Physical Exercise Reduce Symptoms Depression Health And Social Care Essay

Physical Exercise Reduce Symptoms Depression Health And Social Care Essay The aim of this essay will be to discuss and apply selected evidence related to nursing practice within a chosen field. Evidence based practice is an approach used by clinicians to deliver the highest quality care to meet the needs of patients and their families. By finding appraising and using the best evidence, health professionals are able to achieve optimum outcomes for all. (Melnyk Finout-Overholt 2005). However, an alternative view suggests that evidence exists to inform and guide practice rather than dictate it. (McKenna et Al 1999). When clinicians apply an evidence based model, the best available evidence, modified by patient circumstances and preferences, is applied to improve the quality of clinical judgements. (McMaster Clinical Epidemiology Group 1997) A recognised framework will be used to identify a question and then a systematic literature search will be carried out to assist in answering this question. A copy of this search will be provided and search parameters will be applied to gain the most relevant literature. After applying these parameters the search will be narrowed down to the five most relevant pieces of research. A table will be provided to show the key findings from each piece of literature, and one piece of research will then be critiqued in depth using a recognised framework. The question identified in this essay is Can physical exercise or activity help to reduce the symptoms of depression in older adults, compared to other forms of treatment? Background and Formulation of Question The question was devised using the PICO framework. This framework often is used to formulate clinical questions (Craig Smyth 2002), and it identifies and defines the essential components of a good clinical question. PICO is an acronym for patient population of interest, intervention, comparison intervention and outcome (National Institute for Health and Clinical Excellence 2007). Patient population of interest shall be older persons diagnosed with depression, intervention shall be physical exercise or activity, the comparison intervention shall be other forms of treatment for depression and the outcome will be a reduction in the symptoms of depression. A well thought out and formulated question maximises the potential for finding relevant evidence for a patient population (Craig Smyth 2002) Depression in older adults refers to depressive syndromes defined in the American Psychiatric Associations Diagnostic and Statistical Manual (DSM-IV) and in the International Classification of Diseases (ICD-10) that arise in people older than age 65 years. In old age, the symptoms of depression often affect people with chronic medical illnesses, cognitive impairment, or disability. (Alexopolous et al 2002). For a major depressive episode to be diagnosed, five of the following symptoms must be present: depressed mood, diminished interest, loss of pleasure in all or almost all activities, weight loss or gain (more than 5% of bodyweight), insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feeling of worthlessness or inappropriate guilt, reduced ability to concentrate, recurrent thought of death or suicide. At least one of the symptoms must be either depressed mood or diminished interest or pleasure. The episode should last at least 2 weeks, lead to distress or functional impairment, and not be a direct effect of substance use, a medical condition, or bereavement. (Depression Today 2010). Two of the symptoms detailed above must be present for a minor depressive episode to be diagnosed. Between one and four percent of the general elderly population has major depression, and minor depression has a prevalence of between four and thirteen percent (Blazer 2003). Twice as many women as men are affected. Both the prevalence (Palsson et al 2001) and the incidence (Teresi et al 2001) of major depression double after age 70-85 years. Treatment for depression usually involves a combination of anti depressant drugs, talking therapies such as Cognitive Behaviour Therapy or Interpersonal Therapy and self help. (NHS Choices 2010). A recent review concluded that physical exercise programmes can obtain have a beneficial effect on depressive symptoms in older people. Although not appropriate for all older people exercise may improve mood in those undertaking it. (Blake et al 2009) Systematic Literature Search A systematic review of the literature was carried out using the CINAHL and PubMed databases and the search terms depression physical exercise and old* were used. CINAHL was found to be particularly useful as it possible to specify the age group required in the literature search. For the purposes of this search age 65+ was selected. PubMed is the public access version of Medline, a comprehensive database which indexes thousands of journals in the medical sciences field. (TVU 2010a). The Cumulative Index to Nursing and Allied Health Literature Indexes virtually all English language journals from 1983 onwards. This database covers midwifery, nursing and related disciplines (TVU 2010b). Initially the searches indicated a vast array of literature but by applying a systematic review this was reduced. By using a logical search strategy with Boolean techniques the number of documents was limited to thirty. These were then reviewed and five articles were then selected which addressed the ques tion of exercise as a form of treatment for older people diagnosed with depression. The search parameters were limited to studies written in the English language, the age and the subjects, and both sexes were to be included. Harvard (2007) suggests that by applying parameters such as these the most up to date and relevant literature can be sourced. A full record of this search history is attached in appendix 1 and 2. A summary of the findings in the five pieces of research selected is detailed in the table overleaf. This table follows a structure recommended by Timmins McCabe (2005). Author and Year Journal Type of Study Purpose Sample Design Data Collection Key Findings Blake et al 2009 Clinical Rehabilitation Qualitative To assess efficacy of physical exercise in 11 trials totalling 641 participants Varied Varied 1 Exercise not relevant 2009; 23: 873-887 systematic treating depression in older adults to all in group review 2 May improve mood 3 further research needed to establish medium to long term effects and cost effectiveness Mather et al 2002 British Journal of Quantitative To determine whether exercise is effective 86 participants split into RCT clinical 1 Modest improvement Psychiatry (2002) as an addition to anti depressants in reducing two groups interview in symptoms after 10 180:411-415 depressive symptoms in older adults weeks 2 older people should be encouraged to attend exercise classes Brenes et al 2007 Aging Mental Health Quantitative To test feasibility and efficacy of exercise and 37 participants, 32 completed RCT structured 1 Both exercise Jan 2007;11(1):61-68 anti depressants compared with usual the study clinical interview and medication were treatments for older adults with observed shown to be statistically minor depression self reporting more effective than current treatment 2 Exercise also aided physical functioning Kerse et al 2010 Annals of Family Quantitative To assess effectiveness of home based 193 participants, 187 completed RCT structured 1 exercise and social Medicine 8:214-223 (2010) physical exercise plan in treating older the study clinical interview visits showed similar adults with depressive symptoms compared effects in improving to social visits mood an quality of life 2 More research is required Blumenthal et al Archives of