Dignity in Care for Adults with Learning Disabilities

Dignity in Care for Adults with Learning Disabilities The primary aim of the proposed research is to analyse the meaning, perceptions and quality of dignity in healthcare with respect to adults who have learning disabilities in the United Kingdom and study the range of healthcare services available for adults with learning disabilities. Specific Objectives To assess challenges of access, inclusion, choice, attitudes and legislation faced by adults with learning disabilities in healthcare. To determine whether dignity in care for adults with learning disabilities exists in reality as proposed and promoted by the UK Department of health or not. To understand and compare the types of health care services offered and available to adults with learning disabilities. To analyse the quality of healthcare provided to adults with learning disabilities in the United Kingdom and inequalities faced by them. Methodological Details The primary method that will be utilised in this research is based on systematic literature review whereby observations are made on the basis of data accessible in the respect of people with learning disabilities. Literature search will include key words such as about learning disabilities dignity and type of services offered and available for them in the United Kingdom. This method is implemented in this research because it would definitely be helpful because of various reasons identified in the proposal. The relevant literature will be gathered from various sources including journal articles, research reports and books. Ethical Issues Confidentiality and privacy of individuals participating in a research is quite important especially if the research topic is quite sensitive as the case is with dignity in care for adults with learning disabilities. The researcher needs to understand and realise the seriousness of ethical issues and considerations in such a research. Although there is a danger of participants being named or personal information being compromised, the approval from the ethical issues committee is not necessary, as the proposed study will only present a systematic literature review of the data already accessible by public. Relevance to Practice The entire research would be quite useful in enhancing the level of dignity in adults who are suffering from learning disabilities in United Kingdom. However, one of the major points that should be focused by different agencies and social workers would be how fast and effectively they can implement all these processes. Moreover, significant research has been carried out in this regard from different perspective and from different researchers but the reviewed literature shows several gaps in the standards laid down by different government health authorities and the current practices related to dignity in health care of adults with learning disabilities. Introduction: Dignity is a broad and complicated notion that can be used in legal, religious, bioethics, scientific and political contexts with different meanings. The term dignity signifies that a person has a birthright of being respected and treated morally and ethically by others. Dignity implies that people should be treated in such a manner that they feel their value and worth as individuals within the societal context (Soulen and Woodhead 2006). Dignity can be elevated and alleviated by several factors in a healthcare facility. These factors include the facility culture, surroundings and environment, attitudes and behaviour of caregivers and the practice of care being carried out in the facility. People feel more comfortable, confident and in control for making various decisions on their own in the presence of dignity but if there is a lack of dignity they may feel discomforted, devalued, embarrassed and humiliated (Weisstub and Pintos 2007). Dignity is concerned with how people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as valued individuals (RCN, 2008). As dignity creates a sense of comfort and control, it is quite important that caregivers in medical institutions realise the importance of dignity while giving care to adults with learning disabilities. The proposed research will analyse the literature associated with dignity in care for adults with learning disabilities in the United Kingdom. The study Aim: The primary aim of the proposed research is to analyse the meaning, perceptions and quality of dignity in healthcare with respect to adults who have learning disabilities in the United Kingdom and study the range of healthcare services available for adults with learning disabilities. The Study Objectives: To assess challenges of access, inclusion, choice, attitudes and legislation faced by adults with learning disabilities in healthcare. To determine whether dignity in care for adults with learning disabilities exists in reality as proposed and promoted by the UK Department of health or not. To understand and compare the types of health care services offered and available to adults with learning disabilities. To analyse the quality of healthcare provided to adults with learning disabilities in the United Kingdom and inequalities faced by them. The following section of the research proposal will discuss the literature as methods and methodology used to achieve the research aim. As it is systematic literature review in general and as it used to this study in research particular. Methodology: Research methodology is an important aspect through which researches are conducted. A research methodology will actually depict that what is the appropriate approach of conducting a research and which research strategy will be applied in this research. In the similar manner it would also depict that which data will be collected for the research and how it will be collected. This entire research would focus on learning disabilities with adults and the issue of dignity will also be addressed in this research. The main objective of this research is to understand the issues of meaning, perceptions and quality related to learning disabilities and how dignity of these individuals is affected. The primary method that will be utilised in this research is based on systematic literature review which is useful for several reasons such gives a genuine, clear idea about the issue being studied. This method is implemented in this research because it would definitely be helpful because of several reasons. First and the foremost reason is that it would give a clear about the issue that is being studied. Wolf (2008) presented an idea about that systematic literature review that philosophy of science, development of health related materials etc can be analysed through systematic literature review. In the similar manner it gives a genuine and a clear idea about the issue that is being studied. Through this approach findings can be properly analysed and systematic literature review helps the researchers in the decision making process. Wolf (2008) believed that through this approach the information that is collected for this research can easily be summarised. The benefits of this approach would be that past researches can easily be utilised and this would definitely reduce the cost of researching. Another important factor for choosing this approach is the benefit of time that is at tached with systematic literature review. According to Britton and Jonsson (2004) systematic literature review is actually a cost effective approach for conducting a research. Both the researchers agreed with Wolf (2008) that generalisation and collection of data in this approach is quite simple and easy as compared to other approaches. Therefore, it can be said that because of these benefits this approach