Reflective Account: Ethical Dilemma Treating Cancer

Reflective Account: Ethical Dilemma Treating Cancer This reflective account will discuss an ethical dilemma which arose during a placement within a community setting. To assist the reflection process, the Gibbs (1988) Reflective Cycle which encompasses 6 stages; description, thoughts and feelings, evaluation, analysis, conclusion and action plan will be used which will improve and strengthen my nursing skills by continuously learning from both good and bad experiences, and develop my self confidence in relation to caring for others (Siviter 2008). To comply with the Nursing and Midwifery Code of Conduct (NMC) (2008) and maintain confidentiality all names have been changed and therefore for the purpose of this reflection the patient will be referred to as Bob. Bob is a forty four year old man who has been receiving aggressive and invasive treatment for several months in the form of chemotherapy in an attempt to cure his Hodgkinsons lymphoma cancer. Throughout the treatment Bob remained positive that he would be able to put the worries behind him and live a normal life with his partner and teenage daughter. However, Bob was unable to control his body temperature, which was a possible sign the chemotherapy had not been successful and was offered further investigations to establish his prognosis. Whilst my mentor who is a Community Matron, was talking to Bob, his partner Sue took me to one side and asked me if the investigations revealed bad news would it be possible to withhold this information from Bob because she felt he would not be able to deal with a poor prognosis and would give up hope. Prior to Bobs original admission the possibility of f the chemotherapy failing was discussed but he refused to consider this was an option and was convinced the condition could be treated successfully. I explained to Sue that this situation was outside of my area of expertise but with her permission would discuss it with my mentor and ask her to contact Sue at a mutually convenient time to discuss further. My mentor contacted Sue and advised her that she would discuss the situation with Bobs Consultant once they had received the results of his tests. However, my mentor diplomatically informed Sue that she has no legal right to insist that information be kept from Robert (Dimond 2005). As expected Bobs test results concluded the chemotherapy treatment was unsuccessful. Considering what he knew of Bob, the consultant agreed it would be advantageous to withhold the diagnosis from him. Therefore it was agreed to discuss Bobs test results with his partner. Thoughts and feelings In the first instance I felt that the Consultant was ethically wrong to withhold the results of the investigations from Bob and not necessarily acting in his best interests. I felt that in order to ensure Bobs rights were protected and to give him the opportunity to be involved in his own plan of care he should be informed of the outcome of the tests. Bob had the capacity to consent and as during my placement would be acting as an advocate for him. I felt that if I was in Bobs position, I would want to know what the outcome of any investigations were and it did not seen right that the diagnosis would be documented in his records and his family and possibly friends around him would be aware of his diagnosis whilst he was kept in the dark. I felt that if we were to visit on a regular basis that I would feel very uncomfortable knowing something that had been kept from him and possibly have to lie to him or avoid answering directly when asked difficult questions. I felt that I would be a ble to have a better relationship and understand the care he wanted if he was told the truth about his condition. I also felt that his family were taking denying him the right to autonomy and th right to make informed choices in his end of life care. Analysis The situation was complex in terms of ethical principles. It was not just a matter of clinical practices but providing the best holistic care to Bob during his forthcoming terminal illness. This situation gave rise to multi-disciplinary team discussions to assess whether the diagnosis should have been delivered to Bob. Standing back from the situation, I realize that my own feelings were perhaps judgmental and that I should have taken a more holistic approach rather than just clinical. It also made me aware of the importance of promoting advance directives to patients in situations where an illness may lead to terminal care Evaluation Today patient autonomy is a highly regarded principle that healthcare professionals promote at all times and is fundamental for all patient interactions of which telling the truth to a patient about their diagnosis and prognosis is part (Dimond 2005). Lo (2009) says to be totally autonomous competent patients have to be told the nature of their illness, recovery prospects, how their illness will develop, treatments available and the consequences of any such treatments to enable them to make an informed choice in order to grant consent to treatment of their choice or refuse treatment they do not want. However this has not always been the case, traditionally, paternalism, where the doctor alone would make a decision about whether or not to inform their patient of the diagnosis used to be the preferred method of treating and caring for patients (Lo B 2009). It is only over the past 20 years or so where it is the norm to share decision making with the patient to enable them to make informed choices in their preferred care and treatment (Boyle 1995). However not all patients want to know their prognosis or take part in their end of terminal treatment and care. A study which took place in 1995 concluded that some ethnic groups were less likely to approve of truth telling in respect of diagnosis than others (Blackwell 1995). The UK is culturally diverse and not all patients and families want or accept autonomy. When a person is sick in some cultures, the family prefers to take responsibility for the medical decisions and often wish to receive the diagnosis and nursing plan before the patient. Although this is often the case within Chinese and Japanese cultures, it does not automatically mean that the request to withhold diagnosis from the patient will be upheld. To add to this complex issue, there may be differences within these cultures, such as recent immigrants and older family members wishing to adhere to cultural traditions and younger family members wishing to practice autonomy (Lo B 2009). Advanced care directives definition are used to enable a person to have autonomy. These ethicalBarbosa da Silva (2002) defines an ethical dilemma as: A situation where a person experiences a conflict where he or she is obliged to perform two or more duties, but realizes that whoever action he or she chooses will be an ethically wrog one. Many experts agree healthcare professionals are faced with many ethical dilemmas when caring for terminally ill cancer patients. Communicating the diagnosis and subsequent prognosis is one of the most common (Kuupelomaki and Lauri 1998)(Roy and MacDonald 1998). It is not unusual for relatives to ask a Consultant to withhold information (Alexander et al 2006) which Kenworthy et al (2002) says family members request out of compassion and love. However, (2006) disagrees and suggests it is often the relatives who are unable to cope and have difficulty coming to terms with the impending prognosis. Dimond (2005) suggests withholding the truth can be harmful or lead to a conspiracy of silence but may be justifiable if it is in the patients best interest not to know. In agreement, Lo (2009) points out receiving bad news can have a negative and drastic effect on a patients view of their future. Nurses have a duty in accordance with their professional code of conduct to act as a patients advocate. Whatever their personal thoughts are in relation to withholding diagnosis from a patient, if the Consultant deems it in the best interest of the patient then a nurse has a duty to adhere to the Consultants decision (Dimond 2005).However Georges and Grypdonk 2002 suggest this can lead to nurses feeling powerless, frustrated and concern when involved in palliative care. Evidence suggests that if a Consultant establishes it is not advisable to inform the patient of the diagnosis or prognosis then it is right to give information to the family (Rumbold 2006). Dimond (2005) states patients have no legal rights to information and therefore if a Consultants believes