Literature Review on Breast Reconstructive Surgery The WritePass Journal

Literature Review on Breast Reconstructive Surgery Literature Review on Breast Reconstructive Surgery IntroductionLiterature reviewQuantitative studiesQualitative studiesStudy DesignMethods and MethodologySampleAccessEthics approvalToolsRigorPilot StudyData collection analysisLimitationsTimetableBudgetConclusionReferencesRelated Introduction Research is from the French word â€Å"research† which literally means to investigate thoroughly. It is a process of systematic enquiry into a particular subject (phenomenon) which intends to create new knowledge and is governed by scientific principles (Cormack 1996). The department of health (DOH) defines research as: â€Å"the attempt to derive generalised new knowledge by addressing clearly defined questions with systematic and rigorous methods† (DOH 2005). The Nursing and Midwifery Council (NMC 2008) clearly states that nurses must deliver care based on the best available evidence or best practice. That any advice they give is evidence based if they suggest healthcare products or services and they must have the knowledge and skills for safe and effective practice. Nurses are expected to practice within an evidence based practice framework by utilising current, reliable and valid research (Smith Donze 2010). To achieve this, nurses should be familiar with the research process and how to incorporate findings into practice. Nurses who practice evidence based are fulfilling their responsibility to patients and their professional regulatory body. Nursing research can provide a hugely exciting and challenging facet to the concept that is nursing. Being the largest workforce within the National Health Service (NHS), they are the professionals with the most direct contact with patients it stands to reason that this workforce should have robust evidence to support their practice interventions (Parahoo2006). Patients can be asked to make decisions when they are emotionally fragile and thrust into an often unfamiliar world of doctors, nurses, hospital environments where the language used can seem unfamiliar. Working in the field of breast cancer can provide many opportunities to explore the experiences of women as they strive to make decisions about their physical and psychosocial wellbeing. Making a decision to undergo a breast reconstruction following mastectomy due to breast cancer can be harrowing and efforts must be made to ensure healthcare providers afford the best opportunities that enable women understand this process. A literature search using databases Medline, [emailprotected], British Nursing Index, Embase, CINAHL and PsycINFO was conducted to review previous research undertaken to determine influencing factors on decision making. The terms breast cancer, breast reconstruction, decision making, patient satisfaction and quality of life, Breast Care Nurse and Breast Clinical, Nurse Specialist were used. Results were limited to the English language, relevant to humans. Literature review A literature review should provide a rationale for the study, show why the study is required and how it will add to the body of knowledge already known about the phenomenon. (Parahoo 2006, Cormack1996). Adjusting to a diagnosis and the treatment options of breast cancer is a complex process (Brennan 2001). The process is influenced by numerous factors (Wenzel, Fairclough, Brady, Cella, Garret, Klushman 1999) and altered body image is one of the most significant (DeFrank, Mehta, Stein, Baker 2007). In the last few years there has been increasing attention paid to the role, perceived body image plays in   patient’s, diagnosed with breast cancer has on this adjustment. Pikler and Winterowed (2003) prove that patients who essentially felt good about their body were more firm in their belief in their ability to cope with the disease and the subsequent treatments. Women’s emotional and psychosocial functioning may be significantly affected when Coping with a diagnosis of breast cancer, which may impair their decision making ability. Reaby (1999) supports this view suggesting â€Å"their ability to make an informed decision about breast restoration is greatly reduced because of the emotional and physiological conditions created by their health crisis†. Literature supports the process of breast reconstruction following mastectomy as increasing long term health and wellbeing (Streu, Chung Alderman 2009). This assumption is refuted by Harcourt Rumsey (2001) who suggest this belief is not supported by evidence and further inquiry is required. However whilst there is much literature available highlighting the effects of timing of breast reconstruction, type of reconstruction (autologous or implant) and of the impact other treatment modalities may have on a technical success there is little robust evidence to support one method in favour of another in terms of quality of life or body image (Potter Winters 2008) . Guidelines have been produced by The Association of Breast Surgery, The British Association of Plastic, reconstructive and Anaesthetic Surgeons and the Training Interface Group which recognised that it is difficult to conduct controlled trials in this cohort and hopes the guidance will provide standards for safe breast reconstruction following mastectomy for breast cancer (Lee Bishop 2009). There remains a lack of consensus on when to perform the procedure, what procedure should be performed and which patients are/are not suitable to undergo the procedure.   Without consensus guidance from professionals cannot be anything other than subjective and ultimately can lead to decisions which are not fully informed (Lee, Dominik, Levin, Barry,Cosenza, O’Connor, Mulley Sepucha 2010). The authors of this study report on the necessity of tools to assess the quality of the patient’s decision making which will reflect shared decision making. Quantitative studies The reviewed literature highlights various findings on the decisions women make regarding breast reconstruction. Chevray (2008) suggests that women are not adequately informed about the availability of this option.   Older age and the less educated are less likely to opt for breast reconstruction according to (Greenberg, Schneider, Ko, Lipitz, Mallin, Epstein, Weeks Kahn 2007). Theses particular studies are American where the healthcare system is different from that in theUnited Kingdom. They were quantitative, retrospectively analysed from existing databases and neither study reflected the women’s personal experiences of the process they found themselves having to make decisions within. Limitations to the study such as women’s access to specialist centres for breast reconstruction and financial cost, if not adequately covered by insurance, which may have precluded them from breast reconstruction are not addressed in the findings. Falbijork, Karlsson, Salander, Rasussen (2010) concluded similar results with regard to age but did not take into consideration the meaning of mastectomy or body image to   women although recognise these variables should be considered. They conclude that age is of paramount importance for further studies to enable understanding women’s choices. Stacey, Spring, Breslin, Rao Gutowski (2008) reinforced the multifactorial nature of decision making regarding breast reconstruction following mastectomy for breast cancer. They evaluated the attitudes of circa 100 general surgeons to breast reconstruction; 40% did not refer all patients for breast reconstruction citing reasons which included refusal by patient, need for radiation treatment, may delay adjuvant oncological treatment, patient issues or the lack of available plastic surgeons.   One of the conclusions they reached highlighted the need for education of the referring surgeon and patient about options and indications for reconstructive surgery. A related study by Reefy, Patani, Burgoyne Osman Mokbel (2010) reviewed 127 patients who underwent immediate breast reconstruction following skin sparing mastectomy for early breast cancer. The patients were followed up for 36 months the procedure was associated with low morbidity and deemed oncologically safe for T, T1 T2 tumours without extensive skin involvement. It stated that 85% of patients who required either prior or post mastectomy radiation treatment underwent capsulotomy for significant capsule formation. In keeping with Stacey et al (2008) focus should be on the education of surgeons and patients on the effective, safest management of breast reconstruction to guide informed decision making. Lee, Belkora, Chang, Moy Patridge Sepucha (2011) evaluated patient decision making about breast reconstruction (BR) and patient involvement in the process and concluded that patients were not well informed about BR and as such would benefit from interventions which supported their decision making. Winters, Benson Pusic (2010) systematically reviewed 1012 abstracts of which 34 papers included Health Related Quality of Life (HRQoL) outcomes in breast reconstruction. Their findings showed that robust scientific data is sparse in methodology on HRQoL studies and increasingly patients and healthcare providers seek meaningful information to guide decision making. They concur with Lee Bishop (2009) that