Effectiveness of self instructional module in immunizations

Effectiveness of self instructional module in immunizations Abstract Immunization is the one of the most important and cost effective strategies for the prevention of childhood sicknesses and disabilities and it is a basic need for all children. Seven killer diseases causes a major threat to children and this decreases the health status and making them more vulnerable to infectious disease. The major cause for death is vaccine preventable diseases such as neonatal tetanus, measles, TB, diphtheria, pertusis, polio and Hepatitis B. Infectious diseases are now the worlds biggest killer of children and young adults. They account for more than 13 million deaths a year one in two deaths in developing countries. The present study objective was â€Å"to evaluate the effectiveness of self instructional module.† The Pre- experimental one group pre test and post test design was adopted. The sample of 100 mothers of under-five children selected by convenient sampling technique. A structured knowledge questionnaire was adopted to collect the data from the samples. Descriptive and inferential statistics was used in data analysis. The result of study shown that there was significant difference in the mean post test score. The findings reveals that pre test and post test mean knowledge of mothers of under-five children regarding vaccine preventable diseases is 8.5(SD+3.95) and 16.33(SD+4.79) respectively. Post test mean knowledge score higher than pre test mean score. The‘t’ test value was 12.54 which was significant at 0.05 level. Hence it is concluded that the self instructional module was effective to increase the knowledge of mothers of under five children. This study recommends that similar study can be undertaken on large sample to generalize the findings. Study can be done to assess the knowledge, attitude and practice of nurses regarding vaccine preventable diseases. Keywords: Self instructional module, knowledge, vaccine preventable diseases, mothers of under- five children. I. Introduction Children are fortunately being recognized as people in their own right with their special requirements. Quality survival of the human race depends on provision of adopt care to his vulnerable population in their formative and developmental life years. Therefore Health services for children should be aimed at improving the future quality of human resources of the nation by enabling as many children as possible to reach adulthood with their potential uncompromised by illness, environmental hazards, or unhealthy lifestyle. According to WHO â€Å"Health is a state of complete physical, mental, and social wellbeing and not merely absence of disease or infirmity In India diseases like guinea worm, small pox has been eradicated since 1947 and now poliomyelitis is near to eradicate. In developed countries like in India 68 out of 1000 under-five children were dying each year and another 5 million were disabled by infectious diseases. The vaccination of children against infectious diseases (tuberculosis, diphtheria, pertusis, tetanus, poliomyelitis, measles and hepatitis B) has been a cornerstone of the child health care system in India. As a part of the National Health Policy, the National Immunization Programme is has been implemented on a priority basis. Awareness building about immunization of children, who are under five years of age, provides a sense of responsibility towards the need of the children and their protection. The involvement of mothers in immunization programme help in reduces seven killer diseases. Those mothers who are living in tribal and rural areas mainly ignore the immunization and they do not vaccinate their children. Some mothers have misconception about immunization and they believe their children can catch diseases if they immunize their children. To prevent seven killer diseases it is necessary to screen every child for immunization, coverage opportunities; otherwise full immunization coverage may not be possible. Delayed immunization is associated with low socio-economic status, female illiteracy, lack of knowledge on Vaccine Preventable Diseases as recommended by Universal Programme Immunization (UPI). II. Review of literature A comparative study was conducted to estimate the vaccination coverage level of children aged between 19-35 months living in rural and urban area in Kolar District of Bangalore. The result of study revealed that Statistically significant differences in vaccination coverage levels between the rural population and their urban counterparts were determined for individual vaccines and vaccine series as evidenced by 28% of the children were covered by immunization residing in rural areas whereas 46% were covered in Urban area. The study recommended that health care personnel need to execute the awareness among the needy population of the Kolar District. A study was conducted upon improving status of underfive children through awareness and knowledge of mothers regarding vaccine preventable diseases through health education messages and compare them with those without intervention. An increase of 19 % to 22 % increase was seen in the utilization of vaccination. The mother’s knowledge increased in the follow up from 60 % to 76.5% and the immunization status increased significantly from 46.5% to 75 % after the intervention. The surveys show that the health education messages significantly increased the vaccination status of children of under five years. A study was conducted to assess the knowledge of caretakers of underfive children in a pulse polio immunization booth in the Delhi. A semi –open-ended questionnaire was used. Study results showed that Only 252 (37.0%) respondent correctly answered, 176 (25.8%) gave a wrong answer while the remaining 37.2% gave no answer. While 268 (39.3%) knew at least of four diseases covered by universal immunization programme, only 23.9% knew all four diseases. The researcher concluded that immunization status needs to be improved by educating mothers and caregivers regarding immunization. A quasi experimental study was conducted to evaluate the effectiveness of structured teaching programme (STP) among 50 mothers of underfive children in selected paediatric hospital, Pondicherry. A closed ended questionnaire was used to collect the data followed by intervention of STP. The study finding shows that the post-test knowledge score (22.73) was higher than the pre-test knowledge score (12.78). The study claimed that STP is effective to enhance mother’s mother knowledge regarding the importance of immunization. The study recommended that nursing personnel should continue in health teaching approach especially to the health problems which can be prevented. III. Purpose of the Study: The purpose of the study was to evaluate the effectiveness of self instructional module regarding vaccine preventable diseases among the mothers of under-five children; this is achieved by one group pre and post test knowledge score obtained by the subjects under the study. This study also obtaining answer to research hypothesis. IV. Methodology: A Pre- experimental research design with one group pre test and post test design, to measure the effectiveness of self instructional module. The study was conducted at selected areas in Tarn Taran. Subjects were selected by convenient sampling technique. Structured knowledge questionnaire was used to collect data. Part-I: Socio demographic variables. This part is consist of variables such as age, educational status of mothers, type of family, occupation, religion, family monthly income, no. of children and source of information. Part-II Structured knowledge Questionnaire: It consists 36 items of objective type questions related to knowledge on vaccine preventable diseases. Each item contains four alternative responses. The knowledge questions are chosen from seven common vaccine preventable diseases likely, Tuberculosis, Diphtheria, Measles, Polio, Tetanus, Whooping cough and Hepatitis B. All the items were given equal score. Each correct answer was given a score of 1 and wrong answe rs a score of 0. Thus maximum score was 36 and minimum score was zero. The questionnaire was prepared in English and Punjabi languages. Reliability of an instrument is the degree of consistency with which it measures the attribute it is designed to measure. The reliability of the tool was assessed by collecting data from 10 mothers of under-five children from selected areas in Tarn Taran. The reliability of structured knowledge questionnaire was computed by Split half method i.e by calculating co-efficient correlation first and then by applying Spearman Brown prophecy formula. The reliability of structured knowledge questionnaire was 0.96 and thus found to be highly reliable. Ethical clearance had been obtained from ethical committee, prior permission for conducting the research was obtained from Municipal Corporation of District Tarn Taran and informed consent was taken from mothers of under-five children. The data was analysed by using descriptive and inferential statistics. V. Data Analysis Section A: Analysis of Socio -Demographic characteristics of the samples Table 1: Frequency and Percentage Distribution of Demographic Variables Table no.1 indicates the Majority of subjects 37% are in the age group of 21-25 years, about 25% were in the age group of 30 years. About 36% mothers were secondary educated, 24% were primary educated and minimum no. 20% were Graduate and another 20% respondents were of post-Graduate. Majority of subjects 30% were house wife, 26% were non-government employee, 24% were government and 20% mothers were self employee. About half of respondents were 47 % belong to Sikh religion, 32% were of Hindu, 14% mothers were Christian and 7% were belong to other religion. Majority of mothers 60% were belong to nuclear family and other 40% belong to joint family. 