Tuesday, May 5, 2020

Accounting conservatism and managerial risk - Myassignmenthelp.Com

Question: Discuss about the Accounting conservatism and managerial risk. Answer: The items of equity of Ramsay Health Care limited are listed in the consolidated statement of financial position. Constituent of equity of Ramsay comprise of issued capital, treasury shares, convertible adjusted rate equities securities, retained earnings and other reserves. It also involves parent interest and non controlling interest. Issues share capital is the face value of shares and amount of nominal value of shares that is held by shareholders. It is the amount that shareholders invest in the company. Such shares might comprise of equity shares and preference shares. Treasury shares are the shares that the issuing company buys back from shareholders that have the impact of reducing outstanding shares in open market. Convertible adjustable rate equity securities are types of preferred stock where payment of dividend is set a base rate and a benchmark interest rate (Balakrishnan et al., 2016). Reserves are the amount that is created out of profits of company. Revenue reserves and capital reserves are the two types of reserves that a company has. Retained earnings are the cumulative earning earned by corporation that is not intended for distributing to shareholders (Chaibi et al., 2014). Such earnings are reinvested in the business and are not distributed as profits to shareholders. Total value of equity for Ramsay Health Care limited is recorded at $ 2046061 million in year 2016 compared to $ 1837794 in year 2015. This increase in value of equity is mainly because of increase in value of treasury shares, other reserves and retained earnings. Total amount of income tax paid by Ramsay Health Care Limited is depicted in consolidated statement of comprehensive income. The income tax expense for year 2015 is recorded at $ 221216 million and in year 2016, company reduced income tax expense by amount $ 23542 million. Income tax in year 2016 stood at $ 187674 million (ramsayhealth.com, 2018). In the current year that is 2017, income tax expense is recorded at $ 198669 million. Therefore, income tax expense reduced initially and increased thereafter. Income tax rate that is applicable to Ramsay Health Care Limited is the rate of corporate tax is 30%. Accounting income of company for year 2016 is reported at $ 445298 and for year 2015, amount stood at $ 432073 (ramsayhealth.com, 2018). There was increase in value of accounting income of company. Now, computation of accounting income of firm times the corporate tax rate for both the years is computed at ($ 445298 * 30%) is 311708.6 for 2016 and ($ 432073 * 30%) is $ 302451.1 for year 2015. Computation of above figures is indicative of the fact that the percentage of accounting income to corporate tax has increased. When comparing the above figures with that of tax expenses recorded for particular years, it can be inferred that tax expense for both the years is less than accounting income as income tax percentage. Therefore, figures of income tax expense are considerably different from that of above figures. Factors responsible for causing this difference are that income tax expense has reduced considerably through the years of analysis (ramsayhealth.com, 2018). Deferred tax assets are recorded under the heading noncurrent assets of consolidated statement of financial position. The amount of deferred tax assets for year 2016 is recorded at $ 199726 compared to $ 204977 in year 2015. It indicated that amount of deferred tax reduced in year 2016. On other hand, deferred tax liabilities are recorded under the heading noncurrent liabilities of the statement. Deferred tax liabilities mount for year 2016 is recorded at $ 296130 compared to $ 310204 in year 2015indicating that there was reduction in deferred tax liabilities in year 2016 (ramsayhealth.com, 2018). Recording of deferred income tax is provided for all temporary difference between carrying amount and reporting date between tax base for liabilities and assets for the rationale of financial reporting. Recognition of deferred income tax liabilities is done for temporary differences that are taxable (Agrawal Cooper, 2017). Deferred income liabilities identification is done for deductible t emporary differences, tax losses that are not used and carry forwarding of tax assets that are not used. The amount of income tax payable recorded by Ramsay Health Care limited in its annual report is reported at $ 49560 for year 2016 compared to $ 42021 for year 2015. Higher figure indicates that total amount of income tax payable has increased in year 2016. On other hand, income tax expense was recorded at $ 197674 for year 2016 and $ 221216 for year 2015 respectively. Comparing these mentioned figures, it is depicted that income tax expenses for both the period is significantly higher than income tax that are payable. Expense related to income taxexceeds income tax payable by amount $ 148114 in year 2016 and $ 179195 respectively (ramsayhealth.com, 2018). This difference in value between income tax payable and income tax expense is attributable to difference in accounting treatment of both the values. The amount that is payable by company by way of income tax is based on net profit reported by company. However, this does not form the sole basis of devising the total amount of tax that is to be paid by company. There can be alterations in the total amount of net profit or accounting profits reported by company resulting from various adjustments as per the taxation law that the government imposes (Warren Jones, 2018). Such adjustments can lead to differences in timing between the accounting profits or profit recognition and tax reporting for the purpose of accounting. As a consequence o this, there would be differences in total amount of income tax payable and income tax expenses reported in the income statement of company. Expenses related to income tax of Ramsay Health Care limited is recorded in the income statement while the total amount of income tax paid is recorded in the consolidated statement of comprehensive income. The allocation of income tax expense is done on the basis of tax sharing arrangement on a tailored standalone basis that is according to the principles of income tax of AASB 112. Recognition of tax allocation is done considering decrease or increase in intercompany accounts of subsidiary with the tax consolidated group head company. Expense related to income tax for year 2016 is recorded at $ 197674 while the total amount of income tax paid is $ 13505 million. On other hand, income tax expense for year 2015 is recorded at $ 221216 and amount of income tax is received of amount $ 1041 million. At differences analysis of figures is indicative of the fact that there is significant difference between amount of income tax paid and income tax expenses. Hence, income tax paid is less than total amount of income tax paid in both the years (Lee, 2014). Income tax is the amount of income tax liability of organization and it is calculated using the effective income tax rate. On other hand, accounting profit reported by company forms the basis of calculation of income tax expense. Amount of income tax paid required calculation of taxation determined by taxation rules and income tax expenses is imbibed in determination of net loss and net profit for any particular period. Therefore, income tax expense is calculated using net accounting profit and the concept of financial accounting is involved in total amount of income tax paid. Moreover, general accounting principle and practices is also involved in calculations that lead to differences. Classification of taxable and accounting income is done in form of permanent and timing differences. Timing differences arises because of difference in period in which some items of revenue and expenses are recorded (Warren Jones, 2018). This is because period in which recording of such items in taxa ble income does not coincide with period in which recording of such items are done for arriving at accounting income. This explanation demonstrates the reasons for difference between income tax expense and income tax paid. Analysis of annual report of Ramsay Health Care limited depicts that treatment of tax in the financial statement has been done by proper segmentation. Detailed explanation has been provided in the financial statements notes as there each and every particulars and component of taxation has been discussed. Explanation of difference income tax expense and income tax payable has been explained in the context of temporary and permanent differences. Components of income tax expenses have been shown in separate section. Annual report has also demonstrated numerical reconciliation between calculation of tax expense as per income tax rate and aggregate tax expense that is recognized in the income statement. Moreover, recognition of tax liabilities and tax assets has been done disclosing figures of respective components of tax assets and tax liabilities. Detailed explanation of tax effect accounting has been done in the annual report. Measurement and recognition of income tax and the accountin g treatment of taxation has been discussed in the notes to financial statement. Therefore, analysis of annual report depicts that understanding of treatment of taxation was interesting and information has been gained about accounting for income tax. References list: Agrawal, A., Cooper, T. (2017). Corporate governance consequences of accounting scandals: Evidence from top management, CFO and auditor turnover.Quarterly Journal of Finance,7(01), 1650014. Atanasov, V., Black, B. (2016). Shock-based causal inference in corporate finance and accounting research. Balakrishnan, K., Watts, R., Zuo, L. (2016). The effect of accounting conservatism on corporate investment during the global financial crisis.Journal of Business Finance Accounting,43(5-6), 513-542. Chaibi, H., Trabelsi, S., Omri, A. (2014). Investment opportunity set, corporate accounting policy and discretionary accruals.Journal of Economic and Financial Modelling,1(1), 1-12. Cipriano, M. (2016). Bad Will: Why the FASB's Proposed Fix of Goodwill Accounting Will Not Fix the Goodwill Problem.Journal of Corporate Accounting Finance,27(6), 89-92. Kravet, T. D. (2014). Accounting conservatism and managerial risk-taking: Corporate acquisitions.Journal of Accounting and Economics,57(2), 218-240. Lee, T. A. (2014).Evolution of Corporate Financial Reporting (RLE Accounting). Routledge. Ramsayhealth.com. (2018). Retrieved 4 January 2018, from https://www.ramsayhealth.com/common/emag/rhc/annualreport2017/pubData/source/RHCAR2017.pdf Sierra?Garca, L., Zorio?Grima, A., Garca?Benau, M. A. (2015). Stakeholder engagement, corporate social responsibility and integrated reporting: an exploratory study.Corporate Social Responsibility and Environmental Management,22(5), 286-304. Warren, C. S., Jones, J. (2018).Corporate financial accounting. Cengage Learning. Watts, R. L., Zuo, L. (2016). Understanding practice and institutions: A historical perspective.Accounting Horizons,30(3), 409-423. Williams, J. (2014).Financial accounting. McGraw-Hill Higher Education.