it is in the best interest of the patient they can refuse to give a diagnosis to them. However, some would argue to withhold information would be considered paternalism (Lo B 2009). Paternalism is when an individual, in this case the Consultant, believes they are in a position to act in the best interest of another individual. Although Bobs welfare is key, the consultant has taken away his right to his autonomy to make future healthcare choices including important end of life decisions by making the decision not to inform him of his diagnosis (Sandman and Munthe 2010). Tingle and Cribb (2005) define this as hard paternalism as opposed to soft paternalism in which Bob would not have the capacity to make an informed decision regarding treatment and care following his diagnosis. The may be in beneficience to the patient but conflicts with autonomy. While considering the decision to not tell Bob the truth regarding his diagnosis, the consultant would have taken into account the ethical principles of beneficence (to do good) and non-malifience (to cause no harm) (Dimond 2005). In Rumbolds (2006) opinion it is wrong to not tell the truth or withhold information from a patient as it denies the patient autonomy and is in conflict with the ethical principles of beneficence and non-malificience. Research carried out by Sullivan (2001) suggests patients believe that Doctors should tell them the truth with a staggering ninety nine per cent of patients wanting to be informed of their diagnosis. However there is evidence to suggest the consultant was right to withhold diagnosis as it can initiate denial, and cause the patient psychological damage (Kenworthy et al 2002). Patients react differently to bad news and Elliott and Oliver (2007) suggests information should given slowly enabling the patient to have enough time to absorb the information given. Sadness, despair, anxiety and depression are feelings patients suffer when faced with life threatening illness. >believes that if healthcare professionals have an open and honest relationship with their patients it enables greater trust (Elliott and Oliver 2007). Bowers and Arnold (2010) agrees with this and adds that an open relationship based on trust enables healthcare professionals to support patients to be in control and make preferred choices with issues relating to their end of life care. However, Kenworthy, Snowley, Gilling (2002) are in disagreement with these statement say to force a patient into to face the trust regarding their diagnosis is both unethical wrong and damaging. Millard and Florin (2006) (nursingtimes) says that patients have different needs which can often be complex and it is important to recognise that some patients choose not be involved, that some individuals do not want to be part of their care but put their trust in health care professionals who are t rained in what they do. Elliott and Oliver (2007) states that a hope is fundamental to a terminally ill persons wellbeing and as such is something to be protected. She adds that hope of a cure whilst facing a terminal illness is an individuals right and helps them to face the final stages of life and points out that if hope is taken away it leaves a patient with only fear. Conclusion This experience has made me aware that good listening, hearing and communication skills are vital to gain a holistic view when dealing with patients and close ones in end of life care. It is also important to liaise with other members of the multi-disciplinary team to ensure that the best possible approach and care is delivered to the patient. It is important not to be judgemental but to incorporate all issues when taking a holistiv view in order to make the right decision. As this was my first experience of end of life care in the community, I was in unfamiliar surroundings and as such not experienced enough to make the right decision in Bobs case. The consultant was correct in determining that Bob was not in a position to accept a poor diagnosis and therefore withholding the information was the correct decision. Action Plan. My action plan is to promote advanced decision and power of attorney Assess holistically and taken into account I also feel than advance directives may have cleared some of this issues and will read about their importance in would have resolved some of this issues and read about their importance and promote their importance when the opportunity arises However, the circumstances surrounding this decision could only be applied to Bobs situation. I believe that as a Nurse I will be involved in ethical dilemmas again however I feel that now I my decisions will be based on each unique patient recognising their own individual needs and wants. Delegation This essay is a reflection of a situation I came across whilst on Community Placement. To assist with this process, Driscolls model of reflection will be used to focus my thought processes whilst learning. Driscolls is a straight forward model which encourages one to return to a situation to understand it better and improve future experiences (Driscoll 2000). To comply with the Nursing and Midwifery Code of Conduct (NMC) (2008) and protect the confidentiality of patients pseudonyms have been used throughout. As required by the first stage of Driscolls model I will describe the event s which took place whilst my mentor was on annual leave and I was assigned to Dianne, another district nurse within the community team. The reason I have decided to return to this situation is because registered nurses should ensure their practice does not compromise duty of care to individuals and at the time I felt that Dianne was delegating duties inappropriately and therefore may have been in breach of NMC requirements (NMC 2004). Whilst assigning the days work Dianne said that it would be a good opportunity for my personal development to go out unsupervised to visit patients within the area to carry out their care and treatment. I was asked to visit a 92 year old patient called Rose who the team visited on two or three times a week to treat a couple of problems. Firstly, she had ulcerated legs which the team were treating with four layer compression bandaging which evidence suggests is the best way to encourage venous return in order to maximise the healing process (OMeara et al 2009). Secondly she had a small sacrum sinus which was packed and redressed. Diannes request put me in an awkward position as I had visited Rose on a number of occasions with my mentor and with her supervision had been able to assess, treat and care for Roses problems appropriately with the exception of applying compression bandages as my mentor had explained to me were only to be applied by staff who had received appropriate training . I am keen to take advantage of any professional development opportunities and improve my clinical skills. However I felt that although I was able to manage most of the delivery of care to Rose as required by the NMC Code of Conduct (2008) applying the compression bandaging was outside my remit and would have been unsafe practice. My feelings were that Dianne was not doing this for my personal development but for her own personal reasons resulting in her abdicating her responsibilities. She did not ask me how I felt about attending patients without supervision or check I had the necessary clinical skills. With this in mind I agreed I would visit Rose, take down her dressings, assess and debride the wound, apply appropriate dressings and the first two layers of bandages. However I requested that Dianne called in after me to apply the compression bandages. Dianne did not appear to be very happy with my request but reluctantly agreed. When I arrived at Roses I introduced myself and explained the purpose of my visit and that Dianne would follow me to apply the compression bandages. I explained at each stage what I was doing, to put Rose at ease, remembering look up and face Rose, so that she could hear clearly what I was saying or read my lips and facial expression as she was partially deaf. As agreed with Dianne I took down the existing dressings, debrided and assessed the wound against the current wound care plan. The wound bed had reduced considerably and although an Inodine dressing had been applied previously, the wound had dried considerably and in my opinion did not require replacing. Therefore I telephone Dianne to let her know of my assessment and it was agreed to dress the wound with a simple NA dressing before bandaging. Whilst at Roses I took the opportunity to update the wound