What are two priority nursing diagnoses for this child?


Case Study: Jimmy, ten years old, was admitted to the pediatric intensive care unit after a fall from the second-story townhome were they sustained a fractured left femur and mild head injury. Currently, Jimmy is two days post open reduction internal fixation of the left femur. Orders were updated to transfer Jimmy out of Intensive Care Unit (ICU) after being cleared by the neurologist. He has a long leg cast, and indwelling foley catheter and will require neuro checks every two hours.

· What are two priority nursing diagnoses for this child?

· What are the priority nursing interventions for this patient after being transferred from the ICU?

· What are the risks of foley catheter placement?

· Does the patient still require an indwelling foley catheter? Provide a rationale to support your answer.

No abbreviation

Reference to this link:

Scannell, M., & Ruggiero, K. (2022). Developmentaly appropriate nursing care across care. In Davis advantage for maternal-child nursing care (3rd ed., pp. 456-474). F.A. Davis.

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Apply skills and strategies presented in this lesson to develop a plan for teaching from “Little Things are Big.”

Assignment 5

Apply skills and strategies presented in this lesson to develop a plan for teaching from “Little Things are Big.”

EXPLANATORY NOTE:  This assignment is NOT asking for a formal lesson plan (although you are welcome to submit one if you desire).  It IS asking you to select 4 of the comprehension strategies discussed in the lectures or that you’ve identified through your readings and describe exactly how you will use this text to explicitly instruct students on how to use that strategy to improve reading comprehension (the focus of the lesson is the strategy, not the text).  A simple listing or description of activities that use the strategy is not a sufficient response.  I’m looking for your method to actively engage the students in using the comprehension strategies (“the teacher will” focus, not “the student will”).

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What strategies could be suggested for this older adult couple to enhance their quality of life?

Read the following case study and answer the reflective questions. Please provide evidence-based rationales for your answers. APA, 7th ed. must be followed, minimum of 500 words and 2 scholarly references. No plagiarism please.


 An Older Immigrant Couple: Mr. and Mrs. Arahan Mr. and Mrs. Arahan, an older couple in their seventies, have been living with their oldest daughter, her husband of 15 years, and their two children, ages 12 and 14. They all live in a middle-income neighborhood in a suburb of a metropolitan city. Mr. and Mrs. Arahan are both college educated and worked full-time while they were in their native country. In addition, Mr. Arahan, the only offspring of wealthy parents, inherited a substantial amount of money and real estate. Their daughter came to the United States as a registered nurse and met her husband, a drug company representative. The older couple moved to the United States when their daughter became a U.S. citizen and petitioned them as immigrants. Since the couple was facing retirement, they welcomed the opportunity to come to the United States. 

The Arahans found life in the United States different from that in their home country, but their adjustment was not as difficult because both were healthy and spoke English fluently. Most of their time was spent taking care of their two grandchildren and the house. As the grandchildren grew older, the older couple found that they had more spare time. The daughter and her husband advanced in their careers and spent a great deal more time at their jobs. There were few family dinners during the week. On weekends, the daughter, her husband, and their children socialized with their own friends. The couple began to feel isolated and longed for a more active life. 

Mr. and Mrs. Arahan began to think that perhaps they should return to the home country, where they still had relatives and friends. However, political and economic issues would have made it difficult for them to live there. Besides, they had become accustomed to the way of life in the United States with all the modern conveniences and abundance of goods that were difficult to obtain in their country. However, they also became concerned that they might not be able to tolerate the winter months and that minor health problems might worsen as they aged. They wondered who would take care of them if they became very frail and where they would live, knowing that their daughter had only saved money for their grandchildren’s college education. They expressed their sentiments to their daughter, who became very concerned about how her parents were feeling. 

This older couple had been attending church on a regular basis, but had never been active in other church-related activities. The church bulletin announced the establishment of parish nursing with two retired registered nurses as volunteers. The couple attended the first opening of the parish clinic. Here, they met one of the registered nurses, who had a short discussion with them about the services offered. The registered nurse had spent a great deal of her working years as a community health nurse. She informed Mr. and Mrs. Arahan of her availability to help them resolve any health-related issues.

 Reflective Questions 

1. What strategies could be suggested for this older adult couple to enhance their quality of life?

 2. What community resources can they utilize?

 3. What can the daughter and her family do to address the feelings of isolation of the older couple? 

4. What health promotion activities can ensure a healthy lifestyle for them? 

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Explain Singer’s goal in this article, and then present Singer’s argument that supports his position.

Famine, Affluence, and Morality


Please read the article “Famine, Affluence, and Morality,” by Peter Singer and complete the following tasks:

  1. Explain Singer’s goal in this article, and then present Singer’s argument that supports his position.

The goal of Singer’s article is to make people aware of their moral obligation and responsibility in the society. The society is not an alien concept out there, according to the article it is you and me. He uses the famine and starvation that was being experienced in India, Bangal. Children were dying because there was no food for them as a product of the drought.

Singer’s argument is based on the premise that food is a basic need for every individual in the world and before people think about investing in projects, all people should be fed. People must help others when they are in need, but there are always some excuses that they will come up with in order not to do that. He states that governments send peanuts to help the dying people and want to be praised for it, while they invest ten times the same amount they sent into unfruitful ventures. The conclusion to his argument is that people in affluent states will always find a reason or excuse not to help others yet small sacrifices could mean a lot to those in need. Help knows no race, distance or skin colour.

  • Explain three counter-arguments to Singer’s position that he addresses in the article, and then summarize Singer’s responses to those counter-arguments.

