A Management-Style Report Essay Example | Topics and Well Written Essays - 2750 words

A Management-Style Report - Essay Example Strategy has been stated to be a guide or idea which provides consistency to the resolutions made collectively by the organisation. Strategic management refers to the process of efficiently and innovatively employing the resources of production such as manpower, machinery and materials in an organisational process. This effective and effectual engagement of resources would enable the organisation to develop effectual strategies which would facilitate the company to earn profits along with competency. Stating precisely, strategies are developed to enable the organisation to survive in the future (Scribner, 2011). From a broad perspective, strategic management is considered to be a process which entails five different aspects. Firstly it involves the need of recognising the requirements of an organisation that is necessary to be achieved. With this purpose, the objectives of the organisation are taken into concern and then the identified requirements are associated with the objectives. Secondly, an analysis is conducted of the internal as well as the external business environment so as to obtain an understanding of the factors which can be either termed as positive or negative. Thirdly, a strategy is being developed based on the evaluation and recognition of the problems. The strategy is designed according to the priority of the issues. Fourthly, the strategy is planned to be put into practice by gathering the needed resources as well as commitments required to proceed with the strategies with the purpose of attaining the desired outcomes. Last but not the least is the stage of screening or monitoring those strategies. Monitoring the strategies also helps in understanding their effectiveness and making any needed alterations (Grant, 2005; Scribner, 2011). The aim of the paper is to assess the present strategic position of Toyota along with ascertaining its resources and capabilities which helps the company to attain competitive advantage over its competitors and ensure its existence in the industry. However, certain strategic issues of the company would also be assessed which could have an adverse affect on the success of Toyota in the long run and certain recommendations would be made in that context. 2.0. Toyota’s Current Strategic Position 2.1. Toyota’s Environment Strategy refers to the process of harmonising an organisation’s competencies and resources with the prospects that are observed to take place in the external surroundings. Toyota is a Japanese car manufacturing company and mainly caters to the market of Japan. However, in the period of 1980 and 1990, Toyota planned to invade the car market of North America. It was successful in capturing the North American market along with entering the Western European market as well which was followed with the intention to be a global leader. Soon Toyota was seen to capture the U.S. market in-spite of the presence of strong players like DaimlerChrysler, General Motors (G M), and Ford. The key to this

MBA BUSINESS ANALYSIS, portfolio 1 sub Essay Example | Topics and Well Written Essays - 1000 words

MBA BUSINESS ANALYSIS, portfolio 1 sub - Essay Example Business analytics is the key for the company to run its business activities. As Vijayan (2011, p. 1) states, â€Å"predictive analytics approaches are focused on helping companies glean actionable intelligence based on historical data†. For working on the data provided by the clients and checking its operational feasibility through predictive models, the use of business analytics seems essential. Moreover, the company also uses management information system to manage information in a logical manner. The management information system helps the company in storing and processing of information into useful data which can be used for decision making purposes. Let us take a real life example of the use of business analytics in Front Guide investment Solutions. A client goes to the company to know whether he/she should make investment in the telecom sector of any particular country or not. Now, the company will gather data related to the telecom sector of that country which may incl ude annual revenue, growth potential, GDP deflator, and other important data and will perform statistical analysis of the data to know whether investment in that sector will be a feasible option for the client or not. Looking at this example, it is obvious that the company is a data driven organization and has adopted the use of business analytics to a great extent. How is it benefiting from doing so? The company is getting a number of considerable benefits from the use of business analytics. For example, the company is able to provide accurate details about the feasibility of investment to the clients. Clients come to the company to know what the investment will yield for them in future. The company provides the clients with information based on statistical analysis of data which in not only accurate but also very close to reality as the analysis is done using predictive models. As Stubbs (2011, p. 1) states, â€Å"the value of analytics lies in its ability to deliver better outco mes†. The more the employees will be skilled in using business analytics, more accurate and consistent will be the results of analysis. The well organized business analytics system also provides many other benefits for the company. For example, one of the main benefits of using business analytics appears when the company applies re-apply existing competencies to get real life data regarding investment scenarios. The company also applies modeling skills to increase the revenue, improve customer retention, and maintain the business image. Along with improving the business efficiency, business analytics helps the company in avoiding the risk of miscommunication by communicating the value of business analytics clients in such a way that become able to build support and gain traction. Business analytics does not just relate to statistics, it also plays a key role in organizational change processes (Stubbs 2011). Do analytics contribute to business performance and profitability? The business analytics definitely contribute to improved business performance and profitability. It helps the company maintain its competitive advantage that comes from the firm’s ability to capitalize on uniqueness. Front Guide investment Solutions has the potential to make use of that exact uniqueness in a unique and matchless way. The company takes advantage critical data, which is the biggest

Theories and relevant models about branding

Theories and relevant models about branding In this chapter, concepts, theories and relevant models about branding, brand perception and customer buying behaviour will be discussed in detail. An individual who buys products for personal use and not for manufacture or resale is said to be a consumer. A consumer is someone who can make the decision whether or not to purchase an item at the store, which can be influenced by marketing and advertisements. Each and every consumer is influenced by their own brand perception and buying decisions which depends on various number of factors. 2.2 Branding Brand is the image that consumers have in mind (Aaker, 1991). It is also the unique characteristics that have been developed all the time in order to differentiate actual products from the competitors (Murphy, 1990). In addition, The American Association defines a brand as a name, term, sign, symbol or design, or a combination of them intended to identify the goods or services of one seller or group of sellers and to differentiate them from those of competitors. A brand is thus a product or service that adds dimensions that differentiate it in some way from other products or services designed to satisfy the same need. These differences may be functional, rational, or emotional or intangible related to what the brand represents. Brand concepts must address customer interests and lifestyles. Factors that affect its brand image and brand perception among marketing communication program that implementing to the public to create brand perception, brand characteristic, brand image and bran d equity. De Chernatony and McDonald (1992) define a brand as an identifiable product, service, person or place, augmented in such a way that the buyer or user perceives relevant, unique added values which match their needs most closely. There have been two basic values identified by de Chernatony (1999) that contribute towards the brand premium. One is the functional value such as the price, technology, design and store layout. This functional value is a distinct attribute that a customer adds to the brand and distinguishes the brand from the rest. The second form of added value comes from emotional value. This value is derived from notions like advertising, internal branding, translating the retail brand into consumer taste, and even the shopping experience itself at the retail outlet. 