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My Personal Philosophy Of Nursing Essay - 1028 Words

I am from China and I have been in the United States for over ten years. I developed interest in nursing the main reason is the superior nursing care to my family member offered by the US hospitals. My personal philosophy is universal provision of health-care despite one’s background. As a nurse, one is responsible to offer professional services in any environment. I defined person, environment, health and nursing. My four personal philosophy concepts include competence, accountability, compassion and caring. Nursing philosophy is important because of practice, education, administration and research purposes. Introduction It is very important for individuals to have their social, economic, and political philosophies because of its role in propelling an individual. Nursing have philosophy that makes nurses play their roles effectively and ensure that the safety of the public is maintained and also provide good care to each patient. In this paper, I am going to discuss my nursing philosophy through highlighting my background and what propels my nursing philosophy. I will then define nursing paradigm person, environment, health, and nursing; concepts of personal philosophy, and the importance of nursing philosophy. Background I developed interested in becoming a nurse by three factors. First, I am from China and I have lived in the United States for the last ten years. The health care provision in the US is superior to that provided in China. When my family member wasShow MoreRelatedPersonal Nursing Philosophy : My Personal Philosophy Of Nursing1475 Words   |  6 PagesPersonal Philosophy of Nursing When one thinks of a nurse they often think of a caring, compassionate, knowledgeable individual. They don’t often think that every nurse comes from different situation, past experiences, and life changing events that make nurses who he or she is. Everyone on this earth is unique and has something to contribute. The same goes for patients. Each patient has a different background and have different interests which make them who they are. In order to give the optimalRead MorePersonal Nursing Philosophy : My Personal Philosophy Of Nursing1190 Words   |  5 PagesPersonal Philosophy of Nursing Megan A. Farrell Moberly Area Community College Introduction I, Megan Farrell, am currently a Licensed Practical Nurse at a treatment center that works with prisoners. I accepted a clinical positon here as a graduate, but plan to work in a hospital setting once I have become a Registered Nurse working in the Intensive Care Unit. I quickly worked my way up the latter from the clinic nurse to the Chronic Care nurse and I am quite passionate about furtherRead MoreMy Nursing Philosophy : My Personal Philosophy Of Nursing1093 Words   |  5 PagesPhilosophy is a distinct disciple on its own right, and all disciplines can claim their own philosophical bases that form guidelines for their goal† (Meleis, 2012, p. 28). In simpler terms, philosophy is your worldview and thought process of life. Our philosophy transcends into our beliefs and values’, examining our philosophy allows us to discover what is important to us and helps define priorities and goals (Meleis, 2012, p.28). Being aware of our philosophy creates individuality in each personRead MoreNursing Philosophy : My Personal Philosophy Of Nursing932 Words   |  4 PagesMy Philosophy of Nursing My personal philosophy of nursing began at an early age watching my mother volunteer for 25 years on the local rescue squad, following in the footsteps of her mother. I learned that helping others in a time of need should always be a priority. Respect and dignity should always be shown to people, no matter the who they are or where they are from. I have and will continue to show compassion for others while administering professional holistic care, guided by the AmericanRead MoreMy Personal Philosophy Of Nursing1304 Words   |  6 PagesMy Personal Nursing Philosophy A nursing philosophy is concepts or values that a nurse embraces within his/her practice and allows these concepts and values to shape the way he/she practices nursing and drives the purpose of their nursing care. It is important for each nurse to develop his/her philosophy of nursing to be a purpose driven nurse. Each nurse will have his/her own nurse philosophy because each believes differently. Nursing philosophies might come from different understandings butRead MoreMy Personal Philosophy Of Nursing1053 Words   |  5 PagesThis aforementioned are the podium upon which the value and philosophies of the success of each profession is based. These philosophies and values do not operate in a vacuum. They influence the way which professionals carry out their day to day activities for maximum success. Consequently, Nursing and Nurses are not immune to the great influence of values and philosophies, be it at personal or corporate levels. This is because, nursing as a profession d eals with the constant interaction with patients;Read MoreMy Personal Philosophy Of Nursing949 Words   |  4 PagesMy Personal Philosophy of Nursing My inspiration to pursue a career in Nursing began at a young age, after reading the biography of Florence Nightingale. I was in middle school, and intrigued at her courage, and dedication to care for the sick. As I entered college, and into a formal nursing education program, I still viewed nursing as, the care provided to another in need. Without my knowing, I was developing a philosophy of nursing for myself. As the years passed, I began to realize that nursingRead MoreMy Personal Philosophy Of Nursing1676 Words   |  7 Pagesfamous philosophies and a personal nursing philosophy is presented, including the personal definitions of the four phenomena of nursing namely person, environment, health, and nursing. The said philosophy will then be compared to other professionally-acclaimed philosophies. Included in the discussion is the importance of a nurse’s role in providing health care to persons, family, and the society and how it is able to address problems in the face of cultural and spiritual differences. Personal PhilosophyRead MoreMy Personal Philosophy Of Nursing1081 Words   |  5 PagesRunning head: PERSONAL PHILOSOPHY OF NURSING 1 PERSONAL PHILOSOPHY OF NURSING 6 Personal Philosophy of Nursing Caroline Thiongo BSN V Millers College of Nursing Abstract This paper explores my personal nursing philosophy that I will convey in my career of nursing. It is my belief that nursing is a commitment to public service and a desire to help those in need. Nursing is a discipline of knowledge acquired both through formal education and through life experiences. The sum of these parts continuesRead MoreMy Personal Philosophy Of Nursing1330 Words   |  6 PagesMy Personal Philosophy of Nursing The purpose of this essay is to depict the personal philosophy of nursing and any future aspirations I have acquired in my first semester of nursing school. Before I can create my own philosophy of nursing, I must first understand and define what philosophy is and how it relates to nursing. According to  the Oxford Dictionary, philosophy is â€Å"the study of the fundamental nature of knowledge, reality, and existence, especially when considered as an academic discipline†

Poem Life and Reality Free Essays

In this poem, the poetess, Elizabeth Sewell, has made an extraordinary resolution to make herself a better woman by facing and living with reality in the start of the New Year. New Year is generally understood as starting of a new chapter of one’s life. People make resolution by taking stock of their lives and resolving to be better ones. We will write a custom essay sample on Poem: Life and Reality or any similar topic only for you Order Now Socrates, the great Greek philosopher, is reported to have said that un-examined life is not worthy of living and it is almost a tradition with the sensible and reasonable people to take stock of their life and to resolve to be better people, at the start of the new year. So, the poetess has decided to live with reality in the New Year. Reality is not always comfortable but pinching and disturbing. The use of the image â€Å"bony arms† points to this fact. But the poetess is resolute and will draw comfort fulfilling her resolution. The phrase ‘draining of long droughts is linked with drinking wine but the poetess intends to drink calmness and thinks it necessary for cleansing herself. It is quite natural and true that in loneliness and quiet one can examine one’s life honestly. It is a self-criticism. Life examined critically purifies one for better future life. I will drain Long draughts of quiet As a purgation; Reference These lines have been taken from ‘New Year resolutions’ written by‘Elizabeth Sewell’. CONTEXT: Elizabeth Sewell determines to be quite so that she may know and judge her self. She may face the reality of life. Explanation In these lines the poetess describes her mental state and the way she would drink to purify her soul. She says that she will drink wine at night secretly. She will have long drops during night and will clean herself from all kinds of evils. This will assist her in helping other people because her own mind and spirit will be free from all types of evils. â€Å"Long draughts of Quiet† also suggests that she will keep quiet most of time. This will be the best means for the purification of her soul and it will help her in leading beneficial and successful life. She says; she will talk less and hear more and mold her life into betterment. Remember Twice daily Who I am; Explanation In the given lines Elizabeth says, she will remember herself twice daily, in the evening and in the morning. She will take into consideration what her aim of creation is. She will try to understand the purpose of life in general. Perhaps she means that she should recognize herself, which will help her in recognizing God and leading life for benefit of others. Will lie o’ nights In the bony arms Of Reality and comforted Explanation These are concluding lines of the poem. Here, the poetess says she will accept reality. While, sleeping at night, she will consider the bitter reality of life. During the new year she will make some promises and pledges. She will sleep on thin, less-fleshy arms of reality. Accepting reality and facts is always a difficult thing, but she will accept it bravely. She will feel relieved and satisfied, when she comes to know that she has spent her life for the benefit of others. The image of bony arms is  a hard reality. Even then she will get delight and feel comforted when she has fulfilled her promises and resolutions, she has made on the start of the new year New In this poem, the poetess, Elizabeth Sewell, has made an extraordinary resolution to make herself a better woman by facing and living with reality in the start of the New Year. New Year is generally understood as starting of a new chapter of one’s life. People make resolution by taking stock of their lives and resolving to be better ones. Socrates, the great Greek philosopher, is reported to have said that unexamined life is not worthy of living and it is almost a tradition with the sensible and reasonable people to take stock of their life and to resolve to be better people, at the start of the new year. So, the poetess has decided to live with reality in the New Year. Reality is not always comfortable but pinching and disturbing. The use of the image â€Å"bony arms† points to this fact. But the poetess is resolute and will draw comfort fulfilling her resolution. The phrase ‘draining of long draughts’ is linked with drinking wine but the poetess intends to drink calmness and thinks it necessary for cleansing herself. It is quite natural and true that in loneliness and quiet one can examine one’s life honestly. It is a self-criticism. Life examined critically purifies one for better future life. Critical Explanation: It is a short and interesting poem written by Elizabeth Sewell. The arrival of New Year is usually celebrated with great fervour and enthusiasm. It is a tradition to make some promises in the light of which one wants to spend one’s New Year. Usually people pledge to become better human beings in the New Year. The poetess makes an extraordinary resolution at the beginning of the New Year. She says that in order to purify her soul, she will remain quiet. She will drink long sips of quietness. It is a beautiful simile as if quietness is a medicine that can make her clean physically and spiritually from impurities. Quietness seems to purify her because when a person is quiet and is not taking active part in the problems of the world, he gets time to have an insight into his own soul. He can then see his own impurities and drawbacks and can get rid of them. The poetess also wants to  do this. She will face the reality. She will not have any high opinion about herself in future. She will not lead a conceited life and have no superiority complex about herself. From now on, she will speak the truth to herself. She will not misjudge her own personality. In order to fulfill this goal. She will remind herself about her own reality twice during a day. Her assessment about herself will be true and real. During the night also, she will not forget the reality. Nodoubt, it is a time when one forgets bitter realities of this world and is lost in the imaginary world of dreams. But she pledges that she will not lose her contact with reality though it is hard like the bony arms yet she will prefer it because she has made her pledge and only the fulfillment of her promise will make her happy. It is very hard thing to face the reality and specially the reality about our own self. Our ego and our conceited self stop us from seeing our weakness. Without facing these realities, we are unable to improve ourselves. So the resolution to see the reality is the first step towards reformation. New 2 â€Å"New Year Resolutions† By Elizabeth Sewell (Reference to the Context) Reference: These lines have been taken from the poem â€Å"New Year Resolutions†, written by Elizabeth Sewell. Context: This poem is about the new year resolutions and promises. Another year has lapsed. On the start of the new year, the poetess takes stock of herself very realistically. She tries to make this world a better place by making new pledges. Her untraditional resolution is to face and lie with reality. Lines 1 – 3 Explanation: In these lines the poetess describes her mental state and the way she would drink to purify her soul. She says that she will drink wine at night secretly. She will have long draughts during night and will purge herself from all kinds of evils. This will assist her in helping other people because her own mind and spirit will be free from all types of evils. â€Å"Long  draughts of Quiet† also suggests that she will keep quiet most of time. This will be the best means for the purification of her oul and it will help her in leading beneficial and successful life. She says; she will talk less and hear more and mould her life into betterment. Lines 4 – 6 In the given lines Elizabeth says, she will remember herself twice daily, in the evening and in the morning. She will take into consideration what her aim of creation is. She will try to understand the purpose of life in general. Perhaps she means that she should recognize herself, which will help her in recognizing God and leading life for benefit of others. Lines 7 – 9 These are concluding lines of the poem. Here, the poetess says she will accept reality. While, sleeping at night, she will consider the bitter reality of life. During the new year she will make some promises and pledges. She will sleep on thin, less-fleshy arms of reality. Accepting reality and facts is always a difficult thing, but she will accept it bravely. She will feel relieved and satisfied, when she comes to know that she has spent her life for the benefit of others. The image of bony arms is a hard reality. Even then she will get delight and feel comforted when she has fulfilled her promises and resolutions, she has made on the start of the new year. My thoughts Explanation In these lines the poetess describes her mental state and the way she would drink to purify her soul. She says that she will drink wine at night secretly. She will have long draughts during night and will purge herself from all kinds of evils.Long draughts of Quiet† also suggests that she will keep quiet most of time. This will be the best means for the purification of her soul and it will help her in leading beneficial and successful life. She says; she will talk less and hear more and mould her life into betterment. Explanation In the given lines Elizabeth says, she will remember herself twice daily, in the evening and in the morning. She will take into consideration what her aim of creation is. She will try to understand the purpose of life in general. Perhaps she means that she should recognize herself, which will help her in recognizing God and leading life for benefit of others. Explanation These are concluding lines of the poem. Here, the poetess says she will accept reality. While, sleeping at night, she will consider the bitter reality of life. During the new year she will make some promises and pledges. She will sleep on thin, less-fleshy arms of reality. Accepting reality and facts is always a difficult thing, but she will accept it bravely. She will feel relieved and satisfied, when she comes to know that she has spent her life for the benefit of others. The image of bony arms is a hard reality. Even then she will get delight and feel comforted when she has fulfilled her promises and resolutions, she has made on the start of the new year These lines have been taken from the poem â€Å"New Year Resolutions†, written byElizabeth Sewell. Context: This poem is about the new year resolutions and promises. Another year has lapsed. On the start of the new year, the poetess takes stock of herself very realistically. She tries to make this world a better place by making new pledges. Her untraditional resolution is to face and lie with reality. Lines 1 – 3 Explanation: In these lines the poetess describes her mental state and the way she would drink to purify her soul. She says that she will drink wine at night secretly. She will have long draughts during night and will purge herself  from all kinds of evils. This will assist her in helping other people because her own mind and spirit will be free from all types ofevils. â€Å"Long draughts of Quiet† also suggests that she will keep quiet most of time. This will be the best means for the purification of her soul and it will help her in leading beneficial and successful life. She says; she will talk less and hear more and mould her life into betterment. Lines 4 – 6 In the given lines Elizabeth says, she will remember herself twice daily, in the eveningand in the morning. She will take into consideration what her aim of creation is. She will try to understand the purpose of life in general. Perhaps she means that she should recognize herself, which will help her in recognizing God and leading life for benefit of others. Lines 7 – 9 These are concluding lines of the poem. Here, the poetess says she will accept reality. While, sleeping at night, she will consider the bitter reality of life. During the new year she will make some promises and pledges. She will sleep on thin, less-fleshy arms of reality. Accepting reality and facts is always a difficult thing, but she will accept it bravely. She will feel relieved and satisfied, when she comes to know that she has spent her life for the benefit of others. The image of bony arms is a hard reality. Even then she will get delight and feel comforted when she has fulfilled her promises and resolutions, she has made on the start of the new year. How to cite Poem: Life and Reality, Essays