38% subjects were in the family income group of >15000. 26% were in the group of 10000-15000, 20 % were comes under the group of 5000-10000 and minimum number of subjects 16% belongs SECTION B: To assess the level of knowledge regarding vaccine preventable diseases among the mother of under five children before and after self instructional module administration. Table 2(a)Grading the knowledge of samples regarding vaccine preventable diseases in pre-test.N=100 The above table 2(a) shows that most of the of samples 76% had inadequate knowledge, 24% of samples had moderately adequate knowledge regarding vaccine preventable diseases and there was no adequate knowledge samples regarding vaccine preventable diseases. Table 2(B): Grading Of Knowledge Regarding Vaccine Preventable Diseases Among Mothers Of Under-Five Children In Post Test N = 100 Table 2(b) shows that most of the samples 67% had moderately adequate knowledge, 16% of samples had adequate knowledge and 17% of samples had inadequate knowledge regarding vaccine preventable diseases in post-test. SECTION C: Table 3: Mean and standard deviation of pre test and post test knowledge regarding vaccine preventable diseases among samples. Table 3 shows that mean score of pre test and post test of samples regarding vaccine preventable diseases is 8.55 (SD + 3.95) and 16.33 (SD + 4.79) respectively. Post test mean score was higher than the pre test mean scores the‘t’ test value is 12.54 which was significant at 0.05 level as (p>0.05). SECTION D: Association Between The Post Test Knowledge Sores And Selected Socio Demographic Variables TABLE-4: Analysis of Association between the post test knowledge sores and with selected socio demographic variables Table 4 shows that the association between post test knowledge score and socio- demographic variables such as education, occupation, no. of children and type of family of mothers of under-five children found significant as calculated values greater than table values at the level of (0.05). The association between knowledge score and the socio- demographic variables score of mothers, religion, family monthly income and source of information found non significant as the calculated value is less than the tabulated value at 0.05 level of significance. VI. Limitation and Research Needed The size of the sample was 100; hence it was difficult to make broad generalizations. No attempt was made to control extraneous variables. This study recommends the following further research. The study can be replicated on large samples for wider generalization Comparative study can be done on knowledge among urban and rural mothers regarding vaccine preventable diseases. Study can be done on the knowledge of health personnel regarding vaccine preventable diseases. A study can be done to assess the knowledge, attitude and practice of nurses regarding vaccine preventable diseases. VII. Conclusion As good health is very important for each individual and knowledge regarding v

A Game of Thrones Chapter Thirty

Eddard I stood last vigil for him myself,† Ser Barristan Selmy said as they looked down at the body in the back of the cart. â€Å"He had no one else. A mother in the Vale, I am told.† In the pale dawn light, the young knight looked as though he were sleeping. He had not been handsome, but death had smoothed his rough-hewn features and the silent sisters had dressed him in his best velvet tunic, with a high collar to cover the ruin the lance had made of his throat. Eddard Stark looked at his face, and wondered if it had been for his sake that the boy had died. Slain by a Lannister bannerman before Ned could speak to him; could that be mere happenstance? He supposed he would never know. â€Å"Hugh was Jon Arryn's squire for four years,† Selmy went on. â€Å"The king knighted him before he rode north, in Jon's memory. The lad wanted it desperately, yet I fear he was not ready.† Ned had slept badly last night and he felt tired beyond his years. â€Å"None of us is ever ready,† he said. â€Å"For knighthood?† â€Å"For death.† Gently Ned covered the boy with his cloak, a bloodstained bit of blue bordered in crescent moons. When his mother asked why her son was dead, he reflected bitterly, they would tell her he had fought to honor the King's Hand, Eddard Stark. â€Å"This was needless. War should not be a game.† Ned turned to the woman beside the cart, shrouded in grey, face hidden but for her eyes. The silent sisters prepared men for the grave, and it was ill fortune to look on the face of death. â€Å"Send his armor home to the Vale. The mother will want to have it.† â€Å"It is worth a fair piece of silver,† Ser Barristan said. â€Å"The boy had it forged special for the tourney. Plain work, but good. I do not know if he had finished paying the smith.† â€Å"He paid yesterday, my lord, and he paid dearly,† Ned replied. And to the silent sister he said, â€Å"Send the mother the armor. I will deal with this smith.† She bowed her head. Afterward Ser Barristan walked with Ned to the king's pavilion. The camp was beginning to stir. Fat sausages sizzled and spit over firepits, spicing the air with the scents of garlic and pepper. Young squires hurried about on errands as their masters woke, yawning and stretching, to meet the day. A serving man with a goose under his arm bent his knee when he caught sight of them. â€Å"M'lords,† he muttered as the goose honked and pecked at his fingers. The shields displayed outside each tent heralded its occupant: the silver eagle of Seagard, Bryce Caron's field of nightingales, a cluster of grapes for the Redwynes, brindled boar, red ox, burning tree, white ram, triple spiral, purple unicorn, dancing maiden, blackadder, twin towers, horned owl, and last the pure white blazons of the Kingsguard, shining like the dawn. â€Å"The king means to fight in the melee today,† Ser Barristan said as they were passing Ser Meryn's shield, its paint sullied by a deep gash where Loras Tyrell's lance had scarred the wood as he drove him from his saddle. â€Å"Yes,† Ned said grimly. Jory had woken him last night to bring him that news. Small wonder he had slept so badly. Ser Barristan's look was troubled. â€Å"They say night's beauties fade at dawn, and the children of wine are oft disowned in the morning light.† â€Å"They say so,† Ned agreed, â€Å"but not of Robert.† Other men might reconsider words spoken in drunken bravado, but Robert Baratheon would remember and, remembering, would never back down. The king's pavilion was close by the water, and the morning mists off the river had wreathed it in wisps of grey. It was all of golden silk, the largest and grandest structure in the camp. Outside the entrance, Robert's warhammer was displayed beside an immense iron shield blazoned with the crowned stag of House Baratheon. Ned had hoped to discover the king still abed in a wine-soaked sleep, but luck was not with him. They found Robert drinking beer from a polished horn and roaring his displeasure at two young squires who were trying to buckle him into his armor. â€Å"Your Grace,† one was saying, almost in tears, â€Å"it's made too small, it won't go.† He fumbled, and the gorget he was trying to fit around Robert's thick neck tumbled to the ground. â€Å"Seven hells!† Robert swore. â€Å"Do I have to do it myself? Piss on the both of you. Pick it up. Don't just stand there gaping, Lancel, pick it up!† The lad jumped, and the king noticed his company. â€Å"Look at these oafs, Ned. My wife insisted I take these two to squire for me, and they're worse than useless. Can't even put a man's armor on him properly. Squires, they say. I say they're swineherds dressed up in silk.