Research paper on the Advantages of PACS (A picture archiving and communication system) that is used today in our medical imaging fields.

Final papers MUST BE double-spaced, in 12 point font, with 1" margins.
All citations within the body of the text, as well as a separate "References" section, must be in APA style.
Embedded images and the References section do NOT count as part of page requirements.
Page Requirements:

Perform a financial analysis for Brocade Communications Systems, Inc.
Analysis should include the following:
Company Overview. Conduct research and describe the company, its operations, locations,
markets, and lines of business. Collect financial statements for the past three (3) years, fiscal or
calendar (please insert these in the appendix). These financial statements must include at least
the income statement and the balance sheet.
Evaluate the companys vulnerability to current financial threats such as a recession, higher
interest rates, and global competition.
Financial Performance. Based on the financial trends of the company, predict how these trends
will impact financial performance in future periods. Explain your rationale for this prediction.
Stock Price Analysis. Given the performance of the stock in the periods presented on the
companys financial statements, discuss how the stock is likely to perform in the future, what type
of investor would be drawn to this stock, and make a recommendation to management to improve
stock performance.
1. Provide a detailed overview of a U.S. publicly traded company. This should be one to two (1-2)
pages.
2. Evaluate the companys vulnerability to current financial threats such as a recession, higher
interest rates, and global competition.
3. Based on the financial trends of the company, predict how these trends will impact financial
performance in future periods. Explain your rationale for this prediction.
Critique financial management strategies that support business operations in various market
environments.
Estimate the risk and return on financial investments.
Apply financial management options to corporate finance.
Use technology and information resources to research issues in financial management.
Write clearly and concisely about financial management using proper writing mechanics

Use Chicago Manual of Style. I need the bibliography and work cited information along with my order for free. I provided 11 reference materials to use. Along with that add at least 20 other references. I need minimum of 15 quotations. I have provided the Introduction of the research paper. Based on the introduction please write the body and conclusion. NOTE Keep my introduction and use that as a base to write the body and conclusion. I am ordering 12 pages in total write 10 pages for the body and 2 pages for conclusion based on my introduction. I am not paying to write an introduction as I would like to use my own introduction. So please write the body and conclusion only and make sure it flows with my introduction. The paper should be based on my introduction and answer the last three topic of the introduction, which are:
- Online cross-cultural communication is more prone to misunderstanding and distrust than face-to-face communication because some of the nonverbal communication cues like body language are missing.
- The building of trust between individuals can lead to successful on-line cross-cultural communication.
- There is a need to understand how the meaning of word may vary between cultures in order to eliminate any potential misunderstanding and distrust between individuals.


Subject: Interpretation across Culture in on-line communication

Introduction:

I have been using my second language, English, since I was two years old. I have been living in the U.S. for nine years and still some words do not portray the same meaning to me as they do to people over here. I have found that the meanings of words can change; I notice this particularly at my workplace. When I started my job, I was given a project, and in an e-mail communication I wrote, "I am working on resolving the problem. I will keep you posted with my findings. In the meantime, if you have any further problems please feel free to contact me again." The word "problem" created a big situation in my department. My manager and my co-workers thought the word "problem" sounded negative and that I should use the word "issue" instead. I explained to them that where I come from, Bangladesh, "issue" sounds very harsh. It makes me feel as if I am attacking someone personally. After much discussion, I stepped aside to think from their perspective and decided to change the word. These made me realize that communicating in the workplace in my second language, even if my colleagues and I do not always understand words the same way, we can eventually understand each other well enough to achieve our tasks at work.

Language is the key factor for communication. The English language is being used globally to communicate through online media. While most people are using the same language to interact, not everyone is communicating with the same cultural values and understanding. Effective communication with people of different culture is especially challenging. There are no established procedures or rules for us to follow to be efficient communicators across cultures. The Internet has caused an explosion in the variety of communication methods and has opened an extraordinary level of communication without boundaries. This is causing an unprecedented possibility for misinterpretation, misunderstanding, and distrust. Trust is a vital element in team development and efficiency building within a traditional team context. Any kind of communication we engage in has our cultural values intermingled in it. Culture teaches us values and principles that direct our thoughts and actions toward anything we encounter. This cultural understanding dictates the way we learned how to speak, write, and interact with others. It creates a challenge in understanding each other. Along with the regular face-t-face cross-cultural communication challenges now we need to pay attention to the cross-cultural communication via on-line media.

To keep costs down and remain competitive in the global economy many organizations are choosing to convert traditional teams to virtual teams and forming Geographically Dispersed Teams (GDT). It is easy to setup virtual teams, but the challenge is in establishing trust among virtual team members to work collaboratively. Individuals in a virtual team not only depend on the use of information technology but also create rapport through on-line communication. In a research done by Dr. Zhou she revealed that virtual team also needs to trust their team members for their work. Because they are dependent on each others assigned task to deliver a successful project. When there is s strong trust built within the team, it is easier for the team members to work efficiently because they are able to depend on each other. It also helps them to have open communication within the group and maintain a collaborative environment. Trust is a vital element in team development and efficiency building within a traditional face-to-face communication of team context. So, we also need to pay attention on how to build trust through on-line communication.

It is phenomenal how people can communicate with each other while connected only by computers. Today, online media has shortened the time span of international communication to a matter of seconds. According to Internet World Stats, on June 30, 2008 the Internet was used by 21.9% of the world population, which is a 5.19% increase since 2006. The increase of Internet usage has brought with it a mixture of new settings and concerns that affect how the world interacts with in cyberspace. It has become a melting pot of different languages, cultural values, laws, regulations, and individual expectations. These factors need to be considered while using the online media to network with people of different cultures around the globe. A majority of work teams now spend at least 25% of their time working in a virtual environment, according to a recent survey by the Institute for Corporate Productivity.

It can also be said that the on-line media is also influencing people to take on new habits from other cultures. Consider the following simple scenario that Satinder Gill, talks about in his article "The Cultural Interface: The Role of Self." Usually, in Japanese culture, everyone addresses their colleagues at work by their last name. When communicating via email they tend to address their colleagues by their first name, which they do not normally do in person (1). Here we can see how online communication changes how Japanese communicators address each other differently online rather than face-to-face. This is just one example of global communication causing unconscious changes to occur in users' communication styles and how we need to pay attention to online communication protocols between cultures.

The emergence of cyberspace is pushing everyone in the workplace to grow an understanding of how different cultural values can play a role in online communication. Online cross-cultural communication in can be unconsciously affected by cultural values. This factor can affect how employees from different countries engage in online communications. All of these issues can play a positive or negative role in our life. If we do not pay attention to potential misunderstanding, then we are more likely to become victims of miscommunication. It will take more than just awareness to overcome these issues and communicate online across culture. On-line cross-cultural communication is a vital element in todays communication at workplace for team development and efficiency. In this study I plan to explore some of the potential reasons for misunderstanding and distrust in on-line communication. I believe to address this question I need to tackle the following issues listed below:

- Online cross-cultural communication is more prone to misunderstanding and distrust than face-to-face communication because some of the nonverbal communication cues like body language are missing.
- The building of trust between individuals can lead to successful on-line cross-cultural communication.
- There is a need to understand hw the meaning of word may vary between cultures in order to eliminate any potential misunderstanding and distrust between individuals.


Some Resources to use in the paper Annotated Bibliography


Nastri, J., Pea, J., and Hancock, J. T. (2006). The construction of away messages: A speech act analysis. Journal of Computer-Mediated Communication, 11.4, article 7.
This research study focuses on away messages in IM and how it can be used for better communication. A total of 483 away messages written by 44 individuals were studied. The messages were broken down indo different categories. They are primarily assertives, followed by expressives and commissives, but rarely with directives. These findings are discussed in terms of computer-mediated discourse and online self-presentation.
Coppola, N. W., Hiltz, S. R., & Rotter, N G. (2004). Building trust in virtual teams. IEEE Transactions on Professional Communication. 47.2, 95-104
The authors, researchers at the New Jersey Institute of Technology, Newark uses Debra Meyersons concept, swift trust at the beginning of an on-line course to build trust between temporary teams in online courses. The industry is moving towards a virtual world and along with it the academia is also preparing the students to work in a virtual world. As the students are meeting for a short time they can be compared to the temporary groups at workplace how everyone is pressured to become familiar in a limited amount of time. It shows the faculty members who were able to build trust between the team within the first week of the class were able provide successful learning community. The same phenomenon works within virtual teams at work place. Trust needs to be present between team members so they can count on each other and work more effectively towards their task without additional worries.
Suchan, J. & Hayzak, G. (2001). The communication characteristics of virtual teams: a case study. IEEE Transactions on Professional Communication; 44.3, 174-186
The authors, researchers are from the Naval Postgraduate School and the U.S. Army explores on how there is greater need by the industry to deliver to their client in the most efficient way and how they are turning towards virtual team to give them the nimbleness to leverage their resources. They research analyzed the communication technologies like Customer Support Virtual Team (CST) for a Fortune 500 organization. Advanced electronic media provide the primary means of interaction between the virtual team members. For an effective team they found the great need for self driven team members and a great deal of trust along with the most efficient communication tools. In contrast they also found that organizations need to have staff to support these technologies for virtual team to perform effectively. As the industry is getting more demanding with the turnaround time of their project this study shows how managing a productive virtual team directly depends on a reliable communication systems. They show an interlinked relationship connecting the need to maintenance the uptime of these systems which helps the virtual team to be productive and as a result support their clients.
Zhou, L., & Zhang D. (2005). A heuristic approach to establishing punctuation convention in instant messaging. IEEE Transactions on Professional Communication. 48.4, 391-400
The author, researcher at the University of Maryland, MD explores the behavioral indicators of deception in virtual group when using instant messaging as a media of communication through qualitative study. He also discovered the difference in linguistic behavior between deceivers and the truth teller. This study is crucial for industries as most are instant messaging or synchronous computer mediated communication now pervades in daily life of the workplace. The study also compares the research on deception in face-to-face communication based on the clue theory with the deception via instant messaging. The interpersonal deception theory from social science was also used to guide the deception research in the group studied using instant messaging. Compared to face-to-face interaction instant messaging is influenced by the lack of incoming social cues as the communicators doesnt get to see the facial expressions. It is important identify these deceptions as organizations interact with each other virtually to reduce project failures. The results from this research can be used to understand knowledge of deception behavior in human communication and be aware of deceptions in the virtual world.

Grosse, C. U. (2002). Managing communication within virtual intercultural teams. Business Communication Quarterly. 65.4, 22-38.
This study was based on the findings from a graduate level business communication class assignment and interviews with four executives from France, United Kingdom, and US. The study focuses on how to build a strong virtual team through technology at the same time keep the interaction more humanized. It is a challenge for the traditional workers to work with teammates where there is no face-to-face interaction so there is a greater need for human touch to make them comfortable. There is also a need to have awareness of cultural diversity in the global virtual team to avoid unnecessary misunderstanding. The study also troughs the idea of a first face-to-face interaction between the team before forming them into virtual team but this is not always feasible due to geographical location and cost. The organization need to encourage open communication from the beginning between the virtual team members to grow trust and understanding. In the long run this will help the team to be more efficient and productive.

Shaw, B. , Scheufele, D. and Catalano, S. "The Role of Instant Messaging as a Tool for Organizational Communication: An Exploratory Field Experiment" Paper presented at the annual meeting of the International Communication Association, Sheraton New York, New York City, NY Online Retrieved 2008-06-20 from http://www.allacademic.com/meta/p14438_index.html
Millions of adults currently use instant messaging (IM) in the workplace and yet there is very little research examining how use and perceptions of this new medium affect intra-organizational communication. While one of the characteristics of instant messaging is the ability to exchange real-time communication, what truly distinguishes instant messaging from other widely adopted forms of mediated communication is the integration of presence technology, which allows parties to detect if others are online and available to communicate. In this paper, we propose a theory of productivity benefits of presence-aware communication technology, building upon past research. Based on this model, we use a quasi-experimental longitudinal research design with quantitative and qualitative methods to test how providing instant messaging to selected workgroups at a Fortune 1000 company impacts employees attitudes and work behavior. Results suggest that IM use had a positive effect on improving productivity with participants citing reductions in voice mail and phone tag, improvements to how easy it was to see if colleagues were online and available to communicate as well as increased productivity served by back-channel communications conducted via IM. Results and future research directions are discussed.

Panteli, N. & Davison, M. R. (2005). The role of subgroups in the communication patterns of global virtual teams. IEEE Transactions on Professional Communication. 48.2, 191-220
This study was collaboration between the University of Bath, UK, and the City University of Hong Kong, China. The author, researchers represents both the universities and led a group of 47 students by dividing them into 8 subgroups. The research explores the emergence of subgroups in global virtual and the communication pattern of teams in virtual settings. Extensive observation was made for 8 months to analyze the way all the teams communicated on the same projects by using on-line file exchanges, chats, and discussion forums. The study ws very close to real life scenario because of the geographical proximity and the organizational homogeneity of the members in two different locations. The study shows how misunderstand between team members caused lack in team cohesiveness thus creating boundaries. Although the end result of the task between the team were very good but interestingly the study show there is greater need to have highly skilled team leader to maintain the serenity between the subgroups and to help taking ownership of faults, thus reducing misunderstanding. The study does a great job in discussing the insinuations of the findings and how to apply in practice. As businesses are moving toward outsourcing this study can be used as source in understanding some of the shortcomings of virtual teams and ways to overcome them.

Burn, J. & Barnett, M. (1999). Communicating for advantage in the virtual organization. IEEE Transactions on Professional Communication. 42.4, 215-222
The authors, researchers at the Edith Cowan University, Australia studies six virtual organizational models and explores how the electronic network of virtual organizations rises above the conventional organizations. All these models have some common needs. They all seek for innovative way to come up with low-cost communications technology and employ rich functionality. The models also explore how virtual organizations are dynamic and are going through constant changes. The most stable virtual organization that run most efficiently are the ones that treat communication knowledge as their core need for their infrastructure. The trend to the formation of virtual organizations industry and a lot can be learned from their communication structure which can be applied to the traditional organization and to the formation of their virtual teams.

Zhou, L. (2005). An empirical investigation of deception behavior in instant messaging. IEEE Transactions on Professional Communication. 48.2, 147-160
The author, researcher at the University of Maryland, MD explores the behavioral indicators of deception in virtual group when using instant messaging as a media of communication through qualitative study. He also discovered the difference in linguistic behavior between deceivers and the truth teller. This study is crucial for industries as most are instant messaging or synchronous computer mediated communication now pervades in daily life of the workplace. The study also compares the research on deception in face-to-face communication based on the clue theory with the deception via instant messaging. The interpersonal deception theory from social science was also used to guide the deception research in the group studied using instant messaging. Compared to face-to-face interaction instant messaging is influenced by the lack of incoming social cues as the communicators doesnt get to see the facial expressions. It is important identify these deceptions as organizations interact with each other virtually to reduce project failures. The results from this research can be used to understand knowledge of deception behavior in human communication and be aware of deceptions in the virtual world.

Judith A. H. (2005). Building trust and collaboration in a virtual team. Team Performance Management. 7.3, 36-48
The author from the Holland College, Canada focuses on how building and having trust in virtual organization is important for it to be productive. Organization are moving toward a virtual team environment and to have effective virtual team there needs to me seamless communication between team members and they need to be able to rely on each other without any doubts. She studied six members in a virtual team to find the out how level of trust is important in team effectiveness. She suggest the application of Jung's theory of personality types to assess virtual teams in a positive and laissez-faire way to highlight value of diversity so the team members are at ease to share their personal and work style preferences, thus creating a circle of trust. Trust is need between all kinds of team but it is crucial for virtual team as there is no face-to-face interaction between team members and there is vulnerability for deception.

Jarvenpaa L. S. & Leidner E. D. (1999). Communication and trust in global virtual teams. Organization Science. 10.6, 791-816
The authors, researchers, at the University of Texas at Austin, TX studied three hundred and fifty master's students from 28 universities for six weeks in virtual team setting to explore the how trust was developed through virtual interaction. The study show communication challenges dues o cultural in interpersonal differences and thus creating misunderstanding between team members. The presence of the SIDE theory was found in the study as there were pauses between the members during their interactions which influence individuals to build stereotypical intuitions about each other. In this study we also see the application of Debra Meyersons theory of swift trust but between the team members were very fragile and temporary. There are challenges in virtual team due to geographical distance so organizations need to focus on open communications between the virtual team members so there is less misunderstanding. A productive virtual team cannot be built just with the proper communication tools but there is need for trust, respect, and relationship between team members.





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I need a Bachelors degree thesis on The Effects of Picture Archiving Communications Systems (PACS) and Computerization on Radiology Workflow and Turn Around Time. Basically how the advent of Radiology Information systems (RIS) and Picture Archive Communication Systems (PACS) has effected todays modern Rdiology department. Things discussed should include improved turn around time for examinations, improved and streamlined workflow, immediate delivery and accessibility of digital images virtually anytime anywhere.

The Picture Exchange Communication System (PECS) is a communication tool used often with students with autism. This is a research paper. Research PECS; compare and contrast it with two other types of communication system for children who do not display functional speech.

5 pages total
4 pages as a summary paper with an abstract, discussion and summary/4 references
1 page as a discussion page answering the following:

Discussion: Explain and give examples of advantages and disadvantages of PECS.
or a 1 page discussion on " Why do children who have limited conversation required additional communication systems? (Either one will do!)

Hi! I'm Michelle.
I need your help to write research project.

The following is the description of this research project.

Research proposal ? students are required to complete a proposal for a research project. In the proposal, relevant literature will be reviewed and a study in or related to the field of special education will be developed. The proposal must be typed and submitted in the format specified in the American Psychological Association (APA) publication manual. The following are required for successful completion of the project:
a. a. Introduction: A discussion introducing the general idea of the research problem to the field of special education. It will include:
i) General statement of the problem
ii) Definition of terms; and
iii) Specific research questions and statement of the hypothesis
iv) Significance of the proposed study
b. b. Review of the Literature: The review of the literature is to demonstrate how previous research relates to that which the investigator is preparing to undertake. It is the background information from which to view the proposed study. You are required to cite not less than 10 articles and at least some of the reports must be empirical studies. A bibliography is to be included with the final draft of the report. Most articles should be no more than 10 years old.
c. c. Methodology: This section is to describe, in outline form only, exactly how the investigator will conduct the proposed study. This section is to include: a description of who the sample will be, how the sample will be developed, the instruments to be used, the design of the study, and the procedures to be followed.
i) Design
ii) Setting
iii) Participants or Subjects
iv) Measures or Instrumentation
v) Procedures
vi) Data Analysis Procedures-how to analysis data
vii) Limitation of he study


The following is my topic. I want to you write based on my topic.

The topic to be investigated in this study is how teaching AAC early on impact on developing verbal communication skills for children with autism.

Children with autism who are taught AAC early on develop more verbal communication skill than those who are only taught speech.