According to Singer, there are three excuses that people come up with in order not to help. They include:

  • Proximity – people argue that when the problem is not close by then it is not possible to help the people. However Singer argues that it is possible to send the assistance to the people when we come together as a society no matter how far they are. This is made possible by technology that has turned the world into a global village.
  • One person only cannot make any change- this is also another counterargument people use. It is true that one person cannot make a change but it all starts with you as an individual before it becomes the entire society. The best way is to have the motivation and pass it onto others as well in doing the right thing.
  • Safety in numbers- it is based on the belief that numbers lessen obligation to the society. However how can we judge ourselves using others? We are different and we have different convictions, if others jump off the bridge one will not so it is best to make individual decisions based on our own convictions.
  • Define Singer’s concept of marginal utility, and explain how this concept relates to his argument.

Marginal utility in this case is based on the point at which giving even an extra unit of cash will lead to suffering of the giver or his dependants in the same extent as the other person in Bengal. Singer argues that we should give only to the point where giving will mean that we shall suffer as well. So if everyone is giving out £5, then one can give the same amount or more depending on his capability.

  • Compare how the ideas of duty and charity are different in Singer’s proposed world as opposed to how they are currently used in our society.

According to Singer, duty is responsibility. It is our responsibility to look out for each other especially in times of need. It is our duty to be our brother’s keeper. Charity is all about sacrifice, giving out to ensure someone else gets something more important than you would have, had you not given out. Currently duty is what one does so as to get paid or for benefits. For instance a person’s job is a duty but giving back to the society and helping people is not a duty, it is an act of philanthropy. Charity is all about helping people especially when there is publicity or when it aids in hiding something else. In a nutshell what duty and charity is in the contemporary society is far much different from what Singer describes it to be.

  • Finally, present your personal response to Singer (this should be no more than one page of the entire assignment). Develop an argument either in support of Singer’s position, against his position, or somewhere in the middle in relation to his position. Remember that when you present your own positions you need to support those positions with as much logical reasoning and factual evidence as possible. 

I completely agree with Singer, just as poverty and death knows no language, race or country, kindness should not as well. We live in a world where there is inter-dependence, today its one person who requires help and tomorrow it’s the other. It is our obligation to help each other especially in times of need. Helping does not simply mean feeding people it’s also about showing them how to fish to prevent the same situation from recurring.

A good example is during the time of Hurricane Katrina, very many countries in the world came out to help the victims in New Orleans, inclusive of China. Then the Tsunami hit China and it was time for the world to assist the victims. In a world of natural catastrophes, the last thing we need to say is that every man for himself. Responsibility is not to something or someone that helps you, responsibility is about acts of humanity, giving in to our convictions. This is something we need to teach children as they grow up and have it embedded into their conscience. That responsibility and charity is a priority in our interactions. Responsibility is all about giving back to the society, especially because we always have set expectations from the society and the government. Charity is all about making sacrifices for other people regardless of whether you know or do not know them. Charity is all about the greater good, it about, as Singer put it, allowing our clothes to get muddy in order to save a drowning child in a pool of water. It general it is about the greater good: saving people.


Singer, P. (1972). Famine, Affluence, and Morality: Journal of Philosophy and Public Affairs, Volume 1, no 1. Springer Publishers

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Explain the implications of this problem for the stakeholders involved in this home health organization

Explain the implications of this problem for the stakeholders involved in this home health organization

In consideration of Sara’s privacy and in an effort to educate members of the organization of the possible outbreak, what strategies/steps should the Department of Human Resources (HR) do to ensure health information is provided to all stakeholders? Explain each strategy and offer concrete information to support your viewpoint.

Explain the implications of this problem for the stakeholders involved in this home health organization

Explain the implications of this problem for the stakeholders involved in this home health organization. Be sure to compare and contrast the implications for the different stakeholders and give special attention to the residents that Sara visited in their homes.

 The assignment is based on this Scenario below:

Congratulations! You have been hired as Assistant Manager of a Home Health Care Agency. The agency offers a wide range of skilled medical services such as nursing care, physical therapy, occupational therapy from qualified medical professionals. The agency also provides home health aide services including assistance with activities of daily living, such as bathing and eating.

Your supervisor told you that she recently received a call from an advocate whom an employee consulted via the Employee Assistance Program because the employee felt that she had been treated unfairly after contracting an illness. She explained that a few months ago, one of your agency’s home health aides, Sara, became ill. Sara had been coughing for approximately six weeks, lost weight without trying, had no appetite, was having difficulty sleeping, and had an intermittent fever. She became concerned and went to see a healthcare professional who diagnosed her with active tuberculosis (TB).

Sara missed a lot of time from work while completing treatment for TB. Her physician cleared her to return to work after she was no longer contagious. Upon returning to work, Sara felt isolated because her boss and co-workers refused to spend time with her. She heard that someone from the agency’s Human Resources Department told her co-workers her diagnosis. The stressful circumstances at work became even worse when another home health aide started to display the same symptoms Sara had.

Your supervisor has asked you to review the entire situation and how it was handled by the agency. Each module includes information about epidemiology, health statistics, public health, health communication and advocacy, health literacy, healthcare delivery systems, the Affordable Care Act, ethical considerations, human resources management, legal aspects, cultural and global perspectives, and financial considerations for the organization.