care plan and therefore documented the size of the wound, excudate, smell etc etc and documented all my findings and actions in the care plan. Whilst at Roses I also required to redress the sacral sinus in accordance with her care plan. When assessing the wound I noticed that although her skin was not broken, her sacrum was very red. I had also previously noticed that although she had a pressure cushion sitting on another chair I had never actually seen her sat on it. Therefore I took the opportunity to encourage her to become involved in promoting her own health and explained that her sacrum was very red and that as she sat for long periods of time, it was possibly that her skin would break down, which was why she had been issued with a pressure cushion. We discussed why she did not use the pressure cushion, she said that she did not find it very comfortable in her favourite chair, I explained the benefits of the pressure cushion and we agreed that she would sit in another chair with the pressure cushion in situ for a least part of the day and that we would discuss how she got on next time I visited. Before leaving Roses I documented my assessments, nursing interventions, evaluation and actions in her care plan. The second stage of Driscolls entitled now what will look at the chain of events which has led me to reflect on when it is appropriate to delegate care. Delegation involves entrusting and transferring a task or responsibility to another person who is able to accept responsibility for the task, typically one who is less senior than oneself (Sullivan and Decker 2005, Oxford dictionary 2011). However Wheeler (2004) argues that delegation and abdication amount to the same thing. On the other hand MacKenzie (1998) states that abdication is giving up either by abandonment or resignation and says that whilst delegation can offer potential benefits to both individuals and organisations, many nurses practice abdication which can be attributable to the current economic climate of underpaid and overstretched employees. Whilst I did appreciate that Dianne thought I was capable to deliver appropriate care to Rose I also suspected that she thought it she would have an easier day if she asked me to carry out the more routine and mundane tasks. The NMC standards of proficiency (2004) state whilst nurses should delegate care to others they should also accept responsibility and accountability for such delegation. As a registered nurse under the NMC Code of Conduct (2008) nurses have a duty of care to ensure that patients receive care in a safe and skilled manner. Dianne was not aware if I was competent or not to carry out compression bandaging as she had neither previously worked with me or questioned me about my clinical skills. In line with the NMC Code of Conduct (2008) I understand that I must work within the scope of my professional competence and it is for this reason I refused to apply the compression layer. It is important for organisations and individuations to delegate in order for them to develop and function resourcefully and successfully (Ellis and Hartley 2004). Effective Delegation requires skills in planning, analysis and self-confidence. The tasks to be delegated should be assessed, planned, communicated, implemented, monitored and evaluated (Royal College of Nursing 2006). In the UK, the rate of change is accelerating and the delivery of services are regularly restructured in an attempt to provide the most effective and efficient care to patients (Shepherd 2008). This environment has lead to the evolvement of work from junior doctors to nursing staff such as giving intravenous therapy and with the evolvement of nursing practitioners many agree that the role of the nurse is increasingly difficult to define as the boundaries are constantly changing (Shephard 2008, Spilbury and Meyer 2005, McKenna et al 2006). A study conducted by Ulster University condones that there is much ambiguity amongst the nursing role. It concluded that although nurses are happy with role extensions they have less patient contact as they would like. Some nurses like the role extension of technical jobs, however others see it at the menial tasks Doctors do not want to do (Allen 2002). However this was only a small survey of 26 nurses and therefore may not be a true representation of all RGNs (McKenna et al 2006). It can be assumed therefore that demands on nursing care at times are greater than RGNs can cope with, and therefore increasing expected to to delegate some tasks routinely, traditionally carried out by RGNs, such as personal care (Curtis and Nicholl 2004). Effective delegation can give RGNs more time for other activities which enables them to focus on doing fewer tasks well rather than many tasks poorly and offer HCAs the opportunity to become competent and improved confidence (Kourdi 1999). Shepherd (2008) articulates that it is important for these tasks to be defined and when devolved it should not be at the detriment to the patient. As a result health care assistant (HCA) roles have increased in both numbers and cope of activity undertaken and it is therefore important that all health care staff understand their roles and accountability in the delegation process. Health care staff need to work together in order for patients to receive safe and effective care from the most appropriate personnel (Pearcey 2007). However some nurses find it difficult to relinquish any part of their role and find it difficult to delegate (Wheeler 2004) Zimmerman (1996) suggests this might be because some nurses were trained before delegation skills were required. However Nicholl and Curtis (2004) state that delegation is not an art and but a nursing skill which can be learned and is becoming increasing important in changing times. Delegation also enables health care professionals to train in new skills and broaden their skill range. However Wheeler argues that some could abuse their power of delegation for example to provide themselves with extra breaks while their subordinates may have to forfeit theirs to complete additional tasks. Or one nurse could favour a subordinate resulting in some always receiving more appealing tasks than others. Delegation is a complex process and to successfully delegate consideration should be given to both existing workload and skill mix of staff should be known. Delegation of too many tasks may result in loss of control, but failing to delegate may lead to one member of staff being overwhelmed, overworked and can lead to incompletion of duties and de-motivated and un-cooperative team. Most HCAs give personal care due to the fact they are usually more available than RGNS. Many studies have indicated that RGNS favour the employment of HCAs (McKenna and Hansson 2002). However the MIDRIS (2001) study suggests that care provided by HCAS is task based and fragmented. There are many pros and cons for delegating tasks. Detailed Job Descriptions (JD) may result in staff being reluctant to take on new responsibilities that are not specified on their JD. Others will be reluctant and believe if you want a job done properly do it yourself. This can inhibit delegation leading to nurses being overworked stressed with little job satisfaction (Kourdi 1999). On the other hand Wheeler (2001) suggests effective delegation encourages staff to have a better understanding and be able to influence the way in which work is carried out. She also says that by participating in decision-making it will increase motivation, morale and ultimately job performance enabling the organisation to become more flexible and responsive to change. Effective delegation will enable a business to move forward as new ideas and viewpoints will be encourage and it will better prepare nurses to be able to cope when career opportunities arise (Wheeler 2001). Delegation frees up time to enable a nurse to carry out other duties which cannot be delegated. Although at first the time saved might me minimal once the HCA becomes proficient more time will become available. Fewer tasks are better than many that are inefficient (Kourdi 1999). In order to delegate effectively it important to decide which task to delegate , select the best person to carry out that task, assessing the task in detail and offer clearly the level of authority associated with it, , check the skills and experience of the delegates, follow the task process and assess and discuss the progress (Curtis and Nicholl 2004). Cohen suggests it is right to delegate in order to carry out an organisations needs as long as