Sunday, April 26, 2020

The Fundamentals of Writing an Essay in Support of a Viewpoint Samples Revealed

The Fundamentals of Writing an Essay in Support of a Viewpoint Samples Revealed This form of essay expects that you take the argumentative essay writing format up a notch with the addition of a couple more details. Don't forget that any argumentative essay sample you'll discover on the internet will require a full rewriting in order to prevent plagiarism. The ideal place to remember is a totally free online English writing lab named Purdue OWL. The major component which produces a persuasive essay in English stand out from the remainder of assignments is the use of reasoning. There are lots of men and women who don't need to understand what's in their food. 1 leading area that students have a tendency to go stumped on is the best way to provide evidence to back up their claims. The additional information you have regarding a literary work or another sort of art, the more you fully grasp the ah-ha! Being a real desk gives me the chance to learn from students along with meet various kinds of individuals. Rumors, Lies and Writing an Essay in Support of a Viewpoint Samples The conclusion portion of college essay should not depart from your audience with negative impressions of a person's work. Thoroughly read all the points drafted, to make certain that you cover the critical facts. Do everything you can to engage the audience. For your debate to be a strong one you always need to double check to see whether there are enough data and information that can back up your viewpoint. There are various topics for exemplification essay to select from. Come and have a look to create your essays stick out from the rest. Now that you're aware that we are the very best online essay writing service to work with, don't hesitate to stop by our site and order an essay. The key to writing a superb essay of any type lies in deciding on a nice and intriguing topic for your essay. A rhetorical analysis essay involves the viewpoint of the author on a particular te xt. Be certain your viewpoint is stated clearly at the start of the writing. Pick the writer to finish your academic assignment. Details of Writing an Essay in Support of a Viewpoint Samples Therefore, you require a helping hand. You want to understand just what's going to happen to your entire body and you've got the right to know that info. The first thing you're likely to have to do is to pick a topic that has more than one clear side. Identify whether all events happen in a specific time before or future. What You Need to Know About Writing an Essay in Support of a Viewpoint Samples There needs to be unity and coherence among the examples which you use in your essay. A straightforward strategy is essential to success in the crucial essays. An interesting rhetorical analysis example will allow you to begin with rhetorical essays. Reiterate your viewpoint of the problem. A superb essay needs to be focused to answer the specific question which is being asked on the ex am. Two people may have a different interpretation of the identical book. A piece cannot fascinate readers in the lack of truthful logic. To start with, let us investigate the term Rhetoric. During the time you will compose an explanatory essay, the secret to success is formulating a logical plan. If you're still not a hundred percent sure you will manage the endeavor, you might contact our customer service group and ask them for aid. Others continue to be in the learning procedure. Not only will the switch help reduce the expense of textbooks, but nevertheless, it will also be saving the environment by decreasing waste and diminishing the quantity of paper used. Writing an Essay in Support of a Viewpoint Samples While preparing a last document, be positive that you use the words wisely. Our publication also lets you know how to compose your Accuplacer essay so as to find a great score from the program. Usually, the debut of your opinion constitutes of a couple of pages. Usually, the debut of an opinion paper is a couple of pages. A travel essay in addition gives a glimpse of the culture of a particular place. It's somewhat easy to comprehend. Writing can be a real chore but being in a position to do it consistently well will pay dividends for you later on. 1 body paragraph needs to be written about each reason for your perspective. Each body paragraph should include a point that supports your principal idea. Needless to say, you are conversant with different forms of essay including descriptive, argumentative and narrative. The argumentative essay is a. Alcohol use involves using addictive substances like beer wine or other types of hard liquor with the capacity to impair physical and mental dependence of its consumers. But What About Writing an Essay in Support of a Viewpoint Samples? You simply write down all the theses that pop up in your head when thinking over the subject of your essay. An argumentative essay requires you to choo se a topic and have a position on it. Every argumentative essay ought to depend on a topic which can be debated. Just click the Order button, and receive an essay which you dream about! Logical proofs and dependable evidence will help to make your opinion even stronger. Once an argument appears in your thoughts, make certain you've got something to record it. A superb argument ought to be based on irrefutable evidence and logical reasoning. Restate the significance of the topic, review the nature of the argument, and leave the reader with his final thought on the problem. Professional custom writing companies will produce an outstanding essay for you within a couple of days. Some offer writing help while some concentrate on editing. When you decide to get assistance from our cheap paper writing service, you ought not be concerned about the individual who will work on your task. With the demand for writing help rising, various paper writing services are established to assi st you with your writing tasks.

How to Choose What is the Most Interesting Thing About a Topic

How to Choose What is the Most Interesting Thing About a TopicYou may be in a little bit of a pickle if you are trying to decide what is the most interesting thing about something. It can be quite difficult, but there are a few things you can do to help you narrow down what the most interesting thing about a topic might be. This can all come in the form of using search engines.When you go online, you are going to find that most of the things you find on search engines are not very interesting. You will find that there are certain places where people will always rank well for the most interesting things to research for fun. In this case, they tend to be those areas which might be related to the topic. These include music, movies, sports, books, and so on.The reason that the most interesting things to research for fun will be those which are related to the topic is because it is so much easier to find things on search engines when they are related to the topic. For example, you will fi nd that when you use the words 'murder,' you will be able to get information about murder cases on the Internet. Of course, the reason why it is so easy to find this information is because there is a lot of data associated with those terms.There are many different pages on the Internet that have information about murder cases, and they all are related to this subject. These pages will be filled with links to web sites that might have these types of links listed in their databases. Of course, if you do a good amount of research you will be able to get lots of information from these web sites.One of the most interesting things about researching murder cases on the Internet is that you will be able to find a lot of information on various cases. Most of the time, if you do a good amount of research you will be able to get information on these cases from an external source. This is usually done through a book or some other type of news publication.This will be because most cases involve a criminal and what happened to him or her during the process. As a result, you will find that many people who write books about the murder cases will include these types of details. It is also quite easy to find a newspaper and do a lot of research because you will be able to find plenty of articles in them which relate to murder cases.If you want to try and research something that involves murder, you will want to use the article databases that are available. These are going to help you with the research since you will be able to do it from the comfort of your own home. Of course, you are going to need to be careful when researching online because some of the information can get a little skewed.With all of these options, you will be able to do research into many interesting things. It will help you see what you might like and what you might not like. Of course, you will find that there are many different ways that you can spend your time online, and these will help you find all of the interesting things to research for fun.

