This paper is an in-depth critique of the study by Taufiq (2015) that focuses on wrong time medication administration errors (WTMAE). The selected research is conducted in accordance with the quantitative research approach and presents empirical data related to the prevalence and causes of medical errors. This critique integrates various elements of analysis, including data collection, interpretation, ethical issues, etc.
Title of the Research Report
The title of the study is “Prevalence and causes of wrong time medication administration errors: Experience at a tertiary care hospital in Pakistan”. It identifies the target population of Pakistani as well as the theme of the research. From the title, a reader quickly understands that such variables of WTMAE as occurrence and reasons compose the object of the investigation. However, the type of study is not revealed in the title, yet it is specified in the methodology section.
Problem Statement
Identifying the problem, the author points out that WTMAE significantly threatens patent safety, leading to severe harm or even lethal outcome. In other words, the pertinent background shows that the problem of timely medical administration is somewhat relevant to modern nursing that, in its turn, justifies the initiation of the study and the necessity to explore the topic thoroughly. The problem can be regarded as researchable as necessary data can be easily collected and evaluated by an electronic medication administration record (eMAR).
Conceptual Framework
As a conceptual framework, the author applies descriptive research, mentioning it in the study design section of the article. It seems that the chosen framework is quite applicable to this research as it allows properly supporting the collected data. Providing numerical data, the author explains and interprets it to make the findings clear for both scholars and average readers. Therefore, it is possible to state that the model is developed and comprehensible.
Review of Literature
To back up her study with evidence, Taufiq (2015) considers the articles of different scholars, working in the field of medication administration errors (MAE) and WTMAE. Several relevant databases that include both primary and secondary sources are used to overview the current literature while the classic citations are not used. Critically reviewing the collected literature, the author integrates it into the table format, distinguishing such subheadings as country, setting, method, outcome, and recommendations. Such an approach helps to visualise information that promotes comprehensiveness and logical organisation of the literature review. For example, it is easy to note that there are such countries as the USA, the UK, France, and the Netherlands that makes it possible to conclude that the study has an international nature. The researcher cites both opposing and supporting views, principally focusing on primary sources. The only flaw is that no summary complements the literature review.
Purpose of the Study and Hypothesis
The purpose of the study is indicated explicitly at the very beginning of the study. It can be revealed as follows: To explore the prevalence and causes of WTMAE among patients of a tertiary care university hospital in Pakistan. The declarative statement used by the author seems to be appropriate for the study. Even though there are no research questions or hypotheses, it can be understood from the introduction and literature review that high rates of WTMAE are expected to be discovered. As it was mentioned above, the variables are defined operationally. The descriptive study design supported with quantitative research approach is selected appropriately, fitting to the purpose of the study and its variables. The mentioned study design can be evaluated as a deliberate solution, integrating quantitative data along with its interpretation and further recommendations.
Sample
Taufiq (2015) uses a universal sampling technique to collect medical information from February 10, 2012, to May 9, 2012. The three months is selected according to the probability method that fits the purpose of the research. The study covers the patients of one Pakistan hospital that serves more than 650 000 people. It is clearly stated that the five departments are taken into account, including medical, intensive care, surgical, pediatric, and coronary care units. No inclusion and exclusion criteria are identified. The author indicates no threats to the external validity of the study.
Data Collections Procedures, Instruments, Analysis, and Results
Data collection steps are poorly described as it is just noted that eMAR system is used to collect data that then is transferred to Microsoft Excel. The above instruments as well as SPSS version 19 program and Chi-square test that are used to collect and analyse data seem to be relevant to this study due to their understandable and accurate nature. Meanwhile, these tools are valid and utilised by plenty of studies all over the globe. Although validity terms are not discussed, the description of each of the statistical tools involves the purpose of its application and corresponds to the methodology. The scores of validity are not specified.
The results of the study begin with the statement of the fact that 17 per cent prevalence of WTMAEs is discovered, thus addressing the purpose of the research. Therefore, the characteristics of the sample are not given, and the research question is answered separately. The results are not limited to data reflect as they also involve brief detailing of distinction between day and night shifts, for example. No improper generalisations are detected. The author uses several tables and figures to illustrate her findings that are carefully labelled and mentioned in the text.
Discussion, Recommendations, and Generalisations
The limitation of the study concerns the fact that it can be generalised only to the third-world countries. The researcher undoubtedly relates the findings to the problem and the purpose of the study, claiming that timing errors that are discovered in the course of the research can threaten patient safety. It is also noted that the study supports the literature review as it detects the same tendencies of timing errors. No serendipitous findings are mentioned. There are no generalisations made beyond the study. Based on the results, the author provides valuable recommendations concerning nursing practice and perspective research. In particular, it is recommended that nurses to become more sensitive to on-time medication administration that should be ensured by management. Besides, continuous control and intervallic review of WTMAE through eMAE is necessary. The article lacks recommendations regarding education.
