminished supply situation causing a steadily widening gap between demand and supply of wood. Forests in Bangladesh Bangladesh has 2.60 million ha of forest land which is about 17.62% of the land area of the country. Of the forest land, Forest Department manages 10.37% (1.53 million ha) while the rest of the area is managed by either deputy commissioners of three hill districts (unclassed state forests) or privately manage (rubber and tea garden and social forestry plantation) though forest land is about 18%. However, actual tree covered area is only 8.6% (hill forest 2.7%, littoral 3.3%, Sal forest 0.8% an village forest 1.8%). The forest area of Bangladesh is presented in table 1. Forest situation in Bangladesh Bangladesh has lost over 50% of its forest resource over the period of about 25years. According to forests experts, we should have at least 25% of our total land area covered with trees, or forests to enjoy the benefit of nature. But a total of 769,000 hectares or 6% of the countries land mass have actual tree cover (from forestry master plan surveys by multi-lateral donor agencies). At approximately 0.02 ha per person of forest, Bangladesh currently has one of the lowest per capita forest ratio in the world. In Bangladesh, government owned forest area covers 2.19 million ha with the remaining 0.27 million ha being privately controlled homestead forests. Of the government owned forest land, 1.49 million ha are national forests under the control of the Department of Forest, with the rest being under control of local governments. Of the state owned forests, over 90% is concentrated in 12 districts in the Eastern and South-Western region of the country. However, due to over exploitation these forests have become seriously degraded. Major Causes for depletion of forest An inventory shows that there has been overall depletion in forest resources in all major state owned forest. The growing stock in Sundarban has been depleted from 20.3 million cubic meters in 1960 to 10.9 million cubic meters in 1998. In the Hill forest of hill districts, the growing stock has depleted from 23.8 million cubic meters in 1964 to less then 20.7 million cubic meters in l998. Over-cutting by timber merchants, increased consumption linked to population growth, shifting cultivation, encroachment, illegal felling and land clearing for agriculture, lack of participatory management have been the principal causes of deforestation and shrinking of forest land in the country. Status of the resources base Because of heavier exploitation than a desirable level, there has been an overall depletion in forest resources in all the major forests. The growing stock in Sundarbans has depleted from 717 million cu. ft. in 1960 (forestral) to 375.7 million cubic feet in 1984 (Chaffey, et.al.). This is roughly 48% depletion of tree resources in Sundarbans over 25 years. Similarly, in the reserved forest of Chittagong Hill Tracts the growing stock has depleted from 840 million cubic feet in 1964-65 (Forestral) to less than 700 million cubic feet in 1985. According to De Milde, et.al. (1985) there has been 61% depletion in growing stock in Ranglheong Reserve forests in the Hill Tracts between 1963 and 1983. Similarly the growing stock in the unclassed state forest has dwindled from 121 million cubic feet in 1964 (forests) to less than 50 million cubic feet at present. There has not been any stock taking of village resources after 1981. However, it is generally believed that over exploitation has caused substantial depletion of village tree resources. Flood has also caused a major destruction of village tree resources. Consumption According to the latest assessment, the per capita consumption of fuel wood and timber in 2.3 and 0.38 cubic feet respectively (Byron et. al. 1983). Based on this assessment, the consumption of fuel wood and timber during the current year is about 246.0 million cubic feet respectively. The broad usages of fuel wood are cooking fuel (Approx. 69%) brick burning (23% approx) and industrial fuel and raw material (Approx 8%). However, the above information does not provide an overall picture of the energy consumption in the country. Cooking fuel constitutes only about 70% biomass fuel consumption in the country and fuel wood constitutes only about 20% of all biomass fuel utilized as cooking fuel. Agriculture residue and cow dung constitute about 60% and 20% respectively of the biomass fuel consumption in the country. According to available information (BAPP report, 1985; Islam, 1986) about 38% of roughly 61 million metric tons of agricultural residues and 34% of 22 million tons of cow dung are used annually as cooking fuel. Agricultural residue and cow-dung can be used more profitably as animal feed and organic fertilizer. The result of use of these two commodities as cooking fuel has far reaching implication which are not confined just loss of animal feed and nutrients. Forest management in Bangladesh In Bangladesh management of government forest is the responsibility of the Forest Department under the Ministry of Environment and Forest. In this process the department is managing, protecting, developing the forest resources, forest land and also collecting the revenues. People have never been consulted nor involved in forestry activities. From the management point of view, forest of Bangladesh is being divided into three categories such as: ↠ State owned forest under the administrative control of Forest Department. ↠ State owned forest under the administrative control of Ministry of Land through District administration. ↠ Private village forest managed by private individuals. Type of forest The natural forests of the country are classified into three categories: 1) Tropical evergreen/ semi-evergreen forest in the eastern districts of Sylhet, Chittagong, Chittagong Hill Tracts, and Coxs Bazaar: 2) Moist/dry deciduous forest also known as Sal forests in the central and the northwest region and 3) Tidal mangrove forest along the coast, known as the sundarban, the largest mangrove ecosystem in the world. These forests are official reserves and placed under the jurisdiction of the Forest Department. Unfortunately, recent inventories indicate a continuing depletion of all major forests. Forest under Forest Department control and management again divided into three major types, †¢ Hill Forests †¢ Plain land Forests and †¢ Mangrove Forests. Hill Forests: The tropical evergreen/semi evergreen forest cover as approximately 1.32 million ha of which 0.67 million ha is controlled by the forest department and rest is under the control of hill district council. Clear felling followed by replanting with suitable species (both long and short rotation) is the method of management in hill forest. Because of increased demand for timber and fuel wood and prevailing socio-economic condition of the country this forest has greatly affected and rate of denudation is considerably high. The forest department is mainly confined in raising of single species plantation. Inventory shows that most of these plantations would not give the desirable output. This programme suffers from technical, social and administrative soundness. Another problem is most of the hill forest are subjected to shifting cultivation by the hill tribes. The tribes are entitled to shifting cultivation in forest land under administrative control of district administration which has resulted in the total destruction of this tropical evergreen forest. The growing stock has depleted from 23.8 million cubic meters in 1964 to less than 20.7 million cubic meters in 1998. In the Chittagong Hill Tracts, substantial loss of forest resources is attributed to commercial exploitation of immature trees for sale in the black market in collusion with an unscrupulous section of the forest department people, said some sources that who preferred not to be identified. Commercial use of forest land for mono-culture of rubber and fuel wood also left negative impact on the country’s forestry resources. Mangrove Forests: The single largest chunk of productive forest in the country is located in the intertidal zone in the south western districts of Khulna, Bagerhat and Satkhira. It has a type of tree formation which grows on swampy land in undated daily by tidal water-which is known as a mangrove forest. This forests, otherwise known as the Sundarbans with an area of 1.46 million acres in the single largest source of timber and fuel wood in the country. It is also the single largest productive mangrove forest in the world. Sundarban forests are being managed by selection felling method followed by natural regeneration. Beside Sundarbans, plantations are being raised with mangrove species in the newly accreted char land all along the Coast of the Bay of Bengal. Sundarban forest is an official reserve forest; unfortunately recent inventory shows a continuous depletion due to over-cutting, illegal felling. It is estimated that in less then 25 years, the volume of commercial species Sundari, Gewa, has declined by 40 to 50% respectively. A new form of encroachment of forest is the clearing of trees for shrimp culture in the coastal areas, especially in Satkhira and Cox’s Bazaar. According to the department