Tele Health And Tele Care Health Health And Social Care Essay

Tele Health And Tele Care Health Health And Social Care Essay Telehealth and Telecare are both advocated as a means of delivering social health and services effectively and economically in peoples home. By using these two technologies, monitoring activities and safety, providing virtual home visiting, and activating reminder system can be done quickly. Therefore, most of the consumers are elderly people .This paper compares Telehealth and Telecare technologies and highlights the popularity of each technology. The literature review of the paper has focused on defining each technology and looking to the users satisfaction from each technology. The SWOT analysis has been used to demonstrate the strength, weakness, opportunities and threats of each technology. To find the popularity of each technology some questionnaire forms has been used which distributed between 40 elderly people of Toronto by random. The results show that people between ages 66-75 are the highest consumers of telehealth and telecare and more satisfied. The overall analysis show ed that telecare satisfaction percentage is higher than telehealth satisfaction percentage however it is recommended for more advertisement for telecare products due to facing lots of people who were unfamiliar with telecare products. Future recommended research is an investigation on elderly and telehealth and telecare technology and focusing on telecare and telehealth interactions and requirements. INTRODUCTION 1.1- Introduction During the past few years there have been growths in possibilities of technical developments in smart environments. Developing the life quality for young, elderly and disabled people has become more and more vital task for todays societies all around the world. What is a smart home? According to the (Smart home, 2009) The terms smart homes, intelligent homes, home networking have been used for more than a decade to introduce the concept of networking devices and equipment in the house. According to the Smart Homes Association the best definition of smart home technology is: the integration of technology and services through home networking for a better quality of living Other terms that are related to smart homes are aware house changeable home, attentive house and ambient intelligence These terms are used to emphasize that the home environment should be able to respond and modify itself continuously according to its diverse residents and their changeable needs According to (Allen, 2001) Assistive technologies (AT) which can be known as a branch of Smart homes is applied to any kind of system or device, which has been designed to help disabled or elderly to overcome their individual disabilities. In other word Assistive technologies are broad range of devices and services that are designed to increase the functional abilities of disabled people. Assistive technology enables disabled and elderly people to become independent and participate more actively in their daily life. Telecare and Telehealth are two effective extensions of smart home technology as the concern is to use of technology to monitor the health of the users. Both telecare and telehealth systems rely on telephone lines or broadband internet as means of transferring information from the source which can be house to the receiver who maybe a doctor or a nurse. 1.2 -Background Telehealth, which is a part of information and communication technologies introduced for delivering health care services and it is considered as a way to answer lots of essential changing in healthcare systems in current years. Many of telehealth projects are taking place to targeting countryside and remote the population. So far, different kinds of telehealth applications have been implemented in developing countries and have shown the outcomes. However telehealth technologies have increased the availability of technology and telecommunication around the world. As (Gagnon et al , 2006) argue in their research, the execution of telehealth still faces major barriers, typically barriers related to structural, organizational and finally professional imperatives. Furthermore the structural barriers related to licensure, information technology developments and settlement of telehealth. Also, issues about health care organizations are also important to ensure the telehealth adoption. More over the adoption of telehealth technology by an individual is considered to be difficult which is determined by a large set of physical factors. According to (Perry et al, 2009) Telecare also is a part of telecommunication and technology which can provide care and support people in their homes. There are three kinds of people who can benefit most from telecare service, elderly people, disabled and those with mobility impairments. The use of this technology is determined to reduce the inappropriate or unnecessary admissions to the hospital especially for falls or any kind of accidents at home. To increase the benefits of telecare, it is necessary to know the opinion of the users about this technology. As (Crump, 2010) discusses, telecare services provide opportunities for technology to replace people in some roles. Although it is a rapid and effective technology for supporting services but it is necessary to have some training before using this technology. In other word this technology can be useful only if you know how to use it correctly otherwise it could be harmful. According to Nation health executive (NHE, 2006), by increasing an ageing population and prevalence of chronic disease a challenge for the management and integration of health care is growing. The need for new care models and new technologies for long term illness is more visible and clinical partnerships and networks supports the care strategies within home Environment. Therefore emerging telecare and telehealth have the potential to enable long term medical care in peoples own homes. Many studies indicate that telecare and telehealth technology has a positive effect on the clinical outcomes, user independencies, reduction in emergency visits and lower admission to hospital. However there is a lack of evidence to execute that these two technologies are cost effective-whilst there is a belief about assistive technologies exists that they should help to reduce costs in long terms and supports for faced problems. 1.3- Research The main focus of this research is to comparing telecare and telehealth and their consequences in medical business. The aim of this paper is to find out the popularity of these two technologies between elderly and finding their good and bad consequences on people, society and business. According to ( Sixsmith ,2000) Many people in the field trial reported enhanced feelings of safety and security, which could help to stimulate independence and help them to remain living in their own homes The monitoring system increased the care choices available to elderly people and supported and enhanced the cares role Technical perspective of telehealth and telecare concerns the use and development of ICT based systems. The marketplace of these technologies continues to see rapid developments. Therefore telecare and telehealth can make a real difference to the lives of elderly and disabled people. In this research the author is going to define telehealth and telecare separately and talking about the advantages and disadvantages of each of these two technologies as well as cost analysis of them due to the several studies over the years executes that these two systems achieved a considerable cost saving. Furthermore telecare and telehealth satisfaction is going to evaluate. 1.4- Research Aim and objectives The major significance of this study is to probe deeply in to the comments and analysis of several authors conducting their research in the subject of telecare and telehealth, to identify evidence of advantage or flaws and weaknesses that may or may not exist in the present exploitation of the services and related devices technology as well as evaluating the comments of elderly about telecare and telehealth, and finally evaluating the telecare and telehealth satisfaction between elderly. Therefore, the major objectives of these investigations are: * To provide necessary response to questions arising from the comparisons between telecare and telehealth. * To evaluate the popularity of telecare and telehealth between elderly and possible flow that may or may not exist in the present use of telecare and telehealth * To criticize and analyze the results. * To make some recommendation for future development of telecare and telehealth REVIEW OF LITERATURE Telecare and Telehealth ; as a part of the collection smart home play a major role in the comfort and quality of life of all people. This role is even more important when these technologies and services are contributed to a special group called elderly. (BBC news, 2008) produces program about chronic disease patients and elderly to use telehealth and telecare products at home and monitor their health by mobile phones. As declared in (BBC , 2008) Patients with high blood pressure and chronic lung disease will be initially recruited to test new technology that allows them to measure their blood pressure,and oxygen levels at homeThe readings will be sent via mobile phone into a central computer and collated into an online health record that can be accessed by both the patient and their GP. As BBC announced ; it is expected that project of telehealth and telecare to be expanded between 1500 patients by 2012. However the question is that how well do elderly people know these products? 