2.3 Brand Perception Perception is how we see ourselves and the world we live in. However, what ends up being stored inside us doesnt always get there in a direct manner. Often our mental makeup results from information that has been consciously or subconsciously filtered as we experience it, a process we refer to as a perceptual filter. To us this is our reality, though it does not mean it is an accurate reflection on what is real. Thus, perception is the way we filter stimuli (e.g., someone talking to us, reading a newspaper story) and then make sense out of it. Perception has several steps. Exposure sensing a stimuli (e.g. seeing an ad) Attention an effort to recognize the nature of a stimuli (e.g. recognizing it is an ad) Awareness assigning meaning to a stimuli (e.g., humorous ad for particular product) Retention adding the meaning to ones internal makeup (i.e., product has fun ads) Brand perception is consumers ability to identify the brand under different conditions, as reflected by their brand recognition or recall performance (Kotler Lane, 2006). Brand recall refers to consumers ability to retrieve the brand from the memory (Keller, 1993). According to the improvement of measurement for brand equity, consumer-based brand equity was described for four dimensions; brand awareness, brand association, perceived quality, and brand loyalty (Pappu, et al, 2005). Brand awareness was defined as the consumers ability to identify or recognize the brand (Rossiter and Percy, 1987). It refers to the strength of a brand presence in consumers minds. Brand awareness has several levels starting from the less recognition of the brand to dominance (Aaker, 1991). Perceived quality was evaluated and decided by consumers. Perceived quality is another valuation of brand to push the customer to buy products. Brand building has been around for centuries as a means to distinguish the goods of one producer from those of another. The earliest signs of branding in Europe were the medieval guilds requirement that craftspeople put trademarks on their products to protect themselves and consumers against inferior quality. In the fine arts, branding began with artists signing their works. Brands today play a number of important roles that improve consumers lives and enhance the financial value of firms (Kotler Lane, 2006). Brand awareness and brand perceived quality as the significant factors to create and maintain brand equity. There are positive relationship among brand awareness, perceive quality and brand equity (Aker, 1996, Buzzell Gate, 1987). The marketing program has effect to improve the perceive quality of brand for different customers. Brand perception is consumers ability to identify the brand under different conditions, as reflected by their brand recognition or recall performance (Kotler Lane, 2006). Brand recall refers to consumers ability to retrieve the brand from the memory (Keller, 1993). According to the improvement of measurement for brand equity, consumer-based brand equity was described for four dimensions; brand awareness, brand association, perceived quality, and brand loyalty (Pappu, et al, 2005). Brand awareness was defined as the consumers ability to identify or recognize the brand (Rossiter and Percy, 1987). It refers to the strength of a brand presence in consumers minds. Brand awareness has several levels starting from the less recognition of the brand to dominance (Aaker, 1991). Perceived quality was evaluated and decided by consumers. Perceived quality is another valuation of brand to push the customer to buy products. Brand building has been around for centuries as a means to distinguish the goods of one producer from those of another. The earliest signs of branding in Europe were the medieval guilds requirement that craftspeople put trademarks on their products to protect themselves and consumers against inferior quality. In the fine arts, branding began with artists signing their works. Brands today play a number of important roles that improve consumers lives and enhance the financial value of firms (Kotler Lane, 2006). Brand awareness and brand perceived quality as the significant factors to create and maintain brand equity. There are positive relationship among brand awareness, perceive quality and brand equity (Aker, 1996, Buzzell Gate,1987). The marketing program has effect to improve the perceive quality of brand for different customers. 2.4 Brand Equity Source: Aaker, 1991 Brand equity is the added value endowed to products and services. Aaker (1991) defined the brand equity as a set of brand assts and liabilities linked to brand that adds or detracts the product or service value based on the customers perspectives. This value may be reflected in how consumers think, feel and act with respect to the brand that consumers had perceive from marketing programs. Brand equity is an important intangible asset that has psychological and financial value to the firm. The value of brand equity depends on the number of same people who buy regularly (Aaker, 1996). The brand loyalty, brand awareness, and brand perceived quality are necessary to maintain the brand equity (Motameni Shahrokhi, 1998). There are two different perspectives of brand equity; financial and customer based. The first perspective evaluates the asset value of a brand name that creates to the business (Farquhar et al, 1991). Brand equity increased the discounted future cash flows and revenue comparing to the same product did not have the brand name (Motameni Shahrkhi, 1998). According to the second perspective, the premise of customer-based brand equity models is that the power of brand lies in what customers have responded, seen, read, heard, learned, thought and felt about the brand over time. In other words, the power of brand lies in the minds of existing or potential customers and what they have experienced directly and indirectly about the brand. The customer-based brand equity finally drives the financial return to the company (Lassar et al, 1995). The valuation of brand has been studied for different approaches, for example, marketing, premium pricing market value, customer factors, replacement cost perspective. According to the valuation based on consumer factors, the measurement of customers preference and attitude can be used to evaluate the brand equity (Aaker, 1991 and Kapferer, 1992). 2.5 Marketing Communication The marketing communication is considered as the strategic activities for brand managers to build and maintain the brand image of targeted customers (Duncan Mulhern, 2004). It is a significant driver of competitive advantage to create the ability of companies to attract, retain, and leverage customers (Kitchen, Joanne, Tao, 2004). Duncan (2002) explained that marketing communication is a process for managing the customer relationship that affects brand value lastly. Marketing communication programs are not only above the line activities such as advertising and sales promotions but also below the line activities such as public relations. Regarding recent concept of marketing communication, two-way communication as well as one way communication is a key determinant of brand strategies to stimulus the brand orientation process (Aaker, 1996 and Urde, 1994). 2.6 Consumer Behaviour Schiffinan and Kanuk (2004) define Consumer Behaviour as the behaviour that customers display in searching for, purchasing, using, evaluating and disposing of products and services that they expect will satisfy their needs. Consumer buying behaviour incorporates the acts of individuals directly involved in obtaining, using and disposing of economic goods and services including the decision process that precede and determine these acts (Huctings 1995). image0.jpg Source: (http://www.dummies.com/how-to/content/consumer-behavior-for-dummies-cheat-sheet.html, accessed on 20 /10/10 at 8.40pm) Lamb, Hair and McDartiel (1992) note that consumer behaviour is a study of the processes the consumer uses to make purchase decisions as well as the use and disposal of the purchased goods and services. It also includes the analysis of factors that influences purchase decisions and goods usage. Further more consumer behaviour is a process and purchase is only one step in that process. Santon,Etzel and Walker (1994) states that consumers are complex in nature and keep changing constantly. So it is a must for the marketers to constantly improve their understanding of consumers and understand what influences the needs of the consumers. In short, the understanding of the buying behavior of existing and potential customers is imperative for marketers (Lancaster 1998). It is also needed for the competitive survival. When the consumer is viewed in the proper perspective, the outcomes could be quite positive for the manufacturer. Lamb,Hair and McDaniel (1992),claim that the knowledge of consumer behavior reduces uncertainty when creating the marketing mix. The field of customer behavior covers a lot of ground: It is the study of the processes involved when individuals or groups select, purchase, use, or dispose of products, services, ideas, or experiences to satisfy needs and desires (Michael, 2003). Earlier, the field was referred to as buyer behavior, which emphasized o n interaction between consumers and producers at the time of purchase. Now marketers feel that consumer behavior is not merely a consumer handing over money in return for a service or good, but it is an ongoing process. The exchange of a transaction in which two or more organizations or people give and receive something of value is an integral part of marketing. 2.7 Consumer Decision Making Mahatoo (1985) defines Consumer Behavior decision making process consisting of a number of steps that begin before the purchase and reaches beyond the buying act. He suggests that marketers have to go beyond the various influences on buyers and develop an understanding of how consumers actually make their buying decisions .The ability to create a good service and to persuade the market to buy this offering instead of its competitors offering depends upon the insight into the consumer purchase decision on the understanding of how the target customers arrive at their purchase decisions. Price is one of the dominating factors when it comes to making a purchase decision. It generally plays a vital role in determining consumers brand choice while selecting a product. Consumers look into the price while taking a buying decision and check whether it is within their affordable limits. This helps them to maximize their immediate utility that they gain from the purchase. The consumers give relative importance to both price and quality, so while choosing a brand they make a choice consistent with the relative importance attached to both attributes (Nor Khasimah Alimana and Md Nor Othman, 2007). It is also known that consumers look upon the additional services and freebies which come along with the product rather than looking on the price factor. Customers were believed to put different weights on every factor when it comes to the evaluation process. Analysis shows that customers who had experienced bad customer service tend to consider more thoroughly all aspects of the serv ice when it comes to choice of product (Tor W. Andreassen and Line L. Olsen, 2008).   According to Kotler (2003), there are five roles people play during a purchase. They are Initiator: It is the person who gives the idea of buying the product or service. Influencer: It is the person who reviews or influences the decision. Decider: It is the person who makes the buying decision: what to buy, how to buy, when to buy and where to buy. Buyer: It is the person who actually makes the purchase. User: It is the person who consumes or uses the product or service. 