of environment (DOE), Chokoria and some other parts of the Cox’s Bazar area, have been completely destroyed in the last 13 years. Shrimp culture having devoured most of the forest land there. Plain land Forests: Plain land forests covering 0.30 million acres are located in greater district of Dhaka, Tangail, Mymensingh, Jamalpur, Rangpur, Dinajpur and Rajshahi. These forests are also known as Sal forests, because Sal is the predominant species. Silvicultural system applied for Sal forest was coppice with standard system. In this system matured trees were felled and the areas were protected for coppice regeneration. The typical nature of Sal forest is that this forest is scattered. In the forest areas there are agricultural lands owned by the adjacent people. Frequently these land owners are extending their lands and encroaching to forest and in the process they are destroying the forest and subsequently converting the area to agricultural land. In this process forest lands are being marginalized day by day. FAO estimated that only 36% of the Sal forest cover remained in 1985; more recent estimates that only 10% of the forest cover remains due to over exploitation and illicit felling through there is an official base on logging since 1972. Most of the Sal forests are now substantially degraded and poorly stocked. Forest management approaches in Bangladesh Since 1960 two major approaches regarding the role of forestry in development have been reflected in the forestry sector of Bangladesh. In the 1960s, Bangladesh as a part of Pakistan and then as an independent nation has followed An Industrialization Approach consonant with the international conventional wisdom at that time. As a result, Department of Forest raised large-scale Industrial plantation which were seen as conversion of low-yielding natural forest into artificial plantation of species (mostly teak) of great economic importance. This conversion of semi-evergreen and evergreen forest into deciduous teak plantation was largely concentrated in hill forest areas. During the plantation raising local people were not consulted and often they did not drive any benefits from these plantations. The lack of support by the local people/ communities in combination with lack of silvicultural knowledge and lack of proper maintenance contributed to raise low quality plantations and these plantations were also lost due to illegal felling. Forest Department was considered as revenue earning department. The main activities of Forest Department were concentrated in extraction of trees from the forest and replanting of those felled areas where applicable, Forest Department has not considered the people and their participation in managing forest of the country. In the 1980s following a change in thinking about the role of forestry in development, and people’s participation in forestry activity was encouraged. People participation with the forestry sector realized the need of people oriented forestry programme to replenish the degraded forest resources of the country. Accordingly, in 1994 Government formulated a forest policy replacing earlier one enunciated in 1979 with a due emphasis to the need for peoples participation in forest management. Participatory forest management approach in Bangladesh (a). Past activities Forest extension activities were formally launched in the country in the year of 1964 with the establishment of two forest extension divisions at Dhaka and Rajshahi and later two divisions at Comilla and Jessore. It was really a very small programme and the activities were confined only to establish nursery in the districts headquarter and raised seedling and sell the same to individuals and organizations. The location of this programme was so urbanized and limited that it only partially served the needs of the effluent town dwellers only. (b). Betagi- pomora comunity forestry project The first community forestry programme in the country, started at Betagi and Pomora mouza under the district of Chittagong in the year of 1979 with the personal initiative of Prof. A. Alim, renowned forester and Prof. Dr.Mohammed Yunus, founder of Gramen Bank. Initially the project covered 160 ha of Government denuded hilly land at Betagi and with 83 landless participants from adjacent community and subsequently extend over another 205 ha of Government owned denuded hilly land at Pomora with another batch of 243 landless (families) participants. Under this programme each landless participant was provided with 1.62 ha of land for growing tree and horticultural crops with technical and financial assistance from the Forest Department. This community programme has given the landless an identity of their own and a sense of direction in life. But this model has not been replicated in the other areas due to lack of initiative of the Forest Department as well as the Government. (c). Rehabilitation of Jhumia families (shifting cultivator families) Another project was undertaken by the Forest Department in the Hill tract areas to establish plantation through rehabilitation of Jhumia families in 1980. Main objectives of the programme were, I. To rehabilitate tribal families in the Unclassed State Forest (USF) lands along with rehabilitation of denuded USP land; II. To introduce a sustainable agro forestry production system; III. To improve the socio-economic condition of the tribal people and IV. To motivate tribal people in development of forestry. Under this programme each family was allocated 2.02 ha of USF land for growing agricultural crops (over 1.20 ha), raising plantation (0.80 ha) and for house construction (0.20 ha). The rehabilitated families were given land use rights and were allowed to enjoy 100% benefits accrued to those lands. The participants were given input support for growing agriculture, horticulture and forestry crops and cash support for house construction. This programme continues for quite a long period of time but could not sustain mainly because of nomadic character of the tribal groups. Another reason of failure was that the families were rehabilitated in clustered villages without considering their cultural and religious values. Thus in most of the cases, it was found that the families have left the area. A parallel programme was also initiated by the Chittagong Hill Tract Development Board in which Forest Department was responsible for implementation of afforestation component where Chittagong Hill Tract Development Board was responsible for the rehabilitation component. This program was also not found so much responsive to hilly people except for some plantation establishment. (d). Development of community forests project The activities of the first phase of this project began in 1981 and were completed in 1987 in seven greater districts of the North-Western zone of the country. The main components of the project were: ââ€" ª Strip plantations along roads and highways, railways, canal sides, district and Union Parishad roads, totaling about 4,000 km. ââ€" ª Fuel wood plantation on 4800 ha of depleted Government land on participatory concept. ââ€" ª Agroforestry demonstration farms over 120 ha also with participatory concept. ââ€" ª Replenishment of depleted homestead wood lots in 4,650 villages. ââ€" ª Training of Forest Department Personnel and Village leaders. (e). Development of forest extension services (l980-l987) Development of Forest Extension Services (Phase II) began in 1980 with the Government funding and subsequently amalgamated in some areas (i.e. North-North West district) with Asian Development Bank funded Community Forestry Project. The main activities under this programme were: ↠ afforestation in some 3100 villages. ↠ roadside tree planting along 3600 km of primary highways and roads and about 600 km of Union Parishad roads. ↠ Production of 49 million seedlings for distribution. (f). Thana afforestation and nursery development project This project is a follow-up of Development of Community Forestry Project and Forest Extension Project and has been designed primarily to: o Increase the production of biomass fuels and o Enhance the institutional capability of FD and local administration in implementing a self-sustaining nationwide social forestry programme. In order to increase the production of biomass fuel and to arrest the depletion of tree resources, the project envisaged to develop tree resources base through planting of depleted Sal forest as well as brining all suitable and available land in the rural areas under tree cover with active participation of the rural poor of the locality. Originally the project was to be implemented by the Forest Department and former Thana Parishad during the period of 1987 to 1994. But in 1992 Government decided that the all project activities were to be implemented by Forest department alone. The major components of the project were: 1. Establishment of plantation over 20,225 ha depleted Sal forest areas. 2. Development of agroforestry over 4,200 ha in the Sal forest lands. 3. Raising strip plantation on 17,272 km along Road and highway, Railways, Embankment and Feeder Roads. 4. Raising l, 282 ha plantation in the land outside the BWDB. 5. Planting 7.017 million seedlings at the premises of different education, religious and social institutions 6. Establishment of 345 nurseries at Thana headquarters. 