Nutrition Assignment Essay

Cooking is the application of one of two types of heat. Name them and then classify all the methods of cooking (baking, blanching etc) listed in your course according to which type of heat they use. Cooking is the application of one of two types of heats which are using moist or dry methods of cooking. Baking: Baking is a commonly used cooking technique that applies dry heat to a food, along with an air flow. It avoids the problems of nutrient loss due to leeching, and is effective at breaking down starches. However, heat labile nutrients will be destroyed and the long cooking time will negatively affect nutrient value. Baked goods loose moisture and tend to be dry; fats will leech out as well. Blanching: Blanching is the plunging of a food item into boiling water for a very short time period, before removing it and transferring it to cold or icy water. The cold water stops the cooking process. Blanching can remove the bitter taste from some vegetables and can also enhance their colour, making them more appealing. The application of very high heat will kill many micro-organisms and will also soften the tough fibres in vegetables. Braising: A method of cooking that is similar to baking, however, a liquid is placed beneath the food, or the food placed in a liquid. The liquid, at high temperatures, will convert to steam and so the food will be partially baked and partially steamed. It is used primarily in the preparation of meat dishes, where the tough collagen fibres require high heat and time to become softened and palatable. This of course impacts on the level of heat labile nutrients in the food, and leeching may also be a problem in the early stages of cooking. High temperatures will seal foods quickly, helping to trap juices and the nutrients within them to some extent. Other terms for braising include stewing or pot-roasting. Casserole and stews are braised dishes. When the meat is kept in the fluid, or the fluid returned to the meat nutrient losses will be lessened. Grilling: Grilling, like baking, is a dry cooking method, the difference being that grilling is the direct application of heat to the food as opposed to hot air. Food is generally cooked very quickly, which is good for limiting nutrient degradation, but at very high heat, which causes loss of the heat labile nutrients. Barbecuing, cooking over hot coals or charcoals are all consider variations of grilling. With larger cuts of meat, cooking time is lengthened, resulting in additional nutrient loss. Poaching or Boiling: Poaching, as opposed to boiling, is the gentle heating of a food in water. Typically, an acid is also added to the water (wine, vinegar, citrus juice) and this can impact on acid/pH sensitive vitamins such as vitamin K. Leaching is of course a major source of nutrient loss, but as the heat is lower; B group vitamins should remain intact as the temperature is below 100C. Mineral content is not dramatically altered with poaching or boiling but is more apparent than other cooking methods. Comment on the ease/difficulty for a person, suffering the medical condition you investigated, who has to stick to the dietary guidelines you created in question 7. Write a paragraph. If a person is naturally used to eating healthy following the crohn’s diet might be easy to follow for a person. Fatty and oily foods must be avoided all together as they are difficult to digest when a person has this medical condition. Eating a softer and blander diet is also essential to avoid discomfort. Sometimes bland foods are hard to follow as they are boring to an individual this can be hard to follow. Coffee lovers might also find it hard as caffeine can irritate the stomach as well. References http://www.heartfoundation.org.au/healthy-eating/mums-united/healthy-eating/Pages/default.aspx?gclid=CPKCw6rk5rMCFUhZpQodSn0AXg http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/behavior.htm http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Weight_loss_a_healthy_approach http://www.aafp.org/afp/2003/0415/p1769.html http://www.diabetes.co.uk/diet-basics.html http://www.livestrong.com/article/426491-nutritional-requirements-for-diabetics/#ixzz2D7F4J47I http://www.livestrong.com/article/286671-diet-for-gastric-problems/ http://www.livestrong.com/exercises-for-obese-people/ http://www.kitchensavvy.com/journal/2006/03/blanching_food.html http://www.bbc.co.uk/health/treatments/healthy_living/your_weight/whatis_bmi.shtml http://www.arhp.org/publications-and-resources/quick-reference-guide-for-clinicians/postpartum-counseling/diet Course Notes http://www.trimdownclub.com/introduction/index.html?ad=311 Health Magazines have also been investigated.

A Team in a Slump

For someone who is not much of a sports fan as he claims himself to be, Richard Cohen is the most unlikely person to write about the parallelisms of a Knicks’ season and the Iraq War.For Cohen, a game and a war must   both be won.   He disagrees with Vince Lombardi with the latter’s famous quote that winning is not the only thing.   He is more in agreement with Henry Ford about learning more from failures than in successes.Cohen cited the New York Knicks as having the highest paid players in the league, including those who sit it out in crucial games.   The bench warmers have $53 million contracts.   He thinks the figure to be pretty expensive for a ball club finishing at the bottom notch of the Eastern Conference.Cohen likewise called to mind Gil Hodges of the Dodgers who performed below expectations in 1952 and was for an uncomfortable length of time on such a sudden decline, or on a slump.   Hodges was well-loved, extremely good and quite strong.   But as most people would say then, things happen.   Things were not always within one’s control.The Cohen essay is also about George W. Bush once the owner of the Texas Rangers.   Owning a ball club before, Cohen believes that Bush should have known that as in the case of the Knicks, money nor power, does not a winner make.  Ã‚     In Iraq, even with all its resources America is ineffective.   It is like the Knicks on a slump.Cohen wrote, â€Å"It’s not the bench that needs to be replaced.   It’s the front office.†Ã‚   The reason for the defeat is not because the players or the soldiers are not that good, it is more of the person owning the ball club or the commander in chief from whom the orders are coming being incapable of leading his team to victory.   What it takes to win, the man in charge should know.This may be a different way to look at the much-debated Iraq War, at a sports angle with   a sports analysis on the side.  Ã‚  Ã‚   Rich ard Cohen, from his own admission is an occasional sports fan.For the most part of his essay, one would not easily find a connection between a team in a slump and a protracted war, between a former ball club owner and a president who calls the shots in Iraq.   For the average American who has a home team to root for he would understandably like to separate his sports from his politics.   As for Cohen, he should shoot from another angle.Works CitedCohen, Richard. â€Å"A Team in a Slump.† 20 April 2006.   Washington Post Writers Group. 15 May 2007

A Cautionary Analysis of Transhumanist Philosophy Essay -- Philosophy

To understand many of the dangers and shortcomings of these technological ambitions, it is essential to first understand the philosophy which has become so synonymous with these efforts. Transhumanism can best be described as a philosophy which advocates the use of technology in order to improve not only the quality of life of human beings, but also their lifespan, mental capacity, and physical ability. In essence, transhumanism is a radical extension of humanism. Similar to humanists, transhumanists value â€Å"rational thinking, freedom, tolerance, democracy, and concern for our fellow human beings.† The major difference in the case of transhumanism, however, is the additional belief in improving not only the â€Å"human condition and the external world,† but the human species as a whole. When arguing for biological enhancements, transhumanists typically refer to a belief in the autonomy th ijntje Smits. â€Å"A European Approach to Human Enhancement.† Paper presented at the European Union Science and Technology Options Assessment workshop, Brussels, Belgium, February 24, 2009. http://www.europarl.europa.eu/stoa/events/workshop/20090224/background_en.pdf (accessed March 24, 2010). Aubrey de Grey, â€Å"The War on Aging.† In The Scientific Conquest of Death, edited by Bruce J. Klein, 29-45. Buenos Aires: LibrosEnRed, 2004. http://www.imminst.org/SCOD.pdf (accessed March 24, 2010). Andy Miah. â€Å"Be Very Afraid: Cyborg Athletes, Transhuman Ideals Posthumanity.† Jounral of Evolution Technology 13, no. 1. (October 2003), http://jetpress.org/volume13/miah.html (accessed March 24, 2010). Andy Miah. â€Å"Posthumanism: A Critical History.† In Medical Enhancement and Posthumanity, edited by Ruth Chadwick and Bert Gordjin, 71-94. Dordrecht: Springer Netherlands, 2009.

Terror Personal Statement Example | Topics and Well Written Essays - 500 words

Terror - Personal Statement Example This belief of mine was shattered when one of my friends was badly bitten by a rabid dog and after a few days he died because of the non-availability of appropriate treatment. The incidence occurred when we all were on an educational trip, where we were asked to live and sleep in tents and were exploring out things. My friend was a group leader and therefore he was marching ahead of the crew. Suddenly, while he was passing the stretch of lonely area a rabid dog appeared and my friend out of fear and panic he threw a stone on the dog. The dog turned furious and attacked my friend. We all were in a group and following him as we were behind him. We also got freeze after witnessing the incidence. After the preliminary first-aid, he was immediately rushed to the hospital which was 2 hrs from their place. By the time he reached the hospital it was late and injections were not available in the stock. He was crying in pain and panic and no one could help him to relieve his sufferings except for the first-aid. It is really pity and sad when you see someone dying in front of your eyes and you cannot help. The incidence was enough to inculcate panic and fear in my mind for the dogs.

Solar Panel Battery Charger 6-12V Research Paper

Solar Panel Battery Charger 6-12V - Research Paper Example The comparator compares the voltage from the battery and acts as a switch for the voltage regulator circuit. Finally, the battery voltage checker checks the voltage of the battery (as it received from the panel) to determine if the battery needs to charge more. The circuit is designed to be simple, efficient and reliable by using easily available field replaceable parts. It uses a 12V, 5W solar panel rated from 100 milliamps to 1A and a lead acid or other rechargeable battery that is rated from 500 milliamp hours to 40 amp hours of capacity. This circuit regulates the voltage flow from the photovoltaic panel to the lead acid battery. It can produce currents up to 150mA. When external pass transistors are added to this circuit, output currents can reach up to 10A. The maximum input voltage to this circuit is 40V (LM723, 2004) with an output voltage adjustable between 2V and 37V. This circuit consists of a series regulator, LM723. ... Figure 11 and Figure 12 are the connection diagram and the datasheet circuit (Voltage regulator, 2012) as below: Figure 11: Connection Diagram Figure 12: Datasheet Circuit The basic building blocks of LM723 are: 1 The Reference Voltage Amplifier 2 The Error Amplifier 3 The Series Pass Transistor. The equivalent circuit of LM723 (LM723/LM723C Voltage Regulator, 1994) is shown in Figure 13 as below: Figure 13: Equivalent circuit of LM723. The main components used in the voltage regulator circuit are (Table 1): Table 1: Main components of the voltage regulator circuit Quantity Component Value 1 LM723 - 1 R1 4.87k ? 1 R2 7.15k ? 2 Transistor 2N3055 1 Diode 1N4007 1 VR 10k ? 1 C1 0.1?F 1 C2 500PF Calculations: Following are the calculations for design and operation of the circuit: Output voltage- Vout = Vref x ((R1+R2)/R2) Where R1= 4.87K, R2= 7.15K and Vref= 7.35V from the datasheet. Vout= 7.35 x ((4.87 + 7.15)/7.15) = 12.36V. Figure 14: Output voltage. Current- The current is establishe d from the Darlington transistor pair in the regulator circuit (Q1 and Q2 in Figure 10). Q1 and Q2 (2N3055) are silicon, Epitaxial-Base Planar NPN transistor mounted in a Jedec TO-3 metal case (Charger Circuit for 6V or 12V Car Battery, 2012) and are recommended for use in power switching circuits, series and shunt regulators, output stages and high fidelity amplifiers. Figure 15 shows the Darlington transistor pair: Figure 15: Darlington transistor pair used in voltage regulator circuit. In this circuit, a voltage of 0.7V is applied to the base (B) of the first transistor (TR1) to switch it on. A current of 300 milliamps passes through the first transistor from the collector (C) to the Emitter (E). The emitter of TR1 is connected to the second

A picture of reading Essay Example | Topics and Well Written Essays - 250 words

A picture of reading - Essay Example They turned their flashlights on. They each went separate ways, imagining different lands and living in different societies. Luke went to a faraway island because of a sunken ship, while Jenna went to Mars as the first girl astronaut. The photo shows the prestige of reading to children who grow in an environment where they have access to books. The reading is happening inside their home, which suggests, that their parents or someone in the family values reading enough to provide them books. The setting is important in showing that parents have a large role in encouraging their children to love reading. Also, in this photo, reading has become an act of bonding and going to different adventures. It shows that girls and boys alike can enjoy reading because they can read the books they like. Brothers and sisters can enjoy reading together. They may not be directly playing with one another, but they can talk about the stories later. The photo shows that reading is good for creativity and

Auditing Essay Example | Topics and Well Written Essays - 2000 words - 1

Auditing - Essay Example he corporate managers have grossly increased to unprecedented levels where their decisions might have had a greater impact on the larger good of the stakeholders i.e. Shareholders, general public, government etc. In the heat of competition the managers of these organizations take decisions which may not be in favor of internal as well as external customers of these organizations. This has therefore necessitated the more proactive role of the board of the directors of organizations in promoting good governance specially their role in ensuring the effectiveness of the internal controls of the organization is stressed upon a lot. An effective internal audit function can play an important role in helping Board of directors to discharge their responsibility of ensuring effective control. However before discharging this responsibility, an internal audit function within the organization need to be objective and proactive in nature with a mandate to conduct independent reviews and with the n ecessary organizational flexibility to report their findings to the highest authority within the organization so that not only independence is maintained but also the results are communicated to the platform where they can be executed and explored without any internal compromises and with an aim of safeguarding the interests of the shareholders by adding value to their investments. Corporate governance has succeeded in attracting a good deal of public interest because of its apparent importance for the economic health of corporations and society in general. However, the concept of corporate governance is poorly defined because it potentially covers a large number of distinct economic phenomenon. As a result different people have come up with different definitions that basically reflect their special interest in the field. It is also believed that if the firm is nothing more than a legal fiction than its values must be driven by its stakeholders thus the companies values emerge as a