randomised clinical trials are required to establish guidelines to inform decision making. Another study carried out by Jeevan, Cromwell, Brown Traveller Pereira, Caddy, Sheppard Van Der Mullen (2010) identified that of 44, 837 women who underwent mastectomy for breast cancer, 7375 underwent immediate reconstruction. (IR) They showed that the uptake rate for IR was highest in the younger age group (50 years of age) and lowest in those over 70 years, a finding which concurs with Greenberg et al (2007) Falbijork et al (2010). Jeevan et al focused on the regional variations of IR uptake and showed that women from more deprived areas were less likely to undergo IR as were non white women. This is direct contrast to Osborn, Hodin, Drew, Fielder, Vaughn-Williams Sweetland (2005) who found no association between deprivation and ethnicity and treatment choice but did find older age as an indicator of being less likely to undergo breast reconstruction. Qualitative studies Qualitative studies have attempted to establish patterns in women decision making when considering surgical options. Reaby (1998) developed a decision making model hope to enhance decision making capability of the women. It seems to be designed to essentially slow down the women’s decision making to allow time for her to explore her understanding of the options that should have been presented to her, to alert that there may be options available and to explore the impact such decision making may be having on her and her family. The study Reaby conducted suggested that the specialist nurse was in a valuable position to undertake the role of providing physiological and psychological support, acting as their advocate thus enhancing the decision making process. Harcourt Rumsey (2001) conducted a literature review identified the need for further research into the experiences of women deciding for or against reconstruction and the process by which they decide. They highlight that studies in their review did not take cognisance of the nurse specialist. They identified the drawback of randomised controlled trials citing them as inappropriate in this area, and suggest that research in this area should be prospective and from the time of diagnosis. This is an identified gap this study seeks to address. Three years later Harcourt Rumsey (2004) followed up their previous research showing that individually, women need appropriate information, time to make decisions and ongoing emotional support. Limitations to the study were that interviews were conducted post decision which left the gathered information subject to recall and there were unidentified difficulties with the study being prospective. Lally (2009) study involving 18 women newly diagnosed with breast cancer who were to make decisions regarding surgical options, showed that women felt supported by specialist nurses and the surgeon in their decision making. This has implications for clinical practice providing evidence of the importance of the availability of these healthcare professionals to this patient cohort. Wolf (2004ab) identified the importance of the role of the breast clinical nurse specialist in facilitating the process of how patients receive information. Information giving has been associated with increased autonomy, moving away from a paternalistic approach and considered to help patients cope with cancer. Study Design Qualitative research seeks to lend understanding of how people think individually and as part of a group. The approach is one that is interactive, holistic and inductive, data collection is flexible and reflexive (Parahoo 2006). This results in data collection and analysis that has evolved as the researcher gains insight and new questions emerge throughout the process (Pollit Beck 2004). The following study design describes the approach to enquiry, the methods and methodology to be used to collect data, when, where and from whom the data will be collected and how the data will be analysed. Methods and Methodology In quantitative research comes from a philosophical paradigm which suggests  Ã‚   that human phenomena can be subject to objective study (Parhaoo 2006). Historically quantitative researchers believed that human behaviour could be predicted, a belief based on the positivist approach to natural science that the world works according to fixed laws of cause and effect or causality by testing hypothesis and theories (Muijs 2011). This approach strives for objectivity and to avoid bias advocates distance between researcher and subject (Holloway Wheeler 2002). Quantitative research has been used by nurses dating back to the Crimean war (1853-1856) and can produce robust scientific data which is essential for evidence based practice (Parahoo 2006). However it has been criticised for being narrow and inflexible, of focussing on a small part of the human experience where nursing concerns itself with a holistic approach (Pollit Beck2004). In comparison qualitative research is flexible and the relationship between researcher and participant less formal. Phenomenology, grounded theory and ethnography are the main research traditions which underpin the philosophical approach to qualitative research (Polit Hungler 1997). Such research traditions explore the subjective nature of the human experience (Magilvy2003) and aim to collect data in naturalistic environments ensuring a holistic approach to data gathering which requires the researcher to be intensely involved in the fieldwork   as â€Å"a full co-participant†(Polit Beck 2008). Each of the disciplines focuses on the experience of human beings and their interpretation of the experience (Holloway Wheeler 2002). The approaches demand careful collection and analysis of rich in-depth data to provide a comprehensive understanding of peoples thinking and behaviour which can improve efficiency and predict outcomes in the healthcare setting (Parahoo 2006). Qualitative research has been criticised as anecdotal, for producing findings that are neither scientific nor generalisable and, due to the intense involvement of the researcher, objectivity is lost (Parahoo2006). To reduce researcher bias or maintain objectivity in data collection a process known as bracketing may be used which enables the setting aside any personal beliefs, prior knowledge or expectations the researcher has regarding the study. Qualitative and quantitative research methods are appropriate for nursing research and both create or increase knowledge that may explain or describe the phenomenon being studied (Harper Hartman1997). The intent of this study is to explore and lend understanding about how women decide to uptake breast reconstruction or not following mastectomy for breast cancer therefore a qualitative approach will fit as it seeks to explore the experiences of decision making. Sample Sampling is the process of selecting a portion of the population from the total population of the subject of the enquiry; a sample is a subset of that population (Pollit Beck 2004). Sampling allows cost effective research as resources such as time and funds are likely to be limited and can provide robust information. There are two basic types of sample; probability and non-probability. A probability sample is randomly selected in contrast a non-probability sample is chosen to provide the sought data (Parahoo 2006). The selection of the sample should be robust enough to identify and use the participants who can supply the information to inform the study (Polit Hungler 1997).Qualitative researchers aim to gather data which is rich and in-depth; this is the underlying principle which guides the sampling technique. For the purpose of this study the researcher intends to recruit 8-10 participants using purposeful sampling technique. Polit and Beck (2008) describe this as using the researcher’s knowledge about the sample population to â€Å"hand pick† potential participants who will most benefit the study.   