certain criteria is met such as right task, right circumstance, right person right communication and right supervision. The third stage, of the Driscolls reflection model requires what can be done differently in the future and what actions to be taken. Dianne was right to delegate the more junior tasks in order to ensure the fewer tasks she had were carried out more effectively. However should have verified my competence prior to delegating. If she had communicated with me effectively to assess my competence I would not have felt awkward having to point out that I did not have the skills to carry out compression bandaging and only practice within my capabilities (NMC 2008). In the future in such a situation I would not do anything differently as I believe I have a responsibility for practicing within my own capabilities in line with the NMC Code of Conduct (2008). Had I been a permanent member of staff I would have asked for compression training, however this would have been impractical as I was on placement for only a short period of time. When I qualify this situation I will be aware that I am ultimately responsible for the care of patients even when tasks are delegated to HCAs. I will also ensure that I do not delegate anything that involves critical thinking skills such as nursing assessments, planning and evaluation of patient care and nursing judgement. (take off 90 for references)

Mass Marketing Is Dead

Mass market advertising was once an effective marketing tool. The â€Å"one product suits all† approach had its heyday and is now declining. Hallerman (2006) wrote that in an American Association of Advertising Agencies (AAAA) survey, only 28.7% of respondents now believe that untargeted advertising will be very effective by 2010. The survey is validating the consensus that mass marketing is dead. Increasingly, business leaders, marketing and advertising practitioners are looking at niches, market segments and differentiated audiences as targets.Emergence of Mass MarketingAccording to Lake (2007), marketing is the systematic conduct of business activities to result in a mutually advantageous exchange of products between buyers and sellers. It started off from the sales techniques used by traders and the promotional methods of skilled artisans. Mass marketing is a marketing approach in which the marketer addresses all segments of the market as though they are the same. It refer s to the treatment of the market as a homogenous group and offering the same marketing mix to all customers. (â€Å"Market Segmentation†. n.d.)Companies that employ this strategy expect to generate profits through economies of scale. Marketing, particularly mass marketing, became a discipline as we know it today after the emergence of (1) the mass production of goods; (2) channels of mass distribution of products; and (3) media for mass communication.Mass marketing required a mass supply of goods and the Industrial Revolution facilitated reaching greater volumes of production. New technologies engendered better machinery and production processes. Large quantities of products could now be manufactured at lower costs. This placed the goods within the reach of a greater number of consumers. It made little business-sense to encourage the purchase en masse of a product if such product was non-existent or not readily available for transfer to the buyer.The mass production of goods would have been, however, useless if the products did not reach the consumers. Again, the Industrial Revolution helped bring this forth. The invention of the steam engine led to the establishment of railways that brought the products en masse to distant markets at cheaper rates. Essentially, the railways brought isolated communities closer. Where before, produce of the area could only be sold within the locality, these may now be transported to and sold in far-away areas through the railway system.Now that products are easily reaching distant markets, their existence had to be brought to the attention of potential buyers. The message that â€Å"products were available for purchase affordably† had to be communicated. Again, the Industrial Revolution helped realize this. First, the Gutenberg press allowed the wide-scale dissemination of information through newspapers. Later on, we had the radio, television (broadcast and cable) and the internet.Of course, mass marketing did not magically emerge as soon as the objective condition of having mass production, mass distribution and mass communication existed. The subjective element had to exist. Entrepreneurial vision, drive, organization and resources had to implement the strategy. (Meyer and Dailey. n.d.)A classic example for mass marketing would be Henry Ford’s Model T car. Ford adopted mass production techniques and standardized output that resulted in lower costs. To generate demand for the Model T, it marketed as an automobile that would meet the needs of all buyers at an affordable price.Changing Consumer DemandA big impetuous for mass marketing came after the close of the Second World War. The war effort resulted in increased production capacity, new technology and most importantly, increased demand.A large segment of men went into the military service during the war. Women replaced them in the production of goods. Factories that used to produce consumer goods shifted towards producing weaponry and other resources needed to fight the war. This resulted in full employment of the labor force with greater spending capacity. However, due to the war and the limited supply of consumer goods, spending was â€Å"curtailed† and incomes were saved. According to McCann (1995), there was high pent-up demand when the war was over and the men returned home. Mass demand for consumer products logically followed this pent-up demand considering that the populace had wealth to spend.The new production capacity and improvements in electronics resulted in inexpensive radio and affordable television set. Households easily got hold of radio and television sets giving manufacturers a channel through which they may address the consumers. An almost universal audience for the manufacturers’ pitch was created.Bianco, et al. (2004) wrote the United States was far more uniform not only in terms of ethnicity but also of aspiration in the 1950s and 1960s. The ideal was to own the same model of car or lawnmower or products as the Joneses, or at least ones neighbors. This changed in the 1970s and 1980s due to greater affluence. From â€Å"I want to be normal†, says McDonald’s Light, it became â€Å"I want to be special†. (Bianco, et al., 2004)Multiplicity of Communication MediaThe development and widespread use of printed text in Europe in the1500s produced a brand new form of communication. A single message could now be duplicated with little error and distributed to thousands of people. (â€Å"Tutorial: Mass Communication†. n.d.) McCann (1995), however, said that it was broadcast media that served as the cornerstone of mass marketing.Print media is usually read by individuals even though a standard message may be printed in each copy. Broadcast media, on the other hand, can create a â€Å"monolithic eyeball† – millions of consumers tuned in to a single program. By its nature, broadcast media was for a long time a very viable c hannel for marketing. Bianco, et al (2004) reported that an advertiser in the 1960s could reach 80% of U.S. women by airing simultaneously on CBS, NBC and ABC a commercial spot.However, the hegemony of mass media in influencing consumers has diminished. Business competition and technological advances have resulted in a diversified mass media environment. We have the giant broadcast networks and a multitude of narrowcast cable TV stations. A Nielsen Media Research reported that the average U.S. household receives 100 TV channels in 2004 compared to only 27 in 1994. (Bianco, et al. 2004)Traditional broadcast media is also being affected by new media technologies. The internet has opened a new channel for marketing and is increasingly affecting advertising revenues traditional mass media. In fact, we now have an online version of almost every television station, newspaper and magazine.The internet has also allowed a democratization of mass communication. Now, every person can send out his message through blogs, personal websites and online forum. This in turn creates even more niches that the mass marketer must consider and contend with. Each website can potentially promote or demote a consumer good.Where the communication flow through traditional mass media