Feminism and International Relations Essay Example | Topics and Well Written Essays - 2000 words

Feminism and International Relations - Essay Example However, there are no agreed standards on how to achieve the equality standards. While most problems in international relations field are considered to reveal around the issue of war and security  as most realists assume, there are numerous groups that are liberal in nature, which are concerned in human rights groups, civil society, international political economy, development in the social space among others. For many years, realism and liberalism have been the two main theorists that address issues in international relations. Vibrant societal networks with entrenched confidence and practice leads lead to acknowledgement of important objectives in the country’s systems.The feminist movements and groups do influence international relations decisions by advocating new and better approaches to global to promote justice, equality, and maximise the value of humanity in globe affairs. Literature Review Feminism is currently a political movement and continues to challenge traditio nal approaches of conceptualising politics in the society and the political disciplines (Randall 1995, 118). There are two types of feminism: radical and Marxist feminism that had a revolutionary mind while the liberal feminists have portrayed themselves as reformists in international relations. As a result, in most western countries, the reformist mindset has won the political space, with many women, feminists included, making an impact in political institutions and professions (Randall 1995, 118). Feminist empiricism advances the perspective that states and interstate relations have been governed by dominating gendered structures, and interactions that have been neglecting women in leadership. Feminist standpoint is that women in their varied experiences in life have gained expertise and knowledge in the political life, which offers different perspectives on social issues that provide reliable and effective solutions to most problems in the world political system (Keohane 1989, 24 5). Therefore, the role of feminisms in international relations is to criticise any patriarchal thinking and introduce gendered structures in the society. The social and political integration have an impact on women discrimination since they diversify foundation of political competition and contribute to formation of diverse identities and understanding among citizens. Societal revolutions such as relocation from rural to city resolution areas, speedy population change, democratic politics, and improvement affect women rights. The political protests by women aim at convincing authorities of particular policies as well as create social norms through endorsing particular social behaviors. Problems Feminist Face in International Relations Women discrimination narrows the potential range of policy responses, undermines the capacity of the society to respond autonomously to the demands of their citizenry thereby weakening the legitimacy of traditional political intermediaries and state a uthorities. These new arrangements promoted the diffusion of new values of good governance, human rights, institutional structures, policy formulation, and democracy. One of the major problems that feminists have sought to deal with is in sovereignty of nations. For many years, sovereignty has been related to reciprocity (Keohane 1989, 247). In other words, as Koehane explains, while states have to claims their sovereignty, such states have a duty to respect the sovereignty of other states. These traditional international relation perspectives were discriminatory and tend to separate a nation from others. As Cohn (1987,

Social Work Compentcies PowerPoint Presentation

Social Work Compentcies - PowerPoint Presentation Example Therefore rather than pathologise her connections in the lives of her family members, I choose to treat this as culturally normal and help her figure out ways to establish some boundaries. This shows what I do in my work with clients that I think is represented in the image that I have included here in my portfolio. This video represents an ethical dilemma. During my practicum experience I am often faced with an ethical dilemma. I watched this video and they suggested several strategies that I have implemented in my agency when I face an ethical dilemma. I used the steps recommended in the video to address several ethical dilemmas. I became aware that a client has selling his food stamps. This is a violation of the agency policy. The client sold these food stamps to get money to buy cough syrup for her daughter who had a severe cough. I realized that although this seemed like a legitimate need for money, the food stamp policy is clear, that food stamps are not to be sold. I followed the steps in this video to think about what should be my action steps. Literacy is an important aspect in the community. It would be beneficial to identify the literacy needs in that community. The needs are assessed and evaluated to know which would be the best method to be used to educate the community. The above image inspired me to involve all the participants during the meetings we held. The above image shows that the world is the way it is because of the presence of diversity. In my practicum experience, I noticed that there were different patients who had different need and thus needed to be treated differently. Recognition of cultural diversity entails respecting the differences of people in the society. Each person’s beliefs and lifestyles are respected while having an understanding and support of the differences. Embracing culture in the society is important in enhancing cultural structure in the society. I was able to

Pepsodent Essay Example for Free

Pepsodent Essay This will be based on the weaknesses, strengths, threats and opportunities of the organization along with the toothpaste brand line of Pepsodent will be assessed. In addition, further information on the current market share, sale, and profitability of Pepsodent in the scope of PESTEL analysis will be provided. At the conclusion of the first section the competitive advantage of Pepsodent will be declared. The subsequent section entails a recommended strategy of marketing employing marketing tools like targeting, positioning and segmentation, the marketing mix as well as SMART objectives. This is as a result of an extremely effective strategy of marketing of the organization formerly. However, principally in an environment that is competitive, such as the personal care sector it is fundamental for Pepsodent that it advances its marketing as well as organizational approaches so as to meet consumer’s demands (Budavari, et al. 1996). In addition, these days a wide array of diverse toothpaste brands is provided to the consumer (eHow, 2012). This in general implies that Pepsodent is obliged to distinguish its merchandise from the competitor’s commodities by being unique and innovative. Furthermore, the toothpaste market is developing continually which signifies that additional diverse demands and anticipations of the consumer will arise. As a result, Pepsodent should utilize marketing tools for instance, market segmentation to well recognize their needs so as to supply them with the fitting merchandise. The threats and opportunities recognized will serve as a foundation for the pinpointing strategy of marketing detailed in this report 3. 1. Political Factors: The government of United Kingdom endorses the just trading obligation for both internal and foreign manufacturers. UK has set regulations regarding issues like disposal of wastes and product safety. Pepsodent is dependent on local, provincial and international laws, rules and regulations. These laws and directives cover a range of areas like product claims, product safety, trademarks, patents, the environment, copyrights, employee health and safety, listing and disclosure, employment and taxes, and corporate governance (Pepsodent Official website, 2012). As a result of the extensive focus of Pepsodent in developing and emerging markets, whichever political transformations for instance, those in fiscal stimulus, foreign direct investment regulation or adjustments in taxation or tariffs could have a great impact on the operations of Pepsodent in the nation. Pepsodent is obliged to engage in constant scanning not just to mitigate political threats, however, to take hold of and seek out novel, appealing openings for political inducements. 3. 2. Economic Factors: United Kingdom is the biggest economy in the planet and third largest in Europe. In the time of recession UK is in its worst time. Organizations are not investing but doing terminations that is why consumer markets are reducing and individuals are losing their power to purchase. The market environment of Pepsodent is turning out to be highly competitive particularly in the United Kingdom. Macro-economic atmosphere is highly tentative which has had an effect on the micro-economic environment in addition, by generating a fear among regular buyers (Watson, Lysonski, Gillanamp; Raymore, 2002). Buyers would not wish to purchase a costly product as a result of current tides of the economy. Rivalry in United Kingdomhas become so strong that Pepsodent is encountering difficulties in a number of regions. Economic turn down in business in an economic decline has resulted in consumer and supplier default. The business of Pepsodent is reliant on constant customer demands for its brands. Diminished customer capital influenced by harsh economic circumstances has resulted in customers turning out to be incapable (Bloch, Satish and  Robert, 2007)or unwilling to acquire Pepsodent products, which has profoundly had an effect on the cash flow, profit margins, turnover, and profits. 3. 3. Social Factors: Social aspects entail the cultural aspects. Socio-cultural aspects UK vary from region to region. This entails: age, education, way of life, and religion(Bang and Joshi, 2008). Pepsodent has structured a well-built corporate repute for numerous years,continuous concentration on societal aspects, as well as encouraging sustainable development and usage of resources that are renewable. The intention of Pepsodent is to assist people look bright, feel well and achieve a lot out of life with services and brands that suitable for them and suitable for the rest too. Pepsodent has effectively maintained standards that are high for the design and creation of merchandise that are harmless for end users.

Germany Competitiveness The Porters Diamond Context Economics Essay

Germany Competitiveness The Porters Diamond Context Economics Essay Context for firm strategy and rivalry: Germany can be considered center of Europe both for its geographic and political position. This gives to Germany the possibility to lead the European market and to manage a relevant diversification of its internal economy; it means to create a hugely competitive business environment for German companies. The efficiency rate in German large and small companies is higher than international standards due to the great amount of off shoring and outsourcing practices so that it makes this economy the most competitive in Europe. Throughout last years, German small and medium enterprisers performed better than the large ones, overtaking even the US competitive standards, as shown by the Work Competitiveness Yearbook 2010. Those small enterprisers are the so called hidden champions because they are little known to the public even if they are world market leaders. In contrast to the practice of the other European countries to develop economies related on large state-owned industrial champions, Germany could be considered such as a private driven economy in which the small and medium enterprises are playing the most important role in boosting investments and employment rate. They also make the success of German export with the 80% of the production sold abroad; the Machinery and Equipment Cluster, for instance, holds almost 20% of world export market share. These companies successfully compete on innovation processes and on improving efficiency, getting a great benefit from both the excellent European and German intellectual property protection. According to the World Economic Forum (WEF), Germany represents one of the worlds best location in planning and operating security and it is one of the leading Nations in the field of propriety rights protection and contracts protection. This excellence let Germany to grant over 12,500 patents at the EU Patent Office only in 2010 and to be the European leader in triadic patents, registered in the three most important worlds patent offices: the European Patent Office, the United States Patent and Trademark Office, and the Japan Patent Office. The German legal system itself can be considered one of the most efficient and independent of the entire world. Moreover, the social and political stability of the country and the Germans culture based on the total respect of the laws principles make this country a greatly attractive places for corporate investments projects even for foreign firms in almost all the industries. In addition to the high quality of the legal organization, Germany has developed a very internationally competitive taxation system: in 2008 an ambitious reform was made in order to decrease the corporate tax burden by around the 25% and the corporate income tax down to 15% on all corporate taxable earnings. Eventually, Germany has developed a unique corporate governance system that makes possible a virtuous match between workers and employers in order to avoid time-consuming and value-destroying disputes: it becomes a key success factor to rise up during recession periods. As a matter of fact, core decisions are taken through Job Alliances that enable flex-security on job market in order to keep companies competitive while maintaining job positions. Great importance is given to the role of federal government which gives big support to this system promoting grants and self-regulation policies. Factor conditions: Germany benefits from a huge number of natural resources such as building materials, natural gas, wood and other strategic natural elements. Its wide land gives to the country a lot of space that can be exploited focusing on clean energy production. Moreover, the climate represents an important factor in producing energy with the key role played by the wind that constantly flows in the northern part of the country. The prevalence of lowlands in northern regions makes Germans able to take the most possible advantage of the wind, becoming part of the Northern Power Cluster for wind energy production. The pretty big population of Germany can be considered little diversified in culture and tradition with a big prevalence of German native speakers over the other cultures ( almost 91% of the entire population, as the CIA World Factbook points out ). The German position on human capital point of view is strongly influenced by the unique education system that represent a best practice in all over the world. This is focused on the importance given to the professional training in order to provide people, since earlier age, with a set of skills useful to join the job market. Parallel to the professional-oriented approach there is also a very good and selective university system for the large number of young people that decide to longer dedicate themselves to study activities: mechanical engineering, with more than 400,000 matriculate students, ranks second in the top 20 of the most in-demand study programs and provides the highest skilled workers for the main sectors of the country such as automotive, machinery, electrical and electronic. This dual track allows enterprises to reduce dramatically the labor costs in term of training programs and young people to enter in the job market already with a high productivity rate. Germany can be considered extremely attractive as a location for investments due to high productivity rates and stable wages. In addition, in recent years the overall labor cost has been the lowest in Europe with an annual increase rate of less than 2%; this job market context contributes to enhance strong competitive business relations. Unskilled workers represent almost the 20% on the total workforce; this evidence reflects the attention paid to education and emphasizes the companies ability to attract skilled workforce from other countries. Germany Important concerns from governments point of view remain the unemployment rate (at the 6% in 2011, as said in CIA World Factbook) and the pretty low participation in work force, compared with countries such as US, UK or Japan. In addition, Germany is one of the worlds leaders in RD investments, both in terms of budget and percentage of GDP, reaching the 2.8% and overlapping the EU average of 2.1%. The high regard to investments is coming both from the public and the private sector and the great number of PPPs (Private and Public Partnership) is playing a key role in German competitiveness and in planned development. The high level of RD investments impacts positively on the dynamicity of German economy: over 27% of the manufacturing turnover is generated from innovative products. Eventually, Germany derives its economic power also from its important and well organized grid of transportation infrastructures: the 2009-2010 Global Competitiveness Report of the WEF ranked Germany at the first position in terms of infrastructures. The rail system, which connects the country with all the neighbors by high speed rail, is gaining more efficiency thanks to the open access to the market given to privates that make the sector much more competitive than the state monopoly. This makes Germany the 6th position for railways infrastructure in comparison with the other states of the world (CIA World Factbook ). Water ways and harbors are extremely well developed too and the airports system is ranked 13th in the CIAs comparison between countries as stated in the CIA World Factbook. By the way, governments biggest challenge is to continue to increase the already large flow of foreign direct investments and to improve, as much as possible, the venture capital system by the adoption of specific policies. Today, German legal framework makes no distinction between national and foreign investments promoting principles such as freedom in trade and payments and the reduction of barriers. Moreover, there are special treatments and opportunities for young entrepreneurs and start-ups: on one hand, special conferences and events like the German Equity Forum, and, on the other one, proposals of venture capital partnerships through development banks and the German Private Equity and Venture Capital Association. Further financial assistance is given at regional, national and European level through a wide number of instruments: cash incentives, interest reduced loans, public guarantees, labor-related incentives and RD grants. Demand conditions: Domestic demand is therefore becoming a more significant driver of Germanys economic expansion (from   CIA World Factbook). Due to the Euro financial crisis the export rate to EU cover the loss in term of exports. In this perspective, a key role is played by the government in boosting investments and supporting internal demand: there are available some governments loans made up for enterprises in order to enable them to borrow new capital at a lower interest rates and, in turn, be able to offer lower prices to the consumers market. A great influence on the demand is played by the high level of quality and environmental standards that characterize German regulation. Germany has a virtuous regulation history, starting with the Deutsches Institut fà ¼r Normung (DIN) during the 20s until today: a huge number of innovations has been introduced in this field such as self-regulation processes related to the new public governance system. German standards and their regulation are also much influenced by EU, which is trying to homogenize the regulation of the Common Market and to stimulate cleaner manufacture and energy production (EU 20/20/20 Program): this affects Germans big industrial sectors such as machinery, chemical and power clusters. This context originates a more complex supply and demand structure which express the need to assess the high level of constraints due to the global environmental challenges. Related and supporting industries: the important number of local suppliers are strongly supported by the efficient system of German scientific infrastructures set up both at the federal and local level . Germany has various types of research locations such as universities, laboratories, non-university institutes, companies and Federal as well as Là ¤nder institutions. Moreover, the German Federation of Industrial Research Associations (AiF) is a great example of how German companies themselves cooperate to research and innovation activity contributing directly to the country competitiveness. The AIF mostly contributes to the technology transfer process and research activity in the growing market of renewable energies such as solar and wind power. Germany is home to several research infrastructures with global significance in physics, earth science, climate research or the humanities. Examples of research infrastructures are: Deutsches Elektronen-Synchrotron (DESY) and the German Cli mate Computing Centre (DKRZ). In addition, Germany has a greatly developed Machinery and Equipment industry which provides the supply of power transmission engineering, material and air-handling technology and machine tools. This is the most innovative sector within the country and heavily influence German economy supporting all the other strategic sectors such as chemical, electronic, automotive and renewable energy, providing the sub-components needed for production processes. Da inserire nel diamante sul cluster: GREEN ECONOMY, INVESTMENTSà ¢Ã¢â€š ¬Ã‚ ¦(clean power) Germany is the world leader in green technologies Æ’Â   leader in sustainable industries (wind energy, photovoltaic, bioenergy industry, Electricity (demand, import, exports, quanto produce il solare, il vento..) WIND ENERGY: p.6 PORTERS FORCES (Porters book) Role of Government: Public demand, self-regulation, promoting networks and clusters. Public RD support and PPP P.11 and others (ig. Website) Role of Federal Government in green energy P.5