† Ned only needed a glance to understand the difficulty. â€Å"The boys are not at fault,† he told the king. â€Å"You're too fat for your armor, Robert.† Robert Baratheon took a long swallow of beer, tossed the empty horn onto his sleeping furs, wiped his mouth with the back of his hand, and said darkly, â€Å"Fat? Fat, is it? Is that how you speak to your king?† He let go his laughter, sudden as a storm. â€Å"Ah, damn you, Ned, why are you always right?† The squires smiled nervously until the king turned on them. â€Å"You. Yes, both of you. You heard the Hand. The king is too fat for his armor. Go find Ser Aron Santagar. Tell him I need the breastplate stretcher. Now! What are you waiting for?† The boys tripped over each other in their haste to be quit of the tent. Robert managed to keep a stern face until they were gone. Then he dropped back into a chair, shaking with laughter. Ser Barristan Selmy chuckled with him. Even Eddard Stark managed a smile. Always, though, the graver thoughts crept in. He could not help taking note of the two squires: handsome boys, fair and well made. One was Sansa's age, with long golden curls; the other perhaps fifteen, sandy-haired, with a wisp of a mustache and the emerald-green eyes of the queen. â€Å"Ah, I wish I could be there to see Santagar's face,† Robert said. â€Å"I hope he'll have the wit to send them to someone else. We ought to keep them running all day!† â€Å"Those boys,† Ned asked him. â€Å"Lannisters?† Robert nodded, wiping tears from his eyes. â€Å"Cousins. Sons of Lord Tywin's brother. One of the dead ones. Or perhaps the live one, now that I come to think on it. I don't recall. My wife comes from a very large family, Ned.† A very ambitious family, Ned thought. He had nothing against the squires, but it troubled him to see Robert surrounded by the queen's kin, waking and sleeping. The Lannister appetite for offices and honors seemed to know no bounds. â€Å"The talk is you and the queen had angry words last night.† The mirth curdled on Robert's face. â€Å"The woman tried to forbid me to fight in the melee. She's sulking in the castle now, damn her. Your sister would never have shamed me like that.† â€Å"You never knew Lyanna as I did, Robert,† Ned told him. â€Å"You saw her beauty, but not the iron underneath. She would have told you that you have no business in the melee.† â€Å"You too?† The king frowned. â€Å"You are a sour man, Stark. Too long in the north, all the juices have frozen inside you. Well, mine are still running.† He slapped his chest to prove it. â€Å"You are the king,† Ned reminded him. â€Å"I sit on the damn iron seat when I must. Does that mean I don't have the same hungers as other men? A bit of wine now and again, a girl squealing in bed, the feel of a horse between my legs? Seven hells, Ned, I want to hit someone.† Ser Barristan Selmy spoke up. â€Å"Your Grace,† he said, â€Å"it is not seemly that the king should ride into the melee. It would not be a fair contest. Who would dare strike you?† Robert seemed honestly taken aback. â€Å"Why, all of them, damn it. If they can. And the last man left standing . . . â€Å" † . . . will be you,† Ned finished. He saw at once that Selmy had hit the mark. The dangers of the melee were only a savor to Robert, but this touched on his pride. â€Å"Ser Barristan is right. There's not a man in the Seven Kingdoms who would dare risk your displeasure by hurting you.† The king rose to his feet, his face flushed. â€Å"Are you telling me those prancing cravens will let me win?† â€Å"For a certainty,† Ned said, and Ser Barristan Selmy bowed his head in silent accord. For a moment Robert was so angry he could not speak. He strode across the tent, whirled, strode back, his face dark and angry. He snatched up his breastplate from the ground and threw it at Barristan Selmy in a wordless fury. Selmy dodged. â€Å"Get out,† the king said then, coldly. â€Å"Get out before I kill you.† Ser Barristan left quickly. Ned was about to follow when the king called out again. â€Å"Not you, Ned.† Ned turned back. Robert took up his horn again, filled it with beer from a barrel in the corner, and thrust it at Ned. â€Å"Drink,† he said brusquely. â€Å"I've no thirst—† â€Å"Drink. Your king commands it.† Ned took the horn and drank. The beer was black and thick, so strong it stung the eyes. Robert sat down again. â€Å"Damn you, Ned Stark. You and Jon Arryn, I loved you both. What have you done to me? You were the one should have been king, you or Jon.† â€Å"You had the better claim, Your Grace.† â€Å"I told you to drink, not to argue. You made me king, you could at least have the courtesy to listen when I talk, damn you. Look at me, Ned. Look at what kinging has done to me. Gods, too fat for my armor, how did it ever come to this?† â€Å"Robert . . . â€Å" â€Å"Drink and stay quiet, the king is talking. I swear to you, I was never so alive as when I was winning this throne, or so dead as now that I've won it. And Cersei . . . I have Jon Arryn to thank for her. I had no wish to marry after Lyanna was taken from me, but Jon said the realm needed an heir. Cersei Lannister would be a good match, he told me, she would bind Lord Tywin to me should Viserys Targaryen ever try to win back his father's throne.† The king shook his head. â€Å"I loved that old man, I swear it, but now I think he was a bigger fool than Moon Boy. Oh, Cersei is lovely to look at, truly, but cold . . . the way she guards her cunt, you'd think she had all the gold of Casterly Rock between her legs. Here, give me that beer if you won't drink it.† He took the horn, upended it, belched, wiped his mouth. â€Å"I am sorry for your girl, Ned. Truly. About the wolf, I mean. My son was lying, I'd stake my soul on it. My son . . . you love your children, don't y ou?† â€Å"With all my heart,† Ned said. â€Å"Let me tell you a secret, Ned. More than once, I have dreamed of giving up the crown. Take ship for the Free Cities with my horse and my hammer, spend my time warring and whoring, that's what I was made for. The sellsword king, how the singers would love me. You know what stops me? The thought of Joffrey on the throne, with Cersei standing behind him whispering in his ear. My son. How could I have made a son like that, Ned?† â€Å"He's only a boy,† Ned said awkwardly. He had small liking for Prince Joffrey, but he could hear the pain in Robert's voice. â€Å"Have you forgotten how wild you were at his age?† â€Å"It would not trouble me if the boy was wild, Ned. You don't know him as I do.† He sighed and shook his head. â€Å"Ah, perhaps you are right. Jon despaired of me often enough, yet I grew into a good king.† Robert looked at Ned and scowled at his silence. â€Å"You might speak up and agree now, you know.† â€Å"Your Grace . . . † Ned began, carefully. Robert slapped Ned on the back. â€Å"Ah, say that I'm a better king than Aerys and be done with it. You never could lie for love nor honor, Ned Stark. I'm still young, and now that you're here with me, things will be different. We'll make this a reign to sing of, and damn the Lannisters to seven hells. I smell bacon. Who do you think our champion will be today? Have you seen Mace Tyrell's boy? The Knight of Flowers, they call him. Now there's a son any man would be proud to own to. Last tourney, he dumped the Kingslayer on his golden rump, you ought to have seen the look on Cersei's face. I laughed till my sides hurt. Renly says he has this sister, a maid of fourteen, lovely as a dawn . . . â€Å" They broke their fast on black bread and boiled goose eggs and fish fried up with onions and bacon, at a trestle table by the river's edge. The king's melancholy melted away with the morning mist, and before long Robert was eating an orange and waxing fond about a morning at the Eyrie when they had been boys. † . . . had given Jon a barrel of oranges, remember? Only the things had gone rotten, so I flung mine across the table and hit Dacks right in the nose. You remember, Redfort's pock-faced squire? He tossed one back at me, and before Jon could so much as fart, there were oranges flying across the High Hall in every direction.