Internal Quantitative to assess effectiveness of exercise 156 participants RCT structured 1 after 16 weeks 1999 Medicine 159(19) (1999) compared to antidepressants for treatment clinical interview exercise equally effective of major depression in older as anti depressantsCritical Appraisal The following appraisal was structured by using an approved and recognised framework for completing such tasks. (Polit et al. 2001) The article selected for critical appraisal is Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder. (Mather et al. 2002). A copy of the article is attached as appendix 2. The aim of the study was to determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. This was clearly defined. In the introduction the authors stated that it is widely held that exercise is useful in depression, but that there were few studies on the potential effects that exercise may have as an addition to antidepressant therapies for older adults. The key finding of this study was that at ten weeks older people with poorly responsive depressive disorder showed a modest improvement in depressive symptoms and should therefore be encouraged to attend group exercise activities. The study conducted was a randomised controlled trial. Randomised controlled trials are the most rigorous way of determining whether a relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment. (Sibbald Rowland 1998). Patients were randomly selected to attend either exercise classes or health education talks for ten weeks. Assessments were blind and were conducted at baseline, ten and thirty four weeks. The primary outcome was measured with the 17 item Hamilton Rating Scale for Depression (HRSD). HRSD is a multiple choice questionnaire used by clinicians to measure the severity of major depression in patients. (Hamilton 1960). The nature of both interventions is clearly described by the authors. All participants were outpatients recruited from primary care, psychiatric services and direct advertisement. 1885 patients were screened with a view to recruitment, and 86 were selected at random for the study. To be included patients were require d to have symptoms of depression, and to be older than fifty three years of age. In addition patients had to have been receiving antidepressant therapy for at least six weeks, without evidence of a sustained improvement in their condition. Patients were excluded if there was: alcohol or substance misuse, structured psychotherapy in place, or were already taking regular exercise. Patients with specific medical conditions preventing physical exercise were also excluded. Both groups were informed of the nature of the trial, and all patients gave written informed consent. The study was approved by a medical research ethics committee. There were two groups with 43 patients in each and were comparable in terms of age range and symptom presentation. There was however a heavy preponderance of women in the exercise group. The authors suggest that this may have introduced a bias into the results, and suggest a control group could be introduced in the future without either intervention. The outcomes for both groups were measured in the same way by the proportion of participants achieving a greater than thirty percent reduction in HRSD score from baseline. The results are shown in a statistical format and are recorded in a table. There are twenty four references in the report which support the evidence presented by the authors. The implications for the health service are that structured group exercise sessions can help to make a modest improvement in patients who are not responding to pharmacological treatment and that older people with depressive disorders should be encouraged to attend group exercise activities. It should be noted that one of the authors of the research is co-director of a company providing exercise classes for older people and whose profits support research into aging. Review of Literature This review of literature will show how the five main studies and all available literature assist in answering the set question. The first part of this review will concentrate on the five main studies and the second part will contain evidence from a wide range of sources and relate this combined information to government policy and guidelines. There will also be evidence of how all the information relates back to practice. It is well acknowledged that depression is widespread (Osborn et al 2003) and is the most prevalent mental health problem for older people (Age Concern 2007) The condition affects one in five people over 65 and rises to two in five in those over 85 (Mental Health Foundation 2008). The use of exercise to combat depression is well supported due to its effects on enhancing mood, improving cognitive function and reducing anxiety; it is also less expensive than medication (Louch 2008). A literature review was conducted to examine whether exercise could be an effective form of treatment for older adults with depressive symptoms. Article 1 (Blake, Mo, Malik and Thomas 2008) conducted a systematic review of eleven randomized control trials in order to establish whether physical activity interventions were successful in alleviating depressive symptoms in older people. Trials were included in the review when more than 80% of the participants were greater than sixty years old. In nine of the eleven studies short term positive outcomes were found, although the mode, intensity and duration of the exercise program differed across the studies. The medium to long term effects of exercise as an intervention were less clear. This outcome is backed up by Mead et al (2008) who concluded that exercise seems to improve depressive symptoms in people with a diagnosis of depression, but the effects are moderate and not statistically significant. However a randomized controlled trial conducted by Blumenthal et al (1999) (Article 2) had reached different conclusions. One hundred and fifty six men and women aged over fifty were split into groups randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride) or combined exercise and medication. After sixteen weeks of treatment the patients did not differ significantly statistically either on Hamilton Rating Scale for Depression or Beck Depression Inventory scores. The study concluded that antidepressant medication had the most rapid effect, but after sixteen weeks exercise was equally effective in reducing symptoms of major depressive disorder. Article 3 (Brenes et al 1999) conducted a pilot study designed as a randomized clinical trial to test the feasibility and efficacy of an exercise program and antidepressant treatment compared with usual care in improving emotional and physical functioning in older adults with minor depression. A total of thirty seven participants aged over sixty five were randomized to treatment: fourteen to exercise, eleven to sertraline and twelve to usual care. Patients who received either exercise or sertraline treatments demonstrated improvement both in clinician led and self reported measures of depressive symptoms. Those participants who received the usual package care experienced small or no improvement in mental state. There are some limitations to this study however. The sample size was small and thus the statistical power was weak. The diagnosis of minor depression was based on self diagnosis rather than clinical interview. It was also not stated in the report what the usual care was. Ther e were however significant trends to suggest that sertraline and exercise could be used as treatments for mild depression in older adults, and that a more in depth study should be undertaken. Article 4 (Kerse et al 2010) published a study comparing the effects of a home based exercise program with regular social contact