7. Raising of l0.6l8 million seedlings for distribution to public. 8. Training of some 76,000 people of different levels. Here this may be mentioned that at the last stage of the project implementation, the Government has found that this was quite impossible to protect the strip plantation and also impossible to trained 76,000 people by the Forest Department alone. The Government invited NGOs to participate in this programme for successful implementation. PROSHIKA, POUSH, GRAMMEN BANK and other NGOs came forward to help the Government for successful completion of the project; NGOs employed their group members to protect the strip plantation and ADAB came forward to train people at different levels with the help of its member organizations. The above plantation activities were carried out with the direct participation of the local people with the help of the NGOs by executing benefit sharing agreement. (g). Coastal greenbelt project Another project financed by Asian Development Bank is under implementation in the Coastal region of Bangladesh. The main objective of the project is to create a vegetative belt all along the coast to save the lives and properties of the people living in the coastal areas from devastated cyclone and tidal surges which occur very frequently in those areas. All of the activities of this project are also being carried out following participatory approach. In this project also the participants have been selected among the poor people living in the adjacent areas by involving NGO and a pre-designed benefit sharing agreements also being executed with the participants to protect their rights over plantations and to ensure benefit expected to be received out of the plantation. (H). Agroforestry research project Pilot Agroforestry Research and Demonstration was implemented by the FD in the Sal forest areas. The project had been developed precisely to design/develop agroforestry modules which is environmentally feasible, socio-economically acceptable enhance tree and crop production at the same time to uplift the socio-economic condition of the participants. The project aimed at using 120 ha of encroached Sal Forest land of Dhaka, Mymenshing and Tangail Forest Division to develop suitable participatory plantation models. (i). Food assisted social forestry programme The World Food Programme assisted the Government to develop Social Forestry as a national programme and the Government incorporated WFP assisted social forestry programme in its annual development plan from 1998. Poverty alleviation, economic rehabilitation of rural poor especially the destitute women of the society by engaging them in forestry activities, social uplift of rural poor and environmental improvement are the main objectives of this project. Historically this programme was conceived in the country since 1989 on pilot basis allocating in kind resources (Wheat) to a limited number of NGOs for raising strip plantation along roads, embankments, Highways etc. in rural areas following the participatory mechanism. In implementing this programme FD was involved later on to provide technical guidance to the NGOs and other GOB agencies. At present probably this is the largest Participatory Forestry Programme in Bangladesh. From l990, 100 NGOs are involved in this programme and at present about 60 NGOs are continuing with the programme. Commencing from 1990 up to 1998 about 31 million trees were planted involving 0.062 million people directly and 0.62 million people indirectly. The programme has created employment to the tune of 68 million man days. This programme is being implemented by the NGOs through contractual benefit sharing among participating poor men women 60%, NGOs 10%, the rest land owners. NGO participation in the forest management In Bangladesh the history of NGO involvement in the field of development is not very old. After liberation, NGO started their activities through relief and rehabilitation of the war victims. During mid-seventies, NGO switched over to the socio-economic development of the rural poor, and at present there are thousands of NGOs most of whose mandate is to organize rural poor and provide awareness, education, skill training and various support services including credit to enhance participation of landless poor in the development process towards self-reliance. On the basis of the networking throughout the country the NGO can be classified into two levels; I) local and II) National. At present more then 100 NGOs both local and National are implementing social forestry programme in Bangladesh. It is not possible to enlist activities of all the NGOs involved in the Social forestry programme in the country. The participatory forestry activities of some of the NGOs are highlighted here who are playing pioneer role in this field. BRAC: The Bangladesh Rural Advancement Committee (BRAC) has been established in 1972 and this is the largest NGO in Bangladesh. BRAC has six categories of projects/ programmes in broad sense among which Social Forestry falls within rural development programme. The Social/ Participatory forestry has three components; 1. Nursery establishment; 2. Plantation and 3. Establishment of agroforestry. They claim that they have assisted their women members in raising more then 225 homestead nurseries and 100 large nurseries with a combined production capacity of a million seedlings of fruits and forest seedlings. They have established 200 mulberry nurseries with the production capacity of 2 million seedlings. Social afforestation programme of BRAC is WFP assisted which has been commenced from 1989 and till now it is going on. Most of the plantation under this programme has been established along the strips. Up to this time about 33.72 million seedlings have been planted over an area of 33,700 km strips along road, railway and embankment. This programme involves about 670,000 participants of which 80% are women. PROSHIKA: Proshika A center for human development is one of the largest NGO in Bangladesh. The Social Forestry Programme of Proshika is a systematic intervention effort to enhance afforestation in the country and to make a case that the poor are the best managers and protectors of forest resources if they are granted usufruct rights on these resources. Proshika has introduced its group members in social forestry activities and provided them with credit and technical support, which contributed significantly to their self-sufficiency. The main components of social forestry programme of Proshika are; a. Homestead plantation; b. Strip and block plantation; c. Natural Forest protection, and d. Nursery establishment. Proshika has planted 71 million seedlings which covered along 8,887 km strips, 37,662 areas of block plantation which included natural Sal forest protection throughout the country. One of the most significant contributors of Proshika to the development arena is the introduction of the concept of participatory forest management for natural forest protection. Proshika has successfully involved the forest dwellers in the Sal forest areas of Kaliakoir, Mirzapur, Shakhipur and Shreepur thanas under district of Tangail and Gazipur for the protection of coppice Sal forest by involving group members of Proshika. It has already been proved that when poor people surviving on the forest resources are organized, trained and granted usufruct rights, they present on enormous human potential needed for afforestation and forest protection. RDRS: The Rangpur Dinajpur Rural Services operating in 28 thanas of greater Rangpur and Dinajpur districts covering 28 thanas. It is the largest International Integrated Rural Development NGOs operating in Northern Bangladesh for more than two decades. Its entry point in forestry was through road side plantation in 1977. Initially, seedlings were protected with bamboo cages. Situation has been changed a lot nowadays and protection of seedlings with bamboo cage has be come a part of history. Besides strip plantation, they also extend their tree plantation programme in homestead, institutional grounds as well as raising of local nurseries. With the assistance of WFP they have planted about 10.66 million trees under their participatory afforestation programme. TMSS: It stands for Thangamara Mohila Sabuj Sangha. It is an NGO exclusively meant for women. Although, it was initiated in l976, its presence was visible only since 1965. This NGO be1ieves in the concept of simple living and high thinking. TMSS was also involved in the social forestry programme particularly in the Northern districts of Bangladesh. The organisation has been implementing both road side and farm forestry with assistance from the WFP and Swiss Development Corporation (SDC) respectively. POUSH: Another NGO has been engaged in planting in the private lands also by persuading the owner farmers in Baroibari, Kaliakoir thana with the food aid from WFP. Its activities in the forestry field are limited to strip plantations and it plans to expand its programme extensively. Target groups of POUSH are mostly landless destitute, widow and divorced women. POUSH also happens to