2.2 -What is meant by Telehealth? As American (telecare, 2009) argues Telehealth is a revolutionary medical tool that affordably expands and improves health care services for patients regardless of age, race, gender or economic status Generally Elderly patients living in remote areas and individuals suffering from a chronic disease are best suited for telehealth services In another word telehealth plays an integral role in the management of long-term conditions. As healthcare professionals begin their health services from pilot to mainstream provision your telehealth partner must help you step by step to go through the transition. These services are usually provided when a Tunstall telehealth projects is started. Tunstall is a founder member of the continua health Alliance. Their policy of ongoing development means that products specification and appearance could change without prior notice. In general, telehealth is general term that includes many various activities. Many of components of telehealth integrated have been presented in the Telehealth Pyramid (figure 2.1). Figure 2.2.1 The Telehealth pyramid, ( Elford , 2004) Although all parts of the pyramid should be coordinated to gain the best result, each section could exist independently. On the basis of past successful telehealth experience, the components of telehealth should be placed in one physical center. In Figure 2.2.1 which has illustrated Telehealth levels in Health care system of USA, various parts of the pyramid will be delineated from the bottom to top. The size of each section could hardly present the number of people involved. The base section is 1-800 health call center. This center is active day and night for 24 hours, 7 days a week. The staff working in this section includes: health professionals, for most parts nurses. When clients call in , the staff would respond major health questions, assist patients with minor health problems and if needed guide the patient to the proper healthcare resource. The next layer (Medical Data and Telemetry call center). Has been set up similar to 1-800 call center, however in spite of receiving telephone calls, would also receive telemetry and medical information such as: blood pressure, EKG, Blood sugar and other types of blood chemistry, weight and pulmonary function test. This information could be sent on a daily basis or upon urgent request. The next section, Internet Health Information and Education provides health information websites for healthcare professional and patients. The patients website includes information on different topics, response to common health questions to choice of e-mailing a health professional on a special health problem, chatting with groups for the patients with special conditions. The health professional website has more complete information for various health conditions and provides access to the health education endeavors. The Tele-education layer is using all the telecommunication technologies and information to provide health education for both patient and health professionals. Some of the website functions of the former level could be used in this section. According to (Elford ,2004) The next layer includes Teleconsultation, Telenursing and Telehome care. Teleconsultation is defined as the provision of any medical services occurring between physician and patient such as: Telepsychiatry, Teledermotology, and Tele ENT All activities mentioned involve a health professional providing a health service a patient. Finally the last layer of pyramid (administrative center, research unit and training center) includes a number of key components that are crucial for the proper operation and long term maintenance of the telehealth. This center would manage and coordinate the following endeavors: a research unit will help in the design implementation and evaluation of telehealth project s and could also be involve d in technical test projects or evaluation. At last, a curriculum in Telehealth and a place for hands on training could be providing for the students. ( Elford ,2004) believes that Professionals (physicians, nurses, technicians) can also take non-credit courses could also take non-credit courses for education or training. Some organizations such as (Department of National Defense) contracting the training center, could provide health training to their personnel. Whilst the telehealth pyramid of NHS (national health center) , which belongs to the UK , shows using telehealth at three levels. Looking through the pyramid from bottom to top will show that 70 -80 % of the population are supported self-care which is possible by web based- tools, and self monitoring. At the second level which is high risk disease, some home monitoring is possible but the availability of doctors and nurses are necessary at this case. And finally at the third level of the NHS telehealth pyramid , because of the highly complex case management , home monitoring of patient, using assistive technology and computerized decision support system can be using all together. Figure 2.2.2 , NHS Pyramid , (Procter , Azarmina , 2007) Telehealth can connect people with one another and by various health organizations as follow: * Wireless mobile devices According to (Hinz ,2010), wireless mobile devices in this study will only be utilized in the context of healthcare. these devices include: consumer mobile phones, medical devices that work in the next generation of consumer mobile phone, and medical devices operates within a home premise and can transmit information through land-line , mobile phone or internet. * Basic mobile phones According to Hinz ,(2010) over the last ten years, the most accepted technology in day to day communication is the mobile phone. Even the most outdated mobile phone can make and receive both calls and text-messages .text messages and specially 3G mobile internets is a suitable media for the health system when we try to connect to patients. Also the appointment reminder alert is a very valuable tool. * Remote care clinical devices (Remote medical care, 2010) argues that In relation to vital signs, medical devices are different in size and complexity and the interaction with ill people. Many of these medical devices have software that could operate as a PC and mobile phone. High performance semiconductor chips which are highly integrated will expand personal medical devices. Whether these devices are a blood glucose meter, digital blood pressure meter, blood gas meter, digital plus/heart rate monitor or a digital thermometer are five system level blocks that are common for each device: * Power battery management * Data processing and control * Amplification and A/D conversation of the sensor input * Some type of Display * The sensor element(s) itself These devices are controlled by a handle, which are activated by battery power and using different biosensors and take measurements. The real performance topology of these blocks is quite different with the sensing, processing and information display demands of the type of meter and the chronic condition it measures. 2.2.1 -Telehealth satisfaction As (Ellis,2009) argued patient satisfaction influences on patients values and expectations from telehealth services therefore by measuring telehealth satisfaction more information and more positive and negative affect will be gained. On the other hand according (Ellis, 2009) the researches on patients satisfaction about quality of interactions and telehealth services are pretty low therefore there is more requires going in depth of this topic. According to the (Clinical evaluation, 2008) which evaluated the telehealth satisfaction from different aspects, most of the users of telehealth were between the ages of 65 to 80. The Pie chart in appendix 2 shows the age dividing in detail. The overall satisfaction level with Telehealth experience shows that 85 % of the users are very satisfied from this technology where only 15 % were satisfied and no one were not satisfied of it. The details of users satisfaction is shown in the pie chart in appendix 3. On the other hand the evaluation shows only 5% of people were disagree about the cost saving of Telehealth whilst 95% were agree about the cost saving. Appendix 4 shows the pie chart of the agreement and disagreement. 2.2.2 Consequences of Telehealth for the patients * Immediate utilization of care specifically for the patient who live in rural environments. * Patients receive care and health from a distance and do not have to go to doctors office to receive attention from their health provider. * Early detection to reduce emergency room visits and hospitalizations * To discharge early from hospital * Patient and family can have access to care from the comfort of their home. * Patients anxiety is reduced. * Increased conformity and ownership to their individual health care plan * Old patients can stay independent rather than going in to assisted living situation * Patients feel thesaurus to take part in their care program. * Increased patients satisfaction in received care In general Telehealth is a very effective tool to handle patients that need the most care and attract the most cost, especially patients with chronic and terminal conditions. The following patient conditions were successful with Telehealth program: 1- Chronic disease which includes: * HIV Aids * Cancer * Asthma * Diabetes * Congestive heart failure 2- Elderly patient cares which includes: * Post stroke * Therapies * Post operative states * Medical compliance 3- General care which includes * High risk pregnancy * Wound care The Telehealth advantage for healthcare providers, administrators and institutions are: * It can improve quality of care and clinical outcome * It can increase productivity for healthcare provider * It is a cost saving method that can advance profitability and business growth There are also some other advantages for doctors and nurses can schedule for patient visits without leaving the office. In this way productivity of the number of patients that can be visited per day could increase. Clinicians can expand their office geographically. Patients can be visited regularly. Healthcare will be able to spend more time with patients and can monitor and regulate their patients care better. Healthcare providers have the advantage of attracting managed care contracts and also will be able to manage cost effective service. (Darkins and Cary, 2000) believe that since healthcare expenses are rising, providers while maintaining good quality care and patients satisfaction .lower their costs. The related technologies help providers to produce their own effective healthcare by maximizing their human and capital resource. 2.3 -What is meant by Telecare? Telecare is to monitor a patients real-time emergencies and his life style changes from a distance in order to manage the risks associated with independent living. Telecare is needed since: As (Camarinha-Matos, Afsarmanesh, 2004) argue It is a highly flexible tool which can be employed by the needs of new users. This technology can be utilized in learning disabilities, physical disabilities and mental health. Telecare can contribute to independent living and quality of life for people and their family significantly. (Tunstall , 2007) believes that The major activity of Telecare services is to manage Telecare assets more effective to guarantee that service remain more productive. According to (Tunestall ,2007) Telecare overlay has been developed to allow the effective implementation of radio Telecare sensors into supported housing communities It enables the monitoring of wandering and bed occupancy as well as environmental issues such as smoke, flood and gas within a sheltered setting (Tunstall, 2007) also argues that the telecare overlay system includes a telecare manager unit and a radio receiver, this equipment is added to the existing communicable vision system and enables staff using a variety of sensors receive alarm calls. These receivers are located around scheme. When a receiver receives the radio signals of a sensor, it will be forwarded to the communicational vision system and then raises the alarm call on the handset carried by onsite staff. Therefore, the onsite staff will be able to talk to the resident. The system can alternately sound on alarm at the responding center. According to James Buckley, the chief executive officer of Telecare times in (Tunstall , 2007) , Telecare will make the cares able to go back to their work, will promote these services to more number of audience, and support people who have learning disabilities. In another word Telecare describes any services that bring health and social care directly to a user, generally in their homes, supported by information and communication technology. It covers social alarms, lifestyle monitoring and Telehealth (remote monitoring of UTIA signs) for diagnosis, assessment and prevention. Telecare covers a wide range of equipment (detectors, monitors alarms, pendants and etc) and also services for monitoring call centers and response. ( Camarinha-Matos , Afsarmanesh ,2004) believes that In the UK Telecare alarms acts as a mediator through call center, however in the US you are able to purchase devices that connects directly to emergency response services. The sample lists of Telecare devices are include: * Safety confirmation phones * Movement /non-movement sensors * Fire/smoke alarms * Food / water alarms * Window/door sensor * Bed/ chair occupancy sensor * Falls sensor * Wrist worn wellbeing monitors * Automatic lighting sensor * Carbon monoxide sensor * Temperature range sensor * Medication reminder sensor 1- Devices for predicting problem: This prediction depends on software that receives signals from sensor and analyses the frequency and severity of monitored event such as minor falls. 