Autism is termed as a syndrome marked chiefly by important difficulty in the development of speech and social functioning. Autism influences three important vicinities of developing namely verbal and nonverbal interaction, social association, and recreational play. (Dawson & Osterling, 1997) Although students with autism have idea of communication, as do students without disabilities, they recurrently cannot discover relevant means to communicate. Frequently, their idea of communications gives rise to behavior problems like oppressiveness, self-destruction, wealth destruction, and frequent quarrels. For this particular reason learning communication assets is the most significant one for students with autism to boost their social cooperation skills and reduce behavior difficulties. Without concise communication system, preference opportunities are hugely reduced. Constrained preference-creating opportunities also bear a semblance in more happenings of difficulties in behavior (Kern et al, 1998). For this particular reason, a basic aim of imbibing children with autism is enhanced communication, the most convenient and socially open attire of which turns out to be speech (Bondy and Frost, 1994). Anyhow, when children with autism are taught the communication skills directly, their proportion of speech attainment is generally retarded, and even when the attempt does not reap any results, a vast chunk of deliberation is needed of children and staff (Carr, 1982). Apart from speech, another section of learning Augmentative and Alternative communication skill as a functional communication skill has been comprehensive of viable or gaining communication entities. However, most parents believe that teaching functional communication skill may hinder children with autism developing verbal communication. The topic to be investigated in this study is how teaching AAC impacts on developing verbal communication skill for children with autism.

If you have question, email to me([email protected] or [email protected])

COMM/470 - Communicating in the Virtual Workplace
Communication Consultants
The New Business (Amazon)

Imagine that you are a team of communication consultants assigned with the task of helping a company executive make his team-oriented projects more efficient and effective. The current teams are working but have inefficiencies, and they are not as effective as they could be. The teams are usually given 1- to 2-week deadlines on projects, and each member must contribute equally. Each team member often has other projects he or she needs to complete individually, as well. This is an e-commerce company, and the team members are usually located in different geographically locations.
The company executive is aware that several competitors have been implementing new methods of communication within their teams and have been producing high quality output in less time. The executive is eager to do the same but wants to understand how communications technologies may help their teams? issues.
Explains how new communication systems provide more options for communication and e-commerce.
Consider your Learning Team as a virtual team.
Analyze the communication process within your team.
Explain how new communication systems will help improve efficiency in virtual teams.
Select the company your consulting group is assigned to work with
Perform a SWOT analysis for your client company: Strengths, weaknesses, opportunities and threats
Identify the potential competition
Identify what the competition is doing right.

I like to discuss the automatic fire alarm system, the composition and working principle. Items that will need to be discussed; design, basic configuration, notification devices, detectors, and emergency voice alarm communication system. Thank you

Explain the concepts of science communication and give examples from readings of each concept.

Concepts
1. Norms(Communalism, Universalism, Disintretedness, Organized Skeptkism)
2. Function of peer review
3. Stages of publications
4. Changes in Publications systems
5. Models of Science communication system today




There are faxes for this order.

Will the implementation of statewide interoperable communications systems adversely affect local jurisdictions?
Interoperability is the ability for emergency responders to interact and communicate together. After the failures of communications systems on September 11, 2001 when police, fire/rescue, EMS, emergency management and other responders were unable to communicate it became readily apparent something had to be done to ensure communications interoperability. This failure of communication hampered response to the World Trade Center disaster and potentially caused an increase in the loss of life. Some say that the establishment of various interoperable communications systems and the establishment of the 800mHz band as the requirement has hurt local jurisdictions with the large cost of equipment and infrastructure requirements.

Outline:

I. Introduction
a. What is Emergency Management

b. What is interoperability

II. Lessons Learned
a. 911
i. Communication Failure
ii. EMS/Fire/Rescue/Police Unable to communication

b. Katrina
i. Different Communications Systems


III. Equipment and Cost
a. 800 MHz Systems
i. FCC Rabanding mandate
1. Public Safety Systems being rebanded for safety
2. Cost?

b. Grant Programs

c. Federal Assistance


IV. Cost vs. Benefit
a. Is it worth the cost?


V. Conclusion

If the writer: "Themich" is available, please present this assignment to her/him.
Please see attached files for more details of assignment & reference material.

Background: Nursing ? Process Improvement and Change

The end of shift Critical Care Unit charge nurse to charge nurse reporting method is currently hand written and updated in the same manner for each shift. The proposed plan is to create a shared drive/folder in the Windows Excel Spreadsheet formula so unit report can be entered electronically and accessed by password. This unit reporting system will also support the SBAR communication system as well as JCAHO National Patient Safety Goals. This project was to be executed over a 7 week time frame.

***ONLY ONE QUOTE PER PAGE PLEASE*****

Assume the role of a Management Information Systems (MIS) consultant hired to review the internal data sources of a rapidly growing business. The business owner wants you to provide specific information explaining how an efficient internal communication system for employees should be established.

What types of tools would you review to fulfill this request?

Please write a 3 page paper and make sure to include a conclusion and references per the APA format.


Application: Adoption of New Technology Systems
As a nurse, you can have a great impact on the success or failure of the adoption of EHRs. It is important for nurses to understand their role as change agents and the ways they can influence others when addressing the challenges of changing to a drastically different way of doing things.
Everett Rogers, a pioneer in the field of the diffusion of innovations, identified five qualities that determine individual attitudes towards adopting new technology (2003). He theorized that individuals are concerned with:
Relative advantage: The individual adopting the new innovation must see how it will be an improvement over the old way of doing things.
Compatibility with existing values and practices: The adopter must understand how the new innovation aligns with current practices.
Simplicity: The adopter must believe he or she can easily master the new technology; the more difficult learning the new system appears, the greater the resistance that will occur.
Trialability: The adopter should have the opportunity to play around with the new technology and explore its capabilities.
Observable results: The adopter must have evidence that the proposed innovation has been successful in other situations.
For this Assignment, you assume the role of a nurse facilitator in a small hospital in upstate New York. You have been part of a team preparing for the implementation of a new electronic health records system. Decisions as to the program that will be used have been finalized, and you are now tasked with preparing the nurses for the new system. There has been an undercurrent of resistance expressed by nurses, and you must respond to their concerns. You have a meeting scheduled with the nurses 1 week prior to the training on the new EHR system. Consider how you can use the five qualities outlined by Rogers (2003) to assist in preparing the nurses for the upcoming implementation.
To prepare:
Review the Learning Resources this week about successful implementations of EHRs.
Consider how you would present the new EHR system to the nurses to win their approval.
Reflect on the five qualities outlined by Rogers. How would addressing each of those areas improve the likelihood of success?
To complete:
Write a 3- to 5-page paper which includes the following:
Using Rogers (2003) theory as a foundation, outline how you would approach the meeting with the nurses. Be specific as to the types of information or activities you could provide to address each area and include how you would respond to resistance.
Analyze the role of nurses as change agents in facilitating the adoption of new technology.
This Assignment is due by Day 7 of Week 6.
Reference:
Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press.




Informatics in Primary Care 2009;17:153??"64 # 2009 PHCSG, British Computer Society

Refereed paper
The NHS Care Record Service (NHS CRS): recommendations from the literature on successful implementation and adoption Kathrin Cresswell BA MSc
Research Associate
Aziz Sheikh BSc MBBS MSc MD DCH DRCOG FRCGP FRCP Professor of Primary Care Research and Development
Centre for Population Health Sciences, The University of Edinburgh, Scotland, UK


ABSTRACT
The implementation of the National Health Services Care Record Service (NHS CRS) is the most ambitious information technology inno- vation ever undertaken in healthcare. This elec- tronic health record system represents the key component of the National Programme for Infor- mation Technology. Its implementation is however proving extremely challenging. Building on a recent systematic review of the eHealth literature, we
critically reflect on factors that can facilitate the implementation of the NHS CRS and suggest rec- ommendations for a way forward to facilitate im- plementation efforts.
Keywords: adoption, electronic health record, im- plementation, NHS CRS

Introduction
The history of large-scale information technology (IT) projects is littered with examples of failure and this is unfortunately also true of healthcare settings.1??"3 A central reason underpinning many of these failures is that IT initiatives are often politically rather than clinically motivated, resulting in disenfranchisement of healthcare professionals and other key stakeholders from the outset. Once a policy decision has been taken, the lack of appreciation of and attention to the socio- cultural implications of new developments on patterns of working and organisational processes is a further recipe for disaster.
Despite the fact that some critics have (repeatedly) called for a radical rethink of the UK governments National Programme for Information Technology, NHS Connecting for Health (NHS CFH) is pressing ahead with development and implementation of a range of
IT initiatives, including deployment of its flagship electronic health record ??" the NHS CRS ??" in English hospitals. Cognisant of the reality of the situation, and based on the findings of our recent systematic review of the international literature on the role of IT in health care,4 we reflect on key socio-technical issues that should, we believe, be considered in order to maximise the chances of realising the vision of suc- cessfully implementing an integrated and nationally used and useful electronic health record (EHR) into English hospitals at this crucial stage of the implemen- tation story.5??"7 This case study will, we hope, offer important insights for similar electronic health record implementations now actively being pursued in parts of North America, Western Europe, Australasia and the Middle East.



154 K Cresswell and A Sheikh

The National Programme for Information Technology, NHS CFH and the NHS CRS
The National Programme for Information Technology was formally established by the then Prime Minister Tony Blair in 2002 as a ten-year initiative to introduce a range of IT systems throughout the NHS. It is the most ambitious national civilian IT venture of its kind anywhere is the world and it is suggested that it will, if successfully implemented, result in significant im- provements to the safety and quality of care, as well as substantial cost savings in the longer-term.8 In 2004 NHS CFH, an arms-length body of the Department of Health, took responsibility for delivering the programme.
Whilst the programme has made significant pro- gress is some areas (e.g. the Picture Archiving and Communication System), a host of problems have beset other functionalities such as the Electronic Pre- scription Service and the Summary Care Record. These problems have included contractual difficulties with system suppliers, a significant underestimation of cost, delays in implementation schedules, changing scope, negative publicity and negative views from healthcare staff on the ground.8??"10
The NHS CRS is made up of a complex range of interrelated IT applications aimed at facilitating data sharing and seamless clinical care (see Figure 1). It is in many ways the backbone of the programme and as such represents a fundamentally transformative initiative.
This is, however, also a potentially very disruptive organisational transformation as the current mixture of paper-based and local electronic record systems are systematically replaced by nationally shared electronic records.5
Several countries are planning widespread im- plementation of electronic health records and some healthcare systems have already developed and em- bedded EHRs in individual hospitals or in localised regions. Most activity in this respect is taking place in the USA (e.g. Kaiser Permanente), where this subject matter has been given a massive political boost fol- lowing President Obamas recent announcement of a national electronic health record strategy. Other areas of activity include Canada, Australia, New Zealand, several countries in Western Europe (such as the Netherlands and the Scandinavian countries) and the Midle East (such as the Kingdom of Saudi Arabia and the United Arab Emirates).
The broader political vision is to achieve inter- operable health records between different healthcare providers and settings and possibly also across differ- ent countries. In relation to the English venture ??" which is the first national implementation of an inpatient electronic health record in secondary care ??" it is important that every effort is made to minimise the possibility of high profile failure, not only because of the risks that this might pose to patient safety and the considerable expenditure, but also because the English experiment will almost certainly cause major ripples in other parts of the world.1??"3






















































































































































Figure 1 Schematic model of NHSCRS. CDSS, computerised decision support system; Prescribing, electronic prescribing; GP systems, general practice systems; NHS CRS, NHS Care Record Service; NHS DCR, NHS Detailed Care Record; NHS SCR, NHS Summary Care Record; PACS, Picture Archiving and Communication System


The NHS CRS: recommendations from the literature on successful implementation and adoption 155

Lessons from the literature
Whilst the literature on implementation of EHRs is at present inevitably somewhat limited, there are nonetheless a number of salutary case studies. Sicotte and colleagues, for example, describe the introduction of electronic health records into four hospitals in the United States.2 The cost of this introduction was considerable at $45 million, but the project failed due to the system being rejected by healthcare staff as they found that the application did not fit in with existing care processes. This high-profile example brought into sharp focus the need for a socio-technical viewpoint, considering social and technical dimensions as closely interrelated when seeking to understand work pro- cesses or fitness-for-purpose. Concerns about the impact on work processes have already publicly been expressed in relation to pilot implementations of the NHS Care Records Service.11
Figure 2 summarises factors that have been repeat- edly found to be important for the successful im- plementation of EHRs across the world. Discussed below are some of the key lessons from the literature.
The need for realistic expectations
Sauer and Willcocks have helpfully noted that the transformational nature, complexity and sheer scale of the introduction of the NHS CRS will almost certainly result in certain problems that are common to most so-called mega-programmes.10 These include factors relating to length, scale, unpredictability (often resulting
in uncertainty) and the need to interface and engage with a very large number and wide variety of stake- holders. They argue that such mega-programmes there- fore need to be viewed through a lens very different from the one through which we typically view more circumscribed initiatives. The implications of this include the need for a considerable lowering of the bar of expectations, at least in the short- to medium- term, and the need for far more honesty and trans- parency in relation to, for example, mitigating actions taken when things (predictably) begin to go off course. It is therefore important, they argue, for all stake- holders to recognise that the significant transform- ations of health care expected to be brought about by the NHS CRS will only be able to be planned for to a certain extent. The need for periodic reconsideration of options and approaches, as well as attempts at reconciling different emerging viewpoints such as, for example, those between NHS CFH (the commis- sioners and politicians), local service providers (the technical designers), NHS trusts (the organisations) and clinicians on the ground (the end-users), is there- fore only to be expected.10
Also relevant in this context is the discussion by Garside of theories of organisational change and how these can be applied to health care.12 One of these is Dawsons model of imperatives for change, which introduces the idea that large-scale programmes should allow for and will have elements of both rationality and irrationality, this latter consideration being par- ticularly important in the context of implementing complex and often unpredictable process change. The practical upshot of this is that planning and imple- mentation should be an iterative process. This can,



































































































Figure 2 Factors important for the successful implementation of EHRs identified in the literature.1 Includes usability, performance and integration, adaptability and flexibility;2 includes attitudes, motivations, resist- ance and expectations, engagement and user input in design, training and support, champions, integration with existing work processes;3 includes getting the organisation ready for change, planning, leadership and management, teamwork and communication, learning and evaluation, realistic expectations


156 K Cresswell and A Sheikh

however, be disconcerting for those used to far more linear models of working, particularly when planning and implementation are being undertaken in the light of considerable political and public scrutiny (and at times frank hostility). Hence, it is important that every effort is made to engage with the various stakeholder groups to make clear that such changes to approach are very much the norm, rather than the exception.
Recognition of the need to plan for and, where necessary, make use of a more flexible approach is therefore important. This must not, however, be an excuse for poor planning and implementation deci- sions, one of the commonest of which is expanding the remit of the programme.
Avoiding mission creep
Whilst in large scale IT projects certain complications are to be expected, a particular problem seems to be their frequently changing scope and increasing breadth.13 For example, the National Programme for IT was originally planned to deliver the NHS CRS, the Elec- tronic Prescription Service and Choose and Book. Later, it was expanded to include a number of other applications such as, for example, GP2GP, the Picture Archiving and Communication System and NHSmail. Despite the fact that implementation of aspects of these secondary applications is making better progress than that towards the primary outcomes, the difficulty with mission creep is that it inevitably takes policy- makers and implementers attention off the primary focus of the programme.
It also has to be kept in mind that the overall plan of creating nationally shared electronic health records was initially intended to emerge from local systems that would eventually be linked together. This has subsequently changed to a more ambitious approach driven in the main by national networking of systems and has led, many have argued, to a lack of sensitivity and responsiveness to local needs.8
Similarly, changes in cost estimations, overall im- plementation strategy and local implementers have led to a lack of public and professional belief in the programme and those delivering it. It has conse- quently been argued that what is needed is greater transparency of how policy decisions are made so that these can be scrutinised against the original plans.8 Although iteration is crucial, a careful balance needs to be achieved between wholesale change of direction and modification of plans (although admittedly under some circmstances a complete change of direction may be unavoidable). What appears crucial is that attention is not allowed to deflect off the main tasks at hand as a result of trying to deal with secondary considerations.
System usability and meaningful stakeholder engagement
The NHS CRS is likely to have a significant impact on working practices. For example, Berg discusses the active role of the medical record in the healthcare setting by considering three case studies, both in single physician??"patient encounters and in multidisciplinary care teams, and the ways in which the medical record can mediate and influence social and professional relationships.14 Berg describes, for instance, how the record structures medical work through the processes of reading and writing, how it co-ordinates care across professional boundaries and also how it contributes to sustaining power relationships between healthcare professionals. Similarly, Berg and Bowker describe how the medical record can contribute to shaping patients bodies and histories, how it impacts on social pro- cesses in health care and how it serves different func- tions for different actors, all of which need to come together for the record to function optimally.15 Al- though these analyses are based on paper records, they indicate the extent to which the introduction of the NHS CRS is likely to transform the experiences of both delivering and receiving care.16
Cultural change is best effected if users can be meaningfully engaged in design and deployment considerations. Above all, the NHS CRS needs to be perceived as useful and also user-friendly as these are essential prerequisites for effective use.17,18 The most important way of ensuring usability is through fostering close collaborations between the designers of applications and end-users, as it is this latter group that is most familiar with the context in which the new application will be deployed.5,19,20 Since it is important for designs to evolve during the establish- ment of a new application in an organisation,21 continuous testing of prototypes with different groups of end-users and redesign of initial and future releases of the NHS CRS will need to be carefully planned.22??"24 The user informed design guidance, which is part of the NHS Common User Interface Programme, is a step in the right direction.25
However, the need to engage meaningfully with end-users extends well beyond issues relating to design. Both individual and group resistance to change is a real threat to the success of the NHS CRS. Garside highlights areas that have been identified as to why individuals may resist change, these including parochial self interest (stakeholders may lose something with the change, e.g. professional status), resentment (can be with either indi- viduals leading change or with change itself), different perceptions of change (this depends on the individuals position in the organisation), misunderstanding or lack of trust and a low tolerance for change.12 Group and organisational resistance to change may stem from feeling threatened in the group structure (e.g. shift in