These individuals will be sampled as those most likely to be able to provide information on decision to undergo reconstruction following mastectomy or not. Sample size does not determine importance of the study or the quality of the data, in qualitative research too large a sample size risks loss of depth and meaning and may reduce the richness of the data (Holloway Wheeler 2002).Some texts recommend between six and eight participants (Holloway Wheeler 2002) others suggest size should be based on informational needs (Polit Beck 2004). If saturation occurs before this number is achieved then recruitment will be limited to the saturation point. Saturation refers to the point when no further meaningful data is obtained and as such the number of participants can be led by the fullness of the data collected (Wood Ross-Kerr 2006). Access To address the research question, the researcher initially considered recruiting female patients requiring mastectomy to the study at the time of diagnosis when discussion regarding breast reconstruction cancer would occur. However, following discussion with the course leader and a period of reflection, it was decided that this was a vulnerable cohort and it would not be ethical to approach them at a time when they were trying to process information regarding a cancer diagnosis and subsequent treatments. A decision was taken to approach the women 3-6 months post diagnosis when their rationale for their decision was still clear to them and breast cancer support mechanisms were in place. The intention is to approach the consultants who are responsible for breast cancer patients in a specific regional area for permission to recruit the patients. Being part of the multidisciplinary team, as a breast clinical nurse specialist, involved in managing the care of these women, the researcher is known to the consultants and does not anticipate any objection to this. Individual participants will be approached by the researcher and given verbal and written information about the study, a suitable length of time to decide to take part or not will be agreed. The individual will be reassured that their decision will be respected and, regardless of outcome, they will continue to receive care without bias. The researcher may be the healthcare professional designated to fulfil a particular aspect of care of some of the sample group. It is anticipated that this would not bias any data collection as the same level of professional intervention is given to all patients undertaking this decision making process. Goodman Moule (2009) highlight the responsibility of the nurse researcher to inform the participant that they are acting as a researcher. Bracketing can be utilised to suspend any researcher beliefs or preconceptions. This theory will be tested in the pilot study and should any bias be revealed then the researcher will ensure the standard care of the study cohort is supplied by an independent practioner. Potential participants will be recruited at a planned follow up appointment where patients attend for review of their treatment. This negates the requirement of an extra appointment for participants. Ethics approval Research supports the development of nursing knowledge and as individuals and professionals nurses undertaking research must consider the ethical issues that can arise (Smith Hunt 1997). When participants in research are vulnerable, as in the health care system, their rights must be protected (Wood Ross-Kerr 2006). The Royal College of Nursing Research Society Ethics Guidance Group (2009) highlight that nurses can have a variety of roles in research including carrying out their own projects, that it is important the nurse understands the important issues in research practice and it is their role to protect the participant and their rights. Beauchamp Childress (1983) illustrate the concept of biomedical standards as four principles; respect for Autonomy, Beneficence, Nonmaleficence and Justice which underpin healthcare ethics. Without understandable information an individual is not able to make an autonomous decision to participate in research or not; they are therefore unable to give informed consent. Berendt, Golz, Bertz Wunsch (2011) conducted a qualitative study asking what patients understood about trial participation, specifically assessing their understanding of informed consent and discovered that patients’ understanding was less than anticipated and the patients’ identified needs including â€Å" clear informed consent consultations†. The notion of informed consent encompasses; the right to be informed, consent to be given voluntarily and competence of the participant (Tschudin 2003). The participants anonymity and confidentiality must be protected therefore any information provided by interviewees will not identify them nor will it be accessible to others. For the purpose of the study suitable storage for data pertaining to the research will be sought. Prior to seeking approval for the study from the local National Health Service (NHS) research ethics committee and the local research and development department, the researcher will seek guidance from the appointed academic supervisor. To ensure informed consent participant information sheets about the study purpose which will include any benefits and risks, dissemination of results, assurance of participant anonymity and consent forms will be provided. Participants will be advised they are free to withdraw from the study at ant time without penalty and asked to sign a consent form a copy of which will be given to the participant and one retained by the researcher. Consent forms and information sheets will be utilised using guidance from the National Research Ethics Service website www.nres.npsa.nhs.uk/. Participants may recall experiences that cause emotional distress and as their needs are greater than those of the study the process would be suspended or discontinued ( Thompson, Melia Boyd 2000). Tools The intention is to generate data using in-depth unstructured interviews which enable the informant unlimited opportunity to convey their perception of events. This is an intentional approach to discovering the participants lived experience of the phenomenon and the interviewers’ ability to listen and convey respect and importance of the experience is crucial (Oman, Krugman Fink 2003). Unstructured interviews are purposeful conversations which enable rich but often unquantifiable information about the phenomenon (Smith Hunt 1997) the conversations are interactive and usually begin with general questions to enable truly unstructured interview, for example â€Å"What happened when you first learned you would need to undergo mastectomy?† (Polit Beck 2004).   Interviews can last from thirty minutes to two hours and interviewer/interviewee interaction may vary therefore in qualitative interviews flexibility of the researcher is key to obtaining useful data (Parahoo 2006). Structuring data generated from unstructured interviews is known as content analysis and themes will be looked for in the data and divided into categories. The categories that will be developed are dependent on the researcher and can be further categorised into frequency tables to indicate the frequency of the response (Wood Ross-Kerr 2006). The qualitative interviewer is the tool of data collection as it will be she who analysis data in her mind during interviews thereafter transcribing and presenting the data in a way that can be easily understood (Parahoo 2006). Rigor Qualitative researchers recognise the subjective nature of the interview process and seek to ensure rigor by incorporating reflexivity and validation of data by the interviewee, reflexivity enables the respondent to report on the accurateness of the transcribed interview and can provide opportunity for clarification (Parahoo 2006). Others utilise four criteria to establish trustworthiness; credibility, dependability, confirmability and transferability (Polit Hungler 1997). Credibility refers to trust in the data enhanced by giving sufficient time to gather data to give in-depth understanding of the study cohort. Member checking is regarded as an important technique for establishing the credibility of qualitative data and involves feedback of the data and researchers findings and recording the respondent’s reactions.   Peer debriefing relates to the exposure of the researcher to others who are experienced in either qualitative inquiry or the studied subject who can review as pects of the inquiry. Dependability refers to the ability of the data to stand the test of time regardless of the conditions and is liked to confirmability. Confirmability is a measure of the objectivity of the data and as such the researcher should present an audit trail of the data, methods and decisions to an external auditor to check trustworthiness. This strategy may offer some protection to support trustworthiness but caution should be used; the unique nature of inquiry may not lend themselves well to different interpretations of data. Transferability requires the researcher to demonstrate the extent their findings can be applied to other contexts (Goodman Moule 2009). Pilot Study A pilot study is a trial of the research method on a small scale the purpose of which is to ensure the study design is feasible (Presly 1996, Polit Beck2004). A pilot study will be conducted using an unstructured interview as planned for the main study. This will enable a trial of the interview process, gauge length of time interviews may take and allow the researcher to familiarise herself with technical equipment (Lacey 2006). Data collection analysis Data collection refers to the way information is collected, recorded and presented to address a research inquiry (Clamp, Gough Land 2004).High quality data increases the value of the research and the aim of the qualitative data analysis in this study is to structure the data into meaningful units using thematic analysis. This stepwise approach begins with the researcher identifying themes in the data, thereafter categorising the themes; this may be a natural occurrence or the researcher must decide the category. The final step is to structure the data and this can be achieved by developing a frequency table which serves to identify the frequency of every category, the response rate and number of participants who gave the same response (Brink Wood 2001). The researcher intends to audio tape participants during unstructured interviews, using field notes to complement data collection. Field notes can facilitate deeper understanding of the data as it enables conveyance