Midwife Views on Amniotomy to Speed Up Labour

Midwife Views on Amniotomy to Speed Up Labour Abstract This dissertation considers the views of midwives on the procedure of amniotomy with the specific relevance of its use in speeding up labour. The available literature is considered in detail to try to establish the current evidence base for the assumption that amniotomy does speed up labour and it finds that the evidence is poor, both in terms of number and quality of the papers available. One of the biggest problems appears to be that it is very difficult to carry out a study that isolates the specific and unique effects of amniotomy on the speed of labour from all of the other potential confounding factors that can influence the eventual outcome. There appears to be a gap in the literature in specific regard to the midwife’s views on the subject. A proposal is therefore made for a pilot project to evaluate the midwife’s views by the means of a qualitative survey using the semi-structured interview technique. The rationale for such a study structure is discussed in detail. Acknowledgements (Client to personalise) Contents page Abstract Acknowledgements Contents Purpose of the study Literature Review What is already known? Amniotomy and induction of labour Complications associated with amniotomy What are the perceived benefits of amniotomy? Does amniotomy speed up delivery? Midwife’s views on the subject Methodology Search history. Classification of evidence levels Research question or hypothesis Study design Sample Data Collection Rigour Ethical Issues Budget Timetable. Dissemination of findings Proposed semi-structured interview questions References Purpose of the study: The research question. The procedure of amniotomy was first described in the 18th century. Despite having therefore been in constant use for over 200 years, its effect on the induction and the course of labour still remains a matter of dispute and conflicting evidence. (Greenwood C et al. 2003) Amniotomy is generally held to be the artificial rupture of intact membranes with a view to facilitating, stimulating or inducing labour. (ODriscoll K et al. 1986). This dissertation has purposely started with a definition of amniotomy that is over 20 years old. During the course of the exploration of the evidence base surrounding the procedure of amniotomy we shall consider whether this definition is still held to be true in current practice. The procedure is typically done with gloved hands and the healthcare professional ruptures the amniotic sac with an amnihook (or similar instrument) between contractions, as this reduces the risk of cord prolapse because the amniotic fluid is under less pressure. (Kirby R S 2004). The hand is kept in the vagina allowing the fluid to drain in a controlled manner and the nature (colour consistency and amount) of the fluid is noted. It would be considered good practice to assess the foetal heart both immediately prior to the procedure and again immediately after it to check for foetal distress due to cord compression. Many authorities advocate performing the procedure in the semi-sitting position in order to minimise the effects of aortocaval compression and thereby optimise the blood supply to the uterus. (Burnett A F 2000) Indications for amniotomy still include the â€Å"promotion of labour†. This can be taken to mean both the induction of labour and the speeding up of labour (Cummingham F G et al. 2005) however, hard evidence for either is difficult to find for reasons that we shall discuss. Literature Review What is already known? For ease of presentation, this section will be divided up into various sub-headings considering the different aspects of amniotomy as a procedure Amniotomy and induction of labour Amniotomy is frequently cited as a means of inducing labour particularly if the cervix is considered to be â€Å"ripe†. Unfortunately amniotomy alone is an unpredictable inducer of labour with the possibility of long intervals between amniotomy and the onset of significant contractions. The Mouldin trial considered a direct prospective comparison of amniotomy alone and amniotomy with an associated oxytocin infusion. The results showed a statistically significant difference in the two groups with the latter group having a shorter induction to delivery interval. (Mouldin P G et al. 1996) There is a huge variation in the literature concerning the ability of amniotomy to hasten the onset of labour. Some early papers suggested that the effect was only minimal (Caldeyro-Barcia R 1975) whereas the majority of others suggest a much more obvious effect. As with other areas of investigation, difficulty arises in trying to separate out the effects of the amniotomy from the myriad of other variable factors that are present when a woman goes into labour. Friedman questions whether amniotomy hastens labour at all since many of the prospective trials have considered the case when amniotomy is done in early labour when the contractions would naturally begin to accelerate in any event (Friedman, E.A 1998) Complications associated with amniotomy This is a particularly contentious area with different authorities citing not only different associations of complications but significantly differing incidences as well. If we consider the Sheiner paper (Sheiner E et al. 2000) we can show a number of significant findings when early amniotomy was compared with both premature rupture of membranes (PROM) and oxytocin induction of labour. The significant differences found between the groups included a higher rate of caesarean section with 26.7% in the amniotomy group and 11.6% in the PROM and 16.9% in the oxytocin groups. It should be noted however, the authors performed a number of subsidiary analyses and showed that when the incidence of a previous caesarean section was controlled for then the amniotomy group had a similar incidence of caesarean section to the other groups. This would imply that amniotomy is more likely to be considered an option when a previous caesarean section has occurred. The authors make no comment as to why the y believe this might be. A much larger and more rigorous survey (Segal D et al. 2000) reviewed the outcomes of nearly 2000 cases of early amniotomy performed in association with a poor cervical score (Bishop scores of Amniotomy has been shown to increase the incidence of abnormalities in the patterns of foetal heart rate.( Goffinct F et al. 1997) Again this effect is hard to isolate convincingly as the risk may be consistently underestimated because women who do not have amniotomy are more likely to be given oxytocin which also increases the incidence of abnormal foetal heart rate patterns. (Rouse D J et al. 1999) Amniotomy may also be associated with an increase in infection rates. (Ventura S J et al. 1997) What are the perceived benefits of amniotomy? A number of authoritative texts state that routine early amniotomy can shorten labour by a variable amount, usually one or two hours (viz. Vincent M (2005) and Sheiner E, et al. (2000) and Albers L L et al. (1996)), Others suggest that it may reduce the use of oxytocics and the number of women who report the most intense degrees of pain during labour. (Klaus M H (1998) This picture is however, clouded by the fact that modern practice with its use of oxytocin (which makes labour more painful) and analgesia, including the epidural, which obviously reduces the overall pain experience, makes the statistical analysis of the relationship between amniotomy and pain very difficult Amniotomy has been cited as being indicated when there is a need for closer monitoring of the foetus allowing the direct attachment of scalp electrodes and incidentally evaluating whether the baby has passed meconium into the amniotic fluid. (Thornton J G et al. 1994). The presence of meconium is a significant clinical sign and is associated with an increased foetal morbidity and mortality (Ramin K D et al. 1996) Although its observation is enhanced by amniotomy, it is only of peripheral relevance to our considerations in this dissertation and therefore will not be considered further. Other