Ethical Issues
The author emphasises that all the information is collected and analysed after the approval of hospital departmental leaders and the Ethical Review Committee (ERC). Such human subjects as anonymity and confidentiality are not presented.
Conclusion
To conclude, it should be noted that the study is essential and relevant to modern nursing needs and standards as it highlights the question of timely medication administration. At this point, eMAE system is a vital means of exploring the theme. In general, the article can be assessed as valid, critical, and contributing to the nursing area. Even though it lacks some elements such as generalisation or detailed description of data collection procedure and sampling, the study is undoubtedly worth turning one’s attention to it. This assignment helps to train analytical skills and understand the organisation of quantitative research.
Reference
Taufiq, S. (2015). Prevalence and causes of wrong time medication administration errors: Experience at a tertiary care hospital in Pakistan. Canadian Journal of Nursing Informatics, 10(1), 1-16.
Procter & Gamble’s Powder Laundry Detergent Compaction
P&G CASE
This recommends the implementation of the North America Compaction Roll Out. In this framework, Powder Laundry Detergent Compaction will be undertaken as well. Mainly, this initiative will lead to substantial market growth and enhanced customer loyalty, which is likely to enhanced profitability over time. It is also targeted at the improvement of business sufficiency.
Background
The sphere of laundry develops with time due to the continuous innovations maintained in various industries. To be distinguished among other businesses, companies, including P&G, need to point out their uniqueness. Thus, the company decided to emphasize compaction. Following global tendencies, P&G started to focus on positive contributions to environmental quality and society. It believes that with the implementation of new compaction, those people will resort to a larger amount of green services and operations. The cleaning product industry is not tightly connected with environmentally friendly changes because it is mainly associated with some chemicals. Thus, with the emphasis on environmental benefits, the company is likely to reach unexpected excellence. What is more, the implementation of detergent compaction is currently seen as a highly valuable offering to clients and positive intervention to professionals because it allows to reduce product price to some degree and to provide more convenient products. Such alteration is required now because the company has existed for almost 20 years already and it has reached the global market, the representatives of which appreciated it so that further improvement can be reached only when resorting to some unusual interventions. In addition to that, P&G has enough experienced employees who can accept a change with a limited course of time and continue to gather different important information. The organization has effective technologies that allow managers to utilize them to provide clients with better services.
Recommendation
As soon as P&G decided to introduce a compacted power laundry, it stopped the provision of products that were manufactured based on the standard formulation. Professionals believed that in this way it would be much easier for them to monitor alterations in human behavior. Still, the price for the product did not change significantly so that everyone had an opportunity to use the laundry. The research study showed that even though P&G provided smaller compaction currently, its advanced qualities allow the representatives of the general public to use for 40 loads just as other standard products of this type. From the very beginning, the company expected a decrease in sales and was getting ready for it. However, it was revealed that people and to give preference to the second option because they emphasize the convenience of the product and its influence on the environment. Thus, at least a 3% increased intake of a new product was offered. Other organizations that operate in the same sphere may try to spend their time to implement this change successfully.
Basis for Recommendation
- The implementation of new cultural approaches that deal with environmentally-friendly transformations allows P&G to attract client’s attention
- Competitive advantage can be obtained with the development of detergents, and P&G is likely to pay back its initiative.
- More powder laundry detergent in smaller and lighter forms expenditures can be reduced, especially operational costs.
- P&G’s products have a stable position in the market regardless of competitors (see Exhibit 1).
Discussion
P&G is likely to obtain the most benefit from the implementation of laundry detergent compaction because it provides a range of benefits for the company and society (see Exhibit 2). For example, it allows the reduction of expenditures but still provides a product that has the same qualities and allows the representatives of the general public to fulfill their needs. As the assessment of P&G’s performance showed, such an approach provides it with the opportunity to increase income and attract clients. It is also environmentally friendly, which allows gathering new customers for whom such characteristic is critical. The increase in income with such an option is not extreme, but even in this way, it provides an opportunity to earn more. Still, it is not clear what should be done if competitors resort to similar alterations.
Another option that can be offered is the opportunity to stick to commonly accepted practices. It means that P&G should not emphasize innovations and should focus on the improvement of existing offerings in a less invasive way. However, many organizations that operate in this market tend to follow such a path, which means that P&G will not be able to differentiate itself from its competitors. The company is not likely to obtain additional income because the resources of the revenue remained the same. All in all, P&G may lose its image and uniqueness if it decides to follow this way.
