How Well Prepared Are Texas Dental Hygienists to Recognize and Report Elderly Abuse
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只有做好充足的准备才能成功英语作文Only with Adequate Preparation Can One SucceedIn today's competitive world, success is no longer just a matter of luck or talent. It requires meticulous planning, hard work, and most importantly, adequate preparation. Whether it is in academics, sports, or any other field, those who put in the effort to prepare themselves well are the ones who ultimately achieve success.One key area where preparation is essential for success is in academics. Students who excel in their studies are not just naturally gifted, but they also put in the time and effort to prepare themselves thoroughly. This includes attending classes, completing assignments on time, and studying diligently for exams. By being well-prepared, they are able to perform to the best of their abilities and achieve excellent results.Preparation is also crucial in sports and other competitive activities. Athletes who reach the pinnacle of their sport do not get there by chance. They spend hours training, honing their skills, and preparing both physically and mentally for competition. This preparation is what allows them to perform at their best when it matters most, leading to victory and success.In the business world, preparation is equally important for achieving success. Entrepreneurs who start successful companies do not do so on a whim. They conduct thorough market research, develop detailed business plans, and surround themselves with a team of talented individuals. This preparation is what gives them a competitive edge and increases their chances of success in a crowded marketplace.In all aspects of life, those who succeed are the ones who take the time to prepare themselves adequately. They set goals, make plans, and work tirelessly to achieve them. They understand that success does not come overnight and that it requires dedication, perseverance, and a willingness to put in the hard work.In conclusion, only with adequate preparation can one succeed in today's competitive world. By taking the time to plan, organize, and prepare oneself thoroughly, individuals can increase their chances of achieving their goals and fulfilling their potential. Success is not a matter of luck or talent, but a result of hard work and preparation. So, let us all strive to prepare ourselves well and take the necessary steps to reach our full potential.。
Be Well Prepared For The Job-hunting College education, closely related to the prosperous of a nation and the future of the young, has been attached importance to. As a result, people concern about it. Nowadays, some universities offer the graduate job-hunting skills, but some people believe that the main function of university is to access knowledge. As far as I am concern, it is essential for universities to provide their student some skills about employment and make them be well prepared for the job-hunting. The reasons for my view can be generalized into two major ones.First and foremost, with job-hunting skills, the graduate can have mare opportunities. We all know that with the development of society, the employment standard has been heightened. What a company needs is a person possesses not only enough professional knowledge but also some communicational skills. In particular, the skills that you can persuade others to believe that you must be the one they need. On the other hand, the increasing number of the graduate make the job market become more and more competitive. As opposed to generations of the past, college graduates today are difficult to obtain the number of high-paying jobs that were once available. As a result, we must realize that in the competitive job market, talent and determination cannot guarantee success, enough skills that assist to find employment are needed as well.Besides, job-hunting skills can help the graduate to get to know society and face the reality. With the informati on of employment they’ve had, they can think further about themselves and the society. Afterwards they may understand what kind of people with ability are needed. They will realize the distance between what he has already had and what he has to have to achieve the job he wants. Knowing the distance, the graduate will be stimulated to develop themselves to diminish the distance as much as possible and be well prepared for the job-hunting. In this way, the graduate will have more chances to get the job they like. As is known to all that a comprehensive talent do have more opportunity and they are more competitive than others. Therefore, people should do everything to make themselves remarkable.From what has been discussed above, we can easily see that the more connections which are collected during the college career, the more options you will have when you begin your job search.。
How to make a full preparation for a good jobFor almost all students, finding a job is a necessary procedure for us. However, most students feel confused about finding jobs since many companies require students with certain experience. In order to find a good job, we should prepare them for jobs as early as possible. In my point , we should make full prepared by the following ways.Firstly, we should do some part-time jobs to accumulate experience. For most students, they spend lots of their free time on entertainment rather than going out to find some part-time jobs during their college. Therefore, they lack of experience by the time they graduate. While, for a small part of students take their time on doing part time jobs to practice themselves to get more experience. Not only such kind of students is preferred by employers and also they can get lots of chance to get good jobs.Secondly, we should try our best on studying our majors. We should get a good knowledge of our major, so that we can understand our major more correctly. Only if you know well about your major, then you will solve many problems related to your major in your future work.Thirdly,we should take part in some social activities and provide ourselves with special training so that we are more confident and courageous enough to face fairly good jobs or certain positions require.In conclusion, not only we should do some part time jobs to get experience during school time, but we should also try hard to master knowledge.。
雅思口语:雅思口语点拨-雅思口语雅思口语点拨1.Be well prepared.做好充分准备是成功的基本保障,这包括对考试风格,模式,题型和最新动态的熟悉,更包括大量的,有针对性的口语练习。
但必须指出一点,准备的过程不应是背诵的过程。
很多考生对自己在面试中的表现感觉良好,最终却对自己出乎意料的低分大吃一惊,百思不得其解,其实原因很简单:考官对考生背诵事先准备好的答案很反感,尤其当他/她听到同一种答案被很多考生重复使用时,那种令人作呕的感觉可想而知。
在考官看来,Using a prepared answer is similar to cheating! 所以给准备雅思考试的考生一个忠告:Over prepared is often as harmful as under prepared.2.Have an easy but concentrated state of mind.心态对于任何事的成功都是至关重要的,语言测试,尤其是一对一的口语测试更是如此。
良好的心态可以使人超水平发挥;糟糕的心态却可以让人遭遇滑铁卢。
在以往的雅思考试中,相当数量的考生是因为心态不好,主要是过度紧张导致失利的。
应该说适度的紧张还是有益的。
我们应该充分重视雅思口语考试,但没有理由惧怕它。
调整心态,放松心情的几种方法:1)尽量把参加雅思面试想象成拜访一个朋友,而那个朋友有一些问题不明白,需要向我请教。
2)面试前一晚一定要睡个好觉,考前一餐不要吃得太饱,当然也不能空腹。
3)进入面试房间前做几次深呼吸,然后告诉自己:既然我知道自己英语说得不错,别人也应该知道。
4)把对方想象成考生,把自己想象成考官,当然该回答的问题还是要认真回答。
5)如果知道自己的英语口语不太好就更没必要紧张了,紧张又不能帮我提高成绩,不如彻底放松,奋力一搏,说不定就能达到柳暗花明的效果。
3.Focus on your English instead of your ideas.考官在考察我们的英文而不是我们的思想,没有必要为了一个我认为“闪光”的思想强迫自己说那些说不清的英文句子,重要的是把我有把握的英文说清楚。
Howtoprepareforajobinterview作文汇总How to prepare for a job interview(一)If you wish to pursue your professional career successfully, it is essential to find a satisfactory job.A job interview, in some cases, can be of critical importance for you to obtain a job you like.Since a job interview is so important, we should be well-prepared for it. Here are some tips for you. First of all, take account of your qualifications, and background and decide whether they satisfy the requirements of the job. If they do, get familiar with them in case you are asked about them during the interview. Secondly, remember your special abilities or hobbies, such as playing sports or music, and mention them if necessary, which may attracts the interviewers. My final advice is that you should take special care of your appearance. Though we should not judge a person by his appearance, the first impression is very important for one to have a job interview.Above all, job interview is becoming more popular nowadays. So to make full preparations for the job interview plays a criticalpart in your success. If you want to find a job successfully, be sure to be self-condition, select proper words and pay attention to the ways of talking in an interview besides your full preparations.(二)It s that time of the year when you re fretting because the end of summer means that you need to enter the big bad world of jobs.With your results in hand, you set out to find your perfect job only to realise you screwed up during your interview! Sounds familiar? Even experienced workers face this problem. So, whether you re a newbie or a pro at the job hunting game, here are a few tips to make that solid first impression.PreparationWhile applying for a job, you need to show that you know about the organisation and what it does.A little homework goes a long way in showing that you genuinely care about the company you wish to join. The simplest way of doing this is to go to the company s website and read the About Us section. If there are profiles of some senior personnel, read up on them too. The more you know about the organisation, the better your chances of cracking the interview.During your interview, you need to be in a Zen state of mind. You may be asked difficult and uncomfortable questions. If you can demonstrate an ability to stay calm when you are put under pressure it tells your potential employers that you can do the same when it comes to handling their projects.PracticeThere is no getting around this. Sit in front of mirror and practice your responses to standard questions you will asked during your interview. Questions like, Why do you want to join us? , Where do you see yourself in five years? will be asked. Get your responses in order, get them checked with a superior if possible and speak with experience when asked.PolishKnowing the dress code of your potential employer is important. You do not want to land at a corporate office wearing jeans and your Nirvana tee. On the other hand, an ad agency or any other creative company will look upon format attire as a sign of having a closed mind. Apart from this, ensure that you look proper. Cut your nails, shave properly, get your hair in order and hide your tattoos as far as you can.Go over your resume once again. Many of us carry old versions of our resumes and use it for each company. It is necessary to tweak your past experience for each particular company. This will also help you to keep your resume updated. Check if a covering letter is required. Write one accordingly and check for errors. Fix them. If references are asked for, ensure that they are in order.Be confident, ensure you ve taken all the documents you need and reach at least 15 minutes before time.Once you've made sure that you have checked and re-checked everything, you re ready to ace that interview. So, just go for it!