of systematic literature review is selected for this research. Ethical Considerations: Ethics is the term used for differentiation of right over wrong, good over evil and signification of justice or equality in the general behaviour or actions of individuals in a society (Hinman 2007). Confidentiality and privacy of individuals participating in a research is quite important especially if the research topic is quite sensitive as the case is with dignity in care for adults with learning disabilities. The researcher needs to understand and realise the seriousness of ethical issues and considerations in such a research. Although there is a danger of participants being named or personal information being compromised, the approval from the ethical issues committee is not necessary, as the proposed study will only present a systematic literature review of the data already accessible by public. The information collected in the proposed research will only be used for research purposes and real identities will be replaced by codes or false names when required. The following sect ion provides an analysis of literature relevant to the research topic that will be used in the proposed research. In this research proposal, there is no need to seek the prior approval of the research ethical issues committee because the study will be beleaguered to summarise the related literature only. All the subjects included as a part of the literature review and studied / observed are free from any such biases. This research does not use any kind of personal information of patients or people suffering from learning disabilities and hence there is no incidence of violation of rights on moral or ethical grounds. Study of the Literature: According to The UK Department of Health (2001) learning disability is a combination or collection of several disabilities and disorders. These disabilities may include disability to understand new information or skills, impaired function in society and an onset of any disability that started before adulthood and had a lasting effect. Learning disability or intellectual disability also referred to as learning difficulty in the United Kingdom is quite difficult to explain as it covers a broad collection of disorders or disabilities that people may face. These disabilities include but are not limited to challenges in processing information, understanding written or spoken language and other challenges that may affect quality of life (Corley and Taymans 2002). This notion by Corley and Taymans (2002) is backed by Turnbull and Chapman (2010) who suggest that people with learning disabilities face several problems in understanding and processing complex information and face challenges in developing new skills. These descriptions of learning disabilities indicate that adults with such disabilities may have difficulties in processing information in several social circumstances including healthcare. This implies that adults with learning disabilities will have a higher degree of healthcare needs as opposed to people with no learning disabilities at all. McGrath (2010) argued in an extensive literature review that people with intellectual disabilities have greater healthcare requirements as compared to the general population. While explaining the nature and intensity of these healthcare needs he argues that the health care needs of people with intellectual disabilities are more complex in comparison with the general population and can result in premature death, which could otherwise be prevented through effective care. This argument by McGrath (2010) is also backed by several other researches conducted in the context of healthcare needs of people with learning disabilities (Michael 2008; Leyshon et al. 2004; Cooper, Melville and Morrison 2004; Paxton and Taylor, 1998; Nocon, Sayce and Nadirshaw 2008). Gaskell and Nightingale (2010) also agree with McGrath (2010) regarding the greater healthcare needs of people with learning disabilities. They suggest that healthcare needs of adults with learning disabilities tend to be higher in comp arison to the general population due to a variety of reasons including visual and hearing impairment, challenges in mobility, heart conditions, diabetes and osteoporosis. The greater needs for healthcare of adults with learning disabilities are also perceived by caregivers as Vecchio, Cybinski and Stevens (2009) in their study analysed the effect of disability on needs of caregivers. They implemented descriptive statistics and regression analysis to conclude that caregivers of adults with disabilities indicated that they required assistance while providing care to such adults. It was also concluded in the study that the needs of adults with learning disabilities were even greater than the needs of adults with physical disabilities with respect to healthcare (Vecchio, Cybinski and Stevens 2009). Adults with learning disabilities face several challenges with respect to societal factors including unethical treatment, abuse, undue pressure in interpersonal communication and biasness from the general population due to their specific disability (Slater 2005). Slater (2005) argued that the most prominent challenges with respect to societal factors in healthcare were neglect, poor treatment and abuse by caregivers. He argues that adults with learning disabilities have every right to dignity in life as the general population and should not be subject to abuse due to a specific disability. The Department of Health (2001) provides a clear strategy regarding treatment and care of elderly people especially when they face challenges due to learning disabilities. The recommendations presented by Slater (2005) are in line with the department of health framework with respect to poor treatment and abuse. The framework clearly outlines that dignity should be a top priority in healthcare where people should be treated in an ethical, moral and respectful manner. The importance of dignity and equality in healthcare services is iterated by another report of The Department of Health (2002) by implying the importance of fair access to care services irrespective of age and any disabilities a person may have. Philp (2007) recommended that dignity in care should not be an afterthought and caregivers should understand and realise the importance of dignity in healthcare of adults with learning disabilities. He suggests that caregivers are very busy and they need to incorporate dignity into the overall framework for providing care. In his study, Philp (2007) emphasised the need for treating adults with respect and integrity while giving them a sense of freedom and control over their actions and behaviour. He concluded that there are various forms of abuse and caregivers need to provide care with thorough understanding and realisation of dignity in care of adults with learning disabilities (Philp 2007). Holland (2000) on the other hand, analysed how ageing affects people with learning disabilities with respect to social, psychological and biological issues. He argued that adults with severe learning disabilities faced more challenges in later parts of life with respect to services as compared to adults without any disabilities. He concluded in his study that gaps were present in the healthcare and social services provided to learning disabilities and the standards established by the department of health (Holland 2000). This implies that albeit healthcare providers may focus on providing the most effective quality of services but improvements can still be made to make the quality of services more effective especially with respect to dignity in care. Batesa and Davis (2004) in their study of social inclusion and services for people with learning