in improving function, quality of life and mood in older people with depressive symptoms. A randomized controlled trial was conducted in which one hundred and ninety three people aged over seventy five with depressive symptoms received either an individualized physical activity program or social visits delivered over six months. The social visits were of the same time span as the exercise program. Outcome measures were obtained at three, six and twelve months. Both physical and mental well being was measured using a variety of techniques including a short function test, and the Nottingham Extended Activities of Daily Living Scale (Nouri Lincoln 1987). It was concluded that a structured activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. There was however no control group bein g measured that was receiving usual care. Article 5 (Mather et al 2002) set out to determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. A randomized controlled trial was conducted in which eighty six participants aged between fifty three and ninety one already receiving anti depressant therapy were given either exercise classes or health education talks over a ten week period. Assessments were made blind at baseline, ten and thirty four weeks using the Hamilton Rating Scale for Depression as the primary outcome. At ten weeks a significantly higher proportion of the exercise group (55% compared with 33%) experienced a greater than 30% decline in depression. In an article in The British Journal of Psychiatry in 2002, Jagadheesan et al critiqued this study and stated that it could have been more meaningful if a control group had been added which received no additional treatment other than continuing antidepressants. (Jagadheesan et al 2002). The majority of research above suggests that physical exercise reduces depression and depressive symptoms in the short term in older adults, but additional well controlled studies are required to determine the long term efficacy. A systematic review carried out by Sjosten Kivela supports these findings (Sjosten Kivela 2002). Direct comparisons between studies is difficult as they differ greatly in characteristics, nature of control comparison group, age of the participants, type and intensity of exercise and outcome measures used to follow up. National Institute for Clinical Excellence guidelines are set out to assist clinicians and patients in making decisions about appropriate treatment for specific conditions. The guidelines for depression suggest that for particularly for patients with mild or moderate depressive disorders, structured and supervised exercise can be an effective intervention that has a clinically significant impact on depressive symptoms. There is also evidence to suggest that individuals with low mood may also benefit from structured and supervised exercise. (NICE 2005). Conclusion Physical exercise is clinically beneficial in the short term for treatment of depressive symptoms in older people. Exercise, although not appropriate for all older persons with depression, may improve mood in this group. Evidence of the cost effectiveness of providing exercise interventions would be beneficial in helping decision making regarding service use and delivery. More well designed research studies are needed to examine the medium and long term benefits of exercise as a treatment for depressive symptoms in older adults, and to examine the types and duration of interventions that have the most positive effect. Word Count 3008 References Age Concern (2007) Mental Health Services Letting Down Older People. [On Line] Available at http://www.ageuk.org.uk/ [Accessed 12 May 2010] London: Age Concern. Alexopoulos, G.S., Buckwalter, K., Olin, J., Martinez, R., Wainscott, C., Krishnan, K.R. (2002) Comorbidity of late-life depression: an opportunity for research in mechanisms and treatment. Biol Psychiatry 2002; 52:543-58. Blake, H., Mo, P., Malik, S., Thomas, S. (2009) How Effective are Physical Activity Interventions for Alleviating Depressive Symptoms in Older People? A Systematic Review Clinical Rehabilitation 2009; 23: 873-887 Blazer, D.G. (2003) Depression in late life: review and commentary. J Gerontol Med Sci 2003; 56A: 249-65. Blumenthal, J.A., Babyak, M.A., Moore, K.A., Craighead, E., Herman, S., Khatri, P., Waugh, R., Napolitano, M.A., Forman, L.M., Appelbaum, M., Doraiswamy, P.M., Krishnan, K.R., (1999) Effects of Exercise Training on Older patients with Major Depression Archives Of Internal Medicine Vol. 159 No.19, October 25, 1999 Brenes, G.A., Williamson, J.D., Messier, S.P., Rejeski, W.J., Pahor, M., Ip, E., Penninx, J.H. (2007) Treatment of Minor Depression in Older Adults: A Pilot Study Comparing Sertraline and Exercise Aging Mental Health, January 2007; 11(1): 61-68 Craig, J.V. (2002). How to ask the right question. In J.V. Craig R.L. Smyth (Eds.), Evidence-based practice manual for nurses (pp. 21-44). Philadelphia: Churchill Livingstone. Depression Today (2010) DSM IV [Online] Available at http://www.mental-health-today.com/dep/dsm.htm [Accessed 8 May 2010] Hamilton, M (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry. 23: 56-62 Harvard, L. (2007) How to conduct an effective and valid literature search. Nursing Times 103, (45), 32-33 Jagadheesan, K., Chakraborty, S., Sinha, V.K., Nizamie, S.H. (2002) Effects of Exercise on Depression in Old Age The British Journal of Psychiatry (2002) 181: 532 Kerse, N., Hayman, K.J., Moyes, S.A., Peri, K., Robinson, E., Dowell, A., Kolt, G.S., Elley, C.R., Hatcher, S., Kiata, E., Wiles, J., Keeling, S., Parsons, J., Arroll B., (2010) Home-Based Activity Program for Older People With Depressive Symptoms: DeLLITE A Randomized Controlled Trial Annals of Family Medicine 8:214-223 (2010) Louch, P. (2008) Depression in Primary Care [On Line] Available at http://www.depression-primarycare.co.uk/ [Accessed 14 May 2010] Mather, A.S., Rodriguez, C., McMurdo, M.E.T. (2002) Effects of Exercise on Depressive Symptoms in Older Adults with Poorly Responsive Depressive Disorder The British Journal of Psychiatry (2002) 180: 411-415 McKenna, H., Cutliffe, J., McKenna, P., (1999) Evidence-based practice: demolishing some myths. Nursing Standard. 14, 16, 39-42. Date of acceptance: November 15 1999. McMaster Clinical Epidemiology Group (1997) Evidence Based Practice Resources [On Line] Available at http://hsl.mcmaster.ca/resources/topic/eb/nurse.html [Accessed 20 May 2010] Mead, G.E., Morley, W., Campbell, P., Greig, C.A., McMurdo, M., Lawlor, D.A. (2008) Exercise for depression. Cochrane Database of Systematic Reviews 2008. Issue 4. Art. No. CD004366.   Melnyk, B. M., Fineout-Overholt, E. (2005). Evidence-based practice in nursing healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams Wilkins. Mental Health Foundation (2007) Depression and Suicide in Later Life [On Line] Available at http://www.mentalhealth.org.uk/information/mental-health-a-z/depression-and-suicide-in-later-life/?locale=en [Accessed 12 May 2010] London: Mental Health Foundation National Institute for Health and Clinical Excellence (2005) Depression: Management of depression in primary and secondary care National Institute for Health and Clinical Excellence National Institute for Clinical Excellence (2007) Developing Clinical Questions [Online] Available at: http://www.nice.org.uk/niceMedia/pdf/GuidelinesManualChapter5.pdf [Accessed 8 May 2010] NHS Choices (2010) Treating Depression [On Line] Available at http://www.nhs.uk/conditions/depression/pages/treatment.aspx [Accessed 16 May 2010] Nouri, F.M. Lincoln, N.B. (1987) An Extended Activities of Daily Living Index for stroke patients. Clinical Rehabilitation 1987; 1:301-5. Osborn, P.J., Fletcher, A.E., Smeeth, L., Stirling, S., Bulpitt, C., Nunes, M., Breeze, E., Edmond, S.W.Ng., Jones, D., Tulloch, A. (2003) Performance of a single screening question for depression in a representative sample of 13,670 people aged 75 and over in the UK: Results from the MRC trial of assessment and management of older people in the community. Family Practice; 20: 6, 682-684 Palsson, S., Ostling, S., Skoog, I. (2001) The incidence of first onset depression in a population followed from the age of 70 to 85.Psychol Med 2001; 31: 1159-68. Polit, D.F., Beck, C.T., and Hungler, B.P. (2001) Essentials of nursing research methods, appraisal and utilisation. (5th Ed.) Philadelphia; Lippincott. Sibbald, B. Roland, M. (1998) Understanding controlled trials: Why are randomised controlled trials important? BMJ 1998; 316:201 (17  January) Sjosten, N., Kivela, S.L., (2006) The effects of physical exercise on depressive symptoms among the aged: a systematic review. Int J Geriatr Psychiatry. 