(三)How to Prepare For a Job Interview?As more and more applicants have applied for one position by holding the identical resume, including their major and experience, employers have determined to evaluate the employee through job interview. Faced with the new challenge, achievement is founded on diligence and wasted upon recklessness.First of all, we need to have a full list of the process in our mind once although it s just an imagined one. According to the list, we can figure out what we need to prepare and what the problems and situation we re likely to come across in the interview. If it s the case, how can we behave properly.Then, based on the clear classification of the materials we may need, we can wisely choose various means to collect information, respectively overall. Such as surfing the internet, going to the library or the professional bookstore to find more about your major and the company and the special interview skills.Besides, we could ask for advice from the predecessors in the same major, our friends or teachers, especially those who had managed to work in the field, or a manager. We should respect the experience of their own and try to learn something invaluable for us and revise our resume to be a brilliant one. This method does helpful and beneficial in a practical way.Above all, learning more specific mattters about the history of the company,its development, the position in the market,and its needs as much as possible can really make a difference. In a word, we should make a overall picture of the company to make a good impression. Therefore, we 'll build our communicationprocess more comfortably and happily.At last, we d better recheck the information we ve gotten and apply the principles and tips into our resume before we send it to the company. With the adequate preparation, we can successfully get the offer just on one condition that please be confident, honest and friendly.(四)How to Prepare for a Job InterviewDuring a job interview, you have the opportunity to sell yourself to the prospective employer. Making the most of it by planning ahead is the key work for getting the job. There are a few advices as follows that a job candidate can take when preparing for a job interview.Firstly, you d better make a great first impression. On one hand, you should dress up and behave appropriately. On the other hand, it is very important to find out as much as you can about the culture of the company you are interviewing with by studying its materials. Meanwhile,researching the company and take notes about recent news items such as a new client or contract. These are things you can mention in the interview to make a great first impression.Secondly, make a list of your“winning characteristics” that will mostly likely convince the employer to hire you over other candidates. These “winning characteristics” must be qualities you possess that the company suggest it desires in a job candidate. For example, if the job description says “we're looking for someone who are good at communicating” and you know that you have this quality, so add it to your list.The last but not the least, you can design several potential interview questions an employer may ask and give the answers. What s more, you d better practice them before you go to the interview. This can release your pressure and help you to become positive and active during the job interview.With the adequate preparation, you can successfully achieve the purpose just on anther condition that you must be confident in yourself. If you can follow all above of these basic steps, you are almost guaranteed to succeed in getting that job.。
关于做准备的英文作文Preparing for Success。
Preparation is the key to success. Whether it's a job interview, a test, or a big project, being well-preparedcan make all the difference. In this essay, I will discuss the importance of preparation and provide some tips on howto prepare effectively.Firstly, preparation allows us to be confident and calm. When we are well-prepared, we know what to expect and we have a plan. This reduces anxiety and allows us to focus on the task at hand. For example, if we have prepared for ajob interview by researching the company and practicing our answers to common questions, we will be more confident and less nervous during the interview.Secondly, preparation helps us to avoid mistakes and setbacks. When we prepare thoroughly, we are less likely to make careless errors or forget important details. This cansave us time and energy in the long run. For instance, if we have prepared well for a test by studying the material and practicing with sample questions, we are less likely to make mistakes and more likely to get a good grade.Finally, preparation allows us to be proactive and adaptable. When we prepare for different scenarios, we are better equipped to handle unexpected situations. We can anticipate problems and come up with solutions in advance. This can help us to stay on track and achieve our goals. For example, if we have prepared for a project by creating a timeline and identifying potential obstacles, we can adjust our plan if something unexpected happens.So, how can we prepare effectively? Here are some tips:1. Start early. Don't wait until the last minute to start preparing. Give yourself plenty of time to research, practice, and plan.2. Set goals. Identify what you want to achieve and break it down into smaller, achievable goals. This willhelp you stay focused and motivated.3. Get organized. Create a schedule, make a to-do list, or use a planner to keep track of your progress. This will help you stay on track and avoid procrastination.4. Practice. Whether it's practicing for a job interview, a test, or a presentation, practice makes perfect. The more you practice, the more confident and prepared you will be.5. Get feedback. Ask for feedback from others, such asa teacher, mentor, or friend. This can help you identify areas where you need to improve and make adjustments to your plan.In conclusion, preparation is essential for success. By being well-prepared, we can be confident, avoid mistakes, and be proactive. By following these tips, we can prepare effectively and achieve our goals.。
做事要先做好准备作文英文回答:Being well-prepared before doing anything is crucial.It helps us to achieve better results and saves us from unnecessary difficulties. When we are prepared, we have a clear plan in mind, know what resources we need, and have considered possible challenges and solutions. In my opinion, there are several reasons why doing proper preparation is important.Firstly, preparation allows us to have a clear understanding of the task or goal at hand. By gathering information and doing research, we can gain knowledge and insights that will guide us in our actions. For example, if I have to give a presentation on a certain topic, I would spend time researching and gathering relevant information. This would not only help me to have a deeper understandingof the topic but also enable me to deliver a moreinformative and engaging presentation.Secondly, preparation helps us to anticipate and overcome obstacles. When we are well-prepared, we can identify potential challenges and come up with strategies to overcome them. This reduces the chances of being caught off guard and allows us to handle unexpected situations more effectively. For instance, if I am preparing for a job interview, I would anticipate possible questions and prepare my answers in advance. This would give me confidence and enable me to respond smoothly during the interview.Furthermore, preparation enables us to make the most of available resources. By planning ahead, we can ensure that we have all the necessary tools, materials, and support required to accomplish our tasks. This saves us time and effort in the long run. For example, if I am planning a camping trip, I would make a checklist of all the essential items such as tents, sleeping bags, and cooking utensils. This would ensure that I have everything I need and avoid any last-minute scrambling.In addition, being prepared allows us to manage ourtime more effectively. When we have a clear plan, we can prioritize tasks and allocate our time accordingly. This helps us to avoid procrastination and stay focused on what needs to be done. For instance, if I have a deadline for a project, I would create a schedule and break down the tasks into smaller manageable chunks. This would help me to stay on track and complete the project on time.中文回答:做事之前做好准备是非常重要的。
全文分为作者个人简介和正文两个部分:作者个人简介:Hello everyone, I am an author dedicated to creating and sharing high-quality document templates. In this era of information overload, accurate and efficient communication has become especially important. I firmly believe that good communication can build bridges between people, playing an indispensable role in academia, career, and daily life. Therefore, I decided to invest my knowledge and skills into creating valuable documents to help people find inspiration and direction when needed.正文:做好充分准备是一个人获得成功的前提英语作文全文共3篇示例,供读者参考篇1Being Well-Prepared is the Prerequisite for One's SuccessSuccess is the ultimate goal that everyone strives for in their lives. However, the path to success is not an easy one. It requires hard work, dedication, and most importantly, beingwell-prepared. As a student, I have learned that preparation is the key to achieving my goals and excelling in my academic pursuits.Preparation is not just about studying for exams or completing assignments on time. It is a mindset that involves being proactive, organized, and focused. When I amwell-prepared, I feel confident and in control of my circumstances. I am able to tackle challenges head-on and navigate through obstacles with ease.One of the most important aspects of being well-prepared is having a solid plan. Whether it is for an upcoming exam, a project, or a presentation, having a clear plan of action can make a significant difference. It allows me to break down my tasks into manageable steps and allocate my time and resources effectively. By following a plan, I can ensure that I cover all the necessary material and avoid last-minute cramming or rushing.Another crucial aspect of being well-prepared is time management. As a student, I often juggle multiple classes, extracurricular activities, and social commitments. Effective time management skills enable me to prioritize my tasks and allocate sufficient time for each one. I have learned to create schedules,set deadlines, and stick to them. This not only helps me stay on top of my workload but also reduces stress and anxiety.Preparation also involves gathering the necessary resources and materials. For instance, before an exam, I ensure that I have all the required study materials, such as textbooks, notes, and practice questions. This allows me to thoroughly review the content and identify any areas where I need additional clarification or practice. Similarly, for a presentation or a group project, I make sure to collect relevant research materials, organize my thoughts, and coordinate with my team members.Being well-prepared also means anticipating potential challenges or obstacles and developing strategies to overcome them. For example, if I know that I struggle with a particular subject or concept, I can seek additional help from my teachers or classmates, or explore alternative learning resources. By identifying my weaknesses and addressing them proactively, I can improve