Achilles Tendon Sprain Case Study

Achilles Tendon Sprain Case Study Name: Lani Thompson Age: 26 Sex: Female Occupation: Merchandiser Height: 179 Weight:77.8, BMI: Diet: Mixed Family: She lives with her partner, no kids. Medical History: No history of Hypertension, Cardiovascular, Diabetics mellitus, pulmonary or any chronic disease. Footwear: A comfortable, properly fitted footwear should be used. Avoid High heels. Daily activities: Usually she goes to Gym thrice in a week, occasionally she goes for swimming. Balance: Muscle performance: No muscle wasting. Posture: Circumferential measurement: Alignment: There is no difference in alignment while she walks. History: Lani Thompson is a hockey and rugby player. About 4 months back, while she was training rugby she had a right ankle sprain. The Incident was happening around 7 in the night. Soon after she was shifted to the hospital and consulted with the doctor. On the same day she had undergone several investigations and examinations, including X-Ray and ultrasound. No evidence of any fracture on the x-ray and was diagnosed as an Achilles tendon sprain. Initial 2 weeks she was in a brace, subsequently she started ankle exercises. Later she exercised with Theraband and had started physiotherapy treatment for 2 weeks, eventually continued her exercises at home. Past Medical History: She has never been hospitalized for any chronic diseases. No history of Diabetes mellitus, Hypertension, Heart diseases, Asthma, Hepatitis, Sexually transmitted diseases or Tuberculosis. She regularly takes medications for depression/anxiety and for contraception. Medication: Venlafaxine, Quitiepine and a contraceptive pill. Surgical Intervention: No surgical interference. Gait pattern: Altered, limping of right leg. Range of Motion (ROM): Normal on left side, right ankle ROM is slightly altered, No muscle stiffness. Palpation: No tenderness or any abnormalities. Anatomy of the Ankle joint: The ankle joint mainly consists of two joints, the subtalar and the true ankle joint. The subtalar joint comprises three bones, the tibia, the fibula and the talus. The mechanism of the ankle joint is very complex. True ankle is responsible for the up and down movements of the foot. The subtalar joint is positioned under the true ankle joint and consists with two bones, the calcaneus and the talus. This joint is responsible for the side to side movement of the foot. The joint is covered with a cartilage known as articular cartilage. The articular joint is lubricated with synovial fluid. Many ligaments connect the ankle bones together, they are anterior fibular ligament, which attaches the fibula to the tibial bone. The second ligament is known as the lateral collateral ligament, which connects calcaneus bone with the fibula and the tibial bone and the third one is deltoid ligament, it connects calcaneus and the talus bones together to the tibia. Many tendons attach the muscles of the lower limb and the bones of the ankle, they are the Achilles, the flexor hallicus longus, the flexor digitorium, the peroneal tendons, the posterior tibialis and the anterior tibialis tendons. Among these tendons the Achilles tendon is considered to be the strongest tendons in the human body. It is located at the posterior of the leg and connects the calcaneus bone to the gastrocnemius ,solens and plantarius muscles. The Achilles tendon is about six inches long and can withstand around four time of body mass during walking and almost eight times while running. Achilles Tendonitis: It is the inflammation of the calcaneus tendon.Over use of the tendon causes pain and stiffness, for instance running up hill or climbing up stairs. Achilles Rupture: asdf†¦Ã¢â‚¬ ¦.. Exercises: Group 1 Exercise: Evertion/ Invertion isometric exercises. Evertion: This exercise can be performed by placing the injured foot adjacent to a door or the leg of a table and gradually push extremely to the lateral side of the foot. Inversion: This exercise can be done by placing the medial aspect of the foot to any fixed objects such as a table leg or a door, then to push gently outward –in for two to three seconds. Evertion/Invertion with an exercise band: Evertion: The client has to sit and fix the leg straight, with the help of an elastic band One end of the elastic band is attached to a table leg and other to the foot and then gradually turns the foot outwards. Invertion: Rotate the foot inwards by reversing the position of the band .The movement of the foot should be apart from the leg of the table. The client can proceed to the group two exercises, if he tolerates to do group one exercise. Group 2 exercises: Gastrocnemius stretch: The patient has to bend forward and push the wall with his hands. The injured leg should be placed just behind the other foot, keeping the foot firmly to the floor for about 30 seconds. Soleus Stretch: Place the non injured foot behind the injured foot and bend the other knee joint. The heel should be raised while stretching. Weight bearing exercises: The client should stand on the floor with the affected leg and bend the other leg, so that the whole body weight should bear on the injured leg for 30 seconds and then lift the heel up and down. Injured leg stand with a cloth: The client is asked to stand on a 2inches thick cloth with the injured leg for 30 seconds. The client can proceed to the group three exercises, if