2- Devices that reduce the chance if problems occurring: For example a bad sensor can prevent falls by turning a light on when a person gets out of bed. This helps because does not need to move around and search for the light switch in the dark room. if the person does not return to bed it can raise an alarm. If the helps received quickly, problems do not rise. 3- Devices that mitigate harm These devices send an alert signal to a call center, therefore, a help can arrive quickly before harm is done .an extreme temperature device is activated when the temperature rises quickly or reaches a low point . 4- Personal safety confirmation: (Camarinha-Matos , Afsarmanesh ,2004) argues that The owner of this phone based device pushes a bottom on an agreed time everyday to inform the call center that they are well and alive. This considered as an alternative for independent people who are not interested in wearing a pendant alarm button or those who may fall and become unconscious and cannot pull an alert themselves. 2.3.1- Telecare satisfaction There were two types of telecare units that were developed. One of them is based on pc setup and video conferencing and another one off- the- shelf video conferencing units. According to (Guillen et al , 2002) there is high satisfaction for the patients who used telecare devices also the medical staff were satisfied due to the improvement in quality of health services. The result of their research shows that medical staffs believe that telecare system is a trustworthy system for patients and there is low risk for patients while using telecare system. However there are more researches needs to be done in this area because of the short duration of previous experiments. 2.3.2-Consequences of Telecare * It can help to maintain independence for people * Safety and confidence could be increased * It could support careers along with traditional healthcare support and housing initiatives. * It could ease the transfer from traditional models of residential care to supporting people at home. The pressure on the NHS can be reduced the environmental risks such as fire, flooding, carbon monoxide , natural gas , high and low temperatures and personal risks such as wandering , falling , inactivity , burglary , bogus callers and many more could protect users. (Camarinha-Matos , Afsarmanesh ,2004) * According to the (department of health ,2010) Telecare could prevent 160.000 people from entering residential care per year, indicating potential cost saving of 20 Billion pound . 2.4 -Comparison of Telecare and Telehealth A high increment in the cost of care or nursing homes is the main reason of inventing new methods of supporting people in their homes. Since according to (Doughty et al ,2007,p.6) the dependency ratio which is defined as( number of working people to those who are retired) is about to fall from 4:1 to 2.1:1 in the next 40 years, so the demands for the care services will increase and services that are based on technologies can replace. (According to Doughty et al ,2007, p.7) The term telecare was selected to cover all electronic technologies of a preventive or supportive nature because it had the necessary buzz and because it implied a modular approach and a need for a developing telecommunications infrastructure As (Doughty et al, 2007, p.7) argued Although the fundamental purpose of the technology is to avoid unscheduled care incidents and, in particular, the management of long-term conditions, it can support Independence because it is capable of overcoming the need for people to move prematurely into a nursing home environment Such technology would appear to be a medical application of telecare, which would be consistent with the new definition of telecare described above However, remote and regular (but not continuous) vital signs monitoring may be fundamentally different to existing UK telecare systems because the purpose is to collect data rather than offer an automated alarm Whilst in the USA, the remote vital signs monitoring system are known as telehealth. The term of telehealth in the Europe has been the Umbrella term which is used for grate range of technologies which includes telemedicine as well. The telehealth and telecare umbrella model will show the alternatives for adoption or rejection. As the figure 2.4.1 shows there are three components of telehealth exist which shows a growing range of assistive technologies. Also there are some disabled facilities has covered .covering number of comparatively expensive fixed assistive technologies like level access showers can be known as effective versions. However consequent removal while the service user moves on is more difficult with the result that the venture is left in the property. This means that following architects to follow the lifetime homes and using free access for the standards is necessary. Telehealth somehow has higher weight than telecare because health is necessary for everyone but maybe not everyone need care. Figure 2.4.1 Telehealth Umbrella model (Doughty et al ,2007, p.9) As figure 2.4.2 shows telecare is term which is used for all defensive technologies which are using electronics, telecommunication and information system. Thats why they can cover some applications such as alarms through monitoring the vital signs either in the home or on the move thus when a term such as Telehealth covers all forms of information and medical monitoring then the advanced form which is telecare could be expanded from environmental to medical areas. In another word According to (Doughty et al ,2007,p.8) the use of community / social alarm system to support independent living as a form of telecare was both a consequence of change in community care but also it produced a valuable service that did not have doctors and nurses as the gatekeeper Figure 2.4.2 umbrella model of telecare (Doughty et al ,2007,p.9) 2.5 -Impact of telecare and telehealth on cost saving There are lots of comparative studies in telehealth and telecare which demonstrate the economic benefits of these technologies. These studies show that improved access to suitable healthcare services, increased patients satisfaction and cost savings. Many of pre- reviewed researches consistent in finding that telehealth and telecare saves the patients, providers and payers money in compare of traditional healthcare system. According to (Jennett et al, 2003), Cost saving of telehealth services can be done by reduction in use of hospitals, nursing home services and transport costs. In other word reduction in transporting patients to emergency departments and therefore to physician offices will cause a reduction in cost of emergency department visits. 4.5- SWOT Analysis Since in primary data , the author couldnt noticed the presented data completely relevant to the research questions and couldnt answer all the objectives of the research therefore she decided to do the SWOT analysis .SWOT Analysis is a kind of evaluation by defining the Strengths, weakness, opportunities and threats of the defined subject. 4.5.1- Telehealth SWOT Analysis The SWOT analysis of telehealth is focusing on what the strength of the telehealth are, what can be known as the weaknesses, what opportunities telehealth has and finally what are the threats o

lighthod The Nigger in Joseph Conrads Heart of Darkness :: Heart Darkness essays

The Nigger and The Heart of Darkness    â€Å"The Heart of Darkness,† by Joseph Conrad was written in 1898 and 1899 and published in 1902.   So, although it wasn’t surprising that the word used to describe a black person was nigger, it was insulting just the same.   Throughout the short story I had to remind myself of the time period it was written. Joseph Conrad is nothing short of a genius.   His writing technique is eloquent, and surreal and yet after having completed â€Å"The Heart of Darkness,† I couldn’t help feeling a little insulted by the oft used word nigger.   My feelings lead me to do a little research on this word nigger.   I checked three dictionaries:   (1) the â€Å"Oxford Concise Dictionary,† (2) the â€Å"Webster’s Ninth New Collegiate Dictionary,† and (3) â€Å"The American Heritage Dictionary.†Ã‚   They all had in common one definition, â€Å"a member of any dark-skinned race.†Ã‚   In addition, they all said it was â€Å"offensive.†Ã‚   Webster’s went one further and said â€Å"a member of a socially disadvantaged class of persons.†Ã‚   Now this last definition was closer to what my parents had told me the meaning of the word nigger was, an ignorant person.   I tend to like my parents’ definition much better than all the r est combined! The word nigger is actually derived from the Latin word niger which means black.   Okay, so we’re getting closer to understanding now.   So why all the controversy surrounding this word?   I even have to wonder if â€Å"The Heart of Darkness† was written by a black author would I have been equally or less offended?   This word nigger was recently the cause of a controversy between two very prominent directors, Spike Lee (black) and Quentin Tarantino (white), in regards to Tarantino’s new movie â€Å"Jackie Brown.†Ã‚   Lee felt Tarantino used the word nigger too many times in his movie and considered it a racist act.   I’m not sure, but I believe Lee too has overused the word in his movies and yet he publicly cries foul when Tarantino does the same thing.   What makes blacks so offended by whites using the word nigger when they use if themselves? The main reason touted is because some blacks use it (and I mean use it often) as a term of endearment.   Then there are some blacks (usually the upper crust) who use the word as an insult, as in Webster, as a description of a low class black person.