Human Resource Management of the City Bank free essay sample

Under early Roman law, banks could only be privately owned, but they were regulated by law. With the fall of the Roman Empire, banking became essentially illegal until the third century A. D. By the fourteenth century, when trade routes were being developed, privately owned banks were once again allowed. And by the fifteenth century, banks were needed to advance the huge sums of money required to send out ships to bring back valuable commodities such as spices, silk and gold. At this time in history, banking was big business. 2. 2 SCENARIO OF BANKING IN BANGLADESH The banking in Bangladesh has passed three decades through different policy environments and comprises central bank at the apex, nationalized commercial banks (NCBs), private commercial banks (PCBs), foreign commercial banks (FCBs) and specialized financial institutions. In the decade of seventies, in an atmosphere of fully regulated banking, the nationalized commercial banks played the active role in intermediation and allocation of credit along with the specialized financial institutions. The decade of the eighties witnessed the active operation of both the NCBs and PCBs (local and foreign) in the banking sector. Before liberation of Bangladesh in 1971, the total banking system was private owned, urban-based and profit oriented. But after the liberation, the Government of Bangladesh nationalized all the banks operating in Bangladesh in 1972, except a few foreign banks branches. It was due to the economic policy of Pakistan Government that we were having a privatized banking structure, till the independence of Bangladesh in 1971. After the separation from Pakistan the party, which came to power was politically committed to adopt such an economic policy which would endure social control and ownership of large industries, banks, insurance companies etc. Moreover, the ownership of those enterprises (including the banks) was largely controlled by west-Pakistani entrepreneurs who left Bangladesh after its independence. Following nationalization, the government also recognized the existing commercial banks into six (6) distinct new banks in the following manner in terms of the Bangladesh Banks (Nationalization) Order, 1972: Existed Banks| Reorganized Bank| The National Bank of PakistanThe Bank of Bahawalpur Ltd. | Sonali Bank| The Premier Bank Ltd. The Habib Bank Ltd. The Commerce Bank Ltd. | Agrani Bank| The United Bank Ltd. The Union Bank Ltd. Janata Bank| The Standard Bank Ltd. The Australasia Bank Ltd. | Rupali Bank| The Eastern Mercantile Bank Ltd. | Pubali Bank| The Eastern Banking Corporation Ltd. | Uttara Bank| Table 3. 1: Reorganization of the commercial banks of Bangladesh in 1972 Source: Khan, Mohammad Khalid, â€Å"Banking System in Bangladesh: 1972-1982†. The Bangladesh Times, March 20, 1982. After the nationalizatio n of banks in 1972, it was expected that the banks would play their due role for protecting social interest and in the economic development process of the country and thus reverse the trend as set in before liberation. Though Bangladesh Banks (Nationalization) Order, 1972 did not specifically spell out the objectives of the nationalization of banks, but considering the discontentment prevailing during Pakistan period and the basic principles of the country which were constitutionally established in 1972, the following major objectives of the nationalization of commercial banks might be discerned: 1. Expansion of bank branches for extension of bank services into rural areas. 2. Mobilization of domestic savings, particularly rural savings more effectively. . Providing adequate credit to priority sectors such as agriculture, small industries, etc. 4. Ensuring balanced regional development. 5. Removal of control of banks by few individuals. 6. Appropriation of bank profits by the government and uses it up for public purposes. After nationalization, the commercial banking in Bangladesh underwent a rapid transformation. The total number of branches of 42 scheduled commercial banks increased from a total of 1,116 in December 1972 to 5,983 in December 1999. Again out of the total branches 61. 6 percent belongs to the rural areas as on December 1999. During the transformation, the Nationalized Commercial Banks (NCBs) were expected to abandon profit-orientation and urban-based character and instead to accept rural-based developments character. Besides performing their traditional functions, the NCBs were also required to participate in the development finance activities like providing credit to agriculture sector and non-farm activities, expanding branches in un-banked rural areas, widening their range of services, etc. It was observed that while performing their duties, the customer services of NCBs deteriorated to some extent, specifically in urban areas and so also their profit and profitability. Number of rural branches of NCBs was, in fact, running at losses. Therefore, under the consideration of falling level of customer services and profitability of NCBs, the Government of Bangladesh decided in 1982 that some of the NCBs would be gradually denationalized and new commercial banks would be allowed to function in the private sector. This decision was taken with a view to improve primarily the customer services and ultimately the profitability of the commercial banks, but without hampering heir participation in the developmental activities. After this decision, till December 1986, 2 out of 6 NCBs have been denationalized and 6 newly formed private commercial banks have been allowed to operate in the banking sector of Bangladesh. These Banks have been considered as first generation Private Commercial Banks (PCBs). Now fourth generation of PCBs is operating their activities. First Generation Banks (Established 1982-1988) National Bank Limited, the City Bank Limited, United Commercial Bank Limited, AB Bank Limited, IFIC Bank Limited, Islami Bank Bangladesh Limited and Al-Baraka Bank Limited (the bank was later named as Oriental Bank Bangladesh Limited and presently it is ICB Islamic Bank Limited). Second Generation Banks (Established 1992-1996) Eastern Bank Limited, National Credit amp; Commerce Bank Limited, Prime Bank Limited, Southeast Bank Limited, Dhaka Bank Limited, Al Arafa Islami Bank Limited, Social Investment Bank Limited and Dutch Bangla Bank Limited. Third Generation Banks (Established 1996-2000) Mercantile Bank Limited, Standard Bank Limited, One Bank Limited, EXIM Bank Limited, Premier Bank Limited, Mutual Trust Bank Limited, First Security Bank Limited, Bangladesh Commerce Bank Limited, Bank Asia Limited and The Trust Bank Limited. Fourth Generation Banks (Established 2000-till now) Shahjalal Bank Limited, Jamuna Bank Limited and BRAC Bank Limited. CHAPTER # 03 Introduction of the Organization THE CITY BANK LIMITED * About TCBL * Mission amp; Vision * Branches of TCBL * Organizational Structure of TCBL Products amp; Service 3. 1 An Overview of the City Bank City Bank is one of the oldest private Commercial Banks operating in Bangladesh. It is a top bank among the oldest five Commercial Banks in the country that started their operations in 1983. The Bank started its journey on 27th March 1983 through opening its first branch at B. B. Avenue Branch in the capital, Dhaka city. It was the visionary entrepreneurship of around 13 lo cal businessmen who braved the immense uncertainties and risks with courage and zeal that made the establishment amp; forward march of the bank possible. Those sponsor directors commenced the journey with only Taka 3. 4 crore worth of Capital, which now is a respectable Taka 330. 77 crore as capital amp; reserve. The City Bank Limited is among the very few local banks which do not follow the traditional, decentralized, geographically managed, branch based business or profit model. Instead the bank manages its business and operation vertically from the head office through 4 distinct business divisions namely 1. Corporate amp; Investment Banking 2. Retail Banking (including Cards) 3. SME Banking amp; 4. Treasury amp; Market Risks. Under a real-time online banking platform, these four business divisions are supported at the back by a robust service delivery or operations setup and also a smart IT Backbone. Such centralized business segment based business amp; operating model ensure specialized treatment and services to the banks different customer segments. The bank currently has 83 online branches spread across the length amp; breadth of the country that include a fully fledged Islamic Banking branch. Besides these traditional delivery points, the bank is also very active in the alternative delivery area. It currently has 25 ATMs of its own; and ATM sharing arrangement with a partner bank that has 225 ATMs in place; SMS Banking; Interest Banking and so on. Soon its Customer Call Center is going to start operation. The bank has a plan to end the current year with 50 own ATMs. The City Bank Limited is the first bank in Bangladesh to have issued Dual Currency Credit Card. The bank is a principal member of VISA international and it issues both Local Currency (Taka) amp; Foreign Currency (US Dollar) card limits in a single plastic. VISA Debit Card is another popular product, which the bank is pushing hard in order to ease out the queues at the branch created by its astounding base of some 400,000 retail customers. The launch of VISA Prepaid Card for the travel sector is currently underway. The City Bank Limited prides itself in offering a very personalized and friendly customer service. It has in place a customized service excellence model called GAP (Graceful-Appropriate-Pleasing) that focuses on ensuring happy customers through setting benchmarks for the banks employees attitude, behavior, readiness level, accuracy and timelines of service quality. The City Bank Limited is one of the largest corporate banks in the country with a current business model that heavily encourages and supports the growth of the bank in Retail and SME Banking. The bank is very much on its way to opening many independent SME centers across the country within a short time. The bank is also very active in the workers foreign remittance business. It has strong tie-ups with major exchange companies in the Middle East, Europe, Far East amp; USA, from where thousands of individual remittances come to the country every month for disbursements through the banks large network of 83 online branches. The current senior management leaders of the bank consist of mostly people from the multinational banks with superior management skills and knowledge in their respective specialized areas. The bank this year, is celebrating its 25th year of journey with the clear ambition of becoming the no. 1 private commercial bank in the country in 3 years time. The newly launched logo and the pay-off line of the bank are just one initial step towards reaching that point. 3. 2 Vision and Mission of CBL Vision To be the leading bank in the country with best practices and highest social commitment. Mission To contribute to the socioeconomic development of the country. * To attain highest level of customer satisfaction through extension of services by dedicated and motivated team of professionals. * To maintain continuous growth of market share ensuring quality. * To maximize bank’s profit by ensuring its steady growth. * To ensure participative management system and empowerment of human resou rces. * To maintain the high moral and ethical standard. * To nurture an enabling environment where innovativeness and performance is rewarded. 3. 3 Branches of CBL TCBL is one of the fastest growing banks in Bangladesh. Now 83 branches are operating all over Bangladesh. 37 Branches in Dhaka Division 15 Branches in Chittagong Division 5 Branches in Comilla Division 9 Branches in Sylhet Division 10 Branches in Bogra Division 7 Branches in Khulna Division The network of TCBL engages itself for providing best quality banking service in retail, commercial, corporate and Islamic banking segments. The country’s top enterprises, multinational and local corporations and financial institutions are served by CBL. With a total asset of BDT 48,755 million, CBL is among the top performing local banks in Bangladesh. 3. 4 Organogram of TCBL 3. OBJECTIVES OF CITY BANK LIMITED The main objectives of The City Bank Limited are as follows: a) To establish, maintain, carry on, transact, undertake and conduct all types of banking, financial, investment and trust business of in Bangladesh and abroad. b) To form, establish and organize any bank, company, institutions or organization either singly and/or in joint coll aboration of partnership with any individual company, financial institution, bank, organization or any government and or government agency for the purpose of carrying on banking, financial investment and trust business and/or any other business as provided hereafter. ) To carry on any business relating to Wage Earner Scheme as may be allowed by Bangladesh Bank from time to time including maintaining of foreign currency accounts and any other matter related thereto. d) To contract or negotiate all kinds of loan and/or assistance, private or public from any source, local or foreign, and to take all such steps as may be required to be complete such deals. e) To form, organize assets, participate or aid in forming, promoting or rganizing any company, bank, syndicate, consortium institute or any holding and subsidiary company in Bangladesh or abroad for the purpose of undertaking any banking financial investment and trust business. f) To take part in the formation, management, supervisio n or control of business or operations of any company or undertaking and for that purpose to render technical, managerial and administrative services and act as administrator, manager and secretary. ) To purpose, or otherwise acquire, undertake, the whole or any part of or any interest in the business, goodwill, property, contract, agreement, right, private assets and liabilities of any other company bank corporation, partnership, body person or persons carrying on, or having ceased to carry on, any business which the company is authorized to carry on such terms and may be deemed expedient. ) To encourage sponsor and facilitate participation of private capital in financial industrial or commercial investment, share and securities and in particular by providing finance in the form of long, medium or short term loans or share participation by way of subscription to the promoter shares, or underwriting supports or bridge finance loans and/or by any manner. i) To amalgamate or reconstru ct or recognize with any commercial bank, or body corporate or association in cooperation with any person, commercial bank or association. ) To establish and open offices and branches to carry on all or any of the above business abroad and within the country provided prior permission is obtained from the Bangladesh Bank. k) To establish provident fund, gratuity, pension, and other fund for the welfare and benefit of the employees and staffs, former or present and any matter related thereon. l) To act as official liquidator and receiver. m) To receive, borrow or raise money on deposit, loan or otherwise upon such terms as The City Bank Limited may approve and to give guarantee and indemnity in respect of any debt or contract. ) To appoint officials, staff, experts, advisers, consultants, auditors, Legal advisers and provide for their suitable remunerations. o) To advance, deposit or lend money to or with such persons or bodies, corporate, unincorporated, statutory, govt. and/or its a gencies on such terms as the City Bank may approve. 