Hindustan Motors Limited Analysis

Hindustan Motors Limited Analysis Hindustan Motors Limited is ancestor to all automobile manufacturing companies of India. It was established in 1942 before Indias independence. It was a flagship company of C.K. Birla group. Initially company had a small assembling plant at Port Okha, Gujarat. Main purpose was to reduce transportation cost because all parts were imported from foreign companies. Later it was shifted to Uttarpara, West Bengal due to cheaper raw materials and cheap labor cost. This later resulted in one of the most successful motor car of India the ambassador. Apart from the ambassador Hindustan Motors Limited has been active in production of various types of passenger cars, trucks and multi utility vehicle. Hindustan motors collaborated with Mitsubishi motors, Japan and introduce mid size premium segment cars such as Mitsubishi Lancer, Lancer select and Lancer Cedia. The company brought first sports utility vehicle to India which was Mitsubishi Pajero. Besides passenger cars (Ambassador, Grand, and Avigo), Multi Utility Vehicles (Trekker, Porter, and Pushpak) and the RTV, Hindustan Motors also manufactures passenger cars in the mid size premium segment (Mitsubishi Lancer, Lancer Select, and Lancer Cedia) and has brought in Sports Utility Vehicle (Mitsubishi Pajero) into the Indian market in collaboration with Mitsubishi Motors, Japan. Company made collaboration with General Motors and their joint venture produced Bedford trucks and Vauxhall motors during eighties and nineties. The partnership became 50-50 when General Motors bought Hindustan Motors plant at Halol, Gujarat in 1999. After almost seven decades Hindustan Motors is still actively contributing in countrys automobile market. Its manufacturing facilities are established in Madhya Pradesh, Tamil Nadu and West Bengal. Hindustan Motors motto is quality, safety with environmental care. It has been providing total solutions for customer care. Executive Summary: C. K. Birla: He is the chairman of the Board of Hindustan Motors LTD. He has a vast experience of business as he has been a successful industrialist since decades. Along with the chairmans post he serves as an independent non executive director of Hindustan Motors LTD. Manoj Jha:  Ã‚  Ã‚  Ã‚   He is recently promoted as a Managing Director at Hindustan Motors LTD. He is an executive vice president of engineering division and member of the management board. He studied hi engineering from Ranchi University. Yogesh Goenka: He is a chief financial officer, compliance officer and company secretary. He did Bachelor of commerce as well as AICWA, ACS, MBM. OBJECTIVE OF THE COMPANY: Main objective of the company is to provide an automobile with comfort and safety. The company has collaboration with international companies such as general motors, Vauxhall motors and Mitsubishi motor suggests that company has always been thriving for technology. Still the company is looking for development and technological enhancement to overcome recent declining in its sell. According to the chairman of Hindustan Motors the company main objective is to increase the selling of their models by improving its managerial structure. The company is looking for new and affordable product which can boost up their selling. Main purpose of this project paper is to study about declining of their once most successful model the ambassador. The Product-à ¯Ã†â€™Ã‚   The ambassador The ambassador model was based on Morris Oxford model which was manufactured in Cowley by Morris motors. Initially Hindustan motors started the production of Land master in 1954 near Uttarpara plant Kolkata. This led to production of ambassador in 1957. Thus 1957 can be counted as e year when ambassador first came into existence. The ambassador was considered to be best suited to harsh Indian terrain thats why it became very popular. AT that time it was said if you want to have comfort have an ambassador. Till 1980s there were only two Indian cars available in Indian market: ambassador and padmini. Due to its comfort and ability to sustain heavy blows on harsh terrain ambassador captured almost 70% of the Indian automobile market. It is to be noted that ambassador was once called the limousine of India because all politicians, famous businessmen prefer to have ambassador. It was a status symbol because of its proud appearance. It is strange that till 2001 the ambassador remain popular in taxi segment because it was said that the ambassador has ability to sustain shock during motor accident better than any other car available at that time. The credit goes to the manufacturing department of ambassador because the chassis of ambassador was such rigid that it can bear heavy blow from front as well as from side and rear. Till 90s India was sellers market means customer had to wait for a long time to get the product. Take an example of BAJAJ scooter, during 80s the condition was if son wants a scooter than father should apply for that so that after a long time son can be able to drive it. Well it is an exaggeration but the conditions for automobile market were very bad especially for a new company to jump in because government had laid very harsh rules on foreign companys entry and imported material became very costly. This give ambassador a dominant position for a few decades with some extraordinary features as discussed above and the ambassador succeeded to maintain it for a long period. Decline-à ¯Ã†â€™Ã‚   The product is in decline during last decade and the sales are decreasing it is surprising for such once successful model. To find out the products recent condition PORTER model analysis and SWOT analysis have been carried out as shown below. PORTER model analysis:- Against new entrants such as Maruti Suzuki, Honda, Ford, Hyundai etc the company failed to compete and continued with their existing strategy. It has found that after the year of 2000 the product has been in decline the table below gives its detail. As shown in the table despite of increasing number of automobiles in India the selling of ambassador is continuously decreasing. The company failed to cop up with ongoing circumstances such as in case of suppliers it failed to judge the pace of the industry and it remained slow in comparison of others. The company remained stick to only one brand means they didnt have varieties of products. The ambassador was available with nearly the same features throughout its existence. While Maruti Suzuki which has become the largest car manufacturer of India implemented various products having various features which made the company growing in terms of profit and selling. Companys market share has been decreased due to internal rivalry among union and management. SWOT analysis: Strength: Ambassador was the first car produce by an Indian company. It became a huge success story as well. There was a time when ambassador was exported to the countries like Pakistan, Bangladesh, Sri lanka and Myanmar. It was exported to Middle East countries as well. Due to its long reign in India Company has a broad network of service centers. It consists of 115 strong dealers, 50 parts dealers and 60 additional exclusive parts dealers. In 2006 the company has invested huge amount to establish production capacity for its product part. As stated earlier