Technology and Decision Making Essay Example for Free

Technology and Decision Making Essay The quality of patient care, communication between health care staff, and the safety of patients has greatly improved since the onset of technology. Through the improvement of information technology, the ability to collect data and manage the decisions based on the data collected has enhanced in the clinical setting as well as in the business portion. Health care informatics incorporates theories from informational science, computer science, and cognitive science (Englebardt Nelson, 2002). This information helps to gather and process it in order to make an informed decision. Important information could be missed if the data is ignored. Some of the most recent technology which includes the internet and cell phones has made it possible to access information quickly in order to make the best decision for the patient in order to provide good quality care. Technology changes every day and it is important to keep up with these changes that will help support clinical decisions made by the caregivers. This paper on informatics will show the systems and information theories, the DIK model, and the role of the expert system in nursing care and medicine. System and information theories System. â€Å"A system is a set of related interacting parts enclosed in a boundary† (Englebardt Nelson, 2002, p.5). There are many types of systems which include but are not limited to: computer systems, school systems, health care systems, and people. Systems can be living or nonliving, open or closed. Closed systems do not act with the environment whereas open system have the ability to act with the environment. Open systems can be used to understand technology and those individuals associated with its use. This type of system takes input from the environment, processes it, and then returns it back to the environment as output, which serves as feedback. This theory can better help the individual understand the way people work with systems in the health care industry and allow for a visualization of the whole picture. A common term using in computer science is GIGO, â€Å"garbage in, garbage out†. This applies in the sense that a system is only as good as its user. If the user is inputting garbage, or poor quality data, the computer is likely to output the same. A system requires an accurate source in order for accurate material to be produced as a result. Open systems have three types of characteristics which include: purpose, functions, and structure (Englebardt Nelson, 2002). The purpose is the reason for the existence of the system or the program and is most often stated in the organization’s mission statement. This is true for health care organizations, churches, and schools. For example, the mission statement of the local public health department to promote health, prevent illness, and control communicable disease by providing quality services, health education, and environmental services for the community. Computer systems are often classified by their purpose and may have more than one purpose. By selecting a purpose that all individuals agree upon within the organization, a system can be chosen. It is important to take the time to identify the purpose with all those who will be using the system. Functions identify the methods in which the system will achieve its purpose. â€Å"Functions are activities that a system carries out to achieve its purpose† (Englebardt Nelson, 2002, p.6). When a computer system is chosen a list of functional specification must be put in writing to identify each function and how it will be performed. Systems are structured to allow the functions to be carried out. Some examples of structured systems include the nursing department. The nurse in charge will assign patients to the staff nurses with the purpose to provide care. The charge nurse will ensure that the team is functioning with the ability to provide the care the patient needs and deserves. Two different models can be used to visualize the structure of a system: hierarchical and web. In the hierarchical model, each computer is a part of the local area network (LAN) which in turn is part of a wide area network (WAN) that is connected to the mainframe computer system. The mainframe is the leader of the system or lead part. The web model functions much like that of a spider-web. It has the capability to pass information to many departments that may use it for different purposes. For example,  laboratory results may be sent to the pharmacy to calculate a medication dosage and patient vitals may be sent to another department for review and use. â€Å"A system includes structural elements from both the web and hierarchical model† (Englebardt Nelson, 2002, p.7). Everything living or nonliving are in a constant state of change. Six concepts are helpful in understanding the change process: 1)dynamic homeostasis, 2)entropy, 3)negentropy, 4) specialization, 5)reverberation, and 6)equifinality. Dynamic homeostasis consists of maintaining an equal balance within the system. At times, increased stress can throw off the balance and cause challenges to the organization. A health care informatics specialist’s job is to decrease the stress and restore the balance within the organization. Entropy can be best described as the tendency of the system to break down into parts. This can be the loss of some data when transmitted from one department to another. All systems, living or nonliving, reach a point where they are no longer repairable. When this point is reached, a system must be replaced. Negentropy is the opposite of entropy and is best described as the system’s ability to multiply and become more complex. As the size of the health car e industry grows, so do the health care information systems. Information technology. â€Å"Information technology has the potential to greatly streamline healthcare and greatly reduce the chance of human error. However, there is a growing literature indicating that if systems are not designed adequately they may actually increase the possibility of error in the complex interaction between clinician and machine in healthcare† (Borycki, E., Kushniruk, A., Brender, J., 2010, p. 714). The term information has more than one meaning and the term information theory refers to multiple theories. The two common theoretical theories of information theories are: Shannon and Weaver’s information-communication model and Blum’s model (Englebardt Nelson, 2002, p. 10). The information theory was presented as a formal theory in 1948 with a publication by Claude Shannon titled â€Å"A Mathematical Theory of Communication†. In this theory, the sender is the originator of the message and then the encoder converts the message into a code. A code can be a number, symbol, letters, or words. The decoder then converts the message to a format that can be recognized by the receiver. Shannon was a telephone engineer and explained this theory in a way that the decoder was the  telephone converting sound waves into a message the receiver could understand. â€Å"Warren Weaver, from the Sloan-Kettering Institute for Cancer Research, provided the interpretation for understanding the semantic meaning of a message† (Englebardt Nelson, 2002, p. 12). He used Shannon’s works to explain the interpretational aspects of communication as each individual perceives things different from the next. Different types of circumstances may occur causing a message to be interpreted wrong. For example, if a physician is using medical terminology that the patient cannot understand there is definitely a communication problem. If the patient cannot hear what is being said because the ear is not transmitting sound, then there is a different type of communication problem. The message must convey meaning and produce the intended result. Bruce L. Blum defined three types of health care computing applications called Blum’s Model. He grouped these applications in data, information, or knowledge. Data are those things such as height, weight, age, and name. Information is defined as data that has been processed. Knowledge is the relationship between data and information. Using these concepts, it is possible to identify different levels of computing and automated systems. Data, Information, and Knowledge (DIK) model Healthcare informatics can be explained using a model consisting of three parts: data, information, and knowledge (Georgiou, 2002). The three parts are demonstrated using a hierarchy pyramid. Data is the platform in the model, representing the foundation. Data is represented as facts and observations, but without supporting context, the data is irrelevant. Until the information is validated or manipulated the data is not significant, once it is manipulated, the data can provide value to the user. Information is the product of data once the data has been manipulated. The result of data and information is evidence-based knowledge. Evidence based knowledge can be used to support evidence based medicine. Some individuals feel that too much focus has been put on data, limiting the ability to practice medicine as a science. Instead, the use of data suggests that medicine is being practiced based on statistics instead of science. Yet, the same critics will use the same hierarchy of data, information and knowledge to treat a patient that develops a fever after hip surgery. The fever alone does not provide significant information but combined with information of a  recent surgery, a physician will test further for signs of infection. The end result is the knowledge of why the patient is feverish. Viewing informatics in the form of the decision-information-knowledge (DIK) model allows individuals to see the process as a whole. The data must be accurately representing what is occurring or the information will not be accurate. The statement, â€Å"dirty in, dirty out,† can be applied to the platform of the model. It is essential that clean data be entered into the system, allowing clean data and information to be produced. The product, knowledge, can then be substantiated through the evidence produced. Just as evidence is used to make clinical decisions, the DIK model is used, in conjunction with the scie ntific information, to build evidence based medicine. Health informatics involves spreading and distributing information as just one piece of the process of producing knowledge which is multifaceted (Georgiou, 2002). The role of expert system in nursing care and medicine Nurses and other health care professionals make decisions on a daily basis that affect patients’ care and treatment. Nurses and health care professionals are not expert in all areas of nursing care and medicine. Health care workers specialized in certain area or field of medicine or nursing are not always readily available to everyone. Expert systems have been developed to assist medical and health care providers with decisions about care and treatment of patient. An expert system is a knowledge-based computer program designed to â€Å"enhance the human ability to analyze, problem solve, treat, diagnose, and estimate prognosis of health-related conditions† (Englebardt Nelson, 2002, p. 114). â€Å"Nursing expert systems can improve the overall quality of care when designed for the appropriate end-user group and based on a knowledge base reflecting nursing expertise† (Courtney, Alexander, and Demiris, 2008, P. 697). Examples of expert systems include MYCIN, a system that advise physicians about antimicrobial selection for patients with meningitis or bacteremia and INTERNIST-1, a system that assist with diagnosing complex problems in general internal medicine (Shortliffe, 1986). Health care workers may not always have the knowledge base to diagnose and treat every condition or situation encountered. Expert systems are used to close the gap in knowledge providing effective, efficient, and  accurate care. The concept of expert system is driven by the desire to improve patient care, reduce cost, and disseminate expert knowledge. Expert systems are used just as x-rays and lab values are obtained to improve the human understanding of a patient’s condition. The human memory has limitations. Expert systems