Calculate the Total Asset Turnover

Question 4: Calculate the total asset turnover, the P, P, & E Turnover, and the intangible asset turnover for each of the past two years. Are these turnover ratios increasing or decreasing? What might explain these trends? Total Asset Turnover is a financial ratio that measures the efficiency of company’s use of its assets to product sales. It is a measure of how efficiently management is using the assets at its disposal to promote sales.The ratio helps to measure the productivity of a company’s assets. Total Asset Turnover is calculated by Net Sales divided by Total Assets. We had to calculate the Total Asset Turnover, the Property, Plant, and Equipment Turnover, and the Intangible Asset Turnover Ratios in 2010 and 2011 for Johnson and Johnson Company. The below table shows the above ratios in 2010 and 2011. |2010 |2011 | |Total Asset Turnover = |61,587 = |60% |65,030 = |57% | | |102,908 | |113,644 | | | | | | | | |P, P, & E Turnover = |61,587 = |4. 3x |65,030 = |4. 41 x | | |14,553 | |14,739 | | | | | | | | |Intangible Asset Turnover = |61,587 = |1. 92x |65,030 = |1. 89x | | |32,010 | |34,276 | |For the Total Asset Turnover, there is a decrease from 60% in 2010 to 57% in 2011. For the Property, Plant, and Equipment Turnover, there is an increase from 4. 23 in 2010 to 4. 41 in 2011. For the Intangible Asset Turnover, there is a decrease from 1. 92 in 2010 to 1. 89 in 2011. Increases in the asset turnover ratio over time may indicate a company is growing into its capacity. A decreasing ratio may indicate the opposite. Asset purchases made in anticipation of coming growth (or the sale of unnecessary assets in anticipation of declining growth) can suddenly and somewhat artificially change a company's asset turnover ratio.

Guide on How to Write Philosophy Essay

Guide on How to Write Philosophy Essay Is there a meaning to life? Do we have a free will? Is there a God? These are some of the so-called â€Å"Big Questions† that often motivated philosophers of the past, are intriguing to academically trained philosophers of the present and will be stimulating intellectual discussions among a more general audience in the future. Such questions may become a topic for your philosophy essay assigned at the university. For many students, writing a philosophy essay is something of a new experience and you might be a little unsure of what you should expect, or of what is expected of you. In this philosophy essay writing guide, you will find some preliminary advice about writing philosophy essays at the university that will help you determine where you should direct your efforts to achieve the best result. What Is a Philosophy Essay? First of all, you should realize that philosophical essays are different from essays in most other subjects. Wondering why? Philosophy essays are not written for the sake of literary self-expression and they can’t be approached like ordinary research papers. They don’t summarize that different scholars have had to say on a certain topic. They don’t present the latest findings of scientific experiments, tests or surveys. And they don’t present your personal impressions, opinions, feelings. Instead, a philosophy essay is a reasoned defense of a thesis. When writing assignments in your philosophy classes, you have to be doing philosophy. You need to ask insightful questions about fundamental ideas and concepts and provide reasoned, well-argued responses to these questions. You need to establish logical relations between your thoughts. Your task is to convince your reader that your thesis is correct so you have to use the method of rational persuasion. To write a strong philosophy essay, you should demonstrate your ability to think critically about certain issues and present your independent thought by offering new analogies, new examples, and counter-examples of familiar points or even a novel argument. What Do You Do in a Philosophy Essay? Your philosophy essay can’t consist of a simple report of your opinions on a particular topic or present a report of the opinions of other philosophers, it must present an argument. Your task is to defend the points you claim in your essay so you must offer convincing reasons to believe your claims. That’s why you can’t merely state: â€Å"My view is that S.† Instead, you must write something like: â€Å"My view is S. I believe it is true because†¦Ã¢â‚¬  or â€Å"I think the following ideas †¦ provide a convincing argument for S.† Typically, you should start with your thesis and then make one of the following steps: Provide reasons to believe your thesis; Give counter-example to your thesis; Provide examples that may help to explain your thesis; Criticize the thesis; Defend your thesis against someone’s criticism; Explain the consequences that the essay’s thesis would have if it were true; Revise the thesis. No matter what purpose for the essay you set, you need to present convincing reasons to accept the claims you make and try to persuade other people to believe you. Philosophy Essay Topics Typically, a list of philosophy essay topics you can choose from is provided by your instructor. The topics are usually designed to invite you to deal with some specific philosophical issue or problem. They might be challenging but they give you a good chance to demonstrate how you understand a certain philosophical issue or problem and show your own skills in doing philosophy that is doing analysis, providing argumentation etc. You may be asked to respond to a certain philosophical statement, provide the explanation of a concept or a theory, give the detailed interpretation of a certain text, critically evaluate a philosophical theory or present your own answers to fundamental