Holistic care of a terminally-ill neonate in Australia - Free Essay Example

Sample details Pages: 9 Words: 2582 Downloads: 3 Date added: 2017/06/26 Category Medicine Essay Type Essay any type Did you like this example? In the Australian tertiary health care system, best practice in the care of a terminally-ill neonate and the neonates family centres on the provision of holistic care. Neonates and their families are considered an interdependent system; therefore, holistic care involves the complete physical and psychological care of both the neonate and the family. However, quality holistic care can be challenging for nurses to achieve, particularly in a complex palliative model of care. Don’t waste time! Our writers will create an original "Holistic care of a terminally-ill neonate in Australia" essay for you Create order This paper discusses the best practice holistic care of a terminally ill neonate and the neonates family in the context of the Australian tertiary health care system. The term palliative care refers to the withholding and / or withdrawal of life sustaining treatment in patients with terminal illness, to prevent or relieve suffering and allow death to occur (World Health Organisation, 2015). In all patients, and children in particular, the World Health Organisation (2015: n.p.) highlights that palliative care must be a holistic process, one which provides active total care of the childs body, mind and spirit, and [which] also involves giving support to the family. Palliative care is concerned with providing a terminally ill neonate with the best conditions in which to live and with facilitating a comfortable death (Ahern, 2013; Bergstraesser, 2013). As parents are fundamental in the decision-making processes around neonatal palliation and as it is they who will be the most signific antly affected by these decisions (Branchett Stretton, 2012; Larcher, 2013), neonatal palliative care places a particular focus on caring for parents. There is consensus in the academic literature for palliation as the best model of care for neonates who are terminally ill; indeed, both the Australian College of Neonatal Nurses (2010) and the Royal Australian College of General Practitioners (2014) highlight palliative care as a best-practice option for terminally ill neonates in the Australian context. It is accepted that the parents of a terminally-ill neonate in palliative care require significant emotional support from neonatal nurses and other members of the health care team. Parents of palliated neonates often experience a complex emotional reaction to their situation, typically one of grief, shock and confusion (Badenhorst Hughes, 2007; Gardner Dickey, 2011). They may also experience feelings of profound loss, related not only to the impending loss of their child but al so to a loss of their expectations, aspirations, role as parents and family dynamic, etc. (Gardner Dickey, 2011). Additionally, it is not uncommon for parents to feel indecisiveness, shame or guilt about the decision to palliate their neonate (Reid et al., 2011), particularly when the outcome of the neonates condition is uncertain. There is evidence from one early Australian study to suggest that women who experience neonatal loss have significantly higher rates of psychological distress and a greater risk of clinical depression than other mothers (Boyle et al., 1996). Thus, it is essential for neonatal nurses to validate the complex emotions the parents of a palliated neonate experience as being part of a normal and healthy psychological process (Badenhorst Hughes, 2007). The provision of a clinical environment where parents complex emotions can be expressed and explored is also important. Best-practice models of neonatal palliative care recommend that parents take a lead role in the care of their infant, both in terms of decision-making and practical care (PSANZ, 2009; Australian College of Neonatal Nurses, 2010). Whilst some parents may resist providing care for and thus becoming attached to a palliated neonate, fearing that this will increase the degree and duration of their grief following the childs death, there is evidence to suggest this is not the case for many parents (Gardner Dickey, 2011). There is also evidence which indicates that many parents regret not spending more time with their deceased neonate, both prior to and following death (Williams et al., 2008). Thus, the literature recommends that parents should be treated by neonatal nurses as welcome partners in the care of their baby (Griffin, 2013). Parents should also be encouraged and supported to be involved in the care of their baby to the extent that they feel comfortable doing so (PSANZ, 2009). So that parents may be meaningfully and safely involved in the care of their palliated baby, it is important that neonatal nurses provide them with the information they require to make informed decisions à ¢Ã¢â€š ¬Ã¢â‚¬Å" and this may begin in the palliation planning phase. Developing a flexible, transparent and family-centred palliation plan is essential, and so that their preferences are met, parents should take a key role in this process (Williamson et al., 2009). The palliation plan must focus on enabling open caregiving policies, highlight parents wishes for their neonate and be legally documented (Breeze et al., 