The Poetry of Emily Dickinson Essay example -- Personal Response Essay

Emily Dickinson has always been one of my favorite poets. I love her poems because of the pain and sorrow they contain to which I can easily relate. She often writes of funerals and death. I myself have watched too many friends die and have wondered why God would let this happen. At every funeral, some well meaning mourner would say--,"The Lord called him" or "She's with Jesus now." My gut reaction was always, "Bullshit." Then Emily Dickinson's poem "My Life Closed Twice Before its Close" would come to mind, especially the last two lines--,"Parting is all we know of Heaven and all we need of hell." More than anything I've ever heard those lines summarize the doubts I've had about an afterlife and the pain of those left behind. My friend Molly Moynahan, recently wrote a novel and titled it Parting is all We Know of Heaven. The book opens with Dickinson's poem in its entirety. It is the story of a young woman whose life is destroyed by grief following her sister's death. I too have been at the point where grief combined with my own stupidity (drugs and alcohol) almost destroyed my life. My best friend since childhood killed herself by eating 56 valium pills. Her suicide note said that she was too ashamed of herself to face her family anymore. Her parents didn't even bother to come to her funeral. We had to take up a collection in the bar to bury her. Two weeks later another good friend choked to death on his own vomit. His three year old daughter found him the next morning. I was overwhelmed with guilt when I realized I had been drinking with him the night before. To this day when I see his wife and children at the supermarket, I can't look them in the face. Within the next two months I lost three other friends t... ... we discussed in class the tradition among New England Puritans of looking in the face of the dead and reading their emotions to determine whether or not they were going to heaven. I've thought about this a lot since I've found God and I hope that it isn't true. Everyone I've known has died a horrible death. They were all cut down in the prime of their lives--face down in their own vomit, on the cold, dirty floor of a bathroom, decapitated in a car wreck, in a crowded AIDS ward in a city hospital. None of them had a chance to make their peace with God or with themselves for that matter. I'm sure none of them died looking content or peaceful but terrified and at best surprised. Therefore I would like to believe that hell is all that has gone on here in this life and that after the parting there is a heaven where those who suffered on earth are given a second chance. The Poetry of Emily Dickinson Essay example -- Personal Response Essay Emily Dickinson has always been one of my favorite poets. I love her poems because of the pain and sorrow they contain to which I can easily relate. She often writes of funerals and death. I myself have watched too many friends die and have wondered why God would let this happen. At every funeral, some well meaning mourner would say--,"The Lord called him" or "She's with Jesus now." My gut reaction was always, "Bullshit." Then Emily Dickinson's poem "My Life Closed Twice Before its Close" would come to mind, especially the last two lines--,"Parting is all we know of Heaven and all we need of hell." More than anything I've ever heard those lines summarize the doubts I've had about an afterlife and the pain of those left behind. My friend Molly Moynahan, recently wrote a novel and titled it Parting is all We Know of Heaven. The book opens with Dickinson's poem in its entirety. It is the story of a young woman whose life is destroyed by grief following her sister's death. I too have been at the point where grief combined with my own stupidity (drugs and alcohol) almost destroyed my life. My best friend since childhood killed herself by eating 56 valium pills. Her suicide note said that she was too ashamed of herself to face her family anymore. Her parents didn't even bother to come to her funeral. We had to take up a collection in the bar to bury her. Two weeks later another good friend choked to death on his own vomit. His three year old daughter found him the next morning. I was overwhelmed with guilt when I realized I had been drinking with him the night before. To this day when I see his wife and children at the supermarket, I can't look them in the face. Within the next two months I lost three other friends t... ... we discussed in class the tradition among New England Puritans of looking in the face of the dead and reading their emotions to determine whether or not they were going to heaven. I've thought about this a lot since I've found God and I hope that it isn't true. Everyone I've known has died a horrible death. They were all cut down in the prime of their lives--face down in their own vomit, on the cold, dirty floor of a bathroom, decapitated in a car wreck, in a crowded AIDS ward in a city hospital. None of them had a chance to make their peace with God or with themselves for that matter. I'm sure none of them died looking content or peaceful but terrified and at best surprised. Therefore I would like to believe that hell is all that has gone on here in this life and that after the parting there is a heaven where those who suffered on earth are given a second chance.

Hard Cover vs. Hard Drive Essay -- Compare Contrast Writing Technology

Hard Cover vs. Hard Drive Will Electronic Publications Ever Replace the Book? At one time our world was strictly an oral culture. We recited stories, kept records stored in our memories. When writing was invented did we suddenly stop speaking to one another or remembering facts? Of course not. At any given moment we can recall, from memory, names, dates, and places that we have committed to memory. When the printing press was invented, did we stop writing by hand? Again, no. So, why would we stop reading a book just because we have access to the World Wide Web? All previous information technologies of language, rhetoric, writing and printing are technological in themselves (Landow 218). These technologies—writing, speaking, typing—may seem second nature, but given time so will the Web. There are reasons for choosing a book over the Internet. To make that choice, first you must ask yourself what material you want to read, and why you want to read it. Then you can more easily discover the best medium to read it on. "It appears that electronic publications are generally either read by different people than those who read printed works, or are used by them differently†¦or as compliments, but not competitors (Pang 344)." If I want driving directions, for example, I could pull out my atlas and look through the pages of roads I’ve never heard of and landmarks I have ever seen. Or, I could go to www.mapquest.com and simply type in my starting point and final destination and get exact directions and mileage along with a map of that specific area in a matter of seconds. This is just one instance where the web is the choice over a book. "A great many—perhaps most—books do not contain literature, the arts, history, or even... ... distinction, I’m not sure. Maybe I have more respect, even a sense of duty, to the classical writers. At any rate "the movement to embrace new technology will not be a movement from something natural or human to something artificial—from nature to technology," and George Landow puts it, "since writing and printing books are about as technological as one can be (Landow 219)." The World Wide Web has just given us a different forum to experience text we have come to love and depend on. Works Cited Tribble, Evelyn B. & Anne Trubek, ed. Writing Material: Readings from Plato to the Digital Age. New York: Longman, 2003. Landow, George, "Twenty Minutes into the Future, or How Are We Moving Beyond the Book?" Tribble & Trubek 214-26. Pang, Alex Soojung-Kim, "The Work of the Encyclopedia in the Age of Electronic Reproduction." Tribble & Trubek 343-51.

plotlear King Lear Essays: Importance of the Parallel Plot in King Lea

Importance of the Parallel Plot in King Lear Literature can be expressed using many different techniques and styles of writing, some very effective and others not as much. One of the methods chosen by many is the use of so called "parallel" plots. "Parallel" plots, or sometimes referred to as minor, give the opportunity of experiencing a secondary storyline going along with the main plot that otherwise would be unmentioned. William Shakespeare shows excellent use of a parallel plot in his play "King Lear", but some question it's essentiality by asking: Is it really necessary? Does it help the story or does it degrade it? Is the Gloucester's plot really needed? Many argue that it is very important and others say it is completely useless. This essay will try to prove that the parallel plot used in "King Lear" is needed and it adds to overall value of the play. Like any other kind of literature "King Lear" contains many themes; one of which is the "parent-child relationship" conflict. Relationship problems are very common, not only in novels but also in everyday life. Lear starts the entire dilemma of hate and destruction by his foolish desire for flattery. He divides his kingdom between two of his daughters and the never ending crave for power and wealth begins. As we can assume from the play's title, Lear and his daughters are part of the main plot. The plot of Gloucester and his sons, is considered parallel. Gloucester is portrayed also with family problems. He experiences trouble with his two sons, Edgar and... ...noring it would be negligent. It is a very important part of "King Lear" and it serves a great purpose. If William Shakespeare ignored the plot in the first place, his point would not be passed through at the level it is passed on now. I am sure Shakespeare knew it very well that Gloucester's character and actions help to understand the play better and improve it. The answer to many who question the parallel plot and it's presence is simple. The plot is necessary and without it, the play would not reach the position at which it stands right now. William Shakespeare was aware that by including the so called parallel plot, he was increasing the value of his own work. Gloucester's plot is one of the essential parts of the entire play. Removal or ignorance of it will diminish the significance of the entire idea.