Plot of Playboy of Western World

Plot Summary. †¦Ã¢â‚¬ ¦. It is an autumn evening along the Irish coast in County Mayo. Shawn Keough stops at Michael James Flaherty’s country pub to visit Flaherty’s daughter, Margaret, called Pegeen Mike by her family and friends. Keough, a fat young fellow devoid of wit or talent, means to marry pretty Pegeen, a spirited colleen of twenty who is minding the tavern in her father’s absence. But she entertains no fancy for Shawn. When he pesters her about the â€Å"good bargain† she would have in becoming his wife, she tells him to stop tormenting her while she is doing her job. †¦Ã¢â‚¬ ¦. Her father enters with Philly Cullen and Jimmy Farrell.They are on their way to Kate Cassidy’s wake. Flaherty and his friends enjoy wakes, which are among the few lively activities in the Mayo countryside, and they generally stay for the whole night to watch the corpse while imbibing spiritous glee. †¦Ã¢â‚¬ ¦. Pegeen is upset about having to tend the pub alone. After all, who knows what evildoer might steal in from the shadows to set upon her. She complains, â€Å"It's a queer father'd be leaving me lonesome these twelve hours of dark, and I piling the turf [peat] with the dogs barking, and the calves mooing, and my own teeth rattling with the fear. †¦Ã¢â‚¬ ¦. When Flaherty suggests that Keough keep her company, Shawn begs off, saying he would incur the wrath of Father Reilly for staying alone with her the whole night. By and by, a slight young fellow named Christy Mahon stumbles in, tired and dirty, and asks for a glass of porter. When he inquires whether the police frequent the establishment, Michael Flaherty thinks he might be on the run. Flaherty and his friends question Christy. Did he commit larceny? Did he stalk a young girl? Did he fail to pay his rent? Is he a counterfeiter? Does he have three wives? †¦Ã¢â‚¬ ¦.Christy, who speaks in a wee voice, says he is the son of a well-to-do farmer and therefore has no need of money. And, says he, he is a decent fellow who would never do wrong to a woman. When Flaherty and the others continue to pump Christy, Pegeen comes to his defense: â€Å"You did nothing at all. A soft lad the like of you wouldn't slit the windpipe of a screeching sow. † But Christy balks at that observation, as if she had accused him of not being man enough to commit a crime. Then he reveals that he is indeed on the run, for he has killed his father, who was â€Å"getting old and crusty, the way I couldn't put p with him at all. † †¦Ã¢â‚¬ ¦. Flaherty, intrigued, motions for Pegeen to refill Christy's glass, then asks Christy how he did the deed. Christy says, â€Å"I just riz [raised] the loy [club] and let fall the edge of it on the ridge of his skull, and he went down at my feet like an empty sack, and never let a grunt or groan from him at all. † †¦Ã¢â‚¬ ¦. After he buried him, he hit the road, walking for eleven days, â€Å"facing hog, dog , or divil. . . .† Jimmy Farrell praises him for his bravery, and Pegeen joins in: â€Å"It's the truth they're saying, and if I'd that lad in the house, I wouldn't be fearing the . . . ut-throats, or the walking dead. † Christy Proud †¦Ã¢â‚¬ ¦. Christy swells with pride, and Flaherty offers him a job in the tavern. Keough objects, but Pegeen silences him. Christy, feeling safe and welcome, decides to stay at least for the night. Jimmy Farrell says, â€Å"Now, by the grace of God, herself [Pegeen] will be safe this night, with a man killed his father holding danger from the door, and let you come on, Michael James, or they'll have the best stuff drunk at the wake. † †¦Ã¢â‚¬ ¦. After Flaherty, Farrell, and Philly Cullen leave, Shawn Keough—jealous—offers to stay with Pegeen, but she pushes him out the door and bolts it.Pegeen now has a brave man, a hero, to protect her, and she and Christy warm to each other, exchanging compliments about th eir looks and other qualities. †¦Ã¢â‚¬ ¦. Meanwhile, the Widow Quin, a woman of about thirty, stops by after hearing from Keough about Pegeen’s visitor. Widow Quin is locally famous for reportedly having murdered her husband. Eyeing Christy, she says, â€Å"Well, aren't you a little smiling fellow? It should have been great and bitter torments did rouse your spirits to a deed of blood. † †¦Ã¢â‚¬ ¦. She wants to take Christy with her to her place.Pegeen tells Christy that the widow killed her husband â€Å"with a worn pick, and the rusted poison did corrode his blood the way he never overed [got over] it, and died after. That was a sneaky kind of murder did win small glory with the boys itself. † Mrs. Quin retorts that a woman who has buried her children and murdered her husband is a better match for Christy than a girl the like of Pegeen. But Pegeen fends her off, for she is determined to keep Christy for herself. †¦Ã¢â‚¬ ¦. In the morning, three village girls—Sara Tansey, Susan Brady, and Honor Blake—come by the tavern with gifts for the brave man that killed his father.Sara has duck eggs, Susan has butter, and Honor has cake. Widow Quin enters after them, saying she has registered Christy in a local athletic competition featuring racing, leaping, and pitching. At the women’s prompting, Christy tells his murder story. †¦Ã¢â‚¬ ¦. He first points out that his father tried to make him marry the Widow Casey, a 45-year-old â€Å"walking terror† who weighed 205 pounds, had a bad leg and a blind eye, pursued both young and old men, and suckled him after he was born. When he refused to marry her, his father swung at him with his scythe. â€Å"I gave a lep to the east,† says Christy. Then I turned around with my back to the north, and I hit a blow on the ridge of his skull, laid him stretched out, and he split to the knob of his gullet. † †¦Ã¢â‚¬ ¦. Pegeen comes in, well knowing wha t the women are up to, and chases them off. Later, Shawn Keough comes back, followed by Widow Quin, to tell Pegeen some of her sheep have strayed into a neighbor’s field to eat cabbage. While Pegeen runs off to fetch the sheep, Keough offers Christy a new hat and coat, as well as breeches and ticket to the western states, if he will just go away so that Shawn can resume courting Pegeen. The widow butts in, telling Christy to try the clothes on.He can decide later, she says, whether to accept Keough’s offer. When Christy goes into another room to try them on, Keough tells the widow he thinks that Christy is just dressing up for Pegeen and has no intention to leave. †¦Ã¢â‚¬ ¦. The widow then offers Shawn a bargain of her own: Shawn must give her his red cow, a ram, the right-of-way across his rye path, and a load of dung at Michaelmas. Shawn not only agrees to her demands but also says he will throw in a wedding ring, a suit for Christy for the wedding day, and vari ous wedding gifts, including two goats for the wedding dinner. †¦Ã¢â‚¬ ¦.After Christy comes back out wearing the new clothes, Shawn leaves so the widow can go to work on Christy. But Christy, spying a fearsome sight coming toward the pub, hides behind a door. It is his father, still alive! After old Mahon enters the pub, he asks Mrs. Quin whether she has seen a young man on the run. She tells him hundreds pass by each day to catch the Sligo boat, then asks why he is looking for him. Mahon says, â€Å"I want to destroy him for breaking the head on me with the clout of a loy. (He takes off a big hat, and shows his head in a mass of bandages and plaster, with some pride. It was he did that, and amn't I a great wonder to think I've traced him ten days with that rent in my crown? † †¦Ã¢â‚¬ ¦. The villain, he says, is his own son. When the widow—who is able to see Christy behind the door—questions old Mahon about his son, Mahon says his son is a good-for-no thing lout who is afraid of women, gets drunk on the mere smell of liquor, and once required medical treatment for drawing on a pipe of tobacco. He’s â€Å"dark and dirty,† says the old man, â€Å"an ugly young blackguard. † †¦Ã¢â‚¬ ¦. Widow Quin tells him she did see such a young man on his way to catch a steamer.She then gives him directions that send him on a wild-goose chase. After old Mahon leaves, the widow scolds Christy, mildly, for pretending to be the Playboy of the Western World. Then she invites him to marry her and live in her house, where she will protect him from inquiries about whether he committed murder. †¦Ã¢â‚¬ ¦. Outside, young ladies are calling for Christy. They want to escort him to the sporting competitions. Christy, meanwhile, tells the widow he has his heart set on Pegeen. He would be forever in the widow’s debt if she helped him win Pegeen.The widow says she will if he promises to give her a ram, a load of dung at Mich aelmas, and a right-of-way across land. Christy promises to do so. †¦Ã¢â‚¬ ¦. Later in the day, Jimmy and Philly return from the wake, both tipsy, and enter the tavern. They speculate about how Christy killed his father and buried him, wondering what will happen if someone discovers the old man’s bones. While they are talking, Old Mahon comes in and sits at a table, for he has had no luck finding Christy. Continuing his conversation with Philly, Jimmy says that when he was a boy he found the bones of a man in a graveyard and tried to put them together like a puzzle.What