authorities observe that this is not a good indication for amniotomy as the release of the amniotic fluid may expose the umbilical cord to increased compression during contractions. (Klaus M H 1998) Amniotomy also allows the positioning of an intrauterine pressure catheter in order to measure uterine contractions. Does amniotomy speed up delivery? This is an issue that has appeared in many older papers. A significant trial of 20 years ago (Seitchik J et al. 1985) concluded that the procedure of amniotomy appeared to enhance the cervical dilatation rate in patients with already well-dilated cervices and that are already dilating at a satisfactory rate and it conversely slows dilatation in some other patients, particularly those whose cervices are less dilated. This finding is cited in a number of contemporary text books. The difficulty is that the findings in this paper are only evidence base level 3. Many other papers refer to the trophic effects of amniotomy but none have had the discriminatory power to isolate the effects of amniotomy from the multitude of other variables which are inevitably present during the process of labour. The paper by Sherman (Sherman D J et al. 2002) primarily considers the patterns of foetal heart rate during the induction of labour and, in doing so, provides circumstantial evidence that amniotomy increases the speed of labour. Amniotomy was however, only performed in this trial if the cervix had dilated to more than 3 cms. without an associated spontaneous rupture of membranes. Oxytocin was also used in a significant number of cases thereby masking any effect which amniotomy alone might have. A different view is expressed by Pozaic who considered the case proven and puts forward the view that amniotomy should only be reserved for cases where there is abnormally slow progress of labour and then amniotomy should be performed to speed up the process. Again this is little more than level 4 evidence as the author does not cite what her evidence base is for making such an assumption. (Pozaic S 2004) To present a balanced argument one can cite the work of Steer (actually written when he was a house officer but then went on to become a professor of obstetrics), who published a controlled study of two matched groups of patients, all of whom had oxytocin induced labour. One group had their membranes ruptured and the others were allowed to rupture spontaneously. Steer found that the duration of labour was shorter in all patients who had ruptured membranes although, for reasons that were not explained, the uterine contractions were found to be at their greatest when the membranes were intact. In short, there was no evidence that amniotomy increased the speed of labour and there was evidence to suggest that the uterine activity was greatest in the group with membranes intact until well into labour. (Steer P J et al. 1975) Midwife’s views on the subject In terms of determining midwife’s views on the subject, there appears to be an almost complete gap in the literature on the subject. Extensive searching reveals no definitive authoritative texts on the subject and a very few that have sought the patient’s view on the issue. The Lavender paper (Lavender T et al. 1999) considered the issue only peripherally as part of a larger exploration of patient’s views and concluded that women who had long and protracted labours welcomed virtually any type of intervention that was perceived to reduce the time in labour and this included amniotomy. Clearly it is likely that this was perceived by the women as a â€Å"labour shortening procedure† and it is very unlikely that any discussion of informed evidence base would have taken place prior to its use. These issues are explored further in the more recent and larger qualitative investigation by Hodnett who considered the experiences and evaluations of childbirth in terms of overall pain experience. The paper is long and involved and, in the main, peripheral to our considerations here other then the fact that one of the main factors that the women cited as significant in terms of their positive appreciation of the process of labour was their perception of the attitude and behaviour of the midwives and this was rated as being more significant than the actual procedures that they employed. This finding appeared to override other factors including such variables as â€Å"age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions, and continuity of care†. (Hodnett, E D. 2002). One can only therefore speculate as to whether this finding vicariously influences the decisions made by the midwives in terms of tr ying to provide a complete service to their patients. Another paper which is peripherally relevant to this issue is the well written and thought-provoking essay and investigation by Sookhoo (Sookhoo M L et al. 2002) which considered the wider issues of how midwives learn their clinical skills and the mechanisms by which they acquire their practical knowledge. The authors devote a substantial proportion of their paper to how this knowledge actually influences their professional judgements in both the assessment and the progress of the course of labour. This particular paper is worthy of examination on several levels, not only for its actual content and results, but because it is structured on a grounded theory premise and conducts a number of semi-structured interviews and then attempts to construct theories from the results. It is very significant that a major finding in this paper was that the authors hypothesise that a major determinant of clinical activity for a midwife is the way in which she conceptualises uncertainty (which clearly is a major element in the management of labour). It is also significant that they found that one of the major techniques for avoiding uncertainty was to rely upon conventions and put trust in specific procedures â€Å"almost as a ritual†. The authors suggest that the experienced midwife tends to draw upon a much wider range of evidence and experience which has been accumulated through their clinical practice than the novice midwife who tends to rely on guidelines and strategies which they t end to see as predictive and protective. This has great relevance to the practice of amniotomy as Sookhoo et al. found that the experienced midwives tended to avoid inappropriate intrusion into the process of labour as a matter of routine. We should therefore be aware that amniotomy may be conceived as â€Å"inappropriate intrusion† by the experienced midwife and our study should perhaps be structured to evaluate this possibility. Perhaps the last word on this subject should go to the overview of the subject published by Katz Early amniotomy remained an independent risk factor for operative delivery on multiple logistic analysis controlling for confounding variables. These findings imply that caution is needed when deciding to perform early surgical induction unless it is a final option or other approaches are contraindicated. (Katz, Miriam 1999) Methodology Search history. The mechanism of the literature review was to conduct a number of literature searches through both electronic and hard copy data bases at the local University Library and the local Post Graduate Library (client to personalise). A number of search terms were used including: amniotomy; amniotomy knowledge; amniotomy indications; amniotomy benefits: amniotomy complications; amniotomy speed of labour; midwife views amniotomy; midwife procedures. The electronic databases included Bandolier and The Cochrane Library and Cinhal. These searches provided a great many texts which were accessed either electronically or in hard copy and then critically reviewed to ascertain the level of the evidence presented. The level of evidence was categorised into the following levels. Classification of evidence levels The highest level of evidence available was then used to support each point raised Research question or hypothesis It appears to be generally accepted that evidence based practice should be the â€Å"gold standard† of modern clinical practice (NMC 2004). However, many experienced healthcare