Finally, it is also possible for P&G to focus on the innovations but not to try to enhance something that has already been created. For instance, it can offer some unique cleaner for carpets. It is expected that the focus on such an innovative idea and provision of a good offering is likely to appeal to the representatives of the general public so that they start buying it. However, the company already has numerous products and can just improve their quality, which will also be less expensive. Otherwise, the development of additional products will increase expenses.
Thus, focusing on three possible options, it can be stated that the most advantageous initiative for the company’s cusses seems to be the first one. It provides a lot of different benefits that are not considered to be vital enough.
Next Steps
P&G has already implemented enormous alterations in the way this business is developed with time. Still, the company believes that it will not only compact powder laundry but also reformulate cleaning compounds completely. It believes that it is possible to use less detergent in comparison to other cleaning powers. P&G also thinks that it may be advantageous to develop products that are targeted at washing machines, etc. However, even though the representatives of the general think about this book and even do not eat in the elevator.
Exhibits
Exhibit 1
Rationale for Recommendation
- The implementation of new cultural approaches that deal with environmentally-friendly transformations is the right thing to do in the current situation. The representatives of the general public tend to pay more attention to those products that are somehow concerned with the issues that are critical for today’s world. In this way, P&G attracted the client’s attention because it revealed its transparency and stated that its clients were free to find out how the company operates.
- Analytics considered the way, in which competitive advantage can be obtained as soon as possible. While standard soaps have been used for numerous years already, nothing unusual could have happened to them. They have already be used from different sides so that it was possible to cope with bathing and soap with time. Still, the first detergent was developed in the 20th century already and the representatives of the general public tend not to worry about them. A detergent sector revealed data that showed that American families have about 600 laundries per year. With the development of the detergent market, penetration increased as well as the amount of the targeted market. As a result, P&G obtained an opportunity to turn into a leading company, with almost a 60% value share of the North American market. In this way, P&G is likely to pay back its initiative.
- Under the influence of retailers and due to the increased customer demand, the company had to consider the opportunity to provide more powder laundry detergent. Trying to enhance product delivery and make it less costly but more streamlined, P&G started to offer the same product in smaller and lighter forms. Soon, the additional alteration was made to appeal to both producers and clients and to reduce transportation costs. With the creation of compacting powder, professionals provided an opportunity to reduce expenditures needed for packing materials and warehousing. The water usage would also improve. All in all, these changes ensure that P&G reduces the number of negative influences made on the environment due to the company’s operations.
- Those products that are provided by P&G turned out to be rather difficult to reach. They are widely used by the individual representatives of the general public and organizations that offer cleaning. The company needs to deal with lots of competitors because they all operate in the same market and have extremely similar components. Still, P&G itself gathers enough revenue so that it is not that vital to have everything ordered.
Exhibit 2
Options Grid
| Option 1 | Option 2 | Option 3 | |
| Description of Option | Implement laundry detergent compaction | Stick to the commonly accepted practices | Add additional product |
| Overall Assessment | Recommend because of increased income, improved image, and high possibility to attract more clients | Do not recommend because of competition created by the existence of numerous similar offerings | Do not recommend it because of existing offerings. The company already has got a lot of products so that new ones will not attract much attention |
| Strategic Fit
(Core Competencies) |
Focus on innovative offerings and superior benefits. This approach allows capitalizing on the company’s strengths, making its weaknesses less critical | Lack of company’s identity. The majority of companies follow the same best practices, which affects differentiation negatively. It will be more difficult for clients to make up their minds and stick to the products of one company | Focus on innovative products. Clients tend to be attracted by innovative items because they associate them with improvement and increased overall benefit |
| Financial Attractiveness | $65million per 10% increase (1-2% per year). First improvements can be observed within the first year of launching this option | No additional income. The company already utilizes this approach, so no significant changes will be observed | Additional expenses for the design and manufacturing of a new product will be needed. Additional assistance can be required |
| Noteworthy Risks | No discussion of competitor’s reaction | Move away from differentiation | No competitive reaction |
Slavery In Different Periods Of American History
Edward Berenson’s textbook “Europe in the Modern World Since 1500”
As transportation networks and technology began to develop, they allowed for fast and efficient shipment of goods anywhere in Europe and across continents. This resulted in a dramatic decline in prices on food and crops, particularly with the arrival of mass shipments from the United States. However, agricultural costs for Europeans remained stable, eventually making it extremely unprofitable for small farmers to grow crops domestically.