The NHS CRS: recommendations from the literature on successful implementation and adoption 157

power balance) and/or disruption of social professional norms.12,26 A sensitive approach aware of potential sources of both individual and group resistance is therefore essential.
At present, there is still a lack of clarity amongst various stakeholders as to what exactly the NHS CRS is (in anything other than broad aspirational terms). This makes it difficult for end-users to begin to appreciate how the use of an EHRS will be integrated into day-to-day working practices. These uncertain- ties are impacting adversely on users perceptions of the programme, contributing to negativity and an inability to see what is expected of users during the process of implementation and, equally importantly, what the personal or patient-level benefits of engage- ment might be.
What is therefore needed is far greater clarity on what it is that will be implemented, how this will fit into existing work practices and a realistic statement of timelines for implementation. Although NHS CFH has made a broad set of goals available, these now need to be refined and tailored to individual professions. Aligning goals with timelines and differentiating be- tween short- and long-term outcomes may be a helpful way of conceptualising this. This process is, again, best informed by actual engagement with end- users themselves while actively seeking opinions and divergent viewpoints in order to promote collective decision making and increase individual autonomy.20,27,28 Only then can users be systematically targeted and motivated to use the application.
Utilising informal social peer networking in influ- encing end-user perceptions of a new application is likely to be important in this context.6,7 This may take the form of demonstrations given by colleagues from early adopter sites, workshops or meetings attended by enthusiasts from the same profession, or those who have knowledge of how to use the NHS CRS speaking about their experiences. Ideally, key players to be targeted are influential individuals (such as managers, consultants or senior nurses) who are similar to future users (e.g. from the same profession) and have exper- ience of using NHS CRS prototypes. Although work- shops demonstrating the new system to healthcare professionals exist, these are currently mainly led by system suppliers. Professional networking is begin- ning to occur, but this is often self-organised rather than facilitated by NHS CFH.
It has to be kept in mind, however, that a variety of social networks are likely to exist in the context of implementing the NHS CRS. These may be operating at both a micro (e.g. profession specific, departmental) and macro level (e.g. hospitals, NHS trusts, clusters). Each of these need to be targeted separately as different groups are likely to use the application in different ways. Non-clinical staff groups such as, for example,
administrative staff also have needs in this respect that are easily overlooked.
NHS CFH may also wish to consider setting up a social network around the NHS CRS in order to promote sharing of ideas and experiences. The ap- pointment of clinical leads is a good start, but this is nationally led, rather than locally, which may pose difficulties in cultivating the local networking that appears particularly important.
Explaining exactly how an integrated electronic healthcare record may improve care and performance in a variety of different settings as well as hearing and then addressing end-user concerns is therefore cru- cial.29 The focus here should be to build on existing values in the NHS, rather than any technical impera- tives.16 There is the related urgent need to provide clinicians with quantitative data on how the NHS CRS is helping to enhance service delivery, rather than outcomes relating to numbers of users (as seems more typical at present).9 There is an opportunity to begin to generate such evidence from studying first- wave sites implementing the NHS CRS.
Local ownership and compatibility
A particular problem in the NHS CRS is that its implementation is top-down and it is therefore liable to be perceived as being imposed by the government. Implementation was (at least initially) planned as a big bang strategy. This is, however, now changing towards so-called soft launches of the NHS CRS, starting on particular wards and allowing for local adjustments to take place. Nevertheless, trusts are asked to purchase from a range of nationally accredited systems provided by a limited number of providers, restricting local input and choice.8 This often includes having to replace perfectly well functioning patient administration systems with those that are compatible with the systems purchased by NHS CFH.
Previous research has shown that top-down big bang implementations can contribute to increased user resistance and therefore carry a high risk of failure.30,31 Smaller, locally developed projects, on the othe hand, that work from the ground up, may lead to increased end-user acceptance.13 Examples from within Scotland and Wales, and from overseas (e.g. Kaiser Permanente in the USA), of the success of locally developed EHRs support this view. In such scenarios, systems are developed organically on a locality basis and the governments role is to pull these together rather than to drive implementation.32
Incremental approaches to change, negotiating goals carefully along the way, may be more effective than big bang approaches as these are likely to result in increased user acceptance. Negotiation is needed in


158 K Cresswell and A Sheikh

relation to design as well as the integration of tech- nology into existing work processes.21,31,33 If users are allowed to identify individual benefits to them and their patients of using the new system (as opposed to organisational benefits only) this can prevent poten- tial resistance.34 Otherwise they may develop either partial use (i.e. only using the parts that are useful to them) or workarounds (i.e. avoiding using the sys- tem altogether).35
Engagement needs to occur on a variety of levels to include stakeholders, NHS CFH and local NHS or- ganisations and trusts. The latter have so far been somewhat neglected and their influence has not been sufficiently harnessed. It needs to be realised that local organisations can be instrumental in opening chan- nels of communication between NHS CFH and indi- vidual stakeholders.
It is further important to clearly define both the role of NHS CFH as the external change agency and its relationship to adopters. However, although NHS CFH is now responsible for all aspects of implemen- tation, there is still some confusion on the ground as to where exactly NHS CFHs responsibilities stop and local responsibilities begin to take over. The notion of the rather unfortunately termed National Local Own- ership Partnership (NLOP) belies this confusion. This is further complicated by the increasing development of local systems and so-called interim solutions.
Evaluation
The importance of appropriate and programme-tail- ored evaluation in IT innovation has been repeatedly highlighted in order to investigate reasons for failure and factors for success.36,37 Evaluation can be difficult in a complex programme such as the National Pro- gramme for IT. Specifically, the introduction of the NHS CRS is difficult to evaluate as it is so multifaceted (Figure 1) and impacts on so many aspects of care delivery and organisational processes. Evaluation activ- ities will need to involve allocating designated staff and giving feedback to the public, individual staff, depart- ments and hospital trusts. It will also involve a delib- erate effort to investigate intended and unintended outcomes as well as unanticipated effects (e.g. such as those subtle impacts on changes in social relationships discussed earlier).
Several evaluations of components of the National Programme for IT (including the NHS CRS) have already been commissioned by the NHS CFH Evalu- ation Programme, although given the probable time needed for these interventions to infuse or embed within the NHS the timescales of these evaluations may need to be reconsidered.38,39 Promoting an increased awareness and involvement of key stake- holders in evaluation activities will be of primary
importance in this context. Efforts will in due course also need to focus on utilising and disseminating data from these effectively. This will mean concentrating not only on summative evaluation but, more import- antly, also on formative evaluation that can help to address problems iteratively. The focus of existing evaluation projects (including the evaluation of the NHS CRS) has mainly been on qualitative methods, as these are well suited to investigate complex socio- technical issues that may differ across local settings.40 Qualitative investigations also allow for more local input from trusts and staff on the ground, thereby facilitating formative evaluation and learning from their experiences.
Conclusions and recommendations
We acknowledge that the introduction of the NHS CRS is a complex venture that will involve a fundamental reorganisation of healthcare delivery structures. Whilst keeping in mind that the pro- gramme may ultimately bring important benefits, its nature and scale have brought significant challenges for all stakeholders and have led to discussions sur- rounding the adequacy of the implementation strategy. What is now needed are realistic expectations and transparent decision making by all involved, mean- ingful end-user engagement and usability testing, and an increased focus on promoting local ownership and formative evaluation.
During this process, tracking of occurring problems and an iterative refinement of the NHS CRS will be important. This will require negotiation with stake- holders, and careful consideration of how refinements will be handled and how much modification will be allowed locally. Acknowledging the inherent difficult- ies and complexities on the part of all stakeholders will be crucial in shifting the focus from blame to team- work.
ACKNOWLEDGEMENTS
The authors thankfully acknowledge the helpful com- ments of the reviewers on a previous draft of this paper. The authors also gratefully acknowledge the work of Dr Bernard Fernando who has kindly pro- vided Figure 2 (schematic representation of the NHS CRS). The authors also gratefully acknowledge the support of colleagues on the NHS CFHEP 001 and NHS CFHEP 005 and NHS CFHEP 010 project teams. We are grateful to the Independent Project Steering Committees that oversee these projects.



The NHS CRS: recommendations from the literature on successful implementation and adoption 159

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FUNDING
This paper is based on a systematic review of the IT literature funded by the NHS CFH Evaluation Pro- gramme (NHS CFHEP 001).
CONTRIBUTORS AND SOURCES
AS is guarantor. This paper is built on a chapter written by the authors as part of a systematic review of the literature examining the impact of IT on the quality and safety of health care. AS conceived the idea for this paper and contributed to interpreting the evidence and drafting the manuscript. KC identified and reviewed the literature and led the drafting of this paper.
CONFLICTS OF INTEREST
The authors are currently funded to undertake an evaluation of the NHS CRS (NHS CFHEP 005), data coding and structuring (NHS CFHEP 009) and the impact of IT on the clinician??"patient relationship (NHS CFHEP 010).
ADDRESS FOR CORRESPONDENCE
Aziz Sheikh?Centre for Population Health Sciences The University of Edinburgh?20 West Richmond Street?Edinburgh?EH8 9DX?Scotland?Email: [email protected]
Accepted September 2009
Copyright of Informatics in Primary Care is the property of Radcliffe Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Warning systems are essential to communicating threats, whether man-made, technological, or natural, to the public. Provide a summary overview of at least two types of disaster warning systems used in the international disaster community or a nation's communication system (other than the U.S.). Discuss the use of these two types of warning systems throughout the world (excluding the U.S.). Then choose one of the two warning systems and fully describe the warning system, its regional coverage, who uses the system, and how, when, and where this communication system has been used. Provide an example of whether this warning system worked to save property or lives.

Task:
Read the book "Language Instinct" written by S.Pinker.
Choose 3 of the following for S.Pinker`s "Language Instinct". The length for each answer is 2 pages( double-spaced, typewritten)

1. All languages are "discrete combinatorial systems," which means they contain rules that combine basic symbols (as words) into an infinite number of different larger structures (such as sentences). Other such systems are rare, but they do exist. The genetic code of DNA-which serves as the basis for life on earth-is built in a similar way, allowing for the creation of a potential infinity of novel life forms.
Some other discrete combinatorial systems that humans possess are involved in aesthetic activities like music and dance. What is the relationship between the language instinct and these other aspects of the human mind? Is it likely that such systems emerged out of language, either through biological evolution or cultural development? Or could they have evolved independently? What sort of evidence would bear on this issue?
2. The structures of speech and sign are constrained by biological mechanisms; they are not cultural innovations. Because of this, the complaint that people nowadays don't use English properly is quite bizarre. It would be like saying that birdsong has been gradually corrupted over the last several hundred years. But writing is a different story. Although it is plainly based on existing languages such as English, it is a cultural invention. Not all societies have it, and children require careful instruction in order to learn it. What is the proper role of "language mavens" in determining rules and standards of writing? How can scientific research on sentence comprehension and composition tell us how to improve the teaching of writing skills?
3. We are entranced by the idea of animals learning language, and popular movies and television shows are are populated with singing chimps, talking dolphins, and even the occasional loquacious horse. Pinker argues that from the standpoint of biology, attempting to teach one species the communicative system of another makes little sense. Trying to teach a human baby to sing like a bird or chatter like a monkey isn't likely to succeed, and would not tell us very much if it did.
Why are we so fascinated by the idea of talking animals? What is at stake-scientifically or socially-in the debate over the capacities of apes and other animals? How are these attempts to teach human language to non humans different from the study of the communications systems that animals use spontaneously in the wild?
4. Debates over the nature of the human mind have always been intimately
related to our political, social, and religious views. Defenders of the claim
that the mind is infinitely malleable, free from biological constraints, view this
as an optimistic, liberal doctrine, while more biological perspectives -
especially those informed by evolutionary theory - are seen by many as
tainted by racism and sexism.
On the other hand, scholars such as the linguist Noam Chomsky have argued that the moral superiority of the empiricist view of the mind is far from clear. Historically, the notion that humans can be "shaped" in any manner that an authority chooses has been the premise behind many brutal and repressive activities. As Pinker puts it, a blank slate is a dictator's dream. Furthermore, a theory of the mind informed by evolutionary theory is actually inconsistent with the notion that there exist profound cognitive differences between human groups.
Should these ethical and political considerations be taken into account as we develop theories of the mind? How have they affected our way of thinking about these issues in the past? In particular, what motivations might have led people to the view that languages are cultural inventions that vary without limit or, alternatively, to believe that language is a species-specific biological instinct?


In my order I pointed that I will be sending sources to your e-mail address or fax. I want to inform you that I will not be able to send you the source. (I won`t send anything else). The author has to find the source in a library or somewhere else.

Read the Case Study below. You are to write a 2-page paper. You are to Give an Overall Response to the Nextel Case Study. Do Not Use Outside Sources.


www.nextel.com
Let the Battle Begin, Nextel Communications. Inc., has recently been embroiled in controversy with Verizon over its walkie-talkie service. Walkie-talkie is a service that allows phones to send voice messages to each other instantaneously. Nextel and Verizon have been in court trying to settle a dispute over Verizons recent announcement of Push to talk. Nextel has used its direct connect walkie-talkie service as its major competitor advantage, and has accused Verizon out false advertising and stealing the slogan Push to talk. Nextel has known about competitors intentions to use the walkie-talkie service offerings for some time. If Verizon succeeds, it could potentially take some of the walkie-talkie service market share from Nextel. How effectively Nextel reacts to this penetration of its market will determine how long it can remain a market leader in this type of service. For 2003, Nextels revenues rose 24 percent to $10.82 billion and earnings fell 11 percent to $1.47 billion. As of February 2004, had 15, 200 employees.

History
Nextel became the large corporation it is today by a series of mergers and acquisitions that have lasted over a decade. Nextel was founded as Fleet Call in April of 1987. It issued an IPO in 1992 (NASDAQ:CALL). Fleet Call was originally founded as a two-way radio service, which eventually became the backbone of technology of Nextels present business. After a series of mergers and acquisitions, the company eventually became Nextel communications in March of 1993. In 2003, Nextel and Nextel partners service became available in 197 of the top 200 US metropolitan areas, which is where 242 million Americans they live or work. Nextel has been dealing with negative profit reports since its inception, until 2002 when the business turned its first profit. The telecommunications market is saturated with competitors, so Nextel is trying to differentiate itself with marketing strategies, technological advances, and infrastructure improvements. The business is aggressively increasing its distribution channels in network capability. Nextel has also done test marketing for Boost Mobile in California and Nevada, which is targeting the youth market.

Current Situation
Nextel has 8.2% market share among the top six national wireless carriers as year end 2002, it also garnered 14.1% of new wireless subscribers, which is helping to build market share growth. In 2002, the company posted significant growth in revenue and subscribers and had its first full year of net income. Nextels major competitive advantage is Nextel direct connect, which is a two-way walkie-talkie service. Customers can instantly have private or group conferences within their local calling area. In 2002, this system was upgraded to allow customers to interact with direct connect nationally on the Nextel network. Direct connect is continually updated and is now allowing customers to interact with other direct connect users traveling with them outside of the local market. This feature is key among competitors initiatives to copy and improve upon. Verizon is the first on the list of competitors to introduce walkie-talkie service. Features like this help Nextel to attract high-value customers. Nextel is the leader in average revenue per user at $70.00


Affiliations
Nextel owns 32 percent of Nextel partners, which provides digital wireless communications services under the Nextel brand name in small to midsize markets. Nextel partners possess the right to operate in 57 of the top 200 metropolitan areas of the US during ranked by population. Nextel partners allow Nextel Communications & Co. to focus on other aspects of the business, www.nextelpartners.com. Bells and whistles attract consumers in todays culture. Handset technology is an important factor in the telecommunications market. All of the companys handsets are manufactured by Motorola except for the Blackberry 6510, which is made by research in motion, Ltd. All handsets incorporate iDEN technology and offer digital wireless services, Nextel direct connect, wireless Internet, and two-way messaging capabilities. Often, consumers will choose wireless services based on the types of phones provided. Having Motorola make considerable technological advancements will help Nextel secure customers in the future; www.motorola.com As of December 31, 2002, Nextel owned 6% of the outstanding common stock of NII Holdings, previously known as Nextel international, which sells wireless communications services to Latin America. NII Holdings filed for Chapter 11 bankruptcy in 2001 but emerged from bankruptcy in November 2002. Prior to its reorganization, NII Holdings was Nextels wholly owned subsidiary, www.niiholdings.com
Mission/Vision
Mission and vision statements were not found on either the Nextel web site for a in the Nextel 2002 annual report. However, Nextel partners, a company partially owned a Nextel that markets its services, has a mission statement on its web site, but no vision statement.
Mission Statement in Guiding Principles-Nextel Partners
Our mission is to provide high-quality, integrated wireless service that maximizes customer and investor value.
Guiding principles:
*Strive for 100 percent partner satisfaction
*Strive for 100 percent customer satisfaction
*Achieve targeted revenue growth with a low cost structure
*Achieve win-win results through the power of teamwork
*Work smart while remaining humble
www.nextelpartners.com/Mission.htm


Organizational Chart
the organizational chart was devised using the titles on executives in the 2002 annual report. Nextel has a functional structure since most of its VPs Functional readership titles. CEO Timothy Donahue has been at the helm since August 1999. He joined the company as COO in 1996. Mr. Donahue was previously Northeast Regional President at AT&T and it is a graduate of the John Carroll University with a B.A. in English literature.
Wireless Environment
The US wireless market has entered a transition phase on the path from start up to maturity. A number of large carriers have emerged as market leaders, offering nationwide service, bundled minutes, and one rate pricing plans. The improved service and greater affordability has boosted market penetration---more than half of the US population has now signed up a wireless service. Major carriers have invested heavily in upgrades to their networks to 2.5G technology, so that they can to support Internet and other data related offerings. The carriers to grow their revenues, firm must look for largely untapped markets. This is no easy task since analysts considered wireless communications a mature product. Upper and middle class consumers are already hooked; therefore those demographic facts are difficult to penetrate. Most of the carriers are currently targeting the youth market with prepaid wireless plans. Another trend appearing is to be all you can talk plans. Carriers are now competing offering more minutes at lower prices, which in turn has caused the ARPU(average revenue per user) to rise only 2% in 2002. Wireless is beginning to replace landline communications services. With an onslaught of plans offering more minutes at an affordable price, many consumers, primarily young adults, has switched to wireless only. For example, college students sometimes live at dorms and at home during the same year. Consolidation among major players in the communication industry seems likely with subscribers growth slowing, heavy capital requirements, and stiff competition. Some areas like Cingular have 15.9% US market share and need radiofrequency rights, while T-Mobile has high fixed costs and needs more customers. Sprint PCS and Verizon have common technology platforms; however, as with any merger, there are obstacles, such as Department of Justice approval and management. In the wireless business, customer churn is an important measurement businss performance. Customer churn is a measurement of customer retention and is defined as the monthly percentage of the customer base that disconnect. Churn measures both voluntary and involuntary disconnects. Involuntary disconnection usually refers to nonpayment situation. Voluntary churn is when the customer decides to disconnect service. To calculate customer churn, divide the number of handsets disconnected from service by the average number handset in use during the period. Its important to have a low churn rate because it is much more costly to acquire new customers and to retain the existing ones.
Legal Governmental Issues
Access to radio redundancies or transmission, or spectrum, is the basic regulatory barriers to entering the wireless industry. A portion of the spectrum that is usable is AM frequencies to infrared. As technology improves, wireless providers are moving up the spectrum to higher frequencies. The Federal Communications Commission (FCC) assigns a range of spectrum associated with different types of technologies. Cellular wireless is between 824- 849 MHz and 869- 894 MHz. PCS provides between 1850 and 1990 MHz. Spectrum is very valuable asset in the wireless communication industry. On September 23, 2003, Nextel announced its intentions to sue Verizon for false advertising of its walkie-talkie service Push to Talk. The feud between Nextel and Verizon has been going on for some time with Verizon suing Nextel in June 2003, for testing unreleased handsets in what Verizon describes as corporate espionage. With competition so intense but unique product offerings, legal battles could continue in wireless industry.
Economic Issues
The US economy is rebounding. The wireless industry and Nextels market share grew significantly even during the economic recession. Apparently, economic uncertainty, high unemployment rates, and war have not affected the demand for wireless communications services. Even though consumers are demanding wireless service, they are also demanding lower prices, which have and will likely continue to shrink ARPU. Inherently, this will force lower margins in considerable cost reduction is not implemented.
Cultural, Social, Demographic Issues
Our society is on the move and people are busy. Wireless communications allows people on the move to communicate freely without slowing down. Even lower income people are warming up to the wireless services. This market has been predominantly untapped. The lower income market may not increase ARPU but it will definitely generate more revenue. There is a positive trend in the use of wireless communications, from 1998 to 2002, wireless communications used increased by over 500 billion minutes in the United States.
Internal Forces
Marketing
Effect of marketing strategies are important for success in the wireless industry. Establishing a strong, loyal customer base is key to being successful. A companys advertising program is a key component of the marketing plan, particularly in the mass market. The effectiveness of marketing in this industry can be gauged in terms of penetration growth and net subscriber additions relative to expenditures. Education is also in achieving growth. Companies of must convince potential customers to pay for innovation. As the wireless market reaches saturation, companies are focusing on retaining customers more than attracting new ones. In 2003, Nextel won the naming rights to NASCARs premier racing series. Previously known as Winston Cup, it will now be known as Nextel cup. This will cost Nextel $700 million over the next 10 years. Many of the top American companies were bidding on the package once it was reported that RJR-Nabisco could no longer pick up the naming rights. NASCAR is an attractive marketing tool and has experienced phenomenal growth throughout the entire country. Nextel is hoping to benefit by offering unique, was related products and creating greater brand awareness. With NASCARs market development, Nextel tried to follow suit more market growth. Retaining customers in the wireless business is of the utmost importance and arguably more important than attracting new ones. The average monthly churn rate was 2.1% in 2002, down from 2.3% in 2001. Strategies have been implemented to reduce its connections that include customer focused programs and efforts to migrate customers to more preferable pricing plans. Also represented by the churn rate is the effort of Nextel to acquire high-quality subscribers that are less likely to switch around.
Information Systems
Nextel has been awarded the best B2Bweb site award among telecommunication carriers in B to Bs 2003 net marketing top 100 list. It was recognized for its account management systems, online demonstrations, customer support, and interactive features. Nextel has shown a strong focus on meeting its customers needs through Web technology; the information systems initiatives are part of the strategy to lower churn rate. Quality information systems will help Nextel to be more responsive to its current customers-base needs. Quickly identifying key market drivers will help it stay ahead of the competition.
Finance
Nextels annual income statement and balance sheets, note that Nextel has recently reduced debt on its balance sheet by reducing its interest payments and increasing equity. Fitch has upgraded Nextels rating on senior unsecured notes from B+ to BB- however, significant long-term debt still exist which could cause problems in the future if Nextel experienced low margin and/or high customer churn. Revenue per customer, its down over the past few years. Nextel has traditionally been the leader in attracting the higher revenue generating customers what is unique offer. If the ARPU continues to fall there could you significant impact on profitability and there could be difficulties in covering overhead costs. However, if Nextel can gain new customers while keeping ARPU high, it could be tremendously profitable in the future. If the customer base remains the same size and ARPU, rises then profit margin will increase simultaneously.