disabilities presented several societal challenges faced by adults with learning disabilities. These challenges include hindrance in local community participation, perceptions of general population, problems in safety and trust, limited access to social networks and limited access to services being offered. The study indicates that these challenges are faced by adults with learning disabilities mainly due to the perceptions of community and general population with respect to these people. The research concludes that social capital concept provides an effective model for services that focus on promoting social inclusion of adults with learning disabilities (Batesa and Davis 2004). The concept of social capital, which is based on social networks, and standards of trust and reciprocity Batesa and Davis (2004) can also be implemented in healthcare for adults with learning disabilities for bet ter outcomes. Health care services are of utmost importance to individuals who are suffering with different learning disabilities. McGrath (2010) believed that people with learning disabilities needs health checks to monitor the discrepancies they have. Annual health checks is a type of health care service that is offered and available to adults with learning disabilities. Usually, people who are facing these difficulties are less likely to receive continuous screening and they have less frequent routine checks. That is the reason why annual health checks should be offered by different health care institutions so that they can benefit from it in both the short and the long run. However, a concern is that whether these health checks are needed or not because if they are not viable enough so there is no need to have an exercise that would engage them in such activity. Albroze (2005) discussed that these annual health checks are very important because they assist the patients in every aspects and peo ple who are suffering from these difficulties can gauge that what is their current situation. People who have learning disabilities usually live in communities and they have the right to access different mainstream health care services. Deshler, Schumaker and Bulgren (2001) discussed that individual importance should be given to people who are suffering with learning disabilities and this can be considered as a health care service. Nurses should be effectively trained in this regard and they should help the individuals who are facing learning difficulties. These researchers also believed that equal health care services should be provided to patients who are suffering from learning disabilities. In the similar manner disability awareness should be given to them in different regards like trainings and workshops should be organised so that they can easily benefit from these activities. Certain special health care services should be allotted to those individuals that have complex and special needs (Bergmark, Parker, Thorslund, 2000). In the similar manner, certain action plans should be developed for this cause so that all these health care services would be implemented in a proactive manner. Besides certain annual che cks individuals suffering from learning disabilities should be offered regular checkups. This will provide an equal opportunity to learn about their health and they can lead a happy and a prosperous life. Certain picture-based books should be provided to them so that they can learn how they can face different complex situations (Deshler, Schumaker and Bulgren 2001). Emerson, Davies and Spencer (2005) analysed that learning disability in adults is a condition that is quite long lasting. A survey showed that about 62% of all the people who are suffering from this disability live with their parents or with their relatives. Similarly, 30% of the people especially adults live in certain form of residential care or they live with people who are also suffering from learning disabilities. However, only 7% of the people live with their partners or they live alone. There are different inequalities faced by adults when they are receiving health care facilities. Michael (2008) believed that at times people receive unequal health care treatment and this can be considered as an important issue for people who are providing learning disabilities and for those who are accessing it. People that are facing learning difficulties are not always offered the same level of services and treatment as the general population. People and health care service providers assume certain things when they are dealing with individuals facing learning disabilities (Kuntz, Minnes, Garcin, Martin, Lewis, Holden, 2005). In the similar manner the routine health care services received by these adults over the year in the United Kingdom is patchy too. Finally, people who are suffering from learning disabilities as not served and perceived as a priority (Michael 2008). Cooper, Melville and Morrison (2004) believed that people who are facing learning difficulties face unequal atmosphere. They are not treated as equal citizens in many conditions and this creates a sense of inequality in them. People with learning disabilities are discriminated in the society and there are different health care professionals who do not understand much about learning disabilities. In the similar manner many professionals in the society are not familiar with the laws associated with capacity to consent. There are certain professionals who are aware with this scenario but most of them do not consult the family of these individuals who are suffering with learning disabilities (Corley and Taymans 2002). Individuals that are suffering with learning disabilities may not understand the significance and importance of health care screening or it is highly probable that they may not recognise the symbols of ill health. This factor might create issues for the carers in both the s hort and the long run. Therefore, people with learning disabilities should be dealt with extreme care and the level of dignity should be maintained so that they can lead a healthy and a prosperous life. Summary: The primary aim of the proposed research is to analyse the issues related to dignity in healthcare with respect to adults who have learning disabilities in the United Kingdom and study the range of available healthcare services. This primary aim will be accomplished by achieving several underlying objectives. All the researches that were analysed in the literature review depict that adults with learning disabilities face several challenges especially with respect to dignity and they should be dealt with extreme care. There are certain discrepancies and difficulties in this regard and there should be a proper equal approach adopted to care for adults with learning disabilities. It was also stressed in this research paper that dignity of these individuals is the main issues and once the dignity of these individuals are present they can live with self respect in the society. Relevance to Practice: The entire research would be quite useful in enhancing the level of dignity in adults who are suffering from learning disabilities in United Kingdom. However, one of the major points that should be focused by different agencies and social workers would be how fast and effectively they can implement all these processes. A significant amount of research has been conducted in this regard but the reviewed literature shows several gaps in standards laid down by government health authorities and current practices. The proposed research will be helpful in filling these gaps. The proposed research would be beneficial for adults who are facing with learning disabilities and it would be beneficial for caregivers who are planning to implement these processes.