3. 6 CAPITAL AND RESERVES The City Bank Limited has been consistently maintaining the Capital Adequacy Ratio, as prescribed by Bangladesh Bank. This has been made possible by a policy of building up both capital and reserves. It started with an Authorized and Paid up Capital of Tk. 1,000. 00 million and Tk. 276. 0 million respectively in 1995. Authorized and Paid up Capital increased to Tk. 6,000. 00 million and Tk. 1,934. 25 million respectively in 2008. In addition to Paid up Capital, the Bank has built up a strong reserve base over the years. 3. 7 STRENGTH AND PERFORMANCE With the active support and guidance from Bangladesh Bank, clients and patrons, the Bank has been maintaining sound financial strength and showing a steady and impressive business performance. The City Bank Limited is one of the few mentionable banks, which maintains Capital Adequacy ratio and has more than required provision as per Bangladesh Bank criteria. Starting with a modest deposit of only Tk. 10,749 million in 1996, the Bank had closed its business with a deposit of Tk. 48,731 million as on December 31, 2007. The total deposits stood at Tk. 53,284 million as on June 30, 2008. Total credit stood at Tk. 39,972 million as on December 31, 2007 against Tk. 34,049 million last year, which stood at Tk. 44,809 million as on June 30, 2008. Bank has posted a pre-tax profit of Tk. 2,010 million during the year ended December 31, 2007 against Tk. 1,183 million last year with a growth of 70%. The Bank’s profit before tax and provision as on June 30, 2008 stood at Tk. ,288 million with a growth of 52% compared to the profit before tax and provision Tk. 845 million as on June 30, 2007. Earning per share (EPS) is Tk. 46. 00 as on December 31, 2007 against Tk. 45. 00 as on December 31, 2006. City Bank has received ICAB National Award 2007 in the financial sector for their published Accounts and Reports. 3. 8 CREDIT POLICY AND PORTFOLIO Cre dit policy of the Bank works within the framework of three main objectives, namely, maintenance and improvement of quality of assets, recovery on time and building-up of an efficient customer oriented credit delivery system. The portfolio includes working capital financing, project financing, import-export financing and domestic trade financing etc. The Bank continued to extend working capital facilities to customers to ensure smooth and uninterrupted operation of their business. At the same time, it expanded project-financing portfolio to meet the growing demands of the economy for long-term finance in a depressed capital market. Due emphasis was given to financing export oriented and export linked industries without losing sight of the need for long term loans by other domestic market based industries and ventures. So far the Bank has financed 843 projects. Among them 129 projects were financed during 2007 amounting to Tk. 34,049 million. In long term portfolio, the bank has been diversifying from Textile and RMG industries to Agricultural Industries, Pharmaceutical Industries, Chemical Industries, Food amp; Allied Industries, Transport amp; Communication, Electronics amp; Automobile Industries, Housing amp; Construction Industries, Engineering amp; Construction Industries including Ship Breaking, Energy amp; Power Industries and Service Industries etc. Moreover, the Bank has also extended credit facilities to CNG filling stations, Shipping, Power Sector, Micro Credit and health services etc. For improved customer services, the Bank now extends One Stop services to corporate clients who require term loan, working capital and import-export financing etc. The Bank also participates in Syndicate Financing and so far has sanctioned Tk. 1. 50 billion in 03 syndications. At The City Bank Limited, the Syndications and Structured Finance unit was setup on October 30, 2004. This unit successfully closed nine syndicated deals till 2008. In 2008 (up to March) The City Bank Limited has arranged 3 syndication deals for a total amount of Tk. 1. 50 billion. The Syndications and Structured Finance team as a business unit soon followed up by closing another deal totaling Tk. 1. 40 billion for a large local corporate. In the year 2008 the unit has given priority to the Power, Telecommunication, Textile and any other lucrative industry. 3. 9 FUNCTIONS OF THE CITY BANK LIMITED The City Bank Limited performs all types of functions of a modern commercial bank, which generally includes: * Mobilization of savings of the people and safe keeping of all types of deposit account. Making advances especially for productive activities and for the other commercial and socio-economic needs. * Providing banking services to common people through the branches. * Handling of export and import trade and foreign remittances and with special support to export activities. * Introduce modern banking services in the country. * Discounting and purch asing bills. * Providing various information, guidance and suggestions for promotion of trade and industry keeping in view of the overall economic development of the country. * Industrial finance for both capital machinery and working capital. Finance relating to constructions of both commercial and residential. * Finance under small business of self employed clients. * Finance of farming and non-farming activities to rural people including purchase of agricultural equipments. * Ensuing proper utilization of credit disbursed. * Developing new products. * Market surveys before making any finance. * Finance for small transport. * Monitoring and forecasting. * Developing marketing campaigns. * Finance for household durables. * Work simplification studies. * Monitoring diversification of portfolio among different sectors. * Pricing and minimum size of transaction ship. . 10 Retail Financial Products of City Bank One of the most remarkable success stories of last 50 years banking industr y globally has been the conceptualization and innovative execution of banking with individual customers, their friends amp; families. The industry has termed it as Retail Banking or Personal Banking or Consumer Banking; and it has now at a very rapid pace become the major revenue line for most of the top banks in the world. City Bank, too, recently has started its journey in Retail Banking. City Retail add a little city to your life is the new brand-mantra, the pay-off line for City Retail. 3. 1 Deposit Products City Bank offers a wide variety of deposit products to meet financial needs of the customers. From current and savings accounts to Fixed Deposits and Pension Schemes each account is designed to give the best value for making money. Retail deposit products of City Bank are as follows: * Current Account * Savings Account * City Onayash * Short Term Fixed Deposit * Fixed Deposit * City Ichchapuron * City Shomriddhi * City Projonmo 3. 12 Loan Products City Bank offers two dif ferent types of retail loan products. They are as follows: * City Drive * City Solution * City Express 3. 13 City Cards * Debit Cards Visa Debit Card from City Bank makes life of people hassle-free and safe. Features: * Cash withdrawal from 500+ Visa ATMs 24/7/365 all over the country. * Shop and dine at hundreds of merchant Visa outlets all over the country. * Balance enquiry. * Fund transfer from your account to credit card 24/7/365. * PIN Change. * Mini statement. * Cash withdrawal @ Taka 12 per transaction at 250+ DBBL ATMs. * Credit Cards City Bank is the first bank to issue Dual Currency Credit Card in Bangladesh. This card enables the customers’ simultaneous usage of their cards both in home and in abroad. Features: * Variable Interest Rate. EMI Plan. * Balance Transfer. * Round the clock cash withdrawal facility at any Visa branded ATM throughout the world. * Round the clock purchasing power for goods and services at any Visa branded POS outlet. * 24% interest on Cash Advance. * No cash Advance fee at CITY ATMs. * Lowest Annual/Renewal Fee. * International Roaming facility. * Internet Transaction. * Convenient Repayment option. * E-statement. * Limited Lost Card Liability. * Secured with your Photo Photo Card. * 24 hours customer service help desk Eligibility: * Bangladeshi Nationals. * Age range for primary card holder is 18 years to 60 years. Age range for supplementary card holder is 18 year to 60 years. * Age bar can be relaxed for secured cards. * Minimum Gross Monthly Income (GMI) for silver card Tk. 12,000. * Minimum Gross Monthly Income (GMI) for gold card Tk. 30,000. * Minimum 6 month permanent employment for salaried executives (this indicates total length of service as a total of all companies he or she has worked for), and 1 year of experience in business or practice for self employed professionals and business person. CHAPTER # 07 Analysis amp; Discussion Recruitment amp; Selection and Training program THE CITY BANK LIMITED * Recruitment Process External Recruitment amp; Internal Recruitment * Benefits and Demerits of External Recruitment amp; Internal Recruitment * Selection Process * Orientation amp; Training programs of the Bank Recruitment: Recruitment in Theoretical term: Recruitment is defined as a process to discover the sources of manpower to meet the requirements of the staffing schedule and to employ effective measures for attracting that manpower in adequate numbers to facilitate effective selection of an efficient workforce. Recruitment Process in The City Bank Limited: In the recruitment process, The City Bank Limited follows two ways to recruit new employees. One is External Recruitment and the other is Internal Recruitment. In my report, I have tried to focus both of these ways and described activities under them. Recruitment Process The good design of the recruitment process is a key to the successful recruitment and staffing process. The HRM Function has to focus on the design of the process and to cooperate with all the involved parties managers, employees, agencies and web recruitment services. The recruitment process is unique for each organization and the HRM Function has to make adjustments in the general design of the recruitment process, which can be taken from any source. The recruitment process design is not an easy job, but the HR Recruiter has to be smart enough to bring the recruitment design, which will fit the organization’s need. The recruitment process of TCBL is like the following flow chart- 1. First a vacancy arises. This is due to the creation of a new job, on other occasions it may be because an existing member of staff has been promoted or is retiring. 2. The job description is updated and an employee specification is written. The job description lists the duties of the job whilst the employee specification gives details of the experience, skills and abilities needed to carry out the job. . A vacancy advertisement is written and is circulated via the recruitment channel that the bank uses. The channels including newspapers, internet recruitment sites, corporate web-site. 4. A shortlist (According to CV) is compiled of applicants who are going to be invited to attend for interview. This is done by the recruitment panel that compare s each application form with the requirements of the employee specification. 5. Interviews are held. The panel will use the same set of questions with each interviewee. The interview includes a selection test. 6. Then references are requested for check. 