Competition
Verizon
Can you hear me now? Yeah, we have heard that a million times. Verizon is the leader in the wireless communications for year end 2002;it is number one nationally in the market share with 32.5 million customers, and revenues of $135.8 million. It operates in 29 states and has 10.1 million long-distance subscribers ranking it third in that particular market; it is also a direct tree publisher and has a global presence in 32 countries. Verizon is divided up into four segments: domestic telecom, domestic wireless, international services, and information services. Other services provided include wireless voice, data services, and equipment sales in the US and internationally. In 2003, Verizon marketed its push to talk feature versus Nextels direct connect.

Cingular
Cingular tries to emphasize freedom of expression in its marketing strategy. Cingular
Is a joint venture of BellSouth and SBC. It is currently the second-largest provider of wireless communications services and the US. Its name was chosen to symbolize unity and individuality. SBC owns 60% of Cingular and 40% of BellSouth. Its customer base is around 22 million. Eleven old brand names were replaced by the Cingular brand. Cingular has been in touch with T-Mobile USA about a potential merger. Recently, the company has cut 2,500 jobs (seven percent of its workforce).

AT&T Wireless
AT&T wireless services operates as a wireless communications service provider in the United States. AT&T sometimes markets itself with regional brand names, such as SunCom in the southeastern US. The company provides wireless voice and data services over two separate, overlapping networks. One network users time division multiple access (TDMA) as its signal transmission technology. As of December 31, 2002, the companys TDMA network covered an aggregate population (POPS)of approximately 203 million, or 70 percent, of the US population. It also provides voice and enanced data services over a separate network that uses a signal transmission technology known as global system for mobile (GSM) communications and general packet radio service (GPRS). As of December 31, 2002, this never covered approximately 63 percent of the US population, or 181 million POPS. As of December 31, 2002, AT&T wirelesses two network covered an aggregate of approximately 213 POPS, or 74 percent of the US population, and operated in 83 US metropolitan areas.

Sprint PCS
Sprint PCS (personal communications systems) group, together with his third party affiliates, all for services in over 300 metropolitan markets. Sprint PCS has licenses to operate and all of the US. Sprint PCS groups has affiliation with other companies that use the same network system. These companies offer wireless service with the Sprint brand-name and bear the expense of the network. In August 2003, Horizon PCS, an affiliate of the PCS group, filed for Chapter 11 bankruptcy protection along with two of its subsidiaries.

Deutsche Telecom/T-Mobile
T-Mobile was formerly known by the name Voicestream and is a subsidiary of Deutsche Telecom. It is one of Europes top wireless communication companies. T-Mobile has major operations in Germany, United Kingdom, and Austria. In 2001, it acquired Voicestream Wireless and Powertel in the US.T-Mobile currently owns 60 percent of the UK Company T-Motion, and focuses on prepaid wireless services, which causes them to have a small ARPU. It is also the fastest growing wireless provider in the US.

Global Perspective
Only 20% of the world has access to wireless communications services, according to Jorma Ollila, CEO of Nokia. A global wireless market expects to reach all the 1.75 billion customers by 2007. Fish traditional wireless communication markets are saturated, companies will likely look at new markets to grow their business. There are more cellular phones in China and there are in the US. According to the Chinese Ministry of information, there are 250 million of them in use. China is a highly populated nation with inferior Landline infrastructure. Some companies are looking to develop nations such as China to increase revenues. There are many risks involved with entering markets such as the Middle East. Physical risk such as terrorism and political instability are legitimate threats to doing business. However, wireless communication companies have to look at these areas to grow revenue. Europe predicted to have substantial wireless communication market growth, which is expected to reach $131 billion in service revenues by 2007. However, most of his market growth for the in areas other than voice. Europes global market share will decrease from 30% to 20% because of high growth rates in Asia and the Americas. Nextel is being marketed to Latin America NII Holdings (Nextel international Inc.), which used to be wholly owned by Nextel Communications & Co.. This market has considerably less competition and is more politically stable than the Middle East and Asia. This could be a potential growth area for Nextel in the future as the US market becomes more and more saturated with competition.

Future Outlook
Nextel will continue to push his walkie-talkie service transition chief competitive advantage; it will have to increase its coverage area and make pricing competitive. It also expects to leverage its relationship with NASCAR auto racing to boost its market share and brand awareness. Or Nextel to become the dominant player in the wireless communication industry, and it will have to focus on retaining customers while encouraging people to switch over. Of mergers is very real and some could occur in the next few years. Competition all the unique services such as walkie-talkie will continue to increase. Nextel is also looking to expand to rural areas of the US where there is less competition. It is repurchasing debt to reduce interest expense and risk, and distribution channels also been expanded so more people can easily sign on to Nextel service. Customer centered operations will continue to be a focus so that high value customers can be retained and customer churn rate will be lowered.

COMM/470 - Communicating in the Virtual Workplace
Communication Consultants For Amazon.com
Post a 500 word paper including: Identify potential new methods of communication

including a compare and contrast: That is, identify the pros and the cons and suggest

which methods are more appropriate.

FOR THIS PAPER PLEASE JUST CONCENTRAIT ON THE CONS

The paper provides an analysis about communication and information technologies that help e-commerce firms to perform work in a virtual work environment. The paper adopts the approach of a consultant tasked with performing SWOT analysis of Amazon. Based on the SWOT analysis of Amazon, the report recommends that the company should adopt DIVA, a group-ware communication and collaboration tool proposed by Sohlenkamp and Chwelos (1994). The model will help Amazon compete with the new e-commerce firms such as Boxed?. The wholesale competitor has efficiently used communication and information technology tools to create a niche in the market.
New communication system: Impact on e-commerce and business communication
Businesses increasingly provide telecommuting facility for their employees. To effectuate this working design, internet and intranet are used as communication sources. To communicate through web-based applications and systems, employees require effective communication skills both formal and informal. The remote working model requires that employees collaborate with the employer through reliable and cost-efficient tool. The impact of these new communication systems is manifold. Time and travel expense of each employee is saved, and the company can hire experts to enhance communication skills. The latest communication systems based on a private intranet of e-commerce companies also help in increasing inter-group proximity in virtual teams. Real-time team communication and work report tracking are also made available through these telecommuting technologies (Cascio, 2000). The information and communication technologies (ICT) also allow e-commerce firms to develop dynamic teams comprising of a multi-skill team members to join work from different locations. Email, voice mail, video conferencing, and messages through social media websites such as Twitter, Face book, and LinkedIn are also used to communicate for work related matters in virtual work environment. Computer aided design (CAD) and excel spreadsheet are used to communicate the work progress taking place in virtual teams. Following is a SWOT analysis of Amazon that will help identify areas in which Amazon requires improvement.
Amazon SWOT
Strengths: The main strength of Amazon is that the company is a cost leader in the e-commerce retail industry. It has the widest product categories to offer to customers. The economies of scale of Amazon?s operations allow the company to offer lowest prices. Amazon?s popular offer was ?refund the difference?. Renowned supply chain: Amazon?s supply chain is one of the most renowned in the work of retail shopping. It has the largest number of fulfillment warehouses in all markets that the company operates. Each fulfillment center is strategically located in the geographical areas served by Amazon. Superior IT capabilities: Amazon?s information technology capabilities are also superior to the competitors. The company offers transactional security and order status monitoring to its customers. Having an excess server capacity, Amazon also offered cloud computing services. Weaknesses: Amazon uses its leadership in market share as a competitive advantage. The approach leaves the company with zero-margin in several product categories. The company mostly relies on cost cutting-methods that also include tax-evasion tactics. Such tactics have recently back0fired. Opportunities: Online money transfer systems such as those operated by PayPal are experiencing rapid growth. Amazon can venture into the financial services sector as it is already a cost leader in e-tailing. Expansion of e-commerce service to Asia-Pacific and Western Europe regions is another opportunity the company can leverage upon. Threats: Due to ruthless cost cutting strategies, Amazon will increasingly feel pressure from e-retailers that provide differentiated products and services. Tax-evasion tactics in UK are also potential threat for the firm. The information security of personal information of clients is also a potential threat for Amazon.
Potential competition and its strengths:
Boxed and e-Bay are two of the most outshining competitors of Amazon. While e-Bay has remained no. 2 for long in the competition race, Boxed? in a rather new e-commerce wholesaler selling products above $75 value. Boxed? started with seed funding of $1 million and are currently offering to deliver over 600 items in 48 states of the US. One aspect that Boxed has improvised more than Amazon is the communication platforms aimed towards communicating customers? needs to its engineering department. Physical work is outsourced to companies such as UPS and other regional warehousing brands. The company performs predictive analytics and suggests products that customers will need to purchase based on their consumption patterns (Mims, 2013).
DIVA: Communication systems for Amazon
As a business communication consultant, it is suggested that Amazon should adopt DIVA, a group work communication and collaboration tool suggested by Sohlenkamp and Chwelos (1994). In the proposed communication and collaboration tool, Amazon will perform operations in a virtual environment. The tool will allow Amazon to perform communication of groups in two basic formats i.e. Synchronous and Asynchronous. Virtual teams of Amazon will be able to communicate in real time and perform simultaneous work using the groupware intranet. Turn-tasking will also be introduced, and the team members will be able to see peer work progress and see the progress reports. The team members working on one project will be able to leave notes for each other. They will work on shared documents, and divergent work on application development will be saved from being performed. Appendix I highlight the communication environment under DIVA method and how it helps to create and infuse an office environment despite workers operating from remote locations. As discussed earlier, Boxed? has performed better in innovation and idea implementation compared to Amazon. Amazon will have to develop its strength in innovative services rather than just cutting the costs of products. People, e-documents, e-desks, and e-rooms are the most essential element of this new work design in a virtual environment. Real-time communication will be through audio-video conference and virtual co-workers will be able to share ideas publicly on the forum or in private conversation.



References
Cascio, W. F. (2000). Managing a virtual workplace. The Academy of Management Executive, 14(3), 81-90.
Mims, C. (2013, Nov). How 10 people built a competitor to Amazon.com for $1 million-in 90 days. QUARTZ. Retrieved from: http://qz.com/149811/how-10-people-built-a-competitor-to-amazon-com-for-1-million-in-90-days/
Sohlenkamp, M., & Chwelos, G. (1994, October). Integrating communication, cooperation, and awareness: the DIVA virtual office environment. In Proceedings of the 1994 ACM conference on Computer supported cooperative work (pp. 331-343). ACM. Retrieved from: http://pdf.aminer.org/000/121/938/integrating_communication_cooperation_and_awareness_the_diva_virtual_office_environment.pdf

please regard that i want you to write about 2 pages as introduction of my article and only one page as conclusion and add them to the attached article below.
Studying the Impacts of Globalization on Tools and Facilities in Iranian Education System
Abstract
Globalization has deeply changed indicators of education system; including important indicators such as educational tools and facilities. Educational technologies make teachers able to learn various styles of learning and make learning interesting for learners and have converted teachers role from provider of knowledge to a guide. The main goal of this research is to realize the degree of globalization in Tools and Facilities of Iranian education system.. Findings suggest that Tools and Facilities of Iranian education system is far from globalized, post modern education Tools and Facilities , actually matches traditional, stagnant and modernity Tools and Facilities
By analyzing the reasons for weaknesses of this indicator in Iranian education system, one can outline factors like the high population sheltered by this education system that caused the high budget needed to equip those schools with technology. From the other side, aged instructors and principals resist due to their own incapability to utilize technology. Based on the essence and mission, education system should coordinate itself in different aspects of transformation, so that does not become an expired institute.
Keywords: Education Tools and Facilities, Globalization, Postmodernism, Iran, tradition

Introduction

Nowadays, the role of Information and Communication Systems in simplifying the flow of information and preparing the path for decision making is clear to almost everyone. Development of the availability of communicating in the shortest time has conquered the time and has led to some new circumstances or so-called Globalization (Shahi et al., 2008).
According to Ginkel, these changes were rooted underground about half a century ago (Ginkel, 2002). One the other hand, Madison regards globalization as an advanced human dynamic (Madison, 2001). Alberto believes that modernity has come to an end and a new era has begun in which the world has completely changed and is approaching to become a whole unit (Alberto, 2001). Based on Charlton and Andreass beliefs, globalization is an aspect of a bigger phenomenon, i.e. modernism, which defines the society with increasingly growing properties of communication complexities (Charlton and Andreas, 2006). All these stand for a reality known as globalization. Globalization, which requires freedom of action, results in variations in factors including monitoring, hierarchical relations, and management-oriented in education management. This matter implies that although globalization does not belong to any doctrines, it is somehow aligned with post-modernity basics and principles. In the contemporary world, post modernism principles are becoming widespread and have led to new debates in political and cultural as well as literal aspects including learning and education (Farmihani, 2010). It seems that Jacques Derridas deconstructive attitudes have stimulated evolutions in education (Derrida, 1974). As evidence suggests, education system have also benefited from globalization consequences. Referring to the fact that the year 2002 was named as Human Globalization by UNESCO, Ginkel believes that the whole education system plays an important role in this matter (Ginkel, 2002). The globalization process is significantly affecting the economic and commercial life of nations. With increasing global competition and the rapidly advancing technologies, the business organizations and business models as well as management systems and practices are undergoing continuous change. To cope up with these changes, the management education is also being restructured and refocused (Mushtaq, 2004).
. The availability of accessing Internet networks for students has made classrooms walls more transparent and penetrable which brings along the possibility of infinite and multipurpose relationships to learners and has resulted in the notion of Global Village.
Besides, easy and flexible access to Internet and thereafter knowledge causes learners to select the desired method from the experience available to him and thereby, seek learning anywhere at any time. Yet, it seems that Iranian education system with the prospect of loyalty to employing traditional educational tools and facilities has withdrawn the possibility of exploiting the needed potentials. While using contemporary technologies and innovations for global education system leads to target meaningful learning and traditional approaches and those that are teacher-oriented are replaced with pervasive ones. Problem solving ability and high level skills of thinking, data analysis, time management and the capability to prioritize skills in information cyberspace and a globalized society based on information is developed and this is subject to the fact that students and teachers should be able to effectively utilize technologies. This research seeks analyzing the effects of globalization on educational tools and facilities in Iranian education system and find out its comparative globalization degree for the purpose of which, the researcher pays attention to the globalized educational tools and facilities.
Material and methods
In the current research, two methods of surveying and document analysis are utilized.
2.1 Statistical Society: The statistical society for the current survey is all the teachers and principals of primary, middle, and high schools for all the four districts of Ahwaz city, Iran during 2010, this includes 7465 individuals.
2.2 Sampling Method : The desired sample was chosen for the implementation of the survey with questionnaire, by the help of a sample size determination table (Morgan & Krejcie) with the help of a stratified random sampling proportional with the population of the society that is 357 individuals. The stratified number of sample was evaluated by this formula:

n: Total volume of the sample
N: Total number of statistical society of the research
Ni: Population of the class
ni: Volume of the sample
2.3 Research Tools: According to the topic of this research, and due to the novelty of the subject, no data collection tool was available. In order to compile the questionnaire, the researcher initially performed a qualitative study and then, using that, a proper questionnaire was compiled for the quantitative aspect of the survey.
Data collection tools include demographic information check list, the questionnaire made by the researcher for globalized education system and document analysis.
Reliability of Research Tools: According to Cronbach's alpha, the resulted coefficient for the questionnaire with 30 subjects and 71 indices is ?=90.
2.4 Data Analysis: Quantitative data were analyzed by the help of SPSS 16 application in the two descriptive and illative levels. In the descriptive part, frequency, mean value, percentage, and standard deviation were used whereas, from the illative aspect, mono-variable T-test and independent variable T-test, one-way analysis of variance (ANOVA), and regression were utilized. Data obtained from the documents is analyzed by the help of inductive content analysis.
Result
From the attitudes of scientists like Foucault and Derrida, Farmahini, and Jiroux, one can perceive some features for the globalization of education Tools and Facilities in post modern system among which the most important are:

Audio and visual equipment in teaching particularly the Internet and computers and equipping schools with laboratories.
The availability of excursions.
The possibility of changing the decoration of the class.
Result from questionnaire:
As it is observed from the table (1), the average and the standard deviation of educational tools and facilities in Iran are 2.385 and 0.745 respectively. The results from the mono-group T-test demonstrate that there is a significant difference between the current situation of educatonal tools and facilities in Iran and its current optimal global situation (t356=-2.264; P=0.001) or in other words, the situation is lower than the optimal level.
In order to study the impacts of demographic characteristics of test subjects on their attitudes towards the level of globalization, we compare them according to these factors respectively.
A) Educational tools and facilities are different at various teaching age group.
The results from (table 2) the mono-variable analysis of variance illustrate that the impact of subjects teaching age group on their viewpoints is not significant regarding educational tools and facilities (P<0.05; F(2.535)=2.648).
B) The situation for the current educational tools and facilities is similar from the points of views of teacher and principals with different education degree.
The results from ( table 3 )the mono-variable analysis of variance illustrate that the impact of subjects education level is not significant on educational tools and facilities (P<0.05; F(3.345)=0.225).
C) Educational tools and facilities in Iran are different according to different subjects administrative position.
Table4: The influence of subjects administrative position on educational tools and facilities is not significant (P<0.05; F(3.354)=1.433).
D) Educational Tools and Facilities in Iran are Different Based on Gender Differences in Schools.
The results from the independent group T-test ( table 5) express that there is no significant difference between educational tools and facilities of two groups of men and women (t355=0.148; P=0.882).