† He laughed uproariously, and even Ned smiled, remembering. This was the boy he had grown up with, he thought; this was the Robert Baratheon he'd known and loved. If he could prove that the Lannisters were behind the attack on Bran, prove that they had murdered Jon Arryn, this man would listen. Then Cersei would fall, and the Kingslayer with her, and if Lord Tywin dared to rouse the west, Robert would smash him as he had smashed Rhaegar Targaryen on the Trident. He could see it all so clearly. That breakfast tasted better than anything Eddard Stark had eaten in a long time, and afterward his smiles came easier and more often, until it was time for the tournament to resume. Ned walked with the king to the jousting field. He had promised to watch the final tilts with Sansa; Septa Mordane was ill today, and his daughter was determined not to miss the end of the jousting. As he saw Robert to his place, he noted that Cersei Lannister had chosen not to appear; the place beside the king was empty. That too gave Ned cause to hope. He shouldered his way to where his daughter was seated and found her as the horns blew for the day's first joust. Sansa was so engrossed she scarcely seemed to notice his arrival. Sandor Clegane was the first rider to appear. He wore an olive- green cloak over his soot-grey armor. That, and his hound's-head helm, were his only concession to ornament. â€Å"A hundred golden dragons on the Kingslayer,† Littlefinger announced loudly as Jaime Lannister entered the lists, riding an elegant blood bay destrier. The horse wore a blanket of gilded ringmail, and Jaime glittered from head to heel. Even his lance was fashioned from the golden wood of the Summer Isles. â€Å"Done,† Lord Renly shouted back. â€Å"The Hound has a hungry look about him this morning.† â€Å"Even hungry dogs know better than to bite the hand that feeds them,† Littlefinger called dryly. Sandor Clegane dropped his visor with an audible clang and took up his position. Ser Jaime tossed a kiss to some woman in the commons, gently lowered his visor, and rode to the end of the lists. Both men couched their lances. Ned Stark would have loved nothing so well as to see them both lose, but Sansa was watching it all moist-eyed and eager. The hastily erected gallery trembled as the horses broke into a gallop. The Hound leaned forward as he rode, his lance rock steady, but Jaime shifted his seat deftly in the instant before impact. Clegane's point was turned harmlessly against the golden shield with the lion blazon, while his own hit square. Wood shattered, and the Hound reeled, fighting to keep his seat. Sansa gasped. A ragged cheer went up from the commons. â€Å"I wonder how I ought spend your money,† Littlefinger called down to Lord Renly. The Hound just managed to stay in his saddle. He jerked his mount around hard and rode back to the lists for the second pass. Jaime Lannister tossed down his broken lance and snatched up a fresh one, jesting with his squire. The Hound spurred forward at a hard gallop. Lannister rode to meet him. This time, when Jaime shifted his seat, Sandor Clegane shifted with him. Both lances exploded, and by the time the splinters had settled, a riderless blood bay was trotting off in search of grass while Ser Jaime Lannister rolled in the dirt, golden and dented. Sansa said, â€Å"I knew the Hound would win.† Littlefinger overheard. â€Å"If you know who's going to win the second match, speak up now before Lord Renly plucks me clean,† he called to her. Ned smiled. â€Å"A pity the Imp is not here with us,† Lord Renly said. â€Å"I should have won twice as much.† Jaime Lannister was back on his feet, but his ornate lion helmet had been twisted around and dented in his fall, and now he could not get it off. The commons were hooting and pointing, the lords and ladies were trying to stifle their chuckles, and failing, and over it all Ned could hear King Robert laughing, louder than anyone. Finally they had to lead the Lion of Lannister off to a blacksmith, blind and stumbling. By then Ser Gregor Clegane was in position at the head of the lists. He was huge, the biggest man that Eddard Stark had ever seen. Robert Baratheon and his brothers were all big men, as was the Hound, and back at Winterfell there was a simpleminded stableboy named Hodor who dwarfed them all, but the knight they called the Mountain That Rides would have towered over Hodor. He was well over seven feet tall, closer to eight, with massive shoulders and arms thick as the trunks of small trees. His destrier seemed a pony in between his armored legs, and the lance he carried looked as small as a broom handle. Unlike his brother, Ser Gregor did not live at court. He was a solitary man who seldom left his own lands, but for wars and tourneys. He had been with Lord Tywin when King's Landing fell, a new-made knight of seventeen years, even then distinguished by his size and his implacable ferocity. Some said it had been Gregor who'd dashed the skull of the infant prince Aegon Targaryen against a wall, and whispered that afterward he had raped the mother, the Dornish princess Elia, before putting her to the sword. These things were not said in Gregor's hearing. Ned Stark could not recall ever speaking to the man, though Gregor had ridden with them during Balon Greyjoy's rebellion, one knight among thousands. He watched him with disquiet. Ned seldom put much stock in gossip, but the things said of Ser Gregor were more than ominous. He was soon to be married for the third time, and one heard dark whisperings about the deaths of his first two wives. It was said that his keep was a grim place where servants disappeared unaccountably and even the dogs were afraid to enter the hall. And there had been a sister who had died young under queer circumstances, and the fire that had disfigured his brother, and the hunting accident that had killed their father. Gregor had inherited the keep, the gold, and the family estates. His younger brother Sandor had left the same day to take service with the Lannisters as a sworn sword, and it was said that he had never returned, not even to visit. When the Knight of Flowers made his entrance, a murmur ran through the crowd, and he heard Sansa's fervent whisper, â€Å"Oh, he's so beautiful.† Ser Loras Tyrell was slender as a reed, dressed in a suit of fabulous silver armor polished to a blinding sheen and filigreed with twining black vines and tiny blue forget-me-nots. The commons realized in the same instant as Ned that the blue of the flowers came from sapphires; a gasp went up from a thousand throats. Across the boy's shoulders his cloak hung heavy. It was woven of forget-me-nots, real ones, hundreds of fresh blooms sewn to a heavy woolen cape. His courser was as slim as her rider, a beautiful grey mare, built for speed. Ser Gregor's huge stallion trumpeted as he caught her scent. The boy from Highgarden did something with his legs, and his horse pranced sideways, nimble as a dancer. Sansa clutched at his arm. â€Å"Father, don't let Ser Gregor hurt him,† she said. Ned saw she was wearing the rose that Ser Loras had given her yesterday. Jory had told him about that as well. â€Å"These are tourney lances,† he told his daughter. â€Å"They make them to splinter on impact, so no one is hurt.† Yet he remembered the dead boy in the cart with his cloak of crescent moons, and the words were raw in his throat. Ser Gregor was having trouble controlling his horse. The stallion was screaming and pawing the ground, shaking his head. The Mountain kicked at the animal savagely with an armored boot. The horse reared and almost threw him. The Knight of Flowers saluted the king, rode to the far end of the list, and couched his lance, ready. Ser Gregor brought his animal to the line, fighting with the reins. And suddenly it began. The Mountain's stallion broke in a hard gallop, plunging forward wildly, while the mare charged as smooth as a flow of silk. Ser Gregor wrenched his shield into position, juggled with his lance, and all the while fought to hold his unruly mount on a straight line, and suddenly Loras Tyrell was on him, placing the point of his lance just there, and in an eye blink the Mountain was failing. He was so huge that he took his horse down with him in a tangle of steel and flesh. Ned heard applause, cheers, whistles, shocked gasps, excited muttering, and over it all the rasping, raucous laughter of the Hound. The Knight of Flowers reined up at the end of the lists. His lance was not even broken. His sapphires winked in the sun as he raised his visor, smiling. The commons went mad for him. In the middle of the field, Ser Gregor Clegane disentangled himself and came boiling to his feet. He wrenched off his helm and slammed it down onto the ground. His face was dark with fury and his hair fell down into his eyes. â€Å"My sword,† he shouted to his squire, and the boy ran it out to him. By then his stallion was back on its feet as well. Gregor Clegane killed the horse with a single blow of such ferocity that it half severed the animal's neck. Cheers turned to shrieks in a heartbeat. The stallion went to its knees, screaming as it died. By then Gregor was striding down the lists toward Ser Loras Tyrell, his bloody sword clutched in his fist. â€Å"Stop him!