La Lodge and Entr’acte

I think that the poem entr'acte describes the painting very well. It brings across the feelings of the two people in it in a very good and sensitive way. Firstly the title of the poem -‘entr'acte' makes the poem sound elegant and impressive, or even sophisticated. The title means in between acts which describes the painting very well because she is just sitting there and he has his eyes on things completely away from the stage. Entr'acte also sounds a bit like ‘attract' so maybe that has something to do with it. At the start of the poem it says ‘the cuff links whispers to the glove, such elegance and all for love' I think in These lines the man speaking and he is saying to himself how elegant he is in his suit, (maybe he is being vain) and he how has done it all for love, maybe the love of the woman sitting in front of him or maybe the women he is looking at through his binoculars. Then in the second stanza ‘the glove confesses to the glass, oh how slowly five acts pass.' I think that it is the woman speaking about herself and how slowly five acts pass. Maybe the five acts pass slowly because she is not interested in the performance and is bored or maybe it is because she is waiting for the end so she can get away and do something else. In the first line of the third stanza, ‘the glass is lifted to the eye' I think this maybe the poet speaking, doing a running commentary of what is going on. On the second line of the stanza,' Show me a tear I cannot dry' I think this is the glass speaking about how the woman might be crying inside. She might be crying in the inside because the man is horrible to her or maybe because she just does not want to be there. Its like she's crying inside but is holding herself together so she doesn't show it. In the first line of the forth stanza ‘The eye shows nothing to the eye' I think this means that if you look at someone you cant judge them by what they look like because you cant see what they are like inside. In the second line ‘such elegance and all for art' I think It could be the man talking and saying that she was there displayed in the front of the box just for show. To say to the other people there that yes he could have a beautiful woman, or she could be there to make other woman jealous. Maybe the line means something completely different and the poet is saying ‘such elegance'- because they are all dressed up in beautiful clothes, and ‘all for art'- because In the end the people in the picture were probably there just to pose for the artist to paint them. In the painting it has the woman at the front of the picture- is this just so the man can show her off or is it because he is being a gentleman and letting her sit in front so she can see better. He is sitting at the back his could because if he looks up at other woman in the audience she won't be able to see. She is also wearing flowers by her face and breast as if to draw attention to these features. Her face is fixed, and her eyes especially make her look sad inside as if she is trying to put on a show, to hide her emotions in public. Her lips are bright red maybe for love, anger, passion or lust. Her dress is black and white stripes like a prisoners clothes, maybe she's trapped by the man behind her from freedom. Overall I think that the man behind her is using her to show of to the woman he is maybe looking at in the audience. He has dressed her and himself up in very exquisite and elegant clothes just for the show and to make him look wealthy. I think she is sad and upset that she is trapped as a model for him and is bored by the whole performance; she not very interested in it and probably wants to be somewhere else.

Who Else Is Lying to Us About Toulmin Essay Samples?

Who Else Is Lying to Us About Toulmin Essay Samples? The most important thing all writers must keep in mind whilst writing this type of essay is to use the very first person tone. When you have gathered ideas on this issue, you have to properly place your thoughts into words. Your very first job is picking a topic. When you have decided the use of the paper, it's time to spot your audience. Sometimes, two proceedings that seem connected in regards to time might not be associated. The two of these structures are normally used. As is true with all kinds of writing, there's nobody right approach to organize or structure an argument. This kind of argument works well whenever there are no clear truths or absolute solutions to an issue. The truth is that same-sex marriages are very similar to the typical heterosexual marriages. It's instead more of the usage of marriage for a weapon to resist against the homosexuals. Just by the simple fact that homosexuality goes against that which we believe in does not signify that it's going to be harmful to the total course. To the contrary, the same-sex marriages perception is that they're illegal, though they are consistent with the rights of people involved. Finding the opportunity to go to school whilst playing sports is such a fantastic thing for an individual's future. This has caused new means of studying the family, including the same-sex partners. The key consideration to bear in mind is that you wish to go for an argument structure that operates well for your situation, meeting the demands of your audience together with your goals as a writer. Look at a nonsmoker in his own house. The prevalence of the web has resulted in an increase in plagiarism amongst students. For instance, you could possibly be interested in knowing more about traffic issues in america. Every individual in the USA should have access to federally-funded medical insurance. Such an essay has to involve plenty of research to be able to acquire factual and correct info. Quite frequently, the very best topic is one which you truly care about, but you also will need to get ready to research it. Following that, you must research that topic to be able to specify the topic's scope, therefore it can be readily discussed in 1000 word essay. If you aiming a great score and stick out in your class, you can practice on the wide variety of essay outlines available on our principal site. Well, you're not the just one. I am quite pleased with the work which he or she did! You should observe the next outline. Therefore, there may be other aspects which influence the specific benefits in school. There are hundreds and hundreds of studies that have shown again and again, no matter the population studied, the quantity of persons involved with the study and the kinds of exercises examined, that exercise does have a positive influence on overall wellness. Yes, they have been done on this too and they show that the outcome and the time it takes to achieve the desired result depends on how often exercising is done, for how long and the types of exercise done. These studies have been so extensive they have delved deep into the kinds of exercise and how much is required for the a variety of health benefits. Failure to know the all-natural climate change will ensure it is impossible to counter the issue of global warming. As soon as it's essential to note you should continue in your search for resources and support throughout this procedure, even as you locate source material, you can start to take into consideration how you intend to bring your ideas and your sources together into a clear, organized method. Not every kid will suffer from a number of the things but there's a chance that a few of the children will and with the effects I have discussed it wouldn't be a risk I am prepared to take. By way of example, write about animal testing and the demand for more laws to stop it. If you are searching for Toulmin essay idea, below are some fantastic topics you can test out. Following that, the last portion of the introduction section should talk about the thesis statement of your essay. Such an essay also presents facts and figures citing it by credible sources so the reader is convi nced. It involves a variety of essays such as cause and effect essay. Thus, they require recognition. It is of amazing value to look after the unborn. To begin with, you will opt for a subject of interest.