2006 May; 21(5):410-8 Teresi, J., Abrams, R., Holmes, D., Ramirez, M., Eimicke, J. (2001) Prevalence of depression and depression recognition in nursing homes. Soc Psychiatry Psychiatr Epidemiol 2001; 36: 613-29. Thames Valley University (2010a) Library Services Databases A-Z [Online] Available at: http://lrs.tvu.ac.uk/eresources/atozlist.jsp?id= [Accessed 2nd May 2010] Thames Valley University (2010b) Library Services Databases A-Z [Online] Available at: http://lrs.tvu.ac.uk/eresources/atozlist.jsp?id= [Accessed 2nd May 2010] Timmins, F. McCabe, C. (2005) How to conduct an effective literature search Nursing Standard November 23: vol 20 no 11 Appendix 1 Copies of Search Strategies

The Interpersonal Relationships in The Workplace

In recent years the corporate workforce has become more diversified in gender, race, ethnicity and sexual orientation. As a consequence the workforce at most major corporations is now more reflective of the general population than it was in the past. Yet the issue of diversity in the workplace is often not addressed or, in some cases, overlooked by management. Of particular interest is the management of interpersonal relationships of both heterosexual and homosexual employees in the workplace. In a prosperous economic climate, corporations are often forced to compete for qualified employees. Many corporations have attempted to attract such employees by offering benefits that meet their lifestyle needs. Some examples of such benefits are on-site daycare and the recognition of same sex couples in terms of benefits. Benefits of this nature project an image of the corporation that emphasizes acceptance and fairness. These characteristics are highly valued by prospective employees and are one of the primary factors considered when choosing between competing offers. From a management perspective the interpersonal relationships of employees is a delicate issue that requires attention. Management must recognize that the workforce is a diverse ever-changing entity. To that end management must assess the lifestyle needs of the workforce and integrate that into the corporate policy in such a way as to not adversely affect other areas. To accomplish this, management must constantly evaluate and evolve corporate policy to address the issues that will undoubtedly arise. The effective management of interpersonal relationships is intrinsically complex. From an organizational level it requires a corporate policy that defines what it considers a workplace relationship and specifies guidelines regarding what is and is not acceptable behavior. First and second level managers are then required to implement the corporate policy on the frontline. Also of concern is the method, if any, of enforcing such a policy. The complications of workplace relationships are varied. There are obvious cases of problems within the relationship that are directly observable and able to be managed. But there are also cases where complications arise outside of the relationship. An important aspect of the management of interpersonal relationships is the ability to detect and resolve these complications fairly. In discussing the management of interpersonal relationships in the workplace, it is important to clarify what is typically considered a workplace relationship. Most corporations that acknowledge relationships between employees, and subsequently have policies restricting their behavior, define a workplace relationship as that of a legally married heterosexual couple. In recent times some corporations have changed their policy to include same sex partners or spousal equivalents in their definition of a workplace relationship. Regardless of whether or not they are formally recognized by the organization, the majority of issues that face married heterosexual employees in a workplace relationship also apply to heterosexual and same sex partners who are not married. For the purposes of this paper we will consider both married and unmarried heterosexual and homosexual couples as a being involved in a workplace relationship. When it comes to workplace relationships, corporations are fearful of all of the associated pitfalls. Generally, an employer will document certain corporate policies pertaining to who can be in a relationship with another employee. Some common restrictions are that managers are prohibited from relationships with their subordinates or that a couple is not supposed to work for the same manager. More often than not, there is an unwritten workplace code that employees should not start relationships from within the same group because of the possible negative consequences. Most corporations will also subject employees to workplace diversity or compliance training where the new employees will learn what is considered appropriate behavior. This usually includes sensitivity training for correctly dealing with diverse employee groups and various sexual harassment issues. Even small companies require these types of policies and training because many types of relationships exist in the work environment, including the introduction of same sex relationships in the workforce. As a result of today's lawsuit prone environment, corporations are more fearful than ever of impropriety by their employees. The training and rules are designed to avoid the costly litigation involved in harassment suits and the requisite problems that evolve from relationships. Corporations realize the importance of stopping such claims and limiting their liability by enforcing these laws. The problem though, as with any corporate decree, is that it is only as strong as the managers who implement the policies. The first step for a corporation is to put the policy into writing. If a corporation does not have a written policy on workplace relationships, all that is left are unwritten rules. Unwritten rules are left up to the manager to determine what is right, wrong, and the enforcement for that part of the organization. This leads to chaos because there are no management mediation techniques, no way for the employees to know they are about to cause organizational friction, and no common implementation from managers. On the other end of the spectrum, a few companies have gone as far as Aerotek, a high-tech temp agency with a strict no-dating-at-work rule. 1 Once the policy is completed, the next step is to communicate the policy to not only the managers, but also the employees. There are several ways the corporation can choose to notify their employees of any policy changes. First, managers need to attend training and orientation classes to learn how to effectively handle any situation and to receive materials on how to correctly disseminate the information to their employees. Managers will need to sit down with their group and spell out the issues. There is danger here in how the manager communicates the policies. If the manager does not respect the