professionals would attest to the fact that clinical decisions in their everyday practice is still influenced by individual experience and advice from colleagues. (Williams P R 2000). The rationale behind this study derives from the suspicion that many midwives use amniotomy to speed up labour and that there appears to be little in the way of a hard evidence base to support this view. It is the intention of this study to try to define the degree that individual midwife practice is determined (in this specific regard) by their own experience and professionally received advice and to what extent it is determined by reliance on their own independently derived evidence base. Study design This study will be qualitative in design. There are a number of different qualitative approaches that could be adopted (DeWalt, K. M et al. 1998) and brief consideration will be given to each. The phenomenological approach is primarily a philosophical mechanism which employs that technique of concentrating on the conscious and subjective experiences of the subjects. (Hammond et al, 1995). It is therefore written from the first person viewpoint. Such an approach is not without its critics however, as the classic approach is from the third person (impersonal) viewpoint (Ahmed, 2006). Hammond characterises the phenomenological genre as â€Å"unconstrained by scientific rigour† as it is simply a recording of the experience as the observer experiences and interprets it. It is therefore not purged of subjectivity and bias as many other scientific approaches are. The phenomenological approach was considered for this project and discounted as it is conceded that such an approach may give rise to a very idiosyncratic view of the subject and may not be representative of the majority view. Grounded theory may, at first sight, appear to be a suitable approach for this study. The prime element in a grounded theory study is the fact that the data is obtained and then the investigators then attempt to formulate or identify appropriate theories from the processed data. (Glaser, 1992). This approach may seem suitable by virtue of the fact that midwives could be approached and data obtained to see if there are any constant factors which motivate their particular pattern of behaviour when considering the procedure of amniotomy. A problem may arise however, because of the intrinsic need for theory formulation. Charmaz characterises the problem by stating â€Å"It compels the researcher to impose explanations were no explanations naturally exist, or indeed are necessary†. (Charmaz, K. 2006). In this study it is the intention to explore midwife’s views on whether amniotomy increases the speed of labour rather then to specifically generate theories to explain these views. For this reason grounded theory was discounted as a possible approach After much consideration it was decided to adopt an ethnographic approach to the study. This involves a hybrid approach with an analysis termed by Agar as being from the point of view of â€Å"The professional strangerâ€Å" (Agar, 1996). This approach has elements of both qualitative and quantitative analysis and is primarily carried out using the analysis of â€Å"in the field† interviews of midwives. Kottak describes the ethnographic approach (in the broadest terms) as collecting data â€Å"in the field by living among and blending in with a particular group, society or culture, observing and recording their particular habits and detailing their experiences and reactions† (Kottak, 2005). The researcher is expected to be a part of the community studied but to â€Å"retain a certain degree of detachment, impartiality and objectivityâ€Å" (Kottak, 2005). The object of this study requires the observer to record the number of times a midwife uses the procedure of amniotomy and then to obtain her views on the rationale for the procedure through the mechanism of the semi-structured interview. Sample Constraints on time and finances will largely dictate the overall size of the project (client I have no idea what potential funds you have available for this project so I have made a number of assumptions that you will have to modify if they are not correct). It is considered prudent to make a pilot study in order to test the validity of the interview questions and to also trial the analysis techniques. The initial pilot would be in the labour ward of the author’s hospital (client to personalise here) and would therefore potentially include 12 midwives. If the study were to yield potentially significant findings, then its scope could be widened to include staff from different sites and thereby include perhaps different protocols and possibly different work practices. This would have the benefit that it is possible that certain work practices may be determined by peer pressure in a specific geographical location and broadening the scope of the investigation would help to minimise the biasing effect of such practices. (Rosner B 2006). There is also considerable merit in trying to ensure that the cohort of midwives studied contains a wide spectrum of experience, ideally from the newly qualified midwife through to the most experienced, as it would be unlikely that the work practices would be the same in all groups. (Strauss, A et al. 1990). It is therefore clearly of benefit to try to structure the sample to include representatives from all of these groups in order to minimise the effects of such potential bias. (Carr L T 1994). It foll ows from this requirement that the study group will be asked to provide information relating to their years of experience in addition to other demographic markers. Analysis of the pilot study will help to determine whether purposeful sampling or general sampling will be appropriate in the final study. (Moher D et al. 1999). In the former method, subjects are specifically chosen because of the likelihood of their being able to give valuable information to the study. Patton describes this method of recruitment as â€Å"selecting only a limited number of information-rich cases for investigation, in order to obtain a particularly detailed insight into an issue. (Patton 1999). Although this may be, at first sight, useful in trying to maximise the information yield of the study, it has the obvious downside that it is a source of considerable potential bias giving rise to a small and potentially unrepresentative sample. (Patton 1999). A variation of this technique of recruitment is called snowballing whereby one key subject is asked to recommend others who may have either specialist knowledge or a specific interest in the subject in question. This te chnique is recommended by MacQueen as â€Å"being particularly suitable in qualitative studies, where detailed and in-depth understanding of a little-known subject is required† (MacQueen K M, et al. 2004). Although this clearly has the ability to optimise the collection of significant information, it does not eliminate the potential for bias apparent in the purposeful sampling technique. If we consider that amniotomy is a widely used practice amongst midwives, then neither method is sufficiently useful to outweigh the potential bias that they would engender. For these reasons it is considered appropriate to approach all of the midwives in the local unit to take part in the study. Data Collection In line with the principles of the ethnographic approach, this study will adopt the dual mechanisms of direct observation and the semi-structured interview. (Breakwell et al, 1999). The semi-structured interview technique is explored in depth by De Martino who contrasts the technique with unstructured and fully structured interviews. The former â€Å"essentially amounts to an informal conversation with no guiding principles, and structured interviews are characterised by the asking of a predetermined and fixed set of questions with strict guidelines. Semi-structured interviews however, entail asking a preset group of questions but with some flexibility, so that interesting leads can be explored further† (De Martino B et al. 2006). The semi-structured interview technique is considered to be the most useful for this type of study because of the lack of rigid constraints placed upon both interviewer and subject. The questions are designed to be â€Å"open† thereby allowing the subject to introduce appropriate topics which can then be followed up at the interviewer’s discretion. This flexibility is perhaps the most appropriate for this type of study as the interviewer does not know in advance just what factors influence the midwife’s opinions. Frey broadens the issue by suggesting that, in this context, attitudes of the subjects can be typically analysed in any of three â€Å"dimensions†, namely: emotion, cognition, and behaviour. (Frey et al. 2001). It might therefore be important to structure the semi-structured interview questions so that they cover all three of these dimensions. Typical examples in this regard might be (a)â€Å"How does performing as amniotomy on your patients make you feel emotionally?