can be the answer to eliminating a large number of preventable medical mistakes. This system can alert health care workers about drug interactions and allergies, and provide preferable form o f treatment. Expert systems can assist in diagnostic suggestions, testing prompts, therapeutic protocols, and practice guidelines. The utilization of expert systems has an impact on the quality of care, economy, and medical education of staff. Expert systems, when used effectively can improve patient outcomes and decrease health care costs. Fewer mistakes lead to lower financial expenditures and increased profits. Improved quality of care result in improved patient satisfaction that leads to increased reimbursement from Medicare and Medicaid. Expert systems can also decrease the variation in medical practice emphasizing standardized and evidence-based practice of care. Along with expert systems, decision aids and decision support systems are used to improve patient care. The use of decision aids and decision support systems Clinical decision aids help to identify solutions to clinical situations. Decision aids can be either paper-form or electronic. The electronic decision aids can be accessed via recorded media or the Internet. Decision aids are utilized to facilitate shared decisions between the patient and interdisciplinary team taking care of them. They help the patient to think about the multiple decisions they must make in the course of their treatment regimen. An example is the Ottawa Patient Decision Aid. This decision aid helps to determine whether or not patients should seek antibiotics for bronchitis. Another example is a decision aid about whether or not someone should place his or her family in a long-term care facility for Alzheimer’s disease (Englebardt Nelson, 2002). A decision support system (DSS) is an interactive, flexible, and adaptable computer-based information system (CBIS), which was made to support decision-making as it relates to the solution of an individual problem. â€Å"A clinical decision support system (CDSS) is an automated decision support system (DSS) that  mimics human decision making and can facilitate the clinical diagnostic process, promote the use of best practices, assist with the development and adherence of guidelines, facilitate processes for improvement of care, and prevent errors† (Englebardt and Nelson, 2002, p. 116). Decision support systems utilize data and provide easy user interface that permit for the decision maker’s own insights. Four components of decision support systems are user interface, model library, model manager, and report writer. User interface makes communication between the executive and decision support system. Model library includes statistical, graphical, financial, and â€Å"what if† models. Model manager accesses available models. Report Writer generates written output (Englebardt Nelson, 2002). Four types of CDSS used in patient care decision-making are systems that use alerts to respond to clinical data, systems respond to decisions to alter care by critiquing decisions, systems suggest interventions at the request of care providers, and systems conduct retrospective quality assurance reviews. Examples of nursing-specific decision support systems are nursing diagnosis systems such as the Computer Aided Nursing Diagnosis and Intervention (CANDI) system, care planning systems such as the Urological Nursing Information System, symptom management systems such as the Cancer Pain Decision Support system, and nursing education systems such as the Creighton Online Multiple Modular Expert System (Courtney, Alexander, and Demiris, 2008). The uses of technology for patient and client management As Information Technology continues to have more presence in health care, patients, physicians, and staff are benefiting from on-demand access to information anyplace, anytime it is needed. Advances in technology provide healthcare organizations the ability to improve the quality of patient care. An ultimate goal of using technology is to improve the quality of care patients receive (Become a Meaningful User of Health IT, 2010). Technology can be found patient homes, clinics, extended care facilities, and hospitals, to name just a few. As the number of chronic diseases continues to increase technologies like telemedicine and video-conferencing can improve the quality of life of patients with chronic conditions, and reduce costs caused by these illnesses (Finkelstein Friedman, 2000). Improving quality, access, and client management is done by enhancing the  exchange of information between providers, institutions, and payers, allowing patients to receive uninterrupted continuity of care. For the people living in rural areas, the restrictions placed on services and specialists can be improved using technology (Smith, Bensink, Armfield, Stillman, Caffery, 2005). Telecommunications in the healthcare environment can provide patients and providers an opportunity to meet and even exceed expectations clients and the community have. A physician accessing a patients’ record from his home can provide treatment and develop a plan of care without sitting in his clinic to access the patients’ chart. Caregivers are no longer at the mercy of ongoing education provided at a variety of locations and cost. Learning management systems available via the Internet allow staff to review material and participate in competency testing. Tools are available through the advances in technology, which allow training by developing simulations of patients used for assessment training in virtual environments, assessing cognitive skills of providers (McGowan, 2008). As technologies in healthcare continue to improve, caregivers and patients will continue to experience changes in many areas.  Communication, teaching, and documenting will be affected, which change the way clinicians provide care and the way clients will receive it. Analysis of the effect of technology on health care and health status Prior to computers and digital equipment seen in today’s healthcare facilities, most of what was done for patients was done manually. Manual processes could be time consuming and the opportunity for human error, which could affect the quality of care a patient received, was real. In a recent report from the Institute of medical care, it was stated that humans are inherently imperfect, and error is frequent in medical car (Patton, 2001). Technologies affecting patient care and a person’s health status include improvements to imaging systems, documentation solutions, and scheduling systems. Modern medicine relies on technological systems coming together: the operating room, clinical laboratory, radiology department, and radiation oncology facility each incorporate interrelated networks of technologies (Patton, 2001). Surgeries that once required large incisions can be done through microscopic incisions resulting in shorter hospital stays. Early diagnosis and improved treatment plans have been inevitably affected by technology. Although technology allows healthcare to improve access to patient information allowing easier access that is current and up-to-date there are also disadvantages to this kind of access. Consumers and caregivers have large volumes of information, which can be accessed, not all of the information accessed will be understood or accurate. Society must be aware that not all sites will be able to monitor and ensure information being accessed is credible; it is inevitable some of the information provided and retrieved will be inaccurate. Worse yet information which are by law confidential, may also be accessed without the consent of the patient. In addition to the ability to monitor healthcare information, technology may also make it challenging for physicians to practice under complete autonomy. With the increase in the complexity of technology, physicians must agree on how components relate to one another, also known as standards (Patton, 2001). As a result, some physicians can be seen resisting the adoption of new processes, but with ongoing development of user-friendly systems, resistance can be overcome. References Become a Meaningful User of Health IT. (2010). HHN: Hospitals Health Networks, 84(12), 47. Borycki, E., Kushniruk, A., Brender, J. (2010). Theories, models and frameworks for diagnosing technology-induced error. Studies In Health Technology And Informatics, 160(Pt 1), 714-718. Finkelstein, J. J., Friedman, R. H. (2000). Potential Role of Telecommunication Technologies in the Management of Chronic Health Conditions. Disease Management Health Outcomes, 8(2), 57-63. Retrieved from EBSCOhost. Courtney, K. L., Alexander, G. L., Demiris, G. (2008). Information technology from novice to expert: implementation implications. Journal of Nursing Management, 16(6), 692-699. doi:10.1111/j.1365-2834.2007.00829.x Englebardt, S. P. Nelson, R. (2002).Health care informatics. An interdisciplinary approach. St. Louis, MO: Mosby Elsevier. Georgiou, A. (2002). Data information and knowledge: the health informatics model and its role in evidence-based medicine. Journal Of Evaluation In Clinical Practice, 8(2), 127-130. McGowan, J. J. (2008). The Pervasiveness of Telemedicine: Adoption With or Without a Research Base. JGIM: Journal of General Internal Medicine, 23(4), 505-507. doi:10.1007/s11606-008-0534-z Patton, G. (2001). The two-edged sword: how technology shapes medical practice. Physician Executive, 27(2), 42-49. Shortliffe, E. H. (1986). Medical Expert Systems- Knowledge Tool for Physicians. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1307157/?page=2 Smith, A., Bensink, M., Armfield, N., Stillman, J., Caffery, L. (2005, October-December). Telemedicine and rural health care applications. Journal of Postgraduate Medicine, 51(4), 286.

Parental Conflict In Turtle Mo :: essays research papers fc

The Parental Conflict in Turtle Moon   Ã‚  Ã‚  Ã‚  Ã‚  For the average person, occasional inter-personal conflicts are a fact of life. Nowhere do these conflicts manifest themselves with greater tension than in the parent-adolescent relationship. Through their works, writers of fiction illuminate the sources of strain common to parent-child interactions. In the novel Turtle Moon, Alice Hoffman exemplifies this conflict in the relationship between Keith Rosen and his mother Lucy. There are several factors that contribute to this conflict and the work as a whole. The strife between Keith and his mother results from Keith’s desire to live in New York with his father, the lack of parental involvement, and the lack of communication between Keith and his mother.   Ã‚  Ã‚  Ã‚  Ã‚  The discord between Keith and his mother results from his preference to live with his father in New York. Keith has no choice in the decision and now he lives in Verity, a town he hates. This situation lies at the root of his rebellion against his mother. When he lives in New York he is never particularly well behaved, â€Å"but after eight months in Florida, he is horrid†(5). Through his rebellious actions Keith generates grief and worry in his mother Lucy. His backpack must be checked â€Å"for contraband everyday†(31), and he and his mother fight constantly. Because he is forced to live with his mother, Keith resents her. Keith is angry with Lucy because he feels as if he is trapped in Verity. â€Å"He wanted to live with his father, but who asked him?†(6). Keith deliberately disobeys Lucy and has no respect for her. He counts down the days until he can go back to New York and this ignites many arguments between them. Keith’s rebelli ous actions advance the novel’s theme of searching for identity and independence. McBane In addition to living in Verity, another source of the conflict between Keith and Lucy is her lack of parental involvement. Lucy and Keith grow more and more distant from each other because Lucy stays out of Keith’s life. In the same way Keith avoids his mother at every available opportunity. â€Å"He waits in bed until he’s sure she’s left, so he won’t have to see her and pretend to be normal or cheerful or whatever it is she wants him to be†(6). Because Lucy does not involve herself in Keith’s life she wonders what he is doing and tends to assume the worst about him.

