Ict and Banking Industry Free Essays

string(107) It is normal that there will be enormous increments to the capital base and saves on the obligation side. A PROJECT REPORT ON THE EFFECT OF INFORMATION AND COMMUNICATION TECHNOLOGY ON THE EFFECIENCY OF BANKING INDUSTRY (IN UDAIPUR CITY) IN THE PARTIAL FULLFILLMENT OF THE REQUIREMENT FOR MASTER OF BUSINESS ADMINISTRATION (MBA) 2007-2009 PACIFIC INSTITUTE OF MANAGEMENT, UDAIPUR Post Box No. 12, Pratap Nagar Extension, Airport street Udaipur-313003 Ph: 0294-2491340 E mail: pimanagement@rediffmail. om,pimplacement@rediffmail. We will compose a custom exposition test on Ict and Banking Industry or then again any comparable theme just for you Request Now com Submitted by: Submitted to: Chanda Joshi Mr. Dhiraj Jain MBA Part-2 Asstt. Educator, PIM Acknowledgment Industrialists in proficient life are likely and definitely mindful of their feeling of indebtness to numerous individuals who have invigorated affected their scholarly advancement in customarily. The inclination is officially communicated in standard motions of affirmation in this manner it appears to be just right to affirmation my appreciation with feeling of reverence to the god-like different individuals helped me to work in methodical smoother way. I might want to communicate my significant gratitude to all the respondents who were co sufficiently employable and saved their important time in topping off the survey. Words are not in vocabulary to communicate my true feeling of appreciation for my tutor, tip top guide and way Mr. Dhiraj Jain and, Prof. B. P SHARMA (Director, pacific foundation of Management) whose important direction prompting consolation innovative contemplations productive analysis had helped me to achieve this examination work effectively. CHANDA JOSHI PREFACE The hazardous development of data and correspondence innovation (ICT) is quickly changing the financial business and harsh rivalry between the expanding quantities of banks has brought about high venture on ICT. This report examines the impact of ICT on banking industry (administration) in Udaipur city regarding open and private banks. Two Questionnaires were utilized to gather information from various clients and bank representatives independently; the clients and bank workers acknowledge as obvious that ICT affects banking industry in India. The consequences of study without a doubt show the enormous effect of ICT on the presentation of the financial business in India. File PARTICULARS DESCRIPTION 1. Affirmation 2. Prelude 3. Official SUMMARY 4. Presentation 5. INDUSTRY PROFILE 6. RESEARCH METHODOLOGY 7. Information INTERPRETATION 8. FINDINGS,CONCLUSIONS . Proposals 10. Poll 11. Book reference EXECUTIVE SUMMARY Advances in the financial division have introduced a period of multi †item and multi †administration being conveyed utilizing various yet incorporated channels. The utilization of data and correspondence innovation (ICT) is on the expansion and envelops almost the whole array of banking tasks. Rising rivalry and client desires have constrained top administration actualize, and consistently update , coordinated versatile ICT practices and arrangements. The immensity and scope of banking administrations joined with the intricacy of incorporated and ICT †empowered conveyance systems require far reaching associations to be fashioned among banks and suppliers of ICT arrangements. ICT has a pivotal task to carry out in the money related division in at any rate three principle regions: improving the range and proficiency of banking administrations accessible to clients, bringing down costs expanding the effectiveness of capital markets, and taking into consideration progressively successful guidelines of a wide range of budgetary markets and related exchanges. The utilization of ICT empowers a superior conveyance of banking administrations to the two contributors and borrowers inside a nation and between nations. ICT has a focal job in the activity of different capital markets, for example, financial exchanges, security markets and outside trade markets, and it is seriously utilized by showcase coordinators, advertise experts and speculators in this business sectors. ICT is additionally a basic instrument for administrative or administrative collections of these business sectors at both national and worldwide levels. This exploration presents the primer discoveries of an examination study to recognize the impact of execution of ICT on the productivity of banks in Udaipur. The system incorporates the assortment of information by the poll overview. Two kinds of polls are to be set up for the information assortment One survey has been appropriated among the clients to know the proficiency of the financial administrations by utilizing ICT. The subsequent poll is to be filled by the authorities of the banks, which will give data about the need, significance of the ICT for the effectiveness of the bank. Section 1 INDUSTRY PROFILE INDUSTRY PROFILE What is banking? Bank might be characterized as a monetary establishment which is occupied with the matter of saving cash for investment funds and financial records or for trade or for giving advances and credit and so on. A lot of administrations proposed for private clients and described by a higher caliber than the administrations offered to retail clients. In light of the thought of customized administrations, it intends to offer exhortation on speculation, legacy designs and offer dynamic help for general exchanges and the goals of advantage related issues. The fundamental capacity of a bank is to offer types of assistance identified with the putting away of stores and the reaching out of credit. Fundamental capacity may incorporate Credit assortment, Issuer of banking notes, Depositor of cash and loaning advances. Presently a days banking isâ not in itsâ traditional way, with the headway of innovation its focusingâ on moreâ comfort of customerâ providing administrations, for example, †¢Online Banking †¢ Investment Banking †¢ Electronic Banking †¢ Internet Banking †¢ PC Banking/Mobile Banking †¢ E-Banking The significance of banking segment is colossal in the advancement and flourishing of any State or nation. INDIAN BANKING INDUSTRY The development in the Indian Banking Industry has been more subjective than quantitative and it is relied upon to continue as before in the coming years. In light of the projections made in the â€Å"India Vision 2020† arranged by the Planning Commission and the Draft tenth Plan, the report conjectures that the pace of development in a critical position sheets of banks is probably going to decelerate. The absolute resources of all planned business banks by end-March 2010 are assessed at Rs 40, 90,000 crores. That will involve around 65 percent of GDP at current market costs when contrasted with 67 percent in 2002-03. Bank resources are relied upon to develop at a yearly composite pace of 13. 4 percent during the remainder of the decade as against the development pace of 16. 7 percent that existed between 1994-95 and 2002-03. It is normal that there will be huge augmentations to the capital base and saves on the risk side. You read Ict and Banking Industry in class Exposition models Banks in India can be sorted into non-booked banks and planned banks. Booked banks comprise of business banks and co-usable banks. There are around 67,000 parts of Scheduled banks spread across India. During the main period of monetary changes, there was a nationalization of 14 significant banks in 1969. This essential advance prompted a move from Class banking to Mass banking. From that point forward the development of the financial business in India has been a constant procedure. The Public Sector Banks (PSBs), which are the base of the Banking area in India represent more than 78 percent of the all out financial industry resources. Lamentably they are troubled with over the top Non Performing resources (NPAs), huge labor and absence of present day innovation. Then again the Private Sector Banks are gaining huge ground. They are pioneers in Internet banking, versatile banking, telephone banking, ATMs. Undoubtedly they are probably going to prevail in the Indian Banking Industry. Indus land Bank was the principal private bank to be set up in India. In the Indian Banking Industry a portion of the Private Sector Banks working are IDBI Bank, ING Vyasa Bank, SBI Commercial and International Bank Ltd, Dhanalakshmi Bank Ltd,Karur Vysya Bank Ltd, Bank of Rajasthan Ltd and so forth are some private division banks. Banks from the Public Sector incorporate Punjab National bank, Vijaya Bank, UCO Bank, Oriental Bank, Allahabad Bank , Andhra Bank and so on. ANZ Grindlays Bank, ABN-AMRO Bank, American Express Bank Ltd, Citibank are a portion of the remote banks working in the Indian Banking Industry . Section 2 INTRODUCTION â€â€â€â€â€â€â€â€â€â€â€â€â€â€â€â€- Meaning of ICT The term â€Å"ICT† portrays the utilization of PC †based innovation and the web to make data and correspondence administration accessible to a wide rang of clients. The term is utilized extensively to address a scope of advancements, including phones. Vital to these is the Internet, which gives the system to shipping information in various arrangements including content, pictures, sound, and video. Moreover, ICT manages the application layer, the frameworks that empower data to be gathered and disseminated, broke down, and prepared. Be that as it may, while ICT is commonly versatile to various data. Necessities and conditions, its viability in understanding advancement gives despite everything relies upon the substance it conveys. â€â€â€â€â€â€â€â€â€â€â€â€â€â€â€â€- The New Era The 21st century will achieve an all †grasping assembly of processing, correspondence, data and information. This will fundamentally change the manner in which we live work and think. The development of high †speed systems, combined with the falling expense of figuring power, is making conceivable application under dream of before. Voice, information, pictures, and video m

JDBC essays

JDBC papers The term customer/server appeared during the mid 1980s while organizing PCs got mainstream. The essential idea driving the model is that there is one machine that demand an assistance and one machine that offers a support. The machine making the solicitation is known as the customer and the one offering the support is the server. Prior to the customer/server model was presented there were two primary appropriated framework models being ordinarily utilized however both were indicating their age in the advanced figuring The first of these was the centralized computer engineering. This had an amazing focal host PC that completed all the preparing. To utilize the framework the client associated with the centralized server by means of a fake terminal. Anyway as the business moved towards the utilization of Graphical User Interfaces this model began to vacillate as fusing them was extremely troublesome. The subsequent sort is the record sharing design. In this model the server sends the mentioned record to the terminal where it very well may be utilized. This implies it utilizes the terminals assets taking a great deal of strain off the server. Anyway it has issues if the measure of information being moved is high and it can likewise prompt issues with information consistency since two individuals can call the record simultaneously both make distinctive alters and afterward both spare. The individual who spares the document first will lose all there changes once the subsequent individual recoveries. The quantity of concurrent clients was additionally exceptionally constraining. Just 12 individuals could interface at once before execution turned into a noteworthy issue The customer/server model contrasts from these models since it utilizes a database server rather than a document server. The old centralized servers are frequently utilized as the server in this framework. This permits a client to question the documents without downloading the entire grinds along these lines chops down the measure of traffic that goes over the system. The Database Management framework likewise guarantees that referential trustworthiness is... <!