† (b)â€Å"What are your views about amniotomy and the speed of labour?† (c)â€Å"How do you actually choose to speed up your patient‘s labour?† This may not prove to be completely relevant, as one could suggest that emotional involvement is actually counterproductive in this particular circumstance. It is clear that a large element of discretion will have to be left with the interviewer as it is likely that the answers given may clearly be either carefully considered and evidence based on one extreme or superficial and unconsidered on the other. This flexibility will allow the subject to impart their own intention without being unduly hampered by rigid questioning and should allow the emergence of a detailed set of data which reflects each individual midwife‘s opinions and practices clearly. (Concato, et al. 2000) In addition to the semi-structured interviews there will also be an element of direct observation to ascertain the labours that are managed with amniotomy and to contrast them with the labours that are managed without the procedure. It may well be of considerable value to include an element of questioning in the semi-structured interview phase that asks about the rationale for performing the procedure Data Analysis Data analysis can be carried out using time-honoured methods originally developed in the social science setting with various qualitative analytical methods. (Vickers, A. J et al. 2001). The most commonly used is probably thematic analysis (Braun V et al. 2006) which involves coding the themes that are derived from the responses. The themes are initially identified during the semi-structured interview stage and are then assigned a code (or number) depending upon the frequency with which the various subjects refer to the particular theme. From reading Braun it is apparent that there is considerable flexibility in the coding and identification of the themes (which is in contrast to the mechanisms described for both grounded theory and other forms of qualitative analysis). Some authorities find that this flexibility and lack of proscription is a negative feature of the thematic approach but Braun argues that it enhances the quality of the analysis by allowing a â€Å"richness of analysi s not provided for by other methods†. (Braun V et al. 2006). This is clearly a complex exercise and it will be attempted in the pilot study by the author, but it is accepted that it may be more appropriate to enlist the help of an experienced researcher to assist in the analysis of the full project It is considered likely that the various themes will be obvious from the data obtained. Braun suggests a five stage mechanism for optimum data retrieval, namely: (1)Familiarising oneself with the data. (2)Developing a coding system and identifying bits of data consistent with specific codes. (3)Looking for and identifying themes in the data (4)Labelling or naming the themes identified, with appropriate justification (e.g. quotations from interview transcripts) (5)Writing up the report, including data extracts, in a compelling fashion. (Braun V et al. 2006). The interviews will be initially tape recorded and then transcribed in order to allow for identification of the various themes. It is clearly likely that the themes will be expressed in different terms by different subjects and therefore a degree of latitude will be needed by the interpreter to ensure that similar themes will be included and analysed together. (Berlin J A et al. 1989) Rigour The value of any study ultimately depends upon the rigor with which it is conducted. (Green J et al. 1998). It is in the very nature of a qualitative study that it does not intrinsically possess the precision of the classical quantitative study. It is therefore of great importance that attention is paid to reliability and repeatability during both the design and execution stages of the study. Triangulation is one mechanism that can help in this regard. (Piantadosi S. 1997). This requires comparison of the results obtained by one method with those obtained by another. The classic structure is to see whether the data obtained from the study matches with that obtained from subject feedback. (Leaverton PE. 1998). Berwick also suggests that any apparently aberrant or atypical cases should be examined as these will help to establish the overall validity of the study. (Berwick D. 1996) Ethical Issues It is central to the instigation of any study that the approval of a Local or National Ethics Committe

Essay on Language, Imagery, and Symbolism in To Be of Use

Use of Language, Imagery, and Symbolism to Develop the Theme of   To Be of Use  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚      In the minds of most people, the words, "hard work" and "heavy labor" carry a negative connotation.   What these words imply is not something that is generally welcomed with enthusiasm but is often accepted either by force or obligation.   Marge Piercy's poem "To Be of Use" conveys an opposing connotation about the idea of work.   The central theme of the poem is that satisfaction, gratification, and self-fulfillment can be attained by using one's capabilities to serve a functional purpose in life, for it is the opinion of the speaker that an idle existence has no value or significance because it is worthless, vain, futile, and pointless.   Piercy uses figurative language, imagery, symbolism, description, and details to develop this theme throughout the poem.   Piercy begins developing the theme in the first stanza by describing "The [type of] people [she loves] the best" (1).   Piercy states that they "jump into work head first/without dallying in the shallows..." (2-3).    With this imagery Piercy reveals that she admires individuals who are not afraid of work; rather, they tackle their jobs "head first/without dallying" ( ); in other words, they are not lazy and do not delay or procrastinate the completion of their duties.   Piercy adds that the people she regards highly "... swim off with sure strokes almost out of sight" (4).   With this image Piercy indicates that these adored individuals work with so much confidence and diligence that often they become so busy that their work puts distance between them and those with whom they associate or live.   Further, Piercy declares that "They seem to become natives of that element, / ... ... the fruits of a person's hard labor will linger to give honor to their memory after their death.   However, Piercy adds that "they were made to be used" to indicate that this won't be the case if a person's labor is not the fruitful productive type.  Ã‚   Piercy concludes by stating that "The pitcher cries for water to carry and a person for work that is real" (25-26).   With this figurative language Piercy develops the theme by affirming that people need to be willing to work hard in order to reach the satisfaction of accomplishing something that is meaningful in their lives. In her poem, Piercy developed the theme of success through active participation in hard work through her use of language. Works Cited Piercy, Marge.   "To Be of Use." Responding to Literature.   2nd ed. Ed. Judith   A. Stanford. Mountain View, CA: Mayfield Publishing Company, 1996. 596.