Besides, price declines in the industrial sector resulted in low-profit margins and potential losses for companies. Small businesses were focused on artisanal products and lacked mass production capabilities. They could not increase their production to compensate for financial losses or compete with larger firms that had begun to implement mechanized production. Less developed nations in Southern and Eastern Europe experienced a decline of entire national industries, increasing cheap imports to ensure basic survival needs, but failing to support domestic production.
Britain experienced a period of technological stagnation, which led to its factories and equipment becoming outdated, preventing the process of industrialization from making significant progress. Furthermore, Britain lacked a variety of assets needed to compete with the United States and Germany, including natural resources, slowing the process of modernization. Besides, other countries had the advantage of human capital, particularly the United States, whose labor force increased dramatically with the influx of immigrants at this time.
Even Germany, which was experiencing the effects of economic depression along with the rest of Europe, chose to reform its industry and financial sector so that they would become more efficient and specialized and subject to the lowest possible risks. Britain failed to address these issues in its industry sufficiently or capitalize on the advantages the country enjoyed economically and politically.
Economic nationalism increased as prices continued to decline, resulting in countries implementing tariffs and other mandatory policies which were intended to support domestic products by making it difficult to import cheap foreign alternatives. This policy was based on protectionism, which would ideally allow national industries to regain their footing. Large farmers benefited as tariffs were implemented on imported grains. Industrial companies with a domestic market also prospered. However, many specialized industries, such as pharmaceuticals and chemicals, experienced difficulties. Economic nationalism was implemented by most countries and entailed placing tariffs on imports in a retaliatory manner. These steps began to limit international trade severely.
Despite being initially opposed to imperialism, Europe adopted the approach of bringing modern civilization to less developed parts of the world. European societies, filled with nationalistic pride, considered their nations to be superior economically, culturally, and militarily to the peoples they conquered. With the support of significant resources and human capital, Europe was able to colonize the world. The Industrial Revolution created the technology, production capabilities, communication methods, and transportation networks required for conducting large-scale military and economic operations.
Conquest was a method for building empires, which was intended to further increase a country’s power and influence and to gain access to new markets, resources, and goods. There was a shortage of raw materials in Europe needed for rapid industrialization, with the result that the mostly undeveloped lands in other parts of the world were seen as an opportunity to acquire cheap resources. Imperialism as a whole was an economic endeavor that attempted to stabilize the supply-demand balance in Europe, while each country wanted to ensure access to new markets and trade routes.
European policies and the administration of colonies allowed for the creation and adoption of new governing practices. For example, Britain created the concept of civil service in India based on indigenous practices regarding tax collection and judicial procedure, which was later implemented domestically. Other aspects, such as food management during crises and fingerprinting techniques in criminal investigations, were developed through colonization.
European powers gained military experience and developed new tactics, particularly for suppressing uprisings and resisting guerrilla warfare. There were cultural changes as colonialism created a flow of foreign traditions and goods that were considered exotic, thus attracting public interest and further glorifying the “heroism” of the colonists. This aspect of colonialism was commercialized by many enterprises, leading to the creation of a whole movement in journalism and products that sought to take advantage of the public interest in colonial life.
Germany was strategically in a very weak position. Most of its allies, such as Austria-Hungary and the Ottoman Empire, had been defeated, leaving Germany alone on the Western Front. Any attempts at counter-attacking failed, as Germany was now faced with fighting fresh American troops arriving in Europe in large numbers. The war of attrition that Germany had attempted to fight to this point ultimately proved to be a failed strategy.
Allied forces supported by the US began to utilize innovative technology and weapons that further put Germany at a disadvantage. Meanwhile, Germany was experiencing numerous domestic socio-political issues. The war devastated the country, causing a famine that was exacerbated by the Allied blockade. Military morale was extremely low, resulting in mutiny and desertion. The German people openly protested the war, and there were political disagreements between the military dictatorship and civilian leaders about Germany’s further participation in the war. The Kaiser refused any participation in peace negotiations, as he saw them as destructive for the country, but he ultimately failed to consider the national attitude towards the war.
Cabet’s Voyage to Icaria of 1842
Public health and safety are heavily emphasized in Cabet’s description of Icaria. The air is circulated and decontaminated if required. There are no cemeteries, chemical production facilities, or hospitals within city limits that can contaminate the air. The streets are kept clean, preventing the accumulation of trash, dust, and mud. Animal control is strict within the city to limit waste and accidents. Transportation is strictly regulated to prevent waste and ensure pedestrian safety. Cross-walks and intersections are constructed with pedestrian precautions in mind. Sidewalks are covered to protect from the weather while not blocking out the light. Overall, the city is well illuminated, and its urban design focuses on public health and well-being.