he tolerates to do group two exercises. Group 3 exercises: Lateral step and bound exercise. This exercise is performed by placing a folded towel on the floor and to stand beside the towel and client steps on the folded towel. Other foot should be placed firmly on the floor. Repeat the same exercise with other leg. As the pain allows, increase the repetitions and speed accordingly. Hop exercise: It is performed by placing a folded towel on a floor and the client is asked to stand beside the towel and bound over the folded towel and to rest on the other foot. Then reverse the entire exercise with the other leg.As the pain allows, slowly raise the speed and hops. Rehabilitation: Range of movement: Stretching of the calf muscle: When the patient will be able to sand comfortably with an injured leg, he is asked to move back the injured foot and move the hip gradually forward, so that the calf muscle is stretched. Hold for 20 seconds and repeat for at least 2 times per day. Alphabet writing: The patient has to write alphabets with his greater toe at least 2 times per day. Balance training exercises: By holding a fixed object firmly with one hand and stand on a single leg, keeping the other knee folded. Repeat the same with the other foot as well. As the patients balance improves, he is encouraged to repeat the same exercise with eyes shut. GOALS: Short term: Phase 1 and 2 Improve joint range of motion and flexibility Increase ankle strength Gain normal gait pattern Progressive Proprioception and motor coordination Long term: Phase 3 and 4 Improve cardiovascular endurance Return to complete sports activity Rehabilitation program involves: Stretching of the calf muscle and around the ankle muscle Strengthening exercise Deep massage techniques Cardiovascular endurance exercise Agility training Phase 1: T o gain range of motion Stretching- Calf plantar fascia stretch: Sit on the floor with leg extended and knees straight Loop a towel around the affected leg and grip the end of towel on each hand. Affected leg should be in straight and pull the towel near the body Hold the position as same for 30 seconds and relax Repetition: 3 to 5 Calf muscle stretching: Open kinetic chain exercise: Toe curls Marble pickups Four-plane surgical tubing exercises Sub maximal Isokinetics in short arc Strengthening exercise: Plantar flexion exercises with Theraband Inversion and eversion exercise isometric exercise Flexibility: Grade 1 and 2 mobilization Alphabet ROM Proprioceptive: Stork standing Single plane tilt board Biomechanical ankle platform system in non-partial Weight bearing position. Cardiac endurance exercise: Pool therapy Stationary cycling. PHASE 2: Stretching: Achilles stretches in sitting and standing positions Open kinetic chain exercise: full –arc ISO kinetics Close kinetic chain exercise: Shuttle squats Heel raises Toe raises Tubing lunge steps Proprioception: Wobble board work Walking on uneven surface Biomechanical ankle platform system with partial Cardiac endurance training: Treadmill Stairmaster PHASE 3: Program in this phase should be considered according to the Strength and progression of the client. The program involves dynamic and functional tolerance of the patient. Start up with increase weight bearing force on the ankle joint Stretching of Achilles tendon in a supinated position Eccentric heel drop with knee straight Eccentric heel drop with knee bent Lunges and squats Step ups Side step ups with weight bearing To focus on lateral stability –up and down sideways movement Back pedalling exercise Caricos Plyomettric drills Proprioception: Ladder drill Netball throwing and catching with Standing on the affected leg moving to catch the ball and return to land on the same leg. Four square hopping drills Agility training: Shuttle running with changing the direction Zigzagging or figure of 8 runs Phase 4: functional rehabilitation activities such as tip toe walking. Polymeric progressions –hopping, bounding, depth jumps and box drills Sport-specific training Unstable surface training Stationary cross country skier Ensure normal plantar to dorsiflexion strength ratios and muscle balance Careful increase in training regimens

Analysis of Massachusetts’ Health Care System :: essays research papers

Analysis of Massachusetts’ Health Care System Merna Chung   Ã‚  Ã‚  Ã‚  Ã‚  Massachusetts is located in the northeastern section of the United States with a land area of 7 ,838 sq. miles. It is nicknamed the Bay State. The total population of Massachusetts is 6,016,425. Massachusetts has a white majority with the protection of the rights of minorities. There is no single body responsible for making and enforcing health care policy. The majority of the population is White 5,405,374 ( 89.8 % ) ; Blacks 300,130 ( 5.0 % ) ; Hispanic 287,549 ( 4.8 % ) ; Asian 143,392 ( 2.4 % ) ; and the American Indian 12,241 ( 0.2 % ). The median age is 33.4 years. 22.5 % is under 18 and 13.6 % is over 65 years.   Ã‚  Ã‚  Ã‚  Ã‚  The major industries are Health Care , tourism, education , farming , and fishing making this state more rural than urban. It is not economically depressed because tourism has become an important factor in the economy.   