intangible elements such as body language and feelings. They are also useful in the event of failure of audio equipment. Limitations Surgery for breast cancer is an emotional experience and mastectomy can be particularly harrowing as women face disfiguring surgery and a potentially life threatening disease. Making decisions at a difficult time may render potential study participants emotionally unavailable which may impact on recruitment to the study and delay the planned recruitment period. Should this situation evolve the intended cohort will be extended to include those women who underwent mastectomy more than six months previously but no longer that eight months to capture the freshness of their experience. The study forms part of a Masters programme which allows circa ten months for the completion of the study therefore any delay in the timeline could be crucial. As such ethical approval will be sought early to facilitate a prompt beginning to data collection. Timetable Details of the plan of work and timescales show the expected duration of each stage of the study and endeavour to show the feasibility of the study (Cormack1996). A Timetable for the proposed study has been prepared (appendix 2) and will be adhered to. It demonstrates the beginning and expected conclusion of the study activities and shows where they run simultaneously. Budget The budget estimation for this enquiry is as follows: Researcher time  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Agreed by local management / colleagues Transcribers’ time (agreed)                  Ã‚ £ 40.00 Paper                                                                                 Ã‚ £ Ink                                                                                       Ã‚ £ Transport costs                                                  £ Postal costs  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚    £ Conclusion The reviewed literature reveals a variety of reasons why breast reconstructive surgery is undertaken by some women following mastectomy for breast cancer. These include age, socio economic status, ethnicity, availability of surgeon, potential effects of radiotherapy id required amongst others. It has been highlighted that decision making ability may be impaired due to emotional conditions caused by a health crisis. All of the research identified the need for further research. There was very limited inquiry into how the women made their choices and none of it captured the women’s experiences of making the decision. This study provides an opportunity to discover how women feel about making decisions. It is anticipated such a study could enhance how healthcare providers attend to the needs of women who must make a decision to undergo breast reconstruction following mastectomy due to breast cancer. References Beauchamp TL, Childress JF (1983) Principles of Biomedical Ethics 4th Ed Oxford University Press.Oxford. Behrendt C, Golz T, Roesler C, Bertz H Wunsch A (2011) What do our patients understand about their trial participation? Assessing patients’ understanding of their informed consent consultation about randomised clinical trials. Journal of Medical Ethics 37: 2: 74- 80 Brennan J, (2001). Adjustment to cancer-coping or personal transition? Psycho-oncolgy 10 1-8. Brink JP, Wood MJ (2001) Basic Steps in Planning Nursing Research: From Question to proposal 5th Ed Jones and Bartlett Publishers.London. Chevray P, 2008. Timing of Breast Reconstruction: Immediate Versus Delayed. The Cancer Journal 14 (4), July/August, pp 223-229. Clamp CGL, Gough S, Land L (2004) Resources for Nursing Research: An  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Annotated Bibliography. 4th Ed Sage Publications.London Cormack   DFS. (Ed) Research process in nursing 3rd ed. get updated version DeFrank J, Mehta C, Stein K, Baker F. (2007) Body image dissatisfaction in cancer survivors. Oncology Nursing Forum 34 (3), pp623-631 Department of Health (2005) Research Governance Framework for Health and Social Care, second edition pg 3.London. 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Part 1: decision making and sources of information European Journal of Oncology Nursing 8: 211-223 Wolf (b) (2004) The information needs of women who have undergone breast reconstruction. Part 11: Information giving and content of information 8: 315-324 Wood JM Ross-Kerr JC (2006) Basic Steps in Planning Nursing Research: From Question to Proposal 6th Ed Jones and Bartlet Publishers. London

Case Study Essay Example | Topics and Well Written Essays - 750 words

Case Study - Essay Example These prior meetings have been based upon the need to update the stakeholders on the progress of the project on far simpler issues. As a result, these past meetings have been much smoother, but this time, serious challenges that touch on the project scope will arise. These include; an extension of the project deadline by up to four weeks; the proposal for implementation of a formal change-order process and managing the client’s resistance to change. Timeline delay Although, as a software project manager my mantra is keeping an eye on time, and budget, sometimes the two issues may require adjustment due to unexpected issues that stem from the implementation process (Wysocki, 2010). Owing to the fact that most of such projects are not completed within the timeline as agreed upon at the beginning of the project implementation process, this one is not an exception. This project is expected to delay by between one to four weeks due to changes in the requirements of the system. More specifically, we have spent more time that we expected, waiting for new resources. The need to expand the functionality of technology in order to allow for a seamless way to monitor the various human resources functions have extended past the original scope. The client’s systems need â€Å"gold plating,† which is expected to consume more time that was expected. An extension of time to allow for successful completion of the project and ensure that the deliverables are realized is therefore imperative. It is important to note that, even though the stakeholders came together to develop all their requirements before starting the project, system requirements have changed, making the project to wait for the shipments of new product supplies. Change-order Process Owing to the variation of costs and the timeline for completing the project, change-order processes will help the stakeholders to make the necessary modifications to the original project plan and scope as a trade-of f for the realization of quality project deliverables (Wysocki, 2010). The original agreement spelt out the structure of the network systems and the expected final result. However, due to the changes in the system requirements, it is important for the client to give in to extra funding in order to keep an eye on quality, as effective measures have been put in place to guard against project creep. More specifically, the stakeholders need to adjust to the new timeline for the completion of the project by at most four weeks so as to satisfy all the stakeholders’ new expectations. The client will be required to sign the change order form detailing the modified plan, including the system services, hardware and software, and designs as a way of formalizing a mutually binding agreement. Resistance to change This project had a clear scope within which to work, hence should be respected. However, due to the fact that changes that arise during the implementation process are inevitable, all the stakeholders should work in tandem to respond to the changes reasonably and more appropriately to ensure that the final deliverables are achieved (Wysocki, 2010). The existence of new stakeholders is the major risk facing the project, even as some flexible stakeholders are striving not to compromise quality for limiting costs and the amount of time that is required to successfully complete the

Roman Republic Essay Example | Topics and Well Written Essays - 500 words

Roman Republic - Essay Example But having said that, in case the three parties contradict with each other, then living in Rome could become like running on thorns. As explained, each party controls crucial departments which are integral for the development of economy in Rome. If the consuls do not agree with the decisions of the senate then the country’s security would be in trouble causing the businesses running in the country, to fear for their lives. Similarly if the senate refuses to pay for working committee, then the revenue of the country could get a deep hemorrhage resulting in large number of people losing out on their jobs. On the other hand, If people fail to execute their rights properly by acknowledging committed performances from their compatriots or punishing the guilty properly or even if they contradict with the senate with regard to ramifications or penalties, then that could also ruin the lives of people as those carrying out illegal activities may feel even more comfortable knowing that the government is not providing proper penalties. On a personal opinion, as mentioned above, the rules and regulations, the policies, all could become the best ones available only if the three parties of the government work in unison.