Kyoto Protocol In Canada

The Kyoto Protocol has enormous implications on the greenhouse gas emissions scene in Canada and indeed all industrial countries. Its targets for reducing emissions has faced scepticism from both environmentalists who argue that it does not go far enough where as businesses and industry representatives complain over the enormous costs that will be endured in the process of achieving these targets.This essay gives a short description and background to the Kyoto protocol in the Canadian context. It then focuses on the benefits and advantages of the Kyoto protocol to Canada while the last section focuses on the disadvantages and potentially negative impact of the Kyoto protocol in Canada.BackgroundKyoto Protocol was signed in the Japanese city of Kyoto in the year 1997 between countries in order to decrease greenhouse emissions and counter climate change. The Protocol was signed a year later by Canada and formally ratified in late 2002 after a lengthy debate in the argument.The Liberal government in charge decided to decrease greenhouse emissions in the country by 6% below what they were in 1990. This was designed to occur over five years between 2008 and 2012.After the Conservative government came to power in early 2006, they called the Kyoto targets unrealistic as well as unachievable. In turn, the new government decided to focus on developing Canada’s own solutions to the problem, and decided to use the funds to improve the environment within Canada and not on global credits. It also decided to invest in the development of clean technologies.The Kyoto Protocol calls for these actions to be undertaken by national governments:Encourage Huge Final Emitter SystemAt the end of 2005 the government added greenhouse gases such as carbon dioxide and methane to the list of toxic substances. This was done under the umbrella of Canadian Environmental Protection Act in turn opening the doors to regulation.These regulations were published in 2006 as part of the Canada Gazette Part I and were followed by sector-specific greenhouse gas emissions targets. The deal was to decrease the total emissions by 45 mega tons in total.The Kyoto Promote Renewable Energy:This particular initiative offered the Wind Power Production Incentive as well as the Renewable Power Production Incentive. These initiatives included subsidy for producers of renewable energy of 1cent for ever Kwh of energy produced. These incentives were designed to decrease emissions by 15 mega tons in total.Promote Partnership FundDesigned to offer support to inter-government agreements, this fund offered cost sharing in order to sustain initiatives for reducing greenhouse gas emissions. Cash was directed towards aiding the province of Ontario to close coal-fired power plants which were among the worst emitters.This had the potential to offer 10% of the reductions promised as part of Canada’s Kyoto commitment of 6%. The Partnership Fund was also to offer financial support to Quebec f or executing its own climate change plan and also to help other provinces in decreasing their own emissions. These initiatives have the potential to reduce anywhere between 55 and 85 mega tons of greenhouse emissions.Promote ProgramsThis initiative has as part of it the Ener Guide program for homes and residential estates. It also promotes incentives for motorists to adopt more energy efficiency practices.As a result of the high success rate in the Ener Guide program, the government decided to channel in another $225 million in the program as part of budget in 2005 in order to increase 4 times the number of residential properties that had been retrofitted from 125,000 to half a million.One more initiative that found a lot of success was EGLIH (Ener Guide for Low Income Households) which was started in 2006. This program was designed to pay the full cost for energy efficiency upgrades to those found to qualify as low-income households. These programs are expected to result in a net d ecrease of 40 mega tons over a period of 5 years.Promote the One-Tonne ChallengeDesigned as a public education program, it called for all Canadians to reduce their annual emissions of greenhouse gases from five tons to four tons. The exception for this program is to reduce emission by a total of 5 mega tons.Promote the Climate FundThis fund was set up to establish a permanent institution that would buy emissions reduction as well as removal credits on behalf of the federal government. The Climate Fund was to buy credits from domestic as well as international sources which were recognized as well as approved under the Kyoto Protocol. This program is expected to result in a net decrease of 75 to 115 mega tons in emissions.Negative impact of Kyoto protocolThe federal government allocated a billion dollars in the year 2003 in order to phase in the Kyoto protocol and to reach the target of cutting emissions by eight percent of the total target. Compliance of the Kyoto agreement is admini stered by an institution called Environment Canada.This particular agency funded close to a hundred and fifty million dollars or roughly eighteen percent of the annual allocation of $841 million. By employing this as the standard, the cost to administer the Kyoto agreement was put at 1.18 billion dollars and this was to be funded by collecting taxes.

THE EFFECT OF FINANCIAL DISTRESS ON OPERATING CASH FLOWS - Free Essay Example

Sample details Pages: 17 Words: 5006 Downloads: 4 Date added: 2017/06/26 Category Finance Essay Type Cause and effect essay Did you like this example? This paper provides new evidence on the financial performance of Joint stock firms by emphasizing the role played by financial distress. The purpose of this paper is specify a model for early predication of financial distress that allows us to predict the specific nature of financial distress that can effect operating cash flow and which can lead the firm toward bankruptcy and to see the effect of financial distress on operating cash flows of companies listed on Karachi Stock Exchange. Financial distress is a situation when a firms assets value falls below some threshold. Don’t waste time! Our writers will create an original "THE EFFECT OF FINANCIAL DISTRESS ON OPERATING CASH FLOWS" essay for you Create order Firm starts to incur losses and it is not in a position to generate positive cash flows. A firm enters to financial distress before it goes bankrupt. We have studied 67 firms listed on Karachi Stock Exchange to see the effect on financial distress on their cash flows. Our sample includes financially distressed as well as financially health firms. We have incorporated financial data of consecutive four years (2003 to 2008) of 67 firms. In order to measure the financial distress we have used Modified Altman Z-Score as a proxy. Other independent variables, which have been used, are size of the firm, Working Capital, Working capital productivity and Operating Profit. By regressing these Five variables (Financial Distress, Working Capital, Size of Firm, Working capital productivity and Operating Profit) on Operating Cash Flows we have found that financial distress have a negative effect on corporate cash flows. However Size of Firm, Operating Profit and Working capital productivity have p ositive effect on Corporate Cash Flows. Working Capital has a negative effect on operating cash flows. We have estimated our model with the help of regression analysis. Our study is unique in a sense that there is a dearth of literature on financial distress with special reference to Pakistan. Keywords: Financial distress, Working capital, Working capital productivity, Bankruptcy, Altman Z-Score, Corporate Failure, Insolvency, Survival Analysis. Table of Contents 2 Abstract 2 Table of Contents 4 1. Introduction 5 2. Literature Review 8 3. Methodology 13 Data and Variables 13 Measurement of Variables 14 Operating Cash Flows (OCF) 14 Explanatory Variables 14 Financial Distress (FD) 14 Size of Firm (SZ) 15 Operating Profit (OP) 15 Working Capital (WC) 15 Working capital Productivity (WCP) 15 Hypotheses Testing 15 4. Empirical Framework 17 5. Results 17 Model Summary (b) 20 6. Discussion 22 Conclusion 23 Refererences 25 1. Introduction Financial Statements basically show the historical performance or record of the company at some previous point of time. By the time when financial statements are made public, changes are many economical areas such as market conditions, currency exchange rate and inflations can change the values of assets and liabilities. In this case there often exist discrepancies between book value of assets and their market values. In above case there might be companies that are healthy and many go through period of financial distress. In particular is the threat of not being able to meet debt obligations. The first Indication of financial distress is when firm does not have enough liquid assets (short-term assets) to cover (pay for) current liabilities (short-term liabilities) when this happen than firm ability to covering long-term liabilities is reduced resulting in creditors taking on more risk than the investment of loaning money to the firm is worth. When company is facing financi al distress, book value of company liabilities can become worth more than the market value of the same liabilities. If this happen, than firm is in danger of not meeting its obligations to creditors. In this case creditors may not be paid and in worst of financial distressed time, the creditors may receive nothing in interest or principal, if the firm files for bankruptcy. The importance of financial-decision making goals is to increase shareholders value and to keep them away from financial distress. The Predicting of financial distress is an early warning signal to keep investors from being loss. It has been more than 70 years, since Ramser Foster, and Fitzpatrich in 1931-1932, and 44 years, since Beaver (1966) but still they have not found the theory of financial distress ( Laclere M,2006). They were more statistical consideration then the intuitive models or fundamental causes of financial distress (Ooghe Prijcker, 2007; Balcean Ooghe, 2004). Since The Altmans model widely used among the investors, though it is not an intuitive model, once a firm is predicted having a financial distress next year, it has been treated as it has been financial distress currently (whtaker, 1999). This work aims at studying the effect of financial distress on operating cash flows of corporations. The interest in the area of financial distress has increased due to considerable number of corporate failures around the globe in recent years especially since the early 1990s. Notable failures include Global Crossing, Enron, Adelphia, Worldcom, HH Insurance, One Tel, and Ansert Airlines in 2001, and most recently FIN Corp in 2007. Financial distress is defined as a low cash flow state of a firm in which it incurs losses without being insolvent or financial distress is a term in Corporate Finance used to indicate a condition when promises to creditors of a company are broken or honored with difficulty. Financial distress is different from insolvency. Financially distressed companies have lower profitability, higher leverage, lower past excess returns and larger size compared to active companies. The failure or bankruptcy of financially distressed firms results in significant direct and indirect costs to many stakeholders; including shareholders, managers, employees, lenders and clients. For instance Shareholders lost nearly $11 billion when Enrons stock price, which hit a high of US$90 per share in mid-2000, plummeted to less than $1 by the end of November 2001. Failure of