a sight those bones were, Jimmy says—one would never again find the like of them. Overhearing that part of the conversation, old Mahon gets up and shows them his skull, saying, â€Å"Tell me where and when there was another the like of it. † He tells them it was his own son who struck him. †¦Ã¢â‚¬ ¦. They are impressed—but unaware that Mahon is Christy’s father. The window Quin comes in again, aghast to see old Mahon. He tells her he had no luck tracking down his son. Mrs. Quin gives him a drink and seats him out of earshot of the others. Then she tells Jimmy and Philly that old Mahon is daft.It was a tinker who split his skull, she says, but the old Man—upon hearing about the local hero, Christy—claims it was Christy who did it. They believe her. †¦Ã¢â‚¬ ¦. Cheering is heard. Everyone in the tavern looks out the window and sees Christy winning the mule race. When the spectators raise him onto their shoulders, old Mahon identifies him as his good-for-nothing son. Widow Quin pronounces Mahon mad for thinking so, for how could his son—if he is the fool that Mahon says he is—be such a great sportsman and win the admiration of so many people?Mahon admits he has not been himself lately: â€Å"There was one time I seen ten scarlet divils letting on they'd cork my spirit in a gallon can; and one time I seen rats as big as b adgers sucking the life blood from the butt of my lug. † †¦Ã¢â‚¬ ¦. The widow tells him he’d best leave, for the lads in the crowd don’t take kindly to madmen. When he goes on his way, Philly goes with him, saying he will give the old fellow some supper and a place to rest, then check to see if he is as mad as the widow says. Meanwhile, with the continuing cheers of the crowd following him, Christy enters the tavern in his jockey’s uniform with Pegeen and other girls.The people present him prizes, including bagpipes and a fiddle. Christy, riding the glory of the moment, asks Pegeen to marry him, and she consents. Michael Flaherty Returns †¦Ã¢â‚¬ ¦. Michael Flaherty returns then from the wake and congratulates Christy for his great victory in the race. When Pegeen tells him she plans to marry Christy, her father at first objects. But moments later, when Shawn Keough is afraid to fight Christy for Pegeen, old Flaherty renounces Keough as a coward a nd welcomes Christy as his daughter’s future husband. †¦Ã¢â‚¬ ¦.Then old Mahon returns with a club, reveals himself as Christy’s father, and begins beating Christy. The crowd then turns on Christy for posing as a murderer. Even Pegeen condemns him, saying, â€Å"And to think of the coaxing glory we had given him, and he after doing nothing but hitting a soft blow and chasing northward in a sweat of fear. † †¦Ã¢â‚¬ ¦. Christy has only one option—to kill his father again. The two men fight. Christy grabs the club and chases Old Mahon outside. In the center of the crowd, Christy brings down the club. There is a cry, then dead silence.Christy returns to the tavern in a daze. This time the crowd, having witnessed a real murder close up, is horrified at the deed. Pegeen says: †¦Ã¢â‚¬ ¦. â€Å"I'll say, a strange man is a marvel, with his mighty talk; but what's a squabble in your back-yard, and the blow of a loy, have taught me that there's a gr eat gap between a gallous story and a dirty deed. † †¦Ã¢â‚¬ ¦. After the people tie Christy up, he asks Pegeen to release him, but she refuses. Then they burn his leg with sod. A moment later, though, old Mahon—wonder of wonders—comes back from the dead one more time.When he asks Christy why he is tied up, Christy says, â€Å"They're taking me to the peelers [police] to have me hanged for slaying you. † †¦Ã¢â‚¬ ¦. Old Mahon, who now admires his son for his bravery, unties him and says, â€Å"My son and myself will be going our own way, and we'll have great times from this out telling stories of the villainy of Mayo, and the fools is here. † †¦Ã¢â‚¬ ¦. Christy willingly goes along but declares that henceforth he will be master of the house. He is a changed man—confident now, self-assured. †¦Ã¢â‚¬ ¦. Shawn Keough declares that a miracle has been worked in his favor.Now, he says, he can marry Pegeen. She boxes his ears and te lls him to go away. Then, throwing a shawl over her head and weeping, she says, â€Å"Oh my grief, I've lost him surely. I've lost the only Playboy of the Western World. † . Theme: Escaping a Humdrum and Suffocating Life †¦Ã¢â‚¬ ¦. Christy Mahon acts to change his life—first by cracking his father’s skull and second by telling a grand tale that endears him to his listeners. Neither action, of course, is how a young man in the real world should go about improving himself.But The Playboy of the Western World takes place in a fanciful world that allows the author to do the implausible and the outrageous. So Christy describes himself as the most admirable of murderers to the rural folk of County Mayo. Ironically, though, Christy really does transform himself in response to the adulation heaped on him. However, his admirers—people hungry for diversion from their humdrum life—do not change; the closest they get to an exciting life is to drink, liste n to exciting stories, or attach themselves to a hero, Christy, from the outside. After he returns home, they return to their monotonous life. Climax . †¦Ã¢â‚¬ ¦.The climax of a play or another literary work, such as a short story or a novel, can be defined as (1) the turning point at which the conflict begins to resolve itself for better or worse, or as (2) the final and most exciting event in a series of events. The climax of The Playboy of the Western World occurs when the local residents discover that Christy's father is still alive. According to the second definition, the climax occurs when Christy â€Å"kills† his father a second time but reconciles with him after the old man recovers. . Synge’s Style †¦Ã¢â‚¬ ¦. Synge was a master at writing lively dialogue laced with exaggeration and colorful imagery.In The Playboy of the Western World, he infuses the speech of his characters with the rich English-language dialect of the Mayo County Irish, a dialect in fluenced by the syntax and vocabulary of Gaelic—an ancient Celtic tongue of Ireland and Scotland. To learn the intonations and speech patterns of the people of western Ireland, Synge lived several years in the Aran Islands off the Atlantic coast, in Galway Bay. Gaelic and Gaelic-tinged English have been spoken there for centuries. It was not uncommon for Synge to take notes when he heard Aran denizens speaking. †¦Ã¢â‚¬ ¦.When writing the dialogue for Playboy, Synge laced it with authentic western-Irish regionalisms and vulgarisms, as well as inflections and rhythms characteristic of western-Irish speech. However, he also peppered the dialogue with words or phrases common in other parts of Ireland. Synge explained his writing scheme in the preface to the play. The preface says, in part: In writing The Playboy of the Western World, as in my other plays, I have used one or two words only that I have not heard among the country people of Ireland, or spoken in my own nursery before I could read the newspapers.A certain number of the phrases I employ I have heard also from herds and fishermen along the coast from Kerry to Mayo, or from beggar-women and balladsingers nearer Dublin; and I am glad to acknowledge how much I owe to the folk imagination of these fine people. Anyone who has lived in real intimacy with the Irish peasantry will know that the wildest sayings and ideas in this play are tame indeed, compared with the fancies one may hear in any little hillside cabin in Geesala, or Carraroe, or Dingle Bay.All art is a collaboration; and there is little doubt that in the happy ages of literature, striking and beautiful phrases were as ready to the story-teller's or the playwright's hand, as the rich cloaks and dresses of his time. It is probable that when the Elizabethan dramatist took his ink-horn and sat down to his work he used many phrases that he had just heard, as he sat at dinner, from his mother or his children. In Ireland, those of us who kno w the people have the same privilege. †¦Ã¢â‚¬ ¦. As to the imagery, it relies heavily on vivid metaphors and hyperboles.For example, when Michael Flaherty asks Christy Mahon whether he has committed larceny, Christy replies that he has no need to stoop to thievery, for his father â€Å"could have bought up the whole of your old house a while since, from the butt of his tailpocket, and not have missed the weight of it gone. † †¦Ã¢â‚¬ ¦. Most of the humor in the play grows out of the dialogue—but not all of it. Synge also relies on situation comedy for humorous effect—having a character hide behind a door or barge in unexpectedly.Old man Mahon pulls off the ultimate surprise—coming back from the dead. In making the transition from one conversation to the next, Synge demonstrates superlative writing skill. Never do the transitions seem forced or contrived; instead, one conversation flows smoothly into the next. The trick is that Synge steers the di alogue in one conversation toward a subject of interest to a person who initiates a new conversation. The theatergoer or reader hardly notices that the author has been tugging at his marionette strings.