7. Appoint the successful candidates and arrange induction. External Recruitment The External Recruitment is the source of the fresh blood for the organization. As a very critical HR Process, the external recruitment process has to be set up very carefully. The external recruitment is a process, which is very sensitive to changes on the external market like unemployment rate, labor-market conditions, economic factors and others and the managers are very sensitive about that as well. In The City Bank Limited HR managers are mainly concern about how to be successful with external recruitment and an obvious job market analysis. External Recruitment Channels The City Bank Limited uses external recruitment channels to communicate job vacancies to the public audience and the correct usage of the external recruitment channel brings the right candidate for the particular job position. Generally the HRM is responsible for monitoring the job market and react appropriately to the changes on the job market with the proper use of the channels used to bring the expected level and number of candidates at the affordable costs. The City Bank Limited generally uses the following recruitment channels- a. Corporate Web-site b. Newspaper c. Job Web-site d. Interns (Less frequently used) HR managers in the bank has to make critical decision based on the some criteria for above recruitment channels which are like speed, cost, quality, available external recruitment budget. This means managers have to decide whether there is people willing to do job or not, what channel will cost how much to the company, what will be the quality and is there resources to bring new people in organization. To use the external recruitment channel HRM department has to prepare the recruitment plan in the beginning of the year so that the bank can allocate funds per channel. The entire HR department has to be the decision maker as this department is responsible for the cost and quality of the delivered candidates. External Recruitment Advantage The external recruitment is not just about choosing the right or ideal candidate for the vacancy in the organization. The external recruitment is also about the competition. The competition is about the attractiveness of the job advert, communication and quick response from the candidates. In The City Bank Limited, it follows the way as other bank does. Like newspaper, job web-site and other. At the same time bank enjoys some advantages of external recruitment like the following: * The City Bank Limited is one of the most renowned bank in Bangladesh and oldest. People feels esteemed to work in a reputed organization. Its name attracts people when a vacancy created. The potential job candidates will not apply for the position with the organization, which has no name. So people feels attracted to work in this bank and fresh blood enters into the organization. * Channel is the way through which people came to know about the vacancy. And The City Bank Limited strongly focuses on newspaper advertisement. It has flexibility in terms of information. As a result, the company gets huge response applications from a large number of candidates who are marginally qualified for the job. * The candidate will not wait for a long time to be invited for the job interview. Potential candidates will continue to seek jobs. So whenever a vacancy created in the bank the HR department started its work very early so that the rest of the process runs smoothly. By doing so candidates apply for the job and possibility for getting best people from the pool of candidates. External Recruitment Weakness Like the advantage external recruitment also has some weakness. The weaknesses are the just opposite of its advantages. Weakness of external recruitment is categorized under the following: * Expense: Recruiting externally costs the bank much higher. As it is mentioned before that the bank spends lot after advertisement. Hence, the cost becomes one of the weaknesses of external recruitment. * Time-Consuming: Time consuming is another disadvantage of external recruitment. It takes time to advertise, test and select suitable employees. At the same time if the suitable candidates are not available the whole process need to be repeated. Uncertainty: There is no guarantee that The City Bank Limited will ultimately be able to hire the services of best or suitable candidates. External Recruitment Process Key Issues The external recruitment process is a very complex HR Process. This involves clear follow-up of the individual process steps. Generally in the bank the whole HRM department is res ponsible for setting and defining the external recruitment process. The HR managers push other department managers to deliver clearly defined job profiles of the vacancies and the job profile cannot be changed during the recruitment process. Otherwise the change of the job profile cancels the search and starts a new one again. And if this happens it becomes very complex in the recruitment process. Also when the job profile changes during the search, it may bring a lot of job candidates unsuitable for the job position. The most crucial condition for the successful external recruitment process is a clear decision and the agreement about the final person to decide about the new hire to the organization. Cost of the Recruitment The recruitment process is not cheap for the organization. The real cost of the recruitment process is more significant for the organization. The visible cost of the external recruitment is the invoices from the newspaper companies and external job websites. Also the bank has to pay different advertising agency for outside ads and TV ads. As it is mentioned earlier advertisement is the strong basis of external recruitment hence The City Bank Limited spends a large amount after this. The HR managers decide about the potential cost of the recruitment and prepare the budgets for this to bank and the bank provides fund at the beginning of the year. Internal Recruitment Internal recruitment refers to the filling of job vacancies from within the business -where existing employees are selected rather than employing someone from outside. Sources of Internal Recruitment In The City Bank Limited it has several sources of recruiting internally. The following are the most commonly used methods of recruiting people in The City Bank Limited: * Promotions amp; Transfers: This is a method of filling vacancies from within through transfers and promotions. Transfer is a lateral movement within the same grade, from one job to another. It may lead to changes in duties and responsibilities, working conditions, etc. but not necessarily salary. Promotion, on the other hand, involves movement of employee from a lower level position to a higher level position accompanied by changes in duties, responsibilities, status and value. Organizations generally prepare transfer lists or a central pool of persons from which vacancies can be filled for manual jobs. Such persons ar e usually passed on to various departments, depending on internal requirements. * Job Posting: The City Bank Limited uses another way of internal recruitment which is Job Posting, another way of hiring people from within. In this method, the organization publicize job opening on bulletin boards, staff notice board, in-house magazine. One of the important advantages of this method is that the bank enjoys a chance to highly qualified applicants working within the company to look for growth opportunities within the company. * Employee Referrals: Employee referral means using personal contacts to locate job opportunities. In Bangladesh most of the people gets job by using employee referrals. It is a recommendation from a current employee regarding a job applicant. Employees working in the organization are encouraged to recommend the names of their friends, working in other organizations for a possible vacancy in the near future. In fact, this has become a popular way of recruiting people highly competitive job markets nowadays. Internal Recruitment Benefits The internal recruitment process has some benefits for the bank. Internal benefits for The City Bank Limited are like following: * Economical: The cost of recruiting internal candidates is minimal. No expenses are incurred on advertising. * Suitable: The organization can pick the right candidates having the requisite skills. The candidates can choose a right vacancy where there talents can be fully utilized. * Reliable: The organization has the knowledge about suitability of a candidate for a position. The bank can identify who will be more reliable for the known position. Because the bank believes ‘Known devils are better than unknown devils’. * Satisfying: Internal recruitment within the bank is a policy of preferring people from within offers regular promotion for employees. It motivates them to work hard and earn promotions. * Retention: Internal recruitment is a way to retain most potential employees in The City Bank Limited. Internal Recruitment Weakness At one side, The City Bank Limited enjoys the benefits of internal recruitment also simultaneously it has some weakness. The main weakness for the bank are- * Limited choice: The internal recruitment of the employees reduces the area of choice. The reduction in the area of choice means less number of applicants. The choice is to be made out of people working in the bank. It discourages entry for talented people, outside the organization. * Encourages Favoritism: Internal source encourages favoritism in this system. Most of the time it is seen that the superiors usually select their favorites. The worst part of this system brings sometimes huge loss for the bank as a less capable person is appointed for the post. * Restriction on Fresher: The defect of the internal source of recruitment is that the young people fully equipped with the modern technical knowledge but they remain excluded from entry. As a result, old people run the bank with their old ideas and thinking. Selection Selection in theoretical term: Selection is the process of picking individuals who have relevant qualifications to fill jobs in an organization. The basic purpose is to choose the individual who can most successfully perform the job from the pool of qualified candidates. The purpose of selection is to pick up the most suitable candidate who would meet the requirements of the job in an organization best, to find out which job applicant will be successful. To meet this goal, the company obtains and assesses information about the applicants in terms of age, qualifications, skills, experience, etc. The most suitable person is then picked up after eliminating the unsuitable applicants through successive stages of selection process. Any mismatched in this regard can cost an organization a great deal of money, time and trouble. Selection Process Selection is usually a series of hurdles or steps. The City Bank Limited follows its own established Selection process for selecting appropriate candidates. In this process each of the steps are successfully cleared before the applicant proceeds to the next one. Selection Process of The City Bank Limited starts with the screening of available resumes for a particular job. 1. Screening of resumes is done for figure out totally undesired or unqualified candidates. It is essentially a sorting process in which the necessary information is elicited from the candidates about their education, skills, experience. 2. After sorting interview HR personnel of the bank sort out the eligible candidate for the position and are being asked for sitting in written exam. In written test of The City Bank Limited it takes several tests. These are- a. Conceptual Test: In conceptual the candidate is given a case study. In that the bank can measure how effectively the candidates respond to the given scenario. b. Informal Test: Informal test is kind of a candidate may have to act in a role play. Sometimes candidates are given a scenario and are asked to what he or she would do if the situation arises. c. Intelligent Quiz Test: Intelligent quiz test is like MCQ type. Candidates are some kind of mathematical problem in MCQ type and have to answer those. d. General Knowledge: In written test of The City Bank Limited candidates have to face general knowledge test. In this test candidates have be aware about the current affairs of the country as well as internationally. In addition, some historical facts have to answer. 3. Interview is an essential element of selection and no selection procedure is complete without interviews. In addition, The City Bank Limited is no exceptional from this step. In the interview, candidates are asked questions related with their educational background, past work history, training attended and other which are filled in their resume. In The City Bank Limited when a candidate sits for interview the panel takes some test of the candidates. These are like- e. Intellectual Test: These are mental ability tests. The interview panel measure the candidate’s learning ability and the ability to understand instructions and make judgments. These tests also measure several abilities such as memory, vocabulary, verbal fluency etc. . Skill Test: Skill test measure an individual’s potential to learn certain skills like accounting, mechanical, mathematical, etc. This test indicate whether or not an individual has the capabilities to learn a given job quickly and efficiently. g. Personality Test: Interview panel of The City Bank Limited measures a candidate’s personality t est generally through the style of him/her. Candidate’s dress-up, grooming style, way of behave and talking all those reflects personality and this is an important factor for hiring the selected candidate. h. Integrity Test: This test is taken to measure the applicant’s honesty. The applicants are expected in this test to answer in â€Å"yes† or â€Å"no†. 4. Reference check in selection process is an important point. Here candidates are asked to mention in his application form, the names and addresses of two or more persons who know him well. These may be his previous employers, heads of education institutions. These people are requested to provide their frank opinion about the candidate without incurring any liability. 5. After the interview candidates are shortlisted by the department and are finally approved by the executive of concerned department. . After final approval, employment is offered in the form of an appointment letter mentioning the post, the rank, the salary grade, the date by which the candidate should join and other terms and conditions in brief. 