the image of ambassador as a car is still strong in Indian customers mind as trustworthy vehicle in all terms. Weaknesses The model hasnt been changed much since its first appearance. A customer needs change with improvement in outer look as well as its performance. As far as performance is concerned the ambassador is OK if compared with the modern cars. In case of look, its not at all attractive or impressive for younger generation. The company came to manufacturing when government rules were tough for any outsiders. As stated earlier Indian market at that time was sellers market. Low volume high price is all that Hindustan motors gave to its customers. When the laws were made liberal and new companies jumped into Indian market the company didnt make considerable changes for manufacturing process which couldnt cop up with new demand. Ambassador is the most dominant among all products of Hindustan motors. However new customers want safety with fuel efficiency. Ambassador promises safety but it was not fuel efficient when compared to modern cars. The employees were not efficient due to union problems which were a result of improper human resource management. Though the company had made several tie ups but later on when required to obtain new technology it lacks global export markets. Opportunities The ambassador is still recognized as the most comfortable car. Old age people prefer to have ambassador than any other car due to its impressive record against accidents. The company can modify the same car and it can make it more fuel efficient to attract middle class. There are examples of such long reigning cars. Take an example of Volkswagen beetle which was introduce in early 40s and its production continued till the beginning of 21st century. Volkswagen has achieved this by continuously changing the design and internal features. Same is needed to be done in case of ambassador as well. Threats Employees are not motivated enough to their job faithfully. More and more new companies are coming to India as it is becoming a giant market for automobile industry. Every companys aim is to provide the most fuel efficient and trustworthy car. According to company ambassador has been designed and manufactured over the years in such a way that it is almost difficult to change its features. It is most important to see how company has implemented the marketing mix strategy to its product so that it is declining. 4 PS OF MARKETING: Product: Ambassador the first Indian car manufactured in India. The most successful car of Indian automobile history. Figure : Ambassador The ambassador has a powerful 5420 cc engine, heavy axles, hydraulic brakes and bigger suspensions. Before considering the ambassador first of all it is required to know what company should be looking for when they introduce their product. For whom it is manufacturing its product? How much benefit they are expecting? Which position going to be the best for their product? What is their product offering that others is not? When the ambassador was launched the company was fully aware that only rich people would be buying their product therefore they provided all facilities that were present at that time. Also ambassadors have been used by ministers as well so for them there were special models having security implements such as bullet proof glass. The company was fully aware of what it going to achieve because at that time there was no competition and the market was open to it. Price: Pricing is another important element of marketing mix. Pricing brings money back to the company and companys profit depends on it. Other three Ps depends on price; it is easy to understand that remaining P require cost. Product needs cost from early design to manufacture. Placing means distribution also needs cost. Promotion also requires cost. These costs are variable cost to the company. Pricing to be perfect must show supply and demand relationship. Pricing a product too high or too low cause loss to the company therefore it should lie in between. There are different factors which should be considered as shown below. Fixed and variable costs Competition Company objectives Proposed positioning strategies Target group and willingness to pay In case of ambassador Hindustan Motors has used Product Line Pricing i.e. For the same product the company has set different prices for different features. Place: Place strategies Place strategies include the ways of distribution by the manufacturer. The manufacturer should have a clear idea about the market. The manufacturer should be aware of the demand and accordingly it should provide the supply. These demand and supply should be balanced properly because in a condition where supply is less than demand, the customer dissatisfaction in acquiring the product results into loss for the company. In most conditions the customers starts favor other companies product though they are not as better. Therefore just because of improper supply the company lost its good will. There are mainly two kinds of placing strategies. The manufacture may go through any one of them depending upon which suits it the most. As shown in figure in one strategy there isnt direct contact between manufacturer and the customer in this case the company doesnt need to carry out surveys for demands all it needs to do is maintaining proper supply to the whole seller. However in this case the company may not come to know about what the customer wants and this leads to misinterpretation of customer need due to indirect contact having so many extra elements in between. This problem can be removed by maintaining direct contact of the company with its customer as shown in figure. In this case the manufacturer directly supplies its products to the customer. But this needs a wide distribution network by the company which is costly depending upon the size of the company. First channel of distribution is called indirect distribution and second channel of distribution is called direct distribution. indirect distributiondirect distribution Figure : Above indirect distribution (left) and direct distribution (right).   The ambassador has been distributed by indirect distribution method thats the reason why in later years the company fails to recognize the customers need. Depending on the type of product being distributed there are three common distribution strategies available: Distribution: According to the nature of the product there are few distribution strategies as shown below. Intensive distribution: As the name suggests this distribution is high in numbers and widely spread. It generally doesnt need the survey as the products are common and general. Example: chocolate, soft drinks, biscuit Exclusive distribution: Some products are there which need proper demonstration and guidance so that customer can be made fully aware of what he is paying for. These products are highly prices. Example: Cars, bikes etc. Selective distribution: This kind of distribution consists of wide space where customer has a freedom to have a look and select a product from wide varieties. Example: TV, computers etc. Hindustan motors have used exclusive distribution method over the year which is common for any car manufacturer. Promotion Promotion means advertising the product. A product without promotion is a complete failure as