my chances of success.In addition to academic pursuits, being well-prepared is equally important in other aspects of life. Whether it is applying for a job, attending an interview, or participating in a competition, proper preparation can give me a significant advantage. It demonstrates my commitment, dedication, andprofessionalism, which are qualities that are highly valued by employers, admission committees, or judges.Furthermore, being well-prepared has a positive impact on my overall well-being. When I am organized and have a clear plan, I experience less stress and anxiety. I am able to focus better and approach tasks with a positive mindset. This, in turn, leads to better performance and a greater sense of accomplishment.However, it is important to note that preparation alone is not a guarantee of success. There may be unforeseen circumstances or external factors that can impact the outcome, regardless of how well-prepared I am. In such situations, it is essential to maintain a flexible and adaptable mindset. Being well-prepared means having the ability to adjust my strategies and approach when necessary.In conclusion, being well-prepared is the prerequisite for one's success. It is a crucial skill that every student should cultivate and nurture. By developing effective planning, time management, resource gathering, and problem-solving skills, I can increase my chances of achieving my academic and personal goals. While preparation alone may not ensure success, it certainly provides a solid foundation upon which to build andnavigate through life's challenges. As a student, I strive to embrace the mindset of being well-prepared, as it has proven to be a valuable asset in my journey towards success.篇2Being Well-Prepared is a Prerequisite for SuccessAs a student, I have come to realize that success in any endeavor requires meticulous preparation. Whether it's acing an exam, delivering a compelling presentation, or excelling in a extracurricular activity, being well-prepared is the key to unlocking one's full potential and achieving desired outcomes. This essay will explore the multifaceted nature of preparedness and its pivotal role in facilitating success.Firstly, it is essential to acknowledge that preparation is a multidimensional concept, encompassing both mental and physical aspects. Mental preparation involves cultivating a growth mindset, setting achievable goals, and developing a comprehensive understanding of the subject matter at hand. Physical preparation, on the other hand, entails organizing resources, creating a conducive environment for learning or practice, and ensuring that all necessary materials are readily available.One of the primary benefits of being well-prepared is the confidence it instills. When we invest time and effort into thoroughly comprehending a topic or honing a skill, we naturally develop a sense of self-assurance. This confidence serves as a powerful catalyst, enabling us to approach challenges with a positive attitude and unwavering determination. It is awell-known fact that individuals who exude confidence tend to perform better and are more likely to achieve their desired outcomes.Furthermore, preparedness fosters time management and organizational skills, both of which are invaluable assets in the pursuit of success. By planning ahead and allocating sufficient time for preparation, we can avoid the stress and anxiety that often accompany last-minute cramming or rushed efforts. Effective time management not only enhances our productivity but also allows for a more balanced approach to various aspects of our lives, preventing burnout and promoting overallwell-being.Another significant advantage of being well-prepared is the ability to adapt and respond effectively to unexpected challenges or curveballs. When we have a solid foundation of knowledge and skills, we are better equipped to think critically,analyze situations from multiple perspectives, and devise innovative solutions. This adaptability is particularly crucial in an ever-changing world, where the ability to pivot and embrace change is essential for long-term success.Moreover, preparedness cultivates discipline and perseverance – two qualities that are indispensable for achieving excellence. The process of preparation itself requires dedication, focus, and a willingness to overcome obstacles and setbacks. By consistently engaging in thorough preparation, we develop a habit of resilience and a tenacious mindset, which serve us well in both academic and professional pursuits.It is important to note that being well-prepared is not a one-time endeavor; it is an ongoing process that requires continuous effort and commitment. As we progress through various stages of our academic and professional careers, the challenges we face will evolve, necessitating the acquisition of new knowledge and skills. Therefore, it is crucial to embrace a lifelong learning mindset and continually invest in personal and professional development.While the importance of preparedness cannot be overstated, it is equally important to strike a balance and avoid obsessive or unhealthy behaviors. Overpreparation can lead to burnout,anxiety, and diminishing returns. It is essential to recognize our limitations, prioritize self-care, and seek support when needed.In conclusion, being well-prepared is a prerequisite for success in any endeavor. It cultivates confidence, fosters time management and organizational skills, enhances adaptability, and instills discipline and perseverance. By embracing a mindset of continuous learning and preparation, we equip ourselves with the tools necessary to navigate the challenges and seize the opportunities that life presents. Success is not an accident; it is the result of diligent preparation, unwavering commitment, and a relentless pursuit of excellence.篇3Being Well-Prepared is a Prerequisite for SuccessSuccess is the ultimate goal that we all strive for in our lives. It is the driving force that motivates us to work hard, push our limits, and go the extra mile. However, success is not something that can be achieved overnight or by sheer luck alone. It requires a combination of hard work, dedication, and most importantly, being well-prepared.Preparation is the key to unlocking the door to success. It is the foundation upon which our achievements are built. Withoutproper preparation, our efforts are likely to be in vain, and our dreams may remain unfulfilled. Imagine a student who walks into an exam without studying or a athlete who steps onto the field without training. The chances of success in such scenarios are slim to none.Preparation involves more than just gathering the necessary resources or acquiring knowledge. It is a mindset, a way of approaching challenges with a proactive and strategic mindset. It means anticipating potential obstacles, identifying areas for improvement, and developing contingency plans to overcome them.One of the key benefits of being well-prepared is the sense of confidence it instills within us. When we know that we have done everything in our power to prepare for a task or challenge, we approach it with a heightened sense of self-assurance and belief in our abilities. This confidence translates into a more focused and determined approach, which, in turn, increases our chances of success.Furthermore, preparation allows us to identify and address our weaknesses before they become glaring issues. By taking the time to analyze our strengths and weaknesses, we can develop strategies to capitalize on our strengths and mitigate ourweaknesses. This proactive approach not only enhances our chances of success but also helps us grow and improve as individuals.Another crucial aspect of preparation is time management. Effective preparation requires allocating sufficient time to gather resources, acquire knowledge, and practice the necessary skills. Procrastination is the enemy of preparation, as it leads to rushed and incomplete efforts, which can significantly undermine our chances of success.In the academic realm, being well-prepared is crucial for achieving academic excellence. Students who take the time to study diligently, review their notes, and practice problem-solving skills are more likely to perform well on exams and assignments. Additionally, well-prepared students are better equipped to engage in class discussions, ask insightful questions, and contribute meaningfully to the learning process.In the professional world, preparation is equally vital. Employees who thoroughly research their projects, anticipate potential challenges, and develop contingency plans are more likely to deliver successful outcomes. Well-prepared professionals are also better positioned to adapt to changingcircumstances and navigate the complexities of the business world.Preparation is not limited to academic or professional pursuits; it is equally important in personal endeavors. Whether it is planning a trip, organizing an event, or pursuing a new hobby, being well-prepared can significantly enhance the chances of success and minimize potential setbacks.Of course, preparation alone is not a guarantee of success. There are numerous factors at play, including external circumstances, luck, and the efforts of others. However, by being well-prepared, we increase our chances of capitalizing on opportunities and mitigating the impact of unforeseen challenges.It is important to note that preparation is not a one-time event; it is an ongoing process that requires continuous effort and adaptability. As circumstances change and new challenges arise, we must be willing to re-evaluate our strategies and adjust our preparations accordingly.In conclusion, being well-prepared is a prerequisite for success in any endeavor. It involves a proactive mindset, effective time management, strategic planning, and a willingness to address weaknesses. By prioritizing preparation, we increase ourchances of achieving our goals, overcoming obstacles, and realizing our full potential. Success may not be guaranteed, but with proper preparation, we can tilt the odds in our favor and approach challenges with confidence and resilience.。
How to Get Prepared for a Job?With more and more graduates from colleges and universities every year, job hunting has become more and more difficult, In order to gain an upper hand, it is necessary for us to prepare ourselves when we are still on campus.There are several measures college students can take to sharpen their edges. First, it is important to learn the kind of writing skills that will help us get an interview. Writing effective resumes, letters of application, and interview follow-up letters can give us an edge in the job market. Second, we should have knowledge of the job itself. The job we are looking for should neither be beyond our reach nor should it be too easy. Instead, it should bring your abilities into full play.If I do get an interview, take time to prepare well for it. It could be the most important meeting of my career. Try to anticipate what questions will be asked and have answers ready. Present your best appearance and conduct. As a matter of courtesy, and to strengthen your case, write a follow-up letter to thank the interviewer for the interview.In a word, opportunity will only favor those with a ready mind. We should get well-prepared for the future success.。