philosophical questions. Such philosophical questions may concern ethics and morality, science and technology, the universe and reality, human nature and human consciousness etc. Here are some examples of such philosophical questions that you are free to use as topics for your philosophy essays. Is Human Society Moving in the Right or Wrong Direction? Is There any Purpose in Life? Are There any Limits to What Human Mind Can Comprehend the Nature of Reality? Does Math Accurately Represent the Reality? Can Rational Thinking Exist Without Language? How Would You Define Human Creativity? Does It Have any Limits? Do Animals Have Morals? What is Your Definition of Morality? Is Poverty Inevitable? What is the Biggest Threat to Our Society? Before you start writing, you should make sure you understand the assignment. If you were given a longer prompt, pay attention to such words as â€Å"compare†, â€Å"evaluate†, â€Å"explain† or â€Å"outline†. You should present your own answers, give reasons, answer objections, and critically evaluate alternative approaches. Make an Outline and Structure Your Essay You should start with organizing your thoughts on the given topic. A good outline will increase your chances to make your philosophy essay logical, clear, and coherent. Besides, you will be able to see if you miss some elements in your argument. Your outline may look like this one: Introduction – draft your thesis statement; Analysis – provide a summary of your evaluation of the key points of your topic; Arguments – make a bulleted list of the major arguments you are going to make to defend your thesis; Counter-arguments – think about at least one objection to your argument; Summary – summarize your key points in response to your topic. Your next step is to think about a clear structure of your essay that will help your audience follow your argument and reduce the chances that your readers may get confused. Typically, your essay should follow the outline we have presented above and consist of the introduction, body paragraphs where you present your arguments and counterarguments, and the conclusion that summarizes your key points. Write a Draft Philosophical problems are complex and writing a philosophy essay requires careful and extended reflection. You can’t do it during the night before your essay is due so it’s important to start thinking about your topic as early as possible. Most likely, you will need to write more than one draft and make a lot of revisions to ensure that your essay is logical, clear, and concise. So it’s best to start working on your essay as soon as it is assigned to you. When writing your essay, you should use simple, straightforward words and keep your paragraphs and sentences short. Try to avoid complicated language when you can find simple ways to communicate the same idea exactly. Introduction Begin your introduction with formulating your thesis. You inform your reader what your essay sets to achieve – what your thesis is and how you are going to support your point of view. e.g. In this essay, I will argue that Mr. Smith †¦ I will use the following approach †¦ You should also explain some technical terms that you use in your argument to avoid ambiguity and help your readers grasp your ideas. Besides, you can provide motivation for your reader to read your essay to the end and explain why your argument is important and why your readers should care about it. If necessary, you should clarify how you are going to present your argument and lay out the structural plan for your essay to make the structure of your essay obvious to your readers and help them follow it. If your task is to critically evaluate someone’s argument, you will need first to explain this argument to your audience and only after that you should provide your critique. Keep in mind that you will need to present the argument in your own words and make your explanation concise and precise. Body Paragraphs In the body of your essay, you need to give your own argument on a specific essay topic and use plenty of examples and definitions. Philosophic claims are very abstract and difficult to understand and examples may help to make those claims clearer to the audience. You should write as many paragraphs as you have the key points and devote one paragraph to one point of your argument. It’s the most critical part of your essay because it will actually show your understanding of the subject and your ability to make your points concisely, thoroughly, and coherently. When discussing views of other people, you can use direct quotations or paraphrases and reference them properly according to the citation style specified by your instructor. But you should quotations and paraphrases to the minimum because it’s your essay and your instructor is interested to see your own words. Your argument will be stronger if you anticipate possible objections to it and respond to them. Very often this is an essential part of your philosophy essay. It actually provides support to your main argument and makes your key points more compelling. There can be different objections to your thesis but you should always think about the strongest objections and reply to them. Don’t take the unconvincing objections you can easier respond to. If you can’t formulate a decisive reply to these objections, you should admit it as well. Sometimes, your assignment may be to think about and provide several objections to your thesis and defend it against them. When presenting your argument and providing objections, you should to be very precise and state exactly what you mean. In this way, you will minimize the chances of being misunderstood. Commonly, you should expect to complete a short essay of about 3 double-spaced