Psychosocial interventions - Free Essay Example

Introduction This report aims to critically appraise psychosocial interventions (PSI) that are utilised when working with complex cases. In order to do this the term complex is explored with reference to people with psychosis. Different types of complexity are discussed with a more detailed examination of a specific complexity; the relationship between substance misuse and psychosis (dual diagnosis). The effects that substance misuse and psychosis have upon the service user and their care givers are outlined. An overview of the use of psychosocial interventions when working with complex cases is given. This discussion is then focused on particular interventions for dual diagnosis that show promise for enhancing service user and carer experience, namely a integrated treatment approach of cognitive-behavioural therapy, motivational interviewing and family therapy. These interventions are critically appraised with reference to evidence base, policy and guidelines. Examples from clinical practice are given to illustrate potential barriers, and outcomes when implementing such interventions with service users with complex needs and their caregivers. Strategies to overcome such barriers are generated and recommendations are made. Aliases are used within the scenarios of this report in order to maintain anonymity of the service users and carers described to illustrate points and examples. Complexity The term complex case is referred to frequently within mental health literature, policies and guidelines but there are very few definitive explanations of what the term actually means. Griffiths Allan (2007) discuss how the term complex case is ill defined within mental health literature summarising how the term is often used to denote circumstances where people appear to have many interrelated needs that require several, coordinated responses from multiple services. The term complex case is often used to denote needs that services do not fully understand or provide for effectively. This report aims to explore the term complexity in relation to individual cases of those with serious mental illness. Complex: ‘Made of many different things or parts that are connected; difficult to understand (Soanes Stevenson 2005) Interpreting the above definition of complex within the Oxford Dictionary of English one could describe a complex case as a service user with more than one problem or need that are connected making the case more difficult to work with. For example having a diagnosis of schizophrenia and being detained within a medium secure unit. A person fitting this example would potentially present the mental health professional with more challenges than a person with moderate depression living with their supportive family. Wilson, Holt and Greenhalgh (2001) discuss the term complexity in relation to human health and illness. They suggest there are a number of factors (outlined in Table 1) that we all posses that makes us all complex. They go on to suggest that human illness and behaviour are not predicable and neither can be thought of as a simple cause and effect system. Again, adding to the complexity of individuals that because one individual responds one way to an event does not mean all will. Although this list of human complexities was written with medical practice in mind it applies to all and provides the baseline of those service users we work with in mental health services. Table 1 (Wilson, Holt, Greenhalgh 2001 p685) Factors that add the human complexity The human body is made up of multiple interacting and self regulating physiological systems including biochemical and neuroendocrine feedback loops. An individuals behaviour is determined partly by an internal set of rules based on past experiences and partly by unique and adaptive reaction to external stimuli. The web of relationships in which individuals exist contained varied and powerful determinants of their beliefs expectations and behaviour. Individuals and their immediate social relationships are embedded within wider social political and cultural systems which can influence outcomes in entirely novel and unpredictable ways. All of these interacting systems are dynamic and fluid. A small change in one part of the web of interacting systems may lead to a much larger changes in another part through amplification of effects. If we bear this in mind, that all humans are complex, then maybe the term complexity needs to b e described as a continuum (Figure 1). That the more problems a person has or the more difficulties they face the further they move up a complexity continuum. People with a diagnosis of serious mental illness (as with all people) can face a large number of problems and difficulties through the course of their lives for example, positive symptoms, negative symptoms, anxiety, depression, mania. When adding this to the complexity of an individual this produces more challenges for the health care professional, the individual and their carers/families. However, these experiences also produce problems and difficulties for the service user making their case even more complex. For example the impact of experiencing voices does not end here but effects other areas of a persons life (see Table 2). Table 2. Laura Case study Laura first started to hear voices at the age of 9 and at first these did not bother her. As she got a bit older and discovered that this wasnt ‘normal her voices started to become critical of and derogatory towards her. To cope with this Laura started to experiment with Illicit drugs and alcohol as this blocked out the voices for a short time. However, this also made Laura lose her inhibitions and she would participate in sexual acts with men in her local area. This fuelled the voices and they became much more negative. So to cope Laura would take more drugs. Eventually Laura would run out of money and so would shoplift and resorted to prostitution. Her life became very chaotic and at 16 her mother kicked her out. Laura was now sleeping in neighbours gardens, sheds, anywhere she could. Laura lost touch with all her family and friends, her physical health suffered and she ended up very underweight and her voices became worse. Eventually Laura was found by the police sleeping semi-clothed in a car park under the influence of drugs and alcohol. It was at this point she was admitted to an acute mental health unit. From the case of Laura it can be seen how not even having a diagnosis of schizophrenia, but experiencing positive symptoms can result in stigma, social exclusion and have a huge impact on a persons life. Lauras case was exacerbated by the use of illicit substances and alcohol demonstrating how substance misuse can add greatly to the complexity of an individual. Within the literature it can be seen that there are many factors that add to the complexity of a person with mental health needs including: medication resistant symptoms (Tarrier et al 1993), receiving care within secure forensic units (DOH 2005), psychological reactance (Moore, Sellwood, Stirling 2000), poor social functioning (Cather 2005, Couture et al 2006), , learning disabilities (DOH 2001a), insight (David 1990 and Buckley et al 2001), physical health (Marder et al 2003) home lessness (Randall et al 2006), and dual diagnosis (DOH 2002). These complexities have been recognised by the government and national drivers have been produced to guide mental health professionals and services to enable delivery and provision of the best services. For example ‘The National Service Framework for Mental Health (1999a) outlines a number of interventions for several complex groups including some of those mentioned above. Rankin Regan (2004) discuss how the term complexity means that there is no generic complex needs case. This therefore suggests each individual has a unique interaction between their own health and social care needs, therefore, requiring personalised responses from mental health services. Adopting an approach that incorporates psychosocial interventions could help to achieve a personalised response and provide individualised, tailored care for the service user and their care givers. Psychosocial Interventions The use of psychosocial interventions (PSI) is advocated in national drivers such as ‘Schizophrenia: Core intervention is the treatment and management of schizophrenia in adults in primary and secondary care (NICE 2009). This guidance recommends that all service users and their families are offered psychosocial interventions as a treatment of schizophrenia. Also, documents such as ‘From values to action: The chief nursing officers review of mental health nursing (DOH 2006) recommends the use of psychological therapies to improve outcomes for service users and ‘The mental health policy implementation guide (DOH 2001b) advocates the use of psychosocial interventions through a variety of service delivery modes. Demonstrating the emphasis that is placed upon such interventions in the treatment of serious mental illness. Mairs and Bradshaw (2005 page 28) suggest PSI is â€Å" a range of evidence-based interventions for people with psychosis and their care givers. The term is generally used to include both models of service delivery such as assertive outreach and specific interventions, for example Family Intervention and Cognitive Behavioural Therapy (CBT). PSIs aim is to reduce stress experienced by an individual with psychosis or help him or her to cope with stress more effectively.† As a result of adopting a PSI approach an individualised service is offered to the service user to help meet their needs utilising a variety of interventions and services with great emphasis being placed upon collaboration. Psychosocial interventions assume a complex link between biological, environmental, and sociological factors which suggests that ambient stress, together with life events may trigger onset or relapse of, mental health in some people (Gamble Curthoys 2004). A model which displays this link is the Stress Vulnerability Model by Zubin and Spring (1977 cited in Norman, Ryrie 2004). This model helps explain the aetiology, course and outcome of mental illness, demonstrating how stress has different effects on individuals. The Stress Vulnerability Model (See figure 2) suggests that some people are more vulnerable to stress than others and that when an individuals stress threshold is passed they can become unwell i.e. experience positive symptoms. In terms of a complex case it could be proposed that an individuals complexities cause stress in themselves and/or increase a persons vulnerability to stress. An example of how ‘The Stress Vulnerability Model can be illustrated to enable it to be shared with a service user with complex needs, using an easy to understand analogy can be seen in Appendix 1. As previously mentioned the aim of PSI is to reduce stress or to help cope with stress better; therefore, it can be seen how the Stress Vulnerability Model plays a central role in providing psychosocial interventio ns. Substance Misuse and Psychosis Over 50% of people with a severe mental illness also use illicit drugs and/or alcohol at hazardous levels (Cleary et al 2009) and even low levels of substance misuse can have detrimental effects and cause serious complications (Barrowclough et al 2001). The combination of substance misuse and mental health problems (dual diagnosis) is associated with a range of social, behavioural, physical and psychological problems (see table 3) providing challenges for mental health services and adding to the complexity of an individual (Hussein 2002). In addition to this complexity ‘The national service framework of mental health (DOH 1999a) identifies patients whom misuse substances and have a diagnosis of serious mental illness as a population of greater risk of stigmatisation and exclusion from existing service provision. Demonstrating some of the factors that add to an individuals complexity. Table 3 Complications posed by dual diagnosis (Cleary 2009, Drake Mueser 2000, Clark 1996, Dixon, McNarey Lehman 1995, Griffiths Allen 2007 and Gibbins Kipping 2006) Increased risk of Suicide, Self Neglect, Violence, Poor compliance with treatment, More inpatient stays worsening psychiatric symptoms Relapse, Homelessness, HIV and Hepatitis, Contact with criminal justice system Prejudice and Stigma. Negative impacts on Social relationships Financial resources (of individual and/or family/friends) Family Relationships i.e. increased burden, increased expressed emotion Within literature the most commonly reported reason that people with serious mental illness use illicit drugs is to self medicate, for example, to relieve negative symptoms of schizophrenia (Littlejohn 2005). However, as Conley Benishek (2003) report there is the additional complexity of trauma that has lead to the use of substances for various reasons including dissociati on, and modelling from parents. They continue recommending that nurses