A Poison Tree Poem Commentary - 774 Words

POEM COMMENTARY A POISON TREE BY WILLIAM BLAKE A Poison Tree is a poem written by William Blake which is themed around hate, anger and revenge. The poem is basically a metaphor or a piece of pathetic fallacy wherein the speaker has ascribed his feelings and state of mind to the form of a tree. William Blake wrote a series of poems called Song of Experiences, which were a collection of texts in which he shows the human spirit when it is confirmed to rules, resulting in strong emotions of anger, resentment and hatred. Throughout his life Blake was a dissenter; a rebel from the policies and regimes of the Anglican Church. Influences of this part of his life are seen in his poems as well. In A Poison Tree, the speaker expresses the†¦show more content†¦Vengeance seems to be the ending theme of the poem, as the speaker is shown to be content and â€Å"glad† with the result of his wrath. The poet uses a lot of imagery to express emotion and depict the situation. Each stanza in the poem has a simple rhyming scheme (AA, BB). The rhythm varies in all of the stanzas. The first and second lines of a stanza are in anapaestic dimeter while the third and fourth lines are in iambicShow MoreRelatedAnalysis of A Poison Tree Essay1370 Words   |  6 Pageswithin his social commentary. Similar to a fable, Blake weaves a poetically mystical journey for the reader, usually culminating in a moral lesson. One such poem, A Poison Tree, clearly illustrates some of William Blakes moral beliefs. With his use of imagery, as well as an instinctive knowledge of human nature, William Blake shows just how one goes from the light to the darkness (from innocence to experience) by the repression of emotions. If one were to read the A Poison Tree on a strictlyRead MoreLiterature and Language10588 Words   |  43 Pages: ex.9-1 The 1960 dream of high rise living soon turned into a nightmare. In this sentence, there is nothing grammatically unusual or â€Å"deviant† in the way the words of the sentence are put together. However, in the following verse from a poem, the grammatical structure seems to be much more challenging, and makes more demands on our interpretative processing of these lines: ex.9-2 Four storeys have no windows left to smash But in the fifth a chipped sill buttresses Read MoreA Picatrix Miscellany52019 Words   |  209 Pagestheir celestial archetypes, which were mentioned at the end of Book I, form the opening topic of this chapter. This is the subject of the ninth aphorism ot the pseudo-Ptolemaic Centiloquium. Next comes the story of a magical cure, taken from the Commentary of Ibn al-Dà ¢ja on this aphorism, which recounts how, in his youth, the author came to occupy himself with magic while testing Ibn al-Dà ¢ja’s prescription for the cure (pp.55-57). Then follows an excursus on sensory perception, including a quotation Read MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 PagesSee J. P. Rushton and A. R. Jenson, â€Å"Thirty Years of Research on Race Differences in Cognitive Ability,† Psychology, Public Policy, and the Law 11, no. 2 (2005), pp. 235–295; and R.  E. Nisbett, â€Å"Heredity, Environment, and Race Differences in IQ : A Commentary on Rushton and Jensen (2005),† Psychology, Public Policy, and the Law 11, no. 2 (2005), pp. 302–310. Avery, McKay, and Wilson, â€Å"What Are the Odds? How Demographic Similarity Affects the Prevalence of Perceived Employment Discrimination†; and Raver

History Of Intermodal Containers And The World Trade Commerce

History of Intermodal Containers For a very long time people have been trading goods with each other within their city, out of their city, and even across borders and oceans. As technology has advanced, so has different modes of transportation to make it easier for people to get their products that they need while shipping out products to other people. The world that we live in is a great big place and in order for us humans to survive and grow we need ways to reach out to other people and communicate the things that we need to do that. What I m going to be talking about is the history of intermodal containers and how they play a big role in the world trade commerce. It all started with a man that goes by Malcolm McLean who was born in 1913 in Maxton, North Carolina. Malcolm started out by pumping gas at a local gas station to where he saved up enough money to buy him a truck. 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Is Abortion A Medical Procedure - 966 Words

Abortion is the name given to a medical procedure, which involves the killing of a foetus, which is a baby. You are one in 250 million sperm cells that made it to the egg to create you surroundings Even at the 6th day you are special, around 2/3rd of embryos fail at this stage, but you made it. You proved that you were healthy enough to be embedded in your mothers lining. By week four your tiny little heart already has a beat. At week four your face has already started to take shape, and at 8 weeks later (week 12) your own unique finger tips are forming. At week 14 your immune system is starting to develop, a week later males are reaching the starting point of their testosterone levels males receive more at this stage and that is how their genitals are formed. Females receive less and that is why they don’t grow penises. At week 28 your eyes are beginning to see your surroundings. Limbs have fully developed by week 11 and you are able to flex them, this is when you are in the process of becoming a left or right handed person, which ever arm you stretched out more or favoured sucking one thumb. There are around 500 abortions per day in the UK; this means one in five pregnancies ending in abortion. This statistic is disgusting, an abortion is murder. If a woman cannot care for a child then she should not take the risk of becoming pregnant. Even the use of contraception is not 100% guaranteed to prevent all pregnancies, but at least the couple is trying to be safe. MostShow MoreRelatedAbortion : A Medical Procedure1213 Words   |  5 PagesAbortion is, as defined by Merriam-Webster’s Dictionary, â€Å"a medical procedure used to end a pregnancy and cause the death of the fetus.† A procedure done within the first 9 weeks of pregnancy is done with medicines and the effects are similar to that of a natural miscarriage. 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Role of Hospital Administrators Process of Synthesising

Question: Describe about the Role of Hospital Administrators for Process of Synthesising. Answer: Introduction Administration is a process of synthesising and activating the potentials of workforce and materials to achieve the defined goals of the organisation. The concept of hospital and health care organisation have changed with the course of time and changing environment in the community (Wilson, 2014). Doctors and healthcare staffs plays essential role at a medical facility by treating medical conditions and diagnosing the patients. But, the success of the healthcare organisation depends up the administrative details like marketing, budgeting and accounting (Mueller, 2012). Hence, the healthcare administrators and managers are an essential character in a healthcare organisation that supports the medical professionals to perform their duties in an effective manner. The primary role of hospital administrator is to maintain a balance between the communitys expectations and internal management of organisation by maintaining a positive relation with the patients and staffs on one side and the health related communities on the other side (Hefferin, Horsley, Ventura, 2012). Hence, the administrators are assigned to a management role in an organisation that makes them the key to improve performance of the firm. It is important for the healthcare administrators to maintain a good relationship with every members of the organisation and promote them to perform well. On the other hand, the administrator has the key responsibility to evaluate the effectiveness and efficiency of different departments of the organisation (Sakharkar, 2009). Hence, the paper has been developed to analyse the roles and responsibilities of the healthcare administrators and make a discussion on how the administrator ensures that all staffs aligned to their role meet all quality standards for the clients. On the other hand, the study also emphasises on discussing the evaluation methods employed by the administrators in order to measure the efficiency and effectiveness of different departments of the organisation. Hence, an administrator is the key person responsible for planning the activities and evaluating its effectiveness in a healthcare firm. Role of Administrator The hospital and its Organization Hospital or health care organisations are multifaceted firms that comprises of different departments, committees, services and types of personnel. It is a people oriented institution that runs a business along with taking care of the communities (Forrest, Johnson, Mosher, 2016). As healthcare organisations provide medical assistance to the people of the society, it requires well trained and experience professionals capable of delivering high quality services to the clients (Sakharkar, 2009). Hence, the role of the administrators is to maintain the activities of the healthcare institutions and organise the task in an appropriate manner to carry on its operations without any disruption. Hence, organisation is a key element of administration that must be considered while analysing the role of administrator in a hospital. The primary role of healthcare managers or administrators is to maintain a well developed organisation structure that employs a diversified workforce in respect to skills, knowledge and experience. Coordinating with the staffs of the hospital and maintain a good bonding among them is one of the essential role of the healthcare managers (Wilson, 2014). The administrator is responsible to take care of the healthcare quality that are delivered to the patients and maintain a good public relation. Marketing is another primary role of the administrator towards the hospital or organisation. The administrator or healthcare manager needs to take care of all marketing needs and activities and implement a proper management information system that can be used to improve the efficiency of the workforce. The administrator is also responsible for taking care of the ethics and conducts to maintain a harmony at the workplace (Sakharkar, 2009). Hence, it is important for the hospital administrators to understand the roles and responsibilities towards the hospital and the organisation to make the healthcare institution seek growth in the long run. Hospital Administration The healthcare administrators play the management role in an organisation through effective planning and organising of operations. According to Sakharkar (2009), the five major administrative functions of hospital administrator are planning, organizing, controlling, leading and directing, and budgeting. Hence, the functions of hospital administrations that must be conducted by the healthcare managers are discussed in details herein below: Planning Planning is the primary basic function of the hospital administration. It mainly involves the chalking of future actions and decisions that are to be followed to carry on with the operations of the organisation. The hospital administrators make decision regarding the operations for the organisation. They make decision regarding what to do, how to do and when to do. Hence, decision