Microsoft Vega Project Essay Example

Microsoft Vega Project Essay How does Microsoft conduct strategic planning and what role human resource management plays in that process? It is apparent that people are Microsofts greatest asset. Linking production areas and using an atmosphere that caters to the 30 year old average employee age, has made the company a fantastic place of employment. Human Resources is responsible for identifying, hiring, and retaining their gifted talent. Microsoft has also boasted as very generous compensation and benefits program that has created a quality employee experience. Microsofts work environment, is a catalyst for great achievements. With a strategic human resource plan, Microsoft ensures that a diverse range of candidates are considered for opportunities as well as retaining them in a very competitive market. Their results are shown through enhanced product development and employee performance. The HR department is great at spotting talent and potential and aim to hire people who are smart, work hard, and get the right things done. HR staffing seeks to hire talented people who are passionate about their work. This passion translates directly into products and services that enable Microsoft customers to do their very best. Its an important mission — bringing the right people in and taking good care of them. It plays a critical role in helping Microsoft generate technology that positively affects the lives of millions of people around the world (Microsoft. com 2008). The case study on the Vega Project shows that HR department as well as company directors are using the plan to promote, educate, and empower individuals. As this case shows, it does not always work out to be a successful match. However, according to Microsoft’s home page, I believe their HR approach is a great example of how to recruit, retain, and promote motivated employees. We will write a custom essay sample on Microsoft Vega Project specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Microsoft Vega Project specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Microsoft Vega Project specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Where along the transactional-commitment continuum does Microsoft choose to be located ? Transactional leaders use strategy, structure and culture to strengthen their organization. This type of leadership can be displayed through a system of contingent-reward exchanges as well as active management. This style of leadership can be characterized through a process of goal-setting, setting expectations, and defining how followers will be rewarded (Gerhardt 2004). By achieving specific goals for both leaders and their followers, transactional leadership seeks to maintain stability rather than promoting change within an organization. This leadership style is closley related to the style used by Jim Kaplan in 1998. By recruiting MacLellan, he set goals, explained the rewards associated for meeting those goals, and maintain as close relationship with his new recruit. MacLellan was very excieted about his new Vega project and felt empowered to complete the project on time and meet the specified goals. He had a great commitment to the project, his team, and used many resources to ensure that it was a success. In my opinion I feel that due to the nature of Microsoft’s business, the company is high on the transactional-commitment continuum. This type of leadership is shown through the offer to MacLellan from Kaplan. Delivering the Vega project would mean a 14,000 dollar bonus, an allocation of 2,800 stock options, and promoted to a level 33 program manager, which carried a salary range of 85,000 to 110,000 dollars (Bassert page ? ). Microsoft Home Page http://members. microsoft. com/careers/careerpath/humanresource/default. mspx 2008 http://www. paulgerhardt. com/homework/TranformationalTransactonalLeadershipInRetail. pdf Paul Gerhardt-Transformational and Transactional Leadership in Retail (2004)

How to Do Research Paper Writing. Outline and Examples.

How to Do Research Paper Writing. Outline and Examples. Here is the complete information about the research paper writing. What Is a Research Paper? A research paper is the culmination product of an involved process of critical thinking, research, organization, composition and source evaluation. In other words, it is an extended essay that presents your own interpretation or argument or evaluation of the information you discover with absolute documentation of the sources. When writing a research paper, you build your thought about the question and make a purposeful attempt to find out what experts write or know. Have your hands full with urgent tasks? No stress anymore!  Ã‚  is ready to  make your college life easier. Here well tell you how to write a research paper and offer you a list of research paper topics. But if you wish to have your research paper written by our professional writers, place an order. Research Paper Outline Most courses in the university involve some extended writing assignments, often in the form of a research paper. The papers always require a student to identify a broad area of research related to the course. Becoming an experienced researcher in any field takes a great deal of practice. Remember, even the most seasoned academic writers had to learn how to write a research paper at a given time of their career. Here is the basic research paper outline: Research Paper Title Page The title should tell the reader what to expect in your research paper, addressing keywords that will be used in the literature review. It must include the author(s): full name and affiliation for persons who might have questions about the research. Research Paper Abstract The abstract is used by readers to quickly review the overall content of your research paper. It should provide a complete synopsis of the research paper, introduce the topics and specific research questions. It must provide a statement regarding