working within the substance misuse field should be trained in picking up such information. If an approach adopting psychosocial interventions was utilised and therapies such a cognitive behavioural therapy were delivered then this historical information may be identified and dealt with appropriately. Therefore, leading to a different delivery of services compared to someone who uses substances to self medicate. However, the mental health professional must also bear in mind that service users also use substances for the same reasons as others (Littlejohn 2005). Even though the NICE (2007) Guidelines, ‘Drug Misuse: Psychosocial Interventions recommends that CBT be offered to those with anxiety and depression who are stabilised with their drug use, but does not discuss its use with those with psychosis. There is growing literature examining the use of CBT for those with a dual diagnosis (Cleary et al 2009, Barrowclough et al 2001, Baker et al 2006, Weiss et al 2007 and Haddock et al 2003) although, as mentioned earlier the amount of literature in this area is limited. Also the CBT that is delivered to the participants within the studies has been adapted to suit the needs of those with dual diagnosis. This integrated treatment, namely C-BIT (Cognitive-Behavioural Integrated Treatment), has a number of components; Cognitive Behavioural Therapy, Motivational Interviewing and Family Interventions. C-BIT is not only about adapting psychosocial interventions to suit those with dual diagnosis but it is also about service provision and development (Thylstrup Johansen 2009, Graham et al 2006, Graham et al 2003). Such interventions are used as part of an individualised treatment plan that incorporates the key principles of working with dual diagnosis (see table4). Table 4 (Drake et al 1993 cited in Abou-Saleh 2004) Principles of treatment of substance misuse in people with severe mental illness Assertive outreach to facilitate engagement †¢ Close monitoring to provide structure and social reinforcement †¢ Integrated concurrent service †¢ Comprehensive, wide range of interventions †¢ Stable living situation †¢ Flexibility and specialisation (modified approaches) †¢ Stages of treatment: engagement, persuasion, active treatment and relapse prevention †¢ Longitudinal perspective for relapsing and chronic disorder †¢ Optimism instilling hope in patients and carers Motivational Interviewing (MI) The aim of this intervention is to increase a persons ability to recognise and do something about any problems they have (Gamble Curthoys 2004) and that change would be desirable (Kipping 2004 and Miller Rollnick 2002). This approach conveys hope and is non-confrontational in it style (Kemp et al 1996) and is largely used within substance misuse services (DOH 1999b). This intervention is used alongside Prochaska DiClemente (1986 Cited in Kipping 2004) Model of Change (see Figure 3) to provide a framework of which interventions should be used at which stage of change a service user is at. Motivational Interviewing is mainly used as a persuasion tool to move people from precontemplation/ contemplation to decision and active change. Four General principles are followed as outlined by Miller Rollnick (2002); expressing empathy, developing discrepancy, rolling with resistance, and supporting self efficacy in order to facilitate this change. When a service user demonstrates that t hey have arrived at the decision or action stage of the cycle of change cognitive behavioural interventions are then commenced. Cognitive Behavioural Therapy (CBT) The aim of CBT is to lessen distress caused by negative feelings; it attempts to do this by changing the thoughts (cognitive) and beliefs that underpin them. It can also alter actions (behavioural) and circumstances that are affecting these thoughts and feelings (Nelson 2005). This approach has been written about for many years and has arguably evolved from the work of Aaron Beck, a psychiatrist whose work dates back to the 1950s. There is a vast amount of literature examining the use of CBT with psychosis (Jones et al 2004). Generally the research and literature supporting the use of CBT for Those with serious mental illness often excludes people who misuse illicit drugs and/or alcohol for example Garety et al (2008), and Jackson et al (2008). The topics covered within CBT sessions for those with dual diagnosis differs from that of someone who does not use substances. For example Baker et al (2006) outlines components of CBT sessions used within their trial. They include, prese nting the model of problematic substance use and psychotic symptoms (Graham et al 2004), specific techniques for managing substance use, and identification of triggers and beliefs that could lead to substance use and increase psychotic symptoms. Finally a large component of CBT for dual diagnosis is around relapse prevention, identifying unhelpful thinking patterns and managing cravings. Family Interventions (FI) A relative of a person with a diagnosis of schizophrenia may experience negative consequences in many areas including: emotionally, socially, psychologically and economically, as they adjust to their new role as a care giver (Reader 2002). How the care giver attempts to cope with these consequences can have an effect on their relative. Research has shown that expressed emotion within families could lead to relapse in schizophrenia (Brown et al 1962, Kavanagh 1992). Often a person with dual diagnosis is only marginally engaged with services but may have regular contact with their families who provide financial and psychological support (Thylstrup Johansen 2009). Putting them under immense strain; but also in prime position to work with mental health services to promote engagement and treatment adherence. There is a vast evidence base to support FI for promoting recovery from psychosis (Pharoah et al 2006, Pilling et al 2002). The family dynamics of a person with a dual diagnosis is often impacted greatly due to the complexities discussed earlier and there is growing evidence to suggest how family involvement can have positive impacts on outcomes for both the service user and their families (Fischer et al 2008; Dixon, McNarey and Lehman 1995). Within integrated treatment Barrowclough et al (2001) use family interventions as a means of encouraging care givers to adopt motivational interviewing styles to improve motivation, and treatment adherence amongst other interventions. See Table 5 to illustrate how minimal family work in the form of psycho-education enhances the experience of service users and their care givers, even when staff have had no formal training. Unfortunately, family relationships of those with dual diagnosis can often be put under vast amounts of strain that cause the family dynamics to breakdown. Leading to people losing contact with their friends and families. This therefore makes family interventions very difficult as often one or bot h parties (care giver(s) and service user) do not wish to accept family work. In addition to this there are service users who do not wish their care givers be informed of their illicit drug use as they are worried of the consequences this may bring, for example: negative appraisal due to the stigma surrounding substance misuse. From experience this can be overcome in some cases through normalisation and psycho-education. Providing a good rationale of why care givers should be informed and how doing this can help the situation. Although, this often takes a lot of guidance and motivational interviewing techniques. Table 5 Psycho-education with Laura and her Father. Once Laura was admitted to the rehabilitation unit where she is currently residing her father got in touch. Laura was keen to build on the relationship between her and her father and started to visit him once a week. Staff at the unit (whom are not trained in family interventions) thought it would be a good idea to spend some time with Laura and her father to help them both gain an understanding of each others situation, thoughts, feelings and behaviours. After explaining the benefits of this to Laura she consented and her dad was offered to come and have a few informal sessions with Laura and her named nurse. Lauras dad explained how he had never been given any information about schizophrenia or substance misuse and how he knew very little of how these effected his daughter. This information was shared with both Laura and her dad. The stress vulnerability model was explained to Lauras dad with a view to building on his understanding of why his daughter experiences psychotic sympto ms and providing a reason why she uses drugs. Leading on to state how this only causes more problems (all of this was discussed with Laura at an earlier date). Lauras Dad was given the opportunity to voice any concerns he had about regaining contact with Laura i.e. financial drain, crime, and ‘picking up the peices. These problems were discussed and brainstormed with both Laura and her dad to identify ways to prevent these happening, and produce a contingency plan if either person felt they needed support. Lauras Dad reported that these sessions made it easier for him to build on lost relationships with his daughter and reduced his fears that he would have to ‘deal with it all if things went wrong. Laura also felt much more positive as now she was starting to rebuild relationships providing more motiviation to change and sustain change. Her mood improved slightly and she had more hope for the future. Arguably the benefits Laura experienced may have inevitably occurred wi thout staff intervention. Literature Review A small number of studies examining interventions for use with people with dual diagnosis will now be appraised.Two of the Studies are Randomised Controlled Trials (RCTs) and are considered the gold standard method for evaluating treatment efficiency (Greenhalgh 2006). They are said to produce the least biased results as random samples are used to minimise the possibility of error in design and conduct (Roberts, 1999). Barrowclough et al (2001) and Haddock et al (2003) Barrowclough et al (2001) produced one of the first robust RCTs to examine the impact an integrated intervention programme consisting of CBT,MI and FI had upon service users. The design of the trail was robust in that it was a RCT, ensured as far as possible good treatment fidelity (making certain that the treatment being delivered is the one intended (Leeuw 2009)) and the assessors in the trial were blind to group allocation (reducing the risk of bias). However there were some limitations of this study such as small numbers of participants, short follow up period, and treatment was delivered by cognitive behavioural therapists. In reality it is not possible for all service users with dual diagnosis to receive interventions from a cognitive behavioural therapist. All of these limitations question the generalisibility of the results. Although care givers were in receipt of interventions their outcomes were not reported in this study. It would have been interesting to see these re sults; even those whom were in the control group received more interventions than the majority of families of substance misusers get (based on experience). One could hypothesise that the results of the two groups were not too dissimilar due to the fact that both sets of care givers were being supported. The Haddock et al (2003) study is a follow on from the Barrowclough et al (2001) study reporting further service user outcomes, cost effectiveness and carer outcomes over an 18month period. The robustness of the study was discussed above. This study found quite significant positive outcomes of those whom received the integrated intervention programme. Results demonstrated improved outcomes for the service users general and social functioning, and reduced number of negative symptoms to a significant degree. When examining this result with experience from practice it could be hypothesised that when a service users level of functioning increases they rely less upon their care givers. Thereupon improved functioning has a positive indirect effect upon carers. There was also a small difference in the percentage of days of abstinence between the two groups with the treatment group proving more favourable. However, the clinical significance of this is questionable. Although carer outcomes were reported within the Haddock et al (2001) paper they are only briefly examined with more of an emphasis based on cost effectiveness. However, the results do show promise for care givers within the treatment programme, showing some trends towards better personal outcomes. At the 12 month follow up the treatment group demonstrated a reduction in needs and objective and subjective burden. However, these results were not statistically clinically significant. Haddock et al (2003) suggest more intensive work should be done with families due to the high rates of expressed emotion. Baker et al (2006) Baker