Health Care Roles in Communication Essay

Elisabeth Kubler-Ross once said,† â€Å"We have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalized science in the service of prolonging life rather than diminishing human suffering.† In the health care field there are many roles that balance each other. Whether it is the doctor, patient, or medical assistant all play a vital role in the care of others. The purpose of this paper is to compare the differences in communication between the different roles in the hospital. This paper will also be providing an appropriate solution for the scenario provided. The scenario provided is about a young Asian girl named Lena. She was taken to the emergency room by her friend Susie after she fainted in class. Raised in a culture, which has made Lena independent, She verbally attacks her friend yelling about how she is not weak. When she tries to leave, Susie retrieves the medical assistant. The medical assistant restrains Lena and is then sent away by the doctor. The doctor tries to reason with Lena and explain why she is there, but gets no response from her. Finally, the doctor leaves to care for other patients. For this scenario I will be examining the role of the doctor first. From the perspective of the doctor, Lena is very stubborn. This doctor has to see dozens of patients a day and does not have time to argue with one patient who does not want to be there. A doctor’s time is precious, especially in the emergency room. Although the doctor sees many cases which are easy, such as a runny nose or a broken finger, there are many emergencies that require immediate attention. If there was a call for a doctor to assist in a patient from a major auto accident , this doctor may choose to put a fainting girl on the sideline to assist with the trauma. On the other hand, the doctor should still attempt to treat the patient to the best of his or her abilities in the short time allowed. There are other ways to gain  information regarding Lena’s situation, which will be discussed later. The medical assistant was the first medical professional to confront Lena after she woke up. From the tone of voice portrayed in the scenario, the medical assistant wanted to help the patient. The assistant rushed to the patient’s side, knowing she was very sick and needed medical attention. Unfortunately, Lena could not be reasoned with between the time the medical assistant arrived and the time the doctor walked in. The medical assistant was not given enough time to calm the patient or explain the situation. Susie seems concerned for her best friend’s health and safety. Even though Susie knows her friend has an independent attitude, there has to be a reason she brought Lena to the emergency room. Unless Lena had been sick for a while or had fainted before, there would be no cause for Susie to rush her to the hospital. Susie also shows her concern for Lena by rushing to get the attention of the medical assistant when Lena tries to leave. Susie must believe that Lena’s health is important enough to bring her to a place where she can get the medical help she needs to get better. Finally, there is Lena, the patient. Lena was brought up to be independent and strong. Many residents raised in Southeast Asia that find it hard to conform to western medicine. Even though Lena has lived in the United States for 10 years, which means she has spent the majority of life around the medicinal practices of her parents and her culture. As an example, if Lena is from Vietnam her knowledge of medicine would be vastly different (Schultz, 1980). In most areas of Vietnam, residents and medical practitioners steer away from prescription medicine and favor herbs instead. Eastern medicine relies heavily on the spiritual element in the human body as much as western medicine relies on the chemical makeup (Vietnam National Administration Of Tourism, 2010). If Lena was used to Vietnamese eastern medicine her reaction to being in the hospital is not surprising. Her idea of medicine may come in the form of a root instead of a bottle. Within the scenario are many complications with the communication between individuals. First, there is the confrontation between Lena and Susie. Lena  instantly blames Susie for taking her to the hospital. While Susie is her best friend and is the one sitting in the room with her, it may not have been Susie’s choice to send Lena to the emergency room. Because Lena fainted in class, it would be the responsibility of her instructor to make sure she was taken care of. The instructor’s reaction may have been to call the paramedics to make sure the student received proper medical attention. There would have been nothing Susie could have said to prevent the paramedics and medical professionals from making the decision to take Lena to see a doctor. Once at the hospital, Susie could have worked to calm her friend down before rushing to find the medical assistant to restrain her. She could have also provided some insight, to the doctor, regarding Lena’s recent medical problems leading to the fainting. This may have softened the doctor’s approach to Lena’s silence. While the medical professional was doing her job by keeping the patient in the hospital, extra empathy should have been given. The initial approach was rough and direct. Each patient should be given the same consideration regardless of the circumstances. Instead of verbally attacking Lena, the medical assistant should have approached Lena in a different manner. Being too direct will put the patient in a defensive position rather than a position to listen. When the medical assistant states she doesn’t have time to deal with Lena, it lowers the value of the patients worth as someone who needs care. It is like saying the person with a bloody nose should take priority over someone who has fainted and may have a serious underlying condition. Admonishing a patient and telling them they are sick is worthless. Lena knows she is sick. She just wants to prove she can cure herself without the interference of doctors. Had the medical assistant shown more empathy and expressed her understa nding of Lena’s situation it may have diffused the angry encounter. Many communication conflicts with the doctor in regard to everyone else in the room. First is the treatment of the medical assistant by the doctor. From the scenario we can see that the doctor was close behind the assistant as she came through the door. The medical assistant did not have enough time to do her job before the doctor told her to leave the room. Had the doctor  allowed the medical assistant to stay in the room it may have had a positive effect on the patient. If the doctor is a male, Lena may have felt uncomfortable around him and the presence of a female assistant may ease the worry. The doctor could have gained immeasurable information about Lena’s condition from Susie. Had the doctor questioned the best friend it could have revealed how long this had been going on and what other symptoms Lena had been exhibiting. Instead the doctor completely ignores Susie and turns attention to Lena. When the doctor tells Lena what is going on he does not pay attention to how, she is reacting, only that she is not answering the questions. The doctor makes the assumption that Lena is quite on purpose and leaves to go treat other patients. In the scenario are a few key points that the doctor missed and misinterpreted. Just like with the medical assistant, more care should have been given to calming Lena down instead of becoming defensive. By being understanding, the doctor would have caught the signs of something more serious going on with Lena’s health. The blank look on her face may not have given much away, depending on her age. Many people who look blank or vacant when someone is telling him or her about a topic they know little about. However, her eyes may have helped the doctor realize something serious was happening. A blank look may mean nothing, but a glassy eyed stare could mean something. Lena had started to sweat profusely. Most hospitals keep the complex cooler than normal to help stave off nausea and fever in most patients. The sweating, blank stare, and non-responsiveness could have signaled the doctor there was something worse than just fainting in Lena’s condition. With just the few symptoms exhibited in the scenario, Lena could be suffering anything from heat exhaustion to a deadly pulmonary embolism (WebMD, LLC, 2010). Last, there is the patient, Lena. Her lack of communication is born from family traditions that go back hundreds of years. Even so, Lena has lived in the United States for 10 years. It would be impossible for her to live in this country and go to school here without seeing a western medicine doctor. She could be used to smaller clinics; however, her reaction to the emergency room is unwarranted. The scenario made it seem as if Lena did not want to  talk to the doctor because she resented being in the hospital. Her outburst upon waking, and her non-responsiveness to the doctor, may have been a part of her illness. She might not have been aware of where she was by the time the doctor was through explaining her condition. An appropriate solution for the situation should be patience and empathy. The medical assistant and the doctor should have been more understanding toward the patient. There should have been compassion toward a young girl who was upset and confused. More attention to detail was needed by the doctor. Susie should have spoken up when Lena could not. Her information could help her friend from getting worse. Lena, having lived in the United States for 10 years, should have been willing to hear what the doctor had found before making the decision to leave. I have been in the customer service field for 13 years. From Banking, to telecommunication, to healthcare, the only factor that changes is the service provided. There will always be someone else who needs the attention of the representative. The key to communicating to a customer is empathy. Allowing a person to realize you understand their situation and showing a willingness to help, makes the difference. When you have a patient who is screaming and upset, you cannot take it personally. They are hurt, confused, and afraid. A caregiver cannot treat patients the same if they take everything personally. Lena was not yelling because she hated the assistant or the doctor. She was yelling because she did not think she was as sick as the doctor did. Both the doctor and the assistant treated Lena as if she were wasting their time, instead of looking at the situation rationally. In conclusion, communication all comes down to how a person handles customer service. Each role in this scenario is a tough one to have. First, the patient, who is full of fear and has been raised to think differently. Next, the best friend, who is afraid of losing her friend to illness but is too scared to speak up. Third, the assistant, who has many other patients to see. Last, the doctor, who is skilled in what he does, but fails to see the obvious signs of something worse. All of these roles are true, from day to day. They are in every hospital, clinic, and emergency room. There should be  more classes within medical schooling that teach caregivers how to show empathy and understanding to their patients. There should also be continuing education for all caregivers to refresh what they have been taught. References WebMD, LLC. (2010). WebMD Symptom Checker. Retrieved from http://symptoms.webmd.com/symptomchecker Vietnam National Administration Of Tourism. (2010). Vietnam Traditional Medicine. Retrieved from http://www.vietvisiontravel.com/vietnam/travel-guide/Traditional_medicine/ Schultz, S. L. (1980, August). Southeast Asian Health Beliefs and Practices. Education Resources Information Center

Iago Soliloquey Essay

Iago’s soliloquy essay At the end of the first act in scene three Iago convinces Roderigo to go to Cyprus. Roderigo then exits, leaving Iago alone. This gives him the chance to express his thoughts through a soliloquy. The purpose of this soliloquy is to show that Iago is always plotting and to show what his plan is. Shakespeare ends the first act with it to put the audience on edge and go into the second act knowing that something bad is going to happen. Before, in his conversation with Roderigo, Iago was speaking in prose. However, now, in his soliloquy, he speaks in verse. Shakespeare does this to demonstrate Iago’s intelligence and implies that Roderigo is not clever or of high intellectual status. If the audience had their doubts about Iago’s dislike of Othello then â€Å"I hate the Moor† dispels such doubts. This phrase has an immediate impact because in a soliloquy a character will not lie; in previous conversation the audience cannot be certain if the duplicitous Iago is telling the truth. So, for the first time he reveals that he hates Othello with a passion. Or, on the contrary, Iago might be trying to convince himself that he really does hate Othello, which implies that Iago doesn’t, and has no good reason to do so. â€Å"And it is thought abroad that twixt my sheets he’s done my office. I know not if’t be true†¦Ã¢â‚¬ ¦will do as if for surety† Here Iago does not know for sure if his wife is having an affair with Othello but will believe it because it serves his purpose. Again this supports the theory that Iago is trying to convince himself that he has a good reason to hate Othello when he actually doesn’t. Iago thinks that Othello is not suitable for Desdemona: â€Å"Cassio’s a proper man. † This implies that he thinks Cassio is more manly than Othello, and that people would be likely to believe in him as an adulterer. This also shows Iago to be racist because he thinks that a Moor is not a proper man. Later, he also describes Othello as gullible: â€Å"The Moor†¦ †¦thinks men honest that but seem to be so, And will as tenderly be led by the nose As asses are. † The phrase â€Å"let me see now† shows that Iago is already plotting; he creates a clever plan spontaneously, while thinking out loud. This is evidence that Iago is clever. His character is very duplicitous, scheming and, above all, spiteful. If anyone did anything to upset him he would take it too far. Iago says Othello is foolish and easily led: â€Å"And will as tenderly be led by the nose as asses are† This shows Othello is easily led as asses can be led by merely holding a tender part of the nose. Also this insults Othello calling him an â€Å"ass. † In Elizabethan times being compared to any kind of animal was considered insulting and rude, as then humans were considered the only proper race. In addition asses were considered to be stupid and comical. Thus comparing Othello to one is considered an insult. Furthermore, this implies that Iago knows that what he is doing is wrong and evil and yet he still goes through with it. This shows Iago to be evil. â€Å"I hate the moor† What did Othello do to him? He didn’t give Iago the job he wanted. Thus Iago decides to plot against him. This shows that Iago is spiteful and also jealous of Cassio (the man who got the job instead of him). â€Å"That he [Cassio] is too familiar with his [Othello] wife. this demonstrates that Iago is jealous because not only is he plotting against Othello but also against Cassio. Iago’s plan involves using Cassio’s status as a womaniser in order to get revenge. This could be perceived as jealousy of Cassio’s way with women, as well as creating a sense of poetic justice. To turn Cassio’s own success with women into a tool to bring him down shows Iago’s quick wit and cunning. This is also a shrewd method of dealing with two problems at once. The final rhyming couplet shows that Iago knows what he is doing is wrong: â€Å"Hell and night must bring this onstrous birth to the world’s light† The word â€Å"monstrous† was used by Iago to show that this plan is evil therefore he knows it is wrong and he shouldn’t do it. Also â€Å"hell and night† shows that this â€Å"birth† is worthy only to be delivered by Hell and night; both of which can be associated with evil, as in every religion good is represented by light and day, but bad is symbolized by dark and night. As Othello is black this could also be a reference to racism. By calling his idea a â€Å"birth† Iago is emphasising that it is his creation. This reveals that he is not ashamed by what he is about to do and that he might even be proud to lay claim to it. The soliloquy as a whole gives us many new insights into Iago’s character, intentions and abilities. It shows him to be deceitful, devious and intelligent; while the intended outcome of his plan reveals that he will stop at nothing to gain the success that he believes he has been cheated out of. Before this soliloquy, the audience may have suspected that his character was not as good as it seemed, but by the end of the act they can be in no doubt.