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The general objective of this research is to assess the effectiveness of corporate governance practices on the quality of audit reports

Amended Proposal

Table of content


1.0 Background of the Study. 3

1.1 Statement of the Problem.. 3

1.2 Objectives of the Study. 4

1.2.1 General Objective. 4

1.2.2 Specific Objective. 4

1.3 Hypotheses. 4

1.4 Significance of the study. 5

1.5 Scope of the Study. 5



2.1 Empirical Review.. 6

2.1.1 Corporate Governance. 6

2.1.2 Benefits of Corporate Governance. 6

2.1.3 Corporate Audit 7

2.1.4 Issues in Corporate Governance. 7

2.2 Theoretical Review.. 8

2.2.1 Overview of Audit Quality. 8

2.2.2 Audit Committee and Corporate Governance. 9

2.2.3 Board Structure and Audit Quality. 9

2.2.4 Ownership Structure and Audit Quality. 10

2.2.5 CEO Duality and Audit Quality. 11

2.3 Corporate Governance in Kenya. 11

2.4 Gap. 12

2.5 Conceptual Framework. 12



3.1 Research Design. 14

3.2 Population. 14

3.3 Sample and Sampling Design. 14

3.4 Data Collection. 15

3.5 Data Analysis. 16

Reference. 18


1 Questionnaire. 23

2 Study Timetable. 24

3 Budget 24


1.0 Background of the Study

Auditing in public corporations is aimed at protecting shareholders who are members of the public by virtue of being taxpayers. Legally, public corporations are required to make available to any interested party the most recent audit results and financial fillings upon request. In this context, auditing is designed to act in a regulatory capacity, keeping public corporations fiscally responsible and honest about their financial practices and economic situation (Economist, 2004).

Procedural audit covers various aspects of a corporation including compliance with environmental laws, laws to protect workers’ safety, and all other types of laws relating to management of corporations. Procedural audit may also involve an evaluation and assessment of practices and procedures at a corporation, usually with the objective of improving operational performance. Usefulness of audit reports largely depends on two aspects namely quality of audit and integrity of auditors. Audit quality can be ascertained looking for presence of critical information like accurate financial statements and indicators of organization’s performance. These two are dependent on the extent of auditors’ willingness to issue qualified and independent report (Chen et al., 2005).

Though a number of studies have been undertaken on the topics of corporate governance and corporate audit, not much has been said about implications of corporate governance on audit quality. This study will attempt to examine possible explanations as to why public corporations in Kenya which though promptly publish their audit reports as require by law, continue to perform dismally compared to private corporations. One of the assumptions guiding this study includes possible explanations that quality of audit reports from these public corporations could be significantly compromised.

1.1 Statement of the Problem

Poor corporate governance is perhaps the most important factor blamed for poor performance of public corporations. There is much that can be done to improve the integrity of financial reporting through greater accountability, the restoration of resources devoted to audit function, and better corporate governance practices (Saudagaran, 2003). This thesis will extend and contribute to existing research using data from public corporations in Kenya to investigate the likely impact of corporate governance on audit quality. The thesis is motivated by the interests surrounding the appropriateness of public sector reforms instituted by the government of Kenya in response to public corporate failures, global best practice and their implied efficacy in the face of significant implementation and audit quality.

1.2 Objectives of the Study

1.2.1 General Objective

The general objective of this research is to assess the effectiveness of corporate governance practices on the quality of audit reports.

1.2.2 Specific Objective

  1. To assess the relationship between the strength of audit committee and the quality of audit report.
  2. To assess the relationship between the existence of an internal audit function and quality of audit report.
  3. To assess the relationship between the strength of corporate code of conduct and quality of audit report.

1.3 Hypotheses

The research proposal intends to test the following hypotheses:

  1. There is a significant relationship between the strength of audit committee and the quality of audit report.
  2. There is a significant relationship between the existence of an internal audit function and quality of audit report.
  3. There is a significant relationship between the strength of corporate code of conduct and quality of audit report.

1.4 Significance of the study

This study will provide useful insights into improving audit quality of public corporations in Kenya. It will further contribute to audit literature given that it will provide additional empirical evidence on the impact of governance practices on audit quality. The study will also reflect the quality of audit services between different audit firms in Kenya. This study will be useful to taxpayers in Kenya as it will provide evidence on the relationship between corporate governance and audit quality and the reforms instituted by the government in formulating the Code of Corporate Governance for public corporations.

1.5 Scope of the Study

This study will be premised on the appraisal of audit quality in Kenya. Therefore, data on public corporations in Kenya will be sought to provide answers to the problems and questions that have been raised for the study. The study will cover selected public corporations listed under the Public Corporations Act, Laws of Kenya that are physically located in Nairobi.



2.1 Empirical Review

2.1.1 Corporate Governance

Corporate governance is the way in way everyday activities of a corporation are being run, or technique by which corporations are directed and managed. The governance of corporations is entrusted to the board of Directors as well as concerned committees, all as per shareholders’ interests. Governance activities include balancing individual and societal goals and economic and social goals. In corporate governance, there exist elaborate interaction of stakeholders including shareholders, board of Directors, and management. All the stakeholders work collectively in shaping corporations’ performance. For success to be realized in any corporation there is need to foster healthy working relationships between shareholders and management. Shareholders must ensure actual performance is as per the standards of performance (Management Study Guide, 2012).

Put into broader perspective, corporate governance focuses the manner shareholders guarantee themselves of getting fair return on their investment. This requires distinguishing between shareholders and management. Management should be solely responsible for decision making and authority of the corporation. To ensure shareholder interests are protected, corporate governance ensures transparency which in turn ensures strong and balanced economic development. Demand for good corporate governance is driven by emergence of market-oriented economies and globalization. Corporate governance ensures corporations emphasize trustworthiness, morality, and ethics (Management Study Guide, 2012).

2.1.2 Benefits of Corporate Governance

A number of benefits can be realized from corporate governance. These include lowering of capital costs, positive impact on corporation’s share prices, ensuring corporate success and economic growth, and helping in brand formation and development. Other benefits of corporate governance include providing proper inducement to shareholders and management to achieve objectives that are in interests of the owners and the organization, and minimizing wastages, corruption, risks and mismanagement (Management Study Guide, 2012).