making is an important factor for planning the future actions of the organisation (Ziegenfuss Sassani, 2014). Planning is the determination of the actions that are needed to be conducted to achieve the desired goals of the firm. It is a systematic way of thinking and accomplishing the pre-determined goals. The hospital administrator is the core person responsible for planning all the activities of the firm and executes the actions according to the pre-determined plans (Ziegenfuss Sassani, 2014). Organising Organising is the process of bring together the human, physical and financial resources of the healthcare organisation to develop a productive relationship among them for achieving the goals of the institution. A healthcare organisation has several activities to be conducted on a daily basis. Hence, execution of the plans is only possible with proper organisation of the available resources (Moellering, 2009). The hospital administrators have the role of indentifying the activities and classify the activities into small groups to make it easier for the staffs to execute them. Along with that, the administrators need to assign the duties to each and every member of the organisation depending upon their skills and experience. The hospital administrator has the role of delegating the authority and creates responsibilities by assigning the right job to the right person (Moellering, 2009). It is important for the hospital administrator to coordinate with the higher level officials as well as with the front line staffs to maintain a good relationship among the members of the healthcare institution. Hence, organising is a key administrative function of the hospital managers to seek success in the long run. Leading and Directing The hospital administrator has the key role of leading and directing the human resources of the healthcare organisation. The administrator has the function of manning the structure of the organisation by planning the recruitment process and provides proper training to the employees. They provide remuneration to the staffs and conduct the performance appraisal program in the organisation (McGibony, 2009). The promotions and transfer of the employees depends upon the planning and execution of the administrators. Hence, leading and directing is one of the primary functions of the hospital administration. The administrators are responsible to assign task to the employees and allocate them to particular roles as per their capability. They supervise the performance of the subordinates, motivate to perform well (Kenny, 2012). The administrator acts like a leader in a healthcare institution and communicates with every member to maintain a good relationship amongst the employees. Controlling Controlling is a process of accomplishing standards and measuring the current performance in order to correct any deviation from the achievement of the organisational goals. The primary purpose of controlling is to ensure that all activities are conducted according to the decided standards of the organisation (Dunlap Pillepich, 2014). Hence, the controlling function of the administrators enforced them to check and monitor the performance of the employees to keep a tight control over the operations of the institution. The administrators establish the performance standards and measure the actual performance (Ziegenfuss Sassani, 2014). They need to compare the actual performance with the desired standards and observe the deviation from the actual path. Finally, the role of the administrators is to correct the actions by establishing new strategies. Budgeting Budgeting is one of the most important tasks of the hospital managers or administrators. The administrators are responsible for preparing the periodical budgets of the organisation according to the pre-determined plans (Kenny, 2012). Budgets are prepared by observing the cost and expenditure of the previous years and appropriate amount of money is allocated to each department depending upon the pre-determined budgets (Dunlap Pillepich, 2014). The administrator is responsible for ordering the supplies and inventories of the institution and remunerates the employees of the firm. Hence, it is important for the hospital administrators to evaluate the expenditures incurred by the healthcare organisation to maintain a positive financial position of the firm. The administrators look after the activities of the accountants and implement the best accounting solutions to make the task effective and efficient. Nursing Services The hospital administrators are responsible to take care of the quality of the nursing services that are provided to the clients to enhance the reputation of the firm in the community (Forrest, Johnson, Mosher, 2016). The nursing service administrators are responsible for managing the nursing care services and programs to ensure high quality services to the clients. It involves monitoring the performance of the nursing staffs and ensures that the activities are conducted by considering the healthcare standards and practices set by the regulating bodies and the organisation itself (Hefferin, Horsley, Ventura, 2012). The nursing administrators hire the nursing staffs, supervise them and conduct a performance evaluation. The nursing administrators coordinates the staff budgeting, purchases supplies and equipments, assign resources, and provides proper training for career development. The nursing administrators are also expected to create new programs and services for both nursing and patient staffs. They are responsible for developing nursing procedures, policies, and standards. Furthermore, the administrators are responsible for ensuring that the nursing units meet all the rules and regulations of the government healthcare authorities (Hefferin, Horsley, Ventura, 2012). The nursing administrators work together with the patients and staffs to resolve any care or treatment issues. Along with that, they coordinate the training and development programs for the nursing staffs (Ziegenfuss Sassani, 2014). The nursing administrators are responsible for instructing the patients family about the post hospital care and communicate with the senior hospital management and physicians regarding the nursing activities of the organisation (Mueller, 2012). Additionally, the nursing administrators work together with external organisations and other departments of the organisatio n to ensure best patient care services provided to the clients. Clinical Support Services Support service associates have played a significant role in healthcare facilities. Amidst the continuing changing environment of healthcare background, hospital administrators have been responsible for reducing cost of the business as well as improving the status of patient care attached to the hospital setting (Conway, 2009). First of all, identifying the available clinical support services of the healthcare organisation, hospital administrator is accountable to control every possible physicians activities building cooperation. Understandably, clinical support services of a hospital include registered nurses, medical staffs and medical doctors (Kenny, 2012). In order to exhibit superior support services, healthcare administrator must figure out significant ways to deliver sustainability in managing the registered nurses, medical staffs and doctors of the hospital (Kovner Neuhauser, 2014). As the support service personnel of any hospital have contributed majorly to satisfy the pati ents and their families, it is the responsibility of the hospital administrator to improve the facilities given to the support services staffs. Therefore, in order to improve the standards of hospital support services department, it is the duty of the administrator to increase professed organisational support among the support services employees. Furthermore, the distribution of the support services tasks must be given according to the schedule to reduce the job-related stress among the subordinates (Stillwaggon, 2014). Admittedly, by doing so, the hospital administrator develops job satisfaction and commitment of the staffs to create an efficient support services team. Decisively, in promoting ethics, culture and career sustainability, administrator influences collaboration, teamwork and efficiency of the support services to aid healthcare facilities on a larger scale (Tabish, 2010). Precisely, in healthcare management, it is accountability of the administrator to improve the productivity of support services through evidence-based moves creating a well-organised collaboration between the nursing activities and support services teamwork (Marziali, Damianakis, Donahue, 2016). In order to maintain a clean and healthy environment around the hospital premises, the role of the support service department is inevitable, to say the least. Hence, integrated support service must be monitored in accordance with adequate proficiency standards to meet the clinical needs and responsibility (Sakharkar, 2009). As the nursing staffs have sometimes been forced to work with the limited resources due to shortened facilities in hospitalisation, the administrator of a hospital must increase the responsibility of the support service team to reduce the stress from the nursing staffs. Thus, a well-designed management facility can be structured to maintain the highest medical standards of the patients care (Tabish, 2010). Meanwhile, the intervention of administrator is highly instinctive to create a focused work schedule of support services team representing a healthcare organisation. Administrative Services Administrative duties and responsibilities are identified as the most obvious role for a hospital administrative during the course of the time. Being a healthcare executive, it is the accountability of the designation to address staff management, legal obedience and budget status of the healthcare firm. Precisely, for a generalist administrator, who manages entire facilities of the administration, may sometimes find it extensively difficult. Meanwhile, it is the independent responsibility of the administrator to verify the entire legal adherence associated with the healthcare facilities (D'Orazio, Snook, Paul, 2014). For instance, a healthcare administrator must identify the legal terms in relevance to medical operations, constitutional role, MTP Act, CPA Regulations and other statutory responsibilities (Kawamoto, 2010). Apart from that, the administrator has to deal with employment and labour laws on the basis of the legal terms. Correspondently, it is also the duty of the administ rator to overview the patient billing, health insurance terms, insurance fraud related issues and confidentiality of the patient (Lamprey, 2014). Staff management has been identified as one of the crucial administrative duties for a healthcare administrator. According to the demand of the healthcare operations, the administrator needs to dictate the terms to position the staffs and nursing personnel to fulfil the supply maintenance (Syed, Sekhar, F., 2013). The positioning of staffs to the appropriate system can be difficult at times as significant issues can be created during the management of human resources. Hence, execution of backup plan has been crucial to identifying the efficiency of an administrator to manage the staffs uniformly (Sakharkar, 2009). In a larger healthcare facility, the role of the administrator has been divided according to the different section for better management and strategic planning. Also, a public health administrator has to take