pages so you should avoid using too many arguments because too many arguments will confuse your readers. Keep your structure simple, focus on your topic, and stick to your thesis and arguments. Keep in mind that your essays in philosophy don’t necessarily have to provide a straight affirmative or negative answer to your question or a definite solution to a problem. It’s OK to ask questions in your essay even if you can’t answer them. You can use the following structure for your essay to make it flow smoothly. Thesis statement Argument 1 a. Counter-argument 1 Reply Argument 2 a. Counter-argument 2 Reply Conclusion Conclusion Your conclusion should be brief. Tell your audience what you think your argument has established. You should restate your thesis statement and give a short summary of your argument. You should be creative and don’t copy your introduction. In this part of your essay, you want to emphasize the most important limitations and implications of your own argument. Don’t provide any new information. Revise Your Draft, Edit, and Proofread: Tips from Experts When you finish your rough draft, put it aside for a couple of days and then revise it several times, considering the structure of your argument and your word choice as well. Typically, you will need to revise your draft several times and you should save all your drafts as you go along. That will allow you to go back if you decide to change your mind. Your final draft should provide the clearest version of your final argument. When revising your draft, you can make the following steps: Revise your introductory and concluding paragraphs to ensure that you have a clear thesis and that both the paragraphs support each other. Revise the structure to ensure that your argument is clear and logical. Delete any unnecessary sentences and words that don’t bring value to your argument. You may also need to add some sentences or words to make your argument clear but in this case, you should be very brief. When you are satisfied with the structure and content and are sure you won’t need any such changes anymore, you need to check spelling, grammar, and punctuation and fix mistakes if there are any. You can use some grammar and spell checking tools online. You should proofread your philosophy essay very carefully to fix minor mistakes and typos. A good idea is to find someone to read your essay. Your family member or a friend may notice some mistakes that you may overlook on your own because of the typical writer’s blindness. Before you submit your essay, make sure you have done everything possible to make it the best it can be.

The History of 911 Emergency Calls

The History of 911 Emergency Calls Who designed and installed the first 911 emergency telephone call system in the United States? Alabama Telephone Company 911 Pioneers The race to be first will always be part of human nature as long as a bridge remains to be crossed, mountains to be climbed, or a telephone exchange to be cut-over, with a team working together as Alabama Telephone had. B.W. (Bob) Gallagher - President of the Alabama Telephone Company a subsidiary of Continental Telephone. Initiated and directed the overall 911 effort.Robert (Bob) Fitzgerald - Inside State Plant Manager. Designed and engineered the needed circuitry for the first U.S. 911 system.Jimmy White - Technician on 911 installation team.Glenn Johnston - Technician on 911installation team.Al Bush - Technician on 911 installation team.Pete Gosa - Technician on 911 installation team. Need for a Universal Number Emergency Call System The ability to dial a single number to report emergencies was first used in Great Britain, in 1937. The British could dial 999 to call for police, medical or fire departments, from anywhere in the country. In 1958, the American Congress first investigated a universal emergency number for the United States and finally passed the legal mandate in 1967. The very first American 911 call was placed on February 16, 1968, in Haleyville, Alabama made by Alabama Speaker of the House, Rankin Fite and answered by Congressman Tom Bevill.   The new emergency number had to be three numbers that were not in use in the United States or Canada as the first three numbers of any phone number or area code, and the numbers had to be easy to use. The Federal Trade Commission along with ATT (which held a monopoly on phone services at that time) originally announced the plans to build the first 911 system in Huntington, Indiana. Alabama Telephone Company Takes the Initiative Bob Gallagher, President of the Alabama Telephone, was annoyed that the independent phone industry had not been consulted. Gallagher decided to beat ATT to the punch line and have the first 911 emergency service built in Haleyville, Alabama.   Gallagher consulted with Bob Fitzgerald, his state inside-plant manager. Fitzgerald let Gallagher know that he could do it. Gallagher moved quickly getting approvals from Continental Telephone and the Alabama Public Service commissioner and releasing a press release on February 9 announcing that the Alabama Telephone Company would be making history. Fitzgerald examined all twenty-seven Alabama exchanges choosing the Haleyville location, and then engineered the new circuitry and made the modifications needed for the existing equipment. Fitzgerald and his team worked around the clock to install the first 911 emergency system in under one week. The team worked their regular day jobs in Fayette, traveling each night to Haleyville to do the 911 work during off-peak hours. The work was completed on February 16, 1968, at exactly 2 p.m. celebrated with a team cheer of Bingo! Details of this story were provided by Reba Fitzgerald, wife of Robert Fitzgerald.