2.1.3 Corporate Audit

Corporate audit refers to examination of financial and operational procedures at a corporation. Internal or external corporate audit teams either conduct these examinations, and they can serve a variety of functions. The sole purpose of auditing is to confirm that corporations are operating within the law, and that their stated ethical standards are upheld by their practices. Corporate audit takes various forms; in the financial sense it involves detailed inspection of accounts and financial practices of a corporation. Auditors will mainly look at possible financial irregularities which may indicate tax evasion, funds embezzlement, as well as other illegal activities. Financial audits may also be concerned with ways of helping a corporation operate more efficiently and effectively by suggesting ways in which a corporation may cut costs and improve performance (Economist, 2004)

2.1.4 Issues in Corporate Governance

Successful corporations are those that experience financial stability such that interests of shareholders and the corporation itself are effectively addressed and enhanced. Financial stability of a corporation can be achieved by the interaction of three basic necessities namely sound leadership at the corporation level, strong prudential regulation and supervision, and effective market discipline. Sound leadership begins with good corporate governance consisting capable and experienced board of Directors and management staff, a coherent strategy and business plan, and clear lines of responsibility and accountability (McDonough, 2002).

Since the board of Directors is mandated to develop overall strategy development within a corporation, it is important that only individuals with necessary skills and competencies are represented in the board. It is necessary that clear guidelines establishing independence of the board are established. The top management should be constituted by individuals capable of setting prudent business strategies and can pursue decisions that would ensure long-term objectives and policies set by the board are realized (McDonough, 2002).

To ensure financial stability, execution of the overall objectives of a corporation must be supported by rigorous internal controls and effective risk management. An effective internal control apparatus is critical to provide reasonable assurance that the information produced by the corporation is timely and reliable and that errors and irregularities are discovered and corrected promptly. Such an apparatus is also needed to promote the firm’s operational efficiency and to ensure compliance with managerial policies, laws, regulations, and sound fiduciary principles. This is where corporate governance associates with audit quality (McDonough, 2002).

Past years have brought widespread questioning of the quality and integrity of the information that corporations make available to the market and the behavior of some corporate executives. Although the developments that gave rise to this questioning are regrettable, there has, in fact, been a positive side. The public uproar that these developments have created and the turmoil they have generated in the financial markets have been immensely powerful as forces for meaningful public sector reform. These painful experiences should help educate a generation

of younger managers about the importance of integrity and sound corporate governance based on independent oversight and good audit quality (Konczal, 2009).

2.2 Theoretical Review

2.2.1 Overview of Audit Quality

The various changes in accounting, financial reporting and auditing were all designed to provide protection to investors. This is being achieved by imposing a duty of accountability upon the managers of a company (Crowther and Jatana, 2005). In essence, auditing is used to provide the needed assurance for investors when relying on audited financial statements. More precisely, the role of auditing is to reduce information asymmetry on accounting numbers, and to minimize the residual loss resulting from managers’ opportunism in financial reporting. Effective and perceived qualities (usually designated as apparent quality) are necessary for auditing to produce beneficial effects as a monitoring device. The perceived audit quality by financial statements users is at least as important as the effective audit quality. Conceptually, DeAngelo (1981) defined audit quality as the market-assessed joint probability that the auditor discovers an anomaly in the financial statements, and reveals it. Agency theory recognizes auditing as one of the main monitoring mechanisms to regulate conflicts of interest and cut agency costs. Therefore, assuming a contracting equilibrium in the monitoring policy, a change in the intensity of agency conflicts should similarly involve a change in the acceptable quality of auditing.

2.2.2 Audit Committee and Corporate Governance

Literature suggests that a valuable audit committee should play an important role in strengthening the financial controls of a business entity (Collier, 1993; English, 1994; Vinten and Lee, 1993). A number of studies have found that companies with an audit committee, particularly when that committee is active and independent, are less likely to experience fraud (Beasley, et al., 2000; Abbott, et al., 2000; McMullen, 1996) and other reporting irregularities (McMullen, 1996; McMullen and Raghunandan, 1996). Findings also suggest that audit committees are effective in reducing the occurrence of earnings management that may result in misleading financial statements (Defond and Jiambalvo, 1991; Dechow, et al., 1996; Peasnell, et al., 2000). Audit committee is also expected to enhance the effectiveness of both internal and external auditors (Simnett, et al., 1993). However, Cohen, et al. (2000) report that a number of audit practitioners involved in exploratory interviews expressed concern over the effectiveness of audit committees, with some partners suggesting that audit committees are not powerful enough to resolve conflicts with management.

It is generally agreed that, for an audit committee to be effective, a majority, if not all members, should be independent (Cadbury, 1992) and they should have an understanding of accounting, auditing and control issues (Cohen, et al., 2000; Goodwin and Seow, 2000; Hughes, 1999; Lear, 1998). Literature also linked audit quality with the boards of directors, and the audit committees of boards of directors. This shows that audit quality is positively related to boards and audit committees when they are more independent (that is, higher number of outside directors). Carcello and Neal (2000) show that auditors are more likely to issue going concern reports in the presence of more independent boards and are less likely to be fired by the company following the issuance of a going concern audit report. 

2.2.3 Board Structure and Audit Quality

The linkage between the board and the quality of audit services performed may be formal or informal. In terms of formal linkage, the board of directors typically collaborates with management in selecting the external auditor, often subject to shareholder ratification. Since the auditor is to look to the board as its client, it is reasonable to expect the board to review the overall planned audit scope and proposed audit fee (Blue Ribbon Committee 1999; Public Oversight Board 1994). The board also may influence audit quality through informal means. The board’s commitment to vigilant oversight may signal to management and the auditor that the expectations placed on the audit firm are very high. If the auditor understands that the client (that is, the board) is particularly of high quality and demanding, the auditor may perform a higher-quality audit so as not to disappoint the client and jeopardize the relationship. Given the board’s oversight of the financial reporting and audit processes, as well as prior literature linking certain board characteristics to adverse financial reporting outcomes (Beasley, 1996; Dechow, et al. 1996), this current study explores the link between board characteristics and audit quality in Nigeria.