† Ned shouted, but his words were lost in the roar. Everyone else was yelling as well, and Sansa was crying. It all happened so fast. The Knight of Flowers was shouting for his own sword as Ser Gregor knocked his squire aside and made a grab for the reins of his horse. The mare scented blood and reared. Loras Tyrell kept his seat, but barely. Ser Gregor swung his sword, a savage two-handed blow that took the boy in the chest and knocked him from the saddle. The courser dashed away in panic as Ser Loras lay stunned in the dirt. But as Gregor lifted his sword for the killing blow, a rasping voice warned, â€Å"Leave him be,† and a steel-clad hand wrenched him away from the boy. The Mountain pivoted in wordless fury, swinging his longsword in a killing arc with all his massive strength behind it, but the Hound caught the blow and turned it, and for what seemed an eternity the two brothers stood hammering at each other as a dazed Loras Tyrell was helped to safety. Thrice Ned saw Ser Gregor aim savage blows at the hound's-head helmet, yet not once did Sandor send a cut at his brother's unprotected face. It was the king's voice that put an end to it . . . the king's voice and twenty swords. Jon Arryn had told them that a commander needs a good battlefield voice, and Robert had proved the truth of that on the Trident. He used that voice now. â€Å"STOP THIS MADNESS,† he boomed, â€Å"IN THE NAME OF YOUR KING!† The Hound went to one knee. Ser Gregor's blow cut air, and at last he came to his senses. He dropped his sword and glared at Robert, surrounded by his Kingsguard and a dozen other knights and guardsmen. Wordlessly, he turned and strode off, shoving past Barristan Selmy. â€Å"Let him go,† Robert said, and as quickly as that, it was over. â€Å"Is the Hound the champion now?† Sansa asked Ned. â€Å"No,† he told her. â€Å"There will be one final joust, between the Hound and the Knight of Flowers.† But Sansa had the right of it after all. A few moments later Ser Loras Tyrell walked back onto the field in a simple linen doublet and said to Sandor Clegane, â€Å"I owe you my life. The day is yours, ser.† â€Å"I am no ser,† the Hound replied, but he took the victory, and the champion's purse, and, for perhaps the first time in his life, the love of the commons. They cheered him as he left the lists to return to his pavilion. As Ned walked with Sansa to the archery field, Littlefinger and Lord Renly and some of the others fell in with them. â€Å"Tyrell had to know the mare was in heat,† Littlefinger was saying. â€Å"I swear the boy planned the whole thing. Gregor has always favored huge, ill-tempered stallions with more spirit than sense.† The notion seemed to amuse him. It did not amuse Ser Barristan Selmy. â€Å"There is small honor in tricks,† the old man said stiffly. â€Å"Small honor and twenty thousand golds.† Lord Renly smiled. That afternoon a boy named Anguy, an unheralded commoner from the Dornish Marches, won the archery competition, outshooting Ser Balon Swann and Jalabhar Xho at a hundred paces after all the other bowmen had been eliminated at the shorter distances. Ned sent Alyn to seek him out and offer him a position with the Hand's guard, but the boy was flush with wine and victory and riches undreamed of, and he refused. The melee went on for three hours. Near forty men took part, freeriders and hedge knights and new-made squires in search of a reputation. They fought with blunted weapons in a chaos of mud and blood, small troops fighting together and then turning on each other as alliances formed and fractured, until only one man was left standing. The victor was the red priest, Thoros of Myr, a madman who shaved his head and fought with a flaming sword. He had won melees before; the fire sword frightened the mounts of the other riders, and nothing frightened Thoros. The final tally was three broken limbs, a shattered collarbone, a dozen smashed fingers, two horses that had to be put down, and more cuts, sprains, and bruises than anyone cared to count. Ned was desperately pleased that Robert had not taken part. That night at the feast, Eddard Stark was more hopeful than he had been in a great while. Robert was in high good humor, the Lannisters were nowhere to be seen, and even his daughters were behaving. Jory brought Arya down to join them, and Sansa spoke to her sister pleasantly. â€Å"The tournament was magnificent,† she sighed. â€Å"You should have come. How was your dancing?† â€Å"I'm sore all over,† Arya reported happily, proudly displaying a huge purple bruise on her leg. â€Å"You must be a terrible dancer,† Sansa said doubtfully. Later, while Sansa was off listening to a troupe of singers perform the complex round of interwoven ballads called the â€Å"Dance of the Dragons,† Ned inspected the bruise himself. â€Å"I hope Forel is not being too hard on you,† he said. Arya stood on one leg. She was getting much better at that of late. â€Å"Syrio says that every hurt is a lesson, and every lesson makes you better.† Ned frowned. The man Syrio Forel had come with an excellent reputation, and his flamboyant Braavosi style was well suited to Arya's slender blade, yet still . . . a few days ago, she had been wandering around with a swatch of black silk tied over her eyes. Syrio was teaching her to see with her ears and her nose and her skin, she told him. Before that, he had her doing spins and back flips. â€Å"Arya, are you certain you want to persist in this?† She nodded. â€Å"Tomorrow we're going to catch cats.† â€Å"Cats.† Ned sighed. â€Å"Perhaps it was a mistake to hire this Braavosi. If you like, I will ask Jory to take over your lessons. Or I might have a quiet word with Ser Barristan. He was the finest sword in the Seven Kingdoms in his youth.† â€Å"I don't want them,† Arya said. â€Å"I want Syrio.† Ned ran his fingers through his hair. Any decent master-at-arms could give Arya the rudiments of slash-and-parry without this nonsense of blindfolds, cartwheels, and hopping about on one leg, but he knew his youngest daughter well enough to know there was no arguing with that stubborn jut of jaw. â€Å"As you wish,† he said. Surely she would grow tired of this soon. â€Å"Try to be careful.† â€Å"I will,† she promised solemnly as she hopped smoothly from her right leg to her left. Much later, after he had taken the girls back through the city and seen them both safe in bed, Sansa with her dreams and Arya with her bruises, Ned ascended to his own chambers atop the Tower of the Hand. The day had been warm and the room was close and stuffy. Ned went to the window and unfastened the heavy shutters to let in the cool night air. Across the Great Yard, he noticed the flickering glow of candlelight from Littlefinger's windows. The hour was well past midnight. Down by the river, the revels were only now beginning to dwindle and die. He took out the dagger and studied it. Littlefinger's blade, won by Tyrion Lannister in a tourney wager, sent to slay Bran in his sleep. Why? Why would the dwarf want Bran dead? Why would anyone want Bran dead? The dagger, Bran's fall, all of it was linked somehow to the murder of Jon Arryn, he could feel it in his gut, but the truth of Jon's death remained as clouded to him as when he had started. Lord Stannis had not returned to King's Landing for the tourney. Lysa Arryn held her silence behind the high walls of the Eyrie. The squire was dead, and Jory was still searching the whorehouses. What did he have but Robert's bastard? That the armorer's sullen apprentice was the king's son, Ned had no doubt. The Baratheon look was stamped on his face, in his jaw, his eyes, that black hair. Renly was too young to have fathered a boy of that age, Stannis too cold and proud in his honor. Gendry had to be Robert's. Yet knowing all that, what had he learned? The king had other baseborn children scattered throughout the Seven Kingdoms. He had openly acknowledged one of his bastards, a boy of Bran's age whose mother was highborn. The lad was being fostered by Lord Renly's castellan at Storm's End. Ned remembered Robert's first child as well, a daughter born in the Vale when Robert was scarcely more than a boy himself. A sweet little girl; the young lord of Storm's End had doted on her. He used to make daily visits to play with the babe, long after he had lost interest in the mother. Ned was often dragged along for company, whether he willed it or not. The girl would be seventeen or eighteen now, he realized; older than Robert had been when he fathered her. A strange thought. Cersei could not have been pleased by her lord husband's by-blows, yet in the end it mattered little whether the king had one bastard or a hundred. Law and custom gave the baseborn few rights. Gendry, the girl in the Vale, the boy at Storm's End, none of them could threaten Robert's trueborn children . . . His musings were ended by a soft rap on his door. â€Å"A man to see you, my lord,† Harwin called. â€Å"He will not give his name.