7. Induction is done in bank after joining of a new employee. Induction is the process of receiving employees when they begin work, introducing them to the company and to their coll eagues, and informing them of the activities, customs and traditions of the company by the branch manager. Orientation amp; Training programs: After recruiting the new employee an orientation program effectively introduces them into the organization and assists with retention, motivation, job satisfaction, and quickly enabling each individual to become contributing members of the work team. It is very important to have an orientation and training program for every newly hired employee . Accidents occur in all areas of the operation. For that Human resource development is an essential pre-requisite for achieving organizational goals. No organization can run successfully in a changed environment without developing its employees’ human qualities. Training is a recognized way through which organization could help improving the efficiency its employees’. It is also an ongoing systematic process. It helps to bring about developmental changes in knowledge, skill and attitude of an employee. New employees should always be given a training or orientation session before they actually begin their work. A thorough training session should also be held for all employees at the beginning of each season. During the orientation session, management should review and explain the policies and work rules with the employees. After orientation, the manager should walk through the operation with employees and explain the task areas. This may seem monotonous but it will help to perform the task amp; responsibilities. The walk through should include a review of the responsibilities of each individual job. Be sure to cover the responsibility of each worker in the event every task. Without a well-planned orientation, new employees end up confused. The employers lack of direction and disorganized approach rapidly diminishes the employees commitment to the company. The best new employee orientation programs: * Make a good first impression. * Make new employees feel welcome and valued as key players on the team. * Explain the mission/purpose of the company and the job so employees can see the big picture. * Assure them they will be carefully and patiently trained — not thrown in to sink or swim. * Familiarize employees with rules, policies and procedures. * Help employees adapt to their new surroundings, as well as learn who all the players are and how they work together. * Establish friendly relationships among co-workers and managers. Ensure new employees have all the information and tools they need to do their jobs. * Motivate employees to succeed as an integral part of the team. * Develop the long-term commitment you want from every member of your workforce. * Tell them whats in it for them — in sum, reinforce their buying decision. After successful selection process they start their own strategy to make a very effective man po wer for the Bank. Like the other organization The City Bank Limited organize an well designed orientation amp; training programs for their newly recruited employees. This program designed by the HRD of The City Bank Limited. this programs is held in the training Institute of the bank under the super vision of the principal of the training institute. Generally the duration of an orientation amp; training programs is 15-30 days. The first day of the programs the following person are present: 1. CEO amp; Managing Director of TCBL 2. DMD of TCBL 3. Head of HRD of TCBL 4. Principal of TCBL training institute 5. Faculty members from TCBL training institute. 6. Occasionally, other department heads First day of the orientation programs the newly recruited employees are introduce with the Honorable CEO amp; Managing Director of TCBL, Deputy Managing Director and Some other top level Executive of the bank. The also know the different hierarchy level of the bank, Different department of the bank. After the introduction day the newly recruited employees get the following training in training institute. Beside the faculty member top amp; mid level executive from different division amp; branch are also providing lecture in this orientation amp; Training programs. Basic Training on Bank operation: After that they provide the different concept about the banking, the function of the bank which are provided by the above executive amp; faculty members of TCBL training institute . like the 1. General banking Department : a. Account opening procedure b. Process of Issuing cheque book /D. D/,T. T/Pay order/Pay slip/FDR c. Function of Clearing house /Clearing cheque d. Different heading amp; Function of Accounts * Current account * Saving accounts * Short Term Deposit * DPS * Suspense Accounts /sundry creditor e. Different types of voucher /document/ cheque 2. Foreign Exchange Department : * Import department Export department * Back -to -Back L. C * NRB function 3. Advance /Credit Department : a. Different type of credit * Industrial credit * General Loans/credit b. Different part of credit i. Credit operation ii. Credit Administration c. Different document of credit i. Charges document ii. Letter of Authority iii. Letter of Agreement iv. Letter of disbursement Training for the newly recruited employees: Besides these basic banking operation concepts TCBL have divided their training and development process for the fresher also in the following sections. All this training are arranged and taken by support and development segment. Service mind set * Service based training * Value added service based training * Computer skill Service mind set: They start their very first strategic implementations by giving service mind set training. The main focus of this training is to give the new employees inspiration about the work. They try to make the employee really professional so that they can match this real corporate life. They try to set everyone’s mind to the work process so that they can give their best and it‘s proven that this is the best tool The City Bank Limited is implementing to the employee and it works like a charm. Service based training Service based training focused on the various kinds of services that The City Bank Limited providing for example Account opening service, Remittance Loan and Advance. They give the new employees a brief knowledge as there part of strategic planning as they are going to distribute those candidates in different segments of the organization. Value added service based training The City Bank Limited has provides some service like Demand draft, Telegraphic transfer, Mailing transfer and Pay order. They provide a very brief training to the employee as they have to deal with each and every day. Computer skills Technology can’t think about the computer. So it’s so easy to judge that all the work going to happen in a bank company through compute. So it‘s a must to have knowledge that each and every candidates have basically in this training they show various tools that required for the work place. Employee Training The City Bank Limited employs a large number of employees for performing various jobs. For the newcomers, they need more knowledge and skill for better performance of jobs. They are, therefore, in need of proper training to contribute to the achievement of the organizational goals. There are some jobs that require little or no training but many of them need to be performed by adequately training. The use of modern technology has created new jobs in the organization, which required training. Training involves the change of skills, knowledge, attitudes or behavior of employees. Although training is similar to development in the methods used to attract learning, they differ in time frames. Training is more present day oriented; its focus is on individuals’ current jobs, enhancing those specific skills and abilities to immediately perform their jobs. Employee development, on the other hand, generally focuses on future jobs in the organization. Training differs from education. Training is concerned with increase in knowledge, skills, and abilities of the employees in doing a particular job. It has a narrow aim limited to increase in knowledge and skill related to a job. Education, on the other hand, broadens the mental faculties and horizon of knowledge. It is concern with enhancing general knowledge and motivating one to understand the total environment. Training is often understood as a learning experience. So, if employees are to understand what training can do to improve an employee’s job performance, employee should begin by explaining how learn. Training widens job related knowledge of the employee. Employees become more skilled and update their knowledge through training. Training provides necessary instructions for performing the current job efficiently. Training differs from education and development. Imparting of training to the employees has become very much important in modern times for better performance of the job. Here it can be said that the question of training does not arise but making choice of the method of training arise. Survey Analysis Frequently used External Recruitment Sources Corresponding to this data I have drawn a pie chart. According to the responder most of them answered newspaper is mostly used for recruiting people externally. Frequently used Internal Recruitment Sources From the answer given by different employees in the bank most of them had responded in case of internal recruitment employee referrals is widely used. Best way to recruit People The employees at TCBL expressed their varied views about the best way, to recruit people. The employees in bank bear an opinion (about 40%) that advertisement is the best way to recruit people. Advertising helps to define exactly the need of the company, and what separates it from its competitors. Willingness to do Job From the chart it can be understood that most of the employees are inspired by the reputation of the bank. Also the respect in banking job matters for people to job according to the respondents. Effectiveness of Recruitment Process From the above chart it is seen that most of the respondents think that the current process of recruitment is effective for the organization. Some think that the bank should be more economic when it is about to advertise vacancy in publicly. Effectiveness of Selection Process Almost all of the respondents are satisfied with the process of selection of the bank which is seen from the graph. Most Reliable Source of Recruitment In term of reliable source the attitude of the respondents were in favor of external because they think candidates from outside are more experienced and skilled. Less were in favor of internal source of recruitment. CHAPTER # 08 Analysis amp; Discussion SWOT THE CITY BANK LIMITED * Strengths * Weakness * Opportunity * Threat * Regression Analysis 7. 1 SWOT Analysis of The City Bank Ltd. The acronym for SWOT stands for: * Strength * Weakness * Opportunity * Threat The SWOT analysis involves an examination of a firm’s strengths, weaknesses, opportunities, and threats. It should help to evaluate a firm’s strategies to exploit its competitive advantages or defend against its weaknesses. Strengths and weaknesses involve identifying the firm’s internal abilities or lack thereof. Opportunities and threats include external situations. SWOT analysis gives an organization an insight of what they can do in future and how they can compete with their existing competitors. This tool is very mportant to identify the current position of the organization relative to others, who are playing in the same field ad also used in the strategic analysis of the organization. The SWOT analysis of The City Bank Ltd. is given below: 7. 1. 1 Strengths: 1. The bank generated modern facilities to serve internal and external customers; 2. The bank provides most efficient client service through its organized and trained personnel; 3. The bank operate within mandate, policy, regulation and guiding principles of Bangladesh Bank; 4. Loan applications are assessed fairly, timely and dispose of earliest possible period of time; 5. Loan money is secured good collateral system; 6. Lending policy is defined, coordinated and clear to all customers; 7. Documentation systems are scientific for maintaining records of loan money and collateral; 8. The bank have continuously been expanding its services due to its due diligence in the cliental services 9. The growth of the Bank is increasing day by day due to efficient and client friendly services; 10. The bank earned profit taka- 358 million in 2004 and taka-839 million in 2008 due to its good management and this has created good reputation resulting in achieving the bigger corporate clients 7. . 2 Weaknesses: 1. The bank is not desperate in increasing its services with the new clients or innovative products line; 2. The operation system is not yet fully modernized according to present demand of the banking system as a whole; 3. ATM facility is not according to demand; 4. The staff often leave bank for better prospects; 5. Shortage of manpower which impact in service d elivery 6. Required level of logistics are not ensured for optimum services 7. There is no regular training provision 8. The checking system of clients’ credit worthiness in respect of mainly previous credit position and its default, is not efficient because present operations takes more time as the system is not centralized. 7. 1. 3 Opportunities: 1. There is scope for creating new clients and investment in new products/items if the bank introduce more efficient operation system through adapting advance technology; 2. The diversified Corporate Sector, Retail Banking, Money Market Operations, Consortium and Structured Financing and Export Oriented and remittance initiatives are the scope for higher growth; 3. The City Bank Ltd. is contracted with Bangladesh Bank for on Online CIB (Credit information Bureau) report which will help client assessment and opportunity for quick service delivery; 4. If in-house training provision is ensured quality and quantity services will be enhanced and would impact in increasing growth of the operational performances of the Bank; 5. The growing business prospects in Bangladesh and the international market is the scope of bank for expanding its services; 6. The bank may expand its operation country-wide through increasing its service centre/branch at viable scales; . 1. 4 Threats: 1. The banking services in Bangladesh is being more competitive due to continuous introduction of new generation Banks; 2. Expansion of foreign bank services in Bangladesh is also challenge for local banking services because they are more healthy in respect of capital and well organized to provide quality services world-wide; 3. Frequent changes of investment policy, lending polic y and operational policy of Banking services; 4. Uncertainty of favorable terms of international trade and commerce; 5. Instability of socio-economic environment of the country;