through the promotion the customer comes to know about the product. There are different promotion strategies as shown below. Advertisement: Advertisement can be said as a non personal promotion activity through media. Public relations: Good relations with the customers as well as media persons make the promotion easier as in this case company doesnt need to do anything. Sales promotion: Company can give vouchers or coupons to attract the customer. Discount scheme, free scheme are examples of sales promotion. Personal selling: Door to door selling or personal to personal selling comes under this category. Promotion of ambassador comes under the public relations as due to its image as a successful car the media and people has been promoting it over the years. The company has never or barely used advertisement or sales promotion. RECENT CONDITION: Company Sales during 2010 (million Rs.) Hindustan motors 5802.7 Maruti suzuki 296230.10 Swaraj Mazda 7167.60 Mahindra and Mahindra 186021.10 Table : Comparison of sales with other companies (Source: http://bseindia.com/bseplus/StockReach/AdvanceStockReach.aspx?scripcode=500500) It can be seen from the figures that at present the company is far behind from market leaders like Maruti Suzuki and Mahindra and Mahindra. CRITICAL ANALYSIS: Critical analysis of this particular project requires thorough understanding of marketing mix strategy. To give personal views about anything first of all one should make himself familiar with the subject. Thats exactly what I did. Before starting the project I went through on line papers and explanation about the marketing mix strategy. I found that though everywhere the concept to be used was marketing mix but its implementation was different. Like All roads lead to Rome all of them were leading to the success of their company by successful implementation of marketing mix strategy. During the lectures I heard the tutors saying about getting into marketing mix by doing a practical experiment. It is obvious that they were not saying about establishing a new company of implementing a marketing mix strategy actually. Its about taking any company and than putting my own ideas about marketing mix strategy into motion. The same thing has been done by me during this assignment. I have sele cted a company the product of which is in decline since three or four years. I carried out analysis based on what was taught to me. Now I am going to give my personal opinion about marketing mix strategy and its implementation. In the beginning it is important about the value offered by the company to its customers. I have selected the oldest Indian automobile company named Hindustan motors. The product which I considered was ambassador car. The product has been successful until last two decades than it started declining due to the factors which I have discussed earlier. So what is value? In general the value can be defined as the ratio of function to the cost. Any company can increase the value of its product by increasing its function and decreasing its cost. Functions may vary accordingly such as it may be visual appearance, comfort, promising performance etc. It seems simple to increasing value by increasing function or by decreasing cost but actually it is the most important and complex feature for any manufacturing company to be succeeded. A customer always judge the product by the value offered from it. Sometimes it may be more functions sometimes it may be less costs. The company should be therefore aware of what customer wants from its product. If company knows the value expected from the customer it tries to make some changes into the product in terms of functions or cost. This is not an easy task because the company has to make some changes in its manufacturing process and sometimes within the organization. One wrong step can lead to complete contradict out come and leads company to the loss. According to Devst the value creation process is more effective in manufacturing company than other sectors (Deyst, 2000). Other sectors include service sectors such as an airline company, insurance company where the company provides service instead of the product. It appears that these service sectors change their goal and direction more rapidly than the manufacturing sectors. Therefore value creation process is not as important for them as it is for manufacturing companies. For manufacturing companies final value of the product depends on value of the product during its manufacturing process. In other words according to Lean development of product and final value of the product are strongly related with each other (Lean, 1998). Thus the value should be defined after each phase of the product development process. However creation of value at each stage requires severe value addition to move ahead of the competitor. There are few who think that value creation process cant lead company towards its goal. According to Lloyd value creation doesnt indicate the vision of the company. Value is nothing rather than a conceptual idea. I dont agree with that because I have found during the research for this particular company that defining value is the most important factor to attain marketing lead. Hindustan Motors failed to attain value in terms of appearance and fuel efficiency of ambassador when other companies were launching new products into the market. This leads to decreasing sales of ambassador. The company didnt make proper market research and they continued to do the same over the past years. The outlook of the ambassador is the same as it was 40 years ago. The ration of function to cost became unstable due to decreasing functions of the car. In terms of price also the car was costly as company was making limited production and failed to grasp new concept of high volume production for low price and high profit. From my research of old papers and publications I found one thing in common. Most of the authors consider marketing as an art of selling. However now day marketing is becoming more than an art. It has become a necessity. Without marketing selling the product is impossible. Now days lots of companies are spending more and more money on marketing their product. The marketing value of the product is sometimes higher than the manufacturing and raw material value. It is strange that Hindustan Motors took the marketing strategy very lightly. According to me the main reason is when they came into existence they didnt have any competitors all they need to do is manufacturing and selling of the car. As I have stated earlier before 80s Indian automobile market was sellers market which means manufacturing companies have the command on the market not the customers. Having customers command on the market is essential otherwise the development stops. The same thing happened, ambassador remains the same car as it was when it was first introduced. Hindustan Motors didnt promote the car because as a single Indian car it was already famous. Distribution was not that much difficult because car owners were few. The price of the ambassador was relatively high because those who needed the car didnt have another option. Also the government rules on importing the components were harsh and company was paying high prices for them. It seems obvious what the company did during those years. But when