Ã‚  Ã‚  Ã‚  Ã‚  Health care is a major industry in Massachusetts. It has seen a rapid growth in managed care organizations in recent years. These organizations strive to deliver high quality health care in a cost – effective manner by using our health care premiums to contract with doctors and hospitals. Two – thirds to three quarters of Massachusetts residents receive their health care through managed care organizations.   Ã‚  Ã‚  Ã‚  Ã‚  There are many health care systems and managed care organizations in Massachusetts. To name a few - Caregroup Health Care System ; Northeast Health Systems ; Partners Health Care Systems , Inc. Aetna Health Care ; Cigna Health Care of Massachusetts ; ConnectiCare of Massachusetts ; Fallon Community Health Plan ; Harvard Pilgrim Health Care , Inc. ; Health New England , Inc.   Ã‚  Ã‚  Ã‚  Ã‚  In general the population of Massachusetts is very healthy considering that there are so many health care organizations. Massachusetts General Hospital was founded in 1811 and is the third oldest general hospital in the United States and the oldest and largest in New England. This medical center has 820 beds and offers highly sophisticated diagnostic and therapeutic care in every specialty and subspecialty of medicine and surgery. Massachusetts General Hospital Admits approximately 35,000 in patients each year and handles more than 1 million visits in its outpatient programs at the main campus and at its four health centers. Annually the emergency department at the main campus handle about 80,000 visits.

Admissions to Montclair State University

â€Å"By learning you will teach, by teaching you will learn†. This is a Latin proverb that has echoed in my mind when I experience the joy of sharing my knowledge and whenever I feel the urge to search for answers to my endless questions.Early in life I have developed a keen interest in the field of biology. My fascination to know how living things survive, reproduce, and change in time led me to ask questions, read books, perform observation, and view documentary shows about science.I could vividly recall spending my childhood leisure hours in the garden to observe the different species of butterflies, how a caterpillar transform into pupa and later into an adult butterfly. Then, in my high school freshman days, I performed a five week experiment to determine how plants grow. This experiment has further awakened my interest as I learn to test the quality of the soil, and the right amount of water, light and temperature to sustain the life of the plants.My endless quest for k nowledge has led me to search for answers through the use of various sources of information. Whenever I have found the answers to my nagging questions, I could not resist sharing the information to my family, friends and classmates.The satisfaction that I have gained in imparting my knowledge is immeasurable. I enjoyed the exchange of ideas, the transfer of knowledge, and the acquisition of new knowledge. There is joy in seeing their faces light up as they understand and appreciate what I was discussing. All these experiences have confirmed my interest to be an educator in the field of biology.I decided to major in Biology as I believe that the study of life is the most important subject in the world. The field of biology deals with the meaningful and profound knowledge of the existence of all living things. Studying life and the processes involved in sustaining it goes beyond the teaching of evolution.For me, biology allows me to explore the world as I study nature closely and unde rstand the diversity of life. However, it is not sufficient to gain knowledge of the subject matter. What would matter most is how students would learn through self discovery while teachers keep their goals in mind and allow room for improvement. This is an area that I need to learn as I have observed some of my classmates regard biology as a subject that often require memorization of scientific words related to classification and phylum.By pursuing an Education degree major in Biology in Montclair State University, I would learn about educational strategies and classroom management in order to keep students engage in their task, awaken their interest about the life on earth, and link their activities to the understanding of biological concepts as they acquire scientific knowledge. In addition, I intend to be committed in an experimental research or independent project so I could contribute to the field of Biology.As a high school student in (write the name of your school), I have a cquired a 3.050 cumulative GPA. I have received the William P. Orr scholarship for Fall 2007 and was given an award for being an active member in the SSS Star Program in the Spring of 2007.After completing my Bachelor degree in Education, I intend to teach high school junior and senior students while pursuing a graduate study. I also aim to get a doctorate degree in the same field so I can teach college students. Although I plan to study continuously while I am teaching, my passion to educate the learners will not begin and end with acquiring knowledge and earning degrees.My passion is focused in teaching the unknown and in facilitating the students’ understanding on the benefit of learning biology as applied to their daily life. I strongly believe that with my determination to succeed together with MSU’s excellent program, diverse faculty and student body combined with the individual attention of a small college, I will become an effective teacher who is deeply commit ted to serve the community of learners.