be the first of its kind to get involved in participatory forestry in the hill district of Bandarban. Problems and prospects of participatory forest management Considering the demand and supply situation for forest products to meet the economic and environmental needs, no one can deny the need of peoples participation in forestry. Probably there is no second answer except participatory forestry in developing, managing, and protecting the countrys forest land and the forest resource. But there are numbers of issues remain unresolved. As a technical department, Forest Department is playing pioneer role in implementing and popularizing Participatory Forestry in the country. Up to this time Forest Department is managed by the professional foresters who have educational background only in managing traditional forests and who do not consider people as development partners. Participatory Forestry, if we recollect the Chinese proverb, needs mental development managers towards the people. Realization has started among the planners, policy makers, administrators and senior managers to involve people in forestry development activities. But up to this time Government has failed to adopt real Participatory Forestry programme to address the basic need of the peoples. Mobilization of the people in participatory forestry programme is another bottleneck of the Forest Department who has not had the machinery to reach the community people. NGOs who work at the grassroots level have developed their own expert to mobilize people and ensure their participation in any development programmes as partner. So NGO should be involved in the implementation of the participatory forestry programme where Forest Department should confine their activities only in technical aspect. In the context of Bangladesh, the scarcity of land is a most vital problem. On the other hand, Forest Department controlling over 16% of the total land area of the country is still hesitant to allow Participatory Forestry in reserved forest areas. According to FD, it should be confined only in public and private lands beyond reserved forest areas through these are devoid of trees. The Participatory Forestry is being practiced in marginal lands which are under administration control of other Government departments. Recently, due to pressure from planners and donor communities, Forest Department has allowed to practice participatory forestry in Sal Forest areas. Tenure of the contract was found as a bottleneck for implementing Participatory Forestry. Forest Department allowed rights of participants over these lands for a period of seven years, but there was a strong desire, that this tenure should more and at least for rotation period, so that participants can manage and protect trees till harvesting. A negative attitude was also observed among the Foresters to involve women in forestry activities. They viewed that activities of women should be confined in the areas where there is a locality apprehending the social problems. But in participatory forestry both men and women should be treated equally. Recommendations †¢ All vacant areas within existing forests which is about 50% of the total forest areas should be brought under tree cover immediately to make total forest areas 25%. †¢ Use of organic fertilizer should be encouraged to people as alternative use of fuel wood and burning of cow dung and agro residues should be reduced. †¢ The forest policy of 1994 needs a fundamental change to make participatory forestry approach as a core concept for social fencing against forest destruction and for poverty alleviation through income generation. †¢ An independent Forest Policy needs to be formulated to promote Participatory Forestry in the country. †¢ For implementing Participatory Forestry programme, Land as an input is to be ensured with authority. Preset land lease system is neither responsive nor effective for practicing Participatory Forestry in the country. Tenurial rights of land in-stead of land use right is to be given to the participants. †¢ To make effective participation of the people on a sustained basis, sufficient motivation is required and this responsibility must be given to the NGOs. †¢ Involvement of the groups in planning and decision making is to be ensured through proper policy directions. †¢ Provision should be made for giving subsistence to the participants so that they can survive and keep confined their activities in the programme. †¢ A National forum where there will be representation all from Government politicians, NGOs and private sector. They will act as a coordination body to coordinate among all the participants like land owning agency, NGO, Forest Department and the participants. †¢ NGO should act as a catalyst and they should not be treated as a competitor of Forest Department. †¢ Process of recruiting NGOs by inviting tender for implementing any Participatory Forestry programme of the Government must be avoided. ADAB may be given the responsibility to identify the NGOs for a particular programme implementation. †¢ Major reforestation and afforestation programmes with community participation in a profit sharing basis and improvement in technology and management of plantation are required. †¢ Institutional capacity, policy and legal framework of forestry management should be strengthened. †¢ Forestry professiona1s should be trained in environmentally sound forestry. †¢ Implementation strategies for community management of forestry resources should be developed. Conclusion Bangladesh has a small land base and a large population. Area under tree cover is small and shrinking. Some forest areas are located in inaccessible areas. It is important that whatever area is for planting, should be brought under such practice in an organized fashion. Through intensive manipulation of crops, it is to increase production per unit of land substantially. If such is the importance of forests, of trees, in the ecology and the economy of a country, and therefore in the lives of its people, it is very urgent to manage the resources. Traditionally, forest has remained the function of only the forest department. A change of this attitude is essential and development, management and production of forest should become the function of the entire population of the country, not only for ensuring improved supply of wood but also for the maintenance of a quality environment.

British & independence Essay Example for Free

British independence Essay Through this education, Douglass witnessed and later identified the hypocrisy that came from a country that fought the British for independence, yet was unwilling to extend that right to his own people as well as the hypocrisy that existed in Christianity in which the religion was used by slave owners, to justify the continuation of the institution. In this book, Douglass touches on a number of important subjects. This includes but is not confined to, Douglass’ view on friendship, power of the mind and body as well as what exactly it means to be a man as well as an individual of African descent. Can the two coexist with each other? And if so, what measures must a man go in order to secure these rights? Douglass would spend his lifetime answering that question for himself as well as for every Africana American who had been adversely affected by the crippling racism that was so much a part of America’s past. Frederick Douglass’s 1852 speech â€Å"What to the Slave is the 4th of July† is further proof that African Americans at that time, were not docile and meek. Douglass spoke in ways that had deprived the African American slave since 1624. In this speech, there lie two distinct and separate halves. The first half, Douglass speaks in glowing terms about America’s forefathers as fearless patriots. However, one of the words that continues to be used when describing the holiday and then men and women of the Revolution who helped to shape it, was the second person possessive: â€Å"you† and â€Å"yours. † â€Å"Oppression makes a wise man mad. Your fathers were wise men, and if they did not go mad, they became restive under this treatment. They felt themselves the victims of grievous wrongs, wholly incurable in their colonial capacity. † Douglass is setting up the audience and the reader for the real heart of his speech and to help show the sheer irony in asking a former slave, at a time when nearly four million African Americans were still enslaved, to speak on the 4th of July. After ending with his pleasantries and speaking in positive terms about the founding fathers as they relate to White America, Douglass sharply changes his diction and leads a verbal assault on the irony of not only America, but of Christianity, a faith that Douglass holds close to his heart. Douglass, after giving a history lesson to his audience; a lesson that had been glorified to nearly spiritual heights by that time, Douglass changes his tone and then speaks to a passion that is also close to his heart: American slavery. I will, in the name of humanity which is outraged, in the name of liberty which is fettered in the name of the constitution and the Bible, which are disregarded and trampled upon, dare to call in question and to denounce, with all the