2007; Wiliamson et al., 2009; Gardner Dickey, 2011). Whilst most parents wish to be involved in decisions and planning around end-of-life care for their neonate, they may find this responsibility overwhelming (Williams et al., 2008). Parents will be exposed to a range of options and opinions which they must synthesise in order to make the best decisions for their family; however, it is important for neonatal nurses to realise that highly emotive situa tions can often cause significant deficits in parents ability to comprehend and process such information (Williams et al., 2008). Evidence suggests that repetition printed literature is important in the provision of information to parents in situations involving neonatal death (PSANZ, 2009). The timing and delivery of the information provided by neonatal nurses should also be carefully planned to ensure maximal uptake (PSANZ, 2009). Australian guidelines recommend that when supporting the parents of a palliated neonate, neonatal nurses focus on the normalcy of parenthood wherever possible (PSANZ, 2009). Neonatal nurses should assist parents to engage in normal parenting opportunities à ¢Ã¢â€š ¬Ã¢â‚¬Å" including holding, changing and bathing their baby, and routine interactions such as reading cues and providing comfort à ¢Ã¢â€š ¬Ã¢â‚¬Å" if they feel able to do so (PSANZ, 2009). For babies with longer palliative periods and where the babys condition permits, feeding à ¢Ã¢â€š ¬Ã ¢â‚¬Å" including breastfeeding or the feeding of expressed breast milk à ¢Ã¢â€š ¬Ã¢â‚¬Å" is also an important consideration. Normal rituals associated with infancy, such as naming ceremonies and baptism, should also be followed if the family consider these to be important (PSANZ, 2009; Weidner et al., 2011). A palliated neonates relationship with extended family may also be an important consideration for many families. Though visiting in intensive care nurseries is often restricted to parents, photographs and videos of the baby may be shared with extended family members and these relatives may be encouraged to send toys, clothing and nursery decorations, etc. for the baby in return (PSANZ, 2009). Research suggests that the support of family is a significant factor in the recovery of parents from the death of a neonate; indeed, the grief of parents may be enhanced when there is a lack of familial engagement with a palliated neonate (Gardner Dickey, 2011). Grief of the family its elf is also essential to consider; for example, there is evidence to suggest that better outcomes are achieved when grandparents and siblings are engaged with parents in the process of bereaving a deceased neonate (Roose Blanford, 2011). The literature suggests that the creation of tangible memories is fundamentally important to the parents of a palliated neonate, and this is included as a recommendation in Australian perinatal mortality guidelines (Capitulo, 2005; PSANZ, 2009). Memories collected may include photographs and videos, prints or casts of the hands and feet, locks of hair, identification bracelets or cards, toys and gifts, nursery decorations, and blankets, hats or clothing, etc. (De Lisle-Porter Podruchny, 2009; PSANZ, 2009). It is important to note that many parents, and particularly those in denial of their babys palliative state, may resist collecting such memories; in this case, it is recommended that hospitals do so and hold these with the babys clinical docu mentation until such time as the family is ready to receive them (PSANZ, 2009). So that parents may maximise the quality time they spend with their neonate, it is important for neonatal nurses consider the wider social factors which may affect them and their families (Ahern, 2013). Issues related to finances, employment commitments, accommodation, transport and the care of other children should be referred to a hospital social worker. Where required, postnatal medical attention in a clinical area where the mother will not be in close proximity to other healthy neonates, in addition to the suppression of lactation, are important (Badenhorst Hughes, 2007). The environment in which the palliative care takes place must also be considered; Australian guidelines suggest that this environment should be private, comfortable, peaceful and supportive (Kain, 2006; PSANZ, 2009). Once the decision has been made to palliate a neonate, all treatment which is not essential to the babys comfo rt must be withheld and withdrawn. This includes removing all inessential intravenous lines, invasive ventilation, monitors and pharmaceutical treatment. As the neonate begins to decline physiologically and the activity of the gastrointestinal system reduces, nasogastric feeding and hydration should also be ceased (Porta Frader, 2007). Administering an appropriate dose of narcotic analgesia to relieve discomfort and sedate the respiratory drive may be useful (Williams et al., 2008; Carter Jones, 2013); however, parents should be assured that this does not constitute euthanasia, which is illegal in Australia. At this stage, the end-of-life rituals should be conducted according to parental preference (Ahern, 2013). As the neonate progressively declines, it is essential that neonatal nurses prepare parents with information about how the babys death will likely occur. This includes the possibility of the neonate