Conclusion

Results of the analysis on educational tools and facilities in a globalized and postmodern education system indicated that using audio and visual equipment, specially computer and the Internet and laboratories play an important role in in-depth learning and availability of excursions and change of class formation pursuant to change of subject are of great significance.
Talking about Information Technology, Scrimshaw and McCormick in their article entitled Information and Communications Technology consider pervasive interactions which are unique to postmodernism. These interactions provide the availability of infinite, multi-purpose relations for learners whose continuity assists in the formation of small and numerous societies in a school (McCormick and Scrimshaw., 2001)
Communicational innovations affect both the process and consequences in schools and direct information freeways from universities to schools. Internet brings along unique opportunities for practicing a new type of democracy in which every culture and human units are able to advocate and disseminate their attitudes and critics and this makes schools as wide as the globe with every human being inside it; whereas, in modern era, information was handled by governments. In a globalized education system, governments possess little chance to refine tastes and by the help of the internet, frames of the classroom are becoming more and more transparent and permeable Farmihani, 2003).
Special features of modern classrooms such as particular position of instructors, blackboard, and row structure of students in the form of regular benches and desks implied that instructors are the owners of knowledge and students are learners and this was not aligned with globalization perspectives like deconstruction, creativity-oriented, etc. The formation and decoration of classrooms should be defined by the subject.

As it was observed from table 1, there is noticeable gap between the current situation of using educational tools and facilities with the desired situation of them in a globalized, post-modern, education system.
In other words, the situation is lower than the desired situation. These findings is compatible with Mahdi Azads(2010) findings by electronic government analysis of education system in Ahwaz which was placed as in the second step (full-fledged) among five stages offered by United Nations research. By analyzing the reasons for weaknesses of this indicator in Iranian education system, one can outline factors like the high population sheltered by this education system that caused the high budget needed to equip those schools with technology. From the other side, aged instructors and principals resist due to their own incapability to utilize technology, however, since young staff are keen to employ innovation and are indeed capable, and students are trained by out-of-school institutes, schools have become forced to employ technology. Budgets and actions have been undertaken in this regard, but weaknesses in strategic management have resulted in dissatisfactory results of this indicator. Factors such as employing inefficient staff as responsible for computer sites and laboratories even despite the investments have caused intense weaknesses.
Formation of classroom as row aligned was a big technical step from the traditional form. Each row simplified the process of controlling each student at a time and all students at the same time by giving a specific place to each student. This has led to bringing up obedient, norm-centered, and introvert individuals which is one of the other weakness indicators.
On the other hand, a globalized education system seeks developing extrovert and creative individuals. In this system, the formation of a classroom is flexible and changes according to the needs of each subject and avoids any form in which instructors stands at the peak and hierarchical relationship between students and instructors are evaded as well.
A proper general and formal education system requires an interdisciplinary, interactional, cultural-educational approach in building educational environments and formation and equipment supply and needs to abide by technical, engineering principles and standards, climate variations and urban planning principles and according to needs and following age, gender and physical requirements of educators; this provides a proper formal school. However, unfortunately, the existing education system is facing limitations in resources and facilities and technical labor which is one of the other challenges and is a major cause of the gap with a proper system (Secretariat of Higher Education, 2010)
Based on the essence and mission,education system should coordinate itself in different aspects so that does not become an expired institute;in particular, in the age where innovation sphere leads to new capacities at times. Legal legislation system should possess mental preparation and ability necessities to be updated not to question formal education systems efficiency. Dullness in taking proper actions is a challenge threatening this system (Secretariat of Higher Education, 2010)In order to further the analysis of educational tools and facilities, demographic properties of subjects of the test were investigated. The results of a one-way variance analysis (table 2) demonstrated that the teaching age group in which instructors are working could not have an impact on applying educational tools and facilities and led to no improvement.
Results from the one-way variance analysis (table 3) and (table 4) indicated that education level and rank of subjects could not have any influence on applying educational tools and facilities, either. Besides, results of the independent-group T-test (table 2-3-5) presented that based on the two divisions of men and women; the state of educational tools and facilities is evaluated inefficient. For demonstrating this, it can be said that the many consensus clarify the deep gap between the current situation of educational tools and facilities and its desired state and it can also be noted that the centralized system of Iranian schools and lack of instructors accessibility to educational facilities have affected their scientific capabilities significantly and denies any kind of creativity.
References
Albero, M. ( 2001). Global Era:The Sociology of Globalization. Translated into Persian by Nader Salar Zadeh Amiri. Azad Andishan Press, Tehran, 2004 (in Persain). Charlton and Andreas, 2006.
Azad ,M( 2010). Analyzing the Electronic Government Model in Staff Department of Ahwaz Education Bureau.Masters Dissertation, Ahwaz: Chamran university
Charlton, B., G., & P. Andras, (2006). Globalization in ScienceEducation: an Evitable and Beneficial Trend; Medical Hypotheses,Vol. 66.
Derrida, J.,( 1974). Of Grammatology Trans. Gayatri Chakravorty, Spivak Baltimore. John Hopkins University Press.
Farmaini Farahani, M. (2010). Post Modernism and Education System. Tehran, Ayeej Publications.
Farmihani Farahani , M. (2003) . Studying Postmodernism Education Views with a Focus on Foucault and Derridas Attitudes. Shahed University Bimonthly Scientific & Research Journal, 10th Year, No. 3.
Ginkel, H. ( 2002) . What Does Globalization Mean for Higher Education. Globalization: what Issues are at Stake for Universities, Universite Lavel; Quebec Canada.
Madison, J. P. (2001) . "Globalization: Challenges and Opportunities" ; Translated by Mahmud Salimi, Rahbord Journal, Vol. 22 (in Persain).
McCormick R,. & Scrimshaw P.( 2001) . Information and Communications Technology. Knowledge and Pedagogy, Education, Vol. 1, no. 1.
Mushtaq ,H. ( 2004) . Globalization and Management Education in Developing Countries. viewed 5 July 2011, http://ideas.repec.org/p/pra/mprapa/29020.html
Secretariat of Higher Education,( 2010). Transformation Document Guideline for Formal Education System of Islamic Republic of Iran. Legislation Prospect. 826., pp57-59.
Shahi, S. and Naveh Ibrahim, A. & Mehralizadeh Y. 2008. Higher Education Encountering Global Challenges in Khuzestan Universities. Research in Higher Education Quarterly, no. 50, pp. 19-45.

There are faxes for this order.

Requirement: This is your end-of-block exam for L100. The purpose of this assignment is for you to demonstrate your ability to synthesize the organizational development processes you learned from the L100 lessons (L101-L109) and apply them to a case study. The L100 exam case study is available to you in a separate document.

The assessment rubric for the exam is listed below on page two and provides the grading criteria for the exam question. Ensure you address the specified criteria when formulating your response. Ensure you write your response as an argumentative essay.

While ST 22-2 specifies third person for academic writing, the L100 exam requires you to write your essay in first person to take personal credit for your leadership knowledge, skills, and abilities. Your answer will be no less than four (4) pages and no more than five (5) pages in length (double-spaced, using 12-point Times New Roman Font, and one-inch margins). Your completed essay is due at the end of the block, after lesson L111. The L100 take-home exam is worth 60% of the L100 block grade.

Always cite your sources. If something is not your original thought, you need to cite your source using either footnotes or endnotes IAW the Turabian style (7th Edition) of documentation; do not use parenthetical citations. (ST 22-2 dated June 2012 is based on this 7th Edition.) In addition to the case study, you MUST integrate concepts from L100 into your responses. Specifically, you may want to use some of the models or theories discussed in L100 as you answer your exam. Finally, you will complete the student self-assessment portion of the CGSC Form 1009w writing evaluation, and submit that completed 1009w with your take-home exam argumentative essay for grading.





Your Exam Question

What is the critical leadership problem facing the 56th HBCT Brigade Commander and how will you, as the new brigade commander, improve the organization?

Assessment Rubric
Evaluative Criteria Communications Criteria Score
90 Points

Apply critical-thinking skills to identify, explain, and defend the selection of the critical leadership problem. Use relevant facts and assumptions from the 56th HBCT case study to support your argument. (30 Points)

Describe your vision for the brigade and how you will measure effectiveness in achieving that vision. (20 Points)

Describe the process you will use to solve the problem and implement your vision based on the readings and lesson material from L100. (40 Points)

10 Points

(1) The introduction clearly states the thesis and introduces major points.

(2) Major points are fully developed using clear reasoning.

(3) The conclusion reinforces the thesis and major points.

(4) Style is concise, primarily in active voice, and generally free of errors in grammar, punctuation, and spelling.

(5) Proper use of citations IAW ST 22-2.
_______________________________________________________________

US ARMY COMMAND AND GENERAL STAFF COLLEGE
Command and General Staff Officer Course (CGSOC) Common Core
L100: Developing Organizations and Leaders


L100 Take Home Exam Case Study
Class 13-01
?The 56th Heavy Brigade Combat Team?

You are LTC Osborne a promotable lieutenant colonel who commanded a battalion in the 56th Heavy Brigade Combat Team (HBCT). One month ago you returned to the 56th HBCT after a 2 ?-year absence to assume the Deputy Brigade Commander?s (DCO) position. While you are excited about getting reacquainted and acclimated with your old unit, you know that a lot has happened, including a deployment, in your absence.

The 56th Heavy Brigade Combat Team (HBCT) returned from Afghanistan 55 days ago and is now in its RESET phase of the ARFORGEN process. The 56th?s parent division headquarters and the other three divisional BCTs did not deploy with the brigade. Instead, the 56th HBCT worked for two other divisions during their deployment and with a number of other BCTs. Further, due to operational needs and capability shortfalls in another brigade, the 56th detached one of its combined arms battalions for thirteen of the deployment?s fifteen months. The brigade has been back at home station for almost two months; Reintegration Training and block leave are complete. As you settle into your new position and surroundings, you realize that few, if any, of the HBCT staff remains from your last tour with the unit. Further, many of the current HBCT staff will PCS in the next few months. The change of command for five of the six battalions is scheduled in the next 30 days. Your initial conversations with COL Axel, the brigade commander (BCO) and CSM Rose, the brigade command sergeant major, were positive. Both appear to have genuine concerns about the actions needed to improve the brigade and prepare it for the next mission. Your discussions with LTC(P) Lennon, the outgoing deputy brigade commander (DCO), seemed out of synch with the BCO and CSM and caused you some concerns about the current climate within the brigade.

You remember that just three short years ago, the 56th HBCT was considered among the best maneuver brigades in Forces Command. By all measurements, the brigade excelled. Morale across the brigade was high, as it seemed the brigade attracted the best of the officer and non-commissioned officer corps. Leaders wanted to lead, Soldiers wanted to soldier, and a supportive family atmosphere existed among the battalions. There was a strong work ethic. Problems existed, but there was a prevailing attitude that all could be resolved. More often than not, the problems were solved at lower levels and rarely reached the brigade command level. Competition within the brigade existed, but it was positively oriented toward the success of the brigade. Frequent coordination occurred among peers to share information, resources, and lessons learned. Often, the brigade and battalion officers would meet informally for happy-hour type social events. Although these were definitely social occasions, the leaders could not help but discuss ways to improve their brigade. Leaders shared information freely with little regard for ownership or competitiveness. Often, the battalion and brigade commanders were active participants. Brigade officers were often ridiculed by their peers in the division as ?whackos? who always wanted to discuss ?work? issues. A similar environment existed among the battalion and brigade NCOs. Now it appears the environment has changed and the Battalions are competing not to improve the Brigade but to make themselves distinct from the Brigade. Camaraderie amongst the outgoing Battalion Commanders and Command Sergeant?s Major appears to be only skin deep. You are concerned this is due to the environment set by the BCT Command Team.

Just prior to your departure as a task force senior trainer at the Joint Multinational Readiness Center (JMRC) in Germany, the 56th HBCT received notification that its deployment location changed from Iraq to Afghanistan and that the deployment would be 15 rather than 12 months long. As a battalion commander, you took pride as you observed all leaders pitching in to ?make it happen.? Although some officers, non-commissioned officers, Soldiers, and families voiced concerns about the impact the deployment?s length and the significant change in operating environment could have on the brigade, all were committed to making the transition occur as smoothly as possible. Soon after the notification and your departure, the brigade experienced a change of command. The new brigade leadership team assumed responsibility for the predeployment train-up period. Your remaining brigade contacts indicated the transition and train-up seemed to go as well as could be expected. The 56th completed its Mission Readiness Exercise (MRE) at the National Training Center and deployed for war.

While the majority of the brigade took block leave over the last month, you have had the opportunity to review a number of historical documents, attend routine battle rhythm events, speak with members of the brigade, and walk around the brigade?s footprint.

Your review of the brigade?s historical unit status reports (USR), indicates the 56th HBCT completed all necessary training and received its required equipment prior to departure. The HBCT deployed at 92 percent strength although the assigned strength was 105 percent. The commander?s comments specifically highlighted that brigade leaders and Soldiers were well-trained and qualified. The majority of the non-deployable Soldiers remained at home station for medical reasons that came to light within 60 to 90 days prior to the departure date. During the deployment, the brigade redeployed over 100 Soldiers for non-combat-related medical problems. While the installation?s medical providers addressed many of the non-deployers? medical concerns, a significant number of non-deployable Soldiers remain on unit roles. Additionally, since returning, the number of medical non-deployable soldiers has slightly increased above pre-deployment numbers.

The brigade?s historical records from Afghanistan reveal that the unit was fairly successful in accomplishing all missions. The documents suggested that violence in the 56th?s sector did not significantly increase, nor did it decrease, and casualties in Afghanistan were considered light with one critical exception. Security of the populace and US forces was a major priority that was accomplished very well, but the records indicated the HBCT?s ability to support the host nation was mixed, with limited success in training Afghan Army units and police forces. It appeared the HBCT staff was able to manage day-to-day operations effectively, but struggled with their ability to capitalize on opportunities and to anticipate potential threats.

Approximately five months into the brigade?s fifteen month deployment, a suicide vehicle-borne IED (SVBIED) attacked a patrol in one of the maneuver battalion?s sector. The attack killed the brigade commander, brigade command sergeant major, and one of the Battalion Commanders as well as wounded several other Soldiers and Afghan Security Forces. In the immediate aftermath of the attack, LTC(P) Lennon assumed command of the brigade until the arrival of COL Axel and CSM Rose. The division headquarters assigned LTC Hendrix, a battalion command-selectee already commanding a MiTT team with the brigade, to assume battalion command.

Another document you reviewed was a comprehensive report with the findings of a Center for Army Lessons Learned (CALL) study conducted for the 56th in Afghanistan. From all accounts, the HBCT performed as well as possible in Afghanistan, and the leadership performed well given the circumstances. However, the official record also indicated significant challenges requiring attention. The extensive study identified several specific issues that may have an impact on the BCT?s future effectiveness. You highlighted the following sections of the report.

Multiple and often incompatible communications systems hampered command and control throughout the brigade. At battalion and below levels, the varying battlefield, electronic, and environmental conditions required leaders to carry multiple radios to communicate effectively. Further, the dispersed nature of multiple Combat Outposts (COPs) and Joint Security Stations (JSS) created significant digital network challenges for the brigade?s network technicians. The digital network frequently crashed making communication loss between the brigade and subordinate battalion headquarters a normal, if not daily, occurrence. While tactical satellite (TACSAT) and high frequency (HF) radios provided some redundancy, the limited number of systems and frequencies available to the brigade in some cases created operational and personal friction.

Personnel authorizations on the battalion staffs were not sufficient to allow 24-hour operations over a sustained period. Often, battle captains were taken ?out of hide? to conduct the mission, resulting in unqualified and untrained personnel attempting to perform battalion tactical operations center functions, especially during the evening hours. This contributed to increased friction between the brigade and battalion staffs.

During the brigade?s deployment, the DCO was tasked at different times to supervise the military transition teams (MiTTs) operating within the brigade?s battlespace, synchronize the operations of the brigade support battalion (BSB) at a different forward operating base, be the ?voice? of the HBCT to the media, LNO to coalition forces, and act as a BCT chief of staff. These varied missions for the DCO created confusion within the brigade, and this confusion created the perception of a weakened HBCT command structure. This perception was strengthened when COL Axel assumed command but left many of the responsibilities for daily operations with the DCO.

The modular BCT structure, first implemented during your time as a battalion commander, continued to create training challenges, especially within the combined arms battalions. Whereas previously the maneuver battalion commanders and staffs were able to focus on traditional infantry and armor skills (e.g., Bradley and tank gunnery, individual infantry and armor soldier skills, infantry and armor platoon skills), the same commanders and staffs were required to attain and maintain proficiency at planning and executing individual and collective skills in areas outside their areas of expertise. Moreover, the report identified subject-matter expertise, once resident within the maneuver battalions, was diminished within the maneuver battalions. The impact of this additional complexity and burden was identified at all levels of leadership. The Army?s decision to augment the brigade with three MiTTs just prior to the MRE required the leaders to rethink combat organization. The BCT never quite compensated for this additional mission even after COL Axel, who had MiTT experience, arrived to take command. The strain between the MiTT mission and the combat role of the BCT was known throughout the BCT and was well known on the Division Staff as well.

The Afghanistan environment placed severe demands upon available manpower. Specifically, the need to protect the population and expand operations in previously unsecured areas increased the need for infantry squads. As a result, armor, engineer, artillery, and other Soldiers filled the void performing typical infantry tasks and not their own military occupational specialty (MOS) core competencies. Soldiers from the Forward Support Companies also augmented maneuver platoons as vehicle drivers and as alternate Quick Reaction Forces (QRF) within the maneuver battalions.

The 56th HBCT trained for the wrong mission-essential tasks during its training ramp-up for deployment to Afghanistan. The brigade trained exclusively on their assigned M1 Abrams, M2 Bradley combat platforms (focusing on gunnery skills and qualification) prior to deployment and during stability operations. However, upon arrival in theater, operational necessity required use of seven different mine-resistant armor protected (MRAP) variant vehicles in lieu of tanks, Bradleys, and up-armored HMMWVs. The brigade had few assets available at Bagram Airbase to execute drivers? training during RSOI, requiring the creation of a drivers? training program to train drivers during the first few months in combat. Further, the number of ?patrol sets? required to support the operational tempo (OPTEMPO) affected not only the maneuver units, but the brigade?s special troops battalion (STB) and the brigade support battalion (BSB). The brigade STB was specifically affected due to a lack of critical MTOE authorizations for the battalion staff to support both brigade and battalion operations. The dispersed nature of the battalions required the BSB to spend increased time on the roads resupplying outlying locations. Lastly, during pre-deployment train-up, the artillery battalion provided indirect fire support for the cavalry squadron and combined arms battalions? tank and Bradley platoon qualification tables. The six months dedicated to supporting this mission, including both an internal artillery gunnery certification program and the direct support to maneuver platoons, limited the amount of time available at the platoon and battery level to train on dismounted infantry and patrolling skills.