† â€Å"Send him in,† Ned said, wondering. The visitor was a stout man in cracked, mud-caked boots and a heavy brown robe of the coarsest roughspun, his features hidden by a cowl, his hands drawn up into voluminous sleeves. â€Å"Who are you?† Ned asked. â€Å"A friend,† the cowled man said in a strange, low voice. â€Å"We must speak alone, Lord Stark.† Curiosity was stronger than caution. â€Å"Harwin, leave us,† he commanded. Not until they were alone behind closed doors did his visitor draw back his cowl. â€Å"Lord Varys?† Ned said in astonishment. â€Å"Lord Stark,† Varys said politely, seating himself. â€Å"I wonder if I might trouble you for a drink?† Ned filled two cups with summerwine and handed one to Varys. â€Å"I might have passed within a foot of you and never recognized you,† he said, incredulous. He had never seen the eunuch dress in anything but silk and velvet and the richest damasks, and this man smelled of sweat instead of lilacs. â€Å"That was my dearest hope,† Varys said. â€Å"It would not do if certain people learned that we had spoken in private. The queen watches you closely. This wine is very choice. Thank you.† â€Å"How did you get past my other guards?† Ned asked. Porther and Cayn had been posted outside the tower, and Alyn on the stairs. â€Å"The Red Keep has ways known only to ghosts and spiders.† Varys smiled apologetically. â€Å"I will not keep you long, my lord. There are things you must know. You are the King's Hand, and the king is a fool.† The eunuch's cloying tones were gone; now his voice was thin and sharp as a whip. â€Å"Your friend, I know, yet a fool nonetheless . . . and doomed, unless you save him. Today was a near thing. They had hoped to kill him during the melee.† For a moment Ned was speechless with shock. â€Å"Who?† Varys sipped his wine. â€Å"If I truly need to tell you that, you are a bigger fool than Robert and I am on the wrong side.† â€Å"The Lannisters,† Ned said. â€Å"The queen . . . no, I will not believe that, not even of Cersei. She asked him not to fight!† â€Å"She forbade him to fight, in front of his brother, his knights, and half the court. Tell me truly, do you know any surer way to force King Robert into the melee? I ask you.† Ned had a sick feeling in his gut. The eunuch had hit upon a truth; tell Robert Baratheon he could not, should not, or must not do a thing, and it was as good as done. â€Å"Even if he'd fought, who would have dared to strike the king?† Varys shrugged. â€Å"There were forty riders in the melee. The Lannisters have many friends. Amidst all that chaos, with horses screaming and bones breaking and Thoros of Myr waving that absurd firesword of his, who could name it murder if some chance blow felled His Grace?† He went to the flagon and refilled his cup. â€Å"After the deed was done, the slayer would be beside himself with grief. I can almost hear him weeping. So sad. Yet no doubt the gracious and compassionate widow would take pity, lift the poor unfortunate to his feet, and bless him with a gentle kiss of forgiveness. Good King Joffrey would have no choice but to pardon him.† The eunuch stroked his cheek. â€Å"Or perhaps Cersei would let Ser Ilyn strike off his head. Less risk for the Lannisters that way, though quite an unpleasant surprise for their little friend.† Ned felt his anger rise. â€Å"You knew of this plot, and yet you did nothing.† â€Å"I command whisperers, not warriors.† â€Å"You might have come to me earlier.† â€Å"Oh, yes, I confess it. And you would have rushed straight to the king, yes? And when Robert heard of his peril, what would he have done? I wonder.† Ned considered that. â€Å"He would have damned them all, and fought anyway, to show he did not fear them.† Varys spread his hands. â€Å"I will make another confession, Lord Eddard. I was curious to see what you would do. Why not come to me? you ask, and I must answer, Why, because I did not trust you, my lord.† â€Å"You did not trust me?† Ned was frankly astonished. â€Å"The Red Keep shelters two sorts of people, Lord Eddard,† Varys said. â€Å"Those who are loyal to the realm, and those who are loyal only to themselves. Until this morning, I could not say which you might be . . . so I waited to see . . . and now I know, for a certainty.† He smiled a plump tight little smile, and for a moment his private face and public mask were one. â€Å"I begin to comprehend why the queen fears you so much. Oh, yes I do.† â€Å"You are the one she ought to fear,† Ned said. â€Å"No. I am what I am. The king makes use of me, but it shames him. A most puissant warrior is our Robert, and such a manly man has little love for sneaks and spies and eunuchs. If a day should come when Cersei whispers, ‘Kill that man,' Ilyn Payne will snick my head off in a twinkling, and who will mourn poor Varys then? North or south, they sing no songs for spiders.† He reached out and touched Ned with a soft hand. â€Å"But you, Lord Stark . . . I think . . . no, I know . . . he would not kill you, not even for his queen, and there may lie our salvation.† It was all too much. For a moment Eddard Stark wanted nothing so much as to return to Winterfell, to the clean simplicity of the north, where the enemies were winter and the wildlings beyond the Wall. â€Å"Surely Robert has other loyal friends,† he protested. â€Å"His brothers, his—† â€Å"—wife?† Varys finished, with a smile that cut. â€Å"His brothers hate the Lannisters, true enough, but hating the queen and loving the king are not quite the same thing, are they? Ser Barristan loves his honor, Grand Maester Pycelle loves his office, and Littlefinger loves Littlefinger.† â€Å"The Kingsguard—† â€Å"A paper shield,† the eunuch said. â€Å"Try not to look so shocked, Lord Stark. Jaime Lannister is himself a Sworn Brother of the White Swords, and we all know what his oath is worth. The days when men like Ryam Redwyne and Prince Aemon the Dragonknight wore the white cloak are gone to dust and song. Of these seven, only Ser Barristan Selmy is made of the true steel, and Selmy is old. Ser Boros and Ser Meryn are the queen's creatures to the bone, and I have deep suspicions of the others. No, my lord, when the swords come out in earnest, you will be the only true friend Robert Baratheon will have.† â€Å"Robert must be told,† Ned said. â€Å"If what you say is true, if even a part of it is true, the king must hear it for himself.† â€Å"And what proof shall we lay before him? My words against theirs? My little birds against the queen and the Kingslayer, against his brothers and his council, against the Wardens of East and West, against all the might of Casterly Rock? Pray, send for Ser Ilyn directly, it will save us all some time. I know where that road ends.† â€Å"Yet if what you say is true, they will only bide their time and make another attempt.† â€Å"Indeed they will,† said Varys, â€Å"and sooner rather than later, I do fear. You are making them most anxious, Lord Eddard. But my little birds will be listening, and together we may be able to forestall them, you and I.† He rose and pulled up his cowl so his face was hidden once more. â€Å"Thank you for the wine. We will speak again. When you see me next at council, be certain to treat me with your accustomed contempt. You should not find it difficult.† He was at the door when Ned called, â€Å"Varys.† The eunuch turned back. â€Å"How did Jon Arryn die?† â€Å"I wondered when you would get around to that.† â€Å"Tell me.† â€Å"The tears of Lys, they call it. A rare and costly thing, clear and sweet as water, and it leaves no trace. I begged Lord Arryn to use a taster, in this very room I begged him, but he would not hear of it. Only one who was less than a man would even think of such a thing, he told me.† Ned had to know the rest. â€Å"Who gave him the poison?† â€Å"Some dear sweet friend who often shared meat and mead with him, no doubt. Oh, but which one? There were many such. Lord Arryn was a kindly, trusting man.† The eunuch sighed. â€Å"There was one boy. All he was, he owed Jon Arryn, but when the widow fled to the Eyrie with her household, he stayed in King's Landing and prospered. It always gladdens my heart to see the young rise in the world.† The whip was in his voice again, every word a stroke. â€Å"He must have cut a gallant figure in the tourney, him in his bright new armor, with those crescent moons on his cloak. A pity he died so untimely, before you could talk to him . . . â€Å" Ned felt half-poisoned himself. â€Å"The squire,† he said. â€Å"Ser Hugh.† Wheels within wheels within wheels. Ned's head was pounding. â€Å"Why? Why now? Jon Arryn had been Hand for fourteen years. What was he doing that they had to kill him?† â€Å"Asking questions,† Varys said, slipping out the door.