Capital Market Essay

~ Capital market is the market for leading and borrowing of medium and long term funds. ~ The demand for long-term funds comes from industry, trade, agriculture and government (central and state). ~ The supply for funds comes from individual savers, corporate savings, banks, insurance companies, specialized financial institutions and government. *SIGNIFICANCE: ~ A sound and efficient capital market is extremely vital for the economic development of a nation. ~ So, the significance of capital market has increased. ~ The following points clearly bring out the role and significance of capital market in India. i)CAPITAL FORMATION: ~ Capital market encourages capital formation as it ensures speedy economic development. The process of capital formation includes collection of saving effective mobilisation of these savings for productive investment. ~ Thus three distinctive inter-related activities i.e. collection of savings, mobilisation of savings and investment lead to capital formation in the country. ~ The volume of capital formation depend s on the efficiency and intensity with which these activities are carried on. ii) ECONOMIC GROWTH: ~ Capital market plays a vital role in the growth and development of an economy by channelising funds in developmental and productive investments. ~ The financial intermediaries channel funds into those investments that are more important for economic development. iii) INDUSTRIAL DEVELOPMENT: ~ Capital market promotes industrial development and motivates industrial entrepreneurship. ~ It provides cheap, adequate and diversified funds for industrial purposes such as expansion, modernisation, technological upgradation, establishment of new units, etc. ~ It also provides services like provision of underwriting facilities, participation in equity capital, credit-rating, consultancy services, etc. vi) MODERNISATION AND REHABILITATION OF INDUSTRIES: ~ Capital markets also contribute towards modernisation and rehabilitation of industries. ~ Developmental financial institutions like IDBI, IFCI, ICICI, etc provide finance to industries to adopt modern techniques and new upgraded machinery. ~ They also participate in the equity capital of industries. v) RIVIVAL OF SICK UNITS: ~ Commercial and financial institutions provide adequate funds to viable sick unit to overcome their industrial sickness. ~ Bank and FIs may also write off a part of the loan or re-schedule the loan to offer payment flexibility to weak units. vi) TECHNICAL ASSISTANCE: ~ The financial intermediaries in the capital market stimulate industrial entrepreneurship by providing technical and advisory services like preparation of feasibility reports, identifying growth potential, and training entrepreneurs in project management. ~ This promotes industrial investment and leads to economic development. vii) DEVELOPMENT OF BACKWARD AREAS: ~ Capital markets provide funds for projects in backward area and facilitate their economic development. ~ Long-term funds are also provided for development projects in backward / rural areas. viii) EMPLOYMENT GENERATION: ~ Capital markets provide Direct Employment in capital market related activities like stock markets, banks and financial institutions. ~ Indirect Employment is provided in all the sectors of the economy through various funds disbursed for developmental projects. ix) FOREIGN CAPITAL: ~ Capital markets make it possible to generate foreign capital by enabling Indian firms to raise capital from overseas market through bonds and other securities. ~ Such foreign exchange funds have a great impact on the economic development of the nation. ~ Moreover, foreign direct investments (FDIs) also bring in foreign capital as well as foreign technology that leads to greater economic development. x) DEVELOPMENT OF STOCK MARKETS: ~ Capital markets lead to development of stock markets by encouraging investors to invest in shares and debentures and to trade in stocks. ~ FIIs are also allowed to deal in Indian stock exchange. xi) FINANCIAL INSTITUTIONS: ~ Financial institutions play a major role in capital markets. ~ They provide medium / long term loan to industrial and other sectors and also undertake project feasibility studies and surveys. ~ They refinance commercial banks and rediscount their bills of exchange. ~ They provide merchant banking services. ~ They subscribe to equity capital of the firms. xii) INVESTMENT OPPORTUNITY: ~ Capital markets provide various alternative sources of investment to the people. ~ People can invest in shares and debentures of public companies and earn good returns. xiii) INVESTMENT IN INDUSTRIAL SECURITIES: ~ Secondary market in securities encourage investors to invest in industrial securities by providing facilities for continuous, regular and ready buying and selling of these securities. ~ This facilitates industries to raise substantial funds from various sectors of the economy. xiv) RELIABLE GUIDE TO PERFORMANCE: ~ Capital market serves as a reliable guide to the performance of corporate institutions. ~ It values companies accurately and thus promotes efficiency. ~ This leads to efficient resource allocation and economic development. *CONCLUSION: ~ Thus we can say that capital markets play a crucial role in the economic development of a nation. ~ A sound and efficient capital market is one of the most instrumental factors in the development of a nation.