the methodology and the general statement about the finding and results. It is often written last because it is the summary of the whole research paper. Research Paper Introduction It introduces the overall topic and provides the basic background information. Introduction narrows down the research questions relating to your study. It either gives the focus and purpose for the rest of your research paper or sets up the entire justification for the research paper. Research Paper Methods This section describes the methodology and research design used to complete the study. For instance, you should provide the context and setting of the study, population if applicable, specify the study design, identify the main study variables, sampling strategy, outline analysis methods and data collection procedures and instruments. Research Paper Results What did you find? This section focuses only on results that are related to your research question, and not their significance. However, the results presented will depend on whether the study was qualitative or quantitative. Tables and graphs should only be used when you have too much data that cannot be efficiently included within the text. Research Paper Discussion Give information that interprets your results like the main finding of the study, strengths, and limitation of the results, practice and policy implications of the results. The hypothesis should be to give the answers as validated by your interpretation of the results. It should also discuss how your findings relate to the previous research. Research Paper  Conclusions Do not mention the discussion or the data. State inferences, hunches or speculation and offer the perceptions of future work. References/Bibliography Here, you ensure you cite all the references made in your paper to other sources of information and research studies. This should be laid out according to the specified format, including APA, MLA, Chicago, Oxford and other formats as directed by your professor. Check out our FREE APA REFERENCING TOOL How to Write a Successful Research Paper A research paper is your thought on a given topic, informed by the research you have done. It is a daunting process for both new and experienced writers alike. Here is our step by step guide to help you keep focused down to the path of a successful research paper. 1. Getting started.  Sit down with your computer and identify tasks and build a schedule. Identify the milestone for all steps involved in research and writing process. Check your final due date, and take some time to scheme the task ahead of you before you get started. Ensure you understand your assignment: type, research paper format, and length. 2. Select a topic.  The topic of the research paper is what you want to write about. Narrow the topic by reading the background articles on general references, the internet, magazine, encyclopedia or talk to your professor and peers, while jotting down main ideas. 3.  Set your objective.  Before you start your research, you need to compose a thesis statement, which describes your viewpoint concerning the research. Because your aim is to prove the validity of your thesis, your thesis statement offers a controlling idea that will enable you to choose the resource materials and limit your note taking. 4. Research and  take notes.  List the potential sources of information. Apart from the card catalog and guides for reference books, there are other important sources that can help you locate books and articles relevant to your topic. Often look for unique sources that can distinguish and strengthen your paper. 5. Create an outline for a research paper.  Your outline should reflect the organization format you have selected for your paper, depending on the topic and the thesis statement. It is a process of organizing your thoughts to help you write your research paper. Consider what points you will include, the introduction, the order of the points and how you plan to conclude. 6. Write the draft.  After you have completed creating the outline for a research paper, you can begin to write your draft. At this point, you need not worry about the grammar, spelling, typos, and style. Instead, you should concentrate on content based on your outline. It only consists of three parts: introduction, body, and conclusion. 7. Edit your paper.  When you are through with the draft, edit it, paying close attention to the organization and content of the paper. Is each idea supported by evidence? Do the paragraphs have topic sentences that relate to your thesis? Are there clear transitions in one paragraph to the other? Let your paper ideas or arguments support the research and structure. 8. Bibliography and citations.  Give credit to the sources of ideas, facts, and quotations that have included in your research paper to avoid plagiarism. In fact, documenting your sources of information, allow your leaders to follow your thought process and see how you creatively built upon the thoughts. 9. Formatting.  Depending on the formatting style your professor instructed you to use (APA/MLA/Chicago/Oxford), the title page should be part of the title of the research paper, the instructor’s name, your name, the name of the course and the date the paper is due. 10. Proofread and submit.  A professional proofreading is the last step that enables you to submit your paper in the best light possible. Don’t skip this step! Correct the grammar, spelling and punctuation errors, and mistakes that your system could not catch. Double check the formatting, plus bibliography and citations. If everything is right, submit! How to Start a Research Paper Writing a research paper is a challenge to many college and university students. One of the biggest problems for many students is how to get started. Choosing the topic and doing the research might be half the battle, but starting an introduction always proves to be a daunting task. If done effectively, starting a research paper would be simple and can help you write the whole paper quickly. Here is how to start a research paper: Choose a topic and research it thoroughly.  