Collective Bargaining in the Public Sector

Collective Bargaining in the Public Sector Linda Howerton PHI 103 Informal Logic Instructor: Ms. Tanya Martin October 22, 2012 ? Collective Bargaining in the Public Sector Union membership is today at an all time low. It has been steadily declining since the 1980’s. Private sector union membership has been affected the most, while that of the public sector has remained relatively strong (Devinatz, 2011 Spring). Public worker unions, especially state and federal government unions, must be allowed to continue to bargain collectively to ensure the rights and job security of their members.Collective bargaining allows union members to have a voice regarding their wages, benefits, and working conditions. According to Raymond Hogler, in the â€Å"Labor Law Journal†, Fall 2012, â€Å"The erosion of institutions of collective bargaining will inevitably lead to a diminution of wages, benefits, and working conditions for workers† (Hogler, p. 163). Many public employees, esp ecially teachers who work for the state, receive much lower pay than other professionals. Collective bargaining allows public employees a much needed say about their jobs, wages, and benefits.Whereas teachers, for instance, have lower pay than many other professionals, collective bargaining has ensured that they have one of the best retirement systems. In addition, collective bargaining has protected teachers’ job tenure, thus preventing them from being fired without a due process hearing and other protections. The need for unions were a direct result of the unfair labor practices employed during the Industrial Revolution beginning in the late 18th century and continuing on into the early 20th century.Since there were no labor laws initially, especially regarding child labor, women and children were often employed for long hours at low wages. At one time, women and children made up 75% of the factory work force since they could be hired for lower wages. Children proved more m alleable and adapted more easily to the newer methods employed. Children as young as eight years old were sent to work in the factories or in the mines where their smaller bodies could fit into tight and often highly dangerous places (Bond, Gingerich, Archer-Antonson, Purcell, & Macklem, 2003).Children were also preferred at times to work in factories since their small hands could reach into tight places when moving parts became jammed. There were few safeguards in place to prevent the children’s hands and arms from becoming maimed if caught between moving parts on a machine. During the late 1700s in England, a man named Slater employed a Pauper system whereby he used children from poor families as workers in his mills. These children worked twelve to sixteen hours a day for six days a week.Instead of being paid wages, these children received room and board, thereby alleviating the burden of feeding them from their families. Families of the children were appalled at the tight discipline, lack of heat, and the working conditions in the mills. Many of the children chose to run away. When the employment of just children proved problematic, entire households were hired. The father negotiated the contract and stipulated the conditions for each family member (Tucker, 2005 May, p. 24). During the Industrial Revolution, government adopted a hands-off or laissez-faire attitude towards business.Therefore, business owners could treat their workers however they wished. Since children could be hired for less pay, they were hired in great numbers, working 12 to 14 hour days under horrible conditions. Many of these children became apprentices to the factory owners where they lived in miserable dormitories. They were frequently under-fed, ill-clothed, and beaten with fist and whip. There was a high death rate among child laborers (Hackett, 1992). Since all or most members of the family were working for upwards of eighteen hours daily, the family unit broke down.Childre n’s family contact usually amounted to the few hours spent at home sleeping. Since many families lived in shared housing with other families, family units withered even further. Children received little or no education, were malnourished and sickly, and experienced stunted growth. They grew up maladjusted since they had never been taught how to properly behave. The living conditions were appalling with little or no sanitation. As a result, infant mortality skyrocketed during the Industrial Revolution: over 50% of infants died before they eached two years of age (Bond, Gingerich, Archer-Antonson, Purcell, & Macklem, 2003). It is largely due to the unsafe conditions, abuse of laborers, especially women and children, and the workers’ lack of a voice over their employment that labor unions first came into existence. The earliest unions were established as â€Å"friendly societies† that charged dues to be used to assist workers during unemployment or sickness. It was n’t long before they grew into organizations seeking to win improvements for workers by the use of strikes and collective bargaining.Industrial workers increasingly became involved politically to encourage the passage of laws favorable to them. This drive by workers to increase their political power, as well as the right to vote, was largely responsible for the 19th century spread of democracy (Hackett, 1992). Today, labor unions seek to control the supply of labor. This control over the labor supply enables unions to secure collective bargaining agreements that have â€Å"brought millions of America’s workers into the middle class† (Gitlow, 2012 Summer, p. 124).The fear of being unionized exerts psychological pressure on employers which can often serve as a check on their otherwise abusive and exploitative inclinations (Gitlow, 2012 Summer). According to Givan and Hipp, in a 24 nations study of workers’ views about the efficacy of unions, entitled  "Public Perceptions of Union Efficacy: A Twenty-Four Country Study,† most laborers who belong to unions: feel most positive about the ability of unions to improve working conditions and job security. Women tend to hold a more positive view than men of the effects of unions on job security.Women are generally more susceptible to various forms of workplace discrimination, which creates a greater need for the kind of protection provided by unions (Givan and Hipp, 2012 March, p. 25). Thus we can easily see the importance of unions for the protections they offer workers regarding pay, working conditions, the right to strike if necessary, and most especially, the right to collectively bargain. Unions and the right to collectively bargain are increasingly endangered across the United States.At least 17 states have passed legislation or have bills pending that would severely curtail the right of employees to collectively bargain (Rigiero, 