Cabet described the city as circular and divided into two parts by a river, which has been artificially deepened to allow in shipping vessels. The river splits again to form an island in the middle of the city with a large palace, monuments, and wharves. The city is divided into blocks which are formed by 50 streets crossing both parallel and perpendicular to the river. Housing is equal on all blocks, with public and commercial infrastructure distributed equitably throughout the city.
Public buildings are located in streets surrounded by houses, which are designed to form an exterior residential section. Paved streets contain tracks going in both directions to accommodate an efficient transportation network. Individual streets are designated for the movement of cargo. The citizens openly discuss and decide how the city should be built based on the analysis of current large urban centers. All infrastructure would be focused on public use and comfort. There would be no aristocratic residences or institutions.
Commerce is merged so that each industry has shops that are aesthetically pleasing and have anything a person could want. It would be pleasant to visit these stores and purchase artisanal crafts and goods produced by the city. Monuments and museums of considerable size would be typical in the city. Cultural objects such as paintings and sculptures will be available to the public, openly displayed and not hidden away like in other cities. Promenades and public gardens will be open for recreational and artistic use. The city would have various public recreational and cultural infrastructures such as arenas and theaters. Common institutions such as schools, hostels, and temples would be supported as places of the popular assembly.
Places of public indecency such as cabarets, roadhouses, smoking joints, or gambling facilities would not exist in the city. Even places such as stock exchange, prisons, or barracks would not be present. There would not be offensive behavior such as prostitution, thieving, or drinking. Toilets would be established around the city and kept clean. Graffiti and insulting vandalism would not be tolerated, and children would be trained to reject anything indecent and inappropriate. Commercial advertising and posters would not be allowed to maintain the aesthetic appearance of the buildings. Specially designated bulletin boards would be ornamentally installed throughout the city to relay any announcements.
Karl Marx “The American Civil War”
The export of slavery to new territories provided prospectives for advancement for poor whites. The slaveholding oligarchy of the South sought to maintain their support through the promise of new land and the potential to become slave owners in the future. Furthermore, the Republican party sought to legally limit the spread of slavery to new territories. In the long run, it would put the territories under Northern influence, leaving the Southern states as a minority coalition in Congress. Despite not owning slaves, most poor whites followed the Southern political ideology and sought to protect the economic survival of their states.
Southern slave owners consistently sought to expand the practice of slavery (and therefore political influence) over new territories, including foreign lands. Buchanan was elected with the priority to establish control over Cuba by any means possible. Northern Mexican lands were divided by land speculators. Meanwhile, filibusters traveled to Central America on direct orders from the White House. The scheme for this international expansion was based directly on the alliance between the South and Northern Democrats.
The Union government secretly maintained the stance of legalizing and reopening the slave trade since it was exponentially growing despite laws against it. Under pressure from the South, US foreign policy sought to expand the country’s borders with the introduction of slavery into more territories.
The Kansas crisis that was a result of an alliance between Southern slaveholders and the Northern Democrats resulted in a widely popular anti-slavery Republican Party. The Northern Democrats, realizing the loss of public support, took a different approach by making the introduction of slavery dependent on the will of settlers in the territories. The South meanwhile maintained the Constitutional approach and wanted to force slavery onto territories with the support of Northern Democrats, similar to what was done in Kansas. However, Democrats were rapidly losing political power to the rising Republic party and were unable to satisfy the Southern ambitions.
Meanwhile, the territories were antagonized by the constant change in-laws and Southern attempts to force slavery onto their societies. The South only saw the Union as valuable if slavery powers were relinquished on a federal level, which was unlikely to happen. The Democrats stopped supporting slavery, and after Lincoln was elected, it was the perfect opportunity and excuse for the South to secede.
The initial Missouri Compromise, which banned slavery north of the 36th parallel, was continuously challenged politically and judicially. Slave owners had close connections to the Northern Democrats who were in power at the time. Stephen Douglas proposed the Kansas-Nebraska Act in 1854, which sought to repeal the slavery clause of the Missouri Compromise. In this way, the concept of slavery was made equivalent to freedom and therefore would have to be recognized as a sovereign right of the people. Settlers could vote whether to enable slavery in their state, eventually resulting in New Mexico becoming a slave territory. Any geographical limits to slave ownership were removed.
However, after failure in other territories, the South sought to judicially challenge any slave regulations in the Supreme Court. Since the majority of the judges were siding with the South, it was an effective solution. The 1857 Dred Scott case recognized that American citizens could take any property with them across territories. Since slaves were constitutionally recognized as property, the South utilized a legal loophole to introduce slavery into the territories, despite the majority of settlers being opposed. This helped further the political influence of the South over the Western territories.