channels was one-way, new media allowed interactivity. Readers or viewers can interact with the source of information being viewed. A blogger establishes a regular audience by addressing special interests. As with online forums, viewers are encouraged to respond.Current technology now also allows the consumer to by-pass even the most targeted advertising that a marketer may come up with. Personal video recorders are allowing consumers to watch a program when they want to. This has increased television viewing. Research, however, shows that personal video recorders were used to skip about 70% of ads. (Bianco, et al. 2004)SummaryThe same elements that gave rise to mass marketing are tearing it apart. Technologi cal advances brought forth mass production, mass distribution and mass communication. The ordinary consumer is faced with tons of consumer goods. Production techniques now allow mass production of custom products. Automobiles can now be produced in different styles, color, and accessories preferred by the consumer with minimal disruption in the assembly and at little additional cost.Products and consumer goods can now be easily distributed. Shipping of consumer goods is accessible to all. Individual sellers can easily sell and ship products as shown by the success of such online auction site as eBay. More importantly, information and communication technology has developed to the extent that access to information can not be limited. This allows consumers to be more discriminating.Mass marketing is a thing of the past. Mass marketing requires a mass market, a single market without differentiation. In fact, M. Lawrence Light, McDonald's global chief marketing officer said that the mass market never really existed. It was just that the available technologies of the past did not allow companies to reach the individual markets that existed then. (‘Marketing in the â€Å"Age of I†. 2004) While the world has grown smaller due to technological advances, it has magnified the diversity of consumers. Disparate communities are brought closer but proximity does not always translate into homogeneity.Since advances in technology will enable better data gathering, marketers will also be better at connecting with consumers. The marketing message can be refined to the point that it is not intrusive or invasive. According to James Stengel, Procter ; Gamble’s global marketing officer, the future of marketing will be oriented to permission marketing wherein marketing and advertising will be welcomed by consumers because they are viewed as relevant. (Bianco, et al. 2004) This, however, can no longer be done through mass marketing.ReferencesBianco, A., Lowry, T., Berner, R., Arndt, M., and Grover, R. The Vanishing Market. BusinessWeek (July 12, 2004). September 28, 2007. ;http://www.businessweek.com/magazine/content/04_28/b3891001_mz001.htm;Hallerman, David. June 16, 2006. The Death of Mass Marketing: eMarketer looks at the rise of ad targeting. September 28, 2007. ;http://www/imediaconnection.com/content/10063.asp;Lake, Laura. n.d. Marketing vs. Advertising: What’s the Difference? September 28, 2007. ;http://marketing.about.com/cs/advertising/a/marketvsad.htm;â€Å"Market Segmentation. n.d. September 29, 2007.   ;http://www.netmba.com/marketing/market/segmentation/;â€Å"Marketing in the ‘Age of I’†. BusinessWeek (July 12, 2004). September 28, 2007. ;http://www.businessweek.com/magazine/content/04_28/b3891011_mz001.htm;McCann, John M. March 10, 1995. The Changing Nature of Consumer Goods Marketing ; Sales. September 28, 2007. ;http://www.duke.edu/~mccann/cpg/cg-chg.htm;Meyer, Earl C. and Dailey, Lori A. n.d. Ma ss Marketing. September 29, 2007. ;http://www.answers.com/topic/mass-marketing?cat=biz-fin;â€Å"Tutorial: Mass Communication†. n.d. September 29, 2007. ;http://www.rdillman.com/HFCL/TUTOR/Media/media2.html;

Ocd Research Paper

Obsessive-Compulsive Disorder OCD stands for obsessive-compulsive disorder. An individual with OCD tends to worry about many different things. On average, one out of fifty adults currently suffer from this disorder, and twice that many have had it at some point in their lives. When worries, doubts, or superstitious beliefs become excessive then a diagnosis of OCD is made. With OCD it is thought that the brain gets stuck on a particular thought or urge and just can't let go. Most often people with OCD describe the symptoms as a case of mental hiccups that won't go away. This causes problems in information processing.OCD was generally thought as untreatable until the arrival of modern medications and cognitive behavior therapy. Most people continue to suffer even though they had years of ineffective psychotherapy. Today treatments tend to help most people with OCD. OCD is not completely curable but is somewhat treatable. OCD is a potentially disabling condition that may persist through out a person's life and get worse without treatment. An individual with OCD becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but are extremely powerful and hard to overcome.OCD can occur in cases from mild to severe, but if left untreated can destroy a persons life and capacity to function at work, school, and even at home. Some of the worries and rituals can get out of control. An individual life becomes dominated by thoughts and behaviors they know make absolutely no sense but they are powerless to control. People with OCD tend to fear uncertainty; these people are plagued by persistent and recurring thoughts or â€Å"obsessions† that they find very disturbing. These thoughts usually reflect exaggerated anxiety or fears that have no basis on reality.A person who suffers from OCD has constant doubts about their behaviors and constantly seeks assurance from other people. Many people who suffer from this disorder feel compell ed to perform certain rituals or routines to help relieve the anxiety caused by their â€Å"obsessions†, however the relief is only temporary. Some rituals or â€Å"obsessions† include cleaning, checking, repeating, slowness, and hoarding. Usually an individual has both obsessions and compulsions, though sometimes they have only one or the other.A person with OCD usually wants everything around them to be perfect. {What is 1}? Most common symptoms of OCD go along with a certain compulsion for instance: A need to tell, ask, or confess goes along with praying. A need to have things â€Å"just so† goes along with hoarding or saving. Forbidden thoughts equals arranging. Excessive religious or moral doubt = counting. Intrusive sexual thoughts or urges cause touching. Imagining losing control or aggressive urges causes checking. Imagining having harmed ones self or others creates the symptom of repeating.Fear of contamination or germs causes constant washing. Compulsi ons are intrusive thoughts, impulses, and images that feel out of control and occur over and over again. A sufferer does not want to have these ideas and knows that they don't make any sense but find them intrusive and disturbing. A person with OCD may be obsessed with the idea they are contaminated or may contaminate someone else and worry excessively about dirt and germs. This person could also have an intense fear that they harmed someone else although they usually know it is not realistic. {What 3}Some of the most common obsessions of OCD in children are extreme concern with order, concern that a task or assignment has been done poorly or incorrectly, concern with certain sounds or images, fear that a disaster will occur, there is also the fear of AIDS, fear of getting dirty, fear of losing important things, recurring thoughts, and a fear of saying something wrong. Checking compulsions are rituals that are precipitated by fear of harm to oneself or others and this includes the c hecking of doors, locks, heaters, alarms, faucets, switches, and other objects that could be a threat.This can create problems for the learning of a child. For example while getting ready for school a child may check his or her books several times to make sure they are all there even to the point where the child is late for school. Once the child is in school they may call to return home and check their books once more. These rituals may also interfere with the completion of homework. This could make a child work late at night to complete an assignment that could have taken ten minutes to complete. Repeating compulsions are rituals in which some one repeats a certain action over and over again.These rituals can in some cases be anxiety driven and in other cases have to be done â€Å"just