Take Home Exam on U.S. Economy Essay Example | Topics and Well Written Essays - 1000 words

Take Home Exam on U.S. Economy - Essay Example As an economy deed it recognized that the whole nation drawing out from Mississippi Valley, Maine to Atlantic Ocean and Georgia was a common market. There were taxes or tariffs imposed on intestate commerce. The American constitution stipulated that the federal government was responsible in controlling trade with foreign nations and amid the states. Furthermore, the constitution too gave the government the power to set up uniform bankruptcy laws, create money and control its value, fix values of weight and measures (Fogel 100). The industrial growth of the United States, which first began in Europe between 18th and 19th century, also played a crucial role in the development of North America. By the time Abraham Lincoln was elected president, nearly 17 percent of the US populace lived in urban areas, and most of their income emanated from manufacturing. The up-and-coming North America was wrought by the territorial development of the United States. After the insurrection, the US integ rated only thirteen ex- British colonies in the Northeast and the Southeast (Stanley 24). Government involvement in the United States played a critical role in North America economic affairs. The early years of American history, nearly all political leaders were unwilling to include the federal government too deeply on the economic segment. ... The government engagement in business gained its momentum most importantly throughout the New Agreement of 1930s (Fogel 112). On the same length, all most all significant institutions and laws that distinct America’s today’s economy can be rooted to the New Agreement ear. New Agreement legislation prolonged federal power in agriculture, banking, and public sector. The legislation enacted laws which set up minimum standards for wages and how long one should work in a day. Plans and agencies that in our day appear essential to the operation of United States modern economy was produced. This on the whole acted as catalyst for the development of upper North America economy (Stanley 89). According to Fogel, as United States of America was expanding saw the population of Native Americans, and Africa Americans increase. These Native Americans included Asians, Mexicans and Cubans. United States assimilated these people into the society. Ideally, these group infiltrated America with new cultures and customs. As result, this lead to the development of upper North America social affairs which some have even been adapted. The Spanish cuisine was adopted by most American communities (140). According to Stanley, the relationship between United States and Canada has extended more than two centuries. This integrates a collective British colonial heritage, warfare during the 1779s and 1812, and the ultimate growth of one of the most victorious global relationships in the modern world. Both United States and Canada are main economic partners. Moreover, the comprehensive association between the two nations has increased the comparisons. However, the most serious dent on the relationship between the two allies was the war of 1812. This war

Explain new approaches in respect of how a firm could finance takeover Essay

Explain new approaches in respect of how a firm could finance takeover and acquisition. Identify issues with such approaches, f - Essay Example The strategy adopted by each group is prepared by the management accounting department through analyzing the market, shareholders and the regulatory framework within the industry. In some instances, it may be important to obtain synergies to help analyze the financial and accounting policies applied by each of the companies merging. Although the A&M started in 1980s, the international rate of industrial mergers and takeovers took place during the 1990s. However, the complexity and nature of international operations coupled with other complexities has sophisticated global takeovers and mergers. Mergers and acquisitions normally abbreviated as M&A refer to the corporate strategy aspect, management dealing and corporate finance that involve the selling and buying as well as combining and dividing of different companies aimed at assisting an enterprise grow in its location or sector or venture into a new location or field (Brealey and Myers, 2000, p 89). Such a growth is expected to be w ithout subsidiary, use of joint venture or child entity. Over the years, the distinction between acquisition and merger is  blurred with several aspects especially economic income. Shareholders lawsuits are common in the event that a firm opts to engage financially in an acquisition or takeover and is appreciated as being part of the current market now that they are meritless. Merger lawsuits frequency has increased in the recent years with their life cycle undergoing a complete change. These days, once a merger deal is closed, lawsuits are normally closed. However, some plaintiffs have come out strongly in mergers to refine the way they operate. They insist on keeping such litigation alive even after they have been closed. This is achieved through having extensive discovery more so against the acquirer executives in control of the purse strings. Why mergers and takeovers There are a number reasons cited by firms for mergers and takeovers. However, the most prevalent reasoning cit ed by majority of the firms participating in M&A is profitability and growth sourced from external means. The outsourced growth may be of great economic benefit to the acquirer through increase in the production capacity, product diversification, increased market share, and expansion of the product lines. Some firms cite quantifiable reasons such as tax advantage and increased economies of scale are the main reasons for the mergers. In laying the strategies for merger and takeovers, it is important for the participating firms to focus on their goals and strategies. The management accounting department of the merging firms observes the compatibility of the merging companies to determine the compatibility of the core values and beliefs of these corporations. While quantitative variable provide ideal aspects which makes takeovers and mergers very attractive, their applicability are limited as they fail to portray the clear picture of the scene. Qualitative factors of the merging corpor ations should also be deeply considered. In estimating the real value of each merging firm, intangible factors such as favorable location, the strength of management, and skilled labor force constitute the qualitative aspects of the takeover or merger. Whatever the goal or rationale of the merger, the failure or success of