Australias second largest insurance company, HIH Insurance, in 2001 represents the 2nd largest corporate collapse in Australias history. The collapse of HIH entailed huge individual and social costs. The deficiency of the group was estimated to be $3.6 billion and $5.3 billion. The lineup of major corporate bankruptcies was capped by the mammoth filings of Conseco ($56.6 billion in liabilities), WorldCom ($ 46.0 billion), and Enron ($ 31.2 billion actually almost double this amo unt once you add in the enormous amount of off-balance liabilities making it the largest bankruptcy in the united states. Such costs may be avoided if financially distressed companies are identified well before failure. Then corrective measures can be taken to save the company from ominous bankruptcy. Much of the literary work on financial distress relates to failure prediction and survival analysis of firms. Some studies on financial distress have been made in the context of corporate risk management. Our study aims at studying the financial distress along with key performance indicators of the corporations to see how these indicators (profitability, Size of Firm, Working capital and Working capital productivity.) co-move with the financial distress. There is not sufficient literature on studying the effect of financial distress on corporate cash flows. Especially in Pakistan, the area has not been researched thoroughly. We estimate a linear model, which helps us in the measu rement of magnitude of effect of financial distress on the operating cash flows. Along with financial distress, we also measure the effect of size of firm, operating profits, working capital and working capital productivity on operating cash flows. We have included both financially distressed and financially healthy firms in our sample. Our findings provide evidence that financially distressed Pakistani firms face adverse cash flow problems. The remainder of this paper is organized as follows. Section 2 presents a review of literature in the area of financial distress. Section 3 describes Methodology and research design, i.e. data and variables used in the study. Section 4 describes the empirical framework (Model Description). Section 5 presents the results of the regression analysis. Section 6 Discussion and concludes the paper. 2. Literature Review The effect of financial distress on financial structure decisions is another conflicting point. According to the static trade-off theory, both the advantages of debt (tax shields) as well as its disadvantages (insolvency costs) have been traditionally considered in the capital structure literature. This trade-off between the benefits and costs of debt focuses on ex-ante insolvency costs, whose negative effect on leverage has been theoretically justified (Barnea et al., 1981) as well as empirically documented (Miguel Pindado, 2001). According to (Warner (1977), Altman (1984), Franks Touros (1989), Weiss (1990), Asquith, Gertner and Scharfstein (1994), Opler Titman (1994), Sharpe (1994), Denis Denis (1995), Gilson (1997) Financial distress has both direct and indirect costs. (Opler Titman (1994), (Shleifer Vishny (1992), Direct costs of distress, such as Litigation fees are relatively small. Indirect costs, such as loss of market share and inefficient asset sales are belie ved to be more important, but they are also much harder to quantify. The debate on financial distress started after the occurrence of corporate failures. Theorists and researchers emphasized on how to save a firm from being financially distressed. Opler Titman (1994) provide empirical evidence that financially distressed firms lose significant market share to their health competitors in industry downturns. Chevalier (1995) was of the view that financially distressed firm is likely to violate the debt covenants and these violations put heavy costs on the firm. Froot et al. (1993) established that financially distressed firms forego positive NPV projects. Researchers are of the view that a firm with a high leverage has an incentive to engage in hedging activities. The measurement of financial distress has also been debatable in the literary circles. Some researchers use leverage as a proxy for financial distress. Failure prediction models use firms distance to default as a prox y of the financial distress. Some models used accounting based measures of financial distress. Hill, Perry Andes(1996), Ward Foster(1997), DeYoung(2003), Nikitin(2003) and laitinen(2005) use only financial ratios as financial distress predictors; while Altman(1969), Ahrony, Jones and Swary(1980), Altman Brenner(1981), Broenstein Rose(1995) and Fama French(1995) used only market based covariance. Majority of researchers believe that financially distressed firms appear to exhibit lower profitability, lower historic excess returns and larger size than active companies. Beaver (1966) pioneered the development of model for corporate failure prediction. He found that the model can predict failed firms for at least five years before to failure. His model was based on financial ratios as single predictors of financial distress. Altman (1968) criticized the model and upheld that the model may give inconsistent and confusing classifications results for different ratios on the same fir m. Altman (1968) came up with his own model which can handle multiple financial ratios in predicting companys failure. In Altman (1968) study, five financial ratios include (1) working capital to total assets (2) retained earnings to total assets (3) earnings before interest and tax to total assets (4) market value of equity to par value to debt and (5) sales to total assets. His model found to be the best predictor of corporate bankruptcy. The model is very popular and is called Z Score model. The critics of this model say that it violates the assumption about the multivariate normal distribution of independent variables. Castagna Matolcsy (1981) pioneered the study of corporate financial distress and failure .In USA and Europeon countries, survival analysis techniques form the basis for a number of studies in financial distress research area. Cash flow is strongly related to financial distress. Henbry (1996) studied whether adding cash flow information will improve current ban k failure prediction models. Some researchers were of the view that combining market-driven variables with accounting ratios provide more accuracy to the financial distress models. Compartive studies have also been done in the area of financial distress. Rommer(2005) compared the financial distress predictors between French, Italian and Spanish firms using competing risk models. There are few research studies on financial distress in Asian context. For example, Honjo(2000) employs multiplicative hazards model for investigating business failure for new firms in Japanese manufacturing industry whereas Raj Rinastiti(2002) use Cox proportional hazards model to examine the failed banks in Asia during 1997 Asian crisis. Some of the prior corporate failure studies focus the analysis on specific industry sector. Chen and Lee (1993) focus the study on oil and gas industry. Similarly, Lee Urrutia(1996) have studied the property liability insurance industry. Researchers have establishe d that income capacity, operating efficiency and leverage are important factors in explaining corporate failure and financial distress.According to Hossari Rahman (2005), empirical investigation of corporate failure may be classified in to two categories; the studies that do not use financial data and those which use financial data which may be further classified in to those that use non ratio financial data and those that make use of financial ratios in modeling corporate collapse. The use of financial ratios to predict corporate failure has been well established since the original study of Beaver (1966). Most of the empirical research in this area has used financial ratios and have been successful in discriminating between failed and successful firms. However despite this success, financial ratio models have been criticized because of window dressing of figures on the part of the firm by use of creative accounting. Critics emphasize the use of market-based data along with fina ncial ratios. Many studies make use of market data for analyzing the financial distress of companies. Aharony, Jones and Swary (1980) find differences in the behavior of total and firm-specific variances in returns four years before formal bankruptcy is announced. Altman and Brenner (1981) suggest bankrupt firms experience deteriorating capital market returns for at least a year before to bankruptcy. Clark and Weinstein (1983) suggest that there is negative market return at least three years before to bankruptcy. Mossman et al. (1998), Shumway (2001) and Turetsky and McEwen (2001) also support that there is a relationship between market based variables and the likelihood of corporate financial distress. Company specific variables such as company age, size of the firm and squared size have also been used in the prediction of financial distress. Prior studies suggest that company age and size effect its endurance. The younger and smaller firms are more likely to fail than establ ished or bigger firms as they dont have sufficient experience in the business. Larger firms are expected to better manage and protect them from financial distress than smaller firms (Audretch Mahmood, 1995; Honjo, 2000). Small firms have a higher probability of entering financial distress because they are not resistant to the shocks they might encounter and the large firms have a high probability of entering financial distress because they might have inflexible organizations, problems with monitoring managers and employees and difficulties with providing efficient intra-firm communications. Researchers have also established that probability of financial distress is a decreasing function of firm size. Luoma Laitinen ( 1991) established that the symptoms of financial distress are observable from the deterioration of financial ratios or the effect of such ratios on corporate failure dont stay constant over time. Studies provide evidence that financial distress is not without costs . Financially distressed firms have to incur direct bankruptcy costs, higher contracting costs, the loss of tax shields and loss of valuable investment opportunities All the above studies provide us a solid base and give us idea regarding effect of financial and its components on operating cash flow. They also give us the results and conclusions of those researches already conducted on the same area for different countries and environment from different aspects. On basis of these researches this paper extends the previous research work done on financial distress. We have used modified Altman Z Score as a proxy for the financial distress. After including the financially distressed and financially healthy firms in our sample, we have seen the effect of financial distress on corporate cash flows. Prior to this work hardly any paper can be seen which studies the impact of financial distress on corporate cash flows, especially in Asian context. Our work adds to the literature in a sen se that it not only identifies the financially distressed firms but also measures the effect of financial distress on operating cash flows of the firms listed on Karachi Stock Exchange. Our work also contributes to the literature in establishing a fact that whether the model of financial distress developed by Altman is relevant in Pakistans Corporate Environment. 