2.8 Buying Behavior Buying behavior is a process in which consumers decide and act accordingly to buy certain products for their use. There are certain aspects which we need to understand. Why do consumers buy what they buy? What are the key factors for influencing consumers to buy the products? What are the changing trends in the society? Consumer buying behavior refers to what consumers buy at a certain point of time which involves their decision making. So it is important for any firm to keenly analyze on consumer buying behaviors as it has a great impact on the firms marketing strategy. It also plays a key role in the success of the firm. It is important for any firm to create a marketing mix that satisfies the customers. 2.9 Types of Consumer Buying Behavior There are few types of buying behaviors based on the type of products which needs to be purchased. Complex buying behavior is where an individual seeks lot of information about a high value branded product before purchasing it. Habitual buying behavior is where the individual buys the product out of habit. Variety seeking buying behavior is where the individual likes to shop around and experiment different products. Consumer buying behavior is determined by level of involvement in the purchase decision (Renjith, June 2004). According to Mahatoo (1985), the nature of the decision process varies depending upon the product and the consumer. The marketers need to determine the kind of decision making behavior that is involved with the particular product in order to understand the behavior of the consumer. Howard (1989) classifies consumer buying decision into three broad categories: Routine Response Programmed Behavior- A consumer generally uses a routine response behavior while frequently buying the low cost goods or services. These goods and services can be called low involvement products as the consumer spends little time on decision making and purchases easily. The consumer is familiar with different brands in this product category, but usually sticks on to one brand. The consumer usually skips many steps in the decision process as he buys the product out of habit. Limited Decision Making Buying product occasionally. When you need to obtain information about an unfamiliar brand in a product category. Requires a moderate amount of time for information gathering as it is compared with various brands. Acquiring information about an unfamiliar product category is called as limited decision making. Examples: books, clothes and cosmetics. Extensive Decision Making Consumers usually spend much time on extensive decision making with high involvement when they purchase an unfamiliar expensive product. This is the most complex type of consumer decision making as the consumers need a great deal of information to compare it with its alternate brands. Examples: cars, computers. Complex buying behavior involves three steps: The consumer develops belief about the product. The consumer develops attitude about the product. The consumer makes a thoughtful choice. Consumers usually engage in complex buying behavior when they are highly involved in a purchase, which usually happens when the product is expensive, risky, and highly self expressive. Many products do not carry features unless the buyer does some research. The marketer of a high involvement product must understand consumers information- gathering and evaluation process. According to this the marketer needs to develop strategies which will assess the buyer in learning about the products attributes and their importance. The marketer also needs to differentiate the brand features, motivate store keepers, and use proper print media to describe the brand and the buyers interaction to influence the brand choice. Dissonance-Reducing buyer behaviour According to Herbert (1965), the consumer sometimes gets highly involved in a purchase but see little differences in brands. The high involvement is due to the fact that the purchase is expensive, infrequent and risky. For this type of purchase the consumer will shop around to learn more about the product but purchase it quickly responding to the primary factors like price or convenience. After the purchase, the consumer might experience dissonance by hearing favourable things about other brands or noticing certain disquieting features. Now the consumer will alert the informants who support his or her decisions. For example, here, the consumer acted first then acquired new beliefs and ended up with a set of attitudes. Marketing communication should supply beliefs and evaluations that help the customer feel good about the brand of his choice. Variety-Seeking Buying Behaviour Henry (1987) states that some buying situations are characterised by low involvement but significant brand differences. Usually consumers do lot of brand switching. Take for example, cookies. The consumer has some knowledge about cookies, chooses them without much evaluation and evaluates the product during consumption. But next time the consumer may reach for another brand according to his taste. Brand switching occurs for the sake of variety rather than dissatisfaction. 3.10 Buying Decision Process The consumers engage in a decision process to deal with the marketing environment and make purchases. The consumer goes through a series of logical stages to arrive at the decision when he faces a problem which could be resolved through a purchase. A typical buying process consists of five stages. (Micheal and Elnora, 2000). 2.10.1 Problem Recognition The purchase process starts where the buyer recognises a problem or need. The need maybe triggered by internal or external stimuli. Marketers need to identify the circumstances that trigger a particular need (Micheal, 2003). People have unsatisfied needs and wants that create tension or discomfort, which can be satisfied by acquiring and consuming goods and services. Hence, the process of deciding what to buy begins when there is a need and it can be satisfied through consumption. Mahatoo (1985), states that when the consumer becomes aware of a discrepancy between the existing state and a desired state, a need is aroused. The existing state is the total situation of a consumer, the current needs, attitudes, motives. The desired state is the situation after the kinds of changes the consumer wishes. Both these states are the functions of consumers motivation, personality and past experience of cultural and social influences. Evans and Burman (1984), defines a stimulus as a cure intended to motivate a person to act. It can be social, commercial or non commercial. Need recognition shows a persons readiness to act by becoming aware of a need but does not guarantee that the decision making process will continue. Kotler (2003), suggests that by gathering information from a number of consumers marketers can identify the most frequent stimuli that triggers an interest in a product category, thereby developing marketing strategies that would create a spark in consumers interest. 2.10.2 Information Search When a consumer needs to gain knowledge about a product or service, he or she would be aroused to search for more information in the product category. Consumer information sources fall under four groups: Personal sources: Family, friends, neighbours Commercial sources: Advertising, sales person, dealers, display boards Public sources: Mass media, consumer-rating organizations Experimental sources: Handling, examining, using the product. The relative amount and influences of these information sources vary with product category and consumer characteristics (Peter, Daniel and Nancy, 1986). Customer decisions are based on a combination of past experiences and marketing information. Past experience is considered as an internal source of information. Greater the past experience, lesser the external information the consumer is likely to seek to make a decision. Baker (2000), states that if there is a sufficiently high level of involvement with the problem, the consumers are likely to engage in a complex and extensive information search. If the involvement level is low, they are likely to use a very simple information search. Kotler (2003), states that by gathering information the consumer learns about competing brands and their features. There will be lot of brands available to the consumer in a product category, in which only a few brands the consumer would be aware of (awareness set). Among these brands, few brands will meet consumers initial buying criteria (consideration set). As the consumer gathers more information only a few brands would remain (choice set). All the brands in the choice set might be acceptable. 2.10.3 Evaluation of Alternatives There is no single evaluation process used by all customers or by one customer in all buying situations. The consumers view each product as a bundle of attributes with varying abilities of delivering the benefits needed to satisfy them. The attributes of interest to buyers vary by product. Consumers will pay most attention to attributes that deliver benefits (Mary, James and John, 1997). Once a choice set has been identified, the consumer evaluates them before making a decision. The evaluation involves establishing some criteria against which each alternative is compared. The criteria that consumers use in the evaluation results from their past experience and feelings towards various brands as well as the opinions of family, friends, etc. (Stanton, Etzel and Walker, 1994). The product related attributes such as quality, durability, price, design, etc. Influence the buying decision of a consumer. A way to narrow down the products in the choice set is to pick an attribute and then excl ude all products in the set that does not possess that attribute (Lamb and McDaniel, 1992). Thus the choice which possesses all the required product related attributes can be selected. 2.10.4 Purchase Decision From the evaluation process discussed about, consumer will reach their final purchase decision which is made up of five purchase sub decisions: Brand decision, Vendor decision, Quantity decision, Timing decision and Payment method decision (Joseph and Howard, 1987). After evaluation, the first thing in mind would be to purchase the product or not. If the decision is to buy, a series of related decisions must be made regarding the features, where and when to make the actual transaction, how to take delivery, a mode of payment and other issues. So a decision to purchase starts an entirely new series of decisions that may be time consuming and difficult. Selecting a source from which a purchase can be made is also a buying decision (Stanton, Etzel and Walker, 1994). A consumers decision to modify, postpone or avoid a purchase decision is heavily influenced by risk. The amount of risk varies with the extent of money at stake, the amount of attribute uncertainty and amount of self confide nce. Marketers must understand the factors that create a feeling of risk in the consumer, thereby providing information and support to reduce the risk (Kotler, 2003). 