Research Paper Topics Psychology

Research Paper Topics PsychologyIf you are looking for a project to get you started in the realm of research papers, psychology has a lot to offer. Here are some tips that will help you succeed. It is the understanding of the human mind and how it functions that lies at the core of all legitimate research.There are two main types of research paper topics. The first is the personal dissertation, or personal research paper. The second is the project-based thesis, or project-based research paper. The best psychology research paper topics for this type of paper will involve your own life experiences.If you have already had your graduate degree but haven't pursued a PhD in psychology, you might want to consider starting with a personal dissertation. This is a relatively easy project to do and has several benefits. For starters, you will be able to do your research in the comfort of your own home. You won't need to have to travel to the library. You can answer your questions in your own li ving room, which is a great benefit when you have kids.The other benefit of a personal research paper is that you are more likely to find things out that you are not sure about. For example, you might discover that people think differently than you previously thought. Or you might discover that people also behave differently, including their willingness to pay cash. You might also discover that they may act in ways that you might not have guessed. When you analyze what your research paper topics will uncover, you will find that there are a number of different things that you can find out.Research paper topics can go on forever and it's really up to you as to which you decide to tackle first. But you can start with the basics. Many researchers who are interested in psychology ask themselves, 'What is interesting to me?' The first step is to put yourself in the shoes of the researcher.If you're someone who loves to read, then you're probably interested in psychology. Just take a look at some of the types of research papers that are published in prestigious journals. They all deal with how human beings function, how the human mind works, and how we learn new information. You will find that it is just common sense that you are interested in these topics.One last tip is to try to identify a few topic ideas that you can focus on. For example, if you are looking at stereotypes, then you might want to consider looking at areas such as racism and self-esteem. You might want to consider looking at gender issues or race. There are many topics that you can focus on, and this is why it is so important to start with an area that you are interested in.

Essay Helper - Free Sample Then Pays

Essay Helper - Free Sample Then PaysAn essay helper free sample then pay is a free document from a member of the online essay writing community known as the EssayMountain website. These writers will gladly help you to generate an essay in no time and write it for free, before the price is even applied.This free sample is a step by step guide on how to create your own essay for you to practice with. This means that if you want to use this free essay help you are going to have to use it every time that you need to write an essay. This is done with the help of an automatic process.The automated script will take all the necessary words from the essay and place them into the appropriate places in the essay. In most cases the essay will be worded in a way that will be easy for you to read. The words that you use will depend on the topic of the essay and whether or not you are writing about the event, person, or topic that you are discussing.If you are looking for a guide on how to become a n essay helper, and there is an overabundance of information out there, the guide that you should really try to read is the essay helper free sample then pay. It will be up to you to keep reading and trying different ideas to see which works best for you.When you start to be successful with your essay writing, you will be able to build on this essay helper guide. This is what makes them one of the better ways to go about writing a thesis on your topic. This will allow you to use the essay helper free sample then pay to see what works for you.If you want to know how to become an essay writer for free, you can use the essay helper free sample then pay. You will get plenty of guidance on how to use this tool to get you started, and they will not charge you any money until you decide to spend money on an essay writing guide. When you make a decision to use this tool, the manual will show you how to use it and help you through the entire process.If you would like to learn how to become a n essay writer and want to make money at the same time, this is the free sample then pay that you should really consider. This free guide will show you how to take any topic and write it to make it interesting to read. If you want to make money in your field, this is something you definitely should look into.

Saturday, April 18, 2020

The Role Of Victorian Women Jane Eyre free essay sample

The Role Of Victorian Womans: Jane Eyre By Charolette Bronte Essay, Research Paper Jane Eyre Jane Eyre # 8217 ; s Triumph Over Oppression: Charlotte Bronte # 8217 ; s Example for Women Charlotte Bronte, in her novel, Jane Eyre, establishes us with a first-hand history of a adult females # 8217 ; s victory over adversities. Jain was born orphaned, hapless, and grew up in an un-loving place. To add abuse to hurt, she was a adult female in Victorian society ; a low-level place to get down with. Throughout the novel, Jane faces many adversities that genuinely tested her spirit and unity. She refused to hold her life determined for her, and stayed strong through hardship. By giving us the character of Jane Eyre, Charlotte Bronte gives us a medium in which to experience the agony and impotence of Jane # 8217 ; s state of affairss. The first-person narrative helps the reader relate more closely to the state of affairs, and the victory of Jane # 8217 ; s character through her hardships is an illustration for adult females to populate their lives by. We will write a custom essay sample on The Role Of Victorian Women Jane Eyre or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page When Jane is merely 10 old ages old, we are shown a glance of her strength of character. Confronting much bitterness and immorality in the Reed house, Jane can non be degraded much longer, at least without stating something about it, and confronts Mrs. Reed: # 8220 ; I am non fallacious: if I were, I should state I loved you ; but I declare I do non love you: I dislike you the worst of anybody in the universe except John Reed: and this book about the prevaricator, you may give to your miss Georgiana, for it is she who tells prevarications, and non I ( p.45 ) .† Further portraying Jane’s passion and stamina is what she thought right before standing up for herself. Speak I must: I had been trodden on badly, and must turn: but how? What strength had I to flit revenge at my adversary? I gathered my energies and launched them in this blunt sentence: †¦ ( p.45 ) This is a immense turning point in Jane’s life ; one that greatly affects her for the remainder of her life. After go oning her revenge at Mrs. Reed, Jane feels over-powered. â€Å"Ere I had finished this answer, my psyche began to spread out, to walk on air, with the strangest sense of freedom, of victory, I of all time felt.† ( p.46 ) This gives Jane a sense of assurance in herself to travel out in the universe and be what she wants to be. She straight addressed a fright, stood up for herself, and, in the procedure, gained the strength and fortitude she would necessitat e to confront her approaching adversities. Jane grows up with a natural inquiring of authorization and an independent, un-coercive head. She was non traveling to put down for merely anyone, and was ever cognizant of the subjugation she was enduring, and where it was coming from. When Helen tells Jane to be less unprompted and merely to obey the regulations of her school and†¦ The remainder of the paper is available free of charge to our registered users. The enrollment procedure merely couldn # 8217 ; t be easier. Log in or registry now. It is all free!