3. Methodology The purpose of this research is to contribute towards a very important aspect of financial management known as financial distress effects on operating cash flow with reference to Pakistan. Here we will see the relationship between financial distress effect on profitability of 64 Pakistani Joint stock firms listed on Karachi stock Exchange for a period of six years from 2003 2008. This section of the article discusses the firms and variables included in the study, the distribution patterns of data and applied statistical techniques regression analysis in investigating the relationship between financial distress and operating cash flow. Data and Variables Secondary data has been used in this study. The financial data of 67 companies listed on Karachi Stock Exchange has been compiled. The source of data is Statistics Department, State Bank of Pakistan. We have used financial data of 67 companies for four consecutive years i.e. from 2003 to 2008. We have selected 67 companies from different sectors such as Fuel and Energy, Cement, transport and communication, Engineering, Sugar, Chemical, Paper and Board and Miscellaneous sectors. Our sample consists of financially healthy as well as financially distressed companies. In this study we have operating cash flows as dependent variable and Financial Distress as independent variable. Along with financial distress we have used four other variables; firm size, operating profit working capital and working capital productivity. Measurement of Variables Operating Cash Flows (OCF) OCF has been arrived at by adding depreciation and current liabilities to the operating profit and deducting the accounts receivables there from have measured OCF. OCF is a dependent variable in this study. Explanatory Variables Financial Distress (FD), Size of Firm (SZ), Working Capital (WC), Working capital productivity (WCP) and Operating Profit are explanatory variables. Financial Distress (FD) In order to measure financial distress we have used modified Altman Z-Score model. It has been calculated as follows Altman Z Score= EBIT/Total Assets + Sales/Total Assets + 1.4*Retained Earnings/Total Assets + 1.2*Working Capital/Total Assets Where EBIT stands for earnings before income tax and interest. If Altman Z-Score is 3 or greater than 3, firm is said to be in good financial health. If Altman Z Score is greater than 2 but less than 3 firms has some risk of entering financial distress. And if firm has Altman Z Score of less than 2, it means that firm has entered financial distress and it may become bankrupt. Size of Firm (SZ) We have measured the size of firm (SZ) by taking the natural logarithm of the total sales of the firm. Operating Profit (OP) Operating profit means the profit associated with the core operations of the business. Working Capital (WC) Working Capital has been measured by deducting current liabilities from current assets. WC= Current Assets Current Liabilities Working capital Productivity (WCP) Working capital productivity is an expression of how effectively a company spends its available funds compared with sales or turnover, the working capital productivity figure helps to establish a clear relationship between its financial performance and process improvement. Higher will be the figure better would be working capital productivity. Working capital productivity = Sales à · (Current assets Current liabilities) Hypotheses Testing Since the aim of this study is to examine the relationship between financial distress and operating cash flow, the study makes a set of testable hypothesis {the Null Hypotheses H0 versus the Alternative ones H1}. Hypothesis 1 The first hypothesis of this study: H01: There is positive effect of financial distress on operating cash flow of Pakistani firms. H11: There is a negative effect of financial distress on operating cash flow of Pakistani firms. Hypothesis 2 The second hypothesis of the study is: H02: There is positive effect of operating profit on operating cash flow of Pakistani firms. H12: There is negative effect of operating profit on operating cash flow of Pakistani firms Hypothesis 3 The Third hypothesis of the study is: H03: There is positive effect of size of firms on operating cash flow of Pakistani firms. . H13: There is negative effect of size of firms on operating cash flow of Pakistani firms. Hypothesis 4 The Fourth hypothesis of the study is: H04: There is positive effect of working capital on operating cash flow of Pakistani firms. H14: There is negative effect of working capital on operating cash flow of Pakistani firms. Hypothesis 5 The Fourth hypothesis of the study is: H05: There is positive effect of working capital productivity on operating cash flow of Pakistani firms. H15: There is negative effect of working capital productivity on operating cash flow of Pakistani firms. 4. Empirical Framework Our estimated model, which shows the effect of financial distress on corporate cash flows, is as under: OCF = B B1FD + B2 SZ + B3 OP -B4 WC + B5WCP In this equation: OCF = Operating Cash Flows B= Constant Term or intercept of the equation B1= Slope of the variable financial distress (FD) FD= Financial Distress B2= Slope of the size variable SZ= Size of the firm B3= Slope of the operating profit variable OP= Operating Profit B4= Slope of the working capital WC= Working Capital B5= Slope of the working capital productivity WCP= Working capital productivity 5. Results The model shows that variable FD has a negative coefficient, which means that with the FD has a negative effect on the operating cash flows. Variable Size (SZ) has a positive coefficient which means that greater the size of the firm, the more cash flows for the firm from operations. Operating Profit (OP) has a positive coefficient, which means that OP has robust effect on Operating cash flows. Working capital has negative coefficient, which means that it is negatively related to cash flows from operations and working capital productivity (WCP) has a positive coefficient, which means Sales growing faster than the resources required to generate them is a clear sign of efficiency. B in this equation is intercept of the model or constant term. Let us see some descriptive statistics of our analysis. The table shows the mean values of OCF, FD, OP, SZ, WC and WCP. Descriptive Statistics Mean Std. Deviation N OCF 4525.2953 12646.70110 67 FD (Altman Z-Score) 1.926 1.5573 67 Firm Size 7.45587 2.162929 67 Working Capital 882.35 2587.491 67 Working Capital Productivity Operating Profit 6.75426 1348.82373 1.876545 5619.621546 67 67 Let us see the correlation matrix of the dependent and explanatory variables. The matrix shows that OCF is negatively related to FD while it is positively related to SZ, WC, and OP. It shows that FD is negatively related to OCF and OP while positively related to SZ and WC. Firm Size (SZ) is positively related to all variables. Similarly WC is negatively related to WCP and positively related to positive correlation with all other variables. Operating Profit (OP) has negative correlation with FD while positive correlations with OCF, SZ, WC and WCP .Working Capital Productivity (WCP) is negatively related to WC and positively related to all other variables. Correlations OCF FD(Altman Z-Score) Firm Size Working Capital Working Capital Productivity Operating Profit Pearson Correlation OCF 1.000 -.110 .443 .645 .387 .928 FD(Altman Z-Score) -.110 1.000 .174 .020 .225 -.044 Firm Size Working Capital Working Capital productivity Operating Profit .443 .421 .645 .928 .174 .225 .020 -.044 1.000 1.500 -.043 .309 .343 .348 1.000 .752 .174 -.100 2.50 .285 .309 1.032 .752 1.000 Sig. (1-tailed) OCF . .189 .000 .000 .000 .000 FD(Altman Z-Score) .189 . .079 .437 .000 .363 Firm Size .000 .079 . .002 .079 .005 Working Capital Working Capital Productivity .000 .000 .437 .072 .002 . .387. . .000 Operating Profit .000 .363 .005 .000 .005 . N OCF 67 67 67 67 67 67 FD(Altman Z-Score) 67 67 67 67 67 67 Firm Size 67 67 67 67 67 67 Working Capital Working Capital Productivity 67 67 67 67 67 67 67 67 67 67 67 67 Operating Profit 67 67 67 67 67 67 Variables Entered/Removed (b) Model Variables Entered Variables Removed Method 1 Operating Profit, FD(Altman Z-Score), Firm Size, Working Capital(a) Working Capital Productivity . Enter a. All requested variables entered. b. Dependent Variable: OCF Consider the Model Summary of our Estimated Regression Model. Model Summary (b) Model R R Square Adjusted R Square Std. Error of the Estimate Durbin-Watson 1 .954(a) .911 .905 3892.72617 2.145 a. Predictors: (Constant), Operating Profit, FD (Altman Z-Score), Firm Size, Working Capital (WC), Working Capital Productivity (WCP) b. Dependent Variable: OCF Coefficient of determination (R Square) or Model Fit is 0.911 which means that explanatory variables are capable of explaining 91% variations in the dependent variable i.e. Operating cash flows OCF. The ANOVA Table shows us the F-statistics. F-Statistics shows the overall strength of the model. F Value is 158.653 which is quite high. Hence we reject the null hypothesis that explanatory variables have positive effect on operating cash flows and we establish that Financial distress (FD) has a negative effect on operating cash flows (OCF). ANOVA shows that our model is quite good to estimate the effect of financial distress (FD), Size of the Firm, Operating Profit, Wor king Capital and Working Capital Productivity on Operating Cash Flows. ANOVA (b) Model Sum of Squares df Mean Square F Sig. 1 Regression 9616471554.991 4 2404117888.748 158.653 .000(a) Residual 939505654.596 62 15153317.010 Total 10555977209.586 66 a. Predictors: (Constant), Operating Profit, FD (Altman Z-Score), Firm Size, Working Capital, Working Capital Productivity b. Dependent Variable: OCF Consider the table which shows the t-values for our variables. The table shows that the size of the firm (SZ), operating profit and Working Capital Productivity (WCP) are statistically significant to affect the operating cash flows. If we ignore the sign FD is statistically significant to affect the corporate cash flows. Coefficients (a) Model Standardized Coefficients t Sig. Correlations Beta Zero-order Partial Part 1 (Constant) -3.051 .003 FD(Altman Z-Score) -.101 -2.605 .011 -.110 -.314 -.099 Firm Size .214 5.192 .000 .443 .550 .197 Working Capital Working Capital Productivity -.165 .245 -2.818 5.428 .006 .000 .645 .389 -.337 .500 -.107 .187 Operating Profit .982 16.916 .000 .928 .907 .641 a. Dependent Variable: OCF Coefficient Correlations (a) Model Operating Profit FD(Altman Z-Score) Firm Size Working Capital Working Capital Productivity 1 Correlations Operating Profit 1.000 .105 -.100 -.724 -.200 FD(Altman Z-Score) .105 1.000 -.187 -.046 -.185 Firm Size -.100 -.187 1.000 -.165 -.285 Working Capital Working Capital Productivity -.724 1.500 -.046 -.187 -.165 -0.45 1.000 -.058 -0.56 1.000 Co-variances Operating Profit .017 4.327 -3.154 -.027 -2.564 FD(Altman Z-Score) 4.327 98915.750 -14174.525 -4.175 -12178.252 Firm Size -3.154 -14174.525 58048.854 -11.340 58045.85 Working Capital Working Capital Productivity -.027 -3.254 -4.175 -12175.252 -11.340 4.327 .082 -.028 -4.585 .958 a. Dependent Variable: OCF Case wise Diagnostics (a) Case Number Std. Residual OCF Predicted Value Residual 56 3.892 11960.00 -3190.8577 15150.85766 62 4.706 27198.30 8880.1328 18318.16716 a. Dependent Variable: OCF Residuals Statistics (a) Minimum Maximum Mean Std. Deviation N Predicted Value -7234.8931 94892.6719 4525.2953 12070.79593 67 Residual -6178.19580 18318.16797 .00000 3772.92117 67 Std. Predicted Value -.974 7.486 .000 1.000 67 Std. Residual -1.587 4.706 .000 .969 67 a. Dependent Variable: OCF 6. Discussion Analysis on financial distress prediction model with modified Altman-Z Score results shows that our