2.10.5 Post Purchase Behaviour Every customer after buying a product will experience either satisfaction or dissatisfaction. Hence the marketers job does not end when the product is bought; it must be monitored for post purchase satisfaction and post purchase actions. A very important stage of the consumers decision is the impact of current decisions on the future purchasing behaviour. Mahatoo (1985) says that three general outcomes are possible. They are: 2.10.5.1 Satisfaction Satisfaction occurs when a product performs according to expectations. The brand chosen has served to fulfil the customers needs and thus reinforces the response of purchasing the brand, which also means that beliefs and attributes about the brand are positively influenced and the likelihood of repurchase is increased. 2.10.5.2 Dissatisfaction Dissatisfaction occurs in the reverse situation, when the products performance is not up to the expectation it leads to negative belief and attributes about the brand. A dissatisfied customer is not likely to recommend the product to others. The results of satisfaction and dissatisfaction are recorded in long term memory and become inputs to the internal search of the firm. So the marketers must be careful in satisfying the needs and expectations of the customers. 2.10.5.3 Cognitive Dissonance: Cognitive dissonance occurs when the consumer experiences a feeling of doubt or psychological discomfort about the choice made. It is often felt right after the purchase when the consumer begins to have second thoughts about the product chosen. Dissonance is more likely to occur in complex decision making with high involvement purchases. Dissonance can come from a personal source from advertisement or from experience with the product. Post purchase evaluation is important to marketers because positive evaluation increases the probability of repeat purchases and brand loyalty. Negative or doubtful thoughts increase the probability that different alternatives will be considered next time when the need arises (Husted, Varble and Lowry, 1989). 2.11 Factors influencing the behaviour of buyers http://www.ac.wwu.edu/~market/380dir/cbinfluence.jpg Source: (http://blog.oneshotmarketing.com/2010/08/consumer-buying-behavior-the-laws-of-attraction/ accessed on 20/10/10 at 9.15pm) Consumer behaviour is affected by many uncontrollable factors. Culture is one of the factors that influence behaviour. Culture can be defined as our attitudes and beliefs. It is developed along with age in the society. For an individual growing up, a child is influenced by their parents, brothers and sisters. They learn about their religion and culture which helps them to develop opinions, attitudes and beliefs (Richard, 1976). These factors will influence a buying behaviour of the consumer, other factors like friends or people they look up may also influence their choices of purchasing a particular product. Culture is the most basic cause of a persons wants and behaviour.   Culture is learned from family, church, school, peers, colleagues. It reflects basic values, perceptions, wants, and behaviours. Cultural shifts create opportunities for new products or may otherwise influence consumer behaviour. Peoples social status plays an important role in the consumer buying behaviour. Social class distinctions allow companies to position their products to appeal to certain social classes. The easiest example is automobiles. Marketing for Mercedes Benz is completely different from the marketing campaign from Honda or Toyota because they target individuals from the upper class. Another powerful and easy factor that companies manipulate in their marketing efforts is the social factor. To be part of a group, or represent a certain lifestyle, you must have certain possessions. Personal and Psychological factors are very specific realms and the target market segment becomes even smaller. That means even less amount of people can use these products. This reflects in higher prices to account for the decrease in volume 2.12 Models of Consumer Behaviour The various models of consumer behaviour as per (Ramasamy and Namakumari, 1990) are stated as follows 2.12.1 The Economic Model According to the economic model of buyer behaviour, the buyer is a rational man and his buying decisions are totally governed by the concept of utility. If the customer has certain amount of purchasing power, a set of needs to be met and a set of products in a very rational manner with the intentions of maximising the utility or benefits. 2.12.2 The Learning Model According to the learning model, buying behaviour can be influenced by manipulating the drivers, stimuli and responses of the buyers. The model rests on mans ability at learning, forgetting and discriminating. 2.12.3 The Psychoanalytical Model According to this model the individual consumer has a complex set of deep stated motives that drive him towards certain buying decisions. The buyer has a private world with all his hidden fears, suppressed desires and totally subjective longings. His buying action can be influenced by appealing to these desires and longings. 2.12.4 The Sociological Model According to the sociological model, the individual buyer is influenced by society, by inmate groups as well as social classes. His buying decisions are not totally governed by utility, he has a desire to emulate, follow, and fit in with his immediate environment. Several of his buying decisions may be governed by societal compulsions. 2.12.5 The Nicosia Model Efforts have been made by marketing scholars to build buyer behaviour models from the marketing mans point of view. The Nicosia model and the Howard and Sheth model are two important models. Both of them belong to the category called the systems model where the human being is analysed as the system with stimuli as the input to the system and behaviour as the output of the system. The Nicosia model tries to establish the link between a firm and its customers, how the activities of the firm influences the consumer and results in the buying decision. The information from the firm influences the consumer towar

English: Poetry Commentary Haven’t I Danced the Big Dance? By Jack Mapanje :: English Literature

English: Poetry Commentary Haven’t I Danced the Big Dance? By Jack Mapanje The poem ‘Haven’t I danced the big dance?’ by Jack Mapanje concerns the traditional rain dance of a proud tribesman. The modern representation of his dance that he sees today provokes this nostalgic and emotional response. The speaker, a formal tribal rain dancer, is thinking back to the time when he used to dance this traditional dance, and looking at the new generation, dancing only for show, with sadness. The poem is divided into three stanzas, the two first ones being dedicated to the past, when he was a dancer, and the last one to the present. The first stanza talks about the way he used to dance this traditional rain dance, in a circle around the drums, with amulets, anklets and snakes. The second stanza is insisting on the energy he put into this dance, on how good he was. The third stanza brings us to the present time, now that his daughters are doing the dance, more as an attraction for tourists than as a real tradition, and the speaker is not able to show them the real meaning of the dance. This rain dance is part of the speaker’s traditions, and he seems to be very attached to it. He remembers the way they danced it in the arena to the sound of the big drums. They used to wear special clothes and use specific accessories, ‘Skins wriggled with amulets Rattled with anklets’ to make the dance seem real and magical, at the same time. It had a real value for the speaker. However, this dance, in which he had put so much energy into when he was younger, ‘How I quaked the earth How my skin trembled How my neck peaked’ had not kept the same value. He talks about the way the new generation, his daughters’ generation, dances the dance now, and emphasised the lack of authenticity it has. He says they just wear ‘babble-idea-men-masks’, to make it look like a traditional rain dance to tourists, while it is not really. He compares the ‘mystic drums’ he used to dance to, with the ‘slack drums’ his daughters dance to now. Finally, he lets us understand he would like to show the new generation how the big dance is supposed to be danced, what its original value. However, this helplessness is not the only emotion felt in this poem. At the beginning, the speaker reminisces on the old days, his glory days, both with happiness and excitement and with sadness and regret. As he describes the different characteristics of the dance and the way

Analgesic and Facilitator Pain Assessment