et al (2006) also produced a RCT to examine the impact a series of sessions of CBT and MI has upon service users with a dual diagnosis. This study was not as robust as the Barrowclough et al (2001) study in relation to randomisation and assessor blindness. Within this study participants were paid for their expenses and time attending assessments. Although the authors suggest this was not enough to influence responses, this procedure was not carried out in similar studies such as the one by Barrowclough and colleagues (Barrowclough et al 2001 and Haddock et al 2003) which should be considered when comparing results. Another negative to this study as with that of Barrowclough et al(2001) was that the interventions were carried out by highly trained psychologists; Echoing the argument of generalisability. On a positive note this study did have a larger number of participants almost double that of Barrowclough et al (2001). Baker et al (2006) suggest both this trial and the one c arried out by Barrowclough and colleagues suggest improvements in substance misuse. However from the results these improvements appear minimal. Baker et al (2006) also report that there was no significant difference in improvement of functioning or positive symptoms; providing opposite and contrast results of the Barrowclough et al (2001) study. Baker et al (2006) conclude that this study demonstrates that this challenging case group (service users with dual diagnosis) is able to engage in CBT and demonstrate positive results. Although this ‘excellent therapy-attendance could be questioned due to the use of payment for time and travel. Graham et al 2006 This study carried out by Graham et al (2006) differs from those discussed above in that it is not a RCT, it is a preliminary evaluation of the impact of C-BIT training on 3 assertive outreach teams and service user outcomes and is not an RCT. Care co-ordinators from 5 assertive outreach teams were allocated to two groups. One of which received immediate C-BIT training and the other groups training was delayed. Results of the training demonstrated increased confidence of care co-ordinators in working with substance misuse and mental illness. Graham et al (2006) suggest these findings illustrate the effectiveness of such training and highlights the extent to which implementation actually occurs. They suggest their findings add evidence to the recommendations made for implementation of interventions for this client group presented in Mental Health Implementation Guide: Dual Diagnosis Good Practice (DOH 2002). Graham et al (2006) also discuss the impact of such training upon servic e user outcomes. The results highlighted an improvement in engagement, reduction in alcohol use and a reduction in positive alcohol related beliefs. Demonstrating that this team approach to C-BIT shows promise. This report does not measure impact on care giver outcomes. All of the reports mentioned here suggest further research is needed to establish a firm evidence base for integrated treatment programmes that use interventions such as CBT, MI and FI. Nonetheless, they do provide a good grounding for recommending that such interventions show promise for enhancing service user and carer experience. In order to do this there may need to be a change in service provision. For example for a change within treatment philosophy of a team may mean that all staff must be trained preferably at the same time (Graham 2004). This causes barriers on numerous levels such as cost implications of all staff receiving training, back fill of their hours, cost of trainer and venue etc.. Potential bar riers may occur when implementing these newly acquired skills and knowledge due to feelings of diminished confidence as part of the learning process (Atherton 2008). Discussion Substance misuse services separated for mental health services some time ago (Conley Benishek 2003) and as a result mental health professionals have limited training and experience in working with people who misuse substances. In addition, many drug and alcohol workers have only had minimal education in mental health issues (Frankel 1996). This could result in mental health professionals and substance misuse workers feeling unequipped in working with people with a dual diagnosis; resulting in them receiving inadequate care. A way to overcome this is for more health professionals to acknowledge their deficits in knowledge and attend training. Perhaps as a result of having minimal education in the field of substance misuse, negative attitudes towards those who misuse substances is still present (Howard Chung 2000 and Richmond Foster 2003). This can take the form of moralistic and stereotypical attitudes leading to mistrust, suspicion and avoidance on both sides. Evidence indica tes that when such attitudes are held problems of substance misuse are often overlooked and not dealt with or referred on (Howard Chung 2000). Table 6: Luke Case Study Luke was brought up in a deprived area of a large city and often experimented with illicit substances with his friends. He had a very poor relationship with his mother and siblings (although he did reside with them) and never saw his father. Luke started to hear voices at the age of 18 and was soon admitted to an acute unit where he commenced anti-psychotic medication. Luke was discharged from hospital back to his home. Lukes motivation was draining and he was experiencing little enjoyment in life. it wasnt long before he stopped taking his anti-psychotic medication because it was making him put on weight and causing side effects. Luke soon found that taking crack cocaine provided a release from his ‘blues and was now using frequently. Luke self referred to a local drug scheme (under the pressure of his mother and the threat of becoming homeless) but they were reluctant to take him on because he was self medicating. His Community Mental Health Team found it difficult to meet all of his complex needs and Luke ended up back on an acute ward. Lukes Mother had now had enough and didnt want Luke back home. A place was found for Luke at a rehabilitation unit but he must first give up the use of any illicit substances or he would not be admitted. Luke managed to do this for a few weeks and was admitted to the rehabilitation unit. He was only there a few days when he relapsed and used excessive amounts of alcohol and crack cocaine and his mental health deteriorated dramatically. He was re-admitted to the acute ward. Staff at the Rehabilitation unit were dubious about taking Luke back because of their rule of abstinence and the chaotic lifestyle that surrounds Luke. Fortunately a nurse went to reassess Luke to return back to the unit and gained a greater picture of why he relapsed. Using the Stress Vulnerability Model (Bucket Analogy) she helped Luke to see how his behaviour impacts negatively upon him and that crack cocaine only provides a short term fix. Luke returned to the unit and he has had occasional relapses since but his and the staffs attitude towards them has changed. Despite there being a huge drive from government produced documents and guidelines for people within mental health services to have access to psychological therapies Bird (2006) identifies a number of populations that have difficulties accessing such services. One of which are those with dual diagnosis as services have difficulty providing for their multiple needs. This can lead to people slipping through the net or being passed from service to service with no one willing to take responsibility for a persons care (see table 6: The case of Luke). This is where effective case management comes into play. Onyett (1998) discusses the need for effective case management when meeting the needs of service users and their care-givers. He describes a part of case management as the identification and co-ordination of services that can appropriately meet the service users needs. In essence brokering out to other services and not trying to meet all of the services users needs alone. This means the service user and their care givers should get the best appropriate evidence based care/interventions. This supports the recommendations of Graham et al (2003), Abou-Saleh (2004), and Graham et al (2006) where effective service delivery means teams are developed to meet tailored needs of particular client groups i.e. assertive outreach teams, home treatment, as recommended in the National Health Service Plan (DOH 2000). Unfortunatly, from experience, this is still not a reality and although such teams are present, there is too much demand for such specialised services. Perhaps the answer is to attempt to incorporate evidence based treatments such as those outlined earlier in to practice in more general services too for example Community Mental Health Teams. With a view to provide evidence based interventions for dual diagnosis to those even when not in a specialised team. If health professionals have more of an awareness of the evidence base for psychosocial interventions for all the problems service users with serious mental illness face. Then maybe confidence to work with complex cases may increase, enhancing the service users experience of mental health services and improving individualised outcomes. This suggestion itself produces barriers though; for all health professionals to provide evidence based care they must stay abreast of new knowledge, research, and guidelines in order to practice competently (Turner Mjolne 2001). Although this appears an impossible task when so much information is being published. Unfortunately, figures for production of mental health related literature could not be found Khan et al (1999) suggest over 2 million bio-medical articles are published annually. This number cannot be too dissimilar to mental health literature. With such vast amounts of information how can one stay truly up to date with evidence based practice. A method to help tackle this is the formation of journal clubs within mental health services. Turner Mjolne (2001) and Khan et al (1999) both suggest Journal clubs are an effective way of promoting wider reading and utilization of research. It also supports those who may not have proficient skills at critical appraisal of research. From experience and evidence it could be concluded that the majority of mental health professionals are not fully trained in delivering cognitive-behavioural therapy, amongst other interventions to those with dual diagnosis. Even if people are aware of the evidence base; if they are not trained, then they are not likely to provide efficient treatment. Additionally, when people are trained to deliver specific interventions they require ongoing clinical supervision to build on skills and knowledge, improving competence and confidence (Brooker Brabban 2004). Clinical supervision it thought to reduce burnout, increase job satisf action and alter dysfunctional attitudes (Bradshaw, Butterworth Mairs 2007 and Hykras 2005). Therefore, the use of clinical supervision may also provide a method of reducing the number of negative attitudes towards those who misuse substances, ultimately reducing another barrier that those with dual diagnosis may face when receiving effective psychosocial interventions. Conclusion This report has aimed to discuss the term complexity. Demonstrating that being human makes us all complex and complexity should be viewed as on a continuum. All service users are complex cases but some are faced with and present more challenges to themselves, their care givers and mental health services. There are some psychosocial interventions that show promise for enhancing service user and care giver experience of mental health services and improve individual outcomes. For example the interventions explored in this report (CBT, MI and FI) display potential for improving service users and care givers outcomes and optimising service delivery. Although the evidence for these are still limited and more research is required also a number of barriers make the implementation of such interventions difficult. As possible methods of overcoming these a number of recommendations have been made. In order for mental health professionals to provide interventions such as the ones explored i n this report, training will need to be given and adequate support and supervision. This will allow professionals to build on skills, knowledge and competence when working with complex cases. Supervision also allows a forum for dysfunctional attitudes to be explored and discussed. Hopefully, overcoming any negative thoughts and feelings towards those with dual diagnosis. In addition to this mental health services need to be clear on their admissions criteria, accepting that substance misuse and psychosis are co-morbid and not two separate entities where one must be eradicated before a person can access services. The services do not necessarily need to meet all the needs of the individual but have mental health professionals that are effective case managers. Thus ensuring that if people do not have the skills to deal with such complex needs then they have the skill to recognise this and re-refer to other services. As mentioned within this report it is very difficult for mental health professionals to keep up to date with current evidence based practice due to the large amounts published each year. One way of attempting to overcome this it the use of journal clubs. This would allow for sharing of evidence and encourage staff to remain up to date through reading. All of the above recommendations would enhance service user and care giver experience through staff being more knowledgeable about working with dual diagnosis and providing evidence based psychosocial interventions. Reference List Atherton, J.S. (2008) Doceo;Learning as Loss 1 [On-line] UK: Available: https://www.doceo.co.uk/original/learnloss_1.htm Accessed: 16 May 2009 Baker, A.; Bucci, S.; Lewin, T.J.; Kay-Lambkin, F.; Constable, P.M. Carr, V.J. (2006) Cognitive Behavioural Therapy for Substance Use Disorders in People with Psychotic Disorders. British Journal of Psychiatry. 