rapidly decompensating and displaying distressing signs such as hypoxic a gitation, gasping, intercostal recession, pallour and temperature loss (Brosig et al., 2007; Williams et al., 2008; Carter Jones, 2013). Information provided should also include the fact that timing to death cannot be predicted (Williams et al., 2008). Parents should be given a choice as to whether they remain with the neonate during death. Following death, parents should be provided with the opportunity to hold, change or bathe their baby if they wish to do so (PSANZ, 2009). Whilst many parents are reluctant to or even fear engaging with their deceased baby, there is evidence to suggest that no parent regrets this experience and that many find it valuable (Capitulo, 2005). The policies of most maternity services in Australia allow parents to view their neonate as many times they wish, and some may also provide parents with the option of taking the baby home for a short period (PSANZ, 2009). Once the parents are ready, neonatal nurses should assist them to complete death registr ation and autopsy documents, as appropriate. Nurses should also support parents to organise a funeral through a company of their choice; in Australia, a funeral is legally required for all neonates born at or over 20 weeks gestation. A funeral is particularly important for many parents in terms of achieving closure (Williams et al., 2008). Most literature recommends that the parents who have experienced a neonatal death receive early supported discharge from hospital (Gardner Dickey, 2011). Referral to support services in the parents own community à ¢Ã¢â€š ¬Ã¢â‚¬Å" including general practitioners, counsellors and peer support groups, etc. à ¢Ã¢â€š ¬Ã¢â‚¬Å" are essential considerations. Follow-up is also important; for example, if an autopsy was performed, neonatal nurses should communicate these results to parents in a timely manner (PSANZ, 2009; Reid et al., 2011). Additionally, many parents find personal follow-up, including telephone calls and cards, from the neonatal nurse s who cared for their baby to be meaningful (Weidner et al., 2011), reinforcing that their child was important and will be remembered. In the Australian tertiary health care system, best practice in the care of a terminally-ill neonate and the neonates family centres on the provision of holistic care. As they are an interdependent system, holistic care involves the complete physical and psychological care of both the neonate and the family. This paper has discussed the best practice holistic care of a terminally ill neonate and the neonates family in the context of the Australian tertiary health care system. It has demonstrated that whilst holistic care may be challenging to achieve, it is essential in delivering the best positive outcomes in a complex situation such as neonatal palliation. References Ahern, K., (2013), What neonatal intensive care nurses need to know about neonatal palliative care, Advances in Neonatal Care, vol. 13, no. 2, pp. 108-114. Australian College of Neonatal Nurses 2010, Palliative Care in the Neonatal Nursery: Guidelines for Neonatal Nurses in Australia, viewed 04 October 2015, https://acnn.sslsvc.com/acnn-resources/clinical-guidelines/G3-Palliative-care-in-the-neonatal-nursery.pdf Badenhorst, W., Hughes, P., (2007), Psychological aspects of perinatal loss, Clinical Obstetrics Gynaecology, vol. 21, no. 2, pp. 249-259. Bergstraesser, E., (2013), Pediatric palliative care: When quality of lie becomes the main focus of treatment, European Journal of Pediatrics, vol. 172, no. 2, pp. 139-115. Boyle, FM., Vance, JC., Najman, JM., Thearle, JM., (1996), The mental health impact of stillbirth, neonatal death or SIDS: Prevalence and patterns of distress among mothers, Social Science Medicine, vol. 43, no. 8, pp. 1273-1282. Branchett, K., Str etton, J., (2012), Neonatal palliative and end of life care: What parents want from professionals, Journal of Neonatal Nursing, vol. 18, no. 2, pp. 40-44. Breeze, ACG., Lees, CC., Kumar, A., Missfelder-Lobos, HH., Murdoch, EM., (2007), Palliative care for prenatally diagnosed lethal fetal abnormality, Archives of Disease in Childhood, vol. 92, no. 1, pp. 56-58. Brosig, CL., Pierucci, RL., Kupst, MJ., Leuthner, SR., (2007), Infant end-of-life care: The parents perspective, Journal of Perinatology, vol. 27, no. 510-516. Capitulo, KL., (2005), Evidence for healing interventions with perinatal bereavement, The American Journal of Maternal Child Nursing, vol. 30, no. 6, pp. 389-396. Carter, BS., Jones, PM., (2013), Evidence-based comfort care for neonates towards the end of life, Seminars in Fetal Neonatal Medicine, vol. 18, no. 2, pp. 88-92. De Lisle-Porter, M., Podruchny, AM., (2009), The dying neonate: Family-centred end-of-life care, Neonatal Network, vol. 28, no. 2, pp. 75-83. Gardner, SL., Dickey, LA., (2011), Grief and Perinatal Loss, in SL Gardner, BS Carter, M Enzman-Hones JA Hernandez (eds.), Merenstein Gardners Handbook of Neonatal Intensive care, Australian Academic Press, Queensland. Griffin, T., (2013), A family-centred visitation policy in the neonatal intensive care unit that welcomes parents as partners, The Journal of Perinatal Neonatal Nursing, vol. 27, no. 2, pp. 160-165. Kain, VJ., (2006), Palliative care delivery in the NICY: What barriers to neonatal