Barriers of Research Utilization for Nurses

C L I N I C A L N U R S I N G IS S U E S Bridging the divide: a survey of nurses’ opinions regarding barriers to, and facilitators of, research utilization in the practice setting Alison Margaret Hutchinson BAppSc, MBioeth PhD Candidate, Victorian Centre for Nursing Practice Research, School of Nursing, University of Melbourne, Australia Linda Johnston BSc, PhD, Dip N Professor in Neonatal Nursing Research, Royal Children’s Hospital, Melbourne, and Associate Director, Victorian Centre for Nursing Practice Research, Melbourne, Australia Submitted for publication: 4 March 2003 Accepted for publication: 29 August 2003Correspondence: Alison M. Hutchinson School of Nursing University of Melbourne 1/723 Swanston St Carlton, VIC 3053 Australia Telephone: ? 61 3 8344 0800 E-mail: [email  protected] com H U T C H I N S O N A . M . & J O H N S T O N L . ( 2 0 0 4 ) Journal of Clinical Nursing 13, 304–315 Bridging the divide: a survey of nurses’ opinions regarding barriers to, and facilitators of, research utilization in the practice setting Background. Many researchers have explored the barriers to research uptake in order to overcome them and identify strategies to facilitate research utilization.However, the research–practice gap remains a persistent issue for the nursing profession. Aims and objectives. The aim of this study was to gain an understanding of perceived in? uences on nurses’ utilization of research, and explore what differences or commonalities exist between the ? ndings of this research and those of studies that have been conducted in various countries during the past 10 years. Design. Nurses were surveyed to elicit their opinions regarding barriers to, and facilitators of, research utilization.The instrument comprised a 29-item validated questionnaire, titled Barriers to Research Utilisation Scale (BARRIERS Scale), an eight-item scale of facilitators, provision for respondents to record additional barriers and /or facilitators and a series of demographic questions. Method. The questionnaire was administered in 2001 to all nurses (n ? 761) working at a major teaching hospital in Melbourne, Australia. A 45% response rate was achieved. Results. Greatest barriers to research utilization reported included time constraints, lack of awareness of available research literature, insuf? ient authority to change practice, inadequate skills in critical appraisal and lack of support for implementation of research ? ndings. Greatest facilitators to research utilization reported included availability of more time to review and implement research ? ndings, availability of more relevant research and colleague support. Conclusion. One of the most striking features of the ? ndings of the present study is that perceptions of Australian nurses are remarkably consistent with reported perceptions of nurses in the US, UK and Northern Ireland during the past decade. Relevance to clinical practice.If the use of res earch evidence in practice results in better outcomes for our patients, this behoves us, as a profession, to address issues surrounding support for implementation of research ? ndings, authority to 304 O 2004 Blackwell Publishing Ltd Clinical nursing issues Barriers to, and facilitators of, research utilization change practice, time constraints and ability to critically appraise research with conviction and a sense of urgency. Key words: barriers to research utilization, facilitators of research utilization, research dissemination, research implementation, research utilizationIntroduction and background For over 25 years research utilization has been discussed in the nursing literature with growing enthusiasm and amid increasing calls for the use of research ? ndings in practice. Additionally, the evidence-based practice movement, which emanated in the early 1990s (Evidence-Based Medicine Working Group, 1992) has highlighted the importance of incorporating research ? ndings into pra ctice. Furthermore, controversy surrounding the achievement of professional status has resulted in an increased awareness of the need for a research-based body of knowledge to underpin nursing practice.Gennaro et al. (2001, p. 314) contend: Using research in practice not only bene? ts patients but also strengthens nursing as a profession. If nursing is truly a profession, and not just a job or an occupation, nurses have to be able to continually evaluate the care they give and be accountable for providing the best possible care. Evaluating nursing care means that nurses also have to evaluate nursing research and determine if there is a better way to provide care. Twelve years prior, Walsh & Ford (1989) warned that the professional integrity of nursing was threatened by dependence upon experience-based practice.Similarly, Winter (1990, p. 138) cautioned that conduct of nursing practice in this manner is ‘the antithesis of professionalism, a barrier to independence, and a detrim ent to quality care. ’ Winter therefore, recommended that nurses ‘evaluate their status as research consumers, to identify problems in this area, and to develop means to better use research ? ndings’ (p. 138). Evidence-based practice, which should comprise the use of broad ranging sources of evidence, including the clinician’s expertise and patient preference (Sackett et al. , 1996), includes the use of research evidence as a subset (Estabrooks, 1999).Consistent with the classi? cation of knowledge utilization, three types of research use have been outlined (Stetler, 1994a,b; Berggren, 1996). The ? rst is described as ‘instrumental use’ and involves acting on research ? ndings in explicit, direct ways, for example application of research ? ndings in the development of a clinical pathway. The second is termed ‘conceptual use’ and involves using research ? ndings in less speci? c ways, for example changing thinking. The ? nal type o f research use, described as ‘symbolic use’, involves the use of research results to support a predetermined position.The nursing literature is replete with examples of limited use of research in practice and discussion surrounding perceived barriers to research utilization (Hunt, 1981; Gould, 1986; Closs & Cheater, 1994; Lacey, 1994). Despite this, the phenomenon of the research–practice gap, the gap between the conduct of research and use of that research in practice, remains an issue of major importance for the nursing profession. Many researchers have explored the barriers to research uptake in order to overcome them and identify strategies to facilitate research utilization (Kirchhoff, 1982; MacGuire, 1990; Funk et al. 1991a,b, 1995b; Closs & Cheater, 1994; Hicks, 1994, 1996; Lacey, 1994; Rizzuto et al. , 1994; Hunt, 1996; Walsh, 1997a,b). Hunt (1981) suggested that nurses fail to utilize research ? ndings because they do not know about them, do not understa nd them, do not believe them, do not know how to apply them, and are not allowed to use them. According to Hunt (1997), the barriers to research utilization and, therefore, to evidence-based practice fall into ? ve main categories: research, access to research, nurses, process of utilization and organization.Self-reported utilization of research is one method that has frequently been implemented to elicit the extent of research utilization. Responses to selected research ? ndings have been used to elicit and explore respondents’ awareness and use of respective ? ndings (Kete? an, 1975; Berggren, 1996). Numerous researchers have also undertaken to investigate, through self-reporting, the opinions of nurses’ in regard to barriers to research utilization in the practice setting. Funk et al. (1991b) explored research utilization in the US using a postal questionnaire titled the Barriers to Research Utilization Scale (BARRIERS Scale).Their purpose was to develop a tool to a ssess the perceptions of clinicians, administrators and academics in regard to barriers to research utilization in clinical practice. Rogers’ (1995) model of ‘diffusion of innovations’, a theoretical framework, which describes the process of communication, through certain channels within a social network, of an idea, practice or object over time, was used to develop a 29-item scale. The questionnaire was sent out to a random sample of 5000 members of the American Nurses’ Association with a resulting response rate of 40%. 305O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304–315 A. M. Hutchinson and L. Johnston On the data generated, Funk et al. (1991b) undertook an exploratory factor analysis, to elicit a four-factor solution which closely corresponded with Rogers’ (1995) ‘diffusion of innovations’ model. The factors translated into characteristics of the adopter comprising the nurse’s research values, s kills and awareness; the organization incorporating setting barriers and limitations; the innovation including qualities of the research; and communication including accessibility and presentation of the research.Items associated with the clinical setting, a characteristic of the organization, were perceived as the main barriers to research utilization. These included the views that nurses lack suf? cient authority to implement change; nurses have insuf? cient time to implement change; and there is a lack of cooperation from medical staff. Approximately 21% of the respondents in this study were classi? ed as administrators. Over three quarters of the items on the BARRIERS Scale were rated as great or moderate barriers by over half the administrators. The administrators identi? d factors relating to the nurse, the organizational setting and the presentation of research among the greatest barriers. Overall, they cited the organizational setting as the greatest barrier to research use. Approximately 46% of the respondents were classi? ed as clinicians (nurses working in the clinical setting). The clinicians overwhelmingly identi? ed factors associated with the organizational setting as being the greatest barriers to research utilization. They rated all eight factors associated with the setting in the top 10 barriers to research utilization.The clinicians rated perceived ‘lack of authority to change patient care procedures’, ‘insuf? cient time on the job to implement new ideas’ and being ‘unaware of the research’ as the top three barriers to research utilization. The BARRIERS Scale (Funk et al. , 1991b) has been used extensively since it was developed in 1991, as one method to explore the perceived in? uences on nurses’ utilization of research ? ndings in their practice. At least 17 studies that employed the BARRIERS Scale to elicit opinions of nurses regarding barriers to research utilization in practice have been rep orted in the nursing literature.Most studies reported the barriers in ranked order according to the percentage of respondents who rated items as moderate or great barriers. Insuf? cient time to read research and/or implement new ideas was rated in the top three barriers in 13 studies (Funk et al. , 1991a, 1995a; Carroll et al. , 1997; Dunn et al. , 1997; Lewis et al. , 1998; Nolan et al. , 1998; Rutledge et al. , 1998; Retsas & Nolan, 1999; Closs et al. , 2000; Parahoo, 2000; Retsas, 2000; Grif? ths et al. , 2001; Marsh et al. , 2001; Parahoo & McCaughan, 2001).A perceived lack of authority to change patient care procedures was reported in the top three barriers in eight studies (Funk et al. , 1991a; Walsh, 1997a; Nolan 306 et al. , 1998; Closs et al. , 2000; Parahoo, 2000; Retsas, 2000; Marsh et al. , 2001; Parahoo & McCaughan, 2001). In eight studies, the item ‘statistical analyses are not understandable’, was cited in the top three barriers (Funk et al. , 1995b; Dunn et al. , 1997; Walsh, 1997a,b; Rutledge et al. , 1998; Parahoo, 2000; Grif? ths et al. , 2001; Marsh et al. , 2001). ‘Inadequate facilities for implementation’ was cited in the top three barriers in ? e studies (Kajermo et al. , 1998; Nolan et al. , 1998; Retsas, 2000; Grif? ths et al. , 2001; Marsh et al. , 2001). Finally, the item ‘lack of awareness of research ? ndings’ was reported in the top three barriers in four studies (Funk et al. , 1991a, 1995a; Carroll et al. , 1997; Lewis et al. , 1998; Retsas & Nolan, 1999). It is acknowledged that these studies comprised varying populations of nurses, employed differing sampling methods, used sample sizes ranging from 58 to 1368 respondents and resultant response rates ranged from 27 to 76%.In some studies, minor rewording of a limited number of items in the tool had been undertaken. Furthermore, some studies included only 28 of 29 barrier items included in the original BARRIERS Scale. Factor analysis, a stat istical technique aimed at reducing the number of variables by grouping those that relate, to form relatively independent subgroups (Crichton, 2001; Tabachnick & Fidell, 2001), was undertaken in a limited number of these studies. In the UK, Dunn et al. (1997) tested the factor model proposed by Funk et al. (1991b), using con? rmatory factor analysis, a complex statistical technique used to test a heory or model (Tabachnick & Fidell, 2001). Attempts to load each item onto a single identi? ed factor were found to be unsuccessful and they concluded that the US model was inappropriate for their data. Closs & Bryar (2001) further explored the appropriateness of the BARRIERS Scale for use in the UK through exploratory factor analysis. The model identi? ed included the following four factors: bene? ts of research for practice, quality of research, accessibility of research, and resources for implementation. Finally, Marsh et al. (2001) tested, using con? matory factor analysis, a revised v ersion of the BARRIERS Scale. The revision comprised minor changes in wording such as substitution of the term ‘administrator’ with the term ‘manager’. A factor structure that was not possible to interpret resulted and they concluded that the model proposed by Funk et al. (1991b) was not supported and had limited subscale validity in the UK setting. In the light of these ? ndings and those of Dunn et al. (1997), Marsh et al. (2001) suggested that the factor model arising from the original BARRIERS Scale was not sustained in the international context.However, in Australia, Retsas & Nolan (1999) undertook an exploratory factor analysis resulting in a three-factor solution comprising: (i) nurses’ perceptions about the usefulness of research in O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304–315 Clinical nursing issues Barriers to, and facilitators of, research utilization clinical practice, (ii) generating change to practice based on research, and (iii) accessibility of research. Again, in Australia, a four-factor solution arose from another exploratory factor analysis undertaken by Retsas (2000).The resulting factors were conceptualized as: accessibility of research ? ndings, anticipated outcomes of using research, organizational support to use research, and support from others to use research. Given these ? ndings in the Australian context, an exploratory factor analysis was employed in the present study to explore what model would arise from data generated using the BARRIERS Scale. The aim of the present study was to gain an understanding of perceived in? uences on nurses’ utilization of research in a particular practice setting, and explore what differences or commonalities exist between the ? dings of this research and those of studies which have been conducted during the past 10 years in various countries around the world. This study was undertaken as part of a larger study designed to exp lore the phenomenon of research utilization by nurses in the clinical setting. The relative importance of barrier and facilitator items and the factor model arising from this data will in? uence development of future stages of this larger study. who then took responsibility for distribution. It cannot be guaranteed, however, that this process in fact resulted in all nurses receiving the questionnaire.The questionnaire included the 29-item BARRIERS Scale in addition to an eight-item facilitator scale and a series of demographic questions. The respondents were asked to return completed questionnaires in the self-addressed envelope supplied, by either placing them in the internal mail or placing them in the ‘return’ box supplied in their ward or department. Return of completed questionnaires implied consent to participate and all responses were anonymous. Setting The setting for this study was a 310-bed major teaching hospital offering specialist services in Melbourne, Aus tralia. SampleApproximately 960 nurses work in the organization. All Registered Nurses working during the 4-week distribution time frame were invited to complete the questionnaire. This self-selecting, convenience sample therefore, excluded nurses on leave at the time of the study. The study The research question addressed in this study was: What are nurses’ perceptions of the barriers to, and facilitators of, research utilization in the practice setting? Instrument The questionnaire comprised three sections. The ? rst section contained the 29 randomly ordered items from the Barriers to Research Utilization Scale (Funk et al. 1991b), which respondents were asked to rate, on a four-point Likert type scale, the extent to which they believed each item was a barrier to their use of research in practice. The options included 1 ? ‘to no extent’, 2 ? ‘to a little extent’, 4 ? ‘to a moderate extent’ and 5 ? ‘to a large extent’. A â €˜no opinion’ ? 3 option was also given. The respondents were then asked to nominate and rate (1 ? greatest barrier, 2 ? second greatest barrier, and 3 ? third greatest barrier) the items they considered to be the top three barriers.Further to this, the respondents were given the opportunity to list and rate, according to the above-mentioned Likert scale, any additional items they perceived to be barriers. The second section of the survey contained eight items (Table 4), which respondents were asked to rate according to the extent to which they considered them to be a facilitator of research utilization using the Likert scale described above. The respondents were also asked to nominate and rate, from 1 to 3, the items they considered to be the three greatest facilitators of research utilization.Again, the respondents were given the opportunity to list and rate, according to the 307 Method A survey design was chosen to elicit opinions of nurses. This method was selected bec ause the ‘BARRIERS Scale’, a validated questionnaire, based on the work of Funk et al. (1991b), and designed to elicit nurses’ views about barriers to, and facilitators of, research utilization in their practice, was found to have high reliability. Approval to use the tool was gained from the authors. Permission was also given to include questions crafted by the investigators to elicit nurses’ opinions about facilitators of research utilization.Approval to conduct the project was sought and granted by the hospital research ethics committee to ensure the rights and dignity of all respondents were protected. Nurses working during the 4-week survey distribution time frame (n ? 