so†. For instance a person might walk backward and forward or get up and down from a chair many times until the ritual is performed â€Å"just right†. These rituals are also connected with counting rituals. In children the rituals can assume many forms in the classroom. This could lead to many repeated questions because the child may need to remember or know something. On written assignments the student could endlessly cross out, trace, or rewrite letters or words.Lockers can also cause a problem because the combination may need to be repeated several times till it feels right. Note taking is most likely impossible because the student is compelled to take every word down. Computer scored tests are a nightmare because the student has to fill in the circles perfectly. Uncomfortable feelings such as fear, disgust, doubt, or a sensation that things have to be â€Å"just so† usually accompany obsessions. A person tries to make their obsessions go away by performing certain compulsive rituals. These compulsions are acts that an individual may perform repeatedly, often according to certain â€Å"rules†.OCD symptoms do not give a person pleasure but a sense of temporary relief for a short period of time. The relief is only temporary and the discomfort always comes back. These relieve make up a lot of time and interfere with a person's social life and relationships. The less common form of OCD is hoarding which is the excessive saving of typically worthless items. A most commonly thought form of OCD is contamination. This is the awareness of germs, disease, or the presence of dirt that evokes a sense of threat and an incredible inspiration to reduce the presence of contamination.The compulsion of contamination involves a cleaning response such as hand washing and chronic cleaning. {Steven1} Another common form of OCD is checking. Checking involves door locks, lights, switches, faucets, stoves, or items left unchecked that might pose a threat to ones well being or the well being of others. It is not uncommon for people to check items between 10 to 100 times a day. The impulse to recheck can remain until the person experiences a reductio n in tension despite the realization that the item is secure.One other less common form of OCD is ordering in which a person feels compelled to place items in a designated spot in order. Although contamination fears frequently lead to excessive washing they can also have the opposite affect, shoes may be untied, teeth unbrushed, clothing may be slovenly and hair may be dirty. In these cases, fear of contamination of personal objects or body parts leads to the individuals’ refusal to touch them. A combination of excessive hand washing and sloppiness in other areas of grooming had even been reported. Obsessions revolving around a need for symmetry may result in compulsive arranging.Children who engage in symmetry-related rituals may also feel compelled to have both sides of their bodies identical. For instance a child my spend an inordinate amount of time tying and retying shoelaces so that each side of the bow is perfectly even or â€Å"balanced†. Symmetry rituals may c onsist of taking steps that are identical in length or speaking with equal stress on each syllable. In a classroom, symmetry rituals may be seen in the student's compelling need for order. Books on a shelf, items on a desk, or problems on a page must be arranged in a precise manner so that they can appear symmetrical to the student.Most people recognize at some point that their obsessions are not just worries about real problems but are coming from their minds. Compulsions are excessive or unreasonable but the sufferer has to perform them. OCD poor insight is an individual that not recognize that their beliefs and actions are unreasonable and unreal. Extreme severe distress tends to happen when the symptoms wax and ware over time. OCD symptoms can start at any age from as early as preschool too as late as adulthood. 1/3 of 1/2 of adult sufferers said that their symptoms started during their childhood.On an average people spend 9 years seeking a diagnosis and see up to 3 to 4 doctors . Studies also show that it takes an average 17 years from the time OCD begins for an individual to find appropriate treatment. {What 3} OCD may be under diagnosed and untreated for a number of reasons. People with OCD may be secretive about their symptoms or lack insight on the illness. Many healthcare providers are not familiar with the symptoms and are not trained to provide treatment. Some people may also not have access to treatment resources. This is unfortunate since early diagnoses and proper treatment can help an individual.Research suggests genes do play a role in development of the disorder yet no specific genes have been found for OCD. Childhood onset tends to run in the family. An increasing risk for a child getting OCD is if the parent has it. When OCD runs in families it seems to be inherited but not the specific symptoms. One example is if a child has checking rituals his mother might wash excessively. There is no single proven cause for OCD. Research suggests that O CD could involve problems in communication between the brain and deeper structures although this is not proven. what 4} For many years only a small minority of healthcare professionals patients had OCD there for it was thought to be rare. OCD went unrecognized often because many of those afflicted with it kept their repetitive thoughts a secret and failed to seek treatment. This led to the underestimate of the number of people with the illness. {obsessions 1} In approximately 80% of all cases, people performing the rituals are painfully aware that their behavior is unreasonable and irrational. OCD is an anxiety disorder the thought associated with OCD is bizarre.The thoughts associated with OCD are recurrent obsessions that create an awareness of alarm or threat. Obsessions can take form of a threat or physical alarm to oneself or others. People typically engage in some avoidance or escape response in reaction to the obsessive threat. There are three main branches of OCD. The most c ommon and well-known branch of OCD is known as OC where the undoing response generally involves some overt behavior. The next branch of OCD is purely obsess ional this involves the escape or avoidance of noxious and unwanted thoughts.There are a number of treatment strategies, which are specific to obsessive problems. For example, motivations neutralizing behavior and other counter-productive strategies, increasing selective attention and increased negative mood. These serve to maintain the negative beliefs and therefore the obsessive-compulsive problem. Most recently developments in cognitive therapy suggest that the key to understanding obsession problems lies in the way the intrusive thoughts, images, impulses and doubts are interpreted. The general and specific aspects of cognitive-behavioral treatment are described.The important negative interpretations usually include the idea that a person's actions can result in harm to onset to others. This responsibility interpretation has several consequences. { steven 1} OCD can change and affect a person’s life in many ways sometimes alienating them from their friends and family. Many sufferers with OCD are never diagnosed because they are so secretive about their symptoms. They are afraid to let people know and are even embarrassed about their compulsive reactions. It is a fact that approximately one million children and adolescents in the United States alone suffer from OCD.This means that 3 to 5 children in an average elementary school and 20 teenagers in a large high school are currently suffering. OCD affects adolescents during an important time of social development. Schoolwork, homework, and friendships are affected most often. Most children are to young to realize that there obsessions and compulsions are unusual. Adolescents are embarrassed because they don't want to be different from other people and they worry uncontrollably about their behavior. These adolescents usually hide their rituals in fr ont of friends at school or at home and become mentally exhausted and strained.Children and adolescents that suffer from OCD are different from adults because they express their disorder in special ways. Young children often say their rituals are silly. Young children's OCD is never really recognized by their parents until they are about 3 or 4 sometimes even older. To get a proper diagnosis the child should be brought to a doctor or psychiatrist. While a child is at