What Everyone Is Saying About Custom Essay Is Dead Wrong and Why

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Artificial Intelligence Essay - 537 Words

Computers are becoming more and more human. In some areas they are superhuman. Computers can calculate complex math problems in less than one millisecond, beat us at games such as chess, memorize entire books and movies in a single glance, compose entire pieces of music, and they can give people information on virtually any subject. Yet, we still dont have a machine that can do the things that computers have done in science fiction movies, such as translate everyday English into Italian, summarize texts, or make us breakfast without burning down the house. But will computers ever become as intelligent as human beings? According to the website Science Fiction and Fantasy World, artificial intelligence (A.I.) can be defined as the†¦show more content†¦But there are many conflicting views about the technology needed to produce real A.I. Just because computers can get faster doesnt mean they get smarter. People have confused ideal computers with real computers. Although computer scientists and programmers have created plans that are possible in theory, someone needs to write the software that gets the process going, and at the present time, humans have given absolutely no evidence of being able to write such software. With the invention of many new types of communication devices, we are now all connected through telephones, radios, television, satellites, and the Internet. We are beginning to resemble a massive computer spread across the earth, circuited together through these new channels of communication. Our language, music, morals, and style changes within the course of a year, and we seem to do this collectively without voting or taking polls. In the future, we may be able to build a computer that is comparable to the human brain, but not until we truly understand one thing. Lewis Thomas talks about this in his essay, Computers. He says, It is in our collective behavior that we are most mysterious. 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OneRead MoreEssay On Artificial Intelligence1515 Words   |  7 PagesIntroduction I chose Artificial Intelligence since I believe that it is extremely intriguing and important in the field of Information Technology. Artificial Intelligence is the theory and development of computer systems able to perform tasks that normally require human intelligence, such as visual perception, speech recognition, decision-making, and translation between languages. AI is usually defined as the capability of a computer program to perform tasks or reasoning processes that we associate

How is I Bill Made Into a Law Essay example - 532 Words

The basic idea for a law can originate from an array of places ranging from a concerned citizen to the President. In order for a bill to become a law it must begin in either the House or the Senate and can only be introduced by a member of Congress (Schwalbe, 2014). In order for a bill to have a chance at becoming a law it must go through various different stages which include committee consideration, floor debate(by House and Senate), conference committees, and then if both houses pass the bill it is then sent to the president to either be signed and become a law or vetoed. When the president gets the bill he actually has up to five options on what to do with it. (Schwalbe, 2014). He can pass it as a law by both dating and signing it†¦show more content†¦Another example of how bills and laws work is shown with the Student Loan Fairness Act of 2013(H.R. 1330). Authored by Sen. Elizabeth Warren (D-Mass) and sponsored by Representative Karen Bass (CA-37), if this bill is s igned into a law it would dramatically lower the interest rates on federal student loans (Kingkade, 2013). Warren’s plan is to have the percentage rate on government issued student loans lower from 6.8 percent to .75 percent (Kingkade, 2013). When looking at the details of H.R. 1330, you can see the timeline of events that has happened since the bill was introduced in 2013. The details show that Hon. Karen Bass introduced the bill to the House Education and the Workforce, House Financial Services, House Ways and Means, and then the bill was referred to the subcommittee on Higher Education and Workforce Training. (Committee Action, Schwalbe, 2014). As of April 2013, the bill has gained up to 51 different cosponsors however it is still under review by committee and awaiting further action or until the committees are ready to send it to the floor for debate. If this bill did become a law it would help college students with the debt they incur while obtaining higher education. Some people say that bills take too long to pass and looking at H.R. 1330 one can see why most Americans feel this way. (No action since April 2013) The wait time and theShow MoreRelatedLearning Criminal Law and English Common Law Essay920 Words   |  4 Pagesthis first week I learned so much about how criminal law is evaluated, organized, and made. Also I learned about the English common law includes legislation, and a multitude of other legal norms that help on the evaluation of criminal laws, such as federal and state constitutions that are based on congress and state legislatures. It also includes how the lawmakers are made or changed by the judicial powers of review and how the judicial power interpret them. 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Week DQ Free Essays

To be sure we are caring for the entire needs of the attain, we must include a spiritual assessment to make sure the wishes and desires of the patient and family are being met in order for the patient to heal from their illness. To address our own spiritual needs we must be honest and open with ourselves as to what is important to us spiritually. Exploring your own spiritual side may be helpful to deliver the care necessary to your patients and leave room so you can be open to whatever it is that your patient’s spiritual needs may be. We will write a custom essay sample on Week DQ or any similar topic only for you Order Now This may also be important so you can understand what your own beliefs and preferences are so you don’t impose Hess on your patients. You may find that there are certain things you choose to do for your faith in order to stay spiritual. My family chooses to worship together on Sunday mornings in church. We have always done so and now that we are all married, we meet on Sundays and worship together. It brings us all together and I feel at peace when my family is together. When taking care of your patients it is necessary to have an understanding of what it is that they believe and what will help them in their healing process. Many patients become stressed when hospitalized and seek comfort in having their virtual needs addressed. This is when it is important to ask those questions and have the knowledge of what you can do to make your patients as comfortable as possible. Many times patients will ask to see their pastor or want to make a trip to the chapel. Some may just want a quiet place to worship or will find comfort in having a Bible at the bedside. It may be important for your patient to be involved in prayer or meditation in which you may wish to include yourself or not depending on how comfortable you are. Patients like to include their health care providers in their prayer as they live it helps to bring peace to their healing. When a person becomes ill, it often affects the family as well (GUCCI lecture notes, 2011). By asking the patient and family of their spiritual wishes, this allows us to gain a better understanding of who are patient is and what they need while under our care. Addressing and supporting patients’ spirituality can not only make their health care experiences more positive, but in many cases can promote health, decrease depression, help patients cope with a difficult illness, and even improve outcomes for some patients† (The Joint Commission, 2005). A Emily may have certain ceremonies or ways in which they pray together so it is up to the health care provider to allow this and accommodate them to the best of our ability. How to cite Week DQ, Papers

Management Principles of Organization

Question: Task 1 Briefly explain: manager, management and organisation. Assess the significance of managers in achieving organisational success for a company of your own choice? Task 2 Analyse how size and strategy of a company can affect its organisational structure? Support your answer with relevant examples? Task 3 Scenario: Tesco has said it will close 43 unprofitable stores across the UK, The firm is also shelving plans to open a further 49 new "very large" stores. Additionally, Tesco is closing its staff pension scheme, will make cuts of 250m and reduce overheads by 30%. Shares in Tesco rose by more than 13% on Thursday, as investors welcomed the company's announcements. It comes after two years of troubles at Tesco, which has suffered falling sales, in another development, credit rating agency Moody's downgraded Tesco's rating by one notch to Ba1, equivalent to "junk" status. (BBC, 2015). 1. Discuss Tescos current mission, vision and corporate strategy. 2. Suggest and explain the process that can help Tesco to formulate its corporate strategy for the year 2015. 3. What do you understand by the term organisational culture? Can Tesco improve its performance by changing its culture? Discuss. Answer: Introduction Basically the management is the art of the perceptive what anybody needs to do and then the seeing which can be done in the most possible well and the cheapest way. It also entails the basic of the co-ordination of the human effort and the resources so that the organization can achieve its goal and the objectives. The principles of the management are basically the guidelines on the basis of which any of the organization takes the decisions and also the action of the managers. These principles of the management are also essential on the basis of the underlying factors which can forms the basic foundation of the doing the successful management. Task 1 The person who is basically more responsible in doing the planning and also the directing of the work in any of the individuals of the group, monitoring the work of the team mates and also have the capability to take the corrective action when ever and where ever it is needed. A manger also has the power in hiring and also in firing the employees. There are some of the basic roles which the manger needs to maintain to do the proper guidance of any of the organization which are: first of all the manger needs to be a good leader so that he can do the proper organization of the teams and also can create the effective plans. The manager also needs to be an effective mediator so that when it is needed they can do the proper negotiation with the all employees, suppliers, contractors, etc. the manger also needs to have the capabilities to do the proper reinforcement of both the vision and the mission of the organization to the stakeholder, employees and the