Saturday, March 14, 2020

Discusses the management of risk in the care of older adults in hospitals The WritePass Journal

Discusses the management of risk in the care of older adults in hospitals Introduction Discusses the management of risk in the care of older adults in hospitals IntroductionReferences:Related Introduction This essay critically discusses the management of risk in the care of older adults in hospitals, in the prevention of falls.The rationale for selecting this topic is based on several factors.   According to Nazarko (2008), elderly people are admitted to hospital for a variety of health conditions. The family of the patient trust that they are being cared for in a safe environment. However, every environment carries a physical risk to the people within it and this essay will focus on the fact that older people admitted to hospital are more susceptible to experiencing falls (Nazarko, 2008). Moreover, the National Patient Safety agency (NPSA) (2007) state that there are more than two hundred thousand falls that occur in NHS hospitals in England and Wales. NHS Greater Glasgow and Clyde (2011) state that one of the biggest admission for hospital in elderly people are falls. Out of that figure, 99% of them are unhurt, minor or moderate injuries, however 1% of those falls cause severe inj ury, death or fracture bones. Falls are a major problem in hospitals as well as outside of hospital in the UK. Various studies have shown that 30-50% of the population are over 65years old. Most of those falls are happening in the nursing home setting and 10-20 % cause severe injuries (Kennedy 2010, Pountney 2009a and Weaver 2008). Adding to this rationale, Pereault and Bourbonnaise (2005) state that the nurse’s role is to take care of patients from the first time s/he enters the door of the healthcare environment, through assessments, appointments, surgery or any other treatment, as well as discharge of patients from hospitals. Therefore a focus on falls prevention is essential. For this reason author has chosen to focus on this topic. It defines risk and then identifies and explains the nurse’s role in risk assessment and management of elderly people in the hospital and nursing home settings. The essay will highlight why people experience falls, the different the contributing factors that can affect their balance whilst in a professional care setting.   The risks are and how risk management can be used to prevent older people who are in hospital falling as a result of residing within this environment are critically discussed. To do so key measures in place that aim to minimise risk and maximise patient safety in the clinical environment are therefore evaluated. One of the methods this essay will examine is the five HSE steps of how to manage risk in the working environment in practice. There will be an in depth analysis of two different case studies of the STRATIFY risk assessment tool, to show the weaknesses and strengths of this tool. The essay w ill explore the difference education and training can have on the quality of care. The Health and Safety Executive (HSE 2006) state that every day in our life we come across risks. It may be in or outside our homes, as well as in the working environment. Kennedy (2008) states that risk can be described as an episode where something valuable or someone can be affected or damaged and where there is uncertainty of the outcome. Leyshon (2005) have stated that before any action to manage it, risk must be identified in the first place. To improve the health and safety environment in the work place assessing, measuring and controlling risk is therefore essential. The Department of Health (2006) state that ten percent of patients admitted to hospital will be negatively impacted as a result of an avoidable error separate to the original reason that they were admitted. They also state that risks could be reduced by as much as 50%if lessons from previous risk incidents were recorded and analysed. This would therefore serve to reduce the possibility of the same mistake recurring. Tingle (2006) provides further support to this by adding that if lessons were learned from previous incidents it would also help to save costs to the NHS. According to Mitchell (2009), falls can cost the NHS upwards of 1.7 billion pounds a year. Therefore, nurses can have a significant impact on this by promoting patient safety in the NHS to improve care for patients and protect them from any harm, whilst saving money. According to the Nursing and Midwifery Council (NMC) (2008) code of conduct the nurse is responsible for taking care and treating patients with dignity and respect whilst reducing the risk of further harm. Leyshon (2005) suggested that the areas to be focused on in an effort to reduce risks and to protect patients from harm are to assess the work environment and appropriately manage the known risks, as well as being aware of, and minimising, other probable risks. The goal to minimise risk in the healthcare setting means that nurses and other healthcare professionals should critically evaluate past events that have had a negative effect on practice and there should be focus on vulnerabilities and how risks can be managed. Mills and Bowker (2007) further state that there are many ways to assess risk in the health care environment. However, they highlight a simple understanding of the risk assessment tools can help staff develop better understanding of the advantages of successful risk assessment. The Health and Safety Executive (HSE) (2006) identify five easy steps to assess risk in any work place environment which has also been successfully put into practice. The first step is to identify the risk, recognize strengths and weakness to reduce risk and reach the aim using a method, such as a risk check list. Nazarko (2005) also agrees that risk needs to be identified in the first place and then we can take care of those who are at risk to minimize risk. The HSE (2003) states that, the second step is to assess who may be harmed and how using appropriate risk management tools, such as a scoring system, which are individual for different risk assessments. The third step is to evaluate the risk.   