the scenario changed during 90s the market became open to all the government rules became soft and lots of other car manufacturers jumped into the Indian automobile market. This was the time when the ambassador should have changed its strategies. However they didnt make considerable changes on the other side new companies like Maruti Suzuki got the nerve of an Indian customer and introduced cheapest car in the market. Due to this drastic change once giant Hindustan Motors has become a company in loss with one of its most successful car an ambassador in decline. FANTASTIC FOUR The four Ps of marketing which should be studied and understood in a proper way to attain success. During the project I came to know that balancing these four is not an easy task as it seems. Any cannot pick the product randomly, it cannot sell it in the price it wants, it cannot distribute the product whenever and wherever it decides and it has to promote its products such a way that customer attracts to buy it. I have considered all four Ps including my understanding about them, Product Pricing Placing Promotion Product: An initial P for any company to think about. It seems strange to consider which product to be made for marketing. As per my previous understanding marketing comes into picture after selection of product. This was true in old times. But now a days company should be keen towards the product it is going to manufacture. The market condition , market surveys future of the product, availability of the raw materials, environment effect of the raw materials are some of the important factors to be considered before the start of manufacturing the product. I think right product at right time removes half of the troubles for marketing. Take an example of ambassador; it arrives in the market when there were no competitors. As a result it dominated the market for decades. Due to proper timing and place Hindustan motors saved their expenses for promotion. They didnt promote it ever i.e. since my childhood I have never seen an advertisement of ambassador or huge posters promoting the car. A mbassador got promoted by its customers which is ideal for any product. Sometimes good product becomes a loss for the company when it launched at improper timing. There are so many examples of excellent movies which didnt succeed on the box office due to adverse conditions. Pricing: Pricing of the product is non variable factor for the company. The company decides the price of any product after considering other Ps. The expenses during the product stage i.e. manufacturing and raw material expenses. Expenses due to distribution and promotion also considered. The company adds its expected profit as well. Pricing is the most deciding factor because as I think many manufactures are not aware of the ideal price and the customers always think that they have paid more. This dissatisfaction leads to decreasing sales and loss of the company. I think that before pricing the product the company should make a proper survey and it should make the customers fully aware of what they are buying and how much they will get after paying the price. I have seen three kinds of customers, Those who care about price only Those who care about quality only Those who care about balancing the price and quality These customers are generally from three different classes, those who are looking for price are generally relatively poor, those who are looking for quality are rich and those who select the product after looking at price and quality are middle class people. Depending upon the nature of the product the company can make changes in its product. In case of ambassador the companys initial target was rich people because the middle class of India was not in a condition to buy a car. The company provides good quality with comparatively higher cost but it got the customers from India who was looking for the quality. When the era changed and middle class customers increased who now were in a condition to afford a car changed the situation of the market completely. Failing to see this upcoming Hindustan motors fell behind the Maruti Suzuki because of higher price. Placing: Placing according to me is a strong decider for the products success. A product should be distributed such that it gets perfect conditions for it. Ideal customers, ideal geography can be considered as conditions which the company should be looking for. I think that company should be clear and perfect about the product distribution. It involves lot of investment to carry the product from the manufacturing plant to the market. It is economically critical to change the place by distributing the product from one place to another. Thats why I think that for placing also the company needs proper survey in order to distribute the product at right place on right time. Promotion: Advertisement is becoming utmost necessity for selling of the product. Modern market is complex with so many products and companies. It is required therefore for any company to promote the product in a way that customers know about the features of the product. Promotion should be maximum and precise, or I can say it should be concentrated heavily on its target. The company should be aware of the targeted customers and market and should therefore emphasize heavily on them. If it is improper than company will be investing heavily in useless activities. Without promoting or improper promoting the product leads to heavy losses as can be seen in case of ambassador. When it was launched it didnt have any need of being promoted. As a first Indian automobile it was already famous so the company didnt have any need to promote it and company did the same as well. But when as I have discussed later the market changed there was immediate need of promoting to show the new customers wha t the car is and why it was so successful. The company failed to do so and product sell decreased. CONCLUSION: After making a project report on the declining ambassador car I can say that with changing time the company should focus on the ongoing conditions as well as it should be prepared of future. Same strategy wont work for all time in all kind of situations. Customers, environment and competitors change accordingly and company should be looking for continuous improvement rather than remain satisfied from the present. Ambassador is an excellent example of how once market leader can go into loss due to improper marketing strategy by the company.

The Impact of Modern Science and Technology Essay -- Medical Medicine