Psychology- Prejudice Essay Example for Free

Psychology- Prejudice Essay 1. Evaluate Tajfel’s core study in terms of streotypes and weakness [10] Prejudice and Discrimination have been always controversial and it has become one of the crucial topics in the world of Social Psychology. Henry Tajfel was a British social psychology who is well known for his SIT or Social Identity Theory; ‘Intergroup Discrimination’ (1970). This theory has been useful to identify the social causes of prejudice and as well as explaining individual differences. First of all, this study is aimed to show or demonstrate that merely putting or diving people into groups could cause them to discriminate the other group. Tajfel’s procedure of the experiment involved two laboratory experiments. The subjects of the first experiment contained 64 boys, 14 and 15 year-old from a school in Bristol. The boys from each group knew each other well, since they were actually in the same houses at the school. The second experiment was similar to the first one, since 48 students also already knew each other. In terms of stereotypes and his study, Tajfel proposed that Stereotyping or putting people into groups is based on a normal cognitive; we tend to group or categories things. By the statement, he meant that we see the people in our group are just the ‘same’ with us because there are certain similarities that makes us parallel with them and there’ll be a tendency of us calling the ‘same’ people â€Å"us† and those who are different or out-group â€Å"them†. This study also has its weaknesses and strengths. One of the strengths; Laboratory experiment method, which makes him to able controlling the environment in terms of what the subjects had experienced during the test, therefore he can ensure that there are no influences that would change their behaviour later on. Manipulation of the environment also makes him able to obtain replication due to its standardness in procedures. However, since all of the participants were all male, similar age and came from the same country. In terms of experiment, this study has become biased. It is difficult to decide whether it is good enough to be generalised, due to its gender, age and geographical limitations. The ecological validity is doubtful, considering the experiments were lab studies, where we can jump to an argument that this involved unusual task is held in artificial environment. In other words, the participants acted in the way they thought was demanded of them; Demand Characteristic. This experiment deals with a disruptive and anti-social, very general commons of society in explaining and understanding the causes of prejudice and discrimination. Moreover, this piece of research could be beneficial or helpful to our daily life. Nevertheless, the applications are still limited, regard to ecological validity and the gender, race and cultures.

Spirituality in John Greenleaf Whittiers The Worship of Nature :: Whittier Worship of Nature Essays

Spirituality in John Greenleaf Whittier's The Worship of Nature If man ever said that he could not experience God outside of the walls of a church, it is evident that he never read John Greenleaf Whittier. John Greenleaf Whittier was a Quaker who, like all Quakers, placed an emphasis on a simple life. Quakers believe in leading a life without artificial things. Because of his Quaker beliefs, he had a deep understanding of the spirituality of the natural world. In his poem, The Worship of Nature Whittier takes his readers on a spiritual journey through a world untouched by man. The title of the poem is an indication that the reader should prepare himself or herself for some sort of spiritual experience. Whittier uses the word "worship" to title his poem because by the end of the poem the reader will learn that there is much more to the natural world than water, land, and sky. The poem starts with the birth or creation of nature. Whittier explains to his readers that the natural world has existed since God created it. He compares the creation of nature to music. This stanza is very appealing to the senses because nature is musical. The insects, winds, and birds are all a part of this "song" that "has never died away". The poet reminds readers of this very important idea because we as humans have a tendency to forget the value and importance of nature. The second stanza takes readers beyond the initial creation and introduces readers to the many purposes that nature serves. Whittier explains that "prayer is made and praise is given." Personification is an imp ortant tool used in this poem. Obviously nature cannot really pray or give praise, but the various functions of nature in this world give the illusion that it does pay homage to a higher being. For instance the lines in the second stanza, "The ocean looketh up to heaven, /And mirrors every star" says that the ocean is a mirror for heaven. If we look into the deep sea, we are in essence looking into a reflected image of heaven. Other instances when Whittier uses personification in this way are the first and second lines in the third stanza, "Its waves are kneeling on the strand/As kneels the human knee". Whittier tells his readers that just as man bends his knee to show respect to God so the ocean waves bend when they reach the shore as a sign of respect.

Inditex Report Essay

Introduction The aim and objectives of writing this report is to analyse the business strategies or models adopted by the Inditex Group and to review whether this strategies will support its operation in accomplishing their future obligation. Furthermore, it aims to evaluate the strategic option of the organization in either from a corporate strategy view or strategic business unit (SBU) perspective that could be adopted by the Inditex Group. This report will also highlight the vision, mission and objectives of the Inditex Group Company. In addition, the report will go further by accessing the group human resources and management in order to clearly pinpoint any management changes in the organization, if there is any, and to know who the management are and their position in the decision making process of the company. In order to achieve the principle objectives of this report, the report will be categorised into Internal and External analysis. This is done in order to fully analyse the current po sition of Inditex Group in the market from all perspectives, also to access if Inditex is a healthy company to invest in, and also accessing the current strategic adopted by the company. The company Internal analysis will be based on the following; Financial Analysis: This will focus on all the financial aspect of the company. Human resources and Management Analysis: focus on the management system of the company. Market Analysis: This will focus on the company’s current market position. Operations Analysis: This will focus on how and where the company perform it day-to-day activities. Prioritized Strength: This will analyse the strengths of the company internally. Prioritized Weakness: This will analyse the internal weakness of the company that can hinder them from achieving their goals. The company External analysis will be based on the following; Pestel Analysis: this will analyse the possible influence of the failure or success of the company strategies. Porter 5 forces: this will help in analysing the way of attractiveness of the Clothing Industry. Critical Success Factors (CSF’s): This will focus on some unique resources that make the company  successful. Prioritized Opportunity: Prioritized Threat: Company: Inditex Group. The Inditex Group Company, a textile design Industries is a Spanish Multinational clothing company. Inditex have its headquartered based in Arteixo, Galicia in Spain. The Inditex Group was founded and created by Amancio Ortega Gaona the wealthiest man in Spain and third richest man in the world in 1985 and by 2001 they went public and listed on the Bolsa de Madrid stock exchange market1. The Inditex Group which is now considered as the world’s largest clothing apparel company in terms of sales is made up of over 100 companies operating in textile designs, manufacturing, and distributions. Inditex currently have 8 strategic business units operating in four geographical market segments2 which includes Spain. These strategic business units includes; Bershka, Massimo Dutti, Oysho, Pull & Bear, Stradivarius, Uterque, Zara, and Zara Home. Inditex strategic business units collectively occupied about 6249 stores in 86 markets. Company Vision: Good Faith, Dialogue, and Transparency. Company Mission: Is to respond with agility to the demands of the market. This means that Inditex focus highly on the customers’ needs and combines these needs with high degree of vertical integration across all their business