Fama and Jensen (1983) have theorized that the board of directors is the best control mechanism to monitor actions of management. The study explored board independence based on the agency theory. Studies of O’Sullivan (2000) and Salleh, et al. (2006) found that the proportion of non-executive directors had a significant positive impact on audit quality. They suggested that non-executive directors encouraged more intensive audits as a complement to their own monitoring role while the reduction in agency costs expected through significant managerial ownership resulted in a reduced need for intensive auditing.

2.2.4 Ownership Structure and Audit Quality

The relationship between outside shareholders and managers is marked by moral hazard and opportunism, which result from information asymmetry. The social role of financial reporting increases with the separation of ownership and control (Wan, et al. 2008). Indeed, accounting numbers are essential indicators to assess managers’ performance. However, the discretionary power of managers over the accounting policy being important in firms with diffused ownership, their propensity to manipulate the outputs of the accounting process is higher. In contrast to the directors’ ownership, an institutional ownership is an investment from a group of outside investors or investment from a certain institution. The percentage of ownership from institution is normally higher than individual investor. It is assumed that institutional investors have more influence than other individual investors. With the high portion of ownership, institutional ownership has the importance of monitoring role in the process auditing. It is rational that institutional investors demand high quality information from the company. Kane and Velury (2002) observed that the greater the level of institutional ownership, the more likely it is that a firm purchases audit services from large audit firm in order to ensure high audit quality.

For the purpose of the current study, institutional ownership can be separated into two main categories which are financial institutional and non-financial institutional ownership. The main difference between both groups is related to core business of investor. The core business of financial institutions is investment but not for non-financial institutions. However, both institutions are expected not to have different influence on audit quality. Mitra, et al.  (2007) found that diffused institutional ownership was significantly and positively related to audit fees. The study linked their finding to either institutional investor demand for the purchase of high quality audit services as safeguard against fraudulent financial reporting or firms’ endeavor to purchase high quality audits to attract institutional investment in common stock. It is expected that the portion of institutional ownership will have impact on audit quality of the company.

2.2.5 CEO Duality and Audit Quality

This study also intends to discover the relationship between the CEO duality and audit quality. The CEO duality refers to non-separation of roles between Chief Executive Officer (CEO) and the Chairman of the board. In the normal situation, boards with CEO duality are perceived ineffective because a conflict of interest may arise. This is often attributed to the nature of family owned business in developing countries. Yemark (1996) posits that large companies that have separate persons for both functions normally trade at higher price and have higher return on assets and cost efficiency ratios (Pi and Timme, 1993).

2.3 Corporate Governance in Kenya

Concerns for good corporate governance in Kenya started taking shape in 1998 and was driven by a number of factors including; The quality of governance at all levels was increasingly being seen as the most important factor for the success of both the politico-economy and its institutions. Corporate governance was increasingly taking centre stage, with the privatization and corporatization of the economies globally. There was greater expectation from society that corporate organizations, especially private ones, should take a more leading role in the debate and implementation of economic revival strategies (Private Sector Initiative for Corporate Governance, 1999).

In the face of major scandals leading to the collapse of big corporations, especially state owned ones, with disastrous social and economic consequences, it was inevitable that the wider society, led by the mass media, would start questioning how these organizations were run.   Shareholders, especially in publicly listed companies were becoming increasingly vocal demanding better transparency and disclosure of information from their directors. Regulatory bodies, notably the Capital Market Authority and the Nairobi Stock Exchange, were already hinting that they would require good corporate governance practices amongst the publicly listed companies (Private Sector Initiative for Corporate Governance, 1999).

2.4 Gap

The concept of audit quality in the Kenyan Public Corporations has been ignored, as there are recorded cases of corporations collapsing and being put under receivership owing to insolvency yet the Auditor General usually conducts auditing of the same on a regular basis. Does the Office of the Auditor General perform its duties objectively and professionally?  Are the audit reports a true reflection of the corporation’s actual financial status? Does the management of these corporations implement the audit and financial recovery recommendations appropriately?   Why do the corporations collapse yet their accounts are audited and recovery recommendations given?  The result of the research will attempt to give insight and an understanding into this entire dilemma in the Public Auditing process. The very fact that there is no local literature concerning audit quality research puts the study at a head start and the results are likely to stimulate further research and the area of audit quality within the context of Kenyan auditing system.

2.5 Conceptual Framework

Figure 2.1: Conceptual Framework (Source: Author of proposal)

Independent variables of the study are audit committee, CEO duality, business complexity, leverage, executive directors’ ownership, non-executive directors’ ownership, financial institution ownership, non-financial institution ownership and board independence. The dependent variable was audit quality which was measured by size of audit firm (big and non-big).




3.1 Research Design

This study is an explanatory study. Saunders et al., (2007) stated that studies that establish causal relationships between variables may be termed explanatory studies. They emphasized that this has to do with studying a situation or a problem in order to explain the relationships between variables. This research strategy was considered necessary because of its ability to view comprehensively and in detail the major questions raised in

3.2 Target Population

The population for this study consist all the 177 public corporations in Kenya classified into the following categories:

Category of CorporationNumber of Corporations
Commercial / Manufacturing30
Public Universities20
Training and Research13
Regional Development6
Tertiary Education6

Table 3.1: Sampling Frame (Source: Author (2012))

3.3 Sample and Sampling Design

Sample selection depends on the population size, its homogeneity, the sample media and its cost of use, and the degree of precision required (Salant & Dillman, 1994, p. 54).  The people selected to participate in the sample must be selected at random; they must have an equal (or known) chance of being selected. Salant and Dillman (1994) observed that a prerequisite to sample selection is to define the target population as narrowly as possible. In this study, a simple random sample will be drawn without replacement from a population of 177 public corporations classified into 8 categories.