Inspiration from Anywhere

INSPIRATION FROM ANYWHERE As I missed my international flight home to Houston from Trinidad today, I was suddenly struck with an inspiration. Writers can find their muse anywhere at any time. Now, you may be wondering why being stuck at a foreign airport alone with absolutely no money and no lay of the land could inspire this thought in my mind. But just think about it. I’m sitting here, computer on my lap, just tapping away at the keys. Doesn’t matter that I’m in a place completely unfamiliar to me or that I’m completely clueless as to where I’ll lay my head tonight. It’s just me and the keyboard spending some good quality time together. So while I’m here at the airport with a whole lot of nothing to do, I’d like to take these moments to give you some ideas about where you can find inspiration for your own writing. Remember back to things that made you happy in your childhood. Do you recall the first time you ever rode your bike, or the time Santa left the toy you had wanted so badly under the tree? Did you play dress up in your grandmother’s attic or sell lemonade on a hot summer day? Memories like these formed you as a person, and they are the perfect way to dig deep when you feel your writing has lost some of its meaning. Take in the scenery around you. Write about the gorgeous nature (or lack thereof) that resides around you. Watch people as they walk by – each of them unique in character and offering something special to the world. The diversity that is found in all things is a wonderful way to open your eyes (and pen) to new content. Get out. Do you ever feel stuck in the same routine? Do something different. Go somewhere different. Take a drive, go salsa dancing on a Tuesday, sit in the sand at the beach, and hike in the mountains. Simply remove yourself from the norm that is your life, and don’t act surprised when inspiration finds you out of your element. Read. Read books, newspapers, magazines, advertisements, blogs, articles, or whatever else tickles your fancy. Open your eyes to the way others interpret the world through writing, and inspiration may come right out and smack you in the face. What inspires you? We’d love to hear.

United States Vs Wade Involves a Defendant in the Robbery of a Federally Insured Bank essays

United States Vs Wade Involves a Defendant in the Robbery of a Federally Insured Bank essays UNITED STATES v. WADE, 388 U.S. 218 (1967) involves a defendant in the robbery of a federally insured bank who was placed in a lineup several weeks after he had been indicted. The lineup was conducted without notice to and in the absence of his counsel. He was identified by two witnesses as being the robber at the lineup and the trial and was subsequently convicted of the crime. The defendant argues that the lineup violated his Fifth Amendment privilege against self-incrimination and his Sixth Amendment The question in the case was whether courtroom identifications of an accused at trial are to be excluded from evidence because the accused was exhibited to the witnesses before trial at a post-indictment lineup conducted for identification purposes without notice to and in the absence of counsel. The court held that the lineup did not violate the Fifth Amendment, but did find that the Sixth Amendment guarantees an accused the right to counsel at any critical confrontation by the prosecution at pretrial proceedings where the results might well determine his fate and where the absence of counsel might impede the right to a fair trial. Identification procedures, which had theretofore been treated as a purely factual matter left largely for lay jurors to handle, for the first time took on constitutional dimensions and created a new per se rule of constitution law for identification procedures. The catalyst was the determination that a police lineup was deemed to be a "critical stage," thereby entitling an accused who was forced to stand in a lineup to the Sixth Amendment right to the assistance of counsel. The rule applies to any identification technique and a fortiori to a face-to-face encounter between ...

Distinguish among the five types of customer markets Essay

Distinguish among the five types of customer markets - Essay Example Consumer durables are another subtype. Converse to the characteristics of FMCGs, these goods have low volume but high unit value. This can further be categorized into white goods and brown goods. Refrigerators, pressure cookers, dishwashers, washing machines, microwave ovens, etc are primary examples of white goods. Electronic items such as personal computers, video game consoles, multi-media players, etc are good examples of brown goods. Consumer Market is characterized by aggressive marketing campaigns, for consumers tend to be disloyal to brands and can easily switch from one to another. Also, competing companies are focused on innovating and improvising their products and production models to garner greater market share. *Business Markets â€Å"buy goods and services for further processing or for use in their production process, whereas Reseller Markets buy goods and services to sell at a profit.† (Part 2, p.66) The metals industry is a good example of Business Market. Her e, raw metals (sometimes in the form of ores) are bought by private companies from government agencies. The former then go on to process and add value to the metal before selling it to other industries or end consumers. A good example of Reseller Market is the retail industry, which comprises of Supermarket chains, Specialty stores, Chemists, and other retail dispensaries.

Did the New Deal work Why or why not Essay Example | Topics and Well Written Essays - 1000 words

Did the New Deal work Why or why not - Essay Example Hence, prompted intense debates that persisted during the New Deal’s implementation. However, the New Deal eventually realized its goals giving the president during then a firm base meant to response to his critics’ opinions boldly while citing the then improvement of economic sector in all aspects including people’s lives. The New Deal despite at its inception and during implementation faced numerous criticisms from disbelieving opponents, it worked efficiently evident in the way it met its economic targets. As Roosevelt stated, â€Å"substantial gains well known to all of you have justified our course (Roosevelt, â€Å"Relief, Recovery, Reform and Reconstruction†)†. In this case, gains encompassed numerous and varied improvements that characterized then economy besides heightening people’s welfare. The president was even elaborative in defending his strategy with statistics though hesitantly to mention because those whom he was telling espe cially his opponents knew much about them. They encompassed gain in â€Å"average weekly pay† and reemployment of numerous people especially by private sectors, hence his strategy not only was economic-focused but also touched on citizens’ lives. ... this led to reducing incidences of bankruptcy and uncertainties, which the state together with its industrial firms earlier experienced due to economic unpredictability. In this case, Walker’s sentiments aimed at arousing his audience’s thoughts concerning what used to be the norm in comparison to the economy after implementing the New Deal whose benefits they could measure and experience. Therefore, this acted as a wakeup call for the citizens and especially critics of the then idea to see huge federal’s amount of money that had gone into stabilizing the economic and emerged successfully. This was in alignment with the New Deal intentions, which many before its inception thought was ineffective. New Deal’s emergency gave birth to the rise of varied the then emergent agencies aimed at heightening citizens’ welfare irrespective of their respective political persuasions. According to Mooney, â€Å"†¦.the legislation passed in the first â€Å"Hu ndred Days† of the Roosevelt administration created an array of new federal agencies intended to organize the economic recovery (Mooney, 96).† Agencies in the entire framework of the New Deal comprised varied aspects whose intentions were citizen-centered, for instance, WPA. Since, each state’s economic progress is the measure of citizens’ welfare and ability to offset daily bills satisfactorily without compromising regime of the day’s financial goals. Therefore, through strategy the state not only managed to help the people but also met their respective goals through establishment of agencies, though critics seemed too â€Å"blind† to notice them. The inception and taking over of New Deal contrary to numerous debates successfully managed to change

Statistics are Misleading in the Media Essay Example | Topics and Well Written Essays - 1250 words

Statistics are Misleading in the Media - Essay Example Many of the unsuspecting readers are often oblivious of the fact that people creating and quoting statistics do have personal agendas and vested interests (Hodges 2). Thus most of the social statistics is often colored by such devious intentions. The journalists in their zeal for bolstering on the issue under consideration do tend to exaggerate or subdue the available statistical findings (Calif 2). Many a times the entities like governments, political parties and NGOs purposely furnish tainted statistical data and studies so as to accentuate or dilute a specific issue. Thus it is important for any discerning citizen to investigate the basic parameters surrounding a statistical quote that is the entity who created a statistical study (Best 27), the purpose for which a given statistical data was created (Best 28) and the manner in which a statistical research was carried out (Best 29). Sad, but true, many of the subscribers are mostly not so astute, systematic and methodical in their analysis of the statistics published in media and are therefore vulnerable to ending up with faulty perceptions, false notions and misguided views. It is really imperative to understand the dynamics by which statistics is exaggerated, downplayed or manipulated by the media to send a specific message to the masses. Many a statistical studies prefer to choose the samples as per their convenience (Best 52). The samples for statistical studies are often chosen by the media in a non scientific way and at random that go well with their limited budgetary resources. Hence such samples fail to represent the total population and do yield false conclusions. Besides the statisticians hired by the media houses are oft deficient in the expertise to wean out the mutations incorporated while sampling a population. There is no denying the fact that the statistical studies conducted in an academic environment are not bound by the compulsion to yield black and white results. It is a reality that if an academic study ends up with open ended conclusions, the researchers do prefer to leave them as such and never rush in to deduce faulty hypothesis. However, this is not always true so far as media reports are concerned. Most of the media reports by their very nature are expected and bound to give concrete conclusions underlying a statistical study. Thus when the journalists are pushed by their voracious readers to yield results, they often do not hesitate from culling out nonrealistic guesses from the available statistical figures (Best 32). In fact, to sensationalize their news reports, media houses even go to the extent of exaggerating or downplaying the results attributed to a given statistical study. If nothing else, commercial success is often too big a motivation to prevent them