emphasis I can command, everything that serves to perpetuate slavery- the great sin and shame of America. † Douglass is speaking to the irony of both America and those who â€Å"Christians of the land† who Douglass refers to as believers who either own slaves or who support the institution of slavery and asks for his audience to witness the irony as well. Douglass, throughout the rest of his speech, attacks slavery and the fact that he is even asked to speak on such an occasion as the 4th of July as there is no other national holiday at that time that would be more ironic for Douglass to speak upon. â€Å"What, to the American slave, is your 4th of July? I answer: a day that reveals to him, more than all other days in the year, the gross injustice and cruelty to which he is the constant victim. To him, your celebration is a sham; your boasted liberty; an unholy license†¦Ã¢â‚¬  Throughout the rest of the speech, Douglass speaks to the irony at speaking on the 4th of July, of the hypocrisy that exists in both America and the church whose aspects supports slavery and points to England who in the 1830’s had already abolished slavery. In Douglass’s 1855 book My Bondage My Freedom, he speaks about his life and the various factions that he aligned himself. Even though there were aspects of the Christian church that supported and defended slavery, the abolitionist movement in the immediate decades before the start of the Civil War, was almost entirely a Christian movement. This writing of Douglass speaks at length about his relations with abolitionists; both important to American history and those whose efforts that went unnoticed by the historians but to Douglass, served as a chief motivator for himself to become an abolitionist. Douglass first heard the word abolitionist while under the possession of Mr. Auld, his master. â€Å"Every little while, I could hear Master Hugh, or some other of his company, speaking with much warmth and excitement about â€Å"abolitionists. † Of who or what these were, I was totally ignorant. I found, however, that whatever they might be, they were most cordially hated and soundly abused by slaveholders. † Douglass, as it is seen in every book within his biography, that he was not a timid man and that the pursuit of freedom through the collection of action, spurned on my action, was his life goal. It would only be a matter of time before Douglass would become closely aligned with the abolitionist movement. Frederick Douglass was able to first make a name for himself by his aligned with the most famous abolitionist of his day: William Lloyd Garrison; the editor of The Liberator. Douglass commented about this friendship, which although possessing its share of internal conflict, was one of the most advantageous for Douglass as well as for Garrison. â€Å"Mr. Garrison followed me, talking me at his text; and now, whether I had made an eloquent speech in behalf of freedom or not, his was one never to be forgotten by those who heard it. † From this, Douglass was able to write an account of him and of the experiences that he had taken part in. This is the most important aspect of the life and times of Douglass. Had he not written down his experiences, he never would have been able to gain a foothold into the public arena concerning this most important issue. It is through the words and writings of Douglass that he is still remembered today. This would not have been possible, had Douglass never been able to align himself with the various connections that were offered to him through his association with the abolitionist movement. â€Å"In a little less than four years, therefore, after becoming a public lecturer, I was introduced to write out the leading facts connected with my experience in slavery, giving names of persons, places, and dates- thus putting it in the power of any who doubted, to ascertain the truth of falsehood of my story of being a fugitive slave. † Even though it is a fact that many people, even some within the abolitionist movement, did not believe Douglass’ account of his life in slavery, Douglass’ first book, Narrative of the Life of Frederick Douglass, printed in 1845, was so popular, five additional printings followed in the next calendar year. His experience, coupled with the way in which he was able to speak and write about his experiences, made for a very effective combination. If any of the above mentioned were missing, the name of Frederick Douglass would not be remembered today. It is through the life experiences as skill that such a good man, was made great, both by time and circumstance. In both of the abovementioned works, Douglass speaks unapologetically, about the immoral, unfair and unconstitutional aspects of slavery in America. England has freed its slaves and America even officially abolished the slave trade, out of the belief that there is something which speaks against the liberty of people, an issue which all Americans have come to believe to be sacred. Why then are such rights not extended to the slave? The abolitionist movement was unrelenting in its appeal to free the slaves. There is debate concerning exactly what other rights even the most outspoken white abolitionists, were willing to extend to the slave. What is not in doubt, is that the when famous and connected abolitionists, blended their abilities with the abilities and unflinching convictions of Douglass, contemporary audiences, as well as those who would follow, are left with one of the most important American orators and authors because Douglass, unlike other famous fiction writers, spoke about what was true and all too apparent in American society; American slavery which sprouted forth from the soil of racism, prejudice and ignorance. Douglass sought to kill that weed and perhaps second only to Martin Luther King Jr. can the husbandry of a single person, be given the credit of putting to an end, those weeds which would serve as impediments to the flowering opportunity that America gives to its citizens.

Reflective Summary On Prescribing Practice Learning Nursing Essay

Reflective Summary On Prescribing Practice Learning Nursing Essay The author, a nurse practitioner based in an Emergency Department (ED), from here on in will be referred to as the practitioner. The practitioner is currently employed in a development role with the view, following training, of becoming an acute care practitioner. This will entail working autonomously: taking accurate clinical histories, physical examination, gain differential and working diagnosis and organise a plan of care. This plan of care could well include a number of prescribed medications. Hence it is in the practitioners job description (as it is increasingly in many specialist/autonomous nursing roles) to become a Nurse Independent and Supplementary Prescriber (NISP). The Cumberlege Report (1986) suggested that nurses should be able to prescribe independently and highlighted that patient care could be improved and resources used more effectively by doing so. It identified that nurses were wasting their time requesting prescriptions from Doctors. Since the publication of this seminal piece of work, non-medical prescribing has been analysed, reflected upon, researched at great lengths and changes in practice made (DoH 1989, 1999, 2006 2008; Luker et al 1994; Latter et al 2011) and is still under constant review. The aim of this portfolio is to: Reflect on practice as a means of on-going personal and professional development. Demonstrate a capability of integrating learning into practice. Submit a range of material mapped against the module learning outcomes, NMC 2006 prescribing standards, domains of practice and core competencies. Establish an evidence-based approach to practice competence as a safe independent supplementary prescriber. This prescribing practice portfolio will be a reflective portfolio using Rolfe et al (2001) model of reflection to aid learning from experience and close the gap between theory and practice. This model has been chosen as it is something the practitioner is familiar with and has used before. The portfolio will conclude with a reflective summary on prescribing practice learning which will draw together the evidence used to support achievement of the competences identified. After discussing with colleagues who have already completed the NISP course, the practitioner is aware of the complex nature and volume of work that is required over the duration of it. There is a feeling of nervousness due to this but also a feeling excitement over what will be learnt. If successful the practitioner believes her practice will be enhanced significantly as she will have the ability to give patients seamless care. References Department of Health. (1986) Neighbourhood Nursing: A Focus for Care. (Cumberlege Report). London: HMSO Department of Health. (1989) Report of the Advisory Group on Nurse Prescribing. The Crown Report). London: HMSO Department of Health. (1999) Review Of Prescribing, Supply And Administration Of Medicines. (The Crown Report Two) London: HMSO. Department of Health. (2006) Medicines Matters. London: HMSO Department of Health. (2008) Making Connections: Using Healthcare Professionals to Deliver Organisational