2011 April). According to Deb Rigiero, in â₠¬Å"You are now entering the United Corporations of America,† â€Å"We are rapidly becoming the workplace of the past†¦ the workplace without safety regulations; the workplace without workers’ rights; and the workplace without recognition of and appreciation for the worker† (Rigiero, 2011 April, p. 14). Right to work (RTW) laws have been steadily eroding workers’ rights for many years already.Over 22 states have passed RTW laws. The RTW laws aren’t there to guarantee workers the right to a job, but are instead aimed at the unions’ abilities to collect dues to aid in administering the unions. Under RTW laws, it is illegal to for unions to require workers to pay these dues. Without members’ dues to support them, unions’ power and strength of collective bargaining are severely undermined. Many unions may eventually find themselves endangered or extinct (Lafer, 2012 February 6).Then workers will find themselves without represent ation or even a voice regarding their rights. Those people against public employee unions and collective bargaining feel that public sector employees are receiving excessive pay and benefits at the expense of the American taxpayers (Schulz, 2012 January 10). Unions restrict the authority and management of company managers. In addition, unions may have a polarizing effect between management and the employees of a company. Unions also restrict the ability of managers to deal one-on-one with employees.When unions are involved, management is unable to make unilateral changes that may involve hours, wages, or other issues dealing with employment (University of Maryland, Baltimore County, 2012). In â€Å"Why U. S. should cheer for Wisconsin Gov. Scott Walker,† Nick Schulz feels that â€Å"The collective bargaining privilege gives teacher unions political power that is used to block reform efforts and shield K-12 education from entrepreneurial disruptions that threaten established ways of doing things† (Schulz, 2012, Para. 11).Many Republicans espouse school vouchers as the answer to declining test scores across the United States. Vouchers are opposed by teacher unions and most educators who say that they would disrupt or damage our public education system in the U. S. If parents are allowed to use vouchers to choose which school their children attend, then those parents will be able to select the school that best fits their children’s needs and learning style. Whereas this might be great for the child involved, it could pose difficulties for already cash-strapped public schools that would lose some of their state funding.Public school employees who belong to teacher unions should be treated as professionals, yet they receive pay far below that of other professionals such as doctors, lawyers, and engineers. Collective bargaining has allowed public union members to speak on their own behalf regarding their working conditions and job benefits. Publ ic sector unions are currently â€Å"under attack† by right-wing politicians supported by large corporations (McAlevey, 2011 March 7). If public union members are not allowed to use collective bargaining, then they will no longer have a voice in their wages, benefits, or working conditions.Wages could be cut at the whim of management. To finish their jobs for the day, many public employees might find themselves working â€Å"off the clock† since management can require more from them without recompense. According to an article by Raymond Hogler and Christine Henle, entitled â€Å"The Attack on Public Sector Unions in the United States: How Regional Culture Influences Legal Policy,† â€Å"Coincident with union declines, American workers experienced stagnant wages, a diminution of benefits, and overall degradation of working conditions† (Hogler and Henle, 2011 Fall, p. 37). 22 states have now passed right to work laws which â€Å"interfere with unionsâ€⠄¢ ability to maintain solidarity and acquire resources† (Hogler and Henle, 2011 Fall, p. 138). Those states with right to work laws have less union density, as well as â€Å"less equality for their citizens in terms of health care, education, and income† (Hogler and Henle, 2011 Fall, p. 143). Public union employees must be allowed to continue bargaining collectively to protect their right to have a voice in their working conditions, wages, and benefits.Collective bargaining ensures that public union members make a livable wage to support their families now, as well as having a secure retirement pension waiting for them when they retire. Many politicians indicate that teachers earn too much money. A teacher I know now makes below the national poverty level, yet he holds a Master’s Degree plus 30 hours. He is not an isolated case. Many teachers who belong to a teachers’ union still make salaries below the national poverty level. If their pay erodes even fur ther, then many teachers will be unable to afford to continue teaching.Teachers’ and other public employee unions are there to support and protect great teachers, not cover for any â€Å"bad† ones. Don’t we want to hold on to the dedicated teachers who have given of themselves to ensure that all children receive a free quality public education? ? References Bond, E. , Gingerich, S. , Archer-Antonson, O. , Purcell, L. , & Macklem, E. (2003). Impact of the Industrial Revolution. Retrieved Sunday, October 21, 2012, from http://industrialrevolution. sea. ca Devinatz, V. (2011, Spring). U. S. Trade Unionism Under Globalization: The Death of Voluntarism and the Turn to Politics?Labor Law Journal. 62(1). 16-29. Retrieved Saturday, September 29, 2012, from EBSCOhost AN: 59982464 Gitlow, A. (2012, Summer). Ebb and Flow in America’s Trade Unions: The Present Prospect. Labor Law Journal. 63(2). 123-136. Retrieved Saturday, October 13, 2012 from EBSCOhost AN: 7802312 6 Givan, R. & Hipp, L. Public Perceptions of Union Efficacy: A Twenty-Four Country Study. Labor Studies Journal. 37(1). 7-32. Retrieved Saturday, October 13, 2012, from EBSCOhost DOI: 10. 1177/0160449X11429264 Hackett, L. (1992). Industrial Revolution. History World International.Retrieved Sunday, October 21, 2012, from http://history-world. org/Industrial Intro. htm Hogler, R. (2012, Fall). Constitutionalizing Paycheck Protection: What Knox v. Service Employees International Union Means for American Labor. Labor Law Journal. 63(3). 153-164. Retrieved Saturday, September 29, 2012, from EBSCOhost AN:80170928 Hogler, R. and Henle, C. (2011, Fall). The Attack on Public Sector Unions in the United States: How Regional Culture Influences Legal Policy. Labor Law Journal. 62(3). 136-144. Retrieved Saturday, September 29, 2012, from EBSCOhost AN:66687318References Lafer, G. (2012, June 2). Right to Work – for Less. Nation. 294(6). 24-26. Retrieved Saturday, October 13, 2012, from EBS COhost AN: 70466585 McAlevey, J. (2011, March 7). Labor’s Last Stand. Nation. 292(10/11). 22-26. Retrieved Saturday, September 29, 2012, from EBSCOhost AN: 58504081 Rigiero, D. (2011, April). â€Å"You are now entering the United Corporations of America. † Please leave your union card at the border. Massachusetts Nurse Advocate. 82(3). 14. Retrieved Saturday, October 13, 2012, from EBSCOhost AN: 2011071259 Schulz, N. 2012, January 10). Why U. S. should cheer for Wisconsin Gov. Scott Walker. USA Today. Retrieved Saturday, September 29, 2012, from EBSCOhost AN: JOE207214460212 Tucker, B. (2005, May). Liberty is Exploitation: The Force of Tradition in Early Manufacturing. OAH Magazine of History. 19(3). 21-24. Retrieved Sunday, October 21, 2012, from JSTOR http://www. jstor. org/stable/25161943 University of Maryland, Baltimore County. (2001, January 24). Pros and Cons of Collective Bargaining. Retrieved Monday, October 22, 2012, from www. umbc. edu/uwaaup/ collective. ht m