One problem most students run into when starting a research paper is failing to do proper research on the chosen topic. Research is not all about gathering resources; it involves reading and digesting the source material. Make sure you understand the topic. Create an outline of your research paper.  You must understand the direction of your research paper before you write an effective introduction. Your main aim should be to summarize the research in one or more paragraphs, without giving away the conclusion. Draft the opening paragraph.  Write several opening paragraphs, completing each independently. Write the introduction without directly relying on the structure, but it doesn’t mean you ignore your paper outline. You must look at the resource material when writing the introduction. Choose the best draft of your introduction.  Choose one of the best versions of your draft and revise it. Make sure you have the introduction ready before moving to the body of your research. The introduction should indicate its importance of the future research of your paper, summarize and describe the extent of your research. Critique the introduction.  Ask your friends, teacher or professor read the introduction: it must conform to the requirements of the assignment. Remember, a well-written introduction will automatically flow. How to Write a Conclusion for a Research Paper When you reach the conclusion of your research paper, you probably think there is hardly anything left to include, right! However, writing a conclusion for a research paper is crucial for anyone doing research papers. Here is how to write a research paper conclusion: Research Paper Topics Finding a research paper topic is one of the most challenging steps in writing a research paper. Focus on a broad topic, find topic ideas and be creative in the process. Here is a list of research topics you can use: business crime and law, drugs and drug abuse education environment family issues media and communication health, psychology political issues social issues, religion women and gender terrorism Weve got a great list of research paper topics for you: 60 Best  Research Paper Topics Generally, students have higher expectations of themselves when writing a research paper because they believe the paper has to be perfect. The paper should be clear and thoughtful, written to the point and say things that make sense. Research about what other scholars have written about the topic and the formulating your own theories and ideas based on the existing knowledge and data. At , we understand the importance of adhering to your deadline. Obviously, the sooner you let us know about your term paper the better. However, we have also successfully completed assignments with seemingly impossible due dates on time, rendering our services with the same high quality of writing. Therefore, if you can see how busy the road ahead of you will be or if youre down to the wire, contact us. We will be glad to help. General pricing plan for the Research Paper writing is as follows (prices are in US dollars, cost per page) #get_view(blocks/prices2.php)

Consolidation in the Tour Operator Industry Case Study

Consolidation in the Tour Operator Industry - Case Study Example Visit Britain expects tourism to grow into a ?113bn industry if managed properly. However, despite tourism funding by the government being doubled since 1997, there is a threat that the UK tourism sector could slip behind international competitors. Economic Environment The tour operators’ industry has faced both economic and structural challenges over the past five years and through 2013-14 (Ithe BIS World, October 2013). Industry revenues have been as a result of economic downturn, lower disposable incomes, and reduced consumer confidence, due to which domestic tourists seek cheaper destinations. Tour operators’ revenues in 2008 show an increase over 2005 – from â‚ ¬60bn to â‚ ¬84bn (Appendix B) but this could also be, due to rise in tour prices, a rise in airfares and hotel charges. Therefore, loss of consumer confidence and declining incomes is a threat to the sector. ... Consumers demand value for money and consumers seeking mind prefer package aged holidays (Euromonitor International, 2013). Tour operators now offer flexible, dynamic packages but credit crunch impacts tourism as well. Consumers have responded to the credit the unch by choosing to holiday within the UK which has led to the trend of ‘staycation’ (Williams, 2008). Staycation holidays have increased by 13% and outbound travel decreased by 18% (Stamford, 2009a) which suggests that staycation and packaged holidays provide an opportunity to tour operators to redesign their product offerings. Technological Environment Technology has empowered the consumer in many ways. Low-cost airlines have made holidays more affordable; in addition, are the high-speed train networks. Internet penetration provides an additional distribution channel. Technology enables access to consumer data which facilitates tailoring their offerings to consumers. Mobile, technology and social networking have further empowered the consumer in seeking information, comparing and reading reviews about service providers before booking their holiday. This has helped major tour operators such as TUI to target specific segments through the strategy of differentiation. Technology thus is an opportunity to exploit the sector. Environment Tourism is generally associated with environmental degradation and ecological imbalance. The region is negatively impacted when the level of tourists exceeds the environment’s ability to cope with the use (UNEP, n.d.). In addition, natural resources are depleted; land area is reduced as infrastructure development takes place. Local resources are also used up by tourists thereby impacting the lives of the local people.