The stability operations mission created unique issues for the 56th HBCT. Although the size of the HBCT staff had a positive effect on shaping operations within their battlespace, the additional tasks associated with resourcing and supporting the MiTTs from members of the BCT staff created a ?dual-hatted? staff, which reduced the staff?s effectiveness.

The CALL Report also indicated a potential problem exists within the culture of the organization. The desire to be seen as an elite, highly professional unit led to the development of unit rituals that were generally good natured and helped instill an espirit de corps within the unit. However, the CALL reports contain information that implies some NCOs and Junior Officers allowed these events to devolve to an extreme degree during the deployment. The report suggests that the events have progressed from espirit building to ?sanctioned hazing? according to one junior NCO.

You also received a 360-degree commander and staff assessment of the 56th HBCT from the Center for Army Leadership?s (CAL) Leadership Assessment and Feedback Program. A summary of trends from the assessment indicates that the staff had the trust and confidence of the subordinate units. It revealed the NCOs display confidence in their abilities and have a good tactical and technical knowledge. On the other hand, the assessment revealed that commanders share a lack of willingness to include subordinates in decision-making, and they fell short of expectations on developing subordinates, coaching, and counseling. This is apparently driven by a seeming lack of concern for leader-development by the Brigade Commander. The report indicates that company commanders are not routinely counseled on their performance and receive little to no developmental guidance from either their rater or senior rater.

Recently the BCT HQ completed a command climate survey. There are some inconsistencies in the survey report. Many of the Soldiers within the HQ seem to like being a member of the BCT but report they are stressed because of the upcoming deployment and the effect they anticipate on their families. Also there is clearly some disappointment with the Leaders in the BCT indicated by comments like this, ?COL Axel tells us in formations to take care of our families but he never gives us time to do the things we need to do for them. My wife is really fed up with this unit.? Another comment reads, ? MAJ Blackmore (Brigade S4) is always talking to the female soldiers. I can tell he makes them uncomfortable by the amount of attention he pays them. There are some that he even goes out of his way to get into his office. I think it is affecting the performance of the section but what can I do, I am only a Specialist.? You can find no indication that any action was taken by the BCT Leadership on the issues within the survey.

The last historical document you reviewed was the brigade?s Reset plan and timeline. A careful study of the document reveals that the brigade is currently at R+55. According to the DA G3/5/7 Reset EXORD for the brigade?s redeployment, the brigade has another 125 days in the ?Reset? Force Pool before transitioning to the ?Train/Ready? Force Pool. Of immediate concern is the pending arrival of the unit?s containers and redeploying equipment not turned in to Army Material Command (AMC) in Afghanistan. The ship arrived at the port ten days ago and immediately began downloading equipment to rail back to home station. Equipment is expected to start arriving and be complete over the next two weeks. Of critical importance is the turn in of ancillary equipment (NBC, NVGs, and radios) to the Special Repair Teams beginning in ten days. The Special Repair Teams are expected to keep the brigade?s equipment for the next 4 to 6 weeks to complete technical inspections and repair.

You attended the AMC ARFORGEN synchronization conference last week for the HBCT that included representatives from FORSCOM, Department of the Army G1, G3/5/7, G4, G8, AMC, and the division staff primaries; there, you learned from the PM HBCT representative that because the BDE turned in all of its combat platforms (tanks, Bradleys, M113s, Paladins, and TOC equipment) at Bagram during redeployment, you will not receive your new issue for at least another 90 days. Further, PM TOC told you that the brigade will receive all new TOC equipment (tracks, tentage, and C2 systems), but he did not think the equipment would be ready until for another 85 days. The CECOM representative also provided less than optimistic information regarding reset of the brigade?s satellite communication packages. Because the brigade chose to forego much-needed system upgrades prior to the last deployment, the majority of the components on the existing satellite trailers are out of date and no longer under warranty. Additionally, the Army is fielding new communication trailer systems over the next three quarters of the fiscal year with the brigades not scheduled for delivery until just before R+180. Lastly, the AMC representative informed you that the ancillary equipment (wheeled vehicles, trailers, water buffalos, MHE, etc.) the brigade turned into AMC prior to the deployment as left behind equipment (LBE) will be ready for reissue over a 7-week period beginning at R+80.

While the information provided at the conference seemed pretty grim, the Division Chief of Staff, who attended the final outbrief, pledged to both COL Axel and you that he would remain on top of the Division G4 and G8 to ensure that program managers and AMC upheld their end of the Reset agreement and returned equipment to the Brigade as soon as possible.

The manning section of the reset plan looked about as optimistic as the equipment reconstitution section. The brigade was just about to end the DA mandated 60-day stabilization window and begin shedding people as they PCS?d to new assignments or ETS?d out of the Army. Most significantly, the change of command ceremonies for five of the brigade?s six battalions is slated to occur in the next two weeks. LTC Hendrix, commander for one of the combined arms battalions, and COL Axel, will remain in command for at least the next 12 months. On a positive note, about half of the field grade officers in the battalions will remain in the brigade because they deployed late after completing ILE or their division staff time. Generally speaking, the battalion XOs all appear competent and have a good understanding of their battalion?s strengths and weaknesses and brigade-level systems. The brigade did receive some replacement personnel during the deployment, but can expect to fall to below 65 percent strength overall and less than 30 percent strength in key MOSs, especially senior noncommissioned officers until at least R+120. The DA Reset EXORD states HRC is not required to fill the brigade at 80 percent available strength overall and 75 percent senior grade until the end of our Reset window (R+180).

Major Blackmore is the Brigade S4. The S4 section performed poorly during the last deployment. While MAJ Blackmore appears to be a good officer that knows the technical aspects of supply and maintenance management he suffers from a lack of understanding of how to run his staff. His staff is seen as one that lacks commitment to the ideas and direction of the Brigade Commander. The Battalion Commanders also complain of a lack of support from the S4 section when it comes to critical supply efforts to support operations. The S4 section also has conflict with the Division G4 that has lead to an adversarial relationship. The soldiers in the section seem unmotivated and have a general lack of discipline across the group.

Major Springsteen, the brigade?s S6, appeared to be the least likely officer to complain about workload. However, last week after a particularly stressful staff meeting, he commented, ?Sir, I know you are busy, but I have to talk to someone. I?m not sure how much more of this I can take. Nothing we do on this staff seems to be good enough and staffing actions never seem to get the time they deserve. We?re not allowed to make routine decisions at our level, and it seems we jump from one crisis to another with no apparent vision. I thought when we returned from Afghanistan the pace would improve a bit, at least for a short while, and allow me to once again get acquainted with my family. It has been far from that! I even had my leave shortened to support the division command post exercise. A division CPX for crying out loud! We just returned from combat! We were told the division?s new staff needed to resolve some internal staffing procedures, so they scheduled an out-of-cycle training exercise. Given this division?s 24/7 mentality and helter-skelter attitude, I would almost rather be back in Afghanistan. At least there everyone knows they have to work 24/7, and no one really expects to know what will happen next. Plus, you don?t have the family wondering why Daddy isn?t home. Even my wife, who basically ran the brigade?s Family Readiness Group (FRG) when we were deployed and is a very dedicated Army wife, is about to throw in the towel.?

Last week, you witnessed an exchange at a BCT command team meeting. The commander and command sergeant major of one of the brigade?s combined arms battalions provided COL Axel and CSM Rose a detailed review of the effect of the installation?s ?red cycle? on their unit training plans, receipt of equipment and execution of the reset of personnel and equipment, reestablish garrison systems, and leader and incoming Soldier training to address shortfalls identified in Afghanistan. The battalion commander stated, ?We?re caught between a rock and a hard place because we tell Soldiers to reconnect with their families after being away for fifteen months, then pile so many competing requirements on the plate that they have to work until 1900 each night to meet suspenses. When you add on red-cycle taskings, the problem increases because you have fewer Soldiers to do the same amount of work. When I have to defer equipment turn-in for two weeks or keep Soldiers late telling them it?s more important to guard motor pools and ranges than recover our equipment from war, we all lose credibility. Soldiers know the difference between activity to keep them alive, and make-work.?

The battalion CSM added, ?This is worse than I?ve ever seen it. It seems we cannot catch a break on the ever-increasing extra duties and work details. When I mentioned this to the division CSM at his last senior NCO call, he dismissed me by saying, ?we have had red cycles throughout my 26 years in the Army. They?ll always be here, so live with it. Quit complaining! You guys have been nothing but whiners since you returned from Afghanistan!??

The response of COL Axel to both of his subordinate leaders was telling. He responded with, ?Commander, you have to figure it out! Nothing is coming off the plate. Do not expect me or my Sergeant Major to plead your case with the Division. This is life! Meet the mission!?

Your experiences with the officers in the brigade S3 shop were positive. All appeared professional, cooperative, and well-motivated by LTC Fogarty. However, recent comments to you by two battalion S3s indicated a dictatorial side to the brigade S3. They indicated Fogarty?s unwillingness to consider new ways of approaching the diverse training needs brought by the reconfiguration. Moreover, Fogarty indicated if they took their concerns to their battalion commanders (one of whom was fairly new) they would regret it. When this was mentioned to LTC(P) Lennon, he stated, ?Hell, that?s just Fogarty flexing his muscle. There?s no better brigade S3 in the division, and everyone knows it. Those battalion officers need to quit sniveling and get to work.?

As you have moved throughout the Brigade you have picked up on an undercurrent of discussion that centers on a potential incident of sexual harassment within the Briagde between an officer and a soldier. The conversation centers around one of the ?superstar? company commanders within the Brigade, CPT Cooper. As a Platoon Leader he was in charge of the PSD for COL Axel. After the deployment CPT Cooper was placed in command ahead of other senior captains that were waiting for command. While these are troubling discussions you assume they are formed from jealousy among the other officers in the Brigade. You recall your initial conversations with the DCO and begin to wonder about the depth of the apparent positive command climate within the 56th HBCT. When you mention what you have heard to LTC(P) Lennon he avoids the question and changes the topic of discussion to a number of late personnel actions from the S1.

In a private conversation last week, CSM Rose shared with you, ?I?m worried about my senior NCOs. They appear competent, but I don?t see any results from their work. There appears to be little teamwork among themselves and their officers. When I ask them why they don?t speak up and get involved, they ask, ?Why should I? Nothing ever comes of it.??

You have also found out the BCT is experiencing a growing trend in three negative areas: domestic abuse, DUI, and divorces. The increases are across all battalions as well as the HQ. The reports are a strong indicator of the increased stress across the BCT. While the BCT commander has put policies in place to ensure immediate reporting of both abuse and DUI cases there is no plan for prevention. The BCT seems to be in a react mode in these areas. Your discussions with the BCT Chaplain confirm the increase in divorces. He mentions to you the reason appears to be marital unfaithfulness during the last deployment and a continued OPTEMPO that is causing the spouse at home to feel alone and without hope. He also indicates he believes most of the issues with infidelity are internal to the Brigade with a few cases among the senior members of the Brigade staff that are still on-going. Col Axel?s response to the chaplain?s concern about these allegations was simply, ?Those are only rumors. Don?t bring me that stuff without proof!?

Finally, your informal conversations with friends within the division suggest the 56th gained a reputation in Afghanistan for being very ?heavy-handed? in dealing with locals While the characterization started during the initial relief-in-place/transition of authority (RIP/TOA), their behavior took a marked downturn after the death of the brigade command team and battalion commander. According to several sources outside the brigade, this approach appeared to inhibit the brigade?s ability to conduct host-nation responsibilities. One of your more trusted sources stated emphatically, ?Lennon?s negative attitude of the Afghanis created a cancer among some within the brigade, and it?s still there. COL Axel only made things worse with his hyperbole and force oriented approach to the security in the BCT AO. You need to be very careful.?

The past few weeks have been a blur for you. You understand the brigade has undergone numerous changes and know significant challenges lie ahead. Fortunately, the information you received from historical records, CALL and CAL assessments, and conversations and observations with leaders throughout the brigade and division provided some much-needed information. COL Axel knows there is not much time before the brigade will be back in the rotation for deployment and he appears nervous about preparing for a return to the same area. You are scheduled for a meeting with the brigade commander to provide your assessment of the brigade?s status and to chart a course for the next few months. Your major concern is where to start.

One Week Later

Situation:

You are the Deputy Brigade Commander, LTC (P) Osborne. At 10 PM yesterday the Division Secretary of the General Staff called and asked you to report to the Division Commander?s office immediately. Upon your arrival the Division Commander informed you that he has lost confidence in COL Axel?s ability to command effectively. He also informed you that you would immediately take command of the Brigade. He asks you for the following: your assessment of the Brigade including identification of the critical problem facing the Brigade; your vision for the Brigade and how you will measure success in achieving that vision; the process you will use to solve that problem and implement your vision.

Requirement:

See L100 Take Home Exam and Grading Rubric.

Research Brocade Communications System, Inc. as a publicly traded company and then download the annual report for the most recent year reported for use in this assignment.

1. Analyze the companys mission and vision statements against the performance of the organization. Then, evaluate how well the company lives out its mission and vision statement. Provide support from the organizations performance in your evaluation.
2. Assess how the organizations strategic goals link to the companys mission and vision.
3. Analyze the companys financial performance to determine the link between the companys strategic goals, strategy, and its financial performance. Detail your findings.
4. Conduct a competitive and marketing analysis of the organization to determine strengths and opportunities.
5. Apply the appropriate strategy (low cost, differentiation, or niche) that will maximize the organizations return to shareholders. Provide a detailed rationale for the reason you chose this strategy and state the expected outcome(s).
6. Create a detailed scenario in which a merger or acquisition would be a viable strategy to implement. Consider who the merger or acquisition would involve, the market conditions making it a good choice, and the type of strategy that would make it a success.
7. If you were a leader in this organization, determine the appropriate rewards that would best motivate employees toward achieving the desired strategy. Review the financial performance of the company to ensure the rewards are appropriate. Justify your selection.
8. Evaluate how the companys current strategy supports or discourages ethical business behaviors (or perhaps both). Discuss how you arrived at your assessment.

Lecturette Four
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In this weeks reading we learned of Augmentative and Alternative Communication Systems, Technologies That Enable Mobility, Technologies that Aid Manipulation and Control of the Environment and Sensory Aids.? These areas are generally addressed by Speech and Language Pathologists, Physical Therapists and Occupational Therapists.? Many school systems have these therapists available, others do not.? However, very few have therapists that specialize in these areas.? For example, most School Speech Pathologists expect to be working more with fluency and articulation.?
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When your school system employs therapists ? it may be very difficult to request an outside evaluation.? Administration may not understand that there are specialists in these fields.? It will be you job to get that point across.
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Assignment #4:
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For this assignment you will be requesting an outside evaluation.? You have a student that you feel requires a tool or technique that is not available with the staff in your school system. Describe the type of technique or tool that you feel will be required (IE. Mobility aid, Communication aid, etc.)??? List at least three features that you feel that the tool or technique should posses. Explain the needs of the child and why you feel that the evaluation is warranted.?
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Rubrics:
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???? Description of the child and his or her needs ? 4 Pts
???? Choice of required technique or tool ? 4 Pts
???? Persuasiveness of your request ? 5 Pts
???? Discussion entries ? 2 Pts

Textbook
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Cook, Albert & Hussey, Susan (2002) Assistive Technologies: Principles and Practice. 2nd ed. St. Louis, MO. Mosby. ISBN 0-323-00643-4

Please answer these four questions in 150+ words (word count is very important).


Key features of language are part of the communication system, although communication and language are two separate things humans use language as a way to communicate. Words are one of the features of communication weather spoken or signed, written, etc... this allows individuals to communicate, words is what makes communication different from the ways animals communicate. Words are very important in language because words are the main part of a conversation and without words language would not exist.
Another feature of language is grammar, is a set of rules of how words are formed and put together to make sentences.
Arbitrariness and discreteness are two other key features of language that are critical for language.

Arbitrariness- there is no intrinsic or logical connection between a sound signal and it meaning. Whatever name a human language attributes an object is purely arbitrary. The word car is nothing like an actual car. Spoken words are really nothing like the objects they represent. This is also demonstrated by the fact that different languages attribute very different names to the same object. Language is an arbitrary system of vocal symbols by means of which people which people of a certain community can cooperate and interact, which in this case knowing a language also means knowing what sounds are in that language and what sounds are not. Knowing sounds and sound patterns constitutes part of our linguistic knowledge.

Discreteness- is that language can be broken down into small discrete units which are reproducible and combinable. According to chapter nine page 215,( the system can be subdivided into recognizable parts, for example, sentences into words, into sounds; see Demers, 1988 or Hockett, 19600.

1) Which do you think is the most important key feature of language and why?

2) Do you think animals meet the definition of using language? There are gorillas who have been trained to use sign language. Do they meet the definition of using language?

3) What are the factors that make an adult more successful in learning a second language? Is it possible that children are not really better at learning a second language but just different in the way they learn?

4) Does the child brain process second language learning differently from the adult brain?

Customer is requesting that (ResearchPro) completes this order.

Using the to prepare bullets below and the article, please write a two page paper addressing the questions asked. Thank you


Current Information and Communication Technologies
With so much attention focused on health care reform, it is important that nurses be given the opportunity to use high-quality technology tools. These tools can increase access to vital medical information, promote effective communication among health care professionals, and improve the patient experience. By actively seeking out and adopting these tools, nurses can greatly enhance the quality and safety of care that they provide.
This Discussion focuses on identifying quality technology tools that increase the ability of nurses to provide safe, effective care.
To prepare:
Review the various technology tools described in this weeks Learning Resources.
Identify a recently adopted information, education, or communication technology tool in your specialty area. Reflect on how it is used and how its use impacts the quality of care.
Consider how your identified technology tool might impact nursing practice if it were more widely used. What are some barriers preventing increased usage? How could wider implementation be facilitated?
Post on or before Day 3 a description of a current or new information, education, or communication technology tool that is being used in your specialty area and assess its impact on the quality of care. Highlight the effect that increased use of this technology would have on nursing practice and discuss the barriers that are slowing or hindering its adoption. Summarize how adoption of the technology tool could be facilitated.