188, 439-448 Barrowclough, C.; Haddock, G.; Tarrier, N.; Lewis, S.W.; Moring, J.; OBrien, R.; Schofield , N. McGovern, J. (2001) Randomized Controlled Trial of Motivational Interviewing, Cognitive Behavioural Therapy, and Family Intervention for Patients with Co Morbid Schizophrenia and Substance Use Disorders. American Journal of Psychiatry. 158, 1706-1713 Bird, A (2006) We Need to Talk: The Case for Psychological Therapy on the NHS. London: Mental Health Foundation Bradshaw, T.; Butterworth, A. Mairs, H. (2007) Does structured clinical supervision during psychosocial intervention education enhance outcome for mental h ealth nurses and the service users they work with? Journal of psychiatric and mental health nursing. 14, 4-12 Brooker, C. Brabban, A. (2004) Measured success: A scoping review of evaluated psychosocial interventions training for work with people with serious mental health problems. NIMHE: Trent WDC Brown, G.W., Monck, E.M., Carstairs, G.M Wing, J.K. (1962) Influence of family life on the course of schizophrenic illness. British Journal of Preventative and Social Medicine, 16(2) 55-68 Buckley, P.F.; Hasan, S.; Friedman, L. Cerny, C. (2001) Insight and Schizophrenia. Comprehensive Psychiatry. 42(1), 39-41 Cather, C. (2005) Functional Cognitive Behavioural Therapy: A Brief Individual Treatment for Functional Impairments Resulting From Psychotic Symptoms in Schizophrenia. Canadian Journal of Psychiatry. 50, 258-263 Clark, R.E. (1996) Family Support for People with Dual Disorders. New directions for mental health services. 70, 65-78 Cleary, M.; Hunt, G.; Matheson, S. ; Siegfried, N. Walter, G. (2009) Psychosocial Interventions for People with Both Severe Mental Illness and Substance Misuse. Cochrane Database of Systematic Reviews. Issue 1 Conley, H. Benishek. (2003) Dissociation in adults with a diagnosis of substance abuse. Nursing Times Clinical. 99(20) Couture, S.M.; Penn, D.L. Roberts, D.L. (2006) The Functional Significance of Social Cognition in Schizophrenia: A Review. Schizophrenia Bulletin. 32(s1), s44-s63 David, A.S. (1990) Insight and Psychosis. British Journal of Psychiatry. 156, 798-808 Dixon, L.; McNarey, S. Lehman, A. (1995) Substance Abuse and Family Relationships of Persons with Severe Mental Illness. American Journal of Psychiatry. 152, 456-458 DOH (1999a) The National Service Framework For Mental Health: Modern Standards and Service Models. London: Department of Health DOH (1999b) Drug Misuse and Dependence: Guidelines on Clinical Management. London: Department of Health DOH(2000) NHS Plan: A Plan for Investment a Plan for Reform. London: Department of Health. DOH (2001a) Valuing People: a new strategy for Learning Disability for the 21st century. London: Department of Health. DOH (2001b) The Mental Health Policy Implementation Guide. London: Department of Health DOH (2002) Mental Health Policy Implementation Guide: dual diagnosis good practice guide. London: Department of Health DOH (2005) The Offender Mental Health Care Pathway. Department of Health: London DOH (2006) From Values to Action: The chief Nursing Officers Review of Mental Health Nursing. London: Department of Health Drake, R.E. Mueser, K.T. (2000) Psychosocial Approaches to Dual Diagnosis. Schizophrenia Bulletin. 26(1), 105-118 Drake et al (1993) Treatment of substance abuse in severely mentally ill patients. Journal of Nervous and Mental Disease, 181, 606-611 Cited in Abou-Saleh, M.T. (2004) Dual Diagnosis: Management Within a Psychosocial Context. Advances in Psychiatric Treatment. 10, 352-36 0 Fischer, E.P.; McSweeny, J.C.; Pyne, J.M.; Williams, K.; Naylor, A.J.;Blow, F.C. Owen R.R. (2008) Influence of Family Involvement and Substance Use on Sustained Utilization of Services for Schizophrenia. Psychiatric Services. 59, 902-908 Frankel, E.H. (1996) Dissociation: The Clinical Realities. American Journal of Psychiatry. 153, 64-70 Gamble, C. Curthoys, J. (2004) Psychosocial Interventions. Chapter 10 in Norman, I. Ryrie, I. (eds) (2004) The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice. England: Open University Press Garety, P.A., Fowler, D.G., Freeman, D., Bebbington, P., Dunn, G. Elizabeth, K. (2008) Cognitive-behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis: randomised controlled trial. The British Journal of Psychiatry, 192, 412-423 Gibbins, J. Kipping, C. (2006) Coexisistant substance use and psychiatric disorder. Chapter 14 in Gamble, C. Brennan, G. (2006) Workin g With Serious Mental Illness: A manual for clinical practice. Philadelphia: Elsevier Graham, H. (2004) 2004) Implementing integrated treatment for co-existing substance use and severe mental health problems in assertive outreach teams: training issues. Drug and Alcohol Review. 23(4),463- 470 Graham, H.; Copello, A.; Birchwoord, M.; Orford, J.; McGovern, D.; Georgiou, G. Godfrey, E. (2003) Coexisting severe mental health and substance use problems: developing integrated services in the UK. Psychiatric Bulletin. 27, 183-186 Graham, H.; Copello, A.; Birchwood, M. J.; Mueser, K.; Orford, J.; McGovern, D.; Atkinson, E.; Maslin, J.; Preece, M.; Tobin, D. Georgiou, G. (2004) Cognitive-Behavioural Integrated Treatment (C-BIT): A treatment manual for substance misuse in people with severe mental health problems. Chichester: John Wiley Sons Ltd. Graham, H.L.; Copello, A.B.; Max, O.J.; McGovern, D.; Mueser, K.T.; Clutterbuck, R.; Godfrey, E.; Maslin, J.; Day, E. Tobin, D. (200 6)A preliminary evaluation of integrated treatment for co-existing substance use and severe mental health problems: Impact on teams and service users. Journal of Mental Health.15(5),577 — 591 Greenhalgh, T. (2006) How to read a paper: the basics of evidence based medicine. (3rd edition). Oxford: Blackwell Publishing Griffiths, R. Allan, R. (2007) Whose Health, Whose Care, Whose Say? The opportunities and challenges of contemporary policy for people with complex mental health needs: Report of CSIP Eastern and SPN Study day. London: Turning Point Haddock, C.; Barrowclough, C.; Tarrier, N.; Moring, J.; OBrien, R.; Schofield, N.; Quinn, J.; Palmer, S.; Davis, L.; Lowens, I.; McGovern, J. Lewis, S. (2003) Cognitive Behavioural Therapy and Motivational Intervention For Schizophrenia and Substance Misuse: 18 Month Outcomes of a Randomised Controlled Trial. British Journal of Psychiatry. 183, 418-426 Howard, M.O. Chung, S.S. (2000) Nurses Attitudes Towards Substance Mi susers. 1 Surveys. Substance Use and Misuse: An International Interdisciplinary Forum. 35(3), 347-365 Hussein, R.G. (2002) Substance misuse and Mental Health: An Overview. Nursing Standard. 16(50), 47-55 Hykras, K. (2005) Clinical supervision, burnout, and job satisfaction mental health and psychiatric nurses in Finland. Issues in Mental Health Nursing. 26(5), 531-556 Jackson, H.J., McGorry, P.D., Killackey, E., Bendall, S., Allott, K., Dudgeon, P., Gleeson, J., Johnson, T. Harrigan, S. (2008) Acute-phase and 1-year follow-up results of a randomised controlled trial of CBT versus Befriending for first-episode psychosis: the ACE project. Psychological Medicine, 38, 725-735 Jones, C., Cormac, I., Silveira da Mota Neto. J.I. Campbell, C. (2004) Cognitive Behaviour Therapy for Schizophrenia. Cochrane Database of Systematic Reviews 2004, Issue 4 Kavanagh, D.J. (1992) Recent developments in expressed emotion in schizophrenia. British Journal of Psychiatry, 160, 601-620 Kemp R.; Hayward, P.; Applewhaite, G.; Everitt, B. David, A. (1996) Compliance therapy in psychotic patients: randomised controlled trial. British Medical Journal. 312, 345-349 Khan, K.S.; Dwarakanath, L.S.; Pakkal, M.; Brace, V. Awonuga, A. (1999) Postgraduate Journal Club as a Means of Promoting Evidence-Based Obstettics and Gynaecology. Journal of Obstetrics and Gynaecology. 19(3), 231-234 Kipping, C. (2004) The Person Who Misuses Drugs of Alcohol. Chapter 17 in Norman, I. Ryrie, I. (eds) (2004) The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice. England: Open University Press Leeuw, M., Goossens, M.J.E.B., de Vet, H.C.W. Vlaeyen, J.W.S. (2009) The fidelity of treatment delivery can be assessed in treatment outcome studies: a successful illustration from behavioral medicine. Journal of Clinical Epidemiology. 62(1), 81-90 Littlejohn, C. (2005) Links Between Drug and Alcohol Misuse and Psychiatric Disorders. Nursing Times Clinical. 101(01) Mairs, H Bradshaw, T. (2005) Modernising Psychosocial Intervention Education: the new COPE programme. Mental Health Practice. 9(3), 28-30 Marder, S.R.; Essock, S.M.; Miller, A.L.; Buchanan, R.W.; Casey, D.E.; Davis, J.M.; Kane, J.M.; Lieberman, J.A.; Schooler, N.R.; Covell, N.; Stroup, S.; Weissman, E.M.; Wirshing, D.A.; Hall, C.S.; Pogach, L.; Pi-Sunyer, X.; Thomas Bigger, J.; Friedman, A.; Kleinberg, D.; Yevich, S.J.; Davis, B. Shon, S. (2003) Physical Health Monitoring of Patients With Schizophrenia. American Journal of Psychiatry. 161, 1334-1349 Miller, W. Rollnick, S. (2002) Motivational Interviewing: Preparing People to Change Addictive Behaviour (2nd Edn). New York: Guilford Press Moore, A.; Sellwood, W. Stirling, J. (2000) Compliance and psychological reactance in schizophrenia. British Journal of Clinical Psychiatry. 39, 287-295 Nelson, H. (2005) Cognitive Behavioural Therapy with Delusions and Hallucinations: A Practice Manual Handbook (2nd Editi on). Cheltenham: Nelson Thornes Ltd NICE(2007) Drug Misuse: Psychosocial Interventions. London: National Institute for Health and Clinical Excellence. NICE (2009) Schizophrenia: Core intervention is the treatment and management of schizophrenia in adults in primary and secondary care. London: National Institute for Health and Clinical Excellence. Onyett, S. (1998) Case Management in Mental Health. London: Nelson Thorns. Pharoah, F., Mari, J., Rathbone, J. Wong, W. (2006) Family intervention for schizophrenia. Cochrane Database of Systematic Reviews, Issue 4. Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., Orbach, G. Morgan, C. (2002) Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behavioural therapy. Psychological Medicine, 32, 763-782 Prochaska, J. DiClemente, C. (1986) Towards a Comprehensive Model of Change. In Miller, W. Heather, N. (Eds) Treating Addictive Behaviours: Processes of Change. New York: Plenum. Cited in Kipping, C. (2004) The Person Who Misuses Drugs of Alcohol. Chapter 17 in Norman, I. Ryrie, I. (eds) (2004) The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice. England: Open University Press Reader, D. (2002) Working with Families. Chapter 11 in Harris, N., Williams, S Bradshaw, T. (Eds) (2002) Psychosocial Interventions for People with Schizophrenia. Hampshire: Palgrave Macmillan Rankin, J. Regan, S. (2004) Meeting Complex Needs: The Future of Social Care. London: IPPR/Turning Point Randall, G., Britton, J., Brown, S. Craig, T. (2006) Getting through access to mental health services for people who are homeless or living in temporary or insecure accommodation: a good practice guide. London: Department of Health, Care Services Improvement Partnership, Department of Communities and Local Government. Richmond, I.C. Foster, J.H. (2003) Negative Attitudes Towards People with Co-morbid Mental Health and Substanc e Misuse Problems: An Investigation of Mental Health Professionals. Journal of Mental Health. 12(4), 393-403 Roberts, R. (1999) Information for Evidence-Based Care. Oxon: Radcliffe Medical Press Soanes, C. Stevenson, A. (Eds) (2005) Oxford Dictionary of English. Oxford University Press: Oxford Tarrier, N.; Sharpe, L.; Beckett, R.; Harwood, S.; Baker, A. Yusopoff, L (1993) A Trial of Two Cognitive Behavioural Methods of Treating Drug Resistant Residual Psychotic Symptoms in Schizophrenic Patients. Social Psychiatry and Psychiatric Epidemiology. 28(1), 5-10 Thylstrup, B. Johansen, K.S. (2009) Dual Diagnosis and Psychosocial Interventions: Introduction and Commentary. Nordic Journal of Psychiatry. 63(3), 202-208 Turner, P. Mjolne, I. (2001) Journal Provision and the Prevalence of Journal Clubs: A survey of Physiotherapy Departments in England and Australia. Physiotherapy Research International. 6(3), 157-169. Weiss, R.D.; Griffin, M.L.; Kolodziej, M.E.; Greenfield , S.F.; Najavits, L.M.; Daley, D.C.; Doreau, H.R. Hennen, J.A. (2007) A Randomised Controlled Trial of Integrated Group Therapy Versus Group Drug Counselling For Patients With Bipolar Disorder and Substance Dependence. American Journal of Psychiatry. 164, 100-107 Wilson, T.; Holt, T. Greenhalgh, T. (2001) Complexity Science: Complexity in Clinical care. British Medical Journal. 323,685-688 Zubin, J. Spring, B. (1977) Vulnerability A New View Of Schizophrenia. Journal of Abnormal Psychology 86: 103-126. Cited in Norman, I Ryrie, I (eds) (2004) The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice. England: Open University Press