IMT Case Study Example | Topics and Well Written Essays - 500 words

IMT - Case Study Example , he was walking in a hornet’s nest and any single approach from the four options he came up with may have had detrimental impact on the performance of the company if not cautiously implemented. In general, he did a great job when it comes to the understanding of the tasks as well as the prevailing environment in the companies. He also strived to be honest with June, his superior, in his feedback and recommendations. CMCI’s statement is not inspiring enough. A mission statement should not come out as an old novel which lacks both sense of direction and purpose (Neto 24). However, after reading Fort Wayne MIS Directions and Objectives Statement, more light is provided on the direction the company was heading to. The latter talks about the company being structured and with some reasonable level of risk taking. Considering the difference in timelines when the two were written, they can both be said to combine well in giving some form of common management tool. The two statements appear to addressing the same issues with the organizational set up. It is worth pointing out that reading Fort Wayne MIS Directions and Objectives Statement maps it out more clearly than CMCI’s statement which has limited vision and is not comprehensive. Over the last five years, CMCI has been experiencing several developments. This is in terms of expansion through acquisitions. In order to reach out to a larger market. The business has acquire several businesses both within and outside USA. In all these entities, the leadership and the management structures have remained decentralized. This expansion and leadership structures will for sure impact on the overall system architecture of the Fort Wayne Plant. Four options were suggested. The first one was the centralized computing. This involved relying on single networks within each of the companies. The advantage of this proposal is that it allows the company to have more control over its operations (Khosrowpour 53). The shortcoming

Hills like White Elephants Essay Example for Free

Hills like White Elephants Essay Ernest Hemingway published â€Å"Hills like White Elephants† in 1927. The narrative is a young couple is sitting at a train station near the Ebro Valley in Madrid, Spain to highlight the fact that their relationship is at a crossroad. Hemingway expresses many themes and literary elements throughout this short story. A plot is a dynamic element in fiction, a sequence of interrelated, conflicting actions and events that are typically build to a climax and bring about a resolution (Clugston, 2010). The couple sits at a table to have a couple of beers and a conversation. At first the girl talks about what they should have to drink and what she sees outside. You can tell that it is more going on at least in their feelings or its more going on in the story. From (Line 41) â€Å"It’s really an awfully simple operation, Jig† the man said. â€Å"It’s not really an operation at all. This explains why their conversation they were having earlier been awkward. The seemingly petty conversation here about hills and drinks and an unspecified operation is in actuality an unarticulated but decisive struggle over whether they continue to live the sterile, self-indulgent, decadent life preferred by the man or elect to have the child that Jig is carrying and settle down to a conventional but, in Jig’s view, rewarding, fruitful, and peaceful life (Holladay, 2004). The American was asking his girl to have an abortion without using the word so others would not be entertained or concerned at all. Hemingway knows how to raise suspense to the readers. The point of view is how the action is presented to the reader (Clugston,2010). Although â€Å"Hills like White Elephants† is primarily a conversation between the American man and his girlfriend, neither of the speakers truly communicates with the other, highlighting the rift between the two. Both talk, but neither listens or understands the other’s point of view. Frustrated and placating, the American man will say almost anything to convince his girlfriend to have the operation, which, although never mentioned by name, is understood to be an abortion. He tells her he loves her, for example, and that everything between them will go back to the way it used to be. Another literary element is character. A character is an imaginary person in a piece of literature (Clugston, 2010). In â€Å"Hills like White Elephants† there are three characters. The American, who is the male protagonist of the story. His name is never revealed throughout the story. He also tries to convince the girl to have the operation and he does not care what she does. He disconnects his self from the surroundings and not listening and understanding what the girl is saying. The Girl, who is the female protagonist of the story. The American calls the girl, Jig. She alternates the conversation to talk about the operation then avoids it altogether. The thing she says does not clearly defines her emotions or personality. Jig is more of a realistic character. She has issues and behaviors of real people. The bartender is a woman who served drinks to the American man and the girl. The bartender only speaks Spanish. The characters add so much to the theme of the story. A theme in a story is associated with an idea that lies behind the story. In other words the theme in a story is a representation of the idea behind the story (Clugston, 2010). The theme of â€Å"Hills like White Elephants† involves a question of responsibility. The theme of a piece of fiction is its controlling idea or its central insight, and the unifying statement about life implied in the story (Arp Johnson, 2006). Hemingway does this in describing the couple’s dilemma about Jig’s pregnancy. The theme exists when an author attempts to record life as it happens. â€Å"Hills Like White Elephants† centers on a couple’s verbal duel over, as strongly implied by the text and as widely believed by many scholars, whether the girl will have an abortion of her partner’s child. Jig, clearly reluctant to have the operation, suspects her pregnancy has irrevocably changed the relationship but still wonders whether having the abortion will make things between the couple as they were before. The American is anxious that Jig have the abortion and gives lip service to the fact that he still loves Jig and will love her whether she has the procedure done or not. As the story progresses, the power shifts back and forth in the verbal tug-of-war, and at the end, though it is a topic of fierce debate among Hemingway scholars, it seems that Jig has both gained the upper hand and made her decision. The theme of the story is revealed through the couple’s dialogue and through symbolism. Symbolism is something that has a literal identity but also stands for something else (Clugston, 2010). â€Å"Hills like White Elephants† is filled with symbolism. The narrator describes the character symbolic. Jig is called a girl throughout the story to represent her naive behavior, immaturity and lack of confidence about her opinion. The American is called a man throughout the story, representing his position about his opinion on the abortion. The bags they carry have tags on them displaying all of the hotels that the couple has stayed in. This shows that the couples are not serious about a child, still want to have fun and be sex animals. The setting of the story is symbolic. The story takes place at a train junction. This setting represents the fact that their decision can change the direction of their lives. It is less important that we know the course chosen than the significance of the two choices. The rootless barren life, devoid of responsibility represented by the dry hills (Fletcher, 1980). The other side of the valley is green and has a river. The two sides symbolize the decision that Jig has to make. The green side represents fertility, life, hope and the hot, brown side represents sterility. There is several more symbolism in the story, let’s move on to the next literary element. Tone is the attitude reflected by the author in a literary work; it identifies the author’s approach to the subject a story deals with. The tone in â€Å"Hills like White Elephants† The narrator is very controlled, giving us a bare minimum of information outside of the conversations between the man and Jig, or between the man and the woman serving the drinks. This narrator controls the tendency in narrators to tell what the story means. This is giving the readers lots of credit for being intelligent, but can also make for rough reading. We aren’t used to stories being told mostly in dialogue. Speaking of dialogue, both Jig and the man are having a rather controlled conversation. The fact that they are having this conversation in a public place might or might not contribute to this control. â€Å"Hills like White Elephants are very interesting and have many literary elements. From the plot to the tone, Hemingway was very brilliant how privatized his conversation and still managed to get his point across. The symbolism made it seem as if we were there with him and Jig.