Concept Of Risk In Construction Industry - Free Essay Example

Sample details Pages: 15 Words: 4524 Downloads: 10 Date added: 2017/06/26 Category Statistics Essay Did you like this example? 3.1 General risks The meaning of risk changes when time goes on and the meanings differ when they are at the specific socio-cultural and historical contexts which we are located in. (Deborah Lupton, 1999) Risk is exposure to the possibility of economic or financial loss or gain, physical damage or injury, or delay, as a consequence of the uncertainty associated with pursuing a particular course of action (Cooper, Chapman, 1987).According to Cornelius Keating, risk is not the present problem which should be immediately addressed, but it is considered as future issues that can be avoided or mitigated. Risk is considered as a situation which may lead to negative consequences. Generally, six major categories of risk can be identified as the most important concerns for the majority. They are: Don’t waste time! Our writers will create an original "Concept Of Risk In Construction Industry" essay for you Create order Environmental risks, including pollution, radiation, chemicals, floods, fires, dangerous road conditions and so on; Lifestyle risks, which related to the consumption of such commodities as food and drugs, engagement in sexual activities, driving practices, stress, leisure and so on; Medical risks, which related to experiencing medical care or treatment. Such as drug therapy, surgery, childbirth, reproductive technologies and diagnostic tests; Interpersonal risks, related to intimate relationships, social interactions, love sexuality, gender roles, friendship, marriage and parenting; Economic risks implicated in unemployment or under-employment, borrowing money, investment bankruptcy, destruction of property, failure of a business and so on; and Criminal risks are those risks emerging from being a participant in or potential victim of illegal activities.(Deborah Lupton, 1999) 3.2 Risks in Construction Industry 3.2.1 The Concept of Risk in Construction Industry The construction industry experienced a wide variety of risks which may occur in financing, designing, constructing and managing facilities of a project. There are different definitions of risk in construction industry. In order to understand the process of risk management, it is important to understand the basic concept of risk in all aspects. The international standard à ¢Ã¢â€š ¬Ã…“Project risk management à ¢Ã¢â€š ¬Ã¢â‚¬Å" Application guidelinesà ¢Ã¢â€š ¬? holds the theory of probability and consequence and defines risk as a combination of probability of an event which is occurring and its consequences to project objectives (IEC 2001). Ward and Chapman (2003) have made a broader definition of risk and suggest using a more general concept of uncertainty. They argue that risk is considered as threats but not opportunities and when it occurs it affects the project performance. Edwards (1995) points out that risks have a negative impact on the projectà ¢Ã¢â€š ¬Ã¢â€ž ¢s cost, qual ity or time in most situations. These definitions have a common feature: they define risk in terms of uncertain events and may have positive or negative impact on a projectà ¢Ã¢â€š ¬Ã¢â€ž ¢s objectives. According to An (2010), risk interpretations can be considered as the following: The same as the word à ¢Ã¢â€š ¬Ã‹Å"hazardà ¢Ã¢â€š ¬Ã¢â€ž ¢ The consequence of an unwelcome outcome or failure Chances of achieving a given outcome Signifies danger Taking a chance in an activity An (2010) argues the term risk can be defined in the two components: the probability of occurrence of the risk and the magnitude of the consequences if the risk happened. And the relationship is written in the formula: Risk = consequences x probability. The general trend of risks is shown in the figure 3.1 below. When the probability of occurrence is high, the consequences of risks seem to be low and vice versa. Risks with major or severity consequences rarely happen, but risks which are or have low consequences tend to happen frequently. Figure 3.1: Consequences versus probability trend (An, 2010) As mentioned above, the equation seems to be simple, however, the most important thing is to understand and calculate the probability of occurrence and the severity of consequences and express those using numbers. 3.2.2 Risk Classification Project risks can be categorized in a number of ways by considering the level of detail or a selected viewpoint. (Anna Klemetti, 2006) Categorizing risks will do help in identifying risks. According to the study of National Economic Development Office, construction risks can be broadly grouped in the following categories:   Technical Risks include poor design, inadequate site investigation, and uncertainty over the source and availability of materials and appropriateness of specifications. Logistical Risks include availability of resources such as construction equipments, spare parts, fuel and labour and availability of sufficient transportation facilities. Construction Risks include uncertain productivity of resources, weather or seasonal implications and industrial relations problems. Financial Risks include inflation, availability and fluctuation of foreign exchange, delay in payment, repatriation of funds and local taxes. Political Risks include constraints on the  availability and employment of expatriate staff, customs and import restrictions and procedures, difficulties in disposing of plant and equipment and insistence on using of local firms and agents. Both Smith (2006) and An (2010) argue that all project risks can be divided into three main categories: known risks, known unknowns and unknown unknowns. The difference between the categories is the decreasing ability to predict or foresee the risks. Table 3.1 presents a brief explanation about these three categories of risks. Table 3.1 Categories of risks (An, 2010) Known risks Including minor variations in productivity and swings in material costs. These occur frequently and are an inevitable feature of all construction projects. Known unknowns Including the risk events whose occurrence is predictable. Either their probability of occurrence or their likely effect is known. Unknown unknowns Those events whose probability of occurrence or their likely effect is unknown. Risk resources can also be divided into four elements: trivial, expected, hazard and risk management. Events with a low impact are not serious and can be divided into the elements of trivial and expected. For the high impact and low probability, these events are hazards which might occur but are too remote to be considered. (An, 2010)Taking into consideration of the probability of the occurrence and the consequence for project objectives, those events that have high probability and high impact are subjected to risk management. Figure 3.2 shows the classification of risk resources. Figure 3.2 Classification of risk sources (Smith, 2006) The causes of risk are various and depending on the size, complexity, novelty, location of the project as well as on the speed of construction and political or commercial plan. Long-term projects are thought to be more risky because the possibility of something going wrong is bigger to appear and the need for immediate plans of action that allow change is fundamental. The sources of risk are presented in Table 3.2. Table 3.2: Sources of risk (Thompson, Perry, 1992) Source Example Client, Government, regulatory agencies Bureaucratic delays, changes in local regulations Funding, fiscal Changes in government funding policy, liaison between several funders Definition