customer. They also need to be th e good communicator and also the connection between the customers, employees and the other manager of the organization. In this scenario for doing the assignment the Tesco is chosen. Some of the significant roles which the manager needs to play in maintaining the organizational success of the company are given below (Agnihotri, 2014): Increase in operating margins The manger needs to keep the proper look after toward the employees so that they can understand the proper goals and also they have the proper knowledge how to draw the relation of the companys goals and the employees. The manager also needs to do the proper boost up of the productivity of the employees which can naturally lead in the increasing of the profit and the operating margins. The manger also helps to increase the engagement of the employees by developing the proper smart goals (Baker, 2014). Quick execution of the companys strategy The manger also needs to tight the goal alignment and also allows the goals visibility so that it can do the quicker execution of the strategies of the company by properly allocating all the resources of the various projects. The manger also helps in eliminating the redundancies of the job; they also need to keep the proper focus on their staff so that they can properly achieve the goals (Cho, 2014). Reduction in the employee turnover The manger needs to earn the more business values by doing the proper engagement of the employees. They also needs to clear the alignment of the goal which can be proper remedy of the situation and also create the ownership of the greater employees so that it can help the manger to earn the companys ultimate success. By doing the proper management the manager to keep the employees needs to start the reward programs, incentives programs etc (Clausen et al., 2011). Task 2 There are some of the factors which affect both the size and the strategies of the organizational structure which are listed below: Devolution of decision making Evolution cultivate the hierarchical structure of the organization in which both the power of the doing the decision making and the ultimate supreme power are concentrated by the top level manger. In the decision making part, the manger plays the one of the important part in which the manger tells about all the issues and also perspective of the employees they are facing to the top level of the management (Dauber, Fink and Yolles, 2012). Interaction of the customer Both the direct and the indirect interaction of the customer to the top level of the management support in the implementation of the new innovative features and also the helps in doing the improvement of the quality of the product of the organization by analyzing the complexity, a version of the risk, structure of the mechanics etc (Grey, 2014). Innovative values In the innovation of the values the manager just look after the structure of the organization, total quality management and also the controls of the just in time value (Janicijevic, 2012). Task 3 Mainly Tesco focuses on the business and also enjoys the long term businesses. To analyze the vision statement of the Tesco it considers some of the five elements which are innovation, modern and the full of the ideas of the product, also needs to do the inspiration and also the earning of the trust, loyalty of the customers and the communities. It also includes the growing structures of the business and also the opportunities. In the mission statement of the Tesco it also tells about the basic expression of the overall purposes of the businesses of the organization. It also tells about the goals and the objectives of the organizations to all the stake holders. The mission statement also acts as the inspiration and the motivations of all the employees and the stake holders towards its achieving goals and the strategies. In the corporate strategies of the Tesco it includes some of the features which are (Damanpour and Aravind, 2011): Value of the money: Tesco are always committed towards the delivering of the quality products to the customers within the guaranteed of the unbearable prices. Customer service: Tesco always give the special focus on the customer on a unique basis and also deals in delivering the first class service. Loyalty of the customer: customer always rewarded the company Tesco with their loyalty and the dedication towards the one of the specific organization. Products: Tesco are always dedicated in delivering the highest quality of the products and also with the widest possible choice. There also needs to have the varieties in the products so that it can influence the customer needs with the variety of the products. Stores: Tesco always invest in the existing stores and also helps in developing the flexibility of the new stores so that the customers get free in doing the best shopping experience. Some of the key products which help the Tesco to formulate the strategies of the corporate values are listed below (Seal, 2012): Environmental trends and issues: factor which can cause the impacts in the organization are internal factors and the external factors. The internal factors includes: skills, services, resources, needs etc. the external factors includes: outsourcing, threats etc. Strategies: strategies of the organization are fulfilled with the continuation, creation, change and also the elimination of the changes. External: the external environment of the organization includes some of the variables which include the employees, competitors, customers, creditors, trade associations etc. Internal: the internal environment of the organization includes both the variables of the strengths and the weakness of the organization within the control of the short run of the top management. It also includes the structure, resources and the culture of the corporation. In the internal factors it also assesses the value chain analysis which includes both the weakness and the strength of the business and also the linked activities which also generate the values for the customers. The behavior and the culture of the people within the organization and also the meaning through which the people are attached to the behaviors are discussed as the organizational culture. The culture of the organization includes the values, vision, norms, beliefs, habits and the assumption of the organization. Organizational culture also includes seven characteristics which are (Kehinde. A, 2012): Innovation: organization always needs to look after the innovation features and also needs to encourage the employees so that they also do their work in the some of the innovative nature and if needed so that they can improve the performance of the employees (Levenson, 2014). Teamwork: companies needs to organize the work activities in a team so that the employees of the team can work in a team through which it van place the high values in the characteristics of the organizational culture (Mascia, 2014). Emphasis on the outcome: Organization needs to give the important focus on the results and the outcomes of the organization which also creates the high emphasis on the value of the organizational culture (Prictor, 2012). Emphasis on the people: Companies need to place the high values in the characteristics of the organizational culture which also place the importance in the decisions which will effects the culture of the organization. Awareness to the details: The organizational culture characteristics utter the degrees in which the employees are expected to do their work in a very much accurate way. The culture of the organization needs to place some of the high values on the details which expect the employees so that they can perform their scheduled work with the accuracy (Kramer, 2010). Yes, by changing the organizational culture Tesco can improve the performance of their company. Tesco needs to implement some of the new innovative features in their organizational culture so that it can improve their values and the revenues of the organization and also they can persists the more numbers of the employees in their organization by implementing some of the new features and also by improving the existing features of the organization as per the consideration of the customers (Vizzoto et al., 2014). Conclusion By describing all the tasks above it can conclude that in the task 1 it describes all about the managerial roles and the perspectives of the organizations and also significantly discusses how the manger plays the important roles in achieving the success of the organizations. In the second task it discusses all about the strategies and the sizes of the company which can creates the effects in the organizational culture. In the last or the third task it critically discusses all about the mentioned scenarios of the and also discuss about the organizational culture and also how it can improves the performance of the organization by changing its culture. References Agnihotri, A. (2014). Corporate reputation based theory of choice between organic, hybrid and inorganic growth strategies. Corp Comm: An Int Jnl, 19(3), pp.247-259. Baker, E. (2014). Leadership and ManagementGuiding Principles, Best Practices, and Core Attributes. Journal of Public Health Management and Practice, 20(3), pp.356-357. Cho, S. (2014). The Effect of Organizational Culture Type on Organizational Development through Organizational Commitment : Broadcasting Station Case in Daegu. jcs, 14(2). Clausen, T., Pohjola, M., Sapprasert, K. and Verspagen, B. (2011). Innovation strategies as a source of persistent innovation. Industrial and Corporate Change, 21(3), pp.553-585. Damanpour, F. and Aravind, D. (2011). Managerial Innovation: Conceptions, Processes, and Antecedents. Management and Organization Review, 8(2), pp.423-454. Dauber, D., Fink, G. and Yolles, M. (2012). A Configuration Model of Organizational Culture. SAGE Open, 2(1). Grey, C. (2014). An organizational culture of secrecy: the case of Bletchley Park. Management Organizational History, 9(1), pp.107-122. Janicijevic, N. (2012). Organizational culture and strategy. Ekonomika preduzeca, 60(3-4), pp.127-139. Kehinde. A, O. (2012). Organizational Culture and Its Corporate Image: A Model Juxtaposition. BMR, 1(1). Kramer, T. (2010). The impact of economics and technology on changing faculty roles. The Psychologist-Manager Journal, 13(4), pp.251-257. Levenson, A. (2014). Organization design and talent strategies for emerging markets. Organizational Dynamics, 43(3), pp.205-213. Mascia, A. (2014). Project manager: leader, influencer e conflict manager. PROJECT MANAGER (IL), (20), pp.19-23. Prictor, R. (2012). The Strategic Quality Manager: A Handbook for Navigating Quality Management Roles in Health and Aged Care. Australian Journal of Primary Health, 18(1), p.88. Seal, C. (2012). Managerial Roles and Implications in Emergent Change. Organization Management Journal, 9(1), pp.3-3. Vizzoto, A., Pereira, B., Campanher, M. and Ravanello, F. (2014). An Overview on the Studies of Organizational Culture in Journals Indexed in the Business Administration Area (2008-2013). FSRJ, 6(1), pp.132-151.