Essay --

In Black Swan, a ballet dancer named Nina is casted to play both the White Swan and the Black Swan in the famous ballet titled Swan Lake. In the well-known opera, a princess is turned into a White Swan, who falls in love with a prince but then commits suicide when she finds out that the prince confessed his love to the Black Swan. In the movie Black Swan, Nina has to deal with the challenges that arise from trying to accurately portray both characters whom are completely opposite. It is easy for Nina to be the White Swan. She is innocent and controlled. However, it was very hard for her to become the dark, seductive, and mysterious Black Swan. To fully become this character, Nina has to deal with the struggles of becoming the opposite of who she really is. This results in many hallucinations that involve harming herself. She also starts to imagine things that are not really happening. Eventually, Nina has psychotic episodes when she truly becomes the Black Swan. Whenever she takes a step into her transformation, she has hallucinations such as having black feathers come out of her skin. It also seems as if Nina is obsessed with perfection because she even tries to kill herself. The true reality is not what she sees because she is so trapped in the world of Swan Lake. Nina fits the mold of many different mental disorders. I, however, personally think that Nina portrays the symptoms of a person with schizophrenia. In the DSM-5, it states that schizophrenia is characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction. It is required that a person have at least two of these symptoms. It is clear throughout the movie that Nina has hallucinations that ... ... the mold of a dancer. The fact that Nina has an eating disorder shows that it is not rare for people with schizophrenia to display symptoms of another disorder. One of the myths displayed in Black Swan is about how people with schizophrenia are all paranoid. Throughout the movie, Nina becomes more paranoid about losing her leading role and even stabs herself with a piece of glass, believing that she stabbed Lily. People with schizophrenia are not all paranoid. Overall, I think Black Swan was very intriguing and proved to be an accurate display of psychotic dysfunction, particularly schizophrenia. This movie required critical thinking in order to be able to put together the pieces and to understand the depth of schizophrenia. Even though this movie showed the darker side of schizophrenia, I still recommend it to anyone who has an interest in this mental disorder.

Disease Specific Program

In this paper, we would be discussing the application of self-management concepts involved in improving the health and quality of life for people with chronic Diabetes Mellitus. Diabetes Mellitus is a complex disorder of carbohydrate, protein, and fat metabolism in which a relative or absolute insulin deficiency is the essential feature, Drury (1986). Diabetes is recognized as a model of broader based communicable disease control programs, WHO (1991 – 1998).The metabolic derangement is frequently associated with permanent and irreversible functional and structural changes in the cells of the body, those of the vascular system being particularly susceptible. The changes lead in turn to the development of well-defined clinical entities, the so-called ‘complications’ of Diabetes which most characteristically affect the eye, the kidney and the nervous system. Introduction It is not too distant past one of the critical tests of the skill of a nurse was the ability to m eet the needs of a patient with an acute infectious disease such as Typhoid fever or pneumonia.When the patient recovered, the nurse could rightly take credit for having made an important contribution. As infectious diseases have been brought under control, the incidence of chronic illness has risen so that they now account for a significant portion of morbidity and morality. Chronically ill patients often have a wider range of problems and need a greater variety of services than are needed to meet the needs of the acutely ill.Res ¬toration of the patient to optimum status and preven ¬tion of progress of the illness often demands the con ¬tinued efforts of the patient, family, nurse, physician, and other health and welfare personnel as well as the members of the community. With patients in whom progress toward recovery is slow and in whom control or prevention of the progression of disease is the goal rather than complete recovery, the nurse may not be able to see immediate re sults of her or his efforts. Instead of a relatively brief and intense relationship in which the patient is dependent on the nurse, the nurse often has a more or less pro ¬longed relationship.This relationship with the pa ¬tient changes from time to time, from dependence to independence to interdependence. To meet the needs of the patient, the nurse should be able to identify clues indicating the type of relationship best suited to the needs of the patient at a given time and to adapt her or his behavior accordingly. A Clinical Nurse Specialist (CNS) is described as an administrator, leader, manager, collaborator, practitioner, advanced clinician, consultant, educator and researcher (Wilson-Barnett, 1994; Dunne, 1997; McCarthy, 1996).Literature Review Today the test of the skill of the nurse is the ability to meet the needs of the chronically ill patient. If a single disease was to be selected as the modern day test of nursing knowledge and skill, diabetes mel ¬litus would und oubtedly receive many votes. There are many reasons that this is true. Diabetes mellitus has a relatively high incidence. It