of project Change in project scope Project organisation Authority of project manager, involvement of outside bodies Design Adequacy to meet need, realism of design programme Local conditions Local customs, weather windows Permanent plant supply Degree of novelty, damage or loss during transportation Construction contractors Experience, financial stability Construction materials Excessive wastage, quality, delivery Construction labour Industrial relations, multi-racial labour force Construction plant Resale value, spares availability Logistics Remoteness, access to site Estimating data Relevance to specific project availability Inflation Exchange rates Force majeure It is important to use the table as the first step in risk assessment process in order to identify all the relevant risks of the construction project. By identifying all the construction risks in the early stage of risk assessment process, successful risk management can be achieved. Failing to identify risks in the risk identification stage is a hazard to the risk management process. (Perry and Thompson, 1992) Moreover, risks can be classified based on the ability of the project to control them. A separation of risk as a local, global and extreme is based on the controlling ability of project parties on risks. As a result, this method helps to identify 80% of the risk, the last may not be worthwhile looking for, and a few of these risks could not be reasonably foreseen. (Smith, 2006) Figure 3.3 shows the hierarchy of identified risks. Figure3.3: Hierarchy of identified risks (Smith, 2006) Project parties have to manage the manageable risks by the settled frame and prepare to accept the challenges of the unmanageable risks. The preparation can reduce the losses caused by the unmanageable risks. Besides, some global risks can be reduced for sure. Categorization of risks would definitely help to identify risks. No matter what method is used to identify the risks, it is important that risks should be identified and assessed carefully, which is even more important in the early stages of the project since it will affect the decision making of the project participants. 3.2.3 Importance of Risk Management in the Construction Industry Change is inherent in construction work. When an uncertain event occurs, it will impact some of objectives such as the cost, schedule, and quality of the project. Construction projects often have a poor performance due to a lack of reasonable risk management process. (Liu Renhu, 2005) Many projects fail to meet deadline or cost and quality targets. As a result, risk management becomes an important part of construction management. Risk management intends to identify and manage those potential and unforeseen problems that might probably occur during the project implementation. And also, it tries to identify as many risk event as possible minimize their impact on the project, manage the responses to those events that are probably to materialize, and provide contingence funds to cover risk event that actually materialize. The essential purpose of risk management is to improve project performance via systematic identification, appraisal and management of project related risks. The focus o n reducing threats or adverse outcomes, which we might call à ¢Ã¢â€š ¬Ã‹Å"downsideà ¢Ã¢â€š ¬Ã¢â€ž ¢ risk, misses a key part of the overall picture. (Chapman, Ward, 2003) Changes cannot be eliminated, however, by applying risk management in project construction participates are able to improve the construction management. The benefit of risk management can be concluded as follows: Project issues are clarified, understood and considered from start; Decisions are supported by thorough analysis; The definition and structure of the project are continually monitored; Clear understanding of specific risks associated with a project; Build-up of historical data to assist future risk management procedures. (An, 2010) 3.2.4 Project Planning The control of time cannot be affected insulation from resources and costs. Project planning methods should consider the communication with all the parties in a project in order to identify sequences of activates and draw attention to potential problem areas. Careful and continuous planning contributes to successful construction project. Sequences of activities will be defined and linked to a time-scale to ensure that priorities are identified and efficient use of expensive or scare resources. However, since the uncertainty occurs during construction, the plan will always change and it must be updated quickly and regularly in order to maintain the most efficient way of completing the project. In developing a controlling plan, it is vital to distinguish between different categories of change and to fully instigate the formal aspect of the project. (An, 2010) All the parties and resources involved in construction have influences on project plan. However, project plan will change when uncertainty occurs. The purpose of planning is to persuade people to perform tasks before they delay. A framework of decision making in case of change occurs should be included in project planning. (Smith, 2006) 3.3 Risk Management in the Construction Industry 3.3.1 Risk Management strategy Both client and contractor are concerned about the projectà ¢Ã¢â€š ¬Ã¢â€ž ¢s risk allocation. Generally, the client or the project owner has an overall risk management strategy and policy included in the strategic documents and quality management system. Risk management strategy is shown in figure 3.4. Management of project risk Figure 3.4 Risk Management Strategy (Smith, 2006) The most important issues which the project owner concerned in risk strategy are risk ownership and risk financing. Risk ownership is explained as which party owns the risks and risks expose and transfer. Risk financing can be explained as how to include and use budget of risk allowance or contingency. The participants make decisions, which affect the responsibilities of the parties, to define the organization and procedures of a project. (An, 2010) It influences the construction, commissioning, change and risk of a project and this is how it affects the construction processes. (Smith, 2006) 3.3.2Process of Risk Management 3.3.2.1 Introduction Risk management is one of the most critical project management practices to ensure a project is successfully completed. (Chapman, 1997) The goal of risk management in construction industry can be stated as following: à ¢Ã¢â€š ¬Ã…“To be competitive in meeting the clients specifications with solutions that are cost-effective at an acceptable level of riskà ¢Ã¢â€š ¬Ã¢â€ž ¢Ãƒ ¢Ã¢â€š ¬Ã¢â€ž ¢ (An, 2010). To successfully achieve the goals in any projects, the following four aspects need to be met: Competitiveness Specification Cost-effective Risks It is important to consider the four criteria as a whole. There are two major objectives managing risk: one is to avoid the downside risks and the other is to exploit opportunities. Risk management is a process of defining the need for identifying, estimating and evaluating risks in order to control them at an acceptable level. (An, 2010) The risk management system is shown is figure 3.5. Figure 3.5 risk management frame work (An, 2010) Four aspects are involved in risk management, which are hazard identification, risk assessment, risk reduce or risk response and emergency preparedness. These will be introduced in the following paragraphs. 