NURS 6051: Transforming Nursing and Healthcare through Information Technology?Current Technologies?Program Transcript
NARRATOR: One of the most exciting elements of nursing informatics is the potential for continuous, uninhibited growth and development. New technologies and tools are emerging every day that are changing the face of health care and vastly improving outcomes. This week's media segment features Katie Skelton, Doris Fischer, Carina Perez, Shannon Mori, Carmen Ferrell, and Lynn Tamanaha as they discuss current technologies and innovations that are improving the health care field.
KATIE SKELTON: I think one of the huge things that we really will be paying much more attention to is population health. And I think without technology we don't have a chance really in managing that better. Being able to remotely manage patients, be able to have patients be able to call in or have technology report in changes in condition, and be able to have nurses and physicians and therapists be able to take action. Not just on one or two or their assignment of five patients, but literally hundreds of patients out in the community. I think we'll revolutionize health care and how we deliver it out in the community.
DORIS FISCHER: Currently at St. Joseph's Hospital we have a nursing research team which goes and does, not only literature searches for evidence-based practices but also-- because we're a magnet hospital-- they take those suggestions from our bedside nurses when they notice something is-- have a question about something at the bedside. And they research those out into projects. That information that comes from those and the evidence behind it then gets placed at the bedside. But how do you disseminate that throughout the hospital? That's where the technology will come in.
The technology with an intranet. And on that intranet has a place for nursing specific information. What's new? What can you utilize at the bedside, and how can you utilize it? The nurses go to that particular intranet and use that to gather the information that is new and evidence-based within the hospital. What we've done with that is we've taken those nurses who have a specific interest in an area, let's say diabetes, and we've used those nurses as the content experts to be the ones to-- let's call it a webmaster on that particular site-- in order for that evidence-based information to be current and up to date. Because their interest
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will drive them to know what's the latest and most important standards within that particular area.
You also, in that technology, you're looking at things like communication beyond the documentation. What about phones? How do we access our physicians? Now you're looking at not only communication on a medical record, but then now how do you communicate that out to the different members of the team and have them speaking the same language, so that everyone is on the same page. And once you're on the same page, the care for that patient now becomes evidence- based and perfect. Communication between physicians, communications from patients, and those things.
So what I'm working with is I'm working with not only our IT department. I'm also working with our chief nursing officer. And I'm working with the complete board on both the ministry side, and the health system side, in order to figure out what can I leverage that is going to give my nurses the best information flow and the best technology for their use on this ministry. And that means when a patient picks up the call light, where's it going to go. Does it go to the Secretary who says, can I help you, or can I make it go directly to the nurse? Because then you have that one to one nurse-patient. Your evidence is there. Your response time is better. And you know what's going on. So now you have satisfaction on the patient side that they're speaking directly with the nurse. Same with the physicians.
The younger physicians want messages, want to know information, like I said, out of a text message. So can I get that phone, that I can have a directory in, that can text message my physician and still maintain HIPAA standards, where no patient care information is out there and accessible, other than to the people that need it.
CARINA PEREZ: This is an exciting time where information sharing is a luxury. So we really try to optimize our documentation system. So within our documentation system, what we used to calculate as values, like fall risk scores, Braden risk scores, everything auto populates for you with a value and a direction on what to do if you get that value. So that's something that was built in and very helpful. You can also set auto reminders that, based on this, a reminder that says you should really do an intervention. So these are some of the values in it.
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What's coming up in our system is eMAR-BMV. In eMAR-BMV, for example, when you give a pain medication, every single patient has to be reassessed within an x number of time. Now, nurses are very busy and sometimes you don't get to reassess, and that may be forgotten. At other facilities where eMAR-BMV was implemented, the reassessment automatically reminds you, so they get 100% compliance. We are anticipating those same statistics.
eMAR-BMV is Electronic Med Administration Record. BMV is Bedside Medication Verification. eMAR is basically an electronic version of your paper MAR. BMV is bar code scanning at the bedside. Bar code scanning adds another layer of safety to med administration. It allows you to recognize the patient, and recognize the drug, and that it has been ordered and profiled for your patient.
SHANNON MORI: The future is very exciting. I would say I would love to see nurses being able to talk to other nurses across the country on specific diseases or if they need help figuring out what to do for their patients they'll be able to. Once technology also advances, I believe the nurses will be able to spend more time with their patients and less time charting. There's also a big hope for patients themselves. For every one. Being able to have their health record in the palm of their hand. Being able to look at their smartphone and say, oh, these are my medications, this is when I need to follow up with my doctor. I mean we pay the bills on our smartphones, we should be able to make informed decisions on health care as easily.
CARMEN FERELL: In each patient room there's a computer that the patient's documents on and there's a scanner for them to check both the arm band and the medication before delivering meds, because there's a patient safety factor. There's great studies that talked about that if we used a scanner the likelihood of nurses making mistakes in delivering medications is a lot less. So we use that technology for patients.
In every single room we also have-- especially in critical care-- monitors that monitor the patients automatically. Heart rate, blood pressure, respirations, that sort of thing. That information gets translated right into the computers for nurses and physicians to be able to see that automatically.
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In critical care you have the EKG or the electronic heart rate going on. So that gets automatically transmitted as well. If the patient happens to be on a breathing machine, that information also gets translated electronically. And in the critical care setting, which is really my love, there's all kinds of other machines that automatically get transmitted electronically. Like your IV fluid, it's automatically calculated and sent over to the medical record.
So there's a lot of technology that's helping us in a way capture the care that we're delivering. And then it's up to the nurse and the physician to take a look at that and figure out is the treatment correct. Do we need to alter any kind of treatment? And we're not quite there yet, but when we get there in a few months, the physician will be able to access all that patient information from their home, vacation, wherever they're at, and be able to make a good diagnosis without ever coming to see the patient. Because the nurse is pulling all that information into the medical record for them. Because that's what the nurse does.
There's voice recognition dictation today for physicians. But I think that's moving into also the nursing realm, and any other kind of a profession that would like that realm. So if you have someone that's maybe older and not so adept at typing in a computer, they can actually dictate everything that they've seen and done for the patient. While walking, on the phone, whatever. So that's an exciting thing for nurses when they look at the amount of work that they have to do. Also there is the ability for the patient to pull up their medical record at home, or anywhere, and see what care that they got delivered. So that's coming up on the horizon.
NARRATOR: In the following segment Lynn Tamanaha explains the details of a new Electronic Bed Board and how it has increased the efficiency of bed management at St. Joseph's Hospital.
LYNN TAMANAHA: Patients who want to come into our hospital-- Anyone who wants to stay overnight at the hospital, has to go through here. Basically, nowadays we use an Electronic Bed Board that we monitor all patient movement. What beds are available, patients transferring. As you can see on the bed board, pink is for girl. Blue is for boy. Yellow means that the bed is dirty and needs to be cleaned. White indicates the bed is clean and ready to be occupied.
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In the old days, we used to do pink and blue cards, and we have a whole set up with each individual room. And in each room we put in a pink card and a blue card. When we go through the bed huddles we go through each unit. And we go through and see which beds are open, and which ones are occupied, which ones are blocked. We talk about surgical patients that still need to be placed. Patients who are direct admits from physicians offices that are going into the bed that we may not know about yet. We talk about discharges, patients that are going to be going home soon or later on today, and which beds will be opening up.
So when we go through the Bed Board we talk about each unit. What's going on, how many patients they can take in. As you can tell we have a very, very busy ED, so we have to anticipate. What's going to be going on tonight, so we can smooth out the patient flow from our ED and also from our PACU. We also get a number of phone calls from other facilities that patients want to come here. So we have to also know what beds are open. So we can either accept those patients, say yes, we have open beds for them or, I'm sorry we don't have anything available right now.
In the old days, ER would have to call and say, hey, is there a bed open. We'd have to call the floor and say, what rooms do you have open. They say, yes we have a room but the bed is dirty. So we have to call back ED. Say, yes we have a bed, but it's not clean yet. Then they would call us back. Is the room clean yet? Then we would call the floor. Yes it's clean. Then call ED back again.
With the Bed Board, it's all automatic. It's great. When a patient is discharged it sends out an automatic page to our housekeeping staff. They go and they clean the bed. They call into a special number that turns the bed clean. We see that immediately on the Bed Board, so we know the bed is ready. It's cut down on all the phone calls. It's amazing how less phone calls it takes now to get a patient admitted. So patients are admitted quicker. They can receive their care faster on the floor if they don't have to wait as long for clean bed. It's just so much smoother nowadays with the Electronic Bed Board.
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OF WIRELESS TECHNOLOGY TO IMPROVE NURSE COMMUNICATION, RESPONSE TIME TO BED ALARMS, AND PATIENT SAFETY
M T
ExaminationofWireiosTocinoioyToimpove
mursoComunication, RosponseTimetoBed
Aiarms, andPatient Safety
Linda Guarascio-Howard, MA, MS, PhD
Abstract
Objective: A medical-surgical unit in a southwestern United States hospital examined the results of adding wireless com- munication technology to assist nurses in identifying patient bed status changes and enhancing team communication. Fol- lowing the addition of wireless communication, response time to patient calls and the number of nurse-initiated communica- tions were compared to pre-wireless calls and response time sampling period.
Background: In the baseline study, nurse-initiated communi- cations and response time to patient calls were investigated for a team nursing model (Guarascio-Howard & Malloch, 2007). At this time, technology consisted of a nurse call system and telephones located at each decentralized nurse station
and health unit coordinator (HUC) station. For this follow-up study, a wireless device was given to nurses and their team
Author Affiliation: Dr. Howard is President of E&S Research Consultants, LC, in Chandler, AZ.?Corresponding Auttior: Dr. Linda Guarascio-Howard, E&S Consultants, LC, 2121 E. Desert Inn Drive, Chandler, AZ 85249 ([email protected]) Acknowledgments: The author would like to thank Dennis Gallant, Vice President at Hill-Rom, and Steve Henderson, Area Vice President for Support and Technical Contributions, Hill-Rom. The author also thanks contributors Kathy Malloch, RN, PhD, MBA, FAAN, Kathy Malloch and As- sociates; Judy Crook, DM, MSN, RN; and Susie Faz-McCann, RN.
members following training on device use and privacy issues. Method: Four registered nurses (RNs) were shadowed for 8 ; hours (32 hours total) before and after the introduction of the ; wireless devices. Data were collected regarding patient room visits, number of patient calls, bed status calls, response time
. to calls, and the initiator of the communication episodes.?: Results: Follow-up study response time to calls significantly decreased (f-test p = .03). RNs and licensed practical nurses responded to bed status calls in less than 1 minute??"62% of
the 37 calls. Communication results indicated a significant
shift (One Proportion Z Test) in RN-initiated communications, ; suggesting an enhanced ability to communicate with team?; members and to assist in monitoring patient status. Patient
falls trended downward, although not significantly (p > .05), for a 6-month period of wireless technology use comparedto the same period the previous year.
: Conclusions: The addition of a wireless device has advan-?: tages in team nursing, namely increasing communication with
staff members and decreasing response time to patient and
bed status calls. Limitations of the study included a change in?i caregiver team members and issues regarding wireless device " and locator badge compliance. Administrative issues that arose
during this field study Included bed and cable maintenance,?' device battery charging, and the training of new and floating I team members.?; Keywords: Patient safety measures, interdisciplinary teaiDS,
design, response time, patient falls
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I HERD V0LUME4. NUMBER 2. PP 109-120 COPYRIGHT 02011 VENDOME GROUP. LLC
Introduction
Effective communication within caregiver teams is an important element for bed status response and patient safety programs, including patient fall prevention programs. The Joint Commis- sion (2007) identified effective communication among caregivers as a 2008 Patient Safety Goal. Communication issues were listed as the major root cause of patient falls in the Joint Commission Sentinel Event Alert (2000). The ability to com- municate directly with co-workers and to locate team members is important for quick caregiver response to patient conditions, bed status alarms,
and fall prevention. In this follow-up study, re- sponse time to patient calls and bed status alarms was examined following the implementation of bed status alarms linked to wireless technology worn by caregiver teams. Communication pat- terns were collected and compared to a baseline study (Guarascio-Howard & Malloch, 2007) to identify the changes in response time and com- munication fiow patterns of caregiver teams.
Much of the healthcare patient safety literature has focused on fall prevention programs, mod- els (Hignett 8c Masud, 2006; Weatherall, 2004), and patient assessment methods (McFarlane- Kolb, 2004; Morse, Morse, &c Tylko, 1989; Sal- gado, Lord, Ehrlich, Janji, & Rahmand, 2004). The programs consist of a variety of components, including patient assessment, environmental haz- ard analysis, and the use of interventions such as bracelets, bed rails, and bed alarms (Agostini & Baker, 2001). Hospital designs such as decentral- ized nurse stations have been investigated and
linked to positive patient safety outcomes; they
Effective communication within caregiver teams is an important
element for bed status response and patient safety
programs, including patient fall prevention programs.
are considered desirable because they enable pa- tient visibility, access, and information (Brom- berg, 2006; Guarascio-Howard & Malloch, 2007; Page, 2004; Reiling, 2005).
Few studies on wireless technology and bed alarms were found. Wireless technology research by Breslin, Greskovich, and Turisco (2004) and Kuruzovich, Angst, Faraj, and Agarwal (2008) identified cost savings associated with reduced communication times, user preference surveys, and communication fiow efficiencies. Methods to collect patient call data included sampling calls by monitoring rooms, not the caregiver. In a clas- sic study published by the Agency for Healthcare Research and Quality, Tideiksaar, Feiner, and Haby (1998) examined bed alarms and their ef- fect on patient falls. However, wireless technology
was absent, and the focus was the relationship be- tween bed alarms and patient falls. The literature search did not produce research exploring team nursing models nor team communication related to fall prevention and wireless technology.
This follow-up research examines the effect of in- tegrating wireless devices with nurse call systems
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EXAMINATION OF WIRELESS TECHNOLOGY TO IMPROVE NURSE COMMUNICATION, RESPONSE TIME TO BED ALARMS, AND PATIENT SAFETY 1
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and bed alarms to answer the following questions: ( 1 ) How do wireless communication devices affect communication within the team nursing model? and (2) How does wireless technology affect re- sponse time to patient and bed status calls?
Background
Why are bed alarms an important intervention for patient falls, and how can their effectiveness be improved? The field of occupational safety an- alyzes interventions and controls using a system- atic method based on level of protection, feasibil- ity, and effectiveness. In preventing falls or any injury, the National Institute for Occupational Safety and Health (NIOSH, 2008) identifies a hierarchy of controls to prevent injury and illness resulting from hazards such as falls.
Control methods such as substitution at the top of the list in Table 1 are potentially more effective and protective than those at the bottom, such as personal protective equipment, because controls requiring little or no human involvement afford less chance of human error. If a patient is involved in a protective intervention, then a multitude of behavior and physical awareness factors will af- fect the successful outcome of the intervention. Although the most effective at reducing hazards, elimination and substitution are not always fea- sible, or they are extremely expensive to imple-
ment. For example, eliminating falls by manually transferring patients from bed to bathroom would require patient lifts to be installed in rooms at the time of construction or involve considerable expense to retrofit. However, other patient trans- fer scenarios, such as patient room bed transfers
to transport gurneys, can be eliminated by using the patient room bed for transfer to Radiology or other hospital departments.
Engineering controls, the next most effective fall protection category, are interventions such as bed rails and bed height adjustments. Just as a punch press guard may be propped open by an operator, bed rails and height adjustments can be defeated by patient action either intentionally or inadver- tently. When bed alarms are supported by inte- gration with the nurse call system, protection is increased. However, bed alarms that are audible only near the patient room and the health unit co- ordinator (HUC) station risk going unnoticed. If the HUC is unavailable and the caregiver is in an- other patient room, the alarm could ring without
response. The addition of a wireless system allows the caregiver to be notified immediately of a bed status alarm. Redundancy of alarm methods and bed status notification is desirable for increasing the effectiveness of bed status alarms.
Administrative controls include work practices such as fall assessments, fall risk signs, and arm bands. Such work practices are important for identifying fall-risk patients and the need for close monitoring; however, engineering controls such as bed rails and alarms represent a physical barrier that does not require the involvement of a caregiver. When a patient's mental or physical conditions override engineering controls such as bed rails, both alarm and communication systems are needed to alert caregivers. The initial cost of
engineering controls is usually higher than that of administrative controls. However, savings may be
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RESEARCH?HERD VOLUME 4. NUMBER 2. PP 109.120 COPYRIGHT 82011 VENDOME GROUP, LLC
realized in the cost of care for falls that occur during a patient stay that are not compensated by the Centers for Medicaid and Medicare Services (CMS, 2008).
Communication
In a team nursing model,?communication is impor-?tant for the coordination of?healthcare and the efficiency?of response to patient con-?ditions. In an analysis of?144 fatal events, the Joint?Commission (2007) lists lack of communication as the second leading cause of falls, just behind in- adequate training and orientation for caregivers.
To help describe communication in a team envi- ronment, the communication leader or initiator was observed and recorded, and team communica- tions were analyzed. The communication initiator's analysis described communication structure, flow, and tam leadership (Moss & Xiao, 2004). Xiao, Seagul, Mackenzie, Ziegert, and Klein (2003) de- scribed an example of team leadership in an anal- ysis of operating room teams and leaders, which indicated that as team experience increased, there was more shared leadership. However, on a medi-
cal-surgical unit, a team can be distributed in vari- ous areas of the floor including the patient room, an alcove, the HUC station, or a service area.
Efficient workflow may also be inhibited by the team leader having to walk around to identify
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Table 1. Hierarchy of Controls and Interventions
Controls/Interventions Hazard
ProtectionExample
Move patients in room bed.
Utilize bed rails and low bed height adjustments.?8ed rails??"low bed with bed exit alarms, nurse call system, and wireless.
Fall assessments, patient bracelets. armbands, signs, and open doors.
Walkers and hip protectors.
Patient Involvement
No patient involvement.
Patients can adjust bed rails and fall.
Alarms??"call system alone will first need HUC involvement. Wireless- direct alert to caregiver Depend on completion of assessment.
Falls go unnoticed.
Patient involvement and training needed.
Elimination/substitution
Engineering controls
A physical barrier and supportive devices between the patient and the hazard.
Patient transfers- bed to gurney. Patients falling from the bed.
Policy to identify fall- risk patients.
Devices require patient compliance.
Administrative controls
Work practices and policies
Personal protective equipment?Devices to lessen fall risk.
rooms with call lights on or to travel to the mas- ter station to find team members. Several studies have determined that walking the hallways can take up a significant amount of a nurse's time??"as much as 28.9% (Burgio, Engel, Hawkins, Mc- Corick, & Scheve,.199O; Hendrich & Lee, 2004; Ulrich, Quan, Zimring, Joseph, &c Choudhary, 2004). The objective of technology is to help re- duce walking time and increase the efficiency of healthcare services.
Methodology
A medical-surgical care unit in a southwestern U.S. hospital examined the results of adding wireless communication technology and linking it to pre-existing systems to help caregiver teams respond to patient calls and to identify bed sta- tus changes and bed exits. The medical-surgical care unit consisted of 24 rooms arranged in two long, parallel hallways with the HUC located in the center. Caregiver teams were located at the