Case Study Of Unstable Angina

Case Study Of Unstable Angina The patient in context is a 61 year old male, Mr. X, admitted to hospital in the late evening for a case of unstable angina. Presenting complaints include left-sided chest pain which was less severe than that of his previous admission and localized pain during rest. Absent symptoms are profuse sweating as well as nausea and vomiting, orthopnea and paroxysmal nocturnal dypsnoea, cough and fever. Patients past medical history includes diabetes mellitus and hypertension diagnosed 6 years ago, ischaemic heart disease (IHD) since 3 years ago, for which the last hospital admission was 11 months ago. In the previous admission for IHD, Mr. X also suffered from pneumonia and ventricular failure, his electrocardiogram (ECG) indicated right bundle branch block, his serum troponin I levels were 0.3 ng/mL (normal levels 0-0.1 ng/mL), and his creatinine levels were 5.0 mg/dL (normal for males 0.2-0.6 mg/dL). Mr. X is also afflicted with chronic kidney disease, for which his baseline creatinine dur ing his last admission was 208 ÃŽÂ ¼mol//L. Mr. X has retired from the military and is living with his wife, who monitors his medications and compliance. He used to be a chronic smoker but has stopped smoking 15 years ago. His previous medication history is as below: Drug and Form Strength Frequency Furosemide tabs 40 mg BD Omeprazole tabs 20 mg PRN Amlodipine tabs 10 mg OD Simvastatin tabs 20 mg ON Perindopril tabs 4 mg OD Table 1: Table showing past medications of Mr. X. Mr. X takes no non-prescription medications and has no known drug allergies. On examination he appears to be alert and comfortable on his nasal cannula for delivery of oxygen 3L/min. His blood pressure is 134/81 mmHg, pulse rate is 76 bpm, body temperature 37oC, SpO2 of 99%, abdomen feels soft and non-tender, and no pedal oedema was observed. A blood glucose strip test reveals that Mr. Xs glucose levels were 10.3 mmol/L. Emergency ECG shows right bundle branch block and no ischaemic changes. The tentative diagnosis was unstable angina and further tests were scheduled, including a full blood count (FBC), renal profile (RP), liver function test (LFT), troponin and creatinine (CKMB) investigations, as well as a urine full examination and microscopy (UFEME). The immediate plan was to give Mr. X subcutaneous enoxaparin 60 mg stat and twice daily thereafter, aspirin 75 mg tablets once daily, lovastatin 20 mg tablets once daily, sublingual glyceryl trinitrate when required, and to continue the 3L/min oxygen cannula. Clinical Progress Day 1 Morning Patient was well, free from chest pain, tolerating orally and suffering from no nausea or vomiting. He had minimal shortness of breath (SOB). Troponin I levels were at 0.15 ng/mL and ECG showed no acute or evolving changes. Fasting plasma glucose was at 4.8 mmol/L (within normal range). Secondary dehydration was observed using the skin pinch test, so patient was started on intravenous normal saline drip (3 x 500 mL bag per 24 hours). Patient was found to be anaemic due to pre-existing chronic renal failure. Evening Patient reported mild chest pain and SOB. His troponin I levels were 0.15 ng/mL and other vitals were normal. His creatinine levels were 423 ÃŽÂ ¼mol/L. Day 2 Patient felt comfortable and his vitals were normal. His creatinine levels decreased to 345 ÃŽÂ ¼mol/L. Day 3 Patients condition was well, no chest pain was reported but he was still experiencing some SOB in the morning, which subsided in the afternoon. Patient was put on continuous peritoneal dialysis in the late morning. Patients vitals were normal, and he was taken off enoxaparin in the evening. Day 4 Patient complained of chest pain in the morning, with minimal SOB. His vitals were normal. Subcutaneous enoxaparin 60 mg was given and the IV saline was continued. Lab Findings Urine Biochemical Analysis (Day 1) Investigation values Normal values Protein ++100 mg/dL Glucose negative negative Blood negative Leucocytes +-10 WBC/ÃŽÂ ¼L Ketone negative negative Bile negative negative Urobillinogen normal Specific gravity 1.025 1.003 1.040 pH 5.5 4.6 8.0 Nitrite negative negative Table 2: Results of urine biochemical analysis on Day 1 Lipid Panel Fasting Serum Lipid Plasma total cholesterol / mmol/L 4.5 Desirable Borderline 5.17-6.19 High risk >6.20 Plasma triglyceride / mmol/L 1.27 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Desirable Borderline 1.7-5.64 High risk >5.65 Plasma LDL-cholesterol / mmol/L 2.91 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Desirable Borderline 3.36-4.12 High risk >4.13 Plasma HDL-cholesterol / mmol/L 1.01 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Desirable >1.03 High risk Total cholesterol / HDL-cholesterol 4.5 Desirable Borderline 3.8-5.8 High risk >5.9 Table 3: Results of lipid panel (fasting serum lipid levels). Renal Profile Electrolytes Measured levels on Day 1-1.14am Measured levels on Day 1-12.54am Measured levels on Day 2-10.47am Normal range Urea / mmol/L 22.8 22.4 21.1 2.8-7.2 Sodium / mmol/L 129 128 129 136-146 Potassium / mmol/L 5.3 4.8 4.7 3.5-5.1 Chloride / mmol/L 98 94 101 98-107 Creatinine / ÃŽÂ ¼mol/L 423 398 345 58-96 Table 4: Renal profile of Mr. X showing levels of electrolytes and creatinine. Plasma troponin I 0.15 ng/mL Liver Function Test Measured level Normal range Plasma total protein 81 g/L 66-83 g/L Plasma albumin 34 g/L 35-52 g/L Plasma globulin 47g/L 25-44 g/L A/G ratio 0.7 0.9-1.8 Plasma alkaline phosphatase 119 u/L 30-120 u/L Plasma aspartate transaminase 19 u/L Plasma alanine transaminase 43 u/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ Plasma total bilirubin 6 ÃŽÂ ¼mol/L 5-21 ÃŽÂ ¼mol/L ESR 47mm/hour à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ 0-20 mm/hour Table 5: Results of liver function test showing protein and liver enzyme levels in plasma. Full Blood Count (FBC) (Beckman Coulter) Cell type Measured level Normal range WBC 9.9109/L 4-10109/L RBC 3.341012/L 3.8-4.81012/L Haemoglobin 95g/L 120-150g/L Haematocrit 0.273L/L 0.36-0.46L/L Mean cell volume 81.8fl. 83-101fl. Mean cell haemoglobin 28.4pg. 27-32pg MCH concentration 347g/L 315-345g/L Platelets 353109/L 150-400109/L RDW 19.4% Neutrophils 3.3 2-7 x109/L Lymphocytes 1.74 1-3 x109/L Monocytes 0.55 0.2-1.0 x109/L Eosinophils 0.21 0.02-0.5 x109/L Basophils 0.03 0.02-0.1 x109/L Table 6: Full blood count of Mr. X. Vital Stats Chart Date Time Blood Pressure/ mmHg Temperature / oC Pulse Rate/ bpm SpO2/ % Blood Glucose levels/ mmol/L Day 0 11.05 pm 140/80 37 91 100 13.9 11.30 pm 137/84 37 80 100 Day 1 8.30 am 130/80 37 70 4.8 (fasting) 3.55 pm 130/70 37 90 10.30 pm 108/64 37 81 Day 2 8.20 am 119/69 37 78 4.50 pm 130/90 37 82 9.6 9.45 pm 140/90 37 80 6.7 Day 3 8.50 am 114/77 37 72 98 6.6 Table 7: Records of vital stats of Mr. X from Day 0 3. Disease Overview Pharmacological Basis of Drug Therapy Acute coronary syndrome (ACS) is a broad term used to classify a continuum of symptoms and events stemming from acute ischaemic episodes affecting the cardiac muscle.1 This includes unstable angina, non-ST segment elevation myocardial infarction (NTEMI), and ST segment elevation infarction. It is usually characterised by chest pain which increases in its severity at rest or with physical exertion. The ischaemic events usually arise from the development of unstable atheromatous plaques,2 which explains the fact that stable angina (due to a stable coronary atheromatous plaque) is not included under this umbrella term. Rupture, ulceration or fissures of the atherosclerotic plaque often leads to formation of a thrombus, causing occlusion of coronary arteries and inadequate blood flow and, subsequently, inadequate supply of oxygen and nutrients to the cardiac muscle. This can be precipitated by acute stress factors on the sclerotic cap usually consisting of fibrous material, which is caus ed by local blood flow disturbances or vasospasms3. Unstable angina usually occurs without cardiac muscle damage while myocardial infarction (MI) may occur with or without myocardium damage. The thrombus formed in unstable angina is labile and obstruction is transient, and not a full-on occlusion as would occur in MI.4 Unstable angina occurs at rest and is almost indistinguishable from a non-ST segment elevated myocardial infarction except in the severity of cardiac muscle ischaemia. Theoretical definitions of unstable angina would include changes in usual patterns of stable angina after a stable pain-free period, or severe acute anginal pain causing almost total incapacity5, though it is difficult to define it exactly as the term is often used by medical professionals to describe a range of different conditions intermediate between stable angina and MI. The primary clinical symptoms of unstable angina are: sudden occurrence of chest pain that persists for more than 20 minutes which may be felt in other areas such as the jaw, arm, shoulder, neck or back; without cause (as opposed to stable angina which stems from physical exercise); shortness of breath, rapid pulse rate, and sometimes a rapid drop in blood pressure. Patients suffering from an ACS have a high risk of MI and possible even death; immediate hospitalization is often required1 and treatment is of a more urgent nature compared to that of stable angina. It has been suggested by the National Health Service (NHS) Hospital Episode Statistics in 1998 that 1000 out of every million per population is affected with unstable angina, or 10 acute hospital admissions per week.6 On a more recent note, NHS has reported in 2009 that angina affects between 10-15% of women and 10-20% of men aged 65 and above in England.7 Due to the close relationship between unstable angina and coronary events, it is worth noting that the highest averaged rates of cardiovascular events were observed in Glasgow and Belfast (UK), North Karelia and Kuopio (Finland), Newcastle (Australia), and Warsaw (Poland).8 Diagnosis of an unstable angina episode, or any ACS in that matter, is based on several aspects9. Physical symptoms include anginal pain at rest that lasts for 20 minutes or more; new onset angina severely limiting ability of physical activity; or changes in existing angina intensity, frequency or length of attack. One or more of these symptoms are an urgent indication that the patient is suffering from an ACS attack. Upon admission to hospital, ECG and blood tests should be performed to confirm the type of ACS in order to initiate treatment. In unstable angina, the ST segment is not elevated and levels of cardiac enzymes are normal (especially troponin T and I). If the onset of symptoms is unclear as to indicate ACS, a measurement of serum troponin concentration should be carried out 12 hours from presentation to establish the diagnosis.10 Treatment of unstable angina and NSTEMI are similar in terms of pharmacological management; indeed they are at presentation indistinguishable exc ept in terms of the severity and extent of cardiac muscle ischaemia, in which the ischaemia is less severe in unstable angina and less troponin T and I are released into the bloodstream. Antiplatelet agents. Aspirin and clopidogrel are the immediate emergency drugs used in the ambulance, both being antiplatelet drugs. Aspirin is an irreversible inhibitor of arachidonate cyclooxygenase (COX) enzyme, in which covalent acetylation of the serine moiety in a hydrophobic channel in the enzyme11 reduces synthesis of thromboxane A2 in platelets and prostaglandins in the endothelium. This prevents platelet aggregation and further enlargement of the thrombus formed in the coronary artery. Clopidogrel is an inhibitor of the ADP-dependent activation of the GPIIb/IIIa receptor and prevents the formation of fibrinogen bridges between glycoprotein IIb/IIIa receptors on the surfaces of platelets11, subsequently preventing platelet activation. Glycoprotein IIB/IIIA receptor antagonists, eg, abxicimab, have the advantage of inhibiting all pathways in the platelet activation process by inhibiting the glycoprotein IIB/IIIA receptor. Anticoagulants. Unfractionated heparin is an activator of antithrombin III, which inhibits the action of thrombin and serine proteases. The heparin also binds to thrombin; the combined effect of this and the heparin-antithrombin complex formed inhibits thrombin, which decreases the conversion of fibrinogen to fibrin and reduces platelet aggregation. In contrast, low molecular weight heparins (LMWH) have molecular sizes that are too small to bind to thrombin but still bind to antithrombin III, which inactivates all serine proteases including Factors XIIa, IXa, and Xa11, preventing the coagulation process. Direct thrombin inhibitors such as hirudin and bivalirudin inhibit thrombin reversibly. These agents can bind to free and bound thrombin, thus have the ability to prevent and dissolve preformed clots. Synthetic pentasaccharides (fondaparinux) is a selective indirect inhibitor of Factor Xa. It binds to antithrombin III reversibly, catalyzing the inactivation of Factor Xa12 and inhibit ing the coagulation cascade. Beta blockers. All beta blockers bind to beta-adrenoceptors, competitively antagonizing the action of catecholamines. These drugs block the beta-1 adrenoceptors at the heart, achieving a decreased heart rate and force of cardiac contractions, as well as lowering blood pressure. Atenolol is relatively specific