school they usually erase and redo their assignments, which usually results in late schoolwork. Classroom concentration is usually limited because a child is obsessing about their fears and rituals.Parents should tell a child's teacher about the OCD and may ask for occasional progress reports. OCD is not contagious and parents are often blamed for the disorder they are said to have parental perfections, inappropriate toilet training, or even under parenting. The cause for OCD is neurobiological. Although life events can also aid in the onset of OCD. Children's OCD is often said to be started by a death of a loved one, a divorce, moving to a new location, or unhappiness with changes in school. Approximately 80 percent of children and adolescents with OCD at some point during their illness will develop a washing or cleaning ritual.The most common compulsion is hand washing. An individual may feel compelled to wash their hands extensively and according to a self-prescribed manner for minutes or hours at a time. Other individuals may be less thorough about washing or cleaning but may engage in the act a number of times a day sometimes even hundreds. During school these rituals may manifest themselves in the school setting as subtle behaviors not obviously or immediately related to washing or cleaning. The student’s teacher should be alert if the student frequently excuses himself or herself from the classroom under voiding or guise.This child could actually be seeking a private area in which to carry out the cleaning rituals. Another sign is the presence of dry, red, chapped, cracked, or even bleeding hands. Bleeding hands are a result of washing with strong cleaning agents such as â€Å"Mr. Clean† to free themselves of â€Å"contaminants†. OCD sufferers usually experience obsessional thoughts that lead to compulsive avoidance in these cases, individuals may go to great lengths to avoid objects, substances, or situations that are capable of triggering fear or discomfort.For example, fear of contamination may result in the avoiding of objects usually found in the classroom, things like paint, glue, paste, clay, tape, and ink. A child may even inappropriately cover their hands with clothing or gloves or may use facial tissue, shirts, or shirt cuffs to open doors or turn on faucets. A student with an obsessive fear of harm may avoid using scissors or other sharp tools in the classroom. A child may even circumvent the use of a certain doorway because a passage t hrough that entry may trigger a repeating ritual.Children and adolescents with OCD may also engage in compulsive reassurance seeking. In the school setting, they may continually ask teachers or other school personnel for reassurance that there for example are no germs on the drinking fountain or that they have not made any errors on a page. Although reassurance may serve to allay the anxiety or discomfort that frequently accompanies their fears the relief is often short lived, different situations typically arise in the classroom that pose new fears or discomfort for the student.Number obsessions are typically common among young boys. Only certain numbers are â€Å"safe† other numbers are â€Å"bad†. An obsession with a particular number may result in a child's having to repeat an action a given number of times or having to repeatedly count to a particular number. Some children with strong religious ties have an obsessive fear that they are doing something evil. This s ymptom of OCD is called â€Å"scrupulosity† and causes an individual to tell themselves that they constantly commit sins, and they must pray constantly or find ways to condone their imagined sins.Members of the catholic religion who suffer from this may go to confession many times a week. Some individuals create elaborate systems to avoid certain thoughts, memories, or actions, or to replace or equalize â€Å"sinful† thoughts with pure good ones. One of the most reported obsessions in youth with OCD is a fear of contamination. This fear may center on a concern with germs, dirt, ink, paint, excrement, body secretions, blood, chemicals, and other substances. Recently, an increase in obsessions with AIDS had also been witnessed.Preoccupation with contamination may lead to the avoidance of suspected contaminants or constant findings in studies such as testing the effectiveness of different therapies; strongly suggest that it is the working alliance or bond between therapis t and patient, which is paramount to therapeutic success. Interpersonal aspects of treatment such as 1. comfort 2. confidence and 3. a true commitment from both patient and therapist make a great deal of difference in fostering an atmosphere of collaboration. To be successful both the patient and the therapist need to bring their fullest devotion to the explicit and implicit contract of therapy.By saying this it means that at the end of each session both parties need to come to an agreement of the next week's challenges. The patient must except the responsibility and be willing to participate in his or her challenges. Clients can choose to share the challenges of this therapy with an experienced partner or they can choose to decline. The principles of this therapy focus on fostering a sense of therapeutic independence on the part of the client. Equally important to training, knowledge, experience, and credentials are understanding, compassion and warmth.Most often the cognitive-beha viorist believes that self-disclosure is a healthy part of any relationship, including a therapeutic one. Therefore when a client answers questions about themselves it is considered a natural and healthy part of the therapeutic exchange. {steven phillipson 1} The basic premise of this therapy is based on the belief that at the heart of depression exist distorted and irrational thinking patterns. Such patterns revolve around our automatic reactions toward life circumstances, which create upsetting emotional consequences.CBT was developed to assist patients to respond rationally to automatic irrational thoughts. Here automatic thoughts are said to be mental reflexive reactions to upsetting events. Typically, the approach teaches people to learn to identify our reflexive reactions or â€Å"beliefs† that occur as a consequence to upsetting events, that are responsible for the periodic upset we experience. Traditional therapist that specialize in CBT focus on teaching clients to s ubstitute rational thinking for automatic irrational thinking. {steven phillipson 2}Basic CBT believes that within all of us exist irrational ideas. This therapeutic intervention is based on therapists' faith in our ability to learn how to sort out the difference between being rational and irrational. At the heart of learning is the belief that we learn from society, family, and religion how to think in dysfunctional and irrational ways. Traditional CBT for patients suffering with OCD is therefore likely to be counter productive toward achieving a beneficial therapeutic outcome. This approach assumes that persons are reacting irrationally to a rationally safe situation.The problem is that the majority of OCD patients are aware that what they are doing is bizarre and irrational. Most can even predict that the risk of danger is infinitesimal. Yet they feel overwhelmingly compelled to act out some escape response. Therefore using traditional CBT: activating event, automatic thought, em otional reaction, and rational response would be futile. Traditional CBT was developed as a treatment for depression. The two basic components entail, 1. the behind the scenes strategizing and 2. the front line conflict.It is very important not to mix up the appropriate application of these two separate strategies when dealing with OCD. The manner in which one conceptualizes a battle and the behavior exerted in fighting it, are very different. {steven phillipson 3} Cognitive therapy for OCD predominantly focuses on the two mentioned aspects of this disorder. The first aspect initially involves having sufferers develop a healthy and informed understanding of how the mechanisms of OCD operate. This focus will be referred to as cognitive conceptualization.Cognitive conceptualization includes having the sufferer separate themselves from the emotional or moral implications of what the disorder seems to represent. Many people who suffer from the purely obsessional form of this condition a nd responsibility experience tremendous amounts of guilt and shame for having these thoughts or being responsible for the wellbeing of others. Also involved