EXAMINATION OF WIRELESS TECHNOLOGY TO IMPROVE NURSE COMMUNICATION, RESPONSE TIME TO BED ALARMS, AND PATIENT SAFETY 1m m
alcove stations, which were situated between two patient rooms and equipped with telephones and two desktop computers. The baseline study (Guarascio-Howard &c Malloch, 2007) staffing called for three teams of three registered nurses (RNs), three licensed practical nurses (LPNs) and three certified nursing assistants (CNAs). In the follow-up study, staffing was periodically altered and two CNAs shared the 24 patients, three RNs, and LPNs. Communication patterns and the re- sponse to calls in the follow-up study were com- pared to the baseline data.
Baseline Study Technology
Technology in the baseline study consisted of a nurse-locating system that required caregivers to wear badges that were tracked and monitored at the HUC master station. The call lights located outside each room flashed and were visible to care- givers in the hall and monitored at the HUC mas- ter station. Communication audio stations were located near the patient bed, on the patient room wall, in the medication room, in the lounge, and in hallways. Bed status calls consisted of bed exit, bed speaker disconnect, and staff disconnect. Status alarms rang at the HUC master station and in the patient room. The HUC could talk to the patient
through a pillow speaker and notified the caregiv- er, if necessary. The physical arrival of a caregiver at the patient room depended on HUC response time and/or the ability to see the call light.
Follow-Up Study Wireless Technology
The wireless communication device was equipped with display and audio, and it received team communications and alarms regarding bed exit
and bed status changes. The wireless device also allowed team members to communicate with hospital department heads. The nurse-locator system was linked to the wireless communica- tion device, enabling the alarms to reach care- givers assigned to rooms. The unit coordinator was also provided with a wireless device and was able to view all bed status and exit alarms from a master station. The combination of the wire- less device and master station facilitated quick response to patient calls.
The added wireless communication technology provided enhancements to fall protection bed alarms for caregiver teams. Additional alarms and bed status changes could be sent to caregiver wireless devices. Some of the additional bed status alerts available to team wireless devices included bed height, bed brake, head rail, foot rail, system turned off, or bed exit alarm turned off.
The wireless device was added to the floor and caregiver teams for purposes of this follow-up re- search. At the time the research was performed, department heads and administrative units were using the wireless device in the hospital, but it had not been distributed to caregivers. The wire- less device enabled communication with team members via simple commands, such as speaking a team member's name into the device. Bed status changes appeared as text messages with audible
notification.
The following steps were required to update com- munication systems, prepare caregivers, and sup- port experimental conditions:
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1. The nurse locator system had to be linked to the wireless communicator to enable caregiv- ers to receive alarm notifications.
2. A bed alarm protocol and a bed protection template were developed with input from management.
3. Training regarding Health Insurance Portabil- ity and Accountability Act considerations, bed status setup, and providing device information instructions to call team members had to be conducted for day shift caregivers and HUCs.
4. Continued support systems were set up to re- spond to bed communication system failures, wireless device maintenance, and breakdowns.
5. Management enforcement was needed for badges and wireless devices and for additional training for current or new personnel.
The protocols for bed alarm conditions and bed status notification were developed with input from nurse managers and systems manufacturer representatives. Every morning the HUC entered default templates into the system. The default bed protection consisted of bed brake on, bed in the low position, and head rail up. The second level of protection was the activation of the bed exit alarm, determined by an RN and the assess- ment scoring system. The third level of protec- tion required four rails up, activation of the bed exit alarm, and a physician's order. Deviations from the template or changes in bed status initi- ated a notification to the wireless device, alerting
assigned caregivers and the HUC.
The bed alarm and status notification was priori- tized as First Assignment??"RN, Second Assign-
ment??"LPN, Third Assignment??"CNA, and Fourth Assignment??"HUC. The bed alarm and status notification was a low-decibel sound and a unique tone. If the RN chose not to answer the wireless device, the alarm would automatically notify the LPN, the CNA, and then the HUC. The H U C could then observe the locations of caregivers on the Master Station and follow up with the closest caregiver. The RN would be aware of the alarm notifications and have the ability to follow up on them later.
Patient-initiated calls, including normal calls (requests for pain medication, food, etc.), bath- ing, and toilet requests, were routed through the HUC station, which was the same call routing as the baseline study. The HUC also had a wireless device and could use it to notify caregivers to as- ign bed calls, indicate patient-initiated calls, and other needed information.
Five weeks following the training and use by team members, data were collected for four RNs adher- ing to the baseline study experimental procedure (Guarascio-Howard & Malloch, 2007). Four RNs were shadowed from 7:00 a.m. to 3:00 p.m. in the medical-surgical care unit areas excluding patient rooms per institutional review board ap- proval requirements. Data collected were coded to protect patient-sensitive data and to preclude nurse identification. The nurse call system gener-
ated response times to patient calls and change-in- bed-status alerts. The wireless device system ran reports on the number of calls, the call initiator, whether a call was received successfiilly, and the to- tal time of the call. The wireless devices were used
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Table 2. Technology Utilization
Technology
Baseline Follow-up
Face to Face 77.05% 74.76%
Phone Page 20.00% 1.97% 11.39% 1.52%
Audio Stations
0.98% 0.76%
Wireless N/A 11.57%
EXAMINATION OF WIRELESS TECHNOLOGY TO IMPROVE NURSE COMMUNICATION. RESPONSE TIME TO BED ALARMS. AND PATIENT SAFETY 1mCO mS
for a 6-month period following the training and a 5-week adjustment period. Fall data were collected for the 6-month period of the follow-up study and compared to the previous year's 6-month period.
Results
Communication data and safety indicators were compared before and after the introduction of the wireless technology. Results were analyzed from five data sources: shadow log data, the nurse locator report system, the wireless report system, fall records, and audio recordings.
Patient Falls
Patient fall rates trended downward for the 6-month follow-up study period compared to the baseline 6-month period. However, the results were not significant {p > .05). The average 6-month baseline fall rate was 2.7, and the follow-up fell rate was 2.0. Fall rates are dependent on multiple issues and root causes (Joint Commission, 2000). Caregiver communications and bed alarms help control fall rates, but process measurements such as response time and communication events are important indicators of patient safety effectiveness and fall prevention engineering controls.
Technology Use
Data generated from the shadow logs revealed differences in technology use in the follow-up
study (see Table 2). Wireless communicator use was 11%, and phone use decreased from a 20% use in the baseline study to 11.39% use??"almost a 50% decrease. This suggests that communica- tions normally handled by telephone were now being communicated by wireless. The advantage of the wireless communicator over the tele- phone was that team members could contact each other in any area of the medical-surgical care unit, whereas phone use was limited to the alcoves, and nurse-locating systems were at the HUC station, on wall units, and in patient rooms, lounges, conference rooms, and medica- tion rooms. The HUC is also required to find the caregiver and then phone or use the nurse locating system. The wireless device also had a capability for leaving voice messages if team
members were not available.
Table 3 displays data regarding the wireless com- munication use of team members and hospital personnel during the 8-hour shift: sampled. Two reports were generated by the wireless device soft- ware. One report listed all incoming calls and the second report listed outgoing calls. The reports identified the caller, receiver, and total time of the call. RNs made 31 calls, which was 65% of all completed calls. Forty-two percent of the RN calls were made to the CNA. Incoming calls from the HUC to the RN enabled additional monitor-
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Table 3. Wireless Device Use by Caregiver?Team Members RN Outgoing Calls
Incoming Calls to RN
Follow-Up Study
HUC 3 LPN 7 CNA 13 Other RN 4 Other Departments 4
Total Completed Calls 31 Average Time per Call N/A Incomplete Calls 14
ing of bed status alarms and calls from patients. RNs were able to network with other staff RNs and to plan breaks and lunches. Patient informa- tion and questions were immediately communi- cated among team members. The average com- pleted call time was between .5 and .56 minute
or 30 to 34 seconds per call.
Incomplete calls were logged by the wireless sys- tem; however, data indicating the amount of time to initiate incomplete calls were not collected. The training did not include information for contact- ing outside departments, but several RNs quickly realized that speaking the department name into the device provided direct contact. However, in- complete calls did result from the following: the call was not answered by a team member; the team member did not log into the system, an incorrect name was used, or the team member rejected the call. Team members did not answer
calls when engaged with patients, and they could reject calls during a lunch break. A log-in process was required before beginning a shift: and had to be completed before calls could be received. An estimate of incomplete call time was a few sec-
onds, or the time it takes to speak a person's name and for the system to respond.
Response to Calls
Healthcare safety outcomes should include care- giver response to bed status calls and patient calls. Patient and bed status call activity was analyzed for the baseline and follow-up teams for the days sampled. Normal calls included responses to pa- tient requests for medication, food, and so on. Bed status calls included calls related to bed exit alarms, bed rails, bed brakes, and bed height sta- tus. The "all calls" category is the sum of normal calls, bed status alarms, bath, and all other types of call. Table 4 shows a significant decrease in the follow-up team response time to all calls, (i-test,
p = .03) as well as a 145% increase in the num- ber of calls. The increase in bed status calls was expected because of the bed protocols established in the follow-up study environment. Addition- ally, the routing of bed status calls directly to the team helped reduce bed status response time. The number of bed status calls for follow-up data col- lection increased from 3 to 37 calls for 4 days of shadowing, and normal calls increased from 69 to
116 WWW.HERDJ0URNAL.COM ISSN: 1937-5867
Number Time (mins.) Number
Time (mins.) 1.35 6 2.40
3.73 7?6.47 0?2.10 4 1.67 2.11
15.76 .51 N/A
17 8.57 N/A .50 5 N/A
00
4.50 0

EXAMINATION OF WIRELESS TECHNOLOGY TO IMPROVE NURSE COMMUNICATION. RESPONSE TIME TO BED ALARMS. AND PATIENT SAFETY 1m S
Table 4. Nurse Locator Calls and Response Time Baseline
Follow-Up Total Number
179
84 37
Call Type
All Calls?Normal Calls Bed Status Calls
Total Number
73 69 3
Average Response (mins.)
Average Response (mins.)
2.73
4.14
1.32
84. The additional calls suggest additional moni- toring ofpatient rooms.
Table 5 identifies bed status call response time by team member. Follow-up study bed status calls were routed through the protocol: first to the RN and then to the LPN, CNA, and HUC, respec- tively. The RN responded to 38% of the calls in fewer than 30 seconds. The LPN responded to 24% of the calls in less than 1 minute, and the CNA responded to 14% in less than 1.5 minutes. The remainder of the bed status calls had HUC involvement, which included additional time and the need to locate the RN or identify possible bed or alarm issues. Pre-wireless team responses
Table 5. Bed Status Call Response
to bed alarms were greater than 1.5 minutes. Al- though not significant {t-testp >.O5), the number of RN visits to patient rooms also increased by 38%, from 199 to 274 visits, following the intro- duction of wireless technology.
Caregiver Communication Analysis
The number of communication episodes was ana- lyzed by means of a review of the audio recordings collected while shadowing. The total number and duration of communications increased by 77% in total minutes and 78% in total number (see Table 6). An increase in communication episodes among caregivers adds to the efficiency of pa- tiet care by providing additional opportunities
Caregiver Response rime?(HUC or Nearby Caregiver)
0-30 seconds >30 >1 <1.5 minutes
>1.5 <2 minutes
>2 minutes
Total
Average response
Baseline Te<3m Caregiver Response Follow-Up Tearr1
4.05 4.19 2.25
Number Percentage Time Number of Total
Percentage of Total
0 0 0 0
00
2 67
1 33?3 100% 2.25 N/A
38 LPN>30<1 9 24
Protocol?RN 0-30 seconds 14
minute?CNA >1<1.5 5 14 minutes?HUC >1.5<2 2 5 minutes?> 2 minutes 7 19 Total 37 100% Average response 1.32 N/A
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Table 6. Communication Episode Comparison
Communication Episodes
Baseline Pre-Wireless
Follow-up Post-Wireless Increase
Time (Minutes)
245.35
435.03 77%
292 520
78%
124 169 275 245
122% 45%
to clarify expectations and patient orders (Joint Commission, 2000; Xiao et al., 2003).
Team leadership and communication patterns within the caregiver teams were explored by identifying the initiator of the communication episode (see Table 6). The frequency of RN- initiated communication increased significantly over the baseline study and pre-wireless condi- tions (One Proportion Z Test, which compares the proportion or percentage of nurse calls in the two studies). Additional communication episodes suggest enhanced leadership opportu- nities in areas such as care planning, mentoring, and monitoring team activities. Furthermore, the monitoring of patient bed status increased the need for more communication. Several RNs also commented on the ease of locating team members, which lessened the need for addition-
al walking and searching.
Discussion
Results indicate that caregiver team efficiency increased because of decreased response time to patient calls and bed status alarms. The increase in room visits and communication events among team members and hospital stafl^ facilitated in-
creased efficiency and the monitoring of staff and patient activities. Although the reduction in pa- tient falls for a 6-month period was not signifi- cant, process measures such as response to calls was significant. Response to bed status is impor- tant in preventing falls and also for minimizing injury when a fall occurs. The options of head rail, foot rail, and low-bed status in addition to bed alarms are a means to monitor patient status more comprehensively and customize protection measures for individual patients. Tideiksaar et al. (1998) described other advantages to bed status changes such as quick identification of patient
acute illness conditions, which may include fre- quent trips to the bathroom.
However, the implementation of wireless com- munication and additional bed status alarms creates the need for management systems to sup- port these technologies. Bunch (2005) identifies training and management support as extremely important for implementation. Caregiver turn- over necessitates ongoing training. Wireless de- vices and nurse call badges demand compliance and monitoring by management. Beds require the regular testing and maintenance of cables and alarm connections. Additional HUC responsi-
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Number of Episodes
RN-lnitiated
Team-Initiated

EXAMINATION OF WIRELESS TECHNOLOGY TO IMPROVE NURSE COMMUNICATION, RESPONSE TIME TO BED ALARMS, AND PATIENT SAFETY 1m
The implementation of wireless communication and additional bed status alarms creates the need for management systems to support these technologies.
bilities must be kept in mind when considering staffing and bed protocol input.
Limitations of the follow-up study include a change in caregiver teams from the baseline study to one CNA for two RNs and 12 patients instead of eight patients and one RN. This ap- plied to all days sampled, which may have in- creased the need for additional team coordina- tion communication by the RN. Also, there were systemic operational problems, such as software breakdowns, team locator badge com- pliance, wireless device compliance, and Boat- ing staff training. The follow-up study strongly suggests that the wireless device improved nurse efficiency by enabling team members to receive and respond efficiently to bed status alerts. Al-
though most RNs exhibited high enthusiasm for the technology, suggestions were made to extend alarms to patient chairs and to include the physicians who support the unit. One of the RNs sampled had difficulty using the wire- less device; however, a hospital technician pro- vided additional support. Follow-up training is needed for continued caregiver team use after the technology is introduced.
Conclusion
This study suggests that wireless technology offers advantages for communicating the status of pa- tients and fall risk factors. Patient falls occurring during hospital stays result in additional costs to the hospital as well as pain and suffering for the patient. Wireless devices offer additional patient monitoring capabilities, thereby increasing the effectiveness of bed alarms related to bed status changes and the notification of all caregiver team members. This communication results in a faster
response to patient conditions.
The wireless device offered the RN additional op- portunities to communicate with team members. As team leader, the RN is able to communicate with members anywhere on the floor. Conversely, physicians and caregiver teams have easy and im- mediate communication access to the RN. Pa- tient care and caregiver team management were enhanced by this communication device.
Future research should consider collecting data on fall assessment, which is needed to establish proper bed protocols. Protocol management cre- ated additional work for the HUC, who had to obtain information from the RN and enter it into the system. To effectively implement this system, it would be helpful to evaluate all caregiver and management role changes.
A comparison of patient satisfaction scores before and after wireless device implementation indi- cates an additional area for future research. The RN perspective would be a great asset not only regarding patient satisfaction, but for designing
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I HERD VOLUME 4. NUMBER 2. PP 109-120 COPYRIGHT (82011 VENDOME GROUP, LLC
future fall protection systems, including bed sta- tus alarms and wireless devices.
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This paper focuses on wireless networking technologies, protocols, standards and operations. Additionally, capabilities of WPANs (Wireless Personal Area Networks), WLANs (Wireless Local Area Networks) and WWANs (Wireless Wide Area Networks) should be explored. This paper should describe wireless networking capabilities, recent initiatives, and advantages and limitations of wireless networks in accommodating goals, objectives, and requirements in government and/or academic environments.
Additionally, there is a security component that must relate to wireless networking technologies component as stated above. URLs, citations, in-text references, and the reference list must be formatted in APA. Direct quotations should be at a minimum (two at most).

The paper should include:
1.Title (Addressing wireless networking technology and security: A moving target)
2.Rationale for selecting the network technology
3.Capabilities, advantages, and limitations of the technology
4.Outcomes of the investigation that contribute to problem resolution and/or enhancement in a particular environment
5.Security challenges, risks and approaches.
6.A reference list containing at least 14 sources

Included in the specifications are PDFs of journal articles and conference proceedings relating to the paper. I am requesting additional material on wireless networking technology and security in addition to the materials that are submitted. I am requesting that this paper be single spaced 12pt Times New Roman font with one inch margins (11 pages at 600 words per page )

Here is a listing of some of the sources that can be used for the paper.

Amaldi, E., Capone, A., & Malucelli, F. (2008). Radio planning and coverage optimization of 3G cellular networks. Wireless Networks 14 (4), 435-447.

Alexiou, A., Antonellis, D., & Bouras, C. (2006). Evaluating different one to many packet delivery schemes for UMTS. Proceedings of the 2006 international symposium a world of wireless, mobile and multimedia networks. Washington DC, USA, 8, 7-72

Chang, C., Huang, C., & Ho., C. (2008). Capacity based compressed mode control algorithm for inter-system measurements in UMTS system. Wireless Networks 14 (3), 403-413.

Mundt, T. (2004). How much is a byte?: A survey of cost for mobile data transmission. Proceedings of the winter international symposium on information and communication systems. Cancun, Mexico, 4, 1-6

Nadal, V. (2006). Broadband Wireless Access. Nortel Technical Journal 4 (2), 5-12

Skehill, R., McGrath, S., & Antonio de Ramos, C. (2008). Automated troubleshooting of a UMTS-WLAN test platform. Proceedings of the 4th international conference on testbeds and research infrastructures for the development of networks and communities. Innsbuck, Austria, 1, 2, of 10

Yang, S. (2007). Dynamic power saving mechanism for 3G UMTS system. Wireless Networks 12 (1), 5-14.

Canton, J. (2008). Top ten trends: The top ten trends in the future of security what is coming?. Retrieved on 6/6/09 from http://www.globalfuturist.com/about-igf/top-ten-trends/trends-in-security.html
Lacey, D. (2008). The future of network security. Network World. Retrieved on 6/6/09 from http://www.networkworld.com/columnists/2008/013008-jericho-network-security.html
Polstra, R. M. (2005). A case study on how to manage the theft of information. Proceedings of the 2nd annual conference on Information security curriculum development, Kennesaw, Georgia, 05, 135-138.
Zlateva, T. & et al.(2005). Information security in the next decade. Retrieved on 6/6/09 from http://boston.naisg.org/Archive/2005/12NextDecade/Default_files/frame.htm#slide0067.htm





There are faxes for this order.

This assignment is under health financial management.It is more of a proposal for funding for a new service and it has to be persuasive, concise and to the point.

What is required is as follows:

- Choose a health service that can be implemented. ( I would like you to use electronic picture archiving and communication systems "PACS" as the new implemented service but if you feel you can write better with another service that would be OK)
- the service should be large enough to employ approximately 10 people, but not so large that there are so many cost and revenue streams that it would be unrealistic to analyse in a single assignment (a whole hospital)!
- you will receive a word file named preparing a business case which will take you through the items you need to consider to get this done properly.
- in preparing the budget, you should show the build up of the budget from a zero base including all significant items. You should consider both an optimal budget for the service and a budget to show how the service may function if the budget were reduced by 10%.
- please note that budgets include activity as well as financial projections.

PLEASE NOTE:

- I found out from previous experiences that some of the writers don't seem to read or fully understand my instructions of how I like the paper to be like.therefore I expect the writer to ask if they don't understand any part rather than write something they are not certain about.

- PLEASE USE ONLY JOURNALS AND PROVIDE ME WITH THE LINKS TO THE JOURNALS YOU HAVE USED.

- Please follow the correct APA referencing style. I have noticed that some writers use old references and change the dates or do not cite them correctly, or use information from websites and cite it to books or journals which is apparent plagiarism.

- The references should not be older than 5 years (2006 and up)and should be very reliable.

- I EXPECT THIS PAPER TO BE WELL DONE AND NOT PLAGIARIZED - THIS IS VERY IMPORTANT AS MY PROFESSOR IS PRETTY SMART WHEN SPOTTING A PAPER HAS BEEN PLAGIARIZED.

Thanks
There are faxes for this order.