A Balanced Scorecard framework for R&DTeresa Garcı´a-Valderrama,Eva Mulero-Mendigorri and Daniel Revuelta-BordoyFacultad de Ciencias Econo´micas y Empresariales,Departamento de Economı´a de la Empresa,Universidad de Ca ´diz,Ca ´diz,Spain AbstractPurpose –The purpose of this paper is to produce a general Balanced Scorecard (BSC)model that is designed and delimited for managing research and development (R&D)activities.Design/methodology/approach –A methodology based on the validity of content of an instrument of measurement,within the analytical framework of the validation of scales or constructs was employed.Findings –The BSC model for R&D developed in this study has been subject to testing with recognised experts in management and in R&D.It has enabled a proposal to be put forward in respect of those indicators that best define the factors related to organisational effectiveness in the achievement of the strategic objectives set by companies,and to inter-relate them and group them under five broad perspectives of the BSC.Research limitations/implications –The BSC will be validated as a construct in future research.Practical implications –The result is the design of a scale of measurement that ranks the empirical indicators under the perspectives of the BSC;for the measurement of results,this instrument will provide unique values that group all the previous indicators in a single scale of measurement.Originality/value –No studies dealing with the content validation of a BSC have been found in the literature on innovation.Keywords Balanced scorecard,Research and development,Content management,Strategic managementPaper type Research paper 1.IntroductionThe Frascati Manual (OECD,1994,2002)states that scientific and technological innovation can be understood as the transformation of an idea into a new or improved product,a new or improved industrial or commercial process,or a new method by which to serve society.The term “innovation”may take on different meanings in different contexts and the choice of meaning will depend on the specific objectives pursued in its measurement and analysis.The pursuit of innovation also involves a series of scientific,technological,organisational,financial and commercial activities.Research and development (R&D)is only one such activity and may be involved at various stages in the innovation process,not only as the original source of novel ideas,but also as a solution to problems as they are identified.Both the Frascati Manual (OECD,1994,2002)and the Spanish Survey oftechnological innovation in firms,(Instituto Nacional de Estadı´stica,1999)define R&D as:The current issue and full text archive of this journal is available at/1460-1060.htmThis research has been financed under project SEJ2004-01330/ECON of the Directorate General of Research of the Spanish Ministry of Education and Science.Balanced Scorecard framework 241European Journal of Innovation Management Vol.11No.2,2008pp.241-281q Emerald Group Publishing Limited 1460-1060DOI 10.1108/14601060810869884[...]creative work undertaken on a systematic basis in order to increase the stock ofknowledge,including the knowledge of man,culture and society,and the use of this stock of knowledge to devise new applications.The principal objective of this study is to validate the content of a general BSC model for R&D activities.The BSC is an analytical model of strategic information for all types of organisation;it was developed by Kaplan and Norton in 1992and since then hasbeen the subject of many research studies in respect of its possibilities as a tool for strategic management.However,few references have been found to its development and implementation in companies which consider their R&D activities to be of strategic importance.Our principal interest is in providing a solution for one of the problems related to the utilisation of the BSC for this type of activity –specifically,the impossibility of comparing the return or performance achieved between companies through the use of this instrument,when there is enormous heterogeneity in the use of different indicators in each perspective,and the non-existence of databases that could give us such comparative information.Moreover,considering the problems raised in the literature on the management of R&D in respect of measuring the inputs and outputs of this type of activity,there are two reasons why it would be useful to have such a BSC.The first arises from the difficulties found in the employment of some of the indicators traditionally utilised in measuring the success obtained by companies in their R&D activities (Donnelly,2000);the other arises from the lack of consensus in their choice of the dimensions that should be included in reports prepared for the strategic management of this type of activity,as well as from lack of alignment of the measurements of the returns from these activities with the strategy of the company;the BSC is one of the instruments for the measurement of these returns recommended in the literature on management of R&D (Bremser and Barsky,2004;Kerssens-van Drongelen and Cook,1997;Pearson et al.,2000).To this end,the methodology employed in this study is based on the content validity of an instrument of measurement within the general method of validation ofscales or construct.We have used the scale developed by Garcı´a-Valderrama and Mulero-Mendigorri (2005)for measuring the effectiveness of R&D activities and we have adapted it to the financial,customer,innovation,internal processes and learning and growth perspectives of company performance.In our study,the starting point will be an analysis of the four dimensions of the Balanced Scorecard:financial;customers;internal processes;and learning and growth,in order to devise the framework proposed for R&D.In our case,this has been done by means of a review of the bibliography and the judgment of experts (in our case,the heads of R&D of companies with large investments in R&D),academics with expertise in R&D,and two experts in evaluation with the model of the European Foundation for Quality Management (EFQM)Quality Club.By this approach we expect to obtain a very high degree of consensus on the best way to measure each of the variables included in each dimension of our proposed BSC for R&D.We have structured the paper in two main parts.In the first part,we analyse previous experience in developing the Balanced Scorecard for this type of activity.In the second part,we present the objectives of the study and the methodology employed in the development of the proposed BSC for R&D;in particular,we propose theEJIM 11,2242validation of content of this BSC for R&D activities,within the methodological framework of the validation of st,the results obtained and the conclusions drawn are presented.2.The Balanced Scorecard as an instrument for measuring the performance or output from a company’s R&D activitiesThe implementation of strategies requires integrated systems of measurement that capture changes in bothfinancial and non-financial returns.The basis of such systems of measurement should be the alignment of the organisation’s main processes(R&D, production,marketing and other traditional functional areas)with the corporate strategy;and the factors considered critical in achieving the returns should be utilised as parameters for the measurement of these returns.Traditionally,R&D activities have not formed part of corporate strategies,and this has been one of the biggest difficulties in the choice of instruments of measurement of the returns from this type of activity. Today,R&D is a key strategic topic for many if not most companies,and should therefore be aligned with the corporate strategy and associated management procedures(Pearson et al.,2000).On this point,Kerssens-van Drongelen and Bilderbeek(1999)report that,in the literature on R&D,there are relatively few references to the utility of employing measurement techniques for the returns obtained in this type of activity,and they suggest that the BSC could be employed as an integrated system of measurement of the returns from R&ter Neufeld et al.(2001)argued that the BSC offers a“most promising approach”that helps organisations to measure their performance and to achieve their objectives of excellence.According to Kaplan and Norton(1992,p.32)the Balanced Scorecard is:[...]a new framework or structure created for integrating indicators derived from the strategy,that continues to retainfinancial indicators of the past actions,completed with inductors of futurefinancial actions.The inductors,which include the customers,the processes and the perspectives of learning and growth,are derived from an explicit and rigorous translation of the strategy of the organisation into tangible objectives and indicators. The strategies and the lines of action that would enable the company to achieve its strategic vision should be translated into each of the perspectives.The company’s strategies in the perspectives of learning and growth and in internal processes that are important in R&D activities will be those that,in short,help it to meet its strategic objectives related to the satisfaction of its customers and shareholders..Translation of company strategies in thefinancial perspective.The translation of strategies in thefinancial perspective is aligned with the improvement of the company’s situation in the interests of shareholders.Strategies designed to increase market share or to increase productivity should be related to the strategic objective of improving thefinancial situation of the company..Translation of the company strategy according to the customer’s perspective.In this case,the object should be to identify the segments of the market,select those market segments the company aims to satisfy,and identify proposed value to deliver to the segments selected.Customer satisfaction will lead to a higher rate of customer retention and/or the widening of the market,among other objectives.In turn,this will foreseeably generate betterfinancial results for the company.Balanced Scorecard framework243.Translation of the company strategy in the perspective of internal processes.It is in this perspective that we have worked most in the development of the BSC for R&D,the topic of this article.The proposed value to be offered to customers takes material form in the particular attributes and benefits that the supplier company provides,through its products and services,to create satisfaction and loyalty in its customers in the selected market segments.The proposed value is the key concept for understanding how measurements are managed within the groups of indicators of customer satisfaction,increased retention and market share.The satisfaction of both the shareholders and the customers are the consequence or result of the strategy of the company.The company as an organisation executes its strategy through processes that constitute its internal value chain,with special importance being attached to the initial activities of the value chain:R&D activities..Translation of the company strategy in the perspective of growth and learning.The company’s success in the execution of its strategy will be based on the capacity of its organisation to learn,adapt