area. Internal Analysis Financial Analysis: The key profit driver for Inditex Group Company is Zara, contributing 66.11% of the total net sales and 68.5% per square metre in 2012, while Bershka comes 2nd with 9.31% of total net sales in 2012. In terms of geographical region, the Europe (excluding Spain), and Spain accounted for 45% and 21% of the total net sales respectively. While the Americas and Asia (Including rest of the world) represents a significant lower amount of 14% and 20% respectively. In 2012 saw Inditex Group stores increases massively from 4264 stores in 2008 to 6009 stores in 2012. This shows an increase of 40.92% in  stores from 2008 to 2012. Inditex Group Profitability, Liquidity and Efficiency Net sales increases year over year from 2008 to 2012. This shows an increase of 10.3% from 2007-2008, 6.2% increase from 2008-2009, 13.40% from 2009-2010, 10.2% from 2010-2011, and 15.61% from 2011-2012. This is boosted by the increase of sales, higher profits margin and numbers of new stores opened3. Overall, net sales show an increase of 53.22%. While the Net profit soared by a massive 87.26% between 2008-2012. Prior to this, Inditex growth rate has maintained an average of 16% sales growth and net income of 12% for the past 10 years. The decreasing pattern of ROCE from 2008-2009, and also in 2011 is due to a proportionate increase of operating expenses. The Gross Profit Margin (GP%) has seen a slow increase from 2008-2012. This is due to the slower increase of cost of sales (COS). EBITDA increases by 20% when compared to the previous years and EBIT also increased by 24% when compared to the previous years. Debts A very low geared company, as Inditex Group Company managed to pay back some substantial amount of debts through cash reserves. The Group has 0.08% of debt to capital ratio which means that the company pay little attention when it comes to using debts to finance projects. Investors Related Market Capitalization of 66.883 bn euro. Share price 106 euro as at 06/03/14 Earnings per share has been increasing significant from 2008-2012. Dividend per share increased by 12.5% from 2011 to 2012. Inditex Group Company has a slow increase of sales volumes over the years; while some of the key ratios reported a decline pattern during some period. Inditex mostly depends on the Europe excluding Spain and Spain market, however, with an optimistic future growth in the Asia market. The company also has a low gearing ratio which gives them more financial edge in terms of future expansion. Funding Inditex Group Company funds for its company through the issuing of ordinary  share equity, debt financing, credit facilities and self-financing. The company have been profitable over the year which makes them assumed reasonable responsibility of not securing enough debt to finance its operations. So therefore, in terms of liquidity, the company is not exposed to any significant liquidity risk as it maintains sufficient cash and cash equivalent which meet the outflows of its daily operations. More so, the group are not as concerned about credit risk as they have a policy in place that cover any sales franchises and as their majority of revenue is made from retail sales, so they make use of cash collections or credit payment. Inditex Group Company also funds its business by investing in marketable securities which includes short and long term debts with a maturity of 90 days and 12 months respectively. This helps the Group in meeting its short term obligations. The group also have cl ose to 50% stakes in each of the five Economic Interest Groupings they invest in, these groups are involves in leasing of assets. Human Resources and Management Inditex is a multi-cultural and multi-racial company with 120,314 employees and also created about 10,802 jobs in 2012. 82% of Inditex staffs works under an indefinite contract.  In terms of its multi-cultural pedigree, Inditex employees are of over 130 nationalities and 45 working languages. Inditex has a young workforce with an average age of 31 years old and 78.7% of its employees are females. Pablo Isla Alvarez de Tejera is the Chairman and Chief Executive Chairman of Inditex Group Company along with his Deputy Jose Amau Sierra has transformed the fashion industry and created the world’s largest clothing and apparel company in terms of revenue, and the also developed a strong distribution model which helped the group to minimise their design to distribution process within a week. Overall, the Inditex board consist of 9 directors which include 4 executives’ directors and 5 non-executives directors. Inditex Group Company operates a multidivisional structure which helps them in supporting their global operations. At Inditex, the board of directors are the highest decision maker; they supervise and control the body of the company apart from the matters that were reserved to the general meeting of the shareholders. Inditex board of directors are also entrusting with  direction, administration, management and representative of the company and management of the day-to-day activities of the company to the executives. They also manage the team and focusing its efforts on general supervising function which include directing Inditex policy, making relevant decisions and acting as a link with the shareholders of the company. Market Analysis Markets and segment Most attractive market segment is Asia market Market segment by age. Young and middle age group. Products Inditex have constant changes to its products lines. They have identical products in all market segments. Inditex maintain health and safety products standard4. Customers’ orientation: they analyse customers’ feedbacks in order to be able to identify customer trends. Price Inditex has a standard price in all markets segments. The pricing could be different in terms of exchange rate factors due to globalization. It also gives seasonal discount5 like December sales. Inditex price is considered to be medium with an exception of Massimo Dutti. Inditex Amongst Competition. Promotion Inditex has a strict policy and zero advertisement. Online website for each business unit which systematically updates It has an Affinity card for customers: this influences customers’ loyalty6. It communicates with its customers through social networks. Place Location: All of Inditex stores all located at the main shopping streets. A unique design which is influence by the culture of the markets. A display tailored of the product They have excellent customers service Online stores for all its 8 business units available in some major country7 The key strategy of the Inditex marketing departments are performed through customers’ orientation and satisfaction. Inditex main sale-point is where managers received feedbacks from customers, the managers then report to the design departments in order to identify and carried out what the customers’ value. Another factor that did the trick for Inditex is their glamorous stores, where customers’ access its latest products which are always updated four times in a month. The product lifecycle and BCG matrix as you can see on the charts indicates an accurate balancing position within the Inditex portfolio. However, since just one business unit is placed on as a Cash Cow, so therefore, numerous investments might be needed so as to transform the Question Marks into Stars. Inditex Product Lifecycle. Inditex BCG MATRIX. Operation Analysis: Value Chain- Primary Activities Approximately 1000 designers are responsible for recognising any changes in fashion and they are in charge of developing new models to satisfy customers’ desires. Most of the production takes place in the Group’s own factory. The group take full responsibility control of fabrics supply, marking and cutting of the fabrics till the finish goods. Over 50 percent of Inditex manufacturing is carried out by local suppliers. By the end of 2012, Inditex already had a total of 1434 suppliers and all suppliers must agree to adhere to Inditex Code of Conduct. The cost of merchandise includes the cost of raw materials and consumables8. The Inditex Group has its own logistic centre, where all production is received and carried out, and then distributed to various stores worldwide9. Inditex operates 8 logistic centres, at least one for each brands and all of which are in Spain. Stores play significant roles in Inditex business model10. Value Chain- Secondary Activities Research and Development using advanced technology11. Operates manufacturing and procurement12. Research and Development of eco-efficiency13. Human Resources and Management14. Firm Infrastructure15. Corporate Social Responsibility16. Joint ventures and Strategic Alliances17. Inditex unique management business model is based on flexibility and innovation, and its vision of fashion