Short Stories - 1893 Words

Irony, satire, parody, humor and epigrams are deeply connected by having one main thing in common: they are usually meant to hurt the intellectual self of someone. We use it in our everyday’s life to make fun of people, or simply because someone is annoying and we would like them to stop, without being â€Å"too† rude. Irony can be defined as a statement different from what appears to be true. It is an incongruity between what is expected to happen and what actually happens (Meyer, 286-287). In a lot of cases, irony is usually used to raise the readers interest by making the story or poem more unpredictable. In the poem â€Å"Suburban† by John Ciardi, the author approaches the reader with humor and irony. When Mrs. Friar phones Mr. Ciardi, saying:†¦show more content†¦It uses humor as an approach to improvement. In the poem â€Å"AD,† by Kenneth Fearing, a satire, which is an example of the literary art or ridiculing a folly or vice in an effort to expose or correct it. In the poem â€Å"AD,† the use of satires is evident. First, the author talks about what the government wants. Let’s take note of the word wants. When you keep reading the poem, you realize that the government isn’t really picky about the qualities a man possess, which could make most peo ple that are looking for a job, either happy of if you have it, or unhappy, if you don’t; until finally you come to a realization, that anyone is qualified to take this job, there is no special skills that you need, because at the end, you are the one that end up paying†¦with the ultimate sacrifice: life. Another satire, less intense and actually very funny, can be found in â€Å"Will and Grace, Dolls and Dolls,† where one of the characters gets addicted to pain killers. Pain killers are powerful and dangerous drugs. We all know how dangerous drugs can be, and what they can do to our mind and body. In â€Å"Dolls and Dolls,† the author emphasizes on the dangers in a satiric kind of way; he makes fun of the way our society views drugs†¦ its fine to be on drugs as long as they are prescribed, even if they are as dangerous as the illegal ones. It points to what drugs do to you, changing your life destroying your inner self. It can also be anShow MoreRelatedshort story1018 Words   |  5 Pagesï » ¿Short Stories:  Ã‚  Characteristics †¢Short  - Can usually be read in one sitting. †¢Concise:  Ã‚  Information offered in the story is relevant to the tale being told.  Ã‚  This is unlike a novel, where the story can diverge from the main plot †¢Usually tries to leave behind a  single impression  or effect.  Ã‚  Usually, though not always built around one character, place, idea, or act. †¢Because they are concise, writers depend on the reader bringing  personal experiences  and  prior knowledge  to the story. Four MajorRead MoreThe Short Stories Ideas For Writing A Short Story Essay1097 Words   |  5 Pageswriting a short story. Many a time, writers run out of these short story ideas upon exhausting their sources of short story ideas. If you are one of these writers, who have run out of short story ideas, and the deadline you have for coming up with a short story is running out, the short story writing prompts below will surely help you. Additionally, if you are being tormented by the blank Microsoft Word document staring at you because you are not able to come up with the best short story idea, youRead MoreShort Story1804 Words   |  8 PagesShort story: Definition and History. A  short story  like any other term does not have only one definition, it has many definitions, but all of them are similar in a general idea. According to The World Book Encyclopedia (1994, Vol. 12, L-354), â€Å"the short story is a short work of fiction that usually centers around a single incident. Because of its shorter length, the characters and situations are fewer and less complicated than those of a novel.† In the Cambridge Advanced Learner’s DictionaryRead MoreShort Stories648 Words   |  3 Pageswhat the title to the short story is. The short story theme I am going conduct on is â€Å"The Secret Life of Walter Mitty’ by James Thurber (1973). In this short story the literary elements being used is plot and symbols and the theme being full of distractions and disruption. The narrator is giving a third person point of view in sharing the thoughts of the characters. Walter Mitty the daydreamer is very humorous in the different plots of his dr ifting off. In the start of the story the plot, symbols,Read MoreShort Stories1125 Words   |  5 PagesThe themes of short stories are often relevant to real life? To what extent do you agree with this view? In the short stories â€Å"Miss Brill† and â€Å"Frau Brechenmacher attends a wedding† written by Katherine Mansfield, the themes which are relevant to real life in Miss Brill are isolation and appearance versus reality. Likewise Frau Brechenmacher suffers through isolation throughout the story and also male dominance is one of the major themes that are highlighted in the story. These themes areRead MoreShort Story and People1473 Words   |  6 Pagesï » ¿Title: Story Of An Hour Author: Kate Chopin I. On The Elements / Literary Concepts The short story Story Of An Hour is all about the series of emotions that the protagonist, Mrs. Mallard showed to the readers. With the kind of plot of this short story, it actually refers to the moments that Mrs. Mallard knew that all this time, her husband was alive. For the symbol, I like the title of this short story because it actually symbolizes the time where Mrs. Mallard died with joy. And with thatRead MoreShort Story Essay1294 Words   |  6 PagesA short story concentrates on creating a single dynamic effect and is limited in character and situation. It is a language of maximum yet economical effect. Every word must do a job, sometimes several jobs. Short stories are filled with numerous language and sound devices. These language and sound devices create a stronger image of the scenario or the characters within the text, which contribute to the overall pre-designed effect.As it is shown in the metaphor lipstick bleeding gently in CinnamonRead MoreRacism in the Short Stor ies1837 Words   |  7 PagesOften we read stories that tell stories of mixing the grouping may not always be what is legal or what people consider moral at the time. The things that you can learn from someone who is not like you is amazing if people took the time to consider this before judging someone the world as we know it would be a completely different place. The notion to overlook someone because they are not the same race, gender, creed, religion seems to be the way of the world for a long time. Racism is so prevalentRead MoreThe Idol Short Story1728 Words   |  7 PagesThe short stories â€Å"The Idol† by Adolfo Bioy Casares and â€Å"Axolotl† by Julio Cortà ¡zar address the notion of obsession, and the resulting harm that can come from it. Like all addictions, obsession makes one feel overwhelmed, as a single thought comes to continuously intruding our mind, causing the individual to not be able to ignore these thoughts. In â€Å"Axolotl†, the narr ator is drawn upon the axolotls at the Jardin des Plantes aquarium and his fascination towards the axolotls becomes an obsession. InRead MoreGothic Short Story1447 Words   |  6 Pages The End. In the short story, â€Å"Emma Barrett,† the reader follows a search party group searching for a missing girl named Emma deep in a forest in Oregon. The story follows through first person narration by a group member named Holden. This story would be considered a gothic short story because of its use of setting, theme, symbolism, and literary devices used to portray the horror of a missing six-year-old girl. Plot is the literal chronological development of the story, the sequence of events

Modern Anti Cruelty Laws For The United States - 1647 Words

The rights of animals have been battled over for generations. Humans began t o domesticate animals such as dogs, goats, chickens, sheep, and beasts of burden between 10,000 and 18,000 years ago. Many people originally believed that because animals had no souls they also felt no pain; however, this belief changed as the study of animals increased. The first animal-protection law in western civilization was adopted in 1641; making it illegal to â€Å"exercise any Tirranny or Crueltie towards any bruite Creature which are usuallie kept for man’s use.† (7) In 1789, the English philosopher, Jeremy Bentham, was the first to state that animals have rights. This concept was different from the belief that animals felt pain, in his claims animals deserved basic human rights. This new theory shook the foundation of many peoples belief in what animal rights truly is. In 1821, Maine became the first state to adopt modern anti-cruelty laws for the U.S.; every other state eventually passed similar legislation. It still wasn’t until the 21st century that lawsuits in the interest of animals became common. The animal rights movement has become most active in the United States, Canada, Western Europe, Australia, and New Zealand. Animal rights organizations have been using court systems to protect animals from being used in harmful activities, such as the agricultural industry and as being research subjects, in the belief that they have the same basic rights as all humans. Animals have been usedShow MoreRelatedAnimal Testing (Speech Outline)1200 Words   |  5 Pagesuntil half the test subjects died. brb. This example to me personally represents the epitome of cruelty by modern science toward animals. br br(Transition: Now that I have explained the cruel injustices of animals in the past, let us now look at how these problems are solved today.) br brII. One of the ways animals are now protected is through laws and organizations. br1. One such important law that was signed in 1966 was the Animal Welfare Act that regulates the treatment of animals in researchRead MorePolicy Identification And Explanation Of The Ag Gag Law1411 Words   |  6 PagesPolicy Identification and Explanation The policy I am researching is the Ag Gag law which was enacted in Idaho in 2014. Idaho code 18-7042 â€Å"INTERFERENCE WITH AGRICULTURAL PRODUCTION† states that a person commits the crime of interference with agricultural production if the person knowingly: is not employed by an agricultural production facility and enters an agricultural production facility, obtains records of an agricultural production facility, or obtains employment by force, threat, misrepresentationRead MoreAnimal Cruelty And Animal Abuse879 Words   |  4 Pages Animal Abuse is when someone hurts an animal or does not care for the animal responsibly. It’s against the law to hard or be cruel to animals. It’s also called animal cruelty. The topic is going to be over is animal abuse. There’s a lot of people against animal abuse. A lot of researchers try to find a way to stop animal abuse. The FBI is conducting an investigation to find out a way to serve justice to those that abuse animals. Animal abuse has been going on for a very long time now and it needRead MoreThe Fight Against Animal Testing1456 Words   |  6 Pagesthat has been around for thousands of years. Early Green philosophers such as Aristotle and Erasistratus performed experiments on animals as early as 384 BC (Hajar). Though the way animals are used in experimentation has varied over the years, the modern definition of animal is an experiment that deliberately harms a live animal (â€Å"What Is Animal Testing?†). Animals have been used for the purpos e of biomedical research and to understand anatomy all throughout history. Nowadays, some of the uses ofRead MoreThe Ethics Of The Animal Welfare Movement Essay1727 Words   |  7 PagesBritain with the passage stating an act in 1835 to consolidate and amend the several laws relating to the cruelty and improper treatment of animals. In 1911 the Parliament passed the â€Å"Protection of Animals Act, and it is still enforced currently. This policy was established while permitting humans to use animals as test subjects, but making animals suffer in this way is unnecessary (Guither, 1998). In the United States alone it is estimated that over twenty-six million animals are used for testing.Read More Animal Testing (speech Outline) Essay989 Words   |  4 Pagesnbsp;nbsp;nbsp;nbsp;nbsp;This example to me personally represents the epitome of cruelty by modern science toward animals. (Transition: Now that I have explained the cruel injustices of animals in the past, let us now look at how these problems are solved today.) II.nbsp;nbsp;nbsp;nbsp;nbsp;One of the ways animals are now protected is through laws and organizations. 