for cardiac beta-1 adrenoceptors and exerts fewer side effects associated with beta-2 adrenoceptor blockade, for example bronchospasm in asthmatics. Nitrates. Organic nitrates mimic the actions of endogenous nitric oxide to relax vascular smooth muscle by increasing the synthesis of cGMP, leading to the dephosphorylation of myosin light chains.11 Vasodilatation of coronary arteries causes increased coronary blood flow and coupled with its effects of decreasing arterial pressure and also cardiac output, the myocardial oxygen consumption is largely reduced. Statins. Also termed HMG-CoA reductase inhibitors, these medicines inhibit the rate-limiting enzyme in the synthesis of cholesterol, in which this enzyme converts HMG-CoA to mevalonic acid. ACE inhibitors are diuretics acting on the rennin-angiotensin system which inhibit the angiotensin-converting enzyme (ACE) and block the production of angiotensin II from angiotensin I. This reduces vascular resistance, increases tissue perfusion, and reduces cardiac afterload. Angiotensin II receptor inhibitors also act on the same system as the ACE inhibitors, except that they block the angiotensin II receptors directly instead of inhibiting their formation. The outcome is the same as above. Evidence for Treatment of the Condition Antiplatelet Agents The SIGN guidelines advocate that aspirin and clopidogrel be given to patients with ECG ischaemic changes or increased levels of cardiac markers; and aspirin is advocated for all patients suffering from ACS. A meta-analysis of 287 randomised trials proves the protective effect of aspirin on patients with unstable angina, halving the rate of cardiovascular events, including death, non-fatal MI and strokes, or also termed the first primary outcome; while in those with an acute MI, it reduces the rate of coronary events by almost a third13. Long-term use of aspirin for these patients was also shown to be a beneficial antiplatelet therapy. According to the same study, reduction of serious vascular events by clopidogrel was 10% compared to aspirin. The combined use of clopidogrel and aspirin as compared with a placebo and aspirin showed significantly higher success rates in reducing occurrences of first primary outcomes (9.3% compared to 11.4%, P On the flipside, although short term studies have shown that antiplatelet medications are effective for patients with renal failure in the prevention of serious vascular events13, the risks of bleeding is increased by renal disease15, posing a possible contraindication for antiplatelets to Mr. X. A clinical study found that treatment for NSTEMI ACS in patients with chronic renal disease (mild to moderate stages) was less aggressive than those with normal renal function, despite the risk that these patients with renal disease would experience greater adverse outcomes from insufficient treatment for ACS compared to the other patient group16. However the available information on adverse effects of antiplatelets on patients with varying degrees of renal disease is limited and it would appear that this would result in the reluctance of medical professionals in using this class of drugs for patients with chronic renal disease as well as ACS. It can be inferred that Mr. X would gain the maximum benefits if his medications were changed to aspirin 300 mg and clopidogrel 300 mg stat and aspirin 75 mg and clopidogrel 75 mg thereafter, in which the patient should be closely monitored for signs of bleeding. Heparins LMWHs A 2003 review of 7 studies involving 11,092 patients with non-ST elevation ACS found that low molecular weight heparins (LMWH) were more effective than unfractionated heparins in reducing MI events, requirement for revascularization procedures, and thrombocytopenia17. No difference in the mortality, recurrent angina, major and minor bleeds were observed in the two types of drugs. A meta-analysis of 12 randomised trials with 17,157 patients involved found that patients who have had a non-ST elevation ACS who were put on aspirin experienced no significant difference in benefits in efficacy (preventing MI or death) or safety (major and minor bleeding complications) when they were put on unfractionated heparin or LMWH17, implicating no difference in the thrombolytic effect in both classes of drugs. These results are partially similar to those of the first review. Another meta-analysis of 2 phase-3 trials comparing enoxaparin and unfractionated heparin, on the other hand, showed a signifi cant (20%) difference in reducing death or severe cardiac ischaemic events18. From an economic point of view, authors of yet another meta-analysis on the subject stated that the cost of LMWH is 3-5 times higher than unfractionated heparin19. From these data it can be concluded that LMWHs does indeed have additional positive treatment outcomes compared to unfractionated heparins22; it does not show significantly decreased side effects (bleeding). Enoxaparin has, though, an increased bleeding effect on patients with renal disease as reported by an investigation of 106 patients, in which total bleeding complications occurred in 22% of normal patients and 51% of patients with impaired renal function (p It is still the drug of choice for patients present with non-ST elevated ACS, and this is applicable to Mr. X with unstable angina. Beta-Blockers Beta-blockers were not prescribed for Mr. X. The SIGN guidelines states that beta-blockers should be the drug of choice for first line treatment of anginal pain in patients with non-ST elevated ACS. A meta-analysis of 5 trials consisting of 4700 patients in all showed a 13% reduction in anginal pain with the use of beta blockers (initially IV then oral for a week) in patients with non-ST elevated, MI-characterised chest pain23. It was stated in the clinical progress Mr. X had chest pain on Day 1 and 4, thus the addition of a beta blocker to his medications would be useful in alleviating his pain. Despite the popular belief that beta-blockers are contraindicated in patients with diabetes mellitus, it is possible to treat these patients using beta-blockers as long as good glycaemic control is achieved and the patient is monitored regularly24. This would further support its use in Mr. X; furthermore, several studies have shown that diabetic patients derive a significant benefit from the use of beta-blockers after an MI, in which diabetic patients had a significantly lower mortality 1 year post-discharge25, total mortality after 3 years, and deaths from cardiac events26. A multicentre randomized trial, the HINT trial, on patients with unstable angina found that metoprolol, a relatively cardioselective beta blocker, reduced occurrence of myocardial ischaemia or progress to MI within 48 hours, indicating that metoprolol has a short term beneficial effect on patients not already taking beta blockers prior to the unstable angina episode27. It has been suggested that beta-blockers be the first line treatment for unstable angina and if patients remain unstable, a calcium channel blocker should be added28. Statins The beneficial effects of statins in reducing mortality and cardiovascular events have been proven by a meta-analysis of large, randomized controlled trials (n=90,056) where coronary artery disease was present or absent29. The positive results were also proven spanning a large range of serum cholesterol levels. Investigations comparing the use of intensive versus moderate doses of statins in the early stages and post-ACS showed positive results: a meta-analysis of 4 large trials (n=27,548) shows a 16% reduction in cardiovascular deaths or MI, as well as a 16% reduction in cardiovascular deaths or coronary events30. This view is shared by another meta-analysis of the same subject of 13 randomised controlled trials which found a decrease in mortality and coronary events after 4 months of treatment31. These data support the use of statins by Mr. X. Nitrates Nitrates have been widely used in relieving pain from unstable angina, despite its lack of clinical evidence in supporting its role in improving survival and reducing the rate of MI and cardiovascular events32. ISIS-433 and GISSI-334 reports no significant difference of the use of glyceryl trinitrate post-MI in reducing the overall mortality; however this may be explained by the fact that more than 50% of patients in the controlled group are also on other forms of nitrate therapy, such as intravenous glyceryl trinitrate. Despite this, nitrates will still be of use for reducing the pain in post-MI patients and those with unstable angina. The BNF advises against the use of nitrates in patients with serious anaemia (Hb Glycaemic control Mr. Xs plasma glucose levels were elevated on the day he was admitted to hospital (13.9 mmol/L). Diabetes mellitus has been proven to be a strong independent risk marker for coronary heart disease: patients with poorly controlled diabetes at hospital admission have a worse outlook on prognosis and future development of cardiovascular events35. The DIGAMI investigation reports that the use of intensive insulin therapy increased long-term prognosis (P=0.011) of patients presenting with hyperglycemia (>11mmol/L) at admission compared with those on standard antidiabetic therapy36. These data support the use of insulin to control the blood glucose levels of Mr. X which were highly increased upon admission. This is also supported by the SIGN guidelines which advocate immediate control of blood glucose is carried out for MI patients with glucose levels of more than 11.0 mmol/L for at least 24 hours. ACE Inhibitors The SIGN guidelines recommend that patients with unstable angina should be given ACE inhibitors as long-term therapy. In patients at high risk of cardiovascular events, ACE inhibitors (ramipril was investigated in a report37) have been proven to reduce overall mortality, MI, and stroke, particularly in patients with diabetes mellitus. Perindopril was found to reduce cardiovascular risk (relative risk reduction =20%, P=0.0003) in a population with stable coronary heart disease in absence of heart failure38 in a double-blinded, randomized multicentre trial involving 13,655 patients. A meta-analysis of the 2 above trials and a third one (PEACE) showed a reduction in overall mortality, cardiovascular death, non-fatal myocardial infarction, stroke, heart failure, and coronary artery bypass surgery by ACE inhibitors39. This demonstrates the benefits of ACE inhibitors in patients with atherosclerosis: as patients who had an ACS event would have a higher rate of cardiovascular events, the po sitive outcomes of ACE inhibitors can perhaps be extrapolated to this population in order to decrease coronary events and improve prognosis. However, the BNF advises caution and close clinical monitoring if ACE inhibitors are to be used in patients with hyponatremia ( Oxygen therapy On admission, Mr. Xs SpO2 was 99% and remained high throughout his stay in the hospital. The use of oxygen therapy is significantly beneficial only in hypoxic patients (with SpO2 Anaemia and Unstable Angina Anaemia can disturb the balance between myocardial oxygen supply and demand: a decrease in the number of red blood cells can lead to a reduction in the supply of oxygen to the myocardium. Thus correction of the causative factor would be sensible in the treatment of unstable angina for the patient in context. Mr. X was given a combination of ferrous fumarate, vitamin B complex, and folic acid for treatment of his anaemia. From the data in Table 6, it can be seen that Mr. X has low haemoglobin concentrations (95 g/L) and a low mean cell volume (81.8 fl.). To confirm that Mr. X is indeed suffering from iron-deficiency anaemia (as suggested by his treatment medication), three parameters must be established namely the plasma iron, the plasma ferritin, and total iron binding capacity. However, as very few conditions can cause abnormalities in the mean cell volume, and a decreased value is due to iron-deficiency anaemia or thalassemia42, it is safe to assume that Mr. Xs anaemic condition is due to an insufficiency of iron. Iron supplements are given to correct the iron status of the patient, in which the ferrous form given orally is found to be cheap, safe and effective in the majority of patients with iron-deficiency anaemia2. Vitamin B complex and folic acid are only indicated in patients with the respective deficiencies2; there is little evidence that they would be of any significant benefit in patients with iron-deficiency anaemia. Summary Based on the evidence given, Mr. Xs aspirin dose should be changed to 300 mg stat and 75 mg thereafter, and clopidogrel should be added into his medication profile in the same doses. These changes ensure that Mr. X is obtaining sufficient antiplatelet effects from his medications to prevent another attack of unstable angina or even a myocardial infarction. Present drugs that were given for his condition that are suitable and supported by evidences include enoxaparin, lovastatin, insulin, and GTN: these can be safely continued without problems. A beta-blocker (metoprolol tablets) may be given additionally in doses of 50-100 mg as evidences described above have shown that they can be safely used in diabetic patients contrary to popular belief; an ACE inhibitor (perindopril as previously used by Mr. X) may be initiated coupled with regular electrolyte