Political Chaos and Stalemate in East Asia Essay

Political Chaos and Stalemate in East Asia - Essay Example On the other hand, it also may be rather interesting to analyze the views of the opposing side which claims that existence of the Asian values can hardly be held responsible for the success. For example, they argued that people in this part of the world willingly adopt the role of servants of authoritarian regimes. In addition to that, it is suggested that while the above mentioned values existed for a considerable amount of time, the rapid economic growth occurred exclusively in the previous century which challenges the direct connection between the two phenomena.After a detailed examination of the attitude towards the Asian values, it may be rather logical to turn to analysis of some of the states in the region. By far, the country that should be addressed in particular is Japan. Speaking of the future of this member of G7 one might point out and important aspect of its political life: for a considerable amount of time the latter has been dominated by representatives of Liberal Dem ocratic Party (Hrebenar 69). Indeed, the second half of the previous centuries featured only a hand full of Prime Ministers that belonged to a different party. All this provides a person with sufficient grounds suggesting that the future of this country will be closely connected to the activity of the party in question. The next important country of the region is Indonesia. It must be noted that the second half of the twentieth century is marked by the rule of Suharto (Anderson 21).

The introduction of clinical governance and high standards

The introduction of clinical governance and high standards The impetus to achieve high standards of care was endorsed by the introduction of clinical governance and according to Upton and Upton (2005) combines the paired concepts of clinical effectiveness and evidence-based practice. Clinical governance accentuates the importance of providing first class care to patients by appropriate professionals, in a secure environment and in accordance with the needs of individual patients, which is central to quality improvement (Palfrey et al, 2004). It is a framework designed to assist nurses, by means of accountability and responsibility, consider the quality of the care they give and encourages a proactive approach to improve through best practice (Tait, 2004). This has contributed to the increasing value assigned to reflective practice. Matthews (2004) defined reflection as a process that encourages experiential learning which enhances knowledge to inform and improve nursing practice. A nurse has a responsibility to engage in reflection which enc ourages critical thinking and problem solving to advance and support their clinical competence and continued professional development (Wilding, 2008). Schon (1987) identified two different types of reflection; reflection-in-action where the nurse reflects on the practice as it occurs; and reflection-on-action which occurs following the event and allows the nurse to explore and learn from practice. Reflection-on-action is frequently used as a foundation of formal assessment and transforms experience into knowledge (Jasper, 2006). According to Benner (1984) reflection is key to experiential learning leading to positive changes in practice and facilitates the progression from novice to expert. Nurses can utilise reflection as a means of continuous development and Gustafsson and Fagerberg (2004) suggests that there are many theoretical models available. Models of reflection including Gibbs (1988), Mezirow (1991) and Johns (2000) enable nurses to consider and reflect on their practice effectively and focus attention on relevant issues within their practice (Freshwater et al, 2008). There are benefits and limitations to each of these models according to Duffy (2007) and nurses can choose the one that is most appropriate for their needs. As Mezirow (1991) model lacks consideration of interpersonal aspects of learning and Gibbs (1988) models descriptive design and lack of focus on practice they will not be used for this assignment. This assignment will provide an in-depth analysis of an experience in practice using Johns model of structured reflection which has been adapted to suit the situation. Johns (2000) model for structured reflection primarily adopts a humanistic approach which focuses on emotions and feelings, where the nurse and patient are considered as equal partners during the encounter; The model offers a systematic structure of simple questions that encourages a consideration of patients individual needs and is appropriate when reflecting on the interpersonal relationship between the nurse and patient (Woods, 2003). Seminal work by Carper (1978) prov ides the foundation for Johns (2000) model and focuses on aesthetics, personal knowing, ethics, empirics and reflexivity which encourages the nurse to adopt reflection as a means to examine and improve their practice. This reflective assignment will be presented in the first person and describes an experience in practice of administering an intramuscular injection which relates to the module 9 outcome of drug administration. To maintain confidentiality as identified by Nursing and Midwifery Council (2008), the patient will