model is robust in explaining the variations in dependent variable i.e. Operating Cash Flows (OCF). Our estimated model shows that the variable Financial Distress (FD) is negatively related to corporate cash flows. However Firm Size (SZ) Operating Profit (OP) and Working Capital Productivity (WCP) are positively related to FD. In this study we found another negative relationship between Working Capital (WC) and operating cash flow. This study shows that financial distress negatively affects the operating cash flow of firm and if firm would be big in case of size than effect of financial distress on operating cash flow would not be as negative as this will be in case of small firm and positive effect of Working capital productivity and operating cash flow shows that how effectively a company spends its available funds compared with sales or turnover, the working capital productivity f igure helps to establish a clear relationship between its financial performance ,process improvement and operating cash flow. Negative effect of working capital on operating cash flow is obvious because it shows that capital not being put to work properly is being wasted, which is certainly not in investors best interests. Conclusion Our results show that our model is robust in explaining the variations in dependent variable i.e. Operating Cash Flows (OCF). We have used the financial data of 67 firms, half of which were facing financial distress. We measured the effect of Financial Distress (FD) on the Operating cash flows. Our estimated model shows that the variable Financial Distress (FD) is negatively related to corporate cash flows. However Firm Size (SZ) Operating Profit (OP) and Working Capital Productivity (WCP) are positively related to FD. The notion that large firms in Size have more probability of entering financial distress has not been substantiated by our study. Rather our study shows that the larger the size of the firm, the more the operating cash flows and company effectively spends its available funds compared with sales or turnover, the working capital productivity figure helps to establish a clear relationship between its financial performance and process improvement and therefore less chanc es of being financially distressed. Another important finding of the study is negative relationship between working capital (WC) and Operating Cash Flows (OCF). It means the more working capital we have, the less operating cash flows we have. Actually greater working capital means we have more funds tied up which have not been gainfully utilized in the business. This may be as a result of an error of estimating cash for business requirements on the part of the management. Huge working capital has its opportunity cost and that cost may be in the shape of less operating cash flows and less profitability. Our analysis strongly supports that higher operating profits result in higher operating cash flows for the firm; and this is true for small firms as well as for large firms in size. Summing up we can say that by using this model, on large data set we can obtain more generalize ability of the results. Refererences Altman E. (1968). Financial Ratios, Discriminant Analysis and the prediction of Corporate Bankruptcies. Journal of Finance, 23,589-609. Aharony, J., Jones, C. P. Swary, I. (1980).An analysis of risk and return Characteristics of corporate bankruptcy using capital market data.Journal of Finance, 35(4), 1001-1016. Altman, E.I. Brenner, M.(1981).Information effects and stock market responses to signs of firm deterioration. Journal of Financial and Quantitative Analysis, 16(1), 35-51. Audretsch, D.B. Mahmood, T. (1995). New Firm Survival: New Results using a hazard function. The review of Economics and Statistics, 77(1), 97-103. Beaver, W. H. (1966). Financial Ratios as predictor of failure, Empirical Research in Accounting: Selected Studies. Supplement to Vol. 4,71-111. Borenstein, S. Rose, N. L.(1995). Bankruptcy and pricing behavior in U.S. airline markets. The American Economic Review, 85(2) ,397-402. Castagna, A. D. Matolcsy, Z. P. (1981).The prediction o f Corporate Failure: Testing the Australian experience. Australian Journal of Management, 6(1) ,23-50. Chen, K. C. W. Lee, C. W. J. (1993).Financial ratios and corporate endurance: A case of the oil and gas industry. Contemporary Accounting Research, 9(2), 667-694. Clark, T. A. and Weinstein, M . I. (1983). The behavior of the common stock of bankrupt firms. Journal of Finance, 38(2),489-504. Chevalier, J., (1995).Capital Structure and Product Market Competition? An Empirical Evidence from Super Market Industry,Journal of Finance, 50,1112-1195. Froot, K. A., D. S. Scharfstein and J.C. Stein, (1993).Risk Management: Coordinating Corporate Investments and Financing Policies. Journal of Finance ,5,1629-1658. Opler, T. S. Titman, (1994). Financial Distress and Corporate Performance. Journal of Finance 49,1015-1040.

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Question: Discuss about the Certificate IV in Ageing Support. Answer: Responding to people from diverse cultural background: Situation 1- While providing support services to community, once I came across a person from ethic community of Australia. As he had different social and cultural beliefs about illness, I tried to understand his needs. Action 1- The person was not fluent in English and has his own dialect to communicate. I tried to understand his problem by non-verbal gestures and body language. While interacting with him, I was respectful towards him and gave him enough time to respond. I used indirect questions and also clarified whether he understood the meaning of the words. Outcome 1- It made the person comfortable and I got to know his problem. Situation 2- Once I provided support and care service to an aged Catholic who was depressed. Action 2- For me knowing about his problem which leads to depression was important to provide appropriate care and support. I asked him questions about his culture and personal history to examine difference in his culture from my own. I patiently listened to understand the conflicts in his life and situations leading to his current condition. Outcome 2- Appropriate relationship was established through listening and knowing about his cultural beliefs. Situation 3- Once I was involved in a group discussion where people from mainstream culture were dominating the discussion and people from minority culture remained silent. Action 3- I came to know that in some culture, it is customary for them to maintain silence for them before speaking. Women in ethnic minority groups do not speak up because their societies do not regard them as an important contributor of society. I held a personal meeting with the quieter people and encouraged them to speak. I also tried to ask what would make them comfortable in speaking. Outcome- 3- This meeting with the quieter people helped them to speak. Changes noticed within oneself Situation 1- Earlier I was not aware of diverse ideas about cultural difference in community. I judged people from my socio-cultural view point; however this course helped me to understand the diverse socio-cultural beliefs of people from different cultural background. This knowledge helped me in effectively interact with such people. Action 1- The change I find in me is that now I value and respect diversity of each cultural groups. I learned that people from different cultural background have their own style of communication and health beliefs. They take their action on those beliefs. I learnt how the migration experience affected their lives and attitude. The awareness about denial of different rights and exposure to violence helped me understand their needs in a better way and respond accordingly to make their lives better. Outcome- I achieved cross-cultural competence in dealing with such person. Safe work practices Situation- Action taken for workplace risk assessment Action- The following actions were taken to identify workplace risk: Examined past accident or risk in the workplace. Consulted employee about any safety issues or workplace hazards. Inspection and documentation of workplace environment by means of appropriate tool. Analyzed events that might take place due to presence of certain structure or process at the workplace. Evaluation of the severity of harm in different risk category. Outcome- Risk in workplace was identified and risk level rating helped in documenting required action to eliminate the risk. Work legally and ethically Situation 1- As a primary carer in hospital, a women came with serious head injuries for which she needed surgery immediately. However her husband died in the accident and she refused to sign the consent form unless informed about him. Action 1- According to National Competency standard for registered nurse, it is necessary to practice in accordance with legislation affecting nursing practice. According to legal requirement, without informed consent, surgery was not possible. The ethical code of non-malefecence and beneficence avoided me to inform patient about her husbands death. However I gave priority to the ethical code of autonomy so that patient knows about her husband and also gives consent for surgery. Outcome 1- Legal and ethical code for nursing practice was followed. Situation 2- Caring for an aged person as a community service worker. Action 2- As part of ethical principal and standard for aged care, my action needed to be consistent with professional values. I had to be loyal and responsible to avoid any conflict of interest in this group avoiding any harm was also a priority. Hence, while caring for them I indentified the risk and benefit of all intervention for the elderly people. The clients autonomy was balanced according to the best interest of client. Outcome 2- Care was provided within professional boundary. Situation 3- I faced ethical dilemma in community service when a young woman asked for help to arrange an abortion. Action 3- As a community worker, I believed right to life was important for all and I strongly discouraged the women and refused to help her. It was a conflict of interest situation and I avoided any ethical dilemma by stating my professional values do not support this act. Outcome 3- Professional boundary in care was maintained. Situation 1- Ethical dilemma of freedom versus control Action 1- A patient admitted to care service refused to eat due to the sufferings she was having due to her illness. As a carer, it was an ethical dilemma for me as I knew it may harm the patient. I could not force her too, hence I decided to compassionately explain her harmful consequence of avoiding meals and chances of further deterioration in her condition. Outcome 1- Ethical principle of autonomy and beneficence was maintained and patient was ready to eat. Situation 2- Ethical dilemma of truth telling and deception Action 2- A patient was diagnosed with cancer and her family members insisted not to reveal this to patient. However, this may challenge the autonomy and right of patient. I advised the family members that hiding truth may lead to more harm in the future. Outcome 2- Family members were ready to tell about the disease to patient. Situation 3- An elderly person came to the community service and he had diabetes. However, he had no control on his diet and binged on any food items. Action 3- To address the behavioral component of successful aging, the elderly persons lifestyle choices was an ethical dilemma for me. I discussed with him regarding the changes in body due to ageing and diabetes and how eating all types may harm him. Outcome 3- I managed to convince him regarding controlling