Improvements. London: HMSO Latter, S. Blenkinsopp, A. Smith, A. Chapman, S. Tinelli, M. Gerard, K. Little, P. Celino, N. Granby, T. Nicholls, P. Dorer, G. (2011) Evaluation of nurse and pharmacist independent prescribing. Faculty of Health Sciences, University of Southampton; School of Pharmacy, Keele University on behalf of Department of Health [Online] Available at http://eprints.soton.ac.uk/184777/ [Accessed 15th Sept 2012] Luker, K. Austin, L. Hogg, C. Ferguson, B. Smith, K. (1998) Nurse-Patient Relationships: The context of Nurse Prescribing. Journal of Advanced Nursing. (28) 2: 235-242 Rolfe, G. Freshwater, D. Jasper, M. (2001) Critical Reflection in Nursing and the Helping Professions: a Users Guide. Basingstoke: Palgrave Macmillan. Consultation Holistic Assessment Case Study In this case study the consultation, diagnosis, prescribing options and decisions of a 35 year old female seen in the ED will be discussed. This case study will aim to improve the practitioners knowledge of conducting a consultation and its relationship with making a diagnosis and treatment options. To maintain confidentiality, in line with the code of professional conduct, the patient will be referred to as Mrs A (Nursing and Midwifery Council (NMC), 2008). Consultation Examining the holistic needs of the patient is the first of seven principles of good prescribing (National Prescribing Centre (NPC), 1999) and must be undertaken before making a decision to prescribe (NMC Practice Standard 3, 2006). Holistic assessment takes into consideration the mind, body and spirit of the patient (Jarvis, 2008). Traditionally consultation and making a diagnosis has been completed by Doctors. However, nurse diagnosis would appear to have been formally acknowledged since The Crown Two Report (DoH, 1999) as part of the independent prescriber role. Horrocks et al, (2002), found greater patient satisfaction with nurse consultations than with GP consultations. Jennings et al, (2009) and Wilson Shifaza, (2008) also found this to be true of nurse practitioners working in emergency departments. Importantly, they also found no significant variation in other health outcomes. Most of these studies found that consultations with nurses were to some extent longer, they offered more advice on self-care and self-management and that nurses gave more information to patients. Although there are various consultation models that have been described (Byrne Long, 1976; Pendleton et al, 1984; Neighbour, 2005; Kurtz et al, 2003; Stott Davis, 1979), these are based upon observation of doctor, not nurse consultations. Nevertheless, the consultation models and skills described in the medical literature are relevant to all practitioners (Baird, 2004). Consultation models help the practitioner centre the consultation around successful information exchange and try to provide a theoretical structure. Consultation models can also be used to help make maximum use of the time available at each consultation (Simon, 2009). Traditionally the medical model is used to assess patients however; it does not take into account the social, psychological, and other external factors of the patient. The model also overlooks that the diagnosis (that will affect treatment of the patient) is a result of negotiation between doctor and patient (Frankel et al, 2003) In this case study, the practitioner has used Roger Neighbours model of consultation. This was found by the practitioner to be simple and easy to remember, whilst covering all areas needed to make an effective consultation and assessment. He describes a 5 stage model which he refers to as a journey with checkpoints along the way: Connecting establishing a relationship and rapport with the patient. Summarising taking a history from the patient including their ideas, expectations, concerns and summarising back to the patient to ensure there are no misunderstandings. Handing over negotiating between the practitioners and patients agenda and agreeing on a management plan. Safety netting the consideration of what if? and what the practitioner might do in each case. Housekeeping reflecting on the consultation. (Neighbour, 2005) Connecting Mrs A was called through to the Rapid Assessment and Treatment area in the ED. It was apparent from Mrs As facial expression and limp that walking caused her pain. Silverman Kinnersley, (2010) state that non-verbal communication is extremely important and can often provide clues to underlying concerns or emotions. The practitioner had never met the patient before so had no previous relationship with her but was aware that she may have pre-conceived ideas about the ED which may have caused her anxiety. The practitioner introduced herself to Mrs A, explained her job role, the process that was about to be undertook and consent obtained. During this time eye contact was maintained and the practitioner also asked Mrs A how she would like to be addressed. This was done to try and build up a rapport with Mrs A, to help her feel at ease and reassure her. Simon, (2009) and Moulton, (2007) agree and state that rapport is essential to effective communication and consultation. Mrs A was also of fered a trolley to sit on to make herself comfortable and the curtains pulled around for privacy and dignity. On reflection the practitioner was aware that the environment was a busy and noisy assessment area and this can have a negative impact on the consultation (Silverman et al, 2005). Identifying this with Mrs A and apologising may have re-assured her further and gained trust and respect. Summarising The practitioner began with an open ended question and did not interrupt the patients response. Neighbour, (2005) and Moulton, (2007) advise this to open the consultation. Gask Usherwood, (2002) found that if a practitioner interrupts, patients then rarely disclose new information, which could lead to not finding out the real reason for the consultation. Mrs A revealed that she received an insect bite to her right lower leg 5 days ago, since then the surrounding skin had become swollen, increasingly red, painful and hot to touch. She explained that the redness was spreading up her leg and the pain was getting worse. Mrs A explained that she was concerned that it was not going to get better and was very worried that it had got worse during the last 3 days. Upon questioning Mrs A also complained of malaise and that she had been feeling very hot and cold and at times. She had been managing to eat and drink as normal. Mrs A lived with her husband, was a non smoker and drank alcohol occasionally. She had no past medical history and took no prescribed or over the counter (otc) medications. It was also elicited that she was allergic to Penicillin which she had an anaphylaxis reaction to. Taking a medical, social, medication and allergy history is important as it can be relevant to the presenting complaint, makes sure key information has not been overlooked and is essential in preventing prescribing errors (Bickley, 2008; Young et al, 2009). The practitioner actively listened to what Mrs A was saying by maintaining eye contact, using open questions and by summarising the history back to clarify points and to make sure nothing was missed. On reflection the practitioner feels this also gave the opportunity for Mrs A to add any further information not disclosed so far. Closed questions were then used to gain specific information related to the initial information given, this is advised by Young et al, (2009) and Moulton, (2007). Effective communication is important as Epstein et al, (2008) explains that a precise history can supply at least 80% of the information necessary for a diagnosis. Upon examination there was obvious erythema. Light palpation revealed that the area was very warm and tender. Neurovascular assessment was performed and was unremarkable. Mrs As chest was clear, heart sounds normal and her abdomen was soft, non tender. Physical examination is important as it is used to detect physical signs that the patient may not be aware of and can be used to confirm or disprove a possible diagnosis. It also suggests to the patient that their illness is being taken seriously. (Bickley, 2008, Charlton, 2006). Observations were taken including blood pressure, heart rate, temperature, respiratory rate and oxygen saturations. All were within normal parameters except her temperature which was 38.2 degrees Celsius. Venous blood was taken to check haematological, biochemical and coagulation status. Mrs A white cell count (WCC) and C-reactive protein (CRP) levels were raised, all other blood results were normal. Handing Over Before making a final diagnosis, it is important that differential diagnoses are excluded (Nazarko, 2012). The practitioners differential diagnoses were deep vein thrombosis (DVT) or venous eczema. However, Mrs A had a straightforward history (insect bite) that together with her observations (raised temperature), examination findings (redness, heat, swelling and pain) and blood results (raised WCC and CRP) indicated an alternative diagnosis, so DVT and venous eczema were ruled out. The practitioners working diagnosis was cellulitis. This was discussed with Mrs A and she appeared reassured that a diagnosis had been made. The