1.nbsp;nbsp;nbsp;nbsp;nbsp;One such important law that was signed in 1966 was the Animal Welfare Act that regulates the treatmentRead MoreThe Debate On Animal Rights910 Words   |  4 Pagescreated in the image of God. The Greek philosopher Aristotle based his opinions on the idea that animals did not have the ability to reason and so they were below humans (Taylor, 2009). Rene Descartes, a French philosopher who is known as the father of modern philosophy, had a tremendous influence on the animal rights debate and his opinions are still being quoted today in papers and books on the subject. Descartes believed that man was linked to God through his mind which was separate from the physicalRead MoreAn American Ideal Of Equality Is Not An America At All.1501 Words   |  7 Pages An America without equality is not an America at all. The common American citizen would say that the definition of equality is; Equal rights among all people. Equality is also defined as the state or quality of being equal; correspondence in quantity, degree, value, rank, or ability. A historical example that demonstrates the American ideal of equality is the court case Plessy Vs. Ferguson (1896). Plessy was arrested for riding in a white-only seat for being an African-American citizen riding inRead MoreModern Day Genocide1278 Words   |  5 PagesModern Day Genocide Humiliated, beaten, and neglected; an entire group of people are constantly under abuse. They must hide from their own government in fear of death. The citizens expose their neighbors in order to create a more perfect country. No documentation exists that outlaws the violence towards these people. Their leaders do not want to recognize that they have any existence. All of this is happening while surrounding countries sit idle and wait for a resolution to happen. When hearingRead MoreThe Jim Crow Laws Enhanced The Institution Of Racism1034 Words   |  5 PagesThe Jim Crow Laws enhanced the institution of racism in The United States. Reconstruction was meant to rebuild the South from the destructive Civil War and help integrate African American’s into the southern lifestyle. Instead, the Jim Crow Laws segregated colored people from white people and encouraged the discrimination of colored people. Subject to the pervasive reign of terror by the Klu Klux Klan, stripped of their political and civil rights by white state legislatures and white judiciaries

Implementationin Information Technology and Management

Question: Discuss about the Implementationin Information Technology and Management. Answer: Introduction Information system is known an organized system that is used for the collection, organization storage and communication of information. According to Stair and Reynolds (2013), it can also be defined as the study of complementary networks that people and organization can use to collect, filter process, develop and distribute data. It is a combination of hardware, software, infrastructure and trained people to facilitate planning, coordination and decision making in an organization. As mentioned by Cassidy (2016), there are several types of information system that are available such as transaction processing systems, decision support system, office support system, transaction supporting system and management information system. All of these information systems are useful for a business organization. Such as transaction processing system that is capable to provide a way to collect, process, display or cancel transactions (Braglia and Frosolini 2014). On the other hand, decision support system that helps to make decisions by working and analyzing data that can produce arithmetical projections and data models. However, management information system is suggested for McDonalds. Management information system is a unique information system that mostly collects data by the transaction processing system. This data is then used to develop reports in a way that managers can use it to make regular business related decisions. This system is exceptionally useful to deal with organizational problems. This system also increases efficiency of managerial activities. Further in this report, a complete description is provided about management information system along with its importance. It is also mentioned that how this system help McDonald. Systems Development Life Cycle (SDLC) of MIS is also mentioned in this report along with its challenges and solutions. Management Information System (MIS) Management information system delivers knowledge that business companies require to manage themselves effectively. MIS are typical computer systems that are used for managing and organizing a company. According to Choudhary (2015), the five main components of MIS are hardware, software, data (required for decision making method), procedures (design, establishment and documentation) and people (individual employees, teams or organization). This system is different from other information systems as they are used to scrutinize and assist tactical and equipped behavior. Rationally, the term management information system is mainly used to submit to the study of how employees, teams or companies assess, design, supervise and utilize systems to develop information to enhance competence and efficacy of decision making. The idea of MIS has changed enormously over a phase of time comprising many different facets of the organizational meaning. In its preliminary days, the concept of MIS was to route the information available in the organization. Then that data was obtainable in the shape of reports at continuous intervals. MIS was competent of dealing with the data from the level of compilation to dispensation. This concept was later customized by adding a distinction between data and information. Information is known as a product of an analysis of data. This perception is analogous to a raw material and the completed goods (Ma and Ji 2014). Those information can be analyzed in a several ways, generating diverse shades and stipulation of the information as a product. It was, therefore, demanded that MIS should be more individual-oriented so that each employee can have dissimilar orientation towards the information. Later this notion was further changed in a way that I can present information in a different form and format. This different form can develop an impression on its user, infuriating a judgment or an examination. It was understood that some type of discerning step was essential in the system to better study and exposure. Hence, the new conception of exemption exposure was included in MIS. After that the concept of MIS was further developed so that the system can become able of managing requirement based exclusion coverage. This need may either of an individual or a group of people. Importance of MIS for McDonalds Management information systems are extremely important, especially in hospitality and tourism industry. For an organization like McDonalds, the use of MIS is principally focused on the following areas. Flow of information organization-wide: McDonalds is a customer-focused company. MIS can provide a big picture regarding the overall organization wide information. MIS will make sure that updated and strategically necessary information can be generated in the form of data and reports (Choudhary 2015). Decision-making process: Out of management information system can be found in the form of reports. These reports can be used by the management of McDonalds in the decision making process. It will also help McDonalds to prepare itself strategically for the upcoming business venture. Managerial control and scrutiny: According to Braglia and Frosolini (2014), properly formulated, incorporated and centrally consolidated data and knowledge can help a manager with an insight regarding the entire administrative process. MIS does the same job as it helps the managers to have a strong control over the managerial activities and methods. Computer dependant systems: As management information system is a computer based system, it can help McDonald to provide swift and efficient service to its customers (Ma and Ji 2014). Through MIS, employees and managers will be able to gain real time information about the organization. It will help the management of McDonalds to cater to the needs of the customers. Some other advantages that McDonalds will have through MIS are mentioned below. MIS will help the organization to identify its weaknesses through the presence of revenue report, sales report and employee performance report. As the management will get real time strategic report, the management will be able to tap the opportunities at the real time. Besides, it will also help to address the weaknesses which will give the organization a competitive advantage. MIS will help to minimize or eliminate delays and ineffectiveness in the handling of the customers. It will be done as an updated report will be available for the organization related to the taste and preference of the customers. Systems Development Life Cycle (SDLC) In MIS System development lifecycle is referred to as the relevance development-life cycle. It is a phrase used in systems engineering and software engineering to portray a method for planning, developing, testing and deploying an information system (Gupta and Laxmi 2015). System development life cycle of MIS is mentioned below that will help the management of McDonalds to successfully implement the system in the workplace. SDLC will start with a written request which is called as system request which will figure out the needs of an IS. It will also describe the changes or improvements by the management concern. This request could be either minor or major. A minor request can ask for adding a new report of altering an existing evaluation formula. On the other hand, major report will involve the development of an entire information system which will meet the requirements of a new business need. Preliminary investigation is also called as feasibility study that helps to define the business related problems and opportunities. It will also decide whether or not a new system is required, while spending minimum amount of money and time (Bano and Zowghi 2013). Three major aspects of feasibility study are technical feasibility, economic feasibility and operational feasibility. Within technical feasibility, it will be discussed whether the project can be done by using existing equipments or not. Economic feasibility will decide whether there are sufficient amount of benefits in developing the system. Operational feasibility will identify whether the system will used if it is developed and implemented. It will also identify that whether the end users will show any kind f resistance while using this system. The major activities of feasibility study are shown in the table below. Name of the Phase Feasibility Study Important functions To describe problems and opportunities and identify whether or not MIS is feasible. Output Feasibility Study Major tools Techniques related to fact-gathering and estimation of requirements. Tasks of individuals The analyst will collect information related to the problems and opportunities The analyst will develop probable estimates of necessities for probable solutions. More clear estimates will be established by the analyst for the next analysis phase. Management will decide whether they will continue the project or not. Table 1: Steps and tasks of Feasibility Study (Source: Wakchaure and Joshi 2015) Analysis of the system Purpose of this phase is to learn how the existing system is operating. It will help to determine and document what the system is capable to do in order to recommend proper solutions. After gathering the facts, software team will analyze them carefully. This method is called as requirement analysis. After the development of an alternative plan is done, then the end product for this phase comes which is system requirement documents. It will help the management and the users to understand the alternative plan. Based on the documents, the management will develop a system in-house or will purchase a commercial package or will modify the current system. Steps and tasks of this phase are mentioned in the table below. Phase Name Analysis Main Function To identify the requirements of MIS Output Specification of the problems Primary Tools Techniques for fact-gathering, data flow diagrams, system models, system flow charting, data