his diet and leading a healthy life style. Workplace improvement Situation 1- The lack of hygiene at a care centre for aged was compromising the health and safety conditions of care seekers. Action 1- The staffs practices little hygiene and the premised was very dirty which could seriously harm elderly people with ailments. To maintain safety at work place, I took immediate action to train staffs regarding hygiene issues and all resource was provided to maintain cleanliness and avoid risk of infection. Outcome 1- Improvement in hygiene practice among staff was achieved. Situation 2- There was lack of coordination among staffs regarding their role and responsibility in social service and it was leading to many errors and chaotic situation. Action 2- To support good practice and maintain ethical principles, I arranged effective induction process for staff. The workload management included distributing written policy regarding role of social workers and protecting confidentiality of service users. They were made aware of the importance of alignment of service with social work values to maintain social justice. Outcome 2- Discriminatory behavior and inappropriate practice was addressed. Recognize healthy body system Situation 1- I came to know that a person was in severe depression after the loss of his husband and she hardly interacted with anyone. Action 1- Understanding the inner conflict and grief of the person, I gave her enough time and did not forced anything to her. I was very patient and tried to engage her in activities so that she temporarily forgets her sorrow. After she was comfortable with me, I slowly made realize her real worth in life and how she should aim for the future to make a better life. Outcome 1- It made the person overcome her depression and remove negative thoughts about worthlessness in life. Situation 2- I encountered a person with terminal illness who was in the last stage of his life. Action 2- In case of providing support to people with terminal illness, I shifted my care priorities. The main focus was on relieving pain and emotional distress in the person and maintaining their dignity in death too. I paid special attention to helpful interventions that eased the patients discomfort and helped him to connect with loved ones. Outcome 2- Respite care was achieved as it gave patient a break from the intensity of illness. Situation 3- Caring for elderly people with disability with gait. Action 3- I assessed the elderly person for the cause of gait disorder and found that it was due to arthritis. I arranged exercise program and physical therapy to improve balance, flexibility and muscle strength. Outcome 3- Exercise program helped in improving balance in the affected person. Provider support to people living with dementia Situation 1- Supporting people with dementia who struggle with judgement and finding words. Action 1- I tried to interact with the patient and used short words to avoid any confusion. It tried to give the patient appropriate environment such as well-lit room, clocks, calendars and familiar personal effects. In case the patient turned aggressive, I took care to shift the topic to acknowledge his feelings. In case of delusions, I tried to reinforce reality and provide support to patient. Outcome 1- The patient demonstrated congruent verbal and non-verbal communication. Situation 2- Supporting dementia patient who had difficulty in completing activities of daily living (ADLs). Action 2- First I monitored patient for his ability to perform ADLs and labeled patients cloth with name, address and telephone numbers. The patients food and fluid intake was monitored and assistance was given to patient during means. A bowel and bladder program was initiated to maintain continence and urine retention. Outcome 2- It gave the patient independence in self-care and management of ADLs. Reflection on conversation Situation- After the conversation with primary carer of people with dementia, they revealed challenges in providing person-centered care and providing appropriate recreational activities for them. Action- After this conversation, the affect was that I learned to take short break from caring to avoid burnout. Carers may also develop feelings of guilt, loss and anger. In that case, it is necessary to feel the pain and share it with counselors. Carers are often vulnerable to psychological morbidity and social isolation. Psychosocial interventions help to reduce the burden of care givers and build effective partnership with patients. Outcome- It helped in accurate patient care and providing stimulating environment to patients and carers. Facilitate empowerment of older people Situation 1- Used person-centered approach to care for older people Action 1- According to the standards of person-centered care, I have respected values of older people and passionately interacted with them to understand their physical, psychological and spiritual needs. I held the belief that flexible caring environment should be provide to older people where they are protected from all forms of physical, psychological, social abuse and violation of their rights. As they have many disability and health issues due to illness, they were regularly monitored and assessed for risk of infection, injury, imbalanced liquid volume, impaired verbal communication and many others. Outcome 1- Optimum health and well-being was achieved in older people. Situation 2- Adjusted communication for older people Action 2- Effective communication with older people becomes a challenge due to sensory deficits in them and gap in caring techniques of elderly patients and nurses. Generation gap also poses a problem due to different values and expectation of patient and care provider. The main action taken to overcome these challenges was to modify speech while communicating with elderly people. Altered pitch, touch and verbal expression were included in adjusting communication style with caring for elderly people. Outcome 2- It helped elder people to be satisfied with care given or provided. Situation 3- Assisted older people in necessary activities. Action 3- Cognitive intervention was provided to assist them in necessary life activities. The spatial perception of elderly was improved through memory training. It gave them stress management and memory self-efficacy support. They were given assistance in feeding, bathing and ambulating. Appropriate ambulatory support was provided to them to move without any assistance. Comfortable clothing was given and appropriate physical exercise according to their age was given to help in physical activities. Outcome 3- Elderly people achieved assistance in daily life activities. Situation- Adapting different communication styles to maintain positive relation with co-workers Action- To improve interpersonal relationship at workplace, I have adapted open communication style to discuss regarding issues in open platform. In case of written communication, I ensure that the language is simple yet explanatory so that reader understands my message instantly. To positively collaborate with co-workers, I try to provide correct information regarding work so that they do not have any issue or confusion regarding work. Assertive style of communication helped me to be active listener and negotiation any workplace conflicts. Outcome- Positive relation and team collaboration was achieved between co-workers. Situation- During caring for elderly patients, I tried to assess the client for any fall risk. Action- The assessment of fall risk in patient was done by means of multifactorial assessment. It helped to identify different fall risk factors and it included assessment of fall history, gait, muscle weakness, urinary incontinence, visual impairment, environmental hazards, cognitive impairment and medication review. It was done by appropriate fall risk tools. Outcome- Fall risk was identified and appropriate intervention was provided accordingly. Communicate and work in health Situation 1- Engaging in socio-cultural communication with people from different cultural background. Action 1- I made all attempts to understand the health and cultural beliefs regarding illnesss from these groups. This understanding helped in providing care according to their needs and preference. Outcome 1- Cultural competency in care was achieved. Situation 2- I engaged in culturally appropriate communication technique in addressing person from another culture. Action 2- I used different code of speech patterns and non-verbal communication techniques to establish rapport with the person. Before taking any action, I tried to listen and acknowledged their understanding about their personal issues. Outcome 2- Appropriate cooperative behavior was seen. Situation 3- I adapted different communication approach to manage conflict in community service. Action 3- I tried to listen to the opinion of each party and took honest feedback from them regarding challenges in community service. It helped in identify the area of problem and establishing credibility in the work process. Outcome 3- Conflict management in workplace was achieved. Communication barrier in workplace Situation 1- I faced communication barrier when a person from ethnic minority group was speaking in a different language which I did not knew. Action 1: I tried to understand the persons problem by his body language, hand gestures and non-verbal behavior. Outcome 1: I could interpret what the person wanted to say. Situation 2: I was discussing support options for a client who was a victim of domestic violence and the office environment such as noise and people walking by was acting as barrier in communication. Action 2: I moved to a much quieter place so that the client could concentrate and disclose his feelings to me. Outcome 2: The person was now paying attention to the discussion. Situation 3: I got a lengthy and disorganized message in community service and I was having problem in understanding what exactly I needed to do. Action 3: I paid more attention and whatever I understood I repeated it again to my coordinator to avoid any confusion. Outcome 3: I could overcome the problem in understanding message. Clarification of workplace instruction Situation 1: Instructing nurse regarding preparing a staff for surgery. Action 2: All pre-operation detail about the patient was given to the nurse and she had to assess the patient according to those parameters. She had the responsibility to get everything done one hour before surgery. Outcome 1: As instructed, the task was completed within set time frame. Situation 2: Instruction staff regarding supporting an elderly person in physical exercise. Action 2: All instruction regarding correct way of exercise was provided and he was asked not to over-exert himself to avoid any harm. A stop clock was given to him with duration of time to give for each exercise. Outcome 2: The instruction helped in maintaining accurate exercise routine. Support independence and well-being Situation 1: Care plan for balance disorder in an elderly patient. Action 1: It gave detail on multi-factorial assessment of patients and ways to conduct Timed Up and Go Test. Ambulator assistance was given to him to move at home independently and prevent injury. Outcome 1: The person was able to move independently for short distance. Situation 2: Care plan for elderly people with hip replacement surgery. Action 2: The instruction regarding physical therapy exercise helped me to support the client in contracting and relaxing certain muscles and teaching simple activities like sitting and bending. Outcome 2: It helped strengthen the hip and do slight movement by 1 week. Situation 