affects all age groups. Its complications are many and serious. There are, however, effective means for its detec ¬tion, diagnosis, and treatment.With modern methods of therapy, persons with diabetes mellitus can live almost as long as those who do not have diabetes. Even more important, they can have full and useful lives with few restrictions on their activi ¬ties. Persons with diabetes mellitus have been Rhodes scholars, mountain climbers, hockey players, television stars and statesmen. They marry, bear and rear children, and can lead successful, vigorous, productive, lives-a far cry from the predictable fate of the diabetic before the era of insulin therapy. The nurse is always concerned about the epide ¬miology of disease.Understanding the distribution and dynamics (epidemiology) of a disease serves as a basis for meeting objectives of disease detec tion and for education of patient, family, and community. Because diabetes and other chronic diseases are not reportable, they are not subjected to the type of surveillance used for communicable diseases. As sur ¬veys and techniques of detection and diagnosis im ¬prove, reporting will increase and it may be possible to identify and to improve preventive measures.According to the 1975 National Health Interview Survey, a rate of 20.4 per 1,000 population or an estimated 4. 8 million persons in the United States reported diagnosed dia ¬betes. Between 1965 and 1975, the prevalence of diabetes increased by 50 per cent in the United States (Guthrie & Guthrie, 2002; Flarey & Blancett, 1996). There is some question if there is a true in ¬crease in the frequency. The data may represent an increase in recognition due to increased use of automated blood chemistry laboratory techniques.Diabetes mellitus occurs in all age groups and in both sexes. The prevalence rate increases with age, from 1.3/1,000 (1 in 77) for persons under 17 years of age to 78. 5/1,000 (1 in 12) in persons over the age of 65. Diabetes is reported more frequently in females (2. 4 per cent) than in males (1. 6 per cent). Females have a prevalence rate of 24. 1/ 1,000. This is a 50 per cent increase from 1965 data when it was 16. 1 /l, 000. The prevalence rate for males is 16. 3/1,000. The most dramatic changes in preva ¬lence of reported diabetes is the increase of diabetes in nonwhites under the age of 45. This group has a percentage change of 150 per cent.Non ¬whites are 20 per cent more likely than whites to have diabetes (Dunning, 2003). Incidence is the frequency of new cases of a disease developed during a specified time period. In 1963, 17 years after the first Oxford study, 65. 7 per cent of the residents aged 34 to 55 years who lived in Oxford during the first study were re ¬studied. The percentage of diabetics was found to be the same in the second as in the first study (O†™Sulli ¬van, 1969). In the 1930s and 1940s there was marked improve ¬ment in the life expectancy of diabetics. Since that time, there has been little improvement.This may be due to the fact that Diabetes patients are living long enough to develop the more dangerous concomitants (Kessler, 1971). Reasons for failure to prevent the concomitants of Diabetes are one of the problems being studied intensively today. The Management of Diabetes Mellitus The ideal treatment for diabetes would allow the patient lead a completely normal life to remain not only symptom-free but in positive good health, to achieve a normal metabolic state, and to escape the complications associated with long-term diabetes.Nowadays diabetic patients rarely die in ketoacidosis in any number, but the major problem which has emerged is the chronic invalidism, due to disease of both large and small blood vessels, of many of those whose duration of life has been extended. It is well known that diabetics show an i ncreased propensity to fall due to visual impairment and neuropathy, as well as foot problems (Wallace et al, 2002; Keegan et al, 2002) and presumably accelerated cognitive decline (Gregg et al, 2000).Data from clinical studies strongly suggest that although genetic factors affect the susceptibility to develop complications, the incidence of serious retinopathy is related to the degree of diabetic control achieved (Clark & Cefalu, 2000). It is therefore incumbent on all those who are involved in looking after diabetic patients to strive in every way to achieve as good control as is practicable in terms of blood glucose concentration. The management of diabetes demands a broad range of professional skills, which include communication, counseling, leadership, teaching and research to name but a few.The Diabetes Nurse Specialist has the expertise and specialist knowledge to incorporate these skills into practice and so develop standards of care that benefits the patient (Daly, 1997). T he Diabetes Nurse Specialist (DNS) plays a pivotal role within a multidisciplinary team. The recognition of the contribution of the Diabetes Nurse Specialist in helping patients achieve good diabetes control highlights his/her essential role in diabetes care, (DCCT,1995; UKPDS, 1998). Metcalfe (1998) states that a Diabetes Nurse Specialist works in collaboration with a team to ensure continuity of care, lends towards more successful management.Types of Treatment There are three methods of treatment, namely diet alone, diet and oral hypoglycemic drugs and diet and insulin. Each obliges the patient to adhere to a life long dietary regimen. Approximately 60% of new cases of diabetes can be controlled adequately by diet alone, about 20% will need an oral hypoglycemic drug and another 20%, mainly younger patients, will require insulin (Long, et al, 1995). A patient may pass from one group to another – temporarily or permanently. Role of the Nurse in Prevention and DiagnosisNurses have numerous opportunities to assist the identification of persons who either have diabetes or are potential diabetics. The CNS is prepared beyond the level of a generalist (The Report of The Commission on Nursing, 1998). Review of the etiologic factors gives the nurse clues as to the target populations. In addition she or he, regardless of the field of practice, must always be alert to the signs and symptoms of diabetes. Any individual with symptoms suggesting diabetes mellitus should be encouraged to seek medical attention. The Suspicion of the school nurse should be aroused when a child develops polyuria and polydipsia.The public health nurse who visits in the home should be alert to the possibility of diabetes in family members. Some patients are discovered to have diabetes after they are admitted to the hospital. Most hospitals have a rule that before a patient can undergo any type of surgical procedure, the urine must be checked for glucose. The nurse can also assist in commu nity screening programs. In addition to opportunities for the nurse to participate in programs for the identification of persons who have diabetes mellitus, nurses have a role in the prevention of the disease.Because of the frequency with which diabetes in the middle-aged person is associated with obesity, individuals are encouraged to avoid overweight by diet and exercise. The preventive aspects related to genetic counseling are less clear. Persons with diabetes or persons with families in which there is a known history of diabetes should be acquainted with the risks involved when planning marriage. Psychological Aspects Fink (1967) has proposed a model of the processes of adaptation to stressful situations. He proposes that psychological phases follow a sequential pattern as follows:Stage 1: Shock; in this phase the person's cognitive structure is characterized by disorganiza ¬tion. There is inability to plan or to reason. Stage 2: Defensive retreat characterized by denial. Stag e 3: Acknowledgment, giving up the past, and starting to face reality. Stage 4: Adaptation, acceptance. of the modification in health. Planning to care for self and to prevent complications. When a person learns that he or she has diabetes mellitus, even when its presence was suspected, he or she experiences disbelief and then grief. The degree of shock will depend on the individual and what the diagnosis and treatment mean to him or her.Any preexisting problem can be expected to be intensified. The pa ¬tient and family can be expected to react to knowl ¬edge of the diagnosis as they do to other crisis situa ¬tions in life. The patient compares dia ¬betes with health and prefers health. The nurse can usually be of more help to the patient if she or he can help in identifying and expressing feelings rather than telling the patient how lucky he or she is. During the period immediately following diagnosis, the patient and family require psychological support. This should start with the patient’s admission to the office of the physician, to the clinic, or to the hospital.The type and amount of support will vary with each individual. Both the patient and family have a right to expect professional personnel to try to understand their feelings and to accept their behavior as having meaning (Otong, 2003). The nurse should try to convey to the patient that, while understanding or trying to understand his or her feelings, the patient will be able to learn to do what must be done and will be provided with the necessary assistance. Control of Diabetes Mellitus Successful management of diabetes mellitus depends on the intelligent co-operation of the patient and the family.Unlike recovery from an acute infectious disease, recovery from Diabetes does not follow a period of acute illness. Diabetes Mellitus is permanent. Remissions can and do occur, but even these patients should not think of themselves as cured. The fundamental methods used in the treatment are diet, insulin or hypoglycemic agents, exercise, and education. The continued management and con ¬trol of diabetes mellitus depend on the patient. Edu ¬cation as to the nature and behavior of the disease is required so that the patient understands the rea ¬sons for what he or she must do and develops the skills required for it.Diet The keystone for management of the diabetic is dietary control. In most respects the goals of the diet for the diabetic patient are similar to those for the non-diabetic. They are to provide sufficient calories to establish and maintain body weight. The number will vary with the age, sex, body size, activity, and growth and development requirements along with an adequate intake of all nutrients, including minerals and vitamins. Modifications in amounts and types of foods as required in the control of complications of diabetes and other diseases.Meal spacing so that absorption coincides with peak levels of insulin in the blood and protects from hypog lycemia during the night. For patients on intermediate-acting insulin, food is usually dis ¬tributed in five meals-three main meals with a small meal about 4 P. M. and another at bedtime. For the patient who is taking insulin, it is essential that a regular meal schedule be observed. Integration of exercise and diet with medications is essential. Most diabetic diets contain 50 to 60 per cent carbohydrates with 10 to 15 per cent in the form of Disaccharides and monosaccharide.Fats should comprise no more than 35 per cent of the total calories. The remaining calories are