nurses face?, Neonatal Network, vol. 25, no. 6, pp. 387-392. Larcher, V., (2013), Ethical considerations in neonatal end-of-life care, Seminars in Fetal Neonatal Medicine, vol. 18, no. 2, pp. 105-110. Perinatal Society of Australia and New Zealand (PSANZ) 2009, Clinical Practice Guideline for Perinatal Mortality, viewed 04 October 2015, https://www.stillbirthalliance.org.au/doc/Section_1_Version_2.2_April_2009.pdf Porta, N., Frader, J., (2007), Withhold ing hydration and nutrition in newborns, Theoretical Medicine Bioethics, vol. 28, no. 5, pp. 443-451. Reid, S., Bredemeyer, S., van den Berg, C., Cresp, T., Martin, T., Miara, N., Coombs, S., Heaton, M., Pussell, K., Wooderson, S., (2011), Palliative care in the neonatal nursery, Neonatal, Paediatric Child Health Nursing, vol. 14, no. 2, pp. 2-8. Roose, RE., Blanford, CR., (2011), Perinatal grief and support spans the generations: Parents and grandparents evaluations of an intergenerational perinatal bereavement program, Journal of Perinatal Neonatal Nursing, vol. 25, no. 1, pp. 77-85. Royal Australian College of General Practitioners 2014, Paediatric Palliative Care: The Role of the GP, viewed 04 October 2015, https://www.racgp.org.au/afp/2014/april/paediatric-palliative-care/ Weidner, NJ., Cameron, M., Rebecca, C., McBride, J., Mathias, EJ., Byczkowski, TL., (2011), End-of-life care for the dying child: What matters most to parents, Journal of Palliative Care, vo l. 27, no. 4, pp. 279-286. Williams, C., Munson, D., Zupancic, J., Kirpalani, H., (2008), Supporting bereaved parents: Practical steps in providing compassionate perinatal and neonatal end-of-life care, Seminars in Fetal and Neonatal Medicine, vol. 13, no. 5, pp. 335-340. Williamson, A., Devereux, C., Shirtliffe, J., (2009), Development of a care pathway for babies being discharged from a level 3 neonatal intensive care unit to a community setting for end-of-life care, Journal of Neonatal Nursing, vol. 15, no. 5, pp. 164-168. World Health Organisation 2015, WHO Definition of Palliative Care, viewed 04 October 2015, https://www.who.int/cancer/palliative/definition/en/

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Annual Health and Safety Paln Free Essays

string(113) " on their Health and Safety Performance on a variety of subjects, where the winners each month receive a Plague\." J Coffey Construction Ltd ANNUAL REPORT Date of Board meeting: TBC Name of Report: Annual Health Safety Report 2008/2009 Author(s): Alyn Tomkinson Approved by (name of Executive member): James Coffey Presented by: Alyn Tomkinson Purpose of the report: To provide the Board with the Annual Health Safety Report for 2008/2009 Overview of Performance between April 2008 and April 2009 Action required: Approval by the Board Sections 1. 2. 2. We will write a custom essay sample on Annual Health and Safety Paln or any similar topic only for you Order Now 1 2. 2 2. 3 3. 4. 5. 6. 7. Appendix 1 Appendix 2 Appendix 3 Standard Contents Overview Key Achievements Policy Development and Implementation Information Incident Reporting Performance Indicators Raising the Profile of Health and Safety Co-operation and Co-ordination Training and Competence Health and Safety Objectives Accident Summary Prohibition Notice Summary of Insurance Claims Health and Safety Annual Report 2008/2009 Report No: 2 J Coffey Construction Ltd Health and Safety Annual Report 2008/2009 1. Overview The work to continually improve Health and Safety has grown in stature throughout the Company since the last reporting year. Generally awareness of Health Safety has been raised further by the Employment of a Productive Health and Safety Advisor working along side the Health and Safety Manager to ensure compliance is met through Auditing, Documentation Evaluation, Investigation works, continual training, safety meetings and various safety bulletins, as well as filtering all Supervisors and Managers (In due course) through either the SSSTS (Site Supervisors Safety Training Scheme) or the SMSTS (Site Managers Safety Training Scheme) which has enhanced the Health and Safety Culture throughout the Company. The Health Safety Manager and Team has continued the good work within the company to ensure that Site Managers meet their responsibilities, although in some areas this has met with some resistance with some managers still failing to complete weekly document returns. Most Managers have achieved carrying out risk assessments reviews on existing risk assessments as well as producing Method Statements which in the past was lacking. 2. Key Achievements 2008/2009 2. 1 Policy Development and Implementation A key objective of the Health Safety department for this year was to continue the development and implementation of health and safety policies across the company, integrating as far as possible already established systems to ensure minimal changes to working practices. The following guidance has been ratified and implemented: ? No Lone Working – Continued from Last Report. ? Young Persons Health Safety Risk Assessment – Continued from Last Report. ? Implementation of the Health and Safety Action Plan – Within the new Health and Safety Manual. Implementation of a Worksafe Policy – Within the new Health and Safety Manual. ? The introduction of a New method Statement Proforma, Diamond Drilling Check sheets, BROKK Daily/weekly check sheets, Concrete-Screed pump check sheets, Plant issue vouchers and the Health and Safety Observation Cards. Health and Safety Annual Report 2008/2009 Report No: 2 J Coffey Construction Ltd The following policy matters continue t o be worked on from last year: ? Guidance for Managers Team Leaders on the HSE Management Standards for assessing Work Related Hand Arm Vibration (HAVs). ? Guidance for Managers Team Leaders on the HSE Management Standards for assessing Work Related Risk. ? Guidance for Managers Team Leaders on Method Statements and Risk Assessments. ? Manual Handling. ? Supervisors Training. ? Asbestos Awareness. ? Training in general. 