3.3.4.2 Hazard Identification Hazard identification is the first step of the risk management process. It is aimed at determining potential risks which may affect the project. Ideally, all the potential risks and hazards should be identified when the decision is being made so that the participants can deal with before they occur. However, although prevention is better than cure, no risk management system can identify all the risks and hazards in advance. (Martin Loosemore, 2006) In this way, hazard identification needs to be carried out carefully in order to reduce the potential risks in the project. As the first step of risk analysis, hazard identification is the most important one as it helps to identify the potential risks whose effects act as an impediment to the project, and this process will also help with risk mitigation and control. A general definition of hazard is stated as following: à ¢Ã¢â€š ¬Ã…“A hazard is an undesirable outcome in the process of meeting ant objective, performing a task or engaging in an activityà ¢Ã¢â€š ¬Ã¢â€ž ¢Ãƒ ¢Ã¢â€š ¬Ã¢â€ž ¢ (An, 2010). The undesirable outcome of a hazard could involve: Injury to personnel Damage to property Pollution to the environment and A combination of all the above (An, 2010) Risk identification is one of the most important steps of risk management because it makes the risks clearer. As a result, Chapman (2001) points out that the success of later risk management phases is directly affected by the quality of the identification phase. Risk identification procedure identifies and categorizes risks that could affect the project. This procedure includes discovering, defining, describing, documenting and communicating risks before they become problems and affect a project. (Barati, S.,  Mohammadi, S., 2008) Risk identification is a tool for identifying all the significant sources and causes of risk and hazards in a project. Numbers of methods and techniques are used in identifying the project risks (IEC 2001), including brainstorming, expert opinion, structured interviews, questionnaires, checklists, historical data, previous experience, testing and modelling and evaluating other projects. Perry (1992) points out the most popular methods of hazard identification. They are: Checklists prepared by experienced people that are involved in the project. Brainstorming sessions where groups of people are trying to come up with potential risks through conversation and exchange of ideas. Historical data of previous similar projects that can assist in the portraying of risks. Interviews of key participants of the project or experts involved with it. These techniques are to provide a systematic approach for identifying potential hazards in construction industry. (An, 2010) Empirical studies of risk management practice (Lyons, Skitmoreà ¯Ã‚ ¼Ã…’2004) show that the checklists and brainstorming are the most useful techniques in risk identification. And they also point out that risk identification often rely on individual judgments of the project participants. Another method applied for the identifying risk events is the HAZOP study (Hazard and Operability). This is a technique using à ¢Ã¢â€š ¬Ã…“guide-wordsà ¢Ã¢â€š ¬? in order to study deviation from the design objective of a project and its elements. (An, 2010) A helpful action would be to group the risks and separate them into specific categories after the first stage of risk identification. This would benefit the risk assessment process by applying a suitable technique to each category and furthermore in the selection of a risk management response for each type. (An, 2010) in construction industry three main types of hazards which need to be taken into account are the followings: Management Hazards: Associated with management and organizational issues, such as policy, commitment of funds for training, and the project of specific equipment and schedules to be met. Commercial Hazards: Arise from commercial considerations, and particularly associated with decisions on spending. A typical example is the selection of a less expensive material that just meets the minimum standard required instead of opting for the more expensive item with huge specification and a track record of high quality. Sometimes a contract is accepted as a cost below the desired level, and savings have to be made in order to complete the work. This in turn may lead to potential hazards due to commercial factors. Time Hazards: Many projects need to be completed by an agreed date. Delays due to the factors such as late delivery of materials, unforeseen production difficulties or failure to meet specification would affect the ability to meet deadline. As a consequence of failure to meet the deadline, it could affect future contracts and disrupt the schedules. All these events can be considered as hazards or time hazards. Each project has different associated hazards, which differ from various technology or organizations or anything else applied in the projects. A checklist of construction hazard drivers is shown: Financial Hazards Legal Hazards Political Hazards Social Hazards Environmental Hazards Communications Hazards Geographical Hazards Geotechnical Hazards Construction Hazards Technological Hazards Demand/product Hazards(An, 2010) After hazard identification, the potential hazards can be listed and grouped. Then, risk assessment method can be applied to build the risk level. 3.3.4.3 Risk Assessment Once risks have been identified, they must then be accessed. The sources of risks should be identified first, and then the effects of the risks should be assessed or analyzed. Risks can be assessed either using a quantitative or qualitative analysis. (Thompson, Perry, 1992) Qualitative Methods: The first step of the qualitative analysis is also the first step of risk assessment risk identification, which is described above as the first step of risk management. Then, an assessment of the probability of occurrence and impact of the risks should be taken out. Qualitative risk assessment usually includes the following issues: A brief description of the risk The stage of the project when it may occur The elements of the project that could be affected The factors that influence its occurrence The relationship with other risks The likelihood of its occurrence How it could affect the project (Smith, 2006) Using qualitative methods is the first step of risk assessment. Then, a quantitative assessment is only for the risks whose further information is required. These risks are usually serious and can jeopardise the project. Quantitative Methods: According to Barrow (2007), there are four reasons why risk should be managed: to minimize delays, to reduce cost, to improve return on investment, to increase the number of opportunity. Possible consequences of risk occurring are defined and qualified in terms of: Increased cost such as additional cost above the estimate of the final cost of the project Increased time such as additional time beyond the completion data of the project through delays in construction Reduced quality and performance such as the extent to which the project would fail to meet the user performance based on quality, standards and specification. (Smith, 2006) Several methods can be used in risk assessment and risk metrics method is going to be introduced. Risk metric is a two-dimensional presentation of likelihood and consequences using qualitative for both dimensions, event modelling is a systematic way to identify accident scenarios and quantify risk. (Ayyub, 2005) Estimating the probability and impact of risk in simple scales, such as from 1 to 5 or from high to low, is the most common way, and boundaries can also be numerically defined. Risk can be characterized by probability and consequence, and examples are given in table 3.3 and table 3.4. Probability of