policy and the employees notice, the rules will be ineffective in prohibiting problems. In addition, if the employees are used to policies which the corporation does not enforce, the manager may be unable to convince their subordinates of the policy†s importance. Regardless of corporate policies, employees usually know what their managers expect from them. Some managers stick to the rules word for word while most shape the rules to their style and liking. Lower level managers may not recognize the downside risk of certain workplace relationships, specifically those where both employees are in the same work group. It is easy for managers to see decreased productivity but it is impossible to predict future problems. A manager is likely to ignore these relationships if the employees are responsible and don't let their outside lives effect the work life. Some managers even encourage relationships because of the emotional bond that they have formed with their employees. When it does become a problem though, it may be too late to save the group dynamic. Managers have a tendency to trust that their employees will always behave professionally, but when it comes to emotions, work usually takes a backseat. The truth is that over the past 20 years, sexual harassment lawsuits have gone from zero to over 15,000 complaints filed annually with the Federal Equal Opportunity Commission. 1 The costs of inaction are clear. One only needs to look at the problems introduced in the United States White House to see the harm and disruption that can be caused in the workplace. Thus, it is important for the manager to communicate the corporate policies clearly and recognize the possibility of problems. It is also important for the corporation to clearly define the problems associated with workplace relationships so the managers will take the policies more seriously. It is important to note that it is only when the relationship causes work related problems that the manager should act. In addition, once a manager discovers a new relationship within the group, it is important to communicate the corporate policy again to avoid any confusion. Another aspect of corporate workplace relationship policies is relationship contracts. Some companies, to avoid harassment and relationship based litigation, require employees involved in a workplace relationship to declare such status to the human resource department. The human resource department will require the couple to sign a legal contract protecting the company from any problems which may result due to their relationship. The contract will state that in spite of all the risks that you independently and collectively desire to undertake and pursue a mutually consensual social and amorous relationship. If the employees refuse to sign the contract, one or both of the employees may be terminated as a result. The company can promote workplace relationships this way and still protect themselves from future problems. This still does not protect the group from relationship problems which affect the group dynamic. An overlooked segment of corporate policies relates to homosexual employees. It is important for homosexual employees to have a safe, productive, and open work environment. If the corporation does not have a written policy on harassment issues, the homosexual employees will feel like they do not fully belong to the organization. Consequently, homosexual employee's work suffers because of the mistrust, alienation, and emotional conflict about not being able to reveal the truth. It gets much worse when there is a homosexual relationship in the same work group. Not only must they hide their sexual orientation, but also their relationship. When companies have firm written rules about non-traditional relationships and discrimination practices, it makes it easier for the mentioned employees to feel comfortable about who they are and not worry about anything except doing the job. When it comes to homosexual employees, extra policies must be adopted and followed because of the harassment that they are sometimes subjected to in the workplace. The fact is that discrimination and harassment of gays is perfectly legal in most of America. Gays can lose their jobs, homes, kids, and sometimes their lives with little or no recourse available to them. There is no federal protection for gay citizens provided by the U. S. Constitution or Congress. As of the end of 1994, only one-third of the Fortune 1,000 companies had nondiscrimination policies inclusive of sexual orientation. Because of this, it is important for corporations, large and small, to create an inclusive environment for all of their employees. Managers must push for and implement the non-discrimination policies for the good of the organization. Management should also recognize that employees cannot be satisfied with their job without first satisfying the environmental and social problems which are inherent for homosexual employees. Written and enforced corporate policies go a long way towards helping satisfy those lower order needs. All corporate policies are ineffective if the company does not follow through with penalties for those who choose not to follow them. Organizations should have formal written guidelines on what a manager should do if such a problem occurs. Once a manager recognizes a problem, the first step should be to discuss the situation in a friendly environment. It is important for the manager not to confront the employee openly when other employees are present or to address the issue in a hostile fashion. The manager needs to explain what they have noticed and what they think the issue could be. The employee should be given a chance to explain what the problem is. Next, the employee must present what they can do to rectify the situation. The employee then needs to be given time to fix the problem. If the problem continues, the manager can try talking to the subordinate again or forward the issue to the human resource department. It is then up to the human resource employees to handle the problem. The human resource department is better at handling these issues because they do not have the emotional attachment component that the manager may have. The human resource department will be intimately familiar with the policy and can better explain the problems and consequences to the employee. A manager might be willing to work out the employee's issues and give a lot of time for them to change but this may cause unwanted group resentment to the special treatment. Managers need to realize that they have many employees and that they cannot give special treatment to any one individual without compensating other subordinates in some similar fashion. A common cause of resentment among heterosexual employees is the topic of same-sex partner benefits. Most heterosexual individuals do not recognize the validity of same-sex partners and do not think they deserve to have similar benefits to that of married couples. A study done in 1993 showed that although 70% of Fortune 1000 companies claimed to not discriminate on the basis of sexual orientation, just over 5% had domestic partner benefits. For a corporation to be competitive in the workforce and retain homosexual employees and customers, they must be inclusive. Some companies worry that they may suffer a financial loss from the backlash of implementing such a policy, but studies have shown that none of the organizations that have implemented these benefits have suffered a loss of either customers or employees. 