2. 2 Information The Health Safety manual and individual site files continue to be updated and contain the following information: ? ? ? ? ? ? ? 2. 3 Policies HSE Leaflets/Guidance Risk Assessment Guidance Generic Risk Assessments Minutes of Safety meetings Health Safety Newsletters (HSE and Worksafe Partnership) Toolbox Talks Incident Reporting Kind of accident/incident Fatal Major Over 3 Days Minor Total Fall from height 0 0 2 1 3 Slip, Trip, fall – same level 0 0 0 2 2 Injured whilst handling, lifting, carrying 0 0 1 1 2 Struck by moving object 0 0 0 2 2 Struck by moving Vehicle 0 0 0 0 0 Contact with moving machinery/material 0 0 0 1 1 Contact with electricity 0 0 0 0 0 Health and Safety Annual Report 2008/2009 Report No: 2 J Coffey Construction Ltd Strike against something fixed/stationary 0 0 0 2 2 Exposure/contact – harmful substance 0 0 0 2 2 Other 0 0 0 2 2 Total 0 0 3 13 16 2 10 12 Below are the Results for 2007/2008 Total 3. 0 0 Performance Indicators Classically the incidence of accidents has been used as a key performance indicator for health and safety and this continues to develop, although it should be noted that there has been a rise in the number of accidents reported, this may be due to the heightened awareness of reporting procedures available to all operatives. Health and Safety Annual Report 2008/2009 Report No: 2 J Coffey Construction Ltd It should also be noted that, while important, the measurement of the accident rate is a measure of failures, not successes. However although there has been a slight rise in the reporting of accidents the Accident Incident Rate and the Accident Frequency Rate has decreased over the reporting period in relation to the number of employees to the previous year. The Health and Safety Department agrees to use the new Method Statement Proforma and all introduced check sheets to achieve uniformity throughout the company as a performance measure tool together with the new Health and Safety Table. 4. Raising the Profile of Health and Safety The Health Safety Manager issues monthly health and safety bulletin sheet from The Worksafe Partnership Ltd and his own, providing news of new policies and other health and safety matters of interest as well as e-mailing information from the HSE Website on relevant subjects. Health Safety HSE â€Å"Myth of the Month† are continuing to be published on the Health and Safety Notice boards. The Site Managers have, and continue to be active in the way of conducting Toolbox Talks in compliance with current HSE Campaigns and relevant implementations and changes throughout the company. The Health and Safety Manager has introduced a Monthly Health and Safety Table, marking each site on their Health and Safety Performance on a variety of subjects, where the winners each month receive a Plague. You read "Annual Health and Safety Paln" in category "Essay examples" The Company has now become a member of ROSPA (The Royal Society of the Prevention of Accidents). 5. Co-operation and Co-ordination Co-operation and co-ordination with other agencies has continued successfully. A good liaison link has been established with the Health Safety Executive, British Safety Council, IIRSM (International Institute of Risk and Safety Management) and ROSPA. 6. Training and Competence A health and safety training Matrix has proved successful and now has a regular monthly update in line with our OHSAS 18001 Health and Safety Standard. Objectives have been set to fully update our managers to have minimum Health and Safety Annual Report 2008/2009 Report No: 2 J Coffey Construction Ltd certification in the following courses – SMSTS, First Aid, and Environmental Awareness (On-Going). Below is the list of courses under took in this reporting period between April 2008 and April 2009 – NO. TRAINING NO. OF OPERATIVES TRAINED 20072008 NO. OF OPERATIVES TRAINED 20082009 1 PASMA TRAINING 14 0 2 COMBISAFE – SAFETY NET FAN 0 3 GENERAL HEALTH AND SAFETY NVQ 2 1 0 4 MANUAL HANDLING 1 0 5 HAND HELD EQUIPMENT AND TOOLS 1 0 6 FIRE PREVENTION AND CONTROL 1 0 7 EQUALITY AND DIVERSITY 1 0 8 CERTIFICATE OF UNIT CREDIT – LEVEL 2 NVQ IN CONSTRUCTION OPERATIONS 4 0 9 HSE FIRST AID AT WORK 11 0 10 FIRST AID AT WORK 4 0 11 CPCS CERTIFICATE 15 0 12 CSCS CERTIFICATE 25 0 13 C. SCOPE – CABLE AVOIDANCE TOOL 6 6 14 SONDE 6 0 15 SIGNAL GENERATOR SGV 6 0 16 CITB – INTERMEDIATE CERTIFICATE 1 0 17 SAFE USE AND MAINTENANCE OF GOODS HOIST 1 0 18 FIRE SAFETY TRAINING 3 0 19 IEMA ASSOCIATE MEMBERSHIP 1 0 20 ENVIRONMENTAL AWARENESS FOR BUILDERS AND SITE OPERATIVES 0 Health and Safety Annual Report 2008/2009 Report No: 2 J Coffey Construction Ltd 21 ASBESTOS AWARENESS 11 0 22 GGR