Desirable sample size of 72 corporations will be drawn from the various categories of public corporations (60 at an error margin of 7.5% and confidence level of 95%) as shown on Table 3.2. below:

Category of Public CorporationPopulationSample Size Error Margin = 7.5% Confidence Level = 95%
Commercial / Manufacturing3010
Public Universities2010
Training and Research136
Regional Development63
Tertiary Education63

Table 3.2: Sample Size (Source: Author (2012))

3.4 Data Collection

Both primary and secondary data will be used in this study. Primary data will be collected by used of questionnaires containing twenty close-ended questions and given to executive officers of the selected corporations. Secondary data will consist of audited financial reports of public corporations for the period 2010 year-end

3.5 Data Analysis

The data collected will be analyzed using both descriptive and inferential statistics. The descriptive method described information relating to audit firm (categorized into big 4 and non-big 4) and CEO duality. The study will use frequency count, mean, standard deviation, minimum and maximum values of variables. Information relating to the composition of outside director members of board, audit committee composition, board ownership, CEO duality and firm characteristics (which are, company size, business complexity, institutional ownership and leverage) will be collected from company annual reports.

The hypotheses formulated for this study will tested with the use of logistic regression. This will be used to examine the relationship between dependent and independent variables. According to Field (2000), logistic regression is multiple regression but with an outcome variable that is a categorical dichotomy and predictor variables that are continuous or categorical. The logistic regression for this study takes the form:


  β4FINOWN + β5NFINOWN + β6LEVERAGE +                            ………. (1)

                β7COMPLEXITY + β8SIZE + β9CEOSHIP + ε

The dependent variable is audit quality. This variable is dichotomous in nature. Size of audit firm (big 4 and non-big 4) was used as proxy for audit quality. Audit quality was set equal to one (1) if the information obtained from companies audited reports show that it is audited by one of the “big 4” audit firms (KPMG; Ernst and Young; Akintola Williams Delloitte; PWC), otherwise zero (0). This operationalization follows the approach used in Kane and Velury (2002) where big audit firms are assumed to have quality audit services than other smaller audit firms.

 The choice of the independent variables was informed by previous studies (Beasley and Petroni, 2001; Carcello, et al., 2002; Salleh, et al., 2006; Wan, et al., 2008 and Mitra, et.al., 2007). Board independence (BODINDEP) will be measured through the composition of non-executives in the board of directors in form of percentage. The non-executive directors’ ownership (NEDOWN) and executive directors’ ownership (EDOWN) will be based on percentage of share owned in relation to the issued capital of the company. Furthermore, financial institution (FINOWN) and non-financial institution ownership (NFINOWN) will be measured using percentage of shares owned in relation to the issued capital of the company. The variable of CEO duality (CEOSHIP) is a dichotomous variable that will operated as one (1) if the position of Chairman and Chief Executive Officer is occupied by same person and zero (0) if otherwise.

The inclusion of other variables like size of the company (SIZE), business complexity (COMPLEXITY) and leverage of the company (LEVERAGE) will be based on the findings of Kane and Velury (2002) & Wan et al. (2008). The studies noted that these variables have significant relationships with audit quality. The size of the company will be measured by total asset owned by each of the companies while business complexity was measured by the summation of total accounts receivable and total inventory divided by total asset. Furthermore, leverage will be measured by total debts divided by total assets. Upon improvements of the logistic regression (equation i), it will be observed that audit committee independence has collinearity problem while tests for outliers will suggest the removal of some variables which will then lead to the final model as given below:

AUDITQUAL=β0+β1NEDOWN+β4FINOWN+β6LEVERAGE+β8SIZE + ε       ………        (2)







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 and audit fees. Contemporary Accounting Research, 19(3), 365–384

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 18(3), 25-30

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 services: an empirical investigation. Journal of Business Research, 1-8

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1 Questionnaire


1. Name of the organization:_______________________________

2. Is the organization established in the public corporations Act?

Yes                                          No

3. Year of incorporation: _______________________________

4. Is the Government majority Shareholders in your organization?

Yes                                          No

5. Is Controller and auditor general the sole external auditor of your organization?

Yes                                          No


   6.To what extent do you agree with the following statements with regards to the office of the controller and auditor general capacity to perform auditing of your corporation with particular regards to qualifications (Tick appropriately). That of the office of controller and auditor general………………..

                                                                        Yes                              No

Has the Relevant Training?

Performs the auditing process independently?

Performs the auditing Process with due Care?

7. Do you agree with the following statements with  particular regards to the office of the Controller and Auditor General capacity to uphold auditing standards and practices?

That the office of the controller and auditor general (Tick Appropriately)…………

                                                                                                         Yes                  No

Adequately plans the auditing exercise before it takes off

Adequately supervises the auditing process?

Adequately assess the inherent risks in the corporation?

Adequately recommends controls of identified inherent risks?

8. To what extent do you agree with the following statements? That the office of the controller and auditor general produces audit reports that are (Tick appropriately)………………….

Reflective on the picture on the ground                    

Yes                  No




Clear, precise and easy to understand                 


9. To what extent do you agree with the following statements? That the           corporation’s officers are (Tick Appropriate|)……………………………

YES                            NO

Transparent in giving the accounting records                                            

Upholds highest level of integrity

Accountable and \Open when dealing with the external auditors

Upholds highest level of accounting, financial and corporations Ethics

Sustainability, efficiently, effectively and ethical manage the corporation’s resources

(10) Do you think the Controller and Auditor General conduct external audit in public corporations in compliance with International Auditing standards? (Tick the appropriate box)

Yes                                       No      

(11) Do you consider management of your organization to be responsive to risk management and fraud control to safeguard resources of the organization?