The Impact of Modern Science and Technology The quest for scientific knowledge should be boundless. There should not be any type of barriers to prevent such an enrichment of knowledge, and that is exactly what science presents to us. Scientific knowledge can only help us in the long run and even perhaps save us from catastrophes that may occur naturally in the world. There could be an agreement that science has produced many dangerous and destructive things which have brought society many problems, but on the same token the good things that science has produced seems to outweigh the bad. There is much to be said about the bad things that science has produced throughout history. For instance, the creation of nuclear weapons, which have the potential of destroying the whole planet in a matter of hours. There are also many other negative outcomes which science has created in our environments like the depletion of natural resources, technological unemployment, and environmental pollution. Unfortunately, the adversaries of science only want you to look at the negative things that science has created without mentioning and without giving recognition to the good things that science has created. In fact, many of these opposing individuals of science can be called hypocrites from their failure of using technology for their own need and satisfaction. As Bishop mentions in his article "Enemies of Promise", there are many people who are ignorant when it comes to science and, yet these ignorant individuals still have opinions that mislead other people who are less educated and less informed; what greater reason should there be for us in knowing more about science. Under all the scrutiny science has gone through by their adversarie... ...ving no matter how bad our situation becomes or how bad our environment gets and sometimes the combination of both. One could say that science is here to stay and there is nothing to stop it, and if that is the case one must try to learn everything that science introduces to us. It does not matter if the science being done is undesirable, we should still educate ourselves to understand the problem and perhaps fix the problem with newer and even more advanced technology. Trying to avoid science and to go against it would be like putting on blinders because everyone around you is looking forward for something new that could improve the standard of living and even once self being. Work Cited Lunsford, Andrea and John Ruszkiewicz. The Presence of Others: Voices that call for Response 2nd ed. New York: St. MArtin's, 1997 Bishop,J. Michael. "Enemies of Promises" The Impact of Modern Science and Technology Essay -- Medical Medicine The Impact of Modern Science and Technology The quest for scientific knowledge should be boundless. There should not be any type of barriers to prevent such an enrichment of knowledge, and that is exactly what science presents to us. Scientific knowledge can only help us in the long run and even perhaps save us from catastrophes that may occur naturally in the world. There could be an agreement that science has produced many dangerous and destructive things which have brought society many problems, but on the same token the good things that science has produced seems to outweigh the bad. There is much to be said about the bad things that science has produced throughout history. For instance, the creation of nuclear weapons, which have the potential of destroying the whole planet in a matter of hours. There are also many other negative outcomes which science has created in our environments like the depletion of natural resources, technological unemployment, and environmental pollution. Unfortunately, the adversaries of science only want you to look at the negative things that science has created without mentioning and without giving recognition to the good things that science has created. In fact, many of these opposing individuals of science can be called hypocrites from their failure of using technology for their own need and satisfaction. As Bishop mentions in his article "Enemies of Promise", there are many people who are ignorant when it comes to science and, yet these ignorant individuals still have opinions that mislead other people who are less educated and less informed; what greater reason should there be for us in knowing more about science. Under all the scrutiny science has gone through by their adversarie... ...ving no matter how bad our situation becomes or how bad our environment gets and sometimes the combination of both. One could say that science is here to stay and there is nothing to stop it, and if that is the case one must try to learn everything that science introduces to us. It does not matter if the science being done is undesirable, we should still educate ourselves to understand the problem and perhaps fix the problem with newer and even more advanced technology. Trying to avoid science and to go against it would be like putting on blinders because everyone around you is looking forward for something new that could improve the standard of living and even once self being. Work Cited Lunsford, Andrea and John Ruszkiewicz. The Presence of Others: Voices that call for Response 2nd ed. New York: St. MArtin's, 1997 Bishop,J. Michael. "Enemies of Promises"

Nursing Pressure Sore

What are pressure sores? Pressure sores are areas of injured skin and tissue. They are usually caused by sitting or lying in one position for too long. This puts pressure on certain areas of the body. The pressure can reduce the blood supply to the skin and the tissues under the skin. When a change in position doesn't occur often enough and the blood supply gets too low, a sore may form. Pressure sores are also called bedsores, pressure ulcers and decubitus ulcers. What are the symptoms of a pressure sore? There are 4 stages of pressure sores. Symptoms at each stage include the following: Stage 1.The affected skin looks red and may feel warm to the touch. The area may also burn, hurt or itch. In people who have dark skin, the pressure sore may have a blue or purple tint. Stage 2. The affected skin is more damaged in a stage 2 pressure sore, which can result in an open sore that looks like an abrasion or a blister. The skin around the wound may discolored. The area is very painful. St age 3. These types of pressure sores usually have a crater-like appearance due to increased damage to the tissue below the skin's surface. This makes the wound deeper. Stage 4.This is most serious type of pressure sore. The skin and tissue is severely damaged, causing a large wound. Infection can occur at this stage. Muscles, bones, tendons and joints can be affected by stage 4 pressure sores. Who gets pressure sores? Anyone who sits or lies in one position for a long time might get pressure sores. You are more likely to get pressure sores if you are paralyzed, use a wheelchair or spend most of your time in bed. However, even people who are able to walk can develop pressure sores when they must stay in bed because of an illness or an injury.Some chronic diseases, such as diabetes and hardening of the arteries, make it hard for pressure sores to heal because of poor blood circulation. Peripheral vascular disease,MI, Stroke,Multiple trauma,Musculoskeletal disorders/fractures/contractu res,Gibleed , Spinal cord injury (e. g. , decreased sensory perception, muscle spasms),Neurological disorders (e. g. , Guillain-Barre', multiple sclerosis),Unstable and/or chronic medical conditions (e. g. , diabetes, renal disease, cancer, chronic obstructive pulmonary disease, congestive heart failure),History of previous ressure ulcer,Preterm neonates, Dementia, Recent surgical patient. Where on the body can you get pressure sores? Pressure sores usually develop over bony parts of the body that don't have much fat to pad them. Pressure sores are most common on the heels and on the hips. Other areas at risk for pressure sores include the base of the spine (tail bone), the shoulder blades, the backs and sides of the knees, and the back of the head. How are pressure sores treated? There are several