2 Many gay and lesbian people take the availability of these benefits as a signal that an employer values diversity, that the employer in fact wants all its people treated fairly and equitably. The cost of partner benefits is not high. First of all, a large number of gays and lesbians are not going to self-identify. In addition, most of those partners are working and are covered elsewhere. Finally, despite the cost of AIDS, the costs of other medical events ? complicated pregnancies for example ? are higher in the traditional family. At the same time, it is important to provide heterosexual employees with domestic partner benefits. This provides an equitable policy for the entire organization. Once the company has a policy regarding workplace relationships, harassment, and benefits, it becomes time for the managers to take this information and decide how this effects their group. The manager is then responsible for implementing the corporate policy. The possible consequences of unproductive workplace relationships are probation, forced reassignment, or termination. As long as the employee works to fix the workplace problems, and there is no harassment involved, termination should not be an issue. More commonly the employee would be reprimanded by the manager and human resources and be allowed to work through the issue. If the employee and their partner are working together in the same group, a preferred solution would be for one of the employees to transfer to another group. A transfer can eliminate a lot of issues which come up when both employees work together and may be the best solution for the company and the workplace relationship. Some company policies will mandate that married employees cannot work under the same manager and one of the employees will be required to transfer. Termination can also become a problem though, even when the employees are in different groups. If the employee is preoccupied about something personal that happens in the relationship and it causes constant and long-term work degradation, termination may be the only solution for the manager and human resources department. These situations can be reduced if the company policies and consequences are spelt out clearly when employees go through initial orientation as well as when a relationship starts. When an organization refuses to stand behind its nondiscrimination policies with real actions, such as inclusive education, domestic partner benefits, and public support, it is counting on an unspoken rule of the workplace to mysteriously take effect. This rule is that all the employees will put business before everything and act as though their own opinions, ideals, and beliefs are checked at the door in consideration of the common good. However, such a reaction is rarely, if ever, the case when homosexual employees are involved, especially when the issue at hand is so volatile. A manager must look at productivity and motivation. If you have a workplace team in which two of the people conflict because one is homophobic and the other is openly and comfortably gay, your challenge is not to change either of their minds. Your challenge is not getting the employees to accept each other but rather a business problem. The employees do not have to learn to like each other but rather how to work together. In situations where the heterosexual employee cannot handle the situation, they will have to transfer or they will most likely end up being terminated. Other corporate policies can involve nepotism. Most corporations will clearly state that a manager cannot hire a relative or spouse to work under them. Most large companies, like Bell Atlantic and Digital Equipment Corporation, will state that an employee can not influence the hiring process in any way. This includes the hiring of outside firms run by a relative regardless of their qualifications. Such nepotistic actions will generally result in the termination or transfer of the newly hired employees and termination of the offending manager. Managers will not always follow corporate policy so it is important for the human resource department to make sure that nothing discriminatory happens. When it comes to work place relationships, some managers can be expected to act against corporate policy or avoid the situation at all costs. By taking the â€Å"don't ask, don't tell† position, the manager can avoid the situation in most cases. Some managers may just ignore that the relationship exists all together to avoid having to deal with it, or possibly losing their employees. These stances probably cause more harm than good because they don't address the possible problems and leave room open for large issues to arise. It is more important to have good communication with your subordinates. When it comes to same sex relationships, managers must put aside any personal beliefs and perceptions about their different employees. Some people may find this very hard to do and will not be able to tactfully deal with these scenarios. In these cases, the manager will most likely project their negative feelings about the employee and create a poor work environment. The manager may create a bad environment in other ways by assigning undesirable job tasks, jobs which they know the employee cannot complete, limiting compensation and career advancement. This is a way for the manager to force the unwanted employees out of the group. Employees need to recognize these situations and report them to the human resource department. A manager also needs to realize when their subordinates are discriminating against one employee and take quick and decisive action. This is where a good discrimination policy can eliminate bad work conditions and remove non-productive employees. Couples working in the same company will experience some unique challenges because of their relationship. Many of the complications will depend on how closely couples work together. Issues such as personal conflict, affection, children, changing jobs, and the sharing of corporate information are all different complications couples will be forced to address. Personal conflict within a relationship can cause problems in the workplace. During a conflict, couples that have easy access to each other during the day can have some performance degradation above and beyond normal anxiety of being in a domestic conflict. Work related interaction is often the reason couples meet one another in the first place, and hence, the initial steps that lead up to a relationship. Once in the work environment, normal business reasons are the initiator of communication, but personal issues become commonplace conversation. When in a conflict, couples end up taking time out of the workday to talk about the issue without notice by others, since interaction for business reasons is necessary. The opposite effect, personal avoidance, is also a result of personal conflict. In one case regarding a couple that worked together closely, conflict within the relationship would impede performance, because they would avoid one another until resolved. These conflicts caused work requiring each other's assistance not to be performed. On the other hand, many couples are able to put their problems completely aside at work, and find no additional issues with working in the same place during conflict. Many couples insist there are only benefits to working together, and are always able to leave their problems at home. Affection in the workplace has many aspects, and various opinions. Public affection in the workplace, such as hand holding, hugging, and kissing is universally avoided during work hours. Such behavior is viewed as inappropriate, and professionalism prevails, at least publicly. However, differences in opinion regarding particular situations exist. Couples handle affection differently in cases where they are outside of the work area during work hours, or in the case where they are on work property, but before the workday starts. Some people say they have no problem kissing or hugging â€Å"goodbye† after lunch