The Election A Good Day For The Nation s Oldest Third...

The interesting event known as the 2016 election has offered a good day for the nation’s oldest third party. The Prohibition Party has had its biggest national election results since 1988. The Prohibition Party has received over 5,500 votes from the current ballot results, and will likely have a higher total once write-in ballots from other states are reported. The results are already more than 10 times the party’s national vote in 2012. It is a sign of the hard work the Prohibition Party’s members and their advocacy, and is something to offer hope to those who advocate for temperance and for government in service of family and community. To give some background. The Prohibition Party is the oldest existing third party in the United†¦show more content†¦The Party selected James Hedges as its presidential nominee and William Bayes as its vice-presidential nominee. James â€Å"Jim† Hedges is a 78-year-old renaissance man, living in Pennsylvania, with a long history of party involvement. He was born in Iowa, and has a bachelor’s degree in music, as well as a masters in geology. He had spent 20 years in the U.S Marines, in the U.S. Marine Band. He spent 11 years as editor-in chief for the National Speleological Society Bulletin, is a community volunteer, a historian of Prohibition Party history and literature, and runs a print shop in a living history museum. He became interested in the Prohibition Party as a teenager, began his significant involvement with it in the 1980’s, and over time rose to become one of its leaders. He bears the distinction of the first Prohibition Party member to win elected office in the twenty first century. He was elected to two terms as the Assessor for Thomson Township, Pennsylvania. William â€Å"Bill† Bayes is a musician and businessman, living in Mississippi. He was born in Amsterdam New York. He grew up in a military family, and lived in many places before settling Mississippi. He acquired a music degree from the University of Mississippi, and spent many years as a high school band director and a salesman. He currently is the owner of a small manufacturing business. He has been involved in politics for many years, and has participated in manyShow MoreRelatedThe Electoral And Electoral College993 Words   |  4 PagesAmendment in 1804 which is one of the two major contemporary political parties in the United States, combine with the Republican Party to its right. Tracing to its origins returns to Thomas Jefferson s and James Madison s Democratic-Republicans. The modern-day Democratic Party was founded around 1828, making it the world s oldest operational party. 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Historical Analysis of The Industrial Revolution - 1006 Words

The Industrial Revolution was one of the most impactful eras in the history of the world. It changed the way we worked, lived, owned, and generally thought. With advent of economic philosophies like capitalism and communism, the way we worked and lived was written down and itemized, and western civilization was never the same. The concepts of jobs, urbanization, and credit might have allowed the world to progress into a veritable economical ecosystem, defining our modern definition of living, but they also came with an array of downsides and consequences that, in retrospect, painted the time period in which they arrived in an overall negative light. It is with these downsides considered that we must ask ourselves: overall, was The†¦show more content†¦And with overcrowding comes crime. Thus, Jack the Ripper’s crimes seem to be directly related to the conditions that the citizenry were subject to during the industrial revolution’s urbanization movement. That con sidered it did have some positive effects. For example, the high concentration of working individuals near factories did numbers for the already booming British economy. While capitalism’s overall effect on society is debatable, the economic philosophy detailed in Adam Smith’s The Wealth of Nations was expanded due to the equally expanded workforce that was brought about by urbanization. And as previously mentioned, Britains expanded economy allowed it a head start in the world economy. Finally, the topic of the steam engine. Seen by many historians as the kick-off point for the Industrial Revolution, the modern steam engine was invented by Thomas Newcomen in 1712. While this was revolutionary, it wasn’t efficient enough for industrial use. It wasn’t until James Watt improved upon Newcomen’s design in 1781 that the power of this engine was felt. Since then, it’s been a viable, efficient source of energy. When discussing the impact of an invention such as the steam engine, it’s not hard to use those comparisons when talking about the Industrial Revolution as a whole. As such, this ends up being one of the most important topics to discuss. The progress brought on by the steam engine wasShow MoreRelatedThe Inventions During the Industrial Revolution879 Words   |  4 Pagesso my Historical Analysis will be based off of the Science and Technology of the Industrial Revolution. My historical analysis will be about the inventions during the Industrial Revolution. The three I will be focusing on: The Water Frame, The Improved Steam Engine and the Sewing Machine. All three of those inventions all offer some sort of Problem, Progress and Promise to the Industrial Revolution. I will be analyzing those three things. 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Analyzing The Ways Are You re Good At Math - 1602 Words