and grow.This capacity also resides in the resources of the organisation allocated to R&D activities,particularly the personnel.Each measurement is part of a chain of cause-and-effect links.There must be a balance between the measurements of results (against financial,market and customer satisfaction goals)and the motors driving those results (proposed value,internal processes,learning and growth in R&D).In his study on measurements of scientific output Newburn (1972)stated that,while there are many studies where only one criterion is used to measure scientific output,it is generally recognised that scientific performance is multidimensional.In other words,as a general rule,after studying the indicators on the efficacy and efficiency of R&D activities proposed in the literature and applied in practice,many authors have concluded that multiple integrated measurements of output need to be utilised,owing to the complexity of the concept to be measured (Tipping et al.,1995;Utunen,2003;Werner and Souder,1997).Integrated measurements have the particular characteristic of combining numerous aspects of a single reality;they make it possible to utilise a series of quantitative-subjective,quantitative-objective and qualitative measurements jointly for the assessment of a single concept or reality.Often,this integration generates more information on the effectiveness of the R&D activities measured than if each measurement or indicator were taken individually (Werner and Souder,1997).The three types of integrated measurements most frequently utilised in the study of the efficacy of R&D activities are:the Technological Value Pyramid (Tipping et al.,1995),Benchmarking (Bean et al.,2000;Krause and Liu,1993;Tipping et al.,1995;Werner and Souder,1997;Sharif,2002)and the Balanced Scorecard (Kerssens-van Drongelen and Bilderbeek,1999;Kerssens-van Drongelen and Cook,1997;Li and Dalton,2003;Neufeld et al.,2001).In this respect,Bremser and Barsky (2004)argue that companies that employ large amounts of resources in R&D can benefit from the key concepts of the BSC,EJIM 11,2244fundamentally for its basic principles,focused on the achievement of strategies.In particular,these authors identify the following advantages from its utilisation: .the company translates its strategy into operational terms using BalancedScorecards and strategic maps;.the BSC aligns the organisation structure with the strategy,by“cascading”from the highest-level scorecard to strategic business units,to support departments and to external partners;.it makes strategy everyone’s job,by allowing initiatives for creating strategic awareness and for using personal scorecards with related incentives;.it makes strategy a continual process by linking budgets to strategy, implementing a process for learning and adapting thefirm’s strategy;and .it mobilises leadership for change in the strategic management system. Deploying the corporate BSC in the functions and departments of R&D helps to achieve the integration of technological planning with the strategy of the corporation. Pearson et al.(2000)review the literature and report on measurements of R&D performance;they advise the joint use of traditional techniques of measurement of returns focused on the cost control of this type of activity,with strategic measurements in the long term and withfinancial objectives.In this process of integration,the application of a BSC is suggested.With respect to the techniques traditionally employed for measuring the returns from R&D,Donnelly(2000)raises the question of whether techniques for monitoring the results of R&D are feasible or not,and of how these can be related to the strategies of the corporation.This author came to the conclusion that around40per cent of new products developed by a company do not achieve the returns desired.Bremser and Barsky(2004)consider that,in the implementation of strategy,the employment of non-financial measurements related directly or indirectly to the R&D plays an extremely important role,both at the level of internal processes and at the corporate level.In companies with long cycles of product design and development,the cycle of innovation is more important than the operating cycle.The process of innovation usually requires a longer period of time for value creation,in which new markets and new customers see their expectations met;R&D activities are critical in the implementation of these expectations(Bremser and Barsky,2004).The pioneering proposal put forward by Kerssens-van Drongelen and Cook(1997)is based on the argument that all the output measurements utilised in the literature and in practice can be placed under one or several of the followingfive high level parameters: cost(efficiency),quality,time,innovatory capacity and contribution to profits,and that these high level parameters can,in turn,be aligned with the four perspectives proposed by Kaplan and Norton(1992,1993,1996).Quality corresponds to the perspective of the customer,cost(efficiency)and time to the perspective of the internal processes,innovatory capacity to the perspective of learning and growth,and contribution to profits to the perspective offinancial results.The model proposed by these authors is represented in Figure1.Neufeld et al.(2001)analysed eight organisations in the USA and Canada that are leaders in scientific research,with the object of identifying the attributes that define quality of management in research units or departments.Their approach was based onBalanced Scorecard framework245the BSC model of Kaplan and Norton since,according to the authors,the BSC is a point of departure for identifying the attributes of organisations with a high research output (see Table I).Li and Dalton (2003)argue that the BSC needs to be implemented in R&D because of the scale of changes that have taken place in recent years.The rate of growth in the size and scope of R&D departments has been spectacular and rapid,to the extent that problems of visibility are being generated.Managers feel that the basic decisions that were taken relatively easily years ago have now become extraordinarily difficult.In the opinion of Li and Dalton (2003),when there is a lack of visibility from the top down,serious problems emerge from the bottom up,since at the operating level it is difficultFigure 1.Balanced Scorecard forR&D proposed byKerssens-van Drongelenand Cook(1997)EJIM 11,2246have a strategic vision of the company and its objectives.This has created problems in R&D activities,where measurements of productivity are passing through a crisis,as demonstrated in the study already mentioned conducted by Berger Consulting (2002)among 60large multinational chemical companies,and in other studies.The response to this crisis is to recognise the need for better management of R&D activities;a need exists for R&D departments to render accounts of their activities,and for their operational objectives to be focused on supporting the strategy of the company,to enable the decision-makers to identify and justify the potential rewards from these activities.As a case study,the way this problem was solved in the company Pharmacia was by the implementation of software to keep a Balanced Scorecard for the R&D activities of the company.Li and Dalton (2003)describe the use of this tool and show the structure of the BSC applied to Pharmacia,which is presented in Figure 2.As can be seen,the four dimensions of Kaplan and Norton have been extended to five,with “Learning and Innovation”being separated into two;at the same time,each dimension comprises four or five operating objectives,making a total of 23.According to Li and Dalton (2003),the implementation of this management tool has resulted in the following benefits for Pharmacia:(1)The system has permitted more transparency for the managers,who have actedthinking of the long-term results.People The management knows that research abilities andother skills are necessary to fulfil the mission,andtherefore the company contracts,develops andretains the appropriate mix of personsThe employees are highly committed to their work,have confidence in the management,and are proudof their organisationLeadership The current and anticipated needs of the personsengaged in the research work are critical for theorganisation and its research programThe employees and other persons engaged in theresearch work share the vision,values and goals ofthe managementThe portfolio of projects represents appropriateresearch work,with sufficient time and resourcesallocated to perform the work appropriatelyManagement of the research The research projects involve significantleading-edge science,the correct persons are engagedin them,they are on course and within budgetThe research projects attract external financingOrganisational knowledge is systematicallycaptured and transformed into tools of workOrganisational performance and outputThe organisation is widely known and respectedThe organisation knows the needs of everyone whodepends on it Source:Neufeld et al.(2001)Table I.Definitions of the ten attributes in the Balanced Scorecard for R&D Balanced Scorecard framework 247(2)This has had an impressive effect in the short-term:.in the last two years,the company has introduced various redesigns of processes highlighted by using the BSC;.the time cycles in the critical paths of clinical tests have been drastically reduced,by between 34per cent and 75per cent;.the costs per patient have been reduced by 5per cent;.the number of patients recruited for clinical research has increased by 34per cent;.all these results have been achieved while maintaining the level of quality;and .the BSC contributes to the global implementation of strategy and to continuous decision making.Figure 2.Model BSC applied to thecompanyPharmaciaEJIM 11,2248Another of the applications analysed is that described by Bremser and Barsky(2004, p.234).These authors present an example of specific measurements of R&D under the structure of a BSC for the company’s R&D department;these are shown in Table II.In particular,the proposal of these authors is based on relating the indicators of strategic character for the company as a whole,with the specific indicators for the R&D department.As can be observed from the review made in this study on the measurement of the returns from R&D and its models,the literature points to the lack of definition of strategy in the planning of these activities,and the BSC is seen as the instrument that would help to achieve this definition.However,we certainlyfind a lack of homogeneity in the consideration of the indicators for R&D,since each company develops them in a different way,making it practically impossible to undertake any type of research that relates the advantages of the use of this technique with other parameters that could be available to the researcher.With the object of resolving this problem,our proposal is to develop a scale or general BSC model for R&D,with the basic objective of obtaining a measurement tool that would give values that are homogeneous across several companies,and that could be adapted to the characteristics of the sector to which it may later be applied.The validation of scale would be employed to help usfind performance values linked to R&D that are comparable between companies;this methodology