3: Caring for elderly people in activities of daily living Action 3: Instruction regarding ADLs helped me support the person while bathing, dressing, moving and toileting. The patient was given the correct medicine and reminded about medicine on time. Outcome 3: The elderly people key need was met. Provide individualized support Situation: During my placement in health service, the senior nurse helped in supporting elderly in ADLs. Action: She gave me the idea that elderly people have many disabilities like low vision, hearing problem, balance and disorder problem and trouble in movement. She reminded me that never let them take medicine themselves as due to low vision they may take the wrong medicine. Furthermore she gave me all instruction regarding how to support them during feeding, bathing, dressing and toileting. Outcome: Support was given to client in ADLs. Palliative approach Situation- Caring for a cancer patient in palliative care. Action- I was emotionally drained and exhausted after experiencing the last stage of a person in front of my eyes. The suffering of the person each day made me depressed and I could feel the pain of their family members. Outcome- It brought me closer to the reality of death. Client receiving palliative care Situation 1- Assessment of medication in palliative care patient. Action 1- Only necessary medication was given and all unnecessary medication which may prolong suffering was avoided. Outcome 1- The patient suffering due to medication side-effect was reduced to some extent. Situation 2- Continuous assessment of symptoms and psychological needs of patients. Action 2- All attempts was made to maintain dignity in end stage of life. To meet psychological needs, all things were provided that gave the patient pleasure and happy time. Outcome 2- Prompt care was provided. Situation 3- Deactivation of certain medical device. Action 3- Cardiac defibrillator was deactivated to avoid pain and discomforts to patient. Outcome 3- Optimum care was provided. Issues during documenting arise for each of the client because with chronic illness, they presented many form of physical impairment and internal ailments. It was hard to keep track of care provided for different problems in the patient. Personal support needs Situation 1: Supporting elderly people in ADLs. Action 1: I was involved in assisting the elderly person in dressing, feeding, movement and toileting. I felt very positive when I could immediately respond to the need of the person and made sure that he did not have any hard time. Outcome 1: I gained confidence in assisting people in ADLs. While supporting the above person, I noticed a change in my attitude towards elderly. I was now aware about the changes in body due to aging and their disabilities made me a compassionate service staff. Relationship with carers and family members Situation 1: A patient with kidney problem Action 1: Family members were unaware about the dietary needs of patients with kidney ailments. I gave them diet instruction to avoid any problem. Outcome 1: Risk minimized Situation 2: An elderly person with diabetes. Action 2: The person was resisting controlling diet and his family members were asked to coax him to understand the importance of avoiding sweets to prevent further complication. Outcome 2: Physical needs during diabetes maintained. Situation 3: Supporting elderly people in physical exercise. Action 3: Their family members were also involved to make them understand the right way of exercise and correcting the person at home. Outcome 3: Effective physical exercise routine became possible. Action for situation 1: To maintain relationship with family members, they were asked to be patient with the patient and give emotional support to overcome health problem. Action for situation 2: The patient was made aware of his key responsibilities for his family members to avoid eating sweet dishes and control blood glucose level Action for situation 3: Family members were involved in care routine to build compassionate relation with elderly members Intervention for older people Situation 1: An elderly patient with balance disorder. Action 1: The patient was assessed for fall risk through Morse Fall scale. It helped in understanding the risk of fall. Based on the fall risk score, patient was given appropriate environment to prevent fall. Outcome 1: Fall risk minimized Situation 2: Patient with hip replacement surgery. Action 2: The pain level and movement of legs was monitored. Physical therapy was done to help the client strengthen hip muscle and develop their ability to ambulate. Outcome 2: Risk reduced due to physical therapy. Rights of client Situation- A patient with head injury was denied information regarding risk in surgery. Action- To protect the patients right and provide autonomy in care, I insisted all staffs that surgery cannot be done without informed consent. Outcome- Ethical and legal practice was achieved. Situation 1: Patient with hip replacement surgery. Action 1: The pain level and movement of legs was monitored. Physical therapy was done to help the client strengthen hip muscle and develop their ability to ambulate. Outcome 1: Risk reduced due to physical therapy Situation 2: A client was denied the right to autonomy in care and he wanted to know legal complaint process. Action 2: He was asked to fill the grievance form and drop a mail regarding the complain to manager of facility. He was asked to seek legal advice to proceed further. Outcome 2: Legal process explained. Legal and ethical compliance Situation Action Outcome A patient was denied the right to informed consent and the risk associated with surgery was not informed to her earlier. The situation was accurately analyzed to find all those person involved and who were responsible for breach of conduct. Strict actions were taken against them. Impaired practice in staffs due to alcohol or drug abuse Substance abuse places them at both personal and professional abuse. The dilemma was solved by teaching them the ethical principles of autonomy, justice, beneficence and non-maleficence. It led to practice according to ethical models of care. A nurse failing to exercise nursing care according to professional standard of nursing practice. The situation was analyzed and it was a case of negligence that lead to the incident. The nurse was penalized for the offence and use of mobile phones was banned in the premise. Aged Rights Advocacy Service- It provided guidance on rights of older people, how to identify abuse, take a plan of action and respond to elder abuse. Attached file- https://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/policies_and_procedures Collaborative partnerships Situation Action Outcome I had worked with nurse to support elderly people. The nurse made me aware of changes in body due to ageing and how the environment around them was not suitable. It was creating risk of fall in them. Protective environment was provided to elderly person. My partnership with physical therapist. As we were working with older people with balance disorder, the physical therapist gave me the idea regarding appropriate exercise for them to improve quality of life. Appropriate physical exercise according to their needs was provided. My partnership with fall risk assessment team. They gave idea about the structure of premise that might increase risk of fall such as slippery tiles, rugs, spillage, pointed furnitures and many more. The environment around the elderly was modified to prevent them from any injury. To improve networking opportunities for service providers, coordination among them will be promoted and collaborative agreements will be disseminated among them. Networking through sharing newsletters or conference will in improving service. Collaboration will help to build trust and achieve goals together. Effective communication Situation Action Outcome A client gave the feedback that she was not happy with food and hygiene at the hospital. Inspection was done regarding how food was prepared and all process of hygiene at the facility was monitored All poor practice regarding cleanliness was addressed. An elderly patient at the health care clinic gave the feedback that the nurse was inattentive towards her and ignores her whenever she calls him during any problem. As a nurse it is their duty to continuously be available to their patients and provide compassionate care. The nurse was immediately called to know the reason for negligence and another nurse was arranged for the patient. The patients problem was solved. Feedback was taken from elderly people regarding the quality of service provided to them to assist them in ADLs. One of them gave the feedback that although the service was useful, however she could not independently ambulate in her home. Ambulatory device was given to her according to her needs Service improvement achieved. 2. Situation Action Outcome Written communication for rights of elderly. Written policy was prepared regarding rights of aged in the aged care such as legal rights, personal right, right to privacy and many others. Staffs followed this policy. Written instruction for code of conduct in aged care It gave detail on protecting the rights of aged person in care. Staffs became aware of ethical code of conduct Detail about home and community care program for elderly All detail regarding home care package and service package was written. Clients could choose service according to their needs. I faced challenge when a patient was unwilling to sign the consent form for surgery. She was very nervous and she was feeling that it will risk her life. She was informed that physician has carried out all medical assessment to prevent her from any risk and the surgery will benefit her and there is minimum chance of harm. As our hospital reported high rate of falls in patient in the past 6 months, a meeting was held with all staffs to discuss the reason for high fall rate. Based on this discussion, fall risk factors were identified and solutions were proposed to minimize the fall rate. Coordinate service for older people Situation Action Outcome Client with injuries due to fall Coordination with hospital and rehabilitation service was done to promote recovery of patient. Operations for fracture repair were carried out within 24 hours. Prompt action during fall injury became possible Coordinating service for stroke prevention An integrated stroke service was planned consisting of stroke prevention for people at risk, specialist for acute care and rehabilitation and long-term support to patients. It helped in health promotion and stroke prevention. Hospital care for elderly Hospital need was addressed in accordance with the stages of emergency response, early assessment, old age specialist care and care in medical wards. It helped to meet the needs of elderly people. Service planning and delivery Situation Action Outcome Planning of services for older people with disability The plan of action was to make support services easily accessible to these groups and engage in efficient consultation process. Support service access provided to elderly people with disability Planning for mental health in elderly people The plan was early recognition and management of mental health by accurate diagnosis. The service reviewed to assess individual care plan and assessment process. It led to promotion of mental health in aged care. Planning services to prevent fall in elderly Planning process regarding referring older people to appropriate service such fall service for assessment or to hospital in case of injuries. It helped to identify needs of prevention or treatment in patient.