be identified as Jane. Description of Event Jane was admitted to the ward as an emergency admission following an episode of severe abdominal pain. She was evidently in pain and was very distressed on admission. Following Janes thorough assessment and examination by the Senior House Officer a morphine based pain medication was prescribed, which was required to be administered via the intramuscular route. I introduced myself to Jane and proceeded to prepare the prescribed pain medication. I was given the opportunity to administer the injection by my placement mentor, as this was one of my competencies that I needed to achieve before the end of my placement. I was made aware that Jane was a nurse, and this forced me to express some concern to my mentor. I had previously had a negative experience in a previous placement whilst administering an intramuscular injection. This initiated a short discussion with my mentor and although she was able to empathise to some degree with my dilemma she encouraged me to proceed as I needed to co mbat my fear and also complete the competency in a positive and efficient manner. To allay my fears my mentor explained she would guide me and provide positive, constructive feedback following the event. I organised the equipment onto a trolley and the medication was prepared allowing consideration for Janes age, physical build and her pre-existing conditions. A full explanation of the procedure and outcomes was given to Jane at the bedside. Following this informed consent was obtained. Jane expressed her approval that I administered the injection as she appreciated the need for student nurses to learn through practice. Prior to the drug administration Janes name, address, date of birth, medication chart and any known allergies were checked. I commenced the injection and whilst administering I reassured Jane throughout to comfort and reduce any anxiety that might have consequentially increased her pain. Once the procedure was completed I disposed of the sharps safely and ensured that Jane was comfortable. During the private conversation with my mentor I was given positive feedback about my management and administration and then my mentor provided me with the opportunity to discuss my thoughts and feelings, and in particular, my initial reticence to give the injection. Aesthetics The definitive aim of performing the intervention was to achieve one of my competency outcomes for the management placement. Competence assessment according to Gustafsson and Fagerberg (2004) is characteristic of nurse training in the UK and accounts for 50% of the Fitness for Practice (National Assembly for Wales, 2002), allowing mentors to judge the students capabilities. It was important that I accomplished this learning outcome as in previous placements there had been limited opportunities to administer intramuscular injections. Whilst it is important to perform the intervention safely and competently Mantzoukas and Jasper (2004) believe that it is also essential that the invasive impact of such an activity on a patients anxiety and discomfort is recognised. Although the practice of giving intramuscular injections is routine for nurses, it is one of the few invasive practices which has the potential to inflict pain in an attempt to provide relief to patients (Wynaden et al, 2006) . In addition to achieving a competence outcome the administration of the injection would also relieve Jane from her pain and anxiety. Nurses have a considerable part to play in pain management and according to Duke (2006) effective communication between the patient and the nurse, together with successful utilisation of analgesia improves patient outcomes. Jane expressed verbally her distress and need for pain relief however I also identified non-verbal cues of facial grimacing and restlessness, which often reveals more about how a patient is feeling and what they are thinking (Kozier et al, 2008). This was reinforced in a study by Manias et al (2005) which revealed that an inadequate awareness of non-verbal communication resulted in poor pain management. Jane received an explanation of the procedure and had constant assurance and reassurance during the consultation in order to demonstrate learned communication skills, which helped to ensure the successful and professional nurse-patien t relationship. The reluctance to administer the intramuscular injection originated from a negative experience during the first year of training. I was asked to give an intramuscular injection to a patient prior to a surgical procedure. The nurse explained the procedure to me and asked the patient for their consent prior to the administration of the injection. The patient was quite emaciated and I believed that the green needle which was normally used for the procedure was too long. I expressed my concerns to the nurse but was told that it would be acceptable to proceed with the green needle. During the administration of the injection contact was made with the patients thigh bone. I rebounded with repulsion as I believed that I had harmed and hurt the patient. I was too naÃÆ'Â ¯ve to express my concerns to the nurse and on reflection following the incident I questioned my own competence and ability. This negative experience had a significant impact on my confidence and initiated feelings of fear, anger and insecurity. Nursing according to Higginson (2006) is a very complex career and the training presents unique situations that stimulate feelings of fear and anxieties. The negative experience, together with the fact that Jane was a nurse, made me question my capabilities as a nurse. Although Jane seemed unaware of my anxieties I assumed that she and my mentor would doubt my ability. The reluctance to perform the intervention made me feel incompetent and negligent of my duties however support and encouragement from my mentor helped to allay my fears. The Royal College of Nursing (2005) highlights the importance that students are adequately supported and given opportunities to learn