Individual Research Article Critique Presentation Resource: The research study that you selected in Week Two Develop a 10- to 15-minute presentation in which you address the following points (7 pts): †¢Strengths and weaknesses of the study †¢Theoretical and methodological limitations †¢Evidence of researcher bias †¢Ethical and legal considerations related to the protection of human subjects †¢Relationship between theory, practice, and research †¢Nurse’s role in implementing and disseminating research †¢How the study provides evidence for evidence-based practice †¢Identify the following for the research study selected (choose 1 or 2 NOT BOTH): 8 pts. †¢ 1. Quantitative Research Article Critique (Follow the example pp. 433–442 of the text): †¢ a. Phase 1: Comprehension b. Phase 2: Comparison c. Phase 3: Analysis d. Phase 4: Evaluation †¢ 2. Qualitative Research Article Critique (Follow the example pp. 455–461 o f the text): †¢ a. 1. Problem (problem statement; purpose; research questions; literature review; frame of reference; research tradition) b. 2. Methodology (sampling & sample; data collection; protection of human subjects c. 3. Data (management; analysis . 4. Results (findings; discussion; logic; evaluation summary †¢ Format the presentation as one of the following (5 pts): †¢Poster presentation in class †¢Microsoft ® PowerPoint ® presentation including detailed speaker’s notes †¢Video of yourself giving the presentation uploaded to an Internet video sharing site such as www. youtube. com –Submit the link to your facilitator, include a written reference page in APA format †¢Another format approved by your facilitator Pain Assessment in Persons with Dementia: Relationship Between Self-Report and Behavioral Observation Ann L.Horgas, RN, PhD,A Amanda F. Elliott, ARNP, PhD,w and Michael Marsiske, PhDz OBJECTIVES: To investigate the relatio nship between self-report and behavioral indicators of pain in cognitively impaired and intact older adults. DESIGN: Quasi-experimental, correlational study of older adults. SETTING: Data were collected from residents of nursing homes, assisted living, and retirement apartments in northcentral Florida. PARTICIPANTS: One hundred twenty-six adults, mean age 83; 64 cognitively intact, 62 cognitively impaired.MEASUREMENTS: Pain interviews (pain presence, intensity, locations, duration), pain behavior measure, Mini-Mental State Examination, analgesic medications, and demographic characteristics. Participants completed an activitybased protocol to induce pain. RESULTS: Eighty-six percent self-reported regular pain. Controlling for analgesics, cognitively impaired participants reported less pain than cognitively intact participants after movement but not at rest. Behavioral pain indicators did not differ between cognitively intact and impaired participants. Total number of pain behaviors w as signi? antly related to self-reported pain intensity (b 5 0. 40, P 5. 000) in cognitively intact elderly people. CONCLUSION: Cognitively impaired elderly people selfreport less pain than cognitively intact elderly people, independent of analgesics, but only when assessed after movement. Behavioral pain indicators do not differ between the groups. The relationship between self-report and pain behaviors supports the validity of behavioral assessments in this population. These ? ndings support the use of multidimensional pain assessment in persons with dementia.J Am Geriatr Soc 57:126–132, 2009. Key words: pain; dementia; measurement From the ADepartment of Adult and Elderly Nursing, University of Florida, College of Nursing, Gainesville, Florida; wDepartment of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and zDepartment of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, G ainesville, Florida. Address correspondence to Ann Horgas, College of Nursing, University of Florida, PO Box 100197-HSC, 101 S.Newell Drive, Room 2201, Gainesville, FL 32610. E-mail: [email  protected]?. edu DOI: 10. 1111/j. 1532-5415. 2008. 02071. x ain, a persistent daily problem for many elderly adults, is associated with physical and social disability, depression, and poor quality of life. 1 Between 50% and 86% of older adults experience pain; 32% to 53% of those with dementia experience it daily. 2 The high prevalence is associated with proliferation of pain-related health conditions in late life, such as osteoarthritis, hip fractures, peripheral vascular disease, and cancer. Dementia complicates pain assessment, because it impairs memory, judgment, and verbal communication. Dementia is associated with central nervous system changes that alter pain tolerance4 but not pain thresholds (e. g. , minimum level at which a painful stimulus is recognized as pain). 5 No empirical evid ence indicates that persons with dementia physiologically experience less pain; rather, they appear less able to recognize and verbally communicate the presence of pain. Findings that cognitively impaired older adults underreport pain relative to nonimpaired elderly people7 and are less likely to be treated for pain than their cognitively intact peers8,9 re? ect dif? culty assessing pain in this population. Self-report is considered the criterion standard of pain assessment. Despite recent studies supporting the reliability and validity of self-report in persons with dementia,7,10 healthcare providers and pain experts recognize that selfreport alone is insuf? cient for this population and that observational pain assessment strategies are needed.In 2002, the American Geriatrics Society established comprehensive guidelines for assessing behavioral indicators of pain. 1 More recently, the American Society for Pain Management Nursing Task Force on Pain Assessment in the Nonverbal Patien t (including persons with dementia) recommended a comprehensive, hierarchical approach that integrates selfreport and observations of pain behaviors. 11 Recently, tools to measure pain in persons with dementia have proliferated. In 2006, a comprehensive stateof-the-science review of 14 observational pain measures was completed.The authors concluded that existing tools are still in the early stages of development and testing and that more psychometric work is needed before tools are recommended for broad adoption in clinical practice. 12 Others, including an interdisciplinary expert consensus P JAGS 57:126–132, 2009 r 2008, Copyright the Authors Journal compilation r 2008, The American Geriatrics Society 0002-8614/09/$15. 00 JAGS JANUARY 2009–VOL. 57, NO. 1 PAIN ASSESSMENT IN PERSONS WITH DEMENTIA 127 panel on pain assessment in older persons,13 have corroborated these conclusions. 4 In particular, these authors highlight the need for more evaluation of observational pa in measures, including validation against the criterion standard of self-report in intact and impaired populations. Almost all research on measuring pain in persons with dementia has focused exclusively on persons with moderate to severe disease. There has been only one published study that compared pain behaviors and self-reported pain in persons with and without cognitive impairment, but it focused on postoperative patients undergoing rehabilitation and acute pain associated with physical therapy. 5 Thus, the purpose of this study was to investigate the relationship between self-report and behavioral indicators of pain in cognitively intact and impaired older adults with persistent pain. Speci? cally, this study evaluated whether cognitive status (intact or impaired) differentially in? uenced verbal and nonverbal expression of pain. It was hypothesized that self-reported pain would be lower in cognitively impaired elderly people than in those who were cognitively intact but that p ain behaviors, because they are more re? exive and less reliant on verbal communication, would be equivalent in both groups.The relationship between pain behaviors and self-reported pain was also evaluated in cognitively intact elderly people to validate whether behaviors measured are indicators of pain. The following research questions were asked. Does cognitive status in? uence self-reported pain? Does cognitive status in? uence observed pain behaviors? Are self-reported pain and observed pain behaviors related, and is the relationship different in cognitively intact and impaired elderly people? One hundred forty participants were enrolled and completed the baseline interview; 126 (90%) completed the protocol. Attrition analyses revealed no signi? ant differences between completers and noncompleters on demographic, residential status, health, or pain variables. The ? nal sample was predominantly female (81%), Caucasian (97%), and widowed (60%), with a mean age of 83 (range 5 65â⠂¬â€œ98). Thirty-nine percent resided in nursing homes, 39% resided in assisted living, and 22% lived independently in retirement apartments. Participants’ average Mini-Mental State Examination (MMSE) raw score was 24 (range 5 7–30, median 5 27, mode 5 29). Based on 10th percentile education-adjusted MMSE norms as the cutoff,16,17 64 (50. 8%) were cognitively intact, and 62 (49. %) were impaired. See Table 1 for a description of the total sample and of cognitively intact and impaired subsamples. Groups differed only in residential status (cognitively Table 1. Sample Characteristics, Overall (N 5 126) and According to Cognitive Status Total Sample Cognitive StatusA Intact Impaired (n 5 64) (n 5 62) PValue Characteristic METHODS The University of Florida institutional review board approved this study. Informed consent was obtained from cognitively intact participants and from impaired elderly people’s legally authorized representatives, with assent from persons wi th dementia.Design A quasi-experimental, correlational design was used to investigate pain in older adults with mild to moderate dementia, because dementia status cannot be experimentally manipulated. Cognitively intact elderly people functioned as a comparison group to examine behavioral indicators and self-reported pain in the two groups. If self-report and behaviors were related in cognitively intact persons, there would be some basis to infer that the same behaviors indicated pain in cognitively impaired elderly people. Participants One hundred ? ty-eight older adults were screened for enrollment from 17 assisted living facilities, nursing homes, and retirement communities in north central Florida. Inclusion criteria were aged 65 and older, English-speaking, able to stand up from a chair and walk in place, diagnosed osteoarthritis in the lower body, and adequate vision and hearing to complete the interview. Sex, n (%) Male 24 (19. 0) 12 (18. 8) 12 (19. 4) Female 102 (81. 0) 52 ( 81. 3) 50 (80. 6) Race, n (%) White 123 (97. 6) 63 (98. 4) 60 (96. 8) Black 1 (0. 8) 0 (0) 1 (1. 6) Other 2 (1. 6) 1 (1. 6) 1 (1. 6) Marital status, n (%) Married 37 (29. ) 21 (32. 8) 16 (25. 8) Unmarriedw 89 (70. 6) 43 (67. 2) 46 (74. 2) Education, n (%) ohigh school 11 (8. 7) 5 (7. 8) 6 (9. 7) graduate High school graduate 38 (30. 2) 17 (26. 6) 21 (33. 9) Some college or 31 (24. 6) 18 (28. 1) 13 (21. 0) equivalent College graduate or 34 (27. 0) 18 (28. 1) 16 (25. 8) more Residence Assisted living 49 (38. 9) 28 (43. 8) 21 (33. 9) Nursing home 47 (37. 3) 14 (21. 9) 33 (53. 2) Retirement apartment 30 (23. 8) 22 (34. 4) 8 (12. 9) Analgesics taken 579 ? 1,320 313 ? 699 853 ? 1,708 (in acetaminophen equivalents), mean ? SD Age, mean ? SD 82. 2 ? 7. 3 81. 9 ? 7. 83. 1 ? 7. 6 Number of medical 6. 7 ? 3. 1 6. 6 ? 2. 9 6. 9 ? 3. 4 diagnoses, mean ? SD .93 .59 .39 .84 .001z .02 § .55 . 63 A Cognitive status was computed using the following education-adjusted Mini-Mental State Examination s cores as cutoffs: o8th grade education, 20; 9 to 11 years, 24; high school graduate or equivalent, 25; some college, 27; and college degree or higher 5 27. 