should enable us to obtain a much more global and reliable multi-indicator(a scale or construct)than could be obtained from the analysis of individual indicators in isolation.3.Validating the content of a Balanced Scorecard for R&DAs stated in the introduction,in our approach we propose to validate the content of a general BSC model for R&D activities.For this we design a measurement instrument, or scale,that includes all the appropriate variables,financial and non-financial,that have been proposed in the literature on the strategic management of R&D,starting from the structure of the“classic”BSC of Kaplan and Norton(1992,1996).To achieve this objective,we have established the following sub-objectives:.Identification of the principal dimensions of the BSC:The dimensions are the various perspectives of the BSC.In accordance with the literature,we have considered the indicators related to each of the four perspectives,with the addition in our case of afifth perspective termed Innovation,both in respect of the R&D department and in respect of the company as a whole..Delimitation of the objectives or variables measured by these indicators:The purpose of this phase of the work was to explain clearly these objectives or variables in the interviews held with the experts..Definition of each indicator that comprises the object of measurement (delimitation of the contents of the BSC)and design of a questionnaire(scale) in which each of these Indicators is represented by one or more items.3.1MethodologyIn empirical research on the management of R&D,as in other disciplines,the relationships between relevant variables are examined.However,an initial problem may be encountered:how to measure these variables as accurately and reliably asBalanced Scorecard framework249S t r a t e g i c o b j e c t i v e s d e p a r t m e n t S t r a t e g i c i n d i c a t o r s a t fir m l e v e l S a m p l e m e t r i c s a t t h e R &D l e v e l F i n a n c i a l p e r s p e c t i v e A .R e t u r n o n c a p i t a l e m p l o y e d 1.R &D v a l u e c r e a t i o n a t i n n o v a t i o n s t a g e s 1.4(A ,B ,C )B .C u s t o m e r p r o fit a b i l i t y 2.R &D v a l u e c r e a t i o n i n c o m m e r c i a l i s a t i o n s t a g e s 5&6(A ,B ,C )C .R e v e n u e g r o w t h r a t e 3.P e r c e n t a g e o f s a l e s f r o m n e w p r o d u c t s (D ,E )D .C u s t o m e r r e t e n t i o n r a t e C u s t o m e r p e r s p e c t i v e E .M a r k e t s h a r e 4.P r o d u c t m a r k e t l i f e c y c l e (D ,E ,F )F .C u s t o m e r a c q u i s i t i o n (n u m b e r a n d q u a l i t y )5.C u s t o m e r s a t i s f a c t i o n w i t h n e w p r o d u c t s (D ,E )I nt e r n a lb u s i n e s s p r oc e s s G .N e w p r od u c t p r o fit a b i l i t y f o r s t a ge 5(H )6.N u m b e r of n e w p r o d u c t s a p p r o v e d p e r s p e c t i v e H .R &D e f fic i e n c y (t i m e t o m a r k e t )7.A v e r ag e d e v e l o p m e n t c y c l e t i m e s t a g e s 1.4(H )I .P e r c e n t a g e o f r e s o u r c e s t o s u s t a i n p r o d u c t s t a g e s 1.4(G ,H )8.A v e r a g e d e v e l o p m e n t c o s t p e r e x i s t i n g p r o d u c t s J .O th e r m e t ri c s n o t r e l a t e d t o R &D 9.P e r c e n t a g e o f p r o d u c t i d e a s a p p r o v e d f o r s t a g e 4(H )10.P r i c i n g a n d p r o .t p l a n n i n g a c c u r a c y (G )11.N e w p r o d u c t a c c e p t a n c e r a t e (G )12.S a f e t y i n c i d e n t s (H )L e a r n i ng a n d g r o w t h p e r s p e c t i v e K .E m p l o y e e r e t e n t i o n 13.N u m b e r o f p a t e n t s a w a r d e d (M )L .E m p l o y e e d e v e l o p m e n t 14.S t r a t e g i c s k i l l c o v e r a g e r a t i o b y c o m p e t e n c y c a t e g o r y (K ,M )M .S t r a t e g i c s k i l l c o v e r a g e r a t i o b y c o m p e t e n c y c a t e g o r y 15.R &D c o m p e t e n c y v s .c o m p e t i t o r s (i n n o v a t i o n l e v e l )(M )N .E m p l o y e e s u r v e y m e a s u r e s 16.E m p l o y e e s u r v e y m e a s u r e s (N ,O )O .I n n o v a t i v e c u l t u r e s u r v e y s 17.E m p l o y e e t r a i n i n g (h o u r s )(K ,L )N o te :T h e l e t t e r (s )i n p a r e n t h e s e s i n d i c a t e c a s c a d i n g l i n k a g e s t o t h e fir m -l e v e l m e a s u r e s S ou rce:B r e m s e r a n d B a r s k y (2004,p .235)Table II.Sample metrics at the R&D department level EJIM 11,2250possible (Schwab,1980,p.5).Often,the conclusions obtained in research studies on the behaviour of innovative companies and its consequences are measured by the empirical observations of the researchers,and therefore errors of measurement are likely to occur.Research in this field is characterised by a scarcity of studies on the management of R&D.The complete methodology on the validation of an instrument of measurementcomprises a multiphase process,such as that depicted in Figure 3(Garcı´a-Valderrama and Mulero-Mendigorri,2005,p.315):.First,a group of items (empirical indicators),chosen to measure the construct,must be identified.It is necessary first to demonstrate that the empirical indicators are logical and related to the construct,or scale.This step is referred to as the Validity of the Content (Pedhazur and Schemelkin,1991).Two successive techniques are utilised in this phase:a review of the bibliography,and consulting the opinions of experts..Second,the degree of Reliability and Validity of the instrument of measurement must be established[1].This step requires the application of a series of statistical tests that determine,first,the statistical properties of the empirical indicators (O’Leary-Kelly and Vokurka,1998);second,within the analysis of Validity,the validity of construct must be analysed,which encompasses both convergent and discriminant validity;and third,the validity of criterion must be studied,which encompasses the concurrent validity and the predictive validity of the instrument..Finally,the definitive scale is applied to the company or companies being studied,by means of the questionnaire.The methodology followed in our work is centred on the first phase of the completeprocess of validation of scales:the content validity (Garcı´a-Valderrama and Mulero-Mendigorri,2005).The content validity of an instrument of measurement is defined as the sampling adequacy of the items of a test.In practice,the content validation represents a systematic examination of the content of the test,to determine if a sample is relevant to and representative of the behavioural domain that the researcher intends to measure.The following steps should be followed in the validation of content:.definition of the universe of admissible observations;.identification of experts with knowledge of this universe;Figure 3.Stages in the methodologyfor scalevalidationBalanced Scorecard framework251。
How Well Prepared Are Texas Dental Hygienists to Recognize and ReportElderly Abuse?Kellie R. Murphree, B.S.D.H., M.S.; Patricia R. Campbell, R.D.H., M.S.;Marylou E. Gutmann, R.D.H., M.A.; Stacey B. Plichta, Sc.D.; Martha E. Nunn, D.D.S., Ph.D.; Ann L. McCann, R.D.H., M.S.; Gretchen Gibson, D.D.S., M.P.H.Abstract: The elderly are the nation’s fastest-growing population, and the number of elder abuse victims has reached epidemic proportions. In Texas, dentists and dental hygienists are mandated by law to report suspected abuse. This study surveyed Texas dental hygienists regarding elder abuse education received in dental hygiene school and post-graduation. Respondents were also asked to self-assess their knowledge level in recognizing the six types of elder abuse and to answer questions regarding Texas law and mandatory reporting of abuse. A survey designed for this study was mailed to 780 Texas licensed dental hygienists, repre-senting 10 percent of the Texas dental hygiene population. Respondents were selected using a computer-generated random sample. A second mailing was sent to nonrespondents to prevent response bias. Results were analyzed using Statistical Programs for Social Scientists (SPSS). Over one-half of the respondents (56 percent) stated that abuse education was not part of their dental hygiene school curriculum. Only 46 percent of the respondents who replied that abuse education had been included in the curriculum were educated on elder abuse. A majority of respondents stated they lacked knowledge in recognizing the six types of elder abuse, and 81 percent of respondents reported being unknowledgeable about reporting elder abuse. The current status of elder abuse education in dental hygiene programs and post-graduation is insufficient. Dental hygienists have an obligation to become knowledgeable in recognizing and reporting elder abuse in order to provide complete care for their patients.Ms. Murphree is Assistant Professor, Old Dominion University; Ms. Campbell is Associate Professor, Baylor College of Dentistry/A Member of the Texas A&M University System Health Science Center; Ms. Gutmann is Professor, Baylor College of Dentistry/A Member of the Texas A&M University System Health Science Center; Dr. Plichta is Associate Professor, Old Dominion University; Dr. Nunn is Associate Professor, Boston University; Ms. McCann is Associate Professor, Baylor College of Dentistry/A Member of the Texas A&M University System Health Science Center; and Dr. Gibson is Assistant Professor, Baylor College of Dentistry/A Member of the Texas A&M University System Health Science Center. Direct correspondence and requests for reprints to Kellie R. Murphree, Old Dominion University, 4608 Hampton Boulevard, Norfolk, V A 23529-0499; 757-683-5230 phone; 757-683-5239 fax; kmurphre@. This study was funded by Baylor College of Dentistry.Key words: dental hygiene education, elder abuse, education about elder abuse, recognition of elder abuse, reporting of elder abuse, continuing educationSubmitted for publication 5/21/02; accepted 9/6/02T he elderly are the nation’s fastest-growing population.1,2 It is estimated that, by 2030, ap-proximately 20 percent of the U.S. popula-tion will be age sixty-five or older.3-5 While Ameri-cans of all ages are at risk for family violence, the elderly are especially vulnerable. The number of in-dividuals who are victims of elder abuse has reached epidemic proportions.3,6 Statistics on elder abuse vary greatly, but studies from around the United States estimate that between 700,000 and 2.5 million indi-viduals are abused annually.7,8Dentistry and Elder AbuseThe average elderly person makes two dental visits per year.9 Frequent dental visits by the elderly are usually necessary because of the increased rate of periodontal disease in this population.10 Therefore, dentists and dental hygienists are in a health profes-sion likely to see these individuals on a frequent ba-sis and would be in a good position to recognize and report elder abuse and provide resources to the vic-tim.3,10 In addition, two-thirds of injuries sustained in older adults can be easily found during a routine dental exam, and over one-half of the injuries occur in the head and neck region.2,3In all fifty states, dentists and dental hygien-ists are mandated by law to report all cases of sus-pected elder abuse.11-13 However, studies reveal that dentists, dental hygienists, and other health care pro-fessionals are neither comfortable