things you can do to help pressure sores heal: * Relieving the pressure that caused the sore * Treating the sore itself Improving nutrition and other conditions to help the sore heal What can be done to reduce pressure on the sore? Don't lie on pressure sores. Use foam pads or pillows to take pressure off the sore. Special mattresses, mattress covers, foam wedges or seat cushions can help support you in bed or in a chair to reduce or relieve pressure. Try to avoid resting directly on your hip bone when you're lying on your side. Use pillows under one side so that your weight rests on the fleshy part of your buttock instead of on your hip bone. Also, use pillows to keep your knees and ankles apart.When lying on your back, place a pillow under your lower calves to lift your ankles slightly off the bed. When lying in bed, change your position at least every 2 hours. When sitting in a chair or wheelchair, sit upright and straight. An upright, straight position will allow you to move more easily and help prevent new sores. You should change positions every 15 minutes when sitting in a chair or wheelchair. If you cannot move by yourself, have your caregiver help you shift your position. How should the pressure sore be kept clean? In order to heal, pressure sores must be kept clean and free of dead tissue.Stage 1 sores can be cleaned with mild soap and water. You can clean stage 3 sores by rinsing the area with a salt and water solution. The saltwater removes extra fluid and loose material. Your doctor or nurse can show you how to clean your pressure sore. Pressure sores should be kept covered with a bandage or dressing. Sometimes gauze is used. The gauze is kept moist and must be changed at least once a day. Newer kinds of dressings include a see-through film and a hydrocolloid dressing. A hydrocolloid dressing is a bandage made of a gel that molds to the pressure sore and helps promote healing and skin growth.These dressings can stay on for several days at a time. Dead tissue (which may look like a scab) in the sore can interfere with healing and lead to infection. There are many ways to remove dead tissue from the pressure sore. Rinsing the sore e very time you change the bandage is helpful. Special dressings that help your body dissolve the dead tissue can also be used. They are left in place for several days. Another way to remove dead tissue is to put wet gauze bandages on the sore and allow them to dry. The dead tissue sticks to the gauze and is removed when the gauze is pulled off.For more severe pressure sores, dead tissue must be removed surgically. Removing dead tissue and cleaning the sore can hurt. Your doctor can suggest a pain reliever for you to take 30 to 60 minutes before your dressing is changed to help reduce pain. Why is good nutrition important for healing sores? Good nutrition is important because it helps your body heal the sore. If you don't get enough calories, protein and other nutrients (especially vitamin C and zinc, which can help heal wounds like pressure sores), your body won't be able to heal, no matter how well you care for the pressure sore.Your doctor, nurse or a dietitian can give you advice about a healthy diet. Be sure to tell your doctor if you have lost or gained weight recently. What if the sore gets infected? Pressure sores that become infected heal more slowly and can spread a dangerous infection to the rest of your body. If you notice any of the signs of infection listed below, call your doctor right away. Signs of an infected pressure sore include the following: * Thick yellow or green pus * A bad smell from the sore * Redness or warmth around the sore * Swelling around the sore * Tenderness around the soreSigns that the infection may have spread include the following: * Fever * Chills * Mental confusion or difficulty concentrating * Rapid heartbeat * Weakness How are infected pressure sores treated? The treatment of an infected pressure sore depends on how bad the infection is. If only the sore itself is infected, an antibiotic ointment can be put on the sore. When bone or deeper tissue is infected, antibiotics are often required. They can be given intravenous ly (through a needle put in a vein) or orally (by mouth). How can I tell if the sore is getting better? As a pressure sore heals, it slowly gets smaller.Less fluid drains from it. New, healthy tissue starts growing at the bottom of the sore. This new tissue is light red or pink and looks lumpy and shiny. It may take 2 to 4 weeks of treatment before you see these signs of healing. How can pressure sores be prevented? The most important step to prevent pressure sores is to avoid prolonged pressure on one part of your body, especially the pressure points mentioned previously. It's also important to keep your skin healthy. Keep your skin clean and dry. Use a mild soap and warm (not hot) water. Apply moisturizers so your skin doesn't get too dry.If you must spend a lot of time in bed or in a wheelchair, check your whole body every day for spots, color changes or other signs of sores. Pay special attention to the pressure points where sores are most likely to occur. If you smoke, you shou ld quit. People who smoke are more likely to develop pressure sores. Exercise can help improve blood flow, strengthen your muscles and improve your overall health. Talk to your doctor if physical activity is hard for you. He or she can suggest exercises that can work for you, or refer you to physical therapist that can help. Pressure Sore PreventionRelieving pressure: Position must be changed on a regular basis, at least every two hours, and in the very frail at least every hour. Good Diet: A good and balanced diet contributes to healing, as well as avoiding severe nutritional and weight loss Skin Care: Keep the skin clean. Moisture should be minimized. Skin care products should be used that moisturize the skin but do not make it wet or soggy. Use continence aids if a person is unable to control their bladder or bowels. Pads, diapers, convenes or catheterizing. Inspect the skin to see if any redness or breaks in the skin are developing.Use products to relieve and treat pressure sore s; airbeds, foam bed, bed and chair protectors, chair products, continence aids can all contribute to avoiding of bed sores. Clean skin with warm water and minimal friction. Apply lotion often. ————————————————- Avoid direct pressure to bony areas such as ankles and hips. Use pillows and padded protectors to support arms, legs and vulnerable areas. Change the position of a bed-bound person every two hours. Handle and move carefully to avoid skin tears and scrapes.Change the position of a chair-bound person hourly. Discourage the bed-bound or chair-bound person from sitting with the head elevated more than 30 degrees, except for short periods of time. Check and change bed linens as often as necessary Use continence management products if necessary to reduce exposure to moisture. Padded supports, such as doughnut cushions may, themselves, become a source of pressure. Do not massage bony areas of the body. Do not massage pressure sores. Do not use remedies such as iodine, peroxide and cornstarch that may further irritate the skin.Pressure sores (bedsores, decubitus ulcers, pressure ulcers) are areas of skin damage resulting from a lack of blood flow due to pressure. †¢ Sores