16,17 w Unmarried 5 never married, widowed, separated, or divorced. z Chi-square 5 15. 2, degrees of freedom 5 2, P 5. 001.  § t (124) 5 2. 22. SD 5 standard deviation. 128 HORGAS ET AL. JANUARY 2009–VOL. 57, NO. 1 JAGS mpaired elderly people were signi? cantly more likely to reside in assisted living or nursing home facilities). to use in elderly adults than the traditional visual analogue scale. 21 Procedures Participants completed a brief screening interview to con? rm study eligibility and to ascertain cognitive status. Those eligible were interviewed about their pain and completed an activity-based protocol designed to evoke pain behaviors in persons with persistent pain (described in more detail below). Activity Protocol Participants were asked to sit, stand, lie on a bed, walk in place, and transfer between activi ties.Based on previous work, the activity protocol had several strengths for use with this population. First, it simulates performance of basic activities of daily living, thereby enhancing ecological validity of the tasks. Second, it was tested in other studies, and activities were shown to induce pain in persons with osteoarthritis and chronic low back pain, thus providing a naturalistic pain induction method. Third, use of these realworld tasks avoids undue health or safety risks for elderly adults and eliminates potential bias associated with arti? cially induced (e. g. , laboratory-based) pain induction techniques. 8,19 The protocol was simpli? ed by using only 1-minute activity intervals (to reduce complexity of directions and physical demands for frail or cognitively impaired participants) and substituted walking in place for walking across the room and back (to accommodate physical space limitations in residential care facilities where data were collected). Activities were c onducted in random order to minimize order effects, and the entire 10-minute protocol was videotaped. Measures Self-Reported Pain The principal investigator (ALH) or a trained research assistant interviewed each participant in a private session about their pain experience.Pain presence, intensity, locations, and duration were assessed. Pain Presence. Questions from the Structured Pain Interview (SPI)20 were used to assess presence of self-reported pain. During the pain screening interview, participants were asked ‘‘Do you have some pain every day or almost every day (daily pain)? ’’ Pain was also assessed immediately before the start of the activity protocol (‘‘Are you having any pain right now? ’’ (pre-activity)) and immediately after it (‘‘Did you experience any pain during these activities? ’’ (postactivity)).Response choices to all three questions were yes (1) or no (0). Pain Intensity If participants responded ‘‘yes’’ to experiencing pain (daily, pre-activity, or postactivity), they were asked to rate the intensity using a numerical rating scale (NRS). The NRS was presented as a horizontal line with 0 5 no pain and 10 5 worst pain as anchors and equally spaced dashes representing pain intensity rating of numbers 1 through 9. The scale was printed in large, bold font on an 8. 5†³ A 11†³ paper to facilitate use with older adults who may have vision dif? culties. The NRS is considered valid, reliable and easierPain Duration Participants were asked to indicate how long (in months and years) they had experienced daily or almost daily pain. Responses were coded as less than 1 year, 1 to 5 years, 6 to 10 years, 11 to 15 years, or more than 15 years. Pain Locations The pain map from the McGill Pain Questionnaire22 was used to assess pain locations. Participants indicated areas on the body drawing in which they were currently experiencing pain. Total n umber of painful locations was summed. This widely used measure has been validated in several epidemiological studies and has high interrater reliability (average kappa 5 0. 2). 23 Observed Pain Behaviors Pain Behaviors A modi? ed version of the Pain Behavior Measure18 was used to measure behavioral indicators of pain. Based on standardized behavioral de? nitions, occurrence of the following speci? c pain behaviors was evaluated: rigidity, guarding, bracing, stopping the activity, rubbing, shifting, grimacing, sighing or nonverbal vocalization, and verbal complaint. Standardized de? nitions were adapted from previous work,18,19 modi? ed for use in this older, moreimpaired population, and pilot tested in a sample of nursing home residents with dementia. 4 This measure has adequate reliability and validity. 13 Pain Behavior Coding Independent raters, all registered nurses blind to participants’ cognitive status, scored the videotaped activity protocols. Coders completed extensi ve training in coding procedures until intrarater and interrater agreement (with the master coder (PI) and another rater) reached a kappa coef? cient of 0. 80 or greater, indicating good to very good reliability. 25 After coding reliability was attained, reliability checks were conducted on 10% of all videotapes to minimize rater drift.Noldus Observer software was used to analyze digitized videotapes and code pain behaviors (Noldus Information Technology, Wageningen, the Netherlands). The following summary variables were created and used in the analyses: total number of pain behaviors observed, number of times each behavior (rigidity, guarding, bracing, stopping, rubbing, shifting, grimacing, sighing or nonverbal vocalization, and verbal complaint) was observed, and total numbers of pain behaviors observed during each activity state (e. g. , number of behaviors while walking, reclining, sitting, standing, and transferring).Cognitive Status Cognitive status was assessed using the MMS E,26 an 11-item screening instrument widely used to assess general cognitive status in elderly adults. The following MMSE scores served as the cutoffs to classify participants as intact or impaired: less than 8th grade education, 20; 9 to 11 years, 24; high school graduate or equivalent, 25; some college, 27; and college degree or higher, 27. 16,17 JAGS JANUARY 2009–VOL. 57, NO. 1 PAIN ASSESSMENT IN PERSONS WITH DEMENTIA 129 Analgesic Medications Drug data for each participant were coded according to the American Hospital Formulary Service system.All pain medications were identi? ed and converted to acetaminophen equivalents. 8,27 This standardized drugs and dosages to a common metric and facilitated comparison of analgesic dosing. To ensure that only analgesics actually taken would be controlled for, equianalgesic dosages were considered in these analyses only if they were taken within the standard therapeutic dosing window for each drug (e. g. , acetaminophen, every 4â€⠀œ6 hours) before the activity protocol. Data Analysis SPSS, version 15. 0 (SPSS Corp. , Chicago, IL) was used for data analysis.Descriptive statistics, Pearson chi-square (w2) tests, and t-tests were used to describe sample characteristics and examine group differences. Analysis of covariance (ANCOVA) was used to test relationships between cognitive status, pain intensity, and pain behaviors. Logistic regression was used to predict pain presence. Multiple regression was used to predict pain intensity and number of pain behaviors, with a centered cognitive status–by–pain intensity interaction term to identify group differences; standardized regression coef? cients (b) are reported in the results.RESULTS Self-Reported Pain The majority of participants (86. 5%) reported experiencing pain every day or almost every day. More than 65% reported experiencing pain for more than 1 year ( $ 40% indicated duration of 45 years). On average, participants reported pain in four body locations (range 5 1–25); usual pain intensity was 4. 3 (moderate) on a scale from 0 to 10. Immediately before the activity protocol, 45 (35. 7%) participants reported experiencing pain. Mean pain intensity was rated as 1. 7 (range 5 0–9). After the protocol, 79 (62. 7%) reported experiencing pain during the activities; mean pain intensity was 3. (range 5 0–9). Relationship Between Cognitive Status and Self-Reported Pain Chi-square analyses were conducted to examine the relationship between cognitive status (impaired vs intact) and presence of self-rated daily pain and pain duration at baseline. The baseline pain interview was not always conducted on the same day as the activity protocol, and analgesic use before the interview was not assessed. Thus, initial analyses are descriptive only and do not control for analgesic use. At baseline, 77. 4% of impaired and 95. 3% of intact participants reported experiencing pain every day (w2(1) 5 8. 6, P 5. 003).Cognitively impaired elderly people also recalled shorter pain duration (w2(3) 5 16. 0, P 5. 001) than intact participants, but no signi? cant differences were reported in the number of pain locations. Logistic regression, controlling for acetaminophen equivalents, indicated that cognitive status was not signi? cantly predictive of pre-activity pain presence. Regression analyses, with pre-activity pain intensity as the dependent variable and cognitive status and analgesics as predictors, revealed no signi? cant difference between the two groups (Figure 1). Intact Impaired 16 14 12 Mean values 10 8 6 4 2 0 In te a * t ns y SR 😛 a re- cti v in Pa ng cing ing rbal aint sity pi b l n e ra uar ig Sh op rima Rub onv mp Inte B G R St G N al co ain P rb Ve activ tos 😛 SR b Pain indicators cin g n di g i id ty in ift g a tt Si g g g g g in din kin yin rrin l e n L sf a Wa St an Tr c Activity states Figure 1. Relationship between self-report and observed pain behaviors in cognitively int act and cognitively impaired elderly people (N 5 126). aMean self-reported (SR) pain intensity, controlling for acetaminophen equivalents taken. bMean number of behaviors observed for each pain indicator, controlling for acetaminophen equivalents taken. Mean number of behaviors observed during each activity state, controlling for acetaminophen equivalents taken. 130 HORGAS ET AL. JANUARY 2009–VOL. 57, NO. 1 JAGS At the end of the activity protocol, cognitive status was signi? cantly associated with the reported presence of pain, controlling for analgesics (b 5 1. 2, P 5. 002); cognitively impaired elderly people were less likely to report pain. Impaired participants also reported signi? cantly lessintense pain than intact participants after the activity protocol (3. 8 vs 2. 6; F (1) 5 A 5. 0, P 5. 