Accordin g to Young and Woodock (2011) an important question is whether the hazard can be eliminated altogether by removing it.   If this is not possible it must be controlled so as to reduce the chance of harm. According to Waterhouse (2007) the fourth step of HSE risk management is the recording method. The most important part of this method is identified as keeping a record of the patient’s risk assessment. This way, safety is improved and it is shared amongst colleagues as essential practice to protect patients from harm. This also applies to the NMC code of conduct (2008) as good practice, such that information must be shared with colleagues to maintain the safety of those for whom nurses are taking care. The last step of risk assessment is the review which must occur on a daily and ongoing basis to protect patients from hazards. This is constantly monitored to determine progress and changes to their condition. There may be some improvement or adversely, there may be some changes with patient’s health and risk assessments. Therefore it is vital that they must always be accurately recorded and kept up to date. Fullbrook (2007) agreed with these studies, adding that from the nurse’s point of view, assessment is the most important part of risk management. Nurses assess all of the issues that can have an impact on clinical practice and the nurse will often be the first to identify potential difficulties in their working environment, as they are there on a daily basis. According to Hughes and Marshall (2009) risk can be separated into three categories: long-term, medium term and short term. Dependant on the risk classification, the implementation of measures to mitigate the risk vary, according to the size and complexity of the task. These issues in risk are particularly relevant to management of falls in healthcare environments. A study by Pountney (2009b) shows that falls mostly occur in either the morning or evening time due to medication such as night sedation, make them unsteady, visiting the toilet – incontinence first thing in the morning as well as inappropriate shoes making elderly people’s mobility unsteady. Therefore as a result of this, nurses and other healthcare staff must spend more time with those patients, at these times, to protect them from harm. Nazarko (2007) stated that people in hospital who are inpatients are individuals and all of them have a different reason for being in care.   As they are unwell and are often extremely weak they may be at risk of falls. There are many factors that can affect body balance and cause falls, such as age, disease or medication. Some of them may have some obstacles to stop them being fully mobilized like catheter in-situ, drip stand, and as a result of their injuries they may be confused which makes it even harder for them to be mobile with those obstacles. Therefore it is important for nurses and other staff   to have better contact with those patients to provide the best possible care of patients be observed to reduce and minimize the risk of falls. Swann (2010) also added that unsafe clinical areas like broken and wet floor can cause falls. Barker et al (2010) stated there are many assessment tools in the hospital setting to help prevent falls and there are key measures to successful prevention, recommended by many clinical practice guidelines. However those tools are not effective if they are not used appropriately and if healthcare professionals do not evaluate them. Therefore it is the nurse’s responsibility for updating these tools, as assessment is on-going process and patient’s conditions may change. Oliver et al (2008)   advise that 10 years ago there was a practice   risk a assessment tool for rehabilitation published and delivered in the UK for elderly as well as for acute wards known as the St Thomas’ Risk Assessment Tool (STRATIFY). This fall risk assessment tool is to identify high or low risk of falls and have been designed in five simple scoring systems from 0- 5 to predict who may be at risk of falls. According to Kennedy (2010) nurses should have special training to use the STRATIFY risk assessment tool which will raise awareness when used in practise to prevent patients from falls to protect them from further harm or injury. Milisen et al (2007) described in their purposive multicenter study where they evaluated the effectiveness of the STRATIFY fall assessment risk tool. The study was carried out in six Belgian hospitals, the sample size was 2,568 participants mixed female and male and the average age was 67.2 ranging between plus and minus 18.4. The study was carried out in a four surgical, eight elderly and four medical units. The findings of this study show the effectiveness of the STRATIFY tool in the admission of patients in medical and surgical settings for patients younger than 74 show that assessment predict risk of falls well for this age group category. However it was not as successful when measured against an older population, above of 75-85 age range that are admitted in the elderly ward. For older patients with prolonged residential hospital care, it is unclear whether repeated use of the STRATIFY tool would enhance its clinical effectiveness. Furthermore, the study identified   that the risk of falling, as measured on admission is not static and as a result the risk of falling during their subsequent hospital stay must be calculated and updated on a weekly basis. Smith et al (2006) did a similar study on the STRATIFY assessment tool for patients recovering from strokes.   Six stroke units in North of England with 359 participants were selected where they used this assessment.   Every member of staff was trained to use the tool. They average stay was 28 days and the age range was between 34 and 100 years.   