or in the parking lot before going their separate ways. Those who participate in such activities generally think nothing of it, even if people that work for the same company were in the same restaurant or vicinity. In only one case did someone say they felt slightly uncomfortable. In this particular instance, for 10 to 15 seconds the couple would hug and kiss goodbye before getting out of the car when returning from lunch. The level of comfort depended on whether other employees could see them. Another point couples address when working at the same company is the effect on children. The majority of parents actually feel it is easier to bring small children to work, because it means they are able to transport the child to their partner's work location very easily when there is a need. However, parents also mention that by working for the same company, both parents had the same standard set of holidays. This means that when a child is off from school, it is more likely that both parents will be expected to be at work, making it more likely the child would be joining them in the work environment. People involved in relationships who look for jobs will often encounter the opportunity to work at the same company. Besides meeting at work, another common way for couples to work for the same company is while looking for jobs in a new geographical area that requires moving. The most interesting data point for couples looking for jobs is that many times employment opportunities for one partner will arise while the other partner is interviewing for a job. This occurs in several different ways. Often the person being interviewed will mention that a condition of accepting the job is dependent upon the ability of their partner to find a job in the same new geographical area. This leads to the interviewer getting information through their human resource department to find positions that the partner could interview for. In this scenario, it is then up to the couple to interview well enough to both receive offers for employment. The advantage gained by the couple that leads to both being employed by the same company is the help they get accessing information about job availability. There are many cases of jobs being offered to both partners. In one case, the interviewer mentioned that they were aware the interviewee had a partner that was looking for a position, and then proceeded to offer the partner a job on the spot without solicitation. Often times, a person will accept a job with a new company with the understanding that their partner will then have a better opportunity of getting a job once they have secured employment for themselves. This is because many companies provide information about job openings to employees first, then turn to publicizing the position. The employee with a partner looking for a job has a time advantage that often leads to partner employment. In addition, the internal employee will often have additional information about desirable skills can make a potential candidate for a position more attractive. Another very interesting issue arising from relationships in the workplace is the information that couples share that would normally not be available to them. This turns out to be a very significant issue. Under normal circumstances, managers in the corporate environment have access to certain metrics and information that are not available to non-management employees. Information such as salaries, benefits, policies, and raises are closely kept secrets by management. Also, certain information between different company divisions is not normally shared. However people in relationships share this information with each other, often breaking the code. These are items that managers need to know in order to prepare for them such as changes in company policy or reorganizations. Many times the information shared would eventually be available to their partner, but just not in the same timeframe. Some information, however, would never be available to the general employee population. Information such as pay scales and special benefits are many times shared only with those who need to know or those who are participating in such programs. Quite often information about special benefits, such as bonuses or company options, are shared with partners. This type of information is specifically not shared with employees who do not participate because company policy forbids it. Managers are trained to keep confidential material to themselves. In addition, managers often have the added incentive of participating in programs that they are told to keep confidential. Certainly, sharing such information with life long partners is necessary to make financial decisions. But in less permanent relationships, the partner who is not a participator in such benefits has information meant only for those chosen to participate, or those trained to keep it confidential. This breach of confidentiality is much more likely to occur, and slip into the ranks of peers who are not managers. A special complication of workplace relationships is dealing with the issue of nepotism. Although a buzzword in the corporate world, nepotism among couples is rarely an issue. Even in situation where people in relationships feel the opportunity for employment was gained through a partner or relative, rarely do couples feel their employment is viewed as nepotistic. In fact, just the opposite was stated. Many people in relationships feel the companies they work for encourage relationships among employees, as long as corporate policy was adhered to. It is difficult to determine whether such a view is accurate, or simply self-justification. Feeling that one's employment is viewed upon as nepotism is more likely amongst relatives. Rarely do the relatives feel it is looked upon negatively by their peers. The diversification of the corporate workforce has changed the way in which management must deal with workplace relationships. Whether formally acknowledged or not, they are a common occurrence in today's corporate environment that must be addressed. The administration and management of employees is, at the very least, complicated by workplace relationships. From an organizational perspective it is advantageous to have a stated, written policy regarding interpersonal relationships in the workplace. To be effective it is important that the corporation properly communicate the policy to the managers and the employees. If properly implemented such a policy will serve to reduce the legal liability of the corporation and explicitly define what is considered a conflict of interest. It should also state what the corporation will tolerate in terms of a workplace relationship and how it will react to complications that arise from it. In most cases it is the responsibility of the frontline manager to enforce this policy. The implementation of corporate policy is usually executed at the frontline management level. It is the responsibility of the frontline manager to recognize the relationship and ensure that it does not become a workplace issue. When problems occur, the frontline manager must enforce the corporate policy based fairly and authoritatively. From the data gathered, it appears this is the area most in need of improvement. In general, workplace relationships seem to be a positive for both the employer and the employee. From the perspective of the people involved in the personal relationship it offers many advantages such as convenience and increased benefits. For the corporation workplace relationships provide committed, career minded employees who are less likely to change jobs as often. But when complications arise, it is important that a policy is in place and management is properly trained to effectively deal with the situation.