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Ethics for Managers Forward Indirect Path

Question: Discuss about the Ethics for Managers for Forward Indirect Path. Answer: Introduction Ethics is a branch of philosophy that is based on concepts of right and wrong conduct and in business, the right and wrong behavior for achieving business goals is the ethics of codes in an organization. In this business report, the organization that is taken into consideration is Walmart. Walmart Stores, Inc., is one of the leading retail stores across the globe; however, this organization also suffers from some ethical criticism. This report highlights the most significant ethical issues the organization is facing and to discuss the Walmarts corporate social responsibility using CSR model and help in identifying their key stakeholder and ethics in communications and practice. Discussion Walmart contribution to sustainability Sustainability towards society Sterman (2015) depicts that every organization aims for making their business sustainable so that they can serve their business to their valuable customers for better productivity and profitability. This sustainability can be achieved through adopting effectivebusinessstrategies and activities for enhancing the human and natural resources of the organization. According to the case study, it has been found that even though the concerned organization has billions of dollars in the charity and for human development in the society, they are suffering from plenty of criticism that they do not behave well with their employees and other stakeholders. Implementing Sustainability Index Moreover, Benn et al. (2014) illustrates that Walmart uses Sustainability Index to increase the sustainability of its products and desires to make a better supply chain management system. Mainali and Silveira (2015) also portrays that this initiation helps the organization to increase the sustainability that can be highlighted through their achievements. Their achievements are 70 percent of merchandise sold in U.S. stores and global suppliers use the Sustainability Index to assess and share information about their product and business approach (Searcy and Elkhawas 2012). Moreover, Pinar et al. (2014) illustrates that it can also be found that this organization donates $2 million to fund the sustainability consortium. Sustainability towards environment Tachizawa and Yew Wong (2014) also affirms that Walmart took effective procedure for establishing the sustainability can also be demonstrated through their practice of using creating zero waste, renewable energy, reusing of goods and sell eco-friendly products and the use of reducing fossil fuel. They believe in collaborative work with government, NGOs, and academia so that every sector of the society can get aware of their products. They also created Sustainable Value Networks (SVN) for integrating and evaluating efforts in renewable energy. In the context of reducing the amount of using plastic, by applying three R of sustainability- reduce, reuse and recycle (Vijayan et al. 2014) Walmart now uses one-time-use shopping bags. Thus they can reduce plastic bag waste by more than 42% by the end of 2015 compared to the 2007 baseline (Lamine 2015). This recycling of products can be seen through their Smartphone and Tablet Trade-In Program, where they sell electronic recycling and trading newest smartphone that is less expensive. They have earned more than $50 to $300 over 100 smartphones (Tachizawa and Yew Wong 2014). The recycling procedure results in the packaging optimization from both an economic and environmental perspective. Gadakari et al. (2014) further depicts that reduces GHG emissions across our supplier base and eliminated 7.92 MMT of GHG until 2013 and target to eliminate 18MMT of GHG emission by 2016 (Corporate.walmart.com 2016). They also emphasize on pollution free environment and uses energy efficient products like they have installed 115 onsite rooftop solar panels in seven countries that are capable of production of 71 million annual kilowatt hours of electricity. In the USA also they have installed 26 fuel cells that produce 65 million kilowatt hours of annual electricity (Vijayan et al. 2014). They also take initiatives for power consumption by implement daylighting feature in most of their stores and by consuming centrally controlling system. Most significant ethical issues Walmart has faced Lack of benefits to employee Britt et al. (2016) defines that the Walmart being the leading retail organization yet have ethical issues involving employee stakeholders and from the case study, it has been found that they provide low wages and benefits to their employees. They also do not provide health insurance for more than 60 percent of its employees (From the case study). It is also found from the survey that workers, who work 30 hours a week, will