often result from pressure but may also result from pulling on the skin or friction, particularly over bony areas. †¢ The diagnosis is usually based on a physical examination. †¢ Treatment includes cleansing, removal of pressure from the affected area, special dressings, and, sometimes, surgery. Pressure sores can occur in people of any age who are bedbound, chairbound, or unable to reposition themselves. They are more common among older people.They tend to occur over bony projections where pressure on skin can be concentrated, such as over the hip bones, tailbone, heels, ankles, and elbows. They occur where there is pressure on the skin from a bed, wheelchair, cast, splint, or other hard object . Pressure sores lengthen the time spent in hospitals or nursing homes and increase the cost of care. Pressure sores can be life threatening if they are untreated or if underlying health conditions prevent them from healing. Causes Causes that contribute to the development of pressure sores include: †¢ Pressure Traction †¢ Friction †¢ Moisture †¢ Inadequate nutrition Pressure on skin, especially when over bony areas, reduces or cuts off blood flow to the skin. If blood flow is cut off for more than 1 or 2 hours, the skin dies, beginning with its outer layer (epidermis). The dead skin breaks down and forms an open sore (ulcer). Most people do not develop pressure sores because they constantly shift position without thinking, even when they are asleep. However, some people cannot move normally and are therefore at greater risk of developing pressure sores.They include people who are paralyzed, comatose, very weak, sedated, or restrained . Paralyzed and comatose people are at particular risk because they also may be unable to move or feel pain (pain normally motivates people to move or to ask to be moved). Traction also reduces blood flow to the skin. Traction occurs when the skin is stretched by being wedged against something or when it sticks to something, often bed linens. When the skin is stretched, the effect is much like pressure. Friction can lead to or worsen pressure sores. Repeated friction may wear away the top layers of skin.Such skin friction may occur if people are pulled repeatedly across a bed. Moisture can increase skin friction and weaken or damage the protective outer layer of skin if the skin is exposed to it a long time. For example, the skin may be in prolonged contact with perspiration, urine, or feces. Inadequate nutrition increases the risk of developing pressure sores and slows the healing process of sores that do develop. Malnourished people may not have enough body fat to pad the skin and bones or to keep the blood vessels from being squeezed shut.Also, skin repair is impaired in people whose diets are deficient in protein, vitamin C, or zinc. Did You Know†¦? †¢ Inadequate nutrition increases the chances of developing pressure sores and slows the healing of sores that do develop. †¢ Repositioning people who cannot move themselves at least every 1 to 2 hours can help prevent pressure sores. Symptoms For most people, pressure sores cause some pain and itching. However, in people whose senses are dulled, even severe sores may be painless. Pressure sores are categorized into four stages according to the severity of damage: †¢ Stage I: Redness and inflammation Stage II: Some shallow skin loss, including abrasions, blisters or both †¢ Stage III: Full-thickness skin loss down to the layer of fat. †¢ Stage IV: Full-thickness skin loss with exposure of underlying muscle, tendon, or bone Pressure sores do not always progress from mild to severe s tages. Sometimes the first noticeable sign is a late-stage sore. If pressure sores become infected, they may have an unpleasant odor. Pus may be visible in or around the sore. The area around the pressure sore may become red or feel warm, and pain may worsen if the infection spreads to the surrounding skin (causing cellulitis).Infection delays healing of shallow sores and can be life threatening in deeper sores. Infection can even penetrate the bone (osteomyelitis), requiring weeks of treatment with antibiotics. In the most severe cases, infection can spread into the bloodstream (sepsis), causing fever or shaking chills. Spotlight on Aging Aging itself does not cause pressure sores. But it causes changes in tissues that make pressure sores more likely to develop. As people age, the outer layers of the skin thin. Many older people have less fat and muscle, which helps absorb pressure.The number of blood vessels decreases and blood vessels rupture more easily. All wounds, including pr essure sores, heal more slowly. Certain conditions make pressure sores more likely to develop: †¢ Being unable to move normally because of a disorder such as stroke †¢ Having to stay in bed for a long time, for example, because of surgery †¢ Being excessively sleepy (such people are less likely to change position or ask someone to reposition them) †¢ Losing sensation because of nerve damage (such people do not feel discomfort or pain, which would prompt them to change ositions) †¢ Becoming less responsive to what is happening in and around them, including their own discomfort or pain, because of a disorder such as dementia Diagnosis Doctors can usually diagnose pressure sores by doing a physical examination. A doctor or nurse usually measures the size and depth of a sore to determine its stage and plan treatment. If the damage is severe, radionuclide bone scanning or gadolinium-enhanced MRI (magnetic resonance imaging) may be done to check whether infection has spread from the sore to bone—a disorder called osteomyelitis.To diagnose osteomyelitis, doctors may need to take a small sample (biopsy) of bone to see if bacteria grow from it (culture). Prevention Prevention is the best strategy for dealing with pressure sores. In most cases, pressure sores can be prevented by meticulous attention from all caregivers, including nurses, nurses' aides, and family members. Close daily inspection of a bedridden or chairbound person's skin can detect early redness or discoloration. Any sign of redness or discoloration at pressure areas is a signal that the person needs to be repositioned and kept from lying or sitting on the discolored area until it returns to normal.Because shifting position is necessary to keep the blood flowing to the skin, oversedation should be avoided and activity encouraged. People who cannot move themselves should be repositioned every 2 hours if they are in bed and every hour if they are in a chair—more often if possible. The skin must be kept clean and dry because moisture increases the risk of developing pressure sores. Dry skin is less likely to stick to fabrics and cause friction or traction. For people confined to bed, sheets should be changed frequently to make sure they are clean and dry.Applying noncaking body powder to skin in areas where two parts of the body press against each other (such as the buttocks and groin) can help keep the skin in these areas dry. Bony projections (such as heels and elbows) can be protected with soft materials, such as foam wedges and heel protectors. Donut-shaped devices and sheepskins should be avoided as they only shift pressure or friction from one vulnerable site to another. Special beds, mattresses, and seat cushions can be used to reduce