with the first aspect is having clients appreciate that giving in to a ritual or embracing the risk of the obsession, requires making a series of genuine choices and are not pre-programmed reflexive reactions.Critical aspects of this focus involve reshaping one's response set to the risk. This involves concentrating on one's relationship with their condition as that of making choices in the matter of giving in the ritual, or not. This viewpoint is in difference to perceiving the reaction to cognitive threats as obligatory or as having no choice in the matter. In practice this translates into having patients reframe their disposition from, â€Å"I had to† to â€Å"I chose to†.Research has clearly showed that acknowledging our choice in the matter of facing difficult life challenges increases one's tolerance to adver sity. Consistently studies have demonstrated that our ability to tolerate pain is greatly increased as we acknowledge our choice in relation to the decision to seek relief or to tolerate the discomfort. As our perceptible sense of control increases so does our willingness to tolerate discomfort. A minor but crucial aspect of cognitive-conceptualization involves educating people about the actual risks pertaining to their specific concerns.Unfortunately medical science doesn't offer total certainty. Therefore telling someone that the chances of getting AIDS from a door knob is slim at best, does little to take away the general concern. Some people claim to have been guided by their disorder for so long that they have forgotten their real instincts. In addition, becoming informed that people who spike about being a danger to others rarely actually do damaging things or that person with anxiety disorders almost by no means develops schizophrenia might educate, but rarely provides lastin g relief. Steven Phillipson 4} Cognitive-management is the second goal of CT; this involves teaching individuals to respond to obsessive threats in a way that there is little to no debate in response to being spiked. The main goal is to reduce conflict or mental escape in formulating a response to the upsetting thought. The end product is referred to as habituation. Principles are also included in cognitive-management. These principles enhance greater levels of tolerance toward the physical discomfort, generated by the anxiety.The principles include making space for the discomfort and looking upon it as something to be managed effectively, rather that just achieving a period of relief. The search to eliminate the spike is more than likely the greatest cognitive misconceptualization that people bring to the therapeutic process. Eventually the goal of CT for OCD is to manage he spike effectively, not to focus on its existence or disappearance. The same thing could be said about the ex perience of anxiety. Tolerating anxiety focuses on developing room for the experience.Developing room for its presence enables the brain to focus on other information. Cognitive conceptualization focuses on helping take out a sense of culpability, guilt and shame, which is pervasive among obsessive-compulsive sufferers. To access the ideas and philosophy of cognitive-conceptualization in the midst of the challenge would be unadvised because it would tend to be reassurance oriented. The goal for later on in the treatment is instructive in aiding a person's respond effectively to the cognitive prompt of the danger with the least resistance, which thereby allows habituation.Creating an aggressive disposition toward a challenge is tremendously advantageous toward a successful recovery. Aggressiveness is defined as actively looking for anxiety provoking challenges. Paradoxically, when a person seeks an anxiety provoking challenge there tends to be a greater likelihood that experiencing r educed levels of anxiety is achieved. This comes out due to changing the condition's momentum from endless escape to approach. â€Å"As we seek challenges there is less likelihood of finding them†. Cognitive therapy for OCD has two main applications 1. o help people understand the guidelines of anxiety disorders overall plan 2. to provide specific suggestions in response to the moment of being challenged by awareness that there is some imminent danger. Cognitive principles to assist sufferers develop a healthy disposition in the direction of their anxiety is The statement â€Å"within the question lies the answer† proposes that when confronted with a seemingly sincere risk, relying on the consciousness that there is doubt and therefore making the strength of mind to receive the possibility will get rid of a enormous quantity of difficulty solving. steven phillipson 6} The ultimate aspect of cognitive management entails deliberately creating the consciousness and nature of the chance while engaging in the uncovering exercise. This strategy suggests that combining the behavior a compulsive act with a self-talk enhances the impact of an uncovering exercise. Making the choice to put up with the risk tends to close down the brain's natural propensity to alert its host, through physical uneasiness and cognitive warnings, that you should feel unpleasant until the danger is removed.Overall CT involves providing a sufferer with specific responses to the spikes and educating them about the distinction between having these concerns and separating one's identity from the topics of the condition and highlighting general strategies which facilitate anxiety management. This goes to say that providing reassurances and attempting to educate the sufferer about the truly limited risks involved in the spikes is counterproductive and alienating. {steven phillipson 7} lead to excessive washing.

Starbusks And Conservation International - 12350 Words

9-303-055 REV: MAY 1, 2004 JAMES E. AUSTIN CATE REAVIS Starbucks and Conservation International Aligning self-interest to social responsibility is the most powerful way to sustaining a company’s success. —Orin Smith, President and CEO, Starbucks Coffee Company In mid-2002, the management of Starbucks, the world’s leading specialty coffee company, was examining its collaborative efforts with the environmental nonprofit Conservation International to promote coffee-growing practices that would enhance the environment and produce high-quality coffee beans. This four-year-old alliance was an integral part of Starbucks’ business and social strategy of strengthening the well-being of small coffee producers. These efforts were taking place†¦show more content†¦While keeping the focus on quality coffee, Starbucks began global expansion of its stores (Japan and Singapore in 1996 and Taiwan, Thailand, New Zealand and Malaysia in 1998) and established strategic partnerships with PepsiCo for its bottled Frappuccino and Dreyer’s for the Starbucks line of ice creams in 1996. By fall 2002, the company had 4,000 stores in the United States and another 1,500 in 22 other countries, with plans to expand to 10,000 stores in 60 countries by 2005 and 15,000 stores by 2007; each day three new stores opened. Additionally, Starbucks had a wholesale business and sold to food service establishments and supermarkets, as well as through catalogs and the Internet. Starbucks had revenue of $2.7 billion in 2001, up from $465 million in 1995 (see Exhibit 1 for financials). Nearly two-thirds of revenue came from coffee beverages, 15% from coffee beans, and 24% from food and coffee-related items. Mission Statement From the beginning, Schultz wanted to create a company that employees were proud of, was profitable, and was a good place to work.3 In 1990, the senior executive team created with employee input the company’s mission statement: â€Å"to establish Starbucks as the premier purveyor of the finest coffee in the world while maintaining our uncompromising principles as we grow.† The six guiding principles were: †¢ Provide a great work environment and treat each other with dignity and respect. †¢ Embrace diversityShow MoreRelatedStarbucks Is The Premier Roaster And Retailer Of Specialty1308 Words   |  6 Pagesrecycling paper cups. Goodwill can attract customers and gain customer loyalty so it another way of earning profits. Reducing Greenhouse Gas Emission Greenhouse Gas has a great impact on climate change. Starbucks is â€Å"focusing our efforts on energy conservation and the purchase of renewable energy† (Starbucks, 2014) to reduce Greenhouse Gas emission. †More than 80 percent of our GHG emissions are attributable to energy for use in our stores, offices, and manufacturing plants.† (Starbucks, 2014). From