not get the health insurance from the organization. Preference of part-time employer over full-time employees Wielers et al. (2013.) on the other hand, depicts that the concerned organization believes in hiring more part-time employer compared to the full-time employer. The primary reason for adopting this strategy is to get the best out of those candidates for more results that are productive. Shields et al. (2015) hence criticizes by stating that leading organization must have to emphasize more on employee retention by implementing employee motivation strategies like a reward system. Allegation of Bribery Jones (2013) defines that the success of an organization relies on how they extend their organization across the globe. Wallmart also desired to extend their store all over the world and in order to achieve the best location; they take help of unethical approach. From the case study, it has been found that for a suitable location for their Mexican arm, Walmex in Mexico, the concerned organization paid millions in bribes for accessing licensing and zoning permits for the targeted location (Barstow 2012). This bribery scandal gets worse by two primary considerations- top executives at Walmart and bribery among Walmart stores in foreign countries. This organization also has to pay the penalty due to the legislation of Foreign Corrupt Practices Act (FCPA), where to offer a bribe to a foreign official is a crime (Barstow 2012). Misconducts in organizational safety Sethi (2014) depicts that Walmart has caused much safety related trouble for their suppliers in the USA and other countries. This organization employs subcontractors for their product manufacturing procedure. Moreover, citing safety is one of the major concerns that have to be well-equipped with modern and secure technology so that none of their stakeholders will be affected by any adversity. However, valuing more to the cost-cutting technique, he does not focus on these safety technologies and as a result, in Tazreen Fashions Ltd. a Bangladeshi supplier of Walmarts apparel, due to fire 112 workers were killed (From the case study). After an investigation, it has been found that due to improper safety measures like blocked stairwells and a lack of firefighting equipment the fire cannot be stopped at that moment. Violations of labor laws Moreover, in the USA, workers at warehouses demonstrate that Walmart has harsh working conditions and violates labor laws. It is recommended for every organization to formulate their recruiting arrangements like producing application form for candidates, who want to work for the organization. The interview process and group discussion must have to be the next step in recruiting working personnel. However, Landry (2016) states that Walmart overlooked the organizational consideration by hiring their employee through third-party contractors and staffing agencies. Assessment of Walmarts corporate social responsibility using CSR model Moon (2014) depicts that there are three CSR models- CSR Pyramid, Intersecting Circles and Concentric Circles. All these models emphasize on four categories of corporate social responsibility- Philanthropic, ethical, legal and economic domains of responsibility. Barnett 2016) depicts that the concerned organization follows the CSR model of the concentric circle. Figure 1: CSR Model Adopted by Walmart (Source: Moon 2014) Walmart uses the CSR model of the concentric circle that signifies an inclusion system and is an integral part of the CSR. Economic domain of responsibility Lee et al. (2016) mentioned that the major objective of an employee is to enhance the nations economy by attaining more profit through the business system. Walmart by retailing their product in every field- grocery, daily use product, cleaning products, medicines, electronic gadgets and fashion apparel intends to contribute the economic betterment of the country where they have their stores. They provide employment to suitable candidates and by research it is found, that Walmart has 2.3 million associates, who are associated with more than 10,000 communities and operates from 28 countries around the world (From the case study). They also support the economy of the nation by getting associated with other associations like hospitals, food banks, schools and youth sports. Mashaw (2015) stated that this would not only provide promotion to the concerned organization but it will help the organization to strengthen local communities. Legal domain of responsibility According to the perspective of Gerde (2013), even though Walmart is facing adversity in following legal values for accomplishing the business, Walmart supports Fair Labor Standards Act 1938 for providing employment to every suitable candidate and not to discriminate against anyone of them based on their diverse cultural beliefs and background. Moreover, National Labor Relations Act 1935 is also followed by the concerned organization where the private sector employees are guaranteed basic rights to organize into trade unions and the customers can get every right to bargain if the current system of the organization allowed them to do so (Levi et al. 2015). Garrick (2014) Demonstrate that after the fire incident in Bangladesh, Walmart