practitioner explained that she would like to discuss this with a senior Doctor to help decide on a treatment plan. The practitioner presented the patient to an ED Registrar who agreed with the diagnosis. Diagnosis, treatment and prescribing options were then discussed to aid the practitioners learning. Cellulitis is a bacterial infection of the skin and subcutaneous tissue which is potentially serious (Epstein et al, 2008). It is caused by one or more types of bacteria, most commonly streptococci and staphylococcus aureus (Nazarko, 2012). Cellulitis usually occurs on the lower legs, arms and face but can arise anywhere on the body (Bickley, 2008). Patients with cellulitis present with signs of inflammation, distinctively heat, redness, swelling and pain (Nazarko, 2012). Inflammation is localised initially but increases as the infection progresses. Patients can be systemically unwell (pyrexial, tachycardic, hypotensive) and white cell count and C-reactive protein levels will be markedly raised (Beldon, 2011, Wingfield, 2009, Nazarko, 2012). It appears there is a general lack of evidence based literature surrounding the treatment of patients with cellulitis. The practitioner could only find one national guideline on the management of cellulitis in adults, which was published in 2005 by the Clinical Resource Efficiency Support Team (CREST, 2005). However, to the practitioners knowledge, these have not been validated by a clinical study. Morris, (2008) found in his systematic review that antibiotics cure 50-100% of cases of cellulitis but did not find out which antibiotic regime was most successful. Kilburn et al, (2010) also could not find any definitive conclusions in their Cochrane review on the optimal antibiotics, duration or route of administration. Eron, (2000) devised a classification system for cellulitis and its treatment which CREST used in their guidelines. This system divides people with cellulitis into four classes and can serve as a useful guide to admission and treatment decisions. However Koerner Johnson, (2011) found in their retrospective study, comparing the treatment received with the CREST guidelines, that patients at the mildest end of the spectrum were over treated and at the more severe end undertreated. They also found a significant variation in antibiotic regimes prescribed for patients with cellulitis. Marwick et al, (2011) questioned whether classes I and II could actually be merged to improve treatment. The practitioners trust has antibiotic guidelines (updated yearly) which also include a classification system. This aids the prescriber in choosing the correct antibiotic, dose, route and duration for certain conditions, cellulitis being one of them. After discussion with the Registrar it was determined that Mrs A was in Class I or non-severe which meant she could be managed with oral antibiotics on an outpatient basis. The practitioners trust and CREST, (2005) guidelines advise first line treatment for non-severe or class I cellulitis as oral Flucloxacillin 500mg, three times a day. Flucloxacillin is a moderately narrow-spectrum antibiotic licensed for the treatment of cellulitis. However, Flucloxacillin was contra-indicated for Mrs A as she had a severe penicillin allergy (British National Formulary, (BNF) 2012). Clarithromycin is a macrolide which has an antibacterial spectrum that is similar but not identical to that of penicillin; they are thus an alternative in penicillin-allergic patients (BNF, 2012). Clarithromycin is licensed and recommended by CREST, (2005), and by the practitioners trust, as an alternative to Flucloxacillin in cellulitis for patients with a Penicillin allergy. It is indicated in the BNF, (2012) for the treatment of mild to moderate skin and soft-tissue infections. It demonstrates suitable pharmacokinetics, with good distribution into skin and soft tissues, and is effective against the large majority of staphylococcal and streptococcal bacteria that cause cellulitis (Accord Healthcare Limited, 2012), (See drug monologue page 21-28). There were no contraindications in prescribing Clarithromycin for Mrs A. The option of not having any medication was discussed with Mrs A however, she wanted treatment so the benefits and side effects of Clarithromycin was explained, and consent obtained from Mrs A to prescribe the antibiotics and to be discharged, (NMC Practice Standard 5, 2006). Dose and duration were then also clarified and the importance of taking the antibiotics as prescribed and to complete the full course. On reflection, by discussing and deciding on the best treatment together this would hopefully promote concordance. Negotiating with patients and agreeing on a management plan is very important aspect of reaching patient centred care (Neighbour, 2005). Using an FP10 Clarithromycin tablets 500mg twice a day was prescribed by the Registrar (as the practitioner was not a licensed prescriber, NMC Practice Standard 1, 2006), as per trust guidelines, for 7 days. Paracetamol tablets 1g four times a day was also prescribed for its analgesic and anti-pyretic properties (BNF, 2012). A stat dose of both were prescribed and the practitioner asked the nurse to administer the first dose (NMC Practice Standard 9 14, 2006), and was aware that by delegating this task the prescriber remained accountable. The FP10 was given to the patient to take to the pharmacy of her choice for them to dispense (NMC Practice Standard 10, 2006), (See mock prescription page 29). The practitioner did not initially contemplate cost effectiveness but on reflection it has been recognised that this needs to be taken into consideration when prescribing (NPC, 1999). Intravenous antibiotics may have been prescribed, which may have meant an admission into hospital or administration by nurses on an outpatient basis; thus would have increased the cost of treatment significantly. Admission to hospital can also be overwhelming and can put the patient at risk of hospital acquired infections and increased risk of antibiotic resistance (Wingfield, 2008). Safety Netting The erythematous border was marked, with the patients consent, with permanent pen to monitor for any improvement or additional spread of infection (CREST, 2005, Beldon, 2011). The practitioner advised Mrs A that she should return or see her GP if she had worsening symptoms or if by the completion of the course of antibiotics symptoms had failed to resolve. Mrs A was also advised that, if a similar incident occurred, she should seek medical assistance early so that treatment could begin as soon as possible to reduce the risk of severe and long-term complications. In addition it was recommended that she should drink plenty of fluids to prevent dehydration, elevate the leg for comfort and to help reduce the swelling (CREST, 2005, Beldon, 2011). Mrs A was warned that there could be an increase in erythema in the first 24-48 hours of treatment (CREST, 2005). This advice and information empowered Mrs A and made sure that her discharge was as safe as possible. The practitioner brought the consultation to a close by asking Mrs A if she had any questions or if there was anything else she would like to discuss. This gave Mrs A the opportunity of clarifying any information given by the practitioner and the opportunity to divulge any information or concerns not previously mentioned. This re-assured the practitioner that she had addressed her problem appropriately. Housekeeping The practitioner made sure there was clear concise documentation of the consultation and choice of prescription in Mrs A notes (NMC Practice Standard 7, 2006). A discharge letter was also produced to send to her GP NMC Practice Standard 6, 2006). Once the prescription was ready, Mrs A was discharged. This case study has shown the practitioner the importance of effective communication in consultation. By following Neighbours consultation checkpoints it gave structure to the consultation and will be used by the practitioner in future practice. It has also helped the practitioner to gain an understanding of different prescribing options and how to explore these further. For example, the practitioner did find when reading around the subject that there has been some research on the use of corticosteroids in cellulitis to increase resolution, however, to the practitioners knowledge, this is not currently advised in any guidelines and further research is needed. The practitioner would also like to be involved in the development of a cellulitis pathway at her place of work. This could include an algorithm to aid practitioners to differential diagnosis so patients can receive appropriate treatment and reduce the incorrect prescribing of antibiotics. As there are no National Institute for Health and Clinical Excellence (NICE) guidelines on the treatment and management of cellulitis, treatment of patients is not standardised and consequently quality of care could be affected. The optimal choice for antimicrobial therapy requires review and definitive study in clinical trials. References Accord Healthcare Limited (2012) Summary of Product Characteristics for Clarithromycin Capsules 500mg. [online]. Electronic Medicines Compendium. Datapharm Communications Ltd. Available from: http://www.medicines.org.uk/EMC/medicine/25914/SPC/Clarithromycin+500mg+Tablets/ [Accessed 21ST September 2012] Byrne, P. Long, B. (1976) Doctors Talking to Patients. London, HMSO. Baird, A. (2004) The Consultation. Nurse Prescriber. (1) 3: 1-4 British National Formulary: No. 64 (2012) London: BMJ Group and Pharmaceutical Press. Bickley, L. (2008) Bates Guide to Physical Examination and History Taking. 