761) were invited to complete the self-administered questionnaire. It was intended that every nurse receive a personally addressed envelope containing the questionnaire and a self-addressed return envelope. To facilitate this, the envelopes were hand delivered to a nominated nurse on ea ch ward or department O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304–315A. M. Hutchinson and L. Johnston Likert scale, perceived facilitators not listed in the survey. Section 3 of the survey included a series of demographic questions. Validity Content validity, i. e. whether the questions in the tool accurately measure what is supposed to be measured (LoBiondo-Wood & Haber, 1998), of the instrument was supported by the literature on research utilization, the research utilization questionnaire developed by the Conduct and Utilization of Research in Nursing Project (Crane et al. , 1977), and data gathered from nurses. Input was also gained from experts in the ? ld of research utilization, nursing research, nursing practice and a psychometrician to establish face validity, i. e. whether the tool appears to measure the concept intended (LoBiondo-Wood & Haber, 1998), and content validity from an extensive list of potential items. Those items for which face and content validity were established were retained. Further to piloting of the instrument, two additional items were included and some minor rewording of other items resulted. The BARRIERS Scale has been found to have good reliability, with Cronbach’s alpha coef? ients of between 0. 65 and 0. 80 for the four factors, and item-total correlations from 0. 30 to 0. 53 (Funk et al. , 1991b). Cronbach’s alpha is a measure of internal consistency, which is related to the reliability of the instrument. A Cronbach’s alpha of †¡0. 7 is considered to be good. Internal consistency is the extent to which items in the scale measure the same concept (LoBiondo-Wood & Haber, 1998). Item total correlations refer to the relationship between the question or item and the total scale score (LoBiondo-Wood & Haber, 1998). Data analysisData analysis was performed using Statistical Package for the Social Sciences (version 10. 0; SPSS Inc. , Chicago, IL, USA) software. Frequency and descriptive statistics were employed to describe the demographic characteristics of respondents. Analysis of these data indicated that a wide cross section of nursing staff responded to the questionnaire. Factor analytic procedures were employed to reduce the 29 barrier items to factors. The ‘no opinion’ responses (coded to be in the centre of the scale) were included in the factor analytic procedure, on the basis of statistical advice.Suitability of the data for undertaking factor analysis is determined by testing for sampling adequacy and sphericity. The Kaiser–Meyer–Olkin Measure of Sampling Adequacy at 0. 83 was in excess of the recommended value of 0. 6 (Kaiser, 1974), indicating that the 308 correlations or factor loadings, which re? ect the strength of the relationship between barrier items, were high. The Bartlett test of sphericity at 2118. 3 was statistically signi? cant (P < 0. 001). On the basis of these results, factor analysis was considered appropriate.The factor analysis method employed consisted of principal component analysis (PCA), a method of reducing a number of variables (barrier items) to groupings to aid interpretation of the underlying relationships between the variables (Crichton, 2000) whilst capturing as much of the variance in the data as possible. PCA revealed eight components with an eigenvalue exceeding one, indicating that up to eight factors could be retained in the ? nal factor solution. Inspection of the scree plot, a plot of the variance encompassed by the factors, failed to provide a clear indication for the number of factors to include.Eight factors were considered too many to be meaningful, thus factor solutions from two to seven factors were explored. A solution comprising four factors was considered most meaningful. Examination of the factor loadings was then undertaken to determine which items belonged to each factor. Consistent with the procedure employed by Funk et al. (1991b), items were considered to have loaded if they had a factor loading of 0. 4 or more. Varimax rotation, a statistical method employed to simplify and aid interpretation of factors, was then applied.Whilst factor analysis assists in reducing the number of variables to groupings and aids in interpretation of the underlying structure of the data, it does not identify the relative importance of individual items. Thus, while one factor may account for the largest amount of variance in the factor solution it does not mean that the items within that factor are the greatest barriers to research utilization. In order to determine the relative signi? cance of each barrier item, the number of respondents who reported them as a moderate or great barrier was calculated and items were ranked accordingly.Additional barriers recorded by participants were grouped thematically. Similarly, to determine the relative signi? cance of each facilitator item, the number of respondents who reported them as a moderate or great facilitator was calculated and items were ranked accordingly. Additional facilitators recorded by participants were grouped thematically. Results Demographics A total of 317 nurses returned the questionnaires, representing a 45% response rate, assuming that all nurses did, in fact, receive a personally addressed envelope. The age range of respondents was 43 years (minimum ? 1 years, O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304–315 Clinical nursing issues Barriers to, and facilitators of, research utilization maximum ? 64 years) while the range in years since registration was 42 years. The demographic characteristics of the nurses (Table 1) were consistent with those of the State of Victoria’s nursing workforce (The Australian Institute of Health and Welfare, 1999). Factor analysis A four-factor solution was selected as the most appropriate model arising from PCA of the 29 barrier items. This accounted for 39. % of the total variance in re sponses to all barrier items. The factor groupings including the loading for each barrier item and the titles allocated to each factor are included in Table 2. According to the correlation coef? cient or factor loading measure of †¡0. 4, two items, ‘research reports/articles are not published fast enough’, and ‘the research has not been replicated’, failed to load on any of the four factors. Table 1 Nurse demographics (n ? 317) Variable Gender Male Female Missing Age (years) Experience Registered Nurse (years) Clinical experience (years) Years since most recent quali? ation Highest quali? cation Division 2 certi? cate for registration Division 1 hospital certi? cate for registration Tertiary diploma/degree for registration Specialist nursing certi? cate Graduate diploma Masters by coursework Masters by research Others (including education and management quali? cations) Missing Principle job function Clinical Administrative Research Education Others Mis sing Research experience Yes No Missing N (%) Mean (SD) 24 (7. 6) 291 (91. 8) 2 (0. 6) 33. 8 (9. 73) 12. 6 (9. 95) 11. 35 (8. 8) 4. 28 (6. 52) 14 (4. 4) 23 (7. 3) 104 (32. 8) 26 34 9 1 87 (8. 2) (10. 7) (2. 8) (0. 3) (27. ) Factor 1, comprising eight items with loadings of 0. 73 to 0. 43, includes items relating to characteristics of the organization that in? uence research-based change. Eight items loaded onto factor 2 with loadings of 0. 66 to 0. 40. These items are associated with qualities of research and potential outcomes associated with the implementation of research ? ndings. Factor 3 with seven items loading 0. 60 to 0. 41, relates to the nurse’s research skills, beliefs and role limitations. Factor four refers to communication and accessibility of research ? ndings onto which ? ve items loaded 0. 67 to 0. 42.The four factor groupings comprising setting, nurse, research and presentation, generated in the US study 10 years ago (Funk et al. , 1991b), were similar to gr oupings that arose from factor analysis in the present study (Table 2). Cronbach’s alphas were calculated for each factor generated. For factors 1–3 the alpha coef? cients were 0. 75, 0. 74 and 0. 70, respectively, demonstrating good reliability. The alpha coef? cient for factor 4 was lower at 0. 54. The total scale alpha was 0. 86, which indicates that the scale can be considered reliable with this sample. Item-total correlations ranged from 0. 1 to 0. 60. Although a low correlation between some items and the total score was evident, deleting any of these items would have resulted in a reduction in reliability of the scale. Relative importance of barrier and facilitator items The percentages of items perceived by nurses’ as great or moderate barriers are summarized in Table 3. The respondents were also given the opportunity to list and rate any additional perceived barriers not included in the questionnaire. About 27% (85) of respondents documented a total of 1 74 barriers. However, analysis revealed that only 11% (36) of respondents actually identi? d additional barriers. The remainder had reiterated or reworded barrier items already included in the tool. The additional barrier items listed by respondents were grouped into themes, which included funding, organizational commitment, research training, implementation strategy and professional responsibility. The percentages of items perceived by nurses’ as great or moderate facilitators are summarized in Table 4. The respondents were also given the opportunity to list and rate additional perceived facilitators. Eighteen per cent (57) of respondents took the opportunity to record a total of 90 facilitators. Of these, 7. % (24) actually identi? ed additional facilitators whereas the remainder had rephrased or repeated items already included in the tool. Consistent with the themes identi? ed for the additional barriers were funding, organizational commitment, active participation in rese arch 309 19 (6. 0) 252 28 6 10 15 6 (79. 5) (8. 8) (1. 9) (3. 2) (4. 7) (1. 9) 207 (65. 3) 105 (33. 1) 5 (1. 6) O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304–315 A. M. Hutchinson and L. Johnston Table 2 BARRIERS Scale factors and factor loadings US factor groupings Factor loadings Communalities Factor 1 Factor 2 Factor 3 Factor 4Barrier item Factor 1: Organizational in? uences on research-based change Physician will not cooperate with implementation Administration will not allow implementation The nurse does not feels she/he has enough authority to change patient care procedures The facilities are inadequate for implementation Other staff are not supportive of implementation The nurse feels results are not generalizable to own setting The nurse is unwilling to change/try new ideas Factor 2: Qualities of the research and potential outcomes of implementation The research has methodological inadequacies The literature reports con? cting results The conclu sions drawn from the research are not justi? ed The research is not relevant to the nurse’s practice The nurse is uncertain whether to believe the results of the research The research is not reported clearly and readably Statistical analyses are not understandable The nurse feels the bene? ts of changing practice will be minimal Factor 3: Nurses’ research skills, beliefs and role limitations The nurse sees little bene? for self The nurse does not feel capable of evaluating the quality of the research There is not a documented need to change practice The nurse does not see the value of research for practice The amount of research information is overwhelming The nurse is isolated from knowledgeable colleagues with whom to discuss the research There is insuf? cient time on the job to implement new ideas Factor 4: Communication and accessibility of research ? dings Research reports/articles are not readily available Implications for practice are not made clear The nurse is unaware of the research The relevant literature is not compiled in one place The nurse does not have time to read research Setting Setting Setting Setting Setting Setting Nurse 0. 55 0. 52 0. 42 0. 42 0. 34 0. 39 0. 36 0. 73 0. 71 0. 56 0. 54 0. 53 0. 49 0. 43 0. 09 0. 10 0. 06 0. 11 0. 17 0. 30 0. 01 A0. 02 A0. 01 0. 31 A0. 04 0. 19 0. 23 0. 41 0. 09 A0. 04 0. 05 0. 33 0. 02 0. 01 A0. 09 Research Research Research Presentation Research Presentation PresentationNurse 0. 46 0. 38 0. 44 0. 43 0. 46 0. 33 0. 33 0. 46 0. 17 0. 11 0. 11 0. 22 0. 27 0. 11 A0. 04 0. 36 0. 66 0. 59 0. 57 0. 55 0. 53 0. 49 0. 47 0. 40 0. 03 0. 12 0. 30 A0. 13 0. 32 0. 18 0. 03 0. 38 0. 00 0. 04 A0. 05 0. 25 0. 07 0. 19 0. 32 A0. 14 Nurse Nurse Nurse Nurse * Nurse Setting Presentation Presentation Nurse Presentation Setting 0. 57 0. 45 0. 35 0. 55 0. 29 0. 31 0. 38 0. 45 0. 47 0. 33 0. 25 0. 31 0. 23 A0. 04 A0. 04 0. 15 0. 05 0. 31 0. 28 0. 01 0. 06 A0. 04 0. 13 0. 22 0. 39 0. 26 0. 14 0. 47 A0. 01 0. 11 A0. 17 0. 00 0. 31 0. 09 0. 3 A0. 14 0. 60 0. 58 0. 57 0. 55 0. 51 0. 42 0. 41 0. 00 A0. 09 0. 16 0. 13 0. 26 0. 04 0. 21 0. 09 A0. 04 0. 15 0. 16 0. 31 0. 67 0. 60 0. 54 0. 45 0. 42 Two items, ‘research reports/articles are not published fast enough’ and ‘the research has not been replicated’, did not load at the 0. 4 level in this analysis. *The item, ‘the amount of research information is overwhelming’ failed to load on any factor in the Funk et al. model. process – experience, strategy to ensure project completion, implementation strategies, and professional attitude.Discussion The present study generated a four-factor solution with similarities to that produced in the US by Funk et al. (1991b) and in the UK by Closs & Bryar (2001). The ? rst factor comprises characteristics of the organization and re? ects health professional and other resource support for change 310 associated with the implementation of research ? ndings. More broadly , the theme ‘organizational commitment’ identi? ed following analysis of the additional perceived barriers listed by respondents, appears to be associated with this factor.Organizational commitment, many respondents felt, would facilitate mobilization of resources to promote change. Factor 2 relates to qualities of research and potential outcomes associated with the implementation of research ? ndings. This factor re? ects the nurse’s reservations about reliability and validity of research ? ndings and conclusions, O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304–315 Clinical nursing issues Table 3 BARRIERS Scale items in rank order Barriers to, and facilitators of, research utilization Barrier items The nurse does not have time to read research There is insuf? ient time on the job to implement new ideas The nurse is unaware of the research The nurse does not feel she/he has enough authority to change patient care procedures Statistica l analyses are not understandable The relevant literature is not compiled in one place Physicians will not cooperate with the implementation The nurse does not feel capable of evaluating the quality of the research The facilities are inadequate for implementation Other staff are not supportive of implementation Research reports/articles are not readily available The nurse feels results are not generalizable to own setting The amount of research information is overwhelming Implications for practice are not made clear The research is not reported clearly and readably The research has not been replicated The nurse is isolated from knowledgeable colleagues with whom to discuss the research Administration will not allow implementation The research is not relevant to the nurse’s practice The literature reports con? icting results The nurse feels the bene? s of changing practice will be minimal The nurse is uncertain whether to believe the results of the research Research reports/ar ticles are not published fast enough The nurse is unwilling to change/try new ideas The research has methodological inadequacies The nurse sees little bene? t for self There is not a documented need to change practice The nurse does not see the value of research for practice The conclusions drawn from the research are not justi? ed Reporting item as moderate or great barrier (%) 78. 3 73. 8 66. 2 64. 7 64. 1 58. 7 56. 1 55. 8 52 52 50. 8 50. 8 45. 7 45. 5 43. 3 41. 3 41 35 34. 4 34 31. 9 30. 9 30. 6 29. 4 25. 5 23. 3 22. 1 17 13. 8 Item mean score (SD) 4. 06 3. 9 3. 64 3. 51 3. 56 3. 51 3. 41 3. 3 3. 23 3. 16 3. 19 3. 09 3. 07 3. 0 3. 01 3. 16 2. 76 2. 88 2. 67 2. 87 2. 52 2. 58 2. 81 2. 34 2. 85 2. 25 2. 27 1. 9 2. (1. 21) (1. 3) (1. 4) (1. 39) (1. 32) (1. 26) (1. 33) (1. 39) (1. 3) (1. 29) (1. 35) (1. 26) (1. 35) (1. 22) (1. 25) (1. 14) (1. 49) (1. 18) (1. 28) (1. 11) (1. 3) (1. 29) (1. 21) (1. 34) (1. 0) (1. 26) (1. 24) (1. 21) (1. 02) Responding ‘no opinion’ or non- response (%) 0. 9 1. 6 1. 6 0. 9 3. 8 13 7. 6 3. 5 8. 8 6. 3 6. 3 3. 5 6. 9 5 8. 2 26. 1 3. 8 19. 6 4. 4 18. 9 3. 5 4. 7 25. 2 2. 2 32. 5 3. 5 8. 5 1. 6 21 Table 4 Facilitator items in rank order Reporting item as moderate or great facilitator (%) 89. 6 89. 5 84. 8 82. 3 82. 0 81. 4 81. 3 78. 2 Number (%) responding ‘no opinion’ or non-response 8 (2. 5) 6 9 6 10 (1. 8) (2. 8) (1. 8) (3. 2)Facilitator item Increasing the time available for reviewing and implementing research ? ndings Conducting more clinically focused and relevant research Providing colleague support network/mechanisms Advanced education to increase your research knowledge base Enhancing managerial support and encouragement of research implementation Improving availability and accessibility of research reports Improving the understandability of research reports Employing nurses with research skills to serve as role models Item mean score (SD) 4. 52 (0. 93) 4. 39 4. 21 4. 11 4. 15 (0. 94) (1. 02) (1. 13) (1. 08) 4. 12 (1. 11) 4. 16 (1. 1) 4. 04 (1. 22) 5 (1. 5) 8 (2. 5) 9 (2. 