took initiatives for implement Occupational Safety and Health Act 1970 so that every employee at Walmart et the life insurance whether they are working for years and are newly joined workers. Furthermore, Resource Conservation and RecoveryAct(RCRA) is one of the environmental laws followed by Walmart where they focus more on the recycling of the used products and saves the forest resources also use eco-friendly products. Ethical domain of responsibility Walmart has considered some unethical approaches for the betterment of their organization. However, they admit all their unethical conduct of the business procedure and took initiatives for overcoming all these dilemmas. Spence (2014) demonstrates that their global ethics serves as a guide and resource for ethical decision-making and leads to ethics education and communication system in the society. They admitted their Environmental Crimes by violating the environmental law and paid more than $81 million as penalty (From the case study). In the year 2006, hey failed to train their employee for handling hazardous waste management and disposal practices at the store level and as a result, the solid waste products trashed into the bin and liquid water material are poured into the local sewer systems, which does not support the ethical consideration of their business report. Rashid et al. (2013) mentions that the company faced significant ethics and compliance challenges due to bribery case of Walmex in Mexico, they repair that reputation by avoiding discrimination, leadership misconduct, bribery, and safety for their business approach and behave ethically with everyone, who are related to their organization. Philanthropic domain of responsibility Saraf et al. (2012) demonstrates that every organization apart from their proceedings of activities, they are associated with an in-kind donation so that the economic standard of the community can be enhanced. Walmart in such circumstance, donate a huge portion of their annual revenue in the philanthropy work. They also initiate the regulation to provide paid 100 hours of philanthropic work training, sourcing, inclusion and diversity related programs for more than 19 000 associates so that they can choose their field of voluntary interest and contribute their effort in the advancement of the society (From the case study). Schramm-Klein et al. (2015) defines that Walmart donates money for the areas of hunger and nutrition, disaster relief, womens economic empowerment and disaster relief. They also donate $71millionin cashfor these activities for the year 2013 (from the case study). In the year 2011, the concerned organization had donated $100 million for womens economic empowerment an d provides job training to 60,000 women by partnering with partnering with 150 factories (Corporate.walmart.com 2016). Kwak and Kwon (2016) also depicts that in order to improve the existing business machines they have invested $35 million in new processes and procedures. In context of the disaster management projects, Kumar (2013) states that Walmart had donate over $1.5 million for mitigating adversity of Hurricane Sandy, including money, food, and goods. Walmarts key stakeholders according to three key relationship attributes According to the provided case study, the key stakeholders of Walmart are including competitors, suppliers, and employees; however, there are two more stakeholders in the organizational term- Investors and customers. Competitors Foster and McLelland (2015) mentioned that when cost is considered in the business, Wamart has the advantage over the target. Amazon, ALDI, ASDA, Kmart, Shopko in the USA and Real Canadian Superstore in Canada and Comercial Mexicana andSoriana in Mexico are some of the competitors of Walmart. From the case study it has been found that Walmarts executives encourage their store managers to compare prices with competitors so that their price can be the lowest. Suppliers Mentioned by Dunne et al. (2013), suppliers are the last in Walmarts prioritization of stakeholders. These stakeholders have a potential impact on other competitors as they work with Walmart so that they can work collaboratively with the concerned organization so that more of their products sold at Walmart stores in a profitable way and at higher prices. Some of their suppliers are- The Clorox Company, ConAgra Foods Inc, Dean Foods Company, Flowers Foods, Inc., Green Dot Corporation and others. Figure 2: Statistics of Walmart's team supplied by their supplier (Figure: Corporate.walmart.com 2016) Employees The third priority that Walmart considers among their stakeholders is their employees. They provide their employees, companys managerial decision-making while fulfilling their concerns that is job security and higher wages (Korschun 2015). They also assess the performance of each employee and then offer new and challenging job roles and responsibility to their employees as a career development. This not only will motivate their employee to serve their best to the organization but it also represents that the ethical apprehension of the organization. Investors Torres et al. (2012) state that investors are mainly interested in profits and help Walmart to attain more profit so that their