Free Essays on Poverty

The existence of poverty ensures that society’s â€Å"dirty work† will be done. Every society has such work: physically dirty or dangerous, temporary, dead-end and underpaid, undignified, and menial jobs. Society can fill these jobs by paying higher wages than for â€Å"clean† work, or it can force people who have no other choice to do the dirty work and at blow wages. In America, poverty functions to provide a low-wage labor pool that is willing or, rather, unable to be unwilling to perform dirty work at low cost. Indeed, this function of the poor is so important that in some Southern states, welfare payments have been cut off during the summer months when the poor are needed to work in the field. Moreover, much of the debate about the Negative Income Tax and family Assistance Plan has concerned their impact on the work incentive, by which is actually meant the incentive of the poor to do the needed dirty work if the wages there from are no larger than the income grant. Many economic activities that involve dirty work depend on the poor for their existence: restaurants, hospitals, parts of the garment industry, and â€Å"truck farming† among others, could not persist in their present form without the poor. In history during the great depression one key reason for the great crash of 1929 was that, the Harding-Coolidge-Hoover administrations followed laissez faire policies. They refused to â€Å"tamper† with income taxes, interest rates, or use economic regulation powers. This example supports the first functions of poverty. Because the poor are required to work at low wages, they subsidize a variety of economic activities that benefit the affluent. For example, domestics subsidize the upper-middle and upper classes, making life easier for their employers and freeing affluent women for a variety of professional, cultural, civic, and partying activities. Similarly, because the poor pay a higher proportion of their income in property and... Free Essays on Poverty Free Essays on Poverty â€Å"The war on poverty is not a struggle simply to support people, to make them dependent on the generosity of others,† was said in President Johnson’s State of the Union address on Jan. 8, 1964 (Johnson). Lyndon B. Johnson wanted to continue the unfinished work of President John F. Kennedy’s proposals on civil rights and taxes before his assassination on November 22, 1963 (Rulon). The War on Poverty was to break the cycle of poverty that affected nearly 35 million Americans (Greenbaum). After the Vietnam War, the government had over spent for the war and was unable to compensate the soldiers. There were many programs developed to help the Americans who suffered from this war on poverty and to bring the employment rate back up. Welfare was a program developed in Chicago to help support the poor families, and funds were given to help improve Chicago schools. War on Poverty was a success on some counts; a lot had changed from the beginning. From the recent increases of America economy and social lives, one can tell that America had changed since the Vietnam War, riots, and racial issues. President Lyndon B. Johnson’s War on Poverty influenced many American lives. America had turned over since the Vietnam War, riots, and racial issues. President Lyndon B. Johnson’s War on Poverty influenced many American lives. What was the War on Poverty? A cycle of poverty that affected nearly 35 million Americans after the Vietnam War (Greenbaum). A name given by President Johnson which meant America had to strive for a rebuilding in the economy and social lives after the war. Johnson was next in line for presidency after John F. Kennedy was fatally shot. He pushed through Congress many laws designed to help the poor and to add to the economic security of other Americans. Many social programs was established from this depression stage. Programs included the Job Crops, furnished job training fo... Free Essays on Poverty The existence of poverty ensures that society’s â€Å"dirty work† will be done. Every society has such work: physically dirty or dangerous, temporary, dead-end and underpaid, undignified, and menial jobs. Society can fill these jobs by paying higher wages than for â€Å"clean† work, or it can force people who have no other choice to do the dirty work and at blow wages. In America, poverty functions to provide a low-wage labor pool that is willing or, rather, unable to be unwilling to perform dirty work at low cost. Indeed, this function of the poor is so important that in some Southern states, welfare payments have been cut off during the summer months when the poor are needed to work in the field. Moreover, much of the debate about the Negative Income Tax and family Assistance Plan has concerned their impact on the work incentive, by which is actually meant the incentive of the poor to do the needed dirty work if the wages there from are no larger than the income grant. Many economic activities that involve dirty work depend on the poor for their existence: restaurants, hospitals, parts of the garment industry, and â€Å"truck farming† among others, could not persist in their present form without the poor. In history during the great depression one key reason for the great crash of 1929 was that, the Harding-Coolidge-Hoover administrations followed laissez faire policies. They refused to â€Å"tamper† with income taxes, interest rates, or use economic regulation powers. This example supports the first functions of poverty. Because the poor are required to work at low wages, they subsidize a variety of economic activities that benefit the affluent. For example, domestics subsidize the upper-middle and upper classes, making life easier for their employers and freeing affluent women for a variety of professional, cultural, civic, and partying activities. Similarly, because the poor pay a higher proportion of their income in property and...