UNIC – GLASS HANDLING AND MINI CRANES 4 0 23 SKID STEER LOADER 17 0 24 FORWARD TIPPING DUMPER 16 0 25 TELESCOPIC FORKLIFT 2 0 26 RIDE ON ROLLER 5 0 27 LORRY LOADER 4 0 28 EXCAVATOR 2 0 169 0 TOTAL Being Up Dated Currently by Cheryl Winter and Emma Lickley 7. Health Safety Objectives The objectives set for the Health Safety for 2009/2010 are those that indicate continuous improvement and are therefore a continuing set of objectives and will stand as objectives for the coming year. †¢ †¢ †¢ †¢ †¢ †¢ †¢ The company shall impos e a performance indicator on itself e. g. a reduction in reportable incidents by conducting more Courses such as Manual Handling Awareness, Safe Working in around plant and machinery Awareness to avoid reoccurrences in the last reporting period accidents. All Managers/Supervisors to achieve the SMSTS (Site Managers Safety Training Scheme) or SSSTS (Site Supervisor Safety Training Scheme) Courses (On-Going). All Managers to achieve the 4 day Appointed Person First Aid Training. All Managers to be fully trained in the producing of Method Statements and Risk Assessments (On-Going). An increase of 10% to be achieved on the issue of CSCS cards (OnGoing). Continual Asbestos Awareness Training for all operatives (On-Going). Continuous update to all staff on the current HSE Campaigns and Health and Safety Bulletins (On-Going). A Clamp to arrange for Two personnel per month to attend the MACE business school for training. Health and Safety Annual Report 2008/2009 Report No: 2 J Coffey Construction Ltd Appendix 1. SUMMARIES ENTERED INTO DATABASE FOLDER OF ACCIDENTS DANGEROUS OCCURRENCES WITHIN J COFFEY CONSTRUCTION LTD INVESTIGATED BY AN INTERNAL HEALTH AND SAFETY MANAGER (APRIL 2008 – TO APRIL 2009) Fall from Height IP (Injured Party) was exiting an inlet chamber via a ladder, while carrying a staff in one hand, when he fell 5. 5m resulting in Fractures to both heals (HSE Reportable). IP was working in a riser when the plyboard protection (secured by others) gave way and the operative fell 3. 5m resulting in a Fracture of the Transverse Process Lumbar Vertebrae. IP was in the process of propping up a brickwork pier when it cracked and broke free, falling through to the next level, resulting in the operative following it and cutting his leg. Slips, Trips, Fall – Same Level IP was exiting across a scaffold bridge when one of the steps collapsed, resulting in a graze to the leg. IP stepped on a piece of plyboard when it gave way resulting in the operative reaching out a hand to steady himself cutting his right arm. Injured whilst handling, lifting, carrying IP was carrying a wheelbarrow up some steps when he slipped, resulting in an injured back. (HSE Reportable). IP reported muscular pain due to holding and breaking out works. Struck by moving object IP was struck by a moving gate as it swung back resulting in a cut to the heel. IP was struck by his own hammer in the hip area, as he over swung and missed his intended target. Health and Safety Annual Report 2008/2009 Report No: 2 J Coffey Construction Ltd Contact with moving machinery/materials IP was struck by a skilsaw blade when it jumped after hitting the edge of the work bench resulting in a cut to the hand. Strike against something fixed/stationary IP was breaking out concrete when he caught his right arm on a protruding piece of re-bar, resulting in a cut. IP was breaking out concrete when he caught his right arm on a protruding piece of re-bar, resulting in a cut. Exposure/Contact – Harmful Substance 2 No IP`s were trying to unblock a gully without skin protection, into cementatious water, resulting in cementatious burns to their arms. Other IP blew into his safety goggles and as a result got grit/debris caught into his eyes. IP cut his big toe while having a Hilti Nail fired through his boot by another operative. Appendix 2. Prohibition Notice A Prohibition Notice was served by the HSE (Health and Safety Executive) for a defective concrete pump on the 22nd October 2008, which was being used by Floorscreed Ltd on behalf of J Coffey Construction Ltd at the Audi West Project. The pump was inspected 2 days prior to the Prohibition Notice being served by our on site Manager, who did not report any defects. On the day of the 22nd October 2008 the visiting HSE Inspector Mr V Neaverson found the guard protecting the mixing blades to have been snapped off and the operation of the pump still in use, resulting in both J Coffey Construction Ltd and Floorscreed Ltd receiving a Prohibition Notice being served. Actions taken to satisfy the Prohibition Notice : the pump was removed from site the same day and taken to Floorscreed Ltd Plant Yard where the guard was welded back in place and a new hopper lid fitted. The pump was returned to site the next day where it was photographed for evidence of the actions being carried out and emailed to the HSE Inspector as proof, after verbal communication with the HSE Inspector he confirmed work could continue. Health and Safety Annual Report 2008/2009 Report No: 2 J Coffey Construction Ltd Since this incident J Coffey Construction Ltd`s Health and Safety Department have implemented Daily/Weekly check sheets to be completed when carrying out works with static and mobile concrete/screed pumps, which to date has proved very effective. Despite satisfying the Prohibition Notice and introducing new checking systems the Prohibition Notice will remain on record by the HSE for 5 years. Appendix 3. Accident Claim Status Health and Safety Annual Report 2008/2009 Report No: 2 N N 0) s oN rf) ii o IL o : C rx ’; oo o(. )o(. )o ocoooro@o (f) cq_ (o (. )_ o (o c†, .. (9= gE tsss o- F E,r=F o5 93 .n tr)o Et 4l -â‚ ¬ ss ,. iA o jo _69 ES 3 Eh# E o oNo NN o. 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Levendary Caf free essay sample