share of profit will increase that result in higher dividends or earnings per share. Fernandez-Feijoo et al. (2014) also affirms that investors are also responsible for minimizing the operational costs. Ditlev-Simonsen and Wenstp (2013) depicts that lower costs usually lead to higher profits that benefit the Walmart's investors. Customers Customers are the second priority of Walmart after their investors and Walmart always work on the approaches, application of which these customers can get quality products at an affordable cost. These customers purchase their products and help the organization to make more profit. As a result, Walmart has a total number of 260 million customers in over 28 countries where they make a purchase from more than 11,500 stores under 63 banners (Corporate.walmart.com 2016). Their loyalty towards this organization can be seen through $482.1 billion annual revenue in the year 2016 (Corporate.walmart.com 2016). Ethics in Communications and practice An organization has to maintain the rights to honest and fair communications. Gubrium et al. (2014) Illustrates that anything that conveys wrong organizational information in the society is considered as a breaching of ethics in communication. There are many sources where it has been stated that Walmart is the leading retail organization that not only values their customers, but they also value their employee beforehand. However, Cornelissen (2014) depicts that it can be seen from the case study that they provide lower wages to the employees and do not emphasizes on the employee retention and opt for a part-time employee that is not mentioned in the organizational policy. Their practice also reveals that they did not give importance to the health and safety of the employee and that can be seen their Bangladesh fire case and even they do not provide life insurance to the employee who works less than 30 hours a week. This is the policy that is also not been mentioned in the organizatio nal policy. These beaches in communication and the practices of Walmart result in the loss that they are trying to be overcome in the recent days. In order to compensate their loss in the society they already have invested $35 million in new processes and procedures and provide ethical training sessions for their employees (Long et al. 2015). Recommendations for the organization to be a more ethical company in the future As a part of the recommendation, the concerned organization is taking initiatives for improving their reputation for sustainability and corporate governance. They have appointed a special ethical team for ethical standards to monitor the compliance of supplier factories according to the Standards for Suppliers and their safety. They also have taken an effective step for improving the stakeholder relationships by prioritizes the stakeholder list like to value to the government for the nation and the suppliers so that they can support the organization with legal regulation and timely inventory respectively. Moreover, Walmart should also take pledges for introducing a green initiative for maintaining the sustainability of the globe and diminishing the cause of global warming and climate change and decreases its waste and carbon emissions. In addition to that, they should value their employee prior to anyone else and trust them to make the right decision as a result to which they can cre ative solutions to business problems as they are the one, who communicate with the customers directly and can able to determine their requirement better than the managing authorities. Furthermore, they should also improve their CSR rating by helping the needy group of the society and providing 100 hours paid training to their employees per year for opting a voluntary work of their choices so that they can promote Walmart in social welfare. Conclusion This business report is based on the ethical consideration of the Walmart for their organizational approaches for better productivity. However it is found that in certain case, they have selected unethical procedures that violate their policy. Among them the first is to provide less wages to the lower designated working personnel and do not provide them health insurance. The second is that in Mexico, they have bribed the local authorities for getting a suitable place for their retail organization where they can attain maximum profitability. Thirdly, they do not have any recruitment process of their own and they hire employee through consultancy agents and third parties. However, they have to pay billions of penalties for their unethical approaches and they now took initiative for overcoming and rectifying those activities. In this circumstance, they started treating their employee as an important asset and provide them health insurance. They started interviewing 1000 market personnel in various countries for direct selection of the employee and they also dedicated $35 million to new processes and procedures so that the entire business procedure can be started ethically. Thus, with the concept of employee retention, corporate social responsibility and green initiatives they can ensure their success in recent times and future. 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