A personal response Thomas Kinsella Essay Example

A personal response Thomas Kinsella Essay Example A personal response Thomas Kinsella Paper A personal response Thomas Kinsella Paper Thomas Kinsella is a poet that is very aware of transience. He also shows me through his poetry that the things we remember as children take on a different meaning when we are older and also that when someone passes away, we also look at the memories of that person in a different way. His poetry has a harsh outlook on aging, getting old and even gaining knowledge to a degree, however he is not all doom and gloom (as we see in Model school, Inchichore and Dick King), he can also take a positive view on things, even death! My favourite aspect of his poetry is the way he can show you a new perspective while still using simple, everyday language for the most part. Sometimes, his poems can be read in a number of different ways! Kinsella is unique from other poets in the fact that he was influenced by theories of Carl Jung. No other poet I have studied on the leaving cert course that uses outside inspiration as strongly. He also writes a good deal about people in his life, or who were in his life, in his poetry and I think that stands to him as a person. It shows that even in his work, he thinks about those who mean a lot to him. A poem that has a very strong sense of transience is Mirror in February. The poet has an epiphany while shaving in the mirror one day. He realizes that he is the same age as Jesus when he died,reach the age of Christ, but yet the poet has not accomplished his lifes mission. To me, it seems as if the poet obsesses over his age and the fear of growing old for they are not made whole. Kinsella is jealous of the trees because they get hacked clean for better bearing and return again during the Spring, whereas Kinsella cannot just be renewed. When he ages, the years stay with him, how should the flesh not quail that span for span is mutilated more? . We can tell that Kinsella is not happy with the idea of himself growing old, while the trees stay seemingly ageless, In slow distaste. This poem gives me a good insight of the feelings that Im sure many of the adults in my life have experienced at some stage in their lives, and feelings that, I am sure, I will face in time. It has also shown me that although aging is inevitably a part of life, I can go about it in two ways. I can deny it for as long as I can before I have to accept the it, or I can do what Kinsella does in this poem, which I much prefer, and just accept it as part of life. I fold my towel. not young and not renewable, but man. Kinsella isnt happy about the fact that hes aging (and who is? ) but he can accept it and enjoy the time he has left with pride in being who he is, and I like that about him as a person. The main poem from kinsellas works that shows transience is His fathers Hands. This poem is too erratic and long for my liking but I can certainly relate to what he says and this is probably the poem I can relate to most out of all of Kinsellas poems that we have studied throughout the leaving cert course. Things like how his father destroys the point by prodding the air, remind me of my family as my father does the exact same his fingers prodded and prodded marring his point. When my father does it, I too, zone out and start thinking of other things. Kinsellas grandfather also reminds me of my own. My dad is the spitting image of him, so I often think of my grandfather when I see my dad. This is exactly what Kinsella does as well. I have watched his fathers hands before him. My grandfather is also very hard of hearing and near blind, as the grandfather in His fathers hands is. To his deaf, inclined head. This poem reminds me of my grandfather and for that reason alone, I really like this poem. However unlike this poem, my grandfather is not an isolated figure, that is looked upon with pity, my grandfather is the life and soul of a party at times and so I can never read this poem and feel the sadness and loneliness that others do, but that is a plus in my eyes. This poem actually inspired me to look back to my roots, and discover more about who my family was before me. And some years before that the Family came from somewhere around Tullow. Although the style of the poem isnt the type I normally like, this poem is very memorable to me and I dont think I will ever forget it because of the effect it has had on me.

Impact of Innovation on Economic Perfomance on Micro and Macro Level Essay

Impact of Innovation on Economic Perfomance on Micro and Macro Level - Essay Example This essay is one of the best examples of comprehensive theoretic analysis of the mechanism of the impact of technology changes on the competitiveness of a company or an entire economy of a country. The tighter and more competitive business environment is driving firms to innovate in order to maintain their existence as a market player. However, as more firms innovate, the struggle to maintain their share in the market in turn gets other firms to innovate, capturing everybody to be part of a complex economic cycle. A source of new technology is the society’s search for increased economic efficiency and a sincere desire to reduce the cost that it has to pay for the availability of goods. Whether the purpose of the technology is to improve its effective use of available natural resources or to increase or alter the supply of available resources, it has impacted what people buy (hence created new demand types), what they choose to do with their time (leading to new market for leisure events), what jobs are lost due to changes in the overall economic mix, and possibly the price of other goods that compete with the products, that were produced using new technology. Research, entrepreneurship, new start-ups, consolidation of businesses, interaction with other companies and financial markets create an environment that is conclusive to innovations. Novel trends in innovative activities are impacted by new technologies, modifications in the existing knowledge base, as well as changes in consumer needs.

Innovation of Emirates 2 Essay Example | Topics and Well Written Essays - 2000 words

Innovation of Emirates 2 - Essay Example Appraisal of the Organization The Emirates Airlines has had a profitable run for a while now, and this calls for an in depth look at the company. This will involve looking at the company’s strengths, weaknesses, opportunities that the company has and the threats that the company has to its profitability. Strengths of the Airline As seen above, the company has managed to be profitable within the economic downturn that has faced many of her competitors. This certainly points to the strength that this company has to its advantage. One strong point of this company is the level of stability in terms of management that the company has. In light with this, the company is able to transact with its clients who have a high level of trust that the company will deliver when it promises to do so. Another upside to the state ownership is the fact the company has a secure source of funding for its existent or future plans. Unlike most other airlines that compete with the Emirates Airlines, t he issue of funding does not bring in as much headache as it does to a lot of her competitors. This is because the state is in complete control of the airline and has a much wider purse with which it can fund the airline’s operations. This, to a large extent explains why the company has been able to remain successful in the long run. The airline is also committed to the use of technology in improving its services. The company has embraced the use of online booking of its tickets as a way of easing congestion as well as improving the overall customer experience. The company has adopted the use of Verified by Visa (VbV) technology (Pan and Polishuk 2004). This is a move that has been calculated to ensure that the airline has a safer mode of transaction with its clients. Aside from that, this technology is also poised to place the airline on a leadership vantage point in relation to its competitors. In addition, this has the advantage of mounting the trust that the clients place on the airline securing their return services. The airline has also strength in terms of the services that it offers to its travellers. The premium customers will get a limousine ride from their homes or office to the airport (Shaw 2011). This action, which is part, of the company’s product differentiation strategy, is calculated to encourage more clients to explore the premium package. This is further accentuated by the services that the clients will get once they arrive at the airport. These services include a kerbside check-in facility to eliminate the hustle of carrying heavy language into the terminal and further a luxurious lounge and ease for the passenger during checking-in (Shaw 2011). This, obviously remove many of the hustles that go with travelling. Therefore, this has had the effect of ensuring that customer loyalty is upheld as well as customer comfort throughout their travel. Weaknesses of the Airline The airline has a number of issues that limit its performan ce. Some of these issues have a lot to do with the ownership and by extension the management of the airline. Accordingly, the government, having full ownership of the airline highly controls the running of the airline’s operations. The government’s say in the running of the airline is a hindrance in many times (Betz 2010). Though the government having a say in the airline is not such a bad thing in the ultimate outlook, it may constitute interference when it decides to overhaul a decision that the airlines’