Within this group, STRATIFY underperformed as a predictor of falls occurring in the 28 days following the initial assessment. Using the currently recommended score threshold (2 or more as high risk), STRATIFY was found to be inaccurate with a sensitivity rating of just 11.3%. The optimum STRATIFY threshold for our stroke patients was a score of one or more, but even optimising the risk indicator resulted in a sensitivity of just 60% and this was achieved at the expense of specificity.   This study also highlights that some of the questions were not appropriate for all stroke patients as they were not applicable such as mobility ques tions as well as the amount of falls since they have been admitted to hospital. Nazarko (2008) stated that there are further methods to manage risk management in falls and one of them is to assess the location of the nurse’s station which can play a crucial role in risk management especially amongst the elderly population. If patients are located in single rooms and out of sight from nurses and other healthcare staff, there is a greater risk in falls as staff are unable to identify those at risks and react as speedily to patients who are in need of assistance. For this reason, most of the patients hospitalized in wards who may be at risk of falls are moved closest to the nursing station, to assist nurses’ visibility and reduce the impact of falls. However, it is not possible to implement this practice in nursing homes with single rooms or any other wards where patients are located in single rooms. Downing (2011) states that there are more interventions that serve to improve patient care,   particularly amongst the elderly, such as the electronic alarm device which is located on the patient’s bed or chair. Every time the patient attempts to get up it will sound so that healthcare assistants can assist the patient before any fall can occur. These devices can help with high-risk patients who are confused or have got dementia. Pountney (2009a) also recommends the alarms which can be used for patients whosuffer from dementia or are confused and also add that light sensors can improve people from falls. According to Nazarko (2006), bad vision could be a major impact on patient’s falls, as up to 74% admitted patient from falls had a poor vision. Therefore falls cannot be removed but management may improve quality of life for those patients to use those light sensors, especially if patient is located in single rooms out of sings of nurses. Another option, Vitamin D supplements, are   identified as having a role to play in mitigating the impact of falls, as Vitamin D make bones stronger and as a lack of Vitamin D can have a affect on weakness of muscle and bones. The NHS National Institute for Clinical Excellence (2004) however, do not recommend Vitamin D asthey feel there is inconclusive evidence advocating its use. According to Help the Aged (2004) risk assessments and monitoring will not guarantee to stop people from falling, however nurses will be able identify through assessment of potential risk to minimise this and improve patient safety with appropriate action taken. Pountney (2009a) further emphasises that the requirements of risk management must be weighed against the need to empower patients to remain independent and must not overpower the quality aspects of their everyday routine. The aim is to minimize patients from injury but also to encourage their mobility for better quality of life. Therefore managers have got a responsibility for managing risk against effective policy, ensuring staff are fully trained, as well as fostering a good environment to minimize risk of falls to support patients’ well being, as well as quality of life Pountney (2009b) Nazarko (2009) states some patients with conditions generally affecting the elderly such as MS and Parkinsons  disease may have many falls but if the opportunity to walk is removed to prevent falls, it is regarded as more harmful as the patient will have reduced confidence and independency. Nazarko (2009) agrees withSwan (2007) that most of the falls that occur in hospitals are not major injuries, however any falls can have a major impact on each patient as they may lose their confidence as well as dignity.   The patient’s quality of life may change dramatically as they may not be able to undertake daily activities. A loss of confidence and the inability to undertake daily routine can make the patient weaker as well as make the patient feel more isolated (Nazarko 2009). Pountney (2009) state that a lack of training of staff on falls can have a negative impact on patients which will cause inappropriate practice, but also further state that this can cause the unwanted implication to staff, where nurses will have to deal with complaints and increased workload, which leads to increased anxiety. According to Mitchell (2007), one of the major management tools to prevent falls is through the education of staff, as well as patients. Therefore nurses and other healthcare professionals who have contact with patients must have easy access to the tools, whether e-learning or manual.   Whichever one is more suitable for the individual and encompasses as minimum basic skills to maintain acceptable practice. To provide best practice in falls prevention, audits must also be carried out on a regular basis. The author used examples to explain why they chose risk management in falls as a topic.This essay explained what risk is and how risk must be identify before any action is taken. The evidence has also found that if we learned from previous mistakes risk could be reduced as improving patient safety which ultimately reduces costs. The five easy steps of HSE risk assessment were highlighted as best practice throughout the healthcare setting. This statistics provided from England and Wales as well as statistics from Scotland, demonstrated the widespread issue that falls are a major problem for the elderly population outside as well as inside of the hospital settings. Moreover various study show that most falls happening in nursing homes. The essay also focused in-depth at two studies analysing the effectiveness and appropriateness of the STRATIFY risk assessment tool. Both studies were using the STRATIFY assessment risk tool in different healthcare