6th Ed. London: Lippincott, Williams and Wilkins. Beldon, P. (2011) The Assessment, Diagnosis and Treatment of Cellulitis. Wound Essentials. (6): 60-68. Clinical Research Efficiency Support Team (2005) Guidelines on the Management of Cellulitis in Adults. Belfast: Clinical Research Efficiency Support Team. Charlton, R. (2006) Learning to Consult. Abingdon: Radcliffe. Department of Health (1999) Review Of Prescribing, Supply And Administration Of Medicines. (The Crown Report) London: HMSO. Epstein, O. Perkin, G. Cookson, J. De Bono, D. (2008) Clinical Examination. 4th Ed. London: Mosby. Eron, L. (2000) Infections of Skin and Soft Tissues: Outcome of A Classification Scheme. Clinical Infectious Diseases. (31) 287 Frankel, R. Quill, T. McDaniel, S. (2003) The Biopsychosocial Approach: Past, Present, and Future. Rochester: University Of Rochester Press. Gask L, Usherwood, T. (2002) ABC of Psychological Medicine: The Consultation. British Medical Journal (324) 7353: 1567-1569. Horrocks, S. Anderson, E. Salisbury, C. (2002) Systematic Review of Whether Nurse Practitioners Working in Primary Care Can Provide Equivalent Care to Doctors. British Medical Journal. (324) 7341: 819-823. Jarvis, C. (2008) Physical Examination and Health Assessment. 5th Ed. Missouri: Saunders Elsevier. Jennings, N., Lee, G., Chao, K., Keating, S. (2009) A Survey of Patient Satisfaction in a Metropolitan Emergency Department: Comparing Nurse Practitioners to Emergency Physicians. International Journal of Nursing Practice (15) 213-218. Kilburn, S., Featherstone, P., Higgins, B., Brindle, R. Interventions for Cellulitis and Erysipelas. Cochrane Database Systematic Reviews. 2010 Issue 6, Art. No. CD004299. DOI:  10.1002/14651858. Koerner, R. Johnson, A. (2011) Changes in the classification and management of Skin and Soft Tissue Infections. Journal of Antimicrobial Chemotherapy. (66) 232-234. Kurtz S, Silverman J, Benson J, Draper J. (2003) Marrying Content and Process in Clinical Method Teaching; Enhancing the Calgary-Cambridge Guides. Academic Medicine (78) 8: 802-809. Marwick, C. Broomhall, J. McCoowan, C. Phillips, G. Gonzalez-McQuire, S. Akhras, K. Merchant, S. Nathwani. Davey, P. (2011) Severity Assessment of Skin and Soft Tissue Infections: Cohort Study of Management and Outcomes for Hospitalised patients. Journal of Antimicrobial Chemotherapy. (66): 387-397 Morris, A. (2008) Cellulitis and Erysipelas. Clinical Evidence. [online] BMJ Publishing Group Ltd. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907977/ [Accessed 10th September 2012] Moulton L. (2007) The Naked Consultation: A practical Guide to Primary Care Consultation skills. Abingdon: Radcliffe. National Prescribing Centre. (1999) Signposts for Prescribing Nurses General Principles of Good Prescribing. Prescribing Nurse Bulletin. (1): 1-4. Nazarko, L. (2012) An Evidence-Based Approach to Diagnosis and Management of Cellulitis. British Journal of Community Nursing. (17) 1: 6-12. Neighbour, R. (2005) The Inner Consultation. How to Develop an Effective and Intuitive Consulting Style. 2nd Ed. Oxford: Oxford-Radcliffe. Nursing and Midwifery Council (2006) Standards of Proficiency for Nurse and Midwife prescribers. London: Nursing and Midwifery Council. Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. London: Nursing and Midwifery Council. Pendleton, D. Schofield, T. Tate, P. Havelock, P. (1984) The Consultation: An Approach to Learning and Teaching. Oxford: Oxford University Press. Silverman, J. Kurtz, S. Draper, J. (2005) Skills for Communicating with Patients. 2ND Ed. Oxford: Radcliffe. Silverman, J. Kinnersley, P. (2010) Doctors Non-Verbal Behaviour in Consultations: Look at the Patient Before You Look at The Computer. British Journal of General Practice. (60): 76-8. Simon, C. (2009) The Consultation. InnovAiT (2) 2: 113-121. [online] Available at http://rcgp-innovait.oxfordjournals.org/content/2/2/113.full. [Accessed 13th September 2012] Stott, N. Davis, R. (1979) The Exceptional Potential in Each Primary Care Consultation. Journal of the Royal College of General Practitioners. (29): 201-5. Wingfield, C. (2009) Lower Limb Cellulitis: A Dermatological Perspective. Wounds UK. (5) 2: 26-36. Wingfield, C. (2008) Cellulitis: Reduction of Associated Hospital Admissions. Dermatological Nurse 7(2): 44-50. Wilson, A. Shifaza, F. (2008) An Evaluation of the Effectiveness and Acceptability of Nurse Practitioners in an Adult Emergency Department. International Journal of Nursing Practice. (14): 149-156. Young, K. Duggan, L. Franklin, P. (2009) Effective Consulting and History-Taking Skills for Prescribing Practice. British Journal of Nursing. (18) 17: 1056-1061. Drug Monologue. Name of Drug Clarithromycin Drug Classification Macrolide Therapeutic Uses(s) Clarithromycin film-coated tablets are indicated in adults and adolescents 12 years and older for the treatment of the following bacterial infections, when caused by clarithromycin-susceptible bacteria. à ¢Ã¢â€š ¬Ã‚ ¢ Acute bacterial exacerbation of chronic bronchitis à ¢Ã¢â€š ¬Ã‚ ¢ Mild to moderate community acquired pneumonia. à ¢Ã¢â€š ¬Ã‚ ¢ Acute bacterial sinusitis à ¢Ã¢â€š ¬Ã‚ ¢ Bacterial pharyngitis. à ¢Ã¢â€š ¬Ã‚ ¢ Skin infections and soft tissue infections of mild to moderate severity, such as folliculitis, cellulitis and erysipelas Clarithromycin film-coated tablets can also be used in appropriate combination with antibacterial therapeutic regimens and an appropriate ulcer healing agent for the eradication of Helicobacter pylori in patients with Helicobacter pylori associated ulcers Dose range and route(s) of administration Adults and adolescents (12 years and older) à ¢Ã¢â€š ¬Ã‚ ¢ Standard dosage: The usual dose is 250 mg twice daily. à ¢Ã¢â€š ¬Ã‚ ¢ High dosage treatment (severe infections): The usual dose may be increased to 500 mg twice daily in severe infections. Children younger than 12 years: Use of Clarithromycin film-coated tablets is not recommended for children younger than 12 years. Use Clarithromycin paediatric suspensions. Clinical trials have been conducted using clarithromycin pediatric suspension in children 6 months to 12 years of age. Elderly: As for adults Dosage in renal functional impairment: The maximum recommended dosages should be reduced proportionately to renal impairment. In patients with renal impairment with creatinine clearance less than 30 mL/min, the dosage of clarithromycin should be reduced by one-half, i.e. 250 mg once daily, or 250 mg twice daily in more severe infections. Treatment should not be continued beyond 14 days in these patients. Patients with hepatic impairment: Caution should be exercised when administrating clarithromycin in patients with hepatic impairment Administered orally. Pharmacodynamics Mode of Action Clarithromycin is a semi-synthetic derivative of erythromycin A. It exerts its antibacterial action by binding to the 50s ribosomal sub-unit of susceptible bacteria and suppresses protein synthesis. It is highly potent against a wide variety of aerobic and anaerobic gram-positive and gram-negative organisms. The 14-hydroxy metabolite of clarithromycin also has antimicrobial activity. The MICs of this metabolite are equal or two-fold higher than the MICs of the parent compound, except for H. influenzae where the 14-hydroxy metabolite is two-fold more active than the parent compound. Side Effects Dyspepsia, tooth and tongue discoloration, smell and taste disturbances, stomatitis, glossitis, and headache; less commonly: arthralgia and myalgia; rarely: tinnitus; very rarely: dizziness, insomnia, nightmares, anxiety, confusion, psychosis, paraesthesia, convulsions, hypoglycemia, renal failure, interstitial nephritis, leucopenia, and thrombocytopenia Interactions Aprepitant Clarithromycin possibly increases plasma concentration of aprepitant Atazanavir Plasma concentration of both drugs increased when Clarithromycin given with atazanavir. Atorvastatin Clarithromycin increases plasma concentration of atorvastatin. Cabazitaxel Avoidance of clarithromycin advised by manufacturer of cabazitaxel. Calcium-channel Blockers Clarithromycin possibly inhibits metabolism of calcium-channel blockers (increased risk of side-effects). Carbamazepine Clarithromycin increases plasma concentration of carbamazepine. Ciclosporin Clarithromycin inhibits metabolism of ciclosporin (increased plasma concentration). Colchicine Clarithromycin possibly increases risk of colchicine toxicity-suspend or reduce dose of colchicine (avoid concomitant use in hepatic or renal impairment). Coumarins Clarithromycin enhances anticoagulant effect of coumarins. Disopyramide Clarithromycin possibly increases plasma concentration of disopyramide (increased risk of toxicity). Dronedarone Avoidance of clarithromycin advised by manufacturer of dronedarone (risk of ventricular arrhythmias). Efavirenz Increased risk