The Matryoshka and Other Symbols of Russia

The Matryoshka, also known as the Russian nesting doll, is one of the most instantly recognizable symbols of Russia. Other common symbols include include the birch tree, the troika, and the Russian samovar. Discover the origins of these symbols, as well as their significance to Russian cultural heritage. The Matryoshka Doll Nalin Nelson Gomes / EyeEm / Getty Images The Russian Matryoshka doll, also called a nesting doll, is perhaps the best-known symbol of Russia around the world. In Russia, the doll is thought to symbolize traditional values of Russian society: respect for the elderly, unity of the extended family, fertility and abundance, and the search for truth and meaning. In fact, the idea that the truth is concealed within many layers of meaning is a recurring motif in Russian folk tales. In one such folk tale, a character named Ivan searches for a needle representing the death of an evil character. The needle is inside an egg, the egg is inside a duck, the duck is inside a hare, the hare is inside a box, and the box is buried under an oak tree. Thus, the Matryoshka, with its many layers concealed within the larger doll, is a perfect symbol for Russian folk culture. As for the first Matryoshka doll, the most popular theory is that the Matryoshka was conceived in 1898, when the artist Malyutin visited the Mamontov family estate in Abramtsevo. At the estate, Malyutin saw a Japanese wooden toy that inspired her to design a series of sketches reflecting the Russian version of the nesting doll. In Malyutins sketches, the largest doll featured a young woman dressed in townspersons attire holding a black rooster. Smaller dolls depicted the rest of the family, both male and female, each with their own object to hold. Malyutin asked a local wood craftsman Zvyozdochkin to create the wooden dolls. The finished set of eight dolls was called Matryona, a popular name at the time that matched the widely accepted image of the strong, calm, and caring Russian woman. The name suited the dolls, but Matryona was considered too solemn a name for a childrens toy, so the name was changed to the more affectionate Matryoshka. The Birch Tree Tricia Shay Photography / Getty Images Birch is the most ancient and well-known symbol of Russia. It is also the most prevalent tree on Russian territory. Birch is associated with the Slavic goddesses Lada and Lelya, representing female energy, fertility, purity and healing. Objects made out of birch have been used in rituals and celebrations in Russia for centuries. During Ivan Kupala night, young women braided their hair ribbons into the branches of the birch tree in order to attract their soul mates. Birch was often kept in the home for protection from jealousy and bad energy, and when a baby was born, birch brooms were left outside the front door of the familys house to protect the baby from dark spirits and illness. Birch has inspired many Russian writers and poets, particularly Sergei Yesenin, one of Russias most beloved lyric poets. The Troika Aleksander Orlowski, Traveler in a Kibitka (Hooded Cart or Sledge), 1819. Lithograph. Public Domain /  The Hermitage Museum, St. Petersburg, Russia The Russian troika was a harness method for horse-drawn vehicles, used during the 17th-19th centuries. The troika was driven so that the middle horse trotted while the other two horses cantered, keeping their heads turned to the sides. This meant that troika horses took longer to fatigue and could travel much faster. In fact, the troika could reach speeds of 30 miles per hour, making it one of the fastest vehicles of its time. Originally, the troika was used to transport mail, with tired horses being exchanged for fresh ones at regular intervals. The Troika was later used to carry important passengers, at which point it became a cultural icon: featured in weddings and religious celebrations and decorated with bright colors, bells, and gold. Because of its innovative design and impressive speeds, the troika came to be associated with the Russian soul, which is often called bigger than life (Ã'ˆÐ ¸Ã'€Ð ¾Ã ºÃ °Ã'  Ð ´Ã'Æ'Ã'ˆÐ °, pronounced sheeROkaya dooSHAH). The symbolism of the number three, which has significance throughout traditional Russian culture, also played a role in the troikas popularity. According to some accounts, the troika was adapted by the Russian government from secret rituals of the Russian North. Every year on St. Elijah the Prophets Day, ritual troika races took place in northern parts of Russia, with the troika symbolizing the fiery chariot that carried Elijah to heaven. To crash in one of these races was considered an honorable way to die—it was said that Elijah himself took those who died in the races to heaven. The Samovar Nikolai Petrovich Bogdanov-Belsky, The Teachers Guests.. Heritage Images/Getty Images / Getty Images A samovar is a large, heated container used to boil water, especially for tea. The samovar is an iconic symbol of Russian tea-drinking culture. Traditional Russian families spent hours chatting and relaxing around the table with traditional preserves, Russian pretzels (Ð ºÃ'€Ð µÃ ½Ã ´Ã µÃ »Ã' ), and a hot samovar. When not in use, samovars remained hot and were used as an immediate source of boiled water. The word samovar (pronounced samaVARR) means self-brewer. The samovar contains a vertical pipe filled with solid fuel, which heats the water and keeps it hot for hours at a time. A teapot containing a strong tea brew (Ð ·Ã °Ã ²Ã °Ã'€Ð ºÃ °) is placed on top and heated by the rising hot air. The first official samovar appeared in Russia in 1778, though there may have been others made even earlier. The Lisitsyn brothers opened a samovar-making factory in Tula in the same year. Soon, samovars spread across Russia, becoming a much-loved attribute of everyday life for Russian families of all backgrounds.

The School Finance Reform Is Focused On The Distribution...

The school finance reform is focused on the distribution of funds across rich and poor district schools. The reform was based on the thought that rich neighborhoods and households were better in spending on education. These scholars would access better programs and their family backgrounds could put them in the most precious and advanced institutions. Poorer neighborhoods on the other hand struggled to raise fees and sometimes students were forced to drop-out due to financial challenges. The historical development of the school finance reform has always sought to fund schools differently based on students’ family backgrounds (White, 2014). Poorer schools are given priority, low income districts also enjoy more federal aid that high-income district schools. The significance of school finance reforms was poised on previous researches. Studies indicate that a student educated in a school that received 20% higher funding than that of his peer, the scholar was likely to perform 20% better and his chances for adult poverty were 20% lower (White, 2014). Low-income government schools, either at district or state level, will perform better if given adequate financial assistance. Although the school finance reform sought to provide more finances to low-income schools, it was faced by major limitations. One of these is the court ruling of 1973 when the Supreme Court, in the School Finance after Rodriguez (The Politics of School Finance, 2016), decided that inequality in school financeShow MoreRelatedEssay on Schools and Finances1155 Words   |  5 PagesRegardless of the school, public or private, finances play a major role in its survival. 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