Yes                                       No      

2 Study Timetable

This research will take a period of eight weeks. This is considered ideal timeframe given the elaborate data to be analyzed. A detailed summary of the work plan for the research has been tabulated below;

1 WeekResearch proposal development
1 WeekPreliminary literature review search
2 WeeksLiterature review and writing
1 WeekCase study collection
1 Weekdata editing, coding and interpretation
3 daysReport interpretation
4 daysReport writing and presentation

3 Budget                                                                          

The following expenses will be incurred during this study:

ParticularQuantityTotal (KES)
Research Assistant26000
Stationary items (assorted)3000
Data analysis using SPSS3000
Report production (Typing, Printing, Photocopying, and Binding2000

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What is a vulnerability model? What are the distinctive characteristics of this model?

Assignment 1

What is a vulnerability model? What are the distinctive characteristics of this model? 


Vulnerability model is an integrated method of learning the vulnerability of a specific population and its chances of experiencing poor health or being ill. Vulnerability represents a combination of various factors and many majority individuals have no control or little over. The specific characteristic of vulnerability model is that it majors on the attributes of vulnerability for the entire population rather than focusing on vulnerable characteristics of subpopulations. The other distinctive trait is that it is a comprehensive model, entailing both personal and ecological characteristics of risk. This model stresses on the vulnerability convergence. 



Assignment 2

Compared with White Americans, what are some of the health challenges faced by minorities?  What are some of the health concerns for women?  For men? For children?


The percentage of live births with low birth rates in common in minorities compared to White Americans. For instance, Pacific Islanders and Asians are more probable of beginning prenatal care during their first trimesters. Compared to Hispanics, White Americans women of 40 years and above use mammography more. It is observed that non-White Americans have lower life expectancies, higher aged-adjusted death rates for leading causes of death, higher adjusted maternal mortality rates, and higher unfact neonatal and post neonatal mortality rates. American Indians have higher rates of death from drug related causes for instance alcohol. They also have higher chances of getting diabetic and committing suicide compared to White Americans. 



Assignment 3

What childhood characteristics have important implications for health system design?


Among the exceptional childhood characteristics that have significant implications of health system designs are dependency, differential mortality and morbidity patterns, and children’s development vulnerability. Developmental vulnerability is the quick and cumulative emotional and physical alteration that come along with child development and the possible effects that diseases, injuries or untoward family and social circumstances might have on child’s development curve. 


Children have multifaceted and changing dependency connections that affect their growths and impacts their utilization of health services. Children rely on their parents or other people who act as their caregivers to identify and respond to their health concerns, to establish their care and approve treatments, and to conform to recommended treatment regimens. Children are normally affected by various and complex situations that are termed as ‘new morbidities’. The new morbidities entail alcohol and drug use, family and surrounding violence, emotional distress, and learning problems that older generation did not suffer from. These new morbidities come from intricate socioeconomic or family conditions rather than from exclusively biological etiologies. To maintain good results, the new morbidities need a continuum of comprehensive services that entail multidisciplinary assessment, treatment, and rehabilitation as well as community-based prevention methods.  



Assignment 4

Please read the New York Times article “Women in Texas Losing Options for Health Care in Abortion Fight”, by Pam Belluck and Emily Ramshaw on March 7, 2012.  Please post your comments on the Discussion Board.


After reading the article, I fail to understand why they do not come up with other substitutes suppose they claim to have great care and concerned about women. What evils is there supposing they work with Texas legislature to create another organization that better understand health services? I have opinion that Texas need to re-examine itself and come to sense that they are outside reality of caring for the needs of women and their health needs.  The issue that need to be tackled is controlling the needs of women rather than hating abortion. The problems seems deeper than just looking at it at the surface. 


I think it is evident that majority of the women will not be ready to pay for their services. Minus clinics for breast and cervical cancer screening, these women will find it too late when diagnosed. Additionally, the available health care services will be located away from the reach of majority and they will thus lose their sense. With time, statistics on the number of death with increase showing majority of disadvantaged women dying needleless because they lack access to proper health care needs. 



Assignment 5

Please read The New York Times article “Uninsured Numbers Drop as Poverty Rate Holds Steady” by Robert Pear, September 16, 2015.  Please post your comments on the Discussion Board.


I agree with the article that there has been a sharp rise in the number of insured American citizens in the recent years. The American healthcare sector has undergone varied changes and reforms with different governments coming up with a raft of modifications and healthcare bills. The healthcare reform was primarily focused on lowering the cost of healthcare that Americans incurred, healthcare funding, increasing healthcare insurance coverage and eliminating the burden of healthcare on average Americans and it has achieved this. ObamaCare has impacted varied sectors of the economy in varied ways capturing a better population. One of the deeply affected industries is the hospitality and hotel industries and this has led to increase in the number.


Assignment 6

Please read The New York Times article “Puerto Ricans Brace for Crisis in Health Care” by Lizette Alvarez and Abby Goodnough, August 2, 2015.

Please post your comments on the Discussion Board. 


The cut of funding of Medicare program in Puerto Rico will have detrimental consequences on the lives and its economy as a whole. The pay-for-service formulae that they intend to use might not yield a better result to sustain the program as the citizens have the options of moving to the mainland for medical services. They are flexible and better medical services are awaiting in the mainland. Additionally, the great exodus by the medical personnel is alarming. The doctors need better care, improve commissions and good working conditions which seem to deteriorate in Puerto Rico. 


The large population in this program will be at risk suppose it collapses. The local politicians and other proposed strategies to deal with it might not yield better result than when the government would have prioritized it. All Puerto Rico need to do is collaborate with the main government to come to their aid. 