excessive responsibility to make sure that significant training and development facilities must be provided to the new talents to maintain medical efficiency and stan dards of the firm. Moreover, monitoring of the management proceedings and provide significant compensation to the staff members have been assigned to the duty of healthcare administrator (Ziegenfuss Sassani, 2014). In addition to the management role, the administrator is liable to maintain the budget according to the requirement of the healthcare. By following the guidelines and financial status of the healthcare business, accounting and budgeting system must be adhered by the hospital administrator so that current staffing compensation, medical equipment and latest technology can be utilised within the medical facilities for best services to the patient care (Brown, 2012). Furthermore, the administrator must identify to reduce the running cost by cutting down unwanted and unproductive costs of management. Decisively, the budget figures for the healthcare services must be distributed in an efficient order so that training and development facilities will be improved to increase the potential skills of the new talents (Kovner Neuhauser, 2014). Thus, the organisation can increase its productivity and retain best staff members for long-run. Functional Hospital Organization In healthcare management, promoting quality has been recognised as one of the key concepts from successful managements perspective. Therefore, in executive management, role of the administrator is massively elevated to precede regular functions of the healthcare organisation in a convenient process. Meanwhile, system guidelines must be produced by the administrator to be followed by the organisational staffs to attain maximum value (McGibony, 2009). Invariably, the corporate design has to be constructed by the administrator so that a mix of technology, information and corporate people can deliver the most efficient services according to the demand of the healthcare. Based on the priorities, significant quality enhancement initiatives must have been promoted by the healthcare administrator to promote service quality of the healthcare unit. Understandably, it is the earnest responsibility of the administrator to develop a precisely less centralised functional orientation in the service line so that it will evidently support the quality management system. In the contemporary business scenario, product and service-line can be identified as two fundamental designs in healthcare organisations to be delivered (Tabish, 2010). For instance, a number of clinical departments, nursing facilities, laboratory services, pathological services, and complementary healthcare services are somewhat mandatory to show the quality and efficiency of the healthcare unit. By understanding the strategic perspective of the healthcare organisation, it is the accountability of the administrator to align the corporate strategy to the overall business strategy through prioritising strategic change. By developing discipline-oriented functional specialisation area within the healthcare organisation, an administrator can deliver high-end administrative as well as clinical support services to the patients care (Simon, 2008). Tactically, in case of large healthcare organisation, administrators have unanimously identified uniform corporate strategy through balance scorecard of every department. Thus, decision-making has become easier leading to change in order to realign strategic management goal for functional restructuring. Moreover, the hospital administrator has to determine the functions of other sections so that the eventual system can influence the productivity of the staffs. Herein, intervention of the information management system has needed to be review ed by the administrator for betterment of the organisational functions (Kovner Neuhauser, 2014). Prominently, a systematic functional healthcare organisation can independently operate if the administrator has evidently promoted significant structure as per the requirement. By identifying the role of the each section, most efficient functional structure must be brought forward to meet the overall target of the organisation. In this way, a reliable and experienced healthcare administrator can improve the organisational functionality to a certain standard (Wilson, 2014). Evaluation of the role of administrator Healthcare evaluation is one of the most important role and function of the hospital administrator. After planning the activities and organising the resources, it is important for the administrators to evaluate the effectiveness and efficiency of every department and functions in order to promote the growth of the healthcare institution (Greenes, 2007). The effectiveness is related to the benefits delivered by the improvement of the healthcare organisation (Snook Zimmerman, 2014). On the other hand, the efficiency is measured by analysing the cost of the healthcare outputs in regards to the benefits obtained by incurring the cost. Furthermore, the administrators are responsible for evaluating the acceptability of the healthcare services rendered by the organisation (Greenes, 2007). In the designing of an evaluation of the clinical support services team, eponymous framework can be identified to show the best findings. Invariably, evaluation can be considered in a prospective or retrospective channel. Through planned data collection method, prospective evaluation can be done (Snook Zimmerman, 2014). Through the significant healthcare evaluation framework, SMART objectives can be recognised to evaluate each of the dimensions to be measured. SMART i.e. specific, measurable, achievable, realistic, and timely objectives can show the efficiency and effectiveness of the role of administrator to developing productive clinical support service facilities (Ballantyne, Dai, Gray, 2016). Through the understanding of the existing trend of healthcare services evaluation, external assessment i.e. National Patient Survey must have been promoted to identify how effectively the patients have been reacted towards the patient care services issued by the administrators. On the basi s of the outcome of the survey report, measurable interventions and economic evaluation of the system can be produced (Schlairet, Kiser, Norris, 2012). Different measures are used to evaluate the effectiveness and efficiency of the healthcare performance. Sakharkar (2009) introduced four primary measures for analysing the effectiveness and efficiency of the healthcare services. These four measures are known as inputs, process, outcomes and outputs. Input presents the resources, costs, time and expenditures that are used in the intervention to conduct the activities. On the other hand, process presents the activities that are conducted to carry on the healthcare services (Wacht, 2012). Outputs are the program or interventions that are produced by the organisation and the outcomes are the results in form of the benefits and disadvantages that are caused by the programs or interventions. Furthermore, the outcomes are compared with the SMART objectives after considering the inputs, process and outputs to observe the gaps in the healthcare services (Vila Buccellato, 2016). Finally, the administrator plans new strategies and changes in t he services to improve the current status of the healthcare services. Hence, the administrator needs to evaluate the performance of the healthcare staffs considering the outcomes and outputs of the entire process. The administrator needs to compare the results with the objectives goals of the organisation by continuously interacting with the lower level staffs and other medical professionals of the organisation (Wacht, 2012). The administrator will take care of the activities and collect feedbacks from the clients and other employees of the organisation to evaluate the effectiveness and efficiency of the healthcare services. During the time of the evaluation of administrative services, the role of the administrator will be evident, to say the least. Usually, for such event of evaluation of the services, both qualitative and quantitative studies will be considered as ideal for eventual outcome. By undertaking interviews with the healthcare employees can increase the sample size effective for relevant study (Wilson, 2014). Meanwhile, the qualitative sample must ensure that the entire staff group of the healthcare association were taken into consideration. During the quantitative study measures, software such as Stata can be identified as suitable instrument to investigate the response of the staff members, patients and their families in a statistical way (Chatfield, 2009). After the statistical outcome, significant assessment has been made to show the ultimate result of the adopted administrative services. Last but not the least; evaluation of the hospital organisational structure will be mandatory for the study to identify how the framework of services has delivered sustainability to the healthcare organisation (Wilson, 2014). Providing additional insights from the managements viewpoint, the role of the functional hospital organisation has been investigated to influence the performance and productivity of other departments. Also, the cost of the structure must be taken into identification to show the benefits of the system, if any. Meanwhile, the measurement of the evaluation programme will depend on the design of the framework to link the objectives with the overall achievements through the healthcare functions (Schermerhorn, 2014). Undoubtedly, during the assessment, both the patient party as well as the staff members must be included in the study to provide a clear outcome. Clearly, the evaluation framework will identify the success rate of the activities implemented by the adminis trator during the course of the time in hospital management to achieve the overall objectives. Conclusion The study has critically identified the role of a healthcare administrator in a detailed way to understand the accountability and duties. Precisely, healthcare administrators are liable to influence the organisational members affiliated with the hospitals. Through the introduction of significant planning for suitable management, executives have contributed massively in leading the business sustainability. Meanwhile, by identifying regular interventions among the nursing staffs, clinical support members and medical staffs, an explicit collaboration must be featured within the management. Decisively, in the contemporary business scenario, a single healthcare administrator is not recommended for large-scale healthcare organisations as there are different administration sections to be dealt with in an efficient order. Hence, for better management of the proceedings, distinct administrators will be perfect to handle each of the sections efficiently. Furthermore, on the basis of the evolutionary model, the role of the administrator must be improved on a regular basis so that the ever-changing features of healthcare sector must be met. Predominantly, the productivity of the administrative services, nursing services and clinical support services can be elevated through quality assessment of the administrative functions as described in the study. Apparently, the effectiveness and efficiency level of the regulatory role must be compared with the benchmark functionality to ensure quality services and management of staffing without issues. 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