along with quality design and creativity, together with a rapid response to customers demand has resulted in Inditex fast international expansion and an excellent performance of its commercial formats. Inditex business model is centred to its customers, stores, design/production, teams, and logistics. However Inditex group adopted a high degree of vertical integration business model when compared to its competitors. This allows Inditex to cover all phases of its fashion process which includes design, manufacture, logistics and distribution. The group also incorporated a degree of flexibility structure with a strong focus on customers’ demands in all its business areas. Inditex views social and environmental variables as a strategic factor for growth and sustainment for customers demand. The key to Inditex model is its ability of attending to customers desires in a shortes t amount of time possible. This is a key value added activities of the Inditex group Company. Inditex Business Model Structure. Inditex Logistics Centres Prioritized Strengths Inditex is the world largest clothing and apparel company in terms of revenue. Inditex has a great organization knowledge and expertise. This stands for unique resources and core competences of the company. It also has a strong business model (core competence) It has strong brand (unique resource) Inditex has a diversifying marketing strategy (core competence) Prioritized Weakness Inditex depend on one global brand (Zara which generate 66.11% of its total revenue). It also depends on two geographical regions (Europe excluding Spain and Spain). Inditex is exposed to commodity inflation, It has a centralized logistic centre which may cause some problems in future expansion. High training cost. External Analysis P.E.S.T.E.L Analysis Political Global trade agreement18 National trade relationship19 Value added tax (VAT) and foreign taxation policies. Change in government. Pressure group20. Economical Exchange rate: related to GBP, Us dollars, Japanese Yen: As the crisis in Europe area might cause the Euro to be weaker than the Yen, so the company is likely to have exchange loss. Year on year change in GDP21. Financial market uncertainty. Unemployment Commodity price inflations: for instance, the fuel price increase in the Middle East due to the civil unrest may affect the company margins and also increase the cost of transportation. Inflation22 and Interest rate23. Socio-Cultural Social dimension, corporate social responsibility24 and reputations. Consumers’ complaints. Changes in consumers preferences. Changes in lifestyles and trends. New trends among the younger generation in Europe and America. Technology Spending on research and development Information system Eco-efficiency25 E commerce26 Environmental Kyoto protocol Waste and Recycling: more focus on the attention of areas such as sustainable development. The effect of global climate to the production of organic cotton. Toxic chemicals: this includes carbon footprint. Legal Employment law: this has something to do with Child labour and rules and regulations that relate to labour. Consumer law: this regards law and regulation which relates to fashions and clothing Patents and trademarks Supplier rights Health and safety law European companies will be assisted by the abolition of textile and clothing import quotas (ATC) in order to enter into the emerging market of Asia which undoubtedly counted for a huge significant amount of the population of the world. However, due to the uncertainties associated with political and economic situations, this could increase the risk of further expansion strategies. Although the price of cotton has increases by more than $5 over the years while unemployment has risen high especially in Greece and Spain with 28% and 26% respectively which force textile companies to potentially increase their market prices, while disposable income on clothing has decrease because the ongoing problem in the Eurozone consumer gives negatives signal to consumers which affect their confidence, but the confident level in the emerging market (Asia) is optimistic. However, the price deflation of cloths which has been dated back to the 1990s till the start of the financial crisis, the reversing t rends now after the financial crisis have an effect on the overall productivity of the apparel industry positively. Porters 5 Forces Threats of New Entrants There is economic of scales It involves large capital investment There is a brand loyalty in the industry There is a product differentiation Patent and protection tariffs Moderate force which can be overcome Threat of Substitute Price/performance ratio Inditex other brands There is zero switching cost Weak force The Bargaining Power of Buyer Decentralized and Centralized Buyer There is a low switching cost There is zero buyer competition threat Moderate force The Bargaining Power of Buyer There is fewer supplier in the industry There is a low supplier competition threat Suppliers of textile and raw materials Weak force Competitive Rivalry There is existing retailers equally sized Slow growth in the apparel industry Great differentiation Moderate force Three moderate forces and two weak forces make the clothing and apparel industry unattractive for new competitors to break into the industry. However, changes to substitute depends on the consumers’ preferences according to their perception of taste, style and budget, therefore it is high to switch to other providers. Competitive rivalry is the strongest force assisted by the slow growth of the market. Prioritized Opportunity There is still room to grow in the emerging market in this industry. The abolition of quotas Organic market development Technological Innovation New strategic Alliance Prioritized Threats There is high competitive rivalry in the industry There is slow market growth in the industry Increase in commodity inflation Changes in consumers’ taste or trends Exchange rates. CORPORATE STRATEGY Strategic Position Zara which is Inditex main source of revenue because of the amount it generated in terms of sales is ranked on the 4th option of the Bowman strategic clock, it implement a broad differentiation strategy. It offers products to customers at an affordable and reasonable price or a little higher because of its good perception of quality, enriches customers’ satisfaction and loyalty. However, the excellent deployment of its unique resources and its core competences assist Zara to considered as the first mover in the industry27. One of its key value added activities is its focus on customers’ needs and a constant change in its product lines whilst maintaining the same level of price allows Zara to achieve a competitive advantage. Inditex has expanded and grown, according to the Ansoff matrix. By product development: (EcoFootDesign) Systematic changes in products line and innovation. Market penetration: it has increase shares of its key existing markets. Market development: in 2010 saw Uterque one of Inditex business unit opens its first store in Russia which also pave way for Zara home and Zara to follow through. By related and unrelated Diversification: Zara and Massimo Dutti entered into the Indian market in 201028 and 201329 respectively and Inditex enters the furniture retail industry30 through unrelated diversification. Inditex method of pursuing its strategies. Organic development: Inditex continuous performance and innovation is acquired through their knowledge and experience according to their existing  resource and capabilities. Through Acquisition and Takeover: in 1995-1996, Inditex acquired the whole of Massimo Dutti in a 100% acquisition. Form a Strategic Alliance: A Joint Venture with the Tata Group to open the first Massimo Dutti stores in New Delhi, India. Inditex license to other companies: production of finished goods through external suppliers. The Inditex Group Company adopted a parenting role by providing a clear vision of its company objectives, it also assists employees by providing continuous training and facilitating, and enhancing through synergies. Improvement in all Inditex departments is as a result of a great focus in performance evaluation and monitoring. Inditex adopted different portfolio management for each of its business units. According to the results of the strategic analysis, financial analysis, and SWOT analysis above, it has been well documented that the Inditex Group Company has a strong portfolio which make the company likely to overcome any future uncertainties, as it was evidence in its financial performance that they keep growing even during the financial crisis of 2008-2009, they still achieve a significant increase in revenue. However, the problem which the Inditex Group could be facing regarding their adopted strategies will