9)O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304–315 311 A. M. Hutchinson and L. Johnston in addition to bene? ts of use of ? ndings in practice. Factor 3 focuses on characteristics of the nurse. In particular, this factor is associated with the nurse’s beliefs about the value of research and their research skills, in addition to the limitations of their role. The fourth factor is concerned with characteristics of communication. The focus of this factor centres on access to research ? ndings and understanding of the implications of ? ndings. The issues encompassed within this factor re? ect organizational barriers to access, and research presentation barriers.These factors are congruent with the concepts characterized in Rogers’ (1995) model of ‘diffusion of innovations’, including characteristics of the adopter, organization, innovation and communication , on which the BARRIERS Scale was developed. Two barrier items, ‘research reports/articles are not published fast enough’ and ‘the research has not been replicated’, failed to load suf? ciently onto a factor and were subsequently discarded. Exclusion of these items from the model re? ects their minimal signi? cance in relation to the underlying dimensions of the factors. That these items were ranked 23 and 16, respectively, is not surprising because they become less relevant when there is a perceived lack of time to read research and implement change as re? cted in the top two nominated barriers to research utilization. It is also important to note that over one quarter of respondents selected the ‘no opinion’ option or failed to respond to both of these items, which further suggests their lack of importance to respondents. The majority of respondents in this study rated approximately 40% of the barriers items as moderate or great barriers. Thi s is compared with the majority of nurse clinicians in the US (Funk et al. , 1991a) and nurses in the UK (Dunn et al. , 1997), who rated about 65% of the barrier items as moderate or great barriers. Overall, this group of Australian nurses perceived there to be fewer barriers to esearch utilization than their colleagues in the UK or US, with a mean score of 43. 7% of respondents rating all the barriers as moderate or great. In the UK (Walsh, 1997a) and the US (Funk et al. , 1991a) mean scores of 59. 8 and 55. 7%, respectively, re? ect the proportion of respondents who rated all barriers as moderate or great. Possible in? uences such as time, population, nursing education programmes should be acknowledged when considering these comparisons. Content analysis of the data comprising additional perceived barriers elicited ? ve new themes respondents associated with barriers to research utilization. Revision of the instrument to re? ect the themes identi? d and changes that have occurred over the past 10 years may be warranted to achieve a more valid scale for the setting in which it was used in this study. The addition of items consistent with changes in the availability of technological resources, information availability and use, and education may enhance the content validity of the scale. The ranking of perceived barriers in practice resulting from this study showed considerable consistency with rankings reported in other studies, as previously discussed. The top three barriers reported in 12 other studies fell within the top 10 barriers identi? ed in this study. Furthermore, two of the top three barriers in an additional two studies fell within the top 10 barriers identi? ed in the present study. The barrier item ‘there is insuf? ient time on the job to implement new ideas’ was reported within the top three barriers in 13 studies, including this and another Australian study (Retsas, 2000). When Spearman’s rank order correlation coef? cients were generated to compare the rank ordering of perceived barriers, a strong positive correlation between this and several other studies was evident (Table 5). Whilst acknowledging differences in nursing populations, sample size, sampling methods, response rates, and minor variations in item wording and number, this suggests a large degree of consistency regarding Study Funk et al. (1991a) Funk et al. (1995a) Dunn et al. (1997) Rutledge et al. (1998) Lewis et al. (1998) Kajermo et al. (1998) Retsas & Nolan (1999) Parahoo (2000) Retsas (2000) Closs et al. 2000) Parahoo & McCaughan (2001) Grif? ths et al. (2001) Location USA USA UK USA USA Sweden Australia Northern Ireland Australia UK Northern Ireland UK r 0. 866 0. 779 0. 835 0. 816 0. 879 0. 719 0. 884 0. 837 0. 801 0. 762 0. 799 0. 912 P 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 Coef? cient of determination (%) 75 61 70 66 77 52 78 70 64 58 64 83 Table 5 Barrier rank order correlations 312 O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304–315 Clinical nursing issues Barriers to, and facilitators of, research utilization nurses’ perceptions of the relative importance of the barrier items. Marsh et al. 2001) however, caution against international comparisons with the original US data because changes in nursing education and roles, technology, funding and collaboration with other disciplines since then, may invalidate such comparisons. Nonetheless, despite these changes, the ? ndings of the present study have consistencies with not only the US data of 1991 but also more recent studies in the US, UK, Sweden, Northern Ireland and Australia (Table 5). Thus, notwithstanding the increasing momentum of the evidence-based practice movement in recent years, the pursuit of professional status by the nursing profession, the move of nursing education to the tertiary sector, increased access to systematic reviews and research databases, the research – practice gap persists.In the light of the plethora of research and theoretical literature on the research–practice gap and issues surrounding research utilization, it is of concern that nurses’ perceptions of the barriers to research utilization appear to remain consistent. In particular, issues surrounding support for implementation of research ? ndings, authority to change practice, time constraints and ability critically to appraise research continue to be perceived by nurses as the greatest barriers to research utilization. This raises important questions. Firstly, do such perceptions re? ect the reality of contemporary nursing? Or rather, do they represent unchallenged, traditionally held and ? rmly entrenched beliefs, which are founded on an understanding of nursing in a socio-historic context that is no longer relevant? If such perceptions do, in fact, re? ct the reality of current day nursing practice, despite the changes and progress that have been ma de in health care and nursing over the last decade, it behoves us, as a profession, to address the issues related to time, authority, support and skills in critical appraisal with conviction and a sense of urgency. Contextual issues including the socio-political environment, organizational culture and interprofessional relations need to be taken into serious consideration when exploring and formulating potential strategies to overcome these barriers. The hospital in which this study was conducted has since undertaken to explore and develop strategies to address and overcome barriers to, and reinforce and strengthen facilitators of research utilization highlighted in the ? ndings. ther studies using the BARRIERS Scale, may re? ect a response bias. That is, nurses with a positive attitude to research may have been more likely to complete the questionnaire. Internal consistency, the extent to which items in the scale measure the same concept (LoBiondo-Wood & Haber, 1998), of the tool w as reasonable, although not as high as that reported by Funk et al. (1991b). For seven items, more than 10% of the respondents nominated ‘no opinion’ or failed to respond. Furthermore, this study was conducted in one organization; the ? ndings are therefore context speci? c, which makes it dif? cult to generalize to other settings. However, there is consistency over ime and between countries in regard to nurses’ perceptions of the barriers to research utilization. Conclusion In order to gain an understanding of perceived in? uences on nurses’ utilization of research in a particular practice setting, nurses were surveyed to elicit their opinions regarding barriers to, and facilitators of, research utilization. Many of the perceived barriers to research utilization reported by this group of Australian nurses are consistent with reported perceptions of nurses in the US, UK and Northern Ireland during the past decade. Time was the most important barrier percei ved by nurses in this study, which is re? ected by responses to the items, ‘the nurse does not have time to read research’ and ‘there is insuf? ient time on the job to implement new ideas’, resulting in them being ranked as the top two barriers to research utilization. Consistent with this ? nding was the ranking of facilitator item ‘increasing the time available for reviewing and implementing research ? ndings’ as the most important facilitator to research utilization. The employment of qualitative research methods, such as observation and interview, will contribute further to our knowledge about barriers to, and facilitators of, research utilization by nurses by allowing deeper exploration of experiences, perception and issues faced by nurses in the utilization of research in their practice.Fundamental questions about whether nurses’ perceptions actually re? ect the reality of the current context of nursing need to be further investiga ted. Future research should also examine issues surrounding the use of time by nurses. Questions exploring how much additional time nurses require in order to read the relevant literature and how nurses can be given more time to implement new ideas, need to be addressed. Issues related to nurses’ perception of their authority to change patient care procedures, the support and cooperation afforded by doctors and others, the facilities and availability of resources, and their skills in critical appraisal, also require further 313 LimitationsReporting bias associated with the self-report method raises questions about the extent to which the responses accurately represent nurses’ perceptions of the barriers to research utilization. The low response rate achieved in this study, although consistent with response rates reported in several O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304–315 A. M. Hutchinson and L. Johnston exploration. Investigatio n of the information-seeking behaviour of nurses, the means by which they gain and synthesize new research knowledge and the way in which they apply that knowledge to their decision making, will further contribute to our understanding of the research–practice gap phenomenon.Measurement of the actual extent of research utilization by nurses in the practice setting presents a major challenge for researchers in this ? eld. Acknowledgements The authors thank Sandra Funk for her permission to use the BARRIERS Scale for the purpose of this study. We wish to acknowledge and thank the nurses who completed the questionnaire. The authors also wish to acknowledge the statistical assistance provided by Ms Anne Solterbeck, Statistical Consulting Centre, Department of Mathematics and Statistics, The University of Melbourne. Contributions Study design: LJ, AMH; data analysis: AMH; manuscript preparation: AMH, LJ; literature review: AMH. References Berggren A. 1996) Swedish midwives’ awareness of, attitudes to and use of selected research findings. Journal of Advanced Nursing 23, 462–470. Carroll D. L. , Greenwood R. , Lynch K. , Sullivan J. K. , Ready C. H. & Fitzmaurice J. B. (1997) Barriers and facilitators to the utilization of nursing research. Clinical Nurse Specialist 11, 207–212. Closs S. J. & Bryar R. M. (2001) The barriers scale: does it ‘fit’ the current NHS research culture? NT Research 6, 853–865. Closs S. J. & Cheater F. M. (1994) Utilization of nursing research: culture, interest and support. Journal of Advanced Nursing 19, 762–773. Closs S. J. , Baum G. , Bryar R. M. , Griffiths J. & Knight S. (2000) Barriers to research implementation in two Yorkshire hospitals.Clinical Effectiveness in Nursing 4, 3–10. Crane J. , Pelz D. C. & Horsley J. A. (1977) Conduct and Utilization of Research in Nursing Project. School of Nursing, University of Michigan, Ann Arbor, MI. Crichton N. (2000) Information point: p rincipal component analysis. Journal of Clinical Nursing 9, 815. Crichton N. (2001) Information point: factor analysis. Journal of Clinical Nursing 10, 550–562. Dunn V. , Crichton N. , Roe B. , Seers K. & Williams K. (1997) Using research for practice: a UK experience of the barriers scale. Journal of Advanced Nursing 26, 1203–1210. Estabrooks C. A. (1999) Will evidence-based nursing practice make practice perfect?Canadian Journal of Nursing Research 30, 273–294. Evidence-Based Medicine Working Group (1992) A new approach to teaching the practice of medicine. Journal of the American Medical Association 268, 2420–2425. Funk S. G. , Champagne M. T. , Wiese R. A. & Tornquist E. M. (1991a) Barriers to using research findings in practice: the clinician’s perspective. Applied Nursing Research 4, 90–95. Funk S. G. , Champagne M. T. , Wiese R. A. & Tornquist E. M. (1991b) Barriers: the barriers to research utilization scale. Applied Nursing Research 4, 39–45. Funk S. G. , Champagne M. T. , Tornquist E. M. & Wiese R. (1995a) Administrator’s views on barriers to research utilization.Applied Nursing Research 8, 44–49. Funk S. G. , Tornquist E. M. & Champagne M. T. (1995b) Barriers and facilitators of research utilization. Nursing Clinics of North America 30, 395–407. Gennaro S. , Hodnett E. & Kearney M. (2001) Making evidencebased practice a reality in your institution: evaluating the evidence and using the evidence to change clinical practice. MCN, the American Journal of Maternal/Child Nursing 26, 236–244. Gould D. (1986) Pressure sore prevention and treatment: an example of nurses’ failure to implement research findings. Journal of Advanced Nursing 11, 389–394. Griffiths J. M. , Bryar R. M. , Closs S. J. , Cooke J. , Hostick T. , Kelly S. Marshall K. (2001) Barriers to research implementation by community nurses. British Journal of Community Nursing 6, 501–510. Hicks C. ( 1994) Bridging the gap between research and practice: an assessment of the value of a study day in developing research reading skills in midwives. Midwifery 10, 18–25. Hicks C. (1996) A study of nurses’ attitudes towards research: a factor analytic approach. Journal of Advanced Nursing 23, 373–379. Hunt J. (1981) Indicators for nursing practice: the use of research findings. Journal of Advanced Nursing 6, 189–194. Hunt J. (1996) Barriers to research utilization. Journal of Advanced Nursing 23, 423–425. Hunt J. 1997) Towards evidence based practice. Nursing Management 4, 14–17. Kaiser H. (1974) An index of factorial simplicity. Psychometrika 39, 31–36. Kajermo K. N. , Nordstrom G. , Krusebrant A. & Bjovell H. (1998) Barriers to and facilitators of research utilization, as perceived by a group of registered nurses in Sweden. Journal of Advanced Nursing 27, 798–807. Ketefian S. (1975) Application of selected nursing research findi ngs into nursing practice: a pilot study. Nursing Research 24, 89–92. Kirchhoff K. T. (1982) A diffusion survey of coronary precautions. Nursing Research 31, 196–201. Lacey A. (1994) Research utilization in nursing practice: a pilot study.Journal of Advanced Nursing 19, 987–997. Lewis S. L. , Prowant B. F. , Cooper C. L. & Bonner P. N. (1998) Nephrology nurses’ perceptions of barriers and facilitators to using research in practice. ANNA Journal 25, 397–405. LoBiondo-Wood G. & Haber J. (1998) Nursing Research. Methods, Critical Appraisal and Utilization. Mosby, St Louis, MO. MacGuire J. M. (1990) Putting nursing research findings into practice: research utilization as an aspect of the management for change. Journal of Advanced Nursing 15, 614–620. 314 O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304–315 Clinical nursing issues Marsh G. W. , Nolan M. & Hopkins S. 2001) Testing the revised barriers to research utiliz ation for use in the UK. Clinical Effectiveness in Nursing 5, 66–72. Nolan M. , Morgan L. , Curran M. , Clayton J. , Gerrish K. & Parker K. (1998) Evidence-based care: can we overcome the barriers? British Journal of Nursing 7, 1273–1278. Parahoo K. (2000) Barriers to, and facilitators of, research utilization among nurses in Northern Ireland. Journal of Advanced Nursing 31, 89–98. Parahoo K. & McCaughan E. M. (2001) Research utilization among medical and surgical nurses: a comparison of their self reports and perceptions of barriers and facilitators. Journal of Nursing Management 9, 21–30. Retsas A. 2000) Barriers to using research evidence in nursing practice. Journal of Advanced Nursing 31, 599–606. Retsas A. & Nolan M. (1999) Barriers to nurses’ use of research: an Australian hospital study. International Journal of Nursing Studies 36, 335–343. Rizzuto C. , Bostrum J. , Suter W. N. & Chenitz W. C. (1994) Predictors of nursesâ€⠄¢ involvement in research activities. Western Journal of Nursing Research 16, 193–204. Rogers E. M. (1995) Diffusion of Innovations. The Free Press, New York. Rutledge D. N. , Ropka M. , Greene P. E. , Nail L. & Mooney K. H. (1998) Barriers to research utilization for oncology staff nurses and nurse managers/clinical nurse specialists. Oncology Nursing Forum 25, 497–506.Barriers to, and facilitators of, research utilization Sackett D. L. , Rosenberg W. M. C. , Gray J. A. M. , Haynes R. B. & Richardson W. S. (1996) Evidence based medicine: what it is and what it isn’t. British Medical Journal 312, 71–72. Stetler C. B. (1994a) Problems and issues of research utilization. In Nursing Issues in the 1990’s (Strickland O. L. & Fishman D. L. eds). Delmar, New York, pp. 459–470. Stetler C. B. (1994b) Refinement of the Stetler/Marram model for application of research findings to practice. Nursing Outlook 42, 15–25. Tabachnick B. G. & Fidell L. S. (2001) Using Multivariate Statistics. Allyn & Bacon, Needham Heights, MA.The Australian Institute of Health and Welfare (1999) National Health Labour Force Series. Number 20 – Nursing Labour Force 1999. The Australian Institute of Health and Welfare, Canberra. Walsh M. (1997a) How nurses perceive barriers to research implementation. Nursing Standard 11, 34–39. Walsh M. (1997b) Perceptions of barriers to implementing research. Nursing Standard 11, 34–37. Walsh M. & Ford P. (1989) Rituals in nursing: ‘we always do it this way’. Nursing Times 85, 26–35. Winter J. C. (1990) Brief. Relationship between sources of knowledge and use of research findings. The Journal of Continuing Education in Nursing 21, 138–140. O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304–315 315