settings. Furthermore studies show that STRATIFY assessment risk is successful for the younger population but not as successful with older population over 75 and also that it did not appear to be helpful with stroke patients as some questions were inappropriate. There was a focus on how falls could be prevented as there are so many different reasons for patients having a fall. For some of them it could be due to their illness, medication, nursing station location, whether it is morning or night. This essay illustrates the critical role nurse’s play in providing the best possible care and support to patients. Nurses should be specially trained and educated to provide the best care to minimise patients from falls and maximize patients protection. References: Barker, A., Kamar, J. Graco, M. 2011, â€Å"Adding value to the STRATIFY falls risk assessment in acute hospitals†, Journal of Advanced Nursing, vol. 67, no. 2, pp.   450-7. Department of Health. 2006, â€Å"Safety First: a report for patients, clinicians and healthcare managers† [online]. Available from: dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_064159.pdf [Accessed 22nd March 2011]. Downing, W. 2011, â€Å"Preventing falls: how to monitor risk and intervene†, Nursing Residential Care, vol.13, no.2, pp. 82 – 84. Fullbrook , S. 2007, â€Å"The duty of care 2: risk assessment and risk management†, British Journal of Nursing, vol. 16, no. 2, pp.112 – 113. Health and Safety Executive. 2006, â€Å"Five steps to risk assessment† [online]. Available from: hse.gov.uk/pubns/indg163.pdf [Accessed 2nd March 2011]. Help the Aged. 2004, â€Å"Preventing Falls; Managing the risk and effect of falls among older people in care homes† [online]. Available from: housingcare.org/downloads/kbase/2312.pdf [Accessed 2nd March 2011]. Hughes, R. Marshall, R. 2009, â€Å"An introduction to risk management in residential care†   Nursing Residential Care, vol.11, no. 7, pp. 356 – 358. Kennedy, K. 2010, â€Å"A critical analysis of the NSF for Older People standard 6: falls†, British Journal of Nursing, vol. 19, no. 8, pp. 505 – 510. Kennedy, S. 2008, â€Å" The health professional’s role in helping patients understand the concept of cardiovascular risk†, British Journal of Cardiac Nursing, vol. 3, no. 11, pp. 522 – 526. Leyshon, S. 2005, â€Å"Principles of risk management in community nursing†, British Journal of Community Nursing, vol. 10, no. 7, pp. 330-333. Milisen, K., Staelens, N., Schwendimann, R., De Paepe, L., Verhaeghe, J., Braes, T., Boonen, S., Pelemans, W., Kressig, R.W. Dejaeger, E. 2007, †Fall prediction in inpatients by bedside nurses using the St. Thomass Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) Instrument: a multicenter study†, Journal of the American Geriatrics Society, vol. 55, no. 5, pp. 725-33. Mills, H. Bowker, E. 2007, â€Å"Conducting a risk assessment in neuroscience practice: principles and procedure†, British Journal of Neuroscience Nursing, vol. 3, no. 5, pp. 223 – 226. Mitchell, E. 2009, â€Å"The impact of falls on residents and staff: managing riskâ€Å", Nursing Residential Care, vol.11, no.5, pp. 258 – 260. National Patient Safety agency (NPSA). (2007), â€Å"Slips, trips and falls in hospitals† [online]. Available from: nrls.npsa.nhs.uk/resources/?entryid45=59821 [Accessed 24th March 2011]. Nazarko, L. 2005, â€Å"Reducing the risk of falls among older people†, Nursing Residential Care, vol. 7, no. 2, pp. 67 – 70. Nazarko, L. 2006, â€Å" Falls prevention in practice: guidance and case study†, British Journal of Community Nursing,   vol. 11, no. 12, pp. 527 – 529. Nazarko, L. 2007, â€Å"Reducing the risk of falls in the care home†, Nursing Residential Care, vol.9, no.11, pp. 524 – 526. Nazarko, L. 2008, â€Å"Falls part 3: environmental risk factors†, British Journal of Healthcare Assistants , vol. 2, no. 10, pp. 487 490 . Nazarko, L. 2009, â€Å"Falls part 6: risk management†, British Journal of Healthcare Assistants, vol. 3, no. 2, pp. 87 – 90. NHS Great Glasgow and Clyde, 2011, A Home Checklist Which Can Save Lives. [online]. Available from: nhsggc.org.uk/CONTENT/default.asp?page=s1192_3newsid=11231back=s8_1 [Accessed 4th March 2011]. NHS National Institute for Clinical Excellence . 2004, â€Å"Falls: the assessment and prevention of falls in older people† (Clinical Guidelines 21). [internet]. London, NICE (Published 2004). Available at: nice.org.uk/nicemedia/pdf/CG021publicinfoenglish.pdf [Accessed 24th March 2011]. Nursing Midwifery Council, 2008. [online]. Available from: nmc-uk.org/About-us/Policy-and-public-affairs/Politics-and-parliament/Policy-areas/ [Accessed 2nd March 2011]. Oliver, D., Papaioannou, A., Giangregorio, L., Thabane, L., Reizgys, K., Foster. G., Age Ageing, 2008, â€Å"A systematic review and meta-analysis of studies using the STRATIFY tool for prediction of falls in hospital patients: how well does it work?†, Age and ageing (published electroncly) vol. 37, no. 6, pp. 621-627. Perreault, A. Bourbonnaise, F. F. 2005, â€Å"The experience of suffering as lived by women with breast cancer†, International Journal of Palliative Nursing, vol. 11, no.10, pp. 510-519. Pountney, D. 2009a, â€Å"Identifying and managing the risks of falls in the nursing home† Nursing Residential Care, vol. 11, no. 12, pp. 618 – 620. Pountney, D. 2009b, â€Å"Preventing and managing falls in residential care settings†, Nursing Residential Care, vol.11, no.8, pp. 410 414 .      Swann, J. 2007, â€Å" Reducing the risk of falls: Part one†, Nursing Residential Care, vol. 9, no. 3, pp. 120 – 122. Tingle, J. 2006, â€Å"Improving patient safety in the NHS†, British Journal of Nursing , vol.15, no. 4, pp. 86. Waterhouse, C. 2007, â€Å"Development of a tool for risk assessment to facilitate safety and appropriate restraint†, British Journal of Neuroscience Nursing,   vol. 3, no. 9, pp 421 – 426. Weaver, D. 2008, â€Å"Effective strategies in managing falls prevention†, Nursing Residential Care, vol.10, no.5, pp. 217 – 222. Young, A. Woodcock, R. 2011, â€Å"Violence risk assessment in mental health practice: part 1†, British Journal of Healthcare Assistants, vol.5, no. 1, pp. 31 – 34.