Occurrence Scale Descriptor 1 Rare 2 Unlikely 3 Possible 4 Likely 5 Almost Certain Table 3.3 Probability of Occurrence (An, 2010) Rating of consequences Scale Descriptor 1 Insignificant 2 Minor 3 Moderate 4 Major 5 Severe Table 3.4 Rating of consequences (An, 2010) As mentioned in pervious paragraph, Table 3.5 shows that risks can be allocated in three regions. Table 3.5 Risk Matrix (An, 2010) Consequence Probability 1 2 3 4 5 5 Tolerable Tolerable Intolerable Intolerable Intolerable 4 Negligible Tolerable Tolerable Intolerable Intolerable 3 Negligible Tolerable Tolerable Tolerable Intolerable 2 Negligible Negligible Tolerable Tolerable Intolerable 1 Negligible Negligible Negligible Tolerable Tolerable And this can also be replaced by two curves, as its shown in figure 3.6. Figure 3.6 Graphical presentation of risk regions (An, 2010) During risk assessment, identified risks are evaluated and ranked. The goal is to prioritise risks for management. The assessment of the risks leads the hazards to be classified in a region, which would determine the importance (risk level) of each hazard, and the possible regions are the intolerable, tolerable or the negligible region. Figure 3.7 shows the risks listed in the appropriate regions. Figure 3.7 Output of risk assessment element (An, 2010) The risks are allocated in three regions, after that, the risks should be selected the risk response to them. 3.3.4.4 Risk Response Once the risks are identified and assessed, the next step of the risk management procedure is to response to these risks. The nature of the response depends on the decisions made by the management team. In order to respond correctly, the team has to process the information available for the risk. There are two types of responses to risks: immediate response and contingency response. The immediate response mitigates or eliminates the risks through alterations of the project plan. The nature of contingency response is preparing a plan for an alternative course of action and implementing it when the risk arises. (An, 2010) There are four basic ways of responding to risk and they are risk retention, risk transfer, risk reduction and risk avoidance. In order to effectively manage a risk, it is necessary to adopt a combination of strategies to treat it. The selection process can be iterative until the most effective treatment strategy is developed. (Smithà ¯Ã‚ ¼Ã…’2006) Avoidance: Risk avoidance deals with the risks by eliminating the risks through changing the project plan or certain features. Another way of risk avoidance or reduction is re-design or changing the method of construction. (Perry, Hayes, 1985) However, there are only a few situations this response can be used. Reduce: Risk reduction aims at reducing the probability and consequences of a risk event. The measures should be taken with consideration of the value for money. Reducing the level of risks could raise the cost. Only when the value of the reduced risk is beyond the cost it caused, this method can be taken. Risks can be reduced by: Obtaining additional information Performing additional tests/simulations Allocating additional resources Improving communication and managing organisational interfaces(An, 2010) After risk assessment, hazards are allocated in the intolerable, tolerable and negligible regions. There are some guidelines for risk reducing. Hazard in the intolerable region: risks in this level should be eliminated or cost-effective cannot be achieved. As a result, the project should be considered for abandoning. Hazard in the tolerable region: to reduce risks in this region, two aspects should be considered. One is whether the risk is close to the intolerable region, the other one is whether it is a cost-effective reduction process. It is better to reduce the risk no matter how expensive it might cost in dealing with the first situation. For the second consideration, it is better to reduce the risk and checking carefully of its allocation. Hazard in the negligible region: it is recommended that these hazards should be left alone, since they are not worth to reduce. (An, 2010) Transfer: Risk transfer is to transfer risks from one party to another. This would happen between parties in a project or between one party in the project and one outside. (An, 2010) Some contractual obligation can also be used as risk transfer method, because no one is willing to accept a risk without any form of compensation. Generally, it is better to transfer the risks to the parties who can best control them. Acceptance or Retention: If the other methods fail to adequately or fully treat the risk, the project has to be prepared to accept the risk or any residual risk remaining after some initial treatment. The party which is holding a risk may be the only one that can manage the risk or accept the consequences. If the risk is under control of this party, the likelihood of happening or minimise the impact of the risk could be reduced. It is possible for a risk to have a number of potential treatment equally suitable but varying in cost. The selection of a final treatment must be made as cost-effective. The cost of managing the risk should be commensurate with the benefits obtained. The risk response process is directed at identifying a way of dealing with the identified and assessed project risks. Risk reduction is the most frequently used technique within the construction industry. Managing the risks of a project is a rather difficult task. Choosing any form of treatment may itself expose the project to additional risks. In this way, attention should be paid to ensure that the treatment strategy does not expose the project to greater risk than what the original risk was designed to treat. 3.3.4.5 Emergency Preparedness Even when the pervious risk management processes have been well applied, accidents happen occasionally. The goal of emergency preparedness can be concluded as the following: à ¢Ã¢â€š ¬Ã…“To be prepared to take the most appropriate action in the event that hazard becomes a reality so as to minimise its effects and, if necessary, to transfer personal from a location with a higher level to one with a lower risk level.à ¢Ã¢â€š ¬?(An, 2010) Regarding the management of risk, an emergency preparedness is the preparation of contingency plans and courses of action in case the risk arises during construction. The emergency preparedness could also be an alternative course of action prepared as a contingency plan. 3.4 Conclusion Risk management intends to identify and manage those potential and unforeseen problems that might probably occur during the project implementation. And it could identify as many risk event as possible, minimize their impact to the project, manage the responses to those events that are probably to materialize, and provide contingence funds to cover risk event that actually materialize. à ¢Ã¢â€š ¬Ã…“Precaution is better than cure.à ¢Ã¢â€š ¬? The same principle can be applied to risk management which should be a proactive approach rather than a reactive one. Risk management is a preventive process to ensure that negative impacts are reduced and that harmful consequences associated with undesirable events are minimized. Generally, the risk management process should include: risk identification, risk assessments, risk response and emergency preparedness. Once risk has been identified, they must then be accessed on their potential severity of loss and the probability of occurrence. The n through the following stages such as risk avoidance, reduction, retention or risk transfer, the risks can be dealt with and its impact can be decreased to a certain extent.