protein (Arky, 1978). Patients are encouraged to select unsatu ¬rated fats as recommended by the American Heart Association. Concentrated sweets and refined sugars should be avoided. Insulin Treatment with exogenous insulin is indicated in the following situations: diabetic ketoacidosis, juvenile diabetes, diabetes developing before the age of 40, unstable diabetes, oral hypoglycemic failure, diet therapy failures , and during stress of pregnancy, infections, major surgery.For the ketosis-prone individual and the unstable adult an exogenous insulin supply is always required. For the others it may be an intermittent requirement (Bonar, 1977) that is required during periods of stress. In the non-diabetic, insulin is released in response to food intake. The beta cells have the ability to release approximately 40 units daily, and there are another 200 units stored for emergency (Ellenburg et al, 2002). The diabetic does not have an endogenous supply, and an exogenous form is provided. Various types of insulin preparations have been developed.They fall into three general categories: fast-acting (regular and semilente), intermediate (NPH and lente), and long-acting (PZI and ultra lente). The actions of each preparation vary as to time of onset, duration of action, and peak activity time. Hypogly ¬cemic reactions are most likely to occur at time of peak action. Regular insulin is the only form giv en intravenously, and it has a clear appearance. The other insu ¬lin preparations have a turbid appearance. Each type of insulin comes in three concentrations; U-40, U-80, and U-I00. This refers to the concentration of insulin per milliliter.U-40 has 40 units per ml, U-80 has 80 units per ml, and U-100 has 100 units per ml. Syringes are specially calibrated for each concentration. Eventually, the only concentration available will be the U-100 strength (Joshu, 1996). This will decrease confusion and cut down on errors. The objective of insulin therapy is to enable the individual to utilize sufficient food to meet nutri ¬tional needs and, within limits, the desire for food. For many patients this objective can be achieved by a single injection of protamine zinc insulin or one of the intermediate-acting insulin, either alone or in combination with crystalline insulin.The ideal preparation of insulin would be one in which the insulin is released in response to hyperglycemia. At this time there is no such preparation. Persons who require less than 40 units of insulin per day often do very well on a single injection of Protamine Zinc Insulin. Insulin-Equipment and Administration The patient must know the type of insulin, concen ¬tration (U-80, U-100), and the prescribed dosage. It is essential that the appropriate syringe be used for the insulin concentration prescribed.Diabetic pa ¬tients on insulin may use either disposable or reusa ¬ble syringes. The former are used one time only and then discarded. Patients find them highly desirable because they do not require sterilization. Although minimal, cost may be considered a disadvantage. If reusable syringes and needles are used they should be sterilized by boiling before each injection. Boiling is simplified by placing the separated barrel and plunger of the syringe and the needle in a metal strainer. The strainer is placed in a saucepan of cold water and boiled for 5 minutes.When the syringe is removed fro m the water, care should be taken not to contaminate any part of the needle or syringe that comes in contact with the insulin or is intro ¬duced into the patient. When the syringe and needle are kept in alcohol, the alcohol container should be emptied, washed, and boiled at the time the syringe is sterilized. Before the syringe is filled with insulin, alcohol should be removed from the barrel by mov ¬ing the plunger in and out of the barrel a number of times. The skin over the site of injection should be clean, and just before the injection is made, it should be cleansed with alcohol.The hour at which the patient takes the insulin will depend on the type of insulin, the severity of the diabetes, when blood sugar is highest, and the practices of the physician. The most common time is 20 to 30 minutes before breakfast for patients re ¬ceiving one injection a day. Modified insulin con ¬taining a precipitate should be gently rotated until the sediment is thoroughly mixed with th e clear solu ¬tion. Vigorous shaking should be avoided to prevent bubble formation. Insulin, though usually called a protein, is a poly ¬peptide and is digested in the alimentary canal. It must therefore be administered parenterally.The usual method is by subcutaneous injection into loose subcutaneous tissues. Because daily, or more fre ¬quent, injections are required over the lifetime of the individual, care should be taken to rotate the sites, so that one area is not used more often than once each month. Conclusion The nurse has major responsibilities in the care of the diabetic patient. She or he must provide instruction, guidance and understanding for the control and management of the condition. The nurse must be prepared to provide nursing care for the patient if acute or chronic complications should occur.Last but not least, the nurse must recognize that the diabetic is not exempt from other diseases. She or he must be prepared to evaluate the impact of a concurrent illn ess on the diabetes and the impact of the diabetes on the concurrent illness. The sick diabetic has all the problems of any person who is ill and they are compounded by the diabetic state. The special needs of the diabetic must be recognized and met. 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