Assignment 7 – Terminology

  1. Chronic Illness

Chronic illness is a condition in one’s health or a disease that has long-lasting effects. It is normally referred to diseases that do not have cure for instance cancer, asthma, diabetes and different viral diseases for instance hepatitis C. 


  1. Dependency

Dependency is an adaptive condition that comes from the repeated use of something for instance drug. In majority of the case, the body does not function normally suppose the dependency is eliminated. 


  1. Developmental vulnerability

Developmental vulnerability can be explained as the reduce capacity of a person to cope with, resist and recover from the effects of man-made or natural developmental hazards. The concept is relative and dynamic and most often connected to poverty. It can however, be associated with isolation, insecurity and defenseless in face of risk. 

  1. Enabling characteristic
  2. Mediating factors


Mediating factors are factors that account for the connection between a predictor variable and outcome variable. 


  1. Need attributes


An attribute is the trait that is given to an individual or a group of people. This is the characteristics that associates one with how to he or she responds to the needs of others. 


  1. New morbidities


The new morbidities are behavioral, education and social problems that have effects on a person’s health. 


  1.  Predisposing characteristics

These are characteristics or conditions that may have affect perceptions of need and use of healthcare services. Among the predisposing characterizes entail demographics factors, social structure and health belfies. 


  1. Quality of life indicators

These are the overall well-being of a persona and the communities, highlighting the good and bad features of life. It observes the gratification, entailing health, family happiness, educations, employment status, riches, religious beliefs and the general environment. 


  1.  Socioeconomic Status

Socioeconomic status is sociological and economic status combined to determine individual’s work experience and of a person’s or family’s socials and economic statuses in relation to others. These are normally measured on the basis of income, education and occupations. 


  1.  Usual source of care

This is the sources that are normally used by a person or individual. It can also be explained as care that has been used by an individual in majority of cases. 



  1.  Vulnerability

These are the weaknesses that exposes an individual to attacks by diseases for instance old aged people are vulnerable to certain diseases compared to young people

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This essay examines Adair’s business book on leadership as well as an article on leadership skills


This essay examines Adair’s business book on leadership as well as an article on leadership skills. The aim of this essay is to answer some of the research questions provided and thereby suggest that indeed, leadership qualities are essential in an organization.

In order to achieve this, the essay is divided into four sections. The first section gives definitions of the key terms used in the essay. The following section provides an overview of the article while the third section summarizes the book. The last piece highlights the key points from the previous sections.

Keywords: Leadership, effective leader, management



Before the writer of the essay proceeds, it is detrimental to define the various terms used throughout the essay. One of such key terms is leadership qualities, which refers to the characteristics possessed by leaders that would let others to willfully follow what the leader intends to do. An effective leader is a person who possesses the ability to get work done effectively by others in a willful manner. Management, on the other hand, refers to doing things in the right way. However, management is different from leadership since leaders do not need to be managers.

A Summary of the article

In early years, the managers organized and monitored the productivity of labor in the various organizations. Leaders, on the other hand, played a pivotal role in initiating change in an organization so as to assist the firm accomplish its objectives within the shortest possible time. The managers should present leadership qualities in organizations. Persons who possess such leadership qualities qualify to be effective leaders. Indeed, there are different qualities associated with leadership including the ability to have a vision about the future. In line with this, a principled leader focuses about the future success of the organization. Further, a true leader should be flexible in conducting activities within an organization, understand that there are constraints in achieving the objectives of a firm, share and shape ideas, adequately understand the environment around him, respect other people’s ideas and be creative in all his activities. Moreover, the leader should learn to ask other top leaders on how to carry out activities within the organization.. An effective leader would be learned and should possess the necessary skills to run an organization. In addition to this, he should establish a positive attitude to his work as well to other people around him. To sum up the article, it would be fair to say that an effective leader should portray concern for others, ask questions whenever in problems, effectively communicate, show flexibility in making decisions and also be willing to install change in addition to being creative, and innovative when undertaking activities within the organization (Martin, 2003).

A Summary of the Adair’s Book

According to Adair 2010, a strong manager and leader should reach the organization’s goals, assist the workers, promote the value of output, and encourage teamwork within the organization. In order to achieve this, the author outlines three requirements for a strong leader including achieving the task, managing individuals as well as encouraging teamwork. The author encourages individuals to think about their personal success in one’s unique situation.

In order to evaluate the leadership qualities, one needs to set objectives in an organization which should be attained within the set time. Then, planning is essential since it shows how the activities are to be conducted so as to achieve the ultimate goal in the organization. In addition, one has to apply the various leadership qualities in the organization. In case the objectives are effectively attained as set, then this is effective leadership (Eric, 2010).

            In conclusion, it would be appropriate to suggest that indeed, effective leadership is essential in organizations. It assists organizations to achieve their objectives within a given period. Certainly, outstanding leadership qualities are a worthwhile ingredient towards success of virtually all organizations.



Eric, A. J. (2010). Business and Economics/Leadership. London: Kojan.

Martin. (2003). Leading change in Health and Social Care. London: Routledge.




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-How would you evaluate and manage a pediatric patient who has a painful swelling of the hands and feet, fatigue, or fussiness? Which diagnostic studies would you recommend for this patient and why? 

I need the job for today in 2 hours. References (less than 5 years)in APA format. 3 pages

1-How would you evaluate and manage a pediatric patient who has a painful swelling of the hands and feet, fatigue, or fussiness? Which diagnostic studies would you recommend for this patient and why?

2-What physical exam findings and diagnostic results would be concerning to you and why? What would be three differentials in this case?

3-In SCD, the spleen doesn’t work properly or doesn’t work at all. This problem makes people with SCD more likely to get severe infections. What is the treatment for Miah and education for the family?

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