nor knowledge-able about recognizing and reporting suspected el-der abuse.3,14 It has also been implied that while severeabuse is rarely seen in a dental office, dental profes-sionals miss the more insidious and chronic cases of abuse.15Dentists with an increased level of abuse education do report more suspected cases of abuse.16 However, there are no studies regarding dental hy-gienists’ education and reporting of elder abuse. An Overview of Elder AbuseElder abuse is an umbrella term that encom-passes “physical, psychological and sexual abuse, caregiver and self-neglect, and financial exploita-tion,”10 and it is not uncommon for elders to be vic-tims of several types of abuse simultaneously.12 It occurs in every racial, ethnic, and socioeconomic group and can occur in institutional settings and by family members or other caregivers.10While no elder individual is immune from be-ing a potential abuse victim, certain characteristics may increase the chances of abuse. Abuse towards women was reported more frequently, and their inju-ries were more severe than those of their male coun-terparts.7 One national study reported that perpetra-tors of abuse were most often adult children (47 percent), followed by the spouse (19 percent), other relatives (25 percent), friends (6 percent), and ser-vice providers (4 percent).5 Another study, however, found that spouses were most likely to be the abuser (58 percent of all cases in that study).7 Elders who live with friends or family are three times more likely to be abused than those who live alone or in nursing home facilities. In particular, females of an advanced age who are unable to live alone due to inadequate income and who reside with family members are the most likely to be abused by an adult child.8,17No differences were found in rates of abuse and neglect for minority and white elderly, between the very old (over seventy-five years) and the younger old (sixty-five to seventy-four years), nor related to race, ethnicity, religion, or socioeconomic backgrounds.3,7 Additionally, other studies found no difference in rate of abuse in rural or urban settings, nor was the gen-der of the caregiver a clear risk factor in determining possible abuse.6,10Many older adults are reluctant to report abuse, especially if it is by a family member.18,19 Elder abuse victims tend to blame themselves, have low self-es-teem, and fear retaliation by the family member.13,18,19 Additionally, the elder will not report abuse if it means placement in a nursing home rather than re-maining at home.18 An elder’s refusal of intervention is a significant barrier to elder abuse prevention.20Dentistry and Mandatory ReportingAlthough currently there is no federal statute governing elder abuse, all fifty states and the Dis-trict of Columbia have enacted laws requiring man-datory reporting by health professionals for suspected abuse. These laws require reporting of suspected el-der abuse, even against the elder’s wishes, and pro-tect whistleblowers from civil and criminal liabil-ity.12,13 Each state has developed some form of an Adult Protective Services (APS) program to encour-age reporting cases of suspected abuse.12,13APS agen-cies are given authority to investigate the mistreat-ment of elders and provide services to facilitate solutions in abusive and neglectful situations.18 De-spite the laws and the existence of APS agencies in all fifty states, suspected and actual elder abuse re-mains underreported by dental offices.6 Reasons for nonreporting by health care professionals include unfamiliarity with mandatory reporting laws, fear of liability, fear of potential prosecution, and fear of offending patients and families.12 A study specifically about dental practitioners revealed additional reasons for not reporting suspected abuse, including a lack of education and lack of knowledge. In that study, 78 percent of respondents indicated they needed to learn more about elder abuse.21Several studies report the need for increased elder abuse education, and one study recommended that “mandatory family violence courses should be incorporated into the dental curriculum.”10 Currently, 19 percent of dental hygiene programs in the United States and Canada have a specific course in geriatric education, compared to 83 percent in dental schools.22 This is an improvement from an earlier study that reported only 4 percent of dental hygiene programs had a geriatrics course.23 There has been a decrease in the amount of time spent in clinical and didactic educational dental hygiene settings with a geriatric population.22 Studies indicate that dental hygiene stu-dents need to be educated about elder abuse and ne-glect and about mandatory reporting laws.7,8The purpose of this study was to determine the level of education Texas-licensed dental hygienists received on elder abuse in dental hygiene school and post-graduation. Recognition and reporting knowl-edge levels were obtained, as well as awareness of the mandatory reporting laws in Texas. Results from this study will be used to pursue changes in dental hygiene curriculum and continuing education re-quirements.Materials and MethodsStudy DesignThis study was designed to gather data via a cross-sectional mailed survey of a random sample of all dental hygienists practicing in the state of Texas.A packet containing a cover letter, a survey, and a self-addressed postage-paid envelope was mailed to each potential respondent. The cover letter informed the subjects of the purpose of the study, assured them of anonymity, and explained that informed consent would be assumed if the questionnaire was completed and returned. Respondents completed the survey in writing and mailed it back. Coding of the envelopes was done to identify nonrespondents, and a second mailing was done to nonrespondents to maximize the response rate.Survey Instrument and Variables of InterestThe survey instrument contained questions re-garding demographics, type of dental hygiene edu-cation, sources of information and training about el-der abuse, knowledge levels about elder abuse, self-assessed ability to identify different aspects of elder abuse in a patient, and other items of interest. The survey was pilot-tested by five Texas-licensed dental hygienists. Based on feedback from the pilot testing, the survey was modified to ensure clarity and validity.The demographic questions asked respondents about gender, age, race, marital status, and the popu-lation of their city or town (less than 40 thousand, 40-100 thousand, 100-500 thousand, or over 500 thousand). The questions about dental hygiene train-ing included type of degree received (Certificate, Associate, Bachelor’s), type of college attended (two-year or four-year), the state where the training was received, and the number of years they have been in private practice.The respondents’ most formal source of edu-cation about elder abuse was measured by asking about various sources of knowledge such as journal articles, coursework during school, and continuing education. Those respondents who reported no source of knowledge were coded as having “no elder abuse education”; those who reported only reading journal articles but not receiving any formal education were coded as “journal articles only”; and those who re-ported receiving formal elder abuse training (either in school or via a continuing education course) were coded as “received formal education.”The respondents’ actual knowledge of elder abuse issues in Texas was measured using a nine-item true/false quiz. The final score was the percent of items answered correctly. Individual items asked questions about legal, ethical, and clinical aspects of elder abuse.The respondents’ feelings of inadequacy in identifying elder abuse was measured by a six-item Likert scale that asked them the extent to which they agreed/disagreed that they were adequately trained to recognize six different aspects of elder abuse. The six aspects were caregiver neglect, emotional abuse, fi-nancial exploitation, physical abuse, self-neglect, and sexual abuse. The score on each of these six scale items was summed together and divided by six in order to obtain an overall average summary of feelings of in-adequacy in identifying elder abuse. Higher scores indicated greater feelings of inadequacy. The scale had excellent reliability (Cronbach’s Alpha = .94). SampleA 10 percent, computer-generated random sample of all licensed dental hygienists in Texas was selected from a listing provided by the Texas State Board of Dental Examiners (n=780). A survey packet was mailed to each of these 780 hygienists, inviting them to be in the study. Of these 780, twenty-one were returned with no forwarding address, and ninety-seven were returned by nonpracticing dental hygien-ists (and thus not eligible for inclusion). A second mailing was conducted to nonrespondents to limit nonresponse bias. Overall, a total of 375 surveys were returned for a response rate of 56.5 percent.As shown in Table 1, the sociodemographic and training characteristics of the currently practicing respondents are similar to those of the general popu-lation of dental hygienists. Most of the respondents (99 percent) are female. The average age is thirty-nine years (sd=8.69). The majority of respondents are white (89.8 percent) and married (85.9 percent). Respondents are almost evenly spread out among rural areas (townships of less than 40,000), some-what rural areas, and more urban areas (townships of 100,000 and over).In terms of education, 17.6 percent of the respondents have a certificate, 57.3 percent have an Associate’s degree, and 25.1 percent have a Bachelor’s degree or higher. Only four respondentshad a Master’s degree. The majority (75.5 percent) attended a two-year college, and the rest (24.3 per-cent) attended a four-year college. Most of the re-spondents (81 percent) were educated in Texas. The average respondent has been practicing for 13.66 years (sd=8.9): 25.6 percent have been in practice for less than five years, 49.6 percent have been in practice for six to twenty years, and 24.8 percent have been in practice for over twenty years. AnalysisAll statistical analyses are conducted using SPSS-PC version 10. Frequency distributions, means,and standard deviations are used to describe the vari-ables. The relationship between type of elder abuse education and both knowledge and feelings of inad-equacy was examined using one-way Analysis of Variance (ANOV A), as was the relationship of age and years in practice to type of elder abuse educa-tion. The relationship of elder abuse education to marital status, ethnic identity, type of degree, and type of college and state where dental hygiene edu-cation was received was examined using the chi-square statistic. The relationship of marital status, ethnic identity, degree type, and college type and state where dental hygiene education was received to knowledge and feelings of inadequacy was exam-ined using either t-tests or one-way ANOV A. The relationship of age and years in practice to knowl-edge and feelings of inadequacy was examined us-ing Spearman’s correlation coefficients. In all analy-ses, relationships that were significant at p<=.05 are regarded as statistically significant. ResultsKnowledge of abuse was generally poor (Table 2). The