dictionary and Computer-Aided Software Engineering (CASE) for implementing these above mentioned tools. Tasks of individuals Current system will be studied and results will be documented by the analyst. It will help to understand its issues and its strong points. A list of requirements will be then developed for the new system which is MIS. A diagram of the functions for the new system will be drawn. In the end, the analyst can develop a prototype of the system. Table 2: Steps and tasks of Analysis (Source: Sadagopan 2014) Designing the system The main purpose of this stage is to develop a blueprint that will satisfy all the mentioned requirements. Within this phase, all the necessary outputs, files, inputs and application programs will identified along with manual procedures. According to dos Santos et al. (2016), this phase can include the scheming internal and external controls such as computer related and manual features. It will ensure that the system will become dependable, precise, protected and maintainable. Then the design will be documented in the system design requirement which will be presented to the management and users for their reviews and support. The steps and tasks within this phase are hereby shown in the table below. Name of the Phase Design Primary functions To design a new system (MIS) that will fulfill the requirements of users and the management. Output Specification of the Design Primary tools HIPO Charts, data models, data vocabulary, data models, system models and input and output blueprint forms. For implementing these tools, using of CASE is also necessary in this stage. Tasks of individuals All the required hardware and software will be ordered by the analyst. Functional diagram will be altered by the analyst into hierarchical diagrams of the design step. Then the safety measures will be incorporated into the design of the system y the analyst. User interface will be designed by the analyst. It will include input and output formats. Analyst will decide staffing necessities including design methods and work flow. In the next step, proper database should be developed by the database engineer. Specifications and settings of the system will be then reviewed by the users, managers and analyst. They will make sure that the system is accurate. Table 3: Steps and tasks for design (Source: dos Santos et al. 2016) During this stage, MIS will be developed and put in place. Programs of application will be noted, tested and saved. Documents related to the operation and methods will be completed. Management of the organization and users will approve this system. Within the final preparation, the users will be guided about the changes in the new system that is different from the old system. Once the system is ready to use, an assessment will be conducted to figure out overall quality of the information system (Alizarchik and Lukashevich 2015). The management can also use post-implementation system evaluation test to ensure the system is properly operating and its costs are within anticipation. The steps of this phase are hereby mentioned in the table below. Name of phase Implementation Main function To note down and test the computer programs. To transform the older system (computerized or manual) into a new system Output Fully coded and tested programs that are verified by the management and users. Training materials along with documents for users. Main tools Several tools for programmer, structured walkthroughs, computerized weakening testing, application generators, fourth generation languages along with CASE to implement the tools. Tasks The preparation of the site and installation of the required equipments will be monitored by the analyst. The analyst will supervise the testing and correction of the programs and prototype. The new program will be noted down by the analyst. If necessary then the new supporting programs will be bought. The analyst will plan to test the program. The testing team developed by the analyst will test the program. The analyst will then supervise and plan conversation. The programmers will be asked to install the program. The data entry staff will then enter fresh and new data into the new system. Table 4: Steps and tasks for implementation (Source: Wakchaure and Joshi 2015) Operation and assistance to the system (Maintenance) After the implementation stage, the new MIS is ready to be used by the users. During the system operation, maintenance and improvements must be requested to deal with any problem that is identified by the users. After several years of operation, this new MIS must be changed. Maintenance changes are made to eliminate the errors or to conform to government or user demands. Improvements will be modified which will increase capability and accuracy such as delivering new information in an existing report (Wakchaure and Joshi 2015). It can also add a new report after improvement. Steps of this phase 5 are hereby mentioned below. Name of the Phase Maintenance Primary functions To restore and upgrade the system as per requirement. Output Updated and upgraded system and user documentation along with revised program. Main tools Incremental models that will include data dictionary, data models, data flow diagrams, system flow charts, HIPO charts and input-output design forms. CASE products will be required along with application generators and fourth generation languages to use the mentioned tools. Tasks of individuals An end user will notify the analyst about a problem. Then the analyst will develop an incremental model that will assess the impact of the modification. Management along with the board that control any type of change in the organization will decide if the system will be upgraded or not. If the change in the system is approved by the higher authority, then the analyst will improve the system and document all the change. The programmers will test the program. Table 5: Steps and tasks for maintenance (Source: Karim 2016) Probable Challenges of MIS The challenges related to MIS are divided into three factors which are humanistic, organizational and environmental. One of the major problems is lack of knowledge of the managers along with the users as they have no idea about what they want and what information needs are. On the other hand, if the designers cannot properly understand the needs of the users, then they will not be able to develop a user friendly system. Besides, if the managers do not have ample amount of information about the collaboration method with the designer team, then expected system will not be developed. Lack of knowledge of most of the analysts and programmers with new system work atmosphere can also be another challenge (Karim 2016). Last but not the least, if the collected data is not accurate, it will create problems while developing the problem. Organizational factors If the managers, users and system directors are not willing to participate and collaborate then it would be a problem. If the existing manual systems are not consistent and are complex then developing a new system will take a lot of time. It is important to analyze the method before designing the system. If it does not take place, then the development of the system will become complex. Besides, if the organization does not have ample amount of workforce in the management and computer fields then testing will not be done properly. Environmental factors The biggest challenge within this factor is the lack of proper consultants for scheming the system and software. Absence procedures and methodology and stages of developing the system can also hamper the installation of the new system. According to Alizarchik and Lukashevich (2015), it is important to evaluate environmental aspects in MIS. If it is not done, then the system will not work properly. However, over all of this, it is important for the management to provide adequate investment for developing this system. If proper amount of investment is not done, then system will not work as per expectation of the management. Solutions of the Challenges A comprehensive plan must be developed for using information systems in the organization, before using MIS. It will help the employees to learn how information system works. The organization will have to hire skillful and efficient employees who have knowledge about the information system. Existing employees must be encouraged to learn to use information systems. Managers and employees will be using the system must participate in the system creating process. It will allow them to understand the new system from its initial stages. Conclusion In the end, it can be concluded that management information system has a strategic role in an organization that is operating within hospitality industry. It can help to develop products, services and capabilities that will allow an organization to have major advantages over competitive forces it faces in the global market. McDonalds is currently facing immense competition from companies such as KFC, Dominoz, Pizzahut, Burgerking and Subway. Therefore, it can be said that installing MIS will allow McDonalds to deal with its market competitors. However, from the entire discussion, it is also clear that installed MIS should be flexible enough to deal with altering information need of the organization. Designing MIS is obviously a complex task. Therefore, the analyst and programmers will face several challenges. It is the duty of the host organization to provide every type of support to the analyst and programmers so that they can develop a flexible MIS. In short, flexible MIS can only b e achieved if the MIS is planned. Planned means, the development team knows and understand the requirements of the organization. Another important advantage of MIS is its decision support system which is also described in the report. Therefore, it is expected that MIS will fulfill the nee of the organization and will help it to take critical business decisions. However, installing MIS will not solve all the problems. It is possible that for some time it will work properly. However, with the changing demand of the customers the organization will have to change its strategies. In this scenario, MIS must be upgraded and updated. Otherwise it will not provide expected results. References Alizarchik, S. and Lukashevich, A., 2015. Breakfast at MCDonalds or how to survive in the global marketplace. https://cdo.bseu.by:8080/bitstream/edoc/23762/1/Alizarchik,%20S.,%20Lukashevich,%20A..pdf Bano, M. and Zowghi, D., 2013, April. User involvement in software development and system success: a systematic literature review. InProceedings of the 17th International Conference on Evaluation and Assessment in Software Engineering(pp. 125-130). ACM. https://dl.acm.org/citation.cfm?id=2461017 Braglia, M. and Frosolini, M., 2014. An integrated approach to implement project management information systems within the extended enterprise.International Journal of Project Management,32(1), pp.18-29. https://www.sciencedirect.com/science/article/pii/S0263786312001792 Cassidy, A., 2016.A practical guide to information systems strategic planning. CRC press. Choudhary, A., 2015. A REVIEW: IMPORTANCE OF BUSINESS STRATEGIC MANAGEMENT INFORMATION SYSTEMS.International Journal of Engineering, https://ijemmr.co.in/index.php/IJEMMR/article/view/16 dos Santos, R.A., Zorzo, A.F. and Marczak, S., 2016. Towards an SDLC for Projects Involving Distributed Systems.ICEIS 2016, p.158. Gupta, R.S. and Laxmi, V., 2015. Software Development Life Cycle (SDLC) Implementationin Information Technology Management.International Journal of Recent Advances in Information Technology Management,1(1). https://management.eurekajournals.com/index.php/IJRAITM/article/view/20 Karim, N.S.A., Albuolayan, A., Saba, T. and Rehman, A., 2016. The practice of secure software development in SDLC: an investigation through existing model and a case study.Security and Communication Networks. https://onlinelibrary.wiley.com/doi/10.1002/sec.1700/full Ma, Y. and Ji, Z., 2014, October. The Research on Sports Events Organization and Management Information System Based on Process Aware. InIdentification, Information and Knowledge in the Internet of Things (IIKI), 2014 International Conference on(pp. 132-136). IEEE. https://ieeexplore.ieee.org/document/7064014/ Sadagopan, S., 2014.Management Information Systems. PHI Learning Pvt. Ltd.. https://books.google.co.in/books?hl=enlr=id=S5NeBAAAQBAJoi=fndpg=PP1dq=SDLC+and+management+information+systemots=H0fqNoyrresig=2TJCGxs0r0YowY3XYGXLu08e_oI#v=onepageq=SDLC%20and%20management%20information%20systemf=false Stair, R. and Reynolds, G., 2013.Principles of information systems. Cengage Learning. Wakchaure, M.M.A. and Joshi, S.D., 2015. A Framework to Detect and Analyze Software Vulnerabilities: Analysis Phase in SDLC.Journal of Modern Electronics,4(1-2). Ward, J. and Peppard, J., 2016.The Strategic Management of Information Systems: Building a Digital Strategy. John Wiley Sons.