03).Paired t-tests indicated that pain intensity increased signi? cantly from start to end of the protocol for both groups (Figure 1). Table 2. Relationship Between Self-Reported Pa in Intensity and Observed Pain Behaviors (N 5 126) Total Number of Behaviors Observed Model bA P-Value 1 Pre-activity pain intensity Analgesics taken Pain intensity A cognitive status R2 F 2 Postactivity pain intensity Analgesics taken Pain intensity A cognitive status R2 F Standardized regression coef? cient. R2 5 coef? cient of determination. A Relationship Between Cognitive Status and Observed Pain Behaviors On average, 21. pain behaviors per person (range 5 3–50, median 5 21, mode 5 16) were observed during the activity protocol. ANCOVA models, controlling for analgesics, revealed no signi? cant differences in mean number of pain behaviors observed between cognitively intact and impaired participants (covariate-adjusted means 5 21. 8 and 21. 3, respectively; F (1) 5 0. 08, P 5. 77). The number of occurrences of each of the eight behavioral indicators observed was summed. ANCOVA models, controlling for analgesics and using Bonferroni correction for multiple comparisons (P 5. 005), revealed no signi? ant differences between cognitively intact and impaired elderly people for any behavioral pain indicators investigated (Figure 1). Of the activity states observed during the protocol, transferring elicited the most frequent pain behaviors (mean 5 13. 4; range 5 2–43). No signi? cant differences were noted between cognitively intact and impaired participants in number of behaviors observed during any of the ? ve observed activity states. Relationship Between Self-Reported Pain and Observed Pain Behaviors Regression analyses were conducted to examine the relationship between elf-reported pain intensity and total number of pain behaviors observed, controlling for analgesics. Before the activity protocol, pain intensity was signi? cantly predictive of the pain behaviors sum score (b 5 0. 27, P 5. 002), but the relationship did not differ between cognitively intact and impaired participants. After the activity protocol, self-reported pain intensity was signi? cantly (and more strongly) related to number of pain behaviors observed (b 5 0. 40, P 5. 000), and the painby-cognitive status interaction was signi? cant (b 5 0. 22, P 5. 008). Thus, postactivity pain intensity and summed behavioral indicators were signi? antly related in intact but not impaired participants (Table 2). DISCUSSION It was found that cognitive impairment diminishes selfreported pain assessed at rest but only when analgesics are not controlled. At baseline, cognitively impaired elderly people were signi? cantly less likely than cognitively intact elderly people to report pain, consistent with reports in the literature,7 but when analgesics were controlled for, these differences disappeared. This ? nding highlights the need to control for analgesics taken when making group comparisons, which to the best of the authors’ knowledge, has not been previously done.The few studies reporting medication use include drugs prescribed or number of doses taken 0. 27 0. 01 0. 09 0. 08 2. 9 0. 40 A 0. 03 . 22 . 18 6. 70 .003 . 99 . 30 . 02 . 00 . 75 . 01 . 000 (regardless of medication class), whereas the current study identi? ed analgesics in the subject’s body during the pain assessment protocol. After the activity-based protocol was completed, selfreported pain intensity increased for both groups, but cognitively impaired elderly people reported less-intense pain than their intact peers. This ? ding supports the usefulness of the protocol to exacerbate pain in those with painful conditions and highlights the importance of mobility-based pain assessments. 12,14 This ? nding held even when the amount of analgesics taken by participants was controlled for in the statistical analysis. Behavioral indicators of pain observed during activities were equivalent across both groups. This ? nding contradicts previous work15 and may re? ect that medication use was controlled for and that the focus of the current study was on persistent pain, as oppose d to more-acute, postoperative pain. This research con? ms that reliance on selfreport alone is insuf? cient to assess pain in older adults with dementia, because the pain experience may be underestimated,11 and supports growing recognition that behavioral observation is a necessary and useful pain measure, particularly in subjects with cognitive impairment. Cognitively impaired elderly people took signi? cantly more pain medication than their intact peers. The difference was approximately 500 acetaminophen equivalents, approximately the dose of one extra-strength acetaminophen tablet. This ? nding, which contradicts previous work,8,9 warrants further investigation.Post hoc analyses indicated that this difference was not attributable to residential status, number of medical conditions, or demographic characteristics. Thus, it may re? ect recent changes in prescriptive practice as a result of heightened focus on pain in older adults with dementia. Another important ? nding is the sig ni? cant relationship between self-reported pain intensity and observed pain behaviors in cognitively intact persons. This ? nding provided support for the validity of behavioral pain JAGS JANUARY 2009–VOL. 57, NO. 1 PAIN ASSESSMENT IN PERSONS WITH DEMENTIA 31 indicators against the criterion standard of self-report, as least in cognitively intact elderly people, and is consistent with other researchers’ ? ndings. 28 Because there is no evidence that cognitively impaired elderly people experience less pain, it is reasonable to infer that pain behaviors are a valid indicator of pain in persons with dementia, although this assumption cannot be directly tested unless biological tests are developed. 12,24 Pain is subjective, and pain behaviors can be dif? cult to interpret, be subject to bias, and lack speci? city. 14,29 It has been uggested that some behaviors may indicate anxiety or generalized distress, not pain, in those with advanced dementia. 29,30 Thus, pain behavio r measurements should be used in conjunction with selfreport, not as a replacement, and in the context of a comprehensive pain assessment. 14,30 Study strengths are that cognitively intact and impaired elderly people participated, thereby facilitating comparison of assessment strategies in persons of differing cognitive abilities, that a careful analysis of analgesics used during the pain assessment was conducted, and that persistent pain was focused on.Most related prior research has included only persons with advanced dementia and postoperative pain. The sample was limited, however, by being primarily Caucasian and by being restricted to individuals with mild to moderate dementia. This was likely because of inclusion criteria requiring that participants be able to rise, stand, and walk. Individuals with severe dementia are typically more immobilized and unable to follow directions, factors that would impair ability to complete the activity-based protocol in this study. Thus, gener alizations are limited, and further study is needed.This study contributes several important ? ndings to the discourse on pain assessment in persons with dementia. First, it was con? rmed that self-reported pain, although still attainable, may be less reliable in those with mild to moderate dementia than in cognitively intact elderly people, depending on when it is assessed. Second, assessment of pain during movement is supported. Cognitively intact and impaired elderly people both showed greater self-reported pain intensity after movement, indicating that static assessment may underestimate pain.Third, results support the validity of behavioral pain assessment against the criterion standard of self-report and provide evidence of an association between summed pain behaviors and self-reported pain intensity. More work is needed to establish scale properties of pain behaviors in relation to pain severity before this approach can be translated to clinical practice. Fourth, ? ndings hig hlight the importance of carefully evaluating analgesics taken when measuring pain, since results indicate that cognitively intact and impaired elderly people with persistent pain are often medicated differently.This ? nding may re? ect a change in prescriptive practice that warrants further investigation. (Dr. Horgas) and a John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Pre-doctoral Scholarship (Dr. Elliott). Author’s Contributions: Dr. Horgas was responsible for scienti? c oversight of all aspects of the study reported in this manuscript, including study design, data collection, data management, data analyses, and manuscript preparation. Dr. Elliott provided critical review of the manuscript and contributed to the design and study methods, data collection, and data coding.Dr. Marsiske provided critical review of the manuscript and contributed to the design and study methods, data management, and statistical analyses. All authors have approved the ? nal version of this manuscript that was submitted for publication. Sponsor’s Role: The National Institute of Nursing Research sponsored this study but had no role in the design, methods, subject recruitment, data collections, data analyses, or manuscript preparation. REFERENCES 1. American Geriatrics Society. Clinical practice guidelines: The management of persistent pain in older persons.J Am Geriatr Soc 2002;50:S205–S224. 2. Shega JW, Hougham GW, Stocking CB et al. Pain in community-dwelling persons with dementia: Frequency, intensity, and congruence between patient and caregiver report. J Pain Symptom Manage 2004;28:585–592. 3. Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med 2001;17:417–431. 4. Benedetti F, Vighetti S, Ricco C et al. Pain threshold and tolerance in Alzheimer’s disease. Pain 1999;80:377–382. 5. Huffman JC, Kunick ME. Assessment and understanding of pain in patients with dementia. Gerontol ogist 2000;40:574–581. . Bachino C, Snow AL, Kumik M et al. Principles of pain assessment and treatment in non-communicative demented patients. Clin Gerontol 2001;23: 97–115. 7. Fisher SE, Burgio LD, Thorne BE et al. Pain assessment and management in cognitively impaired nursing home residents: Association of certi? ed nursing assistant pain report, Minimum Data Set pain report, and analgesic medication use. J Am Geriatr Soc 2002;50:152–156. 8. Horgas AL, Tsai PF. Analgesic drug prescription and use in cognitively impaired nursing home residents. Nurs Res 1998;47:235–242. 