during their practice placements. By encouraging me to administer the injection the mentor adopted an ethos of learning rather than teaching which promotes independence and active contribution to care (Ireland, 2008). Following the injection Jane expressed her gratitude at being relieved from her pain which increased my confidence and instilled a belief in my competence and abilities as a student nurse. Personal This situation generated many emotions within me of which frustration, fear, disappointment and then relief were the dominant feelings. When my mentor initiated that I was to give the injection my initial feeling was that of fear. Although I attempted to convince myself that I had the confidence to perform the task, the recollection of the previous negative experience emerged and caused increased anxiety. Moscaritolo (2009) believes that high levels of anxiety can affect students clinical performance. However guidance from a placement mentor can facilitate learning, empower students and ensures they are competent in safe and effective practice (Gopee, 2008). Although I was worried about appearing incompetent due to my lack of confidence, especially in front of Jane who was a nurse, my mentor encouraged and supported me throughout the experience. With this encouragement I believed I behaved professionally and competently, ensuring that Jane would be unaware of my anxieties. This incre ased my confidence in my clinical abilities and developed a trusting relationship with my mentor. Whilst the previous negative experience in practice established a fear within of administering intramuscular injections, the fact that Jane was a nurse also generated a preconception that she would review my practice and have an opinion on my abilities as a student nurse. However, on reflection Jane would have been more concerned and preoccupied with her pain and impending diagnosis rather than being focused on the fact that I was a student nurse. As Craven and Himle (2008) believes that appreciating and understanding that patients are individuals is a fundamental part of nursing practice I believed that Jane deserved compassion regardless of my own fears. Her pain and distress would have persisted if immediate treatment was not given therefore it was a moral and professional duty to provide the pain relief (Tan, 2009). I hoped that by giving Jane the medication safely and competently to relieve pain it would establish a trusting relationship between us, which according to Rushton et al (2007) is imperative. Displaying clinical competence ensures that patients are cared for and their needs identified (Iacono, 2007). Sellman (2006) maintains that trust is an essential component of nursing practice and highlights the fragility of it under conditions of immense vulnerability, such as chronic pain or acute illness. I was aware of Janes distress and wanted to provide care based on best evidence and in her best interests which is a prerequisite of good practice. It is crucial that nurses demonstrate clinical competence, display benevolent qualities towards the patient and appreciate the risk involved for the patient, as the equilibrium of power in the nurse-patient relationship is uneven which places the patient in a vulnerable position (Bell Duffy, 2009). Ethics My motivation to pursue a career in nursing was driven by the desire to care for patients whilst appreciating their needs, individuality and autonomous right to excellent care. In pain management, the duty to prevent or relieve suffering is fundamental and as advocates for patients, it is the nurses responsibility to address the current issues (Vaartio et al, 2008). Nurses are committed to the ethical principles of beneficence and nonmaleficence according to Tuckett (2004) and have the best interests of the patients at the centre of their practice which includes achieving optimal pain assessment and management. My action advocated the need for adequate pain relief, ensured that the administration of the injection was safe and I believe that Jane was cared for in a caring and empathetic manner which matched my beliefs of doing what is right and good in a clinical situation, which Carper (1978) described as ethical knowing. The importance of reflecting on previous negative experiences is highlighted by Bulman and Schutz (2004) who encourages nurses to explore their actions, identify problems and develop their future practice. My previous negative experience when administering an intramuscular injection was a traumatic experience however was a powerful catalyst for learning. In health care there is an accepted and elemental predilection for learning from failure which then is used to inform improved practice. The establishment of the National Patient Safety Agency (NPSA) in July 2001 in the UK aimed to improve the safety and quality of care through reporting, scrutinising and learning from adverse incidents in the NHS. I have learned from my negative experience and believe that this demonstrates an ethical consideration to a situation which improves the safety of my patients (Ghaye, 2005). Empirics Carper (1978) describes empirics as scientific knowledge that provides factual evidence that explains, informs and underpins nursing practice. Kozier et al (2008) believes that it is imperative that nurses understand the physiology of pain and have a duty to relieve their patients from this pain where possible. Jane was admitted to the ward for investigations and pain relief however when I observed that Jane was emaciated the feelings that I sensed with my previous experience came flooding back. The situation was a replica of the negative experience and the anxiety, fear and apprehension clouded my judgement. I perceived myself as too inexperienced to administer the injection. Hemsworth (2000) believes that limited opportunities for students to perform injections in practice are associated with restricted knowledge and skills. However this experience helped to inform my practice and provided me with the confidence to