be the over dependence of its other seven (7) business units which includes Bershka, Massimo Dutti, Oysho, Pull and Bear, Stradivarius, Uterque, and Zara Home over Zara which is the unit that generates over half of its total sales (66.11%). The Group should also find a way to increase the percentages of sales to geographical region like America which is has the lowest sales geographically and also in Asia which is an emerging market other than Europe. FUTURE STRATEGIES Proposed strategy for the strongest SBU (Zara) Product development: the company should produce better quality of future product lines. Market development: the company should go on with further expansion in Europe market and the US market. Diversification: the company should enter into the apparel sport wear industry. Market penetration: the company should enter into the Australian market. Corporate Market penetration: further expansion in the Asia market. Backward integration: to acquire a fabric supplier Consolidation: weaken business units should be strengthen Forward integration: manufacturing and logistic process should be decentralised. Do Nothing: continue with the current operations. References Inditex SA, Bloomberg Market, [Online] Available at: http://www.bloomberg.com/quote/ITX:SM Accessed on 20th of February, 2014. H&M (2014), â€Å" H&M Opens first store in East Asia† [Online] Available at: http://about.hm.com/en/About/facts-about-hm/people-and-history/history.html Accessed on 23rd of February, 2014. Inditex, (2008) Inditex annual report 2008, annual report 2008, A Coruna: Inditex. Inditex, (2009) Inditex annual report 2008, annual report 2008, A Coruna: Inditex. Inditex, (2010) Inditex annual report 2008, annual report 2010, A Coruna: Inditex. Inditex, (2011) Inditex annual report 2008, annual report 2011, A Coruna: Inditex. Inditex, (2012) Inditex annual report 2008, annual report 2012, A Coruna: Inditex. Index Mundi, [Online] Available at: http://www.indexmundi.com/commodities/?commodity=cotton Accessed on 20th of February 2014. Unemployment Statistics, [Online] Available at: http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Unemployment_statistics Accessed on 20th February, 2014. Textile and Clothing, [Online] Available at: http://www.companiesandmarkets.com/MarketInsight/Textiles-and-Clothing/Global-Apparel-Industry/NI7468 Accessed on 22nd of February, 2014. The Economics Times, [Online] Available at: http://articles.economictimes.indiatimes.com/2013-04-29/news/38904773_1_brand-massimo-dutti-foreign-investment-promotion-board Accessed on 24th of February, 2014.

The First Amendment And Internet - Free Essay Example

Sample details Pages: 3 Words: 950 Downloads: 3 Date added: 2019/04/26 Category Law Essay Level High school Tags: First Amendment Essay Did you like this example? According to the Constitution, the First Amendment states that Congress shall make no law abridging the freedom of speech (Volokh). This amendment allows citizens to freely express their ideas through written/spoken words and media such as pictures and films. However, at the same time, they are exposed to a wide range of public opinions and views that may come into conflict with their own personal beliefs and cause discomfort. With media becoming more accessible and public, more facts, opinions, and statements can be spread even if they are unpopular or inappropriate. The First Amendment provides independence for the speaker and the audience as well as the entitlement to establish different perspectives on what the individual reads and hears. Despite this freedom, the First Amendment fosters the lack of protection against the dangers and threats that are present online. As the internet becomes more commonly used, it allows anonymity, leaving people vulnerable to the unlimited forms of expression being spread and therefore, it makes it easier for internet trolls to misuse this right and achieve their goal of harassing their target. The First Amendment of free speech raises a lack of and the level of proper authority interference in the social life online. Without firm regulation and policing, it leaves the responsibility of reporting unjust and harmful media posts to the people who come across it. Even if it is reported, the social media platform or the source of authority does not necessarily take the proper actions to confront the problem that is present. Consequently, people have a contradicting attitude toward freedom of speech and government/authority intervention. In other words, citizens wish and demand for freedom, yet they also request for patrol and protection. Thus, the border that lies between: (1) freedom and monitoring and (2) what is considered appropriate or harmful becomes unclear. As a result of this matter, it enables the abuse o f this God-Given freedom. According to Lindy West, these internet trolls weaponiz[e] free speech to maintain cultural dominance. In the view of the fact that the internet allows anonymity, it encourages the trolls, even more, to act as they please. Anonymity functions as an effective mobilizing force for violence (Bailey). For this reason, the internet transforms into a platform for hate speech. In addition to anonymity, the unrestricted and universal use of the internet creates easy targets for the trolls to harass. Likewise, it is advantageous for the internet trolls because they can receive attention and fulfill their desire of causing disturbance/harm to others without exposing their identity. In response to anonymity and the common-use of the internet combined, internet trolling occurs more often. As it becomes more frequent, people start to get used to it or they might pretend to not notice what is happening. When individuals are left with the accountability to filter and protect themselves, it becomes a struggle and pointless effort. By accepting the inevitable, internet trolling not only takes part in the culture of society but also forms a culture itself. According to the research conducted by Monica Anderson, about four-in-ten Americans have experienced online harassment such as physical threats, stalking, sexual harassment, purposeful embarrassment, and etc.. There are over three billion social media users in the world and only 30% of the users have reported the online harassment (Smith and Anderson). Over the course of three years, an estimate of 2.5 million cases have occurred (Buxton and Winters). One notable case of internet trolling, which occurred in 2013, was on Facebook by a man threatening to kill two hundred school children in a mass shooting (Bowcott). These threats were made weeks after the events at Sandy Hook which caused greater panic and fear within the community. The internet troll aimed at the terror and anxiety th at resulted from the Sandy Hook school shooting in order to intensify and feed on the public fear. Another extreme example of internet trolling was the targeting of the deceased. This internet troll posted comments on the tribute pages, mocking the two teenagers that had passed away. One of his victims was a fifteen-year-old girl who died from being hit by a train. He not only posted a comment I fell asleep on the track lolz on the tribute page, but he also made a YouTube video after the victim with her face superimposed on the front of a tank engine (Morris). With the freedom of speech that is granted by the First Amendment, there is less consideration for others and little evidence of self-regulation amongst individuals and their interactions with each other. Thus, self-interest outweighs the consequences and effects of ones actions. Internet trolls can use and twist the concept of freedom to justify their behavior. Although freedom is needed to live life without oppres sion and act/think differently from other individuals, it does not necessarily guarantee safety and happiness. It raises the question of if there is and will be true, complete independence. As former Justice Robert Jackson stated, The price of freedom of speech or of the press is that we must put up with, and even pay for, a good deal of rubbish (United States v.s Ballard). Along with the freedom of speech comes deviance in the form of internet trolling and the lack of sincerity to counter this problem. In conclusion, the common and frequent usage of the internet, which allows anonymity, enables internet trolls to discover targets and harass/threaten them with ease. Through the manipulation of the First Amendment, trolls can defend their actions as proper and continue because of the confidence instilled in them. Therefore, the First Amendment makes it easier for internet trolls to threaten and cause harm to innocent people around the world using the internet. Don’t waste time! Our writers will create an original "The First Amendment And Internet" essay for you Create order