Lavenders first steps and industry analysis Although Lavenders Cafà ©gs decision of entering Chinese market faced some tough challenges, the organization also took some good steps. First of all, the decision of entering China as the target market was a good decision. According to a report by IBIS World, this industry revenue grew by 3. 4% to $190. 2 billion in 201 1 and 2. 6% to $195. 2 billion in 2012. Industry revenue growth will level off as growth rates approach historical levels and the industry is forced to contend with the market saturation issues it has grappled with over the last 10 years. (Koala, April 2010). Since the American racket was already saturated, Chinese market offered an attractive alternative of expansion for Lavenders Cafe. China was a market of 1. 4 billion people where economic growth was around 14. 5% and where growing middle-class citizens, who demonstrated a positive acceptance of quick service restaurants, had a larger disposable income. The original idea of looking for foreign ventures proved also the good performance of the Business Research and Development department, which was taking the correct steps to enter this market. Apart from this, the previous experience of other companies such as KEF or McDonalds was a good example of US. Corporations able to attract a significant amount of customers and handle the existing competition in the market. The restaurant industry in China as well as in the IS. S. Is segmented, which means that rivalry is high because all competitors offer the same kind of products although the concept of establishment differs in each market. The threat of substitutes is also high since there are many other products to choose from: specialty or casual dining establishments.However, Lavenders focus adaptation strategy targeted a segment of consumers that were more health conscious and that allowed industry trends, which gave them an advantage over their competitors of serving a specific niche in the market. Problem statement and main issues concerning Lavenders cafà ©gs actions. The main problem that agenda Cafà © faced was to enter a market like China relying on a tacit agreement with a Chinese operator without a written agreement. Due to the lack of a strategic plan, Lavenders Cafà © was unable to set up a common goal to be followed by the Chinese Operations department.In addition to this, the lack of communication between offices cascaded in the adoption of different enhance practices, and as a result, there was a lack of transparency and agreement reflected in the confusing business models adopted. As mentioned above, the experience of other American businesses serves as an example of actions to be avoided by Lavenders Cafe. For instance, Pretzel Time did not study the assimilation by Chinese consumers of their stores decoration. KEF or McDonalds used joint venture as successful ways of entry for the Chinese Market.These two examples give us an idea of what Lavenders Cafà © did wrong when entering the Chinese market. First of all, the election by Chem. of smaller locations, less full-time staff or even the format of the stores as shown in Exhibit 3 are opposite to the standardized stores established among the U. S. Lavenders should have taken advantage of the difference regarding store costs as well as labor costs between China and U. S and try to replicate the American facilities in China.Bigger spaces would allow them to include the same number of seats, have a greater number of employees who could provide a more personalized service and increase the average traffic of guest per day. As a consequence, the annulled sales of he Chinese locations would be closer to the U. S. Ones, if they followed a more standardized strategy regarding the features and services offered in those stores. The sales volume of the Chinese stores in Exhibit 3 represent only 8% of the sales volume achieved by the American stores.Moreover, it would also help to enforce their brand image since customers in America can expect a similar service in China. Therefore, the standardization of these stores should be controlled by the Operations Department leaded by Mr.. Nick White (Exhibit 1) to control and secure their store opening strategies since any local and international competitors are trying to mimic the standardizing efforts. Secondly, Sheens objectives were quite different from the ones that the CEO had in mind. Sheens goal was to open numerous locations across the country based on price in order to reduce cost as much as possible.Although his main objective was the minimization of costs, the financial statement shown in Exhibit 4 demonstrate that despite his efforts, the net income remained negative. On the contrary, the American Coos goals was to establish a niche stable enough from which to expand in the near torture. She preferred giving more