choose the needle and the site of administration appropriate for Ja ne. In addition to providing comfort and support through effective communication it was important that I also performed the procedure safely and competently. Student nurses should repeatedly utilise opportunities to participate in learning activities to progress and maintain clinical competence and practice (Wilding, 2008). Following my assessment of Jane I believed that the injection should be administered into the ventrogluteal site using the shorter blue needle. The fact that the ventrogluteal site is the safest and the least painful site for delivering injections and that a shorter needle is advisable for patients who are emaciated provided with me with the rationale for my decisions (Craven Himle, 2008). The administration of intramuscular injections according to Hunter (2008) requires the nurse to possess the knowledge and rationale of the guiding principles that underpin the clinical skill. Bandolier (2003) believes that educating student nurses on injection techniques can lead t o improved and safer practice as the National Patient Safety Agency (2007) states that poor practice can create adverse risks for patients and nurses. Reflexivity During the negative incident I had identified that the patient involved was emaciated and raised my concerns with the choice of needle with the nurse. However as a first year student I lacked confidence to assert my choice to refuse to perform the procedure. This experience damaged my confidence in my abilities and had a negative effect on my future involvement with intramuscular injections. Retrospectively I should have asserted myself further and examined both my actions and the nurses immediately following the incident to address the issues. Nurses according to Baxter and Rideout (2006) have a powerful influence in the development of the students perceptions of themselves and their abilities. I approached this recent experience with an open mind and minimal reference to my previous experience nevertheless my mentor should have been informed at the beginning of the placement of my apprehension of intramuscular injections. Allison-Jones and Hirt (2004) believe that a good communicative relationship between a mentor and a student is an important part of learning with the mentors expertise, competency, approach and communication skills playing a central role (Stuart, 2007). Accepting that every situation is different and adopting an approach of clarity and transparency would improve my outlook and confidence for future practice. Saveman et al (2005) maintains that a good interpersonal and communicative relationship, professional approach, and a caring manner are all essential to build a successful nurse-patient relationship. With the refusal to administer the injection the prospect of building a caring and trusting nurse-patient relationship with Jane would have been unattainable. I am disturbed and frustrated that a negative experience influenced my confidence and could have been avoided if it had been addressed at the time by means of reflection and clinical supervision. Reflection according to Ashby (2006) can encourage nurses examine their practice, increase their self-awareness and uncover implicit knowledge. I am pleased however that I was now able to adopt a spirited and willing approach to combat my fears and carried out the procedure in a considerate and professional manner. The administration of pain medication to Jane demonstrated effective pain and distress management which according to Hall-Lord and Larsson (2006) is central to the prerequisite of first class delivery of nursing car e. Conclusion Johns and Freshwater (2005) define reflection as a process that encourages nurses to examine their actions and learn from experience which enhances and informs their practice. Whether the reflection occurs prior, during or following clinical practice it is a process that nurses can apply to understand and appreciate positive or negative experiences (Schon, 1987). The use of Johns (2000) model supports the need for the student to work with the mentor and has enabled me to explore and make sense of this reflective experience. The model offered a systematic structure of simple questions that encouraged a consideration of Janes individual needs and was appropriate when reflecting on the interpersonal relationship between my mentor, myself, and Jane. It has allowed me to understand how the negative experience in the first year had an effect on my confidence when faced with a similar situation. As Jasper (2006) suggested it has helped explain and resolve my original feelings of incompetenc e and failure. By reflecting on my previous negative experience it proved a catalyst for learning and it informed my knowledge and rationale for deciding on the site of administration and needle size for this practice experience. This experience has highlighted the implications of not reflecting adequately and addressing any issues arising from a negative experience in practice. Stein-Parbury (2005) believes that clinical supervision is an ideal opportunity for nurses to share their knowledge and experiences, improving competence in a supportive environment. I believe that this experience has facilitated the appreciation of the significance of aesthetic, ethical, and personal ways of knowing and has developed empirical knowledge (Carper, 1978). Although I administered the injection competently the initial reservations that I had would not have existed if I had had more confidence in my own abilities and addressed past issues. My mentor empathised with my fear and lack of confidence but imparted her knowledge to guide and support me. Johns (1995) believes that the combination of diverse sources of knowledge and personal knowledge is needed to inform a clinical intervention. Following guidance from my mentor an d personal experience from clinical placements I am now more aware of the improvements that I need to make to become a competent student nurse.