9.Won A, Lapane K, Gambassi G et al. Correlates and management of nonmalignant pain in the nursing home. J Am Geriatr Soc 1999;47:936–942. 10. Pautex S, Michon A, Guedira M et al. Pain in severe dementia: Self-assessment or observational scales. J Am Geriatr Soc 2006;54:1040–1045. 11. Herr K, Coyne PJ, Key T et al. Pain assessment in the nonverbal patient: Position statemen t with clinical practice recommendations. Pain Manage Nurs 2006;7:44–52. 12. Herr K, Bjoro K, Decker S. Tools for assessment of pain in nonverbal older adults with dementia: A state-of-the-science review.J Pain Symptom Manage 2006;31:170–192. 13. Hadjistavropoulos T, Herr K, Turk D et al. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 2007;23(Suppl):S1–S43. 14. Stolee P, Hillier LM, Esbaugh J et al. Instruments for the assessment of pain in older adults with cognitive impairment. J Am Geriatr Soc 2005;53: 319–326. 15. Hadjistavropoulos T, LaChapelle DL, MacLeod FK et al. Measuring movementexacerbated pain in cognitively impaired frail elders. Clin J Pain 2000;16:54–63. 16.Crum RM, Anthony JC, Bassett SS et al. Population-based norms for the MiniMental State Examination by age and education level. JAMA 1993;269: 2386–2391. 17. Cullen B, Fahy S, Cunningham CJ et al. Screening for dementia in an Irish community sample using MMSE: A comparison of norm-adjusted versus ? xed cut-points. Int J Geriatr Psychiatry 2005;20:371–376. 18. Keefe FJ, Block AR. Development of an observation method for assessing pain behavior in chronic low back pain patients. Behav Ther 1982;13: 363–375. 19. Weiner D, Pieper C, McConnell E et al.Pain measurement in elders with chronic low back pain: Traditional and alternative approaches. Pain 1996;67: 461–467. ACKNOWLEDGMENTS Con? ict of Interest: The editor in chief has reviewed the con? ict of interest checklist provided by the authors and has determined that the authors have no ? nancial or any other kind of personal con? icts with this manuscript. This study was supported by Grant R01 NR05069 from the National Institutes of Health, National Institute of Nursing Research 132 HORGAS ET AL. JANUARY 2009–VOL. 57, NO. 1 JAGS 20. Weiner D, Peterson B, Keefe F.Chronic pain-associated behaviors in the nursing home: Resident versus caregiver perceptions. Pain 1999;80:577–588. 21. Gagliese L, Melzack R. Age-related differences in the qualities but not the intensity of chronic pain. Pain 2003;104:597–608. 22. Melzack R. The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1975;1:277–299. 23. Lichtenstein MJ, Dhanda R. , Cornell JE et al. Disaggregating pain and its effect on physical functional limitations. J Gerontol A Biol Sci Med Sci 1998; 53A:M361–M371. 24. Horgas AL, Nichols AL, Schapson CA et al.Assessing pain in persons with dementia: Relationships between the NOPPAIN, self-report, and behavioral observations. Pain Manage Nurs 2007;8:77–85. 25. Gibson SJ, Helme RD. Cognitive factors and the experience of pain and suffering in older persons. Pain 2000;85:375–383. 26. Folstein MF, Folstein SE, McHugh PR. ‘‘Mini-mental state’’: A practical method for grading the cognitive state of patients for the clinician. J Psy chiatr Res 1975;12:189–198. 27. Allen RS, Thorn BE, Fisher SE et al. Prescription and dosage of analgesic medication in relation to resident behaviors in the nursing home.J Am Geriatr Soc 2003;51:534–538. 28. Labus JS, Keefe FJ, Jensen MP. Self-reports of pain intensity and direct observations of pain behavior: When are they correlated? Pain 2003;102: 109–124. 29. Weiner DK. Pain in nursing home residents: What does it really mean, and how can we help? J Am Geriatr Soc 2004;52:1020–1022. 30. Kovach CR, Logan BR, Noonan PE et al. Effects of the serial trial intervention on discomfort and behavior of nursing home residents with dementia. Am J Alzheimers Dis Other Demen 2006;21:147–155.

Intro lit. Grammatical person Essay

An Introduction What Is Literature and Why Do We Study It? †¢ Literature [Roberts and Jacobs] – a composition that tells a story, dramatizes a situation, expresses emotions, analyzes and advocates ideas – helps us grow personally and intellectually – language in use; hence inseparable from it – product of a particular culture; even more culture-bound than language – makes us human Literary Genres Four genres of literature: Prose fiction †¢ Epic myths, legends, fables, novels, short stories Poetry †¢ Open form and closed form †¢ Relies on imagery, figurative language, sound Drama †¢ Made up of dialogue and set direction †¢ Designed to be performed Nonfiction prose †¢ News reports, feature articles, essays, editorials, textbooks, historical and biographical works FICTION -any imaginative recreation and reconstruction of life which includes short stories and novels -myth and legend — origins and extraordinary events like wars, conquests, births, death, as well as the phenomena of nature Elements of Fiction 1. Setting †¢ a work’s natural, manufactured, political, cultural and temporal environment, including everything that characters know and own (place, time, objects) †¢ Its purpose is to establish realism or verisimilitude, to organize a story, and to create atmosphere or mood. †¢ It may reinforce development of characters and theme. 2. Characters the representations of a human being Classification of fictional characters: – Round (dynamic) = lifelike, fully-developed and recognizes changes in and adjusts to the circumstances – Flat = no growth, static – Stock = representative of a group or class (stereotypical) – Protagonist = the hero or heroine, main person in the story, person on the quest, etc. – Antagonist = the person causing the conflict, in opposition to the protagonist, the obstacle, etc. Five ways of revealing literary characters: 1. Actions 2. Descriptions 3. Dramatic statements and thoughts 4. Statements by other characters 5. Statements by the author speaking as storyteller, or observer 3. Plot and Structure the way the actions are arranged in the story reflection of motivation and causation *In the story, the queen died and then the king died shortly after. Conflict – controlling impulse in a connected pattern of causes and effects – Opposition of two or more forces (e.g., hatred, envy, anger, argument, avoidance, gossip, lies, fighting, etc.) -can be internal (man vs. himself) or external (man vs. fate/condition/other characters) Dilemma – conflict within or for one person – Conflict is a major element of plot because it arouses curiosity, causes doubt, and creates tension therefore producing interest among readers/audience. LITERARY DEVICE flashback foreshadowing local color – the superficial elements of setting, dialect, and customs Closed Plots 1) Linear – arranged chronologically 2) Circular – combination of linear and flashback 3) In Medias Res – begins in the middle part of the action Structure of Closed Plots PYRAMID PATTERN OF DEVELOPMENT Exposition Complication Crisis Climax Resolution (Denouement) 4. Point of View †¢ Refers to speaker, narrator, persona or voice created by the author to tell the story †¢ Point of view depends on two factors: – Physical situation of the narrator as an observer – Speaker’s intellectual and emotional position †¢ First person – I, we †¢ Third person – He, she, they (most common) Omniscient – all-knowing; delves into the minds of the characters at any point in the story Limited omniscient – some insight 5. Theme (Donnà ©e) Theme embodies meaning, interpretation, explanation and significance of every detail in a literary piece along with values in order to appreciate it. It is not as obvious as character or setting. It is important to consider the meaning of what has been read and then develop an explanatory and comprehensive assertion. It points out the significant truth about life and human nature that is illustrated in the actions, preoccupations, and decisions of the characters. It is not just some familiar saying or moral. Theme can be found in any of these: – direct statements by the authorial voice – direct statements by a first-person speaker – dramatic statements by characters – figurative language, characters who stand for ideas – the work itself – as a whole Theme should be: 1. expressed in complete statements 2. stated as a generalization about life. 3. a statement that accounts for all major details in the story 4. be stated in more than one way 5. should avoid statements that reduce the theme to some familiar saying 6. Images –concrete qualities rather than abstract meanings which appeal to the five senses 7. Symbolism Symbols stand for something other than themselves. They bring to mind not their own concrete qualities, but the idea or abstraction that is associated with them. Symbol creates a direct, meaningful equation between & among: – a specific object, scene, character, or action – ideas, values, persons or ways of life Symbols may be: – Archetypes (universal) = known by most literate people and have usually been used in most literary pieces therefore becoming representative figures (e.g., white dove, color black) – Contextual (authorial) = private, created by the author – Allegory = complete and self-sufficient narrative (e.g., â€Å"Young Goodman Brown†) – Fable = stories about animals that possess human traits (e.g., Aesop’s Fables) – Parable = allegory with moral or religious bent (e.g., Biblical stories) – Myth = story that embodies and codifies religious, philosophical and cultural values of the civilization in which it is composed (e.g., George Washington chopping down the cherry tree) – Allusion = the use of other culturally well-known works from the Bible, Greek and Roman mythology, famous art, etc. 8. Tone and Style †¢ Tone = methods by which writers and speakers reveal attitudes or feelings †¢ Style = ways in which writers assemble words to tell the story, to develop an argument, dramatize the play, compose the poem †¢ Essential aspect of style is diction Choice of words in the service of content Formal = standard or elegant words Neutral = everyday standard vocabulary Informal = colloquial, substandard language, slang †¢ Language may be: – Specific = images – General = broad classes – Concrete = qualities of immediate perception – Abstract = broader, less palpable qualities †¢ Denotation = word meanings †¢ Connotation = word suggestions †¢ Verbal irony = contradictory statements – One thing said, opposite is meant – Irony = satire, parody, sarcasm †¢ Understatement = does not fully describe the importance of a situation – deliberately †¢ Hyperbole (overstatement) = words far in excess of the situation