value to customers and going an extra mile to provide personalized customer service in order to build up loyalty while Chem. was focused on attracting a higher number of customers.He actually included changes in the menus that contradicted the companys niche strategy of targeting consumers interested in healthier choices. This conflict of interests comes as a result of the lack of duties and responsibilities clarification included in the agreement between Chem. and the CEO. Finally, the understanding of Chinese policies and procedures in order to plan a integration strategy was not effectively carried out. Lavenders Cafà © did not adopted the Gaps for accounting the revenues collected and, as a consequence, the company concurred in higher expenses.The organization did not consider the different organizational culture of Chinese businesses where the hierarchical structure is bottom-up instead of the top-down structure of American companies. This error explains the lack of communication between the CEO and Chem. as well as the refusal attitude of the last one to implement any change. Therefore, Lavenders Cafà © needs to adapt policies that would reinforce transparency as well as more control over Chinese operations without belittling Sheens efforts.Alternative Strategies Recommendation The following suggestions will help to eliminate or alleviate the conflicts explained above: Dismiss the China operations. The financial statements show that the business is not making any profits and that the situation is not going to turn around in the short-run. Sheens poor management as the Chinese operations CEO has not been proved as profitable as expected and the organization should reconsider the option to form a joint venture as a landed strategy to enter the Chinese market. Standardization strategy.The firm can try to replace the stores that do not follow their standardization strategy and make enough changes to attract the customers targeted by the American Company since the beginning. This strategy would provide consistency to Lavenders brand and would focus more on q uality features rather than quantity. However, the restoration of the 23 stores would increase expenses significantly. Moreover, the adoption of a standardized strategy to attract demand could also force the Chinese operations to incur in ewer net profits because they would be ignoring the advantages of alternative adaptation strategies.Localization strategy. The organization can try to adapt their business by including local dishes in their menus in order to attract a higher customer base. However, this would make competition even higher due to the already high rivalry established by companies that appeal to local tastes. Mixed strategy. Lavenders Cafà © can provide a standardized image through their stores and, at the same time, include some local dishes in their menus or offer two different kind of menus. Although this last option old satisfy different kind of demands, it would also increase marketing and operation expenses.Apart from this, the existence of two opposite menus would pose a huge challenge for the Concept department to meet goals in both markets. An alternative to attract both types of demands is the opening of two separate stores that would appeal to different tastes in a different set of locations. According to the average traffic of guests shown in Exhibit 3, those stores that appeal to local tastes would be located in metro-suburb areas while the stores appealing tastes closer to the Americans would be coated in more centered or developed areas.Optimal solution Lavenders Cafà © needs to turn around their initial pitfall entering the Chinese market and start making profits instead of negative net income. Since the main costs that need to be controlled are labor, marketing, maintenance and rent, there should be an effort by American CEO and Chem. to define coordinate marketing strategies as well as risks analysis, which would make it easier to identify cost drivers. Furthermore, they would need to redefine responsibilities, objectives and expectations in a formal written agreement which would include the features that are important to Lavenders Cafà © when expanding to other locations.However, departments such as Marketing, Operations and Business Development would have to transfer knowledge such as marketing forecasts to Chem. so that he had the appropriate tools to make decisions based on the same criteria than the American managers. This would alienate managerial styles and reduce expenses in the long-run. The best option to achieve a similar goal is to adopt a mixed strategy in which they keep a standardized strategy to offer a consistent brand image and, at he same time, appeal to local tastes through the modification of the menu.Once Lavenders Cafà © achieved a satisfactory profit margin in China, the firm could study the possibility of diversifying their portfolio and opening two different stores attending to different demands. Apart f rom this, they would need to differentiate the drivers of revenue for both markets since in China the volume of sales is the main driver while in America is the gross margin (Dolomite, 2014). A standardized approach such as the Gaps would reconcile the accounting differences and enforce transparency through Lavenders Cafà ©gs practices.