pressure in people who are wheelchair-bound or bedridden.These products can reduce pressure and offer extra relief. A doctor or nurse can recommend the most appropriate mattress surface or seat cushion. It is important to remember that none of these devices eliminate pressure completely or are a substitute for frequent repositioning. Treatment Treating a pressure sore is much more difficult than preventing one. The main goals of treatment are to relieve pressure on the sores, keep them clean and free of infection, and provide adequate nutrition. Adequate nutrition is important in helping pressure sores heal and in preventing new sores from forming.A well-balanced, high-protein diet is recommended as well as a daily high-potency vitamin and mineral supplement. Supplemental vitamin C and zinc may help with healing as well. Electrical stimulation, heat therapy, massage therapy, and hyperbaric O2 therapy have not proven helpful. In the earliest stage, pressure sores usually heal by themselves once pressure is removed. When the skin is broken, a doctor or nurse considers the location and condition of the pressure sore when recommending a dressing. Film (see-through) dressings help protect ea rly-stage pressure sores and allow them to heal more quickly.Hydrocolloid (oxygen- and moisture-retaining) patches protect, keep the skin appropriately moist, and provide a healthy environment for deep sores. Other types of dressings may be used for deeper sores, those that ooze a lot of fluids, and those that are infected. If the sore appears infected or oozes, rinsing with saline and dabbing gently with a gauze pad are helpful. A doctor may need to remove (debride) dead tissue with a scalpel or a chemical solution. Removal of dead tissue is usually painless, because pain is not felt in dead tissue. Some pain may be felt because healthy tissue is nearby.Health care practitioners may flood (irrigate) the sore, particularly its deep crevices, with a sterile solution to help clean away hidden debris. Sometimes a bed that circulates air (an air-fluidized bed) is used in hospitals and nursing homes. This special bed helps reduce or redistribute pressure on the body. ——â₠¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€- Deep pressure sores are difficult to treat. Sometimes they require skin and muscle flaps, in which healthy, thicker tissue with a good blood supply is surgically repositioned to cover the damaged area.This type of surgery is not always successful, however, especially for frail older people who are malnourished. Often, when infections develop deep within a sore, antibiotics are given. When bones beneath a sore become infected, the bone infection (osteomyelitis) is extremely difficult to cure and may spread through the bloodstream, requiring many weeks of treatment with an antibiotic (see Bone and Joint Infections: Osteomyelitis). ————————————————- The terms decubitus ulcer and pressure sore often are used interchangeably in the medical community.Decubitus, from the Latin decumbere, means â€Å"to lie down. † Decubitus ulcer, therefore, does not adequately describe ulceration that occurs in other positions, such as prolonged sitting (eg, the commonly encountered ischial tuberosity ulcer). Because the common denominator of all such ulcerations is pressure, pressure sore is the better term to describe this condition. Pressure is exerted on the skin, soft tissue, muscle, and bone by the weight of an individual against a surface beneath.These pressures are often in excess of capillary filling pressure, approximately 32 mm Hg. In patients with normal sensitivity, mobility, and mental faculty, pressure sores do not occur. Feedback, conscious and unconscious, from the areas of compression leads inIndividuals who are unable to avoid long periods of uninterrupted pressure over bony prominences—a group of patients that typically includes elderly individuals, persons who are neurologically impaired, and patients who are acutely hospitalizedà ¢â‚¬â€are at increased risk for the development of necrosis and ulceration.These individuals cannot protect themselves from the pressure exerted on their body unless they consciously change position or have assistance in doing so. Even the most conscientious patient with an extensive support group and unlimited financial resources may develop ulceration resulting from a brief lapse in avoidance of the ill effects of pressure. [2, 3] dividuals to change body position. These changes shift the pressure prior to any irreversible tissue damage. The inciting event for a pressure sore is compression of the tissues by an external force, such as a mattress, wheelchair pad, or bed rail.Other traumatic forces that may be present include shear forces and friction. These forces cause microcirculatory occlusion as pressures rise above capillary filling pressure, resulting in ischemia. Ischemia leads to inflammation and tissue anoxia. Tissue anoxia leads to cell death, necrosis, and ulceration. à ¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€- Irreversible changes may occur after as little as 2 hours of uninterrupted preSpecialized support surfaces are available for bedding and wheelchairs, which can maintain tissues at pressures below 30 mm Hgssure. urning and repositioning the patient remain the cornerstones of prevention and treatment. The wound and surrounding skin must be kept clean and free A new international guideline with regard to the prevention of pressure ulcers was released in 2009. [11] A collaboration between the National Pressure Ulcer Advisory Panel and the European Pressure Ulcer Advisory Panel, the guideline covers the latest evidence-based recommendations for all patients in all healthcare settings.Clinical practice recommendations in regard to prevention will include: * Current definitions and classification of pressure ulcers; * Risk assessment, including the role of nutrit ion; * Skin inspection and skin care; * Positioning and repositioning patients; * Evidence for use of various support surfaces (air-fluidized beds; alternating air mattresses and cushions; foam-, gel-, or fluid-filled mattresses; overlays for operating tables; turning beds; and other aids for pressure redistribution); * Protective devices used for pressure ulcer prevention; and * Education and training for healthcare providers.

The Domestic Violence Act 1995 Essay - 1499 Words

In New Zealand, 1 in 4 woman will experience a form of intimate partner violence (IPV) throughout the course of their relationships (New Zealand Family Violence Clearhouse, 2015). The Domestic Violence Act 1995 (2014) defines violence in this instance as physical , sexual and psychological abuse. This abuse has a myriad of health consequences on all members of the whÄ nau, including children who witness or are subjected to this violence. The primary health care (PHC) nurse has a range of responsibilities in these contexts including screening for IPV, risk assessing, safety planning, documenting and supporting. The ramification of domestic violence asserts a myraid of health consequences for the victim and also their family and whÄ nau (Hoeata, Waimarie, Li, Young-Hauser, Robertson, 2011). Physical assault, forced sexual acts and psycological abuse are the most common origins (Collins, 2012). 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