average grade on the nine-item fact quiz was 46.2 percent (sd=27.4), with only 20.5 percent of the group scoring 78 percent or higher. Respondents scored particularly low on items about mandated re-porting (only 44 percent knew that they had to re-port suspected elder abuse under Texas state law, and only 32.3 percent knew that Texas has a reporting agency) and on where most cases occur (65.6 per-cent did not know that the majority of elder abuse cases do not occur in institutions).Overall, 48.3 percent of the respondents re-ported that they never had any education on elder abuse at all (Table 3). An additional 27.5 percent re-ported reading journal articles about elder abuse (butTable 1. Sociodemographic and training characteris-tics of respondents (N=375)SOCIODEMOGRAPHIC CHARACTERISTICSMean Age (sd)39.0 Years (8.69)Marital Status PercentSingle (included two widowed) 5.3Divorced8.8Married85.9Ethnic Identity PercentWhite89.8Other10.2Size of Area of Residence PercentLess than 40,000 people25.540,001-100,000 people21.0100,001-500,000 people19.3Over 500,000 people34.3TRAINING CHARACTERISTICSType of Degree PercentCertificate17.6Associate’s degree57.3Bachelor’s degree or higher25.1Type of College PercentTwo-year75.5Four-year24.3State PercentIn Texas81.0Out of state19.0Mean Years Practicing (sd)13.66 Years (8.9)Table 2. Knowledge about elder abuseMean Score on True/False Quiz (sd)46.2 (27.4) Percent Scoring above 78 percent20.5 Individual Items (correct answer in parentheses)Percent Correct1. Texas has a reporting agency for elder abuse. (True)322. Most cases of elder abuse occur in institutions. (False)343. In Texas, dental professionals are mandated by law to report suspected abuse. (True)444. The identity of the reporter will be revealed to the accused abuser. (False)535. Reporting of elder abuse without the patient’s consent is a violation of the victim’s rights. (False)486. Very few older adults are abused. (False)627. People who are abused will display certain behavioral indicators. (True)558. The reporter of abuse can be held liable in litigation. (False)369. Texas requires continuing education on elder abuse for dental professionals. (False)52not receiving any formal training), and 24.3 percent reported that they had received elder abuse training either in dental hygiene school or through continu-ing education courses. Only 12.7 percent of the re-spondents thought they had received adequate elder abuse education in dental hygiene school.The majority of respondents felt at least mod-erately inadequately trained to recognize elder abuse (Table 3). The mean inadequacy score was 4.16 (sd=1.2), out of a possible 6 points, where higher scores indicate greater feelings of inadequacy. Only 16.9 percent of the respondents felt at least some-what adequately educated, whereas 59.6 percent felt moderately inadequately educated and 23.5 percent felt more than moderately inadequate.The level of elder abuse education was signifi-cantly related to both knowledge and feelings of in-adequacy (Table 4). Those who received formal el-der abuse education had a significantly higher score on the knowledge test (p<.001 by the ANOV A test) as compared to those with no education or who only read journal articles. Those who received formal el-der abuse education also had significantly lower lev-els of perceived inadequacy (p<.001 by the ANOV A test) than those with no elder abuse education or who only read journal articles. I t should also be noted that knowledge and feelings of inadequacy were nega-tively correlated (r=-.343, p<.01)—meaning that those with lower knowledge levels tended to have greater feelings of inadequacy in their training.Very few sociodemographic or education vari-ables were significantly associated with type of el-der abuse training received, knowledge, and perceived inadequacy. None of these three were associated with marital status, race, size of town, degree type, col-lege type, or location of the college. However, older age and longer years in practice were associated with type of elder abuse training, knowledge, and per-ceived feelings of inadequacy. The youngest and least-experienced dental hygienists were more likely to have had formal training, higher knowledge scores, and lower feelings of inadequacy. DiscussionElder abuse has reached epidemic proportions, and dental professionals are in a unique position to identify suspected elder abuse victims.13,14 This study suggests that Texas dental hygienists are not prepared to recognize and report elder abuse following gradu-ation from a dental hygiene program. Additionally, this study suggests that dental hygienists are misin-formed and unknowledgeable about the laws pertain-ing to elder abuse in Texas.When self-assessing their knowledge of elder abuse, the overwhelming majority of dental hygien-ists perceived themselves to have limited knowledge in recognizing and reporting elder abuse. This is not surprising, since less than half of the respondentsTable 3. Aspects of elder abuse education and trainingTRAINING CHARACTERISTICMost formal type of elder abuse training PercentNone48.3Journal articles only27.5Formal training (school or continuing education)24.3Feelings of inadequacy in recognizing elder abuse PercentFeeling at least somewhat adequate (score of 1-3)16.9Feeling moderately inadequate (score of 3.01-5)59.6Feeling more than moderately inadequate (score of 5.01-6)23.5Mean inadequacy score (sd) 4.16 (1.2)Ever suspected elder abuse in a patient (percent)9.8Table 4. The relationship of education to knowledge and feelings of adequacyNone Journal Articles Only Formal Training Mean score on knowledge test (sd)39 (26)46 (25)60 (27) ANOVA f-test and p-value f=24.45 p<.001Mean score on inadequacy scale (sd) 4.6 (1.1) 4.3 (1.2) 3.4 (.96) ANOVA f-test and p-value f=39.8 p<.001reported receiving any education about elder abuse in their dental hygiene program. There were no dif-ferences in the level of elder abuse education ob-tained by graduates in two-year and four-year dental hygiene programs. However, those who did receive such education had significantly higher scores on the knowledge quiz. This suggests, as did previous stud-ies,16,22 that increased education levels may be effec-tive in creating a greater awareness of elder abuse.Few respondents in this study had taken a con-tinuing education course on elder abuse. Since three-quarters of respondents indicated an interest in con-tinuing education courses on elder abuse, this offers evidence that current offerings in this area are inad-equate. Continuing education providers need to fill this gap in the educational opportunities offered to hygienists. I ncreasing educational opportunities raises awareness about elder abuse.Less than one-half of the respondents had read about elder abuse in a journal. Of those who had read about elder abuse, the great majority stated the in-formation was obtained from a dental hygiene jour-nal. This suggests that dental hygienists are becom-ing informed about elder abuse, but it appears that the knowledge is not being transferred and applied into the private practice setting. Twelve percent of dental hygienists who suspected elder abuse while in private practice took no action in aiding the elder, while 10 percent took no action when a family mem-ber or friend was the suspected victim. This may in-dicate that it is difficult for dental hygienists to ap-ply this knowledge to personal situations and seek a level of comfort in reporting suspected abuse. It is imperative that hygienists be aware that elder abuse occurs in all situations and environments.There was a correlation between years in den-tal hygiene practice and knowledge of elder abuse. This suggests that knowledge levels increase with experience in the dental hygiene profession or in-crease as a consequence of completing continuing education courses in elder abuse. It may also sug-gest that personal life experience increases dental hygienists’ knowledge level. There was no signifi-cant difference in identifying elder abuse and popu-lation size of the respondent’s city or town. This seems to indicate that a lack of knowledge about elder abuse is not localized to any particular geographic area. Dental hygienists in all geographical areas need to be better educated on the signs and symptoms of el-der abuse.Physical abuse and self-neglect were the two types of abuse respondents felt they could most eas-ily identify in a private practice setting, possibly be-cause the symptoms would be more apparent. Sexual abuse was found to be the most difficult type to de-tect and is confirmed by information obtained in the literature.21 This may indicate that dental hygienists need to be educated on the oral manifestations of sexual abuse in the oral cavity as well as emotional and other physical signs and symptoms.Future research in this area could include a national survey on elder abuse education in order to evaluate recognition and reporting levels by dental hygienists. Other states could use this survey as well to determine the educational needs of dental hygien-ists. Additionally, after several years of implement-ing increased elder abuse education in Texas dental hygiene program curriculums and increasing the availability of continuing education courses, a sur-vey of Texas licensed dental hygienists would be ben-eficial to determine if these efforts have been suc-cessful in raising awareness of elder abuse. Further, information is needed about effective intervention strategies that hygienists can use when addressing elder abuse. One intervention model, the A VDR (Ask, Validate, Document, and Refer) is promising and warrants further evaluation.24 ConclusionDental hygienists need to embrace lifelong learning to ensure continued competency in assist-ing abused elderly patients, and continuing educa-tion providers need to create these opportunities for hygienists. The findings in this study suggest that Texas dental hygienists would benefit from more education on the signs, symptoms, and reporting laws of elder abuse. The results of this study indicate that the current standard of elder abuse education is in-sufficient. Dental hygiene curriculum and course work hours should be expanded to concentrate on the needs of the growing elderly population. Dental hygiene educators, continuing education providers, and researchers should develop courses that will en-hance hygienists’ abilities to recognize and report elder abuse and increase knowledge of the legalities as they pertain to each state. The Texas State Board of Dental Examiners should also aid in this effort by examining current elder abuse laws and the needs of the public. The board could also include elder abuse information in its quarterly newsletter.The number of elderly people is steadily in-creasing, and thus the number of suspected elder abuse victims. Dental professionals can often be